[House Hearing, 111 Congress]
[From the U.S. Government Printing Office]
U.S. DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FY 2011 AND FY
2012
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
February 4, 2010
__________
Serial No. 111-59
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, JR., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY McNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia
Malcom A. Shorter, Staff Director
______
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
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both printed and electronic versions of the hearing record, the process
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unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
February 4, 2010
Page
U.S. Department of Veterans Affairs Budget Request for FY 2011
and FY 2012.................................................... 1
OPENING STATEMENTS
Chairman Bob Filner.............................................. 1
Prepared statement of Chairman Filner........................ 41
Hon. Steve Buyer, Ranking Republican Member...................... 2
Hon. Corrine Brown, prepared statement of........................ 41
Hon. Harry E. Mitchell, prepared statement of.................... 42
Hon. John Boozman, prepared statement of......................... 43
WITNESSES
U.S. Department of Veterans Affairs, Hon. Eric K. Shinseki,
Secretary...................................................... 4
Prepared statement of Secretary Shinseki..................... 43
______
American Legion, Steve A. Robertson, Director, National
Legislative Commission......................................... 37
Prepared statement of Mr. Robertson.......................... 77
American Veterans (AMVETS), Raymond C. Kelley, National
Legislative Director........................................... 35
Prepared statement of Mr. Kelley............................. 73
Disabled American Veterans, John L. Wilson, Assistant National
Legislative Director........................................... 32
Prepared statement of Mr. Wilson............................. 53
Iraq and Afghanistan Veterans of America, Paul Rieckhoff,
Executive Director............................................. 39
Prepared statement of Mr. Rieckhoff.......................... 94
Paralyzed Veterans of America, Carl Blake, National Legislative
Director....................................................... 31
Prepared statement of Mr. Blake.............................. 51
Veterans for Common Sense, Paul Sullivan, Executive Director..... 38
Prepared statement of Mr. Sullivan........................... 98
Veterans of Foreign Wars of the United States, Eric A. Hilleman,
Director, National Legislative Service......................... 34
Prepared statement of Mr. Hilleman........................... 64
Vietnam Veterans of America, Richard F. Weidman, Executive
Director for Policy and Government Affairs..................... 38
Prepared statement of Mr. Weidman............................ 91
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to
Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans
Affairs, letter dated March 25, 2010, and VA responses......... 102
Hon. Steve Buyer, Ranking Republican Member, Committee on
Veterans' Affairs, to Hon. Eric K. Shinseki, Secretary, U.S.
Department of Veterans Affairs, letter dated February 12, 2010,
and VA responses............................................... 112
U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FY 2011 AND FY 2012
----------
THURSDAY, FEBRUARY 4, 2010
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10:00 a.m., in
Room 334, Cannon House Office Building, Hon. Bob Filner
[Chairman of the Committee] presiding.
Present: Representatives Filner, Brown of Florida, Snyder,
Michaud, Mitchell, Hall, Halvorson, Perriello, Rodriguez,
Donnelly, Space, Walz, Adler, Buyer, Stearns, Moran, Boozman,
Bilbray, Bilirakis, and Roe.
OPENING STATEMENT OF CHAIRMAN FILNER
The Chairman. Good morning. Welcome to the hearing of the
Committee on Veterans' Affairs of the House of Representatives
on the U.S. Department of Veterans Affairs (VA) budget request
for fiscal year 2011 and 2012.
I want to be able to move fairly quickly at the beginning
and hear the testimony of the Secretary because we have a
series of votes, unfortunately, somewhere between 10:15 and
10:30. We will be gone for 40 to 45 minutes, so I would like to
get the Secretary's testimony in beforehand.
I ask unanimous consent that all Members may have 5
legislative days to revise and extend their remarks and that
written statements be made part of the record. Hearing no
objection, so ordered.
Mr. Secretary, you and the President have requested a VA
budget of $125 billion, roughly, including a total
discretionary request of over $60 billion. The VA medical care
budget represents 86 percent of the total discretionary budget.
Also, for fiscal year 2011, the Administration is
requesting over $51 billion in resources for VA medical care.
Appropriated resources for fiscal year 2011 have already
been provided in last year's consolidated appropriations act
and the funding level is an increase of $4.1 billion or 8.6
percent over 2010 levels.
Rest assured that this Committee will be working closely
with our counterparts in the Administration and in the Senate
to make sure the process moves forward to ensure veterans have
the medical care resources they need when fiscal year 2012
begins.
The veterans' groups that co-author The Independent Budget,
and who will be testifying today, have recommended a total
resource level for VA medical care of $52 billion and an
overall discretionary funding level of $61.5 billion, which is
$1.2 billion above the Administration's request.
We are looking forward to their testimony and the testimony
of the American Legion, the Vietnam Veterans of America, Iraqi
and Afghanistan Veterans of America, and Veterans for Common
Sense who will also testify today.
Mr. Secretary, I am impressed by your robust budget request
and your emphasis on funding many of the priorities of this
Committee, including addressing the plague of homelessness,
rural health care access, access of women veterans, and the
mental health care needs of our veterans.
The budget addresses problems faced by our newer veterans
while not forgetting the sacrifices and service of veterans
from previous conflicts.
We are looking forward to your testimony today.
Before I yield to our Ranking Member, I know I speak for
our entire Committee, Mr. Buyer, that our thoughts and prayers
are with your family, your wife, and yourself as you go through
a very difficult time.
I yield to Mr. Buyer.
[The prepared statement of Chairman Filner appears on p.
41.]
OPENING STATEMENT OF HON. STEVE BUYER
Mr. Buyer. Thank you very much, especially for your heart-
felt comments.
Mr. Secretary, I apologize. I am going to make a quick
opening statement. I had requested a hearing for a review of
the Comcast/NBC merger. That hearing is now taking place this
morning. They are doing opening statements. I plan to be here
for your opening statement and then I need to go to that
hearing.
So what I will do is I will make a few comments here and
then I am going to incorporate two questions that I would ask
for you to answer even though I will not be here.
With regard to your budget, I want to congratulate you on
your agreed robust budget. There may be some differences we may
have as we present the views and estimates to the Budget
Committee with regard to where I would place some of those
dollars.
The most significant problem, which you also recognize, is
the disability claims backlog. The application of the 21st
century technology solutions are extremely important.
I applaud you with the VA pilot programs reconfigured to
modernize the claims process that are underway in Little Rock,
Providence, Baltimore, and in Pittsburgh, and I look forward to
their results.
And I also want to congratulate you. You faced the
challenges head on with regard to the GI Bill. And much of
those challenges, Congress dropped those challenges right in
your lap. And there was some politics of the moment that did
override the substance and the problem was presented to you.
You did not complain. You met them head on and you met the
challenge. In that process, some veterans were hurt, but that
was no fault of yours. You took a very difficult situation and
you did the best you could and I applaud you for that.
And for those veterans out there that did suffer and some
of whom did not go back to school this fall because of their
particular circumstance, my deepest apologies. But to those
veterans out there across the country, please recognize that we
have a VA Secretary that is off his heels, on his toes, and is
leaning forward.
I also want to commend you for your Consolidated Patient
Account Center (CPAC), the expeditious rollout for which you
are doing. You and I had a good conversation. I was more than
impressed on how you accelerated the timeline and your decision
to go with a single contract rather than moving in installments
in a timeline as presented to you by your own advisors, even in
contracting.
And you have challenged them. You have challenged the
system. But you recognize that as you challenge them, those are
more VA dollars that will come into the system.
And so I have always felt that I was the one that was
always challenging. You out-challenged me. And it is
unfortunate that whatever occurred, dollars were not placed
there, it is a hiccup in the process, we want to work with you.
If you could outline to the Committee kind of what has
happened and what your way forward is on that and your over-
the-horizon view for success for the CPAC rollout, I think, is
extremely important. And I look forward to that, your response
to that.
The other is with regard to the President proposing to use
$30 billion in Troubled Asset Relief Program (TARP) funds to
promote small business. I recognize that this will be a--it
will be subject to political fodder here on Capitol Hill as to
whether it is legitimate or whether that was an intent of
Congress and we are in a political season.
My only challenge to you, Mr. Secretary, is to
incorporate--please send a message to the President. If he is
going to do this, incorporate veterans in the process. So for
the last year, I have been asking for that billion dollars in
loan guarantees for small businesses for veterans and we are
being left out.
So if he is going to actually use those funds and find the
legitimate or legal process in order to use those, I would ask
you to ask of the President for veterans to be included in that
$30 billion of the TARP funds for small business.
The other point I would like to make, and I do not know why
this occurs, maybe this is part of the gamesmanship over the
years, but every time we do a budget, somebody likes to whack
the Inspector General (IG). And we like the IG Office. We like
the IG Office, I guess, as part of our oversight functions,
especially Mr. Mitchell over here nodding his head.
It is a multiplier. I think you probably learned that also
when you were over in the U.S. Department of Defense (DoD).
When those ombudsmen or the IG Office put their eyes on things,
yeah, you can upset people at times, but good things result
from what they are attempting to do.
Also, when I talked about the added dollars for which you
put in the budget, especially on the mandatory side, while I
recognize that you have made some judgments with regard to the
Agent Orange and for there to be presumptions, I want to make
sure that we do not change the paradigm or the matrix with
regard to outpacing science. We have always made science-based
judgments with regard to causal connections and I want to make
sure that we are not changing that paradigm.
And at the same time, you know, I look at that and say all
of a sudden, we have found this money for mandatory funding
while at the same time, part of our values, we sort of pride
ourselves when we talk about taking care of the widow and the
orphans. But in reality, we are not. And that is why I combined
with the Sergeant Major Walz to address and increase Dependency
and Indemnity Compensation (DIC) and eliminate the offset of
the Survivor Benefit Plan (SBP).
So all of a sudden, we have found these funds, but we are
still not taking care of the widows. And I just lay that out
there as a challenge for all of us to come together somehow to
take care of them.
And with that, I am going to yield back my time, and I
respect your efforts.
The Chairman. Thank you, Mr. Buyer, and I agree with a lot
of what you said. I hope the paragraphs on science-based
decisions would be made to your caucus in regard to global
warming. Okay?
Just a little dig. Do not worry, Mr. Secretary.
We welcome you, Mr. Secretary. You are accompanied by Dr.
Gerald Cross, the Acting Under Secretary for Health; Mike
Walcoff, the Acting Under Secretary for Benefits; Steve Muro,
the Acting Under Secretary for Memorial Affairs; Todd Grams,
the Acting Assistant Secretary for Management; and we have
Roger Baker, the Assistant Secretary for Information and
Technology.
By the way, you might let us know when all these acting
positions are going to be dealt with.
You have the floor, Mr. Secretary, and we appreciate all
your efforts on behalf of our veterans.
STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT
OF VETERANS AFFAIRS; ACCOMPANIED BY GERALD M. CROSS, M.D.,
FAAFP, ACTING UNDER SECRETARY FOR HEALTH, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; MICHAEL
WALCOFF, ACTING UNDER SECRETARY FOR BENEFITS, VETERANS BENEFITS
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; STEVE L.
MURO, ACTING UNDER SECRETARY FOR MEMORIAL AFFAIRS, NATIONAL
CEMETERY ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS;
W. TODD GRAMS, ACTING ASSISTANT SECRETARY FOR MANAGEMENT AND
CHIEF FINANCIAL OFFICER, U.S. DEPARTMENT OF VETERANS AFFAIRS;
AND HON. ROGER W. BAKER, ASSISTANT SECRETARY FOR INFORMATION
AND TECHNOLOGY, OFFICE OF INFORMATION AND TECHNOLOGY, U.S.
DEPARTMENT OF VETERANS AFFAIRS
Secretary Shinseki. Thank you, sir.
Chairman Filner, Ranking Member Buyer, distinguished
Members of the Committee, thank you as always for this
opportunity to present the President's 2011 budget and 2012
advanced appropriations requests for the Department of Veterans
Affairs.
I also appreciate the generosity of your time in meeting
with me prior to this hearing. Those are always invaluable
opportunities for me to gain insights.
Let me also acknowledge the presence of representatives
from our veterans service organizations (VSOs) in attendance
today. Their insights have also been helpful to me personally
and to the Department in helping meet our obligations to all of
our veterans.
Thank you, Mr. Chairman, for introducing the members of the
panel today. I would just point out that Mike Walcoff sits to
my left. Todd Grams here is our new Principal Deputy and Acting
Assistant Secretary for Management. Dr. Cross to my right. To
his right, Steve Muro and then Roger Baker, our Chief
Information Officer (CIO), on the end.
Mr. Chairman, I have a written statement, a longer written
statement that I would ask be submitted for the record.
The Chairman. Yes. So ordered.
Secretary Shinseki. Okay. Thank you.
This Committee's long-standing commitment to our Nation's
veterans has always been unequivocal and unwavering. That has
been clear. And such commitment on your part and then the
President's own steadfast support for our veterans resulted in
a 2010 budget that was quite remarkable in providing the
Department the resources to begin renewing itself in
fundamental and comprehensive ways.
And that translates to the efforts, the transformation that
we have been talking about. I report that we are well-launched
on that effort and are determined to continue that
transformation throughout this year, 2010, and carry over into
2011 and 2012.
We have crafted a new strategic framework around three
governing principles that you have heard me espouse for the
past year. It is about being people-centric. It is about being
results-oriented. We want to measure what we say we are going
to do and we want to be able to see what we got for the
investment.
And then, finally, we want to be forward-looking. We think
that there is much yet to be gained out of the potential of
this Department.
This new strategic plan delivers on President Obama's
vision for VA and is in the final stages of review. And we are
prepared to share that plan with you once that review is done.
The strategic goals we have established will do several
things. First, continue to raise the bar on quality and
accessibility of VA health care and benefits while optimizing
value.
The plan also improves our readiness to protect our people,
both our clients as well as our workforce, and our assets day
to day as well as in times of crisis.
The plan enhances even more veteran satisfaction with our
health, education, training, counseling, financial, and burial
benefits and services.
And, finally, the plan invests in our human capital, both
in their well-being and then in their development as leaders.
In order to attain the kind of excellence in our management
and IT systems, as well as our support services, which I
consider vital if we are going to achieve the kind of mission
performance I have described you should expect out of this
Department, we intend to be the model of governance in about 4
years.
These goals got our people to focus on producing the
outcomes veterans expect and have earned through their service
to our country.
Now, to support VA's efforts, the President's budget
provides $125 billion in 2011, as you have pointed out, Mr.
Chairman, $125 billion, $60.3 billion in discretionary, $64.7
billion in mandatory funding.
Our discretionary budget request represents an increase of
$4.2 billion and, as you have pointed out, it is 7.6 percent
over the President's 2010 enacted budget.
VA's 2011 budget focuses on three critical concerns that
are of primary importance as I pick these up in speaking with
veterans.
First, better access to benefits and services.
Second, reducing the disability claims backlog and wait
time for receipt of earned benefits.
And, third and finally, ending the downward spiral that
often enough results in veteran homelessness, those three.
Access, this budget provides the resources required to
enhance access to our health care system and our national
cemeteries. We will expand access to health care through
activations of new or improved facilities, providing health
care eligibility for more, primarily through Priority Group 8
veterans, but others as well, and then making greater
investments in telehealth, which I have described as sort of
the next major step in delivery of health care. We will also
increase access to our national cemeteries through the
establishment of five new cemeteries.
The backlog, we are requesting an unprecedented increase
for staffing in the Veterans Benefits Administration (VBA)to
address the growing increase in disability claims receipts even
as we continue to reengineer our processes, develop a paperless
system integrated with the VLER, the Virtual Lifetime
Electronic Record.
Ending homelessness, we are also requesting a substantial
investment in our homelessness program as part of our plan to
eliminate veterans' homelessness in 5 years through an
aggressive approach that includes housing, education, jobs, and
health care.
In this effort, we partner with the U.S. Departments of
Housing and Urban Development, probably our closest
collaborator, but also with Labor, Education, Health and Human
Services (HHS), Small Business Administration, among others.
Taken together, we intend to meet veterans' expectations in
each of these three areas to be successful in our mission in
access, working the backlog, and in ending homelessness.
We will achieve this by developing innovative business
processes and delivery systems that not only better serve
veterans' and families' needs for many years to come but will
also dramatically improve the efficiency and cost control of
our operations.
Our budget and advanced appropriations requests for 2011
and 2012 provide the resources necessary to continue our
aggressive pursuit of the President's two overarching goals for
the Department, to transform and to ensure client access to
timely, high-quality care and benefits. We still have much work
to accomplish--well-launched but still lots of room for work to
be done.
So, again, Mr. Chairman and Members of the Committee,
thanks for this opportunity to appear before you, and I look
forward to your continued unwavering support and I look forward
to your questions.
If I have time, I will address the question that was asked
by Mr. Buyer. This budget allows VA to more than double the
number of CPACs between 2010 and 2011, growing from three in
2010 to seven in 2011.
Moreover, this budget would allow VA to realize significant
revenues from a 5-year deployment with a third-party
collections increase of about $280 million through 2013 and
about $1.6 billion increase to 2018.
There is an opportunity to go faster and I am looking for
ways to accelerate if those opportunities present themselves.
Hopefully I have addressed the question, Mr. Buyer.
[The prepared statement of Secretary Shinseki appears on p.
43.]
Mr. Buyer. Thank you.
The Chairman. Thank you. Thank you, Mr. Secretary.
Mr. Snyder, you are recognized for 5 minutes.
Mr. Snyder. Thank you, Mr. Chairman.
Thank you all for your service, Mr. Secretary.
The issue of medical research is one that I generally ask
about at the hearing. And I think the staff analysis is that
your number on medical research does not keep pace with the
medical research inflation rate which is higher. And the
problem with that is research projects do best if researchers
do not have to come and go and lay off staff.
And may I ask you, Mr. Secretary or Dr. Cross, do you agree
with that analysis that your number does not keep pace with the
medical research inflation rate?
Secretary Shinseki. Let me call on Dr. Cross, thank you for
the question, to enter into the medical aspects of this and
then I will pick up after him.
Dr. Cross. Congressman, thank you for that question.
Mr. Snyder. Is your microphone on, Dr. Cross?
Dr. Cross. No.
Mr. Snyder. Thank you.
Dr. Cross. Thank you for that question, Congressman.
And for 2011, comparing it to 2009, it is a 16 percent
increase. We do value the----
Mr. Snyder. No, no. My question is, the analysis does not
keep pace with the rate of inflation of medical research in
real medical research dollars. I know what the lines are, but
do you agree with that analysis, it does not keep pace with the
rate of medical research inflation?
Dr. Cross. I agree that we are moving forward with a
research budget that meets the needs of our veterans. I am not
sure what the exact percentage increase is in the research
budget. But the percentage increase that we are looking at for
inflation medically is around four percent, four and a half.
Mr. Snyder. Well, let us do this as a question for the
record then. I believe that your budget does not keep pace with
the increasing costs that occur in medical research, whether it
is within the VA or outside of the VA. If I am right, then it
means that your researchers are going to have to lay off people
or cut back on projects.
So why don't you get back to us on whether you think your
budget number keeps pace with the actual real dollars in
medical research. Can we do that that way?
Secretary Shinseki. I will be happy to provide that for the
record.
[The VA provided the answer in Question #8 in the Post-
Hearing Questions and Responses for the Record, which appear on
p. 107.]
Mr. Snyder. Yeah. That would be great.
The Chairman. Mr. Snyder, we looked at that and we are
going to--I think our Views and Estimates work to reflect an
increase.
Mr. Snyder. An increase, yeah.
The second thing, Mr. Secretary, in your--I do not remember
if you mentioned it in your oral statement, but in your written
statement, you referred to not just the number of claims but
the complexity of claims.
In the time you have been on the job, why do you believe,
what is your conclusion about why claims are more complex? Why
are they increasing in complexity?
Secretary Shinseki. Let me call on Mike Walcoff.
Mr. Snyder. Yes.
Secretary Shinseki. He has a little better working
knowledge of the claims.
Mr. Walcoff. Congressman, I think this is a continuation of
a trend that we have seen over a number of years. The increase
in complexity deals with, first of all, the number of issues
that are being filed with each claim.
It used to be, 15 years ago or so, we would average between
two and three issues per claim. Now that average on all of our
claims is up over four, and the average on the claims that are
coming out of our benefits delivery at discharge sites is over
eleven.
So when you have that many issues coming in on a claim, it
does make it a lot more complex.
Mr. Snyder. Do we know why that is occurring? Are people
being advised by attorneys or advised by the internet or
advised by advisors? I mean, what----
Mr. Walcoff. I think part of it is. I think veterans are
becoming more aware of what they are potentially entitled to. I
think our outreach is better. I think service organizations are
doing a good job in working with them. I think that it is a
combination of a lot of things, and I do not necessarily think
that is a bad thing.
Mr. Snyder. Right.
Mr. Walcoff. I think it is a good thing, but it does add to
the complexity of the work.
Mr. Snyder. Right. And then Dr.----
Secretary Shinseki. I would add----
Mr. Snyder. Yes.
Secretary Shinseki [continuing]. In addition to complexity,
it is also the volume of claims that is also part of this
equation. Last year, VBA processed 977,000 claims and received
a million new claims on top of that. So complexity and volume
are part of the equation here.
Mr. Snyder. Well, I think I will yield back given that I
have only got 20 seconds left.
Thank you, Mr. Chairman.
Thank you all.
The Chairman. Mr. Michaud, would you like to speak before
we recess for our votes?
Mr. Michaud. Thank you, Mr. Chairman.
And thank you, Mr. Secretary, for coming here today and for
bringing us this budget.
I appreciate your willingness and your concern about the
issues you talked about today with homeless veterans, dealing
with veterans in rural areas.
And I also appreciate the fact that the different Veterans
Integrated Services Networks (VISNs) are having their Mini-Mac
meetings back in their individual States, which is actually
very helpful for the veterans service organizations and they
are very informative.
That gets to my question as it relates to rural health. As
you have heard, a lot of Members of this Committee on both
sides of the aisle are very concerned about rural health
issues, making sure that veterans have access to rural health.
I just attended actually a Mini-Mac meeting in Maine and
some of the same concerns I have heard throughout the country.
And we had a hearing not too long ago where actually we were
talking about the distribution of funding the Veterans
Equitable Resource Allocation (VERA) model.
Here is the concern, and it is not unique to Maine. The
fact that rural veterans travel a lot of distance, we increased
the mileage from 11 cents to 41 cents. What we are seeing in
Maine, and I am sure other areas, is Maine funding was $1.5
million that they have given to our veterans in rural areas. It
actually cost over $5 million. There is a shortage.
So what VA Togus is going to have to do, and I am sure it
is the same in other areas because of the VERA model, is they
are going to have to cut back on fee-for-service or not hire or
lay off staff. They are getting penalized because they live in
a rural area.
And it gets right back to the VERA model is have you done a
comprehensive analysis of the VERA model and what are the
driving forces of that model because if they have to cut back
on fee-for-service or cut doctors in rural areas, it actually
is counterproductive in what we are actually not--what we are
talking about not doing.
The other issue is when you look at the Office of Rural
Health, which has been great, they actually have funded good
projects in different regions of the country relating to rural
health, the problem being is these pilot projects that they are
funding, once that money dries up, then that is put back on to
the facilities which, here again, they will have to make those
very tough choices.
What do you plan on doing for some of these pilot projects
that are currently working in the Office of Rural Health,
whether they will have continuing operational funding versus
forcing a rural medical facility to actually make these tough
choices? Are they going to cut doctors or are they going to cut
back fee-for-service, which is counterproductive?
Secretary Shinseki. Mr. Michaud, I am going to call on Dr.
Cross here in a minute, but let me just describe for you.
This is one of the challenges I have wrestled with for the
past year and I do not know that it is the VERA model, but I do
not know that is not either. And we are, as you have pointed
out, we are looking at this very closely to try to understand
the dynamics here.
When we talk about delivery of health care, as you know, we
talk about everything from our medical centers to our
community-based outpatient clinics (CBOCs) to our Vet Centers,
fee service and contract and telemedicine. We spend a
significant amount of money on fee basis.
Mr. Chairman, do we have time for me to finish or----
The Chairman. I think we should wait----
Secretary Shinseki. Okay.
The Chairman [continuing]. Because we have 5 minutes to
vote. There are five or six votes. We will recess until 11:00
a.m.
Secretary Shinseki. Okay.
[Recess.]
The Chairman. I am sorry that the recess took so long. You
never know with votes, and I apologize for holding everybody
up. When we recessed, Mr. Michaud had asked a question and Mr.
Shinseki was answering.
Do you want to briefly rephrase your question, Mr. Michaud?
Mr. Michaud. One of the driving forces as it relates to the
VERA model getting funding back to rural, you know, medical
facilities because some of the concerns I have heard not only
in Maine but nationwide is the fact that you have got regional
rural hospitals are actually going to have to cut back on fee
services or eliminate positions in order to meet their balanced
budget.
Secretary Shinseki. Let me just say that your concerns
about the VERA model, I have similar questions I have asked. We
are taking a look at it. And the rural aspects of this will be
part of the review.
Let me ask Dr. Cross to address the specific issues you
talk about there in Maine.
Dr. Cross. Congressman, thank you for the question.
First of all, in regard to any specific concerns in regard
to Maine, Togus in particular, I and my staff are ready to come
over on very short notice and provide you any details that you
require and go through that very thoroughly.
And the broad answer to your question, VERA has had nine
external reviews thus far since it was created, by
organizations like the U.S. Government Accountability Office
(GAO). But VERA is also being supplemented because we recognize
the needs in the rural community.
One of those supplements that we are working with, I think
this Committee and you and others were very instrumental in
passing it and making it possible, and that relates to Public
Law 110-387, Section 403 in particular. That puts $100 million
in 2011 for contractual and fee-basis care in rural
communities. And I think that would help in Maine as well.
In addition, what we are doing with the rural health
outreach is more CBOCs, more outreach clinics, more
telemedicine. We anticipate that our telemedicine work in 2011
will reach 100,000 veterans in rural communities to make a
difference in their lives for the better.
And I appreciate the work that the Committee has supported
us with on this very important initiative because without your
support, this would not have been possible.
Secretary Shinseki. Mr. Michaud, let me just say the issue
of rural resourcing comes up frequently enough. We will respond
to you and also provide back to the Committee a response to
that question.
[The VA provided the answer in Question #7 in the Post-
Hearing Questions and Responses for the Record, which appear on
p. 107.]
Mr. Michaud. Thank you very much.
My second question actually relates to State Veterans
Nursing Home. As you know, we passed a law back in, I believe
it was 2006, to deal with the per diems for State Veterans
Nursing Homes. Ironically, since the VA has begun implementing
the law, State Veterans Nursing Homes are being paid less, less
than what they were being paid before.
And some of the concerns that I have heard from Veterans
Nursing Homes nationwide is the fact that they might be going
out of business since they are not going to be able to sustain
that, the reduction in costs. And this here really hits hard
those that are Medicare, Medicaid certified Veterans Homes.
We are having a hearing next week on H.R. 4241, which would
allow for increased flexibility in payments to State Veterans
Nursing Home.
I would like to know, have you heard anything about this or
what are your comments as it relates to payments and State
Veterans Nursing Homes?
Secretary Shinseki. Let me just say that we are working
with the Department of Health and Human Services in looking at
these rates. This goes beyond just VA. There is Medicare,
Medicaid involvement here.
Let me ask Dr. Cross to address this in detail.
Dr. Cross. Sir, you asked if we have heard anything about
this, absolutely, and we share your concerns. It is my
intention, and I understand the Secretary's intention, to move
forward with a resolution as cooperatively as possible.
Let me say that we have 137 of these homes at the moment.
They are very important to us and to our veterans. They do
great work. They are run by the States and supported in part by
the VA.
There was a Public Law passed, 109-461, several years ago,
about 2006. We understand that there were some unanticipated,
perhaps technical, issues that have arisen and become clearer
since then.
We are going to have some upcoming hearings with you, and
other sessions. We are going to bring forward our best experts
to propose resolutions.
Mr. Michaud. Great. Thank you very much, Dr. Cross and Mr.
Secretary. Look forward to working with you as we move forward
in making sure our veterans get the best quality care that they
can regardless of where they live. So I appreciate both of you.
Thank you.
Secretary Shinseki. Thank you.
Mr. Michaud. Thank you, Mr. Chairman.
The Chairman. Thank you, Mr. Michaud.
I will ask the Secretary that when your team offers to give
a specific briefing to someone who asks a question that usually
reflects something we are all interested in. I would ask that
any briefing materials that you give to one that you please
share with the whole Committee.
If it was the other side, I would accuse them of a tactic
of divide and conquer, but I would not accuse you of that.
Secretary Shinseki. Happy to do that.
The Chairman. Just make sure we all are briefed as well as
the person who asked the question.
Secretary Shinseki. I will do that.
The Chairman. Thank you, sir.
Mrs. Halvorson.
Mrs. Halvorson. Thank you, Mr. Chairman.
And thank you, Mr. Secretary, for being here.
I, too, want to reiterate that if you are doing anything
with regards to State Veteran Homes somewhere else, I would
like to know about it. I have two of them, Manteno and La
Salle, both in Illinois, in my district that I, too, want to
make sure and keep up on and do something about.
I also want to thank you for working out a date with my
staff and I know we continue to do that so that you can come to
the district which you have agreed to do sometime in March so
that you can see firsthand the issues of the veterans that are
going on and the things.
And I would be remiss if I did not talk about Silver Cross
Hospital in Joliet. And if I could get an update, I would love
to hear from Dr. Cross or somebody with regards to what is
going on with the medical facility in my district.
Secretary Shinseki. Dr. Cross.
Dr. Cross. Congresswoman, thank you for your support and
for working with us on this very important issue in Illinois.
We have a CBOC there and it is about 100 miles, as I
understand, from Hines VA. That is quite a distance. And we
think that that CBOC needs to be expanded.
We are very interested in the proposal that I think you
have been very instrumental in, with regard to a possible
option for Silver Cross Hospital or a portion of it.
And what we are doing is our engineers at Hines VA have
already been out taking a look. The construction staff at the
headquarters of VA here in Washington is getting ready to send,
this month, a further assessment team out to look at it again.
But I wanted to assure you, Congresswoman, that we are
interested. We think that this is a possible option for us. No
final decision has been made yet, but we are moving forward.
Mrs. Halvorson. Thank you.
The Chairman. Would the gentlelady yield?
Mrs. Halvorson. Absolutely, Mr. Chairman.
The Chairman. I have been to that facility and other
buildings around the country. This one is one and there happens
to be one in San Diego. I am sure there are others that may
have outlived their usefulness for a given purpose but can fit
in very nicely with your announced and wonderful policy of zero
homelessness in 5 years.
It seems to me that those buildings could be viewed as a
shelter for those who are now homeless. Not only do the old
hospital buildings have medical facilities, they have private
room space for all kinds of other social service support
programs, which would seem to be a very cost-effective way to
serve our homeless population. They are generally in places
that we do not have the NIMBY (not in my backyard) reaction to
deal with.
I would see this not just as an isolated use of a surplus
building, but as a method to really help solve the problem. Mr.
Secretary, you know how tough it is to build a facility, even
for 30 homeless veterans, and to get the local permits, the
zoning, and all that stuff. It seems to me we have some perfect
places that could really help with the plan you have announced.
I hope it would be seen in a very wide context and not just
a surplus building, whether we need it or not. I thank Mrs.
Halvorson for taking the leadership on that.
Mrs. Halvorson. Thank you, Mr. Chairman.
The Chairman. I yield back.
Mrs. Halvorson. Thank you.
And I do appreciate the time that you have taken and it is
very, very important to our district because of the traffic and
the amount of veterans that are in the area right there where
that would serve. So, you know, I appreciate your diligence so
that I do not have to keep making it, you know, a top priority
for you also.
Secretary Shinseki. We are happy to follow up,
Congresswoman.
And I would, in response to your comment and the Chairman's
also, we are taking a strategic look at all of our facilities.
We have 5,300 facilities in the system, and also looking at
what is available to right size our footprint as we look 10
years in the future where we think veterans are going to be,
long-term care, homelessness, how do we accommodate all of
this.
So we are happy to----
Mrs. Halvorson. Great.
Secretary Shinseki [continuing]. Take a look at a facility
like that.
Mrs. Halvorson. And the only other thing I would like to
add on that is just to hope that you do not get bogged down in
bureaucracy. You know, that is something that sometimes happens
with these sort of things, that we just move quickly.
The only other thing that I would like to touch on is, you
know, since 2007, the VA has increased its workforce by, I
think, about 7,000 people in order to address our most favorite
subject, the backlogs.
However, the backlogs have continued to grow. And I know
that in this budget, you have asked for 4,000 more employees.
What I heard yesterday is even though we are asking and we hire
more employees, it takes 2 years to train them.
What is happening and what do we hope is going to come from
continuing to hire more employees, taking time to train them?
What is happening with regards to the backlog that does not
seem to be getting under control?
This is the thing that people call my office for over and
over again and it is very, very frustrating, I think for all of
us.
Secretary Shinseki. Thank you.
The backlog is something, a year ago when I arrived, I said
I am going to go after. We spent effort on it last year, but
not as much as I would have liked. The GI Bill came along and
we needed to get that put in place.
I would say we succeeded in the fall semester. We started
with zero students in August, and we had 173,000 registered and
being paid by December. So it was an effort that required that
kind of attention.
In the meantime, the attention that I wanted to devote to
the disability claims process was deferred. This year is my
year to spend time getting inside of all of our processes. It
is a convoluted and complex process.
What we have done with the claims process is pulled it
apart and created four pilots. The pilots are running now, one
in Pittsburgh, one in Little Rock, one in Providence, and one
in Baltimore.
The whole purpose here is to take apart the pieces, let us
see what we can do to refine them, and then put them back in a
way that gets us momentum in claims handling.
Right now the inventory on claims is about 420,000. Of
that, my guess day-to-day, is that we run about 150,000 to
170,000 claims in backlog, and that is any claim that is longer
than 125 days.
The last several years we have taken the processing time on
claims from about 190 days down to 180 and 178. Right now we
are at 161 days moving towards 125 days. So there has been
progress.
I reported earlier that last year we processed 974,000
claims, which is an eight or nine percent increase over our
previous performance. At the same time, we got in a million new
claims. So this is an area we are going to have to spend a good
bit of effort on.
I compounded the problem when we make a decision on Agent
Orange. It is the right decision. It was long overdue, needed
to be done, but it adds to this challenge.
So as these four pilots are working to take the processing
time of 161 days and moving it in the right direction, we have
an Agent Orange decision here later this year that is going to
come to play and it could increase processing time. It will
certainly increase the inventory.
We are looking at ways to fast track the Agent Orange
decisions so we do not compound the problem here. What we are
looking for in the Agent Orange claims is proof of presence in
Vietnam to meet the rules. It does not matter whether it was 1
day or 360 days. All we need to do is validate presence,
validate the disease, which a competent medical authority does,
and then adjudicate the extent to which the disease warrants a
disability rating.
We think getting to that kind of focused decision-making we
can take these Agent Orange decisions and move them quickly, at
the same time working on the normal disability claims process.
My estimate is over the next year to 2 years, the inventory
will grow and processing time may get longer. It probably will
get longer, but by 2013, we will be back to where we are today
at about 161 days.
At that point, with the learning that comes out of the
pilots already in the program and within a couple years, we
expect to have eliminated the backlog. We are, although our
incremental budgets talk about reducing, each year reducing the
backlog, the plan is by 2015 for that backlog to be zero. That
is what we are talking about.
Mrs. Halvorson. Thank you. I yield back.
The Chairman. Thank you, Mrs. Halvorson.
Mr. Rodriguez.
Mr. Rodriguez. Thank you very much, Mr. Chairman.
Thank you very much, Mr. Secretary, also for coming by the
district and reaching out throughout the country.
Your budget provides $468 million for minor construction
projects, which is $235 million or 33 percent below the amount
provided in 2010. And the budget also requests for $85 million
for grants for construction of State extended care facilities
which is $15 million or 15 percent below what was provided in
2010.
We had some dialogue about the fact that there might be
about $9 billion out there in terms of construction needs and
we know that of the 153 hospitals that are out there, most are
50 to 60 years old. We know we have some 70 or so clinics that
are also in need of construction. And roughly, once again, I
think that you had quoted in the past needing some $9 billion
just to take care of some immediate needs.
With this kind of budget, how do we expect to look at this
and be able to come up to par with the existing facilities that
we have when we only asked for this low amount?
Secretary Shinseki. Congressman, let me just put into
perspective the construction budget. And I may not have the
details on the State construction that you describe. And if I
do not, I will be happy to provide it for the record.
For major construction, we are requesting in 2011 nearly
the same level at which we requested in 2010, which was fairly
significant, $1.19 billion in 2010 for major construction and
2011 is 1.15 billion. And it will enable us to stay on track
with constructing three medical facilities, design two new
projects, and also expand cemeteries in three locations.
Minor construction appears to be the concern. But in 2011,
we have $468 million going to minor construction. It is the
second largest minor construction budget ever requested. And
the reason it seems to be a drop-off is because the largest
minor construction budget ever requested is in this year, 2010,
when we increased it significantly to $600 million. In
comparison, this minor construction budget for 2011 is a very
strong investment.
On nonrecurring maintenance in 2011, our request is for
$1.1 billion in nonrecurring maintenance. That is the largest
nonrecurring maintenance request ever made by a President.
Between 2000 and 2008, the average request for nonrecurring
maintenance has been about $550 million. That has been the
average across those 8 years.
And so we think this nonrecurring maintenance investment
is----
Mr. Rodriguez. Is it accurate to say that there is a need
of over $9 billion right now that is required?
Secretary Shinseki. There is a backlog on maintenance that
has accrued over many years. It is about $9 billion. You are
correct. And so we are hopeful that if there is a job's bill
that the VA will be seen as an appropriate----
Mr. Rodriguez. And I would also support you in that. What
better way to get Americans back to work than to look at
redoing our hospitals and our clinics throughout the country
for the veterans.
And I think the Committee would also be supportive if there
is a job's bill out there to move in that direction and try to
get some job creation, at the same time we build up our
infrastructure for those veterans.
Secretary Shinseki. Thank you.
Mr. Rodriguez. Thank you very much, sir.
The Chairman. I just want to note, Mr. Rodriguez, that in
our Views and Estimates to the Budget Committee, we are going
to recommend a plus-up in that account----
Mr. Rodriguez. Thank you, sir.
The Chairman [continuing]. As one of the main items. Mr.
Stearns?
Mr. Stearns. Thank you, Mr. Chairman.
And I thank Mr. Boozman for the opportunity. I will have to
leave here to go to another hearing.
Mr. Secretary, it is always a pleasure and an honor to have
you to testify before us and thank you for what you do.
I think all of us will agree that this time, the Veterans
Administration is experiencing an increase in the number of
disabled veterans. I think that is a given. But it appears the
decision to cut the Vocational Rehabilitation and Employment
staff by nine while at the same time increasing the
Compensation and Pension (C&P) staff by almost 4,000 seems to
be puzzling to us.
The vocational rehabilitation employment counselors all
have at least a Master's Degree. They are obviously highly
qualified and capable of rendering services almost from day
one.
On the other hand, the nearly 4,000 new C&P staff will
require, and that is according to the VA, 2 to 3 years to
become effective claims adjustors. Thus, the roughly 4,000 new
C&P staff will have little or no impact on the claims backlog
while the VA will lose 18,000 hours, in our estimate, of
rehabilitation counseling.
So I guess the logic of this is somewhat puzzling to us and
we would like your comment.
Secretary Shinseki. Thank you, Congressman.
Let me call on Mike Walcoff to sort of frame this issue and
then I will add if anything is necessary.
Mr. Stearns. Is the information we have correct?
Secretary Shinseki. In terms of the Voc Rehab----
Mr. Stearns. Yes.
Secretary Shinseki [continuing]. Adjustment? I think that
is correct.
Mr. Stearns. Yes. Yes.
Secretary Shinseki. The specific numbers I will turn to
Mike on, but there is an increase authorized in this budget of
4,000 to VBA. We have increased the resourcing of VBA by 27
percent in this budget to go after long-standing issues about
the backlog and to address Agent Orange requirements that are
coming on.
But the voc rehab question is an important one and let me
ask Mike to address that.
Mr. Walcoff. Certainly we recognize the importance of the
Voc Rehab Program, but let me just explain a couple of things.
The decrease of 9 positions off of 1,155 is totally a
result of the reallocation of management overhead. We use a
formula to allocate that by business line. And the addition of
such a large number of new employees just when we applied the
formula resulted in a loss in that overhead category of nine
for voc rehab. There will not be one person taken out of direct
services to veterans in terms of voc rehab.
Number two, I want to point out that we have added $8.3
million to the contracting budget for voc rehab. That money
gives us flexibility to either use this for contracting or to
go ahead and turn it into a full-time equivalent (FTE). That
money would buy 130 FTE if we decide to use it for that. So
that is the second thing.
And the third thing is that, yes, right now we are talking
about 4,000 additional claims examiners. In managing both
programs as we evaluate the workload that is coming into Voc
Rehab, we have the ability to move FTE from C&P to Voc Rehab.
We will certainly do that if it appears that----
Mr. Stearns. So money is fungible that you can take it from
one----
Mr. Walcoff. That money is, yes.
Mr. Stearns. What is the average vocational rehabilitation
employment caseload for 2011 compared to 2010?
Mr. Walcoff. I do not have that.
Mr. Stearns. Okay.
Mr. Walcoff. I can get back to you on that.
[The VA subsequently provided the following information:]
LVA anticipates a 10 percent increase in the 12-month
average caseload for Vocational Rehabilitation and Employment
services, with an increase from approximately 111,000 in FY
2010 to 122,100 in FY 2011.
Mr. Stearns. The budget my staff tells me has indicated it
is a 10 percent increase in the budget in caseload.
Mr. Walcoff. We are projecting a 10 percent increase. But,
frankly, that is something that at this point we are estimating
because we are still trying to evaluate the impact that the
Chapter 33, the new GI Bill, is having on the voc rehab
program.
At one point, we anticipated that there would be possibly a
decrease in participants because they would be going over to
the GI Bill benefit which is financially a little bit greater.
We do not see that at this point, but it is still early. We put
a 10 percent increase in there as an estimate, but we are going
to be keeping an eye on it.
I think we have enough flexibility in this budget that we
can address the additional work. If it winds up coming to Voc
Rehab, we are in a position to be able to adjust to it.
Mr. Stearns. So the basic thrust to my question is, and I
think you agree then, that we really do not want to be cutting
back the Vocational Rehabilitation and Employment staff
considering the number of disabled veterans that are coming
into there. And so that is, you know, what I think our main
point is.
Mr. Walcoff. Yes. I think we agree. We both recognize how
important this program is and we are going to make sure that as
we monitor the workload that, if necessary, we will move FTE
into that program.
Mr. Stearns. Okay.
Thank you, Mr. Chairman, for the courtesy.
The Chairman. Mr. Walz.
Mr. Walz. Thank you, Mr. Chairman.
Mr. Secretary, thank you for being here as always and, of
course, the work you do. And to each and every one of your
staff, thank you for your continued service to our country.
And I would like to say how much I appreciate, Mr.
Secretary, your thanking those VSOs, those folks that literally
have your back right behind you right now. They are there every
step of the way.
We have held some wonderful roundtables with the Chairman
and the Ranking Member to get their priorities out and it is
that collaboration through The Independent Budget, the things
that are being brought to our attention by those on the front
line of this, and I am appreciative. You have clearly
understood that from your beginning of your tenure. So I
appreciate that.
Just a quick followup. I think Mr. Stearns asked a very
good question and it is one I am hearing quite a bit about. I
absolutely understand your answer on this and understand that
you are addressing it and agreeing with the living allowance
and the new GI Bill, how that would affect.
I am hearing a lot, though, of the need to do something
more with the voc rehab. So it is starting to percolate up. It
is there. Mr. Stearns' question was well put and I am
appreciative that you are on to that and looking at it from
that regard.
So, Mr. Walcoff, I do not know if there is any response,
but that is what I was going to ask.
Mr. Walcoff. No. I appreciate what you are saying.
Mr. Walz. Yeah. Well, thank you for addressing it and we
will stay tightly on it.
Just two things. The Chairman started out talking about it.
I am, too, a big fan of the IG. I am concerned. One of my
biggest concerns as we increase budgets, if we do not increase
that oversight and we know for many years as the IG budget was
sinking, we did not have that there. The worst crime I think we
can commit is, are how dollars allocated by the taxpayers meant
for our veterans do not end up there.
And so I am really sensitive to that and I would like to,
Mr. Secretary, just whatever we can do and know what your plan
is on that.
Something that was brought up in our roundtable by the
Vietnam Veterans of America (VVA), they, too, agree that the IG
is wonderful on fraud and abuse. It is the waste part they are
a little concerned with we may not catch.
And I think all of us together have to figure out a way to
make sure that these newly allocated dollars get to where they
are supposed to go.
Secretary Shinseki. Congressman, you and I come from a
background where the IG is an important part of the
organization. It is almost cultural and I----
Mr. Walz. Yeah.
Secretary Shinseki [continuing]. Would assure you that IG
and the Department of Veterans Affairs have the same status and
respect.
On the budget, I would say if you looked at 2010 to 2011,
you would probably be concerned about it being flat. But if you
looked at from 2009 to 2010 to 2011, you will see a 25 percent
increase in the VA's budget over 2 years.
VA's funding of its IG operations is second or third across
the Federal Government and----
Mr. Walz. Are you comfortable, Mr. Secretary? They are your
eyes and ears. Are you comfortable that they are there?
Secretary Shinseki. I am comfortable with where we are.
And, you know, this is dialogue that, you know, I have from
time to time with the IG himself. And so I am comfortable with
where we are.
Mr. Walz. Okay.
Secretary Shinseki. But, again, if you take a 2-year look
across government, 25 percent, VA has done well in resourcing
our IG operation.
Mr. Walz. Well, I think it is everyone's desire here to hit
that sweet spot on providing the resources that are necessary
in providing the checks and oversight. I am not going to hit on
it.
But just, again, it--I would not call it a red flag. It is
a yellow flag on the information technology (IT) budgeting as
the Virtual Lifetime Electronic Record goes forward to make
sure you have the ability to do that.
This is one that every one of you, everybody behind you,
and everybody up here is frustrated. There is very little
confidence right now and I think it is important that we give
you that, that we give you this opportunity to fix this.
And I would segue to my final point that, I cannot ever
leave this room without saying it, this idea of seamless
transition to get to the systemic problem. I think medical
records, personnel records are a start, but I think all of us
know seamless transition is truly leadership and cultural.
And I guess my question to you, Mr. Secretary, would be is
if you could give just a brief update on that, that Office of
Seamless Transition, because that is another one of these
issues. There are some pretty gray-haired folks behind you that
said I have been fighting this since I was a young strapping
troop and it is still not done. Why is this different this
time?
Secretary Shinseki. It is difficult. I think, Congressman,
you bring up a good point. I would tell you that between VA and
DoD, you have the two largest Departments in government. You
also have the two Departments who have led the way nationally
in developing the most comprehensive electronic records maybe
in the world, certainly in this country, between VistA and
AHLTA. And so culturally two large institutions are going to
have to put their heads together and bring some harmony out of
this.
Part of the reason I worked so hard to get Secretary Baker
to be part of our team is because he comes with the expertise
that, you know, has the skills, knowledge, and attributes to
drive this forward.
I would just say that we are not there yet. The Virtual
Lifetime Electronic Record is where we are headed and when that
happens, all of what we are talking about is going to be
facilitated.
But, as you say, seamless transition is not technology. It
is leadership. And I would offer that Secretary Gates and I are
partners in this and working it very hard.
Between the two Departments, we are already able to share
86 million standard ambulatory data records, 76 million lab
results, 78 million pharmacy records, 12 million radiology
reports, 3.5 million consultations, and I could go on.
So the technology is beginning to arrive. And I will let
Mr. Baker talk about probably one of our more promising steps
and that was a visit here to San Diego where we demonstrated we
could also share this electronically.
Mr. Baker. So just briefly, because we believe it is quite
important, we have incorporated the private sector into the
VLER vision as well and working with HHS now on a national
standard for information exchange with the private sector. And
we will move to that standard for the way we exchange
information with the DoD as well.
Much of the services we provide for veterans or many of the
services provided veterans are done by the private sector and
that ability to incorporate the information that they generate
into our electronic record and the ability to deliver to them
what we have in our electronic record to let them provide
better care to the veteran is representative of the Secretary's
view of VA as the veteran's advocate. It is do whatever we can
do, including delivering our information to the private sector
under appropriate privacy controls to provide better service to
the veteran even if it is us not providing it.
Mr. Walz. Well, I know that many of us feel that this time
might be different. We have had our hearts broken many times,
but I am a Vikings fan and I keep coming back for more. So on
this one, I will keep--we are going to do it one of these
years. So thank you, Mr. Secretary.
Secretary Shinseki. I got you, Congressman. And let me just
add here, I realize that I am out of time here, but leadership,
technology, but it is broader than just medical. DoD and VA
just held a joint mental health conference. We just met
together in a national forum on suicides. VA has hosted a
homeless summit as well.
But it goes to the whole spectrum of ways and reasons we
have to be better at this. It is about benefits delivery at
discharge. That program has to work. It is about DES and being
better at that. We have expanded it, e-benefits portals and we
have to be better at demobilization briefings with the Guard
and the Reserve when they come back so that this seamless
transition is not just technology. It is all the ways in which
we quickly, safely, accurately get youngsters who wear the
uniform 1 day picked up in our system rapidly.
The Chairman. Thank you, Mr. Walz.
Mr. Space.
Mr. Space. Thanks, Mr. Chairman.
Just let me start by thanking you, Mr. Secretary, for the
extraordinary leadership that you have displayed in the last
year. And certainly that is beginning to make its way to the
veterans on the street and in our district. And I am very
grateful for your leadership.
I would like to thank Dr. Cross also for working with us in
the past. He has actually been to our district for a field
hearing and helped us accentuate some of the special challenges
that veterans in rural America face.
And I am grateful for you, Mr. Secretary, in being mindful
of that as well.
The budget expands eligibility of Priority 8 veterans for
health care in 2011 by almost 100,000 new enrollees. And if you
compound that with the fact that we have got, given the current
recession, many Priority 8 veterans who are because of
financial circumstances becoming eligible per se for benefits,
one of the problems, however, we face is in creating awareness
of that eligibility. And we face some special challenges in
reaching out to those folks back in rural Ohio.
My question to you, Mr. Secretary, is, what does this
budget or, more generally, what is the Administration doing
right now to reach out to those Priority 8 veterans who are
going to be newly eligible for health care services?
Secretary Shinseki. Congressman, you mentioned two things
here, Priority Group 8s and the rural issues. And in some ways,
they bump into each other.
Our efforts to reach out to rural veterans, eight million
veterans enrolled with us, three million of them are in rural
or highly rural areas, and so the challenge is not just getting
health care to their locations, which we are doing a lot, it is
also the outreach to find them, inform them, and make sure that
we are meeting needs.
That also addresses some of the challenges with Priority
Group 8s. We program by the end of this first year 266,000
Priority Group 8s. We are a little slow getting started. But at
this point, we started in July enrolling them, we are about 7
months into that program and we have probably 30,000
registered.
We anticipate that part of this is the Priority Group 5 and
7 veterans who have enrolled with us as well. This is part of
this mix. Taken together, we are probably at this point about
74,000 total unique veterans between 5, 7s, and 8s.
We still expect that by the end of this year, 2010, we will
be at 190,000 or so with another 99,000 in 2011 Priority Group
8s, which will put us about 290,000, a little bit off, but
still on a track that we think the 500,000 estimate for 2013 is
still valid. We are not ready to come off of that just yet. But
as I say, we are a little slow getting started, but we are 7
months here.
And if you had questions on rural, I am happy to go----
Mr. Space. Well, you know, given the time constraints, we
will not be able to get into everything I would like to talk to
you about. And you have been kind enough to meet with us
personally on some of these issues and I appreciate that.
I do want to, however, reference one issue and that is
telehealth and the importance that that issue or that approach
has to helping to overcome some of the challenges that we have
in accessing health care in rural Ohio.
One of the dilemmas, however, with regards to telehealth is
that the places where it can do the most good oftentimes lack
the technological resources to take advantage of it. And access
to broadband is certainly a big part of that. It has been a
very important initiative that I have been trying to lead in
southeastern Ohio.
And the question I have is, have you had an opportunity or
do you plan on working with other Federal agencies, such as the
National Telecommunication and Information Administration, for
example, to experience an expansive or an expansive access to
broadband for purposes of telehealth medicine?
Secretary Shinseki. Congressman, let me just up front tell
you that we have $42 million increased in 2011 for telehealth,
telemedicine.
And then let me call on Secretary Baker to address the more
technical aspects of the question.
Mr. Baker. So briefly the answer is yes. We are talking
primarily with the Federal Communications Commission and their
broadband expansion initiative, trying to get them to focus on
areas that we believe are going to have the most benefit for
veterans.
As you can imagine, other folks have other things they
would like them to focus on as well. But we think that is key.
I will tell you that there is a substantial telehealth
effort inside of VA right now that is based on what we
technically call POTS, which is a plain old telephone system,
and communications that way. And those devices are pretty
helpful for the people that have those in their homes at this
point. I do not know the exact number of homes those are in,
but it is, you know, certainly hundreds of thousands that are
in right now.
The Chairman. What did you call that?
Mr. Baker. It is the plain old telephone system.
The Chairman. Oh, I thought you were telling us the VA was
giving out pot there.
Mr. Space. We are not going to go there.
Thank you, gentlemen. Again, Mr. Secretary, thank you for
your fine leadership.
Secretary Shinseki. Thank you, Congressman.
The Chairman. Thank you, Mr. Space.
Mr. Bilbray.
Mr. Bilbray. Thank you, Mr. Chairman.
On just an editorial note, it is interesting that you go
around the world to third-world countries and have internet
connections through satellite connections and everything else
which is something that I think too often some of us in the
first world ought to go look around to see how other people
have been able to connect into the network. And it is
extraordinary how innovative a lot of people have been when
they cannot just plug into the system.
Mr. Secretary, you know that there is one big concern I
have and that is the fact that we have for almost a decade had
a joint co-partnership on this electronic records issue. I
still believe strongly that we need to give you the lead agency
status on this issue.
And you may disagree with that, and I appreciate that
your--especially your diplomatic approach with cooperation with
other departments, but I really think that we need to either
talk to the executive, or the Chairman needs to lead the battle
legislatively to give you lead status so somebody has the lead
responsibility to close this circle down the line.
And I think that is not just critical for veterans, not
just critical for active-duty military, I think it is
absolutely essential for this country to finally start moving
towards that electronic system that the President keeps talking
about and all the great benefits it could bring with it.
But I think it really comes down to us having the
leadership to give you the leadership authority and the
responsibility to close the circle.
Do you have any comments about that approach?
Secretary Shinseki. Congressman, thank you very much.
Thanks for the compliments, first of all.
I would offer to you that electronic health records at VA
have been around about a dozen years, but there were many years
of hard learning before that until we sort of worked it out.
And all the benefits that come from that, we have realized now
for the last 12 years and others are benefitting from it. And
we share what we know, we share what we learn with others.
We worked this very hard with DoD and VA. As I mentioned
earlier, two very large departments and two very good
departments in terms of electronic health records and now we
are working on bringing the culture together.
The San Diego demonstration is where we were able to pass
electronic records with Kaiser Permanente, a civilian health
care system. Huge step. And we think this will bode well for
offering to Health and Human Services a model to look at. It
does not have to be the one they settle on, but a model to look
at of where we have come as they think about the
responsibilities of creating electronic health records for all
Americans.
Part of it is cost, affordability out in the civilian
sector. We have invested heavily in it. I think there will be
some savings to others as a result. We will continue to work
this hard. We think we have some great capability here and
intend to keep that lead in this area of electronic health
records.
It is because of that experience that we are so confident
that we need to make the same inroads into VBA, which is still
paper-bound. We do that, we are going to realize the
efficiencies, the power, and the capabilities that we have been
enjoying for the last 12 years.
Let me turn to the CIO to address some of the technical
aspects of this, Secretary Baker.
Mr. Baker. I think, Congressman, to respond, it has got to
be a partnership no matter who is in the lead on this. And, you
know, the partnership is good. As the Secretary points out,
they are two large organizations and DoD has a mission to fight
wars.
You know, we continue to move down the path. We have lots
of great statistics on the amount of information that is
exchanged. And remember that DoD and VA certainly lead the
Nation in exchanging the electronic health information. We get
a lot of benefits information from them as well.
We are far from where we would like to be and we will
continue to move it forward, continue to move current systems
and the VLER system forward for exchanging more and more
information.
Mr. Bilbray. And, look, my concerns are not anti-DoD, but
the DoD more than anybody else knows how essential chain of
command is. And the fact is there was a big reason why, you
know, even Rome abandoned the twin governance concept of chain
of command.
I just think that in reality, I think we all agree that it
may be a very high profile for them, I mean, a very high
priority. But the fact is there is a lot on their plate. There
is a lot on your plate.
I think that when it comes down to a discussion between our
Chairman and, you know, my cousin Ike over in Armed Services
that you can agree that I think even the Chairman here is
probably more aware, more sensitive to this than anybody in the
system. And that should be reflected in the command structure.
So, again, I will continue to raise this issue. I think
giving you the authority and the responsibility is the fastest
way to move forward and, again, not just to serve our active
duty and our veterans, but to create that prototype that the
rest of America is waiting for you to deliver.
So thank you very much. I appreciate it, and yield back,
Mr. Chairman.
The Chairman. Thank you, Mr. Bilbray.
Ms. Brown.
Ms. Brown of Florida. Thank you, Mr. Chairman. And first of
all, let me thank you for calling this hearing today so we can
hear about the 2011 and 2012 fiscal year budget.
I want to thank you, Mr. Secretary, for your decades of
service defending the freedom in this Nation and thank you for
your commitments to the veterans that have also served this
Nation.
I am very pleased under your leadership, Mr. Filner, that
we passed the largest VA budget increase in the history of the
United States. So I am very proud of that and I want to thank
you for that.
I am also very pleased with the increase in the health care
funding and other priorities. And I am very pleased that more
Priority 8 veterans will be back in the fold. These men and
women have served their country, paid their dues. They deserve
the health care. However, we need to speed up the time table. I
see that we are looking at about 100,000 a year. I am
interested in seeing what we could do to get additional
veterans back in the fold.
And I am also concerned about the increase in the waiting
time veterans are being subject to. I know we have been working
it, but I would like to know what kind of plans you have to
speed it up.
And on a personal note, I want to thank you and the VA for
what we are doing as far as the VA medical center in Orlando.
If the figures do not add up, if there are some problems, I
want to know up front so we can fix it.
I always think of the first President of the United States,
George Washington, and I always like to repeat what he said:
``The willingness with which our young people are likely to
serve in any war, no matter how justified, shall be directly
proportional as to how they perceive the veterans of earlier
wars are treated and appreciated by their country.''
And with that, I was very pleased that we passed the new GI
Bill for the 21st Century. I think, you know, we should have
gotten a lot of good press, but there were a few problems with
it. I want to know the status of the program and how we worked
it out because for veterans, with this economic downturn, the
best thing to do is get additional training and education.
So with that, thank you.
Secretary Shinseki. Thank you, Congresswoman.
Let me just say on the Priority Group 8s, it is a 5-year
program, 500,000 is the target. We estimated that the 1st year
would be 266,000. We began last July. We are really in about
the 7th month here. It is a little slow picking up.
Part of that is that we may not be reaching all the
Priority Group 8 veterans as we need to. And we have attacked
that issue in lots of ways in terms of outreach, through
contacts that we have, through advertising using, I think they
call it, social media as well now.
We still expect, by the end of this year, to have something
around 190,000 Priority Group 8 veterans enrolled with us. By
the end of 2011, we have enough funds that we expect about
290,000 Priority Group 8 veterans will be enrolled with us as
well.
As we go through this year, understanding we made an
estimate at 266,000, if it does not look like we are keeping
pace, then we will look at perhaps opening the aperture a
little bit so we let people who would be in the next phase of
enrollment to begin to creep forward so we get momentum going.
On the backlog, I would just inform that this is my year to
focus on the backlog. Last year was Post-9/11 GI Bill, which
required getting students into school and we successfully did
that. We are well on our way in the spring semester. We have
automated tools coming, one April, one July. By the end of the
year, we should be fully automated and that program will
continue to get better.
Backlog requires attention this year. Four pilots. We are
working those hard. And at some point, we will harvest. We will
not let this run for years. We will harvest what we learned out
of that and put together a virtual regional office of the
future that begins to take advantage of quality claims, new
relationships between VA and veterans and our VSOs, a sense of
advocacy that I am pushing, and we all are, reengineered
business processes, and the automation tools that will
accelerate all of this. We expect a lot of work to be done this
year and we will go after the backlog.
Having said that, Agent Orange decisions made last year
will increase the number of claims. We are going to have to
manage and shape that. Inventory will grow for the next year,
maybe 2 years. Maybe even processing time will increase from
the 161 days we have today.
But the intent is to fast track Agent Orange claims and
also to work on the backlog through the pilots I described and
shape that so that by 2013, we are back to where we are today,
about 161 days, but at that point moving towards eliminating
the backlog by 2014, 2015 time frame.
Post-9/11, I think I mentioned we are in good shape there.
Again, zero students enrolled in August of last year, 173,000
enrolled and being paid on 31 December. No carryover of a
backlog into the spring semester. Zero in August. At this
point, we have 153,000 enrolled, so that is a huge change
between the semesters of which on 1 February, 131,000 checks
were being distributed to those 153,000 students.
The difference here, the claims that have come in since the
19th of January, we are processing those at about 7,000 a day.
So we will have that caught up here very shortly.
Ms. Brown of Florida. Thank you, Mr. Secretary.
The Chairman. Thank you, Mr. Secretary, and thank you for
your leadership.
I just want to bring up two points, if I may. One is the
backlog that you just talked about. I mean, it seems to me that
we have hired over 7,000 new claims processors and Mr. Walcoff
said another 4,000 are coming. I do not know if that number
includes claims processors that were there temporarily or these
are new hires. That is a lot of people.
What you are promising is that in a couple years, we may be
back to where we are in terms of time when you took over and
then you promised it will go to zero, but I do not believe it.
As we talked many times, you are trying to use brute force
to deal with this. We know the training times and the
attrition, and we end up treading water.
I would like for you to briefly explain the four pilot
programs in place to try to speed this up. I am not sure how
those programs are doing or what is different about them than
what we are doing. As you know, I favor just cutting through
this bureaucracy as did the Internal Revenue Service (IRS).
There is a whole model from Professor Bilmes, which says
basically to accept the claim when it comes in and send out a
check. Audit it in whatever time frame it takes.
I have tried to build in some protections against trivial
or fraudulent claims by requiring that the VSOs that are
certified around the Nation that help develop the claim that we
should accept it. That would reduce your time to zero. You send
out the check, or we pick a minimal 30-percent rating and send
out the check. Audit that later.
I think you have to break through this bureaucracy of which
we have now added 11,000 new positions and we do not see any
results. The backlog number seems to grow everyday.
And, I hope you will tell me what the four models are doing
differently than what we are doing now, but I think you need to
try the Bilmes model. Deputy Secretary Gould is pretty familiar
with it. I do not think you are going to get this by brute
force. I just cannot see it.
Secretary Shinseki. Fair enough. You and I have discussed
this, Mr. Chairman, and thanks for your leadership in this area
because, you know, as I admitted before, I did not grow up in
the VA. I am not a clinician. So there is lots here that I have
learned.
Let me just very quickly summarize the four pilots. The
process of disability claims is complex enough that we have had
to pull it apart, sort of try to get the goodness on each of
those parts, and then put it back together again and try to get
momentum out of the processing.
First is in Pittsburgh. That model is designed to address
the quality of the claim, show me how to write or prepare the
best quality claim that will pass through the system with a
high probability potential for the best outcome for the veteran
one time. That is part of the backlog issue.
To do that, we have created a relationship that the veteran
and VA work together. We are advocates here. Veterans, VA, and
VSOs sit down in an effort to put together the best quality
claim.
The Chairman. By the way, in that model or----
Secretary Shinseki. The pilot.
The Chairman [continuing]. Pilot. I have heard some of the
problems. We have some artificial or arbitrary caseload
standards or expectations. In order to meet them, some of the
analysts may not be as accurate as they should in order to meet
the pressure of the quotas. This then leads to even further
problems.
Does the pilot include not using these arbitrary quotas or
do you still have that in there?
Secretary Shinseki. Well, part of your concern and part of
my concern is getting to the quality claim and the quality
outcome. And right now we have, you know, 11,400 good folks
trying to put together the claims.
And usually when we talk about claims, it is a stack of
paper with lots of personnel and lots of medical records. And
what we are trying to create here, what are the essential
elements of information that go into establishing that high-
quality claim so that the majority of the effort is creating
that quality claim and then reserving to a fewer number of
highly experienced adjudicators who have the best outcome for
both accuracy and, you know, and processing time to then make
the adjudication.
So it is changing the relationship between VA and the
veteran. That is the pilot number one. It is sort of like
trying to put together the best legal brief to win an argument
in court. How do we put together the best argument possible.
The second pilot in Little Rock is business process
reengineering and it is the issue of a claim arrives, who
touches it first, how many people get to touch it, have to
touch it, how long is the claim here, and what is the
relationship of the members of the team, how long does it take
to pass that around and how do they work together. So it is
business process.
The third pilot is in Providence and it is automation, the
automation tools that would accelerate all of this. The reason
we pulled it apart was to assure ourselves that we were not
automating bad processes and getting bad outcomes faster. So
sort of a discrete look.
And the fourth pilot in Baltimore was how to put all of
these together in a regional office with, you know, better
relation, new relationships, reengineered processes, higher
quality claims with automation, and try to get us a better
outcome here.
You and I have talked about the IRS model. We have
investigated it and we will continue to look at that.
The Chairman. We do not have enough time here for you to
develop it enough so that I can really understand it, but it
sounds to me that what you are doing in these models is
breaking up the process and just examining them. You are not
really trying a new way to do it. You are monitoring who is
touching what, how that is done, or how the relationship is
handled between the veteran and the VA. It is just taking parts
of it and just looking at it more closely, probably to see
where there are efficiencies of time or motion or whatever.
However, it is not really a new model as to the Bilmes
model. You are just looking at how you can do the current
process faster. It is simply more efficient brute force,
perhaps. Again, I do not know enough about your four pilots,
but it does not sound like you are trying a different way, and
that is what I think we have to do.
It is an insult to the veterans to take years to resolve
these claims. These are your comrade. You feel that, I am sure.
I think we have to try a new way, not just break down what we
are doing and try to make it more efficient.
That is just my sense of looking at it for so many years,
and we keep trying new idea and the claims keep building. We
have 11,000 new claims adjusters. But I do not know how many
thousands of people we have got now doing claims and the
backlog keeps building.
Secretary Shinseki. It is not 11,000 new, it is 11,000 that
we have today. The new budget adds 4,000 and that is--most of
that----
The Chairman. I thought the previous budgets added 7,000 in
the last few years.
Secretary Shinseki. I think our numbers are 11,000 today
and 4,000 in the 2011 budget to address Agent Orange. But I
will get you more accurate numbers?
The Chairman. Thank you. Maybe we will talk about it
further in another forum, but I do not see us trying something
different. I think you need a whole revolutionary approach.
Let me just mention one other thing that we have talked
about. We live in both an age and a country where there is
incredible development of new technologies. In very small,
organizations, they are great for inventions for medical
treatment technology and for internal operations, whether it is
automation for the GI Bill or improvements for third-party
collections.
The technology really moves fast. Bureaucracies by
definition, move slowly. There are people who come to me and my
colleagues every day that have new ideals or inventions and
they cannot get access to the VA. It just takes forever to
break through this bureaucracy.
We have to figure out a way to be better in touch. I do not
think the existing structure is working because somebody will
look at new technology and then they have to go through a whole
new bureaucracy.
Maybe you need an Office of Revolution or something like
that where people have a chance to really demonstrate their
ideas. People need guidance to figure out how to introduce
their products to one of the biggest systems in our Nation.
Whatever we talk about from prosthetics to post-traumatic
stress disorder (PTSD) to third-party billing, I have talked to
people who claim, they have new technologies. We try to get the
VA to look at them and it is like butting up against a stone
wall because every one of the people who work for you is
already working very hard. They say, uh-oh, a new idea. Rather
than see it as a way to really strengthen the whole
organization, it means a heavier workload for them.
You have a deputy who comes from IBM who is used to
introducing new technology into a static environment. I think
we need to figure this out and I think it would be a boon to
every agency in the government if we figured out how to get new
technology quicker.
I just go crazy when I hear something that could help
improve brain injury by 50 percent more than what we are doing
now and nobody will listen. I cannot tell if they are right or
wrong, but they cannot even get someone to listen. I mentioned
to you a new kind of textile for our soldiers that is a million
times better than what we use now. What would that save us in
treatment if we have ways to protect our soldiers?
It is just a thought. I hope you will start thinking about
it. I think we have to find a new way to break through the
bureaucracy. It is an inevitable tendency of bureaucracy to say
that we have enough work to do, do not bring us something else.
Mr. Bilbray. Mr. Chairman, may I----
The Chairman. Yes, please.
Mr. Bilbray. Just to reinforce or it is sort of classic
that a lot of civilians realize that the outdoor community had
a product called Gortex for over a decade before Armed Services
actually included it into the process. They were so wrapped up
with leather, leather.
And here was a new break-through material that was very
user friendly or whatever and the bureaucracy had that. And so
you are right. There is this and that is why, I guess, we are
supposed to go around to help sensitize it and encourage them
along.
I yield back.
Ms. Brown of Florida. Mr. Chairman.
The Chairman. Please, Ms. Brown?
Ms. Brown of Florida. You know, I think that we should
think out of the box in many, many different ways, but keeping
in mind the Secretary inherited an agency that has been
underfunded for years. It is a big agency and it is just like
government. It turns slowly.
And I want to commend him. I think the Secretary is doing a
good job. I have been here for 18 years and I have listened to
several Secretaries and this is one that when he says
something, he is going to try do it and I really think we
should salute him.
The Chairman. I second----
Ms. Brown of Florida. And I know you are doing it, but----
The Chairman. I second your comments. I just want to make
us----
Ms. Brown of Florida. I want to be clear.
The Chairman [continuing]. Move a little faster.
Ms. Brown of Florida. Yeah, I know.
The Chairman. Thank you for clarifying this.
Ms. Brown of Florida. But we are dealing with an old, I
mean, not an old agency, but one that has been underfunded for
years.
The Chairman. Thank you, Ms. Brown.
Secretary Shinseki. Mr. Chairman, may I respond. And my
thanks to Congresswoman Brown here for her very kind comments
and also her leadership in much of this area where we talk
about health care.
Mr. Chairman, I think you know I come from a background
with a lot of contact with research and development. And I
share your impatience here and I think we ought to go faster. I
will look for ways to go faster, smart and fast.
Right now I am trying to put into place an Assistant
Secretary for Acquisition, Logistics, and Construction to
address many of the issues that you are describing.
Like you, I get a lot of calls about good ideas or things
that if we would take aboard right now would solve many of our
problems. And like you, my frustration is I do not know enough
about it to make that judgment.
But having an office that is equipped with the right
skills, right number of people that can take these on, address
them and very, very quickly, turning them around, I think,
would be helpful.
And that is part of my request is support for considering
an Assistant Secretary with the appropriate number of Deputies
to provide us that kind of innovative, thoughtful, and yet
responsible action, reaction to these good ideas, I think,
would be very helpful to the Department.
The Chairman. Thank you.
I echo what Ms. Brown said, that we have confidence that
you will.
Let me just conclude by thanking you for this budget. I
think the Administration and your Department have produced a
great blueprint for the future unlike other departments that
are not subject to cuts. You have fought hard both personally
and institutionally. I thank you for bringing us a budget that
we can be proud of and that will do what has to be done for our
Nation's veterans. We thank you and all of your team for being
here today.
Secretary Shinseki. Great. Thank you very much, Mr.
Chairman.
The Chairman. Thanks so much.
We look forward to panel number two. Please come forward.
Panel two consists of the major organizations that have put
together The Independent Budget which I carry around as my
Bible.
We will bring forward Carl Blake, National Legislative
Director for the Paralyzed Veterans of America (PVA); John
Wilson, the Assistant National Legislative Director for
Disabled American Veterans (DAV); Eric Hilleman, the Director,
National Legislative Service of the Veterans of Foreign Wars
(VFW); and Raymond Kelley, National Legislative Director for
AMVETS.
Mr. Blake, you have the floor.
STATEMENTS OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR,
PARALYZED VETERANS OF AMERICA; JOHN L. WILSON, ASSISTANT
NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; ERIC
A. HILLEMAN, DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS
OF FOREIGN WARS OF THE UNITED STATES; AND RAYMOND C. KELLEY,
NATIONAL LEGISLATIVE DIRECTOR, AMERICAN VETERANS (AMVETS)
STATEMENT OF CARL BLAKE
Mr. Blake. Thank you, Mr. Chairman.
On behalf of the coauthors of The Independent Budget,
Paralyzed Veterans of America is pleased to be here today to
present our views from The Independent Budget regarding the
funding requirements for the Department of Veterans Affairs'
health care system for fiscal year 2011.
Let me say up front that we are pleased that on balance,
this budget is as good as any budget we have seen and we are
pleased to see that the VA looks like they are moving in a very
positive direction.
Despite the fact that Congress has already provided
advanced appropriations for fiscal year 2011, the IB chose to
still present budget recommendations for the medical care
account specifically for fiscal year 2011.
Included in Public Law 111-117 was advanced appropriations
for fiscal year 2011. Congress provided approximately $48.2
billion in discretionary funding combined with $3.3 billion
projected for medical care collections, leading to a total of
$51.5 billion for the operating budget authority.
Accordingly, for fiscal year 2011, The Independent Budget
recommends approximately $52 billion for total medical care, an
increase of $4.5 billion over the fiscal year 2010 operating
budget level established by the consolidated Appropriations
Act.
We believe that this estimation validates the advanced
projections that the Administration developed last year and has
carried forward into this year.
Furthermore, we remain confident that the Administration is
headed in a positive direction that will ultimately benefit the
veterans who rely on the VA health care system to receive their
care.
For fiscal year 2011, The Independent Budget recommends
approximately $40.9 billion for medical services. Our medical
services recommendation includes approximately $39 billion to
maintain current services, $1.3 billion to address our
projected increase in patient workload, $275 million to address
the significant increase in prosthetics expenditures that is
projected, and, lastly, a $375 million initiative to restore
the VA's long-term care average daily census to the level
mandated by Public Law 106-117, the Veterans Millennium Health
Care and Benefits Act.
Finally, for medical support and compliance, the IB
recommends $5.3 billion and for medical facilities $5.7
billion.
The Independent Budget recommendation also includes a
significant increase in funding for information technology. For
fiscal year 2011, we recommend that the VA IT account be funded
at approximately $3.55 billion. This amount includes
approximately $130 million for an information systems
initiative to be carried out by the Veterans Benefits
Administration.
We are concerned that the Administration is short-changing
this account for fiscal year 2011 in a budget in which the VA
and the Department of Defense are called on to jointly
implement the Virtual Lifetime Electronic Record and in which
the Administration proposes to automate claims processing to
improve the accuracy and timeliness of veterans' benefits,
particularly for disability compensation and the new Post-9/11
GI Bill.
Public Law 111-81 requires the President's budget
submission to include estimates of appropriations for the
medical care accounts for fiscal year 2012 and the VA Secretary
provide detailed estimates of the funds necessary for these
medical care accounts in his budget documents submitted to
Congress.
Consistent with the advocacy by The Independent Budget, the
law also requires a thorough analysis and public report of the
Administration's advanced appropriations projections by the
Government Accountability Office to determine if that
information is sound and accurately reflects expected demand
and costs to be incurred in fiscal year 2012 and subsequent
years.
We are pleased to see that the Administration has followed
through on its responsibility to provide a detailed estimate
for the medical care accounts for the VA for fiscal year 2012.
It is important to note that this is the first year that the
budget documents have included advanced appropriations
estimates.
The Independent Budget looks forward to examining all of
this new information and incorporating it into our future
budget estimates.
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.
Mr. Chairman, this concludes my statement. I will be happy
to answer any questions that you might have.
[The prepared statement of Mr. Blake appears on p. 51.]
The Chairman. Thank you.
Mr. Wilson.
STATEMENT OF JOHN L. WILSON
Mr. Wilson. Thank you, Mr. Chairman and Members of the
Committee.
I am glad to be here today on behalf of the DAV, AMVETS,
PVA, and VFW to present our collective budget and policy views
for the 2011 Independent Budget.
My testimony focuses primarily on the variety of VA
benefits programs available to veterans. Preparing this 24th
IB, the IBVSOs draw upon our experience with veterans'
programs, our knowledge of the needs of America's veterans, and
the information gained from monitoring workload demands, and
performance of the veterans benefits and services system.
This Committee has previously 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.
My oral testimony today focuses on four items. One,
concurrent receipt of VA disability compensation and military
longevity retired pay; two, the survivor benefit plan offset of
dependency indemnity compensation; three, automobile grants;
and, four, the disability claims process.
First, concurrent receipt. Current law still provides that
service-connected veterans rated less than 50 percent who
retire from the Armed Forces on length of service will not
receive both their VA disability compensation and full military
retired pay. The IBVSOs recommend Congress enact legislation to
repeal this inequitable requirement.
Second, the offset of survivor benefit plan or SBP
compensation by an amount equal to the dependency indemnity
compensation benefits. Under current law, as you know,
recipients SBP income is reduced by an amount equal to any DIC
for which they are otherwise eligible.
This offset is also inequitable because no duplication of
benefits is involved. It penalizes survivors of military
retirees, of veterans whose deaths are under circumstances
warranting the government to provide compensation for such
loss. It is the recommendation of the IBVSOs that Congress
repeal the offset between DIC and SBP.
Third, automobile grants. The current $11,000 automobile
grant is only 39 percent of the average cost of a new car. To
restore equity, the allowance should be set at a minimum of 80
percent of today's average new cost for a vehicle which is
$22,800. It is the recommendation of IBVSOs that Congress enact
legislation to increase the automobile allowance to at least 80
percent of the average cost of a new automobile.
Fourth and finally, the disability claims process. To
illustrate my point regarding the claims process, let me
recount a story. Between August 25th and September 2nd of last
year, the Roanoke VA Regional Office was visited by the VA's
Office of Inspector General. They found the office did not meet
6 of 14 important operational areas. Inspectors found 29 of
those 118 claims that they reviewed contained errors, a 25
percent error rate. And they found nearly 11,000 folders
sitting on top of full file cabinets. An engineer stated the
load on floors 10, 11, and 12, of this 14-story building, is
double what is considered safe and heavy enough to cause a
potential collapse.
This story provides a timely illustration of the need to
reform the veterans benefits approval system before the very
weight of it destroys the structural integrity of the system
and it collapses in upon itself.
Today, too many disabled veterans and their survivors must
wait too long for disability compensation and pension rating
decisions that are too often wrong or inaccurate. VBA must
develop a work culture that emphasizes quality at all steps of
the process.
It must begin with the development of a management culture
that measures and rewards the quality of results, not just the
quantity, and which provides sufficient training of both VA's
management and workforce in order to achieve accurate outcomes.
VBA must modernize its IT infrastructure and optimize its
business processes. The current paper heavy system must be
replaced with a secure and accessible paperless system that
readily moves and organizes information necessary to help
rating specialists reach correct decisions. The new system must
optimize both the workflow and the business processes.
Finally, VBA must implement a simpler and more transparent
benefits application and approval process. There should be a
universal and simple application procedure that provides
veterans with regular updates on the progress of their claims
and allows them to access the records in a pending claim
securely from any location.
It has been a pleasure to appear before this honorable
Committee today. I would be happy to answer any questions you
may have.
[The prepared statement of Mr. Wilson appears on p. 53.]
The Chairman. Thank you, Mr. Wilson. That is a pretty apt
metaphor that the system is going to collapse under its own
weight, I mean, literally.
Mr. Wilson. Yes, sir.
The Chairman. Mr. Hilleman.
STATEMENT OF ERIC A. HILLEMAN
Mr. Hilleman. Thank you, Mr. Chairman, Members of the
Committee.
On behalf of the 2.1 million men and women of the Veterans
of Foreign Wars and our auxiliaries, it is my pleasure to
testify and present our views before you today.
The VFW works side by side with AMVETS, the Disabled
American Veterans, Paralyzed Veterans of America to produce a
policy and budget recommendation document known as The
Independent Budget. The VFW is responsible for the construction
portion of the IB, so I will limit my remarks to that portion
of the budget.
VA's infrastructure, particularly within its health care
system, is at a crossroads. The system is facing many
challenges, including the average age of buildings 60 years or
more, significant funding needs for routine maintenance,
upgrades, modernization and construction.
VA is beginning a patient-centered information reformation
in the way it delivers care and manages infrastructure to meet
the needs of sick and disabled veterans in the 21st century.
Regardless of what the VA health care system of the future
looks like, our focus must remain on the lasting and accessible
VA health care system that is dedicated to unique needs of
veterans.
VA manages a wide portfolio of capital assets throughout
the Nation. According to its latest capital asset plan, VA is
responsible for 5,500 buildings and almost 34,000 acres of
land. This vast network of facilities requires significant
time, attention from the capital asset managers.
Capital Asset Realignment for Enhanced Services (CARES), a
VA data-driven assessment of their current and future
construction needs, gave VA a long-term road map and has helped
guide its capital planning process over past fiscal years.
CARES showed a large number of significant construction
priorities that would be necessary to fulfill the needs of VA
in the future and Congress has made significant end roads into
funding these priorities. It has been a huge but necessary
undertaking and VA has made slow and steady process in these
critical areas.
The challenge for VA in the post-CARES era is that there
are still numerous projects that need to be carried out and the
current backlog of partially funded projects that CARES has
identified is large. This means that VA is going to continue to
require significant appropriations for major and minor
construction accounts to live up to the promises of CARES.
VA's most recent asset management plan provides an update
of the status of CARES projects, including those in the
planning and acquisition process. The top 10 major construction
projects in queue require $3.25 billion in appropriations. This
is just the tip of the iceberg. There are 82 additional ongoing
or partially funded projects that demonstrate the continued
need for VA to upgrade and repair its aging infrastructure and
that continuous funding is necessary to address the backlog of
projects.
A November 17th, 2008, letter to the Senate Veterans
Affairs' Committee, Secretary Peake said that the Department,
``Estimates that the total funding requirement for major
medical facility projects over the next 5 years would be in
excess of $6.5 billion.''
It is clear that the VA needs a significant infusion of
cash for its construction priorities. VA's own words and
studies state this.
The total major construction request that the IB estimates
is $1.295 billion. The minor request is $785 million.
The IB recognizes that money was provided for military and
veterans' construction in the American Recovery and
Reinvestment Act of 2009 (ARRA). The IB is not requesting plus-
ups of funds in those accounts. However, we recognize that the
Administration numbers are below the IB recommendation.
We would ask that this Committee examine the amounts
remaining in the construction accounts, left over from the
American Recovery and Reinvestment Act. Thank you. I look
forward to your questions.
[The prepared statement of Mr. Hilleman appears on p. 64.]
The Chairman. Thank you.
Mr. Kelley.
STATEMENT OF RAYMOND C. KELLEY
Mr. Kelley. Chairman Filner, thank you for inviting AMVETS
to testify on behalf of The Independent Budget today.
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
these issues and concerns surrounding NCA.
In fiscal year 2009, $230 million was appropriated for the
operations and maintenance of NCA, $49 million over the
Administration's request.
NCA has awarded 49 of 56 minor construction projects that
were in the operating plan.
The State Grant Cemetery Service awarded $40 million in
grants for 10 projects.
The Independent Budget partners also want to recognize NCA
for their foresight in reducing the population threshold for
the establishment of new cemeteries as well as understanding
this policy needs to be flexible to take into account areas
that do not easily fit into this model due to urban or
geographical phenomena.
The Independent Budget requests an operating budget of
$274.5 million for NCA for fiscal year 2011. The Independent
Budget is encouraged that $25 million was set aside for the
National Shrine commitment for fiscal year 2007 and 2008.
In 2006, only 67 percent of headstones and markers in
national cemeteries were at a proper height and alignment. By
2009, proper alignment, height and alignment was increased to
76 percent.
NCA has also identified 153 historic monuments and
memorials that need repair and/or restoration. With funding
from the American Recovery and Reinvestment Act, NCA will make
repairs to 32 percent of these monuments and memorials.
The Independent Budget supports the NCA's operational
standards and measures outlined in the National Shrine
commitment and in the past, The Independent Budget advocated
for a 5-year, $250 million National Shrine initiative to assist
NCA in achieving those performance goals.
However, over the past few years, NCA has made marked
improvements in the National Shrine commitment by earmarking a
portion of its operations and maintenance budget for the
commitment and pending receipts of funding from the ARRA.
Therefore, The Independent Budget no longer believes that
it is necessary to implement the National Shrine Initiative
Program at $50 million a year for 5 years, but rather proposes
an increase in NCA's operating and maintenance budget by $25
million per year until the operational standards and measure
goals are reached.
The State Cemeteries Grants Program faces the challenges of
meeting a growing interest from States and provide burial
services in areas that are not currently served by national
cemeteries. Currently, there are 60 States and tribal
government cemetery construction grant pre-applications, 36 of
which have the required State matching funds totaling $121
million.
The Independent Budget recommends that Congress appropriate
$51 million for the State Grant Program for fiscal year 2011.
This funding level will allow the Grant Program to establish 13
new State cemeteries.
Based on accessibility and the need to provide quality
burial benefits, The Independent Budget recommends that VA
separate burial benefits into two categories, veterans who live
inside the VA accessibility threshold model and those who live
outside the threshold.
For those veterans who live outside the threshold, the
service-connected burial benefit would be increased to $6,160.
Nonservice-connected veterans' burial benefits would increase
to $1,918. And the plot allowance would increase to $1,150 to
match the original value of the benefit.
For the veterans who live inside the threshold, the benefit
for service-connected burial would be $2,793. The amount
provided for nonservice-connected burial would be $854. And the
plot allowance would be $1,150.
This will provide a burial benefit at equal percentages,
but based on the average cost for the VA funeral and not on the
private funeral cost that will be provided for those veterans
who do not have access to a State or national cemetery.
The new model will provide a meaningful benefit for those
veterans whose access to a State or national cemetery is
restricted as well as provides an improved benefit for eligible
veterans who opt for private burial.
Congress should also enact legislation to adjust these
burial benefits for inflation annually.
This concludes my testimony and I will be happy to answer
any questions that you may have.
[The prepared statement of Mr. Kelley appears on p. 73.]
The Chairman. We thank you very much for all the work you
do each year on this Independent Budget. As you know, I use it
as my Bible.
We have a lot of questions, but because of the votes that
are present, we are going to submit them to you. We thank you
so much.
I am going to recognize panel three. You have been sitting
here all morning. If each of you could just stand up or take
your microphone for 30 seconds and tell us what your first
priority is? We are going to recess to go vote and I do not
want to have to have you all waiting here again.
Steve Robertson, Director of the National Legislative
Commission, the American Legion; Rick Weidman, Executive
Director for Policy and Government Affairs for VVA; Paul
Rieckhoff, Executive Director for the Iraq and Afghanistan
Veterans of America (IAVA); and Paul Sullivan, Executive
Director for Veterans for Common Sense. If you would just take
a minute and state what is your top priority and what is
missing from this budget that we ought to be correcting.
Mr. Robertson, I apologize for doing it this way. We have
all of your statements for the record. We will start with you.
STATEMENTS OF STEVE A. ROBERTSON, DIRECTOR, NATIONAL
LEGISLATIVE COMMISSION, AMERICAN LEGION; RICHARD F. WEIDMAN,
EXECUTIVE DIRECTOR FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM
VETERANS OF AMERICA; PAUL RIECKHOFF, EXECUTIVE DIRECTOR, IRAQ
AND AFGHANISTAN VETERANS OF AMERICA; AND PAUL SULLIVAN,
EXECUTIVE DIRECTOR, VETERANS FOR COMMON SENSE
STATEMENT OF STEVE A. ROBERTSON
Mr. Robertson. Mr. Chairman, I just have one request that
we be allowed to add additional comments as we had a very short
window to review the budget and there are a lot of legislative
proposals that we want to flush out before----
The Chairman. Yes. Of course, you will have that extra
time, Mr. Robertson.
Mr. Robertson. And we are very pleased with the budget. It
is very rare that we get to come to a Congressional hearing
where we do not have to beat up on somebody to make sure we get
the benefits that we believe are earned benefits for America's
veterans.
Thank you.
[The oral and prepared statements of Mr. Robertson appear
on pp. 77 and 78.]
The Chairman. Where is your hat?
Mr. Robertson. It is in my pocket.
The Chairman. I did not know you had hair.
Mr. Weidman.
STATEMENT OF RICHARD F. WEIDMAN
Mr. Weidman. I have no hat, Mr. Chairman.
The Chairman. No hair either.
Mr. Weidman. And no hair either. That is right.
The Chairman. The only order that we put you in is
increasing baldness. You can see it goes from Robertson to
Rieckhoff in a stepped up way.
Mr. Weidman. Wow. I am trying to think about how to put
this into one single thing. It is to let VA be VA. And what we
mean by that is to start taking a military history. They are
now exporting the VistA system to the private sector all over
the country and it still does not have a military history in
the damn medical record.
And what it says to people is it is unimportant for future
health care risk where Tim Walz served in the Guard when he was
on active duty during his 30 years in service. And that is a
crock.
We need to be educating. Where 80 percent of American
veterans get their health care is not at the VA and VA does
nothing in terms of educating either its own people properly,
never mind the rest of American medicine, and what are the
wounds, maladies, and injuries of war that we need to start to
address.
Part of that let VA be VA is $590 million in set-aside for
research. Of that, almost none of it is going to research in
the wounds, maladies, and injuries of war.
Mr. Buyer talked about science. Well, you do not get
science, if you do not put out money for research in order to
get the science. And nobody is putting out the research for
Agent Orange, for Gulf War I, never mind other conditions, and
that is what we need to do in that regard.
And, last, but by no means least, has to do with the issue
of transparency and partnership. And there was a lot of
rhetoric about it, but the transparency at VA needs to go back
to where it was prior to 2002, particularly at the Veterans
Health Administration. They do too much stuff in secret. And,
frankly, they screwed it up in secret because they did not
consult with the veterans service organizations or the Hill
properly before they headed off in the wrong direction.
So that is part and parcel of listen to the individual
veterans and to the individual veteran and military service
organizations and Members of Congress and then they will start
to let VA be VA and get it right, sir.
[The prepared statement of Mr. Weidman appears on p. 91.]
The Chairman. Thank you. Thank you for your eloquence and
your succinctness.
Mr. Sullivan.
STATEMENT OF PAUL SULLIVAN
Mr. Sullivan. Mr. Chairman, thank you.
In 30 seconds, Veterans for Common Sense urges Congress to
require VA that they develop more accurate casualty estimates
and implement a long-range strategic casualty plan.
Right now VA is treating a half million Iraq and
Afghanistan veterans. They have almost as many claims. This is
far above any worst case scenario we could have predicted.
For VA's 2012 budget, VA estimated less than 500,000
patients. That is low. That is wrong. A more realistic estimate
of cumulative patients treated by 2012 would be closer to
800,000 new patients and claims from the two wars. And what is
exacerbating that is the claims for PTSD and traumatic brain
injury.
And, finally, Mr. Chairman, you mentioned in your
conversations with the Secretary about a Department of
Revolution that got some giggles in the back of the room among
us bald people.
Disney set up Pixar and Mr. Cameron did Avatar. That is
because they had new ideas and they thought outside of the box
and they are very highly successful.
Mr. Chairman, VBA's Veterans Benefits Management System,
you are right, is nothing more than putting a brand new logo on
a broken down, rundown car.
In our view, we would ask that Congress fund a high
priority task force independent of VA with one mission,
overhaul VBA within 1 year and put them in a little box in a
room somewhere and say here is the veteran, here is the check.
Let us shorten the distance between the two and let us quit
trying to improve on what we know is an absolutely totally
broken model at VBA.
[The oral and prepared statements of Mr. Sullivan appear on
pp. 98 and 99.]
The Chairman. Thank you, Mr. Sullivan.
Mr. Rieckhoff.
STATEMENT OF PAUL RIECKHOFF
Mr. Rieckhoff. Thank you, Mr. Chairman. Thank you to the
Committee.
I am from New York, so I will try to talk fast. We
appreciate you having IAVA here to present our views. And we
are an online-centric organization. So since I am cut for time,
I would encourage you to go to our Web site, iava.org, where
you can see my entire testimony.
We are pleased to see the budget submission for 2011 and
2012. It has all the right ingredients to transform VA and it
is a message to our veterans that we really do have their back.
Our number one priority is modernizing the benefits
delivery. The VA benefits system must be brought into the 21st
century. Right now our veterans are receiving benefits under a
system that was outdated years before most of them were born.
So facing this mountain of bureaucratic red tape and
lengthy wait times, we join with the chorus of other veterans'
groups in recommending that VA modernize their claims process
system by digitizing records, holding processors accountable
for the accuracy of the work, and by removing unnecessary steps
in the evaluation process. It is cost effective. It will save
the taxpayer money.
But disability reform is our number one priority for 2010.
And we will be here all next week with dozens of veterans from
around the country for our annual Storm the Hill trip. We look
forward to meeting with you and we strongly support this budget
and appreciate your time. Check out the Web site.
[The prepared statement of Mr. Rieckhoff appears on p. 94.]
The Chairman. Thank you.
I apologize for having you rush. You all have very
important things to say and we will read the testimony. If you
want to augment it as Mr. Robertson said, try to do it within
the next 5 days so we can get the record complete.
We thank all of you for your testimony and we must adjourn
this meeting.
[Whereupon, at 1:03 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Bob Filner, Chairman,
Committee on Veterans' Affairs
Welcome to the hearing on the Department of Veterans Affairs Budget
Request for Fiscal Year 2011 and Fiscal Year 2012.
The President has requested a budget for VA of $125 billion,
including a total discretionary resource request of $60.3 billion. VA
medical care represents 86 percent of the total discretionary request.
For fiscal year 2011, the Administration is requesting $51.5 billion in
resources for VA medical care. Appropriated resources for medical care
for fiscal year 2011 have already been provided in last year's
Consolidated Appropriations Act. This funding level is an increase of
$4.1 billion, or 8.6 percent over fiscal year 2010 levels.
In accordance with the Veterans Health Care Budget Reform and
Transparency Act, enacted last year with the support of this
Administration and the bipartisan support of this Congress, the VA has
requested $50.6 billion in appropriated dollars and a total resource
level of $54.3 billion, a $2.8 billion, or 5.3 percent increase over
fiscal year 2011 levels. We understand this level is consistent with
the VA's actuarial model.
Rest assured that this Committee will be working closely with our
counterparts in Congress and with the Administration as the process
moves forward to ensure that veterans have the medical care resources
they need when fiscal year 2012 begins on October 1, 2011.
The veterans' groups that co-author The Independent Budget, who
will be testifying on our second panel today, have recommended for
fiscal year 2011, a total resource level for VA medical care of $52
billion, and an overall discretionary funding level of $61.5 billion,
$1.2 billion above the Administration's requested increase of $4.3
billion. We are looking forward to their testimony and the testimony of
The American Legion, VVA, IAVA, and Veterans for Common Sense which are
on our third panel.
Mr. Secretary, I am impressed by your robust budget request and
your emphasis on funding many of the priorities of this Committee,
including addressing the plague of homelessness, rural health care
access, and the mental health care needs of our veterans. This budget
addresses the problems faced by our newer veterans while not forgetting
the sacrifices and service of veterans from previous conflicts.
I note that you are requesting additional funding for more claims
processors and I am looking forward to you providing this Committee
with a roadmap on how we reform the claims process. More money and more
FTE will not solve this broken process and it won't provide us with a
system that is fair to veterans and efficient.
We look forward to hearing about your successes this year, your
frustrations, and how you plan to use the resources in this request to
meet the needs of our veterans. We look forward to working with you to
ensure that you have the money to do the job, and we look forward to
working closely with you to assist you in your goal of creating a 21st
Century VA.
Prepared Statement of Hon. Corrine Brown
Thank you, Mr. Chairman, for calling this hearing today. This will
allow the Secretary to testify in support of his budget request for the
2011 and 2012 fiscal years.
Thank you, Mr. Secretary, for your decades of service defending the
freedom of this Nation. Thank you for your commitment to the veterans
who also served this Nation.
I am pleased with the budget you have submitted earlier this week.
Over the last few years, this Congress, and especially Chairman
Filner has overseen the largest funding increase in the history of the
VA.
That being said, I am pleased with the current increase in funding
for health care and other priorities.
I applaud that you plan to bring more Priority 8 veterans back into
the fold. These men and women have, by serving their country, paid
their dues and earned their right to health care from the VA. However,
maybe you could speed the timeline up further than just the 99,000 you
estimate would additionally use the VA next year.
I am concerned about the increase in the wait times veterans are
being subjected to, and I look forward to hearing how you plan on
reducing the time our veterans have to wait for appointments.
I am pleased that so many contracts are being signed for the new VA
Medical Center in Orlando. The VAMC should be fully funded and I want
to hear about it ahead of time if the numbers are not matching up. We
will fix it, if we know.
I believe the words of the first President of the United States,
George Washington, are also worth repeating at this time:
``The willingness with which our young people are likely to serve
in any war, no matter how justified, shall be directly proportional as
to how they perceive the veterans of earlier wars were treated and
appreciated by their country.''
Prepared Statement of Hon. Harry E. Mitchell
Thank you Chairman Filner, and thanks to Secretary Shinseki and the
Veterans Service Organizations (VSOs) for coming to participate in the
hearing today.
Among the many important issues that this Congress and
Administration must address in the 111th Congress, I wish to highlight
two today.
First, I believe we need to do more to prevent veteran's suicide.
As we all know, many of our newest generation of veterans, as well
as those who served previously, bear wounds that cannot be seen and are
hard to diagnose.
Proactively bringing the VA to our veterans, as opposed to waiting
for veterans to find the VA, is a critical part of delivering the care
they have earned in exchange for their brave service.
At my behest, Secretary Peake overturned VA's self-imposed ban on
television advertising as a method of outreach. Since then, the VA
rolled out a public service announcement and outreach campaign to
inform veterans and their families about the suicide prevention
hotline.
What began as a limited DC area pilot program has been expanded
nationally, and it has been effective. Since its inception in July of
2007, nearly 225,000 calls were received from veterans. And the hotline
has been credited with saving 7,000 lives.
While I applaud the VA and Secretary Shinseki for expanding and
extending outreach, I believe we need to do more. We need to expand and
extend outreach efforts, including the use of twitter, facebook and new
media, to let veterans know where they can get help.
Additionally, I believe the VA needs to aggressively reduce the
claims backlog. The VA must deliver these earned benefits in a timely
manner.
As many have noted, there is a backlog of disability claims that
stretches hundreds of thousands of veterans long. I am pleased that the
Administration has requested funding for more than 4,000 new claims
processors in their FY 2011 request. However, I believe that the VA
needs more than additional manpower to reduce the backlog.
The VA needs a long-term strategy and plan.
Doing so, I believe will provide better services to our veterans
and increase their morale and confidence in the VA.
Finally, I want to say that I am encouraged by Secretary Shinseki's
commitment to reform the VA, and I look forward to working with him,
with my colleagues in Congress, to bring the VA and its services to our
veterans in an effective and efficient manner.
Thank you again to all of our witnesses. I look forward to hearing
your perspective on the budget outlook for the VA in the coming fiscal
year.
Prepared Statement of Hon. John Boozman
Thank you Mr. Chairman. I would agree with the remarks made by the
Ranking Member. This is certainly a generous budget considering the
economic crisis facing the Nation.
Mr. Secretary, I have one major budget concern and that is how VA
proposes to allocate the over 4,000 new VBA employees among the various
business lines. I believe that adding 3,919 FTE to C&P while cutting 9
employees from the Voc Rehab Service needs to be rethought.
The budget documents show a 10 percent increase in the total VR&E
caseload so cutting counseling staffs when more resources are needed to
bring the average caseload down does not reflect a focus on
rehabilitating disabled veterans.
I hope you will revisit this staffing issue and consider shifting
some of the new staffing resources to increase the VR&E staffing to
reduce the average caseload to not more than 100.
I yield back.
Prepared Statement of Hon. Eric K. Shinseki, Secretary,
U.S. Department of Veterans Affairs
Chairman Filner, Ranking Member Buyer, Distinguished Members of the
House Committee on Veterans' Affairs:
Thank you for this opportunity to present the President's Fiscal
Year 2011 Budget and Fiscal Year 2012 Advance Appropriations Request
for the Department of Veterans Affairs (VA). Our budget provides the
resources necessary to continue our aggressive pursuit of the
President's two overarching goals for the Department--to transform VA
into a 21st Century organization and to ensure that we provide timely
access to benefits and high quality care to our veterans over their
lifetimes, from the day they first take their oaths of allegiance until
the day they are laid to rest.
We recently completed development of a new strategic framework that
is people-centric, results-driven, and forward-looking. The path we
will follow to achieve the President's vision for VA will be presented
in our new strategic plan, which is currently in the final stages of
review. The strategic goals we have established in our plan are
designed to produce better outcomes for all generations of veterans:
Improve the quality and accessibility of health care,
benefits, and memorial services while optimizing value;
Increase veteran client satisfaction with health,
education, training, counseling, financial, and burial benefits and
services;
Protect people and assets continuously and in time of
crisis; and,
Improve internal customer satisfaction with management
systems and support services to achieve mission performance and make VA
an employer of choice by investing in human capital.
The strategies in our plan will guide our workforce to ensure we
remain focused on producing the outcomes veterans expect and have
earned through their service to our country.
To support VA's efforts, the President's budget provides $125
billion in 2011--almost $60.3 billion in discretionary resources and
nearly $64.7 billion in mandatory funding. Our discretionary budget
request represents an increase of $4.3 billion, or 7.6 percent, over
the 2010 enacted level.
VA's 2011 budget also focuses on three concerns that are of
critical importance to our veterans--easier access to benefits and
services; reducing the disability claims backlog and the time veterans
wait before receiving earned benefits; and ending the downward spiral
that results in veterans' homelessness.
This budget provides the resources required to enhance access in
our health care system and our national cemeteries. We will expand
access to health care through the activations of new or improved
facilities, by expanding health care eligibility to more veterans, and
by making greater investments in telehealth. Access to our national
cemeteries will be increased through the implementation of new policy
for the establishment of additional facilities.
We are requesting an unprecedented increase for staffing in the
Veterans Benefits Administration (VBA) to address the dramatic increase
in disability claim receipts while continuing our process-reengineering
efforts, our development of a paperless claims processing system, and
the creation of a Virtual Lifetime Electronic Record.
We are also requesting a substantial investment for our
homelessness programs as part of our plan to ultimately eliminate
veterans' homelessness through an aggressive approach that includes
housing, education, jobs, and health care.
VA will be successful in resolving these three concerns by
maintaining a clear focus on developing innovative business processes
and delivery systems that will not only serve veterans and their
families for many years to come, but will also dramatically improve the
efficiency of our operations by better controlling long-term costs. By
making appropriate investments today, we can ensure higher value and
better outcomes for our veterans. The 2011 budget also supports many
key investments in VA's six high priority performance goals (HPPGs).
HPPG I: Reducing the Claims Backlog
The volume of compensation and pension rating-related claims has
been steadily increasing. In 2009, for the first time, we received over
one million claims during the course of a single year. The volume of
claims received has increased from 578,773 in 2000 to 1,013,712 in 2009
(a 75 percent increase). Original disability compensation claims with
eight or more claimed issues have increased from 22,776 in 2001 to
67,175 in 2009 (nearly a 200 percent increase). Not only is VA
receiving substantially more claims, but the claims have also increased
in complexity. We expect this level of growth in the number of claims
received to continue in 2010 and 2011 (increases of 13 percent and 11
percent were projected respectively even without claims expected under
new presumptions related to Agent Orange exposure), which is driven by
improved access to benefits through initiatives such as the Benefits
Delivery at Discharge Program, increased demand as a result of nearly
10 years of war, and the impact of a difficult economy prompting
America's Veterans to pursue access to the benefits they earned during
their military service.
While the volume and complexity of claims has increased, so too has
the productivity of our claims processing workforce. In 2009, the
number of claims processed was 977,219, an increase of 8.6 percent over
the 2008 level of 899,863. The average time to process a rating-related
claim fell from 179 to 161 days in 2009, an improvement of 11 percent.
The progress made in 2009 is a step in the right direction, but it
is not nearly enough. My goal for VA is an average time to process a
claim of no more than 125 days. Reaching this goal will become even
more challenging because of additional claims we expect to receive
related to veterans' exposure to Agent Orange. Adding Parkinson's
disease, ischemic heart disease, and B-cell leukemias to the list of
presumptive disabilities is projected to significantly increase claims
inventories in the near term, even while we make fundamental
improvements to the way we process disability compensation claims.
We expect the number of compensation and pension claims received to
increase from 1,013,712 in 2009 to 1,318,753 in 2011 (a 30 percent
increase). Without the significant investment requested for staffing in
this budget, the inventory of claims pending would grow from 416,335 to
1,018,343 and the average time to process a claim would increase from
161 to 250 days. If Congress provides the funding requested in our
budget, these increases are projected to be 804,460 claims pending with
an average processing time of 190 days. Through 2011, we expect over
228,000 claims related to the new presumptions and are dedicated to
processing this near-term surge in claims as efficiently as possible.
This budget is based on our plan to improve claims processing by
using a three-pronged approach involving improved business processes,
expanded technology, and hiring staff to bridge the gap until we fully
implement our long-range plan. We will explore process and policy
simplification and contracted service support in addition to the
traditional approach of hiring new employees to address this spike in
demand. We expect these transformational approaches to begin yielding
significant performance improvements in fiscal year 2012 and beyond;
however, it is important to mitigate the impact of the increased
workload until that time.
The largest increase in our 2011 budget request, in percentage
terms, is directed to the Veterans Benefits Administration as part of
our mitigation of the increased workload. The President's 2011 budget
request for VBA is $2.149 billion, an increase of $460 million, or 27
percent, over the 2010 enacted level of $1.689 billion. The 2011 budget
supports an increase of 4,048 FTEs, including maintaining temporary FTE
funded through ARRA. In addition, the budget also includes $145.3
million in information technology (IT) funds in 2011 to support the
ongoing development of a paperless claims processing system.
HPPG II: Eliminating Veteran Homelessness
Our Nation's veterans experience higher than average rates of
homelessness, depression, substance abuse, and suicides; many also
suffer from joblessness. On any given night, there are about 131,000
veterans who live on the streets, representing every war and
generation, including those who served in Iraq and Afghanistan. VA's
major homeless-specific programs constitute the largest integrated
network of homeless treatment and assistance services in the country.
These programs provide a continuum of care for homeless veterans,
providing treatment, rehabilitation, and supportive services that
assist homeless veterans in addressing health, mental health and
psychosocial issues. VA also offers a full range of support necessary
to end the cycle of homelessness by providing education, jobs, and
health care, in addition to safe housing. We will increase the number
and variety of housing options available to homeless veterans and those
at risk of homelessness with permanent, transitional, contracted,
community-operated, HUD-VASH provided, and VA-operated housing.
Homelessness is primarily a health care issue, heavily burdened
with depression and substance abuse. VA's budget includes $4.2 billion
in 2011 to prevent and reduce homelessness among veterans--over $3.4
billion for core medical services and $799 million for specific
homeless programs and expanded medical programs. Our budget includes an
additional investment of $294 million in programs and new initiatives
to reduce the cycle of homelessness, which is almost 55 percent higher
than the resources provided for homelessness programs in 2010.
VA's health care costs for homeless veterans can drop in the future
as the Department emphasizes education, jobs, and prevention and
treatment programs that can result in greater residential stability,
gainful employment, and improved health status.
HPPG III: Automating the GI Bill Benefits System
The Post-9/11 GI Bill creates a robust enhancement of VA's
education benefits, evoking the World War II Era GI Bill. Because of
the significant opportunities the Act provides to veterans in
recognition of their service, and the value of the program in the
current economic environment, we must deliver the benefits in this Act
effectively and efficiently, and with a client-centered approach. In
August 2009, the new Post-9/11 GI Bill program was launched. We
received more than 397,000 original and 219,000 supplemental
applications since the inception of this program.
The 2011 budget provides $44.1 million to complete the automated
solution for processing Post-9/11 GI Bill claims and to begin the
development and implementation of electronic systems to process claims
associated with other education programs. The automated solution for
the Post-9/11 GI Bill education program will be implemented by December
2010.
In 2011, we expect the total number of all types of education
claims to grow by 32.3 percent over 2009, from 1.70 million to 2.25
million. To meet this increasing workload and complete education claims
in a timely manner, VA has established a comprehensive strategy to
develop an end-to-end solution that utilizes rules-based, industry-
standard technologies to modernize the delivery of education benefits.
HPPG IV: Establishing a Virtual Lifetime Electronic Record
Each year, more than 150,000 active and reserve component
servicemembers leave the military. Currently, this transition is
heavily reliant on the transfer of paper-based administrative and
medical records from the Department of Defense (DoD) to the veteran,
the VA or other non-VA health care providers. A paper-based transfer
carries risks of errors or oversights and delays the claim process.
In April 2009, the President charged me and Defense Secretary Gates
with building a fully interoperable electronic records system that will
provide each member of our armed forces a Virtual Lifetime Electronic
Record (VLER). This virtual record will enhance the timely delivery of
high-quality benefits and services by capturing key information from
the day they put on the uniform, through their time as veterans, until
the day they are laid to rest. The VLER is the centerpiece of our
strategy to better coordinate the user-friendly transition of
servicemembers from their service component into VA, and to produce
better, more timely outcomes for veterans in providing their benefits
and services.
In December 2009, VA successfully exchanged electronic health
record (EHR) information in a pilot program between the VA Medical
Center in San Diego and a local Kaiser Permanente hospital. We
exchanged EHR information using the Nationwide Health Information
Network (NHIN) created by the Department of Health and Human Services.
Interoperability is key to sharing critical health information.
Utilizing the NHIN standards allows VA to partner with private sector
health care providers and other Federal agencies to promote better,
faster, and safer care for veterans. During the second quarter of 2010,
the DoD will join this pilot and we will announce additional VLER
health community sites.
VA has $52 million in IT funds in 2011 to continue the development
and implementation of this Presidential priority.
HPPG V: Improving Mental Health Care
The 2011 budget continues the Department's keen focus on improving
the quality, access, and value of mental health care provided to
veterans. VA's budget provides over $5.2 billion for mental health, an
increase of $410 million, or 8.5 percent, over the 2010 enacted level.
We will expand inpatient, residential, and outpatient mental health
programs with an emphasis on integrating mental health services with
primary and specialty care.
Post-Traumatic Stress Disorder (PTSD) is the mental health
condition most commonly associated with combat, and treating veterans
who suffer from this debilitating disorder is central to VA's mission.
Screening for PTSD is the first and most essential step. It is crucial
that VA be proactive in identifying PTSD and intervening early in order
to prevent chronic problems that could lead to more complex disorders
and functional problems.
VA will also expand its screening program for other mental health
conditions, most notably traumatic brain injury (TBI), depression, and
substance use disorders. We will enhance our suicide prevention
advertising campaign to raise awareness among veterans and their
families of the services available to them.
More than one-fifth of the veterans seen last year had a mental
health diagnosis. In order to address this challenge, VA has
significantly invested in our mental health workforce, hiring more than
6,000 new workers since 2005.
In October 2009, VA and DoD held a mental health summit with mental
health experts from both departments, and representatives from Congress
and more than 57 non-government organizations. We convened the summit
to discuss an innovative, wide-ranging public health model for
enhancing mental health for returning servicemembers, veterans, and
their families. VA will use the results to devise new innovative
strategies for improving the health and quality of life for veterans
suffering from mental health problems.
HPPG VI: Deploying a Veterans Relationship Management System
A key component of VA's transformation is to employ technology to
dramatically improve service and outreach to veterans by adopting a
comprehensive Veterans' Relationship Management System to serve as the
primary interface between veterans and the Department. This system will
include a framework that provides veterans with the ability to:
Access VA through multiple methods;
Uniformly find information about VA's benefits and
services;
Complete multiple business processes within VA without
having to re-enter identifying information; and,
Seamlessly access VA across multiple lines of business.
This system will allow veterans to access comprehensive online
information anytime and anywhere via a single consistent entry point.
Our goal is to deploy the Veterans Relationship Management System in
2011. Our budget provides $51.6 million for this project.
In addition to resources supporting these high-priority performance
goals, the President's budget enhances and improves services across the
full spectrum of the Department. The following highlights funding
requirements for selected programs along with the outcomes we will
achieve for veterans and their families.
Delivering World-Class Medical Care
The Budget provides $51.5 billion for medical care in 2011, an
increase of $4 billion, or 8.5 percent, over the 2010 level. This level
will allow us to continue providing timely, high-quality care to all
enrolled veterans. Our total medical care level is comprised of funding
for medical services ($37.1 billion), medical support and compliance
($5.3 billion), medical facilities ($5.7 billion), and resources from
medical care collections ($3.4 billion). In addition to reducing the
number of homeless veterans and expanding access to mental health care,
our 2011 budget will also achieve numerous other outcomes that improve
veterans' quality of life, including:
Providing extended care and rural health services in
clinically appropriate settings;
Expanding the use of home telehealth;
Enhancing access to health care services by offering
enrollment to more Priority Group 8 veterans and activating new
facilities; and,
Meeting the medical needs of women veterans.
During 2011, we expect to treat nearly 6.1 million unique patients,
a 2.9 percent increase over 2010. Among this total are over 439,000
veterans who served in Operation Enduring Freedom and Operation Iraqi
Freedom, an increase of almost 57,000 (or 14.8 percent) above the
number of veterans from these two campaigns that we anticipate will
come to VA for health care in 2010.
In 2011, the budget provides $2.6 billion to meet the health care
needs of veterans who served in Iraq and Afghanistan. This is an
increase of $597 million (or 30.2 percent) over our medical resource
requirements to care for these veterans in 2010. This increase also
reflects the impact of the recent decision to increase troop size in
Afghanistan. The treatment of this newest generation of veterans has
allowed us to focus on, and improve treatment for, PTSD as well as TBI,
including new programs to reach veterans at the earliest stages of
these conditions.
The FY 2011 Budget also includes funding for new patients resulting
from the recent decision to add Parkinson's disease, ischemic heart
disease, and B-cell leukemias to the list of presumptive conditions for
veterans with service in Vietnam.
Extended Care and Rural Health
VA's budget for 2011 contains $6.8 billion for long-term care, an
increase of 858.8 million (or 14.4 percent) over the 2010 level. In
addition, $1.5 billion is included for non-institutional long-term
care, an increase of $276 million (or 22.9 percent) over 2010. By
enhancing veterans' access to non-institutional long-term care, VA 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.
VA's 2011 budget also includes $250 million to continue
strengthening access to health care for 3.2 million enrolled veterans
living in rural and highly rural areas through a variety of avenues.
These include new rural health outreach and delivery initiatives and
expanded use of home-based primary care, mental health, and telehealth
services. VA intends to expand use of cutting edge telehealth
technology to broaden access to care while at the same time improve the
quality of our health care services.
Home Telehealth
Our increasing reliance on non-institutional long-term care
includes an investment in 2011 of $163 million in home telehealth.
Taking greater advantage of the latest technological advancements in
health care delivery will allow us to more closely monitor the health
status of veterans and will greatly improve access to care for veterans
in rural and highly rural areas. Telehealth will place specialized
health care professionals in direct contact with patients using modern
IT tools. VA's home telehealth program cares for 35,000 patients and is
the largest of its kind in the world. A recent study found patients
enrolled in home telehealth programs experienced a 25 percent reduction
in the average number of days hospitalized and a 19 percent reduction
in hospitalizations. Telehealth and telemedicine improve health care by
increasing access, eliminating travel, reducing costs, and producing
better patient outcomes.
Expanding Access to Health Care
In 2009 VA opened enrollment to Priority 8 veterans whose incomes
exceed last year's geographic and VA means-test thresholds by no more
than 10 percent. Our most recent estimate is that 193,000 more veterans
will enroll for care by the end of 2010 due to this policy change.
In 2011 VA will further expand health care eligibility for Priority
8 veterans to those whose incomes exceed the geographic and VA means-
test thresholds by no more than 15 percent compared to the levels in
effect prior to expanding enrollment in 2009. This additional expansion
of eligibility for care will result in an estimated 99,000 more
enrollees in 2011 alone, bringing the total number of new enrollees
from 2009 to the end of 2011 to 292,000.
Meeting the Medical Needs of Women Veterans
The 2011 budget provides $217.6 million to meet the gender-specific
health care needs of women veterans, an increase of $18.6 million (or
9.4 percent) over the 2010 level. The delivery of enhanced primary care
for women veterans remains one of the Department's top priorities. The
number of women veterans is growing rapidly and women are increasingly
reliant upon VA for their health care.
Our investment in health care for women veterans will lead to
higher quality of care, increased coordination of care, enhanced
privacy and dignity, and a greater sense of security among our women
patients. We will accomplish this through expanding health care
services provided in our Vet Centers, increasing training for our
health care providers to advance their knowledge and understanding of
women's health issues, and implementing a peer call center and social
networking site for women combat veterans. This call center will be
open 24 hours a day, 7 days a week.
Advance Appropriations for Medical Care in 2012
VA is requesting advance appropriations in 2012 of $50.6 billion
for the three medical care appropriations to support the health care
needs of 6.2 million patients. The total is comprised of $39.6 billion
for Medical Services, $5.5 billion for Medical Support and Compliance,
and $5.4 billion for Medical Facilities. In addition, $3.7 billion is
estimated in medical care collections, resulting in a total resource
level of $54.3 billion. It does not include additional resources for
any new initiatives that would begin in 2012.
Our 2012 advance appropriations request is based largely on our
actuarial model using 2008 data as the base year. The request continues
funding for programs that we will continue in 2012 but which are not
accounted for in the actuarial model. These initiatives address
homelessness and expanded access to non-institutional long-term care
and rural health care services through telehealth. In addition, the
2012 advance appropriations request includes resources for several
programs not captured by the actuarial model, including long-term care,
the Civilian Health and Medical Program of the Department of Veterans
Affairs, Vet Centers, and the state home per diem program. Overall, the
2012 requested level, based on the information available at this point
in time, is sufficient to enable us to provide timely and high-quality
care for the estimated patient population. We will continue to monitor
cost and workload data throughout the year and, if needed, we will
revise our request during the normal 2012 budget cycle.
After a cumulative increase of 26.4 percent in the medical care
budget since 2009, we will be working to reduce the rate of increase in
the cost of the provision of health care by focusing on areas such as
better leveraging acquisitions and contracting, enhancing use of
referral agreements, strengthening DoD/VA joint ventures, and expanding
applications of medical technology (e.g. telehome health).
Investments in Medical Research
VA's budget request for 2011 includes $590 million for medical and
prosthetic research, an increase of $9 million over the 2010 level.
These research funds 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.
This budget contains funds to continue our aggressive research
program aimed at improving the lives of veterans returning from service
in Iraq and Afghanistan. This focuses on prevention, treatment, and
rehabilitation research, including TBI and polytrauma, burn injury
research, pain research, and post-deployment mental health research.
Sustaining High Quality Burial and Memorial Programs
VA remains steadfastly committed to providing access to a dignified
and respectful burial for veterans choosing to be buried in a VA
national cemetery. This promise to veterans and their families also
requires that we maintain national cemeteries as shrines dedicated to
the memory of those who honorably served this Nation in uniform. This
budget implements new policy to expand access by lowering the veteran
population threshold for establishing new national cemeteries and
developing additional columbaria to better serve large urban areas.
VA expects to perform 114,300 interments in 2011 or 3.8 percent
more than in 2010. The number of developed acres (8,441) that must be
maintained in 2011 is 4.6 percent greater than the 2010 estimate, while
the number of gravesites (3,147,000) that will be maintained is 2.6
percent higher. VA will also process more than 617,000 Presidential
Memorial Certificates in recognition of veterans' honorable military
service.
Our 2011 budget request includes $251 million in operations and
maintenance funding for the National Cemetery Administration. The 2011
budget request provides $36.9 million for national shrine projects to
raise, realign, and clean an estimated 668,000 headstones and markers,
and repair 100,000 sunken graves. This is critical to maintaining our
extremely high client satisfaction scores that set the national
standard of excellence in government and private sector services as
measured by the American Customer Satisfaction Index. The share of our
clients who rate the quality of the memorial services we provide as
excellent will rise to 98 percent in 2011. The proportion of clients
who rate the appearance of our national cemeteries as excellent will
grow to 99 percent. And we will mark 95 percent of graves within 60
days of interment.
The 2011 budget includes $3 million for solar and wind power
projects at three cemeteries to make greater use of renewable energy
and to improve the efficiency of our program operations. It also
provides $1.25 million to conduct independent Facility Condition
Assessments at national cemeteries and $2 million for projects to
correct safety and other deficiencies identified in those assessments.
Leveraging Information Technology
We cannot achieve the transformation of VA into a 21st Century
organization capable of meeting veterans' needs today and in the years
to come without leveraging the power of IT. The Department's IT program
is absolutely integral to everything we do, and it is vital we continue
the development of IT systems that will meet new service delivery
demands and modernize or replace increasingly fragile systems that are
no longer adequate in today's health care and benefits delivery
environment. Simply put, IT is indispensable to achieving VA's mission.
The Department's IT operations and maintenance program supports
334,000 users, including VA employees, contractors, volunteers, and
researchers situated in 1,400 health care facilities, 57 regional
offices, and 158 national cemeteries around the country. Our IT program
protects and maintains 8.5 million vital health and benefits records
for veterans with the level of privacy and security mandated by both
statutes and directives.
VA's 2011 budget provides $3.3 billion for IT, the same level of
funding provided in 2010. We have prioritized potential IT projects to
ensure that the most mission-critical projects for improving service to
veterans are funded. For example, the resources we are requesting will
fund the development and implementation of an automated solution for
processing education claims ($44.1 million), the Financial and
Logistics Integrated Technology Enterprise project to replace our
outdated, non-compliant core accounting system ($120.2 million),
development and deployment of the paperless claims processing system
($145.3 million), and continued development of HealtheVet, VA's
electronic health record system ($346.2 million). In addition, the 2011
budget request includes $52 million for the advancement of the Virtual
Lifetime Electronic Record, a Presidential priority that involves our
close collaboration with DoD.
Enhancing Our Management Infrastructure
A critical component of our transformation is to create a reliable
management infrastructure that expands or enhances corporate
transparency at VA, centralizes leadership and decentralizes execution,
and invests in leadership training. This includes increasing investment
in training and career development for our career civil service and
employing a suitable financial management system to track expenditures.
The Department's 2011 budget provides $463 million in General
Administration to support these vital corporate management activities.
This includes $23.6 million in support of the President's initiative to
strengthen the acquisition workforce.
We will place particular emphasis on increasing our investment in
training and career development--helping to ensure that VA's workforce
remain leaders and standard-setters in their fields, skilled,
motivated, and client-oriented. Training and development (including a
leadership development program), communications and team building, and
continuous learning will all be components of reaching this objective.
Capital Infrastructure
VA must provide timely, high-quality health care in medical
infrastructure which is, on average, over 60 years old. In the 2011
budget, we are requesting $1.6 billion to invest in our major and minor
construction programs to accomplish projects that are crucial to right
sizing and modernizing VA's health care infrastructure, providing
greater access to benefits and services for more veterans, closer to
where they live, and adequately addressing patient safety and other
critical facility deficiencies.
Major Construction
The 2011 budget request for VA major construction is $1.151
billion. This includes funding for five medical facility projects in
New Orleans, Louisiana; Denver, Colorado; Palo Alto and Alameda,
California; and Omaha, Nebraska.
This request provides $106.9 million to support the Department's
burial program, including gravesite expansion and cemetery improvement
projects at three national cemeteries--Indiantown Gap, Pennsylvania;
Los Angeles, California; and Tahoma, Washington.
Our major construction request includes $51.4 million to begin
implementation of a new policy to expand and improve access to burial
in a national cemetery. Most significantly, this new policy lowers the
veteran population threshold to build a new national cemetery from
170,000 to 80,000 veterans living within 75 miles of a cemetery. This
will provide access to about 500,000 additional veterans. Moreover, it
will increase our strategic target for the percent of veterans served
by a burial option in a national or state veterans cemetery within 75
miles of their residence from 90 percent to 94 percent.
VA's major construction request also includes $24 million for
resident engineers that support medical facility and national cemetery
projects. This represents a new source of funding for the resident
engineer program, which was previously funded under General Operating
Expenses.
Minor Construction
The $467.7 million request for 2011 for 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 realign critical services; make seismic corrections;
improve patient safety; enhance access to health care; increase
capacity for dental care; enhance patient privacy; improve treatment of
special emphasis programs; and expand our research capability. Minor
construction funds are also used to improve the appearance of our
national cemeteries. Further, minor construction resources will be used
to comply with energy efficiency and sustainability design
requirements.
Summary
Our job at the VA is to serve veterans by increasing their access
to VA benefits and services, to provide them the highest quality of
health care available, and to control costs to the best of our ability.
Doing so will make VA a model of good governance. The resources
provided in the 2011 President's budget will permit us to fulfill our
obligation to those who have bravely served our country.
The 298,000 employees of the VA are committed to providing the
quality of service needed to serve our veterans and their families.
They are our most valuable resource. I am especially proud of several
VA employees that have been singled out for special recognition this
year.
First, let me recognize Dr. Janet Kemp, who received the ``2009
Federal Employee of the Year'' award from the Partnership for Public
Service. Under Dr. Kemp's leadership, VA created the Veterans National
Suicide Prevention Hotline to help veterans in crisis. To date, the
Hotline has received almost 225,000 calls and rescued about 6,800
people judged to be at imminent risk of suicide since its inception.
Second, we are also very proud of Nancy Fichtner, an employee at
the Grand Junction Colorado Medical Center, for being the winner of the
President's first-ever SAVE (Securing Americans Value and Efficiency)
award. Ms. Fichtner's winning idea is for veterans leaving VA hospitals
to be able to take medication they have been using home with them
instead of it being discarded upon discharge.
And thirdly, we are proud of the VA employees at our Albuquerque,
New Mexico Clinical Research Pharmacy Coordinating Center, including
the Center Director, Mike R. Sather, for excellence in supporting
clinical trials targeting current veteran health issues. Their
exceptional and important work garnered the center's recognition as the
2009 Malcolm Baldrige National Quality Award Recipient in the nonprofit
category.
The VA is fortunate to have public servants that are not only
creative thinkers, but also able to put good ideas into practice. With
such a workforce, and the continuing support of Congress, I am
confident we can achieve our shared goal of accessible, high-quality
and timely care and benefits for veterans.
Prepared Statement of Carl Blake, National Legislative
Director, Paralyzed Veterans of America
Chairman Filner, Ranking Member Buyer, and Members of the
Committee, as one of the four co-authors of The Independent Budget
(IB), Paralyzed Veterans of America (PVA) is pleased to present the
views of The Independent Budget regarding the funding requirements for
the Department of Veterans Affairs (VA) health care system for FY 2011.
When looking back on 2009, it is fair to say that the 111th
Congress took an historic step toward providing sufficient, timely, and
predictable funding, and yet it still failed to complete its
appropriations work prior to the start of the new fiscal year on
October 1. The actions of Congress last year generally reflected a
commitment to maintain a viable VA health care system. More important,
Congress showed real interest in reforming the budget process to ensure
that the VA knows exactly how much funding it will receive in advance
of the start of the new fiscal year.
As you know, for more than a decade, the Partnership for Veterans
Health Care Budget Reform (hereinafter ``Partnership''), made up of
nine veterans service organizations, including the four co-authors of
The Independent Budget, advocated for reform in the VA health care
budget formulation process. By working with the leadership of the House
and Senate Committees on Veterans' Affairs, the Military Construction
and Veterans Affairs Appropriations Subcommittees, and key members of
both parties, we were able to move advance appropriations legislation
forward. Congress ultimately approved and the President signed into law
P.L. 111-81, the ``Veterans Health Care Budget Reform and Transparency
Act.'' A review of recent budget cycles made it evident that even when
there was strong support for providing sufficient funding for veterans
medical care programs, the systemic flaws in the budget and
appropriations process continued to hamper access to and threaten the
quality of the VA health care system. Now, with enactment of advance
appropriations the VA can properly plan to meet the health care needs
of the men and women who have served this Nation in uniform.
In February 2009, the President released a preliminary budget
submission for the Department of Veterans Affairs for FY 2010. This
submission only projected funding levels for the overall VA budget. The
Administration recommended an overall funding authority of $55.9
billion for the VA, approximately $5.8 billion above the FY 2009
appropriated level and nearly $1.3 billion more than The Independent
Budget had recommended.
In May, the Administration released its detailed budget blueprint
that included approximately $47.4 billion for medical care programs, an
increase of $4.4 billion over the FY 2009 appropriated level and
approximately $800 million more than the recommendations of The
Independent Budget. The budget also included $580 million in funding
for Medical and Prosthetic Research, an increase of $70 million over
the FY 2009 appropriated level. By the end of the year, Congress
enacted P.L. 111-117, the ``Consolidated Appropriations Act for FY
2010,'' that provided funding for the VA to virtually match the
recommendations of the Administration. While the importance of these
historic funding levels coupled with the enactment of advance
appropriations legislation cannot be overstated, it is important for
Congress and the Administration to continue this commitment to the men
and women who have served and sacrificed for this country.
Funding for FY 2011
Despite the fact that Congress has already provided advance
appropriations for FY 2011, The Independent Budget has chosen to still
present budget recommendations for the medical care accounts
specifically for FY 2011. Included in P.L 111-117 was advance
appropriations for FY 2011. Congress provided approximately $48.2
billion in discretionary funding for VA medical care. When combined
with the $3.3 billion Administration projection for medical care
collections in 2010, the total available operating budget provided by
the appropriations bill is approximately $51.5 billion. Accordingly for
FY 2011, The Independent Budget recommends approximately $52.0 billion
for total medical care, an increase of $4.5 billion over the FY 2010
operating budget level established by P.L. 111-117, the ``Consolidated
Appropriations Act for FY 2010.'' We believe that this estimation
validates the advance projections that the Administration developed
last year and has carried forward into this year. Furthermore, we
remain confident that the Administration is headed in a positive
direction that will ultimately benefit the veterans who rely on the VA
health care system to receive their care.
The medical care appropriation includes three separate accounts--
Medical Services, Medical Support and Compliance, and Medical
Facilities--that comprise the total VA health care funding level. For
FY 2011, The Independent Budget recommends approximately $40.9 billion
for Medical Services. Our Medical Services recommendation includes the
following recommendations:
------------------------------------------------------------------------
------------------------------------------------------------------------
Current Services Estimate $38,988,080,000
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Increase in Patient Workload $1,302,874,000
------------------------------------------------------------------------
Policy Initiatives $650,000,000
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Total FY 2011 Medical Services $40,940,954,000
------------------------------------------------------------------------
Our growth in patient workload is based on a projected increase of
approximately 117,000 new unique patients--Priority Group 1-8 veterans
and covered non-veterans. We estimate the cost of these new unique
patients to be approximately $926 million. The increase in patient
workload also includes a projected increase of 75,000 new Operation
Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans at a
cost of approximately $252 million.
Finally, our increase in workload includes the projected enrollment
of new Priority Group 8 veterans who will use the VA health care system
as a result of the Administration's plan to incrementally increase the
enrollment of Priority Group 8 veterans by 500,000 enrollments by FY
2013. We estimate that as a result of this policy decision, the number
of new Priority Group 8 veterans who will enroll in the VA will
increase by 125,000 in each of the next four years. Based on the
Priority Group 8 empirical utilization rate of 25 percent, we estimate
that approximately 31,250 of these new enrollees will become users of
the system. This translates to a cost of approximately $125 million.
As we have emphasized in the past, the VA must have a clear plan
for incrementally increasing this enrollment. Otherwise, the VA risks
being overwhelmed by significant new workload. The Independent Budget
is committed to working with the VA and Congress to implement a
workable solution to allow all eligible Priority Group 8 veterans who
desire to do so to begin enrolling in the system.
Our policy initiatives have been streamlined to include immediately
actionable items with direct funding needs. Specifically, we have
limited our policy initiatives recommendations to restoring long-term
care capacity (for which a reasonable cost estimate can be determined
based on the actual capacity shortfall of the VA) and centralized
prosthetics funding (based on actual expenditures and projections from
the VA's prosthetics service). In order to restore the VA's long-term
care average daily census (ADC) to the level mandated by P.L. 106-117,
the ``Veterans Millennium Health Care Act,'' we recommend $375 million.
Finally, to meet the increase in demand for prosthetics, the IB
recommends an additional $275 million. This increase in prosthetics
funding reflects the significant increase in expenditures from FY 2009
to FY 2010 (explained in the section on Centralized Prosthetics
Funding) and the expected continued growth in expenditures for FY 2011.
The funding for prosthetics is particularly important because it
reflects current services and represents a demonstrated need now;
whereas, our funding recommendations for long-term care reflect our
desire to see this capacity expanded beyond the current services level.
For Medical Support and Compliance, The Independent Budget
recommends approximately $5.3 billion. Finally, for Medical Facilities,
The Independent Budget recommends approximately $5.7 billion. Our
recommendation once again includes an additional $250 million for non-
recurring maintenance (NRM) provided under the Medical Facilities
account. This would bring our overall NRM recommendation to
approximately $1.26 billion for FY 2011. While we appreciate the
significant increases in the NRM baseline over the last couple of
years, total NRM funding still lags behind the recommended two to four
percent of plant replacement value. Based on that logic, the VA should
actually be receiving at least $1.7 billion annually for NRM (Refer to
Construction section article ``Increase Spending on Nonrecurring
Maintenance).
For Medical and Prosthetic Research, The Independent Budget
recommends $700 million. This represents a $119 million increase over
the FY 2010 appropriated level, and approximately $110 million above
the Administration's request. We are particularly pleased that Congress
has recognized the critical need for funding in the Medical and
Prosthetic Research account in the last couple of years. Research is a
vital part of veterans' health care, and an essential mission for our
national health care system. We are extremely disappointed in the
Administration's decision to virtually flat line the research budget.
VA research has been grossly underfunded in contrast to the growth rate
of other federal research initiatives. At a time of war, the government
should be investing more, not less, in veterans' biomedical research
programs.
The Independent Budget recommendation also includes a significant
increase in funding for Information Technology (IT). For FY 2011, we
recommend that the VA IT account be funded at approximately $3.553
billion. This amount includes approximately $130 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.
This represents an increase of $246 million over the FY 2010
appropriated level as well as the Administrations request. We are
greatly concerned that the Administration is shortchanging this account
in a budget in which the VA and the Department of Defense are called on
to jointly implement the Virtual Lifetime Electronic Record, and in
which the Administration proposes to automate claims processing to
improve the accuracy and timeliness of veterans' benefits, particularly
disability compensation and the new Post-9/11 GI Bill.
As explained in The Independent Budget, there is a significant
backlog of major and minor construction projects awaiting action by the
VA and funding from Congress. We have been disappointed that there has
been inadequate follow-through on issues identified by the Capital
Asset Realignment for Enhanced Services (CARES) process. In fact, we
believe it may be time to revisit the CARES process all together. For
FY 2011, The Independent Budget recommends approximately $1.295 billion
for Major Construction and $785 million for Minor Construction. The
Major Construction recommendation includes approximately $100 million
for research infrastructure and the Minor Construction recommendation
includes approximately $200 million for research facility construction
needs.
We note that the Budget Request reduces funding for Major
Construction and slashes funding for Minor Construction. Despite
additional funding that has been provided in recent years to address
the construction backlog and maintenance needs facing VA, a great deal
remains to be done. We cannot comprehend what policy decisions could
justify such a steep decrease in funding for Minor Construction and we
look forward to reviewing the detailed explanation in the President's
Budget Request.
Advance Appropriations for FY 2012
Public Law 111-81 required the President's budget submission to
include estimates of appropriations for the medical care accounts for
FY 2012 and the VA Secretary to provide detailed estimates of the funds
necessary for these medical care accounts in his budget documents
submitted to Congress. Consistent with advocacy by The Independent
Budget, the law also requires a thorough analysis and public report of
the Administration's advance appropriations projections by the
Government Accountability Office (GAO) to determine if that information
is sound and accurately reflects expected demand and costs to be
incurred in FY 2012 and subsequent years.
We are pleased to see that the Administration has followed through
on its responsibility to provide an estimate for the Medical Care
accounts of the VA for FY 2012. It is important to note that this is
the first year the budget documents have included advance
appropriations estimates. This will also be the first time that the GAO
examines the budget submission to analyze its consistency with VA's
Enrollee Health Care Projection Model, and what recommendations or
other information the GAO report will include. The Independent Budget
looks forward to examining all of this new information and
incorporating it into future budget estimates.
In the end, it is easy to forget, that the people who are
ultimately affected by wrangling over the budget are the men and women
who have served and sacrificed so much for this Nation. We hope that
you will consider these men and women when you develop your budget
views and estimates, and we ask that you join us in adopting the
recommendations of The Independent Budget.
This concludes my testimony. I will be happy to answer any
questions you may have.
Prepared Statement of John L. Wilson, Assistant National
Legislative Director, Disabled American Veterans
Mr. Chairman and Members of the Committee:
I am pleased to have this opportunity to appear before you on
behalf of the Disabled American Veterans (DAV), one of four national
veterans' organizations that create the annual Independent Budget (IB)
for veterans programs, to summarize our recommendations for fiscal year
(FY) 2011.
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 IB--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 24th IB, the IB Veterans Service Organizations
(IBVSOs) 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. 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. My testimony today will focus on three areas: Benefits; General
Operating Expenses; and Judicial Review.
Within the Benefits arena, the first area to address is concurrent
receipt of compensation and military longevity retired pay. It has been
and continues to be the perspective of the IBVSOs that all military
retirees should be permitted to receive military longevity retired pay
and VA disability compensation concurrently, regardless of the level of
their disability rating.
Many veterans, retired from the armed forces based on longevity of
service, must forfeit a portion of their retired pay earned through
faithful performance of military service before they receive VA
compensation for service-connected disabilities. This is inequitable.
Military retired pay is earned by virtue of a veteran's career of
service on behalf of the Nation, careers of no less than 20 years.
Entitlement to disability compensation, on the other hand, is paid
solely because of disabilities resulting from military service,
regardless of the length of service. Most nondisabled military retirees
pursue second careers after serving in order to supplement their
income, thereby justly enjoying a full reward for completion of a
military career with the added reward of full civilian employment
income. In contrast, service-connected disabled military longevity
retirees do not enjoy the same full earning potential. Instead their
earning potential is reduced commensurate with the degree of service-
connected disability.
While Congress has made progress in recent years in correcting this
injustice, current law still provides that service-connected veterans
rated less than 50 percent who retire from the Armed Forces on length
of service will not receive both their VA disability compensation and
full military retired pay.
The IBVSOs recommend Congress enact legislation to repeal the
inequitable requirement that veterans' military retired pay be
offset by an amount equal to their rightfully earned VA
disability compensation.
The next area to address is repeal of the current requirement that
the amount of an annuity under the Survivor Benefit Plan (SBP) be
reduced on account of and by an amount equal to Dependency and
Indemnity Compensation (DIC).
Career members of the armed forces earn entitlement to retired pay
after 20 or more years' service. Unlike many retirement plans in the
private sector, survivors have no entitlement to any portion of the
member's retired pay after his or her death. Under the SBP, deductions
are made from the member's retired pay to purchase a survivors'
annuity. Upon the veteran's death, the annuity is paid monthly to
eligible beneficiaries under the plan. If the veteran died of other
than service-connected causes or was not totally disabled by service-
connected disability for the required time preceding death,
beneficiaries receive full SBP payments. However, if the veteran's
death was due to service or followed from the requisite period of total
service-connected disability, the SBP annuity is reduced by an amount
equal to the DIC payment. If the monthly DIC rate is equal to or
greater than the monthly SBP annuity, then beneficiaries lose all
entitlement to the SBP annuity.
This offset is inequitable because no duplication of benefits is
involved. The offset penalizes survivors of military retired veterans
whose deaths are under circumstances warranting indemnification from
the government separate from the annuity funded by premiums paid by the
veteran from his or her retired pay.
It is the recommendation of the IBVSOs that Congress repeal the
offset between DIC and SBP.
The last area to address within the Benefits section of the IB is
the topic of automobile grants and adaptive equipment. The automobile
and adaptive equipment grants need to be increased and automatically
adjusted annually to cover increases in costs.
The VA provides certain severely disabled veterans and
servicemembers' grants for the purchase of automobiles or other
conveyances. VA also provides grants for adaptive equipment necessary
for the safe operation of these vehicles. Veterans suffering from
service-connected ankylosis of one or both knees or hips are eligible
for the adaptive equipment only. This program also authorizes
replacement or repair of adaptive equipment.
Congress initially fixed the amount of the automobile grant to
cover the full cost of the automobile. However, because sporadic
adjustments have not kept pace with increasing costs, over the past 53
years the value of the automobile allowance has been substantially
eroded. In 1946 the $1,600 allowance represented 85 percent of the
average retail cost and was sufficient to pay the full cost of
automobiles in the ``low-price field.''
The Federal Trade Commission cites National Automobile Dealers
Association data that indicate that the average price of a new car in
2009 was $28,400. The current $11,000 automobile allowance represents
62 percent of the 1946 benefit when adjusted for inflation by the CPI;
however, it is only 39 percent of the average cost of a new automobile.
To restore equity between the cost of an automobile and the allowance,
the allowance, based on 80 percent of the average new vehicle cost,
would be $22,800.
It is the recommendation of the IBVSOs that Congress enact
legislation to increase the automobile allowance to 80 percent
of the average cost of a new automobile in 2009 and then
provide for automatic annual adjustments based on the rise in
the cost of living. Congress should also consider increasing
the automobile allowance to cover 100 percent of the average
cost of a new vehicle and provide for automatic annual
adjustments based on the actual cost of a new vehicle, not the
CPI.
Within the General Operating Expenses arena, the IBVSOs offer
Congress and the Administration many opportunities for improvement. The
first topic of consideration has to do with the Veterans Benefits
Administration (VBA) disability claims process.
While simultaneously enhancing training and increasing individual
and managerial accountability, Congress and the VA must take definitive
steps to reduce delays in the disability claims process caused by
policies and practices that were developed in a disjointed and
haphazard manner.
The adjudication of compensation claims is complex and time
consuming. Failure to develop evidence correctly requires serial
redevelopment, which delays claims resolution and increases
opportunities for mistakes. Further, inadequately trained employees may
fail to recognize when claims development is inadequate for rating
purposes. The lack of effective on-the-job training, as well as the
failure to involve program expertise of senior Veterans Service
Representatives (VSRs) and Rating Veterans Service Representatives
(RVSRs) earlier in the process are critical failures. As a consequence,
VA routinely continues to develop many claims rather than making timely
rating decisions.
Processing policy should be changed to get claims into the hands of
experienced technicians (Journey-level VSRs/RVSRs) earlier in the
process. This way, issues with sufficient evidence can be evaluated,
while development of other outstanding issues continues as directed by
those more experienced technicians.
It is understandable that VA wants to be deliberative as it
determines the next best course of action to address how to improve the
claims process. After all, the VA estimates it will manage as many as
946,000 total claims this fiscal year and provide more than $30 billion
in compensation and pension benefits. The IBVSOs recognize that VA has
a responsibility to administer these programs according to the law.
There is virtually no in-process quality control that could detect
errors before they create undue delays, and provide real-time feedback
to technicians. The claims process is a series of steps VA goes through
to identify necessary evidence, obtain that evidence, and then make
decisions based on the law and the evidence gathered. What fails here
is the execution. While the rules are fairly clear, it is the
overwhelming quantity of the work, inadequate training, lack of
adequate accountability, and pressure to cut corners to produce numbers
that result in an 18 percent substantive error rate (by VA's own
admission). It is difficult to maintain quality control when individual
performance reviews are limited to 5 cases per month, and when there is
virtually no oversight on the propriety of end product closures.
There is ample room to improve the law in a manner that would bring
noticeable efficiency to VA's claims process, such as when VA issues a
Veterans Claims Assistance Act (VCAA) notice letter. These notice
letters, in their current form, do not inform the claimant of what
elements render private medical opinions adequate for VA rating
purposes.
In FY 2007, the Board of Veterans' Appeals (BVA) remanded more than
12,000 cases to obtain a medical opinion. In 2008, that number climbed
to more than 16,000. In the view of the IBVSOs, many of these remands
could have been avoided if VA had accepted sufficient medical opinions
already provided by veterans. While recent court decisions have
indicated that VA should accept private medical opinions that are
credible and acceptable for rating purposes, we have seen no evident
reduction in remands to obtain medical opinions.
To correct this deficiency, we recommend that when VA issues
proposed regulations to implement the recent amendment of title 38,
United States Code Sec. 5103, its proposed regulations contain a
provision that will require it to inform a claimant, in a VCAA notice
letter, of the basic elements that make medical opinions adequate for
rating purposes.
Congress should also consider amending title 38, United States Code
Sec. 5103A(d)(1), to provide that when a claimant submits private
medical evidence, including a private medical opinion, that is
competent, credible, probative, and otherwise adequate for rating
purposes, the Secretary shall not request such evidence from a VA
health care facility. The language we suggest adding to section
5103A(d)(1), would not, however, require VA to accept private medical
evidence if, for example, VA finds that the evidence is not credible
and therefore not adequate for VA rating purposes.
Modifying regional office jurisdiction regarding supplemental
statements of the case (SSOCs) will improve the timeliness of the
appeals process. This proposal is addressed in H.R. 4121, which seeks
to amend title 38, United States Code, to improve the appeals process
of the VA and was introduced by Representative John Hall on November
19, 2009.
In the current process, when an appeal is not resolved, the VA
regional office will issue a statement of the case (SOC) along with a
VA Form 9, to the claimant, who concludes, based on the title of the
Form 9 (Appeal to the BVA) that the case is now going to the VA.
Consequently, the veteran may feel compelled to submit additional or
repetitive evidence in the mistaken belief that his or her appeal will
be reviewed immediately by BVA. But the VARO issues another SSOC each
time new evidence is submitted. This continues until VA finally issues
a VAF-8, Certification of Appeal, which actually transfers the case to
the BVA.
H.R. 4121 would amend this process so that evidence submitted after
the appeal has been certified to the BVA will be forwarded directly to
the BVA and not considered by the regional office unless the appellant
or his or her representative elects to have additional evidence
considered by the regional office. This opt-out clause merely reverses
the standard process without removing any rights from an appellant. The
IBVSOs believe this change should result in reduced appellant lengths,
much less appellant confusion, and nearly 100,000 reduced VA work hours
by eliminating in many cases the requirement to issue SSOCs.
It is the IBVSOs' recommendation that:
Congress should modify current ``duty to assist'' requirements
that VA undertake independent development of the case,
including gathering new medical evidence, when VA determines
the claim already includes sufficient evidence to award all
benefits sought by the veteran.
Congress should allow the BVA to directly hear new evidence in
cases certified to it, rather than require VA's regional
offices to hear the evidence and submit SSOCs.
Congress pass H.R. 4121 to amend the process so that evidence
submitted after the appeal and certified to the BVA be
forwarded directly to the BVA and not considered by the
regional office unless the appellant or his or her
representative elects to have additional evidence considered by
the regional office.
The next area to address is VBA training. Although the VA has
improved its training programs to some extent, more needs to be done to
ensure decision makers and adjudicators are held accountable to
training standards.
The IBVSOs have consistently maintained that VA must invest more in
training adjudicators in order to hold them accountable for accuracy.
VA has made improvements to its training programs in the past few
years; nonetheless, much more improvement is required in order to meet
quality standards that disabled veterans and their families deserve.
Training, informal instruction as well as on-the-job training, has
not been a high enough priority in VA. The IBVSOs have consistently
asserted that proper training leads to better quality decisions, and
that quality is the key to timeliness of VA decision-making. VA will
achieve such quality only if it devotes adequate resources to perform
comprehensive and ongoing training and imposes and enforces quality
standards through effective quality assurance methods and
accountability mechanisms. The Administration and Congress should
require mandatory and comprehensive testing designed to hold trainees
accountable. This requirement should be the first priority in any plan
to improve training. VA should not advance trainees to subsequent
stages of training until they have successfully demonstrated that they
have mastered the material.
One of the most essential resources is experienced and
knowledgeable personnel devoted to training. More management devotion
to training and quality requires a break from the status quo of
production goals above all else. In a 2005 report from the VA Office of
Inspector General, VBA employees were quoted as stating: ``Although
management wants to meet quality goals, they are much more concerned
with quantity. An RVSR is much more likely to be disciplined for
failure to meet production standards than for failing to meet quality
standards,'' and ``there is a lot of pressure to make your production
standard. In fact, your performance standard centers around production
and a lot of awards are based on it. Those who don't produce could miss
out on individual bonuses, etc.'' \1\ Little if anything has changed
since the Inspector General issued this report.\2\ VBA employees
continue to report that they receive minimal time for training, whether
it is self-study, training broadcasts, or classroom training. They
report that management remains focused on production over quality.
---------------------------------------------------------------------------
\1\ Department of Veterans Affairs Office of Inspector General,
Rep. No. 05-00765-137, Review of State Variances in VA Disability
Compensation Payments 61 (May 19, 2005).
\2\ A survey conducted by the Center for Naval Analysis Corporation
for the Veterans' Disability Benefits Commission found that ``some
raters felt that they were not adequately trained or that they lacked
enough experience.'' Veterans' Disability Benefits Commission, October
2007, Honoring the Call to Duty: Veterans' Disability Benefits in the
21st Century. p. 12.
---------------------------------------------------------------------------
The Veterans' Benefits Improvement Act of 2008 mandated some
testing for claims processors and VBA managers, which is an
improvement; however, it does not mandate the type of testing during
the training process as explained herein. Measurable improvement in the
quality of and accountability for training will not occur until such
mandates exist.
Training will only be effective if the VBA training board, or a
more robust oversight entity, can ensure communication and coordination
between the Office of Employee Development and Training, Technical
Training and Evaluation, Veterans Benefits Academy and the five
business lines. Feedback should be collected from ROs to assess the
effectiveness of their training, which can be incorporated into revised
lesson plans as necessary. Communication and close, continued
coordination by each of these offices is essential to the establishment
of a comprehensive, responsive training program.
For a culture of quality to thrive in the VBA, VA leaders must be
the change agents to achieve this important goal. Training is an
essential component to transforming the organization from a production-
at-all-costs focus to one of decisions based quality products which are
delivered in a timely manner.
It is the IBVSOs' recommendation that:
VA should undertake an extensive training program to educate
its adjudicators on how to weigh and evaluate medical evidence
and require mandatory and comprehensive testing of the claims
process and appellate staff. To the extent that VA fails to
provide adequate training and testing, Congress should require
mandatory and comprehensive testing, under which VA will hold
trainees accountable.
VA should hold managers accountable to ensure that the
necessary training and time is provided to ensure all personnel
are adequately trained. Feedback should be collected from ROs
on the effectiveness of the training. The Office of Employee
Development and Training, Technical Training and Evaluation,
Veterans Benefits Academy and the five business lines should
incorporate any emerging trends into revised training plans.
The next topic of consideration is VBA's current accountability and
quality mechanisms. It is the IBVSOs' position that VBA must overhaul
these outdated and ineffective mechanisms.
This can be accomplished through the development and deployment of
a robust new electronic document management system, capable of
converting all claims-related paperwork into secure, official
electronic documentation that is easily accessible and searchable by
all official personnel involved in the process and has built-in
accountability and quality management process management tools.
``Sixty Minutes'' ran a story on January 3, 2010, entitled ``Delay,
Deny and Hope I Die,'' which addressed the issue of the VA's claims
backlog and veterans' frustrations. The VA Deputy Under Secretary for
Benefits, Michael Walcoff, was interviewed for the story. When asked if
VA had a focus on quantity over quality, he stated, ``I don't believe
that they're being pressured to produce claims at the expense of
quality. We stress over and over again to our employees that quality is
our number one indicator, that that's absolutely a requirement for
successful performance.''
While he and others in leadership positions may stress quality,
what employees are compensated for is quantity based on a work credit
system.
In March 2009, the VA's Inspector General discovered that the VA
was making more mistakes than it reported. The internal investigation
found that nearly one out of four files had errors. That is 200,000
claims that ``may be incorrect.''
Although quality may be emphasized and measured in limited ways, as
it currently stands, almost everything in the VBA is production driven.
Employees naturally will work towards those things that enhance
compensation and currently that is production. Performance awards are
based on production alone. They should also be based on demonstrated
quality. However, in order for this to occur, the VBA must implement
stronger accountability quality assurance measures.
What does VBA do to assess the quality of the product it delivers?
The quality assurance tool used by the VA for compensation and pension
claims is the Systematic Technical Accuracy Review (STAR) program.
Under the STAR program, VA reviews a sampling of decisions from
regional offices and bases its national accuracy measures on the
percentage with errors that affect entitlement, benefit amount, and
effective date. However, samples as small as 20 cases per month per
office are inadequate to determine individual quality.
With STAR samples far too small to allow any conclusions concerning
individual quality, rating team coaches who are charged with reviewing
a sample of ratings for each RVSR each month. This review, if conducted
properly, should identify those employees with the greatest success as
well as those with problems. In practice, however, most rating team
coaches have insufficient time to review what could be 100 or more
cases each month. As a result, individual quality is often
underevaluated and employees performing successfully may not receive
the recognition they deserve and those employees in need of extra
training and individualized mentoring may not get the attention they
need to become more effective.
The problems related to the quality of decisions, the timeliness of
decisions, workload management, and safeguarding case files can be
significantly improved by incorporating a robust IT solution. VA should
establish systems that rapidly and securely convert paper documents
into electronic formats, and establish new electronic information
delivery systems that provide universal searchability and connectivity.
This would increase the ability of veterans who have the means and
familiarity with digital approaches to file electronic claims using
VONAPP (Veterans On Line Application) or other future digital claims
filing options. Lost or incorrectly destroyed records must become a
problem of the past, as should the need to transfer thousands of case
files from one location to the next.
The Veterans' Benefits Improvement Act of 2008 (section 226)
required VA to conduct a study on the effectiveness of the current
employee work-credit system and work-management system. In carrying out
the study, VA is required to consider, among other things:
1. Measures to improve the accountability, quality, and accuracy
for processing claims for compensation and pension benefits;
2. Accountability for claims adjudication outcomes; and
3. The quality of claims adjudicated. The legislation requires VA
to submit the report to Congress, which must include the components
required to implement the updated system for evaluating VBA employees,
no later than October 31, 2009. This report was not delivered on time.
This study is a historic opportunity for VA to implement a new
methodology--a new philosophy--by developing a new system with a
primary focus of quality through accountability. Properly undertaken,
the outcome would result in a new institutional mind-set across the
VBA--one that focuses on the achievement of excellence--and change a
mind-set focused mostly on quantity-for-quantity's sake to a focus of
quality and excellence. Those who produce quality work are rewarded and
those who do not are finally held accountable.
It is the recommendation of the IBVSOs that:
The VA Secretary's upcoming report focus on how the Department
will establish a quality assurance and accountability program
that will detect, track, and hold responsible those VA
employees who commit errors while simultaneously providing
employee motivation for the achievement of excellence.
VA should generate the report in consultation with veterans
service organizations most experienced in the claims process.
The performance management system for claims processors should
be adjusted to allow managers to greater flexibility and
enhanced tools to acknowledge and reward staff for higher
levels of performance.
The IBVSOs urge VA to identify new funding for the purposes
enumerated in this section and to ensure that new VBA personnel are
properly supported with necessary IT resources. With restored
investments in these initiatives, the VBA could complement staffing
adjustments for increased workloads with a supportive infrastructure to
improve operational effectiveness. The VBA could resume an adequate
pace in its development and deployment of IT solutions, as well as to
upgrade and enhance training systems for staff to improve operations
and service delivery to veterans. It is vital to the VBA that many of
their unique needs are met in a timely manner, including the following:
expansion of web-based technology and deliverables, such as a web
portal and Training and Performance Support System (TPSS); ``Virtual
VA'' paperless processing; enhanced veteran self-service access to
benefit application, status, and delivery; data integration across
business lines; use of the corporate database; information exchange;
quality assurance programs and controls; and employee skills
certification and training.
It is imperative that TEES and WINRS develop common architecture
designs that maximize data sharing between the new GI Bill and the
Vocational Rehabilitation programs. These programs share common
information about programs of education, school approvals, tuition &
fees, and other similar data which their processing systems should
share more effectively. TEES provides for electronic transmission of
applications and enrollment documentation along with automated expert
processing.
Also, the IBVSOs believe the VBA should continue to develop and
enhance data-centric benefits integration with ``Virtual VA'' and
modification of The Imaging Management System (TIMS). All these systems
serve to replace paper-based records with electronic files for
acquiring, storing, and processing claims data.
Virtual VA supports pension maintenance activities at three VBA
pension maintenance centers. Further enhancement would allow for the
entire claims and award process to be accomplished electronically. TIMS
is the Education Service system for electronic education claims files,
storage of imaged documents, and workflow management. The current VBA
initiative is to modify and enhance TIMS to make it fully interactive
and allow for fully automated claims and award processing by the
Education Service and VR&E nationwide.
VA's TPSS is a multimedia, multimethod training tool that applies
the instructional systems development methodology to train and support
employee performance of job tasks. These TPSS applications require
technical updating to incorporate changes in laws, regulations,
procedures, and benefit programs. In addition to regular software
upgrades, a help desk for users is needed to make TPSS work
effectively.
VBA initiated its skills certification instrument in 2004. This
tool helps the VBA assess the knowledge base of veterans' service
representatives. VBA intends to develop additional skills certification
modules to test rating veteran service representatives, decision review
officers, field examiners, pension maintenance center employees, and
veterans' claims examiners in the Education Service.
By providing veterans regionalized telephone contact access from
multiple offices within specified geographic locations, VA could
achieve greater efficiency and improved customer service. Accelerated
deployment of virtual information centers will more timely accomplish
this beneficial effect.
It is the IBVSOs' recommendation that:
VA complete the replacement of the antiquated and inadequate
Benefits Delivery Network (BDN) with the Veterans Service
Network (VETSNET), or a successor system, that creates a
comprehensive nationwide information system for claims
development, adjudication, and payment administration.
VA enhance the Education Expert System (TEES) for the Education
Service to support the new GI Bill recently enacted by Congress
in Public Law 110-181.
VA update the corporate WINRS (CWINRS) to support programs of
the Vocational Rehabilitation and Employment (VR&E) Service.
CWINRS is a case management and information system allowing for
more efficient award processing and sharing of information
nationwide.
Congress provide VBA adequate funding for its information
technology initiatives to improve multiple information and
information-processing systems and to advance ongoing,
approved, and planned initiatives such as those enumerated in
this section. These IT programs should be increased annually by
a minimum of 5 percent or more.
VBA revise its training programs to stay abreast of IT program
changes and modern business practices.
VA ensure that recent funding specifically designated by
Congress to support the IT needs of the VBA, and of new VBA
staff authorized in FY 2009, are provided to VBA as intended,
and on an expedited basis.
The Chief Information Officer and Under Secretary for Benefits
should give high priority to the review and report required by
Public Law 110-389 and redouble their efforts to ensure these
ongoing VBA initiatives are fully funded and accomplish their
stated intentions.
The VA Secretary examine the impact of the current level of IT
centralization under the chief information officer on these key
VBA programs and, if warranted, shift appropriate
responsibility for their management, planning, and budgeting
from the chief information officer to the Under Secretary for
Benefits.
Congress require the Secretary to establish a quality assurance
and accountability program that will detect, track, correct and
prevent future errors and, by creating a work environment that
properly aligns incentives with goals, holds both VBA employees
and management accountable for their performance.
The next topic to address in the area of General Operating Expenses
is staffing. It is the IBVSOs' position that recent staffing increases
in the VBA may now be sufficient to reduce the backlog of pending
claims, once new hires complete training. However, any move by Congress
to reduce VBA staffing in the foreseeable future will guarantee a
return to unacceptably high backlogs.
VA began making some progress in reducing pending rating claims in
FY 2008. At the end of FY 2009, over 940,000 claims had been processed,
well above the 940,000 that had been projected. Over 388,000
compensation claims were pending rating decisions, which is above the
386,000 of FY 2008.\3\
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\3\ Monday Morning Workload Report, October 3, 2009, pg. 1.
---------------------------------------------------------------------------
During FY 2008, VA hired nearly 2,000 staff authorized by Congress.
The total number of new hires since 2007 now stands at over 4,200.
Historically, it takes at least two years for new nonrating claims
processors to acquire sufficient knowledge and experience to be able to
work independently with both speed and quality. Those selected to make
rating decisions require a separate period of at least two years of
training before they have the skills to accurately complete most rating
claims.
It would be interesting to know the attrition rate of these 4,200
new hires. How many have successfully completed training? How many
current employees have retired or terminated employment in comparison?
Answers to these questions and other questions would be useful in
discussions on the adequacy of the number of new hires and their
current and future ability to substantially affect the claims backlog.
Once everyone is fully trained and reductions in the backlog are
seriously under way, it would be a mistake of monumental proportions if
Congress were to allow staffing levels to decline. The IBVSOs do not
suggest that VBA staffing remain off limits to Congressional budget
considerations. What we believe, however, is that staffing reductions
should occur only after the VBA has demonstrated, through technological
innovation and major management and leadership reforms, that it has the
right people and the right tools in place to ensure that claims can be
processed both timely and correctly. As with backlog reductions, these
changes will also not occur overnight. Congressional oversight,
therefore, is critical to buttress any real improvements in claims
processing and quality decisions.
It is the recommendation of the IBVSOs that:
Congress require the VA to report the attrition rate for the
4,200 new hires; how many successfully completed training; how
many current employees have retired or terminated employment in
comparison.
Congress continue to monitor current staffing levels and ensure
that they remain in place until such time as the backlog is
eliminated.
Once the backlog is eliminated, Congress consider staffing
reductions in the VBA but only after ensuring that quality
problems are fully and adequately addressed.
Congress ensure through oversight that management and
leadership reforms in the VBA are completed and permanent.
The next topic of consideration is Vocational Rehabilitation and
Employment, a program that continues to provide critical resources to
service-connected disabled veterans despite inadequate staffing levels.
To meet its ongoing workload demands and to implement new initiatives
recommended by the Secretary's Vocational Rehabilitation and Employment
(VR&E) Task Force, VR&E needs to increase its staffing.
The cornerstone among several new initiatives is VR&E's Five-Track
Employment Process, which aims to advance employment opportunities for
disabled veterans. Integral to attaining and maintaining employment
through this process, the employment specialist position was changed to
employment coordinator and was expanded to incorporate employment
readiness, marketing, and placement responsibilities. In addition,
increasing numbers of severely disabled veterans from Operations
Enduring and Iraqi Freedom (OEF/OIF) benefit from VR&E's Independent
Living Program, which empowers such veterans to live independently in
the community to the maximum extent possible. Independent living
specialists provide the services required for the success of severely
disabled veterans participating in this program. VR&E needs
approximately 200 additional full-time employees (FTEs) to offer these
services nationally.
Given its increased reliance on contract services, VR&E needs
approximately 50 additional FTEs dedicated to management and oversight
of contract counselors and rehabilitation and employment service
providers. As a part of its strategy to enhance accountability and
efficiency, the VA VR&E Task Force recommended creation and training of
new staff positions for this purpose. Other new initiatives recommended
by the task force also require an investment of personnel resources.
Finally, VA has a pilot program at the University of Southern
Florida entitled ``Veteran Success on Campus'' that places a qualified
Vocational Rehabilitation Counselor on the campus to assist veterans in
Vocational Rehabilitation as well as veterans enrolled in the Post-9/11
or other VA educational programs. The pilot has garnered high praise
from the University, the American Council on Education, and the press.
VA should be authorized to expand the program significantly in the next
fiscal year.
In FY 2009, VR&E was authorized 1,105 FTEs. The IBVSOs have been
informed that this number has been ``frozen'' due to the unknown impact
the implementation of chapter 33 benefits will have on the VR&E
program. Last year, we recommended that total staffing be increased to
manage the current and anticipated workload as stated in the
Secretary's VR&E Task Force. We believe that this increase is still
warranted. VA currently has approximately 106,000 enrollees in Chapter
31. The IBVSOs believe that a ratio of 1:96 (which includes
administrative support) is inadequate to provide the level of
counseling and support that our wounded and disabled veterans need to
achieve success in their employment goals.
It is the recommendation of the IBVSOs that Congress should
authorize 1,375 total FTEs for the Vocational Rehabilitation and
Employment Service for FY 2010.
The last area of the IB that I wish to address is Judicial Review.
From its creation in 1930, decisions of the Veterans Administration,
now the Department of Veterans Affairs, could not be appealed outside
VA except on rare Constitutional grounds. This was thought to be in the
best interests of veterans, in that their claims for benefits would be
decided solely by an agency established to administer veteran friendly
laws in a paternalistic and sympathetic manner. At the time, Congress
also recognized that litigation could be very costly and sought to
protect veterans from such expense.
For the most part, VA worked well. Over the course of the next 50
years, VA made benefit decisions in millions of claims, providing
monetary benefits and medical care to millions of veterans. Most
veterans received the benefits to which they were entitled.
Congress eventually came to realize that without judicial review,
the only remedy available to correct VA's misinterpretation of laws, or
the misapplication of laws to veterans claims, was through the unwieldy
hammer of new legislation.
In 1988, Congress thus enacted legislation to authorize judicial
review and created the United States Court of Appeals for Veterans
Claims (CAVC) to hear appeals from BVA.
Today, the VA's decisions on claims are subject to judicial review
in much the same way as a trial court's decisions are subject to review
on appeal. This review process allows an individual to challenge not
only the application of law and regulations to an individual claim, but
more importantly, contest whether VA regulations accurately reflect the
meaning and intent of the law. When Congress established the CAVC, it
added another beneficial element to appellate review by creating
oversight of VA decision-making by an independent, impartial tribunal
from a different branch of government. Veterans are no longer without a
remedy for erroneous BVA decisions.
Judicial review of VA decisions has, in large part, lived up to the
positive expectations of its proponents. Nevertheless, based on past
recommendations in the IB, Congress has made some important adjustments
to the judicial review process based on lessons learned over time. More
precise adjustments are still needed to conform judicial review to
Congressional intent. Accordingly, IBVSOs make the following
recommendations to improve the processes of judicial review in
veterans' benefits matters.
In the area of scope of review, the IBVSOs believe that to achieve
the law's intent that the CAVC enforce the benefit-of-the-doubt rule on
appellate review, Congress must enact more precise and effective
amendments to the statute setting forth the Court's scope of review.
Title 38, United States Code, section 5107(b) grants VA claimants a
statutory right to the ``benefit of the doubt'' with respect to any
benefit under laws administered by the Secretary of Veterans Affairs
when there is an approximate balance of positive and negative evidence
regarding any issue material to the determination of a matter. Yet, the
CAVC has affirmed many BVA findings of fact when the record contains
only minimal evidence necessary to show a ``plausible basis'' for such
finding. The CAVC upholds VA findings of ``material fact'' unless they
are clearly erroneous and has repeatedly held that when there is a
``plausible basis'' for the BVA factual finding, it is not clearly
erroneous.
This makes a claimant's statutory right to the ``benefit of the
doubt'' meaningless because claims can be denied and the denial upheld
when supported by far less than a preponderance of evidence. These
actions render Congressional intent under section 5107(b) meaningless.
To correct this situation, Congress amended the law with the
enactment of the Veterans Benefits Improvement Act of 2008 to expressly
require the CAVC to consider whether a finding of fact is consistent
with the benefit-of-the doubt rule; however this intended effect of
section 401 of the Veterans Benefits Act of 2008 has not been used in
subsequent Court decisions.
Prior to the Veterans Benefits Act, the Court's case law provided
(1) that the Court was authorized to reverse a BVA finding of fact when
the only permissible view of the evidence of record was contrary to
that found by the BVA and (2) that a BVA finding of fact must be
affirmed where there was a plausible basis in the record for the
Board's determination.
As a result of Veterans Benefits Act section 401 amendments to
section 7261(a)(4), the CAVC is now directed to ``hold unlawful and set
aside or reverse'' any ``finding of material fact adverse to the
claimant. . . if the finding is clearly erroneous.'' \4\ Furthermore,
Congress added entirely new language to section 7261(b)(1) that
mandates the CAVC to review the record of proceedings before the
Secretary and the BVA pursuant to section 7252(b) of title 38 and
``take due account of the Secretary's application of section 5107(b) of
this title. . . .'' \5\
---------------------------------------------------------------------------
\4\ 38 U.S.C. Sec. 7261(a)(4). See also 38 U.S.C. Sec. 7261(b)(1).
\5\ 38 U.S.C. Sec. 7261(b)(1).
The Secretary's obligation under section 5107(b), as referred to in
---------------------------------------------------------------------------
section 7261(b)(1), is as follows:
(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.\6\
---------------------------------------------------------------------------
\6\ 38 U.S.C. Sec. 5107(b).
Congress wanted for the Court to take a more proactive and less
deferential role in its BVA fact-finding review, as detailed in a joint
explanatory statement of the compromise agreement contained in the
legislation:\7\
---------------------------------------------------------------------------
\7\ 148 Congressional Record S11337, H9007.
[T]he Committees expect the Court to reverse clearly erroneous
findings when appropriate, rather than remand the case. The new
subsection (b) [of section 7261] would maintain language from
the Senate bill that would require the Court to examine the
record of proceedings before the Secretary and BVA and the
special emphasis during the judicial process on the benefit-of-
doubt provisions of section 5107(b) as it 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-doubt'' provision.\8\
---------------------------------------------------------------------------
\8\ 148 Congressional Record S11337, H9003 (daily ed. November 18,
2002) (emphasis added). (Explanatory statement printed in Congressional
Record as part of debate in each body immediately prior to final
passage of compromise agreement.)
With the foregoing statutory requirements, the Court should no
longer uphold a factual finding by the Board solely because it has a
plausible basis, inasmuch as that would clearly contradict the
requirement that the CAVC's decision must take due account whether the
factual finding adheres to the benefit-of-the-doubt rule. Yet such CAVC
decisions upholding BVA denials because of the ``plausible bases''
standard continue as if Congress never acted.
It is the IBVSOs' recommendation that:
Congress clearly intended a less deferential standard of review
of the Board's application of the benefit-of-the-doubt rule
when it amended title 38, United States Code, section 7261 in
2002, yet there has been no substantive change in the Court's
practices. Therefore, to clarify the less deferential level of
review that the Court should employ, Congress should amend
title 38, United States Code, section 7261(a) by adding a new
section, (a)(5), that states: ``(5) In conducting review of
adverse findings under (a)(4), the Court must agree with
adverse factual findings in order to affirm a decision.''
Congress should also require the Court to consider and
expressly state its determinations with respect to the
application of the benefit-of-the-doubt doctrine under title
38, United States Code, section 7261(b)(1), when applicable.
The next topic to address is the appointment of judges to the CAVC.
The CAVC received well over 4,000 cases during FY 2008. According to
the Court's annual report, the average number of days it took to
dispose of cases was nearly 450. This period has steadily increased
each year over the past four years, despite the Court having recalled
retired judges numerous times over the past two years specifically
because of the backlog.
Veterans' law is an extremely specialized area of the law that
currently has fewer than 500 attorneys nationwide whose practices are
primarily in veterans law. Significant knowledge and experience in this
practice area would reduce the amount of time necessary to acclimate a
new judge to the Court's practice, procedures, and body of law.
A reduction in the time to acclimate would allow a new judge to
begin a full caseload in a shorter period, thereby benefiting the
veteran population. The Administration should therefore consider
appointing new judges to the Court from the selection pool of current
veterans law practitioners.
The IBVSOs urge the Administration to consider that any new
judges appointed to the CAVC be selected from the knowledgeable
pool of current veterans law practitioners.
The last topic to address in this area is in reference to Court
facilities. During the 21 years since the CAVC was formed in accordance
with legislation enacted in 1988, it has been housed in commercial
office buildings. It is the only Article I court that does not have its
own courthouse.
The ``Veterans Court'' should be accorded at least the same degree
of respect enjoyed by other appellate courts of the United States.
Congress has finally responded by allocating $7 million in FY 2008 for
preliminary work on site acquisition, site evaluation, preplanning for
construction, architectural work, and associated other studies and
evaluations. The issue of providing the proper court facility is now
moving forward.
It is the recommendation of the IBVSOs that Congress should
provide all funding as necessary to construct a courthouse and
justice center in a location befitting the CAVC.
We hope the Committee will review these recommendations and give
them consideration for inclusion in your legislative plans for FY 2011.
Mr. Chairman, thank you for inviting the DAV and other member
organizations of the IB to testify before you today.
Prepared Statement of Eric A. Hilleman, Director, National
Legislative Service, Veterans of Foreign Wars of the United States
MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE:
On behalf of the 2.1 million men and women of the Veterans of
Foreign Wars of the U.S. (VFW) and our Auxiliaries, I would like to
thank you for the opportunity to 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.
VA's infrastructure--particularly within its health-care system--is
at a crossroads. The system is facing many challenges, including the
average age of buildings (60 years) and significant funding needs for
routine maintenance, upgrades, modernization and construction. VA is
beginning a patient-centered reformation and transformation of the way
it delivers care and new ways of managing its infrastructure plan based
on needs of sick and disabled veterans in the 21st Century. Regardless
of what the VA health care system of the future looks like, our focus
must remain on a lasting and accessible VA health-care system that is
dedicated to their unique needs and one that can provide high quality,
timely care when and where they need it.
VA manages a wide portfolio of capital assets throughout the
Nation. According to its latest Capital Asset Plan, VA is responsible
for 5,500 buildings and almost 34,000 acres of land. It is a vast
network of facilities that requires significant time and attention from
VA's capital asset managers.
CARES--VA's data-driven assessment of VA's current and future
construction needs gave VA a long-term roadmap and has helped guide its
capital planning process over the past few fiscal years. CARES showed a
large number of significant construction priorities that would be
necessary for VA to fulfill its obligation to this Nation's veterans
and over the last several fiscal years, the administration and Congress
have made significant inroads in funding these priorities. Since FY
2004, $4.9 billion has been allocated for these projects. Of these
CARES-identified projects, VA has completely five and another 27 are
currently under construction. It has been a huge, but necessary
undertaking and VA has made slow, but steady progress on these critical
projects.
The challenge for VA in the post-CARES era is that there are still
numerous projects that need to be carried out, and the current backlog
of partially funded projects that CARES has identified is large, too.
This means that VA is going to continue to require significant
appropriations for the major and minor construction accounts to live up
to the promise of CARES.
VA's most recent Asset Management Plan provides an update of the
state of CARES projects--including those only in the planning of
acquisition process. Table 4-5: (page 7.4-49) shows a need of future
appropriations to complete these projects of $3.25 billion.
------------------------------------------------------------------------
Future Funding Needed ($ In
Project Thousands)
------------------------------------------------------------------------
Denver 492,700
------------------------------------------------------------------------
San Juan 122,920
------------------------------------------------------------------------
New Orleans 370,000
------------------------------------------------------------------------
St. Louis 364,700
------------------------------------------------------------------------
Palo Alto 478,023
------------------------------------------------------------------------
Bay Pines 80,170
------------------------------------------------------------------------
Seattle 38,700
------------------------------------------------------------------------
Seattle 193,830
------------------------------------------------------------------------
Dallas 80,100
------------------------------------------------------------------------
*Louisville 1,100,000
------------------------------------------------------------------------
TOTAL 3,246,143
------------------------------------------------------------------------
This amount represents just the backlog of current construction
projects. It does reflect the administration's FY 2011 proposed
appropriation toward Denver, New Orleans, and Palo Alto. (*Louisville's
cost estimate is found on table 5-6, on Page 7.5-93).
Meanwhile, VA continues to identify and reprioritize potential
major construction projects. These priorities, which are assessed using
the rigorous methodology that guided the CARES decisions are released
in the Department's annual Five Year Capital Asset Plan, which is
included in the Department's budget submission. The most recent one was
included in Volume IV and is available on VA's Web site: http://
www4.va.gov/budget/docs/summary/Fy2011_Volume_4-
Construction_and_5_Year_Cap_Plan.pdf.
Table 4-5 shows a long list of partially funded major construction
projects. These 82 ongoing projects demonstrate the continued need for
VA to upgrade and repair its aging infrastructure, and that continuous
funding is necessary for not just the backlog of projects, but to keep
VA viable for today's and future veterans.
In a November 17, 2008 letter to the Senate Veterans Affairs
Committee, Secretary Peake said that ``the Department estimates that
the total funding requirement for major medical facility projects over
the next 5 years would be in excess of $6.5 billion.''
It is clear that VA needs a significant infusion of cash for its
construction priorities. VA's own words and studies show this.
------------------------------------------------------------------------
Major Construction Account Recommendations
-------------------------------------------------------------------------
Recommendation ($ in
Category Thousands)
------------------------------------------------------------------------
VHA Facility Construction $1,000,000
------------------------------------------------------------------------
NCA Construction $60,000
------------------------------------------------------------------------
Advance Planning $40,000
------------------------------------------------------------------------
Master Planning $15,000
------------------------------------------------------------------------
Historic Preservation $20,000
------------------------------------------------------------------------
Medical Research Infrastructure $100,000
------------------------------------------------------------------------
Miscellaneous Accounts $58,000
------------------------------------------------------------------------
TOTAL $1,295,000
------------------------------------------------------------------------
VHA Facility Construction--this amount would allow VA to
continue digging into the $3.25 billion backlog of partially funded
construction projects. Depending on the stages and ability to complete
portions of the projects, any additional money could be used to fund
new projects identified by VA as part of its prioritization methodology
in the Five-Year Capital Plan.
NCA Construction's Five-Year Capital Plan details
numerous potential major construction projects for the National
Cemetery Association throughout the country. This level of funding
would allow VA to begin construction on at least three of its scored
priority projects.
Advance Planning--helps develop the scope of the major
construction projects as well as identifying proper requirements for
their construction. It allows VA to conduct necessary studies and
research similar to planning processes in the private sector.
Master Planning--a description of our request follows
later in the text.
Historic Preservation--a description of our request
follows later in the text.
Miscellaneous Accounts--these include the individual line
items for accounts such as asbestos abatement, the judgment fund and
hazardous waste disposal. Our recommendation is based upon the historic
level for each of these accounts.
------------------------------------------------------------------------
Minor Construction Account Recommendations
-------------------------------------------------------------------------
Category Funding ($ in Thousands)
------------------------------------------------------------------------
Veterans Health Administration $450,000
------------------------------------------------------------------------
Medical Research Infrastructure $200,000
------------------------------------------------------------------------
National Cemetery Administration $100,000
------------------------------------------------------------------------
Veterans Benefits Administration $20,000
------------------------------------------------------------------------
Staff Offices $15,000
------------------------------------------------------------------------
TOTAL $785,000
------------------------------------------------------------------------
Veterans Health Administration--Page 7.8-138 of VA's
Capital Plan reveals hundreds of already identified minor construction
projects. These projects update and modernize VA's aging physical plant
ensuring the health and safety of veterans and VA employees.
Additionally, a great number of minor construction projects address
FCA-identified maintenance deficiencies; the backlog of 216 projects in
FY 2010 with over $1 billion that has yet to be funded.
Medical Research Infrastructure--a description of our
request follows later in the text.
National Cemetery Administration of the Capital Plan
identifies numerous minor construction projects throughout the country
including the construction of several columbaria, installation of
crypts and landscaping and maintenance improvements. Some of these
projects could be combined with VA's new NCA nonrecurring maintenance
efforts.
Veterans Benefits Administration--Page 7.6-106 of the
Capital Plan lists several minor construction projects in addition to
the leasing requirements VBA needs.
Staff Offices--Page 7.8-134 lists numerous potential
minor construction projects related to staff offices.
Increase Spending on Nonrecurring Maintenance
The deterioration of many VA properties requires increased spending on
nonrecurring maintenance
For years, The Independent Budget Veteran Service Organizations
(IBVSOs) have highlighted the need for increased funding for the
nonrecurring maintenance (NRM) account. NRM consists of small projects
that are essential to the proper maintenance of and preservation of the
lifespan of VA's facilities. NRM projects are one-time repairs such as
maintenance to roofs, repair and replacement of windows and flooring or
minor upgrades to the mechanical or electrical systems. They are a
necessary component of the care and stewardship of a facility.
These projects are so essential because if left unrepaired, they
can really take their toll on a facility, leading to more costly
repairs in the future, and the potential of a need for a minor
construction project. Beyond the fiscal aspects, facilities that fall
into disrepair can create access difficulties and impair patient and
staff health and safety, and if things do develop into a larger
construction projection because early repairs were not done, it creates
an even larger inconvenience for veterans and staff.
The industry standard for medical facilities is for managers to
spend from 2 percent-4 percent of plant replacement value (PRV) on
upkeep and maintenance. The 1998 PriceWaterhouseCoopers study of VA's
facilities management practices argued for this level of funding and
previous versions of VA's own Asset Management Plan have agreed that
this level of funding would be adequate.
The most recent estimate of VA's PRV is from the FY 08 Asset
Management Plan. Using the standards of the Federal Government's
Federal Real Property Council (FRPC), VA's PRV is just over $85 billion
(page 26).
Accordingly, to fully maintain its facilities, VA needs a NRM
budget of at least $1.7 billion. This number would represent a doubling
of VA's budget request from FY 2009, but is in line with the total NRM
budget when factoring in the increases Congress gave in the
appropriations bill and the targeted funding included in the
supplemental appropriations bills.
Increased funding is required not to just to fill current
maintenance needs and levels, but also to dip into the extensive
backlog of maintenance requirements VA has. VA monitors the condition
of its structures and systems through the Facility Condition Assessment
(FCA) reports. VA surveys each medical center periodically, giving each
building a thorough assessment of all essential systems. Systems are
assigned a letter grade based upon the age and condition of various
systems, and VA gives each component a cost for repair or replacement.
The bulk of these repairs and replacements are conducted through
the NRM program, although the large increases in minor construction
over the last few years have helped VA to address some of these
deficiencies.
VA's 5-Year Capital Plan discusses FCAs and acknowledges the
significant backlog the number of high priority deficiencies--those
with ratings of D or F--had replacement and repair costs of over $9.4
billion, found on page 7.1-18. VA estimates that 52 percent of NRM
dollars are obligated to toward this cost.
VA uses the FCA reports as part of its Federal Real Property
Council (FRPC) metrics. The department calculates a Facility Condition
Index, which is the ratio of the cost of FCA repairs to the cost of
replacement. According to the FY 08 Asset Management Plan, this metric
has gone backwards from 82 percent in 2006 to just 68 percent in 2008.
VA's strategic goal is 87 percent, and for it to meet that, it would
require a sizeable investment in NRM and minor construction.
Given the low level of funding the NRM account has historically
received, the IBVSOs are not surprised at the metrics or the dollar
cost of the FCA deficiencies. The 2007 ``National Roll Up of
Environment of Care Report,'' which was conducted in light of the
shameful maintenance deficiencies at Walter Reed further prove the need
for increased spending on this account. Maintenance has been neglected
for far too long, and for VA to provide safe, high-quality health care
in its aging facilities, it is essential that more money be allocated
for this account.
We also have concerns with how NRM funding is actually apportioned.
Since it falls under the Medical Care account, NRM funding has
traditionally been apportioned using the Veterans Equitable Resource
Allocation (VERA) formula. This model works when divvying up health-
care dollars, targeting money to those areas with the greatest demand
for health care. When dealing with maintenance needs, though, this same
formula may actually intensify the problem, moving money away from
older hospitals, such as in the northeast, to newer facilities where
patient demand is greater, even if the maintenance needs are not as
high. We were happy to see that the conference reports to the VA
appropriations bills required NRM funding to be apportioned outside the
VERA formula, and we would hope that this continues into the future.
Another issue related to apportionment of funding came to light in
a May 2007 Government Accountability Office (GAO) report. They found
that the bulk of NRM funding is not actually apportioned until
September, the final month of the fiscal year. In September 2006, GAO
found that VA allocated 60 percent of that year's NRM funding. This is
a shortsighted policy that impairs VA's ability to properly address its
maintenance needs, and since NRM funding is year-to-year, it means that
it could lead to wasteful or unnecessary spending as hospital managers
rushed in a flurry to spend their apportionment before forfeiting it
back. We cannot expect VA to perform a year's worth of maintenance in a
month. It is clearly poor policy and not in the best interest of
veterans. The IBVSOs believe that Congress should consider allowing
some NRM money to be carried over from one fiscal year to another.
While we would hope that this would not resort to hospital managers
hording money, it could result in more efficient spending and better
planning, rather than the current situation where hospital managers
sometimes have to spend through a large portion of maintenance funding
before losing it at the end of the fiscal year.
Recommendations:
VA must dramatically increase funding for nonrecurring maintenance
in line with the 2 percent-4 percent total that is the industry
standard so as to maintain clean, safe and efficient facilities. VA
also requires additional maintenance funding to allow the department to
begin addressing the substantial maintenance backlog of FCA-identified
projects.
Portions of the NRM account should be continued to be funded
outside of the VERA formula so that funding is allocated to the
facilities that actually have the greatest maintenance needs.
Congress should consider the strengths of allowing VA to carry over
some maintenance funding from one fiscal year to another so as to
reduce the temptation some VA hospital managers have of inefficiently
spending their NRM money at the end of a fiscal year for fear of losing
it.
Inadequate Funding and Declining Capital Asset Value
VA must protect against deterioration of its infrastructure and a
declining capital asset value
The last decade of underfunded construction budgets has meant that
VA has not adequately recapitalized its facilities. Recapitalization is
necessary to protect the value of VA's capital assets through the
renewal of the physical infrastructure. This ensures safe and fully
functional facilities long into the future. VA's facilities have an
average age approaching 60 years, and it is essential that funding be
increased to renovate, repair and replace these aging structures and
physical systems.
As in past years, the IBVSOs cite the Final Report of the
President's Task Force to Improve Health Care Delivery for Our Nation's
Veterans (PTF). It found that from 1996-2001, VA's recapitalization
rate was just 0.64 percent. At this rate, VA's structures would have an
assumed life of 155 years.
The PTF cited a PriceWaterhouseCoopers study of VA's facilities
management programs that found that to keep up with industry standards
in the private sector and to maintain patient and employee safety and
optimal health care delivery, VA should spend a minimum of 5 to 8
percent of plant replacement value (PRV) on its total capital budget.
The FY 08 VA Asset Management Plan provides the most recent
estimate of VA's PRV. Using the guidance of the Federal Government's
Federal Real Property Council (FRPC), VA's PRV is just over $85 billion
(page 26).
Accordingly, using that 5 to 8 percent standard, VA's capital
budget should be between $4.25 and $6.8 billion per year in order to
maintain its infrastructure.
VA's capital budget request for FY 2009--which includes major and
minor construction, maintenance, leases and equipment--was just $3.6
billion. We greatly appreciate that Congress increased funding above
that level with an increase over the administration request of $750
million in major and minor construction alone. That increased amount
brought the total capital budget in line with industry standards, and
we strongly urge that these targets continue to be met and we would
hope that future VA requests use these guidelines as a starting point
without requiring Congress to push them past the target.
Recommendation:
Congress and the Administration must ensure that there are adequate
funds for VA's capital budget so that VA can properly invest in its
physical assets to protect their value and to ensure that the
Department can continue to provide health care in safe and functional
facilities long into the future.
Maintain VA's Critical Infrastructure
The IBVSOs are concerned with VA's recent attempts to back away
from the capital infrastructure blueprint laid out by CARES and we are
worried that its plan to begin widespread leasing and contracting for
inpatient services might not meet the needs of veterans.
VA acknowledges three main challenges with its capital
infrastructure projects. First, they are costly. According to a March
2008 briefing given to the VSO community, over the next five years, VA
would need $2 billion per year for its capital budget. Second, there is
a large backlog of partially funded construction projects. That same
briefing claimed that the difference in major construction requests
given to OMB was $8.6 billion from FY 03 through FY 09, and that they
have received slightly less than half that total. Additionally, there
is a $2 billion funding backlog for projects that are partially but not
completely funded. Third, VA is concerned about the timeliness of
construction projects, noting that it can take the better part of a
decade from the time VA initially proposes a project until the doors
actually open for veterans.
Given these challenges, VA has floated the idea of a new model for
health care delivery, the Health Care Center Facility (HCCF) leasing
program. Under the HCCF, VA would begin leasing large outpatient
clinics in lieu of major construction. These large clinics would
provide a broad range of outpatient services including primary and
specialty care as well as outpatient mental health services and
ambulatory surgery.
On the face of it, this sounds like a good initiative. Leasing has
the advantage of being able to be completed quickly, as well as being
adaptable, especially when compared to the major construction process.
Leasing has been particularly valuable for VA as evidenced by the
success of the Community Based Outpatient Clinics (CBOCs) and Vet
Centers.
Our concern rests, however, with VA's plan for inpatient services.
VA aims to contract for these essential services with affiliates or
community hospitals. This program would privatize many services that
the IBVSOs believe VA should continue to provide. We lay out our
objections to privatization and widespread contracting for care
elsewhere in The Independent Budget.
Beyond those objections, though, is the example of Grand Island,
Nebraska. In 1997, the Grand Island VA Medical Center closed its
inpatient facilities, contracting out with a local hospital for those
services. Recently, the contract between the local facility and VA was
canceled, meaning veterans in that area can no longer receive inpatient
services locally. They must travel great distances to other VA
facilities such as the Omaha VA Medical Center. In some cases, when
Omaha is unable to provide specialized care, VA is flying patients at
its expense to faraway VA medical centers, including those in St. Louis
and Minneapolis.
Further, with the canceling of that contract, St. Francis no longer
provides the same level of emergency services that a full VA Medical
Center would provide. With VA's restrictions on paying for emergency
services in non-VA facilities, especially for those who may have some
form of private insurance, this amounts to a cut in essential services
to veterans. Given the expenses of air travel and medevac services, the
current arrangement in Grand Island has likely not resulted in any cost
savings for VA. Ferrying sick and disabled veterans great distances for
inpatient care also raises patient safety and quality concerns.
The HCCF program raises many concerns for the IBVSOs that VA must
address before we can support the program. Among these questions, we
wonder how VA would handle governance, especially with respect to the
large numbers of non-VA employees who would be treating veterans. How
would the non-VA facility deal with VA directives and rule changes that
govern health-care delivery and that ensure safety and uniformity of
the quality of care? Will VA apply its space planning criteria and
design guides to non-VA facilities? How will VA's critical research
activities, most of which improve the lives of all Americans and not
only veterans, be affected if they are being conducted in shared
facilities, and not a traditional part of VA's first-class research
programs? What would this change mean for VA's electronic health
record, which many have rightly lauded as the standard that other
health-care systems should aim to achieve? Without the electronic
health record, how would VA maintain continuity of care for a veteran
who moves to another area?
But most importantly, CARES required years to complete and consumed
thousands of hours of effort and millions of dollars of study. We
believe it to be a comprehensive and fully justified roadmap for VA's
infrastructure as well as a model that VA can apply periodically to
assess and adjust those priorities. Given the strengths of the CARES
process and the lessons VA learned and has applied from it, why is the
HCCF model, which to our knowledge has not been based on any sort of
model or study of the long-term needs of veterans, the superior one? We
have yet to see evidence that it is and until we see more convincing
evidence that it will truly serve the best needs of veterans, the
IBVSOs will have a difficult time supporting it.
Recommendation:
VA must resist implementing the HCCF model without fully addressing
the many questions the IBVSOs have and VA must explain how the program
would meet the needs of veterans, particularly as compared to the
roadmap CARES has laid out.
Research Infrastructure Funding
The Department of Veterans Affairs must have increased funding for its
research infrastructure to provide a state-of-the-art research and
laboratory environment for its excellent programs, but also to ensure
that VA hires and retains the top scientists and researchers.
VA Research Is a National Asset
Research conducted in the Department of Veterans Affairs has led to
such innovations and advances as the cardiac pacemaker, nuclear
scanning technologies, radioisotope diagnostic techniques, liver and
other organ transplantation, the nicotine patch, and vast improvements
in a variety of prosthetic and sensory aids. A state-of-the-art
physical environment for conducting VA research promotes excellence in
health professions education and VA patient care as well as the
advancement of biomedical science. Adequate and up-to-date research
facilities also help VA recruit and retain the best and brightest
clinician scientists to care for enrolled veterans.
VA Research Infrastructure Funding Shortfalls
In recent years, funding for the VA Medical and Prosthetics
Research Program has failed to provide the resources needed to
maintain, upgrade, and replace VA's aging research facilities. Many VA
facilities have exhausted their available research space. Along with
space reconfiguration, ventilation, electrical supply, and plumbing
appear frequently on lists of needed upgrades in VA's academic health
centers. In the 2003 Draft National Capital Asset Realignment for
Enhanced Services (CARES) plan, VA included $142 million designated for
renovation of existing research space and build-out costs for leased
researched facilities. However, these capital improvement costs were
omitted from the Secretary's final report. Over the past decade, only
$50 million has been spent on VA research construction or renovation
nationwide, and only 24 of the 97 major VA research sites across the
Nation have benefited.
In House Report 109-95 accompanying the FY 2006 VA appropriations,
the House Appropriations Committee directed VA to conduct ``a
comprehensive review of its research facilities and report to the
Congress on the deficiencies found and suggestions for correction of
the identified deficiencies.'' In FY 2008, the VA Office of Research
and Development initiated a multiyear examination of all VA research
infrastructure for physical condition and capacity for current
research, as well as program growth and sustainability of the space
needed to conduct research.
Lack of a Mechanism to Ensure VA's Research Facilities Remain
Competitive
In House Report 109-95 accompanying the FY 2006 VA appropriations,
the House Appropriations Committee expressed concern that ``equipment
and facilities to support the research program may be lacking and that
some mechanism is necessary to ensure the Department's research
facilities remain competitive.'' A significant cause of research
infrastructure's neglect is that there is no direct funding line for
research facilities.
The VA Medical and Prosthetic Research appropriation does not
include funding for construction, renovation, or maintenance of
research facilities. VA researchers must rely on their local facility
managements to repair, upgrade, and replace research facilities and
capital equipment associated with VA's research laboratories. As a
result, VA research competes with other medical facilities' direct
patient care needs--such as medical services infrastructure, capital
equipment upgrades and replacements, and other maintenance needs--for
funds provided under either the VA Medical Facilities appropriation
account or the VA Major or Minor Medical Construction appropriations
accounts.
Recommendations:
The Independent Budget veterans service organizations anticipate
VA's analysis will find a need for funding significantly greater than
VA had identified in the 2004 Capital Asset Realignment for Enhanced
Services report. As VA moves forward with its research facilities
assessment, the IBVSOs urge Congress to require the VA to submit the
resulting report to the House and Senate Committees on Veterans'
Affairs no later than October 1, 2009. This report will ensure that the
Administration and Congress are well informed of VA's funding needs for
research infrastructure so they may be fully considered at each stage
of the FY 2011 budget process.
To address the current shortfalls, the IBVSOs recommend an
appropriation in FY 2010 of $142 million, dedicated to renovating
existing VA research facilities in line with the 2004 CARES findings.
To address the VA research infrastructure's defective funding
mechanism, the IBVSOs encourage the Administration and Congress to
support a new appropriations account in FY 2010 and thereafter to
independently define and separate VA research infrastructure funding
needs from those related to direct VA medical care. This division of
appropriations accounts will empower VA to address research facility
needs without interfering with the renovation and construction of VA
direct health-care infrastructure.
Program for Architectural Master Plans:
Each VA medical facility must develop a detailed master plan.
The delivery models for quality health care are in a constant state
of change. This is due to many factors including advances in research,
changing patient demographics, and new technology.
The VA must design their facilities with a high level of
flexibility in order to accommodate these new methods of patient care.
The department must be able to plan for change to accommodate new
patient care strategies in a logical manner with as little effect as
possible on other existing patient care programs. VA must also provide
for growth in already existing programs.
A facility master plan is a comprehensive tool to look at potential
new patient care programs and how they might affect the existing health
care facility. It also provides insight with respect to possible
growth, current space deficiencies, and other facility needs for
existing programs and how VA might accommodate these in the future.
In some cases in the past, VA has planned construction in a
reactive manner. After funding, VA would place projects in the facility
in the most expedient manner--often not considering other projects and
facility needs. This would result in shortsighted construction that
restricts, rather than expands options for the future.
The IBVSOs believe that each VA medical Center should develop a
comprehensive facility master plan to serve as a blueprint for
development, construction, and future growth of the facility. Short and
long-term CARES objectives should be the basis of the master plan.
Four critical programs were not included in the CARES initiative.
They are long-term care, severe mental illness, domiciliary care, and
Polytrauma. VA must develop a comprehensive plan addressing these needs
and its facility master plans must account for these services.
VA has undertaken master planning for several VA facilities; most
recently Tampa, Florida. This is a good start, but VA must ensure that
all facilities develop a master plan strategy to validate strategic
planning decisions, prepare accurate budgets, and implement efficient
construction that minimizes wasted expenses and disruption to patient
care.
Recommendation:
Congress must appropriate $20 million to provide funding for each
medical facility to develop a master plan.
Each facility master plan should include the areas left out of
CARES; long-term care, severe mental illness, domiciliary care, and
Polytrauma programs as it relates to the particular facility.
VACO must develop a standard format for these master plans to
ensure consistency throughout the VA health care system.
Empty or Underutilized Space
VA must not use empty space inappropriately and must continue
disposing of unnecessary property where appropriate Studies have
suggested that the VA medical system has extensive amounts of empty
space that the Department can reuse for medical services. Others have
suggested that unused space at one medical center may help address a
deficiency that exists at another location. Although the space
inventories are accurate, the assumption regarding the feasibility of
using this space is not.
Medical facility planning is complex. It requires intricate design
relationships for function, but also because of the demanding
requirements of certain types of medical equipment. Because of this,
medical facility space is rarely interchangeable, and if it is, it is
usually at a prohibitive cost. For example, VA cannot use unoccupied
rooms on the eighth floor to offset a deficiency of space in the second
floor surgery ward. Medical space has a very critical need for inter-
and intra- departmental adjacencies that must be maintained for
efficient and hygienic patient care.
When a department expands or moves, these demands create a domino
effect of everything around it. These secondary impacts greatly
increase construction expense, and they can disrupt patient care.
Some features of a medical facility are permanent. Floor-to-floor
heights, column spacing, light, and structural floor loading cannot be
altered. Different aspects of medical care have different requirements
based upon these permanent characteristics. Laboratory or clinical
spacing cannot be interchanged with ward space because of the needs of
different column spacing and perimeter configuration. Patient wards
require access to natural light and column grids that are compatible
with room-style layouts. Labs should have long structural bays and
function best without windows. When renovating empty space, if the area
is not suited to its planned purpose, it will create unnecessary
expenses and be much less efficient.
Renovating old space rather than constructing new space creates
only a marginal cost savings. Renovations of a specific space typically
cost 85 percent of what a similar, new space would. When you factor in
the aforementioned domino or secondary costs, the renovation can end up
costing more and produce a less satisfactory result. Renovations are
sometimes appropriate to achieve those critical functional adjacencies,
but it is rarely economical.
Many older VA Medical Centers that were rapidly built in the 1940s
and 1950s to treat a growing veteran population are simply unable to be
renovated for modern needs. Most of these Bradley-style buildings were
designed before the widespread use of air conditioning and the floor-
to-floor heights are very low. Accordingly, it is impossible to
retrofit them for modern mechanical systems. They also have long,
narrow wings radiating from a small central core, which is an
inefficient way of laying out rooms for modern use. This central core,
too, has only a few small elevator shafts, complicating the vertical
distribution of modern services.
Another important problem with this unused space is its location.
Much of it is not located in a prime location; otherwise, VA would have
previously renovated or demolished this space for new construction.
This space is typically located in outlying buildings or on upper floor
levels, and is unsuitable for modern use.
VA Space Planning Criteria/Design Guides:
VA must continue to maintain and update the Space Planning Criteria
and Design Guides to reflect state-of-the-art methods of health care
delivery.
VA has developed space-planning criteria it uses to allocate space
for all VA health care projects. These criteria are organized into
sixty chapters; one for each health care service provided by VA as well
as their associated support services. VA updates these criteria to
reflect current methods of health care delivery.
In addition to updating these criteria, VA has utilized a computer
program called VA SEPS (Space and Equipment Planning System) it uses as
a tool to develop space and equipment allocation for all VA health care
projects. This tool is operational and VA currently uses it on all VA
health care projects.
The third component used in the design of VA health care projects
is the design guides. Each of the sixty space planning criteria
chapters has an associated design guide. These design guides go beyond
the allocation of physical space and outline how this space is
organized within each individual department, as well as how the
department relates to the entire medical facility.
VA has updated several of the design guides to reflect current
patient delivery models. These include those guides that cover Spinal
Cord Injury/Disorders Center, Imaging, Polytrauma Centers, as well as
several other services.
Recommendation:
The VA must continue to maintain and update the Space Planning
Criteria and the VA SEPS space-planning tool. It also must continue the
process of updating the Design Guides to reflect current delivery
models for patient care. VA must regularly review and update all of
these space-planning tools as needed, to reflect the highest level of
patient care delivery.
Design-build Construction Delivery System
The VA must evaluate use of the Design-build construction delivery
system.
For the past 10 years, VA has embraced the design-build
construction delivery system as a method of project delivery for many
health care projects. Design-build attempts to combine the design and
construction schedules in order to streamline the traditional design-
bid-build method of project delivery. The goal is to minimize the risk
to the owner and reduce the project delivery schedule. Design-build, as
used by VA, places the contractor as the design builder.
Under the contractor-led design build process, VA gives the
contractor a great deal of control over how he or she designs and
completes the project. In this method, the contractor hires the
architect and design professionals. With the architect as a
subordinate, a contractor may sacrifice the quality of material and
systems in order to add to his own profits at the expense of the owner.
Use of design-build has several inherent problems. A short-cut
design process reduces the time available to provide a complete design.
This provides those responsible for project oversight inadequate time
to review completed plans and specifications. In addition, the
construction documents may not provide adequate scope for the project,
leaving out important details regarding the workmanship and/or other
desired attributes of the project. This makes it difficult to hold the
builder accountable for the desired level of quality. As a result, a
project is often designed as it is being built, which often compromises
VA's design standards.
Design-build forces the owner to rely on the contractor to properly
design a facility that meets the owner's needs. In the event that the
finished project is not satisfactory to the owner, the owner may have
no means to insist on correction of work done improperly unless the
contractor agrees with the owner's assessment. This may force the owner
to go to some form of formal dispute resolution such as litigation or
arbitration.
Recommendation:
VA must evaluate the use of Design-build as a method of
construction delivery to determine if design-build is an appropriate
method of project delivery for VA health care projects.
The VA must institute a program of ``lessons learned''. This would
involve revisiting past projects and determining what worked, what
could be improved, and what did not work. VA should compile and use
this information as a guide to future projects. VA must regularly
update this document to include projects as they are completed.
Preservation of VA's Historic Structures:
The VA must further develop a comprehensive program to preserve and
protect its inventory of historic properties.
The VA has an extensive inventory of historic structures that
highlight America's long tradition of providing care to veterans. These
buildings and facilities enhance our understanding of the lives of
those who have worn the uniform, and who helped to develop this great
Nation. Of the approximately 2,000 historic structures, many are
neglected and deteriorate year after year because of a lack of funding.
These structures should be stabilized, protected and preserved because
they are an integral part our Nation's history.
Most of these historic facilities are not suitable for modern
patient care. As a result, a preservation strategy was not included in
the CARES process. For the past six years, the IBVSOs have recommended
that VA conduct an inventory of these properties; classifying their
physical condition and their potential for adaptive reuse. VA has been
moving in that direction and historic properties are identified on
their Web site. VA has placed many of these buildings in an ``Oldest
and Most Historic'' list and these buildings require immediate
attention.
At least one project has received funding. The VA has invested over
$100,000 in the last year to address structural issues at a unique
round structure in Hampton, VA. Built in 1860, it was originally a
latrine and the funding is allowing VA to convert it into office space.
The cost for saving some of these buildings is not very high
considering that they represent a part of history that enriches the
texture of our landscape that once gone cannot be recaptured. For
example, VA can restore the Greek Revival Mansion in Perry Point, MD,
which was built in the 1750's, to use as a training space for about
$1.2 million. VA could restore the 1881 Milwaukee Ward Memorial Theater
for use as a multi-purpose facility at a cost of $6 million. This is
much less than the cost of a new facility.
As part of its adaptive reuse program, VA must ensure that the
facilities that it leases or sells are maintained properly. VA's legal
responsibilities could, for example, be addressed through easements on
property elements, such as building exteriors or grounds.
We encourage the use of P.L. 108-422, the Veterans Health Programs
Improvement Act, which authorized historic preservation as one of the
uses of a new capital assets fund that receives funding from the sale
or lease of VA property.
Recommendation:
VA must further develop a comprehensive program to preserve and
protect its inventory of historic properties.
Mr. Chairman, this concludes my statement. I would be happy to
answer any questions that you or the Members of the Committee may have.
Prepared Statement of Raymond C. Kelley, National Legislative
Director, American Veterans (AMVETS)
Chairman Filner, Ranking Member Buyer, and Members of the
Committee:
AMVETS is honored to join our fellow veterans service organizations
and partners at this important hearing on the Department of Veterans
Affairs budget request for fiscal year 2011. 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 24th 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.
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 Department of Veterans Affairs National Cemetery Administration
(NCA) currently maintains more than 2.9 million gravesites at 130
national cemeteries in 39 states and Puerto Rico. Of these cemeteries,
70 will be open to all interments; 20 will accept only cremated remains
and family members of those already interred; and 40 will only perform
interments of family members in the same gravesite as a previously
deceased family member. NCA also maintains 33 soldiers' lots and
monument sites. All told, NCA manages 19,000 acres, half of which are
developed.
VA estimates that about 27 million veterans are alive today. They
include veterans from World War I, World War II, the Korean War, the
Vietnam War, the Gulf War, the conflicts in Afghanistan and Iraq, and
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 approximately 111,000 in 2009 to 114,000
in 2010. Historically, 12 percent of veterans opt for burial in a state
or national cemetery.
The most important obligation of the NCA is to honor the memory of
America's brave men and women who served in the armed forces.
Therefore, the purpose of these cemeteries as national shrines is one
of the NCA's top priorities. Many of the individual cemeteries within
the system are steeped in history, and the monuments, markers, grounds,
and related memorial tributes represent the very foundation of the
United States. With this understanding, the grounds, including
monuments and individual sites of interment, represent a national
treasure that deserves to be protected and cherished.
The Independent Budget veterans service organizations (IBVSOs)
would like to acknowledge the dedication and commitment of the NCA
staff who continue to provide the highest quality of service to
veterans and their families. We call on the Administration and Congress
to provide the resources needed to meet the changing and critical
nature of NCA's mission and fulfill the Nation's commitment to all
veterans who have served their country honorably and faithfully.
In FY 2009, $230 was million appropriated for the operations and
maintenance of NCA, $49 million over the administration's request, with
$2.7 million in carryover. NCA awarded 49 of the 56 minor construction
projects that were in the operating plan. The State Cemetery Grants
Service awarded $40 million in grants for 10 projects.
NCA has done an exceptional job of providing burial options for 90
percent of all veterans who fall within the 170,000 veterans within a
75-mile radius threshold model. However, under this model, no new
geographical area will become eligible for a National Cemetery until
2015. St. Louis, Mo. will, at that time, meet the threshold due to the
closing of Jefferson Barracks National Cemetery in 2017. Analysis shows
that the five areas with the highest veteran population will not become
eligible for a National Cemetery because they will not reach the
170,000 threshold.
NCA has spent years developing and maintaining a cemetery system
based on a growing veteran population. In 2010 our veteran population
will begin to decline. Because of this downward trend, a new threshold
model must be developed to ensure more of our veterans will have
reasonable access to their burial benefits. Reducing the mile radius to
65 miles would reduce the veteran population that is served from 90
percent to 82.4 percent, and reducing the radius to 55 miles would
reduce the served population to 74.1 percent. Reducing the radius alone
to 55 miles would only bring two geographical areas in to 170,000
population threshold in 2010, and only a few areas into this revised
model by 2030.
Several geographical areas will remain unserved if the population
threshold is not reduced. Lowering the population threshold to 100,000
veterans would immediately make several areas eligible for a National
Cemetery regardless of any change to the mile radius threshold. A new
threshold model must be implemented so more of our veterans will have
access to this earned benefit.
National Cemetery Administration (NCA) Accounts
The Independent Budget recommends an operations budget of $274.5
million for the NCA for fiscal year 2011 so it can meet the increasing
demands of interments, gravesite maintenance, and related essential
elements of cemetery operations.
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.
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.
The IBVSOs is encouraged that $25 million was set aside for the
National Shrine Commitment for FY 07 and 08. The NCA has done an
outstanding job thus far in improving the appearance of our national
cemeteries, but we have a long way to go to get us where we need to be.
In 2006 only 67 percent of headstones and markers in national
cemeteries were at the proper height and alignment. By 2009 proper
height and alignment increased to 76 percent. The NCA has also
identified 153 historic monuments and memorials that need repair and/or
restoration. With funding from The American Recovery and Reinvestment
Act (ARRA), the NCA will make repairs on 32 percent of these monuments
and memorials.
The IBVSOs support the NCA's operational standards and measures
outlined in the National Shrine Commitment, and in the past The
Independent Budget advocated for a five-year, $250 million National
Shrine Initiative to assist the NCA in achieving its performance goals.
However, over the past few years, the NCA has made marked improvements
in the National Shrine Commitment by earmarking a portion of its
operations and maintenance budget for the commitment and pending
receipt of funding from the ARRA. Therefore, the IBVSOs no longer
believe it is necessary to implement the National Shrine Initiative
program at $50 million per year for five years but, rather, propose an
increase in the NCA's operations and maintenance budget by $25 million
per year until the operational standards and measures goals are
reached.
In addition to the management of national cemeteries, the NCA is
responsible for the Memorial Program Service. The Memorial Program
Service provides lasting memorials for the graves of eligible veterans
and honors their service through Presidential Memorial Certificates.
Public Laws 107-103 and 107-330 allow for a headstone or marker for the
graves of veterans buried in private cemeteries who died on or after
September 11, 2001. Prior to this change, the NCA could provide this
service only to those buried in national or state cemeteries or to
unmarked graves in private cemeteries. Public Law 110-157 gives VA
authority to provide a medallion to be attached to the headstone or
marker of veterans who are buried in a private cemetery. This benefit
is available to veterans in lieu of a government-furnished headstone or
marker. The IBVSOs call on the Administration and Congress to provide
the resources required to meet the critical nature of the NCA mission
and fulfill the Nation's commitment to all veterans who have served
their country so honorably and faithfully.
The State Cemetery Grants Program
The State Cemeteries Grant Program faces the challenge of meeting a
growing interest from states to provide burial services in areas that
are not currently served. The intent of the SCGP is to develop a true
complement to, not a replacement for, our federal system of national
cemeteries. With the enactment of the Veterans Benefits Improvements
Act of 1998, the NCA has been able to strengthen its partnership with
states and increase burial service to veterans, especially those living
in less densely populated areas not currently served by a national
cemetery. Currently there are 60 state and tribal government cemetery
construction grant pre-applications, 36 of which have the required
state matching funds necessary totaling $121 million.
The Independent Budget recommends that Congress appropriate $51
million for SCGP for FY 2011. This funding level would allow SCGP to
establish 13 new state cemeteries that will provide burial options for
veterans who live in a region that currently has no reasonably
accessible state or national cemetery.
Burial Benefits
In 1973 NCA established a burial allowance that provided partial
reimbursements for eligible funeral and burial costs. The current
payment is $2,000 for burial expenses for service-connected (SC) death,
$300 for non-service-connected (NSC) deaths, and $300 for plot
allowance. At its inception, the payout covered 72 percent of the
funeral cost for a service-connected death, 22 percent for a non-
service-connected death, and 54 percent of the burial plot cost. In
2007 these benefits eroded to 23 percent, 4 percent, and 14 percent
respectively. It is time to bring these benefits back to their original
value.
Burial allowance was first introduced in 1917 to prevent veterans
from being buried in potters' fields. In 1923 the allowance was
modified. The benefit was determined by a means test, and then in 1936
the allowance was changed again, removing the means test. In its early
history, the burial allowance was paid to all veterans, regardless of
the service-connectivity of their death. In 1973 the allowance was
modified to reflect the relationship of their death as service
connected or not.
The plot allowance was introduced in 1973 as an attempt to provide
a plot benefit for veterans who did not have reasonable access to a
national cemetery. Although neither the plot allowance nor the burial
allowances were intended to cover the full cost of a civilian burial in
a private cemetery, the increase in the benefit's value indicates the
intent to provide a meaningful benefit by adjusting for inflation.
The national average cost for a funeral and burial in a private
cemetery has reached $8,555, and the cost for a burial plot is $2,133.
At the inception of the benefit the average costs were $1,116 and $278
respectively. While the cost of a funeral has increased by nearly seven
times the burial benefit has only increased by 2.5 times. To bring both
burial allowances and the plot allowance back to its 1973 value, the SC
benefit payment will be $6,160, the NSC benefit value payment will be
$1,918, and the plot allowance will increase to $1,150. Readjusting the
value of these benefits, under the current system, will increase the
obligations from $70.1 million to $335.1 million per year.
Based on accessibility and the need to provide quality burial
benefits, The Independent Budget recommends that VA separate burial
benefits into two categories: veterans who live inside the VA
accessibility threshold model and those who live outside the threshold.
For those veterans who live outside the threshold, the SC burial
benefit should be increased to $6,160, NSC veteran's burial benefit
should be increased to $1,918, and plot allowance should increase to
$1,150 to match the original value of the benefit. For veterans who
live within reasonable accessibility to a state or national cemetery
that is able to accommodate burial needs, but the veteran would rather
be buried in a private cemetery the burial benefit should be adjusted.
These veterans' burial benefits will be based on the average cost for
VA to conduct a funeral. The benefit for a SC burial will be $2,793,
the amount provided for a NSC burial will be $854, and the plot
allowance will be $1,150. This will provide a burial benefit at equal
percentages, but based on the average cost for a VA funeral and not on
the private funeral cost that will be provided for those veterans who
do not have access to a state or national cemetery.
The recommendations of past legislation provided an increased
benefit for all eligible veterans but it currently fails to reach the
intent of the original benefit. The new model will provide a meaningful
benefit to those veterans whose access to a state or national cemetery
is restricted as well as provides an improved benefit for eligible
veterans who opt for private burial. Congress should increase the plot
allowance from $300 to $1,150 for all eligible veterans and expand the
eligibility for the plot allowance for all veterans who would be
eligible for burial in a national cemetery, not just those who served
during wartime. Congress should divide the burial benefits into two
categories: veterans within the accessibility model and veterans
outside the accessibility model. Congress should increase the service-
connected burial benefit from $2,000 to $6,160 for veterans outside the
radius threshold and $2,793 for veterans inside the radius threshold.
Congress should increase the non-service-connected burial benefit from
$300 to $1,918 for veterans outside the radius threshold and $854 for
veterans inside the radius threshold. Congress should enact legislation
to adjust these burial benefits for inflation annually.
The NCA honors veterans with a final resting place that
commemorates their service to this Nation. More than 2.8 million
soldiers who died in every war and conflict are honored by burial in a
VA national cemetery. Each Memorial Day and Veterans Day we honor the
last full measure of devotion they gave for this country. Our national
cemeteries are more than the final resting place of honor for our
veterans; they are hallowed ground to those who died in our defense,
and a memorial to those who survived.
Mr. Chairman, this concludes my testimony. I thank you again for
the privilege to present our views, and I would be pleased to answer
any questions you might have.
Prepared Statement of Steve A. Robertson, Director,
National Legislative Commission, American Legion
Oral Statement
Mr. Chairman and Members of the Committee, thank you for the
opportunity for The American Legion to comment on the President's
budget request for FY 2011. I ask that my written statement be included
in the record and that The American Legion be allow to submit
additional written comments if necessary.
First, The American Legion would like to express its appreciation
for the timely enactment of Public Law 111-81 that authorized advance
appropriations for the Department of Veterans Affairs medical care
accounts.
After reviewing the President's budget request, The American Legion
shares the President's vision to continue VA's transform into a 21st
Century organization. It is a bold paradigm shift to VA's approach to
veterans' care; as a lifetime initiative, from the day the oath is
taken until the day they are laid to rest.
Clearly, the budget request appears to direct funding to assure
veterans and their families would receive timely access to the highest
quality benefits and services provided by VA. The American Legion sees
these benefits and services as earned through honorable military
service.
Secretary Shinseki explained that this budget request focuses on
three specific concerns that are of critical importance to the
veterans' community:
easier access to benefits and services;
reducing the disability claims backlog and the wait
before veterans receive earned benefits; and
ending the downward spiral that results in veterans'
homelessness.
The American Legion is pleased with the President's budget request
of $125 billion for the Department of Veterans Affairs. This budget
request would meet or exceed most of the funding recommendations
offered by The American Legion National Commander Clarence Hill last
September during the joint hearing of the Committees on Veterans'
Affairs.
VA has identified ``six high priority performance goals'' which
this budget request must support:
Reducing the Claims Backlog,
Eliminating Veteran Homelessness,
Automating the GI Bill Benefits System,
Establishing a Virtual Lifetime Electronic Record,
Improving Mental Health Care, and
Deploying a Veterans Relationship Management System.
These are priorities shared by The American Legion.
There are other areas addressed in the budget request supported by
The American Legion such as expanding health care eligibility, meeting
the needs of women veterans, timely access to quality health care for
veterans in rural and highly rural areas, and expanding access to
burial in a VA National Cemetery.
In reviewing this budget request, it is obvious that Information
Technology is going to play an enormous role in achieving the
President's vision and many of these goals and objectives.
Mr. Chairman, thank you for the opportunity to participate in this
review of the President's budget request.
This concludes my oral remarks and I welcome any questions you or
your colleagues may have for The American Legion.
__________
Prepared Statement
Mr. Chairman and Members of the Committee:
The American Legion welcomes this opportunity to comment on the
President's budget request for Fiscal Year 2011/2012. The American
Legion is pleased by the $125 billion total appropriations for the
Department of Veterans Affairs (VA) in FY 2010 and the projected $64.7
billion in mandatory appropriations and $60.3 billion in discretionary
appropriations.
As a Nation at war, America has a moral, ethical and legal
commitment to the men and women of the Armed Forces of the United
States and their survivors. These current defenders of democracy will
eventually join the ranks of their 23.1 million comrades, we refer to
as veterans. The active-duty, Reserve Components and veterans continue
to make up the Nation's best recruiters for the Armed Forces. Young men
and women across the country see servicemembers and veterans as role
models. Chances are, before enlisting in the Armed Forces, these young
people will seek the advice of those they see in uniform or family
members who have served for their recommendations on military service.
Therefore, it is absolutely critical that the entire veterans'
community (active-duty, Reserve Component, and veterans) continue to
remain supportive of honorable military service. No servicemember
should ever be in doubt about:
the quality of health care he or she will receive if
injured;
the availability of earned benefits for honorable
military service upon discharge; or
the quality of survivors' benefits should he or she pay
the ultimate sacrifice.
The American Legion and many other veterans' and military service
organizations are united in advocating enactment of timely, predictable
and sufficient budgets for VA medical care. The American Legion greatly
appreciated the leadership of this Committee in passing Public Law 111-
81 authorizing advance appropriations for VA medical care accounts.
With the decision for advance appropriations behind us, The American
Legion continues to urge Congress to pass the VA budget for FY 2011
before the start of the new fiscal year.
After reviewing the proposed President's budget request for VA in
FY 2011/2012, The American Legion renders its support as follows:
Increases funding for VA in FY 2011 by $11 billion above
FY 2010.
Increases funding for VA's medical care by $4 billion in
FY 2011 and a projected $2.8 billion increase in FY 2012 to $54.3
billion.
Expands enrollment for 500,000 additional Priority Group
8 veterans by FY 2013.
Enhances outreach and services related to mental health
care and cognitive injuries, including post-traumatic stress disorder
and traumatic brain injury, with a focus on access for veterans in
rural and highly rural areas.
Invests in better technology to deliver services and
benefits to veterans with the quality and efficiency they deserve.
Full concurrent receipt of military retirement pay and VA
disability compensation without offsets.
Combats homelessness by safeguarding vulnerable veterans.
Facilitates timely implementation of the comprehensive education
benefits that veterans earn through their dedicated military service.
When National Commander Clarence Hill testified on September 10,
2009 before a Joint Session of the Committees on Veterans' Affairs, he
clearly outlined the funding recommendations for FY 2011. This
testimony will re-emphasize that support for certain specific areas.
Medical Care
The American Legion fully supports funding ``the best health care
anywhere'' in FY 2011 at $51.5 billion and in FY 2012 at $54.3 billion.
VA reports that 6.1 million veterans will receive timely access to
quality health care in FY 2011. This represents an anticipated increase
of 168,904 new patients who will ``vote with their feet'' in making VA
their health care provider of choice. VA medical care is still
America's best investment in quality health care delivery--the right
care, at the right time, in the right facility.
Medical Care Collections Fund
The Balanced Budget Act of 1997, Public Law (P.L.) 105-33,
established the VA Medical Care Collections Fund (MCCF), requiring
amounts 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. Funds collected may
only be used to provide VA medical care and services, as well as 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 all third-party reimbursements and co-payments.
The American Legion adamantly opposes the scoring of MCCF as an offset
to the annual discretionary appropriations since the majority of these
funds come from the treatment of nonservice-connected medical
conditions. VA's ability to capture these funds is critical to its
ability to provide quality and timely care to veterans. Miscalculations
of VA required funding levels result in real budgetary shortfalls.
The American Legion continues to oppose offsetting annual VA
discretionary funding by the MCCF goal.
Medicare Reimbursements
As do most American workers, veterans pay into the Medicare system,
without choice, throughout their working lives, including while on
active duty or as active service Reservists in the Armed Forces. A
portion of each earned dollar is allocated to the Medicare Trust Fund
and, although veterans must pay into the Medicare system, VA is
prohibited from collecting any 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.
The American Legion continues to support a legislative initiative
to allow VHA to bill, collect and reinvest third-party reimbursements
from the Centers for Medicare and Medicaid Services for the treatment
of allowable, nonservice-connected medical conditions of enrolled
Medicare-eligible veterans.
Medical and Prosthetics Research
The American Legion believes VA's focus in research must remain on
understanding and improving treatment for medical conditions that are
unique to veterans. Servicemembers are surviving catastrophically
disabling blast injuries due to the superior armor they are wearing in
the combat theater and the timely access to quality combat medical
care. The unique injuries sustained by the new generation of veterans
clearly demand particular attention. It has been reported that VA does
not have state-of-the-art prostheses like DoD and that the fitting of
prostheses for women has presented problems due to their smaller
stature.
There is a need for adequate funding of other VA research
activities, including basic biomedical research and bench-to-bedside
projects. Congress and the Administration should continue to encourage
acceleration in the development and initiation of needed research on
conditions that significantly affect veterans, such as prostate cancer,
addictive disorders, trauma and wound healing, post-traumatic stress
disorder, rehabilitation, and other research that is conducted jointly
with DoD, the National Institutes of Health (NIH), other Federal
agencies, and academic institutions.
The American Legion recommends $700 million for Medical and
Prosthetics Research in FY 2011.
Major Construction
The CARES process identified approximately 100 major construction
projects throughout the VA Medical Center System, 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
disclosed the plan to deliver health care through 2022, Congress has
the responsibility to provide adequate funds. The FY 2011 President's
budget request calls for ongoing construction of a new medical facility
in Denver, CO; New Orleans, LA; and Palo Alto, CA. Also work is to
begin on new medical facilities in Omaha, NE and Alameda Point, CA.
The American Legion supports these projects; however, we feel the
President's budget request for $864 million in FY 2011 for Major
Construction is inadequate and should be increased to $2 billion to
provide for additional facilities particularly Community-Based
Outpatient Clinics in rural and highly rural areas and additional Vet
Centers.
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, due to the age of these buildings,
continuous renovations, relocations and expansions. When combined with
the added cost of the CARES program recommendations, it is easy to see
that a major increase over the previous funding level is crucial and
overdue. The President's budget request for FY 2011 would fund Minor
Construction at only $468 million.
The American Legion recommends $1.5 billion for Minor Construction
in FY 2011.
State Extended Care Facility Construction Grants Program
Since 1984, nearly all planning for VA inpatient nursing home care
has revolved around State Veterans' Homes (SVHs) and contracts with
public and private nursing homes. Under the provisions of Title 38,
U.S.C., VA is authorized to make payments to states to assist in the
construction and maintenance of SVHs. Today, there are 133 SVHs in 47
states with over 27,000 beds providing nursing home, hospital, and
domiciliary care. Grants for Construction of State Extended Care
Facilities provide funding for 65 percent of the total cost of building
new veterans' homes. Recognizing the growing Long-Term Care needs of
veterans, it is essential the State Veterans' Homes Program be
maintained as an important alternative health care provider for the VA
integrated health care delivery system.
The American Legion opposes attempts to place a moratorium on new
SVH construction grants. State authorizing legislation has been enacted
and state funds have been committed. Delaying projects will result in
cost overruns and may result in states deciding to cancel these much
needed facilities.
The American Legion supports:
increasing the amount of authorized per diem payments to
50 percent for nursing home and domiciliary care provided to veterans
in State Veterans' Homes;
providing prescription drugs and over-the-counter
medications to State Homes Aid and Attendance patients along with the
payment of authorized per diem to State Veterans' Homes; and
allowing full reimbursement of nursing home care to 70
percent or higher service-connected disabled veterans, if those
veterans reside in a State Veterans' Home.
The American Legion strongly recommends $275 million for the State
Extended Care Facility Construction Grants Program in FY 2011.
Rural Health Care
Research conducted by VA indicates that veterans residing in rural
and highly rural areas have poorer health than their urban
counterparts. It was further reported that one in five veterans live in
a rural setting. Providing quality health care to veterans living in
rural and highly rural areas has proven to be an extreme challenge.
The American Legion recommends construction of Community-Based
Outpatient Clinics in areas such as Alaska, Montana, Nebraska, Nevada,
South Dakota, Utah, Vermont and Wyoming.
Information Technology Funding
Since the data theft occurrence in May 2006, the VA has implemented
a complete overhaul of its Information Technology (IT) division
nationwide. The American Legion is hopeful VA takes the appropriate
steps to strengthen its IT security to regain the confidence and trust
of veterans who depend on VA for the benefits they have earned.
Within VA Medical Center Nursing Home Care Units, it was discovered
there was conflict with IT and each respective VAMC regarding provision
of Internet access to veteran residents. VA has acknowledged the
Internet would represent a positive tool in veteran rehabilitation. The
American Legion believes Internet access should be provided to these
veterans without delay for time is of the essence in the journey to
recovery. In addition, veterans should not have to suffer due to VA's
gross negligence in the matter.
The American Legion hopes Congress will not attempt to fund the
solution to this problem with scarce fiscal resources allocated to the
VA for health care delivery. With this in mind, The American Legion is
encouraged by the fact that IT is its own line item in the budget
recommendation.
The American Legion believes there should be a complete review of
IT security government wide. VA isn't the only agency within the
government requiring an overhaul of its IT security protocol. The
American Legion urges Congress to exercise its oversight authority and
review each Federal agency to ensure that the personal information of
all Americans is secure.
The American Legion supports the centralization of VA's IT. The
amount of work required to secure information managed by VA is immense.
The American Legion urges Congress to maintain close oversight of VA's
IT restructuring efforts and fund VA's IT to ensure the most rapid
implementation of all proposed security measures.
The American Legion disagrees with freezing funding at the FY 2009
level of $3.3 billion for Information Technology, as recommended in the
President's budget request; therefore, The American Legion recommends
$3.8 billion in FY 2011.
Homelessness
The American Legion notes there are approximately 154,000 homeless
veterans on the street each night. This number, compounded with 300,000
servicemembers entering the civilian sector each year since 2001 with
at least a third of them potentially suffering from mental illness,
indicates that programs to prevent and assist homeless veterans are
needed. The American Legion applauds VA's continued emphasis as one of
its priority items the elimination of homelessness among America's
veterans.
The American Legion fully supports the $294 million in the FY 2011
President's budget request to help eliminate homelessness among
veterans.
National Cemetery Administration
The mission of the National Cemetery Administration (NCA) is to
honor veterans with final resting places in national shrines and with
lasting tributes that commemorate their service to this Nation. The
American Legion recognizes the NCA's excellent record in providing
timely and dignified burials to all veterans who opt to be buried in a
National Cemetery. Further the American Legion applauds the new VA
guidelines reducing the required population base for creating a
National Cemetery from 175,000 to 85,000. This will allow 90 percent of
all veterans a realistic option within 75 miles of their home.
The American Legion feels that the President's budget request for
$251 million for NCA and $46 million for the State Cemetery
Construction Grants program is not enough to carry out this hallowed
mission. Therefore, The American Legion recommends $260 million be
allocated to the National Cemetery Administration and further that $50
million be provided for State Cemetery Construction Grants Programs in
FY 2011.
Homeless Providers Grant and Per Diem Program Reauthorization
In 1992, VA was given authority to establish the Homeless Providers
Grant and Per Diem Program under the Homeless Veterans Comprehensive
Service Programs Act of 1992, P.L. 102-590. The Grant and Per Diem
Program, offered annually (as funding permits) by the VA, funds
community agencies providing services 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 recommends $200 million for the Grant and Per
Diem Program for FY 2011.
Veterans Benefits Administration
Clearly, the current VA claims backlog is a major concern to The
American Legion and the rest of the veterans' community. Aggressively
addressing this growing problem will require actions from an array of
approaches. The President's budget request proposes to add both
increases in funding ($460 million) and in personnel (4,048 new FTE).
These increases will be helpful, but The American Legion believes more
will be required to ``turn the tide.'' The American Legion will
continue to work with VA, Congress and the veterans' community to
transform the current process into a more timely and accurate process.
The American Legion applauds the $13.4 billion in supplemental funding
to address the newly approved Agent Orange claims.
Summary of Legislation Proposed in the FY 2011 President's Budget
Request
In reviewing the proposed legislation in the President's budget
request, The American Legion would like to address several of them in
detail:
Compensation and Pensions_Proposed Legislation
Compensation Cost of Living Adjustment (COLA):
Legislation will be proposed to provide a cost of living increase to
all Compensation beneficiaries, including DIC spouses and children,
effective December 1, 2010. The percent increase will align with
increases in the Consumer Price Index and the increase for Social
Security benefits. However, current estimates suggest that the CPI will
not increase; therefore, no COLA may be enacted.
The American Legion has no official position on this proposal.
Expansion of Concurrent Receipt of Department of Defense
Retirement Pay: Legislation will be proposed by the Administration to
expand the veteran eligibility for concurrent receipt of military
retirement pay and VA disability benefits to veterans who are medically
retired from service by the Department of Defense. Eligibility will be
phased in over five years based on the degree of disability assigned by
VA. While the primary impact will be on Title 10 and the Department of
Defense, VA estimates that the cost to VA of concurrent receipt
expansion will be $47 million in 2011 and $254 million over the five-
year period.
The American Legion supports this proposal. Since the offset comes
from military retirement pay, The American Legion is somewhat surprised
that VA would incur any costs.
Use of Health and Human Services (HHS) Data for Purposes
of Adjusting VA Benefits: Public Law 110-157 requires independent
verification of HHS data for purpose of adjusting VA benefits based on
economic need. This proposal seeks to remove the expiration date of 9/
30/11 and extend through 2020. Benefit costs are estimated to be $2.0
million in 2012 with a net savings in later years.
The American Legion has no official position on this proposal.
Special Monthly Pension for Wartime Veterans 65 years of
age and older: This proposal amends Section 1513 of Title 38 and
repeals the Court of Appeals for Veterans Claims (CAVC) rendered
decision in Hartness v. Nicholson. The decision affected the
qualifications for the special monthly pension (SMP) awarded to
veterans who are housebound (H/B). The court decision excluded the SMP
requirement of being permanently and totally disabled for veterans 65
years of age and older. By repealing the court decision, a veteran will
once again only be eligible for SMP if, in addition to basic pension
qualifications, the veteran shows proof of being permanently and
totally disabled. Once a veteran reaches age 65, the requirements for
H/B pension will require a single disability rated at 100 percent, and
a disability or combined disabilities (separate and distinct from the
100 percent disability) independently ratable to at least 60 percent.
This proposal will provide for more equitable treatment of veterans
under the pension program; currently, veterans with lower disability
ratings may receive larger benefits than veterans who are permanently
and totally disabled. The 2011 estimated savings is $3.2 million with
an anticipated caseload of 506,000.
The American Legion strongly opposes this proposal. The American
Legion believes this proposal would take away a needed benefit provided
to disabled elderly wartime veterans as allowed by statute and
confirmed in a precedential decision of the United States Court of
Appeals for Veterans Claims.
VA Pension Limitations for Medicaid-covered Veterans
Without Spouse or Children: This provision limits the amount of pension
payable to a veteran who has neither spouse nor child (or a surviving
spouse with no child) and who is covered by a Medicaid plan for
services furnished by a nursing facility. Title 38, U.S.C. section
5503(d) will expire on September 30, 2011. This proposal seeks to
extend the expiration date an additional five years. Elimination of
this provision would result in increased pension expenditures but money
available to veterans and survivors would actually decrease. The
maximum pension entitlement is not sufficient to cover the normal cost
of nursing home care but receipt of that amount would result in the
termination of Title XVI Medicaid benefits which currently cover
nursing care costs in excess of the projected amount ($90) that is
payable to the veteran under this provision. This is likely to result
in veterans and surviving spouses being unable to afford nursing care.
This proposal will result in VA benefit cost savings of $559.4 million
and net government-wide savings of $246 million in 2012. Mandatory VA
savings through 2015 are estimated at $2.3 billion.
The American Legion has no official position on this proposal.
IRS Income Data Matching for VA Eligibility
Determinations: Section 6103 (I) (7) of the Internal Revenue Code of
1986 (26 U.S.C. Section 6103 (I) (D)) requires the Secretary of the
Treasury and the Commissioner of Social Security to disclose certain
income information to any governmental agency administering certain
programs, including VA's pension, dependency and indemnity
compensation, and health-care programs. Section 5317 of Title 38,
U.S.C., governs VA's use of that information. The duty of the Secretary
of the Treasury and the Social Security Commissioner to disclose that
information and VA's authority to obtain it from them will expire 9/30/
2011. This proposal seeks to extend the expiration date for five years.
While this proposal will result in net mandatory and discretionary
savings of $20 million in 2012, it will result in net mandatory costs
of $20 million in 2012. However, the proposal will result in net
mandatory savings beginning in 2013 and net mandatory savings between
2011-2016 are estimated at $21.9 million.
The American Legion has no official position on this proposal.
Clarification of Monthly Payment Option for the Month of
Death for Compensation or Pensions: This proposal will amend Title 38
U.S.C. 5310 and 5111 (c) (1) to clarify that all surviving spouses are
entitled to receive payment in the amount of the veteran's compensation
or pension rate for the month of the veteran's death, and to simplify
administration of the month-of-death benefit.
The American Legion supports this proposal. There has been much
confusion and misinterpretation of the law by VA regarding the month-
of-death benefit that has deprived thousands of beneficiaries of the
benefits to which they are entitled, causing additional heartache
during an already painful period following the death of a loved one.
Extension for Contract Physicians to Perform Disability
Evaluations: P.L. 108-183, Section 704, provides authority under which
examinations with respect to medical disability of applicants for
compensation and pension benefits are carried out by persons not
employed by the VA. These examinations are funded through discretionary
funds, and there is no limitation to the number of VA regional offices
involved. This authority, extended by P.L. 110-329, Section 105, will
expire December 31, 2010. The proposal would extend the authority by
two additional years to December 31, 2012.
The American Legion has no official position on this proposal.
Readjustment Benefits_Proposed Legislation
Change of Terminology for the Administration of the New
GI Bill: Title 38 U.S.C. uses the term ``institution of higher
learning'' throughout chapter 36. For consistency, this proposal would
adjust the administrative language of the new Chapter 33 benefit from
the use of ``institution of higher education'' to ``institution of
higher learning.''
The American Legion has no official position on this proposal.
Change in VA Authority to Approve Educational Programs:
This proposal would amend 38 U.S.C. Chapter 36 to expand VA's authority
regarding approval of courses for the enrollment of veterans (and other
eligible persons) that are in receipt of educational assistance under
the programs VA administers.
The American Legion has no official position on this proposal.
Extend the Delimiting Date for Caregivers Use of
Education Benefits: This proposal would amend Title 38 U.S.C.
Sec. 3031(d) and Title 38 U.S.C. Sec. 3512, to permit the extension of
delimiting dates for eligible individuals who could not pursue, or had
to interrupt, a program of education while acting as the primary
caretaker for a veteran or servicemember seriously injured while on
active duty in a contingency operation after September 10, 2001.
The American Legion has no official position on this proposal.
Expand Employer Support Eligibility: This proposal would
amend Title 38, U.S.C., Section 3116 to expand eligibility for
incentives paid to employers who provide on-job training and employment
opportunities for veterans with service-connected disabilities who may
be difficult to place in suitable jobs.
The American Legion supports this proposal. If enacted this
legislative proposal would give employers a greater incentive to hire
injured veterans who are trying to obtain gainful employment. The
unemployment rate for veterans is above the national average,
particularly for those between the ages of 18 to 24. The American
Legion believes this legislation will greatly assist servicemembers in
their transition into the civilian workforce and allow them to use
their expertise and military training to fill desirable positions
within high potential industries.
Housing_Proposed Legislation
Authority to Pool Loans: Legislation will be proposed to
extend the authority to pool loans for two years to December 2013. This
will allow the VA to obtain the best pricing for the pooled and
securitized loans and to continue selling loans at a greater return
without any additional risk. VA estimates additional revenue of $87
million in 2012 and overall increased revenue of $190 million over the
2012-2014 period.
The American Legion has no official position on this proposal.
Permission of Occupancy of Veteran's Child/Children:
Legislation will be proposed to allow occupancy by a dependent child to
satisfy occupancy requirements of VA home loans. This will permit a
veteran who is unable to occupy a property as his/her primary residence
due to active duty status or overseas employment, to use his/her earned
Loan Guaranty benefit. No significant costs are anticipated.
The American Legion has no official position on this proposal.
First Lien Exemption for Public Entities: Legislation
will be proposed to extend first lien exemption to public entities as
well as private entities during disaster relief situations only. This
will allow disaster relief agencies and veterans to have more options
in the type of assistance available. No significant costs are
anticipated.
The American Legion has no official position on this proposal.
Insurance_Proposed Legislation
VGLI Increased Coverage Act: This proposal would provide
an opportunity for veterans to increase VGLI coverage in increments of
$25,000 without medical underwriting. The opportunity will be available
every 5 years with a total coverage not to exceed current legislated
maximum SGLI. Current law limits the amount of VGLI allowed to the
amount of SGLI at discharge and as a result, many service-disabled VGLI
insured, have no opportunity to increase coverage to meet current
family needs. This proposed change would allow veterans, including
service-disabled veterans, to purchase adequate amounts of life
insurance to protect their families. There are no PAYGO costs
associated with this proposal and it does not impact the budget.
The American Legion strongly supports this proposal. The American
Legion would welcome such an addition to the VGLI program. This
addition would permit veterans who separated from service prior to the
latest increases in SGLI coverage, and who are thus restricted by
current law to a lower maximum amount of life insurance coverage than
those veterans who separated from service after September 1, 2005, when
SGLI maximum coverage was raised from $250,000 to the current $400,000,
a periodic opportunity to increase their VGLI coverage consonant with
changes in their family situation and the needs of their beneficiaries.
This increases program flexibility and fairness, and provides a greater
benefit to this portion of the veteran population. The American Legion
would like to comment further, however, that in the cases of severely
service-disabled veterans, a federally subsidized premium relief or
waiver element should be included to lessen the financial burden of
VGLI's high premium costs, particularly in the older age groups.
SGLI Two Year Total Disability Extension Retention Act:
Under current law and procedures, if an insured servicemember is
totally disabled at the time of separation from service, the member's
SGLI coverage may be continued for up to two years, for free, following
separation from service. Effective October 1, 2011, this provision
expires and the SGLI extension period will be reduced from two years to
18-months. The SGLI Two Year Total Disability Extension Retention Act
will allow for the indefinite retention of the two-year total
disability extension period. By maintaining the SGLI Total Disability
Extension period at two years, this will maximize the opportunity for
totally disabled veterans, who have no hope of obtaining commercial
insurance, to make informed decisions regarding their life insurance
needs and options. It also guarantees that those most in need, who have
been traumatized by their disabilities, will be fully covered under the
SGLI program during this transition period with no action or cost on
their part. There are no PAYGO costs associated with this proposal and
it does not impact the budget.
The American Legion strongly supports this proposal. It is obvious
that veterans who separate from service with such extensive
disabilities as to render them totally disabled often require a
substantial period of time to bring their personal and financial
affairs into order, due to the debilitating nature of such disabilities
and the resulting period of family adjustment, and so to assist them in
later meeting the premium costs of VGLI coverage as the program's
structure does not provide for any disability waiver of premiums as
other federal and many private life insurance programs do. The American
Legion further believes the process for this extension, which requires
application by the veteran to the OSGLI center for such, be streamlined
and automated so that veterans leaving active duty in a totally
disabled status are automatically granted the extension shortly after
separation.
Medical Care_Proposed Legislation
Homeless Providers Grant and Per Diem Program:
Legislation will be proposed to amend legislative authority in Title 38
U.S.C., Subchapter VII, section 2061, to obtain statutory authority to
offer both capital grants and enhanced per diem payments to eligible
community-based entities who serve special needs veterans including
female homeless veterans, homeless veterans diagnosed with a chronic
mental illness, and those veterans who are failing and/or terminally
ill. This proposal would grant VA permanent authority to offer capital
grants and per diem to agencies that create transitional housing and
supportive services for homeless veterans with special needs; allow for
enhancement of the current per diem rate for transitional housing
services; and remove the requirement to provide grants to VA health
care facilities.
The American Legion supports this proposal. If enacted, this
legislative proposal would provide resources for public and private
sector agencies and organizations who serve special needs veterans,
including female homeless veterans, homeless veterans diagnosed with
chronic mental illness and those veterans who are failing and/or
terminally ill. With the VA and other homeless care service providers
continuing to focus on the various needs (i.e., health issues, economic
issues, lack of safe/affordable housing, and lack of family and social
support networks) of homeless veterans, and the enactment of this
legislation, The American Legion believes that homelessness rates will
continue to drop among the veterans' community. The American Legion
strongly supports taking the necessary means to combat and aid in
ending veterans' homelessness.
Reinstate the Health Professional Scholarship Program
(HPSP): Legislation will be proposed to reauthorize the HPSP. The
authority to provide the financial assistance will be established by
extending the expiration date of the Department of Veterans Affairs
Health Professional Scholarship Program described in Title 38, U.S.C.,
Sections 7611-7618. The HPSP, established by Public Law 96-330, awarded
scholarships from 1982 through 1995 to 4,650 students earning
baccalaureate and masters degrees. Authority for the program expired in
1998. It is recommended that the Health Professional Scholarship
Program be reauthorized and funded because there is no other
scholarship program with a VA service obligation available to the
public at this time. This program, if reauthorized, will provide
financial assistance to competitively selected scholarship recipients
in exchange for 2-year VA service obligations upon graduation and
licensing.
The American Legion supports this proposal. The Health Professional
Scholarship Program maintains the Department of Veterans Affairs
presence in the competitive medical professional market, as well as
helps to lower the attrition rate amongst medical professionals
employed at VA Medical Centers (VAMC).
Remove Requirement that VA Reimburse Certain Employees
for Professional Education: Legislation will be proposed to eliminate
Title 38, U.S.C., section 7411 that states ``The Secretary shall
reimburse any full-time board certified physician or dentist appointed
under section 7401 (1) of this Title for expenses incurred, up to
$1,000 per year, for continuing professional education.'' VHA has a
long history of providing educational and training support to all
clinical and administrative staff. The Employee Education System and VA
Learning University offer a large course catalog with opportunities for
physicians and dentists, as well as other occupations, to obtain
continuing professional education at VA expense. VHA will continue to
manage training and education funding within long-standing parameters
in conjunction with published policies at the national and local
levels. Continuance of the entitlement in section 7411 is no longer
necessary, given the improved competitive recruitment position
resulting from the new pay system.
The American Legion has no official position on this proposal.
Provide Care for Newborns as Part of the Uniform Benefits
Package: Legislation will be proposed to amend Title 38, U.S.C., to
authorize VA to provide care to newborns of enrolled women veterans who
are receiving maternity care through the Department of Veterans
Affairs. This proposal is to cover costs of newborn hospitalization and
is not to exceed 96 hours after delivery. Longer hospitalization or
outpatient costs for the newborn, beyond 96 hours post-delivery, would
not be authorized in this maternity benefit.
The American Legion has no official position on this proposal.
Civilian Health and Medical Program of the Department of
Veterans Affairs (CHAMPVA) Coverage for Caregivers: Legislation will be
proposed to provide health care coverage through CHAMPVA for any
caregiver without entitlement to other health insurance or coverage.
Caregivers for severely wounded veterans are in most cases impacted by
their inability to sustain employment related health coverage. CHAMPVA
health care coverage will help relieve the financial burden of health
care costs incurred by the caregiver of severely wounded veterans and
allow them the reassurance that their medical care needs will be met
while they care for the medical needs of the veteran. This in turn will
reduce veterans' stress as they will not need to worry about how their
caregivers health related needs are met.
The American Legion supports this proposal. This legislative
proposal would adequately provide timely access to quality health care
for those who are unselfishly caring for the Nation's veterans.
Travel Expenses, including Lodging and Subsistence, for
Caregivers: Legislation will be proposed to provide travel, incidental
expenses [e.g., per diem (inclusive of lodging allowance), tolls etc.]
and subsistence for a caregiver of qualifying veterans receiving care
for service-related conditions at a VA or VA authorized facility. The
Department does not have authority to provide lodging expenses to an
attendant if the veteran is not lodging with the attendant. Since the
veteran's caregiver in most cases is a close family member, providing
travel expenses for the caregiver assures the veteran has the
appropriate support while traveling to a VA health care facility. This
will allow the veteran's health care provider to communicate directly
to the veteran's caregiver about the needs of the veteran. This will
also ensure continuity of the veteran's care and help the caregiver
better understand the needs of the patient.
The American Legion supports this proposed. This legislative
proposal would help to ensure veterans receive complete and
uninterrupted care.
Education and Training for Caregivers: Legislation will
be proposed to allow VA to develop caregiver education materials for
caregivers and individuals who support caregivers. In addition, VA
would provide outreach to veterans and their caregivers to inform them
of the support available through VA as well as public, private, and
non-profit agencies. VA currently provides education and training for
veterans and their caregivers regarding medical issues. This proposal
would codify and expand those efforts. These programs generally
demonstrate significant reduction in caregiver burden and the impact of
depressive symptoms on their daily life. This proposal provides VA with
the opportunity to implement a formal approach to educating and
training caregivers so they are better prepared to care for the
veteran.
The American Legion supports this proposal.
Survey of Caregiver Needs: Legislation will be proposed
to conduct a caregiver survey every 3 years to determine the number of
caregivers, the types of services they provide to veterans, and
information about the caregiver (age, employment status, and health
care coverage). Currently, VA does not have adequate information on the
number of caregivers, the number of family caregivers, and the number
of veterans receiving caregiver services from caregivers and family
caregivers, including the era in which each veteran served in the Armed
Forces.
A survey of veteran caregivers will allow VA to gather needed
information that will be used to better understand the population of
caregivers and to identify and understand their specific needs. This
information will allow VA to appropriately develop education, training,
and support programs for veteran caregivers.
The American Legion supports this proposal.
Nonprofit Corporations: Legislation will be proposed to
establish a Central Nonprofit Corporation for VA research. Currently,
there are 88 of these VA affiliated Non-Profit Corporations (NPC). Each
NPC is required to report annually a detailed statement of their
operations, activities and accomplishments during the previous year.
The purpose of the central Non-Profit Corporation will be to: (1) carry
out national medical research and education projects under cooperative
arrangements with VA, (2) serve as a focus for interdisciplinary
interchange and dialogue between VA medical research personnel and
researchers from other federal and non-federal entities, and (3)
encourage the participation of the medical, dental, nursing,
veterinary, and other biomedical sciences in the work of the central
NPC for the mutual benefit of VA and non-VA medicine. The central NPC
would enable facility directors or the Under Secretary for Health to
have an alternative to individual medical-center-based NPCs in those
facilities in which the volume of research and education does not
enable the resources to assure adequate management controls.
The American Legion has no official position on this proposal.
Clarify Breach of Agreement under the Employee Incentive
Scholarship Program (EISP): Legislation will be proposed to amend Title
38, U.S.C., chapter 76, section 7675, subchapter VI, to provide that
full-time student participants in the EISP would have the same
liability as part-time students for breaching an agreement by leaving
VA employment. The current statute clearly limits liability to part-
time student status participants who leave VA employment prior to
completion of their education program. This allows a scholarship
participant who meets the definition of full-time student to leave VA
employment prior to completion of the education program, breaching the
agreement with no liability. This proposal would require liability for
breaching the agreement by leaving VA employment for both full- and
part-time students. All other employee recruitment/retention incentive
programs have a service obligation and liability component. This
proposal would result in cost savings for the Department by recovering
the education funds provided to employees who leave VA employment prior
to fulfilling their agreement.
The American Legion has no official position on this proposal.
Consider VA a Participating Provider for Purpose of
Reimbursement (revenues): Legislation will be proposed that would allow
VA to be treated as a participating provider, whether or not an
agreement is in place with a health insurer or third-party payer, thus
preventing the effect of excluding coverage or limiting payment of
charges for care. With the enactment of the Balanced Budget Act of 1997
(BBA), Congress changed the health insurer and third-party program into
one designed to supplement VA's medical care appropriations by allowing
VA to retain all collections and some other copayments. VA can use
these funds to provide medical care to Veterans and to pay for its
medical care collection expenses. This law also granted VA authority to
begin billing reasonable charges versus reasonable costs for care.
Reasonable charges are based on the amounts that health insurers and
third-party payers pay for the same care provided by non-government
health care providers in a given geographic area. This proposal would
prevent a health insurer or third-party payer from denying or reducing
payment, absent an existing agreement between VA and any health
maintenance organization, competitive medical plan, health care
prepayment plan, preferred provider organization, or other similar
plan, based on the grounds that VA is not a participating provider.
The American Legion supports this proposal.
Military Surgeon Association: This proposal would make
the Department of Veterans Affairs (VA) an Incorporated Member of the
Association of Military Surgeons of the United States (AMSUS). As a
result, VA would be authorized to participate in AMSUS activities to
the same extent as the military services.
The American Legion has no official position on this proposal.
Technical Changes to Fee Basis Authority: This proposal
would amend Title 38 U.S.C. 1703(a) by adding language similar to the
language found in Title 38 U.S.C. Sec. 8123, Procurement of prosthetic
appliances, which will strengthen the Department's interpretation of
legal authority to purchase health care on an individual basis when
needed.
The American Legion supports this proposal. This legislative
proposal would seek to ensure veterans receive adequate and timely
care, to include medical appliances.
Mandatory Disclosure of Social Security Number (SSN) and
3rd Party Health Insurance: The provision would deny access to hospital
care, nursing home care, or medical services that may be provided to
any person under the provisions of Title 38 U.S.C. chapter 17 unless
that person has disclosed his/her social security number and the social
security number of any dependent or beneficiary and furnish VA with
current, accurate third-party health insurance information.
The American Legion has no official position on this proposal.
Permanent Authority for Co-Pays: The provision would
amend Title 38 U.S.C. Sec. 1710 (f)(2)(B) to make permanent VA
authority to collect an amount equal to $2 or $10 for every day the
veteran receives hospital care for a veteran who is required to agree
to pay to the United States the applicable amount determined under
paragraph (2) or (4) or this subsection. This current authority expires
September 30, 2010.
The American Legion has no official position on this proposal.
Permanent Authority for Collections: The provision would
amend Title 38 U.S.C. Sec. 1729 to make permanent VA authority to
recover reasonable charges for care or services for care of nonservice-
connected conditions from a third party to the extent that the veteran
who has a service-connected disability would be eligible to receive
payment for care or services from a third party if the care or services
were not provided by VA. This current authority expires October 1,
2010.
The American Legion has no official position on this proposal.
Eliminate and Change Dates for Certain Congressional
Reports: This proposal would eliminate the Report on Pay for Nurses and
Other Heath Care Personnel (Title 38, U.S.C., Section 7451(f)) and
Report on Long-Range Health Planning (Title 38, U.S.C., Section 8107)
and modify the due date and limit the duration of the Annual Report on
Federally Sponsored Gulf War Research Activity.
The American Legion has no official position on this proposal.
Codify Rules on Billing of Veterans in CHAMPVA: This
proposal would modify Title 38 U.S.C. Sec. 1781 to codify, consistent
with regulations, that the VA determined allowable amount for
reimbursement of medical services represents payment in full and the
health care provider may not impose additional charges on the
beneficiary above the VA-determined allowable amount.
The American Legion has no official position on this proposal.
Other Legislative Proposals
Staying of Claims: This proposal would amend Title 38,
U.S.C., to permit the Secretary of Veterans Affairs (VA) to delay
adjudications as needed to preserve program integrity and to clarify
that the Board of Veterans' Appeals (Board) may decide certain cases
out of docket order.
The American Legion opposes this proposal. The American Legion
would oppose VA from initiating stays involving implementation of
precedential federal court decisions pending the appeal of the decision
without seeking permission of such a stay from the court as is the
current practice. The current procedure for initiating stays in claims
adjudication in such instances allows for VA to preserve program
integrity but also provides a check by not allowing VA to circumvent
the court's authority.
Revise Time Limits and Dates for Herbicide and Gulf War
Presumptions: This proposal would modify statutory time limits to the
review and rule-making process.
The American Legion has no official position on this proposal.
Repeal Obsolete Ethics Provision: This proposal would
eliminate the blanket prohibition against VA employees having interests
in, or receiving income or services from, certain for-profit
educational institutions.
The American Legion has no official position on this proposal.
Notice of Disagreement Filing Period: This proposal would
amend Title 38 U.S.C. Sec. 7105(b)(1) to reduce the time period for
filing of a notice of disagreement (NOD) following the issuance of a
rating decision from one year to 180 calendar days.
The American Legion strongly opposes this proposal. Claimants
currently have one year to initiate the appeals process following the
issuance of a VA rating decision by filing a notice of disagreement.
Arbitrarily reducing this period from 1 year to 6 months for the sake
of expediency serves no purpose other than to adversely impact
appellants who miss the 6 month cut off. If the percentage of
appellants who file after 6 months is large, then a large group of
appellants would be denied their appellant rights. If the percentage of
those who file after 6 months is small, then there can be no great
benefit to timeliness by implementing this change.
Automatic Waiver of Agency of Original Jurisdiction
Review of New Evidence: This proposal would amend Title 38 U.S.C.
Sec. 7105 to specifically incorporate an automatic waiver of agency of
original jurisdiction (AOJ) consideration for any evidence submitted to
VA by the appellant or his or her representative following VA's receipt
of a VA Form 9 substantive appeal, unless the appellant or his or her
representative expressly chooses in writing not to waive such
jurisdiction.
The American Legion supports this proposal. The American Legion
believes the automatic waiver of agency of original jurisdiction (AOJ)
review in instances where the claims file has already been certified
and transferred to the Board of Veterans' Appeals (BVA). However, as it
takes an average of approximately 600 days for the regional offices
(RO) to transfer an appeal to the BVA after the substantive appeal has
been filed, an automatic waiver of AOJ review and or submission of the
evidence directly to the BVA after the substantive appeal has been
received would cause additional delay if the claims file is still at
the regional office. It is also in the best interest of the appellant
for the RO to review evidence and issue a decision, after the appeal
has been perfected, in instances where the claims file is still at the
RO and the evidence submitted would allow a grant of the benefit
sought. As it now takes a year or more, depending on docket date, for
the BVA to make a decision after it has received the claims file,
automatically waiving AOJ review in such instances would cause
unnecessary delay.
The American Legion also suggests the consideration of legislation
addressing the inordinate amount of time it takes the AOJ to certify
and transfer the appeal to the BVA after a substantive appeal is
received.
Board of Veterans' Appeals Video Hearings: This proposal
would amend Title 38 U.S.C. Sec. 7107(d)(1) and (e)(2) to allow the
Board to determine the most expeditious type of hearing to afford an
appellant (i.e. an in-person hearing or a video conference hearing),
restricting the appellant to the hearing selected by the Board unless
good cause or special circumstances are shown to warrant another type
of hearing.
The American Legion opposes this proposal. The American Legion does
not support a denial of the appellant's right to choose the type of
Board of Veterans' Appeals (BVA) hearing he or she desires. The
majority of BVA appellants do not opt to have a personal hearing and
taking away their right to choose their preferred option serves no good
purpose.
Board of Veterans' Appeals'--Rationale in Decisions: This
proposal would amend Title 38 U.S.C. Sec. 7104(d)(1), to define
``reasons or bases'' to mean ``a plausible statement of the reasons for
the Board's ultimate findings of fact and conclusions of law.''
The American Legion has no official position on this proposal.
Definition of Prevailing Party for the Equal Access of
Justice Act (EAJA) and Veterans Benefits Appeals: This proposal would
amend the definition of ``prevailing party'' for purposes of
establishing eligibility to receive attorney fees and expenses fees
under Title 28 U.S.C. Sec. 2412 of the Equal Access of Justice Act
(EAJA) for cases handled by the United States Court of Appeals for
Veterans Claims (Court).
The American Legion has no official position on this proposal.
Filing of Substantive Appeals: This proposal would amend
Title 38, U.S.C., Sec. 7105(d)(3), to establish a clear time period for
filing a substantive appeal in order to perfect an appeal to the Board
of Veterans' Appeals (Board), to make the filing of a timely
substantive appeal a jurisdictional requirement for Board review, and
to establish that finality attaches to any matter in which a timely
substantive appeal is not filed, all for the purpose of promoting
efficiency in the adjudication process.
The American Legion is deeply concerned about the potential impact
this proposal will have, but without reviewing the exact statutory
language we are unable to provide specific comment.
Advisory Committee on Homeless Veterans: This proposal
would extend the Congressional authority to continue the Advisory
Committee for Homeless Veterans (ACHV) for an additional three years
until 2014.
The American Legion supports this proposal. VA's new initiative to
eliminate homelessness among the veterans' population in five years
will require this Committee's insight and guidance to making this
endeavor a reality.
Title 38 Pay Authority To Maintain On-Call Pay for
Information Technology (IT) Specialists in VA OI&T: This proposal would
amend Title 38 to continue to allow Title 5 IT Specialists authority to
serve in an ``on-call'' status and receive ``on-call'' pay because of
the requirement to support VA's health care mission 24 hours a day, 7
days a week.
The American Legion has no official position on this proposal.
Title 38 Pay Authority To Recruit and Retain Health Care
Professionals in VA OI&T: Legislation will be proposed to allow the
Office of Information and Technology (OI&T) Title 38 Pay Authority.
This will enable OI&T to recruit and retain health care professionals
in leadership positions.
The American Legion has no official position on this proposal.
Office of Small Business Programs: This proposal would
change the name of the Office of Small and Disadvantaged Business
Utilization to the Office of Small Business Programs. This change will
bring VA into alignment with DoD's name change in accordance with the
National Defense Authorization Act for Fiscal Year 2006 (Public Law
109-163, Section 904).
The American Legion has no official position on this proposal.
Real Property Enhanced Use Leases (EUL): Legislation will
be proposed to extend the current EUL authority from its expiration
date of December 31st, 2011 for five years, until December 31st, 2016.
The American Legion has no official position on this proposal.
Franchise Fund: This proposal would modify Public Law
109-114, Military Quality of Life and Veterans Affairs Appropriations
Act of 2006, to provide a better financial procedure for the VA
Franchise fund to more quickly return refunds to customers when
improper payments are inadvertently made by the fund on the customer's
behalf.
The American Legion has no official position on this proposal.
VA Police Uniform Allowances: This proposal would update
Title 38 U.S.C. Sec. 903-Uniform Allowance for Department Police
Officers to make the uniform allowance paid to Department police
officers consistent with current Federal statute and regulations.
The American Legion has no official position on this proposal.
CONCLUSION
Mr. Chairman and Members of the Committee, The American Legion will
continue to review the President's budget request. The American Legion
had less than 24 hours to review the President's budget request and
prepare this written testimony.
Once again, The American Legion supports:
Increases funding for VA in FY 2011 by $11 billion above
the FY 2010.
Increases funding for VA's medical care by $4 billion in
FY 2011 and a projected $2.8 billion increase in FY 2012 to $54.3
billion.
Expands enrollment for 500,000 additional Priority Group
8 veterans by FY 2013.
Enhances outreach and services related to mental health
care and cognitive injuries, including post-traumatic stress disorder
and traumatic brain injury, with a focus on access for veterans in
rural and highly rural areas.
Invests in better technology to deliver services and
benefits to veterans with the quality and efficiency they deserve.
Full concurrent receipt of military retirement pay and VA
disability compensation without offsets.
Combats homelessness by safeguarding vulnerable veterans.
Facilitates timely implementation of the comprehensive education
benefits that veterans earn through their dedicated military service.
The American Legion welcomes the opportunity to work with this
Committee and the Administration on the enactment of a timely,
predictable and sufficient budget for the Department of Veterans
Affairs.
Mr. Chairman, this concludes my testimony and The American Legion
would welcome any questions you or your colleagues may have.
Prepared Statement of Richard F. Weidman,
Executive Director for Policy and Government Affairs,
Vietnam Veterans of America
Good morning, Mr. Chairman, Ranking Member Buyer, and distinguished
Members of the committee. Thank you for giving Vietnam Veterans of
America (VVA) the opportunity to offer our comments on the President's
Budget Request for FY 2011. All of us at Vietnam Veterans of America
(VVA) wish to thank the leadership shown by this committee, by the
leadership of the Budget Committee and of the Appropriations Committee,
as well as the Speaker and the leadership of the House of
Representatives for your vision in leading the struggle to enact
Advance Appropriations. Further, your extraordinary vision in securing
the dramatic increases in funding for Department of Veterans Affairs
(VA) in both the medical system and in the Veterans Benefits
Administration in the last three years has been nothing short of
laudatory, and we applaud you for it.
First let me note that Vietnam Veterans of America (VVA) is one of
the many organizations that has endorsed The Independent Budget of the
Veterans Service Organizations (IBVSO). We commend our colleagues at
the Veterans of Foreign Wars, AMVETS, Paralyzed Veterans of America,
and the Disabled American Veterans for their excellent work on this
major undertaking, and thank them for the strenuous effort it takes to
produce this excellent document each year.
Further, VVA commends President Obama and his Administration for
submitting a budget request that continues to move us toward the goal
of full funding of the health care and benefits earned by virtue of
military service. It is a relatively ``lean year'' in regard to the
Federal Budget request, yet the President has recognized that caring
for ``he--or she--who hath borne the battle'' and their survivors is
both part of the cost of war as well as the duty of the nation and our
citizenry. Therefore the President has exempted programs that serve
veterans from the projected budget freeze along with the Department of
Defense, Department of Homeland Security, and other programs vital to
protecting the country.
While VVA does endorse the IBVSO in the main, and lauds the
President's Budget Request, there are a few areas that we must comment
where we see some needs that are not included in either the IBVSO or in
the President's Budget Request for VA.
First, VVA strongly supports the need to indicate where some of the
appropriations increases need to be focused by VA managers, such as
Post Traumatic Stress Disorder (PTSD) services. The reason for this is
that all too often in the past Congress has appropriated additional
funds to deal with specific needs, and the money has been redirected at
other areas of operation. The well documented instance of money
specifically directed by the Congress to start to more properly address
the scourge of Hepatitis C a decade ago is one glaring incident of this
behavior by VA. Even after being pressed hard by the Congress and the
General Accountability Office (GAO), VA could not account for the
majority of the funds that were supposedly directed toward correcting
the deficiencies of the VA health care system in diagnosing and
treating Hepatitis C. There is therefore a natural inclination to
ensure that this type of thing does not happen again, both on the part
of top managers in the Executive branch and in the Congress.
However, because so much of the funding was centrally directed from
Washington, VISN Directors and VA Medical Center Directors reported to
us last tear that they could not meet certain needs because they only
got a small increase of funds from FY 2008 to FY 2009 and/or FY 2009 to
FY 2010. Usually those reported increases were from 1 percent to 3
percent. This of course caused VVA to ask how this could be, given that
there was a much larger increase than that in the appropriation of the
medical operations account? Where did the money go? We were told that
it was in the special accounts, such as for PTSD. However, some of the
unmet needs that local VA managers said they could not meet because of
tight budgets were for additional clinicians to deal with PTSD problems
of young soldiers returned from the current conflicts.
The argument against making medical care part of the mandatory side
of the budget as opposed to keeping it where it is now, in the
discretionary side of domestic spending was that Congress would not
have adequate control over how the funds were spent. That was
persuasive to the veterans' community, so all agreed that we should go
to advance appropriations. With the strong leadership here in the
House, and Senator Akaka and his colleagues in the Senate, as well as
President Obama, we have achieved this important milestone. As you
know, VVA's top legislative agenda item for the 11th Congress was
Advance Appropriations for VA health care. Now that this has been
achieved, our top legislative agenda item is to assist the Congress in
securing much greater accountability in both the efficiency and
effectiveness of how each appropriated dollar is spent. What we are
saying is that the Director of each Veterans' Integrated Service
Network (VISN) and of each VA Medical Center (VAMC) must be given funds
to be able to handle the increased costs of everything from electricity
to salary to supplies, and then held accountable for how well they use
those dollars to deliver high quality medical care to every eligible
veteran. VVA suggest that several billion be added to the pool of funds
that is sent out to the VISNs under the allocation model. VVA further
suggest that Congress direct VA to re-examine the Veterans Equitable
Resource Allocation (VERA) model to make it a more finely tuned
instrument for allotting resources. At present the VA medical
facilities in the north are being shortchanged because the veterans who
have resources move south, leaving generally the veterans who are
poorer, sicker, and in need of more medical services than the more
affluent ones who move to warmer climates. The two tiered system
currently employed does not sufficiently account for this phenomena,
thereby leaving those VISNs in the north without adequate resources to
meet the needs of the veterans in their catchment area.
This does not mean that the President's request should not ask for
targeted dollars (e.g., for PTSD, for increased services to homeless
veterans, etc.), but that as this is passed down to the local level for
actual delivery of services, how much goes where needs to be
transparent. VVA National President wrote to VA on April 9, 2009 asking
for the allocation by VSN and by VAMC of medical care dollars. While it
was partly answered within 30 days, the only information provided was
for the previous (FY 2008) Fiscal Year. It is now almost halfway
through the second quarter of FY 2010, and we are still waiting for
that answer, despite having made repeated efforts to secure same. This
is just not acceptable.
Need for Much Greater Transparency in VHA
It is clear to us that mechanisms to achieve a much higher degree
of transparency in all parts of the Veterans Health Administration
(VHA) needs to be restored, and the trend toward secretiveness that
started in 2003-2004 needs to be sharply reversed. There is no better
way of securing the undivided attention of the permanent managers
employed in the VHA than to make such mandates part of the
appropriations process/language, both in the text of the law and in the
report language. VVA encourages the Committee to suggest possible
language to the Budget and Appropriations Committees in your views and
estimates statement.
Further, there needs to be much more consultation and sharing of
information between key officials in the VHA and leaders of the
veterans' community. The fact that much of the meetings of the
Seriously Mentally Ill Advisory Committee now meets in secret, and the
Advisory Committee on PTSD meets totally in secret should give everyone
pause, particularly after the missteps and serious problems with these
services at VA over the last four or five years.
Outreach and Education to Open the System to ALL Eligible Veterans
VVA encourages the Congress to continue and accelerate the lifting
of the restrictions imposed in January 2003, and to allow so-called
Priority 8 veterans to register and use the system. As a key element in
this effort, VVA strongly urges the Congress to mandate that there be a
line item in each division of VA specifically for outreach and
education, and that all of these efforts be coordinated through the
Office of the Assistant Secretary for Intergovernmental and Public
Affairs. Having been turned away one or more times by the VA, many of
the veterans who they are trying to reach are very skeptical (to say
the least) about responding to any letters that VA may send them to ask
them to come in and register for health care services.
If it is to be successful, this effort must be coordinated, done on
a media market by media market basis, and involve the Veterans Service
Organizations and other key players if it is to be successful in
drawing these veterans back to VA.
Veterans Economic Opportunity
While VVA supports adding additional claims processors to the
Compensation and Pension system, it is equally important to add
additional staff to the rolls of VA Vocational Rehabilitation. VVA
strongly favors reorganizing VA to create a fourth element of VA that
would be known as the Veterans Economic Opportunity Administration,
giving the current Secretary the opportunity to establish a new
corporate culture in the VEOA that focuses on helping veterans to be as
autonomous and as independent as possible. Frankly, getting, and
keeping, veterans who are homeless off of the street a major goal of VA
should make expansion of the VA Vocational Rehabilitation program a top
priority, both for adding rehabilitation specialists, and for adding
more employment placement specialists. There are currently less than
100 employment placement specialists for the entire nation. We have
excellent leadership at the top of VA Vocational Rehabilitation Service
now. It is time to give her the staff and the resources needed to
assist veterans to obtain and sustain meaningful employment at a living
wage. It is important that we add at least 400 staff members to the VA
Voc Rehab staff, with many of those being placement specialist. If we
can add 4,000 new staff members to process claims, then we should be
able to add 400 staff to help veterans return to work.
VA Research
While VVA supports the request for $590 million for VA Research &
Development, we hope that all recognize that this is not nearly enough
for the tasks at hand. Frankly, much of these funds go to research
projects that keep the medical ``stars'' at VA in the VAMC that are
affiliated with a medical school. This is fine, and a useful function.
However, there is a glaring need for funding into the wounds, maladies,
injuries, illnesses, and medical conditions that stem from service by
American citizens in our Armed Forces. The National Institutes of
Health (NIH) does virtually no specific veteran related research.
Similarly, the same is largely true of the Center for Disease Control
(CDC), the National Academies for the Advancement of Sciences (NAAS),
and the Agency for Health Research Quality (AHRQ). While VVA strongly
supports the work of all of these fine institutions as the only VSO to
be a member of the ``Research America!'' coalition, we also know that
there is an immediate and pressing need for veteran specific research.
This vitally needed research would include, but not be limited to,
projects such as research into the genochromosonal effects of Agent
Orange and other toxins across multiple generations, possibly causing
health anomalies in grandchildren and great-grandchildren of veterans
exposed. Or, similarly, the consequences in regard to MS or MS-like
conditions in veterans or the possible birth defects of children of
those exposed to the cloud of chemical and biological weapons detonated
in Iraq at the end of Gulf War I.
If it is necessary to create a new branch of VA that would be
called the Division of Extramural research in order to make it possible
to have such directed research grants available to those inside and
outside of VA on a competitive basis, then VVA recommend that we move
in that direction, and fund these activities to the level of at least
$2 Billion by the year 2015, with commensurate increases of $260 +
million each year to reach that level. Frankly this is important both
for the health of current and future veterans already exposed, but also
as a force health protection activity that will assist in preventing
such maladies in the future, which makes it necessary for our national
security.
In this regard in the short term, VVA strongly urges the Congress
to allocate an additional $30 million for VA to begin to analyze and
study the mountains of epidemiological evidence that it has on veterans
of every generation, to meet Secretary Shinseki's desire that we not
``wait for an Army to die'' but rather get answers about patterns of
health care problems now, without waiting for prospective studies in
the future.
Automating VA IT Functions and Outreach
VA has an ambitious set of proposals to bring the department into
the 21st century, and VVA enthusiastically supports these initiatives.
However, we are still troubled that VA wants an electronic medical
record system that can communicate with the Department of Defense and
the private sector, but which will still not be able to communicate
with the Compensation & Pension Service.
Further, while we can all be proud that the VA's electronic health
care record ``VistA'' is so popular that it is now being exported to
the private sector, VVA is still troubled that this is occurring
without a field being added for military history, thereby sending an
implicit false message to the private sector that exposures and
experiences in military service have no significant impact on the long-
term health care risks for veterans. I think it is safe to say that
most know this to not be the case for all too many veterans.
Mr. Chairman, thank you for this opportunity to share our thinking
and recommendations on these matters.
Prepared Statement of Paul Rieckhoff, Executive Director,
Iraq and Afghanistan Veterans of America
Chairman Filner and Ranking Member Buyer, thank you for the
opportunity to testify on behalf of Iraq and Afghanistan Veterans of
America (IAVA) regarding the ``VA's Budget Request for Fiscal Years
2011 and 2012.'' IAVA is the Nation's first and largest non-partisan,
nonprofit organization representing veterans of the wars in Iraq and
Afghanistan, and we are honored to be invited here today.
We've come a long way since 2004, when my infantry platoon and I
first got home from Iraq. The era of rationing health care for our
Nation's veterans, due to late and insufficient funding, has finally
ended. Nearly two decades ago veterans' advocates began demanding
``sufficient, timely and predictable'' funding for the Department of
Veterans Affairs. Last year, this Congress and Administration finally
delivered. With record increases for the third year in a row, the VA
budget was more than just ``sufficient.'' And although the budget was
passed 2 months after the start of the new fiscal year, by providing
funding for fiscal years 2010 and 2011 we finally had a ``timely'' and
``predictable'' VA budget. IAVA didn't exist when this campaign began,
but we were proud to be a part of the battle and advance appropriations
was our top priority last year. We are sincerely grateful for the work
that the Members of this Committee and the veterans groups seated here
today did to make advance appropriations possible.
I'm sure the Members of this Committee agree that our work is far
from over. Right now, thousands of veterans are unemployed, more than
100,000 are homeless, and hundreds of thousands are desperately waiting
months, and sometimes years, for their well-earned VA benefits.
Veterans, like former Army Specialist and IAVA member Casey Elder, who
suffered a Traumatic Brain Injury when her Humvee struck a roadside
bomb in Baghdad in 2004. After nearly a year of waiting, and despite
clear evidence for a disability rating from the VA's own neurologist,
Casey's initial claim has been denied. She has since appealed the
decision, but it could take up to two years for Casey to receive
compensation--if she receives it at all.
VA employees are highly-dedicated, and we're extremely appreciative
of their service to veterans. However, the Department of Veterans
Affairs must do better. It must do better for Casey Elder, and for
veterans of all generations. IAVA believes that this year's VA budget
request of $125 billion for fiscal year 2011 and $50 billion in advance
appropriations for health care in 2012 signals the beginning of this
new era. One might even be tempted to call this the ``advance
appropriations era,'' but we will borrow a term from VA Secretary
Shinseki, and call it the ``Transformation Era.'' Government budgets
are the clearest expression of a Nation's priorities. IAVA believes
that this VA budget and all future budgets, during this transformative
era, should be evaluated on the following four principles:
Guarantee the Best Care Anywhere
Modernize Benefits Delivery
Recruit Veterans and their Families into the VA system
Support Female Veterans
True VA transformation will mean building a VA capable of handling
the care of veterans and their families recovering from multiple
injuries. Transformation means satisfying the expectations of an
internet generation who can track a package anywhere in the world, but
have no idea what happens to their VA claims once they are mailed.
Transformation means treating a rapidly increasing number of female
veterans using VA facilities. Transformation means providing top
quality care for the surge home of veterans of Iraq and Afghanistan.
And transformation means realigning resources to accommodate a steadily
declining national veterans population. Transformation will not be
easy. But working together, we can make it a reality by focusing on the
following areas:
I. Guarantee the Best Care Anywhere for Veterans
The VA Funding Levels Must Match the Independent Budget Recommendations
To continue to provide the best care anywhere for our veterans the
VSO Independent Budget (IB) recommendations should be the standard for
future VA budgets. The IB budget is a blueprint for constructing a VA
budget that meets the needs of our Nation's veterans. IAVA fully
endorses it. We are grateful that VA funding levels have matched and
sometimes exceeded the IB recommendations over the past three years.
And we are pleased that the President's VA budget request for 2011
appears to have also met the IB's recommendations. We hope to see this
convention for years to come.
The VA Must Collaborate with All Stakeholders to Successfully Implement
Advance Appropriations
In addition to sufficiently funding the VA we must ensure the
responsible and successful implementation of advance appropriations for
veterans' health care. Successful implementation hinges on the VA's
ability to accurately project their financial needs two years in
advance. Everyone here knows this is no small task. I know from
personal experience running a dynamic organization that projecting
needs one year in advance is difficult. Tackling the budget for the
largest health care provider in the United States two years in advance
will require a herculean collaborative effort involving the VA,
Congress and the veterans' community.
Successful collaboration on this scale requires complete
transparency throughout the entire budgeting process. Previous
Presidential VA budget submissions were developed using projection
models based on proprietary data and political scrubbing at OMB that
were not made public. The VA must eschew this closed door approach and
embrace a fully transparent budgeting process where all stakeholders
have access to the core budget data and the projection models being
used. While it may not make for great ratings on C-Span, opening the
budgeting process to review and critique will allow the VA to harness
the full expertise of Congress and the veterans' community.
VA's implementation of the new GI Bill last year was another
transformative program that required an extraordinary effort. Arguably,
one of the most valuable lessons learned during that process is that
when the VA reaches out and involves Congress and the veterans'
community in their decision-making process the overall implementation
runs more smoothly. For example, The VA held three town hall meetings
to develop their implementation regulations for the New GI Bill. After
these meetings they issued rules that students, schools and veterans
groups accepted and generally understood. This was a successful
collaboration. Alternatively, when the VA did not collaborate, and
acted unilaterally, the GI Bill veered off course. This resulted in
unacceptable delays and widespread confusion. The message to the VA
from IAVA and the VSO community is clear: we are here to help. But you
have to answer the phone and listen to what we are hearing from our
Members.
II. Modernize Benefits Delivery
It's long overdue to bring our benefits system into the 21st
Century. Iraq and Afghanistan veterans, like Casey Elder, the wounded
veteran I described earlier, are receiving benefits under a VA
disability system that was outdated years before most of them were
born. This antiquated system, which focuses on quantity over quality,
leads to frequent errors, mountains of bureaucratic red tape, and a
lengthy wait for benefits. With the VA benefits backlog nearing 1
million claims, the need for transformation has never been greater. We
therefore join with the chorus of other veterans groups in recommending
that the VA modernize their claims processing system by digitizing
records, holding processors accountable for the accuracy of their work,
and removing unnecessary steps in the evaluation process. This issue is
of the utmost importance and urgency so IAVA has made disability reform
our number one legislative priority for 2010. These issues are further
described in IAVA's groundbreaking issue report, ``Red Tape: Veterans
Fighting New Battles for Care and Benefits,'' available outside the
door today and at www.IAVA.org/reports.
The greatest obstacle to the VA's modernization of benefits
delivery is its archaic IT system, which cannot exchange electronic
health records between DoD and VA and does not allow veterans to track
the processing of their benefits claims. The DoD still relies on a
paper-based system for military service records, and as troops
transition from the DoD to the VA, medical records and military service
records regularly get lost in the shuffle. Hundreds of thousands of
wounded troops and veterans are forced to wait months, and sometimes
years, for disability compensation because of these IT deficiencies. VA
and DoD have been working on the ability to seamlessly share veterans
health records for over a decade, but progress has been slow and
transparency limited.
In April 2009, the Administration announced a bold initiative to
create the Lifetime Verification Electronic Record (LVER), integrating
health and service data into a format usable between DoD, VA and the
private sector. If successful, benefits processing time will be cut by
months and veterans will receive higher quality health care across the
board. A project of this magnitude is something in our world akin to
landing a man on the moon, and should be given all the resources and
attention necessary to ensure success. Like advance appropriations and
the GI Bill, this initiative will require a truly collaborative effort
on all of our parts.
IAVA is pleased to see that the President's budget submission
contained $52 million for the development of the LVER. We look forward
to seeing regular progress reports from the VA on the strategic goals
to have the LVER up at 3 pilot sites by the end of the year and to have
developed a working prototype by 2012. And we encourage VA to work with
Congress and the veterans' community to ensure that adequate resources
are being provided to guarantee the success of this critical
initiative.
Upgrading these systems better serves our veterans and also makes
the system more efficient. Efficiency results in significant cost
savings, low hanging fruit in a time of historic national deficits. We
are glad to see the VA bringing in one of IAVA's Board members, Craig
Newmark--the Craig in Craigslist. VA leadership will certainly benefit
from his technological expertise and strategic vision. And we also hope
that they will learn from his incredible focus on customer service.
Craig's business card famously reads ``Customer Service
Representative,'' and Craig is not joking. He is committed to providing
Craigslist's users with the best possible experience, and he literally
spends hours a day personally answering customer service emails. This
commitment to customer service has made Craigslist a dynamic,
responsive company that is in close touch with its customers. This has
allowed Craigslist to build an extremely strong and trusted brand.
Changing the culture and processing claims quickly and accurately will
make VA that same kind of trusted brand for veterans.
III. Recruit Veterans and their Families into the VA system
Innovative and Aggressive Outreach is a Must
The Department of Veterans Affairs must shed its passive persona,
by adopting a customer-centered approach, and by recruiting veterans
and their families more aggressively into VA programs. This means
developing a relationship with the servicemember, while they are still
in the service. They can learn from successful college alumni
associations who greet students at orientation and hold student
programs throughout their time in college. And once a veteran leaves
the military, the VA should create a regular means of communicating
with veterans about events, new programs and opportunities. If I got
half as many letters and emails from the VA as I do from my College
Alumni Association, we would be in great shape. The VA must also reach
out to those veterans who have yet to access their VA benefits and
aggressively promote VA programs.
In order to accomplish this phase of transformation, IAVA believes
that the VA must prioritize outreach efforts and include a distinct
line item for outreach within each VA appropriation account. These line
item should help fund successful outreach programs such as the OEF/OIF
Outreach Coordinators, Mobile Vet Centers and the VA's new social media
presence on Facebook and Twitter. Right now, these outreach programs
are still too small and under-resourced to make a transformative
difference. IAVA was disappointed that there were only a few brief
mentions of outreach activities throughout the President's VA budget
submission. Not one of these mentions described a dedicated outreach
campaign.
Based on experience with our own historic Public Service
Announcement (PSA) campaign with the Ad Council, we have learned a
thing or two about veteran outreach campaigns. Hopefully by now you've
seen our iconic PSAs, like the one featuring two young veterans shaking
hands in an empty New York City street. I know Chairman Filner has seen
the ad, because he encouraged us to reenact that scene with the actual
vets on the steps of the Capitol last year.
These TV ads are just one component of this groundbreaking
campaign. That famous ad is complimented by billboards, radio
commercials, and web banners that have blanketed the country and
touched millions of Americans. In just the first year of the campaign,
IAVA has already received $50 million dollars in donated media, and
reached millions of veterans.
This entire campaign directs veterans to an exclusive online
community that strongly demonstrates to our Nation's new veterans that
``We've Got Your Back.'' It also directs them to a wide range of mental
health, employment and educational resources--operated by both private
non-profits AND the VA. This campaign is an example of the type of
innovation coming out of the VSO and non-profit community that can help
guide the VA. Innovative, aggressive outreach programs like this should
become part of the new VA culture, and can fuel-inject desperately
needed outreach efforts. We are learning what works, and we are happy
to share our knowledge with anyone.
We Must End the Suicide Epidemic
IAVA's outreach efforts are also designed to make a dent in the
suicide epidemic ripping through the military and veterans' community.
During the first eight days of this new year, eight servicemembers have
already taken their own lives. And in 2009, a record 334 servicemembers
committed suicide. Last year, more servicemembers died due to suicide
than combat in Iraq. These numbers do not even include the veterans who
commit suicide after their service is complete--whose fatalities are
tragically insufficiently tracked. Untreated mental health problems can
and do lead to substance abuse, homelessness, suicide, and difficulties
at home.
In 2008 a RAND study reported that almost 20 percent of Iraq and
Afghanistan veterans screened positive for Post Traumatic Stress
Disorder (PTSD) or major depression. A recent study by Stanford
University found that this number may be closer to 35 percent. Less
than half of those suffering from mental health injuries are receiving
sufficient treatment. Exacerbating the problem of inadequate treatment
is the heavy stigma associated with receiving mental health care. More
than half of the soldiers and Marines in Iraq who test positive for a
psychological injury, report concerns that they will be seen as weak by
their fellow servicemembers. One in three of these troops worry about
the effect of a mental health diagnosis on their career. As a result,
those most in need of treatment may never seek it out.
In order to end the suicide epidemic and forever eliminate combat
stress stigma we believe that VA and DoD must declare war on this
dangerous stigma by launching a nationwide campaign to combat stigma
and to promote the use of DoD and VA services such as Vet Centers and
the Suicide Prevention Hotline. This campaign must be well-funded,
research-tested and able to integrate key stake-holders within Veterans
Service Organizations and community-based non-profits like the members
of the Coalition to Support Iraq and Afghanistan Veterans (CIAV).
Furthermore, the VA should develop and aggressively disseminate combat
stress injury training programs for civilian behavioral health
professionals that treat veterans outside of the VA (e.g., college
counselors, rural providers, behavioral health grad students and
professional associations).
IAVA is pleased to see that the VA has allocated $5.2 billion
toward the treatment of hidden injuries such as PTSD and TBI, a
sizeable 8.5 percent increase over last year's budget. However, the VA
must allocate specific resources towards battling this dangerous stigma
or we will never see the critical mass of veterans coming into the VA
to seek help.
End Veterans' Homelessness
The VA estimates there are 131,000 homeless veterans on any given
night and nearly twice as many veterans experience homelessness at some
point during the year. New veterans are especially at risk. At the
height of the housing crisis, foreclosure rates in military towns were
increasing at four times the national average, and already more than
3,700 Iraq and Afghanistan veterans have been seen in the Department of
Veterans Affairs' homeless outreach programs. Unlike previous
generations of veterans, Iraq and Afghanistan veterans are often
appearing in the Nation's homeless shelters within two years of
separation from the military, and a significant percentage of the
homeless are female veterans and their children.
In 2009, the VA laid out a bold vision to fully eradicate
homelessness among veterans within the next 5 years. This ambitious
plan will require a new model for serving veterans and extensive
collaboration between government agencies, traditional Veterans Service
Organizations (VSOs), and the new breed of grassroots and
nontraditional nonprofit organizations. This partnership between the
public and private sector must also be utilized to smooth the
transition home for all veterans. IAVA believes the VA should be
granted discretion to match the Grant and Per Diem (GPD) program
payment rates to the actual cost of helping a homeless veteran. We must
also expand the HUD-VA Supportive Housing (HUD-VASH) voucher program,
to include the funding of 30,000 additional housing vouchers, will
transform the lives of tens of thousands of homeless veterans.
IAVA applauds the VA's goal to cut in half the number of veterans
sleeping on our streets by the end of this year and we believe that the
additional $294 million for joint VA-HUD programs in the President's
budget request will go a long way towards accomplishing that goal.
IV. Support Female Veterans
While it has made strides in recent years, the VA is still
underprepared to provide adequate care to the surge of female veterans
coming to its hospitals and clinics. Women veterans are the fastest
growing segment of the veteran population, and their enrollment in the
VA is expected to more than double in the next 15 years. Women veterans
make up 15 percent of IAVA's membership, and still face several
barriers when seeking care at the VA, including fragmentation of
services, health care and service providers with poor understanding of
women's unique health issues, lack of knowledge regarding eligibility
for benefits, an unwelcoming VA culture, inadequate privacy and safety
practices at facilities, and no access to childcare. IAVA supports the
President's request to increase funding for female health by an
additional 9.4 percent, bringing the total up to $217.6 million.
IAVA also believes that in addition to increased funding, Congress
must establish a firm deadline for the VA to meet its own goal of
providing comprehensive health care to women and require the VA to
layout clear steps and benchmarks for all VA facilities. We also
recommend increasing funding for Vet Centers and VA medical facilities
to hire female practitioners, especially those who specialize in
women's physical and mental health. Lastly, the VA should provide
health care services to a newborn child of a female veteran who is
receiving maternity care furnished by the Department.
These issues are further described in IAVA's groundbreaking issue
report, ``Women Warriors: Supporting `She Who Has Borne the Battle,'''
available outside the door today and at www.IAVA.org/reports.
V. Conclusion
The President's budget submission for 2011 and 2012 has all the
right ingredients for transforming the VA. It is a message to veterans,
like Casey Elder, that ``We've got their back.''
IAVA strongly supports this budget request, and looks forward to
collaborating with the VA, Congress and the rest of the veterans'
community to see this budget and the priorities listed above realized.
Next week, IAVA will be bringing dozens of our members, from across
the country, to Capitol Hill for our annual ``Storm the Hill''
legislative trip. Our highly-motivated veterans already have over a
hundred meetings scheduled to share their stories and our 2010
Legislative Agenda. We look forward to meeting with your offices to
discuss these priorities in more detail.
Thank you.
Prepared Statement of Paul Sullivan,
Executive Director, Veterans for Common Sense
Oral Statement
Chairman Filner, Ranking Member Buyer, and Members of the
Committee, thank you for inviting Veterans for Common Sense to testify
about the Department of Veterans Affairs' proposed budget for 2011.
VCS strongly endorses President Obama's $125 billion VA budget,
especially the new $300 million in funding to end homelessness by the
end of 2014.
However, we do have some concerns about two cohorts of veterans:
first, our Iraq and Afghanistan veterans, and, second, our Gulf War
veterans.
VCS urges Congress to require VA to develop more accurate casualty
estimates as well as implement a long-range strategic casualty plan.
As of June 2009, VA reported 480,000 veteran patients and 442,000
disability claims from the Iraq and Afghanistan wars. This is far above
any worst case scenario for casualties.
VA treats nearly 9,000 new patients per month from the two wars.
For VA's 2012 budget, VA estimated less than 500,000 patients. A more
realistic estimate for 2012, based on VA data, is as high as 800,000
new patients and claims from Iraq and Afghanistan veterans.
One factor that may increase health care use and claims activity is
multiple deployments, as Stanford University researchers estimated 35
percent of new war veterans may return with post traumatic stress
disorder--PTSD.
VA's failure to accurately forecast demand is serious because one-
in-four patients wait more than 1 month to see a doctor. According to
the Veterans Benefits Administration, more than one million veterans
are now waiting 161 days for an initial answer for a disability claim.
We are alarmed VA's 2011 budget request shows VBA taking a
staggering 190 days to process an initial claim. That's one more month
of waiting for our veterans.
While we support hiring additional VBA staff to process the one-
million claim backlog, VBA must also work smarter. VCS urges Congress
to fund development of a one-page claim form plus new, simpler
regulations VBA staff can learn in 6 months, not 2-to-3 years currently
required. VCS urges Congress to fund a specific program to implement
the proposed lifetime electronic record to end the epidemic of lost and
difficult-to-find military service and military medical records.
VCS supports the Veterans' Benefits Improvement Act of 2008 as a
strong move by Congress to improve quality at VBA. We urge Congress to
hold accountable those VBA leaders who openly flaunted the law by
failing to provide several reports and implement sections of the new
law designed to overhaul VBA's broken claims system.
Specifically, VBA has not created temporary disability rating
systems or reports required under Title II, Modernization of VA's
Disability Compensation System, Subtitle A, Benefits Matters, Section
211.
VCS remains deeply concerned that funding for the Board of Veterans
Appeals only increased three percent when there is a backlog of 200,000
unprocessed appeals, and where veterans wait four years for a decision.
VCS also urges Congress to fund full-time, permanent VBA claims
staff at every military discharge location plus every VHA medical
center and clinic.
Here are some VCS budget recommendations for our Gulf War veterans.
First, VCS urges Congress to create and fund a robust Gulf War
veteran advocacy committee to provide advice directly to VA Secretary
Shinseki on Gulf War illness, treatments, and benefits.
Second, VCS urges Congress to fully fund the Congressionally
Directed Medical Research Program, that identifies ``off the shelf''
treatments.
Third, VCS encourages VA to restore funding for Dr. Robert Haley's
research at the University of Texas Southwestern Medical Center. VA's
IG confirms that VA Central Office employees ``impeded the ability of
the contracting officers . . . to effectively administer the
contract.'' In our view, a few VA staff sabotaged Dr. Haley's research.
Finally, Mr. Chairman, you are correct that VBA's Veterans Benefits
Management System is nothing more than a new name for several existing
broken VBA computer systems.
Disney has Pixar studios, and James Cameron has his movie Avatar
that thought outside the box. VCS urges Congress to fund a high-
priority task force to overhaul VBA immediately, from application to
payment and access to health care.
Essentially, if the VBA claims process can be described as a
bridge, then the current one-lane obsolete wooden structure lacks the
capacity to handle the millions of veterans now using it. There are
traffic jams trying to cross, and veterans constantly fall over the
side or through the cracks and plunge into the icy waters below.
An entirely new concrete and steel high-capacity bridge needs to be
built as a replacement. The more time spent adding timber, changing the
name, and applying paint to the wooden bridge only means more delays
for our veterans seeking health care and benefits.
Thank you. I will be glad to answer your questions.
----------
Prepared Statement
Chairman Filner, Ranking Member Buyer, and Members of the
Committee, thank you for inviting Veterans for Common Sense to testify
about the Department of Veterans Affairs' proposed budget for 2011.
VCS strongly endorses VA's $125 billion budget. Specifically, we
thank the President Barack Obama and VA Secretary Eric Shinseki for
increasing funding by nearly $300 million to end homelessness by the
end of 2014.
Our testimony today focuses on two cohorts of veterans that require
additional funding: first, our new Iraq and Afghanistan veterans, and,
second, our Gulf War veterans.
Our 2.2 Iraq and Afghanistan Servicemembers
More than seven years ago, Veterans for Common Sense voiced
concerns regarding the lack of a funding request by VA to care for
casualties for the impending invasion of Iraq. The Congressional Budget
Office had no cost estimate for health care and benefits for veterans.
This was an oversight of enormous magnitude--an oversight still
haunting this country and veterans today with long delays accessing
health care and benefits.
Tragically, the scope of the Iraq and Afghanistan war casualties
reached far above any worst case scenario. As of June 2009, VA reported
480,000 veteran patients from the two wars. VA also reported 442,000
disability claims filed. Nearly 300 first-time Iraq and Afghanistan war
veterans flood into VA medical facilities every day.
VCS is disappointed that VA does not have an accurate casualty
estimate and a long-range strategic casualty plan. Two months ago, VA
estimated 419,000 Iraq and Afghanistan War veteran patients treated by
VA through the end of September 2010. VA's estimate was wrong. By June
2009, VA had already treated 480,000 patients.
At the current rate of nearly 9,000 new patients per month, a more
realistic VA estimate should have been a cumulative total of 615,000
patients treated as of September 2010. VA's 200,000 patient
underestimation is a colossal failure because VA may lack the mental
health care providers, disability claims processors, and education
benefit processors to meet the need of this increasing cohort of
veterans.
One factor that may increase health care use and claims activity is
multiple deployments, as Stanford University researchers estimated 35
percent of new war veterans may return with post traumatic stress
disorder in a study published last year.
VCS is concerned about VA's continued underestimation of
casualties. For 2012, VA estimated less than 500,000 patients from the
two wars. However, a more realistic estimate, based on VA data, may be
as high as 800,000 by the end of 2012.
As the five years of free health care for Iraq and Afghanistan war
veterans expires, VBA should expect the number of disability claims to
catch up to and then surpass the number of patients. In order to
provide a continuity of care, Congress may want to consider extending
free VHA health care indefinitely to Iraq and Afghanistan war veterans
with pending disability claims stalled at VBA.
This issue is serious because, according to three reports issued by
VA's Office of the Inspector General, one-in-four patients wait more
than 1 month to see a doctor. According to the Veterans Benefits
Administration, more than one million veterans now wait 161 days for an
initial answer for a disability claim.
VCS is highly alarmed that VA's 2011 budget request shows VBA
taking a staggering 190 days to process an initial claim--that's an
unacceptable 1 month addition to the current delays facing our veterans
and families.
VCS remains deeply concerned that funding for the Board of Veterans
Affairs only increased three percent. The Board remains a very serious
unresolved bottleneck in VA's broken claims system, with a backlog of
200,000 unprocessed claims. Veterans wait, on average, four to five
years for a claim decision from the Board, indicating that staffing,
training, policies, procedures, and oversight must be strengthened.
VCS offers a solution for Iraq and Afghanistan war veterans. VA and
DoD must develop and implement a transparent strategic casualty plan.
This means VA and DoD must improve data collection and forecasting so
it is more accurate. VA and DoD must hire more medical professionals,
especially mental health professionals.
Furthermore, our government needs to perform pre- and post-
deployment medical exams, launch a broad national anti-stigma campaign
encouraging veterans to seek medical care, and place full-time,
permanent VBA claims staff at every military discharge location and
every VHA medical center.
VBA must also streamline the claim process with a one-page form and
simpler regulations VBA staff can learn in 6 months--not the current
three years. While VBA has additional funding to hire staff and process
an expected surge of Agent Orange claims, VA's budget does not appear
to contain additional funding to hire staff and process post traumatic
stress disorder claims under new VA's new, streamlined regulations
expected to be finalized this year.
Our 700,000 Gulf War veterans.
The second cohort of veterans in need of additional funding are our
Gulf War veterans. Nearly 20 years after the conflict began, VA and DoD
still do not have a comprehensive plan for medical research to better
understand and treat the 175,000 ill Gulf War veterans.
VCS urges the Obama Administration and Congress to create and fund
a robust Gulf War veteran advocacy committee to provide advice directly
to VA Secretary Shinseki on Gulf War illness, treatments, and benefits.
Furthermore, VCS urges Congress to fully fund the Congressionally
Directed Medical Research Program, a highly effective approach to
identify ``off the shelf'' treatments for our ailing Gulf War veterans.
We urge VA and Congress to work with veterans' advocates to expand
scientific research, especially in the areas of depleted uranium and
chemical warfare agents.
VCS encourages VA to fund the research led by Dr. Robert Haley and
his excellent team at the University of Texas Southwestern Medical
Center in Dallas, Texas.
Finally, VCS urges Congress to ask VA to respond in writing about
how they are implementing the recommendations made by the Institute of
Medicine regarding veterans' health. For example, VA and the military
should indicate when they will implement IOM's recommendation to use
the best available testing method to determine DU exposure rather than
the flawed test they are currently using. Congress should fund the best
tests, research, treatment, and benefits for our Gulf War veterans.
Thank you. I will be glad to answer any of your questions.
VA Fact Sheet
Consequences of Iraq and Afghanistan Wars
Updated January 27, 2010
U.S. Veteran Patients Treated at VA: 480,324
Veteran Disability Claims Filed Against VA: 442,413
Chart #1, U.S. Troops Deployed to Iraq and Afghanistan War Zones \1\
---------------------------------------------------------------------------
Prepared by Veterans for Common Sense using documents obtained
through the Freedom of Information Act:
\1\ Department of Veterans Affairs (VA), ``VA Benefits Activity:
Veterans Deployed to the Global War on Terror,'' Nov. 18, 2009.
----------------------------------------------------------------------------------------------------------------
Servicemembers Still Percent in Veterans Now Eligible
Deployed to War Zones in Military Military for VA Percent Veterans
----------------------------------------------------------------------------------------------------------------
1,946,042 786,405 40% 1,159,637 60%
----------------------------------------------------------------------------------------------------------------
Chart #2, Iraq and Afghanistan Veteran Patients Treated by VA
2 3
---------------------------------------------------------------------------
\2\ VA, ``Analysis of VA Health Care Utilization Among U.S. Global
War on Terrorism Veterans,'' Oct. 2009.
\3\ VA, ``VA Facility Specific OIF/OEF Veterans Coded with
Potential PTSD Through 3rd Qt FY 2009,'' Sep. 2009.
------------------------------------------------------------------------
Category Number of Veterans Percent
------------------------------------------------------------------------
Veteran Patients 480,324 41% of Veterans
------------------------------------------------------------------------
Mental Health Patients 227,205 47% of Patients
------------------------------------------------------------------------
PTSD Patients 134,103 28% of Patients
------------------------------------------------------------------------
Chart #3, Iraq and Afghanistan Veterans' Claims Against VA \4\
---------------------------------------------------------------------------
\4\ VA, ``VA Benefits Activity: Veterans Deployed to the Global War
on Terror, Nov. 18, 2009.
------------------------------------------------------------------------
Category Number of Veterans Percent
------------------------------------------------------------------------
Disability Claims Filed 442,413 38% of Veterans
------------------------------------------------------------------------
Claims Pending 69,397 16% of Claims Filed
------------------------------------------------------------------------
Approved PTSD Claim 67,052 50% of PTSD Patients
------------------------------------------------------------------------
MATERIAL SUBMITTED FOR THE RECORD
Committee on Veterans' Affairs
Washington, DC.
March 25, 2010
Honorable Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. Secretary:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2011 and
Fiscal Year 2012'' on February 4, 2010, I would appreciate it if you
could answer the enclosed hearing questions by the close of business on
May 7, 2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
DMT:ds
----------
Questions for the Record
House Committee on Veterans' Affairs
The Honorable Bob Filner
U.S. Department of Veterans Affairs Budget Request
for Fiscal Year 2011 and Fiscal Year 2012
February 4, 2010
Question 1: Reducing the claims backlog is at the top of the VA's
six high priority performance goals that are supported by the FY 2011
budget request. In addition to the additional FTE investments for VBA,
what other solutions is VA exploring in the near-term to address the
claims backlog?
Response: Bold and comprehensive changes are needed to transform VA
into a high-performing 21st century organization that provides the best
services available to our Nation's Veterans and their families. VA's
transformation strategy leverages the power of 21st century
technologies applied to redesigned business processes.
There are a number of claims process improvement initiatives in
various stages of concept development or execution. Some of the
initiatives are quickly implemented changes to build momentum and reach
out to our Veterans. For example, in an effort to speed up our work and
to connect with our Veteran-clients, VBA now requires staff to reach
out and call Veterans more often during the claims process rather than
to rely solely on written communication. VA is also currently working
to develop over 60 new medical questionnaires to take the place of
current VHA examination templates to improve rating efficiency.
Another initiative is being conducted at our St. Petersburg
Regional Office (RO) to identify and pay Veterans at the earliest point
in time when claimed disabilities are substantiated by evidence we
already have on record. In addition, four ROs are testing the concept
of an ``Express Lane'' to expedite single-issue claims to improve
overall processing efficiencies and service delivery. Yet another
initiative will allow employees and Veterans to communicate regarding
VA benefits using on-line live chat capabilities through the new portal
called e-Benefits. All of the initiatives described and a number of
others are being tracked for impact on timeliness and quality, and we
will launch the successful initiatives nationally. For example, VA has
initiated a new shorter application form--cutting the previous 23-page
form down to 12 pages. In many cases we expect to see significant
improvement in Veteran satisfaction with the application process.
Pilot programs are underway at four of our regional offices to
support our business transformation plan to reduce the claims backlog,
improve service delivery, and increase efficiencies. Each pilot
functions as a building block to the development of an efficient and
flexible paperless claims process. The results of all four pilots will
be incorporated into the nationwide deployment of the Veterans Benefits
Management System (VBMS) in 2012.
The Little Rock Compensation Claims Processing Pilot began in July
2009 following completion of the VBA Claims Development Study by Booz
Allen Hamilton. The Little Rock pilot focused on a ``Lean Six Sigma''
approach to streamlining current processes and procedures. The Veterans
Service Center converted from the VBA's existing claims processing
model into new fully integrated claims processing teams or pods. The
pilot concluded in May 2010, and VBA is evaluating the outcomes to
determine next steps.
The Business Transformation Lab (BTL) in Providence, RI, serves as
a ``test ground'' for defining processes and testing functionality that
will be incorporated into the development and deployment of VBMS. The
primary purpose of the BTL is to utilize a structured approach to
identify the most efficient way to process claims in an electronic
environment incorporating current technology. As part of this process,
the Providence RO is testing paperless claims processing using a small
population of claims. The business process improvements identified by
the BTL will be supported by technology enhancements and be integrated
into VBMS.
The Pittsburgh RO began the Case-Managed Development Pilot in
January 2010. The purpose of the pilot is to identify opportunities to
reduce the time required to request and receive evidence, providing
direct assistance to Veterans in compiling the necessary documentation
to support their claims throughout the claims process. A second
important aspect of the pilot is to enhance relationships and
partnerships with our Veteran-clients through personal communications.
Goals of the pilot include more personalized service to Veterans and
greater advocacy on their behalf; more accurate decisions; and a more
transparent understanding of VA's claims process.
The fourth pilot, the Virtual Regional Office (VRO), has already
produced excellent results. The single and focused purpose of the VRO
pilot was to deliver the specifications for an implementable,
professional-grade technical front end ``dashboard'' of the new system.
This dashboard will enable VBMS users to do their jobs more efficiently
and effectively. Based on the role of that individual user, the
dashboard will provide relevant information about a Veteran's claim
that will enable faster and more accurate processing of claims. The
specifications were not developed in a vacuum but rather side-by-side
with VBA employees who gave input to the developers. The initial field
use of dashboard capabilities is scheduled to begin in November 2010,
and will be primarily focused on testing the software. Each iterative
version of the dashboard will add improved functions and tools.
VBMS will be built upon a service-oriented architecture, enabling
electronic claims processing by providing a shared set of service
components derived from business functions. Initially, VBMS will focus
on scanned documents to facilitate the transition to a paperless
process. Ultimately, it will provide end-to-end electronic claims
workflow and data storage.
VA is also seeking contractor support in development of a system to
support evidentiary assembly and case development of the new Agent
Orange presumptive claims. The system will enable Veterans to
proactively assist in the development of their claims through a series
of guided questions and will automate many development functions such
as Veterans Claims Assistance Act notification and follow up.
In addition to an electronic claims processing system, VA is
committed to improving the speed, accuracy, and efficiency with which
information is exchanged between Veterans and VA, regardless of the
communications method. The Veterans Relationship Management (VRM)
transformational initiative will provide the capabilities to achieve
on-demand access to comprehensive VA services and benefits in a
consistent, user-centric manner to enhance Veterans', their families'
and their agents' self-service experience.
Questions 2: The FY 2011 budget requests $44.1 million to complete
the automated solution for processing Post-9/11 GI Bill claims and to
begin the development and implementation of electronic systems to
process claims associated with other education programs. What are the
projections for FY 2012 and beyond on the out-year resource needs to
fully automate Post-9/11 GI Bill claims and the claims associated with
other education programs.
Response: The Post-9/11 GI Bill automated solution is scheduled for
completion prior to 2012. We are still planning the adaptation of the
Long-Term Solution (LTS) to fully automate the claims associated with
other education programs, to include incorporating lessons learned from
its initial deployment and use. VA is currently formulating its FY 2012
budget request. As part of this process, the immediate and out-year
funding requirements of the Post-9/11 GI Bill claims and the claims
associated with other education programs are being considered.
Question 3: Please provide an update on the expanded enrollment of
Priority Group 8 Veterans in the VA health care system. It is our
understanding that the VA plans to enroll about 500,000 new Priority
Group 8 Veterans with the funds provided in the 2009 appropriations
bill. How much additional funding is needed to meet the 500,000 target
enrollment figure?
Response: No additional funding is needed at this time because the
appropriations already provided for fiscal years 2010 and 2011, along
with the President's Budget request for 2012, includes the funding
needed for the continued enrollment of moderate-income veterans into
the VA health care system by 2013.
VA is closely monitoring observed demand for enrollment and patient
access, and proposes expansion of enrollment only based on the
availability of resources to meet current demand and projected demand
through subsequent relaxations of enrollment restrictions. The resource
requirements for the continued expansion of Priority 8 enrollment will
be included in future budget submissions to Congress.
Question 4: The FY 2011 budget estimates obligating $2.575 billion
for OEF/OIF Veterans in FY 2011, an increase of $597 million in
estimated obligations for FY 2010. Forecasting the cost to care for
OEF/OIF Veterans has been difficult in the past. What specific steps
has VA taken to improve the cost projections? For example, is VA
collaborating with DoD to better estimate the number of returning
Servicemembers who will enroll in the VA's health care system?
Response: Due to operational readiness issues and sensitivity
surrounding actual plans for military deployments, VA utilizes data
from the Congressional Budget Office (CBO) to project the overall
number of Servicemembers that may seek care at VA in any given year.
The VA enrollee health care projection model projects separately OEF/
OIF Veteran enrollment and utilization. The model is updated annually
to reflect VA's most recent experience among the OEF/OIF Veteran
population. The overall FY 2011 and FY 2012 funding levels for medical
care takes into account the impact of publically announced increases in
troop deployment levels. In addition, VA meets regularly with Army and
Navy officials to determine the number of VA Liaisons stationed at
Military Treatment Facilities to transition Servicemembers from DoD to
VA.
Question 5: The FY 2011 budget requests $4.2 billion in 2011 to
prevent and reduce homelessness among Veterans, which includes over
$3.4 billion for medical services and nearly $800 million for specific
homeless programs. Please provide specific details regarding VA's plan
to end homelessness including implantation projections regarding
actions that VA can take using current authorities along with the
metrics the Department plans on utilizing to judge whether these steps
are successful or not.
Response: VA estimated that during the last year, on any given
night, 107,000 homeless Veterans were living in shelters, on the
streets or in places not meant for human habitation. While there has
been a significant reduction in the number of homeless Veterans, VA's
efforts are focused on eliminating and preventing Veteran homelessness.
The average homeless Veteran profile:
served in the post-Vietnam era (1975-1990).
age 51, male, single, and equally likely to be
African-American or Caucasian.
is unemployed and has an income of less than $125 per
week.
At the time of contact with the VA, the average homeless
Veteran is living outdoors or in a homeless shelter and suffers from
medical and mental health/substance use disorders. Many homeless
Veterans suffer with depression, substance use and significant physical
health problems.
Minority Veterans are overrepresented (48 percent of
total) in the homeless population compared to the number of minority
Veterans in the population.
Female Veterans are the fastest growing segment of the
homeless population.
In order to end homelessness among Veterans, VA must proactively
provide needed health care assistance to enable these Veterans to
regain the physical and mental health to move on with their lives. Our
2011 budget requests $3.4 billion to provide core medical services for
homeless Veterans.
VA is taking decisive action toward its goal of ending homelessness
among our Nation's Veterans. To achieve this goal, VA has developed a
5-Year Plan to End Homelessness among Veterans that will assist every
eligible homeless Veteran willing to accept services. VA will help
Veterans acquire safe housing; needed treatment services; opportunities
to return to employment; and benefits assistance. These efforts are
intended to end the cycle of homelessness by preventing Veterans and
their families from entering homelessness. VA's philosophy of ``no
wrong door'' means that all Veterans seeking to prevent or exit from
homelessness must have easy access to VA programs and services. Any
door a Veteran comes to--at a medical center, a regional office, or a
community based outpatient clinic--will offer them assistance.
VA plans to expand existing programs and develop new initiatives to
prevent Veterans from becoming homeless and to aggressively treat those
who are currently homeless. These program enhancements will provide
housing, health care, benefits, employment, and residential stability
to more than 500,000 Veterans and their families. Additional expansion
of these efforts will begin in fiscal year (FY) 2011 through FY 2014,
subject to the availability of appropriations.
The plan seeks to:
Increase the number and variety of housing options
including permanent, transitional, contracted, community-operated, and
VA-operated.
Provide more supportive services through partnerships to
prevent homelessness, improve employability, and increase independent
living for Veterans.
Improve access for VA and community based mental health,
substance abuse, and support services.
The 5-Year Plan to End Homelessness Among Veterans is built upon
six strategic pillars:
Outreach/Education;
Treatment;
Prevention;
Housing/Supportive Services;
Income/Employment/Benefits; and
Community Partnerships.
The provision of safe housing is fundamental. However, programming
must include: mental health stabilization; substance use disorder
treatment services; enhancement of independent living skills;
vocational and employment services; and assistance with permanent
housing searches and placement.
The performance metrics to determine progress toward the goal of
ending homelessness among Veterans will include the number of Veterans
identified by VA as homeless or at risk of becoming homeless, and those
who transition to stability using programs for housing vouchers and
other supportive services.
Our FY 2011 funding includes $799 million in targeted homeless
assistance for a variety of programs that will help to prevent some
from ever falling into homelessness and also rapidly assist those who
are homeless in that condition. The major initiatives are described
below:
EXPANSION OF EXISTING PROGRAMS:
Health Care for Homeless Veterans (HCHV):
HCHV provides ``in place'' residential treatment beds through
contracts with community partners and VA outreach and clinical
assessments to homeless Veterans who have serious psychiatric and
substance use disorders. Expansion of the program will provide services
to 4,800 Veterans in FY 2010, and will ensure that every VA medical
center has the capacity to offer services that are targeted to, and
prioritized for, homeless Veterans who are transitioning from literal
street homelessness. VA expects to spend nearly $116 million and
provide services to 9,500 Veterans in 2011. A total of 70,000 Veterans
are expected to receive services through HCHV Contract Residential Care
between FY 2010 and FY 2014.
Housing and Urban Development-VA Supported Housing (HUD-
VASH):
HUD-VASH is the Nation's largest supported permanent housing
initiative that targets homeless Veterans by providing permanent
housing with case management and supportive services that promote and
maintain recovery and housing stability. More than 6,900 Veterans and
their families obtained permanent housing in FY 2009. Program expansion
will provide additional permanent housing opportunities for Veterans by
allocating 10,000 new Housing Choice Vouchers in FY 2010. VA expects to
spend nearly $151.1 million and provide housing and case management
services to a total of 24,268 Veterans in 2011. A total of 60,000
Veterans are expected to enter the HUD-VASH program by FY 2014.
Grant and Per Diem (GPD) Program:
GPD provides grants to community providers to create and operate
transitional housing programs and provide services for homeless
Veterans. Currently, the program funds over 500 community-based
agencies and provides more than 11,000 transitional housing beds. It is
estimated that program expansions will create capacity to serve
approximately 20,000 Veterans in FY 2010. VA expects to spend nearly
$192 million and provide services to 22,000 Veterans in 2011. A total
of 138,000 Veterans are projected to receive services from this program
between FY 2010 and FY 2014.
Veterans Justice Outreach (VJO) Program:
The Veterans Justice Outreach (VJO) program, formally launched in
2009, aims to prevent homelessness by providing outreach and linkage to
VA services for Veterans at early stages of the justice system,
including Veterans' courts, drug courts, and mental health courts.
Program enhancement is expected to provide services for 7,500 Veterans
in FY 2010. VA expects to spend $12.6 million to provide direct
services to more than 11,000 Veterans in 2011.
VA Residential Rehabilitation Treatment Programs (RRTP)/
Domiciliary Care for Homeless Veterans (DCHV):
There are currently 237 operational Mental Health RRTPs providing
nearly 8,500 treatment beds. DCHV provides homeless Veterans with 24
hour-per-day, 7 day-per-week (\24/7\), time-limited, residential
rehabilitation and treatment services that include medical,
psychiatric, substance abuse treatment, and sobriety maintenance.
Program expansion will increase capacity and access by establishing
five 40-bed DCHV programs in large urban locations in FY 2011. VA
expects to spend nearly $153.0 million and provide services to 6,900
Veterans in 2011 in the DCHV Program. A total of 39,000 Veterans are
projected to receive services from the DCHV Program between FY 2010 and
FY 2014.
DEVELOPMENT OF NEW PROGRAMS:
New HUD/VA Prevention Pilot:
This new prevention initiative is a multi-site 3-year pilot project
designed to provide early intervention to recently discharged Veterans
and their families to prevent homelessness. Priorities for site
selection for this pilot project are in communities where there are
high concentrations of returning OEF/OIF soldiers and rural
communities. Under this pilot HUD will select sites to receive funding
to support housing and supportive services for Veterans and their
families and VA will provide coordinated case management to keep
Veterans in their housing, maintain employment and connect them with VA
health care and benefit assistance. Implementation of this program is
expected to provide services to nearly 100 Veterans and their families
in FY 2010. VA expects to spend $5 million to provide services to
approximately 200 Veterans and families in 2011. A total of 650
Veterans are projected to receive services from this program between FY
2010 and FY 2014.
National Referral Call Center:
This new prevention initiative establishes a National Call Center
that provides linkages for homeless Veterans, their families and other
interested parties to appropriate VA and community-based resources. It
is anticipated that in FY 2010, the Call Center will provide
information and referral assistance to 15,000 Veterans and other
interested parties. VA expects to spend nearly $3.0 million to assist
Veterans in 2011.
Supportive Services for Veterans and Families:
This new homeless prevention initiative will provide grants and
technical assistance to community non-profit organizations to provide
supportive services to Veterans and their families in order to maintain
them in their current housing and to prevent homelessness. Regulations
have been drafted and are under review. Under the 2011 proposed budget
VA will enhance prevention by offering more than $50 million for
Supportive Service Grants for Low Income Veterans and Families at 50
percent or less of area median income. We expect to award funding in
2011 that will provide services for 10,000 Veterans and families. A
total of 65,000 Veterans are projected to receive services from this
program between FY 2011 and FY 2014.
DEVELOPMENT OF NEW INITIATIVES:
National Homeless Registry:
888VA will establish a database to track and monitor expansion
of existing homeless programs, prevention initiatives, and
treatment outcomes for approximately 200,000 Veterans in FY
2010. The Registry will serve as a data warehouse for Veteran
Homeless Services identifying and monitoring the utilization
and outcomes for VA funded homeless services. It will enhance
VA's capacity to monitor program effectiveness and the long-
term outcome of Veterans who have utilized VA funded services.
VA expects to spend nearly $5.9 million for the National
Homeless Registry in 2011.
Management Information System: VA will establish an
information management system (dashboard) for the homeless programs.
The system will include specific program metrics that address
structural, process, and outcome measures. Data from the management
system will be turned into monthly and quarterly reports for senior VA
leadership to monitor progress and to address barriers in helping
Veterans exit homelessness.
Homeless Interdiction Initiative: VA Regional Offices
will develop a homeless interdiction plan specific to their area of
jurisdiction that identifies the segment of Veteran homelessness they
can best address, specific goals for their targeted clients, and the
resources required to properly execute the plan.
Foreclosure Notification Initiative: VA will develop a
strategy to identify Veterans with VA home loans referred for
foreclosure that may need expedited claims processing, benefits
counseling and/or referrals to assistance programs.
Effectiveness: Each initiative under VA's 5-Year Plan is
judged on its effectiveness to limit Veterans from entering
homelessness (prevention programs), or quickly and permanently
returning Veterans to independent living.
Question 6: The FY 2011 budget assumes $5.235 billion in
obligations, an increase of $410 million over FY 2010 for mental
health. Is this sufficient to meet the needs of our returning OEF/OIF
Veterans who suffer from PTSD or TBI? If additional resources were
provided which additional programs or activities, would the Department
undertake?
Response: Yes, the funding level for FY 2011 includes the needed
resources to meet the mental health needs of returning OEF/OIF Veterans
who suffer from post-traumatic stress disorder (PTSD) and other mental
health problems that may exist either as co-occurring conditions with
PTSD or separately. While the treatment of traumatic brain injury (TBI)
is not primarily a function of mental health services, mental health
conditions associated with TBI can be adequately addressed by the
proposed funding increase.
For those Veterans specifically with TBI, the FY 2011 funding level
adequately supports the full continuum of outpatient and inpatient
rehabilitation programs targeted to meet the individualized care needs,
including identification, assessment, treatment, and rehabilitation of
the physical, mental and psychosocial problems that accompany TBI and
Polytrauma.
Question 7: The VA estimates $250 million in obligations for rural
health initiatives in FY 2011. To clarify, does the $250 million in
estimated obligations support the grants awarded by the Office of Rural
Health? Please explain how the funds will be used to meet the
challenges facing rural Veterans. How does this fit into the VA's
overall strategy for increasing access to health care among rural
Veterans?
Response: Yes, the $250 million in estimated obligations does
support the grants awarded by the Office of Rural Health. VA is
committed to enhancing access to health care for Veterans residing in
rural and highly rural areas. To meet the challenges facing rural
Veterans, VA is planning to invest $87.8 million in FY 2011 rural
health funding to sustain funding for CBOCs in 11 Veterans Integrated
Service Networks (VISNs) for the second year of operation. In addition,
$100 million will be supporting the Contract Care Pilot Program for
Highly Rural Veterans (Section 403, P.L. 110-387) in VISNs 1, 6, 15, 18
and 19. Also, in FY 2011, $62.2 million will be utilized to sustain
previously approved rural and highly rural projects including, but not
limited to, mobile clinics, rural telehealth and telemental health
initiatives, home based primary care (HPBC) programs, rural health
outreach clinics, and mental health intensive care management (MHICM)
programs and expansions.
Question 8: The FY 2011 budget requests $590 million for medical
and prosthetic research, which is a modest increase from $581 million
provided in FY 2010. This is well below the 3.2 percent increase in the
biomedical research and development price index, which is developed by
the Bureau of Economic Analysis. Does this mean that VA will be
awarding a smaller number of research grants in FY 2011? How will VA
meet any shortfalls if projections regarding other federal funding
sources prove to be too optimistic?
Response: The increase in appropriations from FY 2009 ($510
million) to FY 2011 ($590 million) is 16 percent. The Office of
Research & Development (ORD) will be able to execute its mission
without any adverse impacts. The number of projects that ORD fund is
not dependent on other federal funding sources.
Question 9: The Secretary's written testimony states that ``after a
cumulative increase of 26.4 percent in medical care budget since 2009,
we will be working to reduce the rate of increase in the cost of the
provision of health care by focusing on areas such as better leveraging
acquisitions and contracting, enhancing use of referral agreements,
strengthening DoD/VA joint ventures, and expanding applications of
medical technology.'' As a percentage of your medical care budget, how
much do you expect to realize in savings if these initiatives are
successful looking toward the future?
Response: The FY 2011 advance appropriation for the three medical
accounts is $48.183 billion. The estimated savings from the initiatives
listed above are approximately $177 million, or 0.4 percent of the
advance appropriation amount.
Question 10: Please provide a detailed list of specific cost-saving
proposals that could be utilized by the VA to reduce future medical
care increase, along with estimated dates as to when these proposals
are expected to be pursued and when cost-savings will be achieved?
Response: The estimated savings referenced in the answer to
question # 9 are for increased use of regional and programmatic blanket
purchase agreements and consolidated national contracts, decreased use
of sole source contracts and increased competition, and improvements in
the contract management process. The specific details of each
individual proposal and the expected dates that the savings will be
achieved have not yet been finalized. In addition to the above, we also
anticipate approximately $252 million in reduced dialysis purchased
care costs, which will be contingent upon the publication of a final
Federal Register notice regarding the specific rates that VA will pay
when purchasing dialysis services from private sector providers.
Question 11(a): The Administration requests $3.3 billion for IT in
FY 2011, which is the same level as the amounts provided in FY 2010.
How does this budget request support all of the ambitious IT
initiatives, such as VLER and the creation of bi-direction,
interoperable health care records?
Response: Our budget provides the resources necessary to continue
our aggressive pursuit of the President's two overarching goals for the
Department--to transform VA into a 21st Century organization and to
ensure that we provide timely access to benefits and high quality care
to our Veterans. The $3.307 billion budget request is sufficient to
meet VA's IT needs and in FY 2011 represents a 32.9 percent increase as
compared to FY 2009. Funding for maintenance and operational costs will
be sustained to keep the systems at current capability and acceptable
performance levels with due consideration made for risk.
VA's decision to centralize IT in the summer of 2006 has resulted
in improved fiscal and budgetary discipline in our IT operations and
development, thus enabling VA to move forward with 21st Century
technology initiatives such as the Virtual Lifetime Electronic Record
(VLER).
We have implemented new, tighter management, including Project
Management Accountability System (PMAS) and prioritization that will
assist VA in making better use of IT funding. The PMAS uses an
incremental development and fiscally responsible approach that will
control development spending and ensure early identification and
correction of failing IT programs. Halting development programs that
fail to meet their delivery milestones will prevent wasteful spending
and provide accountability in the delivery of technologies to help
transform VA.
Our Major Investments will continue to increase above the FY 2010
level to meet the on-going demands for our Veterans and transforming
VA:
Veterans Benefits Management System (VBMS) with $145.3
million requested, is a 104 percent increase above 2010, and is
designed to transition from paper-intensive claims processing to a
paperless environment.
The Post-9/11 GI Bill (Chapter 33) with $44 million
requested is a 28 percent increase above 2010 and will provide the
long-term solution to deliver an end-to-end solution to support the
delivery of tuition, university fee payments, housing allowance and
yearly books and supply stipend.
Financial and Logistics Integrated Technology Enterprise
(FLITE) with $120 million requested, is a 52 percent increase above
2010, and will effectively integrate and standardize financial/asset
management data and processes across VA.
Virtual Lifetime Electronic Record (VLER) with $52
million requested, is a 23 percent increase above 2010, and will create
the capability for VA and DoD to electronically access and manage the
health, personnel, benefits, and administrative information needed to
efficiently deliver seamless health care, services, and benefits to
Servicemembers and Veterans.
Tele-Health and Home Care Model with $48.6 million
requested, will enable VA to become a national leader in transforming
primary care services to a medical home model of health care delivery
with a new generation of communication tools that can be used to
disseminate and collect information related to health, benefits and
other services.
Question 11(b): Please provide an update on the key deliverables
that the VA has met for the Department's priority IT initiatives.
Response: The Department has identified 13 goals for FY 2010 that
IT supports as their priority initiatives. These goals and key
deliverables in the last 6 months include:
1. Eliminate Veteran Homelessness
2. Enable 21st Century Benefits Delivery and Services (through
Veterans Benefits Management Systems-VBMS)
3. Automate GI Bill Benefits (Chapter 33)
4. Implement Virtual Lifetime Electronic Records (VLER)
5. Improve Veteran Mental Health (IVMH)
6. Veteran Relationship Management (VRM)
7. New Health Care Model (NHCM)
8. Expand health care access for Veterans (i.e. women and rural
populations through ACCESS)
9. Preparedness
10. Enterprise Wide Cost Accountability (EWCA)
11. Integrated Operated Model (IOM)
12. Transformation of the Human Capital Improvement Plan (HCIP)
13. Perform research and development (R&D) to enhance the long-
term health and well-being of Veterans
Currently, we report the following updates:
1. Eliminate Veteran Homelessness.
An initial Plan of Action and Milestones (POAM) was developed for
activities known at this time, in concert with the Office of Public and
Intergovernmental Affairs (OPIA), the Office of Policy and Planning
(OPP), Enterprise Infrastructure Engineering (EIE), the Office of
Acquisition and Logistics (OAL), and the Veteran Benefits
Administration Office of Policy and Program Management. VA and
Department of Housing and Urban Development are meeting to establish
data sharing capabilities.
2. Enable 21st Century Benefits Delivery and Services (e.g.,
backlog reduction) (Veterans Benefits Management System--VBMS).
The Veterans Benefits Management System (VBMS) Initiative is a
business transformation initiative supported by technology and is
designed to improve VBA service delivery. It is a holistic solution
that integrates a Business Transformation Strategy (BTS) to address
process, people, and organizational structure factors and a 21st
Century paperless claims processing system--VBMS.
VBMS will provide a modern electronic repository and a new
graphical user interface (GUI), which will enable end-to-end electronic
claims processing. The VBMS technology solution started with the
Virtual Regional Office (VRO), which was completed on May 5, 2010. The
VRO resulted in a system specification and business requirements for
the new GUI. Following the VRO are three iterative pilots leading to
the rollout of the software solution. Pilot 1 is currently under
development and scheduled to be deployed to one VBA Regional Office in
November 2010.
3. Automate GI Bill Benefits (Chapter 33).
Chapter 33 Long-Term Solution (LTS) version 1 was released in March
2010. Version 1.01, which provided some enhancements, was released
April 26, 2010. These releases, the first of several planned, will
provide increasing functionality as we automate the GI Bill process.
6. Build Veteran Relationship Management (VRM) capability to enable
convenient, seamless interactions.
Version 1.3.0 of the Veteran Tracking Application (VTA)--Disability
Evaluation System (DES) was released in March 2010. Version 2.3 of the
eBenefits Web Portal, which provides Veterans and Servicemembers with
Web portal access to health and benefits information and transactions,
was released in April 2010.
9. Ensure preparedness to meet emergent national needs (e.g.,
hurricanes, H1N1 virus) (Integrated Operations Center--IOC).
`The intent of Initiative #9, Preparedness, is to provide oversight
and management direction over those programs that have a substantial
effect on VA continuity and security efforts. Although the two
initiatives--the IOC and Homeland Security Presidential Directive 12
and Personal Identity Verification (HSPD-12//PIV)--are not directly
related, they both are cornerstones in security and preparedness
management.
The IOC will provide a situational center during crisis
or national emergency to serve as a fusion point/single office focal
point for collecting, analyzing, planning, and disseminating
information to its stakeholders.
The HSPD-12/PIV Program will increase the security of VA
facilities and IT systems through identity verification and strong
authentication to prevent logistical and physical intrusions, and
provide better protection for Veterans, VA employees, information
systems, and VA facilities.
11. Establish strong VA management infrastructure and integrated
operating model (IOM).
One component of the Financial and Logistics Integrated Technology
Enterprise (FLITE) solution was deployed as a pilot project. The
Strategic Asset Management System (SAM) Pilot project was deployed on a
limited basis for testing purposes prior to full deployment.
Question 12: The FY 2011 budget request provides $468 million for
minor construction projects, which is $235 million or 33 percent below
the amount provided in FY 2010. In a time when there are long lists of
projects awaiting funding, what is the VA's rationale for a
significantly lower budget request in FY 2011.
Response: Fiscal Year 2011 request is second largest budget ever
proposed for minor construction. The largest ever proposed was in
Fiscal Year 2010--$600 million. VA will use the requested minor
construction funds, as well as funding for non-recurring maintenance
and major construction, to address the Department's highest priority
projects..
Question 13: The FY 2011 budget requests $85 million for grants for
construction of state extended care facilities, which is $15 million or
15 percent below what was provided in FY 2010. However, the most recent
State Veterans Home Priority List shows that there are over $400
million in Priority 1 projects where States have already committed
money to the construction process. What is the Department's
justification for not seeking additional funding in order to address
the Priority 1 backlog?
Response: VA believes it is an unwise public policy to build large
numbers of new nursing home beds at this time. The number of Veterans
over age 65 will peak by 2013 and decline steadily thereafter,
resulting in fewer Veterans needing nursing home care. In addition,
nursing home utilization rates are declining steadily as non-
institutional home and community-based long-term care alternatives to
nursing home care become more widely available both in VA and in the
private sector. Overall occupancy in State Veterans Home beds is only
85 percent; although some states still have a great need for new beds.
VA believes it is unwise to burden states with a brick-and-mortar
infrastructure that will be increasingly difficult for them to maintain
in future years, putting the states at risk of recapture of state home
construction grant funds if they cease to operate their facilities as
State Veterans Homes. Currently, there is no Priority Group 1 backlog
of renovation projects (including renovations to protect the lives and
safety of Veterans) or of new construction projects in states with a
great need for new beds. All of the projects in these categories on the
FY 2010 Priority List received Funding Letters in FY 2010. VA is
confident that the budget request of $85 million for FY 2011 will be
sufficient to fund all Life Safety and other renovation projects and
all new construction projects in states with a great need for new beds.
The Honorable Timothy J. Walz
Question 1: What is the status of the VA's office that handles
seamless transition with the Department of Defense? More Specifically:
Question 1(a): Has the VA hired a director for this office? If so,
who?
Response: Since its inception in 2008, the VA-DoD Collaboration
Service has had an executive director. Robert D. Snyder is the current
executive director and has been serving in that position since June
2009.
Question 1(b): How does the office fall into the JEC/SOC structure?
Response: This Service is the lead on VA-DoD seamless transition
initiatives and provides support to the Joint Executive Committee (JEC)
and the Wounded Ill and Injured Senior Oversight Committee (SOC).
Question 1(c): What is the mission and goals for this office?
Response: The Service's mission is to facilitate the development of
joint policies and programs between VA and DoD and to provide oversight
for the implementation of joint VA-DoD programs and policies as they
relate to activities of the JEC and SOC. The roles and responsibilities
of this Service include coordinating VA's efforts within JEC and SOC,
coordinating VA responses to external requirements and mandates
relative to seamless transition issues, coordinating and facilitating a
VA-wide perspective in VA-DoD collaboration activities and initiatives,
and developing the VA-DoD Joint Strategic Plan (JSP) in coordination
with DoD.
Question 1(d): What are the priorities for the office?
Response: The Service's current priorities are facilitating the
expansion of the Disability Evaluation System (DES) pilot model,
developing and implementing the VA-DoD integrated mental health
strategy, requiring mandatory separation physicals for Servicemembers,
creating a process for early communication of VA benefits to
Servicemembers prior to their separation from active duty, requiring
mandatory attendance during the VA portion of the Transition Assistance
Program (TAP), and refining the VA-DoD strategic planning process.
Question 1(e): What help can Congress provide to the office to
overcome challenges?
Response: VA appreciates the support of Congress in the role of
assisting Servicemembers as they transition from active duty status to
Veteran status. Extension of the VA/DoD Senior Oversight Committee from
Congress last year will ensure continued oversight and assistance in
addressing the issues and challenges of transition activities.
The Honorable Corrine Brown
Question 1: After years of no major hospital construction, there
are two VA medical centers that are scheduled to open in 2012--Las
Vegas and Orlando. In fact, all money has been appropriated to complete
these projects and no money was requested by the Administration this
year for their construction.
Question 1(a): Is there enough money in the pipeline to ensure the
activation of these medical centers?
Response: Yes.
Question 1(b): What will the final costs for completion be when the
construction ends and before the patients are admitted?
Response: The final cost is not available at this time. Since
construction is done in phases, buildings are ready for beneficial
occupancy when construction is complete on that phase. This often
occurs prior to completion of all phases. Therefore, final costs may
not be known at time of occupancy of a particular phase, but rather
when all phases are financially complete.
Las Vegas, Nevada:
The total estimated cost for the Las Vegas, Nevada, medical center
is $600.4 million. This includes two critical items still in design,
the Administration Building and a Photovoltaic system. OALC believes
that the final cost for the construction of this project will be within
these appropriated funds.
Orlando, Florida:
The total estimated projects cost for the Orlando, Florida, medical
center is $665.4 million. OALC believes that the final cost for the
constructions of this project will be within these appropriated funds.
Committee on Veterans' Affairs
Washington, DC.
February 12, 2010
The Honorable Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Secretary Shinseki,
In reference to our Committee hearing of February 4, 2010, I would
appreciate your response to the enclosed additional questions for the
record by close of business Wednesday, March 17, 2010.
It would be appreciated if you could provide your answers
consecutively on letter size paper, single spaced. Please restate the
question in its entirety before providing the answer.
Thank you for your cooperation in this matter.
Sincerely,
Steve Buyer
Ranking Republican Member
SB:dwc
Enclosure
----------
Questions for the Record
The Honorable Steve Buyer, Ranking Member
House Committee on Veterans' Affairs
The Department of Veterans Affairs Budget Request for
Fiscal Year 2011 and Fiscal Year 2012
February 4, 2010
Question 1: Some employees at the Muscogee National Call Center
have expressed their frustration with the phone system. Apparently, the
system automatically kicks callers out of the system whenever too many
customer service representatives are on the phone. Our staff was told
that the reason VA chose that particular phone system for the call
center was that it was installed at other VA locations. Is there any
plan to modernize the phone system at the Muscogee Call Center and if
so, is that money in the budget?
Response: The immediate issue expressed by Muskogee National Call
Center employees was corrected with configuration changes to the phone
system and the plan to modernize the phone system is underway. The
modernization plan includes the Veterans Relationship Management (VRM)
project, which is intended to address call center system instability
issues by modernizing voice access and routing systems. VRM funding is
included in VA's budget.
Question 2: How will the Veterans Benefits Management System
project interact with IT systems at VHA and the Virtual Lifetime Health
Record? Will the systems be interoperable so medical records and
compensation exams can be viewed by both parties?
Response: Yes, the systems will be interoperable. VBMS will
interact with VHA systems as well as the Virtual Lifetime Electronic
Record (VLER). Included within the scope of this overall effort is
development of an interface between VBMS and VHA systems to allow for
the seamless movement of information, from the request of a disability
examination to viewing the examination result. Authorized VHA clinical
staff and VBA claims staff will have access to view pertinent claims
information to conduct disability examinations.
Medical records and disability examinations from the Veterans
Health Administration serve as highly probative evidence in support of
Veterans' disability claims. As a result, VA invested in and achieved a
significant level of interoperability between VHA and VBA in support of
disability claims processing. VHA clinicians and VBA Compensation and
Pension staff already view electronic medical records for the purpose
of providing treatment and adjudicating claims. VHA clinicians access
information through the VA electronic record known as VistA
Computerized Patient Record System, and VBA claims staff access the
same information through its Compensation and Pension Records
Interchange (CAPRI).
In 2009, VA and DoD formed a partnership to develop the Virtual
Lifetime Electronic Record (VLER). VLER will support the full continuum
of care and seamless benefits delivery to Servicemembers, Veterans and
their dependents. To a VHA clinician or VBA employee, VLER will provide
a comprehensive view of the collected health and benefits data,
regardless of where those data are stored. Beginning with progressive
piloting and implementation of the National Health Information Network
(HNIN), the Departments are in the early stages of technology
development that will support VLER, VistA and the Veterans Benefits
Management System (VBMS).
Question 3: What lessons learned will VA incorporate into the
Veterans Benefits Management System program from the numerous other
failed paperless and IT systems for Compensation & Pension?
Response: VA is applying several lessons learned to the development
approach of VBMS.
Rather than follow the traditional waterfall development approach,
VBMS is using a so-called Agile Methodology, a highly collaborative
software implementation approach that delivers small, integrated, and
testable software in weeks rather than months. Agile calls for tight
requirements and clear outcomes on short, even daily, timelines. Of
course, changing methodologies is just the first step, but it is an
important one.
Another important lesson is that our business requirements were not
well articulated, with the predictable result that the technical
specifications were similarly compromised. To remedy this, VA
successfully implemented the first of our ``pilot'' programs, the
Virtual Regional Office (VRO) which ran from January until May of this
year. The sole purpose of the VRO was to create a set of technical
specifications based upon actual user requirements; the exercise was
successful, and we are now in the implementation phase of creating a
new (and modular) user interface, designed to support the eventual
replacement of VETSNET.
Finally, we also included a business transformation work stream,
which will allow us to transform the business process, rather than just
apply technology to the current claims process. VBMS has been placed
under VA's Program Management Accountability System, which tightly
manages the products and deliverables of the program.
Question 4: Secretary Shinseki's testimony stated VA intends to
develop and implement an ``end-to-end'' solution to modernize the
delivery of education benefits. First, which system would VA use,
Benefits Delivery Network (BDN) or VETSNET for the payment system, and
second, how will VA build on lessons learned from the BDN project?
Response: Initially, VA will use BDN as the payment system for the
delivery of education benefits. Once the Financial Application System
(FAS) can be modified to support the delivery of education benefits,
which is scheduled for FY 2011, FAS will be used as the payment system.
We had originally anticipated integrating the ``long-term
solution'' directly to FAS, but recently made the deliberate decision
to use BDN for the time being. In our judgment, this temporary solution
lowered implementation risk, even though much of the work will be
redundant once the FAS interface is in production.
There were several valuable lessons learned as we migrate benefits
programs form the outdated legacy mainframe to a more modern and
extensible platforms. The most important of these are the technical
challenges of creating scalable, maintainable, and modular ``wrappers''
around the existing software components. As VA takes better advantage
of commercial development tools and standards-based environments, we
expect to encounter fewer of these impediments.
Question 5: Section 809 of Public Law 110-389 reaffirmed VA's
existing authority to purchase advertising in national media outlets
for the purpose of promoting awareness of benefits, including
assistance for programs to assist homeless veterans, promote veteran-
owned small business, provide opportunities for employment in the
Department of Veterans Affairs, and for education, training,
compensation, pension, vocational rehabilitation, and health care
benefits, and mental health care including prevention of suicide among
veterans. We have seen VA's TV ads to recruit health care employees.
When will VA begin using that authority to increase the awareness and
understanding of veterans benefit programs and what is the budget for
the national media marketing effort for this fiscal year and FY 2011?
Response: In Fiscal Year 2010 and Fiscal Year 2011 VA will spend at
least $30M to increase awareness and understanding of Veterans benefits
and programs (a portion of which will include paid media).
Question 6: The President has proposed using $30 billion in TARP
funds to promote small business. Noting that I have introduced H.R.
295[sic], which would reestablish the VA's Small Business Loan Guaranty
Program, what will be VA's role in that effort?
Response: The Department testified in September 2009 in support of
the concept of reauthorizing the VA's Small Business Loan Guaranty
Program contained in H.R. 294, and more recently introduced in H.R.
4220. However, as we testified, several aspects of H.R. 294, which
continue to be reflected in H.R. 4220, led us to conclude that we could
not support the bill as written. We do believe an alternative approach
to reauthorizing the program could be centered on an Interagency
Agreement with the Small Business Administration (SBA) in order to
utilize the Certified and Preferred Lenders who currently manage Small
Business Loan Guaranty applications. This would allow VA to leverage
SBA's expertise in this business area. As the Department has not run a
federal credit program involving small business loans in many years, we
are still evaluating the programmatic and cost implications associated
both with the contractual approach presented in H.R. 294/4220 and the
public partnership option with SBA. Once an evaluation of all cost
implications and partnership options is complete VA will provide the
Committee with these estimates upon completion.
Question 7: Following Mr. Snyder's question during the hearing
regarding the complexity of claims, VA does not get full credit for
that complexity because VA only reports the number of claims, not the
total number of issues which are the driving factor in processing
claims. Could VA change the reporting process to include total claims?
Response: We agree that reporting not only the number of claims
received and completed but also the number of issues (disabilities)
claimed would increase awareness and understanding of the complexity of
the claims process. New support architecture is under development that
will allow VBA's integration into a comprehensive issue-based reporting
structure. We anticipate incorporating this data into our reports by
the end of fiscal year 2012.
Question 8: The new IT system for the Post-9/11 GI Bill is
scheduled to be in place by December 2010. Let's assume that despite VA
and SPAWAR's best efforts to meet that date, full implementation slips
by at least a fiscal quarter. In that case, what is the plan and will
you need additional funds to retain at least some of the term employees
through the implementation and transition periods?
Response: While VA expects the successful delivery of the Post-9/11
GI Bill long-term solution in December 2010, we plan to continue to
utilize the interim processing solution to process Post-9/11 GI Bill
claims if full implementation of the new IT system is not provided on
schedule. VA's budget request includes funding to retain temporary
claims examiners through the third quarter of FY 2011.
Question 9: Since the President has taken office, the backlog of
disability claims has grown by 25 percent, and this budget projects
that the average days to complete a claim will rise from 165 days in FY
2010 to 190 days in FY 2011. How will the budget request reduce the
backlog?
Response: VA anticipates continued growth in incoming disability
claims. VBA experienced a 14 percent increase in 2009, and we project a
13 percent increase in 2010 and an 11 percent increase in 2011. On top
of these projections, additional claims are anticipated as a result of
the Secretary's decision to add three new diseases to the list of
conditions presumed related to herbicide exposure. The budget request
includes funding to hire 1,820 additional employees to assist in
addressing the increased workload in 2011. However, we recognize that
additional staffing alone is not sufficient to keep up with the growing
workload. We are actively exploring process and policy simplification
and short-term technology enablers, in addition to the traditional
approach of hiring additional employees, to address this increased
demand. VBA established pilot initiatives at the Little Rock,
Providence, Baltimore, and Pittsburgh Regional Offices to improve
claims processing and services to veterans. As we identify best
practices and early successes, we will export those ideas nationwide.
Question 10: Will the Veterans Benefits Management System project
involve VETSNET? If not, how does VA justify the millions of dollars
spent on this project that is now basically obsolete?
Response: The goal of VBMS is to provide a complete claims
processing environment from submission to payment. The underlying
architecture of VBMS will allow seamless integration with current or
future accounting and claims management systems. The VETSNET suite of
applications provides the current tracking and payment infrastructure
and will be closely linked to VBMS to enable not only the paperless
processing of claims, but also provide a much more effective user
interface.
VBMS is based on a service oriented architecture (SOA) that will
facilitate long-term maintenance and upgrades, including and especially
upgrades of the underlying components. VBMS will use Veterans' data and
claim data already contained in the VETSNET database (VBA's corporate
database), as well as production services that are currently part of
the VETSNET suite. Finally, VBMS will deploy the architecture for the
paperless document repository, the workflow engine to facilitate the
processing of a claim, and the interface layer to allow the system to
utilize the business and policy logic, as well as authoritative
corporate records.