[Senate Hearing 110-616]
[From the U.S. Government Publishing Office]
S. Hrg. 110-616
HEARING ON FISCAL YEAR 2009 BUDGET FOR VETERANS' PROGRAMS
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
FEBRUARY 13, 2008
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard M. Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Arlen Specter, Pennsylvania
Barack Obama, Illinois Larry E. Craig, Idaho,
Bernard Sanders, (I) Vermont Kay Bailey Hutchison, Texas
Sherrod Brown, Ohio Lindsey O. Graham, South Carolina
Jim Webb, Virginia Johnny Isakson, Georgia
Jon Tester, Montana Roger F. Wicker, Mississippi
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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February 13, 2008
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 3
Murray, Hon. Patty, U.S. Senator from Washington................. 6
Craig, Hon. Larry E., U.S. Senator from Idaho.................... 8
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 10
Wicker, Hon. Roger F., U.S. Senator from Mississippi............. 12
Tester, Hon. Jon, U.S. Senator from Montana...................... 13
Sanders, Hon. Bernard, U.S. Senator from Vermont................. 68
Webb, Hon. Jim, U.S. Senator from Virginia....................... 72
WITNESSES
Peake, Hon. James B., M.D., Secretary of Veterans Affairs;
Accompanied by: Hon. Daniel L. Cooper, Under Secretary for
Benefits; Hon. Michael J. Kussman, M.D., Under Secretary for
Health; Hon. William F. Tuerk, Under Secretary for Memorial
Affairs; Hon. Robert J. Henke, Assistant Secretary for
Management; Hon. Robert Howard, Assistant Secretary for
Information and Technology; and Hon. Paul J. Hutter, General
Counsel........................................................ 15
Prepared statement........................................... 19
Response to written questions submitted by:
Hon. Daniel K. Akaka....................................... 28
Hon. Richard Burr.......................................... 35
Hon. Patty Murray.......................................... 54
Hon. Bernard Sanders....................................... 55
Hon. Larry E. Craig........................................ 58
Response to questions arising during hearing by:
Hon. Daniel K. Akaka....................................... 58
Hon. Patty Murray.......................................... 58
Hon. Larry E. Craig........................................ 58
Attachment 1............................................. 59
Blake, Carl, National Legislative Director, Paralyzed Veterans of
America........................................................ 81
Prepared statement........................................... 83
Baker, Kerry, Associate National Legislative Director, Disabled
American Veterans.............................................. 86
Prepared statement........................................... 87
Kelley, Raymond C., National Legislative Director, Amvets........ 95
Prepared statement........................................... 96
Needham, Christopher, Senior Legislative Associate, National
Legislative Service, Veterans of Foreign Wars of The United
States......................................................... 99
Prepared statement........................................... 100
Gaytan, Peter S., Director, National Veterans Affairs and
Rehabilitation Commission, American Legion..................... 103
Prepared statement........................................... 104
Rowan, John, National President, Vietnam Veterans of America..... 114
Prepared statement........................................... 116
APPENDIX
National Coalition for Homeless Veterans; prepared statement..... 137
Executive Committee, Friends of VA Medical Care and Health
Research (FOVA); prepared statement............................ 140
Rieckhoff, Paul, Executive Director, Iraq and Afghanistan
Veterans of America (IAVA); prepared statement................. 141
Brasuell, David E., Idaho Division of Veterans Services; letter.. 142
Hess, Francis J., Jr.; letter.................................... 144
HEARING ON FISCAL YEAR 2009 BUDGET FOR VETERANS' PROGRAMS
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WEDNESDAY, FEBRUARY 13, 2008
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:30 a.m., in
room 418, Russell Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
Present: Senators Akaka, Murray, Brown, Tester, Webb,
Sanders, Burr, Craig, and Wicker.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, U.S.
SENATOR FROM HAWAII
Chairman Akaka. Aloha and welcome to the hearing. Before we
begin, I ask for a moment of silence to honor the memory of a
longtime member of the veteran community, Richard Fuller, who
died last evening.
Richard began his work on veterans' issues in the late
1970's when he joined the staff of the House Veterans' Affairs
Committee. Later, and for many years after that, Richard was a
tireless and tenacious advocate for the Paralyzed Veterans of
America.
Today's hearing is just the sort of event for which he
would have prepared testimony or appeared or both. His
intelligence and charm and wit were such effective tools in
helping policymakers to truly understand the needs of veterans
and our responsibility to them.
Richard will be greatly missed by those who knew and worked
with him. So let us have a moment of silence for Richard.
[Pause.]
We thank God for Richard and send blessings to him and his
family.
Again, aloha and welcome to all.
When the President released billions of dollars in
contingency funding last month, he put VA on course to make the
improvements that we all know are needed. It was my sincere
hope that the fiscal year 2009 budget would build upon that
financial commitment.
After all, the challenges facing veterans grow more complex
as the wars in Iraq and Afghanistan continue. Yet, in his very
last budget, submitted to this body, the President is proposing
limited funding overall and at the same time some very severe
cutbacks to key programs.
The Administration is quick to say that this latest budget,
if enacted, would nearly double the budget in effect since
President Bush took office 7 years ago. This statement ignores
the fact that it was the work of Congress which has, on
average, doubled the President's request each and every year.
While the Administration is requesting a straightforward
increase for VA, an even greater of level of resources must be
dedicated to care for the newest veterans and for their very
specific needs. The Administration has consistently
underestimated the impact that Operations Enduring and Iraqi
Freedom would have on the VA health care system.
An even more pressing concern is the need for VA to do a
better job of reaching out to these veterans and bringing them
into the fold for care. Preventing suicide and healing
invisible wounds, especially for members of the Guard and
Reserves, takes a much more aggressive approach than is
embodied in this budget.
It is also true that the budget before us targets key areas
for drastic funding cuts. To cut VA research again is
incredibly shortsighted. To cut the Inspector General's Office
again, the central gear in oversight efforts is unwise. And to
drastically cut construction at a time when VA should be
upgrading its infrastructure is reckless and will prove to be
quite costly in the long run.
On the benefits side of the ledger, in the last year
Congress has provided a significant amount of funding through
VA for much needed staffing to adjudicate claims. Our Nation's
veterans deserve nothing less than having their claims rated
accurately and in a reasonable period of time.
Now, the American people, especially veterans, will expect
to see a decreasing backlog and increased timeliness and
quality. I pledge to you my continuing support to get veterans
the benefits they need in an appropriate amount of time. I am
committed to working with the Secretary and my colleagues on
both sides of the aisle to ensure that the Department gets what
it truly requires to deliver high quality benefits and services
to veterans.
I am also deeply committed to working with all Members of
Congress to recognize the reality that meeting the needs of
veterans is truly part of the ongoing costs of war.
This budget takes a meek approach to funding VA, especially
in light of the sacrifices made by those who have served in the
past conflicts and the devastating injuries sustained by many
who are serving today. I do not doubt that we will turn this
budget around. We must support a much more aggressive approach
for improved health care and benefits, and we have much work to
do.
Secretary Peake, before I yield to my colleagues, I want to
ask you to pass along to the President, Secretary Gates, and
others involved in the process, my very deep disappointment
with the proposal made by the President in his State of the
Union regarding GI Bill benefits.
To put before the Nation a proposal that does not seem to
have been very well thought out, either in terms of cost or
impact it could have on the ability to keep critical personnel
in the Armed Forces, is ill-advised.
I look forward to our dialog with Secretary Peake and other
top VA officials as well as the representatives of veterans
service organizations here with us today.
One last matter before I turn to Senator Burr and others
for opening statements. Today's hearing is our first event back
in the Committee's hearing room following a major renovation
which began last spring.
The changes to the room are dramatic, as you can see. When
I walked into the room this morning for the first time, I
wondered whether I was in the right room. It has certainly been
improved. It is much better than it was and it is dramatic.
Some of it you can see, but many changes are not visible.
While a great many people had a hand in bringing about
these changes, one individual truly made it all happen and that
is the Committee's Chief Clerk, and I wanted to point her out.
Kelly Fado, if you are here, will you please stand?
[Applause.]
As any homeowner who has been through a renovation can
attest, Murphy's Law applies nowhere more strongly than in
connection with renovation efforts. Kelly had her hands full
for many months, all the while performing myriad other tasks as
the Committee's Clerk.
As you can see from the results, she did a superb job.
Kelly, I again thank you for your extraordinary and detailed
work that brought the Committee this awesome kind of change.
Senator Burr.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Thank you, Mr. Chairman.
One can only walk into the room and say, wow. Being a true
conservative, though, I miss the folding tables we used before.
[Laughter.]
It is, indeed, a sign that the work that is done in this
room is extremely important and, Mr. Chairman, I want to thank
you and, more importantly, Kelly, for overseeing the transition
to what I think is a state-of-the-art room where people--not
just in the room, but people outside, now with the
telecommunications ability here and TV capacity--have the
opportunity to see these hearings, to hear the substance, to
hear the insight of the witnesses.
General Peake, let me take this opportunity to welcome you
to your first hearing in the Senate as the man in charge, and I
truly do say the man in charge.
You have had a very short time to get your hands around a
$90 billion budget, but I know you have prepared well for the
hearing and I look forward to your testimony.
Of course, it is helpful to have a good budget to support
and I think on the whole you do. The medical care and
disability benefits of our Nation's veterans are among our top
priorities.
The fiscal year 2009 budget puts the right focus on
critical programs that serve our Nation's heroes, wherein the
overall medical care increases 5.8 percent. We see a 9 percent
growth for mental health services, a 10 percent growth for
prosthetics, a 7 percent growth for rehabilitative care; and,
maybe most important during this time of war, a 21 percent
increase in medical services for veterans of Operations Iraqi
Freedom and Enduring Freedom.
But, I would like us to take a new approach in how we view
the VA budget. We all know that funding for veterans has
doubled since President Bush took office. This increase has
come during a time when most other domestic agencies have been
held at little or no growth. So, clearly VA's budget has been
and will remain a top priority to this Administration.
What I would like to know is if this money is translating
into a better, more modern health and benefits system for our
veterans. If it is, then we know we have made a good
investment. But, if the system is not what we would like, then
I suggest we think a little differently in how we propose to
spend over $90 billion to improve the lives of veterans.
Let me give you an example. Recently I introduced the
Veterans Mental Health Treatment First Act. That legislation
would put VA's focus on what we all agree should be VA's most
important job: restoring the capability of disabled veterans
and improving their quality of life.
To me, there are two troubling facts for veterans with Post
Traumatic Stress Disorder. One, there has been a 120 percent
increase in the number of veterans with PTSD on the disability
compensation roles since 1999. Two, the VA Inspector General
tells us that once a veteran with PTSD is on the rolls, the
disability rating tends to get progressively higher until a 100
percent rating is assigned to that veteran.
These facts raise a number of questions. If VA has
recognized medical treatment therapies that are effective, then
why does the evidence suggest that its core population, the
service-disabled, simply progressively get worse and never
better?
I believe there are two ways that we can improve on this.
First, we need appropriate incentives to get veterans into
treatment. Second, we need VA to emphasize wellness, recovery
and restoration first, as opposed to focusing on a rush to
assign disability ratings.
Both the Dole-Shalala and the Disability Benefits
Commission highlighted the need for appropriate incentives to
achieve the desired goals of wellness and employment. I happen
to agree with both of those commissions.
Although the Treatment First Act focuses on veterans with
mental illness, I am wondering if similar problems exist for
other veterans. How has VA's focus on prevention and clinical
practice guidelines translated into helping veterans with
service-related conditions to become less disabled, or, at
worst, not as disabled as they would otherwise have been
without treatment?
After all, shouldn't that be our primary goal? Is not that
the expectation of today's modern warrior? Frankly, a renewed
focus on prevention and wellness is the forward thinking
solution to the claims backlog problem, as well. After all, if
we help veterans get well, stay well and help them to be
gainfully employed, maybe they will not need to file disability
claims. Under that scenario everybody wins.
Speaking of the claims backlog, it is another area where
the traditional approach to solving problems in Washington has
not gotten us very far. Veterans from my home State of North
Carolina regularly tell me how frustrated they are with the
claims process.
I would like everyone to follow along with me as I read
from the VA budget on why backlogs and processing delays
continue, and I quote, Instead of the traditional average of
two to three disabilities per claim, regional offices are now
dealing with a workload in which approximately 16 percent of
the cases involve eight or more issues per claim. The
multiplicity of issues coupled with the procedural changes
flowing from decisions by the court and from the complaint
notification requirements mandated by law has increased the
amount of time required to resolve an initial disability
compensation claim.''
Sound familiar? It should. Folks, I just read from the 1997
VA budget submission. The same reasons given in 1997 for
backlogs, delays and frustrated veterans are nearly identical
to the reasons given for those same problems in this year's
budget and I suspect every year in-between.
How has Congress addressed the backlog problem since 1997?
Since 1997 the budget has more than doubled, resulting in a
doubling of staff dedicated to claims processing. But still the
problem remains. What this should tell us is money is not
necessarily the cure-all to this problem.
We need a new approach. I am anxious to work with my
colleagues here at the VA to try to find something new. We also
need to begin addressing the fundamental problems with the
disability system. Both the Dole-Shalala and the Disability
Benefit Commission tell us that the disability rating schedule
is out of date, that it needs to be completely overhauled, that
it needs to be updated to reflect loss of quality of life and
that a modern compensation system should place more emphasis on
treatment and vocational rehabilitation.
These are fundamental reforms that are long overdue. We
have got to act with urgency so that there is a modern,
coordinated and coherent purpose attached to the overall VA
benefits system that we can all be proud of. Our goal should be
a system that empowers veterans--a system that gives them the
opportunity to return to a full and productive life, yet
compensates them for the loss of quality of life and earnings
capacity.
Let me finish with one final thought. VA has been a leading
innovator in health care delivery. The electronic patient
record is an example of this innovation that the private sector
should and will do well to follow.
There is one area, however, where I think the VA is lagging
behind the private sector. VA does not do enough to compare
itself to the services provided to the outside world. I must
say, though, that it is not the VA's fault. It is Congress's
fault.
We have had a law on the books that says VA cannot compare
its own costs for a particular medical service against the same
service performed by a non-VA provider. How does this make any
sense? Why is this good for veterans? I have yet to hear a good
business case made for keeping this outdated ban in place.
Mr. Chairman, in summary, I am pleased to have a good
starting point to talk about veterans' services for the coming
fiscal year. We also need to start looking at VA's budget
differently. Programs need to show results and they should be
focused on the goals of restoration, recovery, improved care of
the lives of our veterans in this country.
Mr. Chairman, I look forward to exploring these issues with
our witnesses today but also with my colleagues on this
Committee.
General Peake, once again I welcome you.
Mr. Chairman, if I might have the latitude to also welcome
our newest member, Senator Wicker, to our side of the
Committee.
Chairman Akaka. Certainly.
The Chair recognizes Senator Murray for your opening
statement.
STATEMENT OF HON. PATTY MURRAY,
U.S. SENATOR FROM WASHINGTON
Senator Murray. Thank you very much, Mr. Chairman, and
thank you, Senator Burr.
We fully appreciate your holding this very important
hearing as we talk about the President's proposed VA budget for
fiscal year 2009. And I want to thank the representatives from
the veterans service organizations who are here with us as
well. They put a lot of work into writing and crafting the
Independent Budget and they are here today as well to testify
about the resources that our veterans really need.
Mr. Chairman, I also want to take a moment of personal
privilege to welcome a number of my constituents who are AFGE
employees who are here from the Spokane VA and Seattle VA.
These are the people who really make it happen on the ground
and work very hard for our veterans. If you could just stand up
for a minute. I just want to recognize all of you who work for
our veterans on the ground out there. [Applause.]
I join with all of you in extending a warm welcome to
Secretary Peake. He is here for his very first Senate hearing
as Secretary of the VA and we welcome you. And I want you to
know I very much look forward to your trip next week to at the
Walla Walla VA. I appreciate the fact that you responded to my
invitation so quickly to come out and see on the ground what is
happening. I think you will be impressed, as we all are, of the
needs there and how we are moving forward. I really appreciate
your coming out and being there.
Secretary Peake, many veterans and many Members of this
Committee have placed a tremendous amount of faith in your
ability to rise to the unprecedented challenges that are facing
the VA today. We have an opportunity to change course at the VA
but we have to do it quickly and we have got to get it right.
They say out in VISN 20, where we are, that business as usual
is not an option. They wear buttons and T-shirts saying that.
And, Secretary Peake, I know that you know that well.
Secretary Peake, Congress and our veterans really are
counting on you and your first test arrived on February 4 with
the release of the President's budget. Given your short time on
the job, I recognize you did not play a large role in creating
the document, but
you do have the unenviable job of being here today to defend
that budget.
I say ``unenviable'' because at this point I find this
budget unacceptable in many areas for a number of reasons,
starting with my fear that it would close the VA's door to
thousands of our Nation's veterans.
The present budget that was sent to us includes new fees
and increased co-pays that I believe really will discourage
many of our veterans from accessing the VA even as our veterans
are turning to the VA in larger numbers than ever before.
Now, the VA does not discuss the likely impact of that
policy proposal in this year's budget submission but in
previous budgets that have been sent to us the Administration
estimated that those fees and those co-pays would result in
nearly 200,000 veterans leaving the system and more than 1
million veterans choosing not to enroll.
I am also extremely disappointed that this budget continues
to ban Priority 8 veterans from enrolling in the VA health care
system. It is estimated, Mr. Chairman, that more than 1.5
million veterans have already been turned away from the VA
since the Priority 8 ban was put into effect back in 2003 and
many more have been deterred from seeking care.
I have made it very clear over the last several years that
I believe that denying or discouraging our veterans from
seeking care in the VA system because of their income is
morally wrong, and I believe it will also make it harder to
maintain and ensure that we have a strong voluntary military.
Another issue I want to mention is that while the
President's budget does increase spending for VA medical care
by $2 billion, it appears that this level will not meet the
real needs of veterans once medical inflation and other factors
that we need to consider are put in place.
The Independent Budget estimates that the true cost of VA
medical care is $1.6 billion more than the President requested.
I worry that underfunding medical care will prevent the VA from
being able to provide timely and high quality health care that
our veterans deserve. And given the Administration's
involvement in covering up previous shortfalls in VA funding, I
think this Committee has very good reason to be concerned about
a future shortfall.
Along the same line, I am very troubled that the President
is proposing an 8 percent cut to VA medical and prosthetic
research. We all know that one of the signature injuries of the
war in Iraq is Traumatic Brain Injury, but there is still a
great deal more we do not know about the condition.
Cutting funding for research seems to be the wrong thing to
do as we are trying to better understand the injuries that our
veterans are experiencing.
Third, I am incredibly concerned that the President's
budget proposed cutting funding for major and minor
construction by nearly 50 percent at a time when a list of
needed repairs and expanded facilities is stacking up.
The Administration's own budget documents detail the
numerous projects that will not receive funding this year
because of inadequate requests.
Finally, I object to the President's proposed funding cut
to the VA Inspector General. I am very concerned about doing
anything that might hinder the IG's ability to be an effective
watchdog over this incredibly complex system at the very time
we are trying to encourage effective oversight.
Secretary Peake, when I voted for your confirmation in
December, I said that while we should not dwell on the mistakes
of the past, we have to learn from them. So, I am very
concerned that this budget is evidence that the Administration
yet is not learning. And in the State of the Union address just
a few weeks ago the President said he was dedicated to
providing for our Nation's veterans.
But, at a time when we are seeing thousands of new veterans
entering the VA system with serious medical needs as a result
of the wars in Iraq and Afghanistan, the Administration is
underestimating the cost of medical care and it is cutting
funding for construction and medical and prosthetic research.
And at a time when our older veterans are seeking care in
record numbers, the President is proposing fees and co-pays
that will literally shut the door to thousands of patients.
We all know too well what happens when the VA gets
shortchanged. The men and women who have served us end up
paying the biggest price. Our veterans are heroes and they
deserve the best we can give them. I believe that we can do a
lot better than the budget request that has been sent to us by
this Administration.
Secretary Peake, I appreciate your coming before the Senate
Veterans' Affairs Committee. We have a number of questions for
you and I look forward to hearing your responses this morning.
Thank you.
Chairman Akaka. Senator Craig.
STATEMENT OF HON. LARRY E. CRAIG,
U.S. SENATOR FROM IDAHO
Senator Craig. Mr. Chairman, Ranking Member Burr, again
thank you, as all of our colleagues have said, for holding this
hearing in relation to the VA budget.
Secretary Peake and his forces are welcomed before the new
dias of the Veterans' Affairs Committee. This is a pretty swank
place, Danny.
Chairman Akaka. Yes.
Senator Craig. I wonder if we could afford it. But, we are
not going to worry about budgets today, obviously. I do want to
thank you for being here to present the budget that has been
presented to us by the Administration.
I would also like to welcome all of our service
organizations and thank them for their work. We appreciate what
you do and the value of what you do.
I have got to run to another hearing so I will not go into
the detail of the budget. I will say, as a Member of this
Committee long-standing, as many of our colleagues are, we are
very proud of the fact that we have presided over unprecedented
increases in the veterans budget now for nearly 8 years
straight--11 percent, 12 percent, 13 percent, and last year 18
percent. No other agency of the Federal Government other than
Defense and supplemental spending have grabbed the attention of
the Congress like the veterans budget has.
Now, having said that, I also believe it is important that
we do not throw money for the sake of throwing money to look
good. We put money in the right places to make it work on
behalf of America's veterans. I have said it before this
Committee before in talking with two former Secretaries, after
looking at last year's budget in relation to what we wanted to
accomplish, we wanted to go after PTSD and to respond to the
needs of our veterans.
They, in a moment of quietness, said to me, Larry, we
cannot even spend that kind of money because we cannot bring
the systems up fast enough, to go out and recruit the quality
of people we need and train them and put boots on the ground in
relation to serving our veterans in the time that the Congress
expects with the money that we are being sent.
That was a rather dramatic statement but probably an honest
one as it relates to gearing up to get things done, and I think
that, Mr. Chairman, we need to be cautious. We need to be
responsive, and most assuredly, we need to be responsible to
our veterans, but just placing money out there to make it look
good does not necessarily mean the services get to the ground.
A young Marine was home in Idaho during the Christmas
break. He was found in his car dead with a gun on the seat
beside him. The moment the news broke, I turned to my wife and
said, ``I fear that is a suicide.'' Well, it was.
It spoke to me legions about the reality of service today,
the phenomenal responsibility our men and women in uniform have
and take and in some instances the consequence of that service.
So, it is overpowering to me and I think this Committee that we
get it right, we do it right and we respond to these young men
and women in a way that things like that, if at all possible,
can be avoided and they can transition and live a life as a
civilian after they have served our country in a way that we
would hope they can and with that and their families.
Mr. Chairman, I have one other item to cover that I will
raise with you, Mr. Secretary. It is of concern to me. I
introduced legislation in the 109th Congress that became law.
But a specific provision of it has not yet been implemented.
I would like to submit for the record two letters, Mr.
Chairman, one from the Idaho Division of Veterans Services and
one from an Idahoan and his family, who contacted me.
[The letters can be found in the Appendix.]
Senator Craig. The issue is quite simply this, Mr.
Secretary: the Idaho State Veterans Home, and any State
veterans home, as I understand it, is not receiving
reimbursement from the Department of Veterans Affairs for
housing veterans with a disability rate of 70 percent or more
at this time, because the regulation has not been either
written or implemented.
Included in the law is the enactment date of 90 days after
the enactment of the Act. The bill was signed into law December
2006, and yet the provision, I am told, has not yet been
implemented
by VA.
Now, amazingly enough, I am also told that VA is currently
reimbursing private nursing homes who care for veterans with
the same disability rating. In other words, we have been able
to respond to the private homes, but we cannot respond to the
State homes.
These are the facts I have in front of me. I am not going
to ask you to respond at this moment, but if you would get back
to me on it. Again, if this is a matter of bureaucratic
slowness, then shame on VA. But, there appears to be a
discrepancy between what can be provided and is being provided
in private homes versus the State homes.
So, with that, again, Mr. Secretary, and the crew you've
got with you, thank you. Welcome. We are glad you are here. We
look forward to your service to the VA and think you will do a
tremendous job.
Chairman Akaka. Thank you very much, Senator Craig.
STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown. Thank you, Mr. Chairman. Senator Wicker,
welcome to the Committee. I am glad you are on with us.
Secretary Peake, nice to see you. I am proud to have voted
for your confirmation, too.
I just listened to the comments around the table, and
contrasting that with roundtables I have done around Ohio with
different groups of people in 55 of Ohio's counties--some 80
roundtables--many of those roundtables--about a dozen of them--
have been exclusively with veterans or just returning Iraq
soldiers; I just do not buy the comments I hear around the
table implicitly suggesting that we are spending too much, that
the VA cannot keep up.
I have more confidence in you perhaps than my friend from
Idaho does that you can spend wisely. That is the philosophy of
the Defense Department, continuing to pump more money in,
assuming that the generals and the Pentagon will spend it
wisely.
I have that same confidence in you and all of you at this
table. That is why I am so proud that the VSOs have put this
document together--the Independent Budget--because it is clear
to me that we are in times of war. Of course, our budget has
gone up for the VA. It should go up for the VA.
I have met at these roundtables: going to hospitals; going
to funerals; talking to families; talking on the phone to
families who are being ripped apart because of untreated PTSD.
I mean, it is pretty clear to me that we can do a whole lot
better in Congress and certainly the VA is partly at fault, as
Senator Burr suggests, on those waiting lists. But, certainly
the President's budget is, as Senator Murray articulated so
well, is so shortsighted in what we have done.
I have a couple of comments. I will first apologize. I have
a Banking markup I need to go to. I have looked at the
testimony and I will certainly--Diane and all of us will--pay
very specific attention, because by-and-large we know what
needs to be done.
At one of my roundtables in Cleveland, at the Louis Stokes
Medical Center, I met with some recently returning Iraqi war
vets, most in their 20's and 30's. In attendance was also Dr.
John Shupe who was going to be in the audience today, but is
apparently stuck in traffic. Coming from Cleveland, he knows
how to do this traffic. I am surprised he has not been able to
get here yet. Dr. Shupe is part of a group at Cleveland State,
which is working with returning vets to get them into the
classrooms and help make their transition a bit easier.
We have not done that very well. At schools across the
country, a recently returned Iraq solider, a recently returned
Marine will be stuck in class, will be put in class with 30
other students who have had none of that experience in their
lives, and this recently returning soldier has a difficult
time.
Dr. Shupe has put together a program at Cleveland State to
small groups of students as they integrate into this large
campus at Cleveland State groups of veterans, people like Mario
Turner, who was in one of these who suffers from PTSD and was
uncertain about going into a class of 100 other students.
There are programs like that which we are trying to
replicate around Ohio and we would like to work with the VA
overall in helping with that. Part of it is passing the new GI
Bill and what we can do for educational opportunities. That is
great, of course. We should do that. We look at what it did for
our country in the 1940's and 1950's--including, I assume, for
some of you--and in the 1960's. But we have this opportunity.
We need to also do what we can do on the ground that the way.
I also heard in these roundtables consistently the
unhappiness of the proposed increased enrollment fees, doubling
the co-pay and the President wanting to even increase further
than that for prescription drugs. If you are taking four or
five drugs and you have to pay $7 per drug per month, that is
real money. Maybe not to people that dress like we do around
this Committee table. But that is real money for a lot of these
vets.
And I would hope the President would back off. He did once
already under pressure and I hope all of you would consider
that as we move forward.
But another point that I wanted to make, Senator Murray
outlined a lot of the issues of the President's budget overall.
On the one hand, the President's budget for 2009 is $51 billion
in tax cuts for people making over $1 million a year.
Think about the choices and the priorities, $51 billion in
tax cuts for people making over a million a year but we cannot
fund veteran services well enough, people that many of them are
going to be disabled and injured and hurt for the next 30 or 40
years.
It is a moral question. We know that. But also, as Senator
Murray pointed out about oversight, the President's budget cuts
the budget for Office of the Inspector General by $4 million.
Think of the message that sends. You have problems out
there at Walter Reed. You have problems here but we do not
really want to know about them so let us just cut the oversight
budget. I mean, that just speaks volumes; we are a better
people than that, a better government than that. We need to
move in a very different direction there.
The last point. I appreciate Senator Burr's comments about
the backlog. A veteran population of about a million in my
State of Ohio. There is a backlog of 14,000 claims, 5,000 of
those claims have been pending for over 180 days.
I asked Secretary Peake about that before. I really
appreciate his responsiveness. I know he would want to do
something about that. That is a serious, serious issue and I
think we can work on that together.
I thank you all for your public service, those of you at
the VA, and I particularly thank the public service and service
to our country of the activists in the veterans service
organizations that did this and have done so much more now and
did so much more for our country in their lives.
Thank you.
Chairman Akaka. Thank you very much, Senator Brown.
Now, I would like to welcome Senator Wicker to the
Committee. As you know, Senator Wicker was the Ranking Member
on the Mil-Con/VA Appropriations Subcommittee, so we know you
know a lot about VA. I welcome you to the Committee and ask for
your opening statement.
STATEMENT OF HON. ROGER F. WICKER,
U.S. SENATOR FROM MISSISSIPPI
Senator Wicker. Thank you very much, Mr. Chairman. I guess
I have learned a little about the VA during my service in the
House but certainly I think I can learn a lot more under your
leadership and your tutelage here on this Committee, and it is
a pleasure for me to join you and the rest of the Committee.
Secretary Peake, it has been mentioned several times that
this is your first appearance before this Committee so you and
I have that in common today.
As we listen to the opening statements, there is a bit of
frustration that we are going to have a vote at 10:30. There
are other Committees that are also working, so Members have to
come and go.
I think I am learning that questions we might have been
able to ask, we sort of raise in our opening statements and
hope that the witnesses will address them during or perhaps
after the hearing.
Let me congratulate you on your new position and to mention
two things that perhaps the witnesses might talk about when
they finally get a chance to speak themselves.
Senator Craig and Senator Brown, and perhaps others before
them, mentioned the historic increases that this Congress has
provided, and the Chairman is correct. I was happy to have a
role in that as Ranking Member in the Appropriations
Subcommittee on Mil-Con/VA on the House side.
I know that when we were formulating this budget, whether
it was a justified concern or not, we did try to provide the VA
with flexibility in case there were some accounts where you
would not be able to spend all of the money to ensure that the
VA would not be in a position of having to account at the end
of the fiscal year for unused funds.
We wanted to give you funds that you could, indeed, expend.
So, I would like for you to discuss that when it comes time for
your testimony, Mr. Secretary, and particularly with regard to
the medical construction budget for fiscal year 2009. Based on
the historic increases that we had in 2008, I think that the
Committee would benefit from hearing how that played into the
request for this year.
Then there has been a lot of concern with regard to the
interplay between health records--between DOD and the VA--and
this has been a source of frustration for years.
DOD and VA have made progress ensuring electronic health
information. Both Departments have been able to meet several
milestones in response to the emerging and urgent needs for
increased support of care delivered to the returning wounded
warriors.
Both Departments, VA and DOD, have established time lines
that include specific milestones for exchanging electronic
health information, implementing mechanisms to achieve
interoperability and transition from legacy systems.
It does appear that in the hand-off from DOD to VA for so
many of our wounded warriors, we are still seeing what might be
termed ``a patchwork of linkups'' between systems that we
already had.
So, I would also hope that this Committee in working with
you, Secretary Peake, could address the obstacles that there
have been and the potential that we have to develop an honest-
to-goodness, personal, portable electronic medical record for
members to have as members of the military, and also to take
with them as they move to veterans care.
Mr. Chairman, once again I thank you for your warm welcome
and your courtesies to me during my 6 weeks now in the Senate.
To our witnesses, thank you for your attendance, and
certainly also to the veterans who are here today.
I am glad to be part of this and I look forward to working
with you all.
Thank you, sir.
Chairman Akaka. Thank you so much, Senator Wicker.
Senator Tester for your opening statement.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman and Ranking Member
Burr. It is a pleasure to be here. I want to also thank the
Members of this Committee for being here today.
You guys are doing some great work. I will just tell you
that right up front. I will preface all my comments with the
fact that once the folks get in the system, you guys are able
to provide some pretty darn good health care. We do have some
problems and I know that you all are up to the task of meeting
those problems.
I also want to welcome especially Secretary Peake. It is
good to have you in front of the Committee as the confirmed
Secretary of the VA. You have a big job ahead of you, and I
know you are up to the task.
Just a couple of things I want to touch on and I do not
want to be too repetitive. First of all, an increase in the
budget I believe of $2 billion, and there has been eight
straight years of budget increases. But I will also tell you
there is a conflict going on in Iraq and Afghanistan and there
is a big group of folks that are coming home from those
conflicts that are going to need some help from injuries that
are seen and injuries that are unseen. And we need to be geared
up.
If, in fact, we appropriate money to you and you cannot
figure out how to utilize it in a timely manner, then we will
help you in that. You just need to tell us because the truth is
that issues like PTSD are issues that we need to address sooner
than later. And you folks know that. You are the experts at it.
But the truth is that when it comes to an issue that is
unseen like PTSD or TBI, we need to be ready to handle them,
and to be honest with you, the reason I feel more urgency on
this now than ever is because of the hearings I have had around
the State of Montana and the fact that the Vietnam vets are
coming out because it is bringing back memories. They do not
want these folks to go through the same thing that they went
through. So we need to be ready to go.
I would just tell you that in the budget, there are some
things that I find a bit annoying. The fee increase for
prescription drugs and enrollment. It has been mentioned
before. I think it is ludicrous. Quite honestly it does not
make a lot of sense to me. It is kind of like having a person
there and we are going to give you good care but we are going
to needle you a little bit, and I just do not think it is
necessary.
The same thing under deductibility increase, and you are
following the law. I appreciate that. Maybe we need to change
the law as far as the deductibility for travel increase because
quite honestly, in the way it is worded in my document, there
are $20 to $30 million additional if it went back to $6
deductible in medical funds.
The truth is that $20 to $30 million in this overall budget
will treat a lot of people for illnesses. Make no mistake about
it. But, truthfully, it is not a huge line item in this budget,
and we need to figure out how to fund it to get it back down,
because in truth, I mean, it just does not make any sense.
Another issue I want to talk about and I will talk to
Secretary Peake about it as time rolls on but you need to know
it and I do not know if it is this way all over but recruitment
of nurses and doctors and administrative personnel is
critically important; and if, in fact, it is in your rules that
you have to pay less than the private sector, we need to figure
out a way to fix that because quite honestly you are not going
to get the best people if you are stuck out at that level. We
need to figure out ways we can give bonuses for recruitment or
some way to get the very best people to treat our veterans in
this country.
Right now they are understaffed in Montana, and some people
may deny that; but I have talked to veterans, I have talked to
staff members, and across the board they will tell you that we
are deficient in doctors, nurses and administrative personnel.
Finally, the rating system for vets who are potentially
disabled. It has been described to me by veterans on the ground
as the equivalent of Chinese mathematics. Now, I do not know
what that means because I have never taken Chinese mathematics
but it is probably pretty complicated.
If there are ways to simplify that--ways to make a better
understanding of how the ratings system works, less complex,
takes up less time--I think those are all things we need to
strive to work for.
We have a big job ahead of us. This budget, hopefully we
will have the opportunity to work it over and honestly get the
services to the ground. That is what we all want. We do not
want it eaten up by administration. But by the same token, we
have to have the people on the ground be able to deliver the
service in a timely manner when people need it.
So with that, I thank you, Mr. Chairman. Thank you, Senator
Burr, Ranking Member, for holding this hearing and I look
forward to further scrutiny of this budget and I look forward
to your guys' further good work.
Thank you.
Chairman Akaka. Thank you very much, Senator Tester.
Now, I want to welcome Secretary James Peake to your first
appearance here before the Senate Veterans' Affairs Committee,
and we look forward to your statement at this time.
STATEMENT OF HON. JAMES B. PEAKE, M.D., SECRETARY OF VETERANS
AFFAIRS; ACCOMPANIED BY: HON. DANIEL L. COOPER, UNDER SECRETARY
FOR BENEFITS; HON. MICHAEL J. KUSSMAN, M.D., UNDER SECRETARY
FOR HEALTH; HON. WILLIAM F. TUERK, UNDER SECRETARY FOR MEMORIAL
AFFAIRS; HON. ROBERT J. HENKE, ASSISTANT SECRETARY FOR
MANAGEMENT; HON. ROBERT HOWARD, ASSISTANT SECRETARY FOR
INFORMATION AND TECHNOLOGY; AND HON. PAUL J. HUTTER, GENERAL
COUNSEL
Secretary Peake. Thank you, Mr. Chairman. I have a written
statement that I would like to submit for the record.
Chairman Akaka. It will be included in the record.
Secretary Peake. Thank you.
Chairman Akaka and Senator Burr, ladies and gentlemen of
the Committee, I am honored to be here as the sixth Secretary
of Veterans Affairs and now responsible for the care of
veterans. I appreciate the opportunity that the President has
given to be able to make a difference.
With me today to present the President's 2009 budget
proposal for VA is the leadership team of the Department. From
my right we have General Howard, our Assistant Secretary for
Information; Mr. Bill Tuerk, Under Secretary for Memorial
Affairs; and Mr. Bob Henke, Assistant Secretary for Management.
On my far left, Mr. Hutter, our General Counsel; Admiral
Daniel Cooper, Under Secretary for Benefits; and Dr. General
Mike Kussman, Under Secretary for Health.
In my almost 2 months now at the VA, I have seen both the
compassion and the professionalism of our employees. It is
frankly just what I expected. The culture is one of deep
respect for the men and women we serve.
This group at the table and the VA at-large understand that
America is at war and it is not business as usual; and I do
have my button.
I appreciate the importance of and I do look forward to
working with this Committee to build on VA's past successes but
also to look to the future to ensure that veterans continue to
receive timely accessible delivery of high quality benefits and
services earned through their sacrifice and service and that we
meet the needs of each segment of our veterans population.
The President's request totals nearly $93.7 billion--$46.4
billion for entitlement programs and $47.2 billion for
discretionary programs. The total request is $3.4 billion above
the funding level for 2008, and I am talking about the funding
level that includes the $3.7 million plus up from the emergency
funding.
This budget will allow VA to address the areas critical to
our mission, namely, to provide timely, accessible, and high-
quality health care to our highest priority patients.
We will advance our collaborative efforts with the
Department of Defense, particularly working toward the
development of a secure interoperable medical records system.
We will improve the timeliness and accuracy of our claims
processing.
We will ensure the burial needs of our veterans and their
eligible family members are met and maintain veteran cemeteries
as national shrines.
The young men and women in uniform who are returning from
Iraq and Afghanistan and their families presents a new
generation of veterans. Their transition and reintegration into
our civilian society when they take that uniform off is a prime
focus.
Those seriously injured must be able to transition between
DOD and VA systems as they move on their journey of recovery.
This budget funds our polytrauma centers and sustains the
network of polytrauma care that Dr. Kussman and his team have
put in place.
It funds the Federal recovery coordinators envisioned by
the Dole-Shalala report and sustains the ongoing case
management at all levels of our system.
We know that our prosthetic support must keep pace with the
newest generation of prostheses that our wounded warriors have
in transitioning into the VA system, and you will see a 10
percent increase in our budget for this.
In 2009 we expect to treat about 333,000 OEF/OIF veterans.
That is a 14 percent increase. We are estimating and seeing a
slightly rising cost per patient and we have budgeted 21
percent increase in our cost to take care of this group. That
is nearly $1.3 billion to meet the needs of the OEF/OIF
veterans that we expect will come to the VA for medical care.
This budget will sustain our outreach activities that range
from more than 799,000 letters to the more than 205,000
engagements that our Vet Center outreach personnel have made
with returning National Guard and Reserve units as part of the
post-deployment health reassessment process.
VBA has conducted more than 8,000 military briefings to
nearly 300,000 servicemen and women. This is also part of
seamless transition. With the authority to provide care for 5
years coming up for service-related issues, we can without
bureaucracy offer the counseling and the support and care that
might be needed to avert and mitigate future problems. I
highlight the outreach piece because we want these men and
women to get those services.
Mental health, from PTSD to depression to substance abuse,
are issues I know are a great concern to you and they are a
great concern to us. This budget proposes $3.9 billion for
mental health across the board, a 9 percent increase from 2008.
It will allow us to sustain an access standard that says, if
you show up for mental health, you will be screened in 24 hours
and within 14 days have a full mental health evaluation, if
needed.
It will keep expanding mental health access according to a
uniform mental health package, train mental health officials
and there are 51 new CBOCs planned in 2009 in addition to the
64 that are coming on line 2008.
Our Vet Centers will bring on yet an additional 100 OEF/OIF
counselors and Dr. Kussman is prepared, as the need is
identified, to add additional Vet Centers.
We appreciate the access issues in rural America. In this
area our Vet Centers are budgeted for 50 new vans to support
remote access as well as expanding telemental health support in
25 locations.
Even as we speak, Deputy Secretary Mansfield, who would
otherwise be with us here today, is testifying with Dr. Chu on
the progress that has been made in our collaborative efforts
between DOD and VA, in moving forward with recommendations from
the Dole-Shalala report, and our focus on getting this
transition right.
But this budget and our mission is more than just about
these most recently returning servicemen and women. We should
remember that 20 percent of VA patients, who in general are
older and with more co-morbid conditions than the general
population, have a mental health diagnosis.
In fiscal year 2007 we saw 400,000 veterans of all eras
with PTSD. This budget will sustain VA's internationally
recognized network of more than 200 specialized programs for
the treatment of Post Traumatic Stress Disorder through our
medical centers and clinics that serve all of our veterans.
We have a unique responsibility to serve those who have
served before. We still have one World War I veteran. One died
this last week. The World War II and Korea veterans are
recipients of our geriatric care and our efforts in improving
long-term care, non-institutional care, where in this budget we
have increased 28 percent. It will make a huge difference in
their quality of life.
We have currently 32,000 people served by home telehealth
programs. This budget continues our work in this area and in
the expansion of home-based primary care.
Overall, the President's 2009 budget request includes a
total of $41.2 billion for VA medical care, an increase of $2.3
billion over the 2008 level and more than twice the funding
level available at the beginning of the Administration.
With it we will provide quality care, improve access,
expand special services to the 5,771,000 patients we expect to
treat in 2009. That is a 1.6 percent increase above our current
2008 estimate.
In April of 2006 there were over 250,000 unique patients
waiting more than 30 days for their desired appointment date.
That is not good. As of January 1, 2008, we had reduced the
waiting list to just over 69,000. That is not so great either.
Our budget request for 2009 provides the resources to
virtually eliminate the waiting list by the end of next year.
Information technology crosscuts this entire Department.
This budget provides more than $2.4 billion for this vital
function, 19 percent above our 2008 budget, and reflects the
realignment of all of our IT operations and functions under the
management control of a Chief Information Officer.
A majority, $261 million, of the increase in IT funds will
support the VA's medical care program, particularly the
electronic medical records system. I emphasize it here because
it is so central to the care we provide touted in such
publications as The Best Care Anywhere book as the key to our
quality that is lauded worldwide.
This IT budget also includes all the infrastructure
supports such as hardware and software and communications
systems for those 51 new CBOCs, for example. And there is $93
million for cyber security, continuing us on the road to being
the gold standard.
It will also be key as we begin to move our claims model
down the road to paperless processes. It is an investment that
we must make. This budget sustains the work in VETSNET that is
giving us management tools to really get after our claims
processing and virtual VA, our electronic data repository.
In addition to IT, this budget sustains a 2-year effort to
hire and train 3,100 new staff to achieve a 145-day goal for
processing compensation and pension claims in 2009. That would
be a 38-day improvement in processing from 2007, a 24-day or 14
percent reduction from what we expect this year.
This is important because the volume of claims received is
projected to reach 872,000 in 2009. That is a 51 percent
increase since 2000, real numbers even if it is historically a
problem.
The active Reserve and National Guard returning from OIF
and OEF have contributed to a increase in new claims and bring
with them an increased number of issues with each claim.
This graph I think shows that, the number of issues growing
significantly compared to the number of claims. The ADC is
average days to complete, and what you see is relatively
constant even though each one of those individual issues have
to be separately adjudicated and rated.
The President's 2009 budget includes seven legislative
proposals, totaling $42 million. One of these proposals expands
legislative authority to cover payment for specialized
residential care in VA approved medical foster homes for OEF/
OIF veterans with TBI.
We again bring to you this request for enrollment fees for
those who can afford to pay and for a raise of the co-pays.
Again this does not affect our VA budget as the funds would
return directly to the Treasury and that would be $5.2 billion
over 10 years.
But it does reflect the matter of equity for those veterans
who have spent a full career in service and under TRICARE to
pay an annual enrollment fee for life care.
The $442 million to support VA's medical and prosthetic
research program, though less than what we have from the
augmented 2008 budget, is actually about 7.3 percent more than
what was asked for in 2007 and 2008. It does contain $252
million devoted to research projects focused specifically on
veterans returning from service in Afghanistan and Iraq,
including projects in TBI and polytrauma, spinal cord injury,
prosthetics, burns, pain, post-deployment mental health.
In fact, we anticipate with the Federal and other grants
that we would have a research portfolio in the vicinity of
$1.85 billion.
This budget request includes just over $1 billion in
capital funding for VA with resources to continue five medical
facility projects already underway in Denver, Orlando, Lee
County, FL, San Juan and St. Louis, and to begin three new
medical facility projects at Bay Pines, Tampa and Palo Alto,
two of which relate to polytrauma rehab and continue our
priority in this specialized area.
Finally, we will perform 111,000 interments in 2009, 11
percent more than in 2007. The $181 million in this budget for
the National Cemetery Administration is 71 percent above the
resources available to the Department burial program when the
President took office. These resources will operationalize the
six new national cemeteries that will open this year and
provide a burial option to nearly 1 million previously unserved
veteran families and will maintain our cemeteries as national
shrines that will again earn the highest marks in government
and private sector.
This budget of nearing $93.7 billion, nearly double from 7
years ago and with the health care component more than twice
what it was 7 years ago, will allow us to make progress in the
care of all of our veterans and will keep us on this quality
journey in health and management of an extraordinary benefit
and ensuring the excellence of our final tribute to those who
shall have borne the battle.
It is an honor to be with you and I look forward to your
questions, sir.
[The prepared statement of Secretary Peake follows:]
Prepared Statement of Hon. James B. Peake, M.D., Secretary,
Department of Veterans Affairs
Mr. Chairman and Members of the Committee, good morning. I am happy
to be here and I am deeply honored that the President has given me the
opportunity to serve as Secretary of Veterans Affairs. I look forward
to working with you to build on VA's past successes to ensure veterans
continue to receive timely, accessible delivery of high-quality
benefits and services earned through their sacrifice and service in
defense of freedom.
I am here today to present the President's 2009 budget proposal for
VA. The request totals nearly $93.7 billion--$46.4 billion for
entitlement programs and $47.2 billion for discretionary programs. The
total request is $3.4 billion above the funding level for 2008. The
President's ongoing commitment to those who have faithfully served this
country in uniform is clearly demonstrated through this budget request
for VA. Resources requested for discretionary programs in 2009 are more
than double the funding level in effect when the President took office
7 years ago.
The President's request for 2009 will allow VA to achieve
performance goals in four areas critical to the achievement of our
mission:
provide timely, accessible, and high-quality health care
to our highest priority patients--veterans returning from service in
Operation Enduring Freedom and Operation Iraqi Freedom, veterans with
service-connected disabilities, those with lower incomes, and veterans
with special health care needs;
advance our collaborative efforts with the Department of
Defense (DOD) to ensure the continued provision of world-class health
care and benefits to VA and DOD beneficiaries, including progress
toward the development of secure, interoperable electronic medical
record systems;
improve the timeliness and accuracy of claims processing;
and
ensure the burial needs of veterans and their eligible
family members are met and maintain veterans' cemeteries as national
shrines.
ensuring a seamless transition from active military service to civilian
life
One of our highest priorities is to ensure that veterans returning
from service in Operation Enduring Freedom and Operation Iraqi Freedom
receive everything they need to make their transition back to civilian
life as smooth and easy as possible. We will take all measures
necessary to provide them with timely benefits and services, to give
them complete information about the benefits they have earned through
their courageous service, and to implement streamlined processes free
of bureaucratic red tape.
We will provide timely, accessible, and high-quality medical care
for those who bear the permanent physical scars of war as well as
compassionate care for veterans who suffer from less visible but
equally serious and debilitating mental health issues, including
Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD).
Our treatment of those with mental health conditions will include
veterans' family members who play a critical role in the care and
recovery of their loved ones.
The President's top legislative priority for VA is to implement the
recommendations of the President's Commission on Care for America's
Returning Wounded Warriors (Dole-Shalala Commission). The Commission's
report provides a powerful blueprint to move forward with ensuring that
service men and women injured during the Global War on Terror continue
to receive the health care services and benefits necessary to allow
them to return to full and productive lives as quickly as possible. VA
has initiated studies to determine appropriate payment levels for
quality of life, transition assistance, and loss of earnings. The next
step is for Congress to pass the President's legislation, which will
modernize the disability compensation system. VA is working closely
with officials from DOD on the recommendations of the Dole-Shalala
Commission that do not require legislation to help ensure veterans
achieve a smooth transition from active military service to civilian
life.
For example, VA and DOD signed an agreement in October 2007 to
provide Federal recovery coordinators to ensure medical services and
other benefits are provided to seriously-wounded, injured, and ill
active duty servicemembers and veterans. VA hired the first recovery
coordinators, in coordination with DOD, and they are located at Walter
Reed Army Medical Center, National Naval Medical Center, and Brooke
Army Medical Center. They will coordinate services between VA and DOD
and, if necessary, private-sector facilities, while serving as the
ultimate resource for families with questions or concerns about VA,
DOD, or other Federal benefits.
In November 2007, VA and DOD began a pilot disability evaluation
system for wounded warriors at the major medical facilities in the
Washington, DC area--Washington VA Medical Center, Walter Reed Army
Medical Center, National Naval Medical Center, and Malcolm Grow Medical
Center. This initiative is designed to eliminate the duplicative and
often confusing elements of the current disability processes of the two
departments. Key features of the disability evaluation system pilot
include one medical examination and a single disability rating
determined by VA. The single disability examination is another
improvement resulting from the recommendations of the Dole-Shalala
Commission and is aimed at simplifying benefits, health care, and
rehabilitation for injured servicemembers and veterans.
VA will continue to work with Congress, DOD, and other Federal
agencies to aggressively move forward with implementing the Dole-
Shalala Commission recommendations.
medical care
The President's 2009 request includes total budgetary resources of
$41.2 billion for VA medical care, an increase of $2.3 billion over the
2008 level and more than twice the funding available at the beginning
of the Bush Administration. Our total medical care request is comprised
of funding for medical services ($34.08 billion), medical facilities
($4.66 billion), and resources from medical care collections ($2.47
billion). We have included funds for medical administration as part of
our request for medical services. Merging these two accounts will
improve and simplify the execution of our budget and will make it
easier for us to respond rapidly to unanticipated changes in the health
care environment throughout the year. We appreciate Congress providing
us with the authority to transfer funding between our medical care
accounts as this helps ensure we operate a balanced medical program. We
will evaluate the potential need for adjustments to our medical
accounts during 2008.
Information technology (IT) plays a vital role in direct support of
our medical care program and VA is requesting a significant increase in
IT funding in 2009, much of which will help ensure we continue to
provide timely, safe, and high-quality health care services. The most
critical component of our medical IT program is the continued operation
and improvement of our electronic health record system, a Presidential
priority which has been recognized nationally for increasing
productivity, quality, and patient safety. We must continue the
progress we have made with DOD to develop secure, interoperable
electronic medical record systems which is a critical recommendation in
the Dole-Shalala Commission report. The availability of medical data to
support the care of patients shared by VA and DOD will enhance our
ability to provide world-class care to veterans and active duty
members, including our wounded warriors returning from Afghanistan and
Iraq.
Workload
During 2009, we expect to treat about 5,771,000 patients. This
total is nearly 90,000 (or 1.6 percent) above the 2008 estimate. Our
highest priority patients (those in Priorities 1-6) will comprise 67
percent of the total patient population in 2009, but they will account
for 84 percent of our health care costs.
We expect to treat about 333,000 veterans in 2009 who served in
Operation Enduring Freedom and Operation Iraqi Freedom. This is an
increase of 40,000 (or 14 percent) above the number of veterans from
these two campaigns that we anticipate will come to VA for health care
in 2008, and 128,000 (or 62 percent) more than the total in 2007.
Funding for Major Health Care Initiatives
In 2009 we are requesting nearly $1.3 billion to meet the needs of
the 333,000 veterans with service in Operation Enduring Freedom and
Operation Iraqi Freedom whom we expect will come to VA for medical
care. This is an increase of $216 million (or 21 percent) over our
resource needs to care for these veterans in 2008.
The Department's resource request includes $3.9 billion in 2009 to
continue our effort to improve access to mental health services across
the country. This is an increase of $319 million, or 9 percent, above
the 2008 level. These funds will help ensure VA continues to realize
the aspirations of the President's New Freedom Commission Report, as
embodied in VA's Mental Health Strategic Plan, to deliver exceptional,
accessible mental health care. The Department will place particular
emphasis on providing care to those suffering from PTSD as a result of
their service in Operation Enduring Freedom and Operation Iraqi
Freedom. An example of our firm commitment to provide the best
treatment available to help veterans recover from these mental health
conditions is our increased outreach to veterans of the Global War on
Terror, as well as increased readjustment and PTSD services. Our
strategy for improving access includes increasing mental health care
staff and expanding our telemental health program that allows us to
reach about 20,000 additional patients with mental health conditions
each year.
Our 2009 request includes $762 million for non-institutional long-
term care services, an increase of $165 million, or 28 percent, over
2008. By enhancing veterans' access to non-institutional long-term
care, the Department can provide extended care services to veterans in
a more clinically appropriate setting, closer to where they live, and
in the comfort and familiar settings of their homes surrounded by their
families. This includes adult day health care, home-based primary care,
purchased skilled home health care, homemaker/home health aide
services, home respite and hospice care, and community residential
care. During 2009 we will increase the number of patients receiving
non-institutional long-term care, as measured by the average daily
census, to about 61,000. This represents a 38 percent increase above
the level we expect to reach in 2008.
VA's medical care request includes nearly $1.5 billion to support
the increasing workload associated with the purchase and repair of
prosthetics and sensory aids to improve veterans' quality of life. This
is $134 million, or 10 percent, above the funding level in 2008. This
increase in resources for prosthetics and sensory aids will allow the
Department to meet the needs of the growing number of injured veterans
returning from combat in Afghanistan and Iraq.
Requested funding for the Civilian Health and Medical Program of
the VA (CHAMPVA) totals just over $1 billion in 2009, an increase of
$145 million (or 17 percent) over the 2008 resource level. Claims paid
for CHAMPVA benefits are expected to grow by 9 percent (from 7.0
million to 7.6 million) between 2008 and 2009 and the cost of
transaction fees required to process electronic claims is rising as
well.
Our budget request contains $83 million for facility activations.
This is $13 million, or 19 percent, above the resource level for
activations in 2008. As VA completes projects within our Capital Asset
Realignment for Enhanced Services (CARES) program, we will need
increased funding to purchase equipment and supplies for newly
constructed and leased buildings.
Quality of Care
The resources we are requesting for VA's medical care program will
allow us to strengthen our position as the Nation's leader in providing
high-quality health care. VA has received numerous accolades from
external organizations documenting the Department's leadership position
in providing world-class health care to veterans. For example, our
record of success in health care delivery is substantiated by the
results of the December 2007 American Customer Satisfaction Index
(ACSI) survey. Conducted by the National Quality Research Center at the
University of Michigan Business School and the Federal Consulting
Group, the ACSI survey found that customer satisfaction with VA's
health care system was higher than the private sector for the eighth
consecutive year. The data revealed that patients at VA medical centers
recorded a satisfaction level of 83 out of a possible 100 points, or 6
points higher than the rating for care provided by the private-sector
health care industry.
In December 2007 the Congressional Budget Office (CBO) issued a
report highlighting the success of VA's health care system. In this
report--The Health Care System for Veterans: An Interim Report--the CBO
identified organizational restructuring and management systems, the use
of performance measures to monitor key processes and health outcomes,
and the application of health IT as three of the major driving forces
leading to high-quality health care delivery in VA. In October 2007,
the Institute of Medicine released a report--Treatment of PTSD: An
Assessment of The Evidence--that States VA's use of exposure-based
therapies for the treatment of PTSD is effective. This confirms the
Department's own conclusions and bolsters our efforts to continue to
effectively treat veterans of the Global War on Terror who are
suffering from PTSD and other mental health conditions.
These external acknowledgments of the superior quality of VA health
care reinforce the Department's own findings. We use two primary
measures of health care quality--clinical practice guidelines index and
prevention index. These measures focus on the degree to which VA
follows nationally recognized guidelines and standards of care that the
medical literature has proven to be directly linked to improved health
outcomes for patients. Our performance on the clinical practice
guidelines index, which focuses on high-prevalence and high-risk
diseases that have a significant impact on veterans' overall health
status, is expected to grow to 86 percent in 2009, or a 1 percentage
point rise over the level we expect to achieve in 2008. As an indicator
aimed at primary prevention and early detection recommendations dealing
with immunizations and screenings, the prevention index will also grow
by 1 percentage point above the estimated 2008 level, reaching 89
percent in 2009.
Access to Care
In April 2006 there were over 250,000 unique patients waiting more
than 30 days for their desired appointment date for health care
services. As of January 1, 2008, we had reduced the waiting list to
just over 69,000. Our budget request for 2009 provides the resources
necessary for the Department to virtually eliminate the waiting list by
the end of next year. Improvements in access to health care will result
in part from the opening of 64 new community-based outpatient clinics
in 2008 and 51 more in 2009 (bringing the total number to 846).
The Department will expand its telehealth program which is a
critical component of VA's approach to improve access to health care
for veterans living in rural and remote areas. Other strategies include
increasing the number of community-based outpatient clinics and
enhancing VA's participation in the National Rural Development
Partnership that serves as a forum for identifying, discussing, and
acting on issues affecting those residing in rural areas. In 2009 the
Department's Office of Rural Health will conduct studies to evaluate
VA's rural health programs and develop policies and additional programs
to improve the delivery of health care to veterans living in rural and
remote areas.
Medical Collections
The Department expects to receive nearly $2.5 billion from medical
collections in 2009, which is $126 million, or more than 5 percent,
above our projected collections for 2008. About $8 of every $10 in
additional collections will come from increased third-party insurance
payments, with almost all of the remaining collections resulting from
growing pharmacy workload. We will continue several initiatives to
strengthen our collections processes, including expanded use of both
the Consolidated Patient Account Center to increase collections and
improve operational performance, and the Insurance Card Buffer system
to improve third-party insurance verification. In addition, we will
enhance the use of real-time outpatient pharmacy claims processing to
facilitate faster receipt of pharmacy payments from insurers and will
expand our campaign to increase the number of payers accepting
electronic coordination of benefits claims.
Legislative Proposals
The President's 2009 budget includes seven legislative proposals
totaling $42 million. One of these proposals expands legislative
authority to cover payment of specialized residential care and
rehabilitation in VA-approved medical foster homes for veterans of
Operation Enduring Freedom and Operation Iraqi Freedom who suffer from
TBI. Another proposal would reduce existing barriers to the early
diagnosis of human immunodeficiency virus (HIV) infection by removing
requirements for separate written informed consent for HIV testing
among veterans. This change would ensure that patients treated by VA
receive the same standard of HIV care that is recommended to non-VA
patients.
The 2009 budget also contains three legislative proposals which ask
veterans with comparatively greater means and no compensable service-
connected disabilities to assume a modest share of the cost of their
health care. They are exactly the same as proposals submitted but not
enacted in the 2008 budget. The first proposal would assess Priority 7
and 8 veterans with an annual enrollment fee based on their family
income:
------------------------------------------------------------------------
Annual Enrollment Fee
------------------------------------------------------------------------
Under $50,000.................................... None
$50,000-$74,999.................................. $250
$75,000-$99,999.................................. $500
$100,000 and above............................... $750
------------------------------------------------------------------------
The second legislative proposal would increase the pharmacy co-
payment for Priority 7 and 8 veterans from $8 to $15 for a 30-day
supply of drugs. And the last provision would equalize co-payment
treatment for veterans regardless of whether or not they have
insurance.
These legislative proposals have been identified in VA's budget
request for several years. The proposals are consistent with the
priority system of health care established by Congress, a system which
recognizes that priority consideration must be given to veterans with
service-disabled conditions, those with lower incomes, and veterans
with special health care needs.
These proposals have no impact on the resources we are requesting
for VA medical care as they do not reduce the discretionary medical
care resources we are seeking. Our budget request includes the total
funding needed for the Department to continue to provide veterans with
timely, accessible, and high-quality medical services that set the
national standard of excellence in the health care industry. Instead,
these three provisions, if enacted, would generate an estimated $2.3
billion in revenue from 2009 through 2013 that would be deposited into
a mandatory account in the Treasury.
One of our highest legislative priorities is to establish the
position of Assistant Secretary for Acquisition, Logistics, and
Construction. The person occupying this new position would serve as
VA's Chief Acquisition Officer, a position required by the Services
Acquisition Reform Act of 2003. This will elevate the importance of
these critical functions to the level necessary to coordinate their
policy direction across the Department's programs and other government
agencies. An Assistant Secretary with focused policy responsibility for
acquisition, logistics, and construction would ensure these vital
activities receive the visibility they need at the highest levels of
VA. Legislation to accomplish this was introduced in the Senate on
October 4, 2007, as S. 2138. We would appreciate Congress' support of
this legislation.
medical research
VA is requesting $442 million to support VA's medical and
prosthetic research program. Our request will fund nearly 2,000 high-
priority research projects to expand knowledge in areas critical to
veterans' health care needs, most notably research in the areas of
mental illness ($53 million), aging ($45 million), health services
delivery improvement ($39 million), cancer ($37 million), and heart
disease ($33 million).
One of our highest priorities in 2009 will be to continue our
aggressive research program aimed at improving the lives of veterans
returning from service in Operation Enduring Freedom and Operation
Iraqi Freedom. The President's budget request for VA contains $252
million devoted to research projects focused specifically on veterans
returning from service in Afghanistan and Iraq. This includes research
in TBI and polytrauma, spinal cord injury, prosthetics, burn injury,
pain, and post-deployment mental health. Our research agenda includes
cooperative projects with DOD to enhance veterans' seamless transition
from military treatment facilities to VA medical facilities,
particularly in the treatment of veterans suffering from TBI.
The President's request for research funding will help VA sustain
its long track record of success in conducting research projects that
lead to clinically useful interventions that improve the health and
quality of life for veterans as well as the general population. Recent
examples of VA research results that have direct application to
improved clinical care include the use of a neuromotor prosthesis to
help replace or restore lost movement in paralyzed patients, continued
development of an artificial retina for those who have lost vision due
to retinal damage, use of an inexpensive generic drug (prazosin) to
improve sleep and reduce trauma nightmares for veterans with PTSD, and
advancements in identifying a new therapy to prevent or slow the
progression of Alzheimer's disease.
In addition to VA appropriations, the Department's researchers
compete for and receive funds from other Federal and non-Federal
sources. Funding from external sources is expected to continue to
increase in 2009. Through a combination of VA resources and funds from
outside sources, the total research budget in 2009 will be almost $1.85
billion.
general operating expenses
The Department's 2009 resource request for General Operating
Expenses (GOE) is $1.7 billion. Within this total GOE funding request,
nearly $1.4 billion is for the management of the following non-medical
benefits administered by the Veterans Benefits Administration (VBA)--
disability compensation; pensions; education; housing; vocational
rehabilitation and employment; and insurance. The 2009 budget request
provides VBA over two times the level of discretionary funding
available when the President took office and underscores the priority
this Administration places on improving the timeliness and accuracy of
claims processing. Our request for GOE funding also includes $328
million to support General Administration activities.
Compensation and Pensions Workload and Performance Management
A major challenge in improving the delivery of compensation and
pension benefits is the steady and sizable increase in workload. The
volume of claims receipts is projected to reach 872,000 in 2009--a 51
percent increase since 2000.
The number of active duty servicemembers as well as reservists and
National Guard soldiers who have been called to active duty to support
Operation Enduring Freedom and Operation Iraqi Freedom is one of the
key drivers of new claims activity. This has contributed to an increase
in the number of new claims, and we expect this pattern to persist at
least for the near term. An additional reason that the number of
compensation and pension claims is climbing is the Department's
commitment to increase outreach. We have an obligation to extend our
reach as far as possible and to spread the word to veterans about the
benefits and services VA stands ready to provide.
Disability compensation claims from veterans who have previously
filed a claim comprise about 54 percent of the disability claims
received by the Department each year. Many veterans now receiving
compensation suffer from chronic and progressive conditions, such as
diabetes, mental illness, cardiovascular disease, orthopedic problems,
and hearing loss. As these veterans age and their conditions worsen, VA
experiences additional claims for increased benefits.
The growing complexity of the claims being filed also contributes
to our workload challenges. For example, the number of original
compensation cases with eight or more disabilities claimed increased by
168 percent during the last 7 years, reaching over 58,500 claims in
2007. Over one-quarter of all original compensation claims received
last year contained eight or more disability issues. In addition, we
expect to continue to receive a growing number of complex disability
claims resulting from PTSD, TBI, environmental and infectious risks,
complex combat-related injuries, and complications resulting from
diabetes. Claims now take more time and more resources to adjudicate.
Additionally, as VA receives and adjudicates more claims, this results
in a larger number of appeals from veterans and survivors, which also
increases workload in other parts of the Department, including the
Board of Veterans' Appeals and the Office of the General Counsel.
The Veterans Claims Assistance Act of 2000 has significantly
increased both the length and complexity of claims development. VA's
notification and development duties have grown, adding more steps to
the claims process and lengthening the time it takes to develop and
decide a claim. Also, the Department is now required to review the
claims at more points in the adjudication process.
VA will address its ever-growing workload challenges in several
ways. For example, we will enhance our use of information technology
tools to improve claims processing. In particular, our claims
processors will have greater on-line access to DOD medical information
as more categories of DOD's electronic records are made available
through the Compensation and Pension Records Interchange project. We
will also strengthen our investment in Virtual VA, which will reduce
our reliance upon paper-based claims folders and enable accessing and
transferring electronic images and data through a Web-based
application. Virtual VA will also dramatically increase the security
and privacy of veteran data. The Department will continue to move work
among regional offices in order to maximize our resources and enhance
our performance. Also, this year we will complete the consolidation of
original pension claims processing to three pension maintenance centers
which will relieve regional offices of their remaining pension work. In
addition, we will further advance staff training and other efforts to
improve the consistency and quality of claims processing across
regional offices.
Using resources available in 2008, we are aggressively hiring
additional staff. By the beginning of 2009, we expect to complete a 2-
year effort to hire about 3,100 new staff. This increase in staffing is
the centerpiece of our strategy to achieve our 145-day goal for
processing compensation and pension claims in 2009. This represents a
38-day improvement (or 21 percent) in processing timeliness from 2007
and a 24-day (or 14 percent) reduction in the amount of time required
to process claims this year.
In addition, we anticipate that our pending inventory of disability
claims will fall to about 298,000 by the end of 2009, a reduction of
more than 94,000 (or 24 percent) from the pending count at the close of
2007. At the same time we are improving timeliness, we will also
increase the accuracy of the compensation claims we adjudicate, from 88
percent in 2007 to 92 percent in 2009.
Education and Vocational Rehabilitation and Employment Performance
With the resources provided in the President's 2009 budget request,
key program performance will improve in both the education and
vocational rehabilitation and employment programs. The timeliness of
processing original education claims will improve by 13 days during the
next 2 years, falling from 32 days in 2007 to 19 days in 2009. During
this period, the average time it takes to process supplemental claims
will improve from 13 days to just 10 days. These performance
improvements will be achieved despite an increase in workload. The
number of education claims we expect to receive will reach about
1,668,000 in 2009, or 9 percent higher than last year. In addition, the
rehabilitation rate for the vocational rehabilitation and employment
program will climb to 76 percent in 2009, a gain of 3 percentage points
over the 2007 performance level. The number of program participants is
projected to rise to 91,700 in 2009, or 5 percent higher than the
number of participants in 2007.
Funding for Initiatives
Our 2009 request includes $10.8 million for initiatives to improve
performance and operational processes throughout VBA. Of this total,
$8.7 million will be used for a comprehensive training package covering
almost all of our benefits programs. A little over one-half of the
resources for this training initiative will be devoted to compensation
and pension staff while nearly one-quarter of the training funds will
be for staff in the vocational rehabilitation and employment program.
These training programs include extensive instruction for new employees
as well as additional training to raise the skill level of existing
staff. Our robust training program is a vital component of our ongoing
effort to improve the quality and consistency of our claims processing
decisions and will enable us to be more flexible and responsive to
changing workload demands.
national cemetery administration
Results from the December 2007 ACSI survey conducted by the
National Quality Research Center at the University of Michigan and the
Federal Consulting Group revealed that for the second consecutive time
VA's national cemetery system received the highest rating in customer
satisfaction for any Federal agency or private sector corporation
surveyed. The Department's cemetery system earned a customer
satisfaction rating of 95 out of a possible 100 points. These results
highlight that VA's cemetery system is a model of excellence in
providing timely, accessible, and high-quality services to veterans and
their families.
The President's 2009 budget request for VA includes $181 million in
operations and maintenance funding for the National Cemetery
Administration (NCA), which is 71 percent above the resources available
to the Department's burial program when the President took office. The
resources requested for 2009 will allow us to meet the growing workload
at existing cemeteries by increasing staffing and funding for contract
maintenance, supplies, and equipment, open new national cemeteries, and
maintain our cemeteries as national shrines. We will perform 111,000
interments in 2009, or 11 percent more than in 2007. The number of
developed acres (7,990) that must be maintained in 2009 will be 8
percent greater than in 2007.
Our budget request includes an additional $5 million to continue
daily operations and to begin interment operations at six new national
cemeteries--Bakersfield, CA; Birmingham, AL; Columbia-Greenville, SC;
Jacksonville, FL; Sarasota, FL; and southeastern Pennsylvania.
Establishment of these six new national cemeteries is directed by the
National Cemetery Expansion Act of 2003. We plan to open fast track
burial sections at five of the six new cemeteries in late 2008 or early
2009, with the opening of the cemetery in southeastern Pennsylvania to
follow in mid-2009.
The President's resource request for VA provides $9.1 million in
cemetery operations and maintenance funding to address gravesite
renovations as well as headstone and marker realignment. When combined
with another $7.5 million in minor construction, VA is requesting a
total of $16.6 million in 2009 to improve the appearance of our
national cemeteries which will help us maintain cemeteries as shrines
dedicated to preserving our Nation's history and honoring veterans'
service and sacrifice.
With the resources requested to support NCA activities, we will
expand access to our burial program by increasing the percent of
veterans served by a burial option within 75 miles of their residence
to 88 percent in 2009, which is 4.6 percentage points above our
performance level at the close of 2007. In addition, we will continue
to increase the percent of respondents who rate the quality of service
provided by national cemeteries as excellent to 98 percent in 2009, or
4 percentage points higher than the level of performance we reached
last year.
capital programs (construction and grants to states)
The President's 2009 budget request includes just over $1 billion
in capital funding for VA, $5 million of which will be derived from the
sale of assets. Our request for appropriated funds includes $581.6
million for major construction projects, $329.4 million for minor
construction, $85 million in grants for the construction of State
extended care facilities, and $32 million in grants for the
construction of State veterans cemeteries.
The 2009 request for construction funding for our health care
programs is $750.0 million--$476.6 million for major construction and
$273.4 million for minor construction. All of these resources will be
devoted to continuation of the Capital Asset Realignment for Enhanced
Services (CARES) program. CARES will renovate and modernize VA's health
care infrastructure, provide greater access to high-quality care for
more veterans, closer to where they live, and help resolve patient
safety issues. Some of the construction funds in 2009 will be used to
expand our polytrauma system of care for veterans and active duty
personnel with lasting disabilities due to polytrauma and TBI. This
system of care provides the highest quality of medical, rehabilitation,
and support services.
Within our request for major construction are resources to continue
five medical facility projects already underway:
Denver, CO ($20.0 million)--replacement medical center
near the University of Colorado Fitzsimons campus
Lee County, FL ($111.4 million)--new building for an
ambulatory surgery/outpatient diagnostic support center
Orlando, FL ($120.0 million)--new medical center
consisting of a hospital, medical clinic, nursing home, domiciliary,
and full support services
San Juan, PR ($64.4 million)--seismic corrections to the
main hospital building
St. Louis, MO ($5.0 million)--medical facility
improvements and cemetery expansion.
Major construction funding is also provided to begin three new
medical facility projects:
Bay Pines, FL ($17.4 million)--inpatient and outpatient
facility improvements
Tampa, FL ($21.1 million)--polytrauma expansion and bed
tower upgrades
Palo Alto, CA ($38.3 million)--centers for ambulatory care
and polytrauma rehabilitation center.
In addition, we are moving forward with plans to develop a fifth
Polytrauma Rehabilitation Center in San Antonio, TX, with the $66
million in funding provided in the 2007 emergency supplemental.
Minor construction is an integral component of our overall capital
program. In support of the medical care and medical research programs,
minor construction funds permit VA to address space and functional
changes to efficiently shift treatment of patients from hospital-based
to outpatient care settings; realign critical services; improve
management of space, including vacant and underutilized space; improve
facility conditions; and undertake other actions critical to CARES
implementation. Further, minor construction resources will be used to
comply with the energy efficiency and sustainability design
requirements mandated by the President.
We are requesting $130.0 million in construction funding to support
the Department's burial program--$105.0 million for major construction
and $25.0 million for minor construction. Within the funding we are
requesting for major construction are resources for gravesite expansion
and cemetery improvement projects at three national cemeteries--New
York (Calverton, $29.0 million); Massachusetts ($20.5 million); and
Puerto Rico ($33.9 million).
VA is requesting $5 million for a new land acquisition line item in
the major construction account. These funds will be used to purchase
land as it becomes available in order to quickly take advantage of
opportunities to ensure the continuation of a national cemetery
presence in areas currently being served. All land purchased from this
account will be contiguous to an existing national cemetery, within an
existing service area, or in a location that will serve the same
veteran population center.
information technology
The President's 2009 budget provides more than $2.4 billion for the
Department's IT program. This is $389 million, or 19 percent above our
2008 budget, and reflects the realignment of all IT operations and
functions under the management control of the Chief Information
Officer.
IT is critical to the timely, accessible delivery of high-quality
benefits and services to veterans and their families. Our health care
and benefits programs can only be successful when directly supported by
a modern IT infrastructure and an aggressive program to develop
improved IT systems that will meet new service delivery requirements.
VA must modernize or replace existing systems that are no longer
adequate in today's rapidly changing health care environment. It is
vital that VA receives a significant infusion of new resources to
implement the IT-related recommendations presented in the Dole-Shalala
Commission report.
Within VA's total IT request of more than $2.4 billion, 70 percent
(or $1.7 billion) will be for IT investment (non-payroll) costs while
the remaining 30 percent (or $729 million) will go for payroll and
administrative requirements. Of the $389 million increase we are
seeking for IT, 86 percent will be devoted to IT investment. The
overwhelming majority ($271 million) of the IT investment funds will
support VA's medical care program, particularly VA's electronic health
record system.
VA classifies its IT investment functions into two major
categories--those that directly impact the delivery of benefits and
services to veterans (i.e., veteran facing) and those that indirectly
affect veterans through administrative and infrastructure support
activities (i.e., internal facing). For 2009, our $1.7 billion request
for IT investment is comprised of $1.3 billion in veteran facing
activities and $418 million in internal facing IT functions. Within
each of these two major categories, IT programs and initiatives are
further differentiated between development functions and operations and
maintenance activities.
The increase in this budget of 94 full-time equivalent staff will
provide enhanced support in two critical areas--information protection
and IT asset management. Additional positions are requested for
information security: testing and deploying security measures; IT
oversight and compliance; and privacy, underscoring our commitment to
the protection of veteran and employee information. The increase in IT
asset management positions will bring expertise to focus on three
primary functions--inventory management, materiel coordination, and
property accountability.
Our 2009 budget request contains $93 million in support of our
cyber security program to continue our commitment to make VA the gold
standard in data security within the Federal Government. We continue to
take aggressive steps to ensure the safety of veterans' personal
information, including training and educating our employees on the
critical responsibility they have to protect personal and health
information. We are progressing with the implementation of the Data
Security--Assessment and Strengthening of Controls Program established
in May 2006. This program was established to provide focus to all
activities related to data security.
As part of our continued operation and improvement of the
Department's electronic health record system, VA is seeking $284
million in 2009 for development and implementation of the Veterans
Health Information Systems and Technology Architecture (HealtheVet-
VistA) program. This includes a health data repository, a patient
scheduling system, and a reengineered pharmacy application. HealtheVet-
VistA will equip our health care providers with the modern tools they
need to improve safety and quality of care for veterans. The
standardized health information from this system can be easily shared
between facilities, making patients' electronic health records
available to all those providing health care to veterans.
Until HealtheVet-VistA is operational, we need to maintain the
VistA Legacy system. This system will remain operational as new
applications are developed and implemented. This approach will mitigate
transition and migration risks associated with the move to the new
architecture. Our budget provides $99 million in 2009 for the VistA
Legacy system.
In support of our benefits programs, we are requesting $23.8
million in 2009 for VETSNET. This will allow VA to complete the
transition of compensation and pension payment processing off of the
antiquated Benefits Delivery Network. This will enhance claims
processing efficiency and accuracy, strengthen payment integrity and
fraud prevention, and position VA to develop future claims processing
efficiencies, such as our paperless claims processing strategy. To
further our transition to paperless processing, we are seeking $17.4
million in 2009 for Virtual VA which will reduce our reliance on paper-
based claims folders through expanded use of electronic images and data
that can be accessed and transferred electronically through a Web-based
platform.
We are requesting $42.5 million for the Financial and Logistics
Integrated Technology Enterprise (FLITE) system. FLITE is being
developed to address a long-standing internal control material weakness
and will replace an outdated, non-compliant core accounting system that
is no longer supported by industry. Our 2009 budget also includes $92.6
million for human resource management application investments,
including the Human Resources Information System which will replace our
current human resources and payroll system.
summary
Our 2009 budget request of nearly $93.7 billion will provide the
resources necessary for VA to:
provide timely, accessible, and high-quality health care
to our highest priority patients--veterans returning from service in
Operation Enduring Freedom and Operation Iraqi Freedom, veterans with
service-connected disabilities, those with lower incomes, and veterans
with special health care needs;
advance our collaborative efforts with DOD to ensure the
continued provision of world-class health care and benefits to VA and
DOD beneficiaries, including progress toward the development of secure,
interoperable electronic medical record systems;
improve the timeliness and accuracy of claims processing;
and
ensure the burial needs of veterans and their eligible
family members are met and maintain veterans' cemeteries as national
shrines.
I look forward to working with the Members of this Committee to
continue the Department's tradition of providing timely, accessible,
and high-quality benefits and services to those who have helped defend
and preserve liberty and freedom around the world.
______
Response to Written Questions Submitted by Hon. Daniel K. Akaka to
LTG James B. Peake, Secretary, Department of Veterans Affairs
Board of Veterans' Appeals Performance
Question 1. Despite an increase in the number of appeals decided
per Veterans Law Judge, the Board of Veterans' Appeals cycle time
continues to increase. Please explain this disparity.
Response. The Board of Veterans' Appeals (Board) ``cycle time'' is
the average time it takes from when a case is received at the Board
until a decision on that appeal is dispatched, excluding time the case
was with the appellant's service organization representative. The
Board's cycle time decreased from 148 days in 2006 to 136 days in 2007.
The Board anticipates, however, that cycle time may increase in the
short term due to fluctuations in the receipt of certain types of
``priority'' appeals.
The Board gives priority to certain types of cases: including cases
that are advanced on the docket, cases remanded to the Board from the
U.S. Court of Appeals for Veterans Claims, cases returned from the
agency of original jurisdiction (AOJ) after a Board remand, and cases
in which the Board has held a hearing. Historically, when a higher
percentage of the Board's workload is made up of these priority
appeals, cycle time will increase. This is because ``priority''
appeals, by nature of being a priority, are quickly sent to a veterans
law judge for adjudication, with minimal waiting time. Contrarily,
original appeals that do not fall into a ``priority'' category must be
worked in their regular order on the Board's docket.
As productivity continues to increase, the Board is better able to
expeditiously adjudicate these priority appeals, and therefore make
greater progress in adjudicating original appeals. The more original
appeals that the Board is able to adjudicate, the more progress will be
made in reducing the backlog. However, the short-term effect is that
cycle time may increase as more of the earlier cases on the docket are
decided.
It is the Board's intention to meet or exceed the 2009 target of
150 days for cycle time. The Board's strategic target remains 104 days.
The Board expects to make progress toward that strategic target as
newly hired attorneys become fully trained and as the Board continues
to work to improve efficiency and productivity by emphasizing training,
focusing on reducing avoidable remands, and ensuring that decisions are
clear, concise, coherent, and correct.
Court Decision
Question 2. Should legislative and judicial relief from the effect
of the Haas decision fail, what are VA's plans for adjudicating the
nearly 11,000 Agent Orange claims that have been received since August
2006?
Response. The Haas decision could potentially affect many veterans
who have claims based on herbicide exposure in which the only evidence
of exposure is the receipt of the Vietnam Service Medal or service on a
vessel off the shore of Vietnam. In order to be prepared for
adjudication of claims that will be influenced by the decision rendered
by the U.S. Court of Appeals for the Federal Circuit, the Department of
Veterans Affairs (VA) released instructions in December of 2006 to all
regional offices on the correct process for tracking and controlling
claims with Haas issues. Although the Department of Defense (DOD) could
not provide us with exact numbers, it estimated that over 800,000
veterans are potentially affected. More 13,000 claims have already been
received. We do not believe that Congress intended to provide
presumptive exposure to military personnel who served far from Vietnam
merely because they were awarded the Vietnam Service Medal (VSM).
If Haas is not reversed, the veterans affected by the decision fall
within the class in the Nehmer v. United States litigation. Under that
litigation VA would be required to attempt to identify previously
denied veterans and readjudicate their claims awarding service
connection for any of the presumptive disabilities authorized by Agent
Orange Act back to the date the disability was first claimed. Among the
presumptive disabilities are several very common conditions, such as
diabetes and prostate cancer. We do not have data on current number of
denied veterans. We are unable to provide the number because no file
exists in DOD or VA of veterans awarded the VSM. As a consequence, VA
would be required to review all Vietnam era veterans with denied
conditions that are presumptive under the Agent Orange Act.
Proposed Legislative Initiatives
Question 3. The Administration has proposed making permanent the
authority for IRS income data matching for VA eligibility
determinations. Congress frequently relies on this provision as a saver
to pay for enhancements to VA benefit programs. Can Congress expect the
Administration to increase its yearly mandatory budget request to pay
for such improvements in entitlement programs?
Response. Currently, the mandatory compensation and pension (C&P)
account is authorized to reimburse VBA, the Veterans Health
Administration (VHA) and Information Technology Service (ITS) for
operating costs associated with performing the Internal Revenue
Service/Social Security Administration (IRS/SSA) data matches. The
income information is used to verify and determine the correct benefit
payment, eligibility for health care services, co-payment status and
enrollment priority assignment. Income verification helps to ensure the
integrity of both VBA's benefit programs, and VHA's health care
programs. While the operating costs of maintaining these matches total
nearly $27 million in fiscal year 2009 the anticipated savings
generated is estimated at $35 million in fiscal year 2009. The net
savings over 10 years should reach $270 million. The ability to ensure
that veterans and survivors are receiving the appropriate level of
benefits and health care services amounts to good stewardship of
taxpayer dollars, but the savings aren't separately identifiable within
the C&P appropriation. However, if this program is not extended, VA
would have to request more funds from Congress to pay benefits, and
some of these benefits would be erroneously paid due to the loss of
this oversight ability.
Dedicated Staff for Rating Schedule Updates
Question 4. Given the various Commission recommendations on
modernizing the rating schedule, I am concerned that VA does not have
the resources to undertake this monumental task when the appropriate
time arises. How many staff at VA are dedicated solely to updating the
rating schedule?
Response. The regulations staff in the C&P service, consisting of
seven staff members and the services of a contract consultant, is
responsible for maintenance of all regulations in Parts 3, 4 and 13 of
title 38 Code of Federal Regulations (CFR).
A contract was awarded to Economic Systems, Inc. the first week of
February 2008. Two studies are currently underway: Transition Benefits
recommended by the Dole-Shalala Commission, and Quality of Life and
earnings loss payments. Both studies are expected to be completed by
the end of July 2008.
The rating schedule has been undergoing a complete review and
revision since the 1990's through a deliberative process that includes
input from, the Veterans Health Administration, non-VA medical experts,
and veterans service organizations, among others. The general public
also has the opportunity to review and comment on proposed changes to
the schedule. To date, 12 of the 16 body system sections in the
schedule have been revised, and a 13th is nearing publication. The
remaining three body systems are in various stages of development.
Major changes that have been made include the addition of new
conditions and deletion of obsolete and rarely used conditions,
updating of medical terminology, and most importantly, the development
of more objective criteria, based on current medical knowledge. These
changes will promote consistency in evaluations nationwide. Necessary
revisions of body systems in the rating schedule are being carried out
on an ongoing basis.
Adjudication of Global War on Terror Claims
Question 5. VA expects to continue to receive a high volume of
Global War on Terror claims. Given the prioritization of such claims,
would it be helpful to have dedicated FTE toward this initiative or a
Tiger Team of adjudicators for this purpose?
Response. Since the onset of the combat operations in Afghanistan
and Iraq, VA has provided expedited and case-managed services for all
seriously injured Global War on Terror (GWOT) veterans and their
families. This individualized service begins at the military medical
facilities where the injured servicemembers return for treatment, and
continues as these servicemembers are medically separated and enter the
VA medical care and benefit systems. Each regional office (RO) is
required to have an Operation Enduring Freedom/Operation Iraqi Freedom
(OEF/OIF) coordinator to case manage all claims from seriously injured
veterans received in their jurisdiction. The coordinator facilitates
the veteran's claim through the entire process and is responsible for
keeping the veteran and his/her family informed as to the status of
their claim.
In February 2007, VBA began to prioritize the processing of all
GWOT veterans' disability claims. This initiative covered all active
duty, National Guard, or Reserve veterans who were deployed in the OEF/
OIF theatres or in support of those combat operations. Each RO has
dedicated personnel processing GWOT claims on a priority basis. We also
established two development centers in Phoenix and Roanoke to support
OEF/OIF claims processing, and we are in the process of expanding these
centers and adding two more development centers in Lincoln and Togus.
Status of VA/DOD Disability Evaluation Pilot
Question 6(a). In November 2007, VA and DOD began a pilot
disability evaluating system for servicemembers at the major medical
facilities in the Washington, DC, area. To date, how many
servicemembers have participated in this pilot program?
Response. As of February 22, 2008, a total of 181 soldiers,
sailors, airmen, and marines have been designated by the Department of
Defense (DOD) for inclusion in the pilot; and 158 servicemembers have
participated in the pilot program.
Question 6(b). How many examinations have occurred at the
Washington, DC, VA Medical Center?
Response. As of February 22, 2008, 553 specific examinations had
been conducted, an average of about 4 examinations per servicemember in
pilot.
Question 6(c). How long does it take for a servicemember to receive
a decision on a claim?
Response. The strategic target for the pilot is to reduce the
average time it takes for a servicemember separated or retired through
the disability evaluation system (DES) pilot and to receive their first
benefit check from VA on the first day of payment eligibility. The
pilot began on November 26, 2007. None of the participants have
completed the full physical evaluation board (PEB) process and been
separated from service. As of February 17, 2008, one servicemember had
been found medically unfit to return to duty by the service PEB and
referred to VA for rating. That rating, completed in less than 5 days,
was accepted by the member, and he is currently pending separation. The
time from referral to the medical evaluation board (MEB) to the
member's acceptance of the decision was less than 50 days.
Question 6(d). If this pilot program were expanded to cover all
servicemembers who receive a disability decision through the MEB/PEB
process, how would VBA's ability to meet current requirements be
effected?
Response. Expansion to cover all servicemembers being processed
through the MEB/PEB process would impact both VHA and VBA.
At both the MEB and PEB stages of the process, some individuals are
found medically fit for retention. VA is conducting the examinations in
this DES pilot prior to the MEB and PEB fitness determination. Members
who are found fit will have undergone VA examinations that would not
have occurred but for the pilot. Additionally, full implementation of
the pilot would most logically involve VA in the re-examination of
retirees on the temporary disability retired list. In many
circumstances, these too would be additional examinations normally not
done.
From a benefits perspective, additional military services
coordinators would be needed to counsel individual servicemembers, take
claims, schedule examinations, coordinate with PEB liaison officers,
and perform other activities that are part of the DES process.
VBA is currently assessing the resources required to meet our
current and future needs, should the pilot become the standard business
practice in the DES. We believe firmly that a single separation exam is
an important component in a single rating determination. At this point
in the DES pilot, we have too few data to determine if this process
will become a successful standard for all separating servicemembers.
Work remains to be done on the process, scalability and model to ensure
a successful system-wide deployment.
Cuts to the Office of the Inspector General
Question 7. The President's budget recommends a significant cut to
the Office of the Inspector General. This comes at a time when the IG
has just finished its review of the failings in the quality management
of the Marion VAMC surgical program, in addition to other audits.
Please explain why the Administration is seeking this cut, and which
specific investigations or staff would be eliminated.
Response. While the budget proposed for the Office of Inspector
General (OIG) supports fewer positions, the resource level is
sufficient to meet its mandated obligations and to respond to the most
urgent issues raised by Congress and the VA. OIG will continue to
assess and prioritize its workload to maximize productivity and ensure
the greatest impact possible. This budget will allow OIG to continue to
address the challenges and growing demand for VA services.
Numbers of OEF/OIF Veterans
Question 8(a). VA has repeatedly underestimated the growth in
workload from OEF/OIF veterans. The current budget submission projects
that by the end of 2009, VA will have provided health care to 333,275
OEF/OIF veterans, and estimates that in 2007 and 2008, VA will have
served 205,600 and 293,300, respectively. Yet, the most recent VA
Health Care Utilization report states that as of the 4th Quarter of
2007, VA had served a total of 299,585 OEF/OIF veterans in 2007 and
229,015 by the 1st quarter of 2007, indicating that VA served at least
70,570 new OEF/OIF veterans in 2007. Does VA stand by the prediction
that between the end of 2007 and the end of 2009, VA will serve only
33,000 new OEF/OIF veterans?
Response. Yes, based on our experience in fiscal year 2007 and
fiscal year 2008 the 14 percent increase (39,930) appears realistic.
The fiscal year 2007 actual OEF/OIF unique patients were 205,628. The
299,585 figure referenced is a cumulative total since the beginning of
the OEF/OIF. VA estimates it will treat 293,345 and 333,275 OEF/OIF
unique patients in 2008 and 2009, respectively.
Question 8(b). Further, please explain significant underestimation
of the total number of veterans served in 2007, and explain the changes
made in the estimating process as a result.
Response. VA has updated the model each year using the most current
baseline data available and has made several enhancements to the model
methodology. Significant improvements over the past 3 years include
enhanced methodology for projecting OEF/OIF veteran enrollment and
health care use, enhanced veteran enrollment projections, and inclusion
of a more detailed analysis of enrollee reliance on VA health care
versus other providers. VA has also added several new data sources
including the Social Security Death Index, which improved the
projections by providing a more accurate count of enrolled veterans. In
addition, the 2000 Census Long Form has provided more detailed
information on the income of non-service-connected veterans, and has
enabled us to more accurately assign veterans into the income-based
enrollment priorities.
The fiscal year 2007 budget estimate (excluding the effects of
proposed enrollment fees and pharmacy co-payment increases) was
5,498,290 unique patients. The fiscal year 2007 actual was 5,478,929
unique patients, a difference of 0.4 percent or 19,361 unique patients.
The fiscal year 2008 projection is 5,681,420 unique patients of which
4,219,270 had been seen by December 2007.
Construction
Question 9. The President's budget request would cut both major and
minor construction by nearly fifty percent. Minor construction would be
reduced as well. Some estimates of the current Non-Recurring
Maintenance backlog indicate it could be as high $1.5 billion, yet only
$800 million is designated for these projects. Please describe VA's
plan to address the widespread facility problems, and explain how the
funds requested in this budget would address the looming backlog of
projects in all areas of construction.
Response. VHA prioritizes major and minor projects at a national
level using set criteria; therefore, the highest priority projects,
which best reflect the goals and mission contained in VA's strategic
plan and VHA's goals, are included within the budget. The remaining
unfunded major and minor project needs will have to compete in the next
submission cycle. Critical needs that were not supported within this
budget will be addressed through other capital asset investment
options, such as leases or nonrecurring maintenance (NRM).
NRM requests follow a similar prioritizing process; however, the
program and funding is decentralized. The veterans integrated service
networks (VISN) use criteria to prioritize and fund the highest needs
within its respective VISNs. The remaining backlog of NRM needs will be
addressed on an as needed basis. If critical issues arise, VISNs can
supplement the NRM allocation with medical facilities funds.
Priority 8 Veterans
Question 10. The Committee continues to work to resolve the issues
surrounding health care eligibility for priority 8 veterans. In this
process, it is essential to determine the effect on VA of admitting
this group of veterans. Unfortunately, VA has not been able to provide
a reliable prediction of the number of middle-income veterans who would
enter the system if they were made eligible. What is the latest
estimate for the number of such veterans who have been denied access?
Response. Since the suspension of enrollment in Priority 8 in
January 2003 through the end of fiscal year 2007, a total of 386,767
Priority Group 8 veterans have applied for enrollment and were
determined to be ineligible to enroll. This figure does not include
enrollees who were initially denied enrollment and subsequently
enrolled in an eligible priority group based on a change in the
veteran's status.
Research
Question 11(a). The budget request would once again cut research
funding. Among the research projects that would be cut are: 39 from
acute and traumatic injury, 42 from mental health, 26 from substance
abuse, and 36 from diabetes and major complications, to name but a few.
Yet in his testimony before the Committee on February 13, 2007,
Secretary Peake said that mental health and the needs of servicemembers
recently returned from Iraq and Afghanistan are major priorities. In
light of the major advances achieved by VA researchers, and the
enormity of the challenges ahead, how does VA justify a cut in research
funding and the elimination of so many projects?
Response. VA remains committed to increasing the impact of its
research program. We have carefully prioritized our research projects
to ensure they address the needs of OEF/OIF veterans as well as other
veteran populations. In fact, the fiscal year 2009 budget request
includes $252 million for research directed at the full range of health
issues of OEF/OIF veterans, including Traumatic Brain Injury (TBI) and
other neurotrauma, Post Traumatic Stress Disorder (PTSD) and other
post-deployment mental health, prosthetics and amputation health care,
polytrauma, and other health issues. Additional research funding
priorities covered by the fiscal year 2009 budget request include aging
and geriatrics, chronic diseases and health promotion, personalized
medicine, women's health, and long-term care. VA researchers also
compete for and receive funding from other Federal and non-Federal
research sponsors that provide additional resources for VA's research
program.
Question 11(b). The Institute of Medicine recently published a
report addressing the status of research on PTSD treatments. One clear
recommendation was that more research be conducted to determine the
most effective treatments, and that such research ought to be centrally
coordinated and directed. What plans does VA have to coordinate and
advance research on PTSD?
Response. VA has an ongoing, well-established collaboration with
other Federal funding organizations to coordinate and advance PTSD
treatment research. The Institute of Medicine (IOM) report details
important research recommendations that will guide future PTSD
interventional studies in meeting the highest accepted standards for
randomized controlled trials. VA convened a scientific working group in
February 2008 that included National Institute of Mental Health (NIMH)
and DOD representatives to consider the IOM report as well as to
provide guidance for scientists developing PTSD treatment studies.
Other ongoing activities include VA's collaboration with DOD on
reviewing PTSD and TBI research proposals for funding, issuing joint
research solicitations with NIMH, and managing the PTSD research
portfolio to preclude overlap, all of which will lead to even more
treatment advances for PTSD.
VA continues to lead in supporting treatment research related to
the mental and physical health consequences of military service,
including PTSD. VA is particularly proud of the scientists who
contributed to establishing the evidence base supporting the
effectiveness of a psychotherapeutic approach and prolonged-exposure
therapy, highlighted as an example of the highest level of evidence in
the IOM report (October 2007) now being implemented in clinical care.
A few examples of important PTSD research currently being conducted
by VA include: a large trial to determine how well the drug risperidone
works in patients with chronic PTSD when other drug therapy has failed;
a multi-site trial of the drug prazosin that has been found to be
particularly effective in reducing sleep-related problems in PTSD
patients; a longitudinal study of Vietnam veterans to determine the
long-term health consequences related to PTSD; and an innovative study
following veterans from Iraq to determine emotional and psychological
changes related to their deployment.
Question 11(c). Tinnitus is now the number 1 service-connected
disability for servicemembers returning from Iraq and Afghanistan, yet
VA dedicates very little research to this condition. How does VA plan
to address tinnitus, and the linkages between this condition and other
serious medical conditions?
Response. VA supports a broad sensory loss research portfolio,
including several projects addressing tinnitus. VA scientists have
developed a research-based model of tinnitus clinical management that
is designed for efficient implementation in VA audiology clinics. The
researchers plan to implement this program at one VA audiology clinic
and then evaluate its effectiveness and acceptability to patients and
audiologists. If shown to be effective, the program could establish the
standard for tinnitus management at all VA medical centers and clinics.
VA researchers are also developing a diagnostic test to identify
tinnitus, which is currently done by self-report.
In collaboration with DOD, VA investigators are conducting a study
to determine which auditory processing disorders are more often
associated with exposure to high-explosive blasts, whether there is
spontaneous recovery of auditory function after blast exposure, how
much recovery may be expected, and how rapidly it occurs.
In addition, VA researchers are developing new methods capitalizing
on the ability of the ear to produce low level sounds in response to
tones delivered to the ear for the early detection of changes in the
cochlea before permanent noise-induced hearing loss has occurred. Early
detection can allow for the implementation of precautionary procedures
to protect military personnel.
In the clinical setting, VA tinnitus treatment involves a
progressive approach ranging from patient education to more
comprehensive services involving amplification, biofeedback-relaxation
techniques, cognitive-behavioral therapy, drug therapy, sound therapy
(maskers and masking devices), and combined techniques. Because
tinnitus has many causes, many of which are outside the audiology scope
of practice, the approach to tinnitus is multi-disciplinary. Some of
these services are done by audiologists and some are referred to
appropriate professionals. VA has also produced a veteran health
initiative on hearing impairment that devotes a chapter to tinnitus.
Vocational Rehabilitation and Employment
Question 12. Budget documents state that VR&E has implemented over
80 of the 2004 Task Force report and that you ``plan to continue to
implement the remaining recommendations based on receiving the
requested levels of funding and FTE.'' Please explain in detail how
your requested fiscal year 2009 level of 1,073 FTE--which provides no
increase over the fiscal year 2008 level--will allow you to continue to
implement these recommendations.
Response. Fiscal year 2009 will see a continued focus on
implementing and refining the remaining 2004 task force
recommendations. Our initiatives include targeted training for the
field on changes to policy and procedures resulting from task force
recommendations and a study of long-term outcomes geared toward
increasing our rehabilitation rate. The budget level of 1,073 full time
employees (FTE) represents a 6 percent increase since release of the
task force report and will enable us to achieve our program goals of
high-quality, consistent, and outcome-oriented services to veterans.
Question 13. In your budget documents, you note that VA's VR&E
program ``will continue to grow in the area of increasing partnerships
with other agencies and organizations.'' Please provide the Committee
with the amount of funds earmarked for these partnerships in fiscal
year 2008 and proposed for fiscal year 2009.
Response. Vocational rehabilitation and employment (VR&E) continues
to work to extend our partnerships with the community in order to
enhance services for veterans and develop employment opportunities for
veterans. This outreach, funded at over $4.5 million in fiscal year
2008 and $5 million in fiscal year 2009, includes: disabled transition
assistance program (DTAP) presentations and materials, coordination
with community and military organizations via career fairs; together
with DOD, support of early intervention through the Coming Home to Work
program; a joint demonstration project with the Department of Labor
VETS program to improve employment services to veterans; and aggressive
outreach to the employment community.
Education
Question 14. VA has requested a funding level of only $13 million
for reimbursement to State Approving Agencies for fiscal year 2009.
This would constitute over a 30 percent reduction in funds available
for this purpose. Please explain the impact of this reduction on VA's
workload, and on the accuracy and timeliness of approval of education
programs.
Response. VA did not submit a legislative proposal to restore
funding in the fiscal year 2009 budget submission because bills were
already before Congress that would restore or increase funding.
S. 1215 would continue State Approving Agency (SAA) funding at $19
million for years after fiscal year 2007. At a hearing before the
Senate Veterans' Affairs Committee on May 9, 2007, VA testified in
support of S. 1215. VA stated that the statutory requirement to reduce
SAA funding to $13 million would cause SAAs to reduce staffing,
severely curtail outreach activities, and perform fewer supervisory and
approval visits. VA further stated that reduced funding might cause
some SAAs to decline to enter into contracts with VA and that VA would
have to assume the additional duties.
H.R. 2579 would make only $13 million available from the
Readjustment Benefits (RB) account for SAA expenses and permit VA to
use General Operating Expenses (GOE) appropriations for the additional
funds. At a hearing before the House Committee on Veterans' Affairs,
Subcommittee on Economic Opportunity, on June 21, 2007, VA testified
against H.R. 2579 because VA maintains that funding for SAA activities
should be an authorized expenditure from the RB account rather than a
discretionary expense from the GOE account to guarantee that funding is
available for these contracts.
Information Technology
Question 15. The budget request calls for improved collaboration
with the Department of Defense to efficiently and effectively transfer
records between the two agencies, to share critical medical
information, and to process disability claims quickly. The 2009 budget
request does not provide details on how these outcomes will be achieved
or resourced. Specifically, how does the fiscal year 2009 budget
request support IT initiatives to improve VA/DOD collaboration?
Response. The fiscal year 2009 budget request currently identifies
over $65 million to support improved VA/DOD collaboration.
The largest portion of the request, $50.2 million is in direct
support of the wounded, ill and injured, and supports the following:
Automated workflow processes, an expanded document
management capability and the exchange of clinical data from the
combined exam process.
The TBI/psychological health center of excellence
requirement to exchange information collected in the cognitive
assessment tool.
Non-clinical case management by the creation and
integration of a case management system and the development of the My
e-Benefits portal.
More timely exchange of current admissions, discharge and
transfer data to support accurate compensation determination.
Development of an embedded fragment registry.
Indirect support for interagency collaboration is also provided by
various electronic data sharing initiatives. The fiscal year 2009
budget request includes $10.5 million to support the following
projects:
Expansion of the VA/DOD identity repository (VADIR) and
the implementation of the VA Identity and Access Management Strategy.
VADIR is the enterprise database that contains the common population of
active servicemembers, veterans and beneficiaries served by VA and DOD.
Clinical health data repository (CHDR), allowing
computable exchange of lab data with DOD.
Federal health information exchange (FHIE), to provide
clinically relevant data feeds, from DOD's electronic health records
(EHR) to the FHIE repository, for active duty, retired and separated
servicemembers. FHIE is DOD and VA's current interagency method of
storing electronic health records, when servicemembers are separated
from active duty.
The fiscal year 2009 budget request also includes $5 million to
support the North Chicago Federal Health Care Facility initiative.
Funds will be used to address Navy health care provider and
administrative functions such as patient registration and billing,
software designs to enable functions that include single sign-on and
exchange of orders, and project management services.
NCA
Question 16. The 2009 budget request includes $5 million for land
acquisition for future National Cemeteries. How many projects does VA
believe these funds will support, and over what period of time will
this money be spent?
Response. It is difficult to estimate how many land purchases the
$5 million will support or over what period of time the money will be
spent. Recent land acquisition costs associated with major cemetery
construction projects have ranged from $4 million to $12 million. Much
will depend on the location, the existing market conditions, and the
number of acres involved. The money will be spent when an acceptable
parcel becomes available for purchase.
Benefits Delivery at Discharge
Question 17. How does the President's budget request support BDD,
especially for members of the Guard and Reserve?
Response. The President's budget will support expansion and
enhancement of services we provide to separating servicemembers,
including benefits delivery at discharge (BDD) and services to members
of the Guard and Reserves. We operate 153 BDD sites, and we are working
with DOD to pilot a new DES for servicemembers undergoing the MEB/PEB
process. DOD will use this program to determine fitness for continued
military service, and VA will use the program to determine service-
connected disabilities and their severity for purposes of expediting
disability compensation benefits.
The fiscal year 2009 budget request supports expansion of our
outreach to returning National Guard and Reserve soldiers and their
families. When units of National Guard or Reserves soldiers are
returning home, VA provides briefings and assists with filing claims. A
memorandum of agreement was signed in 2005 between VA and the National
Guard Bureau to institutionalize our partnership and support better
communication. We are encouraging State National Guard coalitions to
improve local communication and coordination of benefits briefings to
assure that National Guard and Reserve soldiers are fully aware of
benefits. In 33 States, memoranda of understanding have been signed
between VA, the State National Guard offices, and the State department
of veterans affairs to promote the relationship and cooperation in
providing services and benefits to their members. VA has a memorandum
of agreement with the Army Reserve in the concurrence process that will
formalize this relationship, as we did with the National Guard. We are
also working on agreements with the other Reserve components to
formalize those relationships.
______
Response to Written Questions Submitted by Hon. Richard Burr to
LTG James B. Peake, Secretary, Department of Veterans Affairs
Medical Care
Question 1(a). The nearly 2.8 million veterans in receipt of
disability compensation have a wide range of conditions. I would
imagine that the Department of Veterans Affairs (VA) offers treatment
or physical therapy for a good number of those conditions which could,
at best, make a veteran less disabled or, at worst, halt or slow the
progression of a disability. Is that a fair characterization?
Response. Yes, VA offers treatment of physical therapy for a good
number of conditions. Patients who do not have chronic, degenerative,
or non-reversible disabling conditions are most likely to benefit from
those treatments. In fiscal year 2007, VA provided outpatient physical
therapy services to nearly 304,000 unique veterans, occupational
therapy to more than 104,000 unique veterans, and kinesio therapy to
more than 58,000 unique veterans.
Question 1(b). How many of the 2.8 million service-disabled
veterans seek treatment from VA for their service-connected conditions?
Response. In fiscal year 2007, VA treated 1,373,129 veterans for
their service-connected condition in outpatient clinics and 60,474 as
inpatients. But, because of the overlap (with some patients receiving
treatment both inpatient and outpatient), the net is 1,378,742 veterans
treated overall.
Question 1(c). For those who do seek treatment, do you see an
improvement in their disability status?
Response. Yes, for example, as patients improve their functioning
in the mental health care and polytrauma/TBI, symptoms associated with
disability can often decrease, even if the disability status remains
unchanged.
Question 1(d). Does VA track the relationship between the treatment
it provides and improved disability status?
Response. VA does not systematically track physical disability
status as part of the clinical process of delivering mental health care
and polytrauma/TBI care. Disability rating is a separate process
performed by VBA.
Question 1(e). For those veterans who do not seek treatment from
VA, what incentives do you have to get them to do so?
Response. The best incentive for veterans to seek treatment is the
high-quality care provided at our facilities and our world-class
electronic health record system. To let veterans know about these
opportunities, and given the importance of outreach to servicemembers
and veterans of Operation Enduring Freedom/Operation Iraqi Freedom
(OEF/OIF), VA promotes and conducts activities at both national and
local levels. Our outreach begins with a letter from the Secretary of
Veterans Affairs to each newly separated OEF/OIF veteran. The letter
thanks veterans for their service, welcomes them home, and provides
basic information about health care and other benefits provided by VA.
To date, VA has mailed over 766,000 initial letters and 150,000 follow-
up letters to veterans. VA also partners with Federal agencies,
Veterans Service Organization (VSOs), and State, county, and local
agencies and governments to contact veterans, and we offer outreach to
active duty personnel at military demobilization sites. Special
outreach to Guard and Reserve soldiers is an integral part of VA's
outreach efforts; we provide briefings on benefits and health care
services at town hall meetings, family readiness groups, and during
unit drills near the homes of returning Guard and Reserve soldiers. Our
Vet Centers provide outreach and a full range of readjustment
counseling services to combat veterans in a comfortable, nonclinical
environment for veterans.
Veterans choose their health care providers based on a number of
factors such as: quality of care, economics, demographics, and the
ability of the health care provider to respond to their unique health
care needs. VA's proven track record for providing high-quality health
care is equal to or higher than private-sector health care providers.
VA health care is also cost effective for eligible veterans. Moreover,
VA understands veterans' issues and the health consequences resulting
from their military experience whether combat related or not.
VHA's most powerful incentive is the scope and quality of its
services. As a nationally integrated health care system, VHA provides
veterans with a high-quality and low-cost health care. Through a
network of 153 hospitals and medical centers, over 731 CBOCs, 209 Vet
Centers, and 135 nursing home facilities, VA offers to eligible
veterans a full continuum of health care--from health promotion,
disease prevention, diagnostic, therapeutic, and rehabilitative to
recovery and palliative care.
Question 2(a). The Government Accountability Office (GAO)
criticized VA in prior years for relying on unspecified ``management
efficiencies'' to reduce its need for appropriated dollars. GAO rightly
opined that, if VA couldn't measure how exactly it saved money by
becoming more efficient, then it shouldn't count those savings in the
budget. That does not mean, however, that VA should stop looking to
become more efficient altogether. Please describe VA's efforts to
contain costs by improving operations and service delivery?
Response. Performance measures are used to evaluate the performance
of all facilities in the field to determine if network and facility
directors are providing the oversight to ensure our veterans are
receiving appropriate care in a cost effective manner.
For example, efficient formulary management is an area of cost
avoidance that is measured. This is accomplished through the use of
preferred drug regimens developed at the national and/or network level.
The overall cost avoidance is based on the aggregation of potential
cost savings in 15 drug regimens on the pharmacy benefits management
grid. The potential cost saving is based upon closing 75 percent or
more of the gap between current costs and the average costs of the five
networks with the lowest unit costs.
Advanced clinical access (ACA) is a patient-centered,
scientifically-based set of redesign principles and tools that enable
staff to examine their health care delivery processes and redesign
them. The ACA principles are extraordinarily powerful and result not
only in improved access, but also in improved patient, staff and
provider satisfaction, improved quality, improved efficiency, and
decreased cost. The implementation of ACA assists health care delivery
providers eliminate delays within its systems by implementing key
principles such as measuring supply and demand, reducing backlogs,
decreasing appointment types, developing contingency plans, predicting
and anticipating patient care needs and improving efficiency through
actions such as optimizing rooms and equipment.
The Office of Productivity, Efficiency and Staffing provides
effective management tools for the systematic, longitudinal measurement
and reporting of productivity, efficiency and staffing in VHA. It
produces recommendations for standards and guidance to enhance the
provision of safe, efficient, effective and compassionate care. The
office conducts studies and produce data on ``best practices'' to
optimize clinical productivity, efficiency and staffing, promoting the
goals of clinical excellence and accessible health care. The scope of
this office includes the creation and publication of longitudinal
databases, directives, guidelines, best practices, benchmarks.
The foundation of VHA's integrated delivery system is a primary
care model and, as such, was the first priority for the development of
a staffing model. The primary care panel size staffing model is fully
operational in VHA. A panel size defines the number of active patients
assigned to each primary care provider. The staffing model permits VHA
to measure the overall productivity of primary care providers, system
capacity and staffing. The staffing guidance establishes that for every
1200 active primary care patients (adjusted for patient risk, support
staff and exam room capacity), a 1.0 primary care direct patient care
provider is recommended. This places VHA in the unique position of
having the ability to study and understand the relationship of panel
size (productivity) versus outcomes (quality and satisfaction), access,
and efficiency (cost).
VHA staffing models will be consistent with the President's
Executive Order to ensure health care programs administered by the
Federal Government promote quality and efficient health care delivery.
The Executive Order further calls for Government programs to explore
similar initiatives in the private and non-Federal sector with the
purpose of improving the quality and efficiency of health care. To this
end, VHA will continue to use a relative value unit (RVU) model to
measure productivity of specialty providers. RVU is an industry
accepted metric used in Medicare and the private sector that considers
the time and intensity of the service delivered by the specialty
physician. The use of an RVU model permits the assessment of
productivity and efficiency (cost/RVU) within VHA and comparison to
external benchmarks.
Other examples are: (a) decrease the cost per unit in fee care for
radiation therapy; (b) decrease the cost per unit in fee care for non-
health care common procedure coding system in home services and
supplies; (c) decrease unintended variation in length of stay in non-VA
contract hospitalization for pacemaker care and (d) decrease unintended
variation in level of service in non-VA contract hospitalization for
cardiology care.
Question 2(b). How does VA measure whether it is, in fact, becoming
more efficient and, yet, maintain its quality?
Response. The actuarial model reflects the impact of VA health care
clinical practices that are expected to result in more efficient use,
thereby moderating the increase for 2009 expenditures.
Clinical cost avoidance: Cost is decreased through
initiatives like ACA, management of inpatient care, and high degree of
management for pharmaceuticals.
Pharmacy cost avoidance: This item recognizes that VA's
intensity trend growth (cost trend) will be slower relative to the
private sector as a whole because of its formulary and robust pharmacy
benefit management.
Question 3(a). VA's medical care budget has been criticized by some
as not providing sufficient resources to account for medical inflation.
Response. The President's 2009 request includes total budgetary
resources of $41.2 billion for VA medical care, an increase of $2.3
billion or 5.9 percent over the 2008 level and more than twice the
funding available at the beginning of the Bush administration. Our
total medical request fully accounts for inflation and is comprised of
funding for medical services ($34.08 billion), medical facilities
($4.66 billion), and resources from medical care collections ($2.47
billion).
Question 3(b). Please provide the assumptions that you used to
build your request for medical services and medical facilities.
Response. Our 2009 request for $41.2 billion in support of our
medical care program was largely determined by three key cost drivers
in the actuarial model we use to project veteran enrollment in VA's
health care system as well as the use of health care services of those
enrolled:
inflation;
trends in the overall health care industry; and
trends in VA health care.
The impact of inflation will increase our resource requirements for
acute inpatient and outpatient care by more than $1.4 billion.
There are several trends in the U.S. health care industry that
continue to increase VA's cost of doing business regardless of any
changes in enrollment, number of patients treated, or program
initiatives. The two most significant trends are the rising use and
intensity of health care services. In general, patients are using
medical care services more frequently and the intensity of the services
they receive continues to grow. For example, sophisticated diagnostic
tests, such as magnetic resonance imaging (MRI), positron emission
tomography (PET), and computed tomography (CT), are now more frequently
used either in place of, or in addition to, less costly diagnostic
tools such as x-rays. As another illustration, advances in cancer
screening technologies have led to earlier diagnosis and prolonged
treatment which may include increased use of costly pharmaceuticals to
combat this disease. These types of medical services have resulted in
improved patient outcomes and higher quality health care.
The cost of providing timely, high-quality health care to our
Nation's veterans is also growing as a result of several factors that
are unique to VA's health care system. We expect to see changes in the
demographic characteristics of our patient population. Our patients as
a group will be older, will seek care for more complex medical
conditions, and will be more heavily concentrated in the higher cost
priority groups. Furthermore, veterans are submitting disability
compensation claims for an increasing number of medical conditions,
which are also increasing in complexity.
Question 3(c). What inflationary factors are included in your
assumptions? What inflation rates did you apply to those factors?
Response. Inflation factors such as medical inflation and special
cost trends such as pharmacy, which reflects the increase or decrease
in a constant set of services due to labor and supply costs, were
included in the assumptions.
Question 3(d). How were the inflation rates determined?
Response. Assumptions about future inflation trends are developed
by a workgroup of VA staff and experts on health care trends in the
U.S. The workgroup reviews VA historical inflation trends and
historical and estimated Medical Consumer Price Index (CPI) trends in
developing the assumptions. Separate inflation trends are developed and
applied to inpatient services, ambulatory services, pharmacy, and
prosthetics. This allows the model to be sensitive to the different
inflationary pressures within the various services. The inflation
factors are then used in the model to trend forward the unit costs from
the most recently completed fiscal year to develop unit costs for
future years. The composite impact of the multiple inflation trends in
the expenditure projections supporting the 2009 VA health care budget
was 4.63 percent.
Question 3(e). Are there significant one-time expenditures, such as
equipment purchases, obligated in fiscal year 2008 that explain why
obligations for medical services are expected to grow at a rate that is
less than expected Consumer Price Index inflation?
Response. Yes, the equipment decrease of $1.131 billion is the
result of one-time purchases of state-of-the-art equipment in fiscal
year 2008 and investments in non-recurring maintenance of $0.3 billion.
Question 3(f). What other factors help to explain the low
percentage increase in expected obligations from fiscal year 2008 to
2009?
Response. As stated in the response to Question 3(e), the equipment
decrease of $1.131 billion is the result of one-time purchases of
state-of-the-art equipment in fiscal year 2008 and investments in non-
recurring maintenance of $0.3 billion.
Question 4(a). VA's medical care budget has also been criticized
for possibly underestimating demand for VA care, i.e., many believe
you'll see more Global War on Terror veterans than you've projected.
How did you arrive at the number of total veterans you estimated would
seek treatment in fiscal year 2009 for each priority group? How many
total episodes of care (inpatient, outpatient, Vet Center visits, etc.)
did you project for fiscal year 2009 relative to fiscal year 2008?
Response. VA uses an actuarial model to forecast patient demand and
associated resources needs. Actuarial modeling is the most rational way
to project the resource needs of a health care system like the VHA. The
annual patient projections generated by the VA enrollee health care
projection model are a function of the projected enrolled population
and the mix and intensity of workload for those enrollees as projected
by the model. The patient projections are then adjusted to account for
those enrollees who seek only non-modeled services such as Vet Centers.
While historical relationships are used to develop the patient
projection model, it is recognized that there may be variation between
projected and actual annual patient counts. These variations derive
from differences between priority groups in the percent of respective
enrollees who use VHA services. In addition to the projections made by
actuarial model, VA tracks actuals against projections on a monthly
basis for the prior year and adjustments are made to the budget
accordingly.
The estimates in the 2009 President's submission represent the best
possible estimates based on the information available at that time.
Workload estimates are shown in the chart below:
Summary of Workloads for VA and Non-VA Facilities
------------------------------------------------------------------------
2008
Description Current 2009 Increase/
Estimate Estimate Decrease
------------------------------------------------------------------------
Outpatient Visits (000):
Staff............................. 57,139 62,024 4,885
Fee............................... 6,604 7,211 607
Readjustment Counseling........... 1,113 1,222 109
-----------------------------------
Total......................... 64,856 70,457 5,601
===================================
Patients Treated:
Acute Hospital Care............... 567,503 573,326 5,823
Rehabilitative Care............... 13,933 13,748 (185)
Psychiatric Care.................. 119,948 130,548 10,600
Nursing Home Care................. 92,144 93,002 858
Subacute Care..................... 7,318 6,294 (1,024)
Residential Care.................. 26,962 26,520 (442)
-----------------------------------
Inpatient Facilities, Total... 827,808 843,438 15,630
===================================
Average Daily Census:
Acute Hospital Care............... 8,356 8,219 (137)
Rehabilitative Care............... 1,097 1,073 (24)
Psychiatric Care.................. 5,343 5,899 556
Nursing Home Care................. 34,633 34,970 337
Subacute Care..................... 195 145 (50)
Residential Care.................. 8,157 8,072 (85)
-----------------------------------
Inpatient Facilities, Total... 57,781 58,378 597
Home and Community-Based Care..... 44,192 61,029 16,837
-----------------------------------
Inpatient and Home and 101,973 119,407 17,434
Community-Based Care, Grand
Total........................
===================================
Length of Stay:
Acute Hospital Care............... 5.4 5.2 (0.2)
Rehabilitative Care............... 28.8 28.5 (0.3)
Psychiatric Care.................. 16.3 16.5 0.2
Nursing Home Care................. 137.6 137.2 (0.4)
Subacute Care..................... 9.8 8.4 (1.4)
Residential Care.................. 110.7 111.1 0.4
Dental Procedures................... 3,475,395 3,620,884 145,489
------------------------------------------------------------------------
Question 4(b). How did you arrive at the number of Operation
Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans you
estimated would seek treatment? How many episodes of care did you
assume for these veterans?
Response. VA uses an actuarial model to forecast patient demand and
associated resources needs. Actuarial modeling is the most rational way
to project the resource needs of a health care system like VHA. The
estimates in the 2009 President's submission represent the best
possible estimates based on the information available at that time. VA
estimates it will treat 293,345 and 333,275 OEF/OIF unique patients in
2008 and 2009, respectively. In addition to the projections made by
actuarial model, VA tracks actuals against projections on a monthly
basis for the prior year and adjustments are made to the budget
accordingly.
The annual OEF/OIF patient projections generated by the VA enrollee
health care projection model are a function of the projected enrolled
population and the mix and intensity of workload for those enrollees as
projected by the model. While historical relationships are used to
develop the patient projection model, it is recognized that there may
be variation between projected and actual annual patient counts. These
variations derive from differences between priority groups in the
percent of respective enrollees who use VHA services. The number of
OEF/OIF veterans projected to seek services was adjusted from the model
results to account for veterans who only use non-modeled services and
non-enrolled veterans. Using the base year 2006 enrollee health care
projection model, VA projects following use of modeled services for
OEF/OIF enrolled veterans:
------------------------------------------------------------------------
Service Category 2008 2009
------------------------------------------------------------------------
Inpatient bed days of care...................... 53,646 65,506
Special program services bed days of care....... 135,507 188,842
Ambulatory care services........................ 4,090,239 5,078,094
Outpatient mental health services............... 47,884 67,995
Pharmacy/durable medical equipment services..... 2,803,401 3,595,196
Other devices and equipment services............ 153,932 198,672
Dental procedures............................... 314,798 377,898
------------------------------------------------------------------------
Question 4(c). To get a sense of how accurate VA's forecasting of
demand is, how did your projected demand in the fiscal year 2007 budget
match with the actual demand numbers?
Response. The fiscal year 2007 budget estimate excluding the
effects of proposed enrollment fees and pharmacy co-payment increases
was 5,498,290 unique patients. The fiscal year 2007 actual was
5,478,929 unique patients, a difference of 0.4 percent or 19,361 unique
patients.
Question 4(d). How has your projected demand for fiscal year 2008
matched up with actual demand so far this year?
Response. The fiscal year 2008 projection is 5,681,420 unique
patients of which 4.2 million had been seen by December 2007. The
fiscal year 2008 OEF/OIF fiscal year projection is 293,345 of which
126,000 had been seen by December 2007.
Question 5. What is the per-patient cost for veterans in each of
the eight priority groups? What is the per-patient cost of OEF/OIF
veterans?
Response. Cost per patient, fiscal year 2009 estimates by priority
group is shown in the chart below.
------------------------------------------------------------------------
Cost Per
Priority Groups Patient
------------------------------------------------------------------------
1....................................................... $13,943
2....................................................... 6,501
3....................................................... 5,755
4....................................................... 22,477
5....................................................... 7,122
6....................................................... 3,359
1-6..................................................... 8,997
7....................................................... 3,837
8....................................................... 3,946
7-8..................................................... 3,916
OEF/OIF................................................. 3,802
------------------------------------------------------------------------
Question 6. Assuming that veterans received 100 percent of their
care from VA (i.e., there was no reliance on other sources of care),
what is the total cost of providing health care to veterans in each of
the eight priority groups?
Response. Based on an analysis using the VA enrollee health care
projection model, VA projects that an additional $77.9 billion would be
expended in fiscal year 2009 if all enrollees obtained 100 percent of
their care for modeled services from VHA. The current reliance
expenditures in the table below reflect the model settings and
assumptions developed to inform the fiscal year 2009 budget process.
Non-modeled services such as Vet Centers, long-term care, spina bifida
care, and foreign medical programs are excluded.
The 100 percent reliance expenditures reflect the cost estimates
when adjustments under the current reliance scenario are set to 100
percent for all modeled services, including special programs, dental
and pharmacy. For the 100 percent reliance scenario, all other
assumptions outside of reliance reflect the current scenario; the unit
costs for new services are the same as those developed under the
current reliance scenario. This assumes that VA will provide services
in-house to the same extent that services are currently provided.
Capacity constraints would require many of these services to be
purchased in the community at costs that will vary from VA costs. These
projected additional expenditures do not include the costs of capital
infrastructure that would be needed to provide services in-house under
a 100 percent reliance scenario.
----------------------------------------------------------------------------------------------------------------
2009 Expenditure Projections ($ in
millions)
Average ---------------------------------------
Priority Level Enrollment 100 percent
Current Reliance Additional
Reliance Expenditures
----------------------------------------------------------------------------------------------------------------
1........................................................... 955,551 $8,984.4 $19,529 $10,544.5
2........................................................... 575,201 2,215.4 6,396.6 4,181.2
3........................................................... 1,034,069 3,089.5 10,509.2 7,419.7
4........................................................... 242,301 3,417.3 7,937.4 4,520.2
5........................................................... 2,349,789 10,604.7 30,123.0 19,518.3
6........................................................... 265,712 466.4 2,311.8 1,845.4
7a.......................................................... 19,985 38.7 322.4 283.8
7c.......................................................... 560,975 1,039.6 8,745.9 7,706.3
8a.......................................................... 77,648 171.4 1,161.7 990.3
8c.......................................................... 1,621,256 3,308.8 24,232.9 20,924.2
---------------------------------------------------
All......................................................... 7,702,486 $33,336.3 $111,270 $77,933.7
===================================================
----------------------------------------------------------------------------------------------------------------
Question 7. What provisions in the budget advance or contribute to
the Military Sexual Trauma Program?
Response. In fiscal year 2007, The Office of Mental Health Services
(OMHS) funded a military sexual trauma (MST) support team that is
designed to help ensure that VA is in compliance with legally mandated
monitoring of MST screening and treatment. The team also helps to
coordinate and expand legally mandated education and training efforts
related to MST, and to promote best practices in the field.
In fiscal year 2008, OMHS approved funding for additional personnel
in order to enable the expansion of training/education and program
development efforts, particularly with regard to MST among men. For
example, OMHS conducts monthly national training teleconference and
sponsors an annual MST clinical training program. OMHS has focused on
increasing veterans' access to MST related care by redesigning and
disseminating a MST brochure for veterans; making materials available
to clinical staff on-line; training efforts targeted at frontline staff
who are often pivotal in ensuring that veterans get directed to the
people able to help them get access to MST related care; and,
increasing staff awareness of issues specific to men who experience
MST.
In fiscal year 2009, the MST support team will assess the need for
additional residential treatment programs/treatment tracks for MST,
continue to focus on improving access to MST related care, assure that
all MST coordinators receive evidence-based training for trauma and
assure that the residential and in-patient treatment environment
promotes safety, security and privacy. Based on our initial fiscal year
2008 focus on MST among men there will additional needs for improving
access and training in this specific area.
Question 8(a). It is my understanding that VA is expected to update
its physical therapy qualification standards by July 2008. Is this
correct? If not correct, please provide a timeline on when those
standards will be updated?
Response. Yes. Proposed qualification standards for physical
therapy are currently under review for concurrence within VA from all
parties involved (e.g., labor partners, human resources, etc.). We
expect that final qualification standards would be approved for
implementation in 2008.
Question 8(b). Are there qualification standards for other VA
service providers that are in the process of being revised or will soon
begin the process of being revised? If so, please provide the scheduled
updates.
Response. We are currently revising or developing new qualification
standards for the following health care occupations:
------------------------------------------------------------------------
Received
------------------------------------------------------------------------
Blind rehabilitation specialist..... 11/2004 Fall 2008
Nurse anesthetist (CRNA)............ 5/2006 Summer 2008
Occupational therapist.............. 3/2006 Summer 2008
Pharmacist.......................... 1/2004 Fall 2008
Social worker....................... 12/2003 Fall 2008
------------------------------------------------------------------------
Question 9. What are VA's plans with respect to the authority
granted it under section 201 of Public Law 109-461?
Response. In May 2007, VA provided a report to Congress entitled
``Marriage and Family Therapy Workload.'' As a follow-up to that
report, a recently initiated occupational study will assess the current
and future use of therapists and counselors within VA. During this
endeavor, VA has been in contact with key officials at the American
Association for Marriage and Family Therapy, the American Counseling
Association, the American Mental Health Counselors Association, and VA
professionals in the areas of mental health, social work and pastoral
counseling.
We have received a great deal of information from these
organizations. This information, along with a survey of facility
staffing and health care needs that VA will undertake in the next few
months, will allow VA to create an action plan to properly use these
professionals.
Compensation and Pension
Question 1. If the fiscal year 2009 budget request is adopted,
direct full-time employees for the Compensation and Pension Service
will increase by over 2,600 from fiscal year 2007 to fiscal year 2009.
With those staffing levels, VA expects to complete approximately
943,000 claims in fiscal year 2009, which is about 118,000 more claims
than were decided in fiscal year 2007. Although I applaud the increase
in total production, VA will be producing only 45 additional decisions
per year for each additional direct full-time employee hired since
fiscal year 2007. Do you think this is a good return on our investment?
Do you expect to see bigger gains in productivity in later years?
Response. Our aggressive recruitment program to increase the
staffing level in C&P program is absolutely essential to reducing our
pending claims inventory and providing more timely decisions to
veterans. Because it takes 2 years for new employees to complete their
training and become productive in all aspects of claims processing,
this initial investment in both formal and on-the-job training must be
made.
Our recruitment plan calls for us to continue to add new employees
throughout 2008. This timeline allows us to support their training
requirements and complete the necessary infrastructure changes to our
facilities. As a result of our recruitment initiative as well as our
normal rate of employee attrition, we project that more than one third
of our workforce will have less than 2 years of experience at the end
of fiscal year 2008.
We fully expect decision output per employee to continue increase
in subsequent years as these new employees complete their training and
gain experience.
Question 2(a). In the fiscal year 2008 budget proposal, VA
projected productivity of 101 claims per direct full-time employee in
fiscal year 2008. Now, VA is predicting that productivity in fiscal
year 2008 will be only 85.2 claims per direct full-time employee. What
factors account for this 16 percent drop in this productivity goal
since last year?
Response. The significant increase in new hires lowers the overall
average of cases completed per employee, since these are less
experienced workers
Question 2(b). How do you determine the per-full-time-employee
output goal?
Response. It is important to understand that for the purposes of
the C&P budget, we report output per direct FTE for our primary and
most resource-intensive work unit, disability claims requiring a rating
decision. We project to complete over 878,000 disability rating claims
this fiscal year and over 942,000 in fiscal year 2009. However, in
total we will complete over 2.2 million award actions of all types, as
well as nearly 7 million non-claims related correspondence actions,
over 340,000 fiduciary actions, 8,500 military service briefings to
nearly 400,000 servicemembers, nearly 7 million telephone calls, and 1
million personal interviews. Our direct labor employees in C&P support
all of these requirements, as well as appellate processing
requirements, and include managerial, supervisory, and administrative
support personnel in the field and in Headquarters.
In projecting output per FTE for disability rating claims, VBA
takes into account the total number of direct labor FTE in C&P and the
experience level of our employees. Employee experience is categorized
in 6-month increments until the journey level is attained. An average
weight is assigned to the projected contribution at each experience
level. The weights for fiscal year 2008 are as follows:
0-6 months: 40 percent
6-12 months: 60 percent
12-18 months: 70 percent
18-24 months: 80 percent
Question 3. During fiscal year 2008, the Compensation and Pension
Service expects a direct full-time employee level of 10,304 and a
productivity level of 85.2 decisions per direct full-time employee. If
that same level of staffing was maintained in fiscal year 2009 but
productivity improved to 100 claims per direct employee--a level VA has
achieved in the past--VA would be able to handle over 1 million claims.
That's almost 10 percent more claims than VA expects to complete in
fiscal year 2009 with the addition of almost 700 direct full-time
employees. What factors were considered by VA in deciding to seek more
employees rather than simply focusing on increasing productivity of the
existing employees?
Response. VA considered the continuing rate of increase in our
disability claims workload, as well as increases in all other workload
areas including public contact and outreach; pension, burial, and other
ancillary benefit claims; and appellate workload. Additional resources
are also required to support more and better training, an enhanced and
expanded quality assurance program, and an aggressive program of field
oversight, all of which are also essential to improving the quality and
consistency of our decisions. Increasing and maintaining a staffing
level commensurate with our increasing workloads in all areas will be
key to reducing the inventory, improving both the quality and
timeliness of service delivery, and ensuring we are meeting the needs
of veterans and their families.
Question 4. As partial justification for the requested staffing
level for the Compensation and Pension Service, the Administration's
fiscal year 2009 budget request includes the following explanation:
Recent decisions of the Court of Appeals for Veterans Claims
(CAVC) have also had an impact on [VA's] ability to bring
claims inventories into a more acceptable range and make
progress in achieving our timeliness goals * * *. Court
decisions that mandate the specific content of our notices to
claimants and the specific timing of the notice impose both
highly complex and problematic duties in a claims system that
was designed to be informal.
Are there specific CAVC opinions that, if overturned by Congress,
would help improve VA's ability to handle its caseload without
negatively impacting outcomes for veterans? If so, please list the
specific opinions.
Response. We have identified the following decisions of the United
States Court of Appeals for Veterans Claims (Veterans Court) that, if
overturned, would improve our ability to manage our caseload without
negatively impacting outcomes for veterans:
Mayfield v. Nicholson, 19 Vet. App. 103 (2005) (Mayfield I)--
Framework was provided for prejudicial error analysis concerning all
four Veterans Claims Assistance Act (VCAA) notice elements. The Court
held that first element notice error, informing the claimant what is
needed to substantiate his/her claim, is presumptively prejudicial and
the burden automatically shifts to VA in all cases before the Veterans
Court to demonstrate that did not prejudice the appellant. The U.S.
Court of Appeals for the Federal Circuit (Federal Circuit) affirmed
this holding in Sanders v. Nicholson, 487 F.3d 881 (2007), and further
held that any error by VA in providing the notice is presumptively
prejudicial to the appellant.
These decisions primarily contribute to decisional documents being
unnecessarily lengthy and complex, as any error in the approximately
800,000 notice letters VA sends out annually would be presumptively
prejudicial. Also, it delays resolution of appeals by the Board and the
increased number of remands from the Board solely for notice compliance
exacerbates VBA's workload and claims processing delays with little
tangible benefit flowing to the claimant.
Pelegrini v. Principi, 18 Vet. App. 112, 121 (2004)--VA's
implementing regulation imposes a fourth requirement that VA ``request
that the claimant provide any evidence in the claimant's possession
that pertains to the claim,'' and that notice is defective if it does
not specifically make such a request.
This decision imposes a burden upon veterans service
representatives (VSR) to ensure that VA's notice document specifically
includes this request.
Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006)--Notice must
be provided to a claimant of how a VA service connection claim may be
substantiated as to all five elements of that claim, to include
disability rating and effective date, and that certain standards apply
for the timing and content of that notice. The Court extended the
notice requirements of 38 U.S.C. Sec. 5103(a) to the disability rating
and effective date elements as well.
The Court also held that, if a claimant's application suggests
there is ``specific information or evidence necessary to resolve an
issue relating to elements of a claim,'' VA must ``tailor the notice to
inform the claimant of the evidence and information required to
substantiate the elements of the claim reasonably raised by the
application's wording.''
This decision significantly expanded the content of notice letters
with requirements for heightened specificity on downstream elements
that we do not believe are consistent with the intent of the VCAA to
only provide generic notice of how to substantiate a claim.
Kent v. Nicholson, 20 Vet. App. 1 (2006)--In claims to reopen for
service connection on the basis of new and material evidence, the VCAA
requires VA to review the bases for denial in the prior decision and
respond with a notice letter that describes what evidence would be
necessary to substantiate the element or elements required to establish
service connection that were found insufficient in the previous denial.
Failure to comply with this requirement, in most circumstances, is
presumed to be prejudicial error.
This decision places high burden upon VSRs to ensure that VCAA
notice is compliant with this holding as VSRs must review the file to
determine the exact basis of previous the denial and also inform the
claimant of possible evidence and/or theories to substantiate a claim
that were not considered in the previous denial. In many circumstances
such detailed notice may not be possible without the assistance of a
rating qualified decisionmaker.
Hupp v. Nicholson, 21 Vet. App. 342 (2007)--The Court held that the
notice provided in response to a claim for dependency and indemnity
compensation (DIC) benefits under 38 U.S.C. Sec. 1310 must include:
(1) A statement of the conditions, if any, for which a veteran was
service-connected at the time of his or her death;
(2) an explanation of the evidence and information required to
substantiate a DIC claim based on a previously service-connected
condition; and
(3) an explanation of the evidence and information required to
substantiate a DIC claim based on a condition not yet service-
connected.
This decision imposes high burden upon VSRs to review claims file
and create a notice document that is compliant with this holding and
lengthens the time to process such claims.
Palor v. Nicholson, 21 Vet. App. 325 (2007)--Persons claiming
benefits based upon service in the guerrilla forces of the Philippines
during World War II must be notified by VA: (1) of the opportunity to
submit official United States documentation of service as evidence; and
(2) that United States service department certifications that
Philippine service either qualifies or does not qualify the claimant
for veteran status may be binding.
This decision imposes a high burden upon VSRs to review a claims
file and create a notice document that is compliant with this holding
and lengthens the time to process such claims.
Vazquez-Flores v. Peake, Vet. App. No. 05-0355 (January 30, 2008)--
The Court interpreted 38 U.S.C. Sec. 5103(a) as requiring significantly
more content to be contained in VCAA notice letters sent to veterans in
response to claims for increased ratings. The Court held that, if VA
receives a claim for an increased rating and if the diagnostic code
(``DC'') under which the disability is rated contains criteria
necessary for entitlement to a higher disability rating that would not
be satisfied by the claimant demonstrating a noticeable worsening or
increase in severity of the disability and the effect that worsening
has on the claimant's employment and daily life (such as a specific
measurement or test result), VA must provide at least general notice of
those criteria to the claimant.
This case expands upon the Court's holding in Dingess with
substantial expansion of the specificity of the notice for increased
ratings claims that is a significant departure from the intent that
such notices be generic concerning an increased rating claim. The
burden upon VBA personnel processing claims will be enormous and
require labor-intensive efforts and scrutiny to ensure that such
letters pass judicial muster at the administrative, appellate, and
judicial review levels.
Haas v. Nicholson, 20 Vet. App. 257 (2006)--The Court determined
that Vietnam veterans who served in the waters off the shore of
Vietnam, and did not set foot in Vietnam or serve on its inland
waterways, are entitled to a presumption of exposure to herbicide
agents, to include Agent Orange.
This case expanded the class of veterans determined to have been
presumptively exposed to herbicides in Vietnam significantly beyond the
intent of Congress and VA's implementing regulation, which we believe
is limited to veterans who served on land in Vietnam or service on the
inland waterways. The Haas decision would significantly increase VA's
adjudication workload because if the decision is upheld it would extend
the presumption of exposure to herbicide to as many as approximately
832,000 veterans not previously covered. (This number consists of all
veterans who received the Vietnam Service Medal but did not serve
within South
Vietnam.)
Question 5. In 2001, a task force chaired by Admiral Daniel Cooper
recommended that VA allocate employees ``to those Regional Offices that
have consistently demonstrated high levels of quality and productivity
in relation to workload and staffing levels.'' If the fiscal year 2009
budget request is adopted, would the additional staff for claims
processing be allocated to offices that have consistently performed
well?
Response. VBA allocates resources based on a number of factors,
including the number of claims received at a regional office (RO) and
specific performance factors. VBA's resource allocation model allocates
more FTE to ROs that process claims more efficiently and accurately, as
well as those that receive a greater share of the workload. The model
allocates staffing levels based on four factors: (1) performance on
timeliness measures; (2) accuracy of completed work; (3) volume of
incoming claims work, including compensation and pension claims,
telephone inquiries, and non-rating claims; and (4) performance on
appeals measures. Additional adjustments are made for special
circumstances and new or unique missions performed by an RO. These new
missions include the consolidation of all original pension workload to
the pension maintenance centers, the creation of additional development
centers, and the consolidation of general assistance and education
calls to national call centers.
Question 6(a). According to the fiscal year 2009 budget request,
the Compensation and Pension Service ``proposes to design and develop a
Web-enabled, rules-based automated information system to improve the
business process of [Compensation and Pension] claims adjudication.''
What impact would this initiative potentially have on productivity?
Response. VBA, in collaboration with VA's Office of Information and
Technology (OIT), is developing the paperless delivery of veterans
benefits initiative. This initiative is envisioned to employ a variety
of enhanced technologies to support end-to-end claims processing. In
addition to imaging and computable data, we will also incorporate
enhanced electronic workflow capabilities, enterprise content and
correspondence management services, and integration with our modernized
payment system, VETSNET. We are also exploring the utility of business-
rules-engine software for both workflow management and to potentially
support improved decisionmaking by claims processing personnel.
The initiative builds on two pilot programs currently underway.
These pilot projects have demonstrated the utility of imaging
technology in our C&P business line. Both projects use our virtual VA
imaging platform, which is a document and electronic claims-folder
repository.
To fully develop this initiative, VBA will be engaging the services
of a lead systems integrator (LSI). The LSI will work closely with VBA
and OIT to fully document business and system requirements. In
addition, we will document demonstrable milestones and performance
metrics, as well as life-cycle funding requirements.
Until we have had the opportunity to fully develop the initiative,
it is premature to speculate on productivity or other performance
improvements.
Question 6(b). What are the proposed milestones for this initiative
and target completion dates for those milestones?
Response. As noted above, we will be engaging the services of a LSI
to assist us in fully developing the initiative. Until we have had the
opportunity to complete this development process, it is premature to
speculate on milestones and timelines. In the interim, however, we are
working to expand our current pilot projects to increase the use of the
``e-file'' in compensation claims processing.
Question 6(c). How much funding, in total, would VA need to
complete this initiative?
Response. We will be engaging the services of a LSI to assist us in
fully developing the initiative. Until we have had the opportunity to
complete this development process, it is premature to speculate on the
life-cycle cost of the initiative. By proxy, SSA's ``eDib'' initiative
has a reported life-cycle cost of $800 million and a timeline of 8
years to fully implement.
Question 7. For fiscal year 2009, what level of funding is
requested for the Appeals Management Center and how many full-time
employees will that funding level support? What were the key
performance outcomes (e.g., timeliness and accuracy) for the Appeals
Management Center in fiscal year 2007 and what are they expected to be
in fiscal years 2008 and 2009?
Response. In fiscal year 2008, the Appeals Management Center (AMC)
is funded at $9.5 million and is staffed with 114 full-time employees.
The AMC will hire an additional 6 FTE in fiscal year 2008. The budget
request for fiscal year 2009 provides funding for the AMC to sustain
this increased staffing level.
In fiscal year 2007, the AMC's accuracy rate was 85 percent. The
AMC accuracy target for fiscal year 2008 is 90 percent. Through the
first quarter of fiscal year 2008, the AMC achieved an accuracy rate of
89 percent. It is expected that the quality of decisions will continue
to improve through the remainder of fiscal year 2008 and in fiscal year
2009 as the experience level of decisionmakers increases. In fiscal
year 2007, the average age of remands in AMC's inventory was 349 days.
This was above the fiscal year 2007 target of 317 days. The AMC is
taking several steps to improve the timeliness of pending remands and
to reduce the pending inventory. In addition to significantly
increasing its staffing level, the AMC is brokering claims to VBA
resource centers for processing and has also increased overtime
funding. The AMC's fiscal year 2008 target for the average age of the
remand inventory remains 317 days. Performance targets for the AMC in
fiscal year 2009 have not yet been established.
Insurance
Question 1. A Servicemembers' Group Life Insurance Advisory Council
Meeting was held in November 2007. At that meeting, VA recommended very
specific improvements to the Traumatic Injury Protection coverage under
Servicemembers' Group Life Insurance. For example, VA recommended that
the categories of loss that are eligible for payment be expanded to
include second degree burns on at least 20 percent of the body or face.
What is the status of those recommendations and when do you anticipate
that they will be fully implemented?
Response. A summary of the draft version of the Traumatic Injury
Protection Under Servicemembers' Group Life Insurance (TSGLI) Year One
Review has been presented to DOD for concurrence or comment. Once DOD's
input is received, VA will prepare and implement the final report. At
this date we are awaiting the response from DOD.
Vocational Rehabilitation and Employment
Question 1(a). The Administration's fiscal year 2009 budget request
includes funding for 1,073 direct full-time employees for the
Vocational Rehabilitation and Employment (VR&E) program. Would you
please provide a breakdown of the number of those requested VR&E
employees that would serve in each type of position, including
counselors, employment coordinators, contracting specialists, and
support staff?
Response. For fiscal year 2009, staffing is projected as follows:
Counselors: 764
Employment coordinators: 85
Contract specialists: 24
Management and administrative support: 200
Question 1(b). With the requested funding level, what would be the
average caseload per counselor?
Response. The requested funding level and projected workload
enables us to achieve our average caseload standard of 125 participants
per rehabilitation counselor.
Question 2. According to the Administration's fiscal year 2009
budget request, VA sends ``a motivational letter to all new [individual
unemployability (IU)] beneficiaries to advise them of potential
eligibility to Vocational Rehabilitation and Employment Benefits.''
Does VA plan to revise this policy in response to the Veterans'
Disability Benefits Commission's recommendation that all applicants for
individual unemployability benefits be screened for employability by
VR&E counselors before an IU rating is assigned? What impact would it
have on VR&E's staffing requirements if this recommendation were
adopted?
Response. VA has formed a work group to review the Commission's
recommendations concerning the screening of all individual
unemployability (IU) applicants by VR&E counselors prior to assignment
of IU ratings. Included in this study is an analysis of VR&E staffing
implications. The work group expects to complete its study and provide
recommendations within the next 3 months.
Question 3(a). The fiscal year 2009 Independent Budget recommended
that VR&E ``follow up with veterans after being referred to other
agencies for self-employment to ensure that the veteran's
entrepreneurial opportunities have been successfully achieved.'' What
procedures now govern follow-up with these veterans? Are there
additional steps that should be taken to ensure that veterans who opt
to pursue this track do not fall through the cracks?
Response. Numerous steps and procedures are involved with the
development and follow-up of a plan of service under self-employment.
The veteran is responsible for developing a written business plan for
consideration by either a case manager or contractor specializing in
business plans. The assigned VR&E case manager will ensure that the
veteran works with a professional business consultant, either on a
voluntary or contractual basis, to develop a proposed business plan.
The VR&E case manager continues to work with the veteran during this
initial process. Once the business plan has been developed, a
professional consultant evaluates the economic viability of the
proposed business plan. After acceptance of the business plan and
economic viability evaluation by the VR&E case manager, the veteran
along with the VR&E case manager will develop the self-employment plan.
The VR&E case manager remains involved with the veteran for a minimum
of 12 months after the self-employment plan has been implemented. The
VR&E case manager has scheduled meetings with the veteran to review
his/her individual progress and evaluate any further needs to ensure
success of the veteran.
Question 3(b). Would any such additional steps require more VR&E
staffing?
Response. No additional steps are necessary, and we do not project
the need for any additional FTE.
Question 4. During fiscal years 2008 and 2009, how many VR&E staff
will be dedicated to supporting the CHTW program? How many participants
do you expect during those years?
Response. In order to meet the increased need for VR&E early
outreach, the ``Coming Home to Work'' (CHTW) program has been expanded
to all 57 VR&E field offices. Each VR&E field office will have at least
one person assigned to the CHTW program. Prior to the expansion of the
CHTW program, there were 438 participants. Although we cannot estimate
precisely, this number is expected to increase significantly as a
result of the expansion of the program.
Question 5(a). According to the fiscal year 2009 budget request,
VR&E will be conducting a study of the long-term outcomes of veterans
participating in VR&E programs. What is the expected timeline for this
initiative?
Response. Contractor support is required in developing the design
of the study and survey instrument. The contract is projected to be
awarded in fiscal year 2009 with a completion date for final results by
the end of fiscal year 2010.
Question 5(b). How many veterans do you anticipate surveying?
Response. During the development of the project, the various
statistical elements such as methodology, sample size, and population
to survey will be determined.
Question 5(c). How long after they have completed the VR&E program
will former participants be contacted?
Response. We are unable to make this projection at this early stage
of developing the study.
Education
Question 1(a). As one means of gauging productivity, the
Compensation and Pension Service reports the output per direct full-
time employee. What would be a reasonable per-full-time employee output
goal for the Education Service?
Response. In the education program, we track completed work units,
which includes both original and supplemental education claims as well
as other award actions of all types. A reasonable output goal per
direct education FTE would be approximately 1900 completed work units
per year.
Question 1(b). What level of productivity per direct full-time
employee did the Education Service attain in fiscal year 2007 and what
are the expected productivity levels per full-time employee for fiscal
years 2008 and 2009?
Response. In fiscal year 2007, education attained productivity of
1935 completed work units per direct FTE, and we expect to achieve 1820
completed work units per direct FTE in fiscal year 2008 and 1850 in
fiscal year 2009. While we are adding employees in the education
program in fiscal year 2008, the trainees' lack of experience will
limit their contribution to productivity in fiscal year 2008 and 2009.
In fiscal year 2007, education processed original and supplemental
claims in 32 and 13 days, respectively. In fiscal year 2008, education
expects to process original and supplemental claims in an average of 24
and 11, days, respectively. In fiscal year 2009, education expects to
process original and supplemental claims in an average of 19 and 10
days, respectively. The education payment accuracy rate will increase
from 95 percent in 2007, to 96 percent in 2008 and 2009.
Question 2(a). According to the fiscal year 2009 budget request,
the Education Service ``will continue in 2009 the process of
centralizing Regional Processing Office call centers, which accept all
calls directed to the 1-888-GIBILL1 number.'' During fiscal years 2008
and 2009 how many of these calls do you anticipate receiving?
Response. We project to receive approximately 2 million education
calls in each of these 2 fiscal years.
Question 2(b). During fiscal years 2008 and 2009 how many full-time
employees will be devoted to answering these calls?
Response. We expect to devote approximately 180 FTE to answering
education calls and providing administrative/managerial support to the
Education Call Center in each of these 2 fiscal years.
Question 2(c). Where will those employees be located?
Response. During first quarter of fiscal year 2008, employees
assigned to the four regional processing offices continued to answer
calls to our education toll-free number. Beginning February 2008, phone
service is being transferred sequentially from the Buffalo, Atlanta,
and St. Louis offices to the Education Call Center at the Muskogee
office. By the beginning of fiscal year 2009, all employees devoted to
education phone service will be in Muskogee.
Question 3(a). According to testimony submitted by VA regarding the
fiscal year 2008 budget request, the Education Service was working on
providing individuals with greater access to information about their
education benefits on-line and VA expected ``a decline in the number of
telephone inquiries that we receive as we add more self-service options
on our GI Bill Web site.'' What information is now available to
education participants on-line?
Response. The following on-line services are available to current
Montgomery GI Bill Active Duty (MGIB-AD) and Montgomery GI Bill Select
Reserve (MGIB-SR) program participants: certification of monthly
enrollment, change of address, access to status of pending claim,
access to remaining benefit entitlement, access to delimiting date, and
establishing and changing direct deposit accounts.
Question 3(b). Has VA seen a decline in the number of telephone
inquiries?
Response. During the first 4 months of fiscal year 2008, call
volume has been at its lowest level since fiscal year 2004. This is in
spite of significant increases in education program participation. A
significant factor in the lower call volume is VA's improvements in
claims processing timeliness. On-line self service is a contributing
factor as well. For example, during fiscal year 2007, over 82,000
changes of address were processed on-line. Prior to fiscal year 2007,
this action would have required contacting a benefits counselor during
normal business hours at one of our regional processing offices.
Question 4(a). According to the Administration's fiscal year 2009
budget request, the Education Service ``is working to determine what
outcome-based performance measures will be used to measure the
effectiveness of the [State Approving Agency (SAA)] efforts.'' When do
you anticipate having these performance measures in place? In the
meantime, what steps are being taken to ensure that veterans are being
well-served by the funding provided for SAAs?
Response. Beginning with the fiscal year 2008 SAA contracts, VA has
begun collecting data that will provide baseline information on
resources expended on certain SAA functions. Additionally, VA is
working with the SAAs to determine outcome measures that would be
appropriate and consistently measurable. We are working to incorporate
outcome-based performance measures in the fiscal year 2009 SAA
contracts and business plans.
Question 4(b). Does the fiscal year 2009 budget request include any
funding for SAAs, above the $13 million from the readjustment benefits
account that may be used for that purpose?
Response. VA did not submit a legislative proposal to restore
mandatory funding in the fiscal year 2009 budget submission because
bills were already before Congress that would restore or increase
funding.
S. 1215 would continue SAA funding at $19 million for years after
fiscal year 2007. At a hearing before the Senate Veterans' Affairs
Committee on May 9, 2007, VA testified in support of S. 1215. VA stated
that the statutory requirement to reduce SAA funding to $13 million
would cause SAAs to reduce staffing, severely curtail outreach
activities, and perform fewer supervisory and approval visits. VA
further stated that reduced funding might cause some SAAs to decline to
enter into contracts with VA and that VA would have to assume the
additional duties.
H.R. 2579 would make only $13 million available from the RB account
for SAA expenses and permit VA to use GOE appropriations for the
additional funds. At a hearing before the House Committee on Veterans'
Affairs, Subcommittee on Economic Opportunity, on June 21, 2007, VA
testified against H.R. 2579 because VA maintains that funding for SAA
activities should be an authorized expenditure from the RB account
rather than a discretionary expense from the GOE account to guarantee
that mandatory funding is available for these contracts.
Board of Veterans' Appeals
Question 1. During fiscal year 2009, how many appeals do you expect
the Board of Veterans' Appeals (Board) to receive and how many
decisions do you expect the Board to produce?
Response. In fiscal year 2009, the Board expects to receive 43,000
cases and produce at least 41,000 decisions. We expect even greater
productivity in the future as recently-hired attorneys become fully
trained and more experienced as they reach the journeyman level (GS-14)
over the next several years.
Question 2. According to the fiscal year 2009 budget request, the
Board is responsible for deciding allegations of clear and unmistakable
error in prior Board decisions. How many of these cases did the Board
receive in fiscal year 2007? How many do you expect the Board to
receive in fiscal years 2008 and 2009?
Response. In fiscal year 2007, the Board received 48 motions for
revision of prior Board decisions based on clear and unmistakable error
(CUE). The Board cannot predict the number of motions for revision of
Board decisions based on CUE that will be received in fiscal year 2008
and 2009. However, over the past 3 fiscal years, the Board has received
an average of 78 such motions per year. There is no reason to expect
that the number received for fiscal year 2008 and 2009 would
substantially differ from prior years.
Question 3. According to the fiscal year 2009 budget request,
``[r]ecent judicial precedent had significant effect on the Board's
workload.'' Would you please provide additional detail as the impact
these court opinions have had on the Board's workload? For example, how
many appeals have been stayed, remanded, or reconsidered based on these
opinions?
Response. Veterans law continues to become increasingly complex. In
addition to statutory and regulatory changes, a significant number of
decisions continue to be issued by the Veterans Court and the Federal
Circuit that have immediate and dramatic impact on the policies and
procedures that must be followed by VA in developing and deciding
claims for veterans benefits. One of the most sweeping changes to occur
in the area of veterans' law during the past decade was the
promulgation of the VCAA in November 2000. This legislation continues
to have major impact on VA due to the ongoing issuance of significant
court decisions interpreting VA's duties under the VCAA.
Although VCAA was enacted more than 7 years ago, the courts
continue to provide novel interpretations of the duties to notify and
assist a claimant in substantiating a claim for benefits, as required
by the VCAA. Most recently, the Veterans Court issued a decision in
Vazquez-Flores v. Peake, No. 05-355 (U.S. Vet. App. Jan. 30, 2008),
which sets forth detailed and specific requirements for the type of
VCAA notice that must be provided to claimants seeking an increased
disability rating. Given that increased rating claims constitute 30.8
percent of all issues on appeal (i.e. issues where a notice of
disagreement (NOD) has been filed), this Court decision has had an
immediate and dramatic impact on all pending increased rating claims
and appeals.
VA disagrees with the detailed notice requirements set forth in
Vazquez-Flores, and, as such, has filed a motion for reconsideration of
this decision with the Veterans Court. Simultaneously, a motion was
filed requesting that the Veterans Court stay the precedential effect
of Vazquez-Flores while it rules on the reconsideration motion. Until
such time as these motions are ruled upon, VA is obligated to apply the
holdings in this decision to all increased rating claims and appeals.
While the Board is currently making every effort to render final
decisions in cases involving increased rating claims, these efforts may
be unsuccessful and may result in the need for large numbers of cases
to be remanded to the AOJ for compliance with the detailed notice
requirements set forth in Vazquez-Flores.
Vazquez-Flores is one of several major court decisions issued since
2000 interpreting the requirements of the VCAA. With such ever-changing
interpretations of the duties under the VCAA, many of which include
increased specificity in notice, it has become increasingly challenging
for the Board to render timely final decisions for all types of claims.
Depending on the facts in an appeal, a large portion of each Board
decision is now devoted to a discussion of VCAA compliance. When VCAA
notice is found to be inadequate, the Board must engage in a lengthy
prejudicial error analysis. See Sanders v. Nicholson, 487 F.3d. 881
(Fed. Cir. 2007); Simmons v. Nicholson, 487 F.3d. 892 (Fed. Cir. 2007).
If the Board finds that the claimant was prejudiced by inadequate VCAA
notice, and the appeal cannot be granted in full, the case must then be
remanded to the AOJ to cure any VCAA notice defect. This process
significantly lengthens the time to obtain a final resolution in the
appeal, and contributes to the much criticized ``hamster wheel'' of
appeals and remands in the veterans claims adjudication system.
Question 4. If the fiscal year 2009 budget request is adopted, the
number of staff for the Board's Decision Teams will have increased from
303 in fiscal year 2007 to 352 in fiscal year 2009, a 16 percent
increase. During that same period, the deficiency-free rate is
projected to decline from 94 percent to 92 percent, the appeals
resolution time is projected to increase from 660 days to 700 days, and
the cycle time is projected to increase from 136 days to 150 days. What
specific factors account for these lowered performance goals?
Response. In order to fully respond to the concerns raised by this
question, each of these performance measures is addressed separately,
below.
Deficiency-free rate: The Board's performance goal for the
deficiency-free decision rate has remained unchanged at 92 percent over
the past few years. This goal remains the same for future years. In
practice, the Board's actual performance has exceeded our goal and we
are making every effort to ensure that this trend will continue in the
future. For example, in fiscal year 2007, the Board exceeded the 92
percent goal with a deficiency-free decision rate of 93.8 percent. So
far in fiscal year 2008, through January 31, 2008, the Board is on
target to again exceed our 92 percent goal with a deficiency-free rate
of 94.2 percent. We are endeavoring to maintain this high level of
achievement by a program of rigorous training, mentoring and quality
review.
Appeals Resolution Time (ART): ART is the average length of time it
takes VA to process an appeal from the date the claimant files a NOD
until the case is finally resolved, including resolution at the RO
level or by issuance of a final, non-remand decision by the Board. ART
was initially established as a tracking measure before VCAA was enacted
in November 2000. VCAA, among other things, heightened VA's duty to
assist and duty to notify claimants of the type of evidence needed to
substantiate their claim. This resulted in adding more steps to the
claims process and a concomitant increase in the length of time
required to develop claims. In addition, the Veterans Court and the
Federal Circuit have issued a series of precedential decisions
interpreting VCAA, which required additional action on VA's part. See
Holliday v. Principi, 14 Vet. App. 280 (2001), Quartuccio v. Principi,
16 Vet. App. 183 (2002), Charles v. Principi, 16 Vet. App. 370 (2002),
Pelegrini v. Principi, 18 Vet. App. 112 (2002), Mayfield v. Nicholson,
444 F.3d 1328 (Fed. Cir. 2006), Dingess/Hartman v. Nicholson, 19 Vet.
App. 473 (2006), Kent v. Nicholson, 20 Vet. App. 1 (2006), and Vazquez-
Flores v. Peake, No. 05-355 (U.S. Vet. App. Jan. 30, 2008). The
evolving nature of VA's responsibilities under the VCAA, as interpreted
by the courts, has continued to cause increases in ART.
Other factors affecting ART are the statutory and regulatory
prescribed time periods that are built into the adjudication process,
which allow claimants time to take certain action, such as respond to
requests from VA, submit evidence or argument in support of their claim
for benefits, and pursue the next step in the adjudication and/or
appeals process. After the point in which a NOD is filed, there are 330
days of potential mandatory waiting times in the adjudication system.
For example, the law requires that a NOD shall be filed within 1
year from the date of mailing of the notice of the result of initial
review or determination. 38 U.S.C. Sec. 7105(b)(1); 38 CFR
Sec. 20.302(a). If a purported NOD is filed, but the statement is
unclear and the AOJ cannot identify whether the claimant intends to
appeal, or what adverse decision the claimant may be disagreeing with,
the AOJ will contact the claimant to clarify whether the statement was
intended as a NOD. 38 CFR Sec. 19.26(b). The claimant will have a
period of 60 days to respond to that request, or 1 year from the date
or the decision being appealed, whichever is later. 38 CFR
Sec. 19.26(c)(1).
Once an appellant has filed a NOD, the AOJ sends a notice informing
the claimant that he or she has the right to have the decision reviewed
by a decision review officer (DRO) under 38 CFR Sec. 3.2600(a). To
obtain such review, the claimant is provided a period of 60 days after
VA mails the notice to elect DRO review. 38 CFR Sec. 3.2600(b). The
case must sit without any action for the full 60 day period, or until
the appellant responds to the notice, whichever comes first. If the
appellant chooses to have a DRO review the decision, the reviewer may
conduct additional development, hold an informal conference with a
claimant and/or conduct a hearing, if appropriate. 38 CFR
Sec. 3.2600(c). If the DRO process is not selected, or if the review
process is complete and the decision remains unfavorable, at least in
part, a statement of the case (SOC) is sent to the claimant. 38 CFR
Sec. 19.29. The claimant is then provided a period of 60 days from the
date of the SOC, or the remainder of the 1-year period from the date of
the mailing of the notification of the determination being appealed,
whichever is later, to file a substantive appeal. 38 CFR
Sec. 20.302(b). If additional evidence is received after the
substantive appeal is filed, a supplemental statement of the case
(SSOC) must be issued. 38 CFR Sec. 19.31. A claimant is provided a
period of 60 days to respond to the SSOC, 38 CFR Sec. 20.302(c), and
the claimant may request an extension of this period, for good cause.
If an appellant requests a hearing before a member of the Board,
written notice must be provided to the appellant not less than 30 days
prior to the date a hearing will be held before the Board at a VA field
facility. 38 CFR Sec. 19.76. Once an appeal is before a Veterans Law
Judge (VLJ) for adjudication, if the VLJ determines that a legal or
medical opinion is required in the case, the appellant is provided a
copy of the legal or medical opinion and provided a period of 60 days
to respond. 38 CFR Sec. 20.903(a).
Taking into account the evolving and increasing nature of VA's
responsibilities, and the time needed to train new employees at both
the RO and Board levels, VA expects ART to increase slightly from 660
days to 700 days in 2009. The department's strategic target is 675
days.
The Board and VBA are working together to reduce ART and to reduce
avoidable remands. Veterans deserve timely and correct decisions on
claims for benefits. The record must contain all evidence necessary to
decide the claim and show that all necessary due process has been
provided. If the record does not meet these requirements, and the
benefits sought cannot be granted, a remand for further development is
necessary. However, remands from the Board to the AOJ significantly
increase the time it takes for a veteran to receive a final decision. A
remand typically adds more than a year to the appellate process.
Furthermore, about 75 percent of cases remanded are subsequently
returned to the Board, which increases the Board's workload and further
degrades timeliness. Eliminating avoidable remands is a goal that will
provide better service to veterans and their families and, ultimately,
help diminish the growing backlog and improve timeliness. VA has made
significant progress toward this goal. The Board's remand rate was 35.4
percent in fiscal year 2007, which is down from a high of 56.8 percent
in fiscal year 2004.
In addition, at the direction of the Secretary and in coordination
with VBA, the Board has proposed an expedited claims adjudication (ECA)
initiative that will be launched as a 2-year pilot program at four ROs.
In order to help accelerate the timely processing of all claims and
appeals, VA will offer represented claimants the option of
participating in the ECA initiative for expedited processing of claims
and appeals. A claimant who elects to participate in the ECA will
voluntarily waive specified procedural rights and, in return, be placed
on a fast track for adjudication. The expected rapid disposition of
these claims should reduce the backlog and thereby ultimately improve
the overall timeliness of claims processing.
Participation in the ECA Initiative will be offered in writing by
VA as an option when a claim is received. During the pilot program,
participation will extend to claims for benefits administered by VBA at
four ROs for veterans who are represented. Participation will be only
open to claims for disability compensation benefits under 38 CFR Parts
3 and 4, excluding a narrow class of claims including pension benefits,
survivor benefits, and simultaneously contested claims.
In addition to expedited claims at a participating RO, any claims
appealed to the Board under the ECA Initiative will be screened upon
arrival at the Board to ensure that the record is adequate for
decisional purposes when the appeal reaches its place on the Board's
docket. If the record is inadequate, the Board will take prompt action
under existing law and regulations, such as soliciting a waiver of RO
consideration of additional evidence, and remand the case for further
development, if necessary.
During the summer of fiscal year 2007, the Chairman briefed the
Veterans Service Organizations (VSO), the Senate Veterans' Affairs
Committee, the Subcommittee on Disability Affairs and Memorial
Assistance of the House Veterans' Affairs Committee, and the Office of
Management and Budget regarding the ECA Initiative.
VA is currently in the process of drafting proposed regulations to
implement the ECA pilot program. The Department is excited about this
program and the positive impact it is expected to have in speeding up
the adjudication of claims and appeals before VA, which should be
reflected in an improvement in ART.
Cycle time: The Board's ``cycle time'' is the average time it takes
from when a case is received at the Board until a decision on that
appeal is dispatched, excluding time the case was with the appellant's
service organization representative. The Board's cycle time decreased
from 148 days in 2006 to 136 days in 2007. The Board anticipates,
however, that cycle time may increase in the short term due to
fluctuations in the receipt of certain types of ``priority'' appeals.
The Board gives processing priority to certain types of cases,
including: cases that are advanced on the docket, cases remanded to the
Board from the Veterans Court, cases returned from the AOJ after a
Board remand, and cases in which the Board has held a hearing.
Historically, when a higher percentage of the Board's workload is made
up of these priority appeals, cycle time will decrease. This is because
``priority'' appeals, by nature of being a priority, are quickly sent
to a VLJ for adjudication, with minimal waiting time. Contrarily,
original appeals that do not fall into a ``priority'' category, must be
worked in their regular order on the Board's docket.
As productivity continues to increase, the Board is better able to
expeditiously adjudicate these priority appeals, and therefore make
greater progress in adjudicating original appeals. The more original
appeals that the Board is able to adjudicate, the more progress will be
made in reducing the backlog. However, the short-term effect is that
cycle time may increase as more of the earlier cases on the docket are
decided.
It is the Board's intention to meet or exceed the 2009 target of
150 days for cycle time. The Board's strategic target remains 104 days.
The Board expects to make progress toward that strategic target as
newly hired attorneys become fully trained and as the Board continues
to work to improve efficiency and productivity by emphasizing training,
focusing on reducing avoidable remands, and ensuring that decisions are
clear, concise, coherent, and correct.
General Counsel
Question 1(a). Under Public Law 109-461, veterans and other VA
claimants may now hire attorneys to assist with their claims once a
Notice of Disagreement has been filed. What role does the General
Counsel's office play in monitoring fee agreements from these attorneys
and ensuring that attorneys have complied with all applicable
requirements, such as any training or education standards?
Response. In Public Law 109-461, Congress authorized the Secretary
of Veterans Affairs to review attorney fee agreements and order a
reduction of any fee that is excessive or unreasonable, such decisions
being appealable to the Board. In May 2007, VA published a notice of
proposed rulemaking under which attorneys would be required to file all
fee agreements with the Office of the General Counsel (OGC). Agreements
that are on file with OGC could be reviewed at the request of a
claimant or on OGC's own initiative. A presumption of reasonableness
would attach to fee agreements calling for a fee of not more than 20
percent of past-due benefits awarded by VA. Agreements calling for a
fee exceeding 20 percent would be reviewed for reasonableness under a
standard established in VA's regulations.
VA's notice of proposed rulemaking also addressed the provisions in
Public Law 109-461 that affect VA's accreditation of attorneys. VA
proposed to implement the new law by, among other things, establishing
a standard of conduct for attorneys who represent VA claimants,
establishing accreditation application requirements for attorneys, and
prescribing a qualification standard for attorneys. Under the proposed
rule, OGC would review the application of each attorney to determine
whether he or she meets the accreditation requirements. Additionally,
OGC may initiate suspension or cancellation of accreditation
proceedings when it receives information that an attorney no longer
meets the accreditation requirements, has engaged in improper conduct,
or has demonstrated a lack of competence in providing representation.
The General Counsel's decision canceling the accreditation of an
attorney may be appealed to the Board and reviewed by the Veterans
Court and, as to legal matters, the Federal Circuit. The qualification
standards for attorneys were the subject of extensive comments during
the public comment period. These comments will be addressed in the
final-rule notice.
Question 1(b). Does the requested level of funding provide
sufficient staff to handle those functions?
Response. The requested level of funding is adequate for staffing
OGC's administration of the accreditation and fee-review programs based
on the number of attorneys currently providing representation before
VA. As the program develops, we will monitor the impact of Public Law
109-461 on OGC resources and collect data to support future funding
requests.
Question 2(a). As the Administration's fiscal year 2009 budget
request points out, the caseload at the U.S. Court of Appeals for
Veterans Claims increased by 76 percent from 2004 to 2007. How many
full-time employees of the General Counsel's office are now allocated
to handling appeals before that court?
Response. The employees of Professional Staff Group VII (PSG VII)
of OGC represent the Secretary in all cases filed with the Veterans
Court. There are 108 full-time employees of PSG VII allocated to the
various administrative and legal functions required for handling cases
at the Veterans Court. In addition to that number, there is one full-
time employee (FTE) of VA's Office of Information and Technology who
supports the computer system of PSG VII, and there are three full-time
employees on contract from Xerox Business Systems who support the
photocopying needs of PSG VII.
OGC has increased the FTE in PSG VII in each of the last 5 fiscal
years in response to the rising workload before the Veterans Court.
Current FTE level--108
FTE level fiscal year 2007--98
FTE level fiscal year 2006--96
FTE level fiscal year 2005--79
FTE level fiscal year 2004--73
Moreover, it is anticipated that PSG VII will expand by an
additional 12 employees before the end of fiscal year 2008.
Question 2(b). Would any of the additional staffing requested for
fiscal year 2009 be allocated for that purpose?
Response. No. After ramping up staffing levels in PSG VII over the
past 5 years, OGC will seek to address other growing needs in fiscal
year 2009. OGC intends to place 13 of the additional 14 requested FTE
in its field offices (Regional Counsel). The following table shows
trends in OGC's field and headquarters staffing:
----------------------------------------------------------------------------------------------------------------
2008
-------------------- Increase
2007 Current 2009 (+)
Actual Budget Estimate Estimate Decrease
Estimate (^)
----------------------------------------------------------------------------------------------------------------
Average employment:
Field..................................................... 408 400 412 425 13
Central Office............................................ 262 245 245 246 1
---------------------------------------------------
Total................................................. 670 645 657 671 +14
----------------------------------------------------------------------------------------------------------------
Question 2(c). What is the average caseload handled by VA attorneys
practicing before that court and what is an optimal caseload?
Response. For the 12-month period extending from February 2007
through February 2008, the average caseload per attorney was
approximately 73 cases (72.637 cases per attorney). We are currently
evaluating the optimal caseload per attorney.
Question 3. VA recently announced that it has awarded a $3.2
million contract to Economic Systems Inc. to study the feasibility of
implementing transition payments, the appropriate levels of disability
compensation for loss of earning capacity, and the appropriate payments
for loss of quality of life. Those studies are expected to be completed
in August 2008. If VA were to undergo a comprehensive overhaul of the
disability rating schedule based on the results of those studies or
others, would additional staff be required in the General Counsel's
office?
Response. Staffing needs related to overhaul of VA's rating
schedule would depend upon the breadth of the contractor's findings and
recommendations with regard to the rating schedule, decisions by the
Secretary and Congress about whether and how to implement the
contractor's recommendations, and the time period during which the
overhaul of the rating schedule would occur. However, any effect of
such an overhaul on OGC's staffing needs would not be expected until
after fiscal year 2009.
Information Technology
Question 1. Information Technology (IT) will provide the
infrastructure to accomplish most of the VA-wide improvements you are
trying to accomplish. Please explain how the requested funding level
for IT will ensure that your short, medium, and long term goals are met
with both the speed and the success that they deserve.
Response. VA requested $2.442 billion in fiscal year 2009 to
support IT development, operations and maintenance, and payroll. This
level of funding provides adequate resources to meet VA's most
critical, immediate needs as defined and agreed to by the members of
the IT governance structure.
The IT governance procedures allow VA to effectively manage
competing initiatives, funding allocations, and emergent requirements
in an orderly and disciplined manner while, at the same time, targeting
numerous goals with varying timeframes. In the short term, VA's
infrastructure requires sufficient funding to meet day-to-day service
agreements to ensure effective operational readiness and maintaining a
secure environment. For example, by the end of fiscal year 2009, VA
will have completed 50 percent of the infrastructure for the personal
identification verification initiative, a key element of cyber security
in direct support of a Homeland Security Presidential Directive. We are
also investing in replacement projects to meet future medium and long
term requirements (goals). Our VETSNET initiative, a suite of
applications that permit an orderly transition from the benefits
delivery network (BDN), is on-target to support the retirement of the
BDN in early 2012, while the veterans' health information systems and
technology architecture (VistA) will be replaced by a new system, VistA
HealtheVet, using modern applications and tools well suited to
accommodate future enhancements.
VA's Business Needs and Investment Board (BNIB) is charged with
balancing the immediate needs of today with the emerging needs of the
future while skillfully determining the most appropriate mix of
expenses and investments. The BNIB is comprised of representatives from
VA's business lines and OIT. It provides recommendations to the
Information Technology Leadership Board (ITLB), a senior governance
element, for additional due diligence to make sure the planning process
correctly supports established needs. Finally, the Senior Management
Council (SMC) confirms that the requested IT budget is in harmony with
the strategic goals of VA. Using this method, the operators/providers/
designers of VA's IT infrastructure, architecture, projects, and
programs are accountable to ensure that, not only are the needs of our
internal customers accommodated, but also the needs of our primary
customer, the veteran, are accommodated at the highest level of
satisfaction possible.
National Cemetery Administration
Question 1(a). The National Shrine Commitment list consists of
projects and repairs that must be completed at NCA National Cemeteries
to bring them into compliance as National Shrines. It is my
understanding that new requirements are added annually to the existing
list and then the list is re-ranked in order of assessed importance and
that the number of items on the list that are repaired depends solely
on whatever money you receive that year. Is that correct?
Response. The number of items that are repaired in the National
Shrine project inventory depends on the amount of money received in a
given year, the cost of the items and their priority relative to other
system-wide needs such as gravesite expansions. Keeping existing
National Cemeteries open for burials is NCA's highest priority.
The fiscal year 2002 Millennium Act Report to Congress identified
3,566 repair items for $280 million (i.e., the ``National Shrine
Commitment list''). NCA believes that 497 of these items--estimated at
$35 million--can be deferred indefinitely, leaving a total inventory of
3,069 items for $245 million. Through fiscal year 2007, NCA completed
work on 1,130 items estimated at $100 million. The cost of the
remaining 1,939 items to be accomplished is estimated at $145 million.
NCA's focus on the shrine commitment is not limited to the
Millennium Act study. The report's list represents a ``snapshot'' of
requirements in 2002.
Since that time, other shrine needs have emerged and have received
funding as higher priorities. NCA anticipates spending approximately
$55 million in fiscal year 2008 on National Shrine projects from all
accounts.
Question 1(b). Do you have a strategic plan in place to address the
repairs on the list, e.g., does your budget request use a
recapitalization methodology?
Response. NCA's budget request does not reflect a formal
recapitalization methodology. NCA currently relies on its annual
construction planning process and gravesite assessment survey as the
primary sources for developing the inventory of shrine-related work and
determining project priorities.
______
Response to Written Questions Submitted by Hon. Patty Murray to
LTG James B. Peake, Secretary, Department of Veterans Affairs
Question 1. Secretary Peake, I know you are aware of the serious
need to train psychologists who are skilled in treating PTSD, TBI and
other post-deployment issues--it has been documented in numerous
commission reports just in the past year. In an effort to address this
training pipeline crisis, I spearheaded an effort in VA's 2008
Appropriations Bill providing you with immediate authority to transfer
up to $5 million for a joint effort with HHS. The idea is to take
advantage of their existing Graduate Psychology Education Program to
quickly begin training more specialists in the types of conditions
facing returning veterans. Secretary Peake, can you tell me where this
effort stands at the VA, what your plans are, and your expected
timeframe for initiating this program?
Response. Congress has authorized:
Sec. 227. (a) Upon determination by the Secretary of Veterans
Affairs that such action is in the national interest, and will
have direct benefit for veterans through increased access to
treatment, the Secretary of Veterans Affairs may transfer not
more than $5,000,000 to the Secretary of Health and Human
Services for the Graduate Psychology Education program, which
includes treatment of veterans, to support increased training
of psychologists skilled in the treatment of Post Traumatic
Stress Disorder, Traumatic Brain Injury, and related disorders.
The Department of Veterans Affairs (VA) has determined not to
transfer funding to the Department of Health and Human Services (HHS).
VA recognizes the need for psychology training and has taken internal
steps to expand psychology internship and postdoctoral training
opportunities, thus using this funding to directly enhance care for
veterans mental health. Those have been expanded by 160 positions for
the upcoming training year for a total of 640 funded training positions
in psychology that will recur on a yearly basis.
We do recognize that there are training needs at the graduate level
that would better prepare psychology graduate students for VA
internships and postdoctoral fellowships, as well as eventual VA
employment. Rather than fund graduate programs indirectly in a manner
that would not necessarily result in curricular changes or increased
numbers of VA qualified psychologists, VA will work toward greater
collaboration with selected graduate programs of psychology to enhance
training in clinical content related to VA care, including effective
functioning within an interdisciplinary health care system. For
example, such collaboration might include identifying graduate programs
in psychology to work closely with affiliated VA medical centers that
provide psychology internship or postdoctoral training:
a. In these collaborations, affiliated VA medical center psychology
staff should have faculty appointments in the graduate psychology
education programs to supplement the graduate education in content
areas including:
i. Concepts of interdisciplinary health care provision and the
skills necessary for effective provision of interdisciplinary care.
ii. Clinical content related to Post Traumatic Stress Disorder,
Traumatic Brain Injury and related disorders, if such expertise is
not well-represented among the faculty of the graduate program.
iii. Clinical content related to the ``President's New Freedom
Commission on Mental Health: Transforming Mental Health Care in
America.'' This would include emphasis on the Recovery Model of
Treatment for Serious Mental Illness.
b. Students in such collaborative programs would be eligible to
apply for practicum training experience with VA during the years of
graduate training. Psychology training staff at the affiliated VA
facility will make decisions regarding acceptance of students for
training, based on their judgment of the students.
______
Response to Written Questions Submitted by Hon. Bernard Sanders to
LTG James B. Peake, Secretary, Department of Veterans Affairs
Question 1. Secretary Peake, as you know in January of 2003 the VA
announced that it would no longer allow Priority 8 veterans to enroll
into the VA health care system. Can you tell me the amount of time, the
resources, and anything else that the VA would need from Congress so
that we can bring these Category 8 veterans back into the system in an
orderly way? Can you also provide your best estimate of how many
veterans per year have not been able to use the VA health care system
due to this Priority 8 policy?
Response. At the request of the House Veterans' Affairs Committee,
VA analyzed the strategic resources related to reopening enrollment for
Priority 8 veterans. The report was sent to Chairman Filner on 2/25/08.
VA's projected demand for health care services is expected
to increase in the next several years under the current enrollment
policy. Accounting for the increased growth expected under the current
enrollment policy and reopening enrollment in 2013 to new Priority 8
veterans would result in a total growth in enrollees of 22 percent and
a total growth in users of 21 percent.
VA estimates that it would require $3.1 billion dollars to
provide health care services to the additional 1.4 million enrollees
and approximately 750,000 patients during the first year of
implementation. The full magnitude of the cost of reopening enrollment
to new Priority 8 veterans must be viewed within a long-term strategic
framework, namely the estimated 5-year cost of $16.9 billion and the
10-year cost of $39.2 billion, as well as capital costs not included in
these estimates.
As of the end of fiscal year 2007, 386,767 Priority Group
8 veterans had applied for and been determined to be ineligible to
enroll based on the January 2003 enrollment decision. This figure does
not include enrollees who were initially denied enrollment and
subsequently enrolled in an eligible priority group based on a change
in the veteran's eligibility. VHA analysis of current Priority Group 8
enrollees indicates that 45 percent are not users of VHA health care
services in any year. Assuming that the non-enrolled Priority Group 8
veterans exhibit the same characteristics (and thus would use services
in a similar way), we estimate that approximately 212,722 non-enrolled
Priority Group 8 veterans have not been able to use VHA services due to
the 2003 enrollment decision.
Question 2. Secretary Peake, there was a good deal of discussion at
this week's hearing of the need for more extensive outreach to our
returning and existing veterans. Given this and the fact that you
mentioned you would soon be talking about outreach with the Nation's
Adjutant Generals, I wanted to inform you about an innovative outreach
program we have in the State of Vermont. This program, established with
funds secured through the Department of Defense, is run by the Vermont
National Guard, in coordination with the local VA Medical Center. It
uses trained veterans to contact each and every returning Iraq and
Afghanistan servicemember and their family to check in on them and see
if they are getting the help they need. This could include but is not
limited to: mental health counseling (such as for PTSD), VA benefits,
military benefits, marriage counseling, financial counseling, suicide
prevention, substance abuse, and other areas. They also provide
appropriate referral services to the VA, State, local, or other
appropriate avenues for assistance. This program is coordinated with
the Guard's existing Family Assistance programs. The program also has a
24-hour helpline staffed by Vermonters who work for the National Guard,
who are there to help returning veterans and their families in need.
While this program is operated using DOD resources, I believe a similar
effort could be established within VA. Working with my colleagues, I
was able to secure $3 million in the Department of Defense
Appropriations bill to have this program replicated on a national
level. The funding is now part of the larger Yellow Ribbon
Reintegration Program established in Public Law 110-181. I would
welcome the opportunity to discuss our Vermont program with you and
explore ways that the VA can become more actively involved in similar
outreach programs. I would appreciate any comments you may have on our
Vermont program and the possibility to expand these types of programs.
Response. VA is in full support of GWOT Guard and Reserve soldiers
returning from the war and VA participates in the execution of Guard
and Reserve post-deployment health re-assessment (PDHRA) events along
with reintegration programs. VA also collaborates with the National
Guard in the execution of State coalitions and full collaboration and
training with the National Guard and VA transitional assistance
advisors (TAAs). These State coalitions use the State leadership Triad
of the State Director VA, State Adjutant General and VA leadership in
each State.
The Vermont Door Knockers Program is an additional program in the
State that hired National Guard staff to proactively divide the State
into regions and act as State outreach mobile teams to provide face-to-
face contact to those returning from the war. Information about home of
record is shared with outreach workers to facilitate enrollment into VA
health care and other VA benefits. Those needing additional services
are referred to the State TAA for specialized outreach and coordination
efforts with the local VA medical center or RO. VA is supportive of all
outreach efforts and facilitates the development and maintenance of
State coalitions to ensure the integration of services that are
delivered to Guard and Reserve soldiers returning home. VA is
partnering with all stakeholders at the State and local area by
providing training, outreach materials and access to health care and
benefits by experts at the VA medical center, RO, Vet Centers, VSOs,
community organizations, State directors VA; as well as, active
participation in Welcome Home and Family Program events held in regions
throughout the State for returning troops.
Question 3. Secretary Peake, can you provide me with the VA's best
estimate
of how many veterans would leave the VA system or choose not to enroll
if VA
were to implement the copayment and enrollment fees proposed in the
President's budget?
Response. VA estimates that approximately one-half of the estimated
1.7 million enrolled Priority 8 veterans, or 852,000 enrollees, would
be assessed the tiered enrollment fee in 2010--the first year the
tiered enrollment fee would be assessed. Of these 852,000 Priority 8
veterans, VA estimates that 440,000 enrollees will choose not to pay
the enrollment fee. According to VHA's analysis of enrollment and use
data, approximately 45 percent of Priority 8 enrollees do not seek VHA
health care in any given year. VA estimates nearly two-thirds of
enrollees who will choose not to pay the tiered enrollment fee are non-
users of VA health care.
A very large proportion (all but 1 percent) of Priority 7 enrollees
have incomes below the $50,000 threshold; therefore most Priority 7
enrollees would not be subject to the tiered enrollment fee.
Question 4. Secretary Peake, establishing a Community-Based
Outpatient Clinic in Brattleboro, VT, is an issue that is very
important to the veterans that live in the southern part of my State. I
was very interested and happy to see you discuss CBOCs in your prepared
remarks and I very much hope that a CBOC in Vermont is among those 64
CBOCs you discussed opening this year. My office has heard from many
veterans who live in this southern part of the State who are without a
nearby veterans' health care facility. My understanding is that the
proposed 2008-2012 VA New England Health Care System Strategic Plan has
come to the same conclusion about the challenges to access our veterans
in this region are experiencing. Since the need for a facility is
something that there seems to be agreement on, I would like to work
with you to advance this process and take the steps necessary to
establish the clinic, including securing the appropriate funding and
receiving approval from the VA Central Office in Washington. Is that
something we can work on together and that I can count on your support
for?
Response. We are continuing to evaluate the health care services
being provided within the VISN 1--VA New England Health Care System,
and will consider expanding those services as needs are identified.
The Secretary's 2004 Capital Asset Realignment for Enhanced
Services (CARES) decision document for VISN 1 did not include a CBOC
for the Town of Brattleboro, VT; however, a preliminary review
conducted by VISN 1 has identified Brattleboro as an underserved area.
In order to determine the validity of establishing a CBOC, a business
plan must be reviewed and approved. A business plan to open a CBOC in
Brattleboro is currently under development. VISN 1 will submit a
proposal during the fiscal year 2008 national call for CBOC business
plans for potential fiscal year 2009 activation. This proposal will be
evaluated against a set of national criteria and will prioritize the
need for a CBOC in this location against other proposals nationwide.
Question 5. Secretary Peake, as you may know, the VA's National
Center for PTSD has it Executive Division located in White River
Junction, VT, at the VA Medical Center there. The Center, with its six
divisions, has emerged as the world leader in research and education on
PTSD and provides essential clinical tools and guidance to facilities
around the country. In fact, your prepared remarks hailed the work that
the VA has done in PTSD research. Now, with so many returning
servicemembers experiencing PTSD and older veterans from the Vietnam
era experiencing reoccurrence of their PTSD, the work of this center is
more important than ever. Currently the Center is experiencing a major
space shortage at its Executive Division in Vermont. It shares space
with the VA Medical Center and while they are honored to have the
Center in White River, the current need for space is hampering the
operation of both facilities. I wrote to then-Secretary Nicholson about
this in
August of 2007 and Acting Secretary Mansfield wrote me back in October
of 2007 saying that the VA Central Office was planning to provide $2.4
million in funding for a modular building, archival storage space, and
video conferencing capabilities to meet these needs. This was very
welcome news. Can you give me an update on the status of that project
and when these resources will be available to begin
construction?
Response. The expansion project for the National Center for PTSD
(NCPTSD) is still being developed. The tentative plan consists of
erecting a modular building of approximately 7,500 gross square feet,
which would meet the NCPTSD expanding requirement needs.
White River Junction VA Medical Center is currently working on a
minor construction proposal to submit to VA Central Office by the end
of fiscal year 2008.
______
Response to Written Questions Submitted by Hon. Larry E. Craig to
LTG James B. Peake, Secretary, Department of Veterans Affairs
Question 1. Previous Federal regulations provided for reimbursement
to States for a $300 per burial interment cost if the interment took
place within 2 years of the permanent burial cremation. This is
important to me because my State of Idaho paid for numerous remains of
veterans to be moved to our State Veterans Cemetery, although Idaho did
not qualify within the 2-year timeframe.
In Public Law 110-157, language would eliminate the 2-year
timeframe and allow States, such as Idaho, to receive the $300
reimbursed by the Department of Veterans Affairs. My question is,
whether States have begun to get reimbursed for the cost of
reinterment. If not, can you please provide me with a timeframe for
reimbursement to take place?
Response. Section 202 of Pub. L. 110-157 removed the time limit for
States to file for reimbursement for the burial in State cemeteries of
unclaimed remains of deceased veterans (for interments and inurnments
occurring on or after October 1, 2006). States may apply for
retroactive reimbursement for burials from that date. Guidance to
implement this provision has been drafted and will be released to
regional offices in the spring.
Question 2. Public law 110-157, section 202, also contains language
for a grant program for States, not to exceed $5 million, to be used
for operating and maintenance costs of veterans' cemeteries. Can you
please provide me with the information, criteria and methodology for
implementing this grant and when you think this grant will be made
available to the States?
Response. NCA is developing a regulation to implement the amendment
for operation and maintenance grants for State cemeteries. The
methodology for the grants will be similar to NCA's program to maintain
national cemeteries as shrines. The focus will be to correct gravesite
deficiencies, such as cleanliness, height and alignment of headstones
and markers, leveling of gravesites, and turf conditions. The proposed
regulation will be published in the Federal Register, and we expect to
begin awarding grants for operation and maintenance in fiscal year
2009.
______
Response to Questions Arising During the Hearing by Hon. Daniel K.
Akaka to LTG James B. Peake, Secretary, Department of Veterans Affairs
Question 18. What is the funding for outreach in the fiscal year
2009 Budget.
Response. This is still in process and should be provided shortly.
______
Response to Questions Arising During the Hearing from Hon. Patty Murray
to LTG James B. Peake, Secretary, Department of Veterans Affairs
Question 1. Clarify what is and is not funded at American Lake
complex.
Response. What is funded: American Lake Seismic Corrections--
Nursing Home Care Unit & Dietetics. The project will construct a one
story, 83-bed Nursing Home Care Unit with Alzheimer Ward, Dietetics and
other support functions. The project is intended to improve patient and
staff flow as well as correcting life safety, fire and seismic
deficiencies.
What is not funded: Two projects for Seattle--Nursing Home Care
Unit and Replacement of the Mental Health and Research building. The
NHCU includes seismic corrections, and the Mental Health and Research
building provides appropriate space and life safety corrections. Both
were submitted in the fiscal year 2009 Major Construction cycle, but
were not scored high enough for funding. Therefore, they were submitted
for the fiscal year 2010 cycle.
______
Response to Questions Arising During the Hearing from Hon. Larry E.
Craig to LTG James B. Peake, Secretary, Department of Veterans Affairs
vha issue brief
Issue Title: Status of Regulations to implement Public Law 109-
461--Full Cost of Care for State Veterans Nursing Homes
Date of Report: 2/20/2008
Issue: Members of Congress are querying VA about the status of the
development of regulations for the State veteran nursing homes so that
they may be reimbursed for providing services to disabled veterans
rated at 70 percent or higher. These inquiries are being made a result
of questions they have received from their constituents, primarily the
members of the National Association of State Veterans Home
Administrators.
Background: On December 22, 2006, the President signed Public Law
109-461, Full Cost of Care for State Veterans Nursing Homes, which
added a new section 1745 to title 38, United States Code. This new
section requires VA to begin paying States a higher rate for nursing
home furnished to certain veterans in State nursing homes. The higher
rate must be paid for veterans with an SC disability rated 70 percent
or higher, and those receiving care for an SC disability. The new law
also includes a provision requiring VA to furnish or pay for drugs for
certain additional veterans receiving care in a State nursing home.
Both of these new provisions are effective 90 days after the law was
signed, or in late March 2007.
Current Status: The following information is provided in response
to recent Congressional inquiries from Hon. Larry E. Craig:
Question 1. Why has it taken over a year and yet the regulations
are still not implemented for the State VA nursing homes to be
reimbursed for providing services to disabled veterans rated at 70
percent or higher.
Response. The regulation development process for all Federal
agencies has prescribed phases that proposed regulatory changes must go
through; these include initial development, internal agency
concurrences, submission to OMB, and publication in the Federal
Register for public comment. Following the public comment period,
issues that are raised are reviewed and changes, when appropriate can
be incorporated into the final rule. The average VA time for processing
two-stage regulations is 22.4 months. VA is presently at the 13-month
point in processing these new State nursing home regulations.
Question 2. Where is VA in the process of implementing these
regulations? Have the regulations been drafted? Are the regulations
being reviewed by OMB?
Response. VA has been actively pursuing the regulation development
process. The regulations have been drafted. VA expects the regulations
to be forwarded to OMB by April 30, 2008. The history and projected
timelines associated with this initiative are included in attachment
one, Chronology of Regulation Development Actions Related to Pub. L.
109-461.
Question 3. What is the projected implementation date and timeline
so that constituents can be advised?
Response. VA expects the projected implementation date to be
October 2008. This includes allocations for 45 days for internal VHA
and VA reviews and concurrences; 90 days of processing time through
OMB; 60 days for publication in the Federal Register and allowing for
the public comment period; and 30 days for VA to review and respond to
comments. After the regulation process has been completed, VA, at the
facility level, will most likely make payments retroactive to March of
2007 (to the date that was 90 days after the President signed the new
Public Law). We would pay the difference between the regular per diem
rate that the veteran received, and the amount that will be given with
the implementation of this new law.
______
Attachment 1
chronology of regulation development actions
related to public law 109-461
December 2006: On December 22, 2006, the President signed Public
Law 109-461, Full Cost of Care for State Veterans Nursing Homes.
January 2007: Preliminary discussions were held at VA and a VA
workgroup of subject matter experts was formed.
February 2007: VA work group, led by the Office of Geriatrics and
Extended Care, was formed. It included VA representatives from Pharmacy
Benefits Management, the Chief Business Office, and the Office of
General Counsel. Preliminary reviews were conducted to determine the
issues associated with the new per diem payable and the issuance of
medications and drugs.
March 2007: VA addressed the National Association of State Veteran
Home Administrators (NASVHA) at their winter conference in Alexandria,
VA. VA considers NASVHA to be one of our primary stakeholders for the
State home program. At this meeting, based on a NASVHA request, VA
committed to working proactively with their membership to assure that
they had an opportunity to actively participate in the regulation
development process, versus having to wait until the public comment
period.
April 2007: Rewriting of the regulation and development of the rate
chart began.
May/June 2007: Meetings were held at VACO to determine proposed
content. Significant effort was put into developing payment computation
formulas that would be consistent with the spirit and intent of the new
Public Law and, at the same time, would give due consideration to
patient needs and revenue generation issues that were surfaced by the
State homes.
July 2007: NASVHA summer conference. VA representatives again
addressed the National Association of State Veteran Home Administrators
(NASVHA) at their summer conference in New Orleans, LA. At this
meeting, VA discussed the regulation development process, associated
timelines, and the proposed methodology for calculating payments under
the new Public Law.
August 2007: Three NASVH members came to VA Central Office and
several NASVHA members joined the meeting via conference call to meet
with members of VA staff who were drafting regulations to implement
Pub. L. 109-461. This meeting included representatives from VA's Office
of Geriatrics and Extended Care, the Office of General Counsel, the
Chief Business Office, and the Office of Public and Intergovernmental
Affairs. Based on discussions at that meeting and the information in
their follow-on letter, dated September 21, 2007, VA modified the VA SC
per diem calculation methodology that was proposed in March 2007, to
include the 13 percent profit margin as a part of the prevailing rate
payable in the geographic area in which the State home is located. VA
also agreed to grant NASVHA additional time so that they could further
define their positions regarding the billing of secondary payers (such
as Medicare) and issues associated with bed holds and social worker
qualifications.
September 2007: Met with Cheryl Sklar and other members of the
Requirements Analysis and Engineering Management Office (RAEM), to
discuss how to capture veteran's priority group status to be able to
report and receive information on 70 percent service-connected veterans
and 50 percent service-connected veterans for full cost of care and/or
free medications.
October 2007: Multiple discussions with VHA staff, attorneys who
were drafting the proposed regulation, and members of the National
Association of State Veterans Homes.
November 2007: Developed a new VA Form for the pharmacy benefit of
free medications for veterans that are 50 percent or more service-
connected. Worked with the Office of Forms and Publications to give the
form a number and the final touches on the form itself. Also, the 10-
5588 and the 10-10SH Forms needed to be revised to include the full
cost of care veterans and the veterans who are eligible for free
medications.
December 2007: Developed the Impact/Cost Analysis with the cost for
the full cost of care and the cost of the medications for the above
mentioned veterans.
January 2008: On Monday, January 28, 2008, VA received final
comments and recommendations from the National Association.
February 2008: VA reviewed comments. Decisions were made to remove
two other sections from the proposed regulations because they were not
mandated by Pub. L. 109-461 and because there were concerns from NASVHA
about their appropriateness. This was delaying the processing of the
regulation. These two items, which addressed bed hold and social worker
qualifications, will be processed through a separate regulatory change
action.
On February 14, 2008, the Office of Geriatrics and Extended Care
submitted the regulation to the office of the Assistant Secretary,
Regulation Policy and Management (00REG) so that it can be placed into
formal VHA and VA concurrence processes.
Chairman Akaka. Thank you very much, Secretary Peake. I
also want to welcome your Under Secretaries and Assistant
Secretaries who are here with you at this time and thank you
for your testimony.
Secretary Peake, during your confirmation hearing before
this Committee you said you would, and I quote, ``work hard
with the Administration, with OMB and would come forward, if
needed, to ask Congress for additional funding for VA.''
Are you fully confident in this budget, given that the
growth in total spending recommended by the President is
actually below the rate of inflation?
Secretary Peake. Sir, I believe that with this budget, as I
just testified, that we can meet the needs of our veterans as
we move forward to improve the access to care, to continue to
improve the quality of the care, and I believe that I have
confidence that we can do that with this budget.
Chairman Akaka. Secretary Peake, Congress has extended the
access afforded to combat veterans for VA health care from 2 to
5 years.
Secretary Peake. Yes, sir.
Chairman Akaka. Improving access will help, but it will not
be the catalyst for all veterans to come in for the care and
services they need. Outreach is what is critical now and that
falls squarely on your shoulders.
How much is designated in this budget for outreach? And are
you confident that this is enough to move VA from a passive
approach to a much more aggressive one to prevent suicides and
improve the quality of life for veterans?
Secretary Peake. Sir, I believe that I tried to highlight
in my testimony what I believe is the importance of outreach
and I think that we can do better with it.
We send out an unbelievable number of letters--800,000--
that go out from the Department. The Under Secretary for
Benefits sends out two different packages with all the
information.
One of the things that I touted recently at a talk with the
military health system was the importance of grabbing the
reservists as they come back, and trying to make sure that they
get oriented.
I think we need to do a better job of reaching to their
families, because they are the ones-- particularly in the area
of mental health--that may be able to recognize an issue and
throw the flag, and encourage the soldier, sailor, airman or
Marine to come in for assistance.
So, I met just last night with the Oregon Adjutant General
to talk about issues. I look forward to engaging the TAGS when
they come into town about how to better reach National Guard
and Reserve populations.
But, with this opportunity to bring people in now with 5
years that gives us a chance, even if they are still getting
their benefit adjudicated--it does not rely on that--that we
can still get them into our system and give them the counseling
that they need, the care that they need. That is what we will
be focusing on, sir.
Chairman Akaka. Will you please provide the amount of
funding for outreach, for the record?
Secretary Peake. Sir, I will take that for the record.
Chairman Akaka. I have other questions, but let me first
ask for questions from our Ranking Member.
Senator Burr. Thank you, Mr. Chairman.
Secretary Peake, the Institute of Medicine issued a report
last year indicating that there was one kind of treatment for
PTSD, exposure therapy, that it found to be effective.
However, the IOM also found that the quality of research on
PTSD treatment as whole, and I quote their report, ``has not
received the level of research activity needed to support
conclusions about the potential benefits of treatment
modalities.'' And went on to say that the studies conducted for
nearly three decades, and again I quote, ``do not form a
cohesive body of evidence about what works and what does not
work.''
Now, given this criticism, I do not understand why the
budget proposes a $9.3 million reduction in research on mental
illness to a level that is even below the level found in 2007.
Can I ask you to comment or somebody to comment?
Secretary Peake. Yes, sir, you will notice that it still
is, in fact, the largest budget line in the resource portfolio
at $52 million or so, with the addition of substance abuse on
top of it, because I think these are all related. It starts to
get up toward a quarter of our resource portfolio.
We are also going to work very closely with DOD, which has
a big effort in this as well, and in fact, we will be proposing
a deputy to be part of General Sutton's task force in looking
at PTSD as we move forward.
As you know, we have centers around the VA that focus on
PTSD that really are paid for out of clinical funds, as well.
So, although I appreciate and, frankly, agree with the
Institute of Medicine--that we need to know more about PTSD,
mental health, all the co-morbid mental health conditions that
come together--I think we have a reasonably robust portfolio
that I think will give us the information that we need.
Senator Burr. General, let me ask specifically. How does
the VA intend to improve the quality of the research on PTSD so
that we have more evidence-based treatments available for our
veterans?
Secretary Peake. In the clinical environment where you are
taking care of people on protocol and measuring the results,
and with the ability to leverage our computerized patient
records, I think we can follow through with our patients and be
able to develop that kind of information so that we keep moving
the ball forward on that.
Senator Burr. I am not accusing the VA of focusing on a
single treatment, but clearly there are some red flags that we
are raising that we are not aggressively going after. I have
talked to Dr. Kussman and there are efforts being made; and I
commend you for that.
There are over 150 projects listed in your 5-year
department-wide major construction plan. All of these projects,
I would assume, are based on the Capital Asset Realignment for
Enhanced Services, CARES, analysis completed several years ago.
In North Carolina, however, CARES underestimated the
veteran demographics considerably; and I suspect that it is
already obsolete in other areas of the country as well.
Two specific questions. Is CARES still a valid blueprint on
which to base future capital funding decisions?
Secretary Peake. Well, sir, I think CARES is based
generally on 2004 data basically and I think that, as you
rightfully point out, some of the demographics have shifted. I
think it is the kind of thing that needs to be evaluated as we
move along.
In fact, when I asked about the CBOCs, an example, there
were 156 that were in the CARES program, 24 now we think
probably do not really fit the future needs. And when you look
at the 51 that are going to be done in 2009, there are probably
still 10 of the CARES that have not made the priority list.
So I think it is, like any plan, it never survives first
contact with the enemy, you know. But it is better to have a
plan that we can then march off of as we look and continue to
re-evaluate the needs and follow the migration of our veterans.
Senator Burr. I appreciate the fact that you are re-
evaluating.
One last question. I was disturbed, as I am sure you were
and everyone within the VA, to read the Inspector General's
report regarding the substandard care provided to a veteran at
the Salisbury VA Medical Center that may, and I stress may,
have cost him his life.
Let me quote from the IG's report. ``We have determined
that the patient's diagnostic testing was delayed on several
occasions and that providers missed multiple opportunities over
a period of years to diagnose colon cancer. Had providers
followed up with the appropriate colonoscopy surveillance
testing to remove polyps, it is possible that the patient's
developing colon cancer could have been detected and treated in
time to prevent metastatic disease.''
What quality assurance mechanisms are in place to ensure
that this type of mistake is not repeated?
Secretary Peake. Sir, there are a variety of quality
assurance mechanisms across the VA, to include our surgical
quality assurance, that look statistically at outcomes. At the
local level there are quality measures. I think our
computerized patient record is one of the things that will help
us move forward, where clinical reminders are appropriately
made available, where all the tests and all of the diagnostic
x-rays are available to the clinician and not being lost. So I
think there are many mechanisms in place to try to improve
that.
I do not know the specifics of the individual case and
perhaps, Mike, if you have a comment on that specific. I just
do not.
Dr. Kussman. Thank you, sir.
Senator Burr, as you know, that case goes back to 2005. The
IG came and looked at that and came back again, as you know, to
look at what had been put in place. A lot of things were put in
place at Salisbury and across our system to be sure this does
not happen again.
One of the things that I have instituted now is we have
been measuring a lot of things as outpatients and we have done
very well. The question is, well, what is actually going on in
our hospitals and things? And so we have now put in some new
performance measures to look at, if somebody needs a
colonoscopy, how long does it take for that colonoscopy to be
done? How long does it take if something is found in that
colonoscopy, how long does it take to get the definitive
procedures like a biopsy or further surgery.
We are also looking at how long it takes to get cataracts
done, hip replacements, knee replacements. We looked at high
volume procedures. So, we are starting to measure those just
like we measure the blood pressure and other things that people
have. So, there is a lot of effort to try to eliminate those
types of things from happening.
Senator Burr. I appreciate the efforts that you are making.
I thank the Chair.
Chairman Akaka. Thank you very much, Senator Burr.
Senator Murray.
Senator Murray. Thank you very much, Mr. Chairman.
Secretary Peake, last year Congress passed the Joshua Omvig
Suicide Prevention Act, which gave the VA some very important
tools to deal with the tragedy of suicide. This is something I
have been following very closely. I am deeply concerned about
and I am very saddened to hear that we are continuing to hear
about the increases in the number of suicides among our active
duty soldiers.
Yesterday, the AP reported on a VA study that found that
Guard and Reserve soldiers accounted for 53 percent of the
veterans' suicides from 2003 to the end of 2005. That statistic
really raised concerns for me because I know that members of
our Guard and Reserve oftentimes do not think of themselves as
veterans. They see themselves as going back--going back to
their same jobs--and sort of disassociate themselves from the
VA system.
What are we doing in particular to reach out and find those
Guard and Reserve soldiers who go back often to very remote
communities not associated with a military base on the ground?
The VA may not know of them. They may not think of themselves
as veterans. How are we going to get those Guard and Reserve
soldiers who are struggling today and as we see these increased
numbers of suicides, know that it is a population we need to
reach?
Secretary Peake. There were two great examples--one in
Minnesota and one in New Hampshire--where the Guard really
focused on pulling people back in. They got them home and then
they brought them back and had a chance to really get
integrated with the VA and all of the services that were
available to them.
I think that is the kind of effort that we dovetail with
when the units have their post-deployment health reassessment,
which is designed to come later rather than right away because
we know the propensity of soldiers to say, OK, let me fill this
out. I want to go home. We want to get to them after that.
Senator Murray. Is the DOD cooperating with you in trying
to find a way to go out and find these men and women so they do
not get lost?
Secretary Peake. Yes. As I was saying, I would like to find
a way to reach out even further than that, perhaps with calls
or whatever. We send letters, but as you know, that sometimes
winds up in file 13.
Senator Murray. For somebody who is sitting in a chair in a
remote community, a letter does not mean much.
Secretary Peake. The other is to reach their families and
do a family education because it is the family that will notice
something different. We know from the research that was done in
the military that it is the people that may need the help the
most that are least likely to assess it.
When we looked at the information that you reported from,
you mentioned yesterday that population that was looked at was
all the people that had separated. That is active and reserve.
That is about 50/50.
Senator Murray. Right.
Secretary Peake. So, it is not surprising that about half
and half in that particular group. So, it is not an alarming
big difference between the active and the reserves. It is still
significant. There were 144 deaths in that cohort that were due
to suicide and anyone of them is unacceptable.
But, going back to the Act--we have that suicide hot line.
They have had 23,000 calls. 250 of those calls were from active
duty people. We had about 400 rescues is what I understand just
from the suicide hot line piece of it.
We have had a teaching program so that everybody is aware
in our VA facilities. If somebody comes in, they get screened
not only for PTSD but for TBI and suicide tendencies. One of my
former officers told me that she went in and in the radiology
department they were asking her. She says, they are really
serious about this.
Senator Murray. I am glad to hear that and we need to stay
on top of this and we really need to think particularly about
Guard and Reserve soldier while reaching those men and women
out there.
Let me ask you another question. I called you a little over
a month about some serious issues that I had heard about
happening at the VA's Polytrauma Rehab Center in Palo Alto,
California. We have a reporter from KOMO News in Seattle that
had been chronicling the story of several families that had
gotten very poor treatment at the Polytrauma Rehab Center.
As you know, we have a number of men and women coming home
with serious head injuries. They are being sent to that. They
are being told that that is a premier facility and I have to
tell you, it is pretty disheartening for me to watch that news
story and hear that one of the mothers of a young soldier who
had been treated there said if that is premier, then I do not
know what the worst is, honestly. I mean those really stab at
the heart of all of us who want to make sure every one of those
men and women are treated to the best of our ability and are
not forgotten and really treated quickly, fast and with the
best care possible.
I called you about that probably 5 or 6 weeks ago now and
you told me that you were going to look into it and I wanted to
ask you today, for the record before this Committee, what has
happened now at Palo Alto and what are we doing to make sure
that does not happen again?
Secretary Peake. First of all, we acknowledge that there
were some issues. These were cases back in October, as I
understand it,
Senator Murray. Right.
Secretary Peake. And to my knowledge we have not had new
instances.
There was a hard look at what was going on out there. I
think there were some staffing issues. There was a 16-point
plan put in place. One of the issues was leadership. We have a
new director that has now been identified who will be starting
in April who is already making rounds there.
In the 16 initiatives, they range from policy and
procedures to new hiring to training. We have had folks rotate
actually back to Bethesda and Walter Reed. So, they actually
get a sense of where these Soldiers, Sailors, Airmen and
Marines are coming from. So, what was laid out by Dr. Kussman
and his team I think was a good plan and my sense is that it is
moving forward.
Senator Murray. OK. So you have evaluated the situation.
You have hired new leadership. They are going to be there in
April. Meanwhile, if somebody has a brother or a son or someone
who is at the trauma center today, what kind of care are they
getting?
Secretary Peake. I think they are getting excellent care.
As I understand it now, we are back up to full capacity. That
was one of the issues.
Senator Murray. That was one of the issues.
Secretary Peake. They were down and they are up. There was
some question about whether they were cherry picking. I think
there is no suggestion that that is going on now, and so I have
confidence. This is one of our four polytrauma centers.
Senator Murray. Right.
Secretary Peake. And so, it is really important to us that
we do it right.
Senator Murray. I really appreciate that. I am going to
continue to follow this and would love to have a chance to talk
with you again in a few months when your new leadership is in
place; because, as you know, with our Soldiers coming home with
brain injury, we do not want to listen to any parent tell us
that they got less than desirable care. Some of these stories
were pretty horrible.
Secretary Peake. I went out to Bethesda. It was a soldier
that had actually returned to Bethesda from Palo Alto. I spoke
to his wife, so I have a first-hand view of her concerns, as
well.
Senator Murray. Good. One of the things that I am hearing
from parents or spouses of someone who has TBI is, that the
sooner they get the good care to really help their brain
function better is critically important. So, leaving anybody
without care is really disheartening to all of us who want to
make sure we do the right thing.
Secretary Peake. Part of it is being able to care for a
family in distress; that is part of this, as well.
Unfortunately, perception is reality; so we want to--need to--
make sure that we make sure that we wrap our arms around them
as well.
Senator Murray. OK. I really appreciate your direct
attention to that.
I also wanted to ask you about the massive cuts to the
major and minor construction programs in the President's budget
that has been submitted. As you know well, the VA's
infrastructure across the country is well over 50 years old.
There are a lot of really serious upgrades that are needed.
I know in my home State we have four projects that are on
the VA's priority list, two of them are in Seattle and ranked
at No. 4 and No. 5 and they are not going to receive any money
because of such a low number request in this year's budget.
We have important projects at American Lake, at Walla Walla
VA where you are going to be visiting next week. How do we
expect the VA to meet their goals when the Administration cuts
the construction budget in half?
Secretary Peake. Well, we have to responsibly prioritize
against the requirements as we see them. American Lakes, I
understand that we are funding that at about $38 million as I
recall the number.
You are right about there being an aging infrastructure. I
think on average it is 57 years old. We have put money this
year into the maintenance piece of it that will hopefully keep
us eating into our backlog rather than just staying stable with
it.
Senator Murray. Actually in the budget document it is zero
for American Lake.
Secretary Peake. Let me get back to you for the record,
ma'am.
Senator Murray. I really really appreciate that.
Secretary Peake. Because I believe we have money--at least
in design--to move that project along.
Senator Murray. OK. On the documents we have it listed as
zero.
Thank you very much, Mr. Chairman.
Chairman Akaka. Thank you, Senator Murray.
Senator Tester.
Senator Tester. Thank you, Mr. Chairman.
We have another panel coming up that has representatives
from the VSOs and I would love to get their opinion on the
first question I have to ask. It deals with Priority 8 vets.
These are veterans who have no service-connected injury. In
Montana they are classified as Priority 8 if they make over
$27,000 a year. I know that varies around the country.
My question is--it is an issue of fairness as far as I am
concerned and I hear about it a lot when I go back to Montana--
do you think when the guys or gals were recruited that they
were told they were not going to get benefits if they made too
much money?
Secretary Peake. Well, sir, I would tell you that our
priority, I think, is appropriately for those with service-
connected disabilities; those with special needs; and those who
really have a significant economic need. Whether $27,000 is the
right number--I do not really know if that is the right
number--I do think that it is appropriate that we focus on
those that really have the needs that were consequent to their
service to this Nation.
Senator Tester. I could not disagree with that, Mr.
Secretary, and I think that is the right priority, so to speak.
But in all fairness, and I will just say this for the record,
that I think the Priority 8 vets ought to get the benefits,
too. I do not care if they are making $100,000 a year. I think
it is important that we live up to our promise to folks who
protect this country, and it is just that simple for me.
I want to talk about budget construction for just a second.
If you could very briefly--because I know you could go on for
probably hours on this--but how do you construct a budget? Does
the President give you a bottom line that you have to live
under and then you go line-item by line-item and move money
around? How do you construct this budget? And it was probably
done before you got here; so, if you could tell me how your
predecessor did it, it would be great. Or anybody?
Secretary Peake. Let me ask Mr. Henke to talk about the
construction.
Senator Tester. As concise as you can because budgets tend
to get rather weighty. So, if you could just give me how you do
it?
Mr. Henke. Yes, sir. We began the process in the summer of
last year bringing it to conclusion with OMB and the
Administration in November. We do not have a fixed cap total.
We model very accurately the demand for health care and bring
that forward and have extended discussions with the
Administration at the end of the year.
But, there is no ``control total'' to hit that we must live
under. There is no fixed point under which we must come.
Senator Tester. Sir, I understand the benefits portions--
getting the money to the ground for the veterans is critically
important--but oversight helps ensure that it happens, that the
benefits actually get to the veterans on the ground.
There is a $4 million cut to the IG. What is the thought
process on that? Because you have got a huge agency that, as I
said before, does really good work. We want to make sure it
does. I cannot oversee you. I oversee your budget. I cannot,
other than what veterans tell me on the ground, know what is
really going on.
Can you tell me why you cut the IG $4 million?
Mr. Henke. Well, sir, the $4 million cut is from what was
plussed up last year in the contingent emergency funding.
Without the emergency funding it shows a bit of a growth. The
IG has the ability to carry over some funding into 2009. We
will have to understand what the funding impact might be in
2009, but it certainly is not because we do not believe the IG
is a very important element.
Senator Tester. So, what you are saying is that with the $4
million cut the IG is still going to have plenty of flexibility
to go out and determine if the job is being done to the best of
their ability?
Mr. Henke. I will count on them to do that, and I believe
they will have the resources to do that.
Senator Tester. OK. In your opening comments, Secretary
Peake, you talked about, in regard to the enrollment fees, you
said that you were going to charge the fees because retired
military had to pay the fees for TRICARE. Is that what I heard?
Secretary Peake. What I said is, one of the rationales for
charging fees in the first place is an issue of equity. I
pulled the pay table for Sergeant Major E9 with 28 years of
service, and I think it is $3,999 a month. So, if you multiply
that out, it is $48,000 a year. That soldier, who spent 28
years of his life serving his country--maybe multiple tours in
Iraq or whatever--will pay $460 a year for his family as an
enrollment fee for TRICARE for like services.
So, to say that a veteran who is a Priority 8, as an
example, should not pay an enrollment fee who is making $50,000
(which is what it would be); this does not quite seem right.
Senator Tester. But the Priority 8 is not eligible at all.
Secretary Peake. We have some in our system, Priority 7s
and 8s. They are the only people that will be affected by this
enrollment fee.
Senator Tester. The Priority 8s?
Secretary Peake. Yes, 7s and 8s.
Senator Tester. Thank you. I am out of time. I will pass it
on.
Chairman Akaka. Thank you, Senator Tester. We will have
another round.
Senator Sanders.
STATEMENT OF HON. BERNARD SANDERS,
U.S. SENATOR FROM VERMONT
Senator Sanders. Thank you, Mr. Chairman. I apologize for
being late but I was presiding.
First, Dr. Peake, let me thank you. I know that in the
Veterans' Affairs Committee we put a sum of money to make sure
that travel reimbursement rates went up. Senator Tester and I
and others wrote you asking to implement that policy and you
did. And I can tell you that in the State of Vermont there is a
lot appreciation for that. So, I am glad we were able to move
quickly on that.
My line of questioning is going to be pretty simple and
that is to say that any objective look at what is going on in
terms of the needs of our veterans right now suggests that we
cannot pursue a course of policy which is normal--because these
are not normal times.
We have some 29,000 soldiers who have been wounded in Iraq,
many of them seriously. We have--God only knows how many--
soldiers who are going to come home with TBI, but we expect
that tens of thousands of those returning will need to be
diagnosed and treated.
Senator Murray and others have talked about the rates of
suicides which are appallingly high and all of us are concerned
about how we do a better job in preventing that.
On top of all of that we have a situation with our older
veterans, where our waiting lines are extremely long and people
are not getting into the hospitals or clinics in a timely
manner. It takes far too long for many of the claims to be
processed for our veterans. That is what we are facing.
And I do not have to tell you, Mr. Secretary, although you
are new to your job, that Members on this Committee feel that
there is something very very wrong when we have a President who
thinks it is OK to give hundreds of billions of dollars in tax
breaks to the wealthiest 1 percent, but we cannot find a few
billion dollars to begin to address these issues.
I am disturbed. We made some real progress, Mr. Chairman--
and I thank you very much for your leadership on this--in
producing the largest increase in funding for the VA in the
history of that agency. And as you know--I do not mean to be
terribly political here--we had to do this fighting the
Administration.
Now, we are back this year with all of these problems out
there, with PTSD, with TBI, with waiting lists, with claims
backlog; and the President has come forth with a 3.9 percent
increase for the year knowing that all of these problems are
looking at us; staring us in the face. We also know the cost of
medical inflation is very high. We know you are going to have
to hire thousands of doctors and nurses and psychologists and
other people.
So, my first question is, given the enormous problems
facing the VA, why has the President given us a budget that
calls for only a 3.9 percent increase?
Secretary Peake. Well, sir, if you look at the medical
aspect of it in terms of the increase, it is more like 5.8
percent. Medical inflation is about 4.63 percent. So, it is a
real growth of maybe close to 1.2 percent. I understand that
that is where we are.
We were fortunate to have the plus up that we had this last
year because it gave us a chance to do some one timers that
needed to be done. And we got the ability, I think, with the
budget that we have to sustain those, as well as, to move
forward in the area of outreach, as an example. And I owe the
chairman a more detailed breakdown of that.
But I think it starts to sustain the important advances
that we have made and allows us to consolidate. I think we will
continue to do the hiring that we talked about and the budget
is on target for that goal.
Senator Sanders. But you talked about the medical side of
your budget getting an increase. But, everything being equal,
if last year's load was the same as this year's load, we are
talking about not only the old--and I think we are all in
agreement that we are not going to forget about the older
veterans----
Secretary Peake. Right.
Senator Sanders. But, you have all the guys and women
coming home with PTSD and TBI. I think common sense would
suggest that in order to address that need, you are going to
need a budget a heck of a lot larger.
I would point out that we are spending, Mr. Chairman, about
$12, $14 billion a month--a month--in Iraq fighting that war;
and it disturbs me that we cannot come up with a fraction of
what we spend in a month to make sure that we take care of the
people who fought that war.
Do you have any additional thoughts on that?
Secretary Peake. Except to say, sir, that we are looking at
a 14 percent increase in the number of OEF/OIF people that we
think are going to come to us; and we have been very careful
not to underestimate that. But, we have already programmed a 21
percent increase in what we expect to expend on that group of
people.
So, I think we are, again, sir, we are trying to put the
money where the priority is appropriately; and make sure we do
not drop the ball on this important cohort of people; and we
will still take care of our older veterans.
Senator Sanders. And you think this budget will enable us
to appropriately take care of our older veterans and deal with
the huge increase in caseload that the VA is going to
experience?
Secretary Peake. Overall our caseload increase we expect to
be about 1.6 percent above what our current 2008 estimate is.
Senator Sanders. Is there not some dispute about the
accuracy of those estimates?
Secretary Peake. Sir, my understanding is that we have in
the past--some years ago--been as much as 5 or 6 percent off,
and I know that some of it was out of model. Probably because
of the scrutiny of this Committee, I think we have gotten a lot
better at that. And, as I look at the variances, it really is
starting to get tighter.
I think we are doing a better job of forecasting and, you
know, I believe that--and we should be held accountable that
way.
Senator Sanders. I think it would be a tragedy if, for
whatever reason, the VA underestimated the kind of caseload
that it would get and then requested less money than, in fact,
you will end up needing.
So, again, do you think that you have the money to
adequately treat our older veterans and the people coming home
from Iraq and Afghanistan?
Secretary Peake. I do, sir.
Senator Sanders. OK. We may have a disagreement on that,
but let me ask you this then about the fees and the co-pays. My
understanding is that one of the goals, frankly, of increasing
fees is essentially to drive veterans away from the VA system;
to lower the caseload; to say, you are going to be paying more
for your prescriptions or if you are a veteran with a family
income of $50,000 to $75,000; you are either going to pay $250,
or if you have a higher income, your fee will be up to $500. I
think it is quite obvious that a lot of veterans who are hard-
pressed financially will say, I am not going to go into the VA.
Is that the goal: to drive away--and by the way I understand
this is not your invention. This has been going on year after
year. And year after year, of course, the Congress throws this
in the garbage can where it should be thrown.
It is an absurd proposal. And I have to say that the idea
of raising revenue from veterans who have put their lives on
the line defending this country to pay off our deficit--when at
the same time giving tax breaks to billionaires--is literally
beyond comprehension.
Do you have any comment on that, Secretary Peake? Sir, the
estimates are that about 144,000 Priority 8 folks in our system
would choose to not pay the fee.
So, I think, yes, there are some that would go out and our
estimate also is that those are people that already have health
insurance elsewhere. And I know that is an older study, but I
think the number was about 90 percent would have other health
insurance.
Senator Sanders. Some may but some may not. And I think
just to push people outside of the system, to push one veteran
outside the system because he cannot afford the fee is really
outrageous. But we do not have to discuss that too much because
that proposal is going to go nowhere, and it should go nowhere.
I want to get back to Senator Tester's observation about
Priority 8s; and it is, again, the same principle. We have in
the State of Vermont many veterans who served their country who
expected to be able to access VA health care who make more than
$27,000 a year. And as you know, 3 or 4 years ago President
Bush threw these people off of VA health care.
Secretary Peake. It was 2003. Secretary Principi made the
decision because of----
Senator Sanders. Because of what? We cannot afford tax
breaks for the rich and keep veterans in our health care
system?
Secretary Peake. Well, sir, actually part of the issue is
the ability to make sure that we can take care of priority
veterans: those with service-connected disabilities; those with
special needs; those with really means-tested shortfalls.
Senator Sanders. Mr. Secretary, I understand that. We have
heard that very often. And the question is, can we do both? I
think we can. It is not a question of prioritizing. Sure.
Everybody here understands that we want to pay rapt attention,
do everything we can, for those who are coming back.
I do not know necessarily that it has to be an either/or.
Some of us believe that we have the capability and you are
seeing a Committee that wants to do both. We are telling you we
have the money to do that and I will. And I know, Mr. Chairman,
we have had success in this Committee trying to bring Priority
8s back into the VA system. We intend to do that.
My last question, if I might. There has been a tension, to
be very frank--trying not to be political but being very
frank--between the White House and many of us in Congress. And
we have, last year, given you a very ample budget against--I
have to say it--what the White House had requested.
So, you are in this difficult position of being forced to
accept more money than your boss wanted you to have.
[Laughter.]
Many people would very happy to be in that situation, but
you are in a difficult position. I would simply hope, and maybe
get a thought from you. We have given you the money. We want
that money to be spent cost effectively and we want it to do
the job that we have outlined. The needs are so, so great out
there--with the older veterans and the newer veterans--it is
not easy because you are going to have to hire so many people
and do a lot of reorganization.
Can you tell us very briefly how you are going to be doing
that?
Secretary Peake. Yes, sir. Well, you are right that when
you are ramping up, as was brought up earlier, that presents
some challenges. I think some of the opportunities that we have
been given with the physicians' pay bill and so forth allow us
to be more competitive so we are able to see that.
The other good thing about that is that we are seeing an
increase retention. So instead of a 9 percent loss, we wind up
with a 4 percent loss in terms of attrition. So those are all
positive things that I think are going to allow us to move
forward with this money that we have been getting.
Senator Sanders. Are you making, and this is a difficult
issue for the whole health care system not just the VA, but are
you making progress in getting the nurses you need,
psychologists, psychiatrists, physicians?
Secretary Peake. Yes, we are. We are making progress and I
was just looking at some of the other tools that we have in
relation to the personnel and that includes loan forgiveness
and by 2012 we will have like $100 million in loan forgiveness.
We have some scholarship programs that we have been able to
do and we have quite a number of folks in various scholarship
programs.
Senator Sanders. I would love the opportunity. I will give
you a ring and maybe we can chat.
Secretary Peake. Very good.
Senator Sanders. Thank you, Mr. Chairman, whoever the
chairman may be.
Senator Webb, you are the Chair.
Senator Webb [presiding]. We may have a GI Bill by the time
he gets back. [Laughter.]
STATEMENT OF HON. JIM WEBB,
U.S. SENATOR FROM VIRGINIA
I apologize for the late entry here. I have had a Foreign
Relations Committee meeting with Secretary Rice in Armed
Services and another event and then a vote. This is a very
important Committee to be on and these issues I care a lot
about.
I obviously note that the funding in this bill for enhanced
educational benefits is not what we would have expected. I do
not know if you had a question on that before I arrived or not?
Secretary Peake. I have not.
Senator Webb. Would you address that issue?
Secretary Peake. Well, with our voc rehab and education
programs, you will see a drop in manpower of about six, I
think, that really is our headquarters. We have another 53
people going out into the field in our voc rehab that, in fact,
with some of the restructuring that Admiral Cooper is doing, we
will have another 40, I think, out into the field in terms of
our voc rehab counseling and so forth.
Senator Webb. What about educational benefits writ large,
for instance, an enhanced GI Bill? Do you have any planning for
that in this budget?
Secretary Peake. Well, not in this budget and we need to
work with DOD on that. It is where the resources would actually
come from for that.
Senator Webb. You mean in terms of manpower resources to do
it? You are assuming this would come out of Title 10 funding?
Secretary Peake. We wind up administering that benefit, as
I understand it, rather than entirely funding that benefit
ourselves.
Senator Webb. Has that traditionally been true, staff?
Mr. Towers. Yes, sir, that is correct.
Senator Webb. I am talking about GI Bills in the past?
Mr. Towers. Typical GI Bill.
Senator Webb. Typical GI Bill.
Mr. Cooper. The GI Bill that we have now----
Senator Webb. For instance, the World War II GI Bill.
Mr. Towers. Yes, sir. I understand.
Senator Webb. Who paid for the World War II GI Bill?
Mr. Cooper. I cannot answer that question.
Senator Webb. How about the Vietnam GI Bill?
Mr. Cooper. The GI Bill we have right now--the Montgomery
GI Bill--that is in mandatory funding. The money under the
current GI Bill the individual pays, as you know, $1200 in the
first year to become eligible. And then DOD tells us those who
are eligible to execute that bill.
Senator Webb. Right. I mean, DOD tells you who is eligible
to get a veteran benefit, per se, by the character of the
discharge. It does not necessarily mean that DOD will fund
veterans benefits.
Mr. Cooper. Yes, sir.
Senator Webb. It has been my experience in the past that
the VA pays for the title 38 benefits.
Mr. Cooper. We pay for title 38 benefits, yes.
Senator Webb. This would be a title 38 benefit.
Mr. Cooper. That is correct.
Senator Webb. Then you would pay.
Mr. Cooper. There is nothing in the budget.
Senator Webb. Secretary Peake, I would like your thoughts
on the Dole-Shalala formula for characterizing disability. I
had some questions about that when Senator Dole and Secretary
Shalala were testifying. Specifically, how you would work
together with DOD if they are simply characterizing someone as
no longer being fit for active duty service. How is that going
to work?
Secretary Peake. We have a pilot that is going on now; and,
again, this is just a pilot, not a full implementation of what
Dole-Shalala has recommended.
The issue is that the pilot says that the Department of
Defense will determine--and the service specifically will
determine--fitness for duty. That fitness, when that
determination is going to be made, then we would do a full
examination. The VA would do the full examination to find
whatever claimable conditions might be there and adjudicate
those.
One of those claimed conditions would be the unfitting
condition that then we would give that number, how we
adjudicated that particular unfitting condition and that would
be the percent that DOD would use to determine whether that
servicemember was either medically retired or separated with a
severance payment. That is the 30 percent issue.
What Dole-Shalala would say is that any soldier that is
determined to be unfit would get an annuity based on their
time, grade, years of service and so forth, regardless of what
the percentage would be.
We would then pay the benefit based on whatever percentage
we wind up adjudicating. So it would be totally separate. So
the pilot program is kind of a hybrid right now. The Dole-
Shalala would pay a transition.
Senator Webb. So you are talking present law, pilot and
where this might go. You are talking about three separate
issues.
Secretary Peake. Exactly.
Senator Webb. There is present law, DOD will adjudicate a
percentage and the VA makes a separate determination basically?
Secretary Peake. Right.
Senator Webb. So where are you going to go on this?
Here is a thought that I have. Someone is either going to
be given a severance from the military without knowing the
percentage that they are going to receive or they are going to
be adjudicated by the VA before they are discharged?
Secretary Peake. If we can break it down. The way it
currently works is, you go to a medical board. They
theoretically use the VA schedule of rating to make that
determination on only the unfitting condition. That then
determines whether you are retired medically or whether you get
a severance pay and are separated.
In the future with Dole-Shalala if it were to go the full
Dole-Shalala approach--you would go before the Board and you
would be determined whether you are fit or unfit regardless of
the rating. And if you are unfit, you get an annuity based on
your time in service and grade.
Then you get your full adjudication of all of your
potentially claimable conditions by the VA and you get your
benefits from the VA based on that. Those benefits would be
really three different kinds. One is quality of life that would
need to be sorted out. Another would be an earnings; and then
another would be a transition payment that could be either 3
months' worth of pay, or like a stipend for a year in training
or education.
Senator Webb. So, you would receive an annuity based on
your time in the military. Let us say you are 100 percent, you
are fully disabled it would not----
Secretary Peake. It would not make any difference.
Senator Webb. It would not show up in the annuity that you
would receive?
Secretary Peake. That is correct.
Senator Webb. Or, if you were 10 percent you are going to
get an annuity for the rest of your life based on time and
grade.
Secretary Peake. It has nothing to do with the percent.
Senator Webb. I understand. Let us say if you have someone
who is getting out after 5 years and they have a condition that
eventually is going to be adjudicated as 10 percent. As long as
they have been characterized as unable to perform their
military duties, they are going to get an annuity based on 5
years?
Secretary Peake. Correct.
Senator Webb. Have you priced that out?
Secretary Peake. I have not seen the full pricing of that.
Senator Webb. It would be interesting to see. Do you have
any percentages on the number of people now coming out of, say,
Iraq/Afghanistan who are getting some small percentage?
Secretary Peake. Yes.
Senator Webb. What would be the percentage of that force?
Secretary Peake. Let me ask Admiral Cooper. We just looked
at that the other day. There are about 290,000 people, I think,
that had been adjudicated, that have a claim and the numbers
that were less than 10 percent. We have that number for you,
sir.
Mr. Cooper. The total number of people coming out of Iraq
and Afghanistan who have filed a claim is 258,000 out of
800,000 that are now veterans. Out of 800,000 veterans,
258,000----
Senator Webb. Approximately one-third?
Mr. Cooper. Approximately one-third, yes, sir.
Senator Webb. And of those, how many of those--what
percentage of those are being adjudicated as having a claim of
at least 10 percent, having a disability of at least 10
percent?
Mr. Cooper. About 80 percent that are 10 percent and above.
Senator Webb. So, basically one-quarter of those who have
become veterans have claims that have been adjudicated
favorably at 10 percent or higher?
Mr. Cooper. Yes, sir. But that does not necessarily qualify
them as fit or unfit.
Secretary Peake. They may be fit.
Mr. Cooper. As a matter of fact, the No. 1 disability that
we have adjudicated is tinnitus.
Senator Webb. Tendinitis.
Mr. Cooper. Tinnitus--ringing in the ear.
Senator Webb. I have that problem. That is why I cannot
understand the word.
[Laughter.]
Mr. Cooper. Sir, the fact is of all those GWOT veterans
that we have adjudicated, about 80 percent are 10 percent or
above, but very few of those will have the condition that is
limiting.
Senator Webb. You are not estimating that up to 25 percent
of the people serving are going to be adjudicated as unfit for
further military service by DOD before you make the
determination?
Mr. Cooper. That is correct.
Secretary Peake. Many of these folks are reservists still.
You come out, you get a DD-214. You can claim, and if you go
back into the service, you stop getting paid while you are in
the service and then it starts up again when you come back out
if you have a compensable condition.
Senator Webb. I understand under present--in fact, I have a
close family friend who just had that happen to him. Four years
in the Marine Corps, was adjudicated 20 percent. He has just
been called back in the recent call-up and I think he is
probably going to re-enlist, but he has been adjudicated.
I am really curious as to how this transition is going to
work in terms of when you go to an annuity. If you have some
projections--I do not want to take anymore time with this, but
if you have some projections, it would be interesting to look
at those.
Secretary Peake. Let me go back for the record and report
on that in terms of the scoring.
Senator Webb. Senator Murray, I am happy to yield the gavel
back to you.
Senator Murray [presiding]. Yes, Mr. Chairman. Absolutely.
Thank you very much.
Mr. Secretary, thank you. I think Chairman Akaka is on his
way back here. He will be here in a minute, but I did have a
couple of other questions.
Last year, as you know, we did pass the Wounded Warriors
Act as part of the Defense Authorization Bill. It has been
signed into law. A bill, that as you know, made a lot of very
important improvements for our servicemembers as they
transition from the military into the VA including extending
the period of automatic VA eligibility for returning
servicemembers from 2 to 5 years.
However, as I looked through the budget, I did not see any
requests from the VA for additional funding for that extension
or any other legislative requirements that were included in the
Wounded Warrior Act.
Can you tell me how the Administration is proposing to pay
for the cost of extending the VA eligibility?
Secretary Peake. We are estimating overall a 21 percent
increase in what we believe we would need to expend on the 14
percent increase in those that we think will seek our care. So,
we think that we have that covered within our numbers now.
Senator Murray. Are you taking it from something else?
Secretary Peake. Well, it is within the budget if that is
what you mean particularly. We are not taking it from--it is
part of the health care budget. We were not disenrolling any of
those. Even those we were seeing for 2 years, we were not
disenrolling them. We are treating them as Priority 6s.
Senator Murray. What about the other recommendations of the
Dole-Shalala Commission that you are implementing? Where are
you going to get the money to cover those costs?
Secretary Peake. As an example, for the Federal Recovery
Coordinators, they are hired and they are built into our
budget.
Senator Murray. You believe you have enough resources to
enact all provisions of the Dole-Shalala Commission as well?
Secretary Peake. Well, we will need some other legislative
authority to do all the provisions of Dole-Shalala. But, those
things that we can do administratively; we have the resources.
Senator Murray. Do you anticipate asking us for additional
resources as we see what the cost of those are as those things
are implemented?
Secretary Peake. If we have to, in terms of changing the
disability system, as an example, I think we would need to. As
Senator Webb was talking about, we need to get that squared out
and understand. Once we get the studies in, which we have
started, we have contracted to do two studies so that we can
try to understand better what the issues of quality of life
would be, and the issues of the transition payments, and the
earnings issues.
Senator Murray. OK. We had several high-profile cases of
data breach, as you will recall, in 2006; and after that, we
passed a law laying out how we expect the Department to handle
those kinds of events. The requirements of that included an
analysis of the breach by an outside expert or the IG and the
provision of services such as credit monitoring and victim
assistance if individuals were deemed to be at risk, and
reporting back to Congress.
Can you tell me how many breaches have been reported since
this law was enacted? Does anybody have that?
Secretary Peake. Let me ask General Howard if he has that
specific data. I do not.
Mr. Howard. Ma'am, there have been several large ones. For
example, you recall the Birmingham incident.
Senator Murray. Yes.
Mr. Howard. That for sure is one. There have been a lot of
them, but most of them have been very small.
With respect to the provision in the law, we now have a
contract on the shelf that can be used, if we need to, in order
to comply with the law for independent risk assessment. We have
not done that to date, though.
Senator Murray. OK. Are we following the provisions of the
law that require credit monitoring for anybody?
Mr. Howard. Yes, we are.
Senator Murray. And reporting back to Congress.
Mr. Howard. We do two things. First, when we have an
incident, we immediately assess, you know, whether or not
individuals may have been harmed. If there is any inclination
at all that has happened, we immediately notify them. And then
under further review if we believe they should be awarded
credit protection, we also send a letter out to them and they
can opt in for that if they desire.
Senator Murray. Thank you very much. One final question.
Dr. Peake, in the President's State of the Union address,
he called on Congress to allow U.S. troops to transfer their
unused education benefits to family members. But I noticed in
the budget he did not ask for any money for it. We are being
told that it will cost anywhere between $1 and $2 billion
dollars. So I am left wondering where the President's sincerity
is in requesting us to do something when he did not ask the
money for it or not. I am wondering if you could share with us
why there is no additional request for the cost of that in the
budget proposal. That would be helpful.
Secretary Peake. My understanding is that would be a DOD
cost as opposed to VA cost. However, we have been doing this
for the Army. We have done some 300 families. And from our
perspective, we will be able to implement that whenever the
time comes; and we think it is a good thing.
Senator Murray. OK. Very good, thank you.
Mr. Chairman.
Chairman Akaka [presiding]. Thank you very much.
Mr. Secretary, this question builds on what Senator Murray
and I talked about a moment ago.
You state that the President's top priority is to enact the
recommendations of the Dole-Shalala Commission. You added that
Congress needs to pass the President's legislation. I continue
to have reservations about the President's proposal regarding
the disability compensation system.
I can assure you that Congress is doing its due diligence,
but we will not pass legislation until we are satisfied that
such legislation is appropriate for all veterans.
This Committee has held two hearings on veterans'
disability compensation already this session. Another one is
scheduled for later this month.
I also will add that VA has initiated its own studies to
determine appropriate payment levels for quality of life,
transition assistance, and loss of earnings. I believe that
Congress would be in dereliction of its duty to pass
legislation to reform the disability compensation system
without knowing the outcome of these studies.
I want to continue on the topic of compensation and what
can be accomplished in the short term.
We have high expectations for VBA to improve upon the
quality and timeliness of claims decisions. Last year, Congress
was able to increase staffing for this.
Can you tell us when veterans can expect to see results
from this significant investment in manpower? Is there
something more that Congress can provide?
Secretary Peake. Sir, I think you will, given the training
program and the efforts that Admiral Cooper has made in
bringing people on board, we are already starting to see, I
think, a change in those numbers. We expect that it will be
down to 169 days by the end of this year, 145 by the end of
2009. I think we need to move forward with the paperless
process.
We have put an RFI out to get industry input on rules-based
engines. We have a systems integrator that will be hired to
help us look at restructuring how we are doing business.
If you walk through the BVA mail room, I mean, it is like
stepping back into the 1950's and it is not the way we can do
it in an industrial age. And so we are going to need to figure
that out and make the investment to get to a paperless
environment.
I think also, sir, that this issue, we do need to figure
out how to simplify our disability system. When it takes 2
years, 3 years to train somebody adequately to be able to
adjudicate a claim, it is not because they are not bad people
or not smart or anything like that, it means our system is too
complex.
And so I think it is a combination of things, but we have
to get moving on it.
Chairman Akaka. Thank you.
Secretary Peake, I would like to revisit the issue of
Priority 8 veterans. You mentioned that you were unsure if the
current threshold is high enough or not enough. You have the
authority to raise this threshold.
So my question to you is, is this something that you are
considering?
Secretary Peake. Sir, I would tell you that I am certainly
willing to look at it and consider it and I will do so and work
with the Committee on it.
Chairman Akaka. Thank you. I have further questions, but
let me call on Senator Burr.
Senator Burr. Thank you, Mr. Chairman. I only have one
additional question and it is specifically on the VA proposed
budget which requests additional staff to decide disability
claims, process education claims, to litigate, and decide
appeals. But, General, it does not seek additional staffing for
vocational rehab and employment programs. As I mentioned
previously in my statement, I think the focus of the VA should
be on recovery, rehabilitation and returning veterans with
disabilities to the most productive lives we can offer.
So, I would ask whether you think the VA has placed enough
emphasis on this VBA program which, in my view, most closely
aligns with what I think are the goals of the agency and this
Committee.
Secretary Peake. Sir, I agree with your assessment that the
voc rehab and education is one of the things that we really
need to be moving forward. We have too many people that drop
out of it once we get started.
To your first point, sir, there is a headquarters
reduction, but there is a field increase of about 53 people. I
think that we need to make sure that our veterans have more
access to that; and that we look at ways to keep people in
those programs and measure the outcomes in terms of careers and
employment, and not just measure people in the process.
So, it is one of the first briefings I asked to have when I
got to the VA, and it is one that will take an increasing
priority in terms of focus.
Senator Burr. General, I want to take this opportunity to
thank you for responding to the President's request. More
importantly, for the team that you have got assembled around
you of incredibly talented folks that, in many cases, have to
come up here and listen to us rant and rave--some legitimate;
some rantings, quite honestly, none of us will ever figure out
the exact reasons.
But, the fact is that not a day goes past that I do not
think that everyone that is assembled at the VA is focused on
exactly what each is there for, and that is: to serve the
veteran in the most effective way possible.
We ask you to do an impossible thing, and that is: to
project what the future is going to look like--the future
caseload, the future patient mix, the future disabilities that
VA beneficiaries are going to have. It is impossible. We do not
expect it to be perfect.
I hope, collectively, we can begin to make the types of
reforms that I think we would all agree have to be made in any
health care delivery system. And I think it is vitally
important that we understand what it costs us and the length of
time to do a colonoscopy at the VA and what it costs and how
long it takes to do a colonoscopy in the private sector. And if
there is a discrepancy that is major or minor, then we ought to
ask ourselves, are they doing it wrong or are we doing it
wrong?
Maybe we can find some things to replicate and that is what
I am encouraged about is that in every area of the Veterans
Administration, I am seeing people who are searching for what
the answer is to providing that quality care at the most
efficient, effective cost they can find.
I think clearly, as we go forward, you know I am passionate
about looking at the disability system and trying to
collectively come up with something that is understandable, not
just for us, for veterans.
But also to work with Dr. Kussman as we begin to map out
what the VA health care delivery system will look like in the
future and what makes sense based upon the way we treat people
today and a sensitivity as to where they live and how they can
best access the services as more and more of our Guard and
Reserve happen not to come from urban areas but from rural
areas.
This is going to be a challenge. My hope is that there is
not as much pressure on the transportation needs of veterans in
the future because we have been able to redefine how we deliver
medical services in a way that they do not have to go that far.
And my hope is that the Congress will be a partner with the
Veterans Administration for this.
I thank each one of you for your willingness to be here
today and I thank the Chairman for his leadership on this
Committee.
Chairman Akaka. I thank our Ranking Member here; and he did
not have to say it, for his passion about VA issues. And I
certainly am glad he is here, and I look forward to working
with him.
I would now like to ask Under Secretary Tuerk a question.
You came to Hawaii last year to advise Senator Inouye and me on
a planned expansion to the Columbarium space at Punchbowl.
My question to you is, is that still on track?
Mr. Tuerk. Yes, Mr. Chairman, I am glad to have the
opportunity to update you on that. The first phase of that
project, where we intend to spend some $3.7 million to add
3,385 new niches to the Columbarium at the Punchbowl, is on
track. We anticipate awarding a contract this September,
committing 2008 funds to this project. Subsequently, we will
proceed up the existing Columbarium, up toward the rim of the
crater. So my short answer, Senator, is, yes, we are on track.
We are moving right now to begin the first phase of the
expansion. And I am here to assure you again there will not be
any interruption of service at the Punchbowl.
Chairman Akaka. Well, thank you so much for that.
Mr. Secretary, I want to thank you profusely for your
testimony, your answers to our questions, and thank you for
what you are doing as Secretary of VA.
I also want to thank your Under Secretaries who are present
here for what they are doing. There is a difference now in how
we are facing the budget here today.
So, I am looking forward to working with you and with the
Committee on this, and together I know we can do a good job in
providing the best services we can to our veterans.
So, I want to thank you all very much.
Secretary Peake. Thank you very much, Mr. Chairman.
[Pause.]
Chairman Akaka. The hearing will come to order.
I want to welcome the second panel and I want you to know
that I appreciate each of you being here today.
First, I welcome the representatives of the Independent
Budget: Carl Blake, National Legislative Director of Paralyzed
Veterans of America.
Kerry Baker, Associate National Legislative Director for
Disabled American Veterans.
Raymond Kelley, National Legislative Director for AMVETS.
Christopher Needham, Senior Legislative Associate for the
National Legislative Service of Veterans of Foreign Wars.
I also welcome Peter Gaytan, Director of the National
Veterans Affairs and Rehabilitation Commission of the American
Legion.
Finally, I welcome our dear friend over the years, John
Rowan, National President of Vietnam Veterans of America.
Again, I thank all of you for joining us today. Your full
statements will appear in the record of the Committee.
Mr. Blake, will you please begin with your testimony.
STATEMENT OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR,
PARALYZED VETERANS OF AMERICA
Mr. Blake. Mr. Chairman, Ranking Member Burr, on behalf of
the four coauthors of the Independent Budget, I would like to
thank you for allowing us the opportunity to testify today on
the health care recommendations for the Department of Veterans
Affairs for fiscal year 2009.
For fiscal year 2009, the Administration requests
approximately $41.2 billion for Veterans' health care. This
includes approximately $2.5 billion for medical care
collections.
Although we recognize this is another positive step forward
in achieving adequate funding for the VA, we believe still more
can be done.
For fiscal year 2009 the Independent Budget recommends
approximately $42.8 billion for total medical care budget
authority, an increase of about $3.7 billion over the fiscal
year 2008 operating budget authority and approximately $1.6
billion above the Administration's request for fiscal year
2009.
The one lead difference between our recommendation and the
VA's recommendation this year is in the increase in patient
workload. Our increase in patient workload is based on a
projected increase of approximately 120,000 new unique
veterans. This includes Category 1 though 8 veterans and non-
veterans who also have coverage under the VA.
We estimate the cost of these new unique patients to be
approximately $792 million. The increase in patient workload
also includes a projected increase of about 85,000 new
Operation Enduring Freedom and Operation Iraqi Freedom veterans
at a cost of approximately $253 million. This alone puts a
difference of about $600-plus million between our
recommendation and the Administration's recommendation.
Our policy and initiatives include additional funding for
improved mental health and TBI services, long-term care
services, funding for homeland security and emergency
preparedness and prosthetics.
Also, for medical facilities, the Independent Budget
recommends approximately $4.6 billion. This includes an
additional $250 million to address non-recurring maintenance
needs of the VA. We are pleased to see that this year the
President's budget does include a significant plus up in
funding for non-recurring maintenance.
Although not proposed to have a direct impact on veterans
health care, we are deeply disappointed that the Administration
chose to once again recommend an increase in prescription co-
payments and index enrollment fees based on income.
Although the VA does not overtly explain impact of these
proposals in its budget submission, similar proposals in the
past have estimated that nearly 200,000 veterans will chose to
disenrolling from the system and nearly one million veterans
will chose not to enroll.
It is astounding that this Administration would continue to
recommend policies that would push veterans away from the best
health system in the world. Congress has soundly rejected these
proposals in the past and we call on you to do so once again.
Mr. Chairman, as you know, the whole community of national
veterans service organizations strongly supports an improved
funding mechanism for VA health care. However, if the Congress
cannot support mandatory funding, there are alternatives which
could meet our goals of timely, sufficient, and predictable
funding.
We are currently working on a proposal that could change
VA's medical care appropriation tor an advance appropriation
which would provide approval 1 year in advance, thereby
guaranteeing its timeliness and predictability.
Furthermore, by adding transparency to VA's health care
enrollee projection model, we can focus the debate on the most
actuarially sound projection of veterans' health care costs to
ensure sufficiency. Under this proposal Congress would retain
its discretion to approve appropriations, retain all of its
oversight authority, and most importantly, there would be no
PAYGO implications.
We look forward to the opportunity to talk to both your
staff and Senator Burr's staff about this proposal.
We would also ask that this Committee in your views and
estimates for fiscal year 2009 recommend to the Budget
Committee either mandatory funding or this new advanced
appropriation approach to take the uncertainties out of funding
for health care for our Nation's wounded, sick, and disabled
veterans.
Finally, Mr. Chairman, I would end with two points. First,
I would like to thank both your Committee staff and the Staff
of Senator Burr, as well as legislative aides for all of the
members of the Committee, for allowing the Independent Budget
the opportunity, the week before the President's Budget was
released, to come and brief our budget recommendations in
advance and give them an idea of where we intended to go before
the President's budget actually came out.
I would like to believe that this actually fosters a better
working relationship with all the staff on the Committee and it
re-enforces the point that we make that we have nothing really
to hide and only everything to gain in this process.
And finally, Mr. Chairman, I would like to thank you for
your kind words about Richard Fuller. With the exception of his
family and a few really close friends, I am not sure that
anyone has been more impacted by his loss than me. Richard was
my mentor when I started at PVA and I would suggest that he
taught me the responsibility that comes with this job and what
we do everyday for veterans.
So, Mr. Chairman, again, I would like to thank you. I would
be happy to answer any questions that you might have.
[The prepared statement of Mr. Blake follows:]
Prepared Statement of Carl Blake, National Legislative Director,
Paralyzed Veterans of America
Mr. Chairman and Members of the Committee, as one of the four co-
authors of The Independent Budget, Paralyzed Veterans of America (PVA)
is pleased to present our views regarding the funding requirements for
the Department of Veterans Affairs (VA) health care system for fiscal
year 2009.
PVA, along with AMVETS, Disabled American Veterans, and the
Veterans of Foreign Wars, is proud to come before you this year to
present the 22nd edition of The Independent Budget, a comprehensive
budget and policy document that represents the true funding needs of
the Department of Veterans Affairs. The Independent Budget uses
commonly accepted estimates of inflation, health care costs and health
care demand to reach its recommended levels. This year, the document is
endorsed by 54 veterans' service organizations, and medical and health
care advocacy groups.
Last year proved to be a difficult year for the appropriations
process. The year started with an incomplete appropriation for fiscal
year 2007. Congress eventually completed the fiscal year 2007 funding
bills in February, placing VA in a very difficult position. While the
funding levels provided for fiscal year 2007 were very good, the fact
that the bill was not completed for nearly 5 months after the start of
that fiscal year is wholly unacceptable. Congress then followed that
action up by providing more than $1.8 billion in supplemental funding
for the VA.
Unfortunately, the fiscal year 2008 appropriations process did not
go any smoother. Due to political wrangling over the Federal budget,
the VA did not receive its appropriation until December. We were very
disappointed that the VA was forced to endure this situation for the
13th time in the last 14 years. This was particularly disappointing in
light of the fact that the Administration guaranteed that the bill
would be signed into law and because the bill was completed before the
start of the fiscal year on October 1.
The appropriations bill was eventually enacted, but it included
budgetary gimmicks that The Independent Budget has long opposed. While
the maximum appropriation available to the VA would match or exceed our
recommendations, the vast majority of this increase was contingent upon
the Administration making an emergency funding request for this
additional money. Fortunately, the Administration recognized the
importance of this critical funding and requested it from Congress.
This emergency request provided the VA with $3.7 billion more than the
Administration requested for fiscal year 2008.
For fiscal year 2009, the Administration requests $41.2 billion for
veterans' health care. This included approximately $2.5 billion from
medical care collections. Although this represents another step forward
in achieving adequate funding for the VA, it still falls short of the
recommendations of The Independent Budget.
For fiscal year 2009, The Independent Budget recommends
approximately $42.8 billion for total medical care budget authority, an
increase of $3.7 billion over the fiscal year 2008 operating budget
level established by Public Law 110-161, the Omnibus Appropriations
bill, and approximately $1.6 billion above the Administration's fiscal
year 2009 request. It is important to note that our budget
recommendations reflect a distinct change from past years as it
reinforces the long-held policy that medical care collections should be
a supplement to, not a substitute for real dollars. The Administration,
year-after-year, chooses to include medical care collections as part of
its overall funding authority for Medical Services. However, we believe
that the cost of medical care services should be provided for entirely
through direct appropriations. In order to develop this recommendation,
we used the maximum appropriation amount included in Public Law 110-161
for VA medical care and added the projected medical care collections to
that amount to formulate our baseline.
The medical care appropriation in past years has included three
separate accounts--Medical Services, Medical Administration, and
Medical Facilities--that comprise the total VA health care funding
level. However, for fiscal year 2009, the Administration's Budget
Request recommends consolidating Medical Services and Medical
Administration into a single account. In order to properly reflect this
change in our recommendations, the separate accounts for Medical
Services and Medical Administration must be added together. For fiscal
year 2009, The Independent Budget recommends approximately $38.2
billion for Medical Services. Our Medical Services recommendation
includes the following recommendations:
Current Services Estimate............................... $32,574,528,000
Increase in Patient Workload............................ 1,045,470,000
Policy Initiatives...................................... 1,000,000,000
Medical Administration.................................. 3,625,762,000
--------------------------------------------------------
____________________________________________________
Total fiscal year 2007 Medical Services............. $38,245,760,000
========================================================
____________________________________________________
In order to develop our current services estimate, we first added
the estimated collections for fiscal year 2008 to the Medical Services
appropriation for fiscal year 2008. This best reflects the total budget
authority that the VA will use to provide health care services. This
amount was then increased by relevant rates of inflation. We also use
the Obligations by Object in the President's Budget submission in order
to set the framework for our recommendation. We believe this method
allows us to apply more accurate inflation rates to specific
subaccounts within the overall account. Our inflation rates are based
on 5-year averages of different inflation categories from the Consumer
Price Index--All Urban Consumers (CPI-U) published by the Bureau of
Labor Statistics every month.
Our increase in patient workload is based on a projected increase
of 120,000 new unique patients--Category 1-8 veterans and covered non-
veterans. We estimate the cost of these new unique patients to be
approximately $792 million. The increase in patient workload also
includes a projected increase of 85,000 new Operation Iraqi Freedom and
Operation Enduring Freedom (OEF/OIF) veterans at a cost of
approximately $253 million.
The policy initiatives include $325 million for improvement of
mental health services and Traumatic Brain Injury care. This amount
represents the growing trend both within the Administration and the
Congress to enhance the mental health services within the VA.
Furthermore, it reinforces our belief that resources should be provided
to the VA to allow them to be the lead for providing these specialized
services, not outside health care organizations. We also recommend $250
million for long-term care services. The policy portion of The
Independent Budget further explains the shortfall that the VA has in
meeting the Average Daily Census mandated by the Millennium Health Care
Act. We also recommend that the VA be appropriated $325 million for
funding the fourth mission which encompasses homeland security and
emergency preparedness initiatives. Currently, the VA already spends
approximately this amount, but this funding is drawn directly out of
the Medical Services account. Finally, we recommend $100 million to
support centralized prosthetics funding.
As mentioned previously, our Medical Administration recommendation
must be added to our Medical Services recommendation to properly
reflect the format of the fiscal year 2009 budget submission. As such,
The Independent Budget recommends approximately $3.6 billion for
Medical Administration for fiscal year 2009.
Finally, for Medical Facilities The Independent Budget recommends
approximately $4.6 billion. This amount includes an additional $250
million for non-recurring maintenance for the VA to begin addressing
the massive backlog of infrastructure needs.
Although The Independent Budget health care recommendation does not
include additional funding to provide for the health care needs of
Category 8 veterans being denied enrollment into the system, we believe
that adequate resources should be provided to overturn this policy
decision. During fiscal year 2008, the VA estimated that a total of
over 1,500,000 Category 8 veterans would have been denied enrollment
into the VA health care system. Despite the fact that we have not seen
any solid empirical data to substantiate this continued growth rate in
denied Category 8 veterans, the VA continues to project higher and
higher numbers of Category 8 veterans denied enrollment into the health
care system. Based on the projected increase in this population of
veterans over the last 5 years, The Independent Budget estimates that
more than 1,870,000 will have been denied enrollment by fiscal year
2009. Assuming a utilization rate of 20 percent, in order to reopen the
system to these deserving veterans, The Independent Budget estimates
that the actual total cost to reopen the system will be approximately
$1.4 billion in order to meet this new demand. For the sake of
discussion, if the projected collections for this group of veterans
were to be considered in this estimation, the actual cost in
appropriated dollars would be approximately $456 million. We believe
that the system should be reopened to these veterans and that adequate
funding should be provided in addition to our Medical Care
recommendation.
Although not proposed to have a direct impact on veterans' health
care, we are deeply disappointed that the Administration chose to once
again recommend an increase in prescription drug co-payments from $8 to
$15 and an indexed enrollment fee based on veterans' incomes. These
proposals will simply add additional financial strain to many veterans,
including PVA members and other veterans with catastrophic
disabilities. Although the VA does not overtly explain the impact of
these proposals, similar proposals in the past have estimated that
nearly 200,000 veterans will leave the system and more than 1,000,000
veterans will choose not to enroll. It is astounding that this
Administration would continue to recommend policies that would push
veterans away from the best health care system in the world. Congress
has soundly rejected these proposals in the past and we call on you to
do so once again.
For Medical and Prosthetic Research, The Independent Budget is
recommending $555 million. This represents a $75 million increase over
the fiscal year 2008 appropriated level established in the Omnibus
Appropriations Act and $113 million over the Administration's request
for fiscal year 2009. We are particularly pleased that Congress has
recognized the critical need for funding in the Medical and Prosthetic
Research account, and we urge Congress to again overrule VA's request,
one that will seriously erode VA's crucial biomedical research
programs. Research is a vital part of veterans' health care, and an
essential mission for our national health care system. VA research has
been grossly underfunded in contrast to the growth rate of other
Federal research initiatives. At a time of war, the government should
be investing more, not less, in veterans' biomedical research programs.
The Independent Budget recommendation also includes a significant
increase in funding for Information Technology (IT). For fiscal year
2009, we recommend that the VA IT account be funded at approximately
$2.165 billion. This amount includes approximately $121 million for an
Information Systems Initiative to be carried out by the Veterans
Benefits Administration. This initiative is explained in greater detail
in the policy portion of The Independent Budget.
We remain concerned that the Major and Minor Construction accounts
are significantly under funded in the fiscal year 2009 Budget Request.
The Administration's request slashes funding for Major Construction
from the fiscal year 2008 appropriations level of $1.1 billion to $582
million. The Minor Construction account is also significantly reduced
from the appropriated level of $631 million to only $329 million. These
funding levels do little to help the VA offset the rising tide of
necessary infrastructure upgrades. Without the necessary funding to
address minor construction needs, these projects will become major
construction problems in short order. For fiscal year 2009, The
Independent Budget recommends approximately $1.275 billion for Major
Construction and $621 million for Minor Construction. The Minor
Construction recommendation includes $45 million for research facility
construction needs.
Finally, Mr. Chairman, as you know, the whole community of national
veterans service organizations strongly supports an improved funding
mechanism for VA health care. However, if the Congress cannot support
mandatory funding, there are alternatives which could meet our goals of
timely, sufficient, and predictable funding.
Congress could change VA's medical care appropriation to an advance
appropriation which would provide approval 1 year in advance, thereby
guaranteeing its timeliness. Furthermore, by adding transparency to
VA's health care enrollee projection model, we can focus the debate on
the most actuarially sound projection of veterans' health care costs to
ensure sufficiency. Under this proposal, Congress would retain its
discretion to approve appropriations; retain all of its oversight
authority; and most importantly, there would be no PAYGO problems.
We ask this Committee in your views and estimates for fiscal year
2009 to recommend to the Budget Committee either mandatory funding or
this new advance appropriations approach to take the uncertainties out
of health care for all of our Nation's wounded, sick and disabled
veterans.
In the end, it is easy to forget that the people who are ultimately
affected by wrangling over the budget are the men and women who have
served and sacrificed so much for this Nation. We hope that you will
consider these men and women when you develop your budget views and
estimates, and we ask that you join us in adopting the recommendations
of The Independent Budget.
This concludes my testimony. I will be happy to answer any
questions you may have.
Chairman Akaka. Mr. Baker.
STATEMENT OF KERRY BAKER, ASSOCIATE NATIONAL LEGISLATIVE
DIRECTOR, DISABLED AMERICAN VETERANS
Mr. Baker. Mr. Chairman and Members of the Committee, thank
you.
As agreed by the organizations, I will focus my testimony
on under staffing in VBA, the claims backlog and a few other
related highlights from the Independent Budget.
The claims backlog is undeniably growing. By the end of
January there were over 816,000 pending claims including
appeals.
In the 4 years since the end of 2004, pending claims rose
by an average of 63,000 per year. Also the number of cases with
eight or more disabilities increased well over 100 percent from
2000 to 2006. Such complex cases further slow down the claims
process.
Therefore, based on an estimated receipt of 920,000 claims
in fiscal year 2009, the Independent Budget recommends Congress
authorize 12,184 FTE for VA C&P service in fiscal year 2009.
That number equates to successfully processing 83 cases per
year for each direct program FTE authorized.
In addition to staffing increase, we believe VA must attack
the claims' backlog using new methods and policies especially
when they follow the intent of the law, save resources and
protect the rights of disabled veterans.
One example deals with VA's policy of requiring medical
opinions in cases where a claimant has already submitted an
opinion adequate for rating purposes. Congress rescinded VA's
prior policy of verifying a private physician's opinion with a
VA examination prior to awarding benefits.
Yet VA continues to refuse to render decisions in cases
where a claimant secures a private opinion until after VA
obtains its own opinion. We believe these actions are an abuse
of discretion, delay decisions and prompt needless appeals.
Congress should mandate that VA must decide cases based on
a veterans' private medical evidence when it is adequate for
rating purposes. This small change will preserve VA's manpower
and budgetary resources, reduce the backlog, prevent needless
appeals and, most importantly, better serve disabled veterans
and their families.
On another note, the law requires VA to accept lay evidence
as proof of service connection for a disability if a veteran is
a combat veteran. VA accepts certain military declarations as
proof of combat but only a fraction of combat veterans received
one of these qualifying medals.
Military records usually do not document individual combat
experiences. As a result, veterans who suffer a disability in
combat are forced to wait a year or more while VA conducts
research to determine whether a veteran's unit engaged in
combat as claimed. This results in difficulty, even
impossibility, in proving a veteran's personal participation in
combat by official military records.
Congress should clarify its intent by defining a combat
veteran for all purposes under Title 38 as one who, during
active military service, served in a combat zone for purposes
of Section 112 of the Internal Revenue Code of 1986 or
predecessor of law. This amendment would reinforce the original
intent of Congress in liberalizing service connection for sick
and disabled veterans who served in combat.
Also, on behalf of the Independent Budget Veterans Service
Organizations, I am going to call the Committee's attention to
issues involving the Federal Court of Appeals for Veterans
Claims.
The greatest challenge facing the court today is similar to
the VA's, the rising backlog of appeals. However, staffing is
not the court's primary dilemma, rather the court has shown a
propensity to remand cases to the Board of Veterans Appeals
based on errors alleged by VA's counsel for the first time on
appeal, notwithstanding the VA has no right to appeal a
decision by the Board.
In this, the court suggests that a veteran is free to
present those assignments of error to the Board even though
that appellant may have already done so. This leads the Board
to repeat the same mistakes that it made previously. Such
remands reopen the appeal to unnecessary development and
further delays, overburden an already backlogged system and
exemplify a far too restrictive judicial process.
Ignoring legal arguments that serve as the very basis of an
appeal and remanding cases on technicalities a veteran may be
willing to waive merely adds to the claims backlog.
We believe solving this unacceptable situation would be
simple and cost effective. Congress should require the court,
on a de novo basis, to decide all relevant questions of law and
to decide all assignments of error properly presented by the
appellant.
Mr. Chairman, I have only highlighted a few of many
important issues contained in our Independent Budget. We
commend the remainder to you and I will be pleased to answer
any questions from you or the Committee.
Thank you.
[The prepared statement of Mr. Baker follows:]
Statement of Kerry Baker, Associate National Legislative Director,
Disabled American Veterans
Mr. Chairman and Members of the Committee: I am pleased to have
this opportunity to appear before you on behalf of the Disabled
American Veterans (DAV), one of four National veterans' organizations
that create the annual Independent Budget (IB) for veterans programs,
to summarize our recommendations for fiscal year 2009.
As you know Mr. Chairman, the IB is a budget and policy document
that sets forth the collective views of DAV, AMVETS, Paralyzed Veterans
of America (PVA), and Veterans of Foreign Wars of the United States
(VFW). Each organization accepts principal responsibility for
production of a major component of our Independent Budget--a budget and
policy document on which we all agree. Reflecting that division of
responsibility, my testimony focuses primarily on the variety of
Department of Veterans Affairs' (VA) benefits programs available to
veterans.
In preparing this 22nd Independent Budget, the four partners draw
upon our extensive experience with veterans' programs, our firsthand
knowledge of the needs of America's veterans, and the information
gained from continuous monitoring of workloads and demands upon, as
well as the performance of, the veterans benefits and services system.
Consequently, this Committee has acted favorably on many of our
recommendations to improve services to veterans and their families. We
ask that you give our recommendations serious consideration again this
year.
the veterans benefits administration is still
understaffed and overwhelmed
To improve administration of VA's benefits programs, the IB
recommends Congress provide the Veterans Benefits Administration (VBA)
with enough staffing to support a long-term strategy for improvement in
claims processing and for other programs under jurisdiction of the VBA.
Included in our recommendations are new resources needed for training
programs and information technologies; however, this testimony primary
focuses on solving VA's staffing shortages as well as other initiatives
to manage the increase in new claims and reduce the out-of-control
claims backlog. In total, if Congress accepts our recommendations, VBA
will be better positioned to serve all disabled veterans and their
families.
understaffing and claims backlog
Mr. Chairman, the claims' backlog is unquestionably growing. Rather
than making headway and overcoming the protracted delays in the
disposition of its claims, VA continues to lose ground on its claims
backlog. According to VA's weekly workload report, as of January 26,
2008, there were 816,211 pending compensation and pension (C&P) claims,
which include appeals. Putting this number into perspective, at the end
of 2004, 2005, 2006, and 2007, the total number of pending claims was
620,926; 680,432; 752,211; and 809,707, respectively. Therefore, in the
3 years from the end of 2004 to the end of 2007, the total number of
pending C&P claims rose by 188,781 for an average of 62,929 additional
pending claims per year. The VA's pending claims rose by 6,504 just
from the end of 2007 to January 26, 2008--less than 1 month. At this
rate, VA's caseload will pass one million claims in 3 years. With the
wars in Iraq and Afghanistan still raging, together with the mass
exodus from military service that usually occurs following cessation of
combat operations, new and re-opened claims received by VA are more
likely to increase than decrease. A caseload topping one million claims
will truly be a demoralizing moment for America--the time to act is
now.
Throughout the foregoing years, many promises were made in public;
yet VBA staffing has essentially remained nearly flat at between 9,200
to 9,500 full-time employees (FTE)--9,287 in fiscal year 2006; 9,445 in
fiscal year 2007; and 9,559 in fiscal year 2008. (The fiscal year 2008
figure does not currently take into account increased staffing levels
authorized in the most recent appropriations bill for 2008.) While we
do not suggest additional resources as the solitary answer to the
claims backlog, the current VBA staffing levels have proven year after
year to be significantly below the levels needed to halt the growth in
the claims backlog, much less sufficient to begin reducing the backlog.
There is no proverbial silver bullet to solving VA's challenges.
Various policy changes can and should be implemented that may
collectively have a positive impact on reducing VA's claims backlog,
while also improving services to VA's clientele. Nonetheless,
implementing any policy change will utterly fail without a significant
increase in VBA staffing that is at least on parity with VA's increased
receipt of new and reopened claims as well as its ever-growing claims
backlog.
Based on an estimated receipt of 920,000 claims in fiscal year
2009, Congress should authorize 12,184 FTE for fiscal year 2009. That
number equates to 83 cases per year per each direct program FTE. The IB
veterans' organizations realize that 83 claims per FTE are below VA's
historical projections per FTE. Nonetheless, an infusion of new
personnel into VBA's workforce will inevitably result in a reduced
output per FTE for a significant length of time. These newly allotted
employees will be unable to process claims at rates equal to
experienced employees. Additionally, senior staff within VBA will be
forced to frequently halt production of their own workload in order to
provide necessary training to inexperienced employees. We, nonetheless,
strongly encourage the VA to provide adequate training to ensure that
claims are decided properly the first time. Therefore, the reduction in
workload per FTE is unavoidable.
Additionally, VBA's new claims per year continue to increase from 1
year to the next despite VA's 2008 budget assertion that such claims
were going to decline. For example, VBA received 771,115 new rating
claims in fiscal year 2004 and 838,141 new claims in fiscal year 2007,
equaling an average increase of 16,756 additional claims per year.
During this same period, VA received the following Benefits Delivery at
Discharge (BDD) claims: 39,885 in fiscal year 2004; 37,832 in fiscal
year 2005; 40,074 in fiscal year 2006; and 37,370 in fiscal year 2007,
for a total of 155,164 new beneficiaries that had never before been on
VA rolls. At this rate, the average number of new BDD claims per year
is 38,791 for a total of 232,746 new claims through the BDD process by
the end of fiscal year 2009. These figures do not include
servicemembers filing claims through either the military's physical
disability evaluation systems, or those discharging via end-of-service
contracts who then come to VA on their own to file claims after
discharge.
The significance of these new beneficiaries is that large portions
of VA's workload increase via new claims each year are re-opened claims
rather than claims from veterans who have never filed for VA benefits.
Therefore, the increase in brand new beneficiaries into the system will
inevitably increase further the number of re-opened claims, ultimately
causing the total number of claims received by VA each year to continue
growing, contrary to VA's fiscal year 2008 budget estimate. VA's 2009
budget submission reveals the VA added 277,000 beneficiaries to its C&P
rolls in 2007, which further proves this point.
The complexity of the workload has also continued to grow. Veterans
are claiming greater numbers of disabilities and the nature of
disabilities such as Post Traumatic Stress Disorder (PTSD), complex
combat injuries, diabetes and related conditions, and environmental
diseases are becoming increasingly more complex. For example, the
number of cases with eight or more disabilities increased 135 percent
from 21,814 in 2000 to 51,260 in 2006.\1\ Such complex cases will only
further slow down VBA's claims process.
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\1\ Fiscal year 2008 Budget Submission, Volume II, ``National
Cemetery Administration, Benefits Programs, and Departmental
Administration,'' Benefits Summary, Department of Veterans Affairs, Pg.
6A-2 (Retrieved Feb. 2, 2008, from http://www.va.gov/budget/summary/
index.htm).
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We believe that adequate staffing is essential to any meaningful
strategy to get claims processing and backlogs under control. In its
budget submission for fiscal year 2007, VBA projected its production
based on an output of 109 claims per direct program FTE. We have long
argued that VA's production requirements do not allow for thorough
development and careful consideration of disability claims, resulting
in compromised decisions, higher error and appeal rates, and ultimately
more overload on the system. In addition to recommending staffing
levels more commensurate with the workload, we have maintained that VA
should invest more in training adjudicators and that it should hold
them accountable for higher standards of accuracy. Nearly half of VBA
adjudicators responding to survey questions from VA's Office of
Inspector General admitted that many claims are decided without
adequate record development. (The Board of Veterans' Appeals (Board)
and the Court of Appeals for Veterans Claims' (Court's) remand rate
clearly demonstrate this.) The Inspector General saw an incongruity
between their objectives of making legally correct and factually
substantiated decisions, with management objectives of maximizing
output to meet production standards and reduce backlogs. Nearly half of
those surveyed reported that it is generally, or very difficult, to
meet production standards without compromising quality. Fifty-seven
percent reported difficulty meeting production standards while
attempting to ensure they have sufficient evidence for rating each case
and thoroughly reviewing the evidence. Most attributed VA's inability
to make timely and high quality decisions to insufficient staff. In
addition, they indicated that adjudicator training had not been a high
priority in VBA.
Therefore, we believe it prudent to recommend staffing levels based
on an output of 83 cases per year for each direct program FTE. With an
estimated 920,000 incoming claims in fiscal year 2009, that effort
would require 11,084 direct program FTEs in fiscal year 2009. With
support FTE added, this would require C&P authorization of 12,184 total
FTE for fiscal year 2009.
Adjudicating veterans' claims is a labor-intensive system of
personal decisionmaking, with lifelong consequences for disabled
veterans. During Congressional hearings, VA is routinely forced to
defend VBA budgets that it knows to be inadequate to the task. The
priorities and goals of Congress, the Administration, and the VA must
be on par with the necessity for a long-term strategy to fulfill VBA's
mission and confirm the Nation's moral obligation to disabled veterans.
overdevelopment of claims
Numerous developmental procedures in the VA claims' process
collectively add to the enormous backlog of cases. While many of these
procedures are mandatory, they are often over-utilized. This
unnecessarily delays claims for months--when this occurs in, or leads
to the appeals process, claims are delayed for many years. There is no
single answer to solving the claims backlog. Therefore, in addition to
staffing increases, Congress and VA must attack the problem using
alternative methods, particularly when those alternative methods are
parallel with the intent of the law, work to save departmental
resources, and protect the rights of disabled veterans.
For example, rather than making timely decisions on C&P claims when
evidence development may be complete, the VA routinely continues to
develop claims. These actions lend validity to many veterans'
accusations that whenever VA would rather not grant a claimed benefit,
VA intentionally overdevelops cases to obtain evidence against the
claim. Despite these accusations, a lack of adequate training is just
as likely the cause of such overdevelopment.
Such actions result in numerous appeals, followed by needless
remands from the Board and/or the Court. In many of these cases, the
evidence of record supports a favorable decision on the appellant's
behalf yet the appeal is remanded nonetheless. These unjustified
remands usually do nothing but perpetuate the hamster-wheel reputation
of veterans' law. Numerous cases exemplify this scenario; a list can be
provided upon request. One such example is summarized in the IB
submission. For the sake of brevity, we will not repeat the summary
here, but urge the Committee to review the example titled
``Improvements in the Claims Process,'' which can be found in the
Compensation and Pension section of the General Operating Expenses
Chapter.
This example deals with VA requesting unnecessary medical opinions
in cases where the claimant has already submitted one or more medical
opinions that are adequate for rating purposes. VA claimants desiring
to secure their own medical evidence, including a fully informed
medical opinion, are entitled by law to do so. If a claimant does
secure an adequate medical opinion, there is no need in practicality or
in law for VA to seek its own opinion. Congress enacted title 38,
United States Code (U.S.C.), section 5125 for the express purpose of
eliminating the former 38 Code of Federal Regulations (CFR), section
3.157(b)(2) requirement that a private physician's medical examination
report be verified by an official VA examination report prior to an
award of VA benefits. Section 5125 States:
For purposes of establishing any claim for benefits under
chapter 11 or 15 of this title, a report of a medical
examination administered by a private physician that is
provided by a claimant in support of a claim for benefits under
that chapter may be accepted without a requirement for
confirmation by an examination by a physician employed by the
Veterans Health Administration if the report is sufficiently
complete to be adequate for the purpose of adjudicating such
claim. [Emphasis added]
Therefore, Congress codified section 5125 to eliminate unnecessary
delays in the adjudication of claims and to avoid costs associated with
unnecessary medical examinations. Notwithstanding the elimination of
title 38 CFR, section 3.157, and the enactment of title 38 U.S.C.,
section 5125, VA consistently refuses to render decisions in cases
wherein the claimant secures a private medical examination and medical
opinion until a VA medical examination and medical opinion are
obtained. Such actions are an abuse of discretion, which delay
decisions and prompt needless appeals. When claimants submit private
medical evidence that is adequate for rating purposes, Congress should
mandate that VA must decide the case based on such evidence rather than
delaying the claim by arbitrarily and unnecessarily requesting
additional medical examinations and opinions from the agency. Such
enactment will preserve VA's manpower and budgetary resources; help
reduce the claims backlog and prevent needless appeals; and most
importantly, better serve disabled veterans and their families.
standard for determining combat veteran status
Title 38 U.S.C., section 1154(b) requires VA to accept lay or other
evidence as sufficient proof of service connection of a disease or
injury if a veteran alleges that disease or injury occurred in or was
aggravated during combat. While VA recognizes the receipt of certain
medals as proof of combat, only a fraction of those who participate in
combat receive a qualifying medal. Further, military personnel records
usually do not document actual combat experiences. As a result,
veterans who suffer a disease or injury resulting from combat are
forced to provide evidence that may not exist or wait a year or more
while the VA conducts research to determine whether a veteran's unit
engaged in combat.
Congress should amend title 38 U.S.C., section 1154(b) to clarify
military service as treatable service in which a member is considered
to have engaged in combat for purposes of determining combat-veteran
status. Such clarification would properly allow for utilization of
nonofficial evidence as proof of in-service occurrence for service
connection of combat-related diseases or injuries.
This type of legislation would remove a barrier to the fair
adjudication of claims for disabilities incurred or aggravated by
military service in combat zone. Under existing law, veterans who can
establish that they ``engaged in combat'' are not required to produce
official military records to support their claim for disabilities
related to such service. This legislation would not alter the law's
current requirement that a veteran confirm a disability through
official diagnosis. Further, it would not alter the requirement that a
veteran show a nexus between a claimed disability and military service.
The only alteration from current law would be a relaxed standard of
proof, consistent with Congress' original intent, required to establish
a veteran as one who engaged in combat. This relaxed standard of proof
would then only apply to those who serve in a combat zone.
Many veterans disabled by their service in Iraq and Afghanistan,
and those who served in earlier conflicts are unable to benefit from
liberalizing evidentiary requirements found in the current version of
section 1154(b). This results because of difficulty, even
impossibility, in proving personal participation in combat by official
military documents.
Impositions put forth by VA General Counsel opinion 12-99 require
veterans to establish by official military records or decorations that
they ``personally participated in events constituting an actual fight
or encounter with a military foe or hostile unit or instrumentality.''
Oversight visits by Congressional staff to VA regional offices found
claims denied under this policy because those who served in combat
zones were not able to produce official military documentation of their
personal participation in combat via engagement with the enemy. The
only possible resolution to this problem without amending section
1154(b) is for the military to record the names and personal actions of
every single soldier, sailor, airman, and Marine involved in every
single event--large or small--that constitutes combat and/or engagement
with the enemy on every single battlefield. Such recordkeeping is
impossible.
Numerous veterans have been and continue to be harmed by this
defect in the law. In numerous cases, extensive delays in claims
processing occur while VA adjudicators attempt to obtain official
military documents showing participation in combat: documents that may
never be located.
The Senate noted in 1941, in the report on the original bill, that
the absence of an official record of care or treatment in many of such
cases is explained by the conditions surrounding the service of combat
veterans. Congress emphasized that the establishment of records for
non-combat veterans was a simple matter compared to the combat
veteran--either the veteran carried on despite his disability to avoid
having a record made lest he or she be separated from his or her
organization or, as in many cases, the records themselves were lost.
Likewise, many records are simply never generated.
Congress should clarify its intent by amending title 38, United
States Code, section 1154(b), with respect to defining a veteran who
engaged in combat for all purposes under title 38, as a veteran who,
during active service, served in a combat zone for purposes of section
112 of the Internal Revenue Code of 1986 or a predecessor provision of
law.
information technology
Mr. Chairman, in addition to boosting its staffing, we believe VBA
must continue to upgrade its information technology infrastructure and
revise its training tools to stay abreast of modern business practices,
to maintain efficiency, and to meet increasing workload demands. With
the continually changing environment in claims processing and benefits
administration, anything less is a recipe for failure.
In recent years, however, Congress has actually reduced
significantly the funding for such VBA initiatives. In fiscal year
2001, Congress provided $82 million for VBA initiatives. In fiscal year
2002, it provided $77 million; in 2003, $71 million; in 2004, $54
million; in 2005, $29 million; and, in 2006, $23 million, despite VBA's
undeniable challenges.
With restored investments in its initiatives, VBA could complement
staffing increases for higher workloads with a support infrastructure
designed to increase operational effectiveness. VBA could resume an
adequate pace in its development and deployment of information
technology solutions, as well as upgrade and enhance training systems,
to improve operations and service delivery.
court of appeals for veterans claims
The Congressional mandate that VA claimants receive the benefit of
the doubt in appropriate cases is the cornerstone of veterans' benefits
derived from military service. Yet, the Court has ignored the intent of
Congress by creating a judicial roadblock that completely isolates
claimants from their statutory right to the benefit of the doubt.
Title 38 U.S.C., section 5107(b) grants claimants the benefit of
the doubt as a matter of law with respect to any benefit under laws
administered by the Secretary of Veterans Affairs (Secretary) when
there is an approximate balance of positive and negative evidence
regarding any issue material to the determination of a matter. Yet, the
Court has been affirming any BVA denial when the record contains only
minimal evidence necessary to show a ``plausible basis'' for such
finding. This renders a claimant's statutory right to the benefit of
the doubt futile because claims can be denied and the denial upheld
when supported by far less than a preponderance of the evidence.
Congress tried to correct this situation by amending the law with
the enactment of the Veterans Benefits Improvement Act of 2002 \2\ to
require the Court to consider whether Board findings were consistent
with the benefit-of-the-doubt rule. The intended effect of section 401
of the Veterans Benefits Act of 2002 has not been upheld by the
court.\3\
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\2\ Pub. L. No. 107-330, 401, 116 Stat. 2820, 2832.
\3\ Section 401 of the Veterans Benefits Act, effective December 6,
2002, amended title 38, United States Code, sections 7261(a)(4) and
(b)(1).
Prior to the enactment of Veterans Benefits Act, the Court's case
law provided (1) that the court was authorized to reverse a finding of
fact when the only permissible view of the evidence of record was
contrary to that found by the Board, and (2) that a finding of fact
must be affirmed where there was a plausible basis in the record for
the board's determination. However, Congress added new language to
section 7261(b)(1) that mandates the Court to review the record before
the Secretary pursuant to section 7252(b) of title 38 and ``take due
account of the Secretary's application of section 5107(b) of this title
* * *.'' \4\ The Secretary's obligation under section 5107(b), as
referred to in section 7261(b)(1), is as follows:
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\4\ See 38 U.S.C. 7261(b)(1).
(b) Benefit of the Doubt--The Secretary shall consider all
information and lay and medical evidence of record in a case
before the Secretary with respect to benefits under laws
administered by the Secretary. When there is an approximate
balance of positive and negative evidence regarding any issue
material to the determination of a matter, the Secretary shall
---------------------------------------------------------------------------
give the benefit of the doubt to the claimant.
Prior to enactment of Veterans Benefits Act section 401, the Court
characterized the benefit-of-the-doubt rule as mandating that ``when *
* * the evidence is in relative equipoise, the law dictates that [the]
veteran prevails'' and that, conversely, a VA claimant loses only when
``a fair preponderance of the evidence is against the claim.'' \5\
Nonetheless, such characterizations have historically proven to be
nothing more than meaningless rhetoric.
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\5\ Gilbert v. Derwenski, 1 Vet.App. 49, 54-55 (1990).
Reading amended sections 7261(a)(4) and 7261(b)(1) together, which
must be done in order to determine the effect of the Veterans Benefits
Act section 401 amendments, reveals the Court is now directed, as part
of its scope-of-review responsibility under section 7261(a)(4), to
undertake three actions in deciding whether adverse Board findings are
clearly erroneous and, if so, what the court should hold as to that
finding. The plain meaning of the amended subsections (a)(4) and (b)(1)
require the Court (1) to review all evidence before the Board; (2) to
consider the application of the benefit-of-the-doubt rule in view of
that evidence; and (3) if after carrying out actions (1) and (2), the
Court concludes that an adverse Board finding is clearly erroneous and
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therefore unlawful, to set it aside or reverse it.
Therefore, as the foregoing discussion illustrates, Congress
intended the Veterans Benefits Act section 401 amendments to
fundamentally alter the Court's review of Board decisions. This is
evident by the plain meaning of the amended language and the
amendment's unequivocal legislative history. Congress intended the
court to take a more proactive and less deferential role in its
judicial review. For example, Congress specifically intended the Court
``to examine the record of proceedings--that is, the record on appeal--
before the Secretary and BVA. Section 401 also provides special
emphasis during the judicial process to the `benefit of the doubt'
provisions of section 5107(b) as the Court makes findings of fact in
reviewing BVA decisions. The combination of these changes is intended
to provide for more searching appellate review of BVA decisions, and
thus give full force to the benefit-of-the-doubt provision.'' \6\ \7\
This language is consistent with the existing section 7261(c), which
precludes the Court from conducting trial de novo when reviewing VA
decisions--receiving evidence not part of the record before the Board.
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\6\ 148 CONG. REC. S11334 (remarks of Sen. Rockefeller).
\7\ 148 CONG. REC. S11337, H9003 (daily ed. Nov. 18, 2002)
(explanatory Statement printed in Congressional Record as part of
debate in each body immediately prior to final passage of compromise
agreement).
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Perhaps the most dramatic of the three court actions directed by
section 401 was the mandate that the court ``take due account of the
Secretary's application of section 5107(b),'' i.e., the ``benefit-of-
the-doubt rule.'' It is against this more relaxed standard of review
that, through the Veterans Benefits Act section 401, Congress has now
required the Court to review the entire record on appeal and to examine
the Secretary's determination as to whether the evidence presented was
in equipoise on a particular conclusion. The foregoing notwithstanding,
the Court's equipoise review is no better after the Veterans Benefits
Act section 401 than it was before section 401 was enacted. The Court
has ignored Congress' intent.
In light of this background, the section 401 mandate supersedes the
previous Court practice of upholding a factual finding unless the only
permissible view of the evidence is contrary to that found by the
Board. Likewise, section 401 overrules the requirement that a Board
finding of fact must be affirmed where there is a ``plausible basis''
in the record for the determination. Yet, the nearly impenetrable
``plausible basis'' standard continues to prevail to this very date as
if Congress never amended section 7261. The former Ranking Minority
Member of this Committee, spoke in strong support of this amendment and
explained that ``the bill * * * clarifies the authority of the [Court]
to reverse decisions of the [BVA] in appropriate cases and requires the
decisions be based upon the record as a whole, taking into account the
pro-veteran rule known as the benefit of the doubt.'' \8\
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\8\ 148 CONG. REC. H9003.
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Ultimately, the Board sits in near splendid isolation to
arbitrarily weigh evidence and unfairly determine its probative value.
Such determinations are the lynchpin in claims for benefits by disabled
veterans. Regardless of the quantity and quality of evidence in favor
of a claimant's case, a Board's conclusion that an infinitesimal amount
of unfavorable evidence, however much lacking in quality, outweighs and
is more probative than an immeasurable amount of high-quality evidence
is practically untouchable by the Court. Worse yet, it is the Court's
own doing. Essentially, when the Board renders this type of decision
that turns on the weighing of such evidence, the Court is precluded
from even considering the benefit-of-the-doubt rule. Evidence must
first be in equipoise, or balance, for the benefit-of-the-doubt to
apply. As soon as the Board finds the slightest plausible basis that a
claimant's evidence preponderates against the claim, the favorable and
unfavorable evidence is no longer in balance. Unless the Court finds
such a ruling to be clearly erroneous--meaning there is no plausible
basis regardless of how trivial such basis may be--the Court cannot
overturn the ruling. Consequently, if the Court cannot overturn the
ruling, it can never reach a review of the Board's application of the
benefit of the doubt. The Court has therefore created a barrier between
itself and a VA claimant's statutory right to the benefit of the
doubt--a barrier moveable only by Congress.
Congress should not allow any Federal court to ignore its
legislative power, particularly one charged with the protection of
rights afforded our Nation's disabled veterans and their families. To
ensure the Court enforces the benefit-of-the-doubt rule, Congress
should replace the clearly erroneous standard with a requirement that
the court will reverse a factual finding adverse to a claimant when it
determines such finding is not reasonably supported by a preponderance
of the evidence.
solving the court's backlog
The Board and the Court add substantially to the claims backlog by
needlessly and frequently remanding numerous cases on appeal. In many
of these appeals, the evidence of record fully supports a favorable
decision on the appellant's behalf, yet the appeal is remanded
nonetheless. These unjustified remands deprive the appellant, usually
for many additional years, of benefits awardable based on facts already
of record.
The greatest challenge facing the Court is identical to the VA--the
backlog of cases. The Court has shown a reluctance to reverse errors
committed by the Board. Rather than addressing an allegation of error
raised by an appellant, the Court has a propensity to vacate and remand
cases to the Board based on an allegation of error made by the VA's
counsel for the first time on appeal, such as an inadequate Statement
of reasons or bases in a Board decision. Another example occurs when
the VA argues, again for the first time on appeal, for remand by the
Court because VA failed in its duty to assist the claimant in
developing the claim notwithstanding an express finding by the Board
that all development is complete and where the appellant accepts, and
does not challenge such finding by the Board. Such actions are
particularly noteworthy because the VA has no legal authority to appeal
a Board decision to the Court.\9\
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\9\ 38 U.S.C.A., 7252(a) (West 2002) (``The Court of Appeals for
Veterans Claim shall have exclusive jurisdiction to review decisions of
the Board of Veterans' Appeals. The Secretary may not seek review of
any such decision.'')
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Consequently, the Court will generally decline to review alleged
errors raised by an appellant that actually serve as the basis of the
appeal. Instead, the court remands the remaining alleged errors on the
basis that an appellant is free to present those errors to the Board
even though an appellant may have already done so, leading to the
possibility of the Board repeating the same mistakes on remand that it
had previously. Such remands leave errors properly raised to the Court
unresolved; reopen the appeal to unnecessary development and further
delay; overburden an already backlogged system; exemplify far too
restrictive judicial restraint; and inevitably require an appellant to
invest many more months and perhaps years of his or her life in order
to receive a decision that the court should have rendered on initial
appeal. As a result, an unnecessarily high number of cases are appealed
to the Court for the second, third, or fourth time.
In addition to postponing decisions and prolonging the appeal
process, the Court's reluctance to reverse Board decisions provides an
incentive for VA to avoid admitting error and settling appeals before
they reach the Court. By merely ignoring arguments concerning legal
errors rather than resolving them at the earliest stage in the process,
VA contributes to the backlog by allowing a greater number of cases to
go before the Court. If the Court would reverse decisions more
frequently, VA would be discouraged from standing firm on decisions
that are likely to be overturned or settled late in the process.
To remedy this unacceptable situation, Congress should amend title
38 U.S.C., section 7261 to require the Court on a de novo basis to: (1)
decide all relevant questions of law; (2) interpret constitutional,
statutory, and regulatory provisions; and (3) determine the meaning or
applicability of the terms of an action of the Secretary. The Court's
jurisdiction should also be amended to require it to decide all
assignments of error properly presented by an appellant.
general
The benefit programs are effective for their intended purposes only
to the extent VBA can deliver benefits to entitled veterans and
dependents in a timely fashion. However, in addition to ensuring that
VBA has the resources necessary to accomplish its mission in that
manner, Congress must also make adjustments to the programs from time
to time to address increases in the cost of living and needed
improvements. We invite your attention to the IB itself for the details
of those issues, but the following summarizes a number of
recommendations to adjust rates and improve the benefit programs
administered by VBA:
cost-of-living adjustments for compensation, specially
adapted housing grants, and automobile grants, with provisions for
automatic annual increases in the housing and automobile grants based
on increases in the cost of living;
a presumption of service connection for hearing loss and
tinnitus for combat veterans and veterans who had military duties
involving high levels of noise exposure who suffer from tinnitus or
hearing loss of a type typically related to noise exposure or acoustic
trauma;
removal of the provision that makes persons who first
entered service before June 30, 1985, ineligible for the Montgomery GI
Bill, along with other improvements to the program;
no increase in, and eventual repeal of, funding fees for
VA home loan guaranty;
increase in the maximum coverage and adjustment of the
premium rates for Service-Disabled Veterans' Life Insurance;
increase in the maximum coverage available in policies of
Veterans' Mortgage Life Insurance;
legislation to restore protections for veterans' benefits
against awards to third parties in divorce actions; and
legislation to increase Dependency and Indemnity
Compensation for certain survivors of veterans, and to no longer offset
DIC with Survivor Benefit Plan payments.
We hope the Committee will review these recommendations and give
them consideration for inclusion in your legislative plans and will
support their funding in the Congressional Budget Resolution for fiscal
year 2009, as well as subsequent appropriations.
Mr. Chairman, thank you for inviting DAV and other member
organizations of the Independent Budget to testify before you today.
Chairman Akaka. Thank you very much, Mr. Baker.
Mr. Kelley.
STATEMENT OF RAYMOND C. KELLEY, NATIONAL LEGISLATIVE DIRECTOR,
AMVETS
Mr. Kelley. Thank you, Mr. Chairman. Thank you, Ranking
Member Burr, for holding this hearing today.
As a co-author of the Independent Budget, AMVETS is pleased
to give you our best estimates on the resources necessary to
carry out the responsibilities of the National Cemetery
Administration (NCA).
First, I commend the NCA staff who provide the highest
quality service to veterans and their families during their
tremendous grief.
The Administration has requested approximately $181 million
in discretionary funding for operations and maintenance of NCA.
Of that number, $105 million is dedicated for major
construction, $25 million for minor construction as well as $32
million for State cemetery grants programs.
In contrast, the Independent Budget recommends Congress
provide $251.9 million for the operational requirements of NCA,
a figure that includes $50 million toward the national shrine
initiative.
In total, our funding recommendation represents a $71
million increase over the Administration's request.
The national cemetery system continues to be seriously
challenged. Adequate resources and developed acreage must keep
pace with the increased workload.
Currently, there are 13 national cemeteries in some phase
of development or expansion. The Administration's budget
provides funding for only three of these projects, while NCA
expects to perform nearly 115,000 internments in 2009, an 8.7
percent increase over the current year.
Congress must also address the need for gravesite
renovation and upkeep. Although there has been no orderly
progress made over the years, the NCA is still struggling to
remove decades of blemishes and scars from military burial
grounds across the country. To date, $99 million has been
invested in restoring the appearance of our national
cemeteries, completing nearly 300 of the 928 deficiencies
identified in the 2002 study on improvements of veterans
cemeteries.
Therefore, the Independent Budget recommends a $50 million
commitment in fiscal year 2009 and we continue to recommend
Congress establish a 5-year, $250 million fund for the national
shrine so NCA can fully restore the appearance of the national
cemeteries to reflect the utmost dignity and respect for those
who are interred.
The State Cemetery Grant Program is an important component
of NCA. It greatly assists States increasing the burial
services to veterans especially those living in areas where
national cemeteries are under served.
NCA admits only 80 percent of those requesting interment
meet the 170,000 veterans within 75 miles radius threshold the
NCA has set for itself. This re-emphasizes the importance of
the State grants program.
Since 1978 the VA has more than doubled the acreage
available to accommodate more than a 100 percent increase in
burials through these grants. In this year, States have
indicated they plan on establishing 14 new cemeteries over the
next 4 years. Therefore, to provide for these cemeteries and to
reach NCA's threshold goals, the Independent Budget requests
$42 million for the State Cemetery Grant Program in fiscal year
2009.
Also, the Independent Budget strongly recommends Congress
to review the current burial benefits that have seriously
eroded in value over the years. While these benefits were never
intended to cover the full cost of burial, they now pay for
just 6 percent of what they covered when the program was
started in 1973.
The Independent Budget requests a plot allowance be
increased from $300 to $750, to increase the allowance for
service-connected deaths from $2,000 to $4,100 and to increase
non-service-connected burial benefits from $300 to $1,270.
These increases would proportionally bring the benefits back to
their original value.
The NCA honors more than 2.8 million veterans with final
resting place that commemorate their service to this Nation.
Our national cemeteries are more than a final resting place.
They are a memorial to those who have died in our defense, and
hollowed ground to those who have survived.
Mr. Chairman, this concludes my testimony and I will be
happy to answer any questions the Committee has.
[The prepared statement of Mr. Kelley follows:]
Prepared Statement of Raymond C. Kelley,
National Legislative Director, AMVETS
Chairman Akaka, Ranking Member Burr, and members of the Committee:
AMVETS is honored to join our fellow veterans service organizations and
partners at this important hearing on the Department of Veterans
Affairs budget request for fiscal year 2009. My name is Raymond C.
Kelley, National Legislative Director of AMVETS, and I am pleased to
provide you with our best estimates on the resources necessary to carry
out a responsible budget for VA.
AMVETS testifies before you as a co-author of The Independent
Budget. This is the 22nd year AMVETS, the Disabled American Veterans,
the Paralyzed Veterans of America, and the Veterans of Foreign Wars
have pooled our resources to produce a unique document, one that has
stood the test of time.
In developing the Independent Budget, we believe in certain guiding
principles. Veterans should not have to wait for benefits to which they
are entitled. Veterans must be ensured access to high-quality medical
care. Specialized care must remain the focus of VA. Veterans must be
guaranteed timely access to the full continuum of health care services,
including long-term care. And, veterans must be assured accessible
burial in a State or national cemetery in every State.
The VA health care system is the best in the country and
responsible for great advances in medical science. VHA is uniquely
qualified to care for veterans' needs because of its highly specialized
experience in treating service-connected ailments. The delivery care
system provides a wide array of specialized services to veterans like
those with spinal cord injuries, blindness, Traumatic Brain Injury, and
Post Traumatic Stress Disorder.
Looking at the numbers alone, the VA budget would appear to be one
that would garner only praise and be a model for years to come.
However, the budget was signed into law 5 months after the start of the
new fiscal year, marking the 13th time in 14 years the VA had to work
from continuing resolutions to maintain the system. Also, the budget
was contingent on $3.7 billion in emergency funding that was signed
into law less than 1 month ago. This is an unacceptable way of funding
a department that is as fluid in nature as the VA.
Mr. Chairman, as you know, we strongly support mandatory funding
for VA health care. However, if the Congress cannot support mandatory
funding, there are alternatives which could meet our goals of timely,
sufficient, and predictable funding.
Congress could change VA's medical care appropriation to an advance
appropriation which would provide approval 1 year in advance, thereby
guaranteeing its timeliness. Furthermore, by adding transparency to
VA's health care enrollee projection model, we can focus the debate on
the most actuarially sound projection of veterans health care costs to
ensure sufficiency.
Under this proposal, Congress would retain its discretion to
approve appropriations; retain all of its oversight authority; and most
importantly, there would be no PAYGO problems.
We ask this Committee in your views and estimates to recommend to
the Budget Committee either mandatory funding or this new advance
appropriations approach to take the politics out of health care for all
of our Nation's wounded, sick and disabled veterans.
As a partner of the Independent Budget, AMVETS devotes a majority
of its time with the concerns of the National Cemetery Administration
(NCA) and I would like to speak directly to the issues and concerns
surrounding NCA.
the national cemetery administration
The Independent Budget acknowledges the dedicated and committed NCA
staff who continue to provide the highest quality of service to
veterans and their families despite funding shortfalls, aging
equipment, and increasing workload. The devoted staff provides aid and
comfort to grieving veterans' families in a very difficult time, and we
thank them for their consolation.
The NCA currently maintains more than 2.8 million gravesites at 131
national cemeteries in 39 States and Puerto Rico. VA estimates that
about 24 million veterans are alive today. They include veterans from
World War I through the Global War on Terrorism, as well as peacetime
veterans. With the anticipated opening of the new national cemeteries,
annual interments are projected to increase from more than 105,000 in
2008 to 115,000 in 2009.
The NCA is responsible for five primary missions: (1) to inter,
upon request, the remains of eligible veterans and family members and
to permanently maintain gravesites; (2) to mark graves of eligible
persons in national, State, or private cemeteries upon appropriate
application; (3) to administer the State grant program in the
establishment, expansion, or improvement of State veterans cemeteries;
(4) to award a Presidential certificate and furnish a United States
flag to deceased veterans; and (5) to maintain national cemeteries as
national shrines sacred to the honor and memory of those interred or
memorialized.
nca budget request
The administration requests $181 million for the NCA for fiscal
year 2009. The members of The Independent Budget recommend that
Congress provide $252 million and 51 additional FTE for continuing
operations and workload increases of NCA. We recommend your support for
a budget consistent with NCA's growing demands and in concert with the
respect due every man and woman who wears the uniform of the U.S. Armed
Forces.
The national cemetery system continues to be seriously challenged.
Though there has been progress made over the years, the NCA is still
struggling to remove decades of blemishes and scars from military
burial grounds across the country. Visitors to many national cemeteries
are likely to encounter sunken graves, misaligned and dirty grave
markers, deteriorating roads, spotty turf and other patches of decay
that have been accumulating for decades. If the NCA is to continue its
commitment to ensure national cemeteries remain dignified and
respectful settings that honor deceased veterans and give evidence of
the Nation's gratitude for their military service, there must be a
comprehensive effort to greatly improve the condition, function, and
appearance of all our national cemeteries.
In accordance with ``An Independent Study on Improvements to
Veterans Cemeteries,'' which was submitted to Congress in 2002, The
Independent Budget again recommends Congress to fully fund the National
Shrine Initiative by providing $50 million in fiscal year 2009 budget
and a commitment of $250 million over a period of 5 years to restore
and improve the condition and character of NCA cemeteries.
It should be noted that the NCA has done an outstanding job thus
far in improving the appearance of our national cemeteries, but
critical under funding does not allow NCA to remove the backlog of
improvements that need to be met. To date, NCA has invested $99 million
to the initiative, making nearly 300 improvements. Additionally, $28.2
million will be invested in restoration in 2008. This money is the full
amount of supplemental funding that was given to NCA in fiscal year
2008, a fact that should be a wake-up call of the importance of the
National Shrine Initiative. Even with the funding that has been spent
on these improvements, new areas requiring restoration are identified.
By enacting a 5-year program with dedicated funds and an ambitious
schedule, the national cemetery system can provide veterans and their
families with the utmost dignity, respect, and compassion.
the state cemetery grants program
The State Cemetery Grants Program (SCGP) complements the NCA
mission to establish gravesites for veterans in those areas where the
NCA cannot fully respond to the burial needs of veterans. Several
incentives are in place to assist States in this effort. For example,
the NCA can provide up to 100 percent of the development cost for an
approved cemetery project, including design, construction, and
administration. In addition, new equipment, such as mowers and
backhoes, can be provided for new cemeteries. Since 1978, the
Department of Veterans Affairs has more than doubled acreage available
and accommodated more than a 100 percent increase in burials through
this program.
To help provide reasonable access to burial options for veterans
and their eligible family members, The Independent Budget recommends
$42 million for the SCGP for fiscal year 2009. The availability of this
funding will help States establish, expand, and improve State-owned
veterans' cemeteries.
States have intentions of beginning construction of 24 new State
cemeteries in 2008. Many States have difficulties meeting the
requirements needed to build a national cemetery in their respective
State. The large land areas and spread out population in these areas
make it difficult to meet the ``170,000 veterans within 75 miles''
national veterans cemetery requirement. Recognizing these challenges,
VA has implemented several incentives to assist States in establishing
a veterans cemetery. For example, the NCA can provide up to 100 percent
of the development cost for an approved cemetery project, including
design, construction, and administration.
burial benefits
There has been serious erosion in the value of the burial allowance
benefits over the years. While these benefits were never intended to
cover the full costs of burial, they now pay for only a small fraction
of what they covered in 1973, when the Federal Government first started
paying burial benefits for our veterans.
In 2001 the plot allowance was increased for the first time in more
than 28 years, from $150 to $300, which covers approximately 6 percent
of funeral costs. The Independent Budget recommends increasing the plot
allowance from $300 to $745, an amount proportionally equal to the
benefit paid in 1973.
In the 108th Congress, the burial allowance for service-connected
deaths was increased from $500 to $2,000. Prior to this adjustment, the
allowance had been untouched since 1988. The Independent Budget
recommends increasing the service-connected burial benefit from $2,000
to $4,100, bringing it back up to its original proportionate level of
burial costs.
The non-service-connected burial allowance was last adjusted in
1978, and also covers just six 6 percent of funeral costs. The
Independent Budget recommends increasing the non-service-connected
burial benefit from $300 to $1,270.
The NCA honors veterans with a final resting place that
commemorates their service to this Nation. More than 2.8 million
soldiers who died in every war and conflict are honored by burial in a
VA national cemetery. Each Memorial Day and Veterans Day we honor the
last full measure of devotion they gave for this country. Our national
cemeteries are more than the final resting place of honor for our
veterans; they are hallowed ground to those who died in our defense,
and a memorial to those who survived.
Mr. Chairman, this concludes my testimony. I thank you again for
the privilege to present our views, and I would be pleased to answer
any questions you might have.
Chairman Akaka. Thank you very much, Mr. Kelley.
Mr. Needham.
STATEMENT OF CHRISTOPHER NEEDHAM, SENIOR LEGISLATIVE ASSOCIATE,
NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE
UNITED STATES
Mr. Needham. Chairman Akaka, Ranking Member Burr and
Members of the Committee.
On behalf of the members of the Veterans of Foreign Wars, I
would like to thank you for the opportunity to testify today.
As a co-author of the Independent Budget, the VFW is primarily
responsible for the construction section, so I will limit my
remarks to that area.
The President's request for construction funding will not
meet the needs of America's veterans. As part of its budget
submission, the VA has provided hundreds of pages of
construction priorities that require millions of dollars of
investment. Despite this, the Administration has essentially
halved the major and minor construction budgets. We look to you
in Congress, as you have done in the past, to increase the
construction budget and live up to the needs of our veterans.
With respect to the major construction account, the
Administration has requested $582 million, far below the $1.1
billion appropriated this year. This is also far behind the
$1.275 billion called for by the Independent Budget.
Further, the Administration is proposing just $476 million
for hospital construction, less than half of the $1.1 billion
recommended by the IB.
We appreciate that the Administration's request covers
eight medical facilities including three completely new
projects, two of those would expand VA's polytrauma efforts. We
believe, however, that VA can and must do more.
The funding provided for these eight projects is tiny
compared to their total cost. If this budget is enacted, VA
will have a construction backlog of $2 billion in projects. At
the pace of the Administration's request, it would take five
fiscal years for these projects to be fully funded and even
more for construction to be completed.
We need to move forward to keep up with the promise of
CARES. Former VA Secretary Anthony Principi testified before
the House that CARES would require $1 billion a year for 5
years. Since that time, total CARES funding is about $3 billion
when you discount emergency hurricane repairs.
Clearly, more needs to be done and we urge action to live
up to the Secretary's words. You must make a steady investment
in VA's capital infrastructure to bring the system up to date
with the 21st century needs of veterans.
Turning to minor construction, VA's request is just $329
million which is about $300 million less than the current
year's funding level. The IB has recommended $621 million with
the majority of that going to VHA construction and renovation.
For VHA, the Administration's request is just $273 million.
This will not meet the needs laid out in their budget
documentation.
For fiscal year 2009 VA, in its capital plan, lists 145
construction projects. Although VA does not provide cost
estimates for these, the fiscal year 2008 cost per project was
over $5 million per project. Simple multiplication shows that
VA's minor construction budget is not sufficient, and for the
sake of argument even if you halve the cost per project, it
still would not meet the needs.
Fully funding minor construction is important because it
plays a key role in the maintenance of VA's facilities. VA says
that 30 percent of all minor construction funding is used to
offset the deficiencies of the facilities condition assessments
or FCAs.
In fiscal year 2007 VA estimated that there was a $5
billion backlog in FCA maintenance. Although Congress has
targeted funding for these essential projects, most of the
backlog remains. The main way in which VA clears the backlog is
through non-recurring maintenance or NRM. To that end, we were
pleased to see the $802 million request for NRM. This is in
line with what The IB has called for in the past.
Industry standard is for a medical facility to spend
between 2 and 4 percent of its plant replacement value on NRM
funding. In VA's case this corresponds with $800 million to
$1.6 billion, an amount VA agrees with and is included in their
asset management plan.
While we were pleased with the request, given the $5
billion backlog in maintenance, it represents the low end of
what VA needs. Accordingly, we would like Congress to increase
funding, again as you have in the past, to reduce this backlog
and ensure that VA delivers health care in clean, safe and well
maintained environments.
Mr. Chairman, this concludes my testimony and I would be
happy to answer any questions you or the members may have.
[The prepared statement of Mr. Needham follows:]
Prepared Statement of Christopher Needham, Senior Legislative
Associate, National Legislative Service, Veterans of Foreign Wars of
The United States
Mr. Chairman and Members of this Committee: On behalf of the 2.4
million men and women of the Veterans of Foreign Wars of the United
States (VFW) and our Auxiliaries, I would like to thank you for the
opportunity to testify today. The VFW works alongside the other members
of the Independent Budget (IB)--AMVETS, Disabled American Veterans and
Paralyzed Veterans of America--to produce a set of policy and budget
recommendations that reflect what we believe would meet the needs of
America's veterans. The VFW is responsible for the construction portion
of the IB, so I will limit my remarks to that portion of the budget.
The administration's fiscal year 2009 budget request for major and
minor construction is woefully inadequate, especially in light of the
administration's own supporting documents. Despite hundreds of pages of
budgetary documents that show a need for millions of dollars in
construction projects, the administration saw fit to halve the major
and minor construction accounts from the fiscal year 2008 levels,
failing to meet the future needs of our veterans. We look to you in
Congress to correct this, and to advance VA's construction priorities
so that future generations of veterans--those currently serving in the
deserts of Iraq and the mountains of Afghanistan--can have a first-rate
VA health care system that lives up to their needs.
major construction
The President's request for major construction is a paltry $581.6
million for fiscal year 2009. This is a dramatic cut from last year's
funding level of $1.1 billion. While we appreciate that this level
covers eight medical facility projects, including three new previously
unfunded projects, the total level of funding does not come close to
meeting the IB's recommendation of $1.275 billion in construction
projects. $476.6 million of the administration's request covers
Veterans Health Administration projects, significantly lower than the
$1.1 billion that the IB has called for.
In determining our recommendations, we follow VA's prioritization
process as VA discusses in its annual 5-Year Capital Plan, which is
included in Volume III of the Department's budget submission.
VA determines its budget year priorities in two phases. First,
partially funded projects from previous years are ordered by fiscal
year and priority order. Second, newly evaluated projects from the
current budget year are listed in priority order. These are combined,
with the first category receiving priority over the second.
For the current year's process, VA had seven partially unfunded
projects at the top of the list and chose to provide funding for five
of those projects. They also began to provide funding for the top three
new projects as ranked in the current fiscal year: Bay Pines, FL;
Tampa, FL; and Palo Alto, CA. We certainly appreciate the progress on
new construction projects as last year's funding request did not call
for any new projects. We also appreciate the focus on construction and
improvements to VA's polytrauma centers. We believe, however, that more
can and must be done.
While the eight major construction projects might sound like a lot,
the funding levels recommended for them are a tiny blip in the overall
costs of those projects. If we look at just the partially unfunded
projects--the backlog, if you will--even the $320 million aimed at them
barely scratches the surface. Only the Lee County, FL, outpatient
clinic is funded to completion. The other four projects still require a
total future funding level of $1.26 billion. The funding for the three
new projects totals $76.8 million out of a total construction estimate
of $771 million. This is important because it means that there will be
a total construction backlog of over $2 billion when the administration
prepares its request for the following fiscal year. It is increasingly
unlikely that the top priority construction projects--likely to include
this year's number 4 priority project in Seattle, WA, or improvements
in Dallas, TX, or Louisville, KY--will be funded in future years while
VA's meager construction budget is earmarked only to prior projects, as
was the case with last year's funding
request.
I would refer you to the table on Page 7-12 of VA's 5-Year Capital
Plan for the full list of projects VA considered funding in the current
year. The increase in funding that we are calling for could be applied
to those prior year projects we referred to previously, or to the
fiscal year 2009 scored projects. Both categories desperately need
funding beyond the administration's request. Even an increase of about
$31 million would allow VA to begin the first stages of construction on
priority projects 4-6, which typically requires 10 percent of the total
cost estimate.
These projects are necessary to ensure that VA properly reinvests
in its aging physical infrastructure. VA's facilities average over
fifty years old, and VA has historically recapitalized at a rate far
below hospital industry standards. From 1996-2001, for example, VA
recapitalized at a rate of just 0.64 percent per year. This corresponds
with an assumed building life of 155 years, far beyond any reasonable
expectations. VA has made progress since then, but more clearly must be
done, especially if we are to live up to the promise of CARES and
modernize the system so that veterans now and into the future will have
first-rate health care in clean, safe, modern and comfortable
facilities.
We remain concerned about the unfulfilled promise of CARES. Upon
completion of the CARES decision document, former VA Secretary, Anthony
Principi, testified before the Health Subcommittee of the House
Committee on Veterans' Affairs in July 2004. His testimony noted that
CARES ``reflects a need for additional investments of approximately $1
billion per year for the next 5 years to modernize VA's medical
infrastructure and enhance veterans' access to care.''
According to VA's November 2007 testimony before that same
Committee, Congress has appropriated just $2.83 billion for CARES
projects, far below the need to which the Secretary had testified.
Further, this includes a sizable amount for rebuilding facilities after
the Gulf Coast Hurricanes--amounts we have argued that Congress should
have provided as separate emergency funding, outside of VA's regular
planning process. With the fiscal year 2008 appropriation, the total is
up to $3.9 billion--better, but still lagging.
With just $581 million requested for major construction in fiscal
year 2009, which is far below VA's demonstrated needs, it is clear that
VA is falling short. After that 5-year de facto moratorium on
construction while CARES was ongoing and without additional funding
coming forth, VA and veterans have an even greater need than they did
at the start of the CARES process. Accordingly, we urge action to live
up to the Secretary's words by making a steady investment in VA's
capital infrastructure to bring the system up to date with the 21st
century needs of veterans.
minor construction
We also are greatly concerned with the administration's proposed
slashing of the minor construction budget. As with the major
construction account, this cut is contrary to the information the
Department provides in the total budget document. For fiscal year 2009,
the recommendation is just $329 million, $301 million below the fiscal
year 2008 level and far below the $621 million called for in the
Independent Budget.
$273 million of the request is targeted for VHA facilities and $18
million--about 5 percent of the total--is allocated for staff offices
to accommodate the consolidation of VA's information technology
programs.
VA has a long list of minor construction projects targeted for
fiscal year 2009. There is a list of 145 minor construction projects
listed on page 7-95 of the 5-Year Capital Plan. Although there is no
cost specifically associated with them, we can estimate the cost using
the average cost of the scored projects from fiscal year 2008, which
can be found on page 7-90. For the fiscal year 2008 projects listed,
the average price per project is $5.6 million. If you multiply that
cost per project by the 145 proposed fiscal year 2009 projects, VHA
would require a budget of $812 million, nearly $500 million more than
they have actually requested. We understand that VA has some carryover
funding for minor construction to offset some of that balance, but even
if all $267 million of that were applied to this list of projects, VHA
would still require $545 million in funding instead of the $273 the
administration has requested.
The minor construction request seems even more deficient when you
factor in its role with respect to the maintenance of VA's facilities.
Every medical center is surveyed at least once every 3 years and given
a thorough assessment of all component systems. These reviews comprise
the Facility Condition Assessment (FCA), and the scores are used, in
part, to produce the condition index of the facility, one of the
benchmark statistics in VA's Real Property Scorecard. The majority of
funding for projects and systems found to be deficient through the FCA
is nonrecurring maintenance (NRM), but VA says that 30 percent of all
minor construction is targeted to correct documented FCA deficiencies.
In fiscal year 2007, VA notes that its FCA backlog was well over $5
billion in projects. Congress has done a good job to improve some of
these deficiencies--notably the $550 supplemental that was targeted
toward FCA problems--but more must be done if VA is going to properly
maintain its
facilities.
nonrecurring maintenance
Those FCA reviews show the importance of nonrecurring maintenance
(NRM), and the $5 billion backlog shows how woefully deficient past NRM
requests and appropriations have been. It is sad that it took the
unconscionable situation at Walter Reed--a non-VA facility--to
demonstrate the importance of the account. We certainly applaud VA's
efforts post-Walter Reed to assess the maintenance of its
infrastructure and Congress' immediate response, but it should not have
come to that. The problems with the lack of NRM funding have been
repeatedly pointed out in the Independent Budget, and we continue to
ask Congress and the administration to do more.
For fiscal year 2009, we are pleased to see that the President has
requested $802 million for NRM funding. This is in line with what the
IB has called for in the past. For justification of our number, we
continue to cite the Price Waterhouse review of VA's facility
management programs that cited industry standards to claim that VA
should be spending between 2 and 4 percent of its plant replacement
value on NRM. VA accepted this recommendation and adopted it as part of
its Asset Management Plan. That VA document noted that VA's plant
replacement value was approximately $40 billion, and accordingly, the
NRM budget should be between $800 million and $1.6 billion.
With the near-$5 billion backlog in FCA-observed maintenance needs,
the proposed $802 million is surely on the low end. That amount would
allow VA to perform maintenance at current levels, but not to dip into
the backlog. Accordingly, we would like Congress to increase funding
for this account, as has been done in the past. We need to eliminate
the backlog to ensure that veterans have health care in clean, safe,
and efficient locations, and that VA properly cares for its
infrastructure to ensure that it lasts for years into the future.
Mr. Chairman, this concludes my statement. I would be happy to
answer any questions that you or the Members of the Committee may have.
Chairman Akaka. Thank you very much, Mr. Needham.
Mr. Gaytan.
STATEMENT OF PETER S. GAYTAN, DIRECTOR, NATIONAL VETERANS
AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION
Mr. Gaytan. Thank you, Mr. Chairman, for allowing the
American Legion to offer its views on the President's budget
request for fiscal year 2009.
Last September, the National Commander, Marty Conatser,
presented the American Legion's budget recommendations for the
Department of Veterans Affairs in fiscal year 2009.
Since our complete written testimony is submitted for the
record, I will only address a few key concerns with the
President's budget requests.
Also, on behalf of the American Legion, I thank you and
your colleagues for the fiscal year 2007 and fiscal year 2008
VA budgets last session.
The initial fiscal year 2008 budget agreed to by both
bodies met or exceeded the recommendations of the American
Legion and we appreciate the hard work of this Committee.
Approval of the emergency funding provided in Pubic Law 110-161
was also a welcome addition to the VA budget.
While the fiscal year 2009 VA budget request does, indeed,
raise health care funding slightly, it does not appear that
this request takes into consideration several critical factors
that will impact the actual value of the fiscal year 2009 VA
budget, such as the normal rate of inflation, the recent
downturn in the economy and increased unemployment, the
successful surge of troops in Iraq and their pending re-
deployments, the extension of health care for returning OIF and
OEF veterans from two to 5 years, and the increased medical
research and treatment needed on Traumatic Brain Injury and
Post Traumatic Stress Disorder.
The American Legion does not believe that now is the time
to cut funding for medical and prosthetic research. The
American Legion believes each of these factors will increase
demand for services within VA and will strain an already
overburdened system.
The veterans' community is all too familiar with the
adverse impact and miscalculations in usage of VA services. We
continue to urge Congress to provide medical care funding that
is timely, predictable and sufficient each year. The American
Legion looks forward to working with you and your colleagues to
achieve this goal.
Additionally, the American Legion is very concerned with
the unfunded major construction projects identified in the
CARES final report. These locations have been identified as
priority construction projects that will allow VA to fulfill
its mission of providing quality health care to America's
veterans and they must be funded at a level that will allow
them to achieve that goal.
The American Legion adamantly opposes 2009 policy proposals
contained in the fiscal year 2009 budget submission that seek
to impose an annual enrollment fee and practically double the
current co-payment for pharmaceuticals.
The American Legion has opposed these proposals in the past
and we once again call on the Members of this Committee to join
us in defeating any proposal that seeks to balance the VA
budget on the backs of America's veterans.
Mr. Chairman, that concludes my remarks and I am available
for any questions you may have.
[The prepared statement of Mr. Gaytan follows:]
Prepared Statement of Peter S. Gaytan, Director, National Veterans
Affairs and Rehabilitation Commission, The American Legion
Mr. Chairman and Members of the Committee: The American Legion
would like to begin this hearing by expressing our gratitude to you and
your colleagues for your work on the fiscal year 2008 budget for the
Department of Veterans Affairs (VA). From the very beginning of the
110th Congress, there was a great deal of fiscal work to be
accomplished. In essence, you and your colleagues had to put together
two VA appropriations budgets during the First Session.
The American Legion supported the Budget Resolution for the first
time in many, many years. The American Legion supported the original
version of the Military Construction, Veterans' Affairs, and Related
Appropriations for fiscal year 2008, passed overwhelmingly with
bipartisan support in both chambers; however, we were also very pleased
when President Bush requested the additional $3.7 billion provided in
Public Law 110-161. Needless to say, last year was an unusual
appropriations cycle.
The veterans' community continues to request an annual VA
appropriation that is timely, predictable, and sufficient to meet the
growing demands on VA. Every VA program is specifically designed to
address the various needs of America's veterans and their families.
Some programs date back to past proprieties of an earlier era of
veterans such as the greatest piece of social legislation ever enacted,
the Servicemen's Readjustment Act of 1944 (the GI Bill of Rights).
Newer areas of concern include improved diagnosis and treatment of
Traumatic Brain Injury. Some programs are individual entitlements that
are funded through mandatory appropriations, while the balance are
subject to the annual discretionary appropriations battle in Congress.
But all represent the thanks of a grateful Nation.
The American Legion does not support the 2009 policy proposals
contained in the fiscal year 2009 Budget submission that seek to impose
an annual enrollment fee and practically double the current co-payment
for pharmaceuticals. The American Legion has opposed these proposals in
the past and we once again call on the Members of this Committee to
join us in defeating any proposal that seeks to balance the VA Budget
on the backs of America's veterans.
Mr. Chairman, The American Legion welcomes the opportunity to
present recommendations on the fiscal year 2009 VA appropriations and
other appropriations that fall under the jurisdiction of this
Committee. The American Legion appreciates the efforts of the Secretary
of Veterans Affairs and his capable leadership staff to produce a
budget request that reflects the fiscal needs of VA to provide timely
access to the earned benefits provided to those who served in the Armed
Forces of the United States. In a Nation of over 300 million citizens
and a host of visitors, only 24 million veterans have accepted the
challenge of military service. Some veterans were placed in harm's way,
but all accepted the oath of enlistment. All were prepared to give
``the last full measure of devotion.''
Last September, The American Legion National Commander Marty
Conatser testified before you and your colleagues to outline budget
recommendations for fiscal year 2009 and address some legislative
concerns as well. To briefly recap, here is a table that reflects the
final VA appropriations for fiscal year 2008, The American Legion's
budget request for fiscal year 2009, and the President's budget request
for fiscal year 2009:
----------------------------------------------------------------------------------------------------------------
Final Fiscal Legion's Request President's
Discretionary Funding Programs Year 2008 Pub. Fiscal Year Request Fiscal
L. 110-161 2009 Year 2009
----------------------------------------------------------------------------------------------------------------
Medical Services.......................................... $29.1 billion ................
Medical Administration.................................... $3.2 billion ................ $34 billion
Medical Facilities........................................ $4.1 billion ................ $4.6 billion
-----------------------------------------------------
Total Medical Care...................................... $36.7 billion $38.4 billion $38.7 billion
Medical/Prosthetics Research.............................. $480 million $476 million $442 million
Major Construction........................................ $1.1 billion $560 million $582 million
Minor Construction........................................ $579 million $485 million $329 million
CARES..................................................... ................ $1 billion ................
State Extended Care Facilities Grants Program............. $165 million $275 million $85 million
State Veterans' Cemetery Construction Grants Program...... $39 million $45 million $32 million
National Cemetery Administration.......................... $195 million $228 million $181 million
General Operating Expenses................................ $1.6 billion $2.8 billion $1.7 billion
Information Technology.................................... $2 billion $2.3 billion $2.4 billion
----------------------------------------------------------------------------------------------------------------
veterans affairs and rehabilitation
The American Legion breaks down its Veterans Affairs and
Rehabilitation testimony into three sections that mirror the major
organizational segments of the Department of Veterans Affairs (VA). In
these separate sections The American Legion will discuss our
legislative budget priorities regarding the Veterans Health
Administration (VHA), the Veterans Benefits Administration (VBA) and
the National Cemetery Administration (NCA).
Veterans Health Administration
The distinction of the VA as the Nation's leader in providing safe,
high-quality health care in the health care industry (both public and
private), has been recognized by several reputable sources:
The medical journal Neurology commented, ``The VA has
achieved remarkable improvements in patient care and health outcomes,
and is a cost-effective and efficient organization'' (2007).
Harvard University's Kennedy School of Government
presented VA with the highly coveted ``Innovations in American
Government'' for its advanced electronic health records and performance
measurement system (2006).
The Journal of the American Medical Association (JAMA)
noted VA's health care system has ``quickly emerged as a bright star in
the constellation of safety practice, with system-wide implementation
of safe practices, training programs and the establishment of four
patient-safety research centers'' (2005).
The recent book by Phillip Longman entitled ``Best Care
Anywhere: Why VA Health Care is Better Than Yours'' (2007).
Veterans' Health Care Benefit Enrollment Discrimination
All veterans eligible to receive benefits from VA should have
access to the VA health care system. The American Legion opposes any
enrollment policy that disallows any eligible veteran, who was prepared
to give his or her life for this country, access to what is often
described as the best health care in the Nation. Honorable military
service, whether for a single enlistment period or for a 30-year
career, is not merely another period of employment in an individual's
personal history. It is a defining portion of one's life.
Maintaining the quality of care that VA is currently known for
should be a national priority. But that quality of care is being denied
to an ever-increasing number of America's veterans. Fiscal year 2009
budget request continues the suspension of enrollment of new Priority
Group 8 veterans due to the increased demands for services. According
to VA, the number of Priority Group 8 veterans denied enrollment in the
VA health care system at the end of fiscal year 2007 was 386,767. The
American Legion believes this number is significantly higher because it
does not include those veterans who have not attempted to use the VA
because they are aware of the suspension. Given the recruiting and
retention problems the Armed Forces face, it is clear that denying
earned benefits to eligible veterans does not solve the problems
created by an inadequate Federal budget.
As the Global War on Terrorism wages on, fiscal resources for VA
will continue to be stretched and this Nation's veterans will continue
to beg elected officials for monies to sustain a viable VA. A viable VA
is one that cares for all veterans, not just the most severely wounded.
More importantly, VA is often the first experience veterans have with
the Federal Government after leaving military service. This Nation's
veterans have never let this country down; it is time for Congress to
do its best not to let them down.
All veterans, who are eligible to receive benefits from VA, should
have timely access to the VA health care system. Honorable military
service is evidence of an individual's commitment to this Nation. In
return for honorable military service, the thanks of a grateful nation
should not simply be a conditional benefit that can easily be
restricted or denied by political or bureaucratic whim, but should be
regarded as an earned right in recognition for faithful service to this
country.
Quality, timely and accessible VA health care is the ongoing cost
of war. It is unconscionable to send the young men and women in the
Armed Forces to every corner of the globe and then limit the funding to
take care of their injuries suffered in service to this country. VA was
created to take care of the unique needs of a very specific population,
those veterans that wore the uniforms of the Armed Forces. Once those
uniforms are off, these veterans should be able to depend upon the VA
health care system for their health care needs--regardless of the type
or severity of their injuries. Many veterans will need health care for
the rest of their lives. The American Legion expects the VA health care
system to ensure and provide the very best health care for this
Nation's heroes. The American Legion strongly supports the
reinstatement of enrollment for Priority Group 8 veterans.
Mandatory Funding of VA Medical Care
The American Legion believes the time for mandatory funding for
veterans' health care is now. Congress should act to ensure that we, as
a Nation, will always provide the funding necessary to ensure veterans,
who seek timely access to quality health care through the VA health
care delivery system, are provided the health care they earned.
A new generation of young Americans is now deployed around the
world, answering the Nation's call to arms. Like so many brave men and
women who honorably served before them, these new veterans are fighting
for freedom, liberty and security of us all. Also like those who served
before them, today's veterans deserve the respect of a grateful nation
when they return home.
Previous generations of wartime veterans were welcomed at VA
medical facilities until the 1980's. Unfortunately, without urgent
changes in health care funding, these new veterans will soon discover
their battles are not yet over. This Nation's newest heroes will be
fighting for the life of the VA health care system. Just as the
veterans of the 20th century did, they will be forced to fight for the
care they are eligible to receive.
The American Legion believes that the Veterans Health
Administration's (VHA) recurring fiscal difficulties will only be
solved when its funding becomes a mandatory appropriation item. As a
mandatory appropriation, law would guarantee VA health care funding for
all eligible enrollees--and it will be a patient-based, rather than a
budget-driven, annual appropriation.
The American Legion continues to support legislation that
establishes a system of capitation-based funding for VHA. This new
funding system would provide all of VHA's funding, except that of the
State Extended Care Facilities Construction Grant Program which would
be separately authorized and funded as a discretionary appropriation.
Although VHA continues to struggle to maintain its global
preeminence with a 21st Century integrated health care delivery system,
it is handicapped by funding methods that were developed in the 19th
Century for a now antiquated inpatient delivery system. No modern
health care organization can be expected to survive with such an
inconsistent and inadequate budget process. The American Legion's
position on VA health care funding is that health care rationing for
veterans must end. It is time to guarantee health care funding for all
veterans seeking VA health care.
Third-Party Reimbursements
The Balanced Budget Act of 1997, Pub. L. 105-33, established the VA
Medical Care Collections Fund (MCCF). The law requires that money
collected or recovered from third-party payers after June 30, 1997, be
deposited into this fund. The MCCF is a depository for collections from
third-party insurance, outpatient prescription co-payments and other
medical charges and user fees. The funds collected may be used to
provide VA medical care and services and for VA expenses for
identification, billing, auditing and collection of amounts owed the
Federal Government.
The American Legion supported legislation to allow VA to bill,
collect and reinvest third-party reimbursements and co-payments.
However, The American Legion has adamantly opposed the scoring of MCCF
as an offset to annual discretionary appropriations because almost all
of these funds derive from the treatment of non-service-connected
medical conditions. Historically, these collection goals far exceed
VA's ability to collect accounts receivable.
Once again, the President's budget request for fiscal year 2009
raises the bar on MCCF from $2.3 billion to $2.5 billion. VA's ability
to capture these funds is critical to its ability to provide quality
and timely health care to veterans. Miscalculations of VA required
funding levels results in real budgetary shortfalls. Seeking an annual
emergency supplemental appropriation is not the most cost-effective
means of funding the Nation's model health care delivery system.
Government Accountability Office (GAO) reports have described the
continuing problems in VHA's ability to capture insurance data in a
timely and accurate manner and have raised concerns about VHA's ability
to maximize its third-party collections. GAO visited three VA medical
centers and found the following concerns: VA lacked the ability to
verify insurance; VA could not accept partial payment as full payment;
VA had inconsistent compliance with collections follow up; VA failed to
ensure documentation by VA physicians was sufficient; VA had
insufficient automation; and, VA had a shortage of qualified billing
coders. All of these concerns are key deficiencies contributing to the
collections shortfalls. VA should implement all available remedies to
maximize its collections of accounts receivable.
The American Legion opposes offsetting annual VA discretionary
funding by the arbitrarily set MCCF goal, especially since VA is
prohibited from collecting any third-party reimbursements from the
Nation's largest federally-mandated health insurer, Medicare.
Medicare Reimbursements
Veterans contribute to the Medicare Trust Fund, as do most American
workers, without choice, throughout their working lives. Veterans also
paid these contributions when they served on active-duty. However, when
a veteran is treated at a VA medical facility, VA is prohibited from
collecting Medicare reimbursements for the treatment of allowable,
nonservice-connected medical conditions. Since over half of VA's
enrolled patient population is Medicare-eligible, this prohibition
constitutes a multi-billion dollar annual subsidy to the Medicare Trust
Fund. No other Federal health care provider is prohibited from
receiving Medicare reimbursements. The American Legion supports
allowing Medicare reimbursement to VHA to pay for the treatment of
allowable, nonservice-connected medical conditions of enrolled
Medicare-eligible veterans.
Medical Construction and Infrastructure Support
Major Construction
The CARES process identified more than 100 major construction
projects in 37 States, the District of Columbia, and Puerto Rico.
Construction projects are categorized as `major' if the estimated cost
is over $10 million. Now that VA has a plan to deliver health care
through 2022, it is up to Congress to provide adequate funds.
The CARES plan calls for, among other things, the construction of
new hospitals in Orlando, FL, and Las Vegas, NV, and replacement
facilities in Louisville, KY, and Denver, CO, for a cost estimated to
be well over $1 billion for these four facilities. VA has not had this
type of progressive construction agenda in decades. Major construction
money can be significant and proper utilization of funds must be well
planned. Recently, Congress approved funding for a new Veterans Affairs
Medical Center in Denver. It is our hope that funding will be provided
for Louisville and Las Vegas as well.
In addition to the cost of the proposed new facilities are the many
construction issues that have been virtually ``put on hold'' for the
past several years due to past inadequate funding and the moratorium
placed on construction spending by the CARES process. One of the most
glaring shortfalls is the neglect of the buildings sorely in need of
seismic correction. This is an issue of safety. The delivery of health
care in seismically unsafe buildings cannot be tolerated and funds must
be allocated to not only construct the new facilities, but also to pay
for much needed upgrades at existing facilities. Gambling with the
lives of veterans, their families and VA employees is absolutely
unacceptable.
The American Legion believes that VA has effectively shepherded the
CARES process to its current State by developing the blueprint for the
future delivery of VA health care--it is now time for Congress to
adequately fund the implementation of this crucial undertaking.
The American Legion recommends $560 million for Major Construction
in fiscal year 2009. Although the President's budget request for fiscal
year 2009 calls for Major Construction to be $582 million, The American
Legion also recommends an additional $1 billion specifically designated
for approved CARES major construction.
Minor Construction
VA's minor construction program has also suffered significant
neglect over the past several years. Maintaining the infrastructure of
VA's buildings is no small task. Because the buildings are old,
renovations, relocations and expansions are quite common. When combined
with the added cost of the CARES program recommendations, it is easy to
perceive that a major increase over the previous funding level is
crucial and overdue.
The American Legion recommends $485 million for Minor Construction
in fiscal year 2009.
Veterans Benefits Administration
The President's annual budget request is a detailed outline of the
mandatory and discretionary funding needed by the Veterans Benefits
Administration (VBA). Given VBA's many challenges and responsibilities,
which include the annual expenditures for compensation, pension, and
related benefit payments, it is imperative that Congress ensure that
VBA's programs have the personnel and other resources necessary to
operate efficiently and can provide quality and timely service. The
budget debate process and oversight hearings provide opportunities to
evaluate how well VBA is, in fact, performing its missions and whether
the needs and expectations of its stakeholders are being met.
For several years, VBA has endeavored to implement its long-term
strategic plans to hire and train a new cadre of adjudicators, to
continue the computer modernization program, and to institute a variety
of procedural and programmatic changes intended to improve the claims
adjudication process. However, external factors, such as the enactment
of legislation providing new benefits and medical care services and
precedent setting legal decisions by the Federal courts, continue to
play a major role in changing VBA's plans, policies, and operations.
VBA's efforts to address these varied and complex issues have profound
budgetary and operational implications.
One of the most significant challenges plaguing VBA is the sheer
size of the backlog of pending disability claims and appeals. These
claims are usually multi-issue cases arguing complex medical and legal
issues that must be resolved. The American Legion believes the backlog
is a symptom of unresolved systemic problems that adversely affect the
adjudication and appeals process. These unresolved problems further
contribute to the ever-growing backlog. These problems include:
frequent decisionmaking errors at all levels of the decisionmaking
process; failure by VA personnel to comply with the Veterans' Claims
Assistance Act of 2000 (VCAA); lack of personal accountability by VA
employees and managers; ineffective quality control and quality
assurance programs; inadequate personnel training; and, an unreliable
work measurement system. VBA is faced with a serious dilemma. While
endeavoring to address these thorny issues, it is also aggressively
trying to process claims faster. From the results, it does not appear
VBA has found a way to successfully balance these competing priorities.
As of January 5, 2008, there were more than 406,000 rating cases
pending in the VBA system. Of these, 105,693 (26 percent) have been
pending for more than 180 days. There are more than 163,000 appeals
pending at VA regional offices, with more than 147,000 requiring some
type of further adjudicative action. Additionally, there are currently
more than 30,000 appeals pending at the Board of Veterans' Appeals and
more than 19,000 remands pending at the Appeals Management Center.
As previously noted, The American Legion remains deeply concerned
by the problems arising from the VBA's general lack of compliance with
its ``duty to notify'' and its ``duty to assist'' requirements directed
by the VCAA. This legislation is one of the most significant, pro-
veteran improvements in the VA claims adjudication system in the past
decade. However, VBA continues to give only lip service to this law.
While claimants receive what VBA terms a VCAA letter, this letter, in
fact, is generally not very informative about what particular evidence
is needed by VBA to grant the benefit sought by the veteran. In
addition, these VCAA letters are usually long and confusing, not very
specific to the evidence needed from claimants, and written in
bureaucratic language instead of ``plain English.'' Rather than helping
claimants with the development of the claim, these letters frequently
generate more questions, more telephone calls, and more correspondence
to veterans' service officers or the VA regional office. Clearly, the
VCAA letter currently in use by VBA today only serves to delay rather
than facilitate the claims process.
The VBA's work measurement system may directly or indirectly affect
the VBA's failure to reduce the claims backlog. The VBA's work
measurement system is the means by which both individual employee and
station performance is tracked and evaluated. This system is also
relied upon in determining staffing needs at the station, region, and
service levels in support of VBA's annual budget request. A serious
problem can arise if the data developed by the work measurement system
is neither accurate nor reliable in reporting the actual amount of work
accomplished. This produces a distorted view of the way the VBA
adjudication process is operating and what the true staffing needs are,
both locally and system-wide.
The American Legion believes VBA's current work measurement system
is seriously flawed. It does not provide VBA and Congress the needed
information on how long it actually takes to properly process a claim
and how many staff are required to perform this process in a timely
manner. The American Legion advises that this work data is also subject
to frequent manipulation and abuse, thus, its accuracy and reliability
is open to serious question as are the conclusions and decisions drawn
from this work data. In the view of The American Legion, the
development and implementation of a new work measurement system should
be one of VBA's highest priorities. The American Legion fully
understands and appreciates the major challenges facing VBA in the
upcoming year, but as a major stakeholder in VBA's benefit programs we
are committed to ensuring that VBA provides the best quality and timely
service to our Nation's veterans and their families.
National Cemetery Administration
Approximately 24 million veterans are living today. Nearly 690,000
veteran deaths are estimated to occur in 2009. VA estimates that
approximately 111,000 will request interment in national cemeteries.
Considering the growing cost of burial services and the excellent
quality of service the National Cemetery Administration (NCA) provides,
The American Legion foresees that this percentage will be much greater.
Congress must therefore provide sufficient Major Construction
appropriations to permit NCA to accomplish its Stated goal of ensuring
that burial in a national or State cemetery is a realistic option for
our Nation's veterans by locating cemeteries within 75 miles of 90
percent of eligible veterans. The American Legion recommends $228
million be appropriated for the National Cemetery Administration for
fiscal year 2009.
National Cemetery Expansion
According to VA, it takes approximately 20 to 30 Full Time
Equivalents (FTEs), to operate a national cemetery (depending on the
size and workload at a particular facility) and it takes approximately
8 to 10 FTEs to operate a newly-opened cemetery (cemeteries are opened
to interments long before completion of the full site). Thus, it seems
reasonable that at least 50 new FTEs will be needed to operate the six
new cemeteries NCA is planning to bring online in fiscal year 2008. It
is likely, therefore, that these new cemeteries will need the full 20
to 30 FTEs in fiscal year 2009. The average VA employee salary with
benefits is $63,709. The American Legion recommends that funding for an
additional 120-150 employees be included in the fiscal year 2009
budget.
National Shrine Commitment
Maintaining cemeteries as National Shrines is one of NCA's top
priorities. This commitment involves raising, realigning and cleaning
veterans' headstones and markers to renovate their gravesites. The work
that has been done by VA so far has been outstanding; however, adequate
funding is the key to maintaining this very important commitment. The
American Legion supports NCA's goal of completing the National Shrine
Commitment within 5 years. This commitment includes the establishment
of standards of appearance for national cemeteries that are equal to
the standards of the finest cemeteries in the world. Operations,
maintenance and renovation funding must be increased to reflect the
true requirements of the NCA to fulfill this commitment.
VA has assessed burial sections and sites, roadways, buildings, and
historic structures and has identified 928 potential improvement
projects at an estimated cost of $280 million. October 2007 marked the
end of the 5-year plan, but still much work needs to be done. With the
addition of six new cemeteries and the addition of six more cemeteries
that are fast-tracked to come online this year, resources will be
strained. The American Legion recommends that $52 million be
appropriated to the National Shrine Commitment in order to fulfill this
commitment to the Nation's veterans.
State Cemetery Construction Grants Program
This program is not intended to replace National Cemeteries, but to
complement them. Grants for State-owned and operated cemeteries can be
used to establish, expand and improve on existing cemeteries. There are
60 operational State cemeteries and two more under construction. Since
NCA concentrates its construction resources on large metropolitan
areas, it is unlikely that new national cemeteries will be constructed
in all of the States. Therefore, individual States are encouraged to
pursue applications for the State Cemetery Grants Program. Fiscal
commitments from the States are essential to keep the operations of
State cemeteries on track. NCA estimates it costs about $300,000 per
year to operate a State cemetery.
Determining an ``average cost'' to build a new State cemetery or to
expand an existing one is very difficult. Many factors influence cost,
such as location, size and the availability of public utilities. The
American Legion believes States will increasingly use the State
Cemetery Grants Program to fulfill the needs of their veteran
populations that are still not well served by the ``75-mile service
area/170,000 veteran population'' threshold that currently serves as
the VA benchmark for establishing a new national cemetery. New State
cemeteries and expansions and improvements of existing State cemeteries
are therefore likely to increase. With increasing costs, especially
given the high cost of land in urban areas, and with increasing demand,
The American Legion recommends the amount of funding for the State
Cemetery Grants Program be substantially increased. The American Legion
recommends $45 million for the State Cemetery Grants Program in fiscal
year 2009.
economics
The GI Bill and Veterans' Education Benefits
The American Legion has a proud history of developing the
Servicemen's Readjustment Act of 1944 (Public Law 78-346), also known
as the GI Bill of Rights, which served to assist 18 million veterans of
WWII in gaining employment after military service and assisting in the
creation of the American middle class.
Accordingly, The American Legion supports passage of major
enhancements to the All-Volunteer Force Education Assistance Program,
better known as the Montgomery GI Bill (MGIB). The current make-up of
the operational military force requires that adjustments be made to
support all Armed Forces servicemembers. The American Legion supports
legislation that will allow members of the Reserve Components to earn
credits for education while mobilized, just as active-duty troops do,
and be able to use those credits after they leave military service. Two
of the top priorities of any veterans' education legislation are equity
and portability of benefits. However, it is also clear that the current
dollar value of benefits must be increased to meet the greater costs of
today's higher education.
In the 20 years since the MGIB went into effect on June 30, 1985,
the Nation's security needs have changed radically from a fixed cold
war to a dynamic Global War on Terrorism. In 1991, the Active-Duty
Force (ADF) of the military stood at 2.1 million; today it stands at
1.4 million. Between 1915 and 1990 the Reserve Force (RF) was
involuntarily mobilized only nine times. Today the Nation's Reserve
Forces are no longer a strategic force but are an operational force
mobilized continuously and working side-by-side with active duty units
all over the world.
The Department of Defense (DOD) reported as of August 2007 that in
support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom
(OEF) there have been:
2.4 million deployment events;
1.6 million servicemembers have been deployed;
540,000 servicemembers have had more than one deployment;
443,000 National Guard and Reserve soldiers have been
mobilized and deployed to Iraq or Afghanistan since 2001, for an
average of 18 months per mobilization;
Out of 540,000 servicemembers with more than one
deployment, 103,909 are members of the Reserve Components; and
``Stop-loss'' (a policy that prevents troops from leaving
the service when their enlistment end date has arrived) has been
imposed on more than 50,000 troops.
The American Legion recommends that the dollar amount of the
entitlement should be indexed to the average cost of college education
including tuition, fees, textbooks and other supplies for commuter
students at an accredited university, college or trade school for which
they qualify and that the educational cost index should be reviewed and
adjusted annually.
The American Legion supports a monthly, tax-free subsistence
allowance indexed for inflation as part of the educational assistance
package.
The American Legion recommends reauthorizing and funding State
Approving Agencies to assure current staffing and activities and to
assure that there is no harm to veterans receiving education payments.
State Approving Agencies
The American Legion is deeply concerned with the timely manner that
veterans, especially returning wartime veterans, receive their
education benefits. Annually, approximately 300,000 servicemembers
(90,000 of them belonging to the National Guard and Reserve) return to
the civilian sector and use their earned education benefits from the
VA.
Any delay in receipt of education benefits or approval of courses
taken at institutions of higher learning can adversely affect a
veteran's life. A recent GAO Report entitled ``VA Student Financial
Aid; Management Actions Needed to Reduce Overlap in Approving Education
and Training Programs and to Assess State Approving Agencies'' (GAO-07-
384) focuses on the need to ``ensure that Federal dollars are spent
efficiently and effectively.''
GAO recommends that VA should require State Approving Agencies
(SAAs) to track and report data on resources spent on approval
activities, such as site visits, catalog review, and outreach in a
cost-efficient manner. The American Legion agrees. Additionally, GAO
recommended that VA establish outcome-oriented performance measures to
assess the effectiveness of SAA efforts. The American Legion fully
agrees. In response, VA Deputy Secretary Mansfield plans to establish a
working group with SAA to create a reporting system for approval
activities and develop outcome-oriented measures with a goal of
implementation in the fiscal year 2009 budget cycle. Finally, GAO
recommended that VA should collaborate with other agencies to identify
any duplicate efforts and use the agency's administrative and
regulatory authority to streamline the approval process. The American
Legion agrees. VA Deputy Secretary Mansfield responded that VA would
initiate contact with appropriate officials at the Departments of
Education and Labor to help identify any duplicate efforts.
Sec. 301 of Pub. L. 107-330 created increases in the aggregate
annual amount available for State approving agencies for administrative
expenses from fiscal years 2003-2007 to the current funding level of
$19 million. The American Legion fully supports reauthorization of SAA
funding.
The American Legion strongly recommends keeping SAA funding at $19
million in fiscal year 2009 to assure current staffing and activities.
VA Home Loan Guaranty Program
Since the home loan program was enacted as part of the original
Servicemen's Readjustment Act of 1944 (the GI Bill), VA has guaranteed
more than 18 million home loans totaling nearly $914 billion for
veterans to purchase or construct a home, or to refinance another home
loan on more favorable terms. In the 5-year period from 2001 through
2006, VA has assisted more than 1.4 million veterans in obtaining home
loan financing totaling almost $197 billion. About half of these loans,
just over 730,000, were to assist veterans to obtain a lower interest
rate on an existing VA guaranteed home loan through VA's Interest Rate
Reduction Refinancing Loan Program.
The VA funding fee is required by law and is designed to sustain
the VA Home Loan Program by eliminating the need for appropriations
from Congress. Congress is not required to appropriate funding for this
program; however, because veterans must now ``buy'' into the program,
it no longer serves the intent of helping veterans afford a home. The
funding fee makes the VA Home Loan program less beneficial when
compared to a standard, private loan, in some aspects. The current rate
for mortgages is approximately 5.7 percent. The funding fee would be in
addition to the rate given by the lender. A $300,000 loan would
generate a fee in addition to any rate the veteran would achieve. The
funding fee mandates the participant to buy into the program; however,
that goes directly against the intention of the law: to provide
veterans a resource for obtaining a home. Approximately 80 percent of
all VA Home Loan participants must pay the funding fee and the current
funding fee paid to VA to defray the cost of the home loan has had a
negative effect on many veterans who choose not to participate in this
highly beneficial program.
The American Legion supports the elimination of the VA Home Loan
funding fee and urges Congress to appropriate funding to sustain the VA
Home Loan Guaranty Program.
The American Legion reaffirms its strong support for VA's Loan
Guaranty Program. The American Legion also supports any administrative
and/or legislative efforts that will improve and strengthen the VA Home
Loan Guaranty Program's ability to serve America's veterans.
Homeless Providers Grant and Per Diem Program
In 1992, VA was given authority to establish the Homeless Providers
Grant and Per Diem Program under the Homeless Veterans Comprehensive
Service Programs Act of 1992 (Pub. L. 102-590). Grants from the Grant
and Per Diem Program are offered annually (as funding permits) by the
VA to fund community agencies providing service to homeless veterans.
VA can provide grants and per diem payments to help public and
nonprofit organizations establish and operate supportive housing and/or
service centers for homeless veterans.
Funds are available for assistance in the form of grants to provide
transitional housing (up to 24 months) with supportive services,
supportive services in a service center facility for homeless veterans
not in conjunction with supportive housing, or to purchase vans.
The American Legion strongly supports funding the Grant and Per
Diem Program for a 5-year period instead of annually and supports
increasing the funding level to $200 million annually.
Department of Labor Veterans' Employment and Training Service (DOL-
VETS)
VETS is and should remain a national program with Federal oversight
and accountability. The American Legion is eager to see this program
grow and especially would like to see greater expansion of
entrepreneurial-based, self-employment opportunity training.
The mission of VETS is to promote the economic security of
America's veterans. This mission is executed by assisting veterans in
finding meaningful employment. The American Legion believes that by
strengthening American veterans, we in turn strengthen America.
Annually, DOD discharges approximately 250,000 servicemembers.
Recently-separated service personnel will seek immediate employment or,
increasingly, have chosen some form of self-employment.
In order for the VETS program to assist these veterans to achieve
their goals, it needs to:
Improve by expanding its outreach efforts with creative
initiatives designed to improve employment and training services for
veterans;
Provide employers with a labor pool of quality applicants
with marketable and transferable job skills;
Provide information on identifying military occupations
that require licenses, certificates or other credentials at the local,
State, or national levels;
Eliminate barriers to recently separated service personnel
and assist in the transition from military service to the civilian
labor market;
Strive to be a proactive agent between the business and
veterans' communities in order to provide greater employment
opportunities for veterans; and
Increase training opportunities, support and options for
veterans who seek self-employment and entrepreneurial careers.
The American Legion believes staffing levels for DVOP specialists
and LVERs should match the needs of the veterans' community in each
State and not be based solely on the fiscal needs of the State
government.
Contrary to the demands placed upon VETS, funding increases for
VETS since
9/11 does not reflect the large increase in servicemembers requiring
these services due to the Global War on Terrorism. In support of this
fact, the inflation rate from January 2002 to January 2008 is 15.93
percent and yet for State Grants alone, funding has only increased a
meek 2.5 percent ($158 million to $162 million) in the same time span.
The President's budget request for fiscal year 2009 will allow for
an increase of 1 percent for State Grants, the mechanism for funding
DVOPs and LVERs. However, this does not meet the inflation rate and
approximately 100 positions have the potential to be eliminated again
next year.
More services and programs are needed and yet since 2002 the VETS
program has only received a modest 4 percent increase. Transition
assistance, education, and employment are each a pillar of financial
stability. They will prevent homelessness allow the veteran to compete
in the private sector, and let our Nation's veterans contribute their
military skills and education to the civilian sector. By placing
veterans in suitable employment earlier, the country benefits from
increased income tax revenue and reduced unemployment compensation
payments, thus greatly offsetting the cost of Transitional Assistance
Program (TAP) training. The American Legion recommends full funding for
DOL-VETS.
Homelessness (DOL-VETS)
The American Legion notes that there are approximately 200,000
homeless veterans on the street each night. This number, compounded
with 300,000 servicemembers entering the private sector each year since
2001 with at least a third of them potentially suffering from mental
illness, requires intensive efforts. Numerous programs to prevent and
assist homeless veterans are available.
The Homeless Veterans Reintegration Program (HVRP) is a competitive
grant program. Grants are awarded to States or other public entities
and non-profit organizations, including faith-based organizations, to
operate employment programs that reach out to homeless veterans and
help them become gainfully employed. The purpose of the HVRP is to
provide services to assist in reintegrating homeless veterans into
meaningful employment within the labor force and to stimulate the
development of effective service delivery systems that will address the
complex problems facing veterans. HVRP is the only nationwide program
focused on assisting homeless veterans to reintegrate into the
workforce.
The competition for these grants is intense as they have one of the
highest cutoff score thresholds to be in the competitive range for any
grant program. Amazingly, 243 grants did fall into the competitive
range but there was only enough funding to award 145 submissions. The
HVRP program could only award $39 million for fiscal year 2007 but had
to deny 98 fully qualified nominations. These 98 additional qualified
programs would require an additional $30 million. The American Legion
recommends $70 million for this highly successful grant program.
Training
The National Veterans' Employment and Training Services Institute
(NVTI) was established to ensure a high level of proficiency and
training for staff that provide veterans employment services. NVTI
provides training to Federal and State government employment service
providers in competency based training courses. Current law requires
all Disabled Veterans' Outreach Program (DVOP) and Local Veterans'
Employment Representatives (LVER) personnel to be trained within 3
years of hiring. The American Legion recommends that these personnel
should be trained within 1 year. The American Legion further recommends
$6 million in funding to NVTI.
Veterans Workforce Investment Program (VWIP)
VWIP grants support efforts to ensure veterans' lifelong learning
and skills development in programs designed to serve the most-at-risk
veterans, especially those with service-connected disabilities, those
with significant barriers to employment, and recently separated
veterans. The goal is to provide an effective mix of interventions,
including training, retraining, and support services, that lead to long
term, higher wage and career potential jobs. The American Legion
recommends $20 million in funding for VWIP.
Employment Rights and Veterans' Preference
The Uniformed Services Employment and Reemployment Rights Act
(USERRA) protects civilian job rights and benefits of veterans and
members of the Armed Forces, including National Guard and Reserve
soldiers. USERRA also prohibits employer discrimination due to military
obligations and provides reemployment rights to returning
servicemembers. VETS administers this law, conducts investigations for
USERRA and Veterans' Preference cases, conducts outreach and education,
and investigates complaints by servicemembers.
Since September 11, 2001, nearly 600,000 National Guard and Reserve
soldiers have been activated for military duty. During this same
period, DOL-VETS has provided USERRA assistance to over 410,000
employers and servicemembers.
Veterans' Preference is authorized by the Veterans' Preference Act
of 1944. The Veterans' Employment Opportunity Act of 1998 (VEOA)
extended certain rights and remedies to recently separated veterans.
VETS was given the responsibility to investigate complaints filed by
veterans who believe their Veterans' Preference rights have been
violated and to conduct an extensive compliance assistance program.
Numerous Federal agencies and government contractors and
subcontractors are unlawfully circumventing Veterans' Preference. The
use of multiple certificates in the hiring process is unjustly denying
veterans opportunity for employment. Whereas figures show a decline in
claims by veterans of OEF/OIF compared to Gulf War I, the reality is
that employment opportunities are not being broadcast. Federal agencies
as well as contractors and subcontractors are required by law to notify
OPM of job opportunities but more often than not these vacancies are
never made available to the public. VETS program investigates these
claims and corrects unlawful practices.
The American Legion also supports the strongest Veterans'
Preference laws possible at all levels of government. The American
Legion is deeply concerned with the protection of the veteran and the
prevention of illegal and egregious hiring practices. Currently,
veterans are filing corrective action claims after the non-compliance
employment event occurs and therefore may become financially
disadvantaged. Concurrent measures and continuous oversight must be
emplaced to protect veterans from unfair hiring practices, not just
reactionary investigations. The American Legion recommends funding of
$61 million for program management that encompasses USERRA and VEOA.
Veteran-/Service-Connected Disabled Veteran-Owned Businesses
The American Legion views small businesses as the backbone of the
American economy. It is the driving force behind America's past
economic growth and will continue to be the major factor for growth as
we move further into the 21st Century. Currently, more than nine out of
every ten businesses are small firms, which produce almost one-half of
the Gross National Product. Veterans' benefits have always included
assistance in creating and operating veteran-owned small businesses.
The impact of deployment on self-employed National Guard and
Reserve soldiers is severe with a reported 40 percent of all veteran-
owned businesses suffering financial losses and in some cases
bankruptcies. Many other small businesses have discovered they are
unable to operate and suffer some form of financial loss when key
employees are activated. The Congressional Budget Office in its report,
``The Effects of Reserve Call-Ups on Civilian Employers,'' Stated that
it ``expects that as many as 30,000 small businesses and 55,000 self-
employed individuals may be more severely affected if their Reserve
soldier employee or owner is activated.'' Additionally, the Office of
Veterans' Business Development within the Small Business Administration
(SBA) remains crippled and ineffective due to a token funding of
$750,000 per year. This amount, which is less than the office supply
budget for the SBA, is expected to support an entire nation of veteran
entrepreneurs. The American Legion feels that this pittance is an
insult to American veteran business owners, undermines the spirit and
intent of the Veterans Entrepreneurship (TVC) and Small Business
Development Act of 1999 (Pub. L. 106-50) and continues to be a source
of embarrassment for this country.
The American Legion strongly supports increased funding for the
Small Business Administration's Office of Veterans' Business
Development to provide enhanced outreach and community-based assistance
to veterans and self-employed members of the Reserves and National
Guard.
Additionally, the American Legion supports allowing the Office of
Veterans' Business Development to enter into contracts, grants, and
cooperative agreements to further its outreach goals. The Office of
Veterans' Business Development must be authorized to develop a
nationwide community-based service delivery system specifically for
veterans and members of Reserve components of the United States
military.
The American Legion further recommends that funding for the SBA
Office of Veterans' Business Development be increased to $2.3 million
in fiscal year 2009.
conclusion
The American Legion is extremely concerned about the budgetary
process when Congress does not pass appropriations bills before the
start of the new fiscal year. The failure to pass a proper budget has a
significant impact on the veterans' community and the health care
delivery provided to veterans. As a result of the failure of Congress
to pass VA appropriations in a timely manner, all long- and short-range
planning is adversely affected. VA medical facility administrators are
asked to use a ``crystal ball'' to make prudent management decisions--
not knowing when and how much funding they will have available to
finish the fiscal year. Such fiscal irresponsibility spawns gross
mismanagement decisions, rationing of care, and unacceptable delays and
backlogs across the program areas--medical care, facility maintenance,
administration, construction, and State grants programs. It is our hope
that Congress will move to quickly pass this budget so that we can
properly take care of our troops and our veterans.
The American Legion appreciates the opportunity to present its
views and estimates on programs that will affect veterans,
servicemembers and their families. We ask that this Committee take into
consideration the recommendations of The American Legion as your
colleagues formulate the fiscal year 2009 Budget Resolution. We also
ask the Committee not to forget the sacrifices and contributions made
by America's veterans and their families as the budget priorities are
determined for fiscal year 2009.
Chairman Akaka. Thank you, Mr. Gaytan.
Mr. Rowan.
STATEMENT OF JOHN ROWAN, NATIONAL PRESIDENT, VIETNAM VETERANS
OF AMERICA
Mr. Rowan. Good afternoon, Chairman Akaka and Ranking
Member Burr.
You have our testimony and I do not want to go into too
much, but it is interesting to be able to sit in the back and
listen for the last two and one-half hours to people going back
and forth between the Senators and the Secretary and his aides
and some of the other comments made.
I would just like to say some reactions to some of the
things I heard. First of all, let me say that the VVA supports
the Independent Budget. They have done a lot of really good
work; and the detail in their report is unbelievable. We really
commend them for their work.
We also agree that the budget, while significantly
increased over the last several years, is still not sufficient
to do the work the VA needs to do; and we specify details in
the statement.
We also want to thank this Committee for pushing the
National Vietnam Veterans Longitudinal Study to finally get
that work done, which is long overdue. Congress had mandated
the VA to do it years ago. We certainly encourage you to now
start a similar project with the new veterans coming home, so
that they can be tracked over the years to see what happens to
them as they progress further; to find out who knows what pops
up 40 years later, as happened to Vietnam veterans.
Reacting to some things that Senator Burr said earlier with
regard to students on the campuses: I remember the old days
when the Feds used to fund money and they used to send money
out to the campuses for the veterans' programs; and they used
to reward campuses that increased the percentage of veterans
applying and actively showing up on their campuses. If we did
that with an overlay of maybe some extra business with Post
Traumatic Stress Disorder, perhaps we might be able to put that
back into action again--maybe some funding along those lines,
as well.
Of course, a new GI Bill might be useful. That is something
the school administrators would love to be able to have.
That money went to create a very interesting group of folks
over the years; and, frankly, there is an old boy network of
Vietnam veterans out there who started on the campuses many
years ago, and they are still functioning today.
We also want to talk about the whole issue of PTSD that the
Senator mentioned earlier and you are correct that there is an
issue of getting people well rather than just giving them a
check. It would be nice to do that.
The problem we have unfortunately with the Vietnam
veterans, it is often too late and we have been just done for
too many years and the reason why it keeps going from 30 to 60
to 30 to 70 to 100 is because of unfortunately just
deterioration.
The construction issue has been mentioned earlier and we
want to share our concerns with that, particularly with regards
to Puerto Rico. I was there in December 2006. My secretary just
came back from a tour December 2007, and the American Legion
had a very nice article about that as well. And we all had the
same concurrence.
You are trying to stuff a new project into an unusable
situation. You are trying to build a new hospital in a place
that just does not work. I think, really, they need to go back
to the drawing boards and take a look at the whole thing. It is
not functioning. They are not going to ever make it work. They
are going to have a problem with parking and distribution;
people getting in and out. It is just a horror.
Priority 8s. The one thing I would say about Priority 8s,
in my opinion, today's Priority 8 is tomorrow's service-
connected veteran in many instances. One of the problems, we
believe, is that many veterans are not aware, particularly
Vietnam veterans, of their rights and their rights to
compensation for certain disabilities that they are now getting
in their 50's and 60's.
The prostate cancers, the cancers, the diabetics, all of
those folks are now unfortunately not aware that they are
entitled to compensation and I am sure all of my colleagues
here have service officers who tell the sad story about how
they are finally getting to talk to the widow of the guy who
died from a cancer from 7 years ago who did not know it was
service-connected.
I do not know how we rectify that, other than doing a
massive outreach program, which we are frankly trying to do
with the pharmaceuticals and other organizations in the health
industry to try to get the health people out there and the
private sector to understand veterans health.
I also want to throw in, contrary to Bill O'Reilly's
presumptions, homeless veterans are real. They have been real.
I have been working in that program for 28 years now. It is a
real problem. It is continuing to be a problem. It will always
be a problem. PTSD helps to create these folks, and
unfortunately the inability to get decent housing in most areas
today for reasonable amounts of money just only exacerbates the
situation.
Last but not least, I am very glad to hear that we are
finally moving ahead hopefully with an RFI with the computers
at VBA. If we do not computerize VBA and bring it into the 21st
century, all of the additional people in the world will not
change that system and that is the bottom line.
So, again, we thank you for having these hearings. We hope
you keep their feet to the fire and we know you will.
Thank you.
[The prepared statement of Mr. Rowan follows:]
Prepared Statement of John Rowan, National President,
Vietnam Veterans of America
Chairman Akaka, Ranking Member Burr and distinguished Members of
the Committee, on behalf of the Board of Directors, and members, I
thank you for giving Vietnam Veterans of America (VVA) the opportunity
to testify today regarding the President's fiscal year 2009 budget
request for the Department of Veterans Affairs. VVA thanks each of you
on this distinguished panel, on both sides of the aisle, for your
strong leadership on issues and concerns of vital concern to veterans
and their families.
I want to thank you for recognizing that caring for those who have
donned the uniform in our name is part of the continuing cost of the
national defense. Caring for veterans, the essential role of the VA
and, for specific services other Federal entities such as the
Department of Labor, the Small Business Administration, and the
Department of Health and Human Services, must be a national priority.
This is poignantly clear when we visit the combat-wounded troops at
Walter Reed Army Medical Center and Bethesda Naval Hospital.
VVA wishes to note at the outset that the annual exercise of
debating the merits of the President's proposed budget is flawed.
Medical Center directors should not have to be held in limbo as
Congress reworks and adjusts this budget and perhaps misses, yet again,
the start of the next Federal fiscal year. These public servants can be
more effective, more efficient, and better managers of the public trust
if they can properly plan for the funding they need to carry out their
mission of caring for their patients. We hope that this can be avoided
this year and ask that you seriously consider an immediate alternative
to the broken system we currently have and reaching our goal of assured
funding.
To rectify this situation, VVA and the other members of The
Partnership for Veterans' Health Care Budget Reform are developing a
proposal that would give the VA leeway its managers need to properly
plan for the requisites of their patient load. We will have more for
you as this proposal is tightened up.
overview
Concerning the proposal at hand, the President's fiscal year 2009
budget for the VA, we must again take exception to the attempt by the
Administration to tax Priority 7 and 8 veterans with an annual fee just
for signing into the VA health care system; and for almost doubling the
co-payment for prescription pharmaceuticals. To us this is further
evidence of the attempt to rid the system of as many ``higher income''
veterans as possible. We trust that you will see the folly in this, and
will reject outright any attempt to enact these measures into the law
of the land.
We are pleased, however, that the Administration has again
refrained from citing phantom ``management efficiencies'' in the
numbers in this budget proposal. Managers are in general well-paid.
Effective, caring managers should take rightful pride in the jobs they
do. Inefficient managers need to be sanctioned and, if necessary,
transferred or removed.
We are less than sanguine, however, about the claim that ``one of
VA's highest priorities in 2009 will be to continue an aggressive
research program to improve the lives of veterans returning from
service in [Iraq and Afghanistan by devoting $252 million] to research
projects focused specifically on veterans returning'' from service in
these two hot spots. It is our understanding that data collecting on
maladies and diseases troops are returning with is not happening. It's
almost as if our government does not want to know about these ailments
so that it won't be burdened with Dependency Indemnity Compensation
(DIC) payments.
We are pleased that the spirit of cooperation between the VA and
the Department of Defense may actually be bearing fruit. In 2009, VA
and DOD will complete the pilot of a new disability evaluation system
for wounded returnees at major medical facilities in the Washington,
DC, area. We hope that what results from this effort ``to eliminate the
duplicative and often confusing elements of the current disability
process of the two departments'' will lead to less confusion and a
single, viable disability rating determined by the VA.
We are concerned, however, that there still will not be enough
resources to deal with the flood of troops and veterans returning to
our shores and presenting with a range of mental health issues. The VA
ramped down for several years the numbers of mental health
professionals it employed. Now, seeing the error of its ways, it is
hurriedly hiring clinicians. The question is: Will there be enough of
them to meet the challenge?
We are more than a little skeptical that, at the VA touts, the
budget will provide resources ``to virtually eliminate the patient
waiting list by the end of 2009.'' When have we heard this before?
On the benefits side of the ledger, we find it ludicrous to believe
that this budget ``will allow VA to improve the timeliness with which
compensation and pension claims are processed.'' Are VA planners
perhaps a bit overly optimistic that they can reduce the average time
it takes to process a claim to 145 days, 32 days quicker than the
average 177 days it currently takes? No, the Veterans Benefits
Administration requires a complete overhaul, one that introduces a new
way of thinking about vetting veterans who make claims for Compensation
& Pension benefits.
On the whole, this budget proposal is a better start than we have
had in many a year, but the overall request for additional resources
are just too low. With concerted work however it can be the most viable
budget and appropriations document we have had in many years, of which
we all can be proud.
veterans health administration
Last year, VVA recommended an increase of $6.9 billion to the
expected fiscal year 2007 appropriation for the medical care business
line. Congress was very generous and we actually came close to that
figure if one includes the supplemental funding of about $1.8 billion
for veterans' health care. We recognize that the budget recommendation
VVA is making again this year is also extraordinary, but with troops
still in the field, years of under-funding of health care
organizational capacity, renovation of an archaic and dilapidated
infrastructure, updating capital equipment, and several cohorts of war
veterans reaching ages of peak health care utilization, these are
extraordinary times.
VVA asks that you continue ramping up the resources available to
rebuild the organizational capacity to the point where the VA can
really meet the needs of an increasing workload. Frankly, we believe
that VA has (again) underestimated the projected workload for the next
fiscal year. Instead of a growth of about 40,000 new veterans of the
Global War on Terror (GWOT), VVA estimates that the increase will be at
least equal to last year's increase of 90,000 new veterans entering the
system, and probably will be in excess of 100,000 new GWOT veterans,
particularly if the VA starts doing a better job of outreach, reduces
wait times as called for in their plan, and continues to make gains in
adding needed staff capacity.
In contrast to what is clearly needed, we believe the
Administration's fiscal year 2009 request for $2.34 billion more than
the fiscal year 2008 appropriation is not adequate.
The increase the Administration has requested for medical care does
not quite keep pace with inflation (due to increased energy costs,
rising pharmaceutical costs, and other costs VA cannot control), but it
will not allow VA to continue the needed pace of enhancing its health
care and mental health care services for returning veterans, restore
needed long-term care programs for aging veterans, or allow working-
class veterans to return to their health care system. VVA's
recommendation of a $5.24 Billion increase over fiscal year 2008 would
accommodate these goals.
The advances of VA in recent years in improving the veterans'
health care system are well known, and often elucidated by all of us,
particularly VA officials. However, these advances have come with a
cost. For years, the veterans' health care system has been falling
behind in meeting the health care needs of some veterans. At the
beginning of 2003, the former Secretary of Veterans Affairs made the
decision to bar so-called Priority 8 veterans from enrolling. In most
cases, these veterans are not the well-to-do--they are working class
veterans or veterans living on fixed incomes who earn as little as
$28,000 a year. It is not uncommon to hear about such veterans choosing
between getting their prescription drug orders filled and paying their
utility bills. The decision to ``temporarily'' bar these veterans is
still standing, and it is still troubling to thoughtful Americans. As
of this week, VA officials estimated that as many as 250,000 additional
veterans are shut out of the system until they become indigent or
eventually are granted service connection for one or more of their
conditions that originated in military service. No one knows the size
of the ``migration'' from the wilderness of Priority 8 to a category
where these veterans can enter the system at some point when they are
much sicker and/or poorer, because the VA has not tried to track it (at
least not in a public way that we know of). However, VVA believes that
it is a significant number.
It is time to live up to the promise and obligation and to ``Leave
No Veteran Behind'' by restoring access to so-called Priority 8
veterans who are now on the outside and looking in. Of the recommended
increase, $1.3 billion is for restoration of the Priority 8 veterans by
the end of the second quarter of fiscal year 2009. It will take VA at
least 3 to 6 months to add the organizational capacity to ensure that
the system is not overwhelmed all at once.
Congress is to be commended for turning back many legislative
requests for enrollment fees and outpatient cost increases in the past,
which would have jeopardized access to care for hundreds of thousands
of veterans. Hard-fought Congressional add-ons, such as the $3.6
billion added to veterans' health care for fiscal year 2007, and the
more than $11 billion all told in calendar year 2008, now place us at a
position where it is not only feasible to re-open the system to all
veterans who have earned the right to access to this care, but it would
be wrong to continue to shut them out.
medical services
For medical services for fiscal year 2009, VVA recommends $44.3
billion including collections. This is approximately $3.1 billion more
than the Administration's request for fiscal year 2009. VVA is making
its budget recommendations based on re-opening access to the millions
of veterans disenfranchised by the Department's policy decision of
early 2003 that was supposed to be ``temporary.'' The former ranking
member of the House Committee on Veterans Affairs, Lane Evans,
discovered that a quarter million Priority 8 veterans had applied for
care in fiscal year 2005. Similar numbers of veterans have likely
applied in each of the years since their enrollment was barred. Our
budget allows 1.5 million new Priority 7 and 8 veterans to enroll for
care in their health care system. While this may sound like too great a
lift for the system, use rates for Priority 7 and 8 veterans are much
lower than for other priority groups. Based on our estimates, it may
yield only an 8 percent increase in demand at a cost of about $1.9
billion to the system for additional personnel, supplies and
facilities.
mental health--need to restore organizational capacity for substance
abuse treatment
VVA urges that language be inserted in the Appropriations bill
before Congress to express concern that substance abuse disorders among
our Nation's veterans are not being adequately addressed by the
Veterans Health Administration (VHA). The relatively high rate of drug
and alcohol abuse among our Nation's veterans (much of which is self-
medication to deal with untreated PTSD), especially those returning
from service in Operation Enduring Freedom and Operation Iraqi Freedom,
is causing significant human suffering for veterans and their families.
These folks can and will be stronger for their experience if we
only will deliver the effective care they need when they need it in a
way they will accept.
Further delay in moving to restore effective mental health and
substance abuse services will lead to poorer health and more acute
health care utilization in the out years, not to mention economic
opportunity cost to the Nation and needless suffering by these
veterans, and their families.
Specifically, VVA urges the Congress to direct the Secretary to
make concerted efforts to reduce the overall incidence of drug and
alcohol abuse and dependence among enrollees in the Veterans Health
Administration by meeting the performance measurements included in ``A
Comprehensive VHA Strategic Plan for Mental Health Services,'' VA's
current and adopted plan to reform its mental health programs, with the
hallmark of recovery. To its credit, VA has developed a strategy to
``restore VHA's ability to consistently deliver state-of-the-art care
for veterans with substance abuse disorders,'' as a milestone within
that reform plan, but to date has yet to fulfill the promise of its
commitment to recovery, and establishing the goal of every veteran
being able to obtain and sustain meaningful employment at a living wage
as the ultimate goal for all VA mental health programs, including its
substance use disorder programs.
Further, VVA urges the Congress to direct the Secretary to provide
quarterly reports beginning with a baseline report by each Veterans
Integrated Service Network (VISN) on the initiatives set forth in the
VHA Strategic Plan for Mental Health Services, specifically to improve
VA's treatment of substance use disorders. These reports will provide
an ongoing indication of VHA's progress in the implementation of its
adopted Strategic Plan as described in section 1.2.8 of ``A
Comprehensive VHA Strategic Plan of Mental Health Services'', May 2,
2005. In addition to baseline information, at minimum these reports
should include: the current ranking of networks on their percentage of
substance abuse treatment capacity along with plans developed by the
lowest quartile of networks to bring their percentage up to the
national average; and, the locations of VA facilities that provide 5
days or more of inpatient/residential detoxification services, either
onsite, at a nearby VA facility, or at a facility under contract to
provide such care; and, the locations of VA health care facilities
without specialized substance use disorder providers on staff, with a
statement of intentions by each such facility director of plans to
employ such providers or take other actions to provide such specialized
care.
The decade long diminishment of VA mental health programs that we
experienced in the 1990's did level out by 2001, and VA all too slowly
started to rebuild capacity that has been accelerated in recent years.
However, we must continue to restore capacity to deal with mental
disorders, particularly with Post Traumatic Stress Disorder and the
often attendant co-morbidity of substance abuse. In particular,
substance abuse treatment needs to be expanded greatly, and be more
reliant on evidence based medicine and practices that are shown to
actually be fruitful, and be held to much higher standards of
accountability, as noted above. The 21 day revolving door or the old
substance abuse wards is not something we should return to, but rather
treatment modalities that can be proven to work, and restore veterans
of working age to the point where they can obtain and sustain
meaningful employment at a living wage, and therefore re-establish
their sense of self-esteem.
national centers for ptsd
VVA also urges that additional resources explicitly be directed in
the appropriation for fiscal year 2009 to the National Centers for PTSD
for them to add to their organizational capacity under the current fine
leadership. The signature wounds of this war may well be PTSD and
Traumatic Brain Injury and a complicated amalgam of both conditions.
VVA believes that if we provide enough resources, and hold VA managers
accountable for how well those resources are applied, that these fine
young veterans suffering these wounds can become well enough again to
lead a happy and productive life.
Up until recently, VA has not made enough progress in preparing for
the needs of troops returning from Iraq and Afghanistan--particularly
in the area of mental health care. In addition to the funds VVA is
recommending elsewhere, we specifically recommend an increase of an
additional $500 million dollars over and above the $3.9 Billion that VA
now says they will allocate to assist VA in meeting the mental health
care needs of all veterans. These funds should be used to develop or
augment with permanent staff at VA Vet Centers (Readjustment Counseling
Service or RCS), as well as PTSD teams and substance use disorder
programs at VA medical centers and clinician who are skilled in
treating both PTSD and substance abuse at the CBOC, which will be
sought after as more troops (Including demobilized National Guard and
Reserve soldiers) return from ongoing deployments. VVA also urges that
the Secretary be required to work much more closely with the Secretary
of Health and Human Services, and the States, to provide counseling to
the whole family of those returning from combat deployments by means of
utilizing the community mental health centers that dot the Nation.
Promising work is now going on in Connecticut in and possibly elsewhere
in this regard that could possibly be a model. In addition, VA should
be augmenting its nursing home beds and community resources for long
term care, particularly at the State veterans' homes.
To allow the staffing ratios that prevailed in 1998 for its
current user population, VA would have to add more than 15,000 direct
care employees--MDs, nurses, and other medical specialists--at a cost
of about $2 billion. This level, because the system can and should be
more efficient now, would allow us to end the shame of leaving veterans
out in the cold who want and are in vital need of health care at VA,
and who often have no other option.
blind and low vision veterans need much greater resources and attention
The President's request contains a significant reduction in the
efforts to strengthen services for blind veterans. With the number of
blind and very low vision veterans of the Nation's latest wars in need
of services now, VVA strongly recommends the Congress explicitly direct
an additional $30 million for fiscal year 2009 to increase staffing and
programming at the VA's Blind and Visually Impaired Service Centers,
and to add at least one new center.
Further, VVA recommends that the Congress directs the Secretary to
implement an employment and independent living project modeled on the
highly successful ``Project Amer-I-Can'' that so successfully placed
blind and visually impaired veterans into work and other situations
that resulted in them becoming much more autonomous and independent.
That program was a cooperative venture of the New York State Department
of Labor, the Veterans Employment & Training Service (VETS), and the
Blind Veterans Association.
vet centers
VA received an additional $20 million dollars in the Supplemental
Appropriation for the war that was signed into law on March 7, 2007
specifically to increase the number of staff in the Readjustment
Counseling Service (RCS) by 250 FTEE. Whether it was VHA or OMB that
held these funds back, the funds were not released to the RCS to hire
additional staff for the VA Vet Centers until mid-August. The Vet
Centers are the most cost effective, cost efficient program operated by
VA, but which just plain does not have enough staff. Because of the
late arrival of the money the RCS could not hire any new staff, but
used the funds for other things, such as vehicles to do rural outreach.
The additional 250 staff members for the previously existing Vet
Centers are still very much needed, over and above the 100 peer
counselors and approximately 50 mental health professionals they have
already hired as additional staff in the past 2 years.
medical facilities
For medical facilities for fiscal year 2009, VVA recommends a level
of commitment that is at least equal to fiscal year 2008. Maintenance
of the health care system's infrastructure and equipment purchases are
often overlooked as Congress and the Administration attempt to correct
more glaring problems with patient care is good, but needs to be
sustained and if anything increased above the fiscal year 2008 level of
resources level. We urge the Congress to continue the process of
upgrading the physical plant of medical facilities at least at the rate
funding at the fiscal year 2008 level for the next several years.
In a system in which so much of the infrastructure would be deemed
obsolete by the private sector (in a 1999 report GAO found that more
than 60 percent of its buildings were more than 25 years old), this has
and may again lead to serious trouble. We are recommending that
Congress provide an additional $1.5 billion to the medical facilities
account to allow them to begin to address the system's current needs.
We also believe that Congress should fully fund the major and minor
construction accounts to allow for the remaining CARES proposals to be
properly addressed by funding these accounts with a minimum of the
remaining $2.3 billion.
medical and prosthetic research
For medical and prosthetic research for fiscal year 2008, VVA
recommends $500 million. This is approximately $50 million more than
the Administration's request for fiscal year 2009. VA research has a
long and distinguished portfolio as an integral part of the veterans'
health care system. Research funding serves as a means to attract top
medical schools into valued affiliations and allows VA to attract
distinguished academics to its direct care and teaching missions.
VA's research program is distinct from that of the National
Institutes of Health because it was created to respond to the unique
medical needs of veterans. In this regard, it should seek to fund
veterans' pressing needs for breakthroughs in addressing environmental
hazard exposures, post-deployment mental health, Traumatic Brain
Injury, long-term care service delivery, and prosthetics to meet the
multiple needs of the latest generation of combat-wounded veterans.
Further, VVA brings to your attention that VA Medical & Prosthetic
Research is not currently funding a single study on Agent Orange or
other herbicides used in Vietnam, despite the fact that more than
300,000 veterans are now service-connected disabled as a direct result
of such exposure in that war. This is unacceptable.
Mr. Chairman, finally I thank this Committee and the Appropriations
Committee for using the power of the purse in the fiscal year 2008
Appropriations act to compel VA to obey the law (Public Law 106-419)
and conduct the long-delayed National Vietnam Veterans Longitudinal
Study. VVA asks that you schedule a hearing and/or a Members briefing
for the second half of March for VA to outline their plan as to how
they are going to complete this much needed study for delivery of the
final results to the Congress by April 1, 2010, as a comprehensive
mortality and morbidity study of Vietnam veterans, the last large
cohort of combat veterans prior to those now serving in OEF/OIF.
Further, VVA strongly urges the Congress to mandate and fund
longitudinal studies to begin virtually immediately, using the exact
same methodology as the NVVRS, for the following cohorts: (a) Gulf War
of 1991; (b) Operation Iraqi Freedom; and (c) Operation Enduring
Freedom.
Please take action now so that these young veterans are not placed
into the same predicament Vietnam veterans find ourselves today.
homeless veterans
Homelessness is a significant problem in the veterans' community
and veterans are disproportionately represented among the homeless
population. While many effective programs assist homeless veterans to
become productive and self-sufficient members of their communities and
Congress must ensure that the Department of Veterans Affairs has
adequate funding to meet the needs of the over 194,000 homeless
veterans who served this country so proudly in past wars and veterans
of our modern day war. VVA recommends the following increase in VA
fiscal year 2009 budget for homeless programs.
homeless provider grant and per diem program
The Department of Veterans Affairs Homeless Grant & Per Diem
Program has been in existence since 1994. These programs address the
needs of homeless veterans and support the development of transitional,
community-based housing and the delivery of supportive services.
Because financial resources available to HGPD are limited, the number
of grants awarded and the dollars granted are restrictive and hence
many geographic areas in need suffer a loss that HGPD could address.
The Consolidated Appropriations Act of 2008, Public Law 110-161
provides $130 million, the fully authorized level, to be expended for
the GPD program. Based on GAO's findings and VA's projected needs for
additional GPD beds, VVA is concerned about the $138 million
authorization for fiscal year 2009 and believes a $200 million
authorization is required. An increase in the funding level for the
next several years would help ensure and expedite VA's program
expansion targets. It would provide critical funding for service, or
drop-in, centers--the primary portal that links veterans in need with
the people who can help them. It would guarantee continued declines in
veteran homelessness, and provide for scaling back the funding as
warranted by the VA's annual Community Homelessness Assessment, Local
Education and Networking Group (CHALENG) reports
hud-vash
The HUD-VASH program was established as a partnership between the
Departments of Veterans Affairs and Housing and Urban Development to
combine permanent housing with supportive medical services. VVA
supported passage of Public Law 110-161 which included $75 million for
7,500 Section 8 vouchers for homeless and disabled programs. Under this
program, VA must provide funding for supportive services to veterans
receiving rental vouchers. The fiscal year 2009 VA budget must reflect
a significant increase in funding these services.
VVA believes the $7.8 million in the fiscal year 2009 VA budget
proposal was agreed upon before the HUD-VASH vouchers were enacted into
law. Based on historical data that shows each housing voucher requires
approximately $5,700 in supportive services--such as case management,
personal development and health services, transportation, etc.--we
estimate approximately $45 million will be needed to adequately serve
7,500 or more clients in HUD-VASH housing units. Rigorous evaluation of
this program indicates this approach significantly reduces the
incidence of homelessness among veterans challenged by chronic mental
and emotional conditions, substance abuse disorders and other
disabilities.
veterans benefits administration
The Veterans Benefits Administration (VBA) continues to need
additional resources and enhanced accountability measures. VVA
recommends an additional 300 over and above the roughly 700 new staff
members that are requested in the President's proposed budget for all
of VBA.
compensation & pension
VVA recommends adding one hundred staff members above the level
requested by the President for the Compensation & Pension Service (C&P)
specifically to be trained as adjudicators. Further, VVA strongly
recommends adding an additional $60 million dollars specifically
earmarked for additional training for all of those who touch a
veterans' claim, institution of a competency based examination that is
reviewed by an outside body that shall be used in a verification
process for all of the VA personnel, veteran service organization
personnel, attorneys, county and State employees, and any others who
might presume to at any point touch a veterans' claim.
vocational rehabilitation
VVA recommends that you seek to add an additional two hundred
specially trained vocational rehabilitation specialists to work with
returning servicemembers who are disabled to ensure their placement
into jobs or training that will directly lead to meaningful employment
at a living wage. It still remains clear that the system funded through
the Department of Labor simply is failing these fine young men and
women when they need assistance most in rebuilding their lives.
It is also unclear as to whether VA actually added several hundred
of these employment placement specialists for disabled veterans
specifically called for in last year's funding measure, and whether
they are effective in assisting disabled veterans, particularly
profoundly disabled veterans to obtain decent jobs.
VVA has always held that the ability to obtain and sustain
meaningful employment at a living wage is the absolute central event of
the readjustment process. Adding additional resources and much greater
accountability to the VA Vocational Rehabilitation process is essential
if we as a nation are to meet our obligation to these Americans who
have served their country so well, and have already sacrificed so much.
accountability at the va
There is no excuse for the dissembling and lack of accountability
in so much of what happens at the VA. It is certainly better than it
used to be, but there is a long way to go in regard to cleaning up that
corporate culture to make it the kind of system that it can be with
existing resources, and even largely the same personnel as they
currently have on board. It can be cleaned up and done right the first
time, if there is the political will to hold people accountable for
doing their job properly.
Thank you again, Mr. Chairman, for allowing VVA to be heard at this
forum. We look forward to working with you and this distinguished
Committee to obtain an excellent budget for the VA in this fiscal year,
and to ensure the next generation of veterans' well being by enacting
assured funding. I will be happy to answer any questions you and your
colleagues may have.
Chairman Akaka. Thank you very much, Mr. Rowan.
Before we begin with the questions, I want to note that
Secretary Peake and his top VA leaders remained to listen to
this panel.
Mr. Rowan. Yes, we thank them.
Chairman Akaka. Yes. And I do really appreciate that
attention to the views of the veterans service organizations.
So, my first question is to all of you on this panel. I
know some of you have mentioned parts of this in your
testimony. Is there enough funding in this budget to allow VA
to wage a much more serious and aggressive outreach campaign to
bring in all veterans who need VA care and services?
Mr. Blake. Well, Senator Akaka, I will be the first to
admit that outreach is not my expertise. I concur entirely with
John Rowan's points about outreach. PVA is actually taking on a
similar program to reach out to a number of severely disabled
veterans that are out there and we are also considering doing
an outreach campaign as it relates to Traumatic Brain Injured
veterans, as well.
I do not know that you could ever put a dollar figure on
how much outreach should be done and how much it should cost,
but I would hasten to say that it is probably not adequate in
terms of the number of veterans that still do not come to the
VA.
Chairman Akaka. Mr. Baker.
Mr. Baker. Well, like Mr. Blake, I am no expert on
outreach, but I believe that you simply cannot put a dollar
figure on the veterans that are still suffering out there that
are getting no benefits.
As long as there are those, and there are numerous ones
like that, I think we need to do everything we can to make sure
they get into the system and they get the help that they need.
Chairman Akaka. Mr. Kelley.
Mr. Kelley. I concur also that outreach is the key in every
aspect of transitioning servicemembers to becoming a veteran,
whether that is for medical health care or for educational
benefits. There needs to be better outreach so they understand
what is out there for them and that they utilize it properly.
Chairman Akaka. Mr. Needham.
Mr. Needham. I certainly would agree that more outreach
needs to be done. There are two issues I would like to see
addressed with respect to that. Outreach for women veterans, so
that they fully understand their mental health issues; but also
the health care that they are entitled to.
And along with that also, VA also provides some services
for families as well, particularly through the Vet Centers. And
as long as we have more outreach in a proper and stable family
structure, we think that will help with the veterans and their
transitioning as well.
Chairman Akaka. Mr. Gaytan.
Mr. Gaytan. It is the American Legion's hope that Secretary
Peake and his staff do identify the need for increased
outreach. The American Legion has taken steps to help fill that
gap, to smooth that seamless transition, and cause that to
become a reality.
In our ``Heroes to Hometown'' program, the American Legion
has a staff member that works directly with the recovery
coordinators and the service specific staff who help those
transitioning servicemembers who go from active duty to
civilian life, from DOD health care to VA health care.
So, the American Legion's Heroes to Hometown program picks
them up right away when they are returning, and we help to
explain what their benefits are. We help them address the needs
that they have as newly-injured servicemembers and veterans who
are coming back and having to navigate that often confusing
landscape of benefits and understand how to access those
through the Department of Veterans Affairs.
So, the American Legion identifies the problem and wants to
be part of the solution as well.
Chairman Akaka. Mr. Rowan.
Mr. Rowan. There is no outreach program. Nobody is talking
to anybody. The new kids may be getting some information when
they come home in a fairly standard format now, and that is a
good thing, and they are trying to do some programs with them.
But for anybody else before then, nothing.
So, all of my Vietnam veterans, when they come down with
prostate cancer, unless they happen to belong to one of us and
read our magazines--which is another thing that would be nice
if they did, though many of them do not--most of them do not go
to the VA. They do not belong to us; and they do not know that
they are entitled to things.
The VA presently, I believe, is compensating about a
quarter million diabetics--Vietnam veterans primarily--from
service in Vietnam and Agent Orange. That is about less than 10
percent of the folks that stepped foot in Vietnam who qualify.
We believe that number is probably twice that, if not more.
So, that means a quarter million possibly or more people
are out there who are diabetics today entitled to compensation
who are not getting it. Nobody knows about it.
We are trying to work with the private sector medical
community to get the necessary education programs out there so
that when they come across people at their desk, they ask the
question, are you a veteran, and then go from there. And we
think that will have a major, major impact.
And it is not just the Vietnam veteran. Desert Storm
veterans, too. You know that is a long time ago already since
Desert Storm, 17 years ago already and people forget that. And
they have the highest rate of disability of any group yet--I
think it is 30-some-odd--38 percent, I think. I forget the
exact percentage of their numbers who are already getting
disability. And we believe that could be higher and they are
coming up with all kinds of strange things over time, too.
So, unfortunately, you know, we allocate billions of
dollars probably in the Army to be all you can be and Army
strong. They do not tell you about veteran weak.
Chairman Akaka. Thank you, Mr. Rowan.
I now turn to our Ranking Member, Senator Burr, for his
questions.
Senator Burr. Thank you, Mr. Chairman, and more
importantly, thank you to each one of you for not just your
willingness to come and share with us what I think is some
valuable information but to the commitment that all the
organizations and you as individuals make as part of that
organization.
John, I agree with most everything you said. I would love
to think that we could go back to Vietnam veterans, change the
course of treatment for mental health issues and reasonably
expect a different outcome tomorrow. And we all know that is
probably unachievable, though the pharmaceutical industry has
provided us with some tools that I believe the VA is
incorporating that did not exist 20 years ago. That may help to
make life a little bit better. I hope and I believe that we are
doing that within the VA today.
As it relates to homelessness, I agree with you totally.
The challenging thing is that we, as a country, provide a roof
pretty effectively over somebody's head. From a standpoint of
veterans and others we do not do a great job with the wrap-
around services that we need to take a veteran to permanent
housing.
We get the occasional help that is needed, but without
those wrap-around services, they always slip back into a
homelessness situation; and I think this is something, quite
frankly, that we need to tackle together. And it is not just
limited to veterans. It is a population of folks that, for a
multitude of reasons, find themselves not able to stay in
permanent housing even with what I think are some great
programs targeted for them.
I see the VA of the future focused in two areas as it
relates to the delivery of health care specifically. One focus:
to maintain the services to a population that had been promised
and has been in the system; enhancing the care that is
delivered as it is appropriate and technologically available.
And then two: to focus on today's warrior, to learn from
the past where, in fact, we might not have designed the
treatment the most effective way, and to learn where
technologies have now provided us things like prosthetics that
accomplish a level of quality that 20 years ago, quite frankly,
we never believed we could achieve.
I want to use the balance of my time not to ask a question,
but I guess I will sort of be the guinea pig, not to defend the
Administration, but to remind all of us of the past.
In 1996, the Senate Committee on Veterans' Affairs held a
hearing on veterans health care eligibility priorities. I want
to read for you some selective questions and responses of some
or all of the VSOs that are represented here.
Chairman Simpson asked, ``which veterans should receive
free medical care?''
``Answer: I believe anyone who in the service of their
country was injured or disabled in any way that needs medical
treatment once they leave military service. If they were
injured and disabled in the line of duty, which does not
necessarily mean combat, it could be training accidents, should
be entitled to some type of health care once they leave the
service without any expense to themselves.
``Chairman Simpson. If you say expanded and improved VA
health benefits will not open the flood gates, then are you
saying to us that veterans will not seek free care?
``Answer: Although all these veterans may be eligible for
care and they are all eligible for care now, our proposal does
not in any way stipulate or even imply that their care would
not be paid for by somebody.
``The service-connected veteran and the Category A veterans
as defined in the bill would continue to be provided care with
the appropriate dollars as it should be, but everyone else who
comes to the system, Mr. Chairman, is going to have to pay
their own way as they would in any other system through either
co-payments, deductibles or private insurance.
``So, if there is an assumption on the cost of this bill
being predicated upon all these new veterans coming into the
system and not paying for their care, then it is a faulty
assumption and one that drives the cost up.
``Last question and last answer.''
``Senator Rockefeller. To what extent do you think it is
important that access to VA care be provided (a) higher income
veterans with no service-connected disabilities; (b) dependents
of veterans?
``Two answers: In the Independent Budget, DAV proposes,
along with AMVET, PVA and VFW, that the Secretary have the
discretion to treat these parties at their own expense. We do
not request that they be entitled to VA medical care. We
believe that it would be in the best interest to veterans and
the VA to allow these parties to use VA care at their own
expense.
``Additional answer: The American Legion believes that
higher income, non-service-connected veterans and certain
dependents of eligible veterans should be permitted to access
the VA health care system by paying premiums, co-pays and
deductibles. These additional revenue streams would help to
ensure the long-term viability of the VA health care system.
The normal appropriations process would ensure funding for
Category A veterans and the conversion of VA to a market-based
managed care system would attract other paying customers.''
Senator Burr [continuing]. Now, again, I am not here to
object to what you are saying because I firmly believe the
Congress will throw out the Administration's proposal. We have
done so with great frequency and little conscience, but I want
to make the record straight.
No group has always said, no, do not do this. And my only
plea to each one of you is that if we want to go through this
annual Kabuki dance that we do, where you ask for more money,
the Administration tries to do something, we have political
differences up here, and the outcome is the same for veterans,
then we have all failed.
At the end of the day, the question is, coming out the
other end are people better off? Have they gotten what we
promised? More importantly, have we used all the tools that are
available to us, whether they are technological or anything
else, to enhance their future in a positive way?
So, though I am in agreement with you that now is not the
time to talk about this, as we expand the system, one only has
to believe that somebody has to pay for it. If we collectively
believe that it should be the taxpayer, let me suggest to you,
if you look at any system or any health care system in the
world, as it begins to grow like that, it will implode at some
point. If your belief--and there is some disagreements on this
Committee, this is an observation I am sharing of my own.
Bernie----
[Laughter.]
But I appreciate the chuckle.
And, the fact is that each one of you, as representatives
of service organizations, will have to search back in your
history and remember that you made statements based upon your
belief that the integrity of this delivery system long-term was
the single most important thing.
I believe that is the responsibility we have. I believe the
responsibility of our representatives, the Secretary and his
colleagues from VA, is to take what we have provided, to
understand their mission, and carry it out in a way that
provides the highest quality to the most people. And when there
is not enough, to say there is not enough.
I want to say this in ending. I have been in a lot of
congressional hearings in the House and the Senate. Rarely do I
see a Government witness testify and stay to hear what the next
panel says. Not only is the Secretary here listening to what
you are saying, every person he brought from the VA is here
listening to your testimony, listening to our questions. I
think that says, more than anything I can imagine, how
interested they are at doing their job.
Mr. Chairman, I thank you.
Chairman Akaka. Thank you very much, Ranking Member Burr.
And now, Senator Sanders.
Senator Sanders. I apologize again, Mr. Chairman. It has
been one of those days and I keep running in and out.
It seems to be fairly clear that if you ask the American
people whether or not we have a moral obligation to make sure
that all of the men and women who put their lives on the line
defending this country should have the promises made to them
kept--even though, of course, as Senator Burr indicates, it is
going to cost us money. I think the answer is, yes.
I think that is what people will say. And, Senator, any
time that you would like to debate the issue of whether or not
we give tax breaks to billionaires or put money into the VA, I
would love to do it any place in the country; and most people
will agree with me. Because you are right, it costs money.
There is no question about it. But the question is one of
national priority.
The second point that I would make is, I believe there is a
will in this country that we have a moral obligation to take
care of those people who put their lives on the line defending
this country.
The second point, we have made and both of you will
remember, Secretary Nicholson was before us on more than one
occasion talking about the cost-effectiveness of the VA. Am I
correct on that?
He talked about it as a high quality system where study
after study indicated that it was cost effective. And I think
that is what the evidence is. I think the evidence is,
obviously there are exceptions with this, that when these guys
get the money to do their job--they cannot do it if they do not
have the money--that they do it pretty well.
The argument that we keep hearing is, when people get into
the system they are happy with the care that they get. The
problem is that too often there are waiting lines; too often
there is inadequate staffing because they do not have the money
to do their job.
I apologize for not having heard the testimony. The last
point that I would say to Senator Burr, the indication, there
is a difference; there is a philosophical difference. The last
time around under Senator Akaka's leadership, we worked with
many of your organizations. And for the first time in recent
history, we actually implemented most of the measures that were
in the Independent Budget. I think that was the right thing to
do.
And as I mentioned to the Secretary, who is kindly here
right now, my main concern right now is that with so much
influx, with so many new people coming into the system with so
many needs, are they going to have the organizational
capability to make sure that money is spent wisely and that
they are hiring the right people and doing that as efficiently
and as quickly as possible.
May I ask a question, Mr. Chairman?
Chairman Akaka. Yes.
Senator Sanders. To whoever wants to answer, do you have
concerns? Or how do you see progress being made? We gave the VA
more money. We worked with many of your organizations. Are you
satisfied with the beginning--and it is just the beginning, of
course--utilization of that money to address long-standing
needs; and also the very pressing problems for our Iraq and
Afghanistan veterans?
Who wants to comment on that?
Mr. Gaytan. On behalf of the American Legion, I do want to
comment on some of the main concerns that we have in regards to
spending the funds that are provided to the Department of
Veterans Affairs. And one, which is outlined in our testimony,
as you have seen, is concern over cutting the research, medical
and prosthetic research when you have TBI and PTSD as a major
concern of these veterans who are coming back.
VA needs to be prepared to provide that service, not just
now, but PTSD can manifest itself years down the road. VA needs
to be capable of doing that.
Another commitment that VA needs that will require
budgetary increases is long-term care. You cannot ignore the
era of veterans who are turning to long-term care needs right
now and VA needs to be capable of doing that as well.
One other area I just want to mention is the construction,
and that was mentioned in our testimony as well. We cannot
ignore the recommendations of the CARES report in terms of
construction and those needed VA medical facilities.
Senator Sanders. Do you think that the budget that the
President presented will be able to do all of those things?
Mr. Gaytan. It is our hope that it will.
Senator Sanders. Other people like to comment on that?
Mr. Blake. Senator, I would just like to say that--I think
one of my colleagues mentioned--we certainly appreciate
everything the Congress did during the first session of the
110th Congress with regards to the funding for the VA.
We certainly cannot argue with the fact that most, if not
all, of the recommendations in the budget were met when it
comes to budget figures for the fiscal year 2008 appropriation.
I do not think it can be emphasized enough, however, that
certainly our concern is spending that money wisely; and the
fact that the VA did not receive its money or was not enacted
from the President until January, puts the VA at quite a
disadvantage at ensuring that it is wise with its dollars.
Notwithstanding the fact that the VA has learned to live with
this for 13 or 14 years now and knows how to plan around it,
the simple fact is: you cannot put the VA in that kind of a
position and expect them to spend $40 billion plus just on the
discretionary side appropriately and not have some heartache
with some things they do.
Senator Sanders. Anybody else want to comment on it?
Yes, sir.
Mr. Rowan. Yes. I would concur. I think the whole issue of
lag time is a real problem--no question--with regard to the
budget, which is why we would like to see the whole process
changed and brought into something a little bit more effective.
And yes, there have been changes in staffing, but probably
not enough. We are concerned about the losses, particularly in
the VBA side. There are a lot of people retiring in the VA
system. A lot of my Vietnam veteran colleagues have taken their
pensions and leaving, which is creating problems of a brain
drain as much as anything else. It is enough to say, yes, we
are going to hire a bunch of FTEs, but if it takes you 2 years
to train somebody or 3 years to get people up to snuff, it is
going to take a while.
We are concerned, too, about salaries. We are concerned
about the ability--the whole health care system in this country
is, you know, in a crisis; and we do not have anywhere near
enough doctors and nurses or anything for anybody, never mind
the VA.
So, if we are competing against everybody else, frankly,
the only saving grace we have got is the VA hospital's
affiliation with all of these wonderful medical schools, which
have provided us with a lot of folks.
I just happened to recently use the emergency room at the
Manhattan VA Hospital and everybody I talked to was an NYU
doctor, which was fine by me. They have some of the best
medical people in the country.
But, unfortunately, also other systems--when I go to
clinics, for example, it takes a little while and I am a person
who bounces in and out of both systems. I use the VA and I
still have a private system from my retirement as a city
employee. And, frankly, they are in the same strain we are. Let
me tell you. They are all under the same system. Again, they do
not have enough doctors. When you go to a regular private
doctor, you better be prepared to wait because you may take 2
hours before he sees you and that is normal.
Senator Sanders. Unfortunately it is normal.
Mr. Rowan. We need more doctors.
Senator Sanders. We just had a hearing on that, a 3-hour
hearing on that issue yesterday as a matter of fact.
And I know it is very early in the game, and it is hard to
make a judgment. But do you have a sense that the VA is moving
aggressively, in the midst of that very difficult national
climate, to hire of doctors, nurses, psychiatrists,
psychologists? Do you think they understand the severity of the
problem?
Mr. Baker. I cannot answer that question with respect to
the health care side. But with respect to the claims processing
on the VBA side, having not been in the legislative business
very long, I know that there has been a lot of increase in
staffing in the VBA side, and I think that is going to help
tremendously. And we certainly hope that it serves its purpose.
I do not think staffing is the only problem. I hope VA gets
up to speed with their staff, but at the same time we put forth
a lot of policy initiatives. Some of them are small, some of
them are inexpensive, some of them will save money.
But, they all will chip away at the claims backlog. They
will all improve the claims process. And I hope that, you know,
those can be looked at in the future by VA and by the
Committee. I hope that we do not have a sense to make so much
change to a system that has evolved little bit by little bit
into a very good system, that we scrap it and start over and
have none of those safeguards in place that took so long to
get.
I would just like the Committee to consider that.
Mr. Rowan. I would just like to add that I think that the
division directors are trying to do as much as they can as
quickly as they can, but it is a tough system out there,
generally. And so, they are under the same strains as everybody
else.
And again, as far as the VBA is concerned, I can only state
that until they get the computers up and running, all the FTEs
in the world are not going to solve that problem.
Senator Sanders. My last question. I am a fan of--I do not
know what the formal title is--but the outreach clinics. We
have four of them, I think, in the State. My impression is they
work quite well and it has been one of the very positive
innovations that we have seen at the VA in recent years.
Is it your impression that these outreach clinics are doing
what they are supposed to be doing, Peter?
Mr. Gaytan. Yes, sir. Actually, I am glad you brought that
up. If we look at the improvements over the past couple of
decades in VA health care, the quality of care that VA is
providing, in hearing that praise for VA by the actual veterans
who are going there and receiving the care, how it has changed
from the Vietnam era of warehousing patients and how it has
increased in terms of quality and delivering that access, it
has a lot to do with not only the CBOCs, as you mentioned, the
Community-Based Outpatient Clinics providing that care, but
also the change in VA health care from inpatient to outpatient.
That change has been dramatic and we have seen it in
results of quality and delivery of health care. And the
veterans that are walking in and out of those VA hospitals are
the first ones to tell you that the quality of care that they
are receiving at VA is outstanding.
What the American Legion wants to do is ensure that VA is
provided with a budget that will allow them to continue that
quality and delivery of care.
Senator Sanders. That is my impression that the veterans
feel very positively about the CBOCs.
Mr. Gaytan. The only negative, if there is a negative, is
the fact that oftentimes when we get into specialties--when we
get beyond clinical place and somebody asks to go for a
specialty issue--and I have a friend of mine who went through a
whole hip thing and had to get a hip replacement.
When you start getting into that system, then it can bog
down a bit because, again, you are really hitting the crunch
now with way too many patients and not near enough medical
care. It is ability; it is not that the doctors are not any
good.
I mean, I had a guy and he just said I had enough and he
went and got it done somewhere else because he just did not
want to wait 6 months to get it done in the VA. That is going
to take a long time before they build it back up in that part
of the system.
I would also like to take a shot at, while you mentioned
clinics, mention the other outreach programs, the veterans
outreach centers which were created back in my day and helped a
lot of Vietnam veterans survive, frankly.
Those programs are so great. They need to get to these new
kids and I think that is going to be an interesting thing; and
maybe some of us Vietnam vets who have been through the process
can help them out a little bit.
But, if we look elsewhere, you know, we are not the only
ones that deal with veterans in this world. My colleagues in
Australia for years who have had similar outreach centers where
veterans go for mental health counseling, they take the whole
family and they take the kids, and they will treat them,
because there is such a thing called secondary PTSD (which
nobody ever wants to talk about), which is still going on
today.
When we talk about the guy and the girl who comes home and
beats up the husband or wife or whatever and the kids get into
the middle of it all. And with all of these folks coming back
today who have families, many of them with children that we
never had in my generation in the numbers they have today.
So, I think they need to expand that program to include the
family to do real family counseling which is what any good
psycho-social service would definitely want to do.
Senator Sanders. You would be interested to know in
Vermont, we got some money for the VA and for the National
Guard to do just that, to do an outreach program which involves
the whole family.
I have gone over my time, Mr. Chairman, I apologize. Do you
want to comment, sir?
Mr. Kelley. Yes. I just wanted to build off of what Mr.
Rowan was saying about the Vet Centers. And I think,
particularly the Expanded Family Access, because what we are
seeing with a lot of these issues is that the families are
impacted. And the key challenge that we have seen with the Vet
Centers over the last few years is not so much the location of
them, but the staffing. We are concerned that the staffing
levels are not sufficient to fully meet the demands,
particularly as we have seen with the increasing numbers of
OEF/OIF veterans returning. So, that is certainly something we
have got our eye on and something that probably needs to be
addressed.
Senator Sanders. Let me conclude by thanking all of you. I
think by working together we have made some real progress.
Obviously there are some enormous challenges facing us. These
are very, very difficult times--not just in health care, in
terms of the number of people coming back, sick or wounded.
We have got a lot of work in front of us that I look
forward, Mr. Chairman, that we will be able to continue working
with these service organizations to make some real progress.
Thank you.
Chairman Akaka. Thank you very much, Senator Sanders.
We have many more questions. I know some of the Committee
Members do also. Let me end with two questions.
This question is for all of you. Earlier I told Secretary
Peake and Admiral Cooper that there are high expectations for
VBA to increase the quality of claims decisions. And this has
to do with timing, not only for claims, but also for health--to
provide care in a timely manner. I now turn to you for your
quick views.
The question is, what more could Congress do for VBA to
decrease the backlog and increase timeliness and accuracy?
Mr. Baker. It sounds like a benefits question. It is a very
good question and it is one that simply does not have one
answer.
Congress has done a great thing already, I believe, in
providing enough staffing for more employees at VBA almost to
the point that we suggested in the Independent Budget. Though a
little bit short, I believe we were fairly close.
Now, I believe the key is to utilize that staffing to its
best advantage. It is going to take some time to get some
training to the brand new people, and I think that is one area
the VA has to focus on a lot--training.
I believe quality is an area that VBA has to focus on. The
STAR program right now, I believe, is insufficient. It does not
hold individuals accountable. It looks at about 10 cases per
large VA regional office and I think that they have some plans
to increase that. Yet, if you have an office that is putting
out 1,000 claims a month, that is not even 1 percent; and you
cannot even track a trend with that.
I believe we need to tie accountability to quality, at
least as much as you do production, on an even level. I believe
Congress could look at what we suggested in the Independent
Budget. We tried to structure some things around the benefit
side, like I said earlier, that are not expensive or that
actually save resources.
We would be more than welcome to work with the agency to
hone any differences that there may be in some of those
recommendations.
That is probably the best answer I can give you off the
cuff.
Mr. Gaytan. If I can speak for the American Legion. In
terms of addressing the backlog, what Mr. Baker said is true,
and I want to emphasize the fact that focus needs to be given
to the quality of the rating, as opposed to the quota.
You cannot expect the quota to be met and expect the
quality to be met as well, because that is just recycling the
claim back into the system. Quality has to be a focus, and not
so much a stress on the quota and the amount that are being
done. If the quality of that claims review is met, then we will
address the backlog through that process.
Chairman Akaka. Mr. Rowan.
Mr. Rowan. Yes. First, I think the Congress needs to be
prepared in that they are going to be hit with a fairly
substantial bill somewhere down the line--hopefully sooner
rather than later--for the computer system that they are going
to need. And that is going to be a super budget dollar number.
Whatever that comes out to, that is going to have to be
probably a one-shot deal or maybe a couple of year deal.
The Disability Commission talked about a lot of different
things, too. They need regulations and laws to change some of
the way we look at things. And I am not so sure how they do it.
It has been, unfortunately, a couple of years since I have
actually been in the grind doing service rep work, so I am not
sure how they reorganized it on the ground.
But, one of the challenges you are asking people to meet:
you are asking people to do musculoskeletal stuff; you are
asking them to do endocrinology; you are asking them to become
psychologists in their ratings. And, trying to get all that
stuff in a reference book that says, you got this and you do
not move this much, you get ``X'' percentage. If you do not
move that much, you get a bigger percentage. It gets a lot more
difficult than dealing with PTSD cases.
And I think the problem may be that the raters are not
necessarily able to specialize as well as they could, so that,
maybe, the more difficult cases could go to the senior rater,
the person who would understand that stuff better.
I also think that we talked earlier about getting rid of
some of this stuff--that if the doctor comes in and writes on
his note paper, that I am a diabetic; take that and run with it
and do not bother to bring me in for a C&P exam. And I am not
saying they do, but when it comes to other things, we can speed
that process up significantly in the early stages of some of
those really slam-dunk claims, as many of my colleagues would
say.
I mean, when we get into some other cases and we have to
dig out things, the idea of getting into this whole issue of:
if you served in a combat zone, you served in a combat zone
whether you were a cook or a grunt. And, you know, maybe your
disability is not as severe or whatever--your PTSD may not be
as bad--but, you probably got some of it. We ought to just
write that off; and I agree with the idea that you are in a
combat zone, you are in a combat zone, period.
And, you know, let us stop trying to create 43 new medals.
The Air Force just came out with one. The Army came out with a
combat action badge, but not everybody is going to get it. Oh,
please. I mean, we get into all this nonsense. Which is not to
denigrate anything that the folks with the point of the spear
do; but, those of us who have sat in the back and got bombed
regularly or mortared regularly or whatever, it was just a
little disconcerting to say the least.
And so, you know, we should be considered having served in
a combat zone. And, today we noted that the worst job in the
world now is the truck driver; and that was the truth in
Vietnam, as well. But the truck drivers did not get medals; and
try to prove their PTSD claim.
Chairman Akaka. Thank you for those responses.
Let me just say, before I ask my final question--Mr. Baker,
since you mentioned it, too--I want you to know I appreciate
your thoughts on the need for a presumption for combat service.
My bill, S. 2309, would do just that, and I hope to bring that
measure to the full Senate later this year.
My final question to each of you is, I strongly believe
that cutting the IG is not wise. Do you believe the Department
can adequately police itself while funding for the IG is cut at
the same time?
Mr. Rowan. I will jump in.
Chairman Akaka. Mr. Rowan.
Mr. Rowan. No, I do not think they should cut the IG
budget. However, we must understand something: the IG budget
talks about corruption; the IGs worry about people stealing
things. They do not necessarily tell you whether our division
director is a very good manager, or whether your clinician is a
good clinician, or the nurses are actually good nurses.
They go in and they look at systems, and they look at
certain things; but they are more concerned about whether or
not people are walking out the door with something than they
are about the effectiveness of delivery of services. And that
is, unfortunately, the job of the Congress. Maybe GAO can get
more involved in looking at some of the operations in the VA,
as far as oversight is concerned.
But I still do not think the IG budget should be cut
because there are real concerns when you are talking about a
$90 billion budget. I come from an old investigator's
background so I have a real problem with that.
Mr. Gaytan. The American Legion does not support the cut in
the IG budget, sir.
Chairman Akaka. Any other comments?
Mr. Blake.
Mr. Blake. Senator, I would say that we certainly, our
recommendations reflect the fact that we believe that the IG's
budget should actually be increased.
It is interesting that there was a line of questions along
this idea in the House Committee hearing last week. While I
will not comment one way or the other on some of the ideas
brought up, it kind of makes you squirm when you consider what
was being projected for what the IG should be responsible for,
and outcomes that occurred because they did or did not conduct
a particular investigation.
I think their role is too important to cut their budget,
though. I think they can always use a little bit more,
especially with a department this big.
Chairman Akaka. Thank you very much.
Any further thoughts on that?
Mr. Baker. I was going to say, Mr. Chairman, one, thank you
for mentioning my testimony. My time in the field has brought
me close to way too many people that have fallen through that
loophole--that we were in combat and could not prove a specific
incident--and so I appreciate your mentioning that.
As to your question, I think all we really have to do is
look at the incidents that are going in Marion, IL, at the VA
medical center. That will tell us we cannot cut the IG budget.
If we do that, those very things could go on in other centers
and there just might not be enough staff to investigate them
fully, to prevent those things from happening in the future. I
think that is a good example.
Chairman Akaka. Thank you. I have many more questions for
you, but I will submit them for the record at this time.
So, in closing, I want to again thank all of our witnesses
for appearing today. And I want to thank the Secretary and his
leaders who are still here. Thank you so much for doing this.
Your input on these issues is valuable to the Committee as we
consider our budget recommendations.
With that, let me say, thank you very much; and this
hearing is now adjourned.
[Whereupon, at 12:58 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of the National Coalition for Homeless Veterans
The National Coalition for Homeless Veterans (NCHV) appreciates the
opportunity to submit testimony to the House Veterans' Affairs
Committee regarding the U.S. Department of Veterans Affairs (VA) budget
request for fiscal year 2009.
Established in 1990, NCHV is a nonprofit organization with the
mission of ending homelessness among veterans by shaping public policy,
promoting collaboration, and building the capacity of service
providers. NCHV is the only National organization wholly dedicated to
helping end homelessness among America's veterans.
The majority of NCHV members, which includes nearly 280
organizations in 48 States, the District of Columbia, Puerto Rico and
Guam, provide the full continuum of care to homeless veterans and their
families, including emergency shelter, food and clothing, primary
health care, addiction and mental health services, employment supports,
educational assistance, legal aid and transitional housing.
In 2007, VA reported that about 196,000 veterans are homeless on a
given night and 400,000 veterans experience homelessness at some time
during the year. The VA reports its homeless veteran programs serve
100,000 veterans annually, and NCHV member community-based
organizations (CBOs) serve another 150,000.
VA officials report that the partnership between the VA and
community-based organizations has substantially reduced the number of
homeless veterans each night by more than 25 percent since 2003--a
commendable record of achievement that must be continued if this Nation
is to provide the supportive services and housing options necessary to
prevent homelessness among the newest generation of combat veterans
from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF).
fy 2009 va budget--homeless veteran programs
Congress has established a number of programs within VA to address
homelessness among veterans. The primary goal for these programs is to
return homeless veterans to self-sufficiency and stable independent
living. The major homeless veterans programs administered by the VA
include the Homeless Providers Grant and Per Diem (GPD) program, which
includes transitional housing, supportive services centers, special
needs grants, GPD program liaisons, and Stand Down support; the HUD-
Veterans Affairs Supported Housing (HUD-VASH) program; the Multifamily
Transitional Housing Loan Guarantee Program; and the Compensated Work
Therapy Transitional Residence program. Homeless veterans also receive
primary medical care, mental health and substance abuse services at VA
medical centers and community-based outpatient clinics (CBOCs) through
the Health Care for Homeless Veterans (HCHV) program.
The landmark Homeless Veterans Comprehensive Assistance Act of 2001
(Pub. L. 107-95) established new program authorities and reauthorized
long-standing homeless programs within the VA. While the authorization
law set explicit funding levels for many of the VA homeless programs
and authorities, actual annual spending levels are set by the VA
Secretary via allocation of funds from the VA medical services account,
which are appropriated by Congress.
VA homeless veteran programs function not only as a safety net for
homeless veterans unable or hesitant to access emergency shelter,
transitional housing or supportive services organized for the general
population, they also function as a safety valve when other VA programs
fail to reach veterans at a high risk of homelessness, such as veterans
with chronic mental illnesses, addictions and extreme economic
hardships.
Our testimony will focus on these homeless veteran assistance
initiatives, most of which owe their effectiveness and successes to the
leadership of this committee. We have testified many times about the
need for transitional housing and services for veterans in crisis, and
celebrate the reduction in homelessness among these deserving men and
women during the last 5 years. As we continue that legacy, we must also
provide supports that will prevent homelessness among OEF/OIF veterans
returning from war.
Homeless Provider Grant and Per Diem Program
The Homeless Provider Grant and Per Diem Program (GPD) is the
Nation's largest VA program to help address the needs of homeless
veterans and supports the development of transitional, community-based
housing and the delivery of supportive services. The program's goals
are to help homeless veterans achieve residential stability, increase
their skill levels and income, and achieve greater self-determination.
The GPD Program provides competitive grants to community-based, faith-
based and public organizations to offer transitional housing and
service centers for--homeless veterans. The GPD program is an essential
component of the VA's continuum of care for homeless veterans, assuring
the availability of social services, employment supports and direct
treatment or referral to medical treatment. The program also funds GPD
liaisons who provide program oversight, inspections and outcomes
reporting essential to the success and efficiency of grant recipients.
In September 2007 the General Accountability Office (GAO) presented
testimony before the Subcommittee on Health of this Committee regarding
homeless veterans programs, and reported that an additional 11,100
transitional housing beds are needed to meet the demand presented by
current VA estimates of the number of homeless veterans in need of
assistance. This need does not yet include the increased requests for
services expected from OEF/OIF veterans over the next 3 to 5 years.
The Consolidated Appropriations Act of 2008, which became Public
Law 110-161 on December 26, 2007, provided for $130 million, the fully
authorized level, to be expended for the GPD program. Based on GAO's
findings and VA's projected needs for additional GPD beds, NCHV has
concerns about the $138 million authorization for fiscal year 2009 and
believes a $200 million authorization is needed. An increase in the
funding level for the next several years would help ensure and expedite
VA's program expansion targets. It would provide critical funding for
service or drop-in centers--the primary portal that links veterans in
need with the people who can help them. It would guarantee continued
declines in veteran homelessness, and provide for scaling back the
funding as warranted by the VA's annual Community Homelessness
Assessment, Local Education and Networking Group (CHALENG) reports. The
GPD program has evolved into a homelessness prevention network as much
as a proven intervention care and treatment collaborative partner with
the VA.
Special Needs Grants
The VA provides grants to VA health care facilities and existing
GPD recipients to assist them in serving homeless veterans with special
needs including women, women who have care of dependent children,
chronically mentally ill, frail elderly and terminally ill veterans.
Initiated in fiscal year 2004, VA has provided special needs funding to
29 organizations totaling $15.7 million. The VA Advisory Committee on
Homeless Veterans 2007 report States the need and complexity of issues
involving women veterans who become homeless are increasingly
unexpected. Recognizing women veterans are one of the fastest growing
homeless populations, the Committee recommended future notices of
funding availability target women veteran programs including special
needs grant offerings. Pub. L. 109-461 authorizes appropriations of $7
million for fiscal year 2007 through fiscal year 2011 for special needs
grants. The increased risks of homelessness among each of these
populations warrants funding for special needs grants above the
currently authorized level. Additional funding for the Grant and Per
Diem Program would address this need.
HUD-VASH
The joint HUD-VA Supported Housing Program (HUD-VASH) provides
permanent housing and ongoing treatment services to harder-to-serve
homeless veterans with chronic mental health, emotional and substance
abuse issues. NCHV was pleased that Pub. L. 110-161 included $75
million to be used for 7,500 Section 8 vouchers for homeless and
disabled programs. Under this program, VA must provide funding for
supportive services to veterans receiving rental vouchers. The fiscal
year 2009 VA budget must reflect a significant increase in funding
these services.
We believe the $7.8 million in the fiscal year 2009 VA budget
proposal was agreed upon before the dramatic increase in HUD-VASH
vouchers became law. Based on historical data that shows each housing
voucher requires approximately $5,700 in supportive services--such as
case management, personal development and health services,
transportation, etc.--we estimate approximately $45 million will be
needed to adequately serve 7,500 or more clients in HUD-VASH housing
units. Rigorous evaluation of this program indicates this approach
significantly reduces the incidence of homelessness among veterans
challenged by chronic mental and emotional conditions, substance abuse
disorders and other disabilities.
Multifamily Transitional Housing Loan Guarantee Program
This initiative authorizes VA to guarantee 15 loans with an
aggregate value of $100 million for construction, renovation of
existing property, and refinancing of existing loans to develop
transitional housing projects for homeless veterans and their families.
First authorized in 1998, only two projects have survived beyond the
initial planning stages--in Chicago and San Diego--and only St. Leo's
in Chicago has been developed.
While we believe this program seemed promising in its original
design and intent, the real-life difficulties in long-term coalition
building, planning and economic hardships developers have encountered
to date strongly suggest a much more practical and streamlined program
should be developed to address the critical supportive housing needs of
homeless veterans and those at serious risk of homelessness due to
chronic health problems and poverty.
A congressionally mandated analysis of 2000 U.S. Census data in
fiscal year 2006 revealed approximately 1.5 million veterans are living
below the Federal poverty level. The GAO and VA's own reports indicate
an immediate need for more than 11,000 additional transitional housing
beds for homeless veterans. And combat veterans from Iraq and
Afghanistan--now in the fourth year of their repatriation--are
requesting assistance in increasing numbers at VA and community-based
service providers. The need for increased service capacity is
immediate, and many community-based providers have successfully
developed additional transitional and longer-term residential
opportunities for their clients. We believe the resources earmarked for
the Multifamily Transitional Housing Loan Guarantee Program might be
better allocated to support projects that can be developed and brought
on-line more swiftly.
Compensated Work Therapy/Transitional Residence (CWT/TR) Program
In VA's Compensated Work Therapy/Transitional Residence (CWT/TR)
Program, disadvantaged, at-risk, and homeless veterans live in CWT/TR
community-based supervised group homes while working for pay in VA's
Compensated Work Therapy Program (also known as Veterans Industries).
Veterans in the CWT/TR program work about 33 hours per week, with
approximate earnings of $732 per month, and pay an average of $186 per
month toward maintenance and up-keep of the residence. The average
length of stay is about 174 days. VA contracts with private industry
and the public sector for work done by these veterans, who learn new
job skills, relearn successful work habits, and regain a sense of self-
esteem and self-worth. We are pleased to see the additional funding
provided for in the fiscal year 2009 proposed budget.
Mental Health Programs
Virtually every community-based organization that provides
assistance to veterans in crisis depends on the VA for access to
comprehensive health services, and without exception their clients
receive mental health screenings, counseling and necessary treatment as
a matter of course. These services are well documented, and case
managers report this information to the VA as prescribed in their grant
reports. Follow-up services--counseling, substance abuse treatments,
outpatient therapies, medication histories and family support
initiatives--are also monitored closely and reported in client case
files.
Despite significant challenges and budgetary strains, the VA has
quadrupled the capacity of community-based service providers to serve
veterans in crisis since 2002, a noteworthy and commendable expansion
that includes, at its very core, access to mental health services and
suicide prevention. The development of the VA Mental Health Strategic
Plan from 2003 through November 2004, and its implementation over the
last 3 years with additional funding this committee fought for, has
increased the number of clinical psychologists and other mental health
professionals at VA medical centers, community-based outpatient clinics
(CBOCs) and VA Readjustment Counseling Centers (Vet Centers). We
believe the VA budget proposal would facilitate further implementation
of the Mental Health Strategic Plan.
We strongly recommend, however, that more attention be directed to
simplifying and expanding access to community mental health clinics for
OEF/OIF veterans in communities not well served by VA facilities.
Current regulations allow a veteran to apply for authorization to
access services at non-VA facilities, but the process is often
frustrating and problematic, particularly for a veteran in crisis.
Protocols should be developed to allow the VA and community clinics to
process a veteran's request for assistance directly and immediately
without requiring the patient to first apply at a VA medical facility.
In the interest of maximizing the immediate benefit of mental health
supports and minimizing the risk of harmful and even suicidal responses
by a veteran to debilitating pressures--perceived or real--this
initiative should be universal and well publicized.
Conclusion
The National Coalition for Homeless Veterans thanks this committee
for its service to America's veterans in crisis. It has been a long and
difficult campaign, but hundreds of thousands of lives have been
restored and thousands of lives have been saved. We are honored to work
alongside the Congress, the Administration, our Federal partners, and
the service provider network that has transformed policy into hope and
redemption for these deserving men and women. What we have learned in
the last 20 years is the greatest promise we can offer the new
generation of combat veterans coming home from Iraq and Afghanistan--we
are prepared to honor your service, help heal your wounds, and ensure
you enjoy the blessings of the freedom you have preserved.
______
Prepared Statement of Friends of VA Medical Care and
Health Research (FOVA)
FY 2008 Appropriation--$480
FY 2009 President's Proposal--$442
FY 2009 FOVA Recommendation--$555
On behalf of the Friends of VA Medical Care and Health Research
(FOVA)--the diverse coalition representing more than 80 national
academic, medical, and scientific societies; voluntary health and
patient advocacy groups; and veteran-focused organizations--thank you
for your continued support of the Department of Veterans Affairs (VA)
Medical and Prosthetic Research Program. We are deeply concerned about
the President's proposed fiscal year 2009 budget for the VA research
program. A time of war is not the time to cut research on the grievous
injuries being suffered by veterans of the Afghanistan and Iraq wars.
FOVA Recommendations: For fiscal year 2009, FOVA recommends an
appropriation of $555 million for VA Medical and Prosthetic Research
and an additional $45 million for necessary research facilities
upgrades appropriated via the VA Minor Construction account.
Prior Year Support: FOVA thanks the Committee for its strong
support of VA research as evidenced by your fiscal year 2008 views and
estimates with regard to the VA Medical and Prosthetic Research
Program. The Committee's recommendation--$500 million--was an $89
million increase over the previous fiscal year and the President's
fiscal year 2008 proposal. Your support for the program undoubtedly
encouraged both chambers to adopt a significant increase in the
program's final appropriation. FOVA encourages you to develop a views
and estimates statement for fiscal year 2009 that reflects this same
strong commitment to biomedical research for the benefit of veterans,
and ultimately, all Americans.
VA Research Improves Veterans' Lives: The VA Medical and Prosthetic
Research Program is one of the Nation's premier research endeavors,
attracting high-caliber clinicians to deliver care and conduct research
in VA health care facilities. The VA research program is patient-
oriented and focused entirely on prevention, diagnosis, and treatment
of conditions prevalent in the veteran population. Recent successes to
which VA has contributed include the implantable cardiac pacemaker, a
new vaccine for shingles, and Stateof-the-art prosthetics, including a
new bionic ankle.
President's Budget Request Falls Short: Considering the proven
success of the VA research program, FOVA is disappointed with the
President's proposal of $442 million for VA research in fiscal year
2009. The proposal fails to maintain funding at the level appropriated
in fiscal year 2008. If enacted, the proposed $38 million (8 percent)
cut will lead to significant programmatic reductions and will impede
research advances in diseases and injuries that impact the veteran
population. According to the President's proposal, VA will cut funding
for research in central nervous system injury by 20 percent; acute and
traumatic injury, military occupations and environmental exposure, and
substance abuse by 18 percent; and mental illness by 15 percent. The
cuts are counter to the Committee's report language calling for VA to
``expand its research into the areas of neurotrauma, sensory loss, and
Post Traumatic Stress Disorder with a focus on developing clinical
practices using evidenced-based medicine.'' The President's budget
request assumes the cut in the VA research account will be made up by
large increases in Federal funding from other agencies, nonprofits, and
private industry. We are skeptical these sources will be able to
materialize such gains in VA.
Research Advances Require Sustained Investment: While FOVA
appreciates the significant increase in funding approved last year, a
one-time investment in research will not lead to the medical advances
required to improve the lives of the Nation's veterans. VA research
grants are awarded on a 3- to 5-year cycle; funding must be maintained
over the grant cycle to sustain the investigator's research. Cuts in
funding require VA to cut award levels for ongoing projects, thus
diminishing productivity and output. In addition, funding fluctuation
may limit the number of investigators willing to enter--and remain in--
the VA system. The VA research program offers a dedicated funding
source to attract and retain high-quality physicians and clinical
investigators to the VA health care system, who in turn provide first-
class health care to our Nation's veterans. FOVA encourages the
Committee to consider the long-term needs of veterans and VA
investigators when promoting future funding allocations for the
program. The coalition encourages Congress to support planned growth
for the VA research budget over the course of the next 3 years to
continue the upward trajectory of the program in an orderly fashion.
Thank you for considering our views.
the fova executive committee
John M. Bradley III
Veterans Service Organizations Liaison
703-244-3652
[email protected]
Gary Ewart
American Thoracic Society
202-296-9770
[email protected]
Allison Haupt
Alliance for Academic Internal Medicine
202-861-9351
[email protected]
Heather Kelly, Ph.D.
American Psychological Association
202-336-5932
[email protected]
Matthew Shick
Association of American Medical Colleges
202-828-0525
[email protected]
Barbara West
National Association of Veterans' Research and Education Foundations
301-656-5005
[email protected]
______
Prepared Statement of Iraq and Afghanistan Veterans of America (IAVA)
Mr. Chairman and Members of the Senate Veterans' Affairs Committee,
on behalf of Iraq and Afghanistan Veterans of America and our tens of
thousands of members nationwide, I thank you for the opportunity to
testify today regarding the VA budget request for 2009.
From April 2003-February 2004, I served as a First Lieutenant and
Infantry Platoon Leader in Iraq. When I returned home, I quickly became
concerned about the lack of real support for returning troops and
veterans. In the early years of the wars, issues like Traumatic Brain
Injury, Post Traumatic Stress Disorder, and homelessness received far
too little attention.
But times have changed. Last year, this Congress showed tremendous
commitment to our Nation's veterans, providing the VA with its single
largest budget increase in 77 years. On behalf of the millions of
veterans who rely on VA health care, including almost 300,000 troops
newly home from Iraq and Afghanistan, we hope you will continue to show
your support for veterans' health care. IAVA is one of the over 60
organizations who have endorsed the Independent Budget, and we endorse
it again for fiscal year 2009.
As the war in Iraq continues into its fifth year, this generation
of troops and veterans faces new and unique problems. Today, IAVA is
releasing our annual Legislative Agenda. Our Legislative Agenda covers
the entire warfighting cycle--before, during and after deployment--and
outlines practical solutions to the most pressing problems facing Iraq
and Afghanistan veterans. Our Legislative Agenda is available at IAVA's
website, www.iava.org.
The cornerstone of our 2008 Legislation Agenda is a new GI Bill.
After World War II, nearly eight million servicemembers took advantage
of GI Bill education benefits. A veteran of WWII was entitled to free
tuition, books and a living stipend that completely covered the cost of
education.
Today we have the opportunity to renew our social contract with our
servicemen and women, and help rebuild our military. IAVA supports
reinstating a World War II-style GI Bill that will cover the true cost
of education and will fairly reward all combat veterans of Iraq and
Afghanistan. We have endorsed S. 22.
Critics have said the GI Bill is too expensive. The fact is: a new
GI Bill is a bargain. The current GI Bill cost the Veterans' Affairs
Department $1.6 billion in 2004. Even if a World War II-style GI Bill
were to double that cost, it would be about what we spend in a week in
the War on Terror. And the GI Bill is more than a veterans' benefit. It
is also an effective tool to stimulate the economy and to improve
military readiness.
The GI Bill helped rebuild this country's economy after World War
II. A 1988 Congressional study proved that every dollar spent on
educational benefits under the original GI Bill added seven dollars to
the national economy in terms of productivity, consumer spending and
tax revenue.
Many of our Nation's leaders got their start thanks to the GI Bill,
including Presidents Gerald Ford, George H.W. Bush, and Senators Bob
Dole, George McGovern, and Pat Moynihan. The GI Bill also educated 14
Nobel Prize winners and two dozen Pulitzer Prize winners, including
authors Joseph Heller, Norman Mailer, and Frank McCourt.
Veterans of Iraq and Afghanistan, however, receive only a fraction
of the support offered to the Greatest Generation. For many, including
my good friend Sgt. Todd Bowers, the burden of student loans and
mounting debt can simply become too great.
When Sgt. Bowers was activated for his second deployment to Iraq,
he was forced to withdraw from his classes at George Washington
University, racking up an extra semester's debt without receiving
credit for his coursework. While he was deployed to Iraq, Bowers was
wounded when a sniper's round penetrated his rifle scope and sent
fragments into the left side of his face. He was awarded the Purple
Heart and Navy Commendation medal with ``V'' device for Valor. But when
Bowers returned home, he was not greeted as a hero by his university
and credit lenders. His student loans had been sent to collection, and
his credit rating was ruined. Struggling to keep up with payments,
Bowers was eventually forced to leave school.
The GI Bill is also an important recruitment tool. For years, the
military has been lowering recruitment standards and increasing
bonuses. We now spend more than $4 billion annually on recruitment, but
we're still struggling to meet recruiting goals. The GI Bill is the
military's single most effective recruitment tool; the number 1 reason
civilians join the military is to get money for college. A new GI Bill,
one that put college within reach of a new generation of veterans,
would be a tremendous boon to recruitment and would help rebuild our
military after years of war.
Above all, a World War II-style GI Bill would thank this generation
of combat veterans for their service and their sacrifice. As President
Roosevelt said in his signing statement to the original GI Bill: ``[The
GI Bill] gives emphatic notice to the men and women in our Armed Forces
that the American people do not intend to let them down.''
For all of these reasons, IAVA is calling for a new GI Bill to be
funded in this year's budget.
Thank you for your time.
Respectfully Submitted,
Paul Rieckhoff,
Executive Director.
______
Idaho Division of Veterans Services,
Boise, ID, February 11, 2008.
Hon. Larry E. Craig,
U.S. Senate, Washington, DC.
Dear Senator Craig: In the 109th Congress, on June 6, 2006, you
introduced Senate Bill 3421, which would amend title 38, United States
Code to improve the following veterans' benefits:
To amend title 38, United States Code, to repeal certain
limitations on attorney representation of claimants for
benefits under laws administered by the Secretary of Veterans
Affairs, to expand eligibility for the Survivors' and
Dependents' Educational Assistance Program, to otherwise
improve veterans' benefits, memorial affairs, and health care
programs, to enhance information security programs of the
Department of Veterans Affairs, and for other purposes.
Under the provisions of section 1745 of Senate Bill 3421, the
following benefits are stated:
`Sec. 1745. Nursing home care and medications for veterans with
service-connected disabilities
`(a)(1) The Secretary shall pay each State home for nursing
home care at the rate determined under paragraph (2), in any
case in which such care is provided to any veteran as follows:
`(A) Any veteran in need of such care for a service-connected
disability.
`(B) Any veteran who--
`(i) has a service-connected disability rated at 70 percent or
more; and
`(ii) is in need of such care.
`(2) The rate determined under this paragraph with respect to a
State home is the lesser of--
`(A) the applicable or prevailing rate payable in the
geographic area in which the State home is located, as
determined by the Secretary, for nursing home care furnished in
a non-Department nursing home (as that term is defined in
section 1720(e)(2) of this title); or
`(B) a rate not to exceed the daily cost of care, as determined
by the Secretary, following a report to the Secretary by the
director of the State home.
`(3) Payment by the Secretary under paragraph (1) to a State
home for nursing home care provided to a veteran described in
that paragraph constitutes payment in full to the State home
for such care furnished to that veteran.'.
(2) PROVISION OF PRESCRIPTION MEDICINES--Such section, as so
added, is further amended by adding at the end the following
new subsection:
`(b) The Secretary shall furnish such drugs and medicines as
may be ordered on prescription of a duly licensed physician as
specific therapy in the treatment of illness or injury to any
veteran as follows:
`(1) Any veteran who--
`(A) is not being provided nursing home care for which payment
is payable under subsection (a); and
`(B) is in need of such drugs and medicines for a service-
connected disability.
`(2) Any veteran who--
`(A) has a service-connected disability rated at 50 percent or
more;
`(B) is not being provided nursing home care for which payment
is payable under subsection (a); and
`(C) is in need of such drugs and medicines.'.
(3) CONFORMING AMENDMENTS--
(A) CRITERIA FOR PAYMENT--Section 1741(a)(1) is amended by
striking `The' and inserting `Except as provided in section
1745 of this title, the'.
(B) ELIGIBILITY FOR NURSING HOME CARE--Section 1710(a)(4) is
amended--
(i) by striking `and' before `the requirement in section 1710B
of this title'; and
(ii) by inserting `, and the requirement in section 1745 of
this title to provide nursing home care and prescription
medicines to veterans with service-connected disabilities in
State homes' after `a program of extended care services'.
(4) CLERICAL AMENDMENT--The table of sections at the beginning
of chapter 17 is amended by inserting after the item relating
to section 1744 the following new item:
`1745. Nursing home care and medications for veterans with
service-connected disabilities.'.
(5) EFFECTIVE DATE_The amendments made by this subsection shall
take effect 90 days after the date of the enactment of this
Act.
(b) Identification of Veterans in State Homes--Such chapter is
further amended--
(1) in section 1745, as added by subsection (a)(1) of this
section, by adding at the end the following new subsection:
`(c) Any State home that requests payment or reimbursement for
services provided to a veteran under this section shall provide
to the Secretary such information as the Secretary considers
necessary to identify each individual veteran eligible for
payment under such section.'; and
(2) in section 1741, by adding at the end the following new
subsection:
`(f) Any State home that requests payment or reimbursement for
services provided to a veteran under this section shall provide
to the Secretary such information as the Secretary considers
necessary to identify each individual veteran eligible for
payment under such section.'
On December 9, 2006, the President of the United States signed
Public Law 109-461, which enacted your legislation. As of today,
February 11, 2008, fifteen months after enactment, the Idaho State
Veterans Homes can not received reimbursement from the Department of
Veterans Affairs for these veterans because they have not implemented
the law. We have several veteran residents who face making the
difficult decision to leave their Veterans Home and enter into a
private facility where the Department of Veterans Affairs can reimburse
private long-term care facilities and not State Veterans Homes. It is
an injustice to our veterans that wish to remain residents of a State
Veterans Home and cannot because this law has not been implemented.
We request your assistance in encouraging the Department of
Veterans Affairs to put in place Public Law 109-461. We also request
that reimbursements be retroactive to March 9, 2007, since the
implementation of Public Law 109-461 was to be in effect 90 days after
enactment.
I want to thank you for all you have done for the veterans of this
country and especially Idaho. Without someone fighting for our rights
in Washington, DC, we would not have the benefits we enjoy today.
Respectfully,
David E. Brasuell,
Administrator.
______
Boise, ID, February 8, 2008.
Senator Larry E. Craig,
Senator Mike Crapo,
Representative Bill Sali,
Representative Mike Simpson,
The Idaho Congressional Delegation
My father, Francis J. Hess Sr. is a veteran of WWII and an ex-POW.
He is 90 years old and residing at the Idaho State Veterans Home in
Boise. He has a 100 percent service-connected disability.
When discussing admission with the Idaho State Veterans Home over a
month ago they assured me that they were in negotiations with the
Department of Veterans Affairs to be one of the contractors in the
Boise area that would provide nursing home care to veterans with a 70-
100 percent service-connected disability and likely those negotiations
would be complete by March 2008.
A bomb was dropped on my father, myself and my entire family today
when we were informed by the Veterans Home that the Secretary of
Veterans Affairs, Dr. Peake, has decided to halt negotiations until
next year. This will cost my family and all the other families affected
approximately $4300 per month. Our personal situation is even more
precarious because our stepmother is suffering from cancer and has huge
costs associated with that.
What was to be a blessing for our entire family has turned into a
nightmare. How could I possibly move my 90-year-old father to another
facility when he has been experiencing the best care available at the
Idaho State Veterans Home? Why would Dr. Peake stop negotiations with
the finest nursing home for veterans in the State of Idaho?
My entire family is praying that you will be able to prevail upon
Dr. Peake to complete the negotiations now with the Idaho State
Veterans Home.
Please help and thank you for all that you do for Idaho.
Respectively,
Francis J. Hess Jr.