[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON: DRAFT LEGISLATION TO IMPROVE REPRODUCTIVE
TREATMENT PROVIDED TO CERTAIN DISABLED VETERANS; DRAFT LEGISLATION TO
DIRECT THE DEPARTMENT OF VETERANS AFFAIRS (VA) TO SUBMIT AN ANNUAL
REPORT ON THE VETERANS HEALTH ADMINISTRATION; H.R. 271; H.R. 627; H.R.
1369; H.R. 1575; AND, H.R. 1769
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
FIRST SESSION
THURSDAY, APRIL 23, 2015
Serial No. 114-17
__________
Printed for the use of the Committee on Veterans' Affairs
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Available via the World Wide Web: http://www.fdsys.gov
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado CORRINE BROWN, Florida, Ranking
GUS M. BILIRAKIS, Florida, Vice- Minority Member
Chairman MARK TAKANO, California
DAVID P. ROE, Tennessee JULIA BROWNLEY, California
DAN BENISHEK, Michigan DINA TITUS, Nevada
TIM HUELSKAMP, Kansas RAUL RUIZ, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
JACKIE WALORSKI, Indiana KATHLEEN RICE, New York
RALPH ABRAHAM, Louisiana TIMOTHY J. WALZ, Minnesota
LEE ZELDIN, New York JERRY McNERNEY, California
RYAN COSTELLO, Pennsylvania
AMATA COLEMAN RADEWAGEN, American
Samoa
MIKE BOST, Illinois
Jon Towers, Staff Director
Don Phillips, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
DAN BENISHEK, Michigan, Chairman
GUS M. BILIRAKIS, Florida JULIA BROWNLEY, California,
DAVID P. ROE, Tennessee Ranking Member
TIM HUELSKAMP, Kansas MARK TAKANO, California
MIKE COFFMAN, Colorado RAUL RUIZ, California
BRAD R. WENSTRUP, Ohio ANN M. KUSTER, New Hampshire
RALPH ABRAHAM, Louisiana BETO O'ROURKE, Texas
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
----------
Thursday, April 23, 2015
Page
Legislative Hearing on: Draft Legislation to Improve Reproductive
Treatment Provided to Certain Disabled Veterans; Draft
Legislation to Direct the Department of Veterans Affairs (VA)
to Submit an Annual Report on the Veterans Health
Administration; H.R. 271; H.R. 627; H.R. 1369; H.R. 1575; and,
H.R. 1769...................................................... 1
OPENING STATEMENT
Dan Benishek, Chairman........................................... 1
Julia Brownley, Ranking Member................................... 3
Hon. Jeff Miller
Prepared Statement........................................... 35
WITNESSES
Hon. Gus Bilirakis, U.S. House of Representatives 12th District,
Florida........................................................ 4
Prepared Statement........................................... 36
Hon. Janice Hahn, U.S. House of Representative, 44th District,
California..................................................... 6
Prepared Statement........................................... 38
Hon. Jackie Walorski, U.S. House of Representative, 2nd District,
Indiana........................................................ 7
Prepared Statement........................................... 39
Blake Ortner, Deputy Government Relations Director, Paralyzed
Veteran of America............................................. 14
Prepared Statement........................................... 41
Louis J. Celli Jr. Director, National Veterans Affairs and
Rehabilitation Division, The American Legion................... 15
Prepared Statement........................................... 50
John Rowan, National President, VVA.............................. 17
Prepared Statement........................................... 60
Adrian Atizado, Assistant National Legislative Director, DAV..... 19
Prepared Statement........................................... 67
Rajiv Jain M.D., Assistant Deputy Under Secretary for Health for
Patient Care Services, VHA, U.S. Department of Veterans Affairs 28
Prepared Statement........................................... 73
Accompanied by:
Janet Murphy, Acting Deputy Under Secretary for Health
for Operations and Management, VHA, U.S. Department
of Veterans Affairs
And
Jennifer Gray, Attorney, Office of the General Counsel,
U.S. Department of Veterans Affairs
FOR THE RECORD
Hon. Corrine Brown, FC Ranking Member
Prepared Statement........................................... 92
American Health Care Association................................. 93
American Society for Reproductive Medicine....................... 94
Concerned Veterans for America................................... 96
RESOLVE: National Infertility Association........................ 97
Veterans of Foreign Wars of the United States.................... 98
Wounded Warrior Project.......................................... 104
LEGISLATIVE HEARING ON: DRAFT LEGISLATION TO IMPROVE REPRODUCTIVE
TREATMENT PROVIDED TO CERTAIN DISABLED VETERANS; DRAFT LEGISLATION TO
DIRECT THE DEPARTMENT OF VETERANS AFFAIRS (VA) TO SUBMIT AN ANNUAL
REPORT ON THE VETERANS HEALTH ADMINISTRATION; H.R. 271; H.R. 627; H.R.
1369; H.R. 1575; AND, H.R. 1769
----------
Thursday, April 23, 2015
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health,
Washington, D.C.
The subcommittee met, pursuant to notice, at 10:00 a.m., in
Room 334, Cannon House Office Building, Hon. Dan Benishek
[chairman of the subcommittee] presiding.
Present: Representatives Benishek, Bilirakis, Roe,
Huelskamp, Coffman, Wenstrup, Abraham, Brownley, Takano, Ruiz,
Kuster, and O'Rourke.
Also present: Representatives Walorski and Titus.
OPENING STATEMENT OF CHAIRMAN DAN BENISHEK
Mr. Benishek. The subcommittee will come to order.
Before we begin, I would like to ask unanimous consent for
my friends, colleagues, and members of the full committee,
Congresswoman Jackie Walorski of Indiana and Congresswoman Dina
Titus of Nevada, to sit on the dais and participate in today's
proceedings. Without objection, so ordered.
Thank you all for joining us today as we discuss seven
bills that will impact the healthcare provided to our Nation's
veterans by the Department of Veterans Affairs' healthcare
system.
The bills on our agenda today are draft legislation to
improve reproductive treatment provided to certain disabled
veterans; draft legislation to direct VA to submit to an annual
report on the Veterans Health Administration; H.R. 271, the
Creating Options for Veterans Expedited Recovery or COVER Act;
H.R. 627 to expand the definition of homeless veteran for
purposes of benefits under the laws administered by VA; H.R.
1369, the Veterans Access to Extended Care Act of 2015; H.R.
1575 to make permanent the pilot program on counseling in
retreat settings for women veterans newly separated from
service; and, H.R. 1769, the Toxic Exposure Research Act of
2015.
I am proud to sponsor two of the bills on our agenda, the
draft bill to direct VA to submit an annual report on the
Veterans Health Administration and H.R. 1769, the Toxic
Exposure Research Act of 2015.
The draft bill would require the VA to submit an annual
report to Congress regarding the provision of hospital care,
medical services, and nursing home care by the VA healthcare
system. The annual report would contain information regarding
access to care, quality of care, workload, patient demographics
and utilization, physician compensation and productivity,
purchased care, and pharmaceutical prices.
This measure is the result of the subcommittee's oversight
hearing in January where the Congressional Budget Office
testified that VA provided limited data to Congress and the
public about its costs and operational performance and that if
it was provided on a regular and systemic basis could help
inform policymakers about the efficiency and cost effectiveness
of VA's services.
Similar sentiments were echoed by witnesses from The
American Legion and the Independent Budget. VA must become more
transparent and forthcoming about the care that it provides to
our Nation's veterans so that Congress, stakeholders,
taxpayers, and veterans can make informed determinations about
the services that the department is offering and how they can
be improved.
The intent of our hearing in January was to determine the
cost and value of VA care. But during our discussion, it became
painfully obvious that the department leaders were unable to
provide basic information about, say, how much the VA spends on
a single patient encounter in a VA primary care clinic.
As a doctor myself, it is unfathomable to me that the VA
either does not have or is unwilling to share granular data
about the cost of the services it provides. This bill and the
free flow of information that it will require of the VA on a
yearly basis will fix that once and for all, resulting in a
better, stronger VA healthcare system that our veterans
deserve.
My other bill, the Toxic Exposure Research Act of 2015,
would establish a national center for research into the health
conditions experienced by the descendants of veterans exposed
to toxic substances. It would also create an advisory board who
would be responsible for advising the national center,
determining health conditions that result from toxic exposure,
and studying and evaluating the cases of exposure.
In addition, it would authorize the Department of Defense
to declassify documents related to a known incident in which at
least a hundred servicemembers were exposed to a toxic
substance that resulted in at least one case of related
disability.
Finally, it would create a national outreach campaign
jointly led by VA, DoD, and the Department of Health and Human
Services on the potential long-term health effects of exposure
to toxic substances by servicemembers, veterans, and their
descendants.
As I said before, injuries or illnesses that result from
exposure to toxic chemicals can have life-long and generational
effects, the impacts of which we do not yet fully understand,
but are nevertheless painfully prevalent to the veterans and
family members who experience them.
For them and for future generations, we must do more to
recognize, research, and treat toxic exposure issues and
thoroughly evaluate the long-term effects exposure can have not
just on those who serve but on their children and grandchildren
as well.
Mr. Benishek. Enough about my bills. In addition to those
bills, I am proud to be an original cosponsor for H.R. 627
which would expand the definition of a homeless veteran to
include veterans and their families who are fleeing from
domestic or dating violence, sexual assault, stalking or other
life-threatening conditions in their current home and lack the
resources to obtain other permanent housing.
Veterans who are living in a violent home deserve our
support as they recover from the devastating effects of
intimate partner violence and begin to reclaim their lives.
I am grateful to my friend and colleague, Congresswoman
Janice Hahn from California, for championing their cause with
this legislation and I urge all my colleagues to join us in
cosponsoring H.R. 627.
The draft bill 1769, H.R. 1769 and H.R. 627 are supported
by a number of our veteran service organizations and I thank
them all for their support and comments and recommendations. I
look forward to working closely with them, the department, and
other stakeholders beginning with today's hearing to strengthen
these and all the bills on our agenda where needed and advance
them through the subcommittee without delay.
I thank all of our witnesses and the audience members for
being here today and I will now yield to the Ranking Member
Brownley for any opening statements she may have.
OPENING STATEMENT OF RANKING MEMBER JULIA BROWNLEY
Ms. Brownley. Thank you, Mr. Chairman, for calling this
hearing this morning.
I don't have any bills to speak to today personally, but I
do look forward to hearing from members and witnesses today
regarding the five bills and two pieces of draft legislation
that are on the agenda this morning including yours, Mr.
Chairman.
As we deliberate on the multitude of issues and concerns
that are before us each and every Congress, it is critical that
we are as informed as we possibly can be on all of the issues.
We rely on the information we receive during these legislative
hearings to improve upon the services and benefits that the
Department of Veterans Affairs provides to our veterans and
their families. It is also important that we are made aware of
any unintended consequences that may arise from these different
bills.
Today we will hear, as the chair has already stated, we
will hear from the panels on a variety of bills concerning the
subcommittee's jurisdiction. We have two bills addressing the
treatment of mental health, one on domestic violence and on
homeless veterans, one on research and to toxic exposures, and
a bill that addresses the provision of extended care services
to veterans.
In addition to the five bills, we will hear about two
pieces of draft legislation. The first would authorize VA to
provide in vitro fertilization services to eligible veterans
and spouses. The second requires the VA to submit a report to
Congress on hospital care, medical services, and nursing homes.
I am on the record as a supporter of reproductive rights
for all our veterans. Too many of our young men and women have
been injured so severely that having children is now not an
option. IVF might not be the solution for these families and we
need to be sensitive to their needs also.
Hopefully we can work together to find a way forward to
ensure that all veterans who want a family including same sex
veterans will have all the support and assistance they may need
to do that.
I appreciate all the witnesses being here today. I
appreciate the chair calling this meeting and I look forward to
everyone's testimony. I yield back.
Mr. Benishek. Thank you.
Well, we are this morning to be joined by several other of
our members who are sponsoring legislation this morning. Mr.
Miller, the chairman of the committee, will be in, Congressman
Gus Bilirakis from the 12th District of Florida, Congresswoman
Janice Hahn from the 44th District of California, Congresswoman
Jackie Walorski from the 2nd District of Indiana.
I think I will start with Mr. Bilirakis. Would you please
go ahead with your legislation.
STATEMENT OF HON. GUS BILIRAKIS, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF FLORIDA
Mr. Bilirakis. Mr. Chairman, I appreciate it very much and
I want to thank the ranking member as well.
Thank you for holding this very important hearing and
giving me the opportunity to discuss my bill, H.R. 271, the
Creating Options for Veterans Expedited Recovery Act, the COVER
Act.
Statistics show that one in five veterans who serve in Iraq
and Afghanistan have been diagnosed with the posttraumatic
stress. Now, we must responsibly ask ourselves are we doing
enough when it comes to addressing mental health in our
veterans' population. I don't think so.
Recent data has shown that every day in this country,
approximately 18 to 22 veterans take their own lives. This
statistic answers the question I posed earlier. It is obviously
more--Mr. Chairman, more needs to be done in my opinion. That
is why I introduced the COVER Act in the 114th Congress.
The COVER Act will establish a commission to examine the
Department of Veterans Affairs' current evidence-based therapy
treatment model for treating mental illness among veterans. It
will also analyze the potential benefits of incorporating
complementary, alternative treatments available within our
communities.
The duties of the commission designated under the COVER Act
include conducting a patient-centered survey within each
Veteran Integrated Service Network. The survey will examine
several different factors related to the preferences and
experiences of veterans when they have dealt with the
Department of Veterans Affairs.
Instead of presuming to know what is best for veterans, we
should just ask the veteran. It is as simple as that. Then we
can work with veterans on finding the right solution that best
fits their own unique needs. Not one size fits all.
The scope of the survey will include the experience of a
veteran when seeking medical assistance within the Department
of Veterans Affairs, the experience of veterans with the non-VA
medical facilities and health professionals for treating mental
health illness, the preferences of a veteran on available
treatments for mental health and which they believe to be most
effective, the prevalence of prescribing prescription drugs
within the VA as remedies for treating mental illnesses, and
outreach efforts by the VA secretary on available benefits and
treatments.
Additionally, the commission will be tasked with examining
the available resources on complementary, alterative treatments
for mental health. Then the commission will identify what
benefits could be attained with the inclusion of such
treatments for our veterans seeking care at the VA.
Some of the alternative therapies include among others, of
course, accelerated resolution therapy, music therapy, yoga,
acupuncture therapy, meditation, outdoor sports therapy, and
training and care for service dogs.
Finally, the commission will study the potential increase
in health claims for mental health issues for veterans
returning from the most recent theaters of war. We must ensure
that the VA is prepared with the necessary resources and
infrastructure to handle the increase in those utilizing their
earned benefits to address the mental and physical elements
incurred from military service.
Once the commission has successfully completed their
duties, a final report will be issued. Its recommendations and
findings will be made available based on the analysis of the
patient-centered survey, alternative treatments, and evidence-
based therapies.
The commission will also be responsible for creating a plan
to implement those findings in a feasible, timely, and cost-
effective manner.
Last Congress, I was very pleased that the subcommittee
considered the COVER Act in a legislative hearing. At this
hearing, all the VSOs and organizations testified and have
supported the COVER Act. I want to thank all again, all of you
really for your support through your testimonies given today.
In this year's draft, I was also pleased to incorporate the
recommendations offered by the Vietnam Veterans of America.
They suggested that appointees on the commission must not have
proprietary, financial, or any other conflicting interest in
any of the treatment considered, and I think that is very
reasonable and I appreciate their recommendations.
In closing, we have the support from veterans and the
organizations that work closely with them. And it is clear that
there is a need to do more and that is what we need to do. We
need to do more for our true American heroes. We have that
responsibility. We have that duty.
The question now is this: What do we intend to do about it?
We definitely have to act on this bill and I really appreciate,
Mr. Chairman, you agendaing this bill today and I would love to
see it marked up very soon.
With that, I urge my colleagues again to support this bill
and cosponsor this bill. Let's get this done for our heroes.
Thank you.
[The prepared statement of Gus Bilirakis appears in the
Appendix]
Mr. Benishek. Thanks, Mr. Bilirakis.
Now we will hear from our colleague, Representative Hahn.
You are now recognized for five minutes.
STATEMENT OF HON. JANICE HAHN, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF CALIFORNIA
Ms. Hahn. Thank you. And thank you, Chairman Benishek, for
holding this hearing. It is an honor for me to be with Ranking
Member Brownley and really all the distinguished members of
this committee. Thank you.
Homeless veterans are such a pressing problem for this
Nation. More than 62,000 veterans are homeless on any given
night and over 120,000 veterans will experience homelessness
over the course of the year. And while only seven percent of
Americans qualify as veterans, they make up nearly 13 percent
of the homelessness population in this country. Sadly, my
hometown, Los Angeles County, has the most homeless veterans in
the Nation.
And today I wanted to address one segment of homeless
veterans, those who are homeless because of domestic violence.
Currently the Department of Veterans Affairs' definition of
homeless veterans does not include veterans who are homeless
because of domestic violence. And across the country, we know
too many victims of domestic violence feel there is nowhere for
them to turn.
And lacking resources, help, and a safe place to go, many
of these victims feel like their only choice is to remain with
their abusers. And tragically too often women veterans are
among those who find themselves in this horrible situation.
According to the VA, 39 percent of our women veterans
report experiencing domestic violence. That is well above the
national average. And, however, because of antiquated laws on
the books, they have not been eligible to access resources
designated for homeless veterans.
I approached Chairman Benishek with my legislation, H.R.
627, which updates the definition of homeless veteran to
include victims fleeing domestic violence. And not only was he
extremely supportive, but he joined me in introducing it. And
for that, I really thank you, Chairman.
Our legislation will update the definition of homeless
veteran to include veterans fleeing domestic violence and will
correct what I believe is an oversight and ensure that veterans
fleeing domestic violence can receive benefits from the VA.
This is a minor change, but it has great importance to ensure
that our veterans do not feel trapped in dangerous situations.
H.R. 627 is endorsed by countless veterans' organizations
such as the Veterans of Foreign Wars, AMVETS, the National
Coalition for Homeless Veterans, the Servicewomen's Action
Network, Blinded Veterans Association, and we have many more on
that list.
Providing benefits to veterans driven to homelessness by
domestic violence is, I think, something we should all support
and we have supported that in the past. In fact, I have worked
with House Appropriations Veterans Affairs' subcommittee to
include report language the past two years to make these
benefits available.
But that process only helps until the next year and has to
be repeated every year to provide this temporary help. I think
it is time to stop making temporary fixes. This legislation
permanently fixes this loophole for veterans. And while it is
unknown how many veterans will be helped by this bill, I just
believe if it helps one veteran get the support they need and
to leave a dangerous situation, then our work here will be
worth every minute. Let's step up to provide these heroes who
have protected us with the resources they need including a
place where they can be safe and protected.
In conclusion, I want to thank you for working with me to
solve an urgent problem and I yield back the balance of my
time.
[The prepared statement of Janice Hahn appears in the
Appendix]
Mr. Benishek. Thank you very much.
Representative Walorski, you are recognized for five
minutes.
STATEMENT OF HON. JACKIE WALORSKI, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF INDIANA
Ms. Walorski. Good morning. Thank you.
Chairman Benishek, Ranking Member Brownley, members of the
committee, thank you for the opportunity to discuss H.R. 1369,
the Veterans Access to Extended Care Act. This important bill
would expand veterans' access to certain healthcare services
and allow former servicemembers to receive those services from
local providers.
Currently VA offers a variety of long-term services and
support to veterans including nursing home care, adult day
care, respite care. Non-VA providers at community organizations
must contract with the VA under the Service Contract Act to
provide these services.
The Service Contract Act's burdensome reporting
requirements, the Department of Labor, along with the
compliance costs discourage local providers from entering into
contracts with the VA. This situation has left many veterans
and their families without the ability to find providers close
to home.
In February of 2013, the VA issued a proposed rule which
would have allowed providers to enter into these agreements
with the VA under the same guidelines that providers for
Medicare enter into agreements with CMS. Non-VA providers would
no longer be considered federal contractors, relieving them
from the burdensome reporting requirements.
In conjunction with a Senate letter that was sent June of
2014, Congresswoman Tulsi Gabbard and I along with 107 of our
colleagues in the House sent a letter in August of 2014 to
Secretary McDonald encouraging the release of the final VA
provider agreement rule. Unfortunately, despite the willingness
of the department, the VA never had the legislative authority
to begin to enact the rule.
In response, Representative Gabbard and I introduced H.R.
1369, Veterans Access to Extended Care Act. This commonsense
bill gives the VA the legislative authority, the fix it needs
to follow through the original proposed rule. Specifically this
bill exempts extended care service providers from being treated
as federal contractors for the acquisition of goods or
services.
The bill also relieves providers from certain reporting
requirements to the Department of Labor. Lastly, it includes
quality assurance provisions to ensure the safety and a high
standard of care our veterans deserve.
Incentivizing more local providers to work with the VA will
increase access to care that is closer to home, allowing family
and friends to provide additional support structures to our
veterans. The family structure during these times is vital to
ensuring a veteran's quality of life.
These individuals have sacrificed so much in the name of
liberty, they should not have to worry about being able to find
care close to home because their hometown providers don't have
the necessary resources to qualify as a government contractor.
Eliminating this designation will encourage more extended
service providers to enter into agreements which will provide
much more options, many more options to our veterans.
Providing veterans with the care they need and deserve
continues to be a top priority of mine and most of us on this
committee. I am grateful to work with Representative Gabbard,
Senator Hoeven, Senator Manchin, and the committee in
addressing this critical issue for our veterans.
And I thank you again, Mr. Chairman, Ranking Member
Brownley, for the opportunity to be here today. I yield back my
time.
[The prepared statement of Jackie Walorski appears in the
Appendix]
Mr. Benishek. Thank you very much for your testimony.
The chairman of the committee is expected to be here to
testify on behalf of his legislation as well, but I am not
going to ask any questions of the members here in the reference
of time because I know I am going to have adequate time to talk
to them as time goes by here in the House.
Ms. Brownley, do you have any questions?
Any questions for the panel members from any of the
members?
And thank you. The first panel is excused. And then we will
proceed with the second panel.
Mr. Takano. Dr. Benishek, just a real quick question of Mr.
Bilirakis and Mr. Ruiz, Dr. Ruiz.
Your commission that you are trying to set up is a very
interesting one to me and I commend you for the bill. And I
gather the big impetus is to try and find ways to not
necessarily--I mean, former Secretary Shinseki I remember
talking about the use of medications and how we are using too
much of them with our veterans.
I want to share with you that I was at an event probably
last session with a California Commission for the Humanities
and Professor Emeritus David Glidden of University of
California Riverside is a professor of philosophy. And one of
the participants was a female veteran who had taken part in his
philosophy class which explored the big moral questions about
life, you know.
And it strikes me that a lot of veterans face not just the
mental issue, mental health issues but the spiritual issues. We
send young people into battle, many of them not really thinking
about the moral consequences of war, and they come back with
all that weighing on their minds. And rather than medications,
many of them just really could benefit by going to a well-
considered course put together by a very talented person in
humanities.
And I wonder if you might consider looking at including a
perspective, say, from the National Endowment for the Arts or
the National Endowment for the Humanities ways to leverage
those budgets and encouraging our humanities and arts community
to think about how they can engage with our veterans. And this
is also providing a pathway that is different than medication.
And one of the things that this veteran mentioned was that
sometimes there is a stigma attached to seeking mental health
and this is another pathway that a veteran can take that, you
know, doesn't necessarily mean that they have to feel like they
are stigmatized by that.
And, of course, we want to remove the stigma period.
Mr. Bilirakis. Absolutely.
Mr. Takano. But it is a thought I wanted to offer.
Mr. Bilirakis. Oh, I would be willing to discuss that with
you.
Mr. Takano. Yes. Thank you.
Mr. Bilirakis. Again, you know, the examples that I used
are just examples and we are not limiting it to that. And I
would like to hear maybe from Dr. Ruiz, too, because he is a
cosponsor of my bill, the prime cosponsor. But I would take
that into consideration. I would be happy to discuss that with
you.
Mr. Ruiz. Thank you. I think that the commission will be
looking at events like that and that is why want to form the
commission----
Mr. Bilirakis. Absolutely.
Mr. Ruiz [continuing]. Because then they can look at what
the state-of-the-art mental health counseling and therapy exist
out there and start to incorporate those for our veterans. And
I think it will be helpful.
Mr. Takano. Yes. With all respect to the medical
background, and I don't want to diminish any--we don't want to
diminish the role of medication or therapy, but thinking of
also the nonmedical ways of also treating folks even with the
existing budgets or even a tiny bit of leverage from Federal
Government to try these other--so I was hoping that you would
look at representing on the commission folks within the
humanities and the arts as well.
Mr. Coffman. Mr. Chairman.
Mr. Benishek. Yes.
Mr. Coffman. Mr. Bilirakis, one thing I would like the--my
concern as a combat veteran is that the largest cost driver I
think probably in VA healthcare is posttraumatic stress
disorder in terms of disability payments.
In talking to professionals in psychiatry and psychology
and the different therapists seem to think that with the proper
treatment that the stress disorders from being in a combat zone
could be brought down to a level where it is no--that those
stressors are no longer debilitating, yet one of the
considerations I think your commission should look at is should
there be a requirement or what can we do to encourage those who
are on disability for posttraumatic stress disorder to receive
treatment because I think it is a disservice to those veterans
and it is, quite frankly, as a taxpayer, it is a disservice to
the taxpayers of this country.
We have got to figure out how to help people. We have got
two different definitions. The Department of Defense sees
posttraumatic stress as a wound and the Veterans Administration
sees it as a disability. I think we have got to link those two
up. As a combat veteran, I see it as a wound and wounds are
treatable. Some may not be.
But the system makes no effort or little effort and so I
think that it ought to be a factor to say what can we do to
restructure the system going forward, or does it need to be
restructured going forward, I don't know, that creates a
mechanism whereby people are encouraged or required to
participate in treatment.
Mr. Bilirakis. That is definitely worthy of a discussion.
And, again, the idea behind this bill is we need to give the
veteran the choice because not one size fits all with regard to
the therapy. So I will take all these matters under
consideration, but we got to pass the bill first. Thank you.
Mr. Benishek. Mr. Ruiz, Do you have a comment?
Mr. Ruiz. Yeah. I would like to make a statement regarding
this bill and applaud Mr. Bilirakis for the work that you are
doing for our veterans in improving their mental health
services.
So I would like to thank Mr. Chairman and Ms. Ranking
Member and thank also the panelists that we are going to hear
from today, the veteran service organizations for joining us.
The VA's mission is to care for those that, quote, ``shall have
borne the battle.'' And the most essential part of that task is
to heal our wounded warriors, our wounded veterans. However,
more and more our soldiers are returning with psychological
wounds, illnesses that do not present as obviously as physical
maladies but are just as damaging.
That is why I am an original cosponsor of H.R. 271, the
COVER Act, which I am glad to see included in today's hearing.
This bill will ensure that no stone is left unturned in
exploring ways to provide timely, effective, veteran-centered
mental healthcare for those who have served in our Armed
Forces.
I am proud to have worked with outstanding veteran service
organizations and the veterans in my district to ensure that
the VA listens to the foremost experts on what veterans need,
the veterans themselves.
In that same spirit, this bill will help give veterans a
voice in their treatment by requiring a comprehensive survey of
veterans' experiences and preferences. To achieve real progress
towards improving mental healthcare in the VA, we must
incorporate veterans' recommendations.
As a physician who has treated the whole range of patients
that come into the emergency department, I know that one-size-
fits-all approach doesn't work for veterans with mental health
needs. This bill will help give our veterans mental healthcare
options that work for them and will lay the groundwork for
future solutions that are the product of listening to our
veteran community.
I look forward to working with Vice Chairman Bilirakis and
other members of this committee to create an inclusive process
where veterans' voices and views are heard and I urge my
colleagues to support this bill.
Thank you and I yield back.
Mr. Benishek. All right. Thanks.
Does anyone else have any questions or comments?
Mr. Roe. Just very briefly I guess to just second what two
of my colleagues have said.
One, Mr. Coffman, I think you are absolutely right on. We
should stop calling this posttraumatic stress disorder and
posttraumatic stress and look at how we heal these veterans and
get them back into the workforce and have productive lives, not
to say that I have this condition.
If you have been in war, I have said this many times here,
and somebody shoots at you, that is going to make you anxious.
There would be something wrong with you if you didn't. And you
are going to--I mean, I would think there would be something
really wrong if you didn't get scared if somebody shot at you.
And I think the goal ought to be with the commission is how
do we, and I think this is a, Mr. Bilirakis, a tremendous idea
that you all have come up with, to finally get in one arena a
group of people, experts to put together some ideas about how
we do what you are saying, about how we get these folks who are
on disability, get them back in the workforce and get them back
at productive lives. I think that is something we absolutely
have to do.
And, Mr. Takano, I could not agree more with you in
including some alternative things like the arts, music. I can
tell you it is very beneficial for people and can be very
healing to people. And having used that myself, I know it
works. And so I think it is a phenomenal idea.
I am very supportive and I think we need to expand, Mr.
Bilirakis, what you are doing and with all these ideas that
have come in. I think this it is a wonderful idea.
And with that, I yield back.
Mr. Benishek. Great. Okay. Ms. Kuster, Do you have a
question as well?
Ms. Kuster. Just a quick comment. I wanted to thank you,
the chair. I have been an adoption attorney for 25 years and
worked with a lot of people in the area of reproductive health
and just wanted to say I support the effort in your bill. And I
think it is an important point.
And then I think Representative Walorski is gone, but I
just wanted to thank her for her efforts and also
Representative Hahn, the bill about women and her homelessness
issue, about domestic violence and women trying to seek shelter
and safety.
So I just want to commend the chair and the panel for some
great legislation and look forward to working with you all.
Mr. Benishek. Well, thanks.
Ms. Kuster. Thank you.
Mr. Benishek. Appreciate that.
Mr. Miller has arrived, so he wants to present his
legislation as well. Mr. Miller, you are recognized.
Mr. Miller. Thank you very much, Mr. Chairman, to the
ranking member. And I apologize for being late this morning,
but it is always good to be in the Subcommittee on Health. I
appreciate all the members' attention and your diligence at the
full committee level and certainly with what is going on here
today.
I want to talk with you about issues as it relates to
reproductive treatment that is provided to certain disabled
veterans. Now, currently the conflicts in Iraq and Afghanistan
over the last decade have resulted in significant increases in
reproductive organ and spinal cord injuries among our
servicemembers. These wounds can have serious and life-long
repercussions on the daily lives of our veterans and their
families, not the least of which can be the inability to
conceive a child.
While the Department of Veterans Affairs does provide a
number of fertility services to veterans, VA is currently
prohibited via regulation from providing in vitro
fertilization, one of the most well-known and arguably most
effective assisted reproductive technologies. The VA is
prohibited also by statute from providing any such treatment to
a veteran's spouse.
In contrast, the Department of Defense has been providing
IVF to severely-wounded servicemembers since 2010. What this
disparity results in is having severely-disabled veterans
having to decide whether or not to pursue a family through IVF
before they separate from the service while still actively
recovering from their wounds and during what can be a highly
stressful transition period or pay for the procedure out of
pocket once they move to veteran status.
Because IVF can be costly, for some veterans waiting until
they are in VA care can mean having to choose between a
financial free-fall or foregoing their dreams of having a child
altogether. This is an agonizing and unacceptable choice that
this draft bill would help prevent veterans with these
disabilities from ever having to make.
The draft bill would authorize VA to provide assisted
reproductive technology in addition to any fertility treatment
already authorized to enroll veterans whose service-connected
disability includes an injury to the reproductive organs or
spinal cord that directly results in the inability to procreate
without the use of assisted reproductive technology.
Assisted reproductive technology is defined in the bill to
include IVF as well as other technologies determined by VA as
appropriate to be used to assist reproduction. In furnishing
IVF or similar procedures to an eligible veteran, VA would also
be authorized to provide services to that veteran's spouse.
Like DoD, VA would be limited to providing eligible veterans
three in vitro fertilization cycles resulting in a total of not
more than six implantation events.
The draft bill would further stipulate that VA is
authorized to provide for storage of genetic material for three
years after which the veteran and his or her spouse is
responsible for the cost of such storage, that VA cannot
process or make any determinations regarding the disposition of
genetic material, and that VA is required to carry out
activities relating to the custody or disposition of genetic
material in accordance with the relevant state law.
Finally, the draft bill would prohibit VA from providing
any benefits relating to surrogacy or third-party genetic
material donation. So in short, this legislation mirrors the
IVF benefit that is provided to active-duty servicemembers in
DoD, creating parity between the two departments while opening
the door for parenthood for disabled veterans who may otherwise
not have the resources to pursue such a path.
And I am proud to say that this proposal is supported many
of our VSOs, by resolve the National Infertility Association
and by the American Society for Reproductive Medicine. And I
want to thank all of them for their support, for this draft,
and for their thoughtful comments and recommendations for how
it could be improved.
I look forward to working hand in hand with each of you
subcommittee members to address those suggestions and otherwise
strengthen the language in the draft bill before it is
introduced and moved forward. This draft is derived partly from
the recent subcommittee roundtable wherein fertility among
disabled veterans was discussed in depth. And I am grateful to
you, Dan, for holding the roundtable as well as this hearing
today. And I urge my colleagues support this draft bill and I
yield back. Thank you for your time.
Mr. Benishek. Thank you very much, Mr. Chairman.
Any other comments for the chairman?
Mr. Roe.
Mr. Roe. Just very briefly some history. In vitro
fertilization came along in my career as an obstetrician/
gynecologist. Dr. Patrick Steptoe in England did a hundred
laparoscopic in vitro implantations before he had one success.
Egg gatherings, he did a hundred. It is now standard medical
therapy.
And I wholeheartedly support this legislation. It is past
due. We should do this for our very, very seriously-wounded
veterans who want to have families. I can't think of anything
more honorable to do than this.
I yield back.
Mr. Benishek. Thank you.
I think with that, we will ask the second panel to take the
stage here. Joining us on the second panel is Blake Ortner, the
Deputy Government Relations Director for the Paralyzed Veterans
of America; Louis Celli, Jr., the Director of the National
Veterans Affairs and Rehabilitation Division for The American
Legion; John Rowan, the National President of the Vietnam
Veterans of America; and Adrian Atizado, the Assistant National
Legislative Director for the Disabled American Veterans.
Thank you all for being here and for your hard work and
advocacy on behalf of our veterans. I appreciate you being here
to present your views of your members.
And I think we will begin with Mr. Ortner. Mr. Ortner, you
are recognized for five minutes.
STATEMENTS OF BLAKE ORTNER, DEPUTY GOVERNMENT RELATIONS
DIRECTOR, PARALYZED VETERAN OF AMERICA; LOUIS J. CELLI JR.,
DIRECTOR, NATIONAL VETERANS AFFAIRS AND REHABILITATION
DIVISION, THE AMERICAN LEGION; JOHN ROWAN, NATIONAL PRESIDENT,
VIETNAM VETERANS OF AMERICA; ADRIAN ATIZADO, ASSISTANT NATIONAL
LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS
STATEMENT OF BLAKE ORTNER
Mr. Ortner. Chairman Benishek, Ranking Member Brownley, and
members of the subcommittee, Paralyzed Veterans of America
would like to thank you for the opportunity to present our
views on legislation before the subcommittee.
PVA supports the draft legislation to provide assisted
reproductive technology or ART such as in vitro fertilization
to certain disabled veterans. For many disabled veterans, one
of the most devastating results of spinal cord injury or
dysfunction is the loss of or compromised ability to have a
child.
While the Department of Defense does provide ART to
servicemembers and retired servicemembers, VA does not. When a
veteran has a loss of reproductive ability due to a service-
connected injury, they must bear the total cost for any medical
services should they attempt to have children. Procreative
services provided through VA would ensure that disabled
veterans are able to have a full quality of life that would
otherwise be denied them due to their service.
The bill also offers veterans the option of
cryopreservation of genetic material for three years to protect
their viability to have a family in the event medical
treatments or medications affect the quality of their genetic
materials.
While PVA strongly supports this draft legislation, it is
limited in addressing the needs of women veterans. Some women
veterans with a catastrophic injury may be able to conceive
through IVF but be unable to carry a pregnancy to term due to
their disability. In such an instance, implantation of a
surrogate may be their only option.
The current draft of the bill is not inclusive of all women
veterans with a catastrophic reproductive injury and we believe
clarification is necessary where the draft prohibits any
benefits relating to surrogacy or third-party genetic material
donation.
PVA generally supports draft legislation to require a
yearly evaluation of overall effectiveness of the Veterans
Health Administration in improving access to care and the
quality of it. In order to improve this bill, PVA strongly
encourages adding language to reinstate the reporting
requirement that expired in 2008 on the capacity of VHA to
provide specialized services to disabled veterans.
The VA has not maintained its capacity to provide for the
unique healthcare needs of severely-disabled veterans, veterans
with spinal cord injury or disease, blindness, amputations, and
mental illness.
Currently within the SCI system of care, VA not meeting
capacity requirements for staffing or number of inpatient beds
is consistently reported throughout the system. VA has
eliminated staffing positions or operated with vacant
healthcare positions for prolonged periods of time. When this
occurs, veterans' access to VA decreases, remaining staff
become overwhelmed with increased responsibilities, and the
overall quality of healthcare is compromised.
As a component of its workplace planning, VA tracks this
information and is able to compile and use the collected data
for annual reports, so this should not be an undue burden.
PVA understands the intent of and generally supports the
Toxic Exposure Research Act of 2015. However, the bill does not
discuss the processes should the advisory board conflict with
the findings of IOM. We encourage the subcommittee and VA to
work together to ensure legislation fulfills the IOM Committee
recommendations.
PVA supports H.R. 271, the Creating Options for Veterans
Expedited Recovery Act. PVA believes that effective medical
care, traditional or alternative, ought to be readily available
to a veteran in need and that all VA mental healthcare should
meet the specific individual need of the veteran on a
consistent basis.
Complementary and alternative medicines give veterans with
mental illness as well as catastrophic disabilities additional
treatment options and the commission could offer an opportunity
to identify additional best practices across medical
disciplines.
PVA supports H.R. 627 to expand the VA's definition of
homeless to match the definition used by the Department of
Housing and Urban Development since 1987. Domestic violence is
just as much a public health matter as homelessness and for
women veterans, it is a major cause. Thirty-nine percent of
women veterans report experiencing domestic violence, well
above the national average.
As a result of definitions outlined in Title 38, these
veterans are not eligible to access resources for homeless
veterans.
PVA generally supports H.R. 1369, the Veterans Access to
Extended Care Act of 2015, which would allow veterans to obtain
non-VA long-term services and supports from local providers.
The bill would also allow LTSS providers to enter the VA
provider agreement rather than contracting with VA, thereby
avoiding the complex processes required under the Service
Contract Act.
Finally, PVA supports H.R. 1575, a bill to make permanent
the pilot program on counseling in retreat settings for women
veterans newly separated from service in the Armed Forces. The
bill would provide VA with the authority to extend the program
using the same measurements and eligibility requirements. It is
essential that Congress reauthorize this program as we believe
the value and efficacy is undeniable.
Mr. Chairman, PVA thanks the subcommittee for the
opportunity to submit our views and I would be happy to answer
any questions.
[The prepared statement of Blake Ortner appears in the
Appendix]
Mr. Benishek. Thank you very much for your testimony, Mr.
Ortner.
Mr. Celli, you may begin your statement, five minutes.
STATEMENT OF LOUIS J. CELLI, JR.
Mr. Celli. I can't remember a hearing in recent history
where The American Legion completely supported and stood behind
every bill being offered for consideration. What this
demonstrates is an overwhelming bipartisan partnership with
veteran service organizations and with veterans to ensure the
Congress gets it right.
On behalf of our National Commander Mike Helm and the
millions of veterans that make up The American Legion, thank
you. Good job.
The World Health Organization defines reproductive health
as a state of complete physical, mental, and social well-being
at all ages and stages of life and not merely the absence of
reproductive disease or infirmity. According to a study of
veterans who served during OIF and OEF, 15 percent of women and
nearly 14 percent of men reported that they had experienced
infertility.
As a result of more than a decade of war, thousands of male
and female servicemembers are returning home with physical and/
or psychological wounds resulting in a variety of fertility and
reproductive health issues. Many young servicemembers have been
documented with low testosterone levels that can be attributed
to the medications that they take for their physical injuries
or conditions such as TBI or PTSD. That is why The American
Legion supports the draft bill to amend Title 38 to improve the
reproductive treatments provided to certain disabled veterans.
The American Legion has always been a vocal advocate of
transparency and open communication between the American people
and government. Last December, CBO suggested that an annual
report similar to the one that DoD produces relative to TRICARE
would help policymakers evaluate cost efficiencies. And The
American Legion agrees.
Additional data, particularly if it was provided on a
regular basis, could help inform policymakers about the
efficiencies and cost effectiveness of VHA services. The
American Legion through testimony and resolution has
consistently called upon VA to maintain transparency in all
aspects of data reporting.
This is why we not only support this draft legislation, but
we also continue to support H.R. 216 introduced by Ranking
Member Brown, the Department of Veterans Affairs' Budget and
Planning Reform Act.
Last month, The American Legion commander sent a team of
six experts to Los Angeles to work with veterans and learn more
about the West Los Angeles land usage agreement. While in LA,
we reached out to and worked directly with homeless veterans so
that we could get a firsthand sense of the homelessness problem
in Los Angeles.
What we discovered was that while expanding the definition
of what it means to be a homeless veteran as 627 seeks to do
and is something we support, we also realize that there is a
large number of homeless veterans that do not qualify for VA
services and who are completely overlooked in the
administration's goal to eradicate veteran homelessness this
year.
Veterans who have less than honorable discharges due to
struggles with PTSD or other service-connected issues are not
eligible for HVRP or other VA services. The American Legion
calls on VA and this committee to address this issue and work
with VA to ensure these veterans are properly served.
And finally, in September 2013, The American Legion
published our report, The War Within. This report was a result
of comprehensive research conducted by our PTSD/TBI Ad Hoc
Committee which found that, one, VA and DoD have no well-
defined approach toward the treatment of TBI; two, providers
are merely treating the symptoms; and, three, DoD and VA
research studies are weak in the area of new non-
pharmacological treatments and therapies such as virtual
reality therapy, hyperbaric oxygen treatment, and other
complementary and alternative medicine therapies.
In February of last year, The American Legion conducted a
TBI and PTSD veteran survey to evaluate the efficacy of VA's
TBI and PTSD medical care and to see how veterans who are
suffering from these signature wounds are being treated. The
survey showed that 59 percent reported either feeling no
improvements or feeling worse after undergoing treatments for
their TBI and PTSD symptoms. Thirty-three percent have
terminated their treatments and therapies prior to completing
them. And the veterans we surveyed reported that they were
taking up to ten different medications for PTSD and TBI
symptoms.
In June 2014, The American Legion along with military.com
sponsored a TBI and PTSD symposium and again focusing on
complementary and alternative therapies. More information about
this symposium can be found in my written testimony.
In closing, The American Legion strongly supports the use
of complementary and alternative medicines and supports the
funding necessary to assist veterans suffering with PTSD and
TBI with complementary, non-pharmacological treatments that
allow our returning veterans to actively participate in their
own recovery programs without unnecessary sedation or over-
medication.
Thank you.
[The prepared statement of Louis J. Celli, Jr. appears in
the Appendix]
Mr. Benishek. Thank you very much for your comments, Mr.
Celli.
Mr. Rowan, you can proceed with your testimony.
STATEMENT OF JOHN ROWAN
Mr. Rowan. Chairman Benishek and Ranking Member Brownley,
excuse my voice. I have been dealing with a cold for the last
week. The change in weather is just driving me crazy.
We, too, support all of the proposed legislation before us
this morning. The reproductive treatment issue is certainly one
we are concerned about. One of the problems that we saw with
the Agent Orange issue was the fact that a lot of veterans
because of exposure to Agent Orange had reproductive rights
issues, that they had terrible problems.
When we had our town hall meetings on Agent Orange, there
was a lot of complaints by the wives of miscarriages and
stillborns. And so any effort at all to work in that area is a
blessing.
The annual report on VHA, I don't understand why that
hasn't always been done, quite frankly, and it is just another
area that we have been supporting for a long time which is as
much congressional oversight as possible is a good thing. And
the more information that you have to make your oversight
worthwhile will certainly work in that direction.
We support Representative Bilirakis's COVER Act. It is an
interesting area for us. One of the things we always complained
about years ago when the Vietnam veterans came home, frankly,
was the over-medication of Vietnam veterans, way too much
Thorazine and not enough treatment, and led to all kinds of
problems, not the least of which was some serious issues that
ended up with people being put away in jail for a long time.
So the only caveat we might add, we thank the congressman
for adding the issue on the membership, but we would also ask
that any review may ensure that any alternative treatment have
a real scientific evidence background.
Unfortunately, I hate to say it, but there is a lot of
people running around saying they have got a cure for PTSD. And
while they may have some reasonable alternative medicine or
alternative process, some of these things get a little
overblown and, unfortunately, can become real scams. So we
appreciate the effort, though, and I think this commission can
go a long way on that.
Expanding the definition of homeless, that is an issue, you
know, not surprising. We need to do more on that issue. There
was even a problem out in Long Island where we got homeless
veterans a place to live and because they had a place to live,
they couldn't get funding because now they had a place to live
even though the place was a homeless program. I mean, the VA
didn't make sense. They didn't want to fund it. Finally they
did, thank God, and I think Congressman Zeldin, one of your
colleagues, had a lot to do with that.
So I have been working on homeless veterans since 1981 when
they were first discovered in the City of New York. And we
applaud the efforts in LA County and we really applaud the
efforts of the VA in West LA. They really are starting to make
some changes out there. And I am sure Congresswoman Hahn will
be pleased to see that.
We support the other programs, the women's treatment
program and the retreat sounds extremely interesting. And the
expansion of extended care, of course, is something near and
dear to us. Unfortunately, many of my members are becoming
older obviously and need more of that assistance.
But the main bill we are here for is 1769. We believe this
may be the most important bill for veterans since the Agent
Orange Act of 1991. And the key to this is the fact that we
would begin to finally look at what happens to toxic exposure
not only to the veterans but to veterans' families because
interestingly enough, if you look at what the VA has already
agreed to, male veterans only get children with spina bifida.
Female veterans have a much longer list of diseases that affect
their children that has been agreed to by the VA often, again,
with reproductive issues being the forefront.
So our firm belief that this is so important and having
gone out again, we have had over 200 town halls across the
country and it has really been discouraging about what we have
been hearing from the veterans. But the key aspect of this act
is the multi-generational issue. So we not only talk about
Vietnam veterans and the effects of Agent Orange, but we talk
about the effects of all the folks that went to the Persian
Gulf in 1991 and we talk about all the folks who have been in
and out of Iraq and Afghanistan to this day.
We are already getting concerns about some of the folks
coming home and some of the effects on their children. So we
really, really look forward and we thank you all for the
support for this act. Thank you.
[The prepared statement of John Rowan appears in the
Appendix]
Mr. Benishek. Thank you for your comments, Mr. Rowan.
Mr. Atizado, please proceed with your testimony.
STATEMENT OF ADRIAN ATIZADO
Mr. Atizado. Thank you, Mr. Chairman, members of the
subcommittee. I want to thank everybody here for inviting the
DAV to testify at this legislative hearing.
As many of you know, DAV is a 1.2 million service-disabled
veteran service organization and our mission is to empower
veterans to live high-quality lives with respect and dignity.
Many of these bills aim to do just that.
We are pleased to present our views on the bills under
consideration, but for the sake of brevity, I will only talk
about three bills and refer the subcommittee to our written
testimony for our position and comments on the others.
First, DAV supports the intent of H.R. 271, the COVER Act.
As has been discussed here before, this is a bill that would
allow for complementary, alternative medicines to grow in the
VA healthcare system. Our resolution from our members calls for
access to a complete continuum of services for complementary
and alternative medicine.
As part of the Independent Budget, we have long supported
the advent of the availability of these therapies in the VA
healthcare system for all generations of wounded, ill, and
injured veterans, although we do call the subcommittee's
attention to the bill's language that may need just a little
bit of clarification as to whether the commission that would be
established by the bill is expected to study Veterans Benefits
Administration claims with regards to mental health disability
or whether the claims the bill language uses should be replaced
by maybe a more clinically differentiated expression.
The second bill is H.R. 1369 which DAV really does thank
Representatives Walorski and Gabbard for introducing. It is a
necessary bill. The bill would actually help to address adverse
effects that many veterans are feeling right now in the
community.
A lot of service-connected disabled veterans who are in
nursing homes and skilled nursing facilities are facing very
precarious situations where they are not sure who is going to
be able to pay for their care because VA is having a little bit
of difficulty trying to address their provider agreement
authority.
Now, this bill is in line with our resolution and our
resolution talks about enhancing long-term services and
supports for our members. Our members like with the Vietnam
veteran generation and the newest generation are facing
services that need to be provided closer to their home and that
is one of the weaknesses in the bill that we ask that the
committee consider.
Some of these services deal with a specific VA program that
is just beginning to expand and because there are problems with
VA's authority to implement its provider agreement with private
sector providers, that program is being adversely affected.
Finally, we would like to thank the subcommittee for its
continued efforts in improving VA's women veterans' healthcare
programs and services. We are pleased, definitely pleased to
support H.R. 1575.
Now, Congress mandated VA to assess the pilot program which
is the subject of this bill and in that assessment, the results
describe it as a successful program that improves the ability
for women veterans to reintegrate into civilian life.
Making permanent VA's pilot program for counseling
treatments for newly-separated women veterans is keeping with
our resolution which calls for enhanced medical services and
benefits for women veterans.
Equally important is the bill would fulfill a key
recommendation to Congress in DAV's report, Women Veterans'
Long Journey Home. This report reveals that America's nearly
400,000 women veterans using VA are at risk by a system
historically focused on caring for male veterans.
The report paints a compelling picture of federal agencies
and community service providers that consistently fail to
understand that women are impacted differently by military
service and deployment when compared to male experiences.
It also points to challenges that are needed in overall
culture and services provided by Federal Government and local
communities and it lists 27 specific recommendations.
Mr. Chairman, this concludes my statement. I would be
pleased to answer any questions you or other members of the
subcommittee may have.
[The prepared statement of Adrian Atizado appears in the
Appendix]
Mr. Benishek. Thank you very much for your testimony, Mr.
Atizado.
We have just called for votes, so I was going to ask my
questions and then maybe let the ranking member ask and then we
will reconvene after votes to conclude. Sorry about the delay
here, but they moved votes up apparently.
So I just have a few questions. I want to talk just a
minute about the legislation I talked about, to get this annual
report. I am trying to figure out what data to get, and I want
to try to be able to determine what is the cost of the care
that we are providing our veterans through the VA? You know, we
don't know; they are spending a billion dollars on a hospital
here, a billion dollars on a hospital there, and what does it
actually cost them to take care of a patient coming through the
door? And I want to find that out because I think we need to,
give our veterans maybe more for the money that we are spending
in the VA.
So, Mr. Rowan, do you have any further information that you
want to present, because you did comment on the bill?
Mr. Rowan. Yeah, I think that the issue is where our
spending is. I mean one of the things that we have had concerns
about has been this massive growth of bureaucracy, you know,
with the VISNs and other things, rather than the money being
spent on care providers. You know, how much are we actually
spending on doctors, rather than managers? How much are we
spending on nurses, rather than managers?
And that would be an interesting breakdown to see how that
works in the actual provision of services. I mean if we just--
if we take the overall budget and just whack it up by the
number of veterans, you get a number, but that doesn't give you
an idea of what it is being spent on, and that has really been
our concern for a long time.
Mr. Benishek. Well, it is my concern, too, because I mean
if you take the whole budget and the number of veterans that
are in the system and you come up with a thousands-of-dollars-
per-veteran number.
Mr. Rowan. Right.
Mr. Benishek. But you can't figure out what it actually
costs.
Does anyone else have any comment on that?
Mr. Atizado. Mr. Chairman, if I remember correctly, CBO's
report and their testimony, that you have referred to in your
statement when we reviewed that, it was very easy to come to
the realization that what you are trying to do is compare one
health testimony to another, and in CBO's report they basically
say it is nearly impossible.
Now, even if VA were to provide a report like DoD does for
TRICARE, CBO even says that might not even do it. There may be
some information that VA would be able to provide that is
either unavailable or partially available or just nonexistent
in the private sector. I believe this is an important question
and it is one that really is at the heart of the subcommittee's
oversight responsibility. It should be answered, but perhaps it
should be posed to the research community. Most of the seminal
studies in CBO's report about comparing costs talk about
research studies done in the early 1980s, 1990, as early--as
late as 2001 and is probably something that should be sent back
to them for a little bit closer examination.
Mr. Benishek. I appreciate your input because I am trying
to get, the right stuff, the right numbers, the right data, so
that we can, make some changes to the VA to make it better a0nd
more responsive to the needs of veterans. So I am hoping that
we can continue to work together to help me find the right
data.
Does anyone else have any input there?
Mr. Celli. I do, thank you.
And The American Legion agrees that while it may be
difficult, it is not impossible. And while it may be difficult
to completely formulate the type of data that we would need in
order to make informed decisions, that doesn't preclude us from
starting and gathering some form of data and that has to be a
partnership with VA. VA has to be open enough to be able to
provide that data when requested and right now we are not
seeing that type of transparency when it comes to efficiencies
of cost.
We also need to make sure that VA is projecting and
programming out efficiently so we can look back then, three,
four, five years from now and say, well, this is what VA said
that they wanted to do and what they wanted to spend their
money on and this is what they wanted to do as far as new
projects goes and be able to look at that and say, well, how
did that go? And it is okay for it to change, but without a
plan, then it is almost reckless.
Mr. Benishek. Thank you. I am going to yield back my time,
and we will give Ms. Brownley some time here before we run off
to votes. Thanks.
Ms. Brownley. Thank you, Mr. Chairman.
Mr. Rowan, you testified or mentioned the fact that based
on some data that women were suffering a lot more in terms of
their reproductive health because of exposure to any kind of
toxic material. Do we have any hard data on that in terms of
exposure for women, specifically?
Mr. Rowan. You know, I don't know if there is exact data,
but when you look at the presumptive illnesses that VA has
agreed to, men only have spina bifida where the women have
several, most associated with their reproductive organs and
their issues and effects on those, and that is intriguing to
me, why the women have that problem, but not the men. I mean,
you know, because there is really a lot of concern about the
genetic effect of toxic exposure which may lead to all kinds of
genetic problems carried over into the next generations. So
that is why we think that it is important that we take a look
at all of that.
You know, there were several states that were starting to
do that many years ago back in the 1970s and 1980s, New York,
New Jersey, Michigan, I think, started to look at that, but
then, unfortunately, there was no funding for it and nobody
wanted to keep up with it. And they were starting to look at
the data of the children of Vietnam veterans, and they may need
to go back to try to find some of that, if it still exists or
take a look at new ones. And we are really concerned not only
about us, but looking forward.
Persian Gulf have been out 20 years now, so there should be
a lot of data on them. And the new folks, we should start
tracking them now, you know. I always tell the anecdotal story,
I have a cousin who is, you know, in his early 40s as a Seabee
Reservist, went to Iraq twice, dealt with all kinds of horrible
cleanup stuff, dealt with all kinds of exposures. He came home,
and after his second tour, he got non-Hodgkin's lymphoma and
his third child was born with downs syndrome. Now, is there a
connection? I am not a scientist. I can't tell you for sure,
but somebody ought to study it and that is what we are just
saying.
One of the problems we have had with the whole Agent Orange
issue is for all these years, they have never really done a
decent study. They have never really done a decent scientific
review. IOM has been relying on all kinds of extraneous studies
done around the world to come up with all of these things and
we have waited all these years. I mean I am going to be 70 in
September and, you know, it only took three years ago when they
added ischemic heart condition. I mean I don't want to see that
happen to the Persian Gulf vets and I certainly don't want to
see that happen to the new vets, that they have to wait 40
years to find out that they have problems with their children,
that they need to take a look at.
Ms. Brownley. Absolutely. I couldn't agree more with your
comments.
I also wanted to just ask the whole panel, based on Ms.
Brown's bill, H.R. 1575, what are your thoughts--the VA made a
suggestion, I think, that we should, in terms of expanding the
population of eligible veterans, that we should also include
men, as opposed to strictly women. Does anybody have a comment
with regards to that?
Mr. Rowan. I will be honest, I am not an expert in this
field--I never really followed up on it--but that was my first
reaction when I read the bill and looked at that pilot program
as, gee, a retreat form. That is not a bad idea, but why do we
do it just for women? Why not men as well?
I remember former Chairman Filner when he was here, one of
the things he talked about was reverse boot camp. You know, the
idea of we bring people home--we spend all this time and effort
and money to make people into warriors and then when they come
back, we don't spend a nickel to make them into civilians
again; that is an interesting concept.
Ms. Brownley. Any other comments from----
Mr. Celli. Yes, I would like to dovetail on what Mr. Rowan
said. During World War II, after veterans left combat, they had
a three-or-four-week journey back on a boat to reintegrate with
their platoons and really decompress. Right now, you can go
from the battlefield to your living room in 15 days, 10 days, 5
days in some cases, and veterans really need that time to
decompress. And I think that is a huge component of some of the
illnesses that we are seeing now just being exasperated; they
don't have time to deal with it.
Ms. Brownley. Do you think that if we included men and
women, that we should keep them separate, men going together to
one place and women going together in another?
Mr. Celli. Congresswoman Brownley, I cannot answer
definitively whether it should be a separate cohort in each
retreat. But I do know this, the idea of having a retreat
specifically for women veterans really came out of the idea
that they are such a small population compared to the overall
veteran population, and because they are so small, their
ability to support each other and have some kind of peer
support group to learn from each other's experiences became all
the more important.
Now, whether that would apply to male veterans with that
specific respect may not necessarily be the case, but I would
hope that VA would have some kind of reasoning, other than,
well, that is another part of the population for male veterans
to be put in a retreat setting.
Ms. Brownley. Thank you. I am over my time and I yield
back.
Mr. Rowan. If I might add, Congresswoman, the other issue
here is I would remiss--my vice president would take me to
task--she ran a program in Philadelphia for women veterans and
she would be the first one to tell you that unfortunately
homeless women veterans have a high-rate of military sexual
trauma and that may be a perfect reason why they need to be
taken on separately, as from the men, to give them that space
to be able to deal with those issues that they may not be
willing to deal with.
Ms. Brownley. Thank you.
Mr. Benishek. Gentlemen, I am going to ask your indulgence.
We are going to have to go into a recess to do the votes, and
we will reconvene as soon as possible after the votes are over.
Thank you.
[Recess.]
Mr. Benishek. The subcommittee hearing is back in session.
Since we don't have any other members, I am going to ask a few
more questions of this panel here, since I have some time, and
I think Ms. Brownley may have a few more questions, too, and
see if any other folks show up to ask their questions.
I was just going into this question of the reproductive
treatment that we hope to provide for disabled veterans. Some
of the testimony in the record suggested that, there should be
included surrogates and third-party donations. I understand the
reason for those, but the DoD doesn't provide those benefits
and the VA has expressed some concern in previous hearings, on
this issue. So I am just wondering how we are going to deal
with this going forward, and does anyone here have any other
concerns about the complexities that would be involved with the
addition of a surrogacy provision in the draft bill. I know,
Mr. Ortner, you probably have another comment to make on that.
Mr. Ortner. Yes, Mr. Chairman. You know, the approach of
PVA has always been to--that the VA and DoD should try and
bring someone with a disability, especially a catastrophic
disability, as much of a recovery as they can. Their quality of
life should be back to as much as normal as it can be. Now, of
course, you know, in our written testimony, we commented on the
challenges of the individual's who has got a catastrophic SCI
where they may have been able to have IVF, but they are not
going to be able to carry it to term. And the concern we have
on this situation, is that even though DoD doesn't supply it,
we think DoD should. Because you have still got a situation of
an individual that lost the ability to have children due to
their service and we also see it as being probably a very, very
small number of individuals that are going to have this
condition, which is primarily why we, in our testimony, we
talked about there needs to be a little clarification. Because,
obviously, it is probably not something you just say, well, we
are going to open it up and anybody can have a surrogate. But
we probably think there are those situations where you have got
those situations where that individual is unable to carry the
child that should have a consideration.
Regarding the genetic material, that is another thing,
third-party genetic material. We think there is probably a very
unique situation where you are going to have, possibly, you
know, individuals that are going to suffer from something that
causes a damage to the genetic material. But as we saw with
Gulf War syndrome, as we have seen with the various toxic
substances is that you experience in service, you can have that
situation. Essentially, what we are doing is because if someone
serves, they have lost that ability to have children and we
think they should have that.
Mr. Benishek. All right. Thank you. Anyone else have
anything further on that?
Mr. Rowan. No, I would just concur with what the gentleman
was saying in that regard. Clearly, the in vitro fertilization
is one aspect of it, but our concern is going back to the toxic
exposure issue is the effect of genetic material on exposures.
But the issue of women, especially who have been hurt in the
military and the impact on them is interesting. Because, I was
relating a story, I had a client when I was doing service-prep
work back in the twos, early twos, who, she had only been in
the Army like a year and a half and then broke her hip severely
and they did a mediocre job in putting her back together, quite
honestly, and she was having some issues with it.
We got that dealt with, but then when she got pregnant, she
was very concerned about whether or not she was going to be
able to carry a baby to term, whether it would affect her--what
the hip would do, how she would get around. And, unfortunately,
this was the early days of women's programs inside the VA, but
we managed to get her help. But it, clearly to me is one of
those things that the PVA people are well-aware of and we would
support any effort to assist those folks.
Mr. Benishek. Well, thank you very much. I will yield back
the remainder of my time.
Ms. Brownley, do you have any more questions for the panel?
Ms. Brownley. Just one quickly. I just wanted to first
comment that--and to applaud Mr. Bilirakis and Dr. Ruiz and Ms.
Walorski for their bill on alternative approaches to mental
health issues. You know, one part of that bill is looking at
outreach efforts to veterans for mental health services, and in
my mind, I feel as though that is an extremely, extremely
important component because, I think particularly for our
Vietnam veterans and our older veterans, getting them to mental
health, but getting them to the place where they feel
comfortable seeking the help is probably 90 percent of the
issue. And so, you know, how do we encourage and make it feel
right and say for our veterans to seek that health out. So I
think that is really, really important.
I just wanted to ask the panel, and really all of you, you
know, the VA continues to talk about the work that they have
been doing and continue to do around alternative therapies for
mental health. I know we have an extraordinary program in my
district with equine therapy that has been very successful for
our veterans. I am just wondering, at this juncture, how would
you grade the VA in terms of how well they are/we are doing
with regards to alternative approaches to mental health. Just,
you know, a quick response, no--it doesn't have to be evidence-
based, just your general reaction to what would you give the--
what grade would you give the VA?
Mr. Celli. I can tell you that based on the firsthand
research that The American Legion has done, the grade would not
be superior. I think there is a lot of work to be done. I think
that the VA is looking at those options and it is something
that we are interested in looking at with them, similar to
things like this bill.
You know, the VA has come a long way with things like the
vet centers, which have really taken this issue head-on, during
the time of Vietnam, when Vietnam veterans were coming back.
They have vocational rehabilitation, which has almost an
endless supply of resources to help veterans rehabilitate back
into society. Maybe they could look at some kind of mental
health center that is unique to PTSD. You know, maybe if there
was a specific PTSD program that charged these centers with
looking at alternative therapies, trying to get them off
medications and graded them based on success rates, maybe there
would be some more out-of-the-box type of thinking.
Ms. Brownley. Do you still believe that outreach is a
critical component to----
Mr. Celli. Absolutely. Ninety percent of the veterans that
we spoke to did not know what their options were. And we need
to make sure that stakeholders, Congress, VA, the American
public in general, knows that--or is able to communicate to
veterans and participate in that outreach to let them know what
their options are. And, again, vet centers is a wonderful tool
to help do that; it is probably the best kept secret in VA.
Mr. Rowan. Clearly, the vet centers, we helped establish
those things, and I remember back in the Reagan years, trying
to fight back the OMB from killing them. Thankfully we
succeeded, but the problem we always had with them is they only
focused on the veteran. They didn't do enough to bring the
family into the picture.
I must tell you that my colleagues in Australia--I have
been doing family counseling with the veterans for 35 years--
and that would help a lot if that was added, so that they would
be able to work with spouses, children, whatever; the whole
secondary PTSD issue is a big issue.
As far as outreach, the VA has got a very bad mark. I would
give it an F. I don't think they do anywhere near enough of
outreach.
And, frankly, all the alternative stuff is done by private-
sector organizations, and the one thing about--hopefully with
Bilirakis' proposal with this commission is that they would
review all of those things and really try to understand what
are really scientifically attainable and what are not, and what
are just figments of people's imagination. I mean, don't get me
wrong, I love my dog and, you know, if I hang out with my
golden retriever, he has a lot of fun and he can certainly
lower my anxiety levels, but the bottom line is that without a
treatment program on top of that, it is not enough. So
complementary is the keyword there and alternative, not instead
of.
Ms. Brownley. Yes. Any other comments from any other
panelists?
Mr. Ortner. Well, we have only got a couple of seconds, but
I think the biggest challenges with the VA--I kind of go a
little more with the Legion. I would give them maybe a C. But I
think it is--I think part of the challenge with the VA is it is
a huge bureaucracy; bureaucracies are resistant to change. And
I think in the case of the VA, they are more concerned about
having an embarrassment from a fraudulent program than they are
necessarily helping every veteran.
And that sounds negative, but I don't mean it in that way.
It is just like Mr. Rowan mentioned, which I worked on back in
the 1990s, a lot of fraudulent things going on and quack
medicine. There is reason to be resistant, but I think that is
one of the challenges with the alternative things.
As for outreach, that is absolutely critical. I worked
homeless issues back in the mid-1990s, and the outreach was
key, but it really wasn't the VA doing the outreach; it was the
homeless centers and things like that, that were doing the
outreach, funded by the VA. But a lot of that has to do with
mental illness, getting out there and interacting with those
people, and that can be challenging because there is a lot of
fear going into those environments to deal with that.
Ms. Brownley. Thank you for watching the clock for me. I
yield back.
Mr. Benishek. Thanks. Ms. Titus, you are recognized for
five minutes.
Ms. Titus. Well, thank you, Mr. Chairman. And thank you and
the ranking member for allowing me to sit in today.
I want to agree with the ranking member, Ms. Brownley's
comments, that we need to expand this legislation. I hope that
we can work together to be sure these treatment options are
available for all our veterans. As it is currently written, it
is possible that there are veterans who meet all the
requirements contained in this draft legislation, such as
having a service-connected disability that prohibits
procreation, but due to their sexual orientation, they won't be
able to receive this assistance.
Now, I would like to ask the members of the panel if they
have any concerns that this legislation fails to offer services
to legally married same-sex couples. Mr. Ortner, you mentioned
some exceptions that might be needed to be considered. You
mentioned surrogacy and third-party genetic donations, but what
about same-sex couples, if they are denied these benefits as
veterans, is that really fair? So I would ask you all to
comment on that.
Mr. Ortner. Well, Ms. Titus, PVA does not have a position
on that, and I am not in a position to comment due to that.
Mr. Benishek. Who wants to jump in? Okay.
Mr. Rowan. The bottom line for us has been when we have
dealt with gay rights issues, quite frankly, is if the law
allows it, we are in favor of it. I mean it started when they
finally allowed people to come into the military openly gay.
Ms. Titus. Yes.
Mr. Rowan. I mean if you are going to let them in, they are
a veteran when they come out. So if they are a gay veteran,
they are a gay veteran. I mean I think that there is a lot of
adjustment society is going to be making over the next decade
or so on these issues.
We got involved when we talked about the spousal benefits
questions and that got interesting real fast. And, you know,
obviously, some people have very strong opinions on that and
they are not going to be in favor of it, but our feeling was
just simple: if it is the law, then it is the law and it ought
to cover every veteran, not one or--some veterans yes, some
veterans, no.
Ms. Titus. Okay.
Mr. Celli. The American Legion has a similar view. We have
a resolution that states that there should be equality amongst
all veterans and all generations of veterans. So if they are a
veteran and they apply for VA services, they should be entitled
to the same VA services as any other veteran.
Ms. Titus. I am glad to hear you say that.
Mr. Atizado. Thank you, Congresswoman Titus. I will tell
you this, the mission of the DAV is very clear. What we are
about is making sure that any service injury that a veteran
sustains while performing honorable service for this nation,
should be given the opportunity to be given high-quality life,
and as I mentioned, to lead it with respect and dignity. So if
a servicemember happens to have a certain sexual orientation,
but they are injured and unable to have a--are injured and have
reproductive difficulties, while we don't have a specific
resolution on it, based on our mission, we would like to ensure
that that member have the same and enjoy the same benefits as
their counterparts.
Ms. Titus. Well, thank you. That seems to me only fair: A
veteran is a veteran is a veteran, and all veterans deserve
equal benefits. Many states now recognize marriage equality and
it is very likely that the Supreme Court is going to be making
that decision here this summer, so we want to be sure that we
don't enact policy that discriminates and doesn't provide
benefits that all our veterans have earned. So I appreciate
hearing your comments on that and I yield back.
Mr. Benishek. Thank you, Ms. Titus.
In the absence of any further questions, the panel is
excused. Thank you very much, gentlemen.
I will now call up the third panel. This is Dr. Rajiv Jain;
he is the assistant deputy under secretary for health for VA
Patient Care Services.
Thank you, Dr. Jain for coming and waiting for awhile as we
concluded our voting procedures there. You may proceed with
your testimony when you are ready.
STATEMENT OF RAJIV JAIN, M.D., ASSISTANT DEPUTY UNDER SECRETARY
FOR HEALTH FOR PATIENT CARE SERVICES, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS;
ACCOMPANIED BY JANET MURPHY, ACTING DEPUTY UNDER SECRETARY FOR
HEALTH FOR OPERATIONS AND MANAGEMENT, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND
JENNIFER GRAY, ATTORNEY, OFFICE OF THE GENERAL COUNSEL, U.S.
DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF RAJIV JAIN, M.D.
Dr. Jain. Well, thank you, Mr. Chairman, Ranking Member
Brownley, and Members of the Committee. Thank you for inviting
me here today to present our views on several bills that would
affect the Department of Veterans Affairs programs and
services.
Joining me today to my right is Ms. Janet Murphy, acting
deputy under secretary for health for operations and
management, and to my left is Ms. Jennifer Gray, attorney in
the Office of General Counsel.
I would like to start with Chairman Benishek's bill, to
amend the Title 38 United States Code to direct the secretary
of veterans affairs to submit an annual report on furnishing of
hospital care, medical services, and nursing home care by the
Department. We support this bill and are already providing much
of this information on our Web site and through the mandated
reports to Congress. The costs associated with this and other
bills on the agenda are included in my written statement, so I
won't go through them now.
The VA also supports H.R. 627, a bill to amend Title 38
that expands the definition of homeless veteran for purposes of
benefits under the laws administered by the secretary of
veterans affairs. This will align us with HUD's definition of
homeless.
Regarding H.R. 1369, VA appreciates the Committee's
interests in updating our authority to purchase extended care
services from the community providers. We are currently
developing a legislative proposal to address our authority to
purchase hospital care, medical services, and extended care
services. We look forward to working with the Committee on this
vital legislation.
We support the concept Congressman Miller's draft bill to
amend Title 38 to improve the reproductive treatment provided
to certain disabled veterans. We would like to expand the
language, however, to include all veterans who might be
eligible.
VA supports H.R. 271, a bill to exam the efficacy of VA
treatment of mental disorders and the potential benefits of
incorporating complementary alternative treatments available in
non-Department of Veteran Affairs medical facilities within the
community; however, we have concerns with some of the language
that may interfere with the stated goals of the bill. We would
like to work with the Committee to amend the language.
We support the intent of H.R. 1575, a bill to amend Title
38 to make permanent the pilot program on counseling and
retreat settings in women veterans, newly separated from their
service in the Armed Forces. While VA agrees that providing
these retreats is beneficial to women veterans, it should be
made permanent. Other veteran and servicemember cohorts could
benefit from this treatment modality.
As discussed in previous hearings, while we support the
efforts to enhance research on the diagnosis and treatment of
health conditions of the descendants of veterans exposed to
toxic substances during service in Armed Forces, we are unable
to support this bill because a center would duplicate the
efforts of other federal agencies and other reasons that are
discussed further in our written testimony.
Finally, I would like to say to give the VA its best view,
we have worked in collaboration with many agencies to solidify
the views provided on many of the bills discussed today.
Thank you, Mr. Chairman, for the opportunity to testify
before you today. My colleagues and I would be pleased to
respond to any questions that you may have.
[The prepared statement of Rajiv Jain, M.D. appears in the
Appendix]
Mr. Benishek. Thank you, Dr. Jain, for coming and for your
testimony and comment.
I am going to yield myself five minutes for questions. Dr.
Jain, the VA opposes this H.R. 1769 on the grounds that other
federal departments and agencies are poised to support research
on multi-generational health effects of toxic exposures. The
VA's research programs have been praised elsewhere in this
hearing and are, I am sure, more than up to the tasks set forth
in the bill. What is more, the VA's testimony lists the VA War
Related Illness and Injury Study Center, the VA Office of
Research and Development, and the VA Office of Public Health,
among those whose work would be duplicated, according to the VA
by the national center proposed in H.R. 1769.
I have a couple of questions that follow up with that. What
other departments or agencies do you think are better
positioned to study the effects of toxic exposure on veterans
and their descendants than the VA and why?
Dr. Jain. So, thank you, Mr. Chairman, for that question. I
think I wanted to, again, make it very clear that we certainly
support all of the work that needs to be done to find out if
there are any impacts from the exposure to toxic agents for
veterans and their descendants. So, in general, we are
completely in agreement in doing whatever we can do and we must
do.
The concern comes into play, sir, if you really look at
these disorders that happen from exposure to toxic agents, they
are extremely rare. So you need large populations to really
come to any meaningful conclusion of the cause and effect. So a
lot of our experts feel that the exposure in the civilian
setting and the exposure in the military setting has a lot of
parallels where we can learn from both sets of exposures. And
so having, for example, the national center for--the National
Institute of Environmental Health Sciences or The Center for
Disease Control that also have significant efforts in looking
at that, if we could structure a solution that could
collaborate and partner with those agencies, we could maybe
have a better chance in achieving scientifically proven impacts
that I think would----
Mr. Benishek. I don't think there is anything in the bill
that excludes.
Dr. Jain. Right.
Mr. Benishek. You know, it is a research coordination bill;
although, I don't think it excludes getting data from anywhere.
Dr. Jain. It wasn't clear, sir, but I think if the intent
is that the Center could work with other agencies and could
begin to have that broader sense, then that could be something
we can definitely look at.
Mr. Benishek. Okay. Then let me ask you another question
here. What does it say about what is going on in the VA War
Related Illness and Injury Study Center and the VA Office of
Research and Development and the VA Office of Public Health? I
mean shouldn't we coordinate all of that in one place to
explore toxic exposure issues?
Dr. Jain. That, we would agree with you, sir. The only
point that we were making is that we have these areas, the war
related centers, the ORD, all of these departments are
constantly looking at the published literature. They are trying
to understand what is going on.
Mr. Benishek. I understand why you say that, but, you know,
they also said that focusing solely on military exposures would
likely result in inconclusive research. Well, a lot of people
in the civilian life weren't exposed to Agent Orange. Most
people were exposed in the military setting.
And it is similar--and it is very difficult--I would say in
the burn-pit situation, most of the people that were exposed to
toxic fumes in burn pits, that doesn't seem, to me, a very
common civilian exposure. Now, there may be other exposures
that are more common in the civilian life than there are in the
military; I would say maybe lead exposure would be maybe an
example of that. But there is lead exposure in the military,
and maybe that could be coordinated. You know, depleted uranium
exposure doesn't occur that often. I mean there are lots of
things that are kind of specific to the military, Dr. Jain, and
that I think really doesn't--you know, your argument really
doesn't wash with me, okay. So I think that is not a very good
reason to be advocating against a legislation, in my opinion.
Do you have any rebuttal for my comment there?
Dr. Jain. No, sir. The only thing that I would offer that I
was going to suggest, sir, is that if we could have an
opportunity to work with you and the Committee, to work with
some of this language, so that we can achieve some of the goals
that we are looking for. That is all we are saying. But we
agree with what you are saying.
Mr. Benishek. Yes. Well, I am happy to have you involved in
the process, Dr. Jain. We just want to make some progress here.
Dr. Jain. Absolutely.
Mr. Benishek. In view of time, I am going to ask--I am
going to ask the ranking member if she has any questions.
Ms. Brownley. Thank you, Mr. Chair.
And I will just follow up on your line of questioning
regarding your bill. Mr. Jain, you have testified that these
exposures are so rare it is hard for you to come up with a
scientific response. But what exposures do you define as rare?
Dr. Jain. Well, I am not talking about the exposure is
rare, but what I am saying is that the science indicates that
when you look at diseases or conditions caused by toxic agents,
those are rare, because you get into play the genetic factors,
heredity, age, the time of exposure, duration of exposure, the
type of agents, so there are a lot of agents. So I think my
only point is that these are rare conditions, so you need
larger sets of populations. So whatever solution we come up
with, I think as long as we have access to the largest
population base that we can think of so that we can get to the
real bottom of this, I think is all we are saying. So, we are
supportive of that.
Ms. Brownley. Yeah. I would just say that I think in this
case, you know, it is the VA and government in general that I
think has to take a lead on these issues, and if we don't, who
will? I think it is just our responsibility, you know, to do
so.
So another question I wanted to ask with regards to H.R.
627 with homelessness, in response to domestic violence in
veterans' homes, you are saying that you are already serving
these veterans; it is not so much of a problem, yet you lacked
the detailed data regarding the size and the characteristics of
this population. So, can you explain to us how you know that
you are already serving this population?
Dr. Jain. So, I think I am going to turn to my colleague,
Ms. Murphy. She is more familiar with this topic. Janet?
Ms. Murphy. Thank you, Congresswoman.
So, we collect a lot of data on the veterans that we serve
in our homeless programs and, fundamentally, any veteran who
needs--we don't turn down veterans who need homeless services,
so we don't distinguish that you are fleeing domestic violence,
so we can't serve you. So we are already serving those
veterans.
How many? We would have to come back--take a look at that
and come back with that information for you. I think this is
really a technicality, is correcting the law so it is codified
in law and consistent with HUD language, the language in HUD's
regulations, that we are all--because that is our very strong
partner in all of this. But we are already serving those women
veterans and men as well, because men also flee from domestic
violence. So we will continue to do that and we will see if we
can find information which quantifies that for you.
Ms. Brownley. So when you say you don't turn anyone down, a
homeless veteran who needs permanent housing or temporary
housing, you don't turn anyone down, but there is not enough
housing for the homeless veteran population, at least in Los
Angeles County there is not, and I think in my county, in
Ventura County, it is the same.
Ms. Murphy. We don't turn anyone down in terms of access to
services, then the challenge becomes to find them the housing.
We have plenty of HUD vouchers. We have vouchers available to
provide them housing. The challenge is finding the housing,
particularly in areas like Los Angeles, San Francisco, Seattle,
but, you know, we continue to work the problem.
Ms. Brownley. And you are also saying that you don't
collect that data in terms of bifurcating within the homeless
population of veterans, who of the veterans are--who have--who
are there because of domestic violence.
Ms. Murphy. I need to verify that. We collect a lot of data
on our population that we serve and I would need to clarify
whether we collect that specific data and whether that was--we
were able to tease that out and make that available.
Ms. Brownley. Well, I would appreciate it.
Ms. Murphy. We certainly should be collecting it, if we are
not.
Ms. Brownley. And if you would, get back to me or the
Committee with that information, I would appreciate it.
Ms. Murphy. Absolutely.
Ms. Brownley. I yield back.
Mr. Benishek. Thank you.
Ms. Titus, you are recognized.
Ms. Titus. Thank you, Mr. Chairman.
Dr. Jain, I would just go back to the point that I was
making earlier that I worry that Chairman Miller's bill is
written in such a way that it denies benefits to certain
veterans. And I appreciated your comment that you would like to
see it expanded so that you could serve all veterans.
Do you agree that the legislation, as written now, would
not offer options to same-sex couples who might need help
starting a family?
Dr. Jain. Thank you for that question, Congresswoman. This
has a lot of legal implications, so I am going to turn to my
OGC colleague, Jennifer, to address that.
Ms. Titus. Okay.
Ms. Gray. Yes, thanks, Congresswoman.
You have raised some important questions on an important
issue with this legislation, and we will need to research this
further, but we are more than happy to discuss the
applicability of this provision with you at a later date once
we have looked into it a little bit more.
Ms. Titus. You needed help to say that, Dr. Jain.
Dr. Jain. Let me just clarify. I think that there is no
question that we feel that restoring the physical and mental
capability of our veterans is a very important mission of the
VA. And the ability to be a biological parent is very important
for one's mental and physical well-being and sense of well-
being, so we are very much in support of this concept and I
think that if the thought is to begin with the most severely
injured veterans first, we certainly understand that. But at
some point, we do feel that the who IVF technologies should be
made available to a broader group of veterans who have medical
and other reasons for not being able to be a biological parent.
So I am just stating to you the broader sense that we have, but
there are some legal issues with that, and that is why I wanted
to turn to my colleague.
Ms. Titus. I appreciate that, and I would thank you very
much if you could get back to me on that so we could work
together on this to be sure that all our veterans receive the
benefits that they serve.
Thank you, I yield back, Mr. Chairman.
Mr. Benishek. Thank you, Ms. Titus.
I have just another question I want to ask Dr. Jain, too.
In the written testimony, Dr. Jain, you stated that the VA
appreciates the intent of the draft bill to direct VA to submit
an annual report on the Veterans Health Administration, but
notes that the bill may be unnecessary as the data and related
measures contemplated by the bill are already compiled as part
of an ongoing, automated process for data that are available
publicly; yet, in the testimony before the subcommittee in
January, the Congressional Budget Office stated that the VA
provided limited data to the Congress and the public about its
costs and operational performance, and that if it was provided
on a regular and systemic basis, it could help inform
policymakers about the efficiency and cost-effectiveness of
VHA's services. So similar sentiments were also issued by the
Independent Budget and The American Legion and by others during
testimony on the first panel.
Can you explain the discrepancy between what you said in
your testimony and the testimony of the Congressional Budget
Office and the others regarding the VA's record of
transparency?
Dr. Jain. Sir, so this, you could consider this, in part,
an evolution, I guess, you could say in our thinking. But the
current secretary has made it very clear that we want to be
transparent. And as you know, sir, the impact of a lot of the
Choice Act legislations, we are in the process of preparing a
lot of the reports, so when we saw your bill, we certainly
understand the intent of what you want, but our only
clarification that we would like to work with you and the
Committee, is to understand what you are looking for so at the
end of the day we can give you and you are satisfied with the
report. That is the only hesitation of the----
Mr. Benishek. Right. Right.
Dr. Jain. Yes.
Mr. Benishek. Well, I think, you know, if you are already
compiling the data that is required in the bill, presumably
that information could be compiled into a report and provided
to us.
Dr. Jain. We are and, yes, that is correct.
Mr. Benishek. It seems to me that the information--that you
may have the information, but it is not compiled in a way that
makes any sense to us. And, basically, what I am trying to
figure out is what somebody else mentioned here, too: How much
money are we spending on nurses and doctors and how much money
are you spending on bureaucrats? Most hospitals and other
people around the country who provide healthcare, they can
define those kinds of numbers. The VA doesn't. I want to be
sure that the billions of dollars that we are sending to the VA
gets spent in the most effective way that gives the most care
to our veterans and it is not being eaten up by a bureaucracy.
And I think that we don't have access to those kinds of
numbers, Dr. Jain, and those are exactly the kinds of numbers
that I am asking you for. Where is the money going and how are
you compared to everybody else in spending these billions of
dollars that we send to the veterans healthcare?
Dr. Jain. Absolutely, sir. I think once we can work with
you and the Committee to understand your needs--we don't have
that data ready-made; that is the difference, I think, is what
I believe what was stated in the previous testimony. And we
don't have it today, either. We have pieces of that, but if we
understand your needs, we are willing to work with you and to
provide to you----
Mr. Benishek. Well, I am glad that you agree with me that
there is more data----
Dr. Jain. Right.
Mr. Benishek [continuing]. That VA needs to provide to
policymakers so we can make better decisions.
Dr. Jain. Yes, sir.
Mr. Benishek. So I am happy to hear that from you.
I am going to yield back, and does anyone else have any
other questions that they would like to ask?
Well, thank you very much, Dr. Jain for being on the panel.
Thank you for being here, and all the others, and for those
who attended as well. We may be submitting additional questions
for the record, and I would appreciate your assistance in
ensuring that an expedient response to these inquiries is
given. And with that, if there are no further questions, the
third panel is excused.
I ask unanimous consent that all members have five
legislative days to revise and extend their remarks and exclude
extraneous material. Without objection, so ordered.
I would like to thank, again, all the witnesses. The
hearing is now adjourned.
[Whereupon, at 12:46 p.m., the subcommittee was adjourned.]
APPENDIX
Prepared Statement of the Chairman Jeff Miller
It is a pleasure to be here today with you, Subcommittee
Ranking Member Brownley, and other Members of the Subcommittee
on Health as well as with representatives from our Veterans
Service Organizations (VSOs), interested stakeholders, and
audience members to discuss my draft bill to improve the
reproductive treatment provided to certain disabled veterans.
The conflicts in Iraq and Afghanistan over the last decade
have resulted in significant increases in reproductive organ
and spinal cord injuries among our servicemembers.
These wounds can have serious and life-long repercussions
on the daily lives of our veterans and their families, not the
least of which can be the inability to conceive a child.
While the Department of Veterans Affairs (VA) does provide
a number of fertility services to veterans, VA is currently
prohibited via regulation from providing In Vitro Fertilization
(IVF), one of most well-known and arguably most effective
assisted reproductive technologies.
The VA is also prohibited by statute from providing any
such treatment to a veteran's spouse.
In contrast, the Department of Defense has been providing
IVF to severely wounded servicemembers since 2010.
What this disparity results in is severely disabled
veterans having to decide whether or not to pursue a family
though IVF before they separate from service-while still
actively recovering from their wounds and during what can be a
highly stressful transition period-or pay for the procedure
out-of-pocket once they move to veteran status.
Because IVF can be costly, for some veterans, waiting until
they are in VA care can mean having to choose between financial
freefall or forgoing their dreams of having a child altogether.
That is an agonizing and unacceptable choice that this
draft bill would help prevent veterans with these disabilities
from ever having to make.
The draft bill would authorize VA to provide assisted
reproductive technology, in addition to any fertility treatment
already authorized, to enrolled veterans whose service-
connected disability includes an injury to the reproductive
organs or spinal cord that directly results in the inability to
procreate without the use of assisted reproductive technology.
Assisted reproductive technology is defined in the bill to
include IVF as well as other technologies determined by VA as
appropriate to be used to assist reproduction.
In furnishing IVF or similar procedures to an eligible
veteran, VA would also be authorized to provide services to
that veteran's spouse.
Like DoD, VA would be limited to providing eligible
veterans three in vitro fertilization cycles, resulting in a
total of not more than six implantation attempts.
The draft bill would further stipulate that VA is
authorized to provide for storage of genetic material for three
years, after which the veteran and his or her spouse is
responsible for the costs of such storage; that VA cannot
possess or make any determinations regarding the disposition of
genetic material; and, that VA is required to carry out
activities relating to the custody or disposition of genetic
material in accordance with the relevant state law.
Finally, the draft bill would prohibit VA from providing
any benefits relating to surrogacy or third-party genetic
material donation.
In short, this legislation mirrors the IVF benefit that is
provided to active-duty servicemembers in DoD, creating parity
between the two Departments while opening the door to
parenthood for disabled veterans who may otherwise not have the
resources to pursue such a path.
I am proud to say that this proposal is supported by many
of our VSOs, by RESOLVE: The National Infertility Association,
and by the American Society for Reproductive Medicine.
I thank them all for their support of this draft and for
their thoughtful comments and recommendations for how it may be
improved.
I look forward to working hand-in-hand with Subcommittee
Members to address those suggestions and otherwise strengthen
the language in the draft bill before it is introduced and
moved forward.
This draft is derived partly from the recent Subcommittee
roundtable where infertility among disabled veterans was
discussed in depth and I am grateful to you, Dan, for holding
that roundtable as well as this hearing today.
I urge all of my colleagues to join me in supporting this
draft bill and, with that, I yield back.
Prepared Statement of the Hon. Gus M. Bilirakis
Chairman Benishek, Ranking Member Brownley, and members of
the Health Subcommittee,
Thank you for holding this very important hearing and for
the opportunity to discuss my bill, H.R. 271, the Creating
Options for Veterans' Expedited Recovery (COVER) Act.
With statistics showing that one in five Veterans who
served in Iraq and Afghanistan have been diagnosed with Post-
Traumatic Stress, we must responsibly ask ourselves--are we
doing enough when it comes to addressing mental health in our
Veteran population?
Recent data has shown that every day in this country--an
estimated 18-22 Veterans take their own lives. This statistic
answers the question I posed earlier. It is obvious more needs
to be done. That is why I reintroduced the COVER Act in the
114th Congress.
The COVER Act will establish a commission to examine the
Department of Veterans Affairs current evidence-based therapy
treatment model for treating mental illnesses among veterans.
Additionally, it will analyze the potential benefits of
incorporating complementary alternative treatments available
within our communities.
The duties of the commission designated under the COVER Act
include conducting a patient-centered survey within each
Veterans Integrated Service Network. The survey will examine
several different factors related to the preferences and
experiences of Veterans with regard to their interactions with
the Department of Veterans Affairs. Instead of presuming to
know what is best for Veterans, we should simply ask them and
work with them on finding the right solutions that best fits
their unique needs.
The scope of the survey will include: the experience of a
Veteran when seeking medical assistance with the Department of
Veterans' Affairs; the experience of Veterans with non-VA
medical facilities and health professionals for treating mental
health illnesses; the preferences of a Veteran on available
treatments for mental health and which they believe to be most
effective; the prevalence of prescribing prescription drugs
within the VA as remedies for treating mental health illnesses;
and outreach efforts by the VA Secretary on available benefits
and treatments.
Additionally, the commission will be tasked with examining
the available research on complementary alternative treatments
for mental health and identify what benefits could be attained
with the inclusion of such treatments for our Veterans seeking
care at the VA. Some of these alternative therapies include,
among others: accelerated resolution therapy, music therapy,
yoga, acupuncture therapy, meditation, outdoor sports therapy,
and training and care for service dogs.
Finally, the commission will study the potential increase
in health claims for mental health issues for Veterans
returning from the most recent theatres of war. We must ensure
that the VA is prepared with the necessary resources and
infrastructure to handle the increase in those utilizing their
earned benefits to address the mental and physical ailments
incurred from military service.
Once the Commission has successfully completed their
duties, a final report will be issued and made available
outlining its recommendations and findings based on their
analysis of the patient-centered survey, alternative treatments
and evidence-based therapies. The Commission will also be
responsible for creating a plan to implement those findings in
a feasible, timely, and cost effective manner.
Last Congress, I was very pleased this subcommittee
considered the COVER Act in a legislative hearing. At this
hearing, all the Veterans Service Organizations (VSOs) and
organizations testifying had supported the COVER Act. I want to
thank you all again for your support through your testimonies
given today.
In closing, we have the support from Veterans and the
organizations that work closely with them. And it is clear that
there is a need to do more in how we--as a nation--address
these challenges. The responsibility is ours. The question now
is--what do we intend to do about it. With that, I urge all my
colleagues to show your support for our nation's heroes by
signing onto H.R. 271. Let's get this done for our Veterans and
let's work together on finally getting them ``covered.''
Prepared Statement of Hon. Janice Hahn
I would like to thank this Subcommittee, especially
Chairman Benishek and Ranking Member Brownley--two friends of
mine--for holding this important hearing.
Homeless veterans are a pressing problem for this nation.
More than 62,000 veterans are homeless on any given night, and
over 120,000 veterans will experience homelessness over the
course of the year.
While only 7% of Americans qualify as veterans, veterans
make up nearly 13% of the homelessness population.
Sadly, my home of Los Angeles County has the most homeless
veterans in the nation.
Today, I want to address one segment of homeless veterans--
those who are homeless because of domestic violence. Currently,
the Department of Veterans Affairs' definition of homeless
veterans does not include veterans who are homeless because of
domestic violence.
Across the country, too many victims of domestic violence
feel that there is nowhere for them to turn. Lacking resources,
help and a safe place to go, some victims stay with their
abusers.
Tragically, too often women veterans are among those who
find themselves in this horrible situation. According to the
VA, 39% of our women veterans report experiencing domestic
violence, well above the national average. However, because of
antiquated laws on the books, they have not been eligible to
access resources designated for ``homeless veterans.''
I approached Chairman Benishek with my legislation--H.R.
627, which updates the definition of ``homeless veteran'' to
include victims fleeing domestic violence, not only was he
extremely supportive of it, he joined me in introducing it. For
that, I thank you Mr. Chairman.
Our legislation will update the definition of homeless
veteran to include veterans fleeing domestic violence, and will
correct this oversight and ensure that veterans fleeing
domestic violence can receive benefits from the VA.
This is a minor change of great importance to ensure
veterans do not feel trapped in dangerous situations.
H.R. 627 is endorsed by countless veterans organizations,
such as Veterans of Foreign Wars (VFW), AMVETS, The National
Coalition for Homeless Veterans, The Service Women's Action
Network, Blinded Veterans Association, and the list goes on and
on.
Providing benefits to veterans driven to homelessness by
domestic violence is something we all should support--and have
supported in the past.
In fact, I have worked with the House Appropriations
Veterans Affairs Subcommittee to include report language the
past two years to make these benefits available. That process,
however, only helps until the next year and has to be repeated
every year to provide temporary help.
Now is the time to stop making temporary fixes. This
legislation permanently fixes this loophole for veterans.
While it is unknown how many veterans will be helped by
this bill, if it provides one veteran the support they need to
leave a dangerous situation, our work here will be worth every
minute.
We must step up to provide these heroes who have protected
us with the resources they need including a place where they
can be safe and protected.
In conclusion, I want to thank you for working with me to
solve an urgent problem, and I yield back the balance of my
time.
Prepared Statement the Hon. Jackie Walorski
Good morning Chairman Benishek, Ranking Member Brownley,
and members of the Committee. Thank you for the opportunity to
discuss H.R. 1369, the Veterans Access to Extended Care Act.
This important bill will allow the Department of Veterans
Affairs (VA) to enter into provider agreements for extended
care services.
VA offers a variety of long-term services and supports to
veterans in the form of nursing home care, adult day care,
respite care, domiciliary services, hospice and palliative
care. Care is provided through VA medical centers, State
Veterans Homes, or other community organizations. Currently,
non-VA providers at community organizations must contract with
the VA to provide these kinds of services. Under the Service
Contract Act (SCA), these community providers are considered
federal contractors, a designation that imposes burdensome
reporting requirements relating to the demographics of
contractor employees and applicants, ultimately discouraging
numerous providers from entering into contracts with the VA.
For these organizations, reimbursement from the VA for caring
for veterans is simply not worth the cost of compiling and
reporting the data required by general federal contract law.
This situation has left many veterans and their families
without the ability to find providers close to their homes.
On February 13, 2013, the VA released proposed rule, RIN
2900-A015, which would have increased access to these non-VA
extended care services from local providers,\1\ by permitting
these providers to enter into agreements with the VA under the
same guidelines that providers for Medicare enter into
agreements with the Centers for Medicare & Medicaid Services
(CMS). This means that non-VA providers would no longer be
considered federal contractors. Non-VA providers would still
have to comply with all federal hiring laws, but they would be
relieved from the burdensome reporting requirements.
---------------------------------------------------------------------------
\1\ Use of Medicare Procedures To Enter Into Provider Agreements
for Extended Care Services, Proposed Rule: RIN 2900-AO15. Federal
Register Vol. 78, No. 30 (February 13, 2013).
---------------------------------------------------------------------------
In conjunction with a Senate letter that was sent in June
of 2014, Congresswoman Tulsi Gabbard and I, along with 107 of
our colleagues in the House sent a letter in August of 2014 to
Secretary McDonald encouraging the release of the final VA
provider agreement rule. Unfortunately, despite the willingness
of the Department, the VA never had the legislative authority
to begin with to enact this rule.
In response, Representative Gabbard and I introduced H.R.
1369, Veterans Access to Extended Care Act. This commonsense
bill gives the VA the legislative authority it needs to follow
through with the original proposed rule. Specifically, this
bill amends subparagraph (B) of section 1720(c) (1) of Title 38
of the U.S. Code by adding an exemption for extended care
service providers from being treated as federal contractors for
the acquisition of goods or services. The bill also modifies
section 6702(b) of Title 41 of the U.S. Code, which relieves
providers from certain reporting requirements to the Department
of Labor. Lastly, it includes quality assurance provisions to
ensure the safety and a high standard of care our veterans
deserve. Should a provider fail to comply with a provision of
the agreement, VA has the authority to terminate the agreement.
Eliminating this contractor designation will encourage more
extended care service providers to enter into agreements, which
will provide veterans with more options in the community.
Incentivizing more local providers to work with the VA will
increase access to care that is closer to home allowing nearby
family and friends to provide an additional support structures
to our veterans. The family structure during these times is a
vital part of ensuring a veteran's quality of life. These
individuals have sacrificed so much in the name of liberty;
they should not have to worry about being unable to find care
close to home because their hometown providers do not have the
resources necessary to qualify as a government contractor.
Eliminating this designation will encourage more extended care
service providers to enter into agreements, which will provide
veterans with more options in the community that will allow
their family, friends to provide an additional support
structure for them. Providing veterans with the care they need
and deserve continues to be a top priority of mine and every
member of this committee. I am grateful to work with
Representative Gabbard, Senator Hoeven, Senator Manchin, and
the Committee in addressing this critical issue for veterans. I
thank you again for this opportunity to speak today.
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Statement for the Record
Statement of Hon. Corrine Brown, Full Committee, Ranking Member
Women Veterans Readjustment and Reintegration
Mr. Chairman and Members of the Committee, I would like to
offer this testimony on behalf of H.R. 1575, legislation to
honor the service and sacrifice of our heroic women veterans
recently separated from military service after prolonged
deployments. This bill extends and makes permanent a very
successful pilot program at the Department of Veterans Affairs
which provides psychiatric and psychological counseling and
support in retreat settings for newly returned women veterans.
This legislation follows the release of a report by the
Veterans Health Administration showing that this limited, 2-
year pilot program, run by the Readjustment Counseling Service,
has shown positive, measurable results helping returning women
veterans experiencing post-traumatic stress, depression, sleep
disturbances and isolation. Many of these servicewomen have
been evaluated as service connected for severe PTSD.
In surveys, participants have consistently reported
experiencing a marked decrease in stress symptoms and an
increase in coping skills, including understanding better how
to develop support systems and to access available resources at
VA and in their communities following the program and as they
reenter civilian life.
The Veterans Health Administration has completed six
retreats in the two year pilot period. Post 9/11 women
veterans, often combat veterans, are brought together in groups
of about 20, in outdoor settings. Transportation is paid for.
These one-week sessions were held in California, Colorado, New
Mexico and Connecticut. The veterans, most of whom are coping
with the effects of severe PTS, some as a result of sexual
trauma while in the military, participated in trust building
exercises and worked with counselors and psychological
educators to build peer support. Other services offered on an
as-needed basis are financial and occupational counseling and
conflict resolution training.
H.R. 1575 provides VA with permanent authority to extend
the program using the same measurements and eligibility
requirements in the original law, P.L. 111-163. This expansion
will mean an increase in the number of sessions and locations
for the program. VA must submit a report to Congress every two
years on the program.
This program is limited, well run and highly successful
thereby providing us with a bit of good news and, more
importantly, a chance to ensure a healthier, more successful
transition back to civilian life for a specific group of heroic
women warriors.
I appreciate the opportunity to provide this testimony on
behalf of H.R. 1575, invite my colleagues' support, and look
forward to its enactment as soon as possible.
American Health Care Association
Dear Chairman Dan Benishek:
I serve as the president and chief executive officer of the
American Health Care Association (AHCA), the nation's largest
association of long term and post-acute care providers. The
association advocates for quality care and services for the
frail, elderly, and individuals with disabilities. Our members
provide essential care to millions of individuals in more than
12,000 not for profit and for profit member facilities.
AHCA, its affiliates, and member providers advocate for the
continuing vitality of the long term care provider community.
We are committed to developing and advocating for public
policies which balance economic and regulatory principles to
support quality of care and quality of life. Therefore, I
appreciate the opportunity today to submit a statement on
behalf of AHCA for the hearing record in strong support of the
Veterans Access to Extended Care Act (H.R. 1369/S. 739), which
would grant the U.S. Department of Veterans Affairs (VA) the
legislative authority to enter into Provider Agreements for
extended care services.
The VA released a proposed rule, RIN 2900-A015, on Provider
Agreements in February of 2013. This important rule, among
other things, increases the opportunity for veterans to obtain
non-VA extended care services from local providers that furnish
vital and often life-sustaining medical services. This rule is
an example of how government and the private sector can
effectively work together for the benefit of veterans who
depend on long term and post-acute care. Last Congress, close
to half of the U.S. Senate chamber and 109 U.S. House members
signed onto a letter to the VA encouraging the release of the
final VA provider agreement rule. It was determined that the VA
needs the legislative authority to enter into these agreements,
which the Veterans Access to Extended Care Act provides.
It is long-standing policy that Medicare (Parts A and B) or
Medicaid providers are not considered to be federal
contractors. However, if a provider currently has VA patients,
they are considered to be a federal contractor and under the
Service Contract Act (SCA). The Veterans Access to Extended
Care Act would ensure that providers could enter into VA
Provider Agreements, and would therefore not have to follow
complex federal contracting and reporting rules that come with
being deemed a federal contractor or under the SCA.
Federal contracts come with extensive reporting
requirements to the Department of Labor on the demographics of
contractor employees and applicants, which have deterred
providers, particularly smaller ones, from VA participation.
The use of Provider Agreements for extended care services would
facilitate services from providers who are closer to veterans'
homes and community support structures. Once providers can
enter into Provider Agreements, the number of providers serving
veterans will increase in most markets, expanding the options
among veterans for nursing center care and home and community-
based services. Services covered as extended care under the
proposed rule include: nursing center care, geriatric
evaluation, domiciliary services, adult day healthcare, respite
care, and palliative care, hospice care, and home healthcare.
AHCA endorses H.R. 1369/S. 739, and applauds Congresswomen
Jackie Walorski (R-IN-2nd) and Tulsi Gabbard (D-HI-2nd) and
Senators John Hoeven (R-ND) and Joe Manchin (D-WV) for
introducing this important legislation that will ensure that
those veterans who have served our nation so bravely have
access to quality healthcare. Thank you again for the
opportunity to comment on this important matter.
Sincerely,
Mark Parkinson, AHCA/NCAL President & CEO
------
American Society for Reproductive Medicine
Dear Chairman Dan Benishek:
Thank you for the opportunity to offer comments regarding
draft legislation to allow the Department of Veterans Affairs
to provide reproductive treatment to disabled veterans that
includes in vitro fertilization. The American Society for
Reproductive Medicine is pleased that you have considered this
bill for a public hearing. It is nothing but unjust to send our
military personnel into harm's way and to not provide health
care services to address health care needs that arise due to
their service and dedication to our country. ASRM solidly
supports the provision of fertility services to severely
wounded veterans, particularly given that similarly situated
individuals with coverage under TRICARE are allowed this
covered benefit.
ASRM is a multidisciplinary organization of nearly 8,000
medical professionals dedicated to the advancement of the
science and practice of reproductive medicine. ASRM members
include obstetrician/gynecologists, urologists, reproductive
endocrinologists, nurses, embryologists, mental health
professionals and others. As the medical specialists who
present treatment options for patients and perform procedures
during what is often an emotional time for them, we recognize
how important a means to addressing their medical condition can
be for those hoping to build their families.
The draft legislation would direct the Secretary of
Veterans Affairs to provide fertility treatment, including in
vitro fertilization, to a disabled veteran who has an injury to
his/her reproductive organs or spinal cord and such injury
directly results in the veteran being unable to procreate
without assisted reproductive technology. Importantly, the
draft bill provides the same treatment for the veterans'
spouse. We find that the coverage regarding number of in vitro
fertilization attempts and number of years of storage of
genetic material is reasonable. In providing for the coverage
of cryopreservation of genetic material, we would recommend the
bill specifically include gametes (sperm and egg) and also
embryos that may be created as part of the assisted
reproduction procedure. It is important that the
cryopreservation of genetic material include gametes because
the disabled veteran may not be in a position to begin the part
of fertility treatment that includes in vitro fertilization
until he/she is better able to emotionally and physically
prepare for that treatment. The cryopreservation of gametes
allows for the processes of fertilization and transfer of any
resulting embryos to occur when the patient is ready for that
process.
The bill could go further to specifically include coverage
of services to those affected by infertility caused by exposure
to toxins during their deployment as these exposures can also
compromise one's ability to reproduce. So too, fertility
preservation is a common concern for military personnel with
orders to deploy. While this is not currently a covered benefit
under TRICARE and it is not within this panel's jurisdiction to
make requirements of the TRICARE program, fertility
preservation is an important topic to raise. The technology
exists to provide these services. The nature of the promises we
make to those individuals who risk everything for our country
warrants a thoughtful examination of whether this benefit
should also be part of the covered services for military
personnel.
ASRM would further recommend that the bill allow for the
use of donor gametes as part of the covered treatment options.
For some severely injured veterans, sperm or egg retrieval may
be impossible. The desire to have a family is no less important
to those individuals and third party collaboration as a family
building option is an appropriate medical option for some
infertile patients.
The bill limits required treatments to disabled veterans or
their spouse. Until such time that every state legally
recognizes the marriage of same sex partners, the effect of
this bill will be that only those veterans whose marriage is
deemed legal will be furnished those services outlined in the
bill. This effectively denies coverage to injured veterans who
are single or who are in same sex partnerships. It is no longer
a stigma to reproduce outside of the context of marriage, or a
male/female marriage, and ASRM would recommend that holding
veterans to a standard that is not the norm any longer in
today's society is discriminatory just as denying to these
individuals the ability to serve in the military.
Thank you for the opportunity to comment on this bill and
for your attention to this important public health issue. Our
nation's military personnel and veterans deserve to have access
to the full complement of infertility treatments that are
available and we are pleased that this committee has recognized
the need to correct the inequities that exist between the
health plans available under the DoD and the Veterans' Health
plans.
Sincerely,
Rebecca Z. Sokol, MD, MPH, President,
American Society for Reproductive Medicine
Concerned Veterans For America
Draft Legislation on Reproductive Treatment for Disabled
Veterans
To amend title 38, United States Code, to improve the
reproductive treatment provided to certain disabled veterans.
CVA has no position on this legislation.
Draft Legislation Requiring an Annual VHA Report
To amend title 38, United States Code, to direct the
Secretary of Veterans Affairs to submit an annual report on the
Veterans Health Administration and the furnishing of hospital
care, medical services, and nursing home care by the Department
of Veterans Affairs.
CVA supports the principles of the legislation, which
requires more detailed reporting from VHA in important areas
where data have been lacking. In order to ensure
accountability, it is important that VHA report its performance
numbers in a way that enables decision-makers and veterans to
assess their efficiency and efficacy.
A CBO report released last December which examined the
comparative cost of VA-provided healthcare versus and private-
sector healthcare notes that ``Comparing health care costs in
the VHA system and the private sector is difficult partly
because the Department of Veterans Affairs (VA), which runs
VHA, has provided limited data to the Congress and the public
about its costs and operational performance''. \1\
---------------------------------------------------------------------------
\1\ Congressional Budget Office. (2014). Comparing the Costs of the
Veterans' Health Care System With Private-Sector Costs (CBO Publication
No. 49763). Washington, DC: U.S. Government Printing Office. Retrieved
from https://www.cbo.gov/sites/default/files/cbofiles/attachments/
49763-VA--Healthcare--Costs.pdf.
---------------------------------------------------------------------------
This legislation would be an important step towards making
sure that the VHA and the VA become more transparent
institutions, which would benefit both the taxpayers and the
veterans. While CVA remains committed to comprehensive reform
of VHA and the Department of Veterans Affairs, these reporting
requirements are an important step toward more accountability
and better care for our veterans.
CVA supports this legislation.
Draft Legislation: The Toxic Exposure Research Act of 2015
To establish in the Department of Veterans Affairs a
national center for research on the diagnosis and treatment of
health conditions of the descendants of veterans exposed to
toxic substances during service in the Armed Forces that are
related to that exposure, to establish an advisory board on
such health conditions, and for other purposes.
CVA has no position on this legislation.
HR 271: The Cover Act
To establish a commission to examine the evidence-based
therapy treatment model used by the Secretary of Veterans
Affairs for treating mental illnesses of veterans and the
potential benefits of incorporating complementary alternative
treatments available in non-Department of Veterans Affairs
medical facilities within the community.
CVA has no position on this legislation.
HR 627: To Expand of Definition of Homelessness
To amend title 38, United States Code, to expand the
definition of homeless veteran for purposes of benefits under
the laws administered by the Secretary of Veterans Affairs.
CVA has no position on this legislation.
HR 1369: Veterans Access to Extended Care Act of 2015
To modify the treatment of agreements entered into by the
Secretary of Veterans Affairs to furnish nursing home care,
adult day health care, or other extended care services, and for
other purposes.
CVA believes that this legislation represents a good step
forward in alleviating the problems that the Department of VA
has in providing veterans access to the care that they need and
increasing the partnership between VA and private sector care,
by simplifying the process that non-VA providers must go
through to enable them to provide extended care to veterans.
CVA strongly believes that it is important to ensure that there
are more choices for veterans regarding the services that are
available to them within the current overall institutional
arrangement, and that VA should work with private-sector
healthcare providers in effective ways to ensure that veterans
receive the quality of care they deserve. This legislation is
in keeping with that goal.
CVA supports this legislation.
HR 1575: Retreat Counseling for Women Veterans
To amend title 38, United States Code, to make permanent
the pilot program on counseling in retreat settings for women
veterans newly separated from service in the Armed Forces.
CVA has no position on this legislation.
----
RESOLVE:
The National Infertility Association
Dear Chairman Dan Benishek:
Thank you for the opportunity to provide this statement
regarding draft legislation to improve reproductive treatment
provided to certain disabled veterans. This is incredibly
important legislation for our wounded warriors who expect our
government to care for them if they are injured in their
service to our country. The ability to procreate is the most
basic and fundamental desire of human beings. If that ability
is damaged as a result of their service, then we owe it to them
to provide access to medical treatments that will allow them to
become a parent.
RESOLVE: The National Infertility Association was founded
in 1974 to provide information, support, awareness and advocacy
for women and men living with infertility. RESOLVE is the
oldest and largest patient advocacy organization in the U.S.
and the only patient organization advocating for access to
infertility services for our active duty military and veterans.
We applaud the committee for discussing this important topic.
The draft legislation provides for certain disabled
veterans to access in vitro fertilization (IVF). Right now the
Veterans Administration is prohibited from providing access to
IVF, which causes a critical gap in coverage since that same
benefit is offered to wounded service-members still covered
under TRICARE. While the TRICARE supplemental benefit for
certain wounded service-members is needed, most of those who
could benefit from IVF transition to the Veteran's health
system and by the time they are ready to become a parent, they
discover that the VA does not provide access to IVF. This draft
legislation will fix this gap in service and solve a major
problem facing our disabled veterans.
This bill also provides for access to reproductive care for
the spouse of a veteran. While the VA is not responsible for
the healthcare of spouses and dependents, reproduction is
unique in that male and female gametes (sperm and egg) are
needed as well as a female to carry the pregnancy. Only
providing care to the male or female does not work--both must
be treated.
We do ask that the committee consider all of the injuries
that may result in infertility, as the bill only covers injury
to the reproductive organs or spinal cord. Amputations,
Traumatic Brain Injuries and exposure to toxins and chemicals
can also impact the ability to procreate without assisted
reproductive technologies. All of our wounded veterans with
infertility should have access to this coverage.
We applaud the committee for this important first step in
opening up advanced reproductive care to veterans. We are
hopeful that this first step will lead to further coverage in
the future for all veterans, not just those with a service
related injury; access to IVF for service-members covered under
TRICARE; coverage for fertility preservation before deployment
(the freezing of sperm, eggs and/or embryos); access to care
for those who are single or not married with infertility; and
coverage for the use of donor gametes (donated sperm, egg or
embryos) for those who can no longer produce viable gametes to
have a child.
We stand ready to work with Congress to get this important
legislation passed as quickly as possible. Our Veterans are
waiting--we owe it to them to fix this coverage gap with the VA
and let them access the advanced medical care that they need
and so deserve.
Sincerely,
Barbara L. Collura, President & CEO
RESOLVE: The National Infertility Association, 7918 Jones
Branch Drive, Suite 300, McLean, VA 22102, www.resolve.org
[email protected], 1-703-556-7172
----
Veterans of Foreign Wars of the United States
Statement of Carlos Fuentes, Senior Legislative Associate
National Legislative Service, Veterans of Foreign Wars of the
United States APRIL 23, 2015
Mr. Chairman and Members of the Subcommittee:
On behalf of the men and women of the Veterans of Foreign
Wars of the United States (VFW) and our Auxiliaries, thank you
for the opportunity to offer our thoughts on today's pending
legislation.
H.R. 271, Creating Options for Veterans Expedited Recovery
(COVER) Act:
The VFW supports this legislation, which would establish a
commission to examine the efficacy of the Department of
Veterans Affairs' (VA) mental healthcare and identify ways to
improve outcomes.
Too often, the VFW hears stories of veterans who have been
prescribed high doses of ineffective medications to treat their
mental health conditions. Many of these medications, if
incorrectly prescribed, have been known to render veterans
incapable of interacting with their loved ones and even
contemplate suicide. With the expanding evidence of the
efficacy of non-pharmacotherapy modalities, such as
complementary and alternative medicine (CAM) therapies, VA must
ensure it affords veterans the opportunity to access effective
mental health treatments that minimize adverse outcomes.
VA has made a concerted effort to change its mental
healthcare providers' dependence on pharmacotherapy to treat
mental health conditions and manage pain. In 2011, the
Minneapolis VA Medical Center launched its Opioid Safety
Initiative. Aimed at changing the prescribing habits of
providers, the Opioid Safety Initiative educates providers on
the use of opioids, serves as a tool to taper veterans off
high-dose opioids, and offers veterans alternative--non-
pharmacotherapy--modalities for pain management. Last month, VA
deployed the Opioid Therapy Risk Report, a byproduct of the
Opioid Safety Initiative, to enable providers to better track
and manage their patients' high-dose prescriptions.
Timely and accessible mental healthcare is crucial to
ensuring veterans have the opportunity to successfully
integrate back into civilian life. With more than 1.4 million
veterans receiving specialized VA mental health treatment each
year, VA must ensure such services are safe and effective. VA
has made progress in reducing its dependence on pharmacotherapy
to treat mental health conditions and manage pain. However,
more can be done to ensure veterans have access to CAM
therapies that minimize side effects and improve outcomes.
H.R. 627, to expand the definition of homeless veteran for
purposes of benefits under the laws administered by the
Secretary of Veterans Affairs:
The VFW is pleased to support this legislation, which would
clarify the definition of homeless, thereby aligning it with
the McKinney-Vento Act to include those displaced by domestic
violence.
No veteran should ever be homeless, and expanding the
definition of homeless to include veterans who are fleeing
situations of domestic abuse is the right thing to do. This
change would ensure veterans who have the courage to leave
their abusive and sometimes life-threatening situations receive
access to the benefits VA already provides to thousands of
homeless veterans. The VFW believes this legislation will
significantly improve the lives of those who become homeless as
a result of difficult circumstances outside of their control,
and help them begin a new chapter in their lives.
H.R. 1369, Veterans Access to Extended Care Act of 2015:
The Veterans Access to Extended Care Act of 2015 would
strengthen VA's authority to enter into provider agreements
with extended care facilities, while ensuring such facilities
meet certain safety and quality standards. The VFW supports
this legislation, but urges the Subcommittee to ensure it
provides VA the authority it needs to properly administer all
of its nursing home, assisted living, patient-directed and
extended care authorities and programs.
VA has the authority to enter into provider agreements with
extended care facilities to provide long-term care to veterans
who need nursing home level services. However, a recent opinion
by the Department of Justice found that VA provider agreements
must comply with Federal Acquisition Regulations (FAR). Thus,
VA has been unable to proceed with its plans to use its
provider agreement authority to expand the extended care
services it provides veterans.
The VFW has heard from many private sector extended care
facilities that want to care for veterans, but do not have the
staff to comply with the onerous compliance requirements under
the FAR. As a result, veterans throughout the country received
notice that they may be uprooted from the nursing homes they
have called home for many years. For example, the VFW has
received assistance requests from nearly a dozen family members
of veterans in a nursing home in Lincoln, NE, that may no
longer be able to provide services to veterans if its provider
agreement with VA is not renewed. One of the veterans has
rapidly progressing multiple sclerosis and needs comprehensive
healthcare services. His family tells us he is satisfied with
the ``excellent care'' he receives and was looking forward to
calling the nursing facility ``his home for the remainder of
his days.'' This legislation would ensure this veteran and many
like him are able to remain in the extended care facilities
they call home, and authorize VA to provide the same
opportunity for countless veterans.
H.R. 1575, to make permanent the pilot program on counseling in
retreat settings for women veterans newly separated from
service in the Armed Forces:
This legislation would make retreat counseling services
permanent for transitioning women veterans. The VFW supports
this legislation and would like to offer suggestions to
strengthen it, which we hope the Subcommittee will consider.
VA's counseling retreat program has served as an invaluable
tool to help newly discharged women veterans seamlessly
transition back into civilian life. The VFW supported the
original program established by the Caregivers and Veterans
Omnibus Health Services Act of 2010 and is happy to see this
program continue.
Another successful program created by the Caregivers and
Omnibus Health Services Act of 2010 is the childcare pilot
program. This program has been well received by veterans at all
four pilot sites and has also contributed to the success of the
counseling retreat program. The VFW has heard from veterans who
say they could not have completed their treatment programs if
not for the services offered through VA's childcare pilot
program.
When extending successful mental healthcare programs, such
as the retreat counseling program for women veterans, the
Subcommittee must ensure external barriers to access are
removed to grant veterans the opportunity to receive the VA
healthcare and services they need. The VFW urges the
Subcommittee to amend this legislation to extend and expand the
childcare program to every VA medical center to ensure newly
discharged women veterans with children are not precluded from
obtaining the benefits and services they have earned and
deserve.
H.R. 1769, Toxic Exposure Research Act of 2015:
The Toxic Exposure Research Act of 2015, which would
establish an advisory board and a national center for research,
would begin to address the multiple health issues faced by
veterans and their descendants as a result of service-related
toxic wounds. The VFW is pleased to offer its strong support
for this legislation.
This nation has a long history of offering healthcare and
compensation benefits to veterans who suffer traditional wounds
on the battlefield. Veterans who suffer from toxic wounds,
however, have traditionally faced a much more difficult road
towards accessing the healthcare and benefits they have earned
and deserve. The VFW believes that toxic wounds are wounds just
the same and should be treated just as seriously as physical or
mental wounds. Veterans who suffer from conditions as a result
of service-related toxic exposure are equally deserving of VA
healthcare and benefits.
Toxic wounds are different than other wounds, since toxic
exposures have the potential to affect a veteran's descendants
for several generations. For this reason, we strongly support
the provision of this bill that would establish a national
center for research to study the health effects service-related
toxic wounds have on the descendants of individuals who were
exposed to toxic substances during their military service.
Children of Vietnam veterans who were exposed to Agent
Orange receive VA care and benefits for spina bifida, a
debilitating health condition associated with a parent's
exposure to dioxins found in Agent Orange. The VFW suspects
that descendants of Vietnam veterans may suffer from additional
health conditions that may be associated with exposure to Agent
Orange. In addition, exposure to toxic substances is not
limited to Vietnam veterans. The descendants of veterans who
were exposed to toxic chemicals during the Gulf War, veterans
of Iraq and Afghanistan exposed to open air burn pits, and
service members exposed to contaminated water in Camp Lejeune,
just to name a few, may all be suffering from diseases at a
higher rate than the general population. This legislation is a
step toward ensuring veterans' descendants can finally get the
care and benefits they need.
Draft Legislation to Improve the Reproductive Treatment
Provided to Certain Disabled Veterans:
This important legislation would expand VA's authority to
furnish fertility treatments to veterans who have lost their
ability to start a family as a direct result of their service-
connected injuries. The VFW supports this legislation and would
like to offer suggestions to strengthen it, which we hope the
Subcommittee will consider.
Due to the widespread use of improvised explosive devices
during the wars in Iraq and Afghanistan, both female and male
service members have suffered from spinal cord, reproductive,
and urinary tract injuries. Many of these veterans hope to one
day start families, but their injuries prevent them from
conceiving. When these veterans seek fertility treatment from
VA, they are told VA services are very limited. In fact, VA is
prohibited from providing certain fertility treatments like In
Vitro Fertilization. This legislation would expand VA's
authority by aligning it with the Department of Defense's
authority to furnish assisted reproductive treatments to
severely injured service members.
However, service-connected infertility is not limited to
those who have suffered reproductive organ and spinal cord
injuries. Other injuries and illnesses such as Traumatic Brain
Injuries and other mental health conditions are known to cause
infertility. Such veterans deserve the same opportunity to
start a family as their fellow veterans who have suffered
injuries to their reproductive organs. For that reason, the VFW
urges the Subcommittee to expand the eligibility for
infertility treatment to severely wounded, ill, or injured
veterans who have infertility conditions incurred or aggregated
by their military service.
Additionally, veterans may have personal objections to
assisted reproductive technologies such as In Vitro
Fertilization and would like to pursue other options, such as
adoption. However, VA is not currently authorized to help
veterans cover the cost of adoption. The VFW believes that VA
must have the authority to provide veterans the fertility
treatment options that are best suited for their particular
circumstances. For that reason, we urge the Subcommittee to
grant VA more expansive fertility treatment authorities.
This legislation takes several steps toward ensuring
veterans who have lost their ability to reproduce have the
ability to start a family. It would authorize VA to
cryopreserve a veteran's genetic material for up to three
years. Starting a family is a life changing decision that takes
time and should not be hastily made. The VFW strongly supports
giving veterans the opportunity to delay such a decision.
However, we urge the Subcommittee to expand the three year
window. When totaled, a veteran's recovery, education and
career advancement may cause them to wait years before they are
physically and financially prepared to start a family. The VFW
recommends that veterans be allowed to cryopreserve their
genetic material for a minimum of 10 years. This will prevent
veterans from feeling rushed into making family planning
decisions before they are ready.
Additionally, many severely wounded, ill, and injured
veterans have not lost the ability to produce gametes, but have
lost the ability to conceive. The VFW strongly supports the
provision that would authorize VA to furnish fertility
treatments to non-veteran spouses.
Draft Legislation to Direct the Secretary of Veterans Affairs
to submit an annual report on the Veterans Health
Administration:
The VFW supports this legislation, which would require VA
to report the utilization and efficiency of the healthcare it
provides America's veterans. Such reports would enable Congress
to conduct proper oversight of the department's Veterans Health
Administration.
Information Required by Rule XI2(g)(4) of the House of
Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives,
the VFW has not received any federal grants in Fiscal Year
2014, nor has it received any federal grants in the two
previous Fiscal Years.
The VFW has not received payments or contracts from any
foreign governments in the current year or preceding two
calendar years.
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