[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
INDEPENDENT LIVING PROGRAM
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HEARING
before the
SUBCOMMITTEE ON ECONOMIC OPPORTUNITY
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
JULY 10, 2008
__________
Serial No. 110-97
__________
Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE
43-999 PDF WASHINGTON : 2009
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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
SHELLEY BERKLEY, Nevada MICHAEL R. TURNER, Ohio
JOHN T. SALAZAR, Colorado BRIAN P. BILBRAY, California
CIRO D. RODRIGUEZ, Texas DOUG LAMBORN, Colorado
JOE DONNELLY, Indiana GUS M. BILIRAKIS, Florida
JERRY McNERNEY, California VERN BUCHANAN, Florida
ZACHARY T. SPACE, Ohio STEVE SCALISE, Louisiana
TIMOTHY J. WALZ, Minnesota
DONALD J. CAZAYOUX, JR., Louisiana
Malcom A. Shorter, Staff Director
______
SUBCOMMITTEE ON ECONOMIC OPPORTUNITY
STEPHANIE HERSETH SANDLIN, South Dakota, Chairwoman
JOE DONNELLY, Indiana JOHN BOOZMAN, Arkansas, Ranking
JERRY MCNERNEY, California JERRY MORAN, Kansas
JOHN J. HALL, New York STEVE SCALISE, Louisiana
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
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July 10, 2008
Page
Independent Living Program....................................... 1
OPENING STATEMENTS
Hon. John J. Hall................................................ 1
Chairwoman Herseth Sandlin, prepared statement of............ 33
Hon. John Boozman, Ranking Republican Member..................... 2
Prepared statement of Congressman Boozman.................... 34
WITNESSES
U.S. Department of Veterans Affairs, Ruth Fanning, Director,
Vocational Rehabilitation and Employment Service, Veterans
Benefits Administration........................................ 22
Prepared statement of Ms. Fanning............................ 48
______
American Legion, Mark Walker, Assistant Director, National
Economic Commission............................................ 15
Prepared statement of Mr. Walker............................. 44
McCartney, Bruce, Midway, GA..................................... 4
Prepared statement of Mr. McCartney.......................... 34
National Council on Independent Living, John A. Lancaster,
Executive Director............................................. 5
Prepared statement of Mr. Lancaster.......................... 40
Paralyzed Veterans of America, Richard Daley, Associate
Legislation Director........................................... 14
Prepared statement of Mr. Daley.............................. 42
SUBMISSIONS FOR THE RECORD
Disabled American Veterans, Kerry Baker, Associate National
Legislative Director, statement................................ 52
Maui County Veterans Council, Wailuku, Maui, HI, Rogelio G.
Evangelista, President, letter................................. 54
National Rehabilitation and Rediscovery Foundation, Inc.,
Marianne Talbot, Ph.D., President, statement................... 55
MATERIAL SUBMITTED FOR THE RECORD
Hon. Stephanie Herseth Sandlin, Chairwoman, Subcommittee on
Economic Opportunity, Committee on Veterans' Affairs, to
Ms. Ruth Fanning, Director, Vocational Rehabilitation and
Employment Service, U.S. Department of Veterans Affairs,
letter dated July 11, 2008, and VA responses............... 57
INDEPENDENT LIVING PROGRAM
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THURSDAY, JULY 10, 2008
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Economic Opportunity,
Washington, DC.
The Subcommittee met, pursuant to notice, at 1:17 p.m., in
Room 334, Cannon House Office Building, Hon. Stephanie Herseth
Sandlin [Chairwoman of the Subcommittee] presiding.
Present: Representatives Herseth Sandlin, Hall, Boozman,
and Scalise.
OPENING STATEMENT OF CHAIRWOMAN STEPHANIE HERSETH SANDLIN, AS
PRESENTED BY HON. JOHN J. HALL
Mr. Hall [presiding]. Good afternoon, ladies and gentlemen.
The Committee on Veterans' Affairs Subcommittee on Economic
Opportunity hearing on the Independent Living Program (ILP)
will come to order. First, I will ask you to join me in
standing and saying the pledge. The flag is at both ends of the
room.
[Pledge of Allegiance]
Mr. Hall. Thank you, and thank you for joining us. Thank
you for your patience while we were voting. Today's hearing
will give the Subcommittee the opportunity to learn more about
the U.S. Department of Veterans Affairs (VA) Vocational
Rehabilitation and Employment (VR&E) Independent Living Program
and how it is assisting our veterans in a seamless
rehabilitation into family and community life. As many of you
know, the goal of the Independent Living Program is to ensure
that eligible disabled veterans are able to maintain maximum
independence in their daily living by developing learned skills
that may benefit them for future employment.
Some of our panelists might recall this Subcommittee held
its first hearing back in March of last year that gave our new
Members the opportunity to learn about the programs under our
jurisdiction. One such program that was considered was the
Vocational Rehabilitation and Employment. But today, we are
here to specifically review the Independent Living Program.
As we will hear from our panelists, many of our most
severely disabled veterans' lives have been profoundly changed
for the positive as a direct result of these independent living
(IL) services. Unfortunately, Members of this Subcommittee have
also heard from veterans that have raised concerns that the VA
staff is poorly trained to properly refer veterans to available
resources, mismanagement of claims by VA personnel that cause a
delay in service, and the need to increase the current
statutory limit of 2,500 slots annually.
Earlier this year, we received a letter from a veteran who
urged the full Committee Chairman to consider reviewing
independent living services for veterans with chronic and
severe post traumatic stress disorder (PTSD). Specifically,
this veteran would like to see an expansion of the independent
living services to provide Operation Iraqi Freedom (OIF) and
Operation Enduring Freedom (OEF) veterans with opportunities
for employment services that can also benefit older veterans
who have service connected psychiatric disabilities.
I am interested in hearing from our panelists about this
and other suggestions to determine how we can best serve all
our veterans, especially in light of the Department of Veterans
Affairs Office of Inspector General's report dated December 17,
2007. A few of the issues of concern raised in this report
include VR&E rehabilitation rate calculations and information
on total program participation and outcomes were not fully
disclosed in the VA Performance and Accountability Report; the
2,500 statutory cap was underutilized in fiscal year 2006 and
services to our veterans were delayed; and the VA should
effectively monitor the number of new independent living
participants and detailed information should be provided to
Congress for review. It is very important that we examine these
concerns, especially at a time when the VA Secretary recognizes
an increased need for independent living services over the next
10 years.
Today's servicemembers are returning with PTSD, traumatic
brain injury, amputations, and severe burns that would have
been fatal in previous conflicts. Congress must continue to
reexamine the development and results of this program to
provide the best services in a timely manner. The men and women
who serve our Nation honorably deserve, and should receive, the
best our country can offer. I look forward to working with
Chairwoman Herseth Sandlin, Ranking Member Boozman, and other
Members of this Subcommittee to explore how we can improve the
VA's Independent Living Program for our servicemembers and
veterans.
I now recognize Mr. Boozman for his opening remarks.
[The prepared statement of Chairwoman Herseth Sandlin
appears on p. 33.]
OPENING STATEMENT HON. JOHN BOOZMAN
Mr. Boozman. Thank you very much, Chairman Hall. I think
the first order of the day is to thank both members of our
first panel for their service to their country. I believe both
Mr. Lancaster and Mr. McCartney are service-disabled veterans
of the Vietnam War and they honor us with their presence here
today. So, we really do appreciate you very, very much.
Chairman Hall, I believe you and I would agree that the
VA's Vocational Rehabilitation Employment Program should be the
crown jewel of programs for disabled veterans. The program is
generous in its benefits and the law provides VR&E staff with
wide latitude in determining who qualifies for the program. It
is important to note that employment is the goal of the VR&E
Program and for the vast majority of those who participate in
the Program a job is reasonable and achievable.
Unfortunately for our most severely injured, employment is
sometimes not an option so the VR&E Program includes
independent living services for those who cannot work because
of their service connected disability. Such a program is
designed to enable such veterans to achieve maximum
independence in daily living and VA may contract for these
services with qualified providers. Title 38 defines
independence and daily living as ``the ability of a veteran,
without the services of others,'' or ``with the reduced level
of the services of others, to live and function within such
veteran's family and community.'' That is a fairly broad
definition. And I would hope that Ms. Fanning would describe
how her staff determines what fits within the definition.
I want to make a point about one way we judge the Program's
performance. As an example of the difficulty we face in using
VA data to determine the Program's performance, I would call
your attention to the latest Veterans Benefits Administration
(VBA) Annual Benefits Report. On pages 77 to 84, the report
shows 884 veterans receiving independent living services, and
on page 86, the data shows 949 participants and 2,957 veterans
rehabilitated. Clearly the inconsistency between the number of
participants and the number of those rehabilitated, as well as
the two different amounts of participants, does not give us a
clear understanding of how the Program is doing. So I hope that
we can work together so that we can make the data a little bit
more understandable for us.
Finally, I am glad to have Mr. Lancaster, Executive
Director of the National Counsel on Independent Living with us
today. I understand that the National Council on Independent
Living (NCIL) is not represented on the Secretary's Advisory
Council on Rehab. It seems to me that the NCIL should be a
member of the Committee because of their broad experience in
independent living. And I urge Secretary Peake to consider, in
fact I urge him to invite, NCIL to become an active member in
his Advisory Committee.
Thank you, Mr. Chairman, and I yield back.
[The prepared statement of Congressman Boozman appears on
p. 34.]
Mr. Hall. Thank you, Mr. Boozman. Before I proceed,
regarding consistency, I just want to mention that, the first
time I mentioned the 2,500 statutory cap, I mistakenly misspoke
and said dollars as opposed to people. I intended to say 2,500
individuals.
I would like to welcome our panels testifying before our
Subcommittee today. I remind all of our panelists that your
complete written statements have been made part of the hearing
record. Please limit your remarks so that we may have
sufficient time to provide followup with questions once
everyone has had the opportunity to provide their testimony.
Joining us in our first panel is Mr. Bruce McCartney, an
Army veteran from Midway, Georgia; and Mr. John A. Lancaster,
Executive Director of the National Council on independent
living. Mr. McCartney, thank you for your service. Thank you
for traveling from Georgia to be here with us today. You are
now recognized for 5 minutes.
STATEMENTS OF BRUCE McCARTNEY, MIDWAY, GA; AND JOHN A.
LANCASTER, EXECUTIVE DIRECTOR, NATIONAL COUNCIL ON INDEPENDENT
LIVING
STATEMENT OF BRUCE McCARTNEY
Mr. McCartney. Chairman Hall and Members, on behalf of the
hundred or so disabled vets who know I am here, and the couple
hundred thousand who do not, I welcome this invite. My name is
Bruce McCartney. In 1986, I was medically retired from the
United States Army under Chapter 61 after 17\1/2\ years of
active-duty service.
I served four combat tours in Vietnam as a DUSTOFF and
ground pounding combat medic. One-thousand four-hundred seven
boots on the ground days. It was my job to go to the wounded
soldier who walked into a booby trap or was laced across the
gut with an AK-47, try to keep him alive until we could get him
to the hospital. I was not always successful. But more often
than not, death was cheated of another victim.
When I came home from Vietnam, there was little help
available to transition the disabled veteran. One day you are
in the War, the next day you are back in the world trying to
regain some semblance of normalcy. If perchance you met or
heard about a veteran who had acquired a particular VA service
or program, then you applied. Other than that, there was not
much assistance offered by many. I am one of the fortunate, or
so I thought. Had I known when I applied for the Independent
Living Program in November of 2003 that it was leading me into
a 4-year nightmare that would affect me both mentally and
physically, I would not be testifying before this Subcommittee
today.
In 1990, I was advised by the Savannah Vets Center to apply
for Voc Rehab Services. I met with a case manager, was aptitude
tested, and advised I should seek a vocation as a registered
nurse or a teacher. With my experience in combat medics, the
nursing course made sense. Unfortunately, school exacerbated by
PTSD and my education was sporadic at best and disruptions were
the norm. After many counseling sessions with him, his final
statement to me was, ``If you ever get straightened out, come
back and see me.''
I languished for years, much like untold numbers of
disabled veterans even as we speak. In October of 2000, fate
knocked on my door. It was during the filming of the
documentary, ``In the Shadow of the Blade,'' that I was
reunited with my friend and fellow DUSTOFF medic from Vietnam,
Jake Bailado. He told me of a cousin who was also a disabled
Vietnam veteran who had applied for ILP. They assisted him in
obtaining a small tractor to help him work his farm. After
several years of PTSD therapy outside the VA system, in
November of 2003 I met with Voc Rehab counselor Tina Hutchison
in Savannah to apply for ILP. My goal was to try to obtain an
interest-free loan to replace my antiquated tractor so I could
cultivate my nine-acre property. Ms. Hutchison advised that my
goal was out of the question because it was considered a
vehicle. But ILP would in fact assist me with acquiring a
greenhouse.
That is where the nightmare began. To call it a run around
is to put it mildly. Delaying tactics became the norm. Phone
calls were not returned. Application processes were delayed.
Emails went unanswered. And years passed. It was almost as if
the people who were being paid to help were just hoping I would
just die or go away. During my ordeal, I talked with several
other disabled veterans who also needed and were qualified for
ILP. I urged them to apply, but seeing the difficulty I was
having and how it was affecting me both physically and
mentally, they decided it was not worth their well being to go
through with what I was going through. I began to wonder if
this was the whole point. After all, when word gets around how
difficult the process is, fewer veterans will pursue it.
Sharing with them a letter I received with Atlanta Region
Director L. R. Burkes in 2007 apologizing for his subordinates'
failures and promising needed improvements, these veterans did
indeed apply for ILP. They then began the experience the status
quo. Complete an application, it gets lost. Complete another,
it goes into a black hole some call the process. Emails and
phone calls again are not answered. Sometimes when they are,
the veteran is treated with disrespect and scorn as if he or
she is asking for a handout instead of a benefit which they
earned with their broken bodies.
Now as I network with even more disabled veterans, it
appears that ILP is a benefit that is being held close to the
vest, not to be disseminated. Is this because of the 2,500 cap,
which equates to less than 1 percent of the eligible 100
percent disabled veterans population? I cannot answer that. I
do know that malfeasance is being overlooked while the
consequences of ineptitude are being suffered by the very
deserving people the VA exists to serve, America's disabled
vets.
The American people, through their Congress, have made it
clear that they want to support the troops and they want to
support veterans. This body passes legislation for such
programs, but when bureaucratic land mines prevent us from
actually assessing the programs afforded the opportunity to
make a difference for veterans is missed.
Many years ago in the rice paddies of Vietnam, I aided the
wounded. Now these many years later, I have vowed to advocate
for my wounded brothers, yet again. It has become a formidable
task that needs your involvement. I am asking you to take this
battle to task. As American veterans both young and old have
fought for you, we need you to fight for us now. One thousand
four hundred and seven days fighting the enemy in Vietnam. One
thousand four hundred and sixty three days fighting the VA for
an ILP. Thank you.
[The prepared statement of Mr. McCartney appears on p. 40.]
Mr. Hall. Thank you, Mr. McCartney. Mr. Lancaster, you are
now recognized.
STATEMENT OF JOHN A. LANCASTER
Mr. Lancaster. Thank you, Chairman Hall and Ranking Member
Boozman. Thanks for this opportunity to testify before you on
behalf of the National Council on Independent Living. Mr.
Boozman, if we did get an official request to serve on the VA's
Independent Living Program Committee we would gladly and
honorably accept that role and do what we could.
I am a disabled vet as well, only I guess I am far more
fortunate than Bruce next to me in that years ago, I did get
relatively what I consider decent service from the VA system.
It sent me back to my alma mater where I was able to get a law
degree. It did great physical rehabilitation for me. It even
then, before there was an Independent Living Program per se,
gave me a few independent living services. They gave me driving
lessons with hand controls on the car, which is a major part of
independent living, being able to get around.
Fortunately, I have had a successful life and a successful
career and have not had to rely on such services. And my career
over the years has brought me to my current position as
Executive Director of the National Council on Independent
Living. We are an association representing all the Centers for
Independent Living and State Independent Living Councils around
the country. This Independent Living Program is, as you know,
funded through Title 7 of the Rehabilitation Act and
administered by the Rehabilitation Services Administration of
U.S. Department of Education. Three hundred and thirty six
centers receive direct Federal funding through Title 7 of the
Rehab Act. Another maybe 70 to 80 centers receive indirect
funding through their State governments and through indirect
Federal funding, making a little over 400 centers in this
country providing independent living services to people with
very severe disabilities in every Congressional district in the
country, except five. And we will get those other five sooner
or later.
Services they provide are peer counseling. People with
severe disabilities working with, mentoring, showing through
steps other people with severe disabilities how to manage their
lives, how to be fully included in the community, and how to be
productive citizens. They provide information and referral.
They do independent living skills training on everything from
managing one's life in their own home to balancing checkbooks,
to navigating housing authority processes, to navigating
employment service processes. And then fourth, all of these
centers are providing advocacy on some level or another.
Individual advocacy on behalf of the individual who might need
that advocacy, and systems advocacy, working with the community
to make sure that the community is more accessible to and
inclusive of people with disabilities.
And I have included in my written testimony the value of
our program. The number of people that have been able to get
out of institutions; the number of people that they have
prevented from going into institutions; the employment services
that they have delivered; personal care attendant services;
transportation services; assistive technology.
We welcome the opportunity, and indeed some of our centers
are starting to working closely with the VA on a number of
independent living initiatives. And I indeed, personally, have
met with Ruth Fanning and we have had a successful, I hope,
beginning in terms of continuing a dialog.
There are some differences in the way the VA approaches
independent living to what we do. At the core of our belief in
our system is consumer control. That you take the individual
and you put them in control of their own services and their own
lives, and you support them and teach them, and mentor them in
getting to that point. So that the veteran, in this case, the
disabled veteran, would become the hub and the controller, if
you will, of the things that that individuals needs to
participate fully in the community and ideally to have a job.
If that means personal care attendant, personal care attendant.
If that means access to affordable, accessible, inclusive
housing, then that gets provided or at least you work with a
veteran to make sure that they get their Section 8 voucher if
that is what they need, or whatever other support. If it is
home modifications, home modifications. Those sorts of advice
and suggestions. So we have a much, I think, more expansive,
broader view. We feel that independent living does not stop
with the ability to operate in your home. That it really ends
when the person has achieved full inclusion in their community
and has achieved economic self-sufficiency. Often, that means a
job.
We have three recommendations in this area, which our
network certainly has a major responsibility for, at least in
two of them. Number one, there needs to be much great sharing
of information between the Veterans Administration and the
Independent Living Program, and State veterans organizations
and the Independent Living Program. And when I say the national
VA, the Department of Veterans Affairs, we are talking more
here about regional and local offices than a dialog that might
go on between, say, Ruth and I here in Washington. It has got
to live down in the communities across the country. So, there
are training programs we could be doing. There is some, you
know, encouragement from ideally up here in Congress to get
parties talking together down at the local level. But there
needs to be a better understanding between the two systems. And
certainly we take responsibility for that. And there are some
things, good things going in that regard in States like Alaska,
Minnesota, Michigan, in particular, Florida. So we do have some
things going there.
Second----
Mr. Hall. Mr. Lancaster, in the interest of time, please
summarize.
Mr. Lancaster. Yeah, two final recommendations. Second, the
need for CILs to better understand, Centers for Independent
Living, in our network, the whole veterans world and for lack
of a better word the veteran culture and to establish
relationship with veterans service organizations (VSOs) as well
as State and Federal VA things.
Third, and I think this would go a long way, is in that
system of 336 direct federally funded centers out there around
the country, if the money could be provided, and I figured it
would be in the neighborhood of $25 million, frankly, to place
one veteran, ideally a disabled veteran, as an employee in
every single one of those centers with the primary
responsibility of reaching to the veteran community and to
disabled veterans in their community that need Independent
Living Programs so that we do not have the type of
misunderstanding and miscommunication that was so eloquently
explained by Mr. Bruce McCartney here next to me. So I think
that would be a real solid recommendation that would go a long
way to promoting the independent living of disabled veterans in
this country. Thank you.
[The prepared statement of Mr. Lancaster appears on p. 40.]
Mr. Hall. Thank you, Mr. Lancaster. Let me recognize myself
for a few questions. First Mr. McCartney, thank you for your
service and for your moving testimony. In your opinion, what
would be the major change that the VA needs to make regarding
the Independent Living Program? If you could wave a magic wand
and have one thing change, what would that be?
Mr. McCartney. Directives need to come out that the
Independent Living Program is something to be exploited by each
case manager to every veteran that comes into the door, that it
is explained to them. All these 272,000 100-percent disabled
veterans and the hundreds of thousands of others with 60 and 70
percent disabled, who are qualified for the Program. And then
they need to action these in a fast track. It should not take a
year, it should not take 2 years, 3 years, 4 years, for one
person to get a Program.
Mr. Hall. Thank you. In trying to get assistance from the
Independent Living Program, do you think that the VA personnel
understood the Program and how it should help veterans?
Mr. McCartney. I think there is a break down from the
lowest echelon to the highest echelon. I have been in contact
with each chain of command. And at each level of command, from
the Director's Office down to the local case manager, is
repeatedly delay, no answer. Personally, I felt like I had the
plague or they just wanted me to go away.
Mr. Hall. And sir, what is the status of your application
today?
Mr. McCartney. It was completed in 2007, in December of
2007. And there was supposed to be a 1-year followup between
myself and my case manager. I do not know who my case manager
is. Every month I fill out my report and I have it for them
whenever they are ready for it.
Mr. Hall. What was the problem, or what was more the
problem, your counselor or the program itself?
Mr. McCartney. The personnel running the program. Like I
say, I think it is a close held program. And the ILP is put at
the bottom list of everything. I have communications from the
case manager that said, after 2 years in the process, in
November of 2005, they say, ``Well, I had a really extremely
heavy caseload and I can finally get around to your case now.''
Mr. Hall. Thank you. What do you think, Mr. McCartney, is
the greatest benefit of the ILP? Let us know when you----
Mr. McCartney. Right now it is hard for me to see any
benefits of it.
Mr. Hall. I understand, sir.
Mr. McCartney. Because I am advocating for eight veterans
right now who are going through the same exact thing that I am.
Some of them it has been 15 months since they submitted their
application.
Mr. Hall. Mm-hmm.
Mr. McCartney. And they were resubmitted. So are there any
real benefits? Negligible.
Mr. Hall. When you find some, you will come back and tell
us?
Mr. McCartney. I definitely will.
Mr. Hall. Thank you. Mr. Lancaster, how many referrals does
NCIL get from the VA per month?
Mr. Lancaster. I do not have that information. And I would
suspect that with the exception of two or three States that the
answer would be zero. In Michigan I know there is, there is a
direct linkage and a memorandum of understanding in place
between the State of Michigan which includes the Independent
Living Program. And I do not know the number of referrals that
that amounts to. But we can find that information out. But I
know in a lot of States what we have learned from a survey that
we did to ourselves that the number of veterans they are seeing
is increasing dramatically. Interestingly enough they are
seeing a large number of Vietnam veterans and a smaller number
of Iraqi/Afghani veterans, although it is our suspicion that in
the future we will start seeing more of those as well. But they
are coming in off the street. They are not coming in as
referrals. Or off the street may be the wrong word, but they
are coming by a word of mouth referral or some other referral
than through the VA.
Mr. Hall. Thank you, sir. Now I will recognize Ranking
Member Boozman and also acknowledge the presence of our Chair,
Chairwoman Herseth Sandlin, and turn the Chair back over to her
at the same time. Mr. Boozman?
Mr. Boozman. Thank you, Mr. Hall. I was reading, and you
mentioned in your testimony, your caseworker saying something
to the effect that if you ever get straightened out come back
and see me. So we are glad that you have gotten straightened
out and that you are here seeing us. At first you wanted a
tractor, and then, you were persuaded, or pushed into the
greenhouse. Has that been helpful? I know you have gone through
this tremendous ordeal. But is that something that, you know,
if we could forget about that, is that entity being helpful to
you in what you are trying to get done?
Mr. McCartney. Initially, I wanted an interest free loan,
or assistance getting an interest free loan, so I could buy my
own tractor.
Mr. Boozman. Right.
Mr. McCartney. And then pay it back. After 4 years, 4 years
and a couple of days, my greenhouse was completed.
Unfortunately, the contractors were not paid as they should
have been and they kept showing up at my door. And I took out a
line of credit and paid them off. And when they got paid then
they reimbursed me. I felt morally that I had to do that
because I had a good relationship with all three contractors
that worked on this project. Since the project has been
completed I have had----
Mr. Boozman. That is my next question. Have they
subsequently reimbursed you? Is that----
Mr. McCartney. The contractors.
Mr. Boozman. Have you gotten paid for----
Mr. McCartney. Yes, sir, I have. The day after they got the
check they came to my door and said, ``We appreciate you
putting this money up front for us.'' You know, 75, 80 days is
too long to pay a contractor.
Mr. Boozman. But since that time the VA has reimbursed you?
Mr. McCartney. Yes, sir. The VA?
Mr. Boozman. You got your----
Mr. McCartney. No, the contractors. The contractors
reimbursed me, yes, sir.
Mr. Boozman. Okay, very good.
Mr. McCartney. Since we have been completed, I have had
three 4-H clubs come to the greenhouse. I am doing all
hydroponics. That is unheard of in southeast Georgia. I have
had a couple master gardeners come and emulate my hydroponics
system. We have had two high school horticulture classes come.
And it is an educational process for them in that I make them
determine the volume of a four by eight pool, and how much
chemicals or nutrients to add to this. So it is a good learning
process for them. It is really been good for me that I am in my
comfort zone and I can do what I like to do in my comfort zone.
Mr. Boozman. Very good. Mr. Lancaster, Mr. McCartney has
very well, in detail, been able to deduce his experience
through the years. In your experience with dealing with other
veterans, have they had the same problems? Or is it a regional
phenomenon? Or----
Mr. Lancaster. No, I would say that there are a number of
veterans who experienced significant disabilities, often one
similar to Mr. McCartney, like PTSD, who have had similar
experiences over the years. There has been some fairly good
efforts through the Vets Centers to deal with some of the
counseling issues. But in terms of getting some of the hard
support issues toward independent living and productivity like
Mr. McCartney is talking about, I think there are some real
issues going on.
Mr. Boozman. You deal with these things. We can see how
long this takes. What would be a reasonable time factor to get
a greenhouse? To accomplish that task that he was trying to get
done?
Mr. Lancaster. I would say from application point to when
he is up and running, not knowing a lot about Mr. McCartney's
business I have to, you know, confess there. So I do not know
what the start up time. But I would think in terms of
application to approval, you know, a reasonable time might be
in the area of a, you know, maybe a month. And then immediately
start getting that, you know, assistance going.
Mr. Boozman. Right.
Mr. Lancaster. I mean, I cannot see why it should take all
that long.
Mr. Boozman. Do you agree, he mentioned, one of the things
that Mr. McCartney mentioned was the fact that lots of veterans
do not know about the program. That we need a better education
program to, so that veterans in this situation will be aware.
Is that a fair statement?
Mr. Lancaster. I would say that is a very fair statement. I
would also say, as I said in my testimony, our system, the
Independent Living Program, needs to know more about the VA's
Independent Living Program so that we can better serve
veterans. And that is a shortcoming on our part. Our centers
are stretched pretty thin. So it would be really good to have
some sort of training program that we could implement, or the
VA could implement, or somebody could implement, to be
systematically training Centers for independent living on what
is available through the VA. So that when a veteran comes in we
can appropriately refer if the referral has them coming from
us. And then also people need to look at what our system, which
has been around since 1978, can do for veterans. It is already
an established system funded in part by the Federal Government
through the Rehabilitation Services Administration. And, you
know, it is a, it is a really good system that empowers people
into taking responsibility for their own lives and getting
involved in the community and achieving economic self-
sufficiency.
So let us not reinvent the wheel, here. Let us create the
linkages and the support systems to make what is out there
work.
Mr. Boozman. Right. Again, I thank both of you for your
service to your country. Your testimony today was very helpful.
Thank you, Madam Chair.
Ms. Herseth Sandlin [presiding]. Thank you, Mr. Boozman. I
just have one quick followup before turning over to Mr. Scalise
for his questions. Mr. Lancaster, then, I know that the Centers
for Independent Living conducted a survey on some of what you
were just discussing in terms of this need for a more formal
connection----
Mr. Lancaster. Mm-hmm.
Ms. Herseth Sandlin [continuing]. And relationship, and the
ideas of systematic training, and understanding among the
Centers are stretched thin. What has been the attempt in the
past to improve the relationship between the Centers and the
VA? Is this primarily a budgetary matter? Or are there some
bureaucratic issues as it relates to identifiable individuals
within the VA that are here to help establish a more formal
connection? You had mentioned in your response to Mr. Boozman
that maybe there is some responsibility on the part of the
Centers. I mean, what has been done in the past?
Mr. Lancaster. Well frankly, to be real honest, not a lot
has been done. There has been a big, how shall I say it, lack
of understanding between what our system has to offer and our
lack of understanding and knowledge of the VA system.
Traditionally and in past years veterans tended to turn to
veterans service organizations for most of their needs and
service and advocacy, or directly to the VA. Recently we have
been seeing a major shift in that. That is why we did this
survey. That is why we are starting to really look at these
issues where we are starting to see significant numbers of
veterans coming for the first time, Vietnam era ones are the
largest number, but now more and more of the Iraqi/Afghani
veterans coming to us for assistance in accessing housing, for
peer support and mentoring, for employment-related services,
for personal care attendant services. And also for other
services, like access to assistive technology and good advice
in that regard. So there is a variety of different things that
these veterans are starting to come to.
Now we feel they are coming to the right place. Then again,
we also know that some veterans are not looking at us as a
support system and a place where they can get services that
will empower them and help them access what they need because
we are not veterans. I am, personally, and some are, but for
the most part it is not like a VSO. And that is where our
system needs to reach out and better understand, for lack of a
better word, kind of the veteran community culture, and the
brother- and sisterhood, if you will, that exists among
veterans.
And why the recommendation that I made I think would be so
valuable. If there could be resources made available for every
single one of those 336 directly federally funded centers to
have the funds to hire a veteran, preferably a disabled
veteran, to work in their centers, to do outreach to veterans
service organizations, to the State Veterans Affairs Agencies,
and the VA, to broker and work with and help put together the
services, I think it could go a long toward developing a, kind
of a more seamless system, if you will, that would be far more
responsive. And that could cover the myriad of opportunities
that are available between the VA, State veterans
organizations, and State veterans benefits, and what veterans
service organizations have to provide.
Ms. Herseth Sandlin. Thank you very much. Mr. Scalise, you
are recognized.
Mr. Scalise. Thank you, Madam Chair. Sergeant McCartney,
your testimony had mentioned VA has some contract counselors.
What is your experience been with them compared to the regular
staff?
Mr. McCartney. The consultants.
Mr. Scalise. Yeah.
Mr. McCartney. Superb. My consultant was a veteran. That
made it easier. He, he could empathize with what I had been
through and what I was going through. And he was a shoulder
that I often went to when I was having problems with the
Regional Office or the Director's Office, or even my local case
manager.
Mr. Scalise. Still followed the same procedures? I guess
what I would be curious to find out is what was he doing
differently than the other staff? Or what were they not doing
within the guidelines that they are all supposed to follow why
would you maybe get one experience----
Mr. McCartney. He did not come on board until after
Congressman Barrow endorsed a letter to Congressman Filner
about getting this project started. It was way overdue. Only
then was he contacted by the Director, who said, ``Let us get
on this one and let us get it done soon.'' So that is when he
came aboard. I have only been in contact with him for a matter
of months. And everything was professional and aboveboard. And
when I called him or emailed him with a question or a concern,
I got immediate replies. So----
Mr. Scalise. And why do you not think you got that same
kind of response from some of the staff that you dealt with in
the past?
Mr. McCartney. Malfeasance. Ineptitude. Caseload. Lack of
caring for disabled veteran needs.
Mr. Scalise. So you could sense not only procedurally maybe
they approached things differently, but just from maybe a sense
of urgency to want to help? You did not find that from some of
that staff that you did find with the contract person?
Mr. McCartney. Not only could I sense it. I felt it. I
lived it.
Mr. Scalise. Now, you said you are also helping some other
veterans. Eight other, I think you said, at the current, at
present time.
Mr. McCartney. Yes, sir.
Mr. Scalise. Now, are you going through the consultant with
them? Or is this going through a different channel?
Mr. McCartney. Everything starts at the local case manager
level. From there they get their application from the case
manager. The case manager sends it to the Regional Office. The
Regional Office sits on it for a period of time. Then it goes
back to the case manager and says, ``Okay, well we are going to
approve this. You know, we have found that this veteran would
be qualified.'' Now that is a change in the system from when I
first applied. The case manager went into the computer, looked
at my records and says, ``Yes, you are qualified for
independent living.'' That is when the process started then.
Now we have a delay, that the case manager has to send to
Regional, Regional might take a month or two or three or six or
seven, as is the case with a couple of the veterans that I am
working with now, before they send anything back down.
Mr. Scalise. Is that a policy change?
Mr. McCartney. I cannot answer that. I would presume it
would be. Because like I say, when I applied, when I applied
with the case manager in November of 2003 she said, ``Well, you
are qualified.'' Now the veterans are applying with the case
manager, they do a small interview, a bio, and it, they might
get called back in a month or two.
Mr. Scalise. So they are not able to get that immediate
response?
Mr. McCartney. Pardon me.
Mr. Scalise. They are not able to get that immediate
response----
Mr. McCartney. No.
Mr. Scalise. All right. That is all I have for now. Thank
you. And thank you both for your service.
Ms. Herseth Sandlin. Thank you. I do not have any further
questions. I do want to thank you, Mr. McCartney, for being
here and sharing your experience. I can certainly appreciate
the level of frustration with the lack of responsiveness, which
oftentimes can be a lot more frustrating than not getting the
desired outcome such as having some sort of forward progress
and resolution to the needs under the ILP program. We
appreciate the insights you have been able to offer today. Mr.
Lancaster, we appreciate your testimony as well, your service
to the country, and for being here today and for offering your
testimony. Thank you very much.
Mr. Lancaster. Madam Chairwoman and Ranking Member, thank
you for this Subcommittee bringing attention to this matter and
holding this hearing. Thank you very much.
Ms. Herseth Sandlin. Thank you.
Mr. Boozman. Absolutely.
Ms. Herseth Sandlin. I would now like to invite our second
panel to the witness table. Joining us is Mr. Richard Daley,
Associate Legislation Director of the Paralyzed Veterans of
America; who is accompanied by Ms. Theresa Barnes Boyd,
Vocational Rehabilitation Consultant of the Paralyzed Veterans
of America; and Mr. Mark Walker, Assistant Director of the
Economic Commission for the American Legion. We thank you all
for joining us today. Mr. Daley, I think we will go ahead and
begin with your testimony. You are recognized for 5 minutes.
STATEMENTS RICHARD DALEY, ASSOCIATE LEGISLATION DIRECTOR,
PARALYZED VETERANS OF AMERICA, ACCOMPANIED BY THERESA BARNES
BOYD, VOCATIONAL REHABILITATION CONSULTANT, PARALYZED VETERANS
OF AMERICA; AND MARK WALKER, ASSISTANT DIRECTOR, NATIONAL
ECONOMIC COMMISSION, AMERICAN LEGION
STATEMENT OF RICHARD DALEY
Mr. Daley. Chairwoman Herseth Sandlin, Ranking Member
Boozman, and Members of the Subcommittee, I would like to thank
you for this opportunity for Paralyzed Veterans of America to
discuss the Department of Veterans Affairs Independent Living
Program which is administered by VA's Vocational Rehabilitation
and Employment (VR&E) Program. PVA believes that the VR&E
Program is one of the most critical programs that the VA
administers in assisting veterans with disabilities to
successfully transition to civilian life.
The primary mission of the VR&E Program is to provide
veterans with service connected disabilities all the necessary
services and assistance to achieve maximum independence in
daily living to the maximum extent feasible, to become
employable, and obtain and maintain suitable employment. In
1980, when the Independent Living Program was first developed,
it was a pilot program. It had a 500 cap maximum to the
program. The program was successful and the 500 cap seemed to
be forgotten. And they went, actually went beyond the 500.
Years after dealing with the 500 case cap, the VA met with
Congressional staff members to request the case cap be removed.
Congress at that time would not remove the cap because they
wanted the VA to implement stronger guidelines for the program.
However, Congress did accede to increase the case cap from 500
to 2,500 in 2001.
Even though the new case cap was increased, the VA
continued to bump up against the case cap for many years. This
caused a slow down in delivery of services. They had to request
counselors when they got close to the cap to send their
applications into the national office for review, and the
review took some time. And so they never quite finished all the
applications for that year and they ran over into the next
fiscal year, then they could approach the cases and open them
up again. The cause in the delay also placed a burden on the
VR&E staff because they had to take the time to review the
applications and they had to also monitor the number of people
that were actually applying so they did not reach the 2,500 or
exceed it.
PVA strongly opposes any unnecessary delay in services,
especially services to severely disabled veterans. PVA is
extremely disappointed that VR&E staff is still forced to abide
by the arbitrary 2,500 new case cap. At this time when the
continuation of our military efforts in Operation Iraqi Freedom
and Operation Enduring Freedom are unfortunately resulting in
ever increasing numbers of veterans who sustain serious
injuries, any limit imposed on the delivery of services to the
severely disabled veterans is at best contrary to the intent of
Congress and the American people.
To achieve the successful outcome with the approximately
95,000 veterans each year, VR&E has made progress through
continual improvement of its programs. In 2004, VR&E hired an
Independent Living Coordinator to manage the Program. In 2005,
the Independent Living Standards of Practice were issued for
the VR&E field staff and provided guidance for them. And over
the last 3 to 4 years VR&E has not met their limit in that gap,
but that is probably because of the slow down in procedures
that you heard about earlier.
The removal of the IL cap, the greater attention directed
to serving veterans with severe disabilities, PVA recommends
that VR&E be given additional, professional, full-time employee
positions for the Independent Living Specialist counselors.
These experienced counselors should be fully devoted to
delivering the service to those veterans determined to have
serious employment handicaps and partnering with other programs
in the community to bring to the veteran the full range of
independent living services available.
Madam Chairwoman, that concludes my testimony. I would be
happy to answer any questions you may have.
[The prepared statement of Mr. Daley appears on p. 42.]
Ms. Herseth Sandlin. Thank you, Mr. Daley. Mr. Walker, you
are now recognized for 5 minutes.
STATEMENT OF MARK WALKER
Mr. Walker. Madam Chairwoman, Ranking Member Boozman, and
distinguished Members of the Subcommittee, thank you for the
opportunity to present the views of the American Legion
regarding the Independent Living Program. The Independent
Living Program serves severely disabled veterans who VA
determined at that time were unable to pursue an employment
goal. The Independent Living Program provides the veteran with
an evaluation and counseling, prosthetic appliances, adaptive
automobile equipment, wheelchair training, and other services
necessary to enable a severely disabled veteran to achieve
maximum independence in daily living. Veterans may remain in an
Independent Living Program for a maximum of 30 months.
Chapter 31 of Title 38, United States Code, limits the
number of veterans who can be placed in Independent Living
Program to 2,500 annually. The American Legion supports the
removal of this cap. VA should effectively manage and monitor
the number of new Independent Living Program participants and
provide detailed information to Congress on delays in veterans
services until a decision has been made to remove the annual
statutory cap.
Severely disabled veterans state that the independent
living services assisted them in adjusting to home life and
participating with family and community at a higher level. The
Program has provided severely disabled veterans much needed
assistance and possible hope for future employment. In February
2007, the VA Secretary stated that the Vocational
Rehabilitation and Employment Program anticipates a steady
increase in the demand for independent living services over the
next 10 years. At this time in the Nation's history, it is
paramount that we ensure the VA is capable of enabling veterans
with disabilities to have a seamless transition from military
service to successful rehabilitation and on to suitable
employment after military service.
For severely disabled veterans this success will be
measured by their ability to live independently, achieve the
highest quality of life possible, and realize the hope for
employment given advances in medical science and technology. To
meet America's obligation to these specific veterans and other
eligible vocational rehabilitation employment veterans, VA
leadership must continue to focus on marked improvements in
case management, vocational counseling, and most importantly
job placement.
The American Legion strongly supports the Independent
Living Program and is committed to working with VA and other
Federal agencies to ensure that America's severely disabled
veterans are provided with the highest level of service and
employment assistance.
Again, thank you for the opportunity to present the opinion
of the American Legion on this issue.
[The prepared statement of Mr. Walker appears on p. 44.]
Ms. Herseth Sandlin. Thank you, Mr. Walker. Let me start
with a question to both of you, just to clarify. Is your
organization's position that the statutory cap should be
removed entirely or increased? If the organization's position
is that it should be increased rather than removed, do you have
a number? A projected number that you would suggest?
Mr. Daley. PVA believes at this time it should be removed.
There is a bill in the Senate to actually remove it. And we
probably do not know what will happen. We do not know about the
caseload that we will get from the current conflict. There are
probably many, many people out there that could qualify for the
program if it is removed.
Ms. Herseth Sandlin. Mr. Walker.
Mr. Walker. The American Legion also desires for the cap to
be removed.
Ms. Herseth Sandlin. Have your organizations both held this
position for many years? Or was this a modification of the
position in light of the increased numbers of severely disabled
veterans we are seeing returning home from OIF and OEF, as well
as some of the more severely disabled veterans from past
conflicts, particularly those Vietnam veterans who may be
suffering from PTSD and have a high degree of service-connected
disability?
Mr. Daley. I was not as familiar with the legislative goals
of PVA in, say, 2000, 2001. I was working with the organization
in another capacity. But why should we have a cap on any
program that is for the severely service-disabled veteran? And
say, ``Well, sorry, thanks for serving your country. Come back
in October 1st, our new fiscal year, so we can deliver benefits
to you.'' No, I do not think that we should ever have a cap and
we have probably felt that way all along.
Ms. Herseth Sandlin. I appreciate that and I am asking a
question that goes back. I am asking the question because prior
to this hearing, this particular program has not gotten the
attention we think it warrants. A number of other veterans
service organizations felt that they were not in a position to
provide testimony as they do in other hearings because this
program is one that VSOs are not as familiar with. This
occurrence sort of goes to the issue of Mr. Lancaster's
testimony, and perhaps both of you could comment on it. As he
recognized the issue, he said, ``Look, well there is just sort
of a general lack of understanding of everybody's systems,
whether it is the VA's system program, whether it is the
systems with the Centers of Independent Living, or whether it
is the VSOs, and how to make those referrals smooth and what
everyone can provide.'' I mean, would either of you like to
comment on Mr. Lancaster's statements?
Mr. Daley. To address what you are referring to,
Chairwoman, about if people do not know about, I called several
service officers that are out in the field for PVA and asked
them about the program. And of course our service officers,
they deal with paraplegics and quadriplegics, so of course they
qualify for Independent Living Programs. And they knew nothing
about it. They said, ``I know of it, and it exists somewhere
within the VA. But I cannot tell you much about it.'' One
service officer with more than 20 years experience, he said,
``Well, let us look it up in the VA publication and see what it
says.'' This is the publication of all the Federal benefits.
And you go to the index, independent living is not in there. So
how would a veteran know about it? How would the parent or the
spouse that is taking care of the severely disabled veteran
even say, ``Well, there is a program here where you may be able
to receive help.'' It is a secret.
And too, since I did not know much about the program, I
asked my colleague Theresa Boyd to accompany me because she has
been very instrumental in putting together several vocational
employment programs for PVA, the one that you have heard about
in Richmond, Virginia. And we have two more on the drawing
board now and she is responsible for that. But she is familiar
with the Independent Living Program also. She has had many
years with the VA. So I wish you could get a little knowledge
from her.
Ms. Herseth Sandlin. Well, I will seek some insight from
her afterward. Maybe Mr. Walker wants to comment, and then I am
going to turn it over to my colleagues. But it is good to know
of Ms. Boyd's experience with the VA as well and perhaps
particularly with this program? With the Independent Living
Program? Okay. Mr. Walker.
Mr. Walker. Well, the American Legion has found the same
things. There is not a lot of outreach with this program. And
there are just a lot of severely disabled veterans that do not
know it even exists. So I think there needs to be some
outreach, obviously, and ILP must engage other community based
services as well. But we found the same thing to be true. That
the word is not out about the program that can assist severely
disabled veterans. It is not known as it should be. This is why
we want the removal of the cap as well.
Ms. Herseth Sandlin. If my colleagues would indulge me for
a moment, I would like to ask Ms. Boyd then. Based on your
experience, both with the VA and with PVA, what accounts for
this lack of outreach? Do you have any recommendations on how
we go about coordinating the sharing and facilitating of
exchanging information more effectively to target and reach
severely disabled veterans?
Ms. Boyd. I think one of the issues that makes it a little
confusing is that you cannot apply directly for a program of
independent living. You have to first go in to the Vocational
Rehabilitation Program and apply for services, and then a
counselor, a VA counselor, has to make the determination that
you are not currently reasonably feasible to achieve a
vocational goal. So you have to go through that process first.
And that may be, while everybody is familiar with the regular
Voc Rehab Program, they are not that familiar with independent
living because you do not apply directly for independent
living.
As far as outreach activities, I think it is difficult when
you have this cap for 2,500 to go and say, ``We want you to
increase your outreach activities but only do it to 2,500
veterans.'' It is very difficult. In previous years when I
worked for VA we did bump up against the cap. And that was very
hard to manage. And nobody was very happy with VA when they
went over the cap. So we were constantly trying to do these
measures, estimate each month as we got near the end of the
fiscal year and got nearer to that cap, and tried to slow the
process down which was very frustrating for both counselors
and, of course, veterans. So I think that may explain some of
the lack of outreach.
As far as recommendations I think there is plenty that
could help improve the program. I believe that specialty
counselors are called for, which could improve those linkages
with community based programs. It is very hard, if you are a
full service counsel in the VR&E program, to try to devote the
time necessary for these cases with severe disabilities, and to
go out and develop community resources to work with. There is
just not a lot of time. It is the caseload issue. So I would,
and I think PVA strongly recommends, specialty IL counselors.
I also think that more staff perhaps at the Central Office
to manage the program would help. If you really want to
increase the program increase the outreach activities, remove
the cap, then you can expect that there will be more veterans
needing to be served. And with that, I think, has to come
appropriate resources.
Ms. Herseth Sandlin. Thank you very much. Mr. Boozman.
Mr. Boozman. Thank you, Madam Chair. Ms. Boyd, we really
have two things going on in the sense that you mentioned the
reasons and I think that makes sense. If you have a capped
program where you are bumping up against the cap then it does
not make a lot of sense to go out and, right or wrong, to
advertise the program. On the other hand, if you have a capped
program and you know that you are going to be servicing so many
individuals, you know, or about that number, unlike a lot of
the other things that deal with it, it seems like it would be
easier to plan your resources. Does that make sense? If you
know that you are, you are going to be handling about 2,500
cases or whatever?
Ms. Boyd. I do not think it makes sense to the individual
counselor out there. It can make sense from a national
headquarters when you are trying to manage it. But I think it
is difficult when you are managing individual caseloads and
your counselors are out doing outreach. I think that is hard to
manage.
I will give you an example of how hard that cap was to
manage, and this was several years ago when I worked at VA and
we had to monitor that cap, as I said, very closely. And we
were kind of estimating how much it was increasing each month.
And 1 month it took us by complete surprise and I think it
might have been the month of July. And it jumped up like 300
cases in 1 month. And it had not done that before. It put us
over the cap. And then we were all in trouble for that. Was
that due to just an increase in outreach activities? Who knows?
But that was very hard to manage and predict. And so while you
say it should be easier to manage, you would think so. But I
think once you get down to the service delivery level, it is
not. It is very difficult to manage that.
Mr. Boozman. I guess what I am saying is you kind of know
how many folks are going to be in the program. The testimony
that we heard where the gentleman had so much trouble with the
delivery. Where is the bottleneck in the system? Now are we
playing some games where caseworkers actually, because of the
cap, is there a way to manipulate that without giving services,
that they push them over into the next year? Because we are
bumping up? I mean, does that kind of stuff go on?
Ms. Boyd. I think you will find that there is not a VA
counselor that does not want to serve a veteran. And so to
answer that question VA did everything in its power not to
delay services. And so, if that meant trying to provide some
services under a different status, for example extended
evaluation, VA counselors did everything to try not to delay
services.
Mr. Boozman. But in this case that we heard, I mean that is
inexcusable.
Ms. Boyd. Yes.
Mr. Boozman. There is no, I mean, it is inexcusable. And
probably we have other cases like that, you know? So I guess I
am asking, where is the problem in that? You have kind of a
finite number of people that you are going to deal with. Now
you might, you have the problem of not bumping over the cap.
That is what I was saying earlier. It is not like we get you in
a situation where, not now because you are not with the VA, but
we get the VA in a situation where they do not really know what
kind of funds they are going to have until late in the system
and all that. But in this particular situation, you know that
you are going to have this group of people to service through
the system. Your only problem is trying to keep that down. Why
cannot we service that many people? Where is the bottleneck in
the system? And in this case, it is inexcusable. I mean, there
is no way to, so where is the bottleneck in the system? And do,
in your experience, do we play games? Because of the cap, do we
push people, do we, does it lay on the desk sometimes for
months because somehow that pushes people into the cap system?
Does that make sense? As far as providing assistance?
Ms. Boyd. I understand what you are saying. And to answer
that part of your question I go back to what I said earlier. I
think, my guess would be that happens rarely. More likely what
counselors are doing are figuring out another way to serve them
without having them counted as a new case, a new IL case, until
the start of the next fiscal year. I think they try very hard
not to delay services intentionally. So they might, I do not
know if I would call it playing games, but they might try to
maneuver a different strategy to offer services without having
to declare them a new IL case, would be my guess and my
experience in working in VA.
Mr. Boozman. But the bottleneck, like you say, the person
on the civilian side says, ``You need to get this rolling
within a month.'' That is normal for, you know, the civilian
side. What drug this thing on for years?
Ms. Boyd. I do not know. And it is inexcusable, as you
said. I think some of the issues might be whatever was going on
in that office, if there was counselor turnover. VA does have a
pretty labor intensive, up front eligibility and entitlement
processing that takes some time. And as I said, in the case of
an IL program you cannot apply directly for that. The counselor
first has to gather information and make the determination that
you cannot achieve, or are not currently reasonably feasible to
achieve a vocational goal. So it may be a combination of all
those things. Counselor turnover, processing a heavy caseload,
but in the end as you said, it is still inexcusable. And nobody
would feel good about a case like that.
Mr. Boozman. Yeah.
Ms. Boyd. The veteran was not well served.
Mr. Boozman. Right. Thank you very much. And I appreciate
your testimony. I feel kind of bad, asking you questions in the
sense of your VA experience. It is good to have you where you
are. I think that you are valuable in the sense, you know, now
that you can see both sides. And again, thank all of you for
being here. Your testimony is very helpful.
Ms. Herseth Sandlin. Thank you, Mr. Boozman. I would just
like to comment, too. I think based on what Mr. McCartney had
stated in response to the question, ``Was it the counselor or
the program,''his response was, ``It was the personnel who were
in charge of this program.'' So I think the other
recommendation you had made was the issue of staff at the
Central Office to manage these programs. While Mr. Boozman said
we do not expect you to defend the VA; yet from your experience
in being able to intuit what might have happened in this
situation, I think there are clearly a number of factors. Also
in this instance, there was an issue of accountability with the
local caseworker, and the staff needed to manage the program
effectively.
We have a vote that has been called, but I think we have
time for Mr. Scalise's round of questions for this panel of
witnesses. Then we will return after a brief recess for our
final panel.
Mr. Scalise. Thank you, Madam Chair. And I will cut it
short so we can get out in time for the vote. But how long, has
the cap been in place since the program started?
Ms. Boyd. Originally the program was started as a pilot
program in I believe 1980. And at that time a cap of 500 was
placed on the program because it was a pilot program. Then what
happened is people kind of forgot about the cap, and VA went
over the cap. And I believe it was in about 2,000 or something
Congress called VA up and they had a discussion about the cap.
And at that time VA asked for the cap to be removed. Congress
wanted stronger guidelines on the program. And they did agree
to increase it to 2,500.
Mr. Scalise. So was the cap put in place purely for
financial reasons? Or was it because it was a pilot and they
wanted to see how it worked before they made it more open
ended?
Ms. Boyd. I believe it was because it was a pilot program.
Mr. Scalise. So now the, I mean this is going back to 1980
so I think we are beyond the pilot stages, but the cap, as you
said, is not 2,500 and we are, at what point in the fiscal
year, I guess they start at zero on October 1st and then when
they hit 2,500 they have to stop. When do they hit 2,500 now,
typically, like in the last few years since that number has
been in place?
Ms. Boyd. I do not know if they have reached the cap in the
last couple of years. When I worked at VA, we did bump up
against it and exceed it. And it was typically about this time
of year, in the fourth quarter of the fiscal year. Around July
and August, it got pretty dicey. We were getting pretty close
and I talked about the time where it jumped up in 1 month. And
it was very hard to manage. You are trying to manage, you are
trying to estimate, you know, the next month. You know, do we
have to cut it off today or can we let it go a while longer?
And so it was about this time of year that it got very
difficult to manage.
Mr. Scalise. When they are getting close and they know they
still have a few months left where there might be light at the
end of the tunnel but there are still services that are being
requested, do they try to prioritize within that while they
are----
Ms. Boyd. Exactly. And that is what Mr. Daley was talking
about in his testimony. It was burdensome, I think, on both the
VA staff and the veterans who had to wait for that. Because one
thing VA did was try to make a determination at that time as to
who was most in need of services. In other words, who could
wait until the start of the new fiscal year and who needed the
services right away?
Mr. Scalise. How closely do your organizations work with
them in making those kind of determinations?
Ms. Boyd. PVA working with VA to make those.
Mr. Scalise. Yeah.
Ms. Boyd. I think that that is a VA determination solely.
Mr. Scalise. Okay. And then we are this, for this fiscal
year we are at the cap? Close to the cap? Where----
Ms. Boyd. I do not have that information.
Mr. Scalise. Okay. I appreciate it and that is all I have
for now, thank you. Madam Chair.
Ms. Herseth Sandlin. Thank you. Well, we thank you for your
testimony and the insights you have offered today and we will
look forward to following up with you on some of the
suggestions that you have offered to the Subcommittee. Thank
you very much.
We will now take a brief recess and return. Let me see how
many votes; we have four votes. So it may take us a little bit
of time to get back here. We will look forward to hearing from
our third and final panel for the day when we return. So we are
in recess for the time being.
[Recess]
Ms. Herseth Sandlin. Well, thank you for indulging this
delay in the time. It is always hard to predict how long debate
and motions to recommit will take and in this case we may have
gotten back and gotten some of your testimony in during the
break, but that is always very hard to predict. Also, the
Ranking Member had a flight to catch as well as some family
circumstances that came up at the last minute. So we will go
ahead and take your testimony. I will have some questions for
you. Then since there are no other Members here to object, I am
going to recognize counsel for the Minority if there are any
questions that he would like to ask for the record that the
Ranking Member may have been prepared to ask before he had to
leave.
Joining us on our third panel is Ms. Ruth Fanning, Director
of Vocational Rehabilitation Employment Service for the
Veterans Benefits Administration for the U.S. Department of
Veterans Affairs; who is accompanied by Dr. Lucille Beck,
Consultant for Rehabilitation Services, National Director for
Audiology and Speech Pathology of the Veterans Health
Administration; and Dr. James F. Burris, Chief Consultant
Geriatrics and Extended Care for the Veterans Health
Administration.
Ms. Fanning, I am going to recognize you first for 5
minutes. I know we received your testimony just late last
night, but it would help a lot if we can get it sooner just for
future reference. It helps counsel and staff prepare. It helps
Members prepare, and have a better chance to read it than the
day of the hearing. We would appreciate if in the future you
can get it to us a little bit sooner than this time. We
appreciate you being here today, and look forward to your
testimony. You are recognized for 5 minutes.
STATEMENTS OF RUTH FANNING, DIRECTOR, VOCATIONAL REHABILITATION
AND EMPLOYMENT SERVICE, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY LUCILLE B. BECK,
PH.D., CONSULTANT FOR REHABILITATION SERVICES, NATIONAL
DIRECTOR, AUDIOLOGY AND SPEECH PATHOLOGY, VETERANS HEALTH
ADMINISTRATION; AND JAMES F. BURRIS, M.D., CHIEF CONSULTANT,
GERIATRICS AND EXTENDED CARE, VETERANS HEALTH ADMINISTRATION,
U.S. DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF RUTH FANNING
Ms. Fanning. Madam Chairwoman and Members of the Committee,
thank you for inviting me to appear before you today to discuss
independent living services provided by VA's Vocational
Rehabilitation and Employment Program. My testimony will
provide an overview, address the cap of 2,500 new independent
living cases per fiscal year, and describe VR&E's efforts to
improve and facilitate the delivery of these essential
services. I am pleased today to be accompanied by Dr. Lucille
Beck, Chief Consultant for Rehabilitation Services, and Dr.
James Burris, Chief Consultant for Geriatrics and Extended
Care. I would also like to voice my appreciation for the
opportunity to learn from the testimony of all the prior
panelists, particularly Mr. McCartney.
Independent living services may be provided to VR&E
applicants when it is determined during the initial evaluation
that they cannot, due to the severity of their disabilities,
currently pursue a vocational goal. After this determination,
each veteran participates in a thorough assessment of his or
her potential IL needs. The evaluation begins with a
preliminary assessment that is usually performed at the
veterans' home. And during this assessment the counselor
obtains information about a variety of issues. Those include
housing, personal and emotional needs, leisure and vocational
activities, and the ability of the veteran to perform
activities of daily living. If potential IL needs are
identified, a comprehensive assessment of IL needs is
conducted. If the IL needs are found and it is determined that
the achievement of goals is possible, the counselor works with
the veteran to develop an independent living plan that outlines
the goals, services, and assistance to be provided, and
benchmarks that are used to determine progress in achieving
greater independence in daily living.
Independence in daily living translates to the veteran's
ability to live and function within his family and community
either without the services of others or with a reduced level
of those services. Total programs of IL services are usually no
longer than 24 months but can be extended for an additional 6
months. Some IL services that VA provides include training in
activities of daily living, attendant care during the period of
transition, transportation when special arrangements are
needed, peer counseling, training to improve awareness of
rights and needs, assistance in identifying and maintaining
volunteer or supported employment, services to decrease social
isolation, and adaptive equipment that increases functional
independence.
With the passage of Public Law 108-103, the Veterans
Education and Benefits Expansion Act of 2001, the limit on the
number of new IL cases per year was increased from 500 to
2,500. VR&E Service monitors newly developed IL plans monthly
to track the total IL cases in comparison to this legislative
cap. Tracking over the past 2 years demonstrates the ability of
VR&E counselors to provide needed services within the current
2,500 statutory cap; on average over the past 3 years 2,300 new
cases of IL services in each year.
Veterans with severe disabilities who participate in
programs of independent living have achieved results that
include increased independence, decreased isolation, decreased
dependence on outside supports, enhanced family relationships,
improved medication and therapeutic intervention compliance,
greater community involvement, pursuit of full or part-time
volunteer employment, and importantly progression from
Independent Living Programs to other VR&E employment programs.
As a result of increased outreach we anticipate more
veterans will participate in programs of independent living
services. Also the medical stabilization of returning OEF/OIF
veterans with catastrophic injuries will necessitate their
participation in vocational rehabilitation programs. The aging
Vietnam era veteran population and the increasing number of
veterans receiving compensation due to presumptive diseases
will also likely increase the utilization of independent living
services.
I would just like to highlight that we have provided the
field in 2005 with guidelines for the administration of the
Independent Living Program. We have provided extensive training
to the field in implementing those guidelines. We are currently
conducting a study to obtain a more comprehensive understanding
of the veterans who participate in IL Programs and this study
is expected to be completed by the end of this fiscal year.
I would like to conclude, since I am running out of time,
with just an illustration of a veteran who we have assisted in
Vocational Rehabilitation in the Independent Living Program. A
veteran with an 80 percent VA disability rating applied for
Chapter 31 benefits. He had also had a multitude of non-service
connected disabilities and used a wheelchair due to the
difficulties he had with ambulation as a result of his
disabilities and injuries. His IL goals included increasing his
ability to access his home independently, increasing his
ability to socialize, and enhancing activities of daily living
by providing adaptive computer equipment and teaching him how
to use that equipment.
Our VR&E counselor worked with a rehabilitation engineer to
determine how best to increase the accessibility of the
veteran's home. Based on the engineer's assessment and
recommendation, VR&E provided the installation of solar-powered
remote-controlled gates, on the veteran's property. Prior to
installing the gates the veteran would have had to manually
open and close those gates and this was difficult for him due
to his disabilities. Now the veteran uses the gates daily and
is able to come and go on his property without difficulty or
pain.
During the veteran's IL Program, he began to interact with
his community at a greater rate. He began to attend community
events and he joined a couple of different social clubs. Using
a computer was also very important to this veteran and he had
difficulty using a computer because his injuries placed
limitations on the use of his hands. The veteran's IL plan
included an adaptive computer, speaking software, and private
instruction to teach him how to use the equipment and voice
activation software. Today the veteran is able to use the
computer to take care of his finances, communicate with his
family and friends, shop, and conduct research.
VR&E foresees an increased need for independent living
services. We continue to assess our progress and develop
methodologies and strategies to improve the delivery of
benefits to these deserving veterans. Last year over 2,700
independent living participants were rehabilitated,
demonstrating they had achieved the goals of their program or
made substantial gains in independence as a result of VR&E
services.
Madam Chairwoman, this concludes my statement. I would be
pleased to answer any questions from you or any other Members
of the Committee.
[The prepared statement of Mr. Fanning appears on p. 44.]
Ms. Herseth Sandlin. Well, thank you, Ms. Fanning. And I
know at the beginning of your testimony you recognized Mr.
McCartney so let me start there. Do you know when was the last
time the office that Mr. McCartney dealt with was visited for
quality assurance?
Ms. Fanning. I do not have that date with me but I can take
that for the record and followup with you.
[The following was subsequently received from the VA:]
The last Vocational Rehabilitation and Employment (VR&E)
quality assurance oversight survey of the Atlanta Regional
Office was in June 2007. A rating is not provided as a part of
the site visit protocol. Instead, offices are provided specific
feedback regarding management and operational issues geared
toward improving the service. The Atlanta quality oversight
survey included three commendable findings and five action
items.
Commendable findings included: (1) effective operational
management and fiscal oversight, (2) effective working
partnerships with the employment community leading to increased
job opportunities for veterans, and (3) effective working
relationships with the military leading to strong outreach with
resulting early intervention services for servicemembers
exiting the military due to service connected disabilities.
Action items included: (1) suggested information technology
enhancements to improve out-based counselors' access to
computer systems, (2) consistency of data entry, (3)
consistently informing veterans in writing regarding
entitlement determinations, (4) consistency in using required
worksheets for documenting evaluation and planning actions, and
(5) increased frequency of case management meetings.
Ms. Herseth Sandlin. If you could take it for the record,
and then if you could tell us how the office was rated when
that quality assurance visit was conducted, we would appreciate
it.
What measures are generally taken as it relates to the
folks at a more local level in administering and implementing
this program to assure accountability, responsiveness, and
quality assurance?
Ms. Fanning. Well, as I noted in my testimony, we did
prepare standard operating procedures (SOPs) for the field in
2005. And since that time we have provided extensive training
to the field in implementing those policies. In addition to
that, and to supplement our current quality assurance program
in which we regularly monitor casework and provide field
offices with feedback, we have implemented a special review of
independent living cases. I believe that these are some of the
most important services that we provide and we want to ensure
that the field is providing the services consistently and in
accordance with the guidelines that we have given them.
Ms. Herseth Sandlin. What about Mr. Lancaster's testimony
when he stated that he felt that there should be a more formal
connection, a better understanding, between the Centers for
Independent Living, the national centers, and the VA's
programs? Do you have any thoughts on the survey that they
conducted? Any ideas for more kinds of systematic training so
that there is a better familiarity between the two entities?
Also, certainly as the VA does, will you continue working with
the VSOs to make sure that there is constant communication and
some outreach activities that occur?
Ms. Fanning. I agree with Mr. Lancaster. It is vital to our
providing excellent services to veterans that we coordinate and
collaborate with all community resources that are attempting to
provide excellent services themselves. I first met Mr.
Lancaster back in February and subsequent to that, we have met
together just to start forming a relationship. We had our
leadership conference for all of our VR&E managers in St.
Petersburg a couple weeks ago and I had invited Mr. Lancaster
to come and speak with all of our staff. Unfortunately, he was
not able to join us but he helped us arrange for one of the
Independent Living Center managers from Michigan to come to our
conference. And she co-presented with the VR&E manager from
Michigan. There is an excellent collaboration in place in
Michigan. And we wanted to let the VR&E officers know about
that collaboration. We provided them with all of the Center for
Independent Living points of contact and locations throughout
the country. And we provided them with training tools that they
could take back to educate their staff about the services
provided by the Centers for Independent Living. We also have
followup meetings planned with Mr. Lancaster's staff later next
month.
Ms. Herseth Sandlin. Now let us go to some of the testimony
of the second panel with regard to the statutory cap on those
participating. As you know, the number of ILPs in any fiscal
year at 2,500. Has this limitation caused problems in placing
veterans into the program?
Ms. Fanning. I took a look at that very closely upon my
arrival in my new position and in preparation for this hearing.
In the last, as I said, the last 3 years the average number of
veterans entering new plans of independent living has been
2,300. So at the current time we are not reaching the goal. No
cases are being held and no veterans have been prevented from
entering into programs of independent living.
Ms. Herseth Sandlin. At least those who have applied, or
those who have become aware of the program through that contact
with a VR&E counselor who would then be working with that
counselor have applied for the program. Can you assure the
Subcommittee of that universe of veterans that no one has been
denied participation?
Ms. Fanning. Yes. And as was mentioned earlier, veterans
apply for Vocational Rehabilitation Services not particularly
for independent living. As a part of our process in screening
veterans and determining entitlement, we look at whether a
veteran is able to obtain and sustain gainful employment. If
that is not feasible for a veteran then independent living
services are explored as an option. In addition, though, I want
to point out that independent living services are also
incorporated into employment programs. And I think that, you
know, one of the reasons that the cap is not presenting an
issue for us at this time is that as a part of the training we
have done over the past 2 years, we have educated the field
staff about the need to look at independent living needs at
every point in the process. So even for a veteran who comes in
that has significant disabilities who can enter into a program
leading toward employment, we look at the independent living
needs we can provide concurrently.
Ms. Herseth Sandlin. Okay. Has that number gone up? You
said 2,300 over the last 3 years. Did that number go up from
the prior 3 years or 5 years? I mean, I would anticipate that
in light of the serious injuries sustained by many in OIF and
OEF the number would have gone up, just as we saw an increased
utilization of the VA following those operations.
Ms. Fanning. At this point it has not gone up. It is
actually lower than it was last year at this point in the year.
Currently we have had 1,277 new IL plans written this year. And
again, I think that the reason for that is that counselors are
more informed as a result of training. And independent living
services are being provided concurrently with job ready
services. And I think that is really best for veterans. We do
not want to operate in a stovepipe manner. We want to provide
comprehensive services that will shorten the time of the
rehabilitation program and move veterans to their goals.
Ms. Herseth Sandlin. Does the U.S. Department of Defense
(DoD) offer you the names and contact information of any
servicemembers who have been medically retired or medically
discharged on a timely basis?
Ms. Fanning. We currently have full time Voc Rehab
counselors at 12 military treatment facilities (MTFs). We have
13 counselors at 12 MTFs. We are in very close contact with
DoD, reaching out to the warrior transition units. DoD is
reaching out to us as well to make sure that as veterans are
coming home, and particularly veterans with disabilities, that
we are there providing early intervention. Our goal is to reach
veterans while they are still servicemembers, while they are
anticipating discharge and going through the medical
rehabilitation phase, and help them get into the Voc Rehab
program. So that even while they are still active duty they can
start pursuing the training or whatever services they will need
to reach their goals.
Ms. Herseth Sandlin. Okay. Well then given how you have
somewhat explained where we have been in not even reaching the
cap, what kind of the comprehensive approach to delivering the
services, would you be opposed to? Would the VA be opposed to
increasing or removing that cap altogether, since it does not
seem to really be coming into play one way or another from your
testimony on delivering services to veterans?
Ms. Fanning. At this point what I can say is that the cap
is not presenting any kind of barrier to us. So I could not,
you know, comment as to whether it would be appropriate to
remove the cap or not. I can say that as the Director of the
program, it is my job to ensure veterans are getting those
services and that we are not holding anyone back. And no one is
being held back. We are able to operate within the current cap.
Ms. Herseth Sandlin. Do you know if there have been any
instances, say in the last 10 years, from documentation that
you have where you could provide when the requests for
independent living services exceeded the cap number? The
requests. Not the applications that were approved, but the
number of requests?
Ms. Fanning. Well, as I mentioned earlier, veterans do not
apply for independent living services when they come to Voc
Rehab.
Ms. Herseth Sandlin. Not directly. So it has to be
something that the counselor recommends? Or makes the veteran
aware of?
Ms. Fanning. The counselor is required to evaluate the need
for independent living services, particularly when a veteran is
found to be infeasible to pursue a vocational goal. That is a
requirement. And if a veteran is found to be infeasible, unable
to achieve an employment goal, and independent living services
are not recommended, that decision by the counselor requires
concurrence from their manager. So we have extra accountability
in place to ensure that we evaluate that thoroughly and provide
the services to veterans who need them.
Ms. Herseth Sandlin. Are the counselors themselves aware at
any point in time in the fiscal year what the total number is
and if anyone is bumping up, if the program is bumping up
against the cap? Or is that something that is known only by
those in managerial positions?
Ms. Fanning. We make the field aware on a monthly basis
exactly where we are in relation to the cap.
Ms. Herseth Sandlin. Overall.
Ms. Fanning. And we do that for two reasons. One, because
we want to keep independent living, the need to develop
independent living services and plans in everyone's mind. We
talk about it on every single hotline call. We also as a part
of that let them know how many plans we have had thus far in
the fiscal year. On the hotline managers are invited, and in my
experience in most offices or at least many offices, their
staff are in the room as well during call. The call is intended
to provide them with a lot of communication and information
about their ability to work within the program.
Ms. Herseth Sandlin. Do you have information that you could
share with the Subcommittee that documents the number of
instances in which a counselor recommends participation in ILP
for the veteran but then that decision is overridden by a
manager? Not specific cases, but overall, do you track that
type of information?
Ms. Fanning. I do not, we do not track when the decision is
overridden, no.
Ms. Herseth Sandlin. Let me just ask couple of questions
here more generally to VR&E. The 2004 VR&E Task Force stated,
``VR&E's best efforts regarding employment of veterans resulted
in only 10 percent of those participating in the program
obtaining employment.'' The Report also states that VR&E
averaged only about 10,000 a year for several years. Do you
agree with the Report? What has been VR&E's average on getting
people employed?
Ms. Fanning. Our rehabilitation rate currently is 74.6
percent. And the way the rehabilitation rate is calculated is
based on those veterans who have received planned services that
will lead toward rehabilitation. So of those veterans who are
provided a plan of services, whether it is independent living
or employment, who exit the program during a given year, 74.6
percent currently are exiting as rehabilitation. The 10 percent
number based on overall participants includes, our current
overall participants, which is over 94,000. Our applicants this
year were around 60,000. So you can see that there is a lot of
cross over from prior years. So to just look at the number of
overall participants, that moves from year to year because
services can extend. For example, independent living services
can be for up to 30 months. It does not provide a good estimate
of the success. What we look at are those veterans who actually
get to the point of a plan being developed and enter into a
plan, and then exit from the plan during a given year. And that
is a success rate that measures, actually, those individuals
who provided concrete services to assist them, either to
maximize their independence, or to become employed, or both.
Ms. Herseth Sandlin. Well, I appreciate that explanation of
the calculation and I certainly understand the importance of
having identifiable measurements. Just a couple more questions
before I turn it over to counsel to see if there are any
further questions that are specific, again, to ILP. In fiscal
year 2007, the VA Secretary stated that VR&E anticipates a
steady increase in the demand for ILP services over the next 10
years. My questions are, can you tell the Subcommittee today
how the VA proposes to meet that increase over the next 10
years? Are you going to need more funding and personnel? Are
there any internet technology issues or concerns we should be
made aware of that would facilitate the delivery of the
services your program provides?
Ms. Fanning. Well, we have been very fortunate to have the
support of Congress in providing resources to us. Currently our
caseload has decreased to the point of what we consider, what
has been considered the ideal level, that being----
Ms. Herseth Sandlin. What is that?
Ms. Fanning. One-to-125 ratio. And currently we are about
1-to-121 ratio. We are actively doing outreach. If we get more
veterans enrolled into our program, I think that is a very good
thing. I think it is a very robust and excellent program that
provides good services. And I trust that if we need more
resources and our caseload starts to grow that that will be
taken care of and we can let, I can let my leadership know and
communicate with Congress. You know, at this time I think we
are equipped to provide services and we are equipped to bring
more veterans onto our rolls.
Ms. Herseth Sandlin. Well I would like to say I would like
to hope that you could count on that support. I do think,
however, that we are going to have to dig a little deeper and
get some additional information from you. Some of the questions
that we will give you following the meeting for the record, you
may have readily available or they may just give you some ideas
on what could be tracked to kind of help us understand a little
bit better how this program is working and being administered.
The final two questions, and this is sort of along that line. I
know we talked, again, the cap and where you have been, about
2,300. How many veterans, in fiscal year 2007 were recommended
for ILP? I know you said they do not apply, but this is what I
really want to get at because I think Mr. Boozman had some of
the same questions about the influence of the cap. This number
has a potential influence for making decisions about the cap.
Do you track or can you provide the total number of veterans
who in fiscal year 2007 were recommended for ILP? And then the
breakdown of those that were recommended? How many applications
were approved and how many were not?
Ms. Fanning. I do not have the data with me. But I, what I
can break down is how many veterans were found infeasible and
of those which veterans were provided independent living
services.
Ms. Herseth Sandlin. Okay. Let us start with that. Okay.
One last question, according to the audit, a Vocational
Rehabilitation and Employment Operations Report, in fiscal year
2006 the cap was underutilized, which I think you have also
documented for the past 3 years. We have been at 2,300 so we
have 200 cases there that could be added. But that audit also
indicated that it found that services to the veterans were
delayed. Clearly we heard Mr. McCartney's experience in terms
of the delay and lack of responsiveness. Do you have any idea
of the timeliness of any responses whether before you came on
board or whether your predecessors addressed it? Or how you may
have addressed that report, that might have been specific
causes of such a result? You do not need to address the
underutilization. I think you have done that already. But what
about any delays in those services for the VR&E operation in
general?
Ms. Fanning. Well, first I would like to say that the
delays that Mr. McCartney experienced are unacceptable. And my
hope is that we dig in, and we are doing, as I said, special
independent living reviews as a part of our quality review
process, and that his situation is not typical of what we will
find. And the reason we are doing the reviews, however, is to
look for situations just as he described so that we can take
corrective action if it does occur. I am sorry, repeat your
question?
Ms. Herseth Sandlin. Well I think submitting any
information about delays, since we do not know if there was a
quality assurance visit down to that particular office. I
understand from your testimony that you are stating that Mr.
McCartney's experience is not the typical one. But when you do
see delays in service, have you been able to identify any
specific causes for that? Has it been in the past that Congress
was able to allocate additional resources when the caseload was
too high? Is there a lack of sufficient staff in the Central
Office overseeing and monitoring the Program? A lack of the
linkages with the community organizations that can help address
that specific veterans' employment and independent living
needs? Have you been able to identify any specific causes for
delays?
Ms. Fanning. Well, certainly I think providing the standard
operating procedures, providing guidance from the Central
Office level, was done in recognition of the field being
primarily focused on providing employment services, and the
rate of independent living being so much less that obviously
the counselors would have less expertise in the independent
living area. So we have tried to mitigate that and correct that
by providing the SOP and extensive training. We have added an
Independent Living Coordinator in Central Office after the task
force recommendations were released. And since I have arrived,
we have added a second person. Because we found that that
expertise has been very valuable to the field. They need
someone who they can come in to for expert advice. And also, we
need folks we can send out on quality site visits to really
take a look at independent living services in various field
offices as we go out to do those reviews.
In terms of any delays, I think as one of the previous
panelists had mentioned, caseloads or staffing shortages could
certainly play a role in an office if that is present, if they
have shortages. Over the last few years, the caseload size
gotten more into the appropriate realm in terms of what was
considered ideal as a result of being able to enhance staffing.
The Independent Living Program, getting a plan started itself,
does take a little bit longer because during the entitlement
process when the counselor completes the entitlement and
determines that the veteran is not feasible to pursue
employment, then a second tier of evaluation occurs. We do a
comprehensive independent living needs assessment. As I
mentioned earlier, that is done in the veteran's home. It can
involve expert advice from rehab engineers or other folks with
expertise, depending on what the veteran's needs are.
Unfortunately, even though that is very needed in order to
identify appropriately what the needs are and the services,
that does add additional time.
Ms. Herseth Sandlin. Mr. Brinck, did you have any
questions?
Mr. Brinck. Thank you, Ms. Chairwoman. Ms. Fanning,
Sergeant First Class McCartney mentioned several names of
friends of his who were disabled veterans seeking ILP services.
Would you get those names from him? Mr. Boozman has asked that
you get those names and provide us with the status of each of
those cases, if you would, please.
[The following was subsequently received from the VA:]
The information requested is of a sensitive nature and is being
provided under separate cover to the Chairwoman and Mr.
Boozman.
So as a follow on to the Chairwoman's last question, what
is the average time it takes to complete the evaluation and
independent living plan?
Ms. Fanning. Currently the average time for evaluation and
planning is 105 days.
Mr. Brinck. Nationally.
Ms. Fanning. Nationally. And that is in in line with the
target for the field, which is also at 105 days.
Mr. Brinck. And the Savannah satellite office, do you have
data on them?
Ms. Fanning. I do not.
Mr. Brinck. Can you provide that for us in terms of
caseload and average time to complete the plans?
Ms. Fanning. I can provide information about the Atlanta
Regional Office, which covers all of Georgia. I do not know if
I can provide specifically information about Savannah. But I
will take that for the record.
[The following information from VA was subsequently
received:]
VR&E Service conducted a site visit in June 2007 at the Atlanta
Regional Office (RO). The Savannah outbased office was not
visited, but the site visit report indicated the Atlanta RO was
performing well overall. At that time Savannah had three case
managers and an average caseload of 142 each. Savannah
currently has four case managers with an average caseload of
110 each.
In FY08, the average number of days a case was in evaluation
and planning status for the Atlanta office was 93. The FY08
target was 105 days.
Mr. Brinck. All right. Thank you. One final question, do
you have an estimate, in your testimony you of course stated
that you had not bumped up against the cap for the last couple
years. But a little later on you mentioned that there were
possible influences that may increase the requests for IL
services. Do you know, do you have an idea of what the cost
would be to remove the cap? Or to put it another way, what is
the cost for, an average cost per IL Program participant?
Ms. Fanning. Currently the average cost of an IL program is
approximately $11,000. I do not have costing on removing the
cap. That is something I would be happy to take for the record.
[The following information from VA was subsequently
received:]
Because we are not currently exceeding the cap, no cost would
be associated with removal of the cap. If workload increases in
the IL program, historical costing data would be utilized to
calculate the increased cost to fund the IL program:
FY2006--$10,500 average cost per IL case
FY2007--$11,545 average cost per IL case
FY2008--$12,640 average cost per IL case
Mr. Brinck. Thank you. Thank you, Madam Chairwoman.
Ms. Herseth Sandlin. Thank you. Well, thank you for your
testimony and for your responsiveness to our questions today.
We will look forward to working with you to get some of the
additional information we have requested for the record. We
thank both Dr. Beck and Dr. Burris for joining you as well and
the Committee staff and counsel, as well as the Members of the
Subcommittee. We look forward to working with all of you, as
well as those that testified previously. Thank you for your
patience and for taking the time. I know votes have a tendency
to slow us up in the afternoon hearings that we have. We really
do value your expertise, your insights, and your service to our
Nation's veterans and the work that you are doing. Again, thank
you, the hearing stands adjourned.
[Whereupon, at 4:27 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Stephanie Herseth Sandlin, Chairwoman,
Subcommittee on Economic Opportunity
Today's hearing will give the Subcommittee the opportunity to learn
more about the Department of Veterans Affairs Vocational Rehabilitation
and Employment's Independent Living Program and how it is assisting our
veterans in a seamless rehabilitation into family and community life.
As many of you know, the goal of the Independent Living Program is
to ensure that eligible disabled veterans are able to maintain maximum
independence in their daily living by developing learned skills that
may benefit them for future employment. Some of our panelists might
recall that this Subcommittee held its first hearing back in March of
last year that gave our new members the opportunity to learn about the
programs under our jurisdiction. One such program that was considered
was the Vocational Rehabilitation and Employment, but today we are here
to specifically review the Independent Living Program.
As we will hear from our panelists, many of our most severely
disabled veterans' lives have been profoundly changed for the positive
as a direct result of these independent living services. Unfortunately,
members of this Subcommittee have also heard from veterans that have
raised concerns that VA staff is poorly trained to properly refer
veterans to available resources, mismanagement of claims by VA
personnel that causes a delay in service, and need to increase the
current statutory limit of 2,500 annually.
Earlier this year, we have received a letter from a veteran who
urged the full Committee Chairman to consider reviewing independent
living services for veterans with chronic and severe post traumatic
stress disorder. Specifically, this veteran would like to see an
expansion of independent living services to provide Operation Iraqi
Freedom and Operation Enduring Freedom veterans with opportunities for
employment services that can also benefit older veterans who have
service-connected psychiatric disabilities. I am interested in hearing
from our panelists about this and other suggestions to determine how we
can best serve all our veterans, especially in light of the Department
of Veterans Affairs Office of Inspector General's report dated December
17, 2007.
A few of the issues of concern raised in this report include:
VR&E rehabilitation rate calculations and information on
total program participations and outcomes were not fully disclosed in
the VA Performance and Accountability Report;
the 2,500 statutory cap was underutilized in fiscal year
2006 and services to our veterans were delayed; and
the VA should effectively monitor the number of new
Independent Living participants and detailed information should be
provided to Congress for review.
It is very important that we examine these concerns, especially at
a time when the VA Secretary recognizes an increased need for
independent living services over the next 10 years. Today's
servicemembers are returning with Post Traumatic Stress Disorder,
Traumatic Brain Injury, amputations and severe burns that would have
been fatal in previous conflicts.
Congress must continue to reexamine the development and results of
this program to provide the best services in a timely manner. The men
and women who serve our Nation honorably deserve and should receive the
best our country can offer.
I look forward to working with Ranking Member Boozman and Members
of this Subcommittee to explore how we can improve the VA's Independent
Living Program for our servicemembers and veterans.
Prepared Statement of Hon. John Boozman, Ranking Republican Member,
Subcommittee on Economic Opportunity
Good afternoon. Madam Chairwoman, I think the first order of the
day is to thank both members of our first panel for their service. I
believe both Mr. Lancaster and Mr. McCartney are service-disabled
veterans of the Vietnam War and they honor us with their presence here
today.
Madame Chair, I believe you and I would agree that VA's Vocational
Rehabilitation and Employment program should be the crown jewel of
programs for disabled veterans. The program is generous in its benefits
and the law provides the VR&E staff with wide latitude in determining
who qualifies for the program. It is important to note that employment
is the goal of the VR&E program and for the vast majority of those who
participate in the program, a job is reasonable and achievable.
Unfortunately, for our most severely injured, employment is
sometimes not an option so the VR&E program includes independent living
services for those who cannot work because of their service-connected
disability. Such a program is ``designed to enable such veteran to
achieve maximum independence in daily living'' and VA may contract for
these services with qualified providers.
Title 38 defines ``independence in daily living'' as, ``the ability
of a veteran, without the services of others or with a reduced level of
the services of others, to live and function within such veteran's
family and community.'' That is a fairly broad definition and I would
hope that Ms. Fanning would describe how her staff determines what fits
within that definition.
I want to make a point about one way we judge the program's
performance. As an example of the difficulty we face in using VA data
to determine the program's performance, I would call your attention to
the latest VBA Annual Benefits Report. On pages 77 and 84, the report
shows 884 veterans receiving independent living services and on page 86
the data shows 949 participants and 2,957 veterans rehabilitated.
Clearly, the inconsistency between the number of participants and the
number of those rehabilitated as well as the two different amounts of
participants does not give us a clear understanding of how the program
is doing.
Finally, I am glad to have Mr. Lancaster, Executive Director of the
National Council on Independent Living with us today. I understand that
the National Council on Independent Living is not represented on the
Secretary's Advisory Council on Rehabilitation. It seems to me that
NCIL should be a member of the Committee because of their broad
experience in independent living and I urge Secretary Peake to invite
NCIL to become an active member in his advisory Committee.
I yield back.
Prepared Statement of Bruce McCartney,
Midway, GA (Veteran)
Executive Summary
I enrolled in the VA Independent Living Program (ILP) in November
2003. Four plus years later, after constant emails, phone calls and
inquiries, the process was completed.
Many other disabled veterans (Vietnam and OIF) are having similar
issues as the ones I faced trying to get assistance with the ILP. The
issues appear to be lack of understanding of the program by local case
managers, lack of transparency (where is the paperwork in the process),
lack of assistance (took months to get a reply), lack of oversight and
auditing (took over 4 years to complete this application and that does
not include a proper post-project dialog) and pass the buck syndrome
(inquiries to higher command are met with auto reply emails/letters
that led to no solutions).
The issues with ILP appear systemic as the Director's office, The
Inspector General's Office, Regional Headquarters, and local case
managers either can not provide adequate answers to the veterans they
are assisting or do not respond to inquires for assistance.
The ILP is a great concept, but is poorly advertised and has weak
follow through; much like a train that has to be pushed by its
passengers.
______
My name is Bruce McCartney. In 1986 I was medically retired from
the United States Army under Chapter 61 after 17\1/2\ years of active
duty service. I served four tours in Vietnam as a DUSTOFF and combat
medic. It was my job to go to the wounded soldier who'd walked into a
mine or was laced across the gut with an AK-47 and try to keep them
alive until we could get them to the hospital. I wasn't always
successful, but more often than not death was cheated of another
victim.
There seemed to be little trained and experienced assistance
available to transition the disabled combat veteran from military
service to civilian life, although today that appears to be vastly
improved. On the 15th of January you're a HERO, on the 16th of January
you're a ZERO unaware of the myriad of programs available from the VA
to assist your broken body and soul. To try and regain some semblance
of normalcy to a life that was disrupted by the bane to mankind we know
as war was relegated to fate. If, per chance, you met or heard about a
veteran who had acquired a particular VA service or program then you
applied. Other than that, there was not much assistance offered by many
of the VA counselors or employees.
I am one of the fortunate. Or so I thought. Had I known when I
applied for the Independent Living Program (ILP) in November 2003 that
it was leading me head-on into a 4 year nightmare that would affect me
both mentally and physically, I would not be testifying before this
Committee.
In 1990, I was advised by the Savannah Vet Center to apply for Voc
Rehab services. I met with a case manager, was aptitude tested and
advised to seek a vocation as a teacher or registered nurse. With my
experience in combat medics he recommended the nursing course.
Unfortunately, due to my disabilities, my education was sporadic at
best and disruptions were the norm. After many counseling sessions with
him his final statement (in 1995) to me was, ``if you ever get
straightened out, come back and see me.'' I languished for years
outside the VA system, much like untold numbers of disabled veterans
even as we speak.
October 2000, fate knocked on my door. It was during the filming of
the documentary ``In The Shadow Of The Blade'' that I was reunited with
my friend and fellow DUSTOFF medic from Vietnam, Jake Bailado. He told
me about a cousin who was also a disabled Vietnam veteran who applied
for ILP. They assisted him in obtaining a small tractor to help him
work his farm.
After several years of continuous treatment with a civilian
therapist, I met with Voc Rehab counselor Tina Hutchison in Savannah to
apply for ILP. My goal was to see if VA could assist me in obtaining an
interest free loan to replace my antiquated tractor so I could
cultivate my 9 acre property. Ms. Hutchison advised me that my goal was
out of the question, but ILP would in fact assist me with acquiring a
greenhouse.
The following is a 4 year recap of my ILP gone awry:
Nov 03--Met with VR&E counselor (Tina Hutchison) in Savannah,
GA. Applied for Independent Living Program (ILP).
1/26/04--Got email reply saying `wheels in motion.'
3/2/04--Requested situation report (SITREP).
5/5/04--Received reply to the above request (almost 2 months to
the day) `I have contacted an ILP contractor to come to this
area and do an ILP assessment for 3 vets, including you. . . .'
6/23/04--Interviewed with Jennifer Johnson, ILP contractor from
Atlanta.
6/24/04--Provided email response to Johnson's request for more
info.
7/27/04--Received email request for a SITREP from Johnson.
7/27/04--Replied to above from Johnson. `I sent my report to
Tina Hutchison several weeks ago. Now it's in the hands of
Tina. . . .'
12/20/04--Received phone call from Hunter Ramseur (another VA
consultant from Atlanta who figured he'd get some interviews
done while in Hilton Head Island, SC). He came to the house for
interview. Hunter requested some documents with a promise to
return them upon his arrival to Atlanta. Have yet to receive
them.
3/4/05--Telephonically requested SITREP from Hutchison. Her
reply--`just got new guidelines, will know something very
soon'. Also advised her about documents given to Ramseur not
returned. Hutchison promised to get in touch with him and have
them returned.
5/16/05--Emailed Hutchison a request for SITREP. Also advised
her still nothing back from Ramseur.
9/22/05--No contact from anyone (VA or consultant) for more
than 6 mos now since telephonic conversation 3/04/05. Emailed
Hutchison a request for SITREP.
12/5/05--Still no contact from anyone. Emailed Hutchison. 2nd
anniversary has now come and gone. Is there really an IL
program? Is Hutchison still working in Savannah? Hello. Is
anyone out there?
12/6/05--Emailed complaint to Inquiry Routing & Information
System (IRIS).
12/6/05--Received email from Hutchison. `sorry . . . have
scheduled appointment for 15 Dec.'
12/7/05--Receive response from IRIS above. ``after discussing
your case with Ms. Hutchison, she reports that due to her
current caseload it has been difficult to complete a specific
proposal for your ILP and meet other demands on her time. She
now has the information from the 2 contractors. . . .''
12/7/05--Replied to Ms. Hutchison email `0900 will be fine.'
12/15/05--Arrived in Savannah VA office at 0850 for appt.
Checked in with front desk. At 0930 Ms. Hutchison asked if I
have an appt. Felt like another bs meeting. Was given another
orientation sheet (NOTE: orientation sheet is given to all
first time VA applicants). Told me Hunter had recommended
concrete floor greenhouse with elec/water/etc. Now she had all
the recommendations she would forward to whomever to get final
approval.
2/2/06--Emailed MS. Hutchison asking for SITREP.
2/7/06--Sent another inquiry to IRIS again--no reply.
2/21/06--Sent another inquiry to IRIS about 2/7/06 inquiry.
2/22/06--Received reply from IRIS. ``. . . request has been
sent to Mr. Ramseur to provide information . . . I encourage
you to keep in contact with Hutchison. . . .''
2/23/06--Responded to IRIS's response. ``. . . after I met with
Hutchison 15 dec she told me she had ALL the paperwork she
needed . . . and I have sent Hutchison 10 emails with only 2
replies and 3 phone messages--0 returned. . . .
2/24/06--Emailed Hutchison with the information outlined in
IRIS response of 2/23/06.
2/24/06--Received email from Hutchison stating she had
contacted Ramseur (AGAIN?) for the info from him.
2/27/06--Received followup from IRIS. ``she is communicating
with you directly . . . please continue to work with her to
complete a plan of service.''
3/27/06--Emailed Hutchison requesting SITREP--``we are going on
just about 2\1/2\ years since this process was started and I
think that's a little excessive.''
3/31/06--Received email from Hutchison. ``Proposal has been
sent to Atlanta for review/approval . . . am looking primarily
at the 8, 10, size range. . . .''
4/1/06--Replied to Ms. Hutchinson email acknowledge receipt of
her email of
3/31/06. Requested copies of Johnson/Ramseur reports. 1st
request for Johnson/Ramseur reports.
5/11/06--Emailed Hutchison for SITREP and 2nd request for
Johnson/Ramseur reports.
5/19/06--Received email from Hutchison ``final approvals have
been received. I am looking for providers and contractors. . .
. Request for information from your file have to go through the
freedom of information office in Atlanta and must be in
writing. If you need I can get you an address.''
5/19/06--Emailed Hutchison for address. 3rd request for
Johnson/Ramseur reports.
6/6/06--Since received no reply with address, sent written
request for information from my file to Ms. Hutchison office
via certified mail. 4th request for Johnson/Ramseur reports.
6/7/06--Ms. Hutchinson's office received certified mail on 1:55
pm, June 07, 2006 per USPS.
7/28/06--No reply in over 60 days. Emailed Hutchison again for
information/address. 5th request for Johnson/Ramseur reports.
7/28/06--Received email from Hutchison ``I'm off on Monday so I
will call you on Tuesday.''
7/31/06--Stayed in-house all day to receive call. Call never
came.
8/1/06--While at a doctor's appt, Ms. Hutchison calls and
leaves msg, ``I'm returning your call.''
8/2/06--Emailed Ms. Hutchison again ask for SITREP and status
of requests for Johnson/Ramseur reports. 6th request for
Johnson/Ramseur reports.
8/7/06--Emailed Hutchison ``did you forward the request for
consultant reports I sent you--7th request for Johnson/Ramseur
reports.
10/30/06--Met with Congressman Barrow's Legislative Assistant
in Savannah regarding lack of response with VA ILP.
10/30/06--Upon return from Congressman Barrow's LA called VR&E
Regional office in Atlanta. After short recap of situation, was
advised to FAX a request for another voc rehab counselor if I
was unhappy with Ms. Hutchison. With that answer it appeared to
me the problem was not only with Hutchison but in fact was
systemic (approx 3 years of issues with no real answers from VA
counselor, IRIS, and ATL regional office).
10/30/06--Mailed request IAW FOIA to VR&E Regional office,
Atlanta, GA. This is the same request asked of Hutchison on 7
previous occasions (via cert mail).
11/6/06--Mailed entire 40+ page packet of entire experience
with ILP to VA Inspector General (IG).
11/9/06--Certified mail delivered Decatur VR&E office 7:47am,
11 NOV 06.
12/12/06--Received phone call from Congressman Barrow's LA.
Says he was advised that since some of my disability is for
PTSD, VA will not release any information from my files to me,
but will release them to my therapist.
12/12/06--Advise Karla Hillen (therapist of 7 years) of
situation. She requested I sign release of records form. Went
to her office and sign forms.
12/13/06--Therapist requested release of info from Hutchison/
regional office.
1/26/07--Received call from Ms. Hutchison. Says got final
approval (AGAIN???) and is going to turn entire packet over to
Hunter Ramseur when he comes to Savannah next Tuesday. He will
again come out to house for prelim survey, negotiation and
coordination for project completion. Additionally she states
she will mail me documents for signature/return. . . .
1/29/07--Received packet from VA IG. ``Unfortunately, we are
unable to take action on your correspondence as it is unclear
exactly what you are alleging and why you are requesting OIG
involvement. We ask that you summarize the 48 pages. . . .''
2/5/07--Received call from therapist. They've received Johnson/
Ramseur reports. Received 11 pages via fax. Both reports
recommendation similar. Still no word from Ramseur. Included is
application approval from Grant Swanson VR&E Regional Office.
DATED 4/3/06. NOW ALMOST 1 YEAR SINCE APPLICATION WAS APPROVED
WITH STILL NO ACTION BEING TAKEN; 3 YEARS PLUS SINCE INITIAL
APPLICATION WAS SUBMITTED.
2/15/07--Haven't heard a word from Hutchison or Ramseur.
Received nothing in mail from Hutchison. Will fax summary back
to IG office today.
2/15/07--Faxed summary back to IG office.
2/19/07--Johnson/McCartney/Singleton (another veteran having
problems with ILP) met with Congressman John Barrow in his
Savannah office. This and other veteran issues are discussed.
Congressman agreed to provide letter of endorsement on package
to be sent to veteran affairs committee members.
3/1/07--Received email from Ms. Hutchison asking if I received
paperwork she allegedly mailed for signature/return.
3/1/07--Replied to Ms. Hutchison's email ``on 1/26/07 you
stated Ramseur would be picking up packet and would be in
contact with me. Also that you would mail documents for
signature. I have not heard from Ramseur or received anything
from you.''
3/2/07--Ms. Hutchison read above email (according to Read
receipt on email).
3/18/07--Received letter from IG. `We have opened a case. . . .
4/3/07--NOW ONE YEAR ANNIVERSARY OF APPLICATION APPROVAL FROM
ATLANTA (4/3/06) AND STILL NOTHING.
4/12/07--Received call from Ramseur stating he was just given
case file and would like to come down to meet getting the
project underway. I asked him why it took him so long to get in
touch he wasn't sure to what I was referring. Then I advised
him that on 26 Jan 07 Hutchison called me and advised he would
pick up my packet from her in be in touch shortly. He assured
me he had no such knowledge thereof and in fact had just been
contacted by the Director to take over this project and get
completed ASAP.
4/16/07--Receive letter from L.R. Burks dtd 4/10/07 apologizing
for the delay and provided excuses for what had (actually had
not) transpired. Stated that procedures were put into place to
prevent future occurrences.
4/18/07--Replied to Burks letter.
4/24/07--Received reply from Burks ``. . . respond more rapidly
more effectively to your needs as well as other veterans. . .
.''
SEE ALL EMAILS FOR UPDATE.
12/3/07--1405 hrs, Received message on answering machine from
Amy Thompson, assistant VR&E director in Atlanta.
12/3/07--1520 hrs, Returned call and left msg on voice mail.
12/4/07--0810 hrs, Returned call and left msg.
12/4/07--1030 hrs, Returned call and talked to Amy. She stated
she would like to help me address some of the concerns I
addressed to Director Fanning. Gave a recap and sent her copy
of my recap. She will read and call back.
12/4/07--1710 hrs, Amy calls and again apologize for shoddy
treatment. States one thing for certain ``authorization for
payment for electrician was completed today and he should
receive payment in 7-10 days.'' I find this incredulous because
I have email from Hunter Ramseur 11/16/07 stating the same
thing. APPARENTLY SOMEONE IS NOT DOING THEIR JOB AND TELLING
FALSEHOODS TO COVER IT UP . . . AGAIN . . . Sent copy of
Hunter's email to her. She explained that apparently someone
doesn't understand the payment process is a 2 step process--
Step 1 Approve at Regional Office. Step 2 Forward to Austin for
payment. SEEMS TO ME IN ALL ACTUALITY IT'S A 3 STEP PROCESS.
Step 1 Approve at Local Office. Step 2 Approve at Regional
Office. Step 3 Forward to Austin for payment. Not withstanding.
Why does it take 50+ days to process an invoice for payment?
And another question. First email from Hunter is 10/26 stating
invoice for Robinette is at the Regional Office for processing.
. . .
Author's note: It appears Director Fanning has requested an in-
house investigation to address the problems I outlined to her.
I really believe it's going to take an upper echelon visit to
look into not only what I addressed, but really come down and
open this Pandora's box. Who knows how many veterans are
affected by this malfeasance. The Regional Director L.R. Burks
told me in his last letter that all problems had been addressed
and corrective actions taken to preclude further occurrences.
Apparently that is not true.
Amy Thompson called veteran Singleton 12/3/07 and states she
couldn't find his records but would call him back. 12/7/07 Vy,
clerk in VR&E office, called him back and stated Amy was out of
office. Also stated she couldn't find his records but would
call him back Monday 12/10/07 to talk again.
12/27/07--Sent Thompson an email inquiring as to whereabouts of
$$$$$ 7-10 days from Dec 4th makes Dec 18th. Is someone lying
again?
1/25/08--Received call from Grant Swanson . . . tries to
justify (we process thousands of pieces of paper yearly and
occasionally one falls thru the crack . . . this ENTIRE case
has fallen thru the crack repeatedly.
Asks to get copy of Robinette invoice (invoice for the
electrician). I faxed to him. Grant stated that I am trying to
be a surrogate in-between Robinette and the VA . . . Amy,
deputy director VR&E, stated that I or Robinette should contact
Finance directly and thus, made me a surrogate in her last
email. . . . I never talked to finance, but sent a followup
letter to Ruth Fanning and Congressman Filner. Isn't this
VR&E's job to ensure that the contractors get paid? Says
doesn't know if there's anything that can be done but will try
. . . my thoughts . . . SOMETHING WILL BE DONE . . . it was
still in excess of 30 days when I PAID him.
* All emails and correspondence available upon request.
Approximately 80 pages.
Nearing project completion, another roadblock to completing my ILP
project develops at VA Regional Office. Contractors who complete work
are not being paid according to their purchase order contracts. 30 days
then 60 days pass and still no payment for services rendered. Having
worked with these contractors, been the recipient of their services,
and having developed a relationship with them, morally I just could not
sit idly by. I took out a line of credit loan and pay them, which they
returned when they were finally paid by VA. Three contractors, one ILP
project, all not paid as contracted. Then, instead of correcting the
situation, I am chastised by the Regional office and Director Fanning's
office for `interfering'. I can sleep at night though. However now
there are three contractors who will never work for VA again.
During my ordeal I met several disabled veterans who also needed
and were qualified for the ILP. I urged them to apply, but seeing the
difficulty I was having and how it was affecting me physically and
mentally they opted to wait see if in fact there was an ILP. It just
wasn't worth their well-being to go through what I was going through. I
had to agree with them.
Once work was finally begun in April 07 and I shared with them the
correspondence from the Atlanta Region Director, L.R. Burks,
highlighting the changes that were made to prevent future occurrences,
did they apply for ILP. Unfortunately, it appears Director Burks was
only paying lip-service to quiet this vet, for the same problems I
encountered are still being encountered by disabled veterans as we
speak.
Disabled 101st Airborne trooper Donald S. went to the Savannah
Outpatient Clinic (OPC) in mid April 07 to obtain an application for
ILP services. He was given VA Form 28-1900, completed and mailed it to
VA regional office as instructed. In August, after no contact, he
called the VA regional office in Atlanta and subsequently received a
letter from that office stating they had received his application.
Shockingly they also stated he would have to complete VA Form 28-1900
before any action could be taken. I'm curious how many VA Form 28-
1900's have to be completed before action is initiated? In November he
called again to determine status. He was advised that a query was sent
to St. Petersburg for his records. The response to his question asking
whether or not they would follow up was answered with ``we'll just wait
for them to respond, but you can contact them if you wish; here's the
phone number.'' He did their work by calling and was told that office
had received nothing from Atlanta.
Also, 100 percent-disabled 1st Cav, Silver Star (2 awards)
recipient James Johnson obtained, completed, and submitted VA Form 28-
1900 in April 07. In January 08, after no response, he again went to
Savannah OPC for another form. He was advised by a case manager it was
best to complete the application via the Internet. He stated he would
rather have a paper copy to take home for completion and submission. He
was then asked ``what, are you computer illiterate?'' Becoming
extremely frustrated and agitated, Mr Johnson informed the case manager
that he was partially blind from 14 glaucoma operations and wanted a
paper copy. Only then was he provided same.
Just recently, February 08, disabled vet Larry Bacon applied for
ILP due to his disabilities. Just several weeks ago he had an
appointment with his case manager, Steve Goist. This case manager
advised this disabled vet that according to his records Mr Bacon was
unable to be gainfully employed. Since Voc Rehab was designed to get
vets back to work there was nothing he could do for him. Mr Bacon told
this case manager he was aware of his inability for conventional
gainful employment and had applied for ILP. Mr Goist stated he ``would
see what I can do and let you know.'' Of course, this is yet another
disabled veteran who is expecting to never hear from VA again.
Iraq veteran Santiago, a double amputee, was out briefed by a VA
counselor on Fort Stewart. He was told to apply for Voc Rehab. As a
result of his disabilities Voc Rehab was not a viable option. I met him
recently and thought he was a good candidate for ILP. He had absolutely
no knowledge of ILP and told me of his out-processing experience by VA.
When I called and inquired about ILP with the VA representative on Fort
Stewart who was responsible for providing guidance to medically
discharged combat veterans, I was told ILP was ``some sort of medical
thing and I should call the Charleston Medical Center for
information.'' She did provide me with their phone number though.
Fortunately when a staffer from Director Fanning's office was
informed of the first two cases I described in January 08 a phone call
was placed and immediate attention was provided for these two disabled
vets. Should disabled veterans like Bacon, Santiago, Potane, Baker,
Frank, Foster, and others have to make that same call to receive the
benefits they paid for with their blood? Many of these vets and others
have opted to just give up. THE SYSTEM IS BROKE. Director L.R. Burk,
your promises of change weren't worth the paper they were written on.
These are just a couple of disabled veterans I happened to come in
contact with. The repeated experiences mirror each other. How many
other untold numbers of disabled vets need advocates, to get the VA to
do their job?
As I network with other disabled veterans and encourage them to
apply for their ILP, a benefit which they earned with their broken body
and sometime spirit, I realize that not one iota has changed. Delays,
failure to respond to emails, conveniently ``lost'' paperwork, and
unreturned phone messages are the rule rather than the exception. THE
PROBLEM IS SYSTEMIC, from the Director's office, the Inspector
General's Office, to Regional Headquarters, down to local case
managers.
After meeting several disabled veterans from South Carolina, I soon
realized the problem is worse there. After contacting the Regional
offices in Charleston and Columbia I'm told by both that ``most
disabled vets aren't qualified for ILP'' and ``we process very few
ILP's.'' This makes me believe the South Carolina ILP program is worse
than what is being experienced in Southeast Georgia. A repeated inquiry
to Director Fanning's office to determine the number of ILP's in
Georgia and South Carolina is ignored.
Perhaps this Subcommittee can obtain information Region by Region
to determine where the most severe problems exist. And believe me there
are problems. Malfeasance is being overlooked daily while consequences
of ineptitude are being suffered by many disabled veterans.
Many years ago, in the rice paddies of Vietnam, I aided the
wounded. Now these many years later I have vowed to advocate for these
my wounded brothers yet again. However, it has become a formidable task
that needs Congressional involvement. As American veterans both young
and old have fought for you, we need you to fight for us.
Thank You.
Prepared Statement of John A. Lancaster,
Executive Director, National Council on Independent Living
Executive Summary
The National Council on Independent Living (NCIL) will provide
testimony regarding Independent Living and the current services within
the Veterans' Administration Vocational Rehabilitation and Education's
Independent Living Program (ILP).
The National Council on Independent Living is the oldest national
cross-disability, grassroots organization run by and for people with
disabilities.
Centers for Independent Living across the country are assisting
veterans in navigating the VA system, obtaining housing, and personal
assistance services, and are providing information and referral.
Centers for Independent Living want to collaborate actively with
the VA. Centers have asked for more funding to be allocated to help
assist the VA in providing essential and timely services to veterans
and their families.
Centers in Alaska, Minnesota and Michigan are working with their
communities to make sure our veterans are receiving the proper supports
to reintegrate into their communities.
Centers for Independent Living have been focusing on one-on-one
support to assist people with disabilities in outlining their future
goals, learning that there is a way to have a high quality of life with
a disability, and creating a support network within the community to
ensure continued independence.
Centers for Independent Living and NCIL are on record requesting
additional funding to be allocated to help assist the VA in providing
essential and timely services to veterans and their families.
NCIL and our Veterans Taskforce welcome the opportunity to discuss
how Centers for Independent Living can help the Department of Veterans
Affairs and the Vocational Rehabilitation Employment program enhance
services for our Nation's returning and aging veterans.
______
Chairman Filner, Ranking Member Buyer, and distinguished colleagues
of the Committee on Veterans' Affairs, thank you for this opportunity
to comment on VA's Independent Living program. My name is John
Lancaster and I am the Executive Director of the National Council on
Independent Living.
The National Council on Independent Living is the oldest national
cross-disability, grassroots organization run by and for people with
disabilities. Founded in 1982, NCIL is the association representing
Centers for Independent Living (CILs) and statewide Independent Living
Councils (SILCs), which provide independent living services and
advocate civil rights of people with disabilities throughout the United
States.
A majority of our Centers for Independent Living and statewide
Independent Living Councils receive federal funding under Title VII of
the Rehabilitation Act, administered by the Rehabilitation Services
Administration of the Department of Education.
Centers for Independent Living serve our Nation in all but five
Congressional Districts. These Centers are non-residential, cross-
disability advocacy organizations. CILs serve people with disabilities
of all ages and income; including people with physical, cognitive and
sensory disabilities, as well as the growing population of people with
mental illnesses and PTSD. All Centers for Independent Living offer
four core services of independent living skills training, peer support,
individual and systems advocacy, and information and referral. Many
Centers offer additional services such as support groups, community
advocacy projects, home modification programs, assistive technology
loan banks, attendant care services, deaf interpreters services,
Braille services, recreation, and other community collaboration
efforts.
According to data collected by the Rehabilitation Services
Administration, during Fiscal Years 2004-2006, Centers for Independent
Living:
Attracted over $520 million through private, state, local, and
other sources annually;
Moved 8,381 people out of nursing homes and institutions, saving
states and the Federal government well over $160 million, not to
mention improving people's quality of life, and;
Provided the core services of advocacy, information and referral,
peer support, and independent living skills training to over 3 million
individuals with disabilities.\1\
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\1\ Rehabilitation Services Administration response to NCIL Freedom
of Information Act request 08-00115-F. November 19, 2007
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In that same period, Centers provided other services to over
659,000 individuals with disabilities in their respective communities
that included:
Services to over 56,000 youth with disabilities;
Assistance to over 169,000 people in securing accessible,
affordable, and integrated housing;
Transportation services to over 106,000 people with
disabilities;
Personal assistance services to over 163,000 people with
disabilities;
Vocational and employment services to 105,000 people with
disabilities, and;
Assistance with Assistive Technology for 114,000 people with
disabilities.
NCIL and all Centers for Independent Living believe in the
principle of consumer-control and that community-based services are an
essential element of integration, which will ensure the full
participation of people with disabilities in all aspects of society.
NCIL has long worked to garner the support and services that people
with disabilities need to achieve community integration and economic
self-sufficiency. We believe people with the most significant
disabilities can be contributing members of society given the proper
supports. Our philosophy demands all individuals be given every
opportunity to succeed when other agencies are content with labeling
them unemployable.
NCIL recently developed a Veteran's taskforce, which conducted a
survey of our Centers for Independent Living. Results showed Centers
for Independent Living are indeed working with veterans to obtain
housing, assist them in navigating the VA system, acquiring personal
attendant care, and providing information and referral. One common
theme that came out of the survey loud and clear is that there must to
be a formal connection between Centers for Independent Living and the
VA. When Centers for Independent Living get a referral from the VA it
is usually at a time of crisis. We would welcome a formal relationship
with the VA and Veteran's Service Organizations to better assist
veterans with disabilities and their families.
The core belief of Independent Living, which NCIL and all Centers
for Independent Living subscribe to, is that all people have the right
to decide how to live, work, and participate in their communities, and
that consumer-directed and community-based services are the most
effective and cost efficient method for the full integration of the
wounded warriors back to civilian life.
The reports of the President's Commission on Care for America's
Returning Wounded Warriors, as well as the VA's Vocational
Rehabilitation and Employment Taskforce, support these fundamental
Independent Living core beliefs and agree on the need to create more IL
programs, which increase access to community-based services.
While the VA's long history of assistance to returning warriors has
focused primarily on clinical treatment and compensation, Centers for
Independent living have been focusing on one-on-one support to assist
people with disabilities in outlining their future goals, learning that
there is a way to have a high quality of life with a disability, and
creating a support network within the community to enhance the lives of
all.
Fortunately, Centers for Independent Living want to collaborate
actively with the VA. Centers for Independent Living and NCIL is on
record requesting additional funding to be allocated to help assist the
VA in providing essential and timely services to veterans and their
families. Many Centers for Independent Living employ veterans and have
reached out to include veterans with disabilities on their staff and
boards of directors so that they may use their real life experience to
improving VA programs in their local community, and use existing
programs to help expand capacity to serve newly injured and aging
veterans who proudly served our country to live independently within
their own local communities.
Centers in Alaska, Minnesota and Michigan are working with their
communities to make sure our veterans are receiving the proper supports
to reintegrate into their communities. In Alaska, the CIL works with
the VA, offering veterans access to their mobility loan closet or their
TBI support groups. In Minnesota CILs are important and valuable
community resources for the VA providing peer-to-peer supports and
accessing community supports at a faster pace. Our independent living
specialists in Michigan are now doing some work with the VA, including
Pre-IL assessments, comprehensive assessments, case management and
other IL supports as needed.
NCIL encourages all Veteran Affairs programs to connect with local
Center for Independent Living through out the country. NCIL and our
Veterans' Task would welcome the opportunity to discuss how Centers for
Independent Living can help the VA enhance services for our Nation's
returning veterans. To this end, NCIL looks forward to working with you
and your staff to address these policy issues.
Thank you for your time and attention to this critical issue.
Prepared Statement of Richard Daley,
Associate Legislation Director, Paralyzed Veterans of America
Chairwoman Herseth Sandlin, Ranking Member Boozman, and members of
the Subcommittee, on behalf of Paralyzed Veterans of America (PVA) I
would like to thank you for the opportunity to testify today on the
Department of Veterans Affairs (VA) Independent Living Program which is
administered by VA's Vocational Rehabilitation and Employment (VR&E)
Program.
PVA believes that the VR&E Program is one of the most critical
programs VA administers in assisting veterans with disabilities to
successfully transition to civilian life. The primary mission of the
VR&E program is to provide veterans with service-connected disabilities
all the necessary services and assistance to achieve maximum
independence in daily living and to the maximum extent feasible, to
become employable and to obtain and maintain suitable employment. In
VR&E's mission statement, independent living services is mentioned
first, emphasizing the importance of the independent living program and
the Congressional intent for the VR&E program to focus on providing
services to veterans with severe disabilities.
In 1980, when the Independent Living (IL) program was first
developed, it was implemented as a pilot program and imposed a 500 new
case cap to the new program. In the succeeding years, the program grew
and proved successful in helping veterans with severe disabilities to
gain greater independence in their daily living activities. The 500 new
case cap seemed to be forgotten and the caseload for independent living
continued to grow well beyond 500 new cases a year. Following years of
dealing with the 500 case cap, VA met with Congressional staff members
to request that the cap be removed. Congress at that time was not
willing to remove the cap as they wanted VA to implement stronger
guidelines for the program. Congress did, however, increase the cap
from 500 to 2,500 new cases in 2001.
Even though the new case cap was increased, VA continued to bump up
against the cap for many years. This meant that starting in the fourth
quarter of each fiscal year VR&E had to constantly monitor the number
of new IL cases opened around the country. As VR&E approached the cap
limit, they had to slow down or delay delivery of independent living
services for new cases until the start of the next fiscal year. When
the VA approached the cap limit, VR&E tried to ensure that veterans
most in need would be served without delay. VR&E did this by requesting
that counselors submit their new IL cases to Central Office for review.
VR&E staff at Central Office then tried to make the determination as to
who needed services immediately and who could wait. Unfortunately, this
procedure is quite disruptive and can endanger the success of the
rehabilitation process. Imagine engaging in outreach activities,
developing new cases, and then having to explain to veterans with the
most severe disabilities that they must wait to receive any services.
In addition to the delay in services, the cap has placed an
unnecessary burden on VR&E staff. Time devoted by VR&E counselors in
the field preparing requests to serve new IL cases and time spent by
Central Office staff reviewing such requests as well as the constant
monitoring of the new IL case count can certainly be used in more
productive ways to provide services to veterans. While VR&E may not
have reached the cap in the last year or two, the cap still presents an
unnecessary burden and seems to be in direct conflict with providing
the necessary services to veterans with severe disabilities.
PVA strongly opposes any unnecessary delay in services for
veterans, especially services to severely disabled veterans. PVA is
extremely disappointed that VR&E staff is still forced to abide by the
arbitrary 2,500 new case cap. At this point in time when the
continuation of our military efforts associated with Operation Iraqi
Freedom and Operation Enduring Freedom (OIF/OEF) are unfortunately
resulting in ever increasing numbers of veterans who sustain serious
injuries, any limit placed upon the delivery of services to severely
disabled veterans is at best contrary to the intent of Congress and the
American public.
The VR&E program provides services to approximately 95,000 veterans
each year. In FY 2007, VA reported that the VR&E program rehabilitated
11,008 veterans with service-connected disabilities. Of the total
number of veterans rehabilitated, 8,252 veterans were determined
rehabilitated through obtaining employment and 2,756 veterans were
determined rehabilitated through achieving their independent living
goals.
To achieve these outcome results, VR&E has made progress through
continual improvement in its programs. In 2004, VR&E hired an IL
Coordinator to manage the program. In 2005, IL Standards of Practice
were issued to VR&E field staff providing detailed guidance. Over the
last 3 to 4 years, VR&E Central Office staff have provided numerous
training sessions on the delivery of IL services.
Yet there is still much more that can be done to ensure that
veterans with severe disabilities are well served in the areas of
independent living and vocational rehabilitation. Outreach activities
targeting severely disabled veterans can be enhanced. Stronger linkages
with other advocacy and community-based programs can be established.
Finally and perhaps most importantly, VR&E needs to direct more time
and attention to assisting those veterans who after achieving their
independent living goals are ready to move toward developing vocational
goals that may include volunteer work, part-time employment, and even
full-time employment.
With the removal of the IL cap and greater attention directed at
serving veterans with severe disabilities, PVA recommends that VR&E be
given additional professional full time employee positions for IL
specialist counselors. These experienced counselors should be fully
devoted to delivering services to those veterans determined to have
serious employment handicaps and to partnering with other programs in
the community to bring to veterans the full range of IL services
available. These specialty counselors will be able to target their
efforts on enhancing both the accessibility and quality of independent
living services available to veterans with severe disabilities.
PVA's recommendation for IL specialist counselor is based upon our
own experience. PVA has developed and implemented a new Vocational
Rehabilitation Services program to ensure that all veterans with spinal
cord injury or disease have equitable employment opportunities and that
the estimated 85 percent unemployment rate among PVA members becomes a
grim statistic of the past. In partnership with VA and cooperate
sponsors (Health Net Federal Services and Tri West Healthcare
Alliance), PVA has been able to open two vocational rehabilitation
services offices: one at the VA SCI Center in Richmond, Virginia and
more recently at the VA SCI Center in St. Paul, Minnesota. We also
anticipate opening a third office in San Antonio, Texas this fall.
PVA's vocational services at these two offices are delivered by Mr.
Rick Schiessler and Ms. Diane Acord. Both rehabilitation counselors
have many years of experience and proper credentials to specialize in
providing services to individuals with SCI disabilities. Our new
program appears to be very promising and in less than a year's time, we
are serving well over 100 veterans and have assisted 20 veterans with
severe disabilities obtain employment. The average starting salary of
our employed veterans is $39,400. We believe a large part of our
success so early in the development stage of the program is due to our
specialty counselors who are able to devote all of their attention to
providing services to veterans with SCI disability.
In addition to specialty IL counselors in the field, PVA also
recommends that staff at Central Office responsible for managing the IL
program be increased. As stated earlier, VR&E has an IL Coordinator who
manages the program. However, having only one individual trying to
manage an entire national program appears unrealistic, especially if
the IL cap is removed and VR&E places more emphasis on serving veterans
with severe disabilities. PVA recommends that if Congress wishes VR&E
to improve the IL program, then management of the program should be
properly resourced.
Chairwoman Herseth Sandlin, Ranking Member Boozman, and members of
the Subcommittee, Paralyzed Veterans of America supports your efforts
to review and improve the existing vocational rehabilitation programs
of the Department of Veterans Affairs, especially those programs
designed to serve veterans with the most severe disabilities. We look
forward to working with you to ensure that the best services are
available particularly for veterans with severe disabilities. This
concludes my testimony. I would be happy to answer any questions you
may have.
Prepared Statement of Mark Walker,
Assistant Director, National Economic Commission, American Legion
EXECUTIVE SUMMARY
The mission of the Veterans Rehabilitation and Education (VR&E)
program is to help qualified, service-disabled veterans achieve
independence in daily living and, to the maximum extent feasible,
obtain and maintain suitable employment. The American Legion fully
supports these goals. The Independent Living Program (ILP) was
established in 1980 by P.L. 96-466, the Veterans Rehabilitation and
Education Amendments. The program serves severely disabled veterans
whom the Department of Veterans Affairs (VA) determined were unable to
obtain and maintain suitable employment when achievement of a
vocational goal is not feasible. ILP services and assistance provided
to veterans include evaluation and counseling; prosthetic appliances;
eyeglasses; communication devices; adaptive automobile equipment;
wheelchair training; and other services necessary to enable a severely
disabled veteran to achieve maximum independence in daily living.
Veterans may remain in the ILP for a maximum of 30 months. Chapter 31
of Title 38, U.S. Code limits the number of veterans who can be placed
in the ILP to 2,500 annually. The American Legion supports the removal
of the cap. Additionally, the VA should effectively manage and monitor
the number of new ILP participants and provide detail information to
Congress on delays in veterans' services until a decision has been made
to remove the annual statutory cap.
The total number of veterans who were rehabilitated through the
Independent Living Program in FY 2006 and FY 2007 were 2,162 and 2,756
respectively. In February 2007, the VA Secretary stated that VR&E
anticipates a steady increase in the demand for ILP services over the
next 10 years. Severely disabled veterans stated that the Independent
Living Services assisted them in adjusting to home life and
participating with family and community life at a higher level. For
example, a veteran from Georgia described that once he was accepted
into the ILP, he was supplied with special walking shoes, an exercise
machine, and a computer. The Independent Living services allowed him to
better operate and feel more productive at home. The program has
provided severely disabled veterans much needed assistance and possible
hope for future employment.
During this time of war we all have an important mission in
enabling our injured soldiers, sailors, and airmen and other veterans
with disabilities to have a seamless transition from military service
to a successful rehabilitation and on to suitable employment after
service to our Nation.
The American Legion strongly supports the ILP and is committed to
working with the VA and other Federal agencies to ensure that America's
severely disabled veterans are provided with the highest level of
service and employment assistance. Again, thank you for the opportunity
to submit the opinion of The American Legion on this issue.
______
Madam Chairwoman and distinguished members of the Subcommittee,
thank you for the opportunity to present the views of The American
Legion regarding the Independent Living Program (ILP), which falls
under the Department of Veterans Affairs (VA) Vocational Rehabilitation
and Education (VR&E) program.
VOCATIONAL REHABILITATION AND EMPLOYMENT SERVICE
Since the forties, VA has provided vocational rehabilitation
assistance to veterans with disabilities incurred during military
service. The Veterans Rehabilitation and Education Amendments of 1980,
Public Law (P.L.) 96-466, changed the emphasis of services from
training, aimed at improving the employability of disabled veterans, to
helping veterans obtain and maintain suitable employment and achieve
maximum independence in daily living. Vocational Rehabilitation and
Employment (VR&E) program employment goals are accomplished through
training and rehabilitation programs authorized under Chapter 31 of
Title 38, U.S. Code. Title 38 provides a 12-year period of eligibility
after the veteran is discharged or first notified of a service-
connected disability rating. To be entitled to VR&E services, veterans
must have at least a 20 percent service-connected disability rating and
an employment handicap or less than a 20 percent disability and a
serious employment handicap.
The mission of the VR&E program is to provide comprehensive
services and assistance necessary to enable veterans with service-
connected disabilities and employment handicaps to become employable,
then obtain and maintain stable and suitable employment. The American
Legion fully supports these goals. The Independent Living Program (ILP)
was established in 1980 by P.L. 96-466, the Veterans Rehabilitation and
Education Amendments. The program serves severely disabled veterans,
who VA determined were unable to obtain and maintain suitable
employment, when achievement of a vocational goal is not feasible. ILP
services and assistance provided to veterans include evaluation and
counseling; prosthetic appliances; eyeglasses; communication devices;
adaptive automobile equipment; wheelchair training; and other services
necessary to enable a severely disabled veteran to achieve maximum
independence in daily living. Veterans may remain in the ILP for a
maximum of 30 months. Chapter 31 of Title 38, U.S. Code limits the
number of veterans who can be placed in the ILP to 2,500 annually.
Administration of VR&E and its programs is a responsibility of the
Veterans Benefits Administration (VBA). Historically, VBA has placed
emphasis on the processing of veterans' claims and the reduction of the
claims backlog, which is extremely important. However, providing
effective employment programs through VR&E must be a priority as well.
Historically, VA has been lacking in its efforts to find employment
for disabled veterans. The Vocational Rehabilitation program has
historically been marketed to veterans as an education program and not
an employment program. A majority of veterans attended universities and
colleges with few enrolled in training programs, such as
apprenticeships and on-the-job training that can lead to direct job
placement.
Until recently, VR&E's primary focus has been providing veterans
with skills training, rather than obtaining meaningful employment.
Clearly, any employability plan that doesn't achieve the ultimate
objective, a job, is an injustice to those veterans seeking assistance
in transitioning into the civilian workforce.
MANAGEMENT AND PERFORMANCE STANDARDS
In 2003, the Secretary of Veterans Affairs established a task force
to examine the entire VR&E Program. The resulting 2004 VR&E Task Force
Report contained 110 recommendations to redesign the program to become
``a proactive, employment-driven, 21st Century program that can
effectively serve veterans with disabilities.'' The task force reported
areas of concern in VR&E's provision of employment services to
veterans, workload management, fiscal accountability, performance
measurement, and information technology (IT) management including a
concern that VR&E's IT systems did not produce the information and
analyses needed to manage program activities. As of April 2007, VR&E
reports that 89 of 110 recommendations have been fully implemented and
13 are planned for implementation. As of July 2008, VR&E reports that
out of the 13 remaining recommendations for implementation, 4 of those
will be implemented within 12 months and 8 will be implemented beyond
12 months.
The Government Accountability Office (GAO) issued a report in June
2004 that concluded that VA has not been effective in meeting its
mandate to find jobs for disabled veterans. The report agreed with the
2004 VR&E Task Force Report finding that VA had not prioritized
returning veterans with service-connected disabilities to the workforce
and that the VR&E Program has emphasized education over employment. The
2004 VR&E Task Force Report stated, ``VR&E's best efforts regarding
employment of veterans have resulted in only 10 percent of those
participating in the VR&E program obtaining employment,'' and stated,
``Despite the tens of thousands of VR&E program participants in a given
year, the number of veterans rehabilitated by obtaining a job or
achieving ILP goals has averaged only about 10,000 a year for several
years.''
Another problem hindering the effectiveness of the VR&E program as
previously cited in reports by the Government Accountability Office
(GAO) is exceptionally high workloads for the limited number of staff.
This hinders the staff's ability to effectively assist individual
veterans with identifying employment opportunities.
As mentioned above, Chapter 31 of Title 38, U.S. Code limits the
number of veterans who can be placed in the ILP to 2,500 annually. Due
to the statutory annual cap on the number of ILP participants, VR&E
Service instructed VA Regional Offices (VAROs) to discontinue placing
veterans into ILP status as they approached the cap unless approved by
VA Central Office (VACO). From FY 2002 through FY 2006, VR&E issued
interim procedures that prohibited VR&E staff from approving new
veterans into the ILP unless VACO program officials authorized the
placements. The interim procedures further directed that if
authorization were denied, the veteran should be considered a priority
for initiation in the new FY and held in the Evaluation and Planning
phase until that date.
As a result, the cap was underutilized in FY 2006 and services to
entitled veterans were delayed. An average of 225 veterans per month
entered the ILP nationwide from October 2005 through June 2006.
However, during the months of July 2006 through September 2006,
subsequent to issuance of the interim procedures, an average of 45
veterans per month entered into the ILP. Ultimately, a total of 2,162
veterans entered the ILP in FY 2006. Even though the number of new
veterans that entered the program did not exceed the annual cap, VR&E
service anticipated exceeding it, which delayed veterans from entering
the ILP when they were eligible. This cap delays benefits to severely
disabled veterans who are entitled to participate in the ILP. VA has
made efforts since 2001 to remove the cap; however, the cap remains in
effect.
The American Legion supports the removal of the cap. VA should
effectively manage and monitor the number of new ILP participants and
provide detailed information to Congress on delays in veterans'
services until a decision has been made to remove the annual statutory
cap, especially during a period of armed conflict.
VA reports that VR&E rehabilitation rates as a measure of Chapter
31 program performance in the annual VA Performance and Accountability
Report (PAR). The PAR should include data on total program
participants, including those who discontinued program participation,
those who obtained and maintained suitable employment, and those who
achieved ILP goals. Currently, the PAR does not accomplish that. The
PAR should provide accurate and complete information for budgetary and
resource decisions.
Unfortunately, most veterans discontinued participation in the
Chapter 31 program and were not rehabilitated. Data in Benefits
Delivery Network (BDN), the major computer system used by VBA to
process veterans' claims, does not provide VR&E management with
sufficient information to analyze the reasons for the high rate of
program discontinuation. Once the reasons are identified, the
information could be used to design interventions to reduce the
probability of veterans dropping out of the program.
VBA currently has a study, Veterans Employability Research Survey,
which is scheduled for completion in September 2008. Study results will
be used to establish nationwide procedures to help reduce the number of
veterans who discontinue the VR&E program.
It seems that the VR&E program has remained in a perpetual state of
transition for the past 25 years, according to countless GAO and VA
reports. The 2004 Task Force Report stated that the VR&E system must be
redesigned for the 21st Century employment environment. The American
Legion continues to support strong leadership and continued
verification of the recommendations made in the 2004 Task Force Report.
In fiscal year (FY) 2006, VR&E funding was $702 million, and the
program served about 90,000 veterans. Adequate funding is needed to
assist the management staff of VR&E to continue its implementation of
the recommendations.
REHABILITATION AND EMPLOYMENT OUTCOMES
Numbers of Rehabilitated/Employed Veterans
----------------------------------------------------------------------------------------------------------------
Veterans successfully Veterans successfully employed with
Year rehabilitated suitable jobs
----------------------------------------------------------------------------------------------------------------
FY 03 9,549 7,525
----------------------------------------------------------------------------------------------------------------
FY 04 11,129 18,392
----------------------------------------------------------------------------------------------------------------
FY 05 12,013 19,279
----------------------------------------------------------------------------------------------------------------
FY 06 Not available Not available
----------------------------------------------------------------------------------------------------------------
FY 07 11,008 18,252
----------------------------------------------------------------------------------------------------------------
The above demonstrates the improved outcomes for the VR&E program.
Although there are improvements needed in the VR&E program,
veterans who have gone through the program stated that the counseling,
training, education, and skills that they acquired led to gainful
employment both within the public and private sectors. A veteran from
Massachusetts went into the VR&E and received an associate degree.
Currently, he operates his own small business, while completing his
bachelor's degree. Severely disabled veterans stated that the
Independent Living Services assisted them in adjusting to home life and
participating with family and community life at a higher level.
For example, a veteran from Georgia described that once he was
accepted into the ILP, he was supplied with special walking shoes, an
exercise machine, and a computer. The Independent Living services
allowed him to better operate and feel more productive at home. The
program has provided severely disabled veterans much needed assistance
and possible hope for future employment.
2008 VR&E AND INDEPENDENT LIVING PROGRAM PARTICIPANTS
----------------------------------------------------------------------------------------------------------------
Locations VR&E Program Participants Veterans Placed in the ILP
----------------------------------------------------------------------------------------------------------------
Indiana 1,880 163
----------------------------------------------------------------------------------------------------------------
Arkansas 1,382 24
----------------------------------------------------------------------------------------------------------------
South Dakota 781 43
----------------------------------------------------------------------------------------------------------------
North Dakota 569 29
----------------------------------------------------------------------------------------------------------------
District of Columbia 2,318 11
----------------------------------------------------------------------------------------------------------------
New York City 1,700 219
----------------------------------------------------------------------------------------------------------------
The total number of veterans who were rehabilitated through the
Independent Living Program in FY 2006 and FY 2007 were 2,162 and 2,756
respectively. In February 2007, the VA Secretary stated that VR&E
anticipates a steady increase in the demand for ILP services over the
next 10 years.
At this time in the nation's history, it is paramount that we
ensure VA is capable of enabling injured veterans with disabilities to
have a seamless transition from military service to a successful
rehabilitation and on to suitable employment after military service.
For severely disabled veterans, this success will be measured by their
ability to live independently, achieve the highest quality of life
possible, and realize the hope for employment given advances in medical
science and technology. To meet America's obligation to these specific
veterans and other eligible VR&E veterans, VA leadership must continue
to focus on marked improvements in case management, vocational
counseling, and most importantly job placement.
The American Legion strongly supports the ILP and is committed to
working with VA and other Federal agencies to ensure that America's
severely disabled veterans are provided with the highest level of
service and employment assistance. Again, thank you for the opportunity
to present the opinion of The American Legion on this issue.
Prepared Statement of Ruth Fanning,
Director, Vocational Rehabilitation and Employment Service,
Veterans Benefits Administration, U.S. Department of Veterans Affairs
Madam Chairwoman and members of the Subcommittee, thank you for
inviting me to appear before you today to discuss the independent
living services provided by VA's Vocational Rehabilitation and
Employment (VR&E) program. My testimony will provide an overview,
address the cap of 2,500 new independent living cases per fiscal year,
and describe VR&E efforts to improve and facilitate the delivery of
these essential services.
Overview of Independent Living
Independent living (IL) services may be provided to VR&E applicants
when it is determined during the initial evaluation that they cannot,
due to the severity of their disability(ies), currently pursue a
vocational goal. After this determination, each veteran participates in
a thorough assessment of his or her potential IL needs. The evaluation
begins with a preliminary assessment. During this assessment, the
counselor obtains information about a variety of issues, including
housing, personal and emotional needs; leisure and avocational
activities; and the ability of the veteran to perform activities of
daily living. If potential IL needs are identified, the VR&E counselor
or another provider with specialized experience and/or training
completes a comprehensive assessment of IL needs. This assessment is
usually performed at the veteran's home. If IL needs are found and it
is determined that achievement of appropriate goals is possible, the
counselor works with the veteran to develop an Independent Living Plan.
This plan outlines the goals, services, and assistance to be provided
and benchmarks to be used to determine progress in achieving greater
independence in daily living.
Independence in daily living translates to the ability of a veteran
to live and function within family and community, either without the
services of others or with a reduced level of those services. Services
are tailored to each veteran's needs and may include a discrete service
or a comprehensive program of services necessary to achieve maximum
independence in daily living.
Total programs of IL services are usually no longer than 24 months
duration. In exceptional circumstances, the counselor may request a 6-
month extension.
Some of the IL services VA provides include training in activities
of daily living, training in skills needed to improve an individual's
ability to live more independently, attendant care during a period of
transition, transportation when special arrangements are required, peer
counseling, housing integral to participation in a program of special
rehabilitation services through an approved independent living center
or program, training to improve awareness of rights and needs,
assistance in identifying and maintaining volunteer or supported
employment, services to decrease social isolation, and adaptive
equipment that increases functional independence.
IL services may also help a veteran become able to participate in
an extended evaluation. The purpose of an extended evaluation is to
assess the ability of the veteran to achieve a vocational goal.
Discrete IL services may also be provided as components of other
rehabilitation plans. The IL services included in these plans must be
directly related to the achievement of the plan goal, whether that goal
is vocational training, a more extensive assessment of vocational
feasibility, or employment.
The VR&E Officer must approve IL program costs exceeding the
counselor approval limit of $25,000 per calendar year. Program costs
exceeding $75,000 per calendar year can be approved by the Director of
the VA Regional Office. Program costs in excess of $100,000 per
calendar year and IL-related construction costs exceeding $25,000 must
be approved by the Director of VR&E Service.
VR&E performs quality assurance reviews of IL casework. Cases are
reviewed during oversight visits at regional offices, and the results
are used to develop training or provide additional guidance when
appropriate.
Independent Living Cap
With the passage of P.L. 107-103, the Veterans Education and
Benefits Expansion Act of 2001, the limit on the number of new IL cases
per year increased from 500 to 2,500. VR&E Service monitors newly
developed IL cases monthly to track total IL cases in comparison to the
legislative cap. Tracking over the past 2 years demonstrates the
ability of VR&E counselors to provide needed services within the
current 2,500 statutory cap. On average, 2,300 new cases have entered
IL services each of the past 3 years.
Independent Living Services and Results
Veterans with severe disabilities who participate in programs of
independent living have achieved results that include increased
independence, decreased isolation, decreased dependence on outside
supports, enhanced family relationships, improved medication and
therapeutic intervention compliance, and greater community involvement.
Other positive outcomes include veterans being able to leave long-term
institutional care to live in the community with reduced reliance on
other federally funded service providers, pursuit of full or part-time
volunteer employment, and progression from IL programs to other VR&E
employment programs.
As a result of increased outreach, we anticipate more veterans will
participate in programs of IL services. Also, the medical stabilization
of returning OEF/OIF veterans with catastrophic injuries will
necessitate their participation in vocational rehabilitation programs.
The aging Vietnam Era population and the increasing number of veterans
receiving compensation due to presumptive diseases will also likely
increase the utilization of IL services.
VR&E Service closely monitors the number of entering cases to
ensure priority services are provided to veterans with the most serious
disabilities. We also provide training and guidance to field staff to
incorporate IL services into Individualized Written Rehabilitation
Plans and Individualized Extended Evaluation Plans when appropriate.
Training
In early 2005, Guidelines for the Administration of the Independent
Living Program were published and implemented. These guidelines include
standards of practice and mandatory job aids for counselors. Use of
these tools improved the quality and consistency of independent living
assessments, plan development, service delivery, and case closures.
To reinforce the understanding and use of these tools and
practices, VR&E Service provides targeted and extensive training about
IL services for counselors and managers, including training workshops
for vocational rehabilitation counselors directly responsible for
developing IL plans and providing IL services.
As a part of ongoing IL training, VR&E Officers and Assistant VR&E
Officers also receive information about community partnerships
facilitating IL planning and service delivery. Building on
collaboration with the Executive Director for Centers for Independent
Living, a panel presentation at the recent VR&E Leadership Conference
focused on information about Centers for Independent Living and current
initiatives at these Centers to work with veterans with severe
disabilities.
Another panel at the VR&E Leadership Conference addressed methods
and services to facilitate the employment of individuals with severe
disabilities, such as traumatic brain injury, post traumatic stress
disorder, spinal cord injury, severe mental illness, and polytrauma.
Panelists included representatives from Easter Seals, the Vocational
Rehabilitation Services Program sponsored by Paralyzed Veterans of
America, and the Compensated Work Therapy program within the Veterans
Health Administration (VHA).
Current and Future Studies
To obtain a more comprehensive understanding of the veterans who
participate in IL programs, VR&E Service funded an Independent Living
Participant Study. This contracted study will provide the first
comprehensive analysis of the veterans, services, and outcomes achieved
by veterans participating in total programs of IL services. This study
will expand our knowledge about the disabilities and disability
ramifications of IL program participants; the use of technology and
adaptive equipment to minimize or ameliorate disability ramifications
in daily life; and utilization of other VA benefits and benefits
available through private providers or other state or federal sources.
Recommendations to improve the administration of IL services under the
VR&E program will be provided. The study is expected to be completed by
September 30, 2008.
Next year, VR&E plans to fund a study to examine factors
influencing the employment of individuals with severe injuries. Many of
these individuals will initially utilize IL services, either in total
programs of independent living or through IL services included in other
rehabilitation plans. The objective of this project is to collect data
and perform a comprehensive analysis of factors influencing the
successful employment of veterans of the military with severe injuries.
The population studied will include individuals with disabilities such
as traumatic brain injury, spinal cord injury, blindness, amputation,
severe mental illness, burns, and polytrauma. Recommendations will be
provided on methods to improve employment outcomes and train counselors
in working with and planning rehabilitation programs for servicemember
and veterans with severe injuries.
Cooperative Relationships
In cooperation with the Specially Adapted Housing Grant program
administered by VA's Loan Guaranty Service, VR&E independent living
services help meet the needs of veterans with severe disabilities and
mobility impairments. In 2005, VR&E Service and Loan Guaranty Service
established formal procedures to facilitate cooperative relationships
while maintaining the integrity of each program. When working with
veterans who have home-modification needs, VR&E counselors investigate
eligibility for the Specially Adapted Housing grant, and may assist the
veteran in the application and coordination process.
Specially Adapted Housing Agents, as part of their initial
interview protocol, discuss potential eligibility for IL services.
Specially Adapted Housing Program Managers regularly attend VR&E
management conferences to provide information on the Specially Adapted
Housing Program.
This cooperation has resulted in the delivery of life-changing
services to veterans. In one instance, a veteran with quadriplegia
received home modifications and a generator from the Specially Adapted
Housing Program. IL services included adaptive equipment and assistive
devices such as a voice activated computer and a flashing telephone and
doorbell. Another veteran, blinded in Vietnam, needed a bedroom and
bath constructed on the first floor of his home. VR&E and the Specially
Adapted Housing Program were able to jointly complete these
modifications, ensuring the veteran's safety in his home and increased
independence.
VR&E also works with programs administered by VHA, including the
Home Improvements and Structural Alterations (HISA) program, the
Automobile Adaptive Equipment program, and the Visually Impaired
Services Team (VIST) program. The VHA provides HISA grants up to $1,200
for nonservice-connected veterans or up to $4,100 for service-connected
veterans who need modifications to their homes to facilitate entry and
provide access within the home.
VA's Automobile Adaptive Equipment program helps veterans or
servicemember who are service-connected for the loss or loss of use of
one or both feet or hands, or who have service-connected abnormal
adhesion of the bones of a joint of one or both knees or one or both
hips. Veterans with severe burns resulting in a rating of loss of use
of their extremities also qualify. The program can provide, among other
things, power steering, brakes, windows, doors, mirrors, seats,
automatic transmission, van lifts, wheelchair and scooter lifts,
shipping costs, and other special equipment necessary to the
individual.
VHA's Compensated Work Therapy (CWT) programs provide supported
employment opportunities for veterans with severe mental illness and
other catastrophic disabilities, including traumatic brain injury and
spinal cord injury. CWT programs are offered at over 162 locations
across the country. The staff of these programs provide a range of
vocational rehabilitation services to veterans who express an interest
in employment. Any veteran may participate who has a severe mental
illness or other severe disability and receives a referral from a VA
Medical Center clinician or physician. For veterans with severe
disabilities, CWT services can be an essential bridge from unemployment
to employment.
VHA's Visual Impairment Service Team (VIST) offers a wide variety
of services, including visual exams, devices to assist with daily
living, and adapted computers and training to veterans with visual
impairments. VHA also offers an array of prosthetic devices and
services for patients based upon such factors as enrollment, medical
evaluations, and prescriptions.
VR&E participates in work groups and Committees that discuss and
recommend policies to serve veterans likely to participate in IL
services. These committees include the Committee on Care of Veterans
with Severe Mental Illness (SMI) and the Traumatic Brain Injury
Caregivers Panel. The SMI Committee is a VHA Committee created to
discuss, develop, and review VA treatment protocols, funding, and
initiatives for veterans with mental illness. Members include VHA
clinicians as well as members of service organizations and
organizations dedicated to mental health issues in the private sector.
Section 744 of the, P.L. 110-181, signed by the President on January
28, 2008, mandated the creation of the Traumatic Brain Injury
Caregivers Panel. The purpose of the 15 member panel is ``to develop
coordinated, uniform, and consistent training curricula to be used in
training family members in the provision of care and assistance to
members and former members of the Armed Forces with traumatic brain
injuries.'' Panel members were appointed after receiving Department of
Defense and White House approval.
Services to Seriously Wounded
VR&E is an integral part of a seriously injured servicemember's or
veteran's adjustment and reintegration into their community. Working
together with military treatment facilities, the Department of Labor,
VHA, as well as VHA's Care Coordinators, and VBA personnel, VR&E
provides an optimal program of vocational rehabilitation and employment
services to assist with seamless transition from military to civilian
life.
Early intervention services for a seriously wounded OIF/OEF
servicemember or veteran begins with a VR&E Vocational Rehabilitation
Counselor directly contacting the individual to inform him or her about
available benefits. This initial contact may occur while the
servicemember is receiving treatment at a medical treatment facility, a
VA Medical Center, or the individual's home. VR&E staff is equipped to
go anywhere necessary to deliver the initial orientation and provide
assistance to the wounded warrior and his or her family.
This initial contact allows for the vocational rehabilitation
process to begin earlier during medical rehabilitation and enables the
veteran to make the transition quickly to work or to a program of
employment services after he or she is discharged and ready to pursue
vocational goals. This early intervention also gives hope to veterans
as they readjust to their disabilities and plan for their future.
Once the eligible servicemember or veteran completes the initial
orientation and the vocational assessment, a plan of service is
developed to assist in meeting the individual's vocational goals. In
developing the rehabilitation plan, VR&E staff work closely with MTF
and VHA personnel, communicating with medical teams to obtain current
information about the veteran's physical capacities and projected
recovery timelines. VR&E is also collaborating with the new Federal
Recovery Coordinators to ensure seamless and timely delivery of
services.
For servicemembers and veterans who are physically recovering from
catastrophic injuries and need independent living services in addition
to planning for their vocational goals, an extended evaluation period
may be needed. Individuals who are so severely disabled that a decision
cannot be made about whether an employment goal is currently feasible
may be provided an extended evaluation of more than the basic 12
months. VR&E Service has authorized field managers to approve extended
evaluations for OIF/OEF servicemembers and veterans up to a total of 18
months.
Another tool to assist the injured servicemember or veteran is the
``Coming Home to Work'' (CHTW) initiative. The CHTW initiative began in
September 2004 as a pilot at Walter Reed Army Medical Center. In
November 2005, responsibility for CHTW was transferred to VR&E Service
and became an integral part of VR&E's early intervention and outreach
efforts to OEF/OIF servicemembers. CHTW is established at all MTFs,
with current staffing provided to 13 Regional Offices serving major
MTFs to support this initiative. CHTW provides opportunities for
eligible servicemembers to fast track into VR&E services, obtain work
experience, develop skills needed to make the transition to civilian
employment, determine the suitability of potential careers, and make
the transition into competitive employment positions.
The need for early VR&E outreach through CHTW has grown and is no
longer contained only within the major Military Treatment Facilities.
The Department of Defense has begun assigning injured servicemembers
pending medical separation to healthcare facilities across the country.
In order to meet the increased need for early VR&E outreach, CHTW has
been expanded to all VR&E field offices to focus on the development of
solid working relationships with the military chain of command,
government agencies, and the VA local service delivery team. This close
coordination and collaboration is vital to the success of VR&E early
outreach efforts for wounded servicemember and veterans.
The Impact of Independent Living Services
This example highlights the impact that IL services have on our
veterans. A veteran with an 80 percent VA disability rating applied for
Chapter 31 benefits. He also had a multitude of non-service connected
disabilities and used a wheelchair due to the difficulties he had with
ambulation due to his disabilities and injuries. His IL goals included
increasing his ability to access his home independently, increasing his
ability to socialize, and enhancing activities of daily living by
providing adaptive computer equipment and teaching him how to use the
equipment.
Our VR&E counselor worked with a Rehabilitation Engineer to
determine how best to increase the accessibility of the veteran's home.
Based on the engineer's assessment and recommendation, VR&E provided
for the installation of solar-powered remote-controlled gates on the
veteran's property. Prior to installing the gates, the veteran would
have to manually open and close the gates. This was difficult for him
due to his disabilities. Now, the veteran uses the gates daily and is
able to come and go on his property without difficulty or pain.
During the veteran's IL program, he began to interact with his
community at a greater rate. He began to attend community events and
joined a social club. Using a computer was very important to this
veteran and he had difficulty using a computer, as his injuries placed
limitations on the use of his hands. The veteran's IL plan included an
adaptive computer, speaking software, and private instruction to teach
him to use the equipment and voice activation software. Today, the
veteran is able to use the computer to take care of his finances,
communicate with family and friends, shop, and conduct research.
Concluding Remarks
VR&E anticipates an increased need for independent living services.
We continue to assess our progress and develop methodologies and
strategies to improve the delivery of benefits to these deserving
veterans. Last year, over 2,700 independent living participants were
rehabilitated--demonstrating they had achieved the goals of their
programs or made substantial gains in independence as a result of VR&E
services.
Madam Chairwoman, this concludes my statement. I would be pleased
to answer questions from you or any of the other members of the
Subcommittee.
Statement of Kerry Baker,
Associate National Legislative Director, Disabled American Veterans
Madam Chair and Members of the Subcommittee:
On behalf of the 1.3 million members of the Disabled American
Veterans (DAV), I am honored to present this testimony to address the
Department of Veterans Affairs' Independent Living Program (ILP).
The purpose of the Vocational Rehabilitation and Employment (VR&E)
program is to provide all services and assistance necessary to enable
veterans with service-connected disabilities to become employable and
obtain and maintain suitable employment, and to the maximum extent
feasible, achieve independence in daily living. However, in any case
wherein the VA has determined that the achievement of a vocational goal
by a veteran currently is not reasonably feasible, such veteran shall
be entitled, in accordance with the provisions of 38 U.S.C.A. 3120, to
an ILP designed to enable such veteran to achieve maximum independence
in daily living. See 38 U.S.C.A. Sec. 3109 (West 2002).
In accordance with 38 U.S.C.A. Sec. 3120, a program of independent
living services and assistance may be made available under this section
only to a veteran who has a serious employment handicap resulting in
substantial part from a service-connected disability. Eligibility for
acceptance into the ILP is hinged on a determination that achievement
of a vocational goal currently is not reasonably feasible. See 38
U.S.C.A. Sec. 3106(d) and (e).
An ILP for services and assistance to a veteran shall consist of
such services as the Secretary determines necessary to enable such
veteran to achieve maximum independence in daily living. The scope of
services and assistance provided is governed by 38 U.S.C.A. Sec. 3104,
and include the following:
1. Evaluation, including periodic reevaluations as appropriate
with respect to a veteran participating in a rehabilitation program, of
the potential for rehabilitation of a veteran, including diagnostic and
related services (A) to determine whether the veteran has an employment
handicap or a serious employment handicap and whether a vocational goal
is reasonably feasible for such veteran, and (B) to provide a basis for
planning a suitable vocational rehabilitation program or a program of
services and assistance to improve the vocational rehabilitation
potential or independent living status of such veteran, as appropriate;
2. Educational, vocational, psychological, employment, and
personal adjustment counseling;
3. An allowance and other appropriate assistance, as authorized
by section 3108 of title 38;
4. A work-study allowance as authorized by section 3485 of title
38;
5. Placement services to effect suitable placement in employment,
and post-placement services to attempt to insure satisfactory
adjustment in employment;
6. Personal adjustment and work adjustment training;
7. (A) Vocational and other training services and assistance,
including individualized tutorial assistance, tuition, fees, books,
supplies, handling charges, licensing fees, and equipment and other
training materials determined by the Secretary to be necessary to
accomplish the purposes of the rehabilitation program in the individual
case,
(B) Payment for the services and assistance provided under
subparagraph (A) shall be made from funds available for the
payment of readjustment benefits;
8. Loans as authorized by section 3112 of title 38;
9. Treatment, care, and services described in chapter 17 of title
38;
10. Prosthetic appliances, eyeglasses, and other corrective and
assistive devices;
11. Services to a veteran's family as necessary for the effective
rehabilitation of such veteran;
12. For veterans with the most severe service-connected
disabilities who require homebound training or self-employment, or both
homebound training and self-employment, such license fees and essential
equipment, supplies, and minimum stocks of materials as the Secretary
determines to be necessary for such a veteran to begin employment and
are within the criteria and cost limitations that the Secretary shall
prescribe in regulations for the furnishing of such fees, equipment,
supplies, and stocks;
13. Travel and incidental expenses under the terms and conditions
set forth in section 111 of title 38, plus, in the case of a veteran
who because of such veteran's disability has transportation expenses in
addition to those incurred by persons not so disabled, a special
transportation allowance to defray such additional expenses during
rehabilitation, job seeking, and the initial employment stage;
14. Special services (including services related to blindness and
deafness) including--
(A) language training, speech and voice correction, training
in ambulation, and one-hand typewriting,
(B) orientation, adjustment, mobility, reader, interpreter,
and related services, and
(C) telecommunications, sensory, and other technical aids
and devices;
15. (15) Services necessary to enable a veteran to achieve maximum
independence in daily living;
16. Other incidental goods and services determined by the
Secretary to be necessary to accomplish the purposes of a
rehabilitation program in an individual case.
A rehabilitation program (including individual courses) to be
pursued by a veteran shall be subject to the approval of the Secretary.
Unfortunately, Congress has limited programs of independent living
services and assistance to no more than 2,500 veterans in each fiscal
year. The first priority is afforded to veterans for whom the
reasonable feasibility of achieving a vocational goal is precluded
solely as a result of a service-connected disability. See 38 U.S.C.A.
Sec. 3120(e). However, among those veterans who are provided a program
of independent living services and assistance, the VA is required by 38
U.S.C.A. Sec. 3120(c) to include, to the maximum extent feasible, a
substantial number of veterans who are receiving long-term care in VA
hospitals and nursing homes, to include contract nursing homes.
The DAV's experience has been that this program provides an
invaluable benefit to the most seriously disabled veterans. We have not
experienced many problems with its implementation or the types of
services it provides. However, the 2,500 statutory limit on enrollees
is incredibly low considering that the program must provide services to
brand new seriously disabled veterans, those in nursing homes and
hospitals, and those in between.
Including the reasons above, the statutory limit is exceptionally
low considering that we are at war, which renders this program more of
a necessity than ever. Therefore, the DAV's primary suggestion is that
the statutory limit should be removed entirely.
Madam Chair, this concludes my testimony on behalf of DAV. We hope
you will consider our recommendations.
Statement of Rogelio G. Evangelista,
President, Maui County Veterans Council, Wailuku, Maui, HI
Maui County Veterans Council
Wailuku, Maui, HI
July 10, 2008
House Committee on Veterans Affairs
Attn: Ms. Orfa Torres
Dear Committee members:
On March 31, 2008 the Maui County Veterans Council presented Dr.
Richard MacDonald, Voc Rehab Counselor, with the ``President's Award''
for having significantly improved the quality of lives of more than 250
of our most severely psychiatrically and physically disabled Vietnam,
Korean and World War II veterans. Dr. MacDonald attributes these
remarkable results to the close collaboration he has with our Maui CBOC
treatment professionals and the unique and profound effectiveness of
the Independent Living Program (ILP). In fact, the entire Maui CBOC
healthcare staff, VA and veteran communities on Maui, Molokai and Lanai
fully endorse and utilize the IL services provided by Dr. MacDonald.
This is because, in addition to Clinic provided therapy and
medications, these IL, services have been so effectively providing
veterans the means they needed to better utilize their time, skills and
interests to help and share with other people. In this way, the IL
Program transforms these hard-to-reach veteran's lives, formerly
characterized by profound depression, isolation, and lack of purpose,
into active, meaningful and socially connected lives. These amazing
results benefit the veterans, their families, communities, and the VA
in terms of reduced treatment costs over time.
Given this use of the Independent Living Program (ILP) services to
these special needs veterans has been utilized far more extensively in
Maui County than elsewhere, they have undergone several Site Surveys by
VACO Vocational Rehabilitation and Employment (VR&E) staff, including
the last one 2 months ago. Dr. MacDonald states that these surveys have
resulted in better assurance that IL services are provided here within
the scope, guidelines and intent of the Chapter 31 Program. However,
these actions have also resulted in larger numbers of veterans awaiting
these services. Nevertheless, Dr. MacDonald is doing the best he can to
expedite these services.
As noted, the Maui County Veterans Council is promoting this unique
utilization of IL services for these special needs veterans because
they have proven to be so critically effective and sustaining to them.
However, given IL, services are need-based, there should be no cap on
the number of veterans who receive them in a year. We also wish to note
that Dr. MacDonald, as the sole provider of Chapter 31 services here,
provides our veterans with VR&E employment services as well as IL
services. Nonetheless, the demand for IL services here remains
extraordinarily high because we have such a high percentage of older
vets living here still suffering from PTSD who are applying and
benefiting from these services.
Lastly, even though we acknowledge our Nation's highest priority is
to serve OIF/OEF veterans, we cannot ascribe a lesser priority to
serving our older veterans especially knowing how essential these ILP
services are in concert with VHA assistance to unlocking the potential
of these special needs veterans to live out the remainder of their
lives with a restored sense of purpose, family, social and community
connection.
Thank you all for what you do for Veterans. God Bless the United
States of America and its Veterans.
Respectfully submitted,
Rogelio G. Evangelista
President
Statement of Marianne Talbot, Ph.D.,
President, National Rehabilitation and Rediscovery Foundation, Inc.
The Hope Project: An Independent Living Program for
Disabled Veterans with TBI
The Need
Medical and neurosurgical techniques have improved since the
seventies, resulting in a dramatic increase in the survival of persons
diagnosed with traumatic brain injuries (TBI). It is estimated that 5.3
million Americans currently live with long-term or permanent
disabilities resulting from TBI (CDC, 1999; Thurman et al., 1999). The
numbers have been increasing with the return of wounded soldiers from
the conflicts in Iraq and Afghanistan. As of 2007, approximately 22
percent of the more than 30,000 wounded soldiers from Iraq and
Afghanistan have sustained a TBI (Stanford Medicine, 2007). The numbers
continue to rise. The recently released RAND Corporation (2008) report
on the Invisible Wounds of War: Summary and Recommendations for
Addressing Psychological and Cognitive Injuries provides some sobering
estimates on the number of deployed servicemembers who have sustained a
TBI and are suffering from psychological issues such as post traumatic
stress disorder (PTSD). Based on surveys, the total number could reach
as many as 320,000 (Tanielian, et. al, 2008). TBI may co-occur with
PTSD and/or traumatic amputation. The cognitive, physical, and
psychosocial changes that occur in an individual post injury are
profound, with lifelong and life altering disabling conditions (NIH,
1999).
The current standard of care following TBI has been first emergency
medical care and stabilization followed by acute and post-acute
rehabilitation with the ultimate goal of independent living. Although
the optimal objective of rehabilitation is successful independent
living through community re-integration, programs and services that
support this transition are not part of the conventional standard of
treatment. A significant gap exists with programs focusing on the
transition from post-acute rehabilitation to independent community
living.
Community re-integration programs (CR) or independent living
programs (IL) are crucial to the quality of life for disabled veterans
and their families. These programs provide a vital role within the
rehabilitation process. By promoting the transfer of skills learned
during acute and post-acute rehabilitation, individuals learn how to
apply and generalize those skills within the community through CR/IL
programs.
Successful CR/IL includes the following constructs to be present in
one's life: independent living aspects (self care, daily routine,
compensatory strategies); productivity/occupation (meaningful and
productive focus); socialization and social supports (supportive
network, leisure activities); and general integration factors (housing,
community involvement and satisfaction with quality of life) (Karlovits
& McColl, 1999).
The next step is to develop a CR/IL prototype that will become part
of the standard of care for disabled veterans to promote independence
and self-sufficiency, thus successful community re-entry.
The Hope Project Overview
The Hope Project, developed by the National Rehabilitation &
Rediscovery Foundation (NRRF) in 2006, is a transitional community
reintegration/independent living program designed to provide disabled
veterans and their families with a comprehensive, community-integrated
program to increase independence and self-sufficiency within a learning
environment. This unique program focuses on the transition from post-
acute rehabilitation to long-term community living and incorporates the
constructs that constitute successful independence and re-entry into
the community. Improving the success of CR/IL for disabled veterans is
essential to allow them to be productive members of their families,
communities, and society.
Through a series of six courses, taught over a 9 month period at
Virginia Tech, Northern Virginia Center, individuals partake in classes
to learn about lifespan issues related to the long-term needs post TBI,
PTSD, and traumatic amputation. Family education and involvement is
highly encouraged during this process. Two courses are offered each
semester. The program includes the following curriculum:
Fall Semester
Module I--self care, self reliance, and compensatory strategy
development
Module II--daily routine development
Spring Semester
Module III--health, leisure education, and socialization
Module IV--productive focus
Summer Semester
Module V--support team development (family involvement/
participation)
Module VI--practicum and mentoring opportunity
Program Impact
The Hope Project has been documenting the vital
importance of this prototype as part of the standard of care within TBI
rehabilitation
The Hope Project is advancing the high quality of
treatment for disabled veterans with TBI and is documenting the
program's efficacy
The Hope Project will give rise to the development of a
model CR/IL program that can be replicated within communities where
disabled veterans reside augmenting and complementing the exceptional
services that currently exist within the Department of Defense and the
Department of Veterans Affairs
Partnerships and Adjunct Services
Partnerships and adjunct services include Virginia Tech, Northern
Virginia Center, Department of Marriage and Family Therapy to provide
individual, couples, and family therapy services as well as a family
support group and graduate level interns. Virginia Tech Department of
Adult Learning is collaborating with NRRF to collect data regarding the
efficacy of the program and to conduct the program evaluation. Virginia
Tech is also providing classroom space as an in-kind contribution to
ensure program success.
NRRF collaborates and coordinates with multiple disciplines
including academia, industry, military services, and the U.S.
Department of Veterans Affairs. Partnerships with local industry are
on-going for practicum and employment opportunities for participants at
the completion of the program.
Program Director
Marianne Talbot, Ph.D., is the Program Director and President of
NRRF. Dr. Talbot earned her Ph.D. in Human Development from the
Virginia Tech. She has a Master of Arts in Education and Human
Development from the George Washington University in Washington, D.C.,
and a Bachelor of Arts from Eckerd College in St. Petersburg, Florida.
She has national certifications as a Rehabilitation Counselor (CRC),
Case Manager (CCM), Rehabilitation Provider (CRP), and Movement Analyst
(CMA). During her master's level internship, Dr. Talbot worked at the
National Institutes of Health (NIH) in the clinical neuropsychology
section administering psychometric tests and collaborating with the
neurosurgery section on research protocols. Dr. Talbot has 22 years of
experience working in neuro-rehabilitation. Additionally, she serves on
several boards and Committees and is President of the Northern Virginia
Brain Injury Association.
References
Centers for Disease Control and Prevention (CDC). (1999). Traumatic
brain injury in the United States: A report to Congress.
Karlovits, T. & McColl, M. (1999). Coming with community
reintegration after severe brain injury: A description of stresses and
coping strategies. Brain Injury, 13, 845-861.
National Institutes of Health (NIH). (1999). Rehabilitation of
persons with traumatic brain injury. Journal of American Medical
Association, 282, 974-983.
Final Report on the President's Commission on the Care for
America's Wounded Warriors (July, 2007).
Richter, R. (Summer, 2007). Fog of war: One soldier's struggle with
Iraq's trademark injury. Stanford Medicine, 20-24.
Tanielian, T, Jaycox, L.H., Schell, T.L., Marshall, G.N., Burnam,
M.A., Eibner, C., Karney, B.R., Meredith, L.S., Ringel, J.S., & Vaina,
M.E. (2008). Invisible wounds of war: Summary and recommendations for
addressing psychological and cognitive injuries. RAND Corporation.
Thurman, D., Alverson, C., Dunn, K., Guerrero, J., & Sniezek, J.
(1999). Traumatic brain injury in the United States: A public health
perspective. Journal of Head Trauma Rehabilitation, 14, 602-615.
Committee on Veterans' Affairs
Subcommittee on Economic Opportunity
Washington, DC
July 11, 2008
Ms. Ruth Fanning
Director
Vocational Rehabilitation and Employment Service
U.S. Department of Veterans Affairs
810 Vermont Avenue, N.W.
Washington, D.C. 20420
Dear Ms. Fanning:
In reference to our House Committee on Veterans' Affairs
Subcommittee on Economic Opportunity hearing on ``Independent Living
Program'' on July 10, 2008, I would appreciate it if you could answer
the enclosed hearing questions by no later then August 11, 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 material for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively on letter size paper,
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
Ms. Orfa Torres by fax at (202) 225-2034. If you have any questions,
please call (202) 225-3608.
Sincerely,
Stephanie Herseth Sandlin
Chairwoman
______
Questions for the Record
The Honorable Stephanie Herseth Sandlin
Chairwoman
Subcommittee on Economic Opportunity
House Committee on Veterans' Affairs
July 10, 2008
Independent Living Program
Question 1: How many veterans were recommended by counselors for
the Independent Living Program in fiscal year 2004, 2005, and 2006?
Response: Data on the number of veterans with independent living
(IL) plans are available from fiscal year (FY) 2005 forward. Tracking
procedures were implemented at that time to track new plans against the
2,500 cap. Total IL plans per year include cases that have been re-
evaluated for changes in plan or have been transitioned from an
employment plan to a program of independent living services. Data for
both new plans and total plans by year is as follows:
----------------------------------------------------------------------------------------------------------------
Fiscal Year New IL Plans Total IL Plans
----------------------------------------------------------------------------------------------------------------
2004 Data not available 3,545
----------------------------------------------------------------------------------------------------------------
2005 2,588 3,667
----------------------------------------------------------------------------------------------------------------
2006 2,213 3,129
----------------------------------------------------------------------------------------------------------------
Question 2: How often does the VA exceed the 24-month time in
providing services to veterans?
Response: From FY 2004 through FY 2006, 13 percent of independent
living plans exceeded the 24-month timeframe. IL plans may be extended
for an additional 6 months if circumstances require an extension. Such
extensions require a second level managerial review and approval.
Question 3: What is the average time for a response when a veteran
calls the VA to check on the status of an application?
Response: Vocational Rehabilitation and Employment (VR&E) does not
track response time of routine inquires concerning status of claims.
All Veterans Benefits Administration's (VBA) regional offices have toll
free lines staffed with trained customer service personnel versed in
all VBA benefits information. Phone counselors are trained to provide
immediate feedback regarding the status of pending claims. If claims
have not yet been logged into the regional office's computer
information system, customer service operators are able to transfer
calls to the appropriate VR&E office for status information. Regional
office VR&E operations are staffed with personnel equipped to
immediately research and provide status information.
Question 4: When was the last time that the office Mr. McCartney
dealt with was visited for quality assurance and how did the office
rate?
Response: The last VR&E quality assurance oversight survey of the
Atlanta Regional Office was in June 2007. A rating is not provided as a
part of the site visit protocol. Instead, offices are provided specific
feedback regarding management and operational issues geared toward the
improving the service provided. The Atlanta Regional Office quality
oversight survey included three commendable findings and five action
items. Overall, the survey identified no significant findings except
the need for increased frequency of case management meetings.
Results of the survey included commendations for:
effective operational management,
effective fiscal oversight,
effective working partnerships with the employment
community leading to increased job opportunities for veterans, and
effective working relationships with the military leading
to strong outreach with resulting early intervention for service
connected disabled servicemembers exiting the military.
Action items included:
information technology (IT) enhancements to improve out-
based counselors' access to computer systems,
consistency of data entry,
consistently informing veterans in writing regarding
entitlement determinations,
consistency in using required worksheets for documenting
evaluation and planning actions, and
increased frequency of case management meetings.
Question 5: What happens after the veteran is not part of the
Independent Living Program and becomes unemployed once again and needs
assistance? Can the veteran see a counselor or will the veteran need to
reapply for the program once again?
Response: Veterans who participate in total programs of independent
living services include individuals who are so severely disabled that
they could not feasibly be employed will not have been determined
infeasible for employment due to the severity of disability conditions.
However, as a part of an independent living program, veterans may
obtain volunteer employment or part-time employment that is within
their ability to perform. The optimal goal of the independent living
program is to assist each veteran in overcoming his or her disabilities
to the extent that they become feasible and can pursue services that
result in gainful employment.
A veteran who has been determined to be infeasible may reenter
vocational rehabilitation services within 1 year without reapplying for
services. Past the 1 year point, a veteran may also file an informal
claim via telephone or letter. A VR&E counselor will contact him or her
to discuss further assistance needed. Any time a veteran becomes
unemployed after VR&E makes a rehabilitation determination or if the
veteran discontinues participation in the VR&E program, he or she may
reapply and a VR&E counselor will work with him or her to determine
further rehabilitation needs leading to reemployment. Even if the
veteran's delimiting date has passed, VR&E may provide employment
services; if the veteran has a serious employment handicap, the
delimiting period may be waived and the veteran may be provided
whatever services are determined necessary to successful
rehabilitation.