[Senate Hearing 109-218]
[From the U.S. Government Publishing Office]
S. Hrg. 109-218
IS THE VA PREPARED TO MEET THE NEEDS OF OUR RETURNING VETS?
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
JULY 6, 2005
__________
Printed for the use of the Committee on Veterans' Affairs
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senate
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COMMITTEE ON VETERANS' AFFAIRS
LARRY CRAIG, Idaho, Chairman
ARLEN SPECTER, Pennsylvania DANIEL K. AKAKA, Hawaii, Ranking
KAY BAILEY HUTCHISON, Texas Member
LINDSEY O. GRAHAM, South Carolina JOHN D. ROCKEFELLER IV, West
RICHARD BURR, North Carolina Virginia
JOHN ENSIGN, Nevada JAMES M. JEFFORDS, (I) Vermont
JOHN THUNE, South Dakota PATTY MURRAY, Washington
JOHNNY ISAKSON, Georgia BARACK OBAMA, Illinois
KEN SALAZAR, Colorado
Lupe Wissel, Majority Staff Director
D. Noelani Kalipi, Minority Staff Director
C O N T E N T S
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July 6, 2005
SENATORS
Page
Obama, Hon. Barack, U.S. Senator from Illinois................... 1
Durbin, Hon. Richard J., U.S. Senator from Illinois.............. 3
WITNESSES
Herres, Stephen, Vietnam Veteran................................. 6
Prepared statement........................................... 7
Lynch, Alan J., Chief Sertvice Representative, Vietnam Veterans
of America..................................................... 9
Prepared statement........................................... 10
Aument, Ronald, VA Deputy Under Secretary for Benefits........... 13
Prepared statement........................................... 15
Crump, Rochelle, Assistant Director, Illinois Department of
Veterans' Affairs.............................................. 16
Petrosky, Joseph, Director, Veterans Affairs and Rehabilitation
Office, The American Legion.................................... 29
Prepared statement........................................... 30
DiGrazia, Carl, Department Service Officer, Veterans of Foreign
Affairs........................................................ 32
Prepared statement........................................... 33
Douglas, Jeanne, Team Leader, Vet Center, Oak Park, Illinois..... 33
Prepared statement........................................... 35
Hetrick, Jack, Director, Hines VA Hospital....................... 36
Prepared statement........................................... 38
IS THE VA PREPARED TO MEET THE NEEDS OF OUR RETURNING VETS?
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WEDNESDAY, JULY 6, 2005
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10:01 a.m., in
room 2525, Everett McKinley Dirksen Building, 219 South
Dearborn Street, Chicago, Illinois, Hon. Barack Obama
presiding.
Present: Senators Obama and Durbin.
OPENING STATEMENT OF HON. BARACK OBAMA,
U.S. SENATOR FROM ILLINOIS
Senator Obama. Good morning, everybody.
I would like to bring our field hearing to order, and I
want to thank all of you for taking the time to join myself and
Senator Durbin today. I want to also thank Chairman Larry Craig
and Ranking Member Danny Akaka of the Senate Veterans' Affairs
Committee, for allowing us to hold this field hearing in
Illinois.
I particularly want to thank my senior senator from
Illinois, Dick Durbin, for joining us here today. He will be
here for the entire first panel. He may have to leave a little
bit early, but we are fortunate to have him. I want to remind
everybody that he is more senior than I am. The only reason
that I am presiding today is I happen to be on the Veterans'
Affairs Committee. But Senator Durbin has been working on this
issue, making sure that veterans get the benefits that they
deserve for a very, very long time, so we appreciate his
service. He will have an opportunity to make an opening
statement.
As of yesterday, 13,190 men and women had been wounded in
Operation Iraqi Freedom; 13,190 husbands, wives, mothers, and
fathers, who will return home from service with scars that may
change their lives forever. They are heroes and they deserve
our deepest gratitude and support. They serve as a reminder to
us that this Committee, the Veterans' Affairs Committee, must
do whatever it takes to guarantee that our veterans receive the
care they need to carry on with their lives when they come
home.
That means the VA and the Department of Defense must work
together to provide more efficient vocational and
rehabilitation services. It means insuring that we have the
capacity to treat specific needs, like soldiers returning home
with post-traumatic stress syndrome. It means that veterans who
are wounded should be greeted with a disability benefit system
that treats a veteran from Illinois the same as a veteran from
New Mexico, both getting a fair evaluation of their claim and a
fair amount of disability benefits.
As we all know, our preparation for the wars in Iraq and
Afghanistan did not adequately consider what these wars would
mean for our Department of Veterans' Affairs. Just last week,
we learned that the VA was more than one billion dollars short
in its health-care funding. That is more than a billion dollars
in VA doctors' visits or veterans' prosthetics that could have
gone without funding. Fortunately, on a bipartisan basis, we
were able to initiate an emergency supplemental. But the VA
almost had to fill this shortfall by shuffling around some of
its funding or dipping into its rainy day fund.
Now, I know that some of the VA said that this was just
routine accounting, but the men and women in the Senate thought
it was a little bit more like fudging the numbers. One of the
things that we are looking for is a strong partnership with the
Veterans' Administration, to make sure that we are adequately
estimating the resources that are needed to provide basic care
to our veterans.
Let me be clear. The Department of Veterans' Affairs should
not be funded on an emergency basis. The Office of Management
and Budget and the Administration have to work harder to ensure
that the budgetary numbers presented to Congress are accurate,
and the fiscal predictions are based not on wishful thinking,
but on reality. Even though we have cleared this recent
budgetary crisis, it is not obvious to me that the VA is where
it should be for our veterans returning from Iraq and
Afghanistan, or for any of our Nation's veterans. I am pleased
to see that Senator Nicholson has been responsive on the issue
of disability benefits, after repeated requests from myself and
Senator Durbin, but we still have more work to do.
Just a couple of other points that I want to make, and then
I will turn it over to Senator Durbin. All of us, I think, were
dismayed, but not terribly surprised to see that Illinois had
ranked at the bottom of the heap with respect to disability
benefits, based on the VA Inspector General's report.
I was concerned that the Inspector General did not evaluate
the denials of post-traumatic stress disorder claims. Unless
these denials are evaluated, we will not know whether Illinois
veterans who are refused PTSD claims are being treated fairly.
The report also found that those veterans who relied on the
services of Veterans' Advocates received on average more than
$6,225 than those who filed claims without any assistance,
which speaks, I think, to the important role that the VSO's
play in making sure our veterans are treated fairly.
I hope that some of the information that has been gleaned
from these reports will help our veterans. We are going to stay
on the case, with respect to Secretary Nicholson. My
understanding is that Secretary Nicholson has added five raters
to the Chicago Regional Office, and that's something that I am
sure we can talk to Mr. Olson about.
I hope today that we can learn more about the Illinois
experience with disability benefits, how the VA is handling
those who would like to have their claims reviewed, and whether
the VA is prepared to handle the returning veterans.
One other issue that we hope to discuss today, and this
will be the focus in particular of the second panel, is whether
the VA is prepared to meet the health-care needs of our
returning veterans. As I mentioned, we already have seen an
underestimation of resources that are needed, that had to be
filled by an emergency spending gap. I know veterans have
difficulty getting access to VA care and I don't want the men
and women risking their lives in Iraq and Afghanistan to return
home to be greeted by a system that tells them thanks for
fighting for your country, now take a number.
We have to start evaluating the needs of the returning
veterans. I know many experts have predicted the veterans
returning from Iraq will be particularly susceptible to PTSD,
and the Government Accountability Office recently found that
the VA may not be prepared to meet these increased mental
health needs. I hope the witnesses on the second panel can
discuss the issue of PTSD and the need of our returning
veterans.
In addition to PTSD, this war has also seen an increase in
the number of serious amputees. Brave men and women who may not
have survived earlier wars are now surviving thanks to advanced
technology. They have a chance not only to survive, but live
normal lives.
A good example that Senator Durbin and myself are familiar
with, Illinois Guard member, Major Tammy Duckworth, an
extraordinary woman who was injured when her Blackhawk
helicopter was shot down last year. She appeared before the
Senate VA Committee, told us not only how she had received
therapy, but how she was hoping to fly again despite the loss
of both legs. Given her bravery and determination, I have no
doubt that she will, but I want to make sure that the VA has
the prosthetic therapy and devices she needs to succeed in her
life goals. I also want that same service available to all our
veterans. I hope that the witnesses in the second panel will be
able to discuss the issue of prosthetics, as well.
I know we could discuss the topics that I have just raised
for weeks here, but unfortunately we only have 2 hours. I am
going to be asking the witnesses to keep their testimony to 5
minutes each, and then myself and Senator Durbin will ask
questions. We will be happy to enter into the record complete
statements from all the witnesses, if they wish. If your 5
minutes are up, we don't have an official timer other than me,
so I am going to be watching my watch. But if you have
additional statements that you want to put into the record, you
will be able to do so.
With that, let me turn it over to my senior Senator,
Senator Dick Durbin.
OPENING STATEMENT OF HON. RICHARD J. DURBIN,
U.S. SENATOR FROM ILLINOIS
Senator Durbin. Thank you very much, Senator Obama. We
welcome you to the Senate, and you came to the Senate at the
right moment in being appointed to the Senate Veterans' Affairs
Committee. I don't think there has ever been a moment in recent
memory when Illinois veterans have needed such a strong voice
in Washington.
The reports that we have received about some of the
disabled veterans who have been shortchanged in Illinois--the
fact that for 20 straight years, Illinois veterans ranked
fiftieth out of 50 states when it came to average disability
payments--really tells us the need for response. Senator Obama
came to the job even before he was sworn in, understood the
gravity of this challenge, asked for appointment to the
Committee on Veterans' Affairs, and we joined together in
bringing Secretary Nicholson to Chicago once the report was
complete.
I salute Secretary Nicholson because as I said at that
hearing, this problem was not his creation but it's his
leadership that can solve this problem. We were happy at that
hearing to have so many veterans' organizations back us up.
They came and said, ``We need to have two things: We need more
people working in this office so that the veterans returning
are going to be dealt with on a timely basis.'' As Senator
Obama said, it shouldn't be a matter of take a number, and get
in line and wait, and hope for the best.
We also need to make certain there's enough advocacy for
the veterans who are disabled. We find that those who have an
advocate with them, a counselor with them going into the VA
system, do dramatically better than those that go in by
themselves and try to handle their claims. We certainly want to
make certain those veterans of the past, who have filed
disability claims and been shortchanged by the system, have
another day in court, another chance for an appeal. So they can
be treated fairly and receive exactly what they need.
We are concerned, too, about the returning soldiers from
Iraq and Afghanistan. The Veterans' Affairs budget documents
projected that 23,553 veterans would return this year from Iraq
and Afghanistan and seek medical treatment. However, Veterans'
Affairs Secretary Jim Nicholson told the Senate Committee, now
there's been advised upwards from 23,000 to 103,000 for the
fiscal year that ends September 30.
In other words, more than four times as many soldiers are
coming back from Iraq and Afghanistan needing help in the VA
system. More than four times what the VA anticipated. This year
the VA will process 80,000 more Iraq and Afghanistan veteran
patients than expected. As surprising as that is, that actually
represents only 1.6 percent increase in the nearly five million
patients treated by the VA.
One might expect a system as big as the VA to be able to
absorb a 1.6 percent increase. But as Senator Obama said, we
have learned to our dismay, just last week, that the Veterans'
Administration is under funded by at least a billion dollars,
maybe a billion-and-a-half. After assuring us for months that
this was not a problem, they finally acknowledged that it is a
problem. They just don't have the resources to help our
veterans as promised. They have told us that the wait times
were null with the VA. That is not what we are hearing from
veterans. We understand the wait times need to be dramatically
improved.
Let me say, as well, that I am concerned about a lot of
people who are coming into the system. Roughly 1.1 million
American troops have served in Iraq and Afghanistan. Already of
the 360,000 who have been discharged, 24 percent, about one out
of four, have come to the VA for medical care. If that ratio
continues to hold and we continue with the military commitment
we have made overseas, we might see a VA patient increase
roughly three times the size of the one that caused the one-
billion-dollar shortfall.
We promised these men and women, if they would serve our
country and risk their lives, we would stand behind them when
they came home. We have to keep that promise. Our challenge for
the future is to not only meet the needs of the expanded
veteran population, but to make sure we never compromise the
quality of care for veterans in the system.
In the Senate, Senator Obama and I have joined together in
passing a $1.5 billion supplemental appropriation bill, which
was sent to the House of Representatives. It was a very
bipartisan bill. I don't think there was a negative vote. It
was an amendment offered first by Senator Patty Murray,
Democrat of Washington, Senator Santorum, Republican of
Pennsylvania. Came together in a bipartisan effort. 1.5
billion. Frankly, the speeches on the floor told the story.
They said before you go home for the Fourth of July parade, do
something for the veterans. And so we passed it.
It went over the House of Representatives where they cut
the amount to be added to the VA to around $950 million, a
pretty dramatic cut over the Senate figure, which we believe
the VA had made clear they need it. As we left Washington, it
was still unresolved between these two numbers. When we return
next week, that number has to be resolved.
We need to talk to the President about making sure the
budget is going to be accurate in the future, and we are
responsive. We need to make certain that we move forward on
mandatory funding for veterans' health care. We need to develop
legislation, as Senator Obama has said, to deal with post-
traumatic stress disorder.
I mentioned to Senator Obama that I had a series of
hearings around the State, and I have done this on many
different issues at many different times. I have never had a
more compelling hearing than those with the returning soldiers
from Iraq and Afghanistan. Some of the best and brightest in
Illinois and America, who come back with no visible scars, but
have invisible scars from some of the things that they have
seen and done and witnessed and gone through. They need
counseling. They need help, as do their families. If we don't
provide them help, the situation will only get worse. Of
course, we are pressing the VA to respond to the specific needs
in Illinois for our veterans, based on the Inspector General's
report.
As helpful as these actions may have been, there's a lot
more work to do. We listened to a lot of experts in Washington.
Today we are going to hear from the real experts, the veterans
of Illinois, and I thank Senator Obama for this hearing.
Senator Obama. Good. Thank you so much, Senator Durbin.
Our first witness is Mr. Stephen Herres, a veteran who's
experienced directly the disability benefit system and some of
its failings.
Mr. Herres, we very much appreciate your taking the time to
be here. If you could just introduce yourself and tell us a
little bit about your story.
STATEMENT OF STEPHEN HERRES, VIETNAM VETERAN
Mr. Herres. I am a Vietnam veteran and I proudly served my
country in the U.S. Marine Corp for 9\1/2\ years.
Before I begin my testimony, though, I would like to thank
my advocate, Mr. Alan J. Lynch, without whose many hours of
dedication and continued support, I would not be here today.
While I was on active duty, I had a safe fall on my knee
injuring it permanently, and in May 1974 my hands were crushed
between an aircraft tow tractor and a mechanical lift.
I filed a claim with the VA in March 1980 for my knees and
my hands, and I was awarded 10 percent disability on my knee.
Upon reevaluation without the actual exam, in 1981 the VA took
back the 10 percent that they gave me for my knee. With the
assistance of Senator Durbin's office in 2001, I was reexamined
and I was reinstated with the 10 percent on my knee.
In August 2002, I contacted Mr. Lynch. He advised that I
see an outside orthopedic surgeon, who ordered both an MRI and
bone scans on me. The VA's MRI found only an abnormal knee,
while the MRI of the independent doctor noted degenerative
joint disease throughout the knee, with nine points of
degeneration.
On my exam of March 18 at the Hines VA office, I brought my
bone scans for the VA to see. I thought I would be seeing a
doctor. A nurse practitioner, Karen Clark, saw me. She refused
to even look at the bone scan, stating that bone scans are
worthless and only her x-rays and her opinion mattered.
My case was sent to Washington, DC on appeal on April 27 of
2004. They returned my file to Chicago on remand in August of
2004. The remand, signed by Federal Judge Flowers, stated that
an orthopedic surgeon see me. My exam was scheduled September
21, 2004, and instead, I was seen by Physician Assistant
Terence Kenton, who did not follow the directions of the
remand.
On the Statement of Case of October 1, 2004, under the
evidence, it is stated that I failed to report for an exam on
August 4, 2004. I was never scheduled for an exam on August 4,
2004. At the assistance of Mr. Lynch, I was rescheduled in
accordance with the remand to see an orthopedic surgeon on
December 28, 2004.
The clear and unmistakable errors of the 1981
discontinuance of my disability on my left knee and the 1980
failure of the VA to process a claim for the crush wounds to
both hands, were returned to Mr. Olson on May 25, 2005 for
proper action. It was passed down through the chain of command
to a rating specialist that denied my entire claim. He ignored
all the documentation and evidence from the last 4\1/2\ years,
to even include the findings of the VA's own orthopedic
surgeon, dated December 28, 2004.
After referring back to the injury to the knee while on
active duty, she stated in her findings: ``Diagnosis:
Degenerative arthritis of the left knee.'' By denying the clear
and unmistakable error on my left knee, the rating specialist
would have you believe that my knee was completely healed and
then mysteriously came back after 20 years. The evidence and
the documentation proved just the opposite.
On the crush wounds to my hands, my military medical file
states, on November 14, 1974, ``Diagnosis: Patient has
arthritis to the joints of both hands from post-crush wounds.''
Referring back to the crush wounds received on May 9, 1974, the
VA's own orthopedic surgeon verified this condition in her exam
of December 28, 2004. She states in her diagnosis, ``post
traumatic arthritis of the MP PIP and DIP joints of the index,
middle, ring and little fingers of both hands.'' After more
than 25 years, the VA still refuses to acknowledge the crush
wounds to these hands. The deliberate arrogance and gross
incompetence of the rating specialist in the handling of my
case is indicative of and fostered by management at the highest
levels of the Chicago VA office. I am sure that there are many
honest, hardworking individuals working there. I am just as
sure that there are many individuals like the rating
specialist, who for many Illinois veterans and their families,
such as my wife and I, have suffered years of anguish and
hardship. This must not go unnoticed, nor without
repercussions.
Everyone in this room is indebted to veterans, past,
present, and future, for the freedom that they enjoy. No
veteran, when going to the VA for a disability claim, should
ever feel that he or she is at war. We have been there. We have
done that. For that, we have served our country honorably, and
we deserve and demand your respect. For that, for all the
positive changes that will occur at the Chicago VA office as a
direct result of today's hearing, in both personnel and policy,
on behalf of all Illinois veterans, present and future, and
their families, I extend to all of you their deepest gratitude
and their most sincere thanks. Thank you, gentlemen.
[The prepared statement of Stephen Herres follows:]
Prepared Statement of Stephen Herres, Vietnam Veteran
I am a Vietnam Vet. I proudly served my country in the United
States Marine Corp. for 9 yrs. and 6 mos. Before I begin my testimony,
I would like to thank my advocate Mr. Allen J. Lynch without whose many
hours of dedication and continued support I would not be here today.
1. Tell of (2) injuries received on active duty. Knee (Field Safe
security chain not in Place) Nov. 1969 Cherry Point., N.C; Hands (Crush
Wounds) May 9, 1974 Beaufort S.C.
2. Filed claim on March 31, 1980 for knee and hands.
Exam Sept. 19, 1980. Received 10 percent disability on knee.
3. Re-evaluated in Sept. 1981. The individual giving the exam said:
``Let me see your hands.'' I showed him my hands and he said he
didn't see any arthritis. He then told me to walk about 10, and back:
then replied: ``I don't see anything wrong with your knee.'' He asked
where I worked; I replied the Post Office. He then said: ``you have
good insurance and collecting disability would threaten your job.'' He
advised me to use my insurance and don't come back. Shortly after my
disability payment stopped.
4. Contacted Senator Durbin February 22, 2001.
5. On May 21, 2001 Mr. Vernon from Senator Durbin's Office said
that Mr. Heinz of the VA was still insistent that I never received any
disability from the VA and such a file simply does not exist. Mr. Heinz
stated that a thorough search was made and my file could not be found.
I had to prove that I had received a disability using my Form 15 U.S.
Civil Service Commission claim 10 point Veteran preference from my
personal file from my place of employment.
6. With Senator Durbin's assistance, it took 6 months for the VA to
schedule an appointment for an exam. The exam took place on August 7,
2001. Although the condition of the knee and wrists were confirmed on
September 5, 2001 and I was paid back to August of 2001, payment for my
knee was not received until March 26, 2002, and not received for my
wrists until February 15, 2003.
7. On August 22, 2002 I contacted Mr. Allen J. Lynch. He advised
that I see an independent doctor. I saw an Orthopedic Surgeon. He wrote
two orders, one for a MRI and another for complete bone scan. Although
the VA's MRI found only an abnormal knee; the independent doctor noted
degenerative joint disease throughout the knee 9 points of
degeneration. My personal physician wrote: Decreased handgrip and
deformity in the MP, and PIP joints.
8. After every exam I would return back to obtain a copy of their
report and write a letter of disagreement. The VA consistently
misquoted me and wrote their own version of the facts.
9. On my exam of March 18, 2003 I brought my bone scan for the VA
to see. I thought a doctor would see me. A Nurse Practitioner Karen
Clark saw me. She refused to look at the bone scan stating that bone
scans are worthless and only her x-rays and her opinion mattered.
10. My case was sent to Washington D.C. on Appeal April 27, 2004.
Washington returned my file to Chicago on Remand August 17, 2004. The
remand, signed by Federal Judge Flowers stated that I see an Orthopedic
Surgeon. My exam was scheduled for September 21, 2004 and I was seen by
Physician Assistant Terrence Kenton. He did not follow the directions
of the remand.
11. On the statement of case dated October 1, 2004 under evidence
it is stated that I failed to report for an exam on August 4, 2004. I
was never scheduled for an exam on August 4, 2004.
12. On October 15, 2004 Mr. Lynch contacted Mr. Keith M. Wilson,
Director Appeal Management Center in Washington, D.C. and Mr. Michael
Stephens, Veterans Service Center Manager, Chicago, IL on the August
4th issue.
13. On November 15, 2004, Mr. Lynch again contacted Mr. Stephens
requesting that another exam be scheduled in accordance with the
remand.
14. On December 28, 2004 I had another exam at Hines Hospital. I
was examined by an Orthopedic Surgeon.
15. The Clear and Unmistakable Errors on the 1981 discontinuance of
disability payments on my left knee and on the 1980 failure of the VA
to process a claim for crush wounds to both bands were returned to Mr.
Olson, Director of Chicago Office on May 25, 2005 for proper action.
Mr. Olton gave my file to Mr. Larry Rogers, Chief ACT Team; he in turn
gave my file to a rating specialist for rating. The rating specialist
denied my claim. Ignoring the documentation gathered over the last 4\1/
2\ yrs. To even include the findings of the VA's own Orthopedic Surgeon
of December 28, 2004. After referring back to the injury of the knee
while on active duty, she stated as her findings: ``Degenerative
arthritis of the left knee.''
By denying the clear and unmistakable error on my left knee the
rating specialist would have you believe that my knee was completely
healed and injury came back after 20 years. The evidence and the
documentation of the VA own Orthopedic Surgeon proves just the
opposite. On my crush wounds to hands; my military medical file states
on November 14, 1974 the diagnosis: ``Patient has arthritis to joints
of both hands from past crush wounds.'' Referring back to the crush
wounds received on May 9, 1974; the VA's own Orthopedic Surgeon
verified this condition in her exam of December 28, 2004.
She states: ``Post traumatic arthritis of the MP, PIP, and DIP
joints of the index, middle, ring, and little fingers of both hands.
After more than 25 years, the VA still refuses to acknowledge the crush
wounds to my hands.''
16. The rating specialist's deliberate arrogance and gross
incompetence in handling my case is indicative of, and fostered by
management at the highest levels of the Chicago VA Office.
I am sure that there are many honest hard working individuals in
the Chicago VA Office. I am just as sure that there are too many other
individuals like the rating specialist at whose cold and callus hands
many Illinois Veterans and their families have suffered years of
anguish and hardship. This must not go unnoticed nor without
repercussions. Every person in this room is indebted to veterans past,
present, and future for the freedom they enjoy. No Veteran while
pursuing a disability claim with the VA should ever feel that he or she
is at war. We have been there and served our country honorably. For
that; we have earned and demand your respect! For all the positive
changes in personnel and policy at the Chicago Regional VA Office as a
direct result of today's hearing; on behalf of all Illinois, Veterans
present and future and their families I extend their deepest gratitude
and most sincere thanks. Thank you, gentleman.
Senator Obama. Thank you very much, Mr. Herres, for your
eloquent testimony. We are going to go through all the
witnesses first, and then Senator Durbin and myself will come
back to you to ask some questions.
Next we have got Mr. Al Lynch, Chief Service
Representative, Vietnam Veterans of America. I should just
mention, I hope you don't mind me mentioning, Mr. Lynch, that
he is a Metal of Honor winner and somebody who has gone above
and beyond the call of duty with respect to protecting this
country.
Mr. Lynch.
STATEMENT OF ALAN J. LYNCH, CHIEF SERVICE REPRESENTATIVE,
VIETNAM VETERANS OF AMERICA, CHICAGO, IL
Mr. Lynch. Thank you. First, I want to thank you for having
this hearing today. I also want to commend the Department of
Veterans' Affairs at the Chicago Regional Office for the work
they have done to improve. Since 1998, I believe, they have
gone from fiftieth, the bottom of the stack, up to about 25, 23
in benefits returned. They have made a lot of progress. I must
say, too, that a lot of the problems that have been created at
the Chicago Regional Office are not really the fault of the
Chicago Regional Office. I wasn't made aware of this until a
few weeks ago.
Several years ago there was a major RIF in the Chicago
office. A number of people were laid off, clerks, typists,
adjudicators, rating specialists, and so on. The amount of
staff reduced, the workload didn't. That's why we have 21
percent of the cases being, I think they call it brokered out,
to other regional offices. The waiting times have increased at
the Chicago office as a result of this. If you want to look as
to why the Chicago office is having troubles with timeliness
and waiting times and so on, look to Central Office. They are
the ones that reduced the staff.
What I was told was that there is a 16 percent pay
differential for rating specialists and staff members of the
Chicago office. It's a lot cheaper for the VA to go to Arkansas
or wherever else, where the cost-of-living is low, and fully
staff those offices, at the same time reducing the staff at the
Chicago office. So much of the problem is not their fault.
However, year after year, those of us that are veteran
advocates have to deal with the same, it seems, the same small,
very small group of rating specialists who are consistent in
their inability to properly rate claims. This is something that
has gone on for as long as I have been there. I have been doing
this for 20 years as a veterans advocate, and we continuously
see the same names pop up and the same types of rating
decisions that are, frankly, viewed under the narrowest of
criteria. Even the Congress wrote the law that says that the VA
will administer the laws under a broad criteria, and yet these
few specialists view it under a very narrow criteria.
The problem is, when you have a regional office that has
had a shrinkage of the number of staff members, these few
rating specialists now do much more work under much more
pressure than they have ever had to do before. Consequently,
the number of cases that they do are increased, and so their
impact on the veteran community is increased. I would maintain
that there needs to be something done, as far as a
disincentive, for these rating specialists to be able to
continue on as they are.
Now, I don't know the inner workings of the VA. All I know
is what I see. When I see the same rating specialists sitting
in the same desks, doing the same job year after year after
year, that says to me that nothing is being done to foster a
change in attitude and a change in the way they rate. When I
see rating specialists, that we have come to know and love as
being the narrowest minded of rating specialists, being
promoted into areas of greater responsibility, team leaders in
the ACT team, maybe even DRO's, decision review officers, that
says to me that they are being rewarded for their narrow view
of the law. A law that you wrote to be broad in its
application.
I would submit that there must be some way of
accountability, individual accountability, on individual rating
specialists that continue to do this. When you have a remand,
an overturn rate, from the Board of Veteran Appeals that passes
60 percent up into 70 percent, I would suggest that there is
something drastically wrong with an office that allows that to
continue. Any office, not just Chicago, but any office. If we
had cars on the road, 60 percent of which were being recalled,
the auto manufacturer would go out of business.
I'd submit that a remand sent back to a regional office for
further work say that somebody didn't do their job effectively
before it was sent forward. I would submit that an overturn
rate, or an award rate, at the Board of Veteran Appeals, or
through the Court of Veteran Appeals say that there were some
mistakes made.
Now, there are disagreements. I have had very good rating
specialists that I have great respect for, who I have disagreed
with. I look forward sometimes, if I may, to their overturning
cases because I know I am going to be in for a real good fight.
Frankly, I enjoy my job quite a lot. I like a good fight and I
like to match my wits against a good quality rating specialist
that's done his job well.
Some of these I can't say that for. I know that I am going
to appeal as soon as I see the name on the rating decision, and
I know that I am going to win at the Board of Veteran Appeals.
This really needs to be stopped because these are people. These
are people that we are dealing with that have pain and
suffering, as you heard from Mr. Herres. His hands are all
gnarled. We have been trying for almost 5 years to get the VA
to do one simple thing, look at his hands. How can you not look
at his fingers and see them gnarled, and not know that he's
disabled as a result of that. We even sent them colored
pictures, and they failed to do it.
Three years ago, when we started this thing, I sent a very
detailed memo to the Chief Service Center Manager. I believe it
was Carrie Witty. With the whole idea of ``just take a second
look at this, just read the file.'' They didn't do it, and so
we ended up in appeal. This has to change.
Again, there's so many very, very good people at the
Chicago office that do a great job, but these few slip through
and they have a tremendous impact on the veteran community.
Thank you.
[The prepared statement of Alan J. Lynch follows:]
Prepared Statement of Alan J. Lynch, Chief Service Representative,
Vietnam Veterans of America, Chicago, IL
I am Allen J. Lynch, Chief Service Representative for the Vietnam
Veterans of America Illinois State Council I am also the Chief, Veteran
Rights Bureau, Office of Illinois Attorney General, Lisa Madigan. I
have been working in the area of veteran affairs since 1970 when I
started with the VA as a Veterans Benefits Counselor. I left that
position in 1979 to become the Chief Ambulatory Care at the North
Chicago VA Medical Center. In 1980 I became the Executive Director of
the Vietnam Veterans Leadership Program. Then in 1985 I became the
Chief of the Veteran Rights Bureau under then Attorney General Neil
Hartigan I have been the Chief of Veteran Rights bureau since that
time.
In 1991 I attended the VVA Service Representative School in
Washington, DC and became a VVA Service Representative a few years
latter I became the Chief Service Representative for the VVA Illinois
State Council. I also assist veterans with appeals as a part of my
position within the Attorney General's office. I am allowed to do this
because claims before the VA are not adversarial. Since becoming a WA
Service Representative I have handled numerous of claims before the VA
and the Board of Veteran Appeals. Most of the claims I assist with are
already in the appeal process.
Over the last several months the Chicago VA Regional Office has
come under fire for its ranking last in the amount paid out to Illinois
veterans in the form of compensation benefits. According to the
recently released IG report, this ranking is no longer the case and in
fact the Chicago office has moved from 44th in 1999 to 23rd in 2004.
This is a substantial move in ranking and one in which the Regional
Office should be proud of achieving. The Regional Office has also moved
up in the accuracy of the claims it processes--again a great
achievement and one that the staff of the Regional Office should be
proud of achieving. It is therefore a disservice to those who have
worked so hard to achieve these goals to be lumped in with those few
still within the Chicago Office who work at a substandard level.
Make no mistake there are still problems that need to be addressed
within the Chicago VA Regional Office. As a Veterans Service
Representative for VVA and in my position with the Illinois Attorney
General's Office I am well aware of the fact that there are still those
Rating Specialists within the Regional Office who consistently persist
in disobeying the law and its intent as written by you in the Congress
and further codified by the VA in the Code of Federal Regulations. The
best indication of how the VA is to govern its laws and regulations is
found at 38 CFR Sec. 3.102 Reasonable doubt which states in pertinent
part.
It is the defined and consistently applied policy of the Department
of Veterans' Affairs to administer the law under a broad
interpretation, consistent, however, with the facts shown in every
case. When, after careful consideration of all procurable and assembled
data, a reasonable doubt arises regarding service origin, the degree of
disability, or any other point, such doubt will be resolved in favor of
the claimant. (Emphasis added)
Yet there are still a few Rating Specialists who take it upon
themselves to disavow the law as you wrote it and as the VA codified it
in the CFR and who choose instead to apply the law under their own
narrow set of criteria that flies in the face of your and the VA
intent.
It is true that most of the employees of the Chicago Regional
office are capable, competent and work hard to administer the intent of
the law as codified in both the 38 U.S.C. and the 38 C.F.R. However,
that does not diminish the negative effect of those few Rating
Specialists who do not obey the intent of the law. The impact of just
one substandard Rating Specialist can impact thousands of veterans over
the course of his/her employment with the VA. If he/she spends 25 years
in the VA system rating claims and only rates one thousand claims a
year over 25 years he/she would affect twenty-five thousand cases. If
the Regional Office has three such raters seventy-five thousand cases
would be rated. These are under estimates and do not reflect actual
case work but are given as an example of the effect of those few who
choose not to obey the law as you wrote it.
PROBLEM DEFINITION
One may think that the Director of the Regional Office is at fault
for all the problems that have found their way into the press recently.
But upon review of the facts as given in the VA's IG report the
Regional Office started to turn the corner in improving its processing
of claims under Director Olsen. In point of fact problems within this
Regional Office go back well over 20 years and several directors and
several administrations both Republican and Democrat.
I believe one of the major causes of the problems in processing
claims at this office started several years ago when the Chicago office
suffered a drastic reduction if force. As a result of this reduction in
force those who were tasked with doing the ancillary work of claims
processing, i.e., inputting awards, developmental letters and other
such tasks were reduced in number. Under this reduction in force
skilled adjudicators and rating specialists were allowed to retire
without being replaced. This created an increased burden on an already
over burdened system. Recently, I was informed that the reason the
Chicago office is consistently understaffed is because of a 16 percent
cost-of-living pay differential given in Chicago and other large
cities. It seems, as I have been told, that it is just cheaper for the
VA to broker out cases to other Regional Offices than to fully staff
cities like Chicago. This ``going on the cheap'' by this and other
administrations has directly affected the ability of the Chicago office
to properly develop and adjudicate claims.
This reduction in force should in no way, however take away the
affect of the negative attitude of those few rating specialists who
persist in taking an arbitrary and capricious view of veteran's claims.
Those of us who serve as veteran's advocates know and can name those
rating specialists who consistently either ``tow ball'' ratings or deny
claims because of their own narrow view of the law and regulation. It
is very disturbing that the Regional Office has persistently allowed
these few Rating Specialists to continue in their positions even
promoting some into positions of greater responsibility.
The effects of those Rating Specialists who persist in their
negative and substandard work greatly affect those whose cases they
rate. We must never forget that these cases are after all real veterans
who are coming to the VA because they believe they are suffering
disabilities that occurred while they were in the military. I believe
it is important to relate the effects of poor rating decisions upon
those veterans affected. When a veteran's claim is denied
inappropriately it directly affects his/her ability to live. One
veteran in particular had to wait almost 4 years to finally win an
appeal for 100 percent. During that time he lived in a terrible
neighborhood. There were gunshots almost every night and he had to
sneak down alley ways to go to a local 24-hour store to get food. His
PTSD would not allow him to go out during the day so he hid in his
basement apartment and would shop for food at 2 o'clock or 3 o'clock in
the morning. Upon getting his 100 percent, he was able to move into a
better neighborhood and though his PTSD persisted his quality of life
improved.
There are many other such stories where the VA has caused veterans
undue hardship because of these few substandard Rating Specialists. One
man had his fingers crushed in an accident while in the military. Year
after year he complained to the VA about his fingers only to have them
completely disregard medical evidence that supported his claim. He even
sent them colored pictures of his gnarled fingers all to no avail. Most
recently he filed a claim for a re-evaluation and a clear and
unmistakable error. Only to have his claim again rated by one of the
few substandard Rating Specialists who simply ``top page'' adjudicate
and again denied the claim. We now have to go back into the appeal
process and spend anywhere from 1 to 3 years in the appeal process on a
claim that should have been awarded 20 years ago.
RECOMMENDATION
Rating Specialists must be held individually accountable for
inaccurate decisions. A simple system of reviewing for accuracy of the
original decision cases that are either remanded or overturned by the
Board of Veteran Appeals would be one way to accomplish this review. As
much as it is inappropriate to deny veterans compensation and pension
benefits because of personal biases it would be just as inappropriate
to award veterans who do not qualify for disability. Clearly there must
be some system put in place in which both awards and denials are
reviewed by an independent third party.
There must also be put in place a system whereby the rankings of
the various VA Regional Offices are monitored. Those who have
consistently low per capita awards should be reviewed for the
appropriateness of their decisions. Conversely those with consistently
high per capita awards should also be reviewed for the appropriateness
to those decisions.
There also need to be put in place a system that establishes
continuity for awards/denials. Where decisions in a court are based
upon precedent, decisions within the VA many times are not based upon
anything except the individual Rating Specialist's interpretation of
law and regulation. This is especially true in rating disabilities
where judgment is needed.
Finally the VA Regional Offices in major metropolitan areas need to
be fully staffed. The VA's attempt to short change those veterans in
States with major metropolitan areas by under staffing those Regional
Offices is a travesty and must be changed. Only when Regional Offices
are properly staffed will we see an increase in productivity and
effectiveness.
CLOSING
The Chicago Regional Office has come a long way in correcting how
it rates claims. I strongly suggest however that it continues to weed
out those substandard employees who persist in disobeying VA law and
regulation. I further call upon the Congress to force the VA to
properly staff the Chicago Regional Office and for that matter all
Regional Offices that are in major metropolitan areas. Veterans in
these States should not be short changed because of a cost-of-living
differential. Finally, I commend the Chicago Regional Office for all
the positive steps taken to improve its productivity and encourage it
to continue to improve its service to veterans.
Senator Obama. Thank you very much for that terrific
testimony.
Next we have Mr. Ronald Aument. Did I pronounce that
correctly?
Mr. Aument. Yes, sir.
Senator Obama. Mr. Aument is the VA Deputy Under Secretary
for Benefits. Mike Olson, Director of the Chicago VA Regional
Office, is accompanying him. My understanding is, Mr. Aument,
you're going to provide the testimony. Mr. Olson will be
available here for questions, along with yourself, when we get
to questions. Is that correct?
Mr. Aument. That's correct.
Senator Obama. OK. Please proceed.
STATEMENT OF RONALD AUMENT, VA DEPUTY UNDER SECRETARY FOR
BENEFITS; ACCOMPANIED BY MICHAEL OLSON, DIRECTOR, CHICAGO
VETERANS ADMINISTRATION REGIONAL OFFICE
Mr. Aument. Thank you, Senator Obama, Senator Durbin. Thank
you for the opportunity to talk with you today about a critical
benefit for veterans, disability compensation.
This morning I will discuss the issue of pay disparities
for disability compensation benefits, and the ongoing
initiatives of the Department of Veterans' Affairs to ensure
consistency in disability rating decisions. I will also provide
an overview of our efforts to support returning service members
and their families.
Consistency in disability evaluations and payments to
veterans has become a very visible concern in recent months.
When the issue of consistency was first raised, the Secretary
asked the Inspector General to review and evaluate the factors
that contribute to State variances in VA disability
compensation payments. The Inspector General published its
review report on May 19, 2005, citing a number of intervening
factors that influence variances in disability compensation
payments.
Several recommendations were included to address the
variance in disability compensation payments. Veterans Benefits
Administration concurs in the recommendations and has efforts
underway to implement those recommendations.
Considerable attention has been focused on the Chicago
Regional Office, its low average disability compensation
payment per veteran. However, when measured on an annual basis,
average payments on cases they cited in recent years have
increased, placing them above the national average, from years
2003, 2004 and this year to date.
Chicago Regional Office management has worked hard over the
past several years to improve the office's performance. These
changes began with the reinforced cultural attitude,
emphasizing granting benefits whenever possible. Aggressive
steps were taken to improve rating quality through increased
training efforts, routine local reviews, and regular feedback
to decisionmakers. The results of those actions are evidenced
by the increased average disability payments achieved over the
past 5 years, as well as marketed improvements in the quality
of the work.
Concern has been expressed that the staffing of the Chicago
Regional Office may not be sufficient to handle a significant
increase in claims, and that VA may not be able to provide
timely service to transitioning service members returning from
Operations Iraqi Freedom and Enduring Freedom. VBA is
addressing the staffing needs in Chicago through the assignment
of permanent and temporary staff.
As mentioned earlier, Chicago Regional Office has recently
hired five new staff members. Only this past week we have given
them additional authority to hire seven more staff members. We
will continue to monitor Chicago's workload demands and
staffing levels to ensure that it is staffed appropriately in
consistency within available resources.
To augment Chicago's claims adjudication staff, VBA has
assembled a team of five seasoned veterans service
representatives, all of whom are skilled in claims development.
The team members are focused specifically on processing claims
from veterans who have submitted new disability claims or
reopened their claims, as a result of the recent attention on
the variance issue.
The Chicago Regional Office's commitment is evidenced by
their efforts to improve performance and partner with State and
local organizations. While there are many improvements to be
made, we need to recognize the positive steps that have been
made to ensure quality services are provided to Illinois
veterans.
On June 8, 2005, VBA leadership and Chicago management met
with Mr. Eric Schuller, who is senior policy advisor to
Lieutenant Governor Pat Quinn, which resulted in development of
a pilot effort to provide alternate services to veterans at the
Illinois Department of Veterans' Affairs office in Springfield,
Illinois. This effort will enable us to provide increased
direct service to veterans in that part of the State.
In conjunction with the pilot, the Chicago Regional Office
will provide training to representatives from local service
organization posts who assist veterans with benefit claims. The
goal is to increase the knowledge of these community-based
representatives, who are widely dispersed throughout the State,
so that they can be more effective in their claims assistance
efforts.
Concurrent with our focus on consistency, VA is working
hard to ensure that military members have a seamless transition
from active duty to VA's benefits and health care systems. VA
employees provide services at 140 military bases, where they
can meet with and counsel service members about their VA
benefits, and assist them to file for those benefits as they
approach discharge.
VA has professional staff at the Walter Reed Army Medical
Center, the National Naval Medical Center in Bethesda, the
Landstuhl Army Medical Center in Germany, and other key
military medical facilities, to ensure that our wounded service
members are aware of their VA health care and benefits long
before they are discharged. We have implemented case management
procedures for seriously disabled service members of Operations
Enduring and Iraqi Freedom, to ease their transition to veteran
status, and ensure the coordinated delivery of benefits and
services. Every regional office and medical center has a
designated OIF/OEF coordinator who reaches out to and
communicates with injured service members, ensures that their
health needs are met and their benefits claims are processed
expeditiously.
The VA strives to honor each new veteran and their family
with compassion and dignity. Our challenge is to ensure that
all regional offices are generating consistently accurate and
timely decisions that provide the maximum benefits to which
veterans are entitled. Thank you, Senators.
[The prepared statement of Ronald Aument follows:]
Prepared Statement of Ronald Aument, VA Deputy Under Secretary
for Benefits
Senator Obama thank you for the opportunity to talk with you today
about a critical benefit for veterans--disability compensation.
This morning I will discuss the issue of pay disparities for
disability compensation benefits and the ongoing initiatives of the
Department of Veterans' Affairs (VA) to ensure consistency in
disability rating decisions. I will also provide an overview of our
efforts to support returning service members and their families.
REVIEW OF STATE VARIANCES IN VA DISABILITY COMPENSATION PAYMENTS
Consistency in disability evaluations and payments to veterans has
become a very visible concern in recent months. When the issue of
consistency was first raised, the Secretary asked the Inspector General
(IG) to review and evaluate the factors that contribute to State
variances in VA disability compensation payments.
The IG published its review report on May 19, 2005, citing a number
of complex and intervening factors that influence variances in
disability compensation payments. Several recommendations were included
to address the variance in disability compensation payments. VBA
concurs in the recommendations and has efforts underway to implement
them.
IMPROVEMENTS UNDERWAY AT THE CHICAGO REGIONAL OFFICE
Considerable attention has been focused on the Chicago Regional
Office's low average annual disability compensation payment per
veteran. However, when measured on an annual basis, average payments to
veterans in Illinois increased, development of a pilot effort to
provide itinerant outreach services to veterans at IDVA's offices in
Springfield. This effort will enable us to provide increased direct
service to veterans in that part of the State.
In conjunction with the pilot, the Chicago RD will provide training
to representatives from local service organization posts who assist
veterans with benefit claims. The goal is to increase the knowledge of
these community-based representatives who are widely dispersed
throughout the State so they can be more effective in their outreach
and assistance efforts.
ACHIEVING CONSISTENCY ACROSS VBA
Quality and consistency are goals that have been at the center of
VBA's efforts for the past 3 years. Achieving consistency and quality
in our regional office operations ensures veterans in every State
receive the benefits and service they have earned. Critical to our
success is our standardized work management model for claims
processing. Under the Claims Processing Improvement Model, veterans
service center employees in every regional office are aligned into
specialized teams designed to expedite claims processing, increase the
quality of decisionmaking, and ensure staff expertise.
Training, both for new employees and to raise the skill levels of
the more experienced staff, is obviously key to consistency in our
rating decisions. VBA deployed new training tools and centralized
training programs that support greater consistency. Training materials
and satellite broadcasts on the proper approach to rating complex
issues have been provided to every field station. Regulations that
contain the Schedule for Rating Disabilities have been revised to
eliminate ambiguous rating criteria and replace them with objective
rating criteria wherever possible.
Accuracy is monitored through VBA's Systematic Technical Accuracy
Review (STAR)--a centralized program that measures national accuracy
using statistically valid sampling. STAR findings are distributed to
field stations and shared with training staff for incorporation into
computer-based training modules, and other training tools.
Regional office operations are monitored continually to identify
areas where quality improvements can be made and processing
efficiencies can be realized. Site visits are conducted on a regular
basis to assess station management, operating performance, training,
and workload management. Training is provided by the site visit team as
needed.
OEFIOIF VETERANS
Concurrent with our focus on consistency, VA is working hard to
ensure that military members have a ``seamless transition'' from active
duty to VA's benefits and health care systems. VA employees provide
services at 140 military bases, where they meet with and counsel
service members about their VA benefits and how to file for those
benefits as they approach discharge. VA has professional staff at the
Walter Reed Army Medical Center, the National Naval Medical Center at
Bethesda, the Landstuhl Army Medical Center in Germany, and other key
military medical facilities to ensure our wounded service members are
aware of their VA health care and benefits long before they are
discharged.
We have implemented case management procedures for seriously
disabled service members of Operations Enduring Freedom and Iraqi
Freedom (OEFIOIF) to ease their transition to veteran status and ensure
the coordinated delivery of benefits and services. Every regional
office and medical center has a designated OEFIOIF coordinator who
reaches out to and communicates with injured service members, and
ensures their health needs are met and their benefit claims are
processed expeditiously.
CONCLUSION
VA strives to honor each new veteran and their family with
compassion and dignity. Our challenge is to ensure that all regional
offices are generating consistently accurate and timely decisions that
provide the maximum benefits to which veterans are entitled.
Senator Obama. Thank you very much.
Our final witness on this panel is Ms. Rochelle Crump,
who's the Assistant Director of the Illinois Department of
Veterans' Affairs.
Just for those witnesses who aren't familiar with how our
veterans offices are structured, the Illinois Department of
Veterans' Affairs is a State agency dealing with veterans, and
so is separate and apart from the Veterans Administration,
which is a Federal agency.
Ms. Crump.
STATEMENT OF ROCHELLE CRUMP, ASSISTANT DIRECTOR, ILLINOIS
DEPARTMENT OF VETERANS AFFAIRS
Ms. Crump. Yes. Good morning, Senator Obama and Senator
Durbin. I, too, would like to take this opportunity to thank
you for holding this hearing today.
In my opinion, there has been significant improvement
within the Department of Veterans' Affairs Regional Office, and
certainly I applaud the VA's willingness to look at cases and
make corrective decisions by stature of law. However, I am very
disappointed that it appears veterans are still having to fight
to get their benefits that they so duly deserve, for benefits
that they have not been awarded for the service that they
contributed to America.
The Department of Veterans' Affairs is still denying cases
individually by statute of human error or by resistance to pay
claims. Certainly, I would be one to just say that over the
years we have seen the increase in responsibility taken by the
VA to do better, but we still are not where we should be.
Different cases I could bring to you, and I will bring
those up, just to give you a scenario of two. A Gulf War
veteran, who served from 1985 to 1998, 1 year 2 months and 28
days, discharged honorably, filed for compensation. His service
medical records indicated that he had minor surgery in service
for the disability in which he was claiming. He was denied
because there was no current medical evidence, and the VA never
examined him, which would have made his actual case prevalent
to what he was actually claiming for.
Another one was a homeless veteran who was denied benefits.
He reopened his claim for post-traumatic stress disorder, and
they indicated there was no new evidence. However, there was a
doctoring statement from Hines Hospital indicating that the
veteran was unable to work because of his post-traumatic stress
disorder. He was denied benefits because they said there was no
new evidence. However, the VA did not prosecute duty to assist
by asking if there were any other medical records or treatment,
what type of treatment he was currently under, and there was
just no consistency in trying to help that veteran.
Overall, I just really think that we still have a lot of
work to do to help our veterans. Hopefully, over the weekend,
the Governor's initiative to host a supermarket of veterans
benefits on Saturday at Navy Pier would allow veterans to come
out and be better informed about how they can get assistance
through representatives.
That's what I am hoping to do, and I just thank you for
what you're doing for Illinois veterans.
Senator Obama. Thank you very much, Ms. Crump.
The way we will proceed, I will ask about 5 minutes worth
of questions. I will turn it over to Senator Durbin for 5
minutes of questions from him. Then we'll just keep on going no
longer than I would say about 15 minutes before we see the next
panel. If people can keep their responses relatively succinct,
I will try to keep my questions relatively succinct.
Let me just start with you, Mr. Herres, because I want to
make sure that I am clear on exactly what happened to you, as
just as an example of some of the problems that we are
experiencing.
From your testimony, my understanding is you have been
dealing with the VA system now for over 20 years, is that
correct?
Mr. Herres. That's correct.
Senator Obama. Your first claim was filed in 1980?
Mr. Herres. Yes, I first filed in 1980. I was awarded a
disability for my knee and nothing for my hands at that time.
Senator Obama. OK.
Mr. Herres. In 1981, I was called back for re-evaluation.
The gentleman that I had seen, I am not sure at this time, I
believe he was a doctor, said, the exam went like this: He
says, let me see your hands. He looked at my hands and says,
``I don't see any arthritis.'' He says, ``walk,'' and he says,
``I don't see anything wrong with your knee.'' He asked me
where I worked, I told him. He says, ``You have good
insurance.'' He says, ``Don't come back, I don't see anything
wrong with you.'' Shortly after, my disability for the 10
percent was discontinued.
Senator Obama. So, you had originally been awarded the 10
percent disability?
Mr. Herres. Yes, sir.
Senator Obama. After this examination in 1981, your 10
percent was eliminated?
Mr. Herres. Yes, sir.
Senator Obama. And, subsequently, you spent the rest of
this time trying to get that disability re-instated?
Mr. Herres. I have been going to civilian doctors and just
dealing with it on my own. At the urging of my wife, she says,
``Well, why don't you see if you can have something done,'' and
that's when I contacted Senator Durbin's office in 2001.
Senator Obama. OK. Senator Durbin's office in 2001, what
kind of assistance did they provide you?
Mr. Herres. They eventually contacted the VA on my case.
Mr. Michael Vernon was there. through the liaison, Mr. Hines,
the VA insisted that I never received anything from them in any
form of disability.
I had to prove this on my own, using my Form 15 U.S. Civil
Service Commission Claim 10 Point Veterans Preference, which
had my file number on it and my place of employment. Still Mr.
Hines refused to acknowledge that I ever did have a claim with
the VA. Yet, when I contacted Ms. Mambrido at Hines, all she
had to do was punch in my service number, my social security
number, and my entire file came up.
Senator Obama. OK. At that point it was established that
you had been awarded the claim?
Mr. Herres. Yes.
Senator Obama. That it had been discontinued, and is this
the point where Mr. Lynch then gets involved?
Mr. Herres. I contacted Mr. Lynch in August of 2002. Mr.
Lynch advised me to see an outside orthopedic surgeon, which I
did.
Senator Obama. Subsequent to that, with Mr. Lynch's
assistance, you were then able, finally, to get recognition of
your disability and a disability claim recognized?
Mr. Herres. Only on my knee. Finally, after years of going
back to the VA where they were supposed to look at the crush
wounds, they never did. Finally we appealed to Washington, DC.,
who sent it back on remand. Still, they have not acknowledged
it.
Senator Obama. At this point you still have no
acknowledgment from the VA that you have a service-related
injury to your hands?
Mr. Herres. Correct.
Senator Obama. OK. Mr. Lynch, you raised a couple of points
that I felt were interesting, so let me take them one at a
time.
The first was, your feeling just based on your regular
actions with the Chicago Regional Office, that the Chicago
Regional Office up until perhaps this year, and the dust up
surrounding this disability payments issue, has been
understaffed, is that correct?
Mr. Lynch. Absolutely. Since the RIF.
Senator Obama. Right. One of the justifications, at least,
that you've heard, it sounds like, for the reason that we are
understaffed relative to some other regional offices is the
fact that the Chicago cost-of-living is higher, and as a
consequence, a set amount of money goes to hire fewer rating
specialists here in the Chicago Regional Office, is that
correct?
Mr. Lynch. Absolutely, it's cheaper.
Senator Obama. I would assume then, that, in fact, the
regional offices are getting a flat amount of money? There are
no accommodations for the fact that the cost-of-living might be
higher in a place like Chicago, and so the Chicago Regional
Office might need to get a slightly higher allocation to
accommodate that, so that you would have the same number of
rating specialists per veteran as you would in any other region
in the country, is that correct?
Mr. Lynch. Well, what I was led to believe, it was not just
the number of rating specialists, but it's the person that
inputs the awards. Let me give you an example. Years ago, when
a veteran would be awarded, it would be about 15 days and he
would get an award letter and very quickly after that a check.
We now have a waiting period in some of our veterans of up to
30 days, 60 days. One we had that was 90 days after the award
was issued. That's absurd.
Senator Obama. Right.
Mr. Lynch. You see the problem is, once the award's made,
it has to be inputted into a computer. Somebody has to do that.
Somebody has to do the development of the case. They have to
send out letters and get other information. If you don't have
people to do that, that falls on the rating specialist who's
already overburdened in trying to rate the case and develop
medical evidence and so on.
You have a system where, you used to be able to send
something to an adjudicator or a clerk typist or whatever, to
get it done. Now it's being done by the rating specialist.
There's an overburden on them. Those that are not up to the
task, just find it easier to not do the job properly.
Senator Obama. Of course, my understanding is, well, one
example that you just used is the waiting period in terms of
getting checks after an award has been made. But we are also
seeing, from your experience, significant wait times just in
terms of having a claim processed in the first place.
Mr. Lynch. I had a case the other day, and I went up and
talked to somebody about it because I had not yet got a
Statement of Case, and it was almost a year old. I just
happened to have come across it in one of my file reviews that
I do, and I am like, well, where's the Statement of Case. I
went up and talked to the individual, he says, ``Well, it takes
about almost 300 days to get one out now.'' I don't know how
true that is, but that's what this person told me.
Senator Obama. What do you think would be a fair amount of
time, given your knowledge of the system, to process something
like a Statement of Case?
Mr. Lynch. A Statement of Case should come within 60 to 90
days, unless there's some more development that needs to be
done. It's not that hard to do, unless if you have to go out
and get more medical evidence and develop it and so on. Then,
you do have to do that. But to just act on a Notice of
Disagreement, if it's a flat Notice of Disagreement, you issue
a Statement of Case.
Senator Obama. Right. What should take 2 to 3 months is
taking potentially up to a year.
Just a couple of other questions. It struck me, based on
your testimony, that there are clearly some rating specialists
who advocates like yourself know are not doing the right thing
by the veterans. That there are ones who are begrudging, in
terms of acknowledging disabilities, and more importantly, who
objectively are overturned again and again at much higher rates
on appeal. Am I correct in saying that?
Mr. Lynch. That's been my experience. Yes, sir.
Senator Obama. OK. It is my understanding that rather than
seeing the Chicago Regional Office correct, retrain, or in some
way temper the amount of damage that these poor rating
specialists can do, instead they have been promoted in some
cases. They have gotten more caseloads. As a consequence, more
veterans are adversely affected by their poor decisionmaking.
Mr. Lynch. Exactly.
Senator Obama. Is this something that you and other
advocates have brought up to the Chicago Regional Office?
Mr. Lynch. Just hallway conversations, you know. We talk
amongst ourselves occasionally, and then the same names keep
popping up.
I am sure the Regional Office has been made aware of that
but, you know, again, they are still there.
Senator Obama. Mr. Aument and Mr. Olson, if you want to
chime in, feel free to do so.
Let's just start with that issue. It strikes me that, at
least among advocates, there is a sense that there are some
rating specialists that just aren't doing the job. It appears
that there's also some objective way of measuring whether
that's the case by reviewing the number of their cases that are
overturned on appeal. Am I correct about that?
Mr. Aument. Let me leave the discussion of the specifics on
Chicago, of course, to Mr. Olson. But I will say that we do
have national quality control systems in place that are
designed to bring more national level consistency, both at the
regional office and the individual level.
In some cases, though, it's a centrally managed and
conducted quality review, a system that uses sample cases
throughout the country. I will say that it gives us a very good
insight into the quality of the work product from any
particular office, but it is not an adequate sample size to be
able to evaluate individual raters.
Being able to do that that finely, hone in on that, there's
where we have to rely largely upon the management at the local
level to be looking at the quality of the individuals working
in their office. With that, I will turn to Mr. Olson.
Senator Obama. Mr. Olson, what about Mr. Lynch's
assessment? And by the way, this is not something that I have
heard simply from Mr. Lynch. I have heard before that the
Chicago Regional Office may have rating specialists who seem to
be repeatedly overturned on appeal. These raters seem to be
extraordinarily stingy when it comes to awarding of benefits.
The awarding of benefits, as Mr. Lynch indicated, should be
viewed in the broadest possible terms as opposed to the
narrowest possible terms. But, from what I have heard, it
doesn't appear as if there's any accountability or mechanisms
whereby those rating specialists who appear to be a problem are
retrained or shifted from their position. I am wondering if
that's something that you want to comment on.
Mr. Olson. Let me say that I respectfully disagree with Mr.
Lynch on specifics. Let me tell you what we have done to
improve the quality of the decisionmaking within the Chicago
Regional Office.
We have assigned two of our best individuals to review
cases as they are completed, before they are promulgated, to
assure that they are done correctly and accurately. If not, the
immediate feedback is given to the decisionmaker and
corrections are made, if necessary.
I will say that within the last couple of years we have
improved our quality 19 points, from a quality level of 72,
which we were not at all proud of, to a quality level of 90
percent right now. Twelfth best in the country, in terms of the
quality of decisionmaking within the rating scheme. It's a
subjective interpretation of the law in many cases.
Senator Obama. Let me interrupt you there, just real quick.
What I am hearing, I guess, is that there may be certain
experienced raters who are repeatedly overturned on appeal. If
somebody has an appeal rate of 60 or 70 percent, that would
indicate potentially that there's some significant problems
there, would it not?
Mr. Olson. Let me say that none of the service officers
have come to me and said you have a problem with X Rater.
Nobody has come to me and said Mr. Jones is consistently
overturned on VBA's.
Senator Obama. But that's not surprising, right? I mean the
service officers are going to be appearing before these same
rating specialists. They are not going to complain to you in a
way that might leave them or, more importantly, their clients
open to retaliation.
The question is, Is there some sort of internal mechanism
within the office that's reviewing and saying, ``You know what,
it looks like this guy is repeatedly overturned, and that
indicates a problem, and let me investigate why that's taking
place''?
Mr. Olson. We aren't finding that. We aren't finding
individuals consistently overturned. I will talk with Al Lynch.
I will talk with the other service officers and ask for
specifics, if they have specifics.
Senator Obama. Are those records kept and available for
public review, the degree to which particular specialists may
be seeing their cases appealed, and then overturned on appeal?
I am assuming that those records, you must keep them, right?
Mr. Olson. I don't believe we have those stratified by that
way.
Senator Obama. You don't keep them that way?
Mr. Olson. No.
Senator Obama. Is there a reason why that would be the
case? I mean, we are in a judge's chamber. I know that the
judge is here. Lifetime appointee Federal judges, there are
statistics that are kept as to whether or not a judge is
repeatedly overturned on appeal. There's a chief judge who's
going to be monitoring that to ensure that at some level
there's consistency in decisionmaking, and there are no
problems with a particular judge. Why wouldn't we do that with
a rating specialist?
Mr. Aument. Possibly I can answer that, Senator.
As I mentioned before, we do tend to keep the statistics on
a national level as far as the office performance. Probably
less with respect to the instances in which they are
overturned, because the Board of Veterans Appeals, when they
are looking at cases, they look at them de novo. The cases that
come to them, almost invariably will contain evidence that was
not looked at by the regional office when they originally made
their decision.
But one of the things we look at very, very carefully are
the instances in which a case has been remanded back to the
regional office, often for inadequate development purposes. The
fact is that we find that in many cases to be more troubling,
if we believe that the regional office has not done a good job
in developing the case. We tend to look at that pretty
carefully.
Senator Obama. Fair enough. One last question, and then I
will turn it over.
There has been obviously some significant discussion about
this discrepancy between disability claims here in Illinois
versus other States. Secretary Nicholson has been responsive.
We appreciate his response, and your office's response. My
understanding is you've already hired five additional rating
specialists and, perhaps I heard correctly that today you're
going to hire an additional seven, assuming----
Mr. Aument. Actually we hired six more already, sir. We
plan to hire six more. We have given them authority to hire six
more.
Senator Obama. Potentially we have got 12 new rating
specialists, and that should help us. I am concerned about how
we are dealing with not only current claims and, Mr. Olson,
it's clear that there has been improvement. I think everybody
acknowledges there's been improvement in the Chicago office on
this front, and we are not saying Illinois ranking fiftieth in
new claims. We are now in the middle of the pack, maybe even a
little bit above that, and that's terrific.
But one of the concerns that I have is what's happening
with somebody like Mr. Herres, and my understanding is, that
there may be a distinction between reviewing cases and
reopening cases. That in one circumstance, somebody like Mr.
Herres has to go through the entire process that he's already
endured, all over again. I still don't understand why no one
has just not looked at his hands.
In contrast, in a review a veteran could come in some
expedited fashion, have that file reviewed, and get prompter
action. I am wondering if you can speak to me a little bit
about whether given these additional resources, we are going to
be able to deal not only with new claims in a more effective
fashion, but whether we are also going to be able to look back
at people like Mr. Herres who may have been dealt with
unfairly, to assure that they are not having to wait another 20
years to get their claims adjudicated.
Mr. Olson. Let me say that those people who have come to us
and asked for a review of their claim, we have made personal
contact with them to get specific information about where they
have a disagreement or where their disability has increased in
severity. So that we have a basis on which to further develop
that claim and help that veteran provide us evidence that will
allow us to further grant benefits.
Senator Obama. How are we reaching out to those veterans?
How do they know to get in contact with you, that this may be
available?
Mr. Olson. Mr. Aument mentioned the outreach effort that we
have with the Illinois Department of Veterans' Affairs. We have
regular meetings with the VSO's asking them to outreach to
their folks.
A number of people have come to the service officers in our
building, asking that their files be reviewed, and the service
officers are working with them to make sure that the benefits
that are appropriate have been granted. If there's an increase
in disability, they help them file a claim for an increase in
disability. We are working closely with the service officers to
attempt to reach as many people as we can.
Senator Obama. I am still not clear about the distinction
between a review and a reopening of a case, and how those
decisions are made. My understanding is there is a difference.
I may be mistaken about that. One could conceivably take much
longer than the other, or is this a distinction that doesn't
exist?
Mr. Aument. I am not sure that is a distinction, Senator.
A reopened case, is a characterization of a case in which
the veteran has come to us either telling us that their
condition has worsened or asking that their case be reviewed,
because their evidence may not have been adequately considered
when it had been looked at previously. Roughly two-thirds of
the workload that we see coming to us consists of re-opened
cases. You know, we expect this year to receive around 800,000
claims nationally. The statistics on those are that roughly
two-thirds of those will consist of re-opened claims.
Review, of course, then, is the process that takes place
once we have actually received the request from the veteran,
that their claim be reviewed.
Senator Obama. I would like us to see what we can do with
respect to Mr. Herres. He's been waiting a long time. My hope
would be that, if nothing else came out of this hearing, that
at least he would get some sort of prompt attention.
Let me turn it over to Senator Durbin. I appreciate my
senior Senator's patience.
Senator Durbin. Thank you very much.
Mr. Herres, when you came to my office, Michael Vernon
helped you?
Mr. Herres. Yes, sir.
Senator Durbin. Michael Vernon has since left my office,
graduated from the University of Illinois Law School, and
passed the bar exam. And you're still looking for help from the
VA.
Do you have any idea how much time has been involved since
you first contacted our office? I thank you for your
persistence, and I am glad you're here today to tell your story
because it really puts a face on a lot of statistics and a lot
of anecdotes. Thank you for your service to our country, as
well.
Thanks to Al Lynch, because we know from the Inspector
General's report that if veterans like Mr. Herres walked into
the VA alone, they are not as likely to be successful. I have
forgotten the exact number, was it 50 percent?
Mr. Lynch. Fifty percent.
Senator Durbin. Fifty percent difference if they have an
advocate by their side like yourself. They do much better than
if they go in alone, which is a sad commentary on the Veterans
Administration. Because I think the quote that you'd made from
the law makes it clear that this is supposed to be an agency
that broadly interprets the law to help the veteran. It's
supposed to be erring on the side of the veteran. It certainly
didn't do that with Mr. Herres, and I think you see a number of
cases along these lines from what you've testified.
Now, it's not in your written testimony, but you spoke
about the frequency of reversing on appeal, and I would move
the figure 60, 70 percent. Now, you've made it very clear and
we should make it very clear that the majority of people
working at the VA are not the problem. They are doing a good
job and working hard under difficult circumstances. But there
are some who you suggest are consistently overruled on appeal.
Can you tell me again what that number was, so it's clear in
the record?
Mr. Lynch. The last figure I got, that it was, and I am not
going to give an exact one because I am not really sure of it,
but I know it's over 60 percent of the cases that go to the
Board of Veteran Appeals. They are either remanded or
overturned by the BVA.
Senator Durbin. And what does that tell us? Does it tell us
that there are rating specialists who don't get it right?
Mr. Lynch. It tells me as a veteran's advocate, if I get a
remand, and many times, and, again, I am only speaking from my
own personal experience. As an example, I will let a rating
specialist know through a memorandum or letter, what have you,
from the veteran that, you know, he was not seen by a doctor,
it was a physician's assistant, and ask for re-examination.
Sometimes that doesn't happen.
A physician's assistant, nursing assistants cannot make
medical opinion. They can examine things as far as range and
motion, but they can't opinion as to what causes things to
happen. When I get an opinion from one of those, I usually let
the rating specialist know that you can't base the rating, the
decision on an opinion of a nurse practitioner or a physician's
assistant.
A lot of times I will have a memorandum go forward where an
examination is over a year old, in a case like of a Notice of
Disagreement or an appeal that is languished at the regional
office for an extremely long period of time. Ask for a new one.
Many times those are ignored. It just varies case by case.
Sometimes there's new evidence that gets ignored.
Senator Durbin. We'll go to the point Senator Obama raised.
Is it well known which rating specialist or particularly
hardened veterans that have a higher incidence of overturn on
an appeal?
Mr. Lynch. I think if you would ask any service officer
within the Chicago office and, off the record, informally, who
they were, I think you would probably find the same names
consistently come up.
Senator Durbin. Are we talking about 5 people, 10 people,
more?
Mr. Lynch. I think it's probably more around four, five, or
six people that are consistently marginal. We all have our
favorites that we disagree with.
Senator Durbin. Out of how many? Out of a pool of how many?
Mr. Lynch. I really don't know how many rating specialists
they have right now.
Senator Durbin. Mr. Olson, how many do you have?
Mr. Olson. Thirty-five.
Senator Durbin. There are four or five that would say, as
an advocate, you take care to try to avoid? It's like picking
the wrong judge.
Mr. Lynch. Well, it's done by terminal digit of a number,
so if they happen to fall into this person's lot, I know that I
am going to have a rough time with the case. It's just
automatic. I know if I get this certain rating specialist, or
whoever, that we are probably going to end up in appeal
because----
Senator Durbin. Mr. Olson, you're not aware of this
phenomenon at all? That there are several of your specialists
who are giving the veterans and the advocates a tougher time
and having a higher rate of being overturned in appeal? You're
not familiar with this?
Mr. Olson. I am not aware of any data that shows us that a
specific rating specialist, or rating VSR, has been
consistently overturned by the Board of Veterans Appeals.
Senator Durbin. We are at a disconnect between you and Mr.
Lynch. It sounds like you're working with two different offices
here. I don't understand why there wouldn't be more of a dialog
and communication between the VA and the veterans advocates, so
that there's at least some conversation that leads to this
statement of the law that says we are on the side of the
veteran together. It isn't an adversarial situation. We are on
the side of the veteran together here.
Mr. Olson. Yes, we are.
Senator Durbin. But it seems like there's some dialog
missing here, some conversation missing.
Mr. Olson. I would say that we have regular monthly
meetings with service officers where we can bring up any issue
that we want to on the VA side. Service officers can bring up
any issue they want.
Mike Stephens, our service center manager, has an open door
policy, and service officers regularly come to him on
individual cases where there is a difference of opinion between
a service officer and rating specialist. Mike will sit down and
talk with the service officer. Mike will sit down with the
service officer and the rating specialist to come to an
understanding. Sometimes that is an agreement to disagree, like
any other decision that involves some judgment.
People have not come to me, not one single veteran service
officer has come to me and said Mr. Jones, Rating Specialist
Mr. Jones consistently is overturned by VBA and I consistently
have arguments with Rating Specialist Mr. Jones. That has not
happened.
Senator Durbin. First thing, going back to Senator Obama's
question, the first point about whether they are consistently
overturned would seem to be something that you ought to know
already. That should be a matter of record, shouldn't it? If
one of your rating specialists is consistently overturned?
Mr. Olson. I would say that I am not aware of it. I am not
aware of any of our rating specialists being consistently
overturned. I would think if that happens I should be aware of
it. Because it's stated doesn't make it a fact.
Senator Durbin. Well, Mr. Lynch, would you like to respond?
Mr. Lynch. There's one simple way to prove whether it's
right or wrong and it's really, I would think, very easy to do.
Every rating specialist is assigned a certain number of cases
by terminal digit. If you can track it on the gross, why can't
you track it on an individual? You have a rating specialist
that signs off on a case, and it goes forward to the Board of
Veteran Appeals. How hard is it to track what happens to that
particular case?
We have computers. You plug it in. You work up a data base.
If it comes back on a remand, it would pop up that Rating
Specialist Jones handled this case. A certain person in the ACT
team handled it next, and a certain other person, a DRO handled
it after that. It still was overturned.
Senator Durbin. Mr. Olson, that doesn't sound unreasonable.
That doesn't sound unreasonable.
Mr. Olson. Let me say that I will meet with Mr. Lynch this
week and talk specifics. I will meet with the other VSO's in
the building, talk specifics about what their complaints may
be. Try to get some exact numbers and some cases that are
representative from their perspective of rating specialists who
are not doing their job.
Senator Durbin. All right.
Mr. Olson. And we'll develop whatever data we can to----
Senator Durbin. Let's work on that. I think developing that
data would kind of get to the bottom of it.
The last thing I want to say before I turn it back to
Senator Obama, Mr. Lynch, you made a point of the deadlines, or
at least the timeliness involved in some of these. Like, the
Statement of the Case that you thought should take 60 to 90
days and takes almost a year, or 10 months I guess. Three
hundred days is what you suggested.
I assume that there are other mileposts along the way
evaluating a disability claim, as to how quickly there's
response. Now, from the Veterans side, there may be medical
information that has to be provided and it takes some time to
get the appointment, bring doctors reports together and such.
But what I am getting to is this: You've made a point that
you think the RIF, the reductions in force of employees has
caused part of this problem. There are not enough people to
handle the work at the regional office. Some of it's being
farmed out to areas that are cheaper for the VA, because the
employees aren't paid as much.
Can we talk about these mileposts and these quality
guidelines to determine what is a reasonable time for the
Statement of the Case to come forward? And then really hold the
VA accountable and say, ``Well, how frequently do you miss
that? How frequently does it take 10 months instead of 2 months
to do a Statement of a Case? Would it be possible for the
service organizations, on behalf of the veterans, to tell us
where these mileposts are and what they think the time
guidelines might be for each one of them?''
Mr. Lynch. I think it would be reasonable to do that. The
problem that we had is under Secretary Principi, he had a
certain number of reports that were due. In our office, what we
noticed was the number of denials went up at the end of the
quarter when reports were due.
What we have is we have a push to get the job done, and
when I push someone, you know, it's the old saying of do you
want the job done now or do you want it done right. I would
rather have the writing specialist do the job right and get it
done properly than to get it done now and we have to spend 2
years in appeal.
Senator Durbin. So, the speed of the initial, the timing of
the initial decision, whatever it might be, Statement of the
Case and such, is less of a concern to you?
Mr. Lynch. Provided they are doing the job properly. I
don't want a hurried job.
Senator Durbin. I see.
Mr. Lynch. Personally, I don't want a hurried job.
When I go to appeal or when I get a denial, I want to know
that every piece of evidence was considered properly.
The law says, in the code of Federal regulations, that you
have to consider all the evidence in the entire record. Many
times they do what we call top page adjudicating, go down the
first couple of inches, look at the last couple decisions, and
move on to continue with the denial, as opposed to looking at
the whole record. That has to stop.
But, again, you have to understand that you have a rating
specialist with 150, 200 cases more that he's got to get
through. You've got somebody from Central Office, who has no
clue of what they are doing on their desk, how long it takes to
process a case, telling them get the job done, get the job
done, get the job done, make me look good. You can't overburden
people like that.
The other problem is you've got rating specialists that do
an excellent job, but there's no incentive for them. They see
year after year--I had one guy that retired recently that told
me, I don't get any incentives any more. I am at the top of
everything I can get. No matter what I do, I am there. There
has to be something.
You know, private industry has many incentive ways of
helping people to do a better job and encouraging them to do a
better job. The government doesn't do that. You have many good
people that are very, very frustrated because it's just more
and more work, more and more stuff, more and more pressure,
more and more get it done, more and more do this, more and more
do that, by someone in Washington who's never even seen a claim
file.
Senator Durbin. Mr. Aument, I will just close by saying, I
know you're in a delicate position. You're supposed to come and
defend the VA budget, hell or high water, and I have heard so
many people from various administrations, Democrats and
Republicans, in that same position.
But it strikes me that the acknowledgment of Secretary
Nicholson of the need for more personnel in this office was not
only responsive to our request, but responsive to a real need.
I hope that you will listen carefully to Mr. Lynch and others,
and go back and take a look as to whether or not there are
adequate personnel for the long haul in this office. If you
need help on the Senate side, Senator Obama and I will be there
to help your agency. Thank you.
Senator Obama. Well, thank you very much, Senator Durbin.
This panel has been outstanding. I appreciate everybody taking
the time.
Just a closing thought for Mr. Aument, as well as Mr.
Olson. Many good suggestions have been made here, and I think
the Chicago Regional Office should be proactive and not simply
reactive, with respect to some of these recommendations.
I appreciate, Mr. Olson, your suggestion that you're going
to meet with Mr. Lynch and other service organizations. But it
sounded to me just in your posture that you were going to meet
with them and have them prove that there's a problem. I guess
my suggestion would be that you should see this as an
opportunity to improve the management of your office.
If there are people in that office who are not doing
outstanding work, and if there are ways of us collecting data
to evaluate how the work is getting done, that shouldn't be
something that you wait for the VSO's to approach you and
prove. That should be something that's incorporated into the
day to day management of the system.
It sounds like some of that is being done, Mr. Aument, at
the national level, using sampling. It strikes me, though, that
the rubber hits the road in the regional office and that there
should be some mechanisms whereby those regional offices can
evaluate and incentivize good performance at a local level.
Let me just, again, reiterate. I would really like to see
somebody speak directly to Mr. Herres and his advocate, to see
if after 20-plus years he can get a resolution of his claim.
Thank you very much all of you. Before we move to the next
panel, I just want to acknowledge that we are in the chambers
of Chief Judge Corcoras, who happened to just walk in. I have
to say, Chief Judge, that these chambers are much nicer than
the Senate hearing rooms. It's good to know.
Chief Judge Kocoras. Use them wisely.
Senator Obama. Absolutely. Thank you very much.
If we could have the second panel join us?
Senator Obama: OK, thank you very much.
Excuse me. For reporters, if you guys can do me a favor,
because we have a second panel, if you can go out in the hall I
am sure Mr. Lynch and Mr. Herres and others will be happy to
answer your questions.
All right. We have got a second panel that's going to be
discussing health care needs of returning veterans.
I should say in advance Senator Durbin's going to have to
leave probably midway through some of the testimony. That's not
his fault. It's just a scheduling conflict that we have, so we
are going to try to be as quick as possible. I won't repeat any
opening statements. We'll go straight to you.
Why don't we start with Mr. Joseph Petrosky, who's the
Director of Veterans Affairs and Rehabilitation Office with the
American Legion.
Mr. Petrosky.
STATEMENT OF JOSEPH PETROSKY, DIRECTOR, VETERANS AFFAIRS AND
REHABILITATION OFFICE, THE AMERICAN
LEGION
Mr. Petrosky. Thank you, Senator Obama and Senator Durbin.
The American Legion and the American Legion of Illinois
want to thank the Committee for allowing us to comment on the
appearance of VA health care for our returning Operation Iraqi
Freedom and Enduring Freedom military personnel.
Many of these personnel coming home are expected to be
discharged at the end of their tours. Many of our returnees are
not active duty, but are members of the Reserve and National
Guard. They are veterans by virtue of their Federal service.
Do these Illinois veterans use the Department of Veterans'
Affairs medical centers? The Department of Veterans' Affairs
states that they are manned and prepared. Some of these facts
may show that they are not as prepared for our returning
heroes. We need to always remember that we have seen news
reports of many of our troops who have been coming home and
asking for health care.
These homecoming veterans have already reported to service
organizations that they have tried to enroll in the VA health
care. The directors of these facilities advise that they
welcome these veterans with open arms. They, the medical
facility employees, use the VA priority category enrollment
system to screen the veterans for their eligibility.
The VA new enrollment veterans who fall in priority eight
may be turned away. What happens to the 2-year free health care
period by the VA? These veterans are frustrated because they
are told that they will be allowed to use the VA care facility
for 2 years after returning from service.
There are several factors that were working against these
homecoming veterans before they went to war. The VA had several
studies to determine how to properly utilize their facilities.
These studies started with the general accounting office in the
early 1990's, and the last study of the Capital Asset
Realignment for Enhanced Services (CARES) Options Study,
conducted by Booz-Allen & Hamilton, which was completed in June
2001.
The Booz-Allen & Hamilton executive study stated that the
results of the studies are yield and many details are for
consideration. One of the things that's important is the
enrollment demands projected show that the peak, in about 2004,
and that a decline of about 7 percent from today's level, 2000
and 2001. 220,000 enrollees in 2000 versus 203,000 enrolled by
2010. Now, this is before we even went to war. They are looking
at a decline of 18 percent in categories one through six.
Some of the characteristics of the studies were Westside,
now Jesse Brown VA Medical Center, is to renovate and service
as a single inpatient facilities of 177 beds. Lakeside
Inpatients are discontinued. The property is sold or used in an
enhanced use arrangement. Hines is renovated. New blind center
building. SCI renovation. North Chicago's renovated into a DOD
Joint VA venture. All four sites providing an extensive array
of multi-specialty ambulatory care facilities.
We need to consider health care of our now returning
troops. Lakeside is an outpatient clinic for now and operates
on just a few floors. Westside was approved and planned for the
total of 177 beds. Construction has not been started as of yet.
Hines has a new blind center and spinal cord unit, and ready
for homecoming military personnel. The Joint DOD VA venture is
operating strongly up in North Chicago.
We must remember the promises we made to our living
veterans from all other wars and conflicts. Modern medicine is
keeping us alive longer and we are not dying off fast enough to
suit Congress. Many older veterans of World War II, Korea, were
not sick when they returned from service. They were successful
in life, and now they are not entitled to VA health care due to
the lengthy procedures of the qualifying VA compensation and
pension benefits.
In priority eight, they may make too much money, they may
be very successful, but to be enrolled for health care they
have to be in one of the higher categories (priority 1-7). In
many cases, they are filing service-connected claims just to be
able to get in the VA health care.
The American Legion supports mandatory funding of VA health
care in the 109th Congress. The American Legion will closely
monitor the progress of H.R. 515 in the House of
Representatives and Senate bill 331 in the Senate. The Veterans
Administration budget is mandatory. Why isn't the Veterans
Health Administration treated the same way? Both of these
budgets support the same heroes who have gone off to war for
this nation.
Remember, after the parades and victory speeches are over,
we still have ill and injured veterans trying to continue
treatment and rehabilitation into our society. Mr. Chairman, it
is disturbing that the homecoming heroes must wait for
treatment when the Nation did not wait to send them to war.
The American Legion thanks you for the opportunity to
comment on this matter.
[The prepared statement of Joseph Petrosky follows:]
Prepared Statement of Joseph Petrosky, Director, Veterans Affairs
and Rehabilitation Office, the American Legion
Mr. Chairman, the Honorable Senator Barack Obama:
The American Legion and The American Legion Department of Illinois
wants to thank the Committee for allowing us to comment on the
preparedness of VA health care for our returning Operation Iraqi
Freedom and Operation Enduring Freedom military personnel. Many of
these personnel coming home are expecting to be discharged at the end
of their tours. Many of our returnees are not active duty, but are
members of the Reserve and National Guard. They are U.S. veterans by
virtue of their Federal service.
Do these Illinois homecoming veterans use the Department of
Veterans Affairs Medical Centers? The Department of Veterans' Affairs
(VA) stated that they are manned and prepared. Some of these facts may
show they are not prepared for our returning heroes. We need to also
remember that we have seen news reports of many of our troops who have
been coming home and asking for health care.
These homecoming veterans have already reported to Veterans Service
organizations that they have tried to enroll in VA health care. The
Directors of these medical facilities advised that they welcome these
veterans with open arms. Many of the medical facilities employees used
VA's Priority Categories Enrollment System to screen these veterans for
their eligibility. The VA's new enrollment veterans who fall under
Priority 8 veterans were turned away. What happened to the 2-year free
health care period that was implemented by the VA? These veterans are
frustrated because they were told that they would be allowed to use VA
health care for 2 years after returning from service.
There are several factors that were working against these
homecoming veterans before they went to war. VA has had several studies
to determine how to properly utilize their facilities. These studies
started with General Accounting Office in the early 1990 to the last
Capital Asset Realignment for Enhanced Services (CARES) Options Study
conducted by Booz-Allen & Hamilton which completed in June 19, 2001.
The Booz-Allen & Hamilton Executive Summary1 states:
The result of these study areas yielded many details for
consideration. For the purposes of this summary however, there are
three important points. They include:
The enrollment demand projections show a peak in about 2004 and
then a decline of about 7 percent from today's level (2000-2001)
(220,000 enrolled in 2000 vs. 203,000 enrolled in 2010).
An 18 percent decline in Categories 1-6 (from 158,173
enrollees to 130,314 enrollees from 2010).
An 18 percent increase in Category 7 (from 61,877
enrollees to 72,595 enrollees in 2010)
Categories 1-6 have highest utilization, composing
approximately 95 percent of inpatient population.
VISN-wide approximately 18.5 percent of veterans
are enrolled.
Because many of VISN 12's facilities are old, they
do not meet today's design standards for privacy,
accessibility, and usability.
VISN 12 is segmented into three markets based upon
population concentration, distance to VA facilities, and other
characteristics.
This characteristics study were:
West Side (now Jesse Brown VAMC) is renovated and services as the
single inpatient facility for Chicago (177 beds)
Lakeside inpatient services are discontinued. The property is sold
or used in an enhanced use arrangement.
Hines is renovated, new Blinded Rehab building, SCI
renovated, maintains mission.
North Chicago is renovated, DOD sharing or a joint VA-DOD
facility.
All four sites continue providing an extensive array of
multi-specialty ambulatory care services.
We need to consider the health care for our returning troops now.
Lakeside is an outpatient clinic for now and operating with just few
floors of the building. Westside (Jesse Brown VAMC) was approved and
planned for a bed tower with 177 beds. Ground clearing has been
completed but construction has not started as yet.
Hines' new Blinded Rehabilitation and Spinal Cord building is now
open and ready for homecoming personnel. North Chicago now has a joint
venture between DOD and VA.
We must also remember the promises made to our living veterans from
all of our other wars and conflicts. Modern medicine is keeping us
alive longer and we are not dying out fast enough to suit Congress.
Many older veterans of World War II and Korean War were not sick when
they returned from service, were successful in life and now are not
entitled to get health care due to the lengthy process of qualifying VA
Compensation and Pension benefits.
The American Legion will stay ever vigilant, as we are involved in
the other CARES decisions for the other VA facilities that veterans are
expecting to access. The American Legion supports mandatory funding
legislation for VA health care in the 109th Congress.
The American Legion will be closely monitoring the progress of H.R.
515 in the House of Representatives and S. 331 in the Senate.
The Veterans Benefits Administration budget is mandatory; why isn't
the Veterans Health Administration treated the same? Both of these
budgets support the same heroes who have gone off to war for this
nation. Remember, after the parades and victory speeches are over you
still have ill and injured veterans trying to continue treatment and
rehabilitation to re-enter society.
Mr. Chairman, it is disturbing that the homecoming heroes must wait
for treatment when the Nation did not wait to send them into harms way.
The American Legion thanks you for the opportunity to comment on
this matter.
Senator Obama. Thank you very much, Mr. Petrosky.
Next we have got Mr. Carl DiGrazia, Department's Service
Officer, Veterans of Foreign Wars.
Mr. DiGrazia.
STATEMENT OF CARL DiGRAZIA, DEPARTMENT SERVICE OFFICER,
VETERANS OF FOREIGN WARS
Mr. DiGrazia. Thank you, Senator Barack Obama and Senator
Durbin.
The Veterans of Foreign Wars would like to thank the
Committee on Veterans' Affairs for allowing us to express our
concerns of the preparedness of VA health care for the men and
women who are returning from Iraqi Freedom and Operation
Enduring Freedom.
A large percentage of our returning military are members of
the Military Reserve and National Guard, but the Department of
Veterans' Affairs has stated that the VA medical centers are
prepared to meet the needs of the returning troops. This
service organization knows that many of the returnees have
already registered with the VA health care system.
Some of these veterans have been refused and do not
understand why. It's priority eight. Veterans need to be
reconsidered. Those veterans need to be reconsidered.
The fiscal budget of 2005 health care fell one billion
dollars short of cost of caring for our health of our veterans.
The Senate unanimously voted for an amendment to add an
additional 1.5 billion to this year's budget, to meet the
health care needs of our veterans, from World War II and those
now coming home from Iraq. There's already an amendment and a
request for additional funding for fiscal year 2006.
The Reserve component of the military on active duty in
support of partial mobilization of the Army National Guard and
Army Reserve is approximately 124,552. The Naval Reserve is
3,323. The Air National Guard and Air Force Reserve is 9,691.
The Marine Corp Reserve is 9,649. The Coast Guard Reserve is
576. The total National Guard and Reserve units total 147,611.
This figure potentially new--health care recipients and
compensation recipients.
Reflecting back to 1990 and 1991 on the veterans, who
fought the Gulf War, many of whom returned with mysterious
illnesses; between 26 and 32 percent of the veterans who served
in the Persian Gulf continue to have serious and persistent
health problems. It is called undiagnosed illnesses.
Now we have a new group of veterans coming home from the
new war in the Middle East. Time will tell only if they will
have the same fate as serious persistent health problems with
no names.
H.R. Bill 1220, the VA Compensation Cost of Living
Adjustment Act, was passed and we support this action. We
particularly support the authorization of 2-year demonstration
project to collect third-party payments from insurance
companies. We wholeheartedly support going after the insurance
companies who reneged on their payments to the government,
overcharge us in our premiums and get wealthy at the expense of
the disabled veteran.
Mr. Senators, the group of Americans we cannot be lukewarm
about supporting are those Americans who have given up their
youth, their health, their limbs, and a portion of their minds
for freedom. The Veterans of Foreign Wars strongly support
mandatory funding for VA health care, and it's going to be up
to you, Senators and Congressmen, to make this a reality. Thank
you for your time.
[The prepared statement of Carl DiGrazia follows:]
Prepared Statement of Carl DiGrazia, Department Service Officer,
Veterans of Foreign Wars
Mr. Chairman, the Honorable Senator Barack Obama.
The Veterans of Foreign Wars would like to thank the Committee on
Veterans' Affairs for allowing us to express our concerns of the
Preparedness of VA Health Care for the men who are returning from Iraqi
Freedom and Operation Enduring Freedom. A large percentage of our
returning military are members of the Military Reserve and the National
Guard.
The Department of Veterans' Affairs have stated the VA Medical
Centers are prepared to meet the needs of the returning troops. This
service organization knows that many of the returnees have already
registered with the VA Health Care System. Some of these veterans have
been refused and do not understand why. `Priority 8' veterans need to
be reconsidered.
The fiscal year 2005 health care budget fell one billion dollars
short of the cost of caring for the health of our veterans. The Senate
unanimously voted for an amendment to add additional 1.5 billion to
this year's budget to meet the health care needs of our veterans from
World War II to those now coming home from Iraq. There is already an
amendment request for additional funds for the fiscal year 2006 budget.
The Reserve Component of the military on active duty in support of
the partial mobilization for the Army National Guard and Army Reserve
is 124,552; Naval Reserve is 3,323; Air National Guard and Air Force
Reserve is 9,691; Marine Corps Reserve is 9,469 and the Coast Guard
Reserve is 576. The total of National Guard and Reserve units is
147,611.
That is 147,611 potential new VA Health Care recipients and
compensation recipients.
Reflecting back to 1990-1991 on the veterans who fought in the Gulf
War many of whom returned with a mysterious illness. Between 26 and 32
percent of the veterans who served in the Persian Gulf continue to have
serious and persistent health problems. It is called undiagnosed
illness. Now we have a new group of veterans coming home from a new war
in the Middle East. Time will only tell us if they will have this same
fate. Serious persistent health problems with no name.
H.R. 1220 The Veterans Compensation Cost of Living Adjustment Act
was passed and we support this action.
We particularly support the authorization of a 2-year demonstration
project to collect third party payments from insurance compares. We
wholeheartedly support going after the insurance companies that renege
on their payments to the government, overcharge us on our premiums and
get wealthy at the expense of the disabled veteran.
Mr. Senator, the group of Americans we cannot be lukewarm about
supporting are those Americans who have given up their youth, their
health, their limbs and a portion of their minds for our freedom.
The Veterans of Foreign Wars strongly supports Mandatory Funding
for VA Health Care by our elected representatives from Illinois. H.R.
515 and S. 331.
Senator Obama. Thank you very much. We appreciate it, Mr.
DiGrazia.
Next, we have Dr. Jeanne Douglas, who's Team Leader of the
Vet Center in Oak Park, IL.
Dr. Douglas.
STATEMENT OF DR. JEANNE DOUGLAS, TEAM LEADER,
VET CENTER, OAK PARK, IL
Dr. Douglas. Thank you for asking me to speak today. It's
been informative already. I have learned a great deal.
The Department of Veterans' Affairs Readjustment Counseling
Service, that is Vet Centers, was established in 1979 under the
Public Law 9622, to address the readjustment needs of Vietnam
veterans. Additional legislation extended program eligibility
to veterans of other combat theaters and to veterans who
experienced sexual trauma as a result of their military
service.
Vet Centers are traditionally located in communities to
provide access to veterans in a setting that is as stress-free
as possible. There are currently 207 Vet Centers in the United
States and Puerto Rico.
The Oak Park, IL Vet Center was opened in January 1980, and
offers services to veterans who live on the Westside of Chicago
and Cook County, extending through the far western communities
in Kane, Dekalb and DuPage Counties. Our staff consists of five
mental health professionals, including veterans from Vietnam
and Operation Desert Storm.
We are currently located at 155 South Oak Park Avenue, in
Oak Park. Our Vet Center provides direct clinical services to
combat veterans and veterans who have experienced sexual trauma
and harassment.
These clinical services may include individual, group,
marital or family therapy. In addition, we provide outreach to
homeless veterans, employment assistance to underemployed and
unemployed veterans, referrals to veterans seeking disability,
education for community mental health professionals, prerelease
planning for incarcerated veterans, bereavement counseling for
family members, and we are present at programs for returning
OIF veterans and their families.
Our area covers an array of ethnic and racial compositions
and includes a wide variety of social economic conditions. It
is our intent to understand the needs of veterans from
different backgrounds, so our services reflect our efforts to
engage our clients with openness and sensitivity.
Therefore, we have worked hard to become part of a network
of services that reach veterans in our community, creating a
continuum of care that provides medical, dental, optical
services, employment, legal and housing assistance, benefits
and educational information, as well as a full range of
psychological and trauma counseling.
We have been able to do this through collaborative
relationships with the Veterans Health Administration, the
Veterans Benefits Administration, Illinois Department of
Veterans' Affairs, County health departments, County veterans
assistance offices and veterans service organizations. These
all help us to ensure a quality lifestyle for returning
veterans.
In addition, there are four other Vet Centers in the
Chicago metropolitan area; one in Beverly, Evanston, and
Chicago Heights, and in Merrillville, IN. The staff at all five
Vet Centers work well together planning citywide events, such
as the upcoming Supermarket of Veteran Services, Stand downs
and various educational opportunities for our staff.
We are able to share tasks when we need representation at
National Guard and Reserve events, or to provide a presence at
job fairs, health fairs, or school programs. This team effort
makes it possible for us to direct veterans to the most
convenient and appropriate facility to meet their needs.
Since the Oak Park Vet Center opened, we have served over
12,000 veterans and their families. In fiscal year 2004, we
provided over 4,400 visits and, to date, in 2005, we have
provided 3,600 visits to veterans. We are actively serving
service members who are returning from the global war on
terrorism and their families, by providing briefings and
materials upon their unit's requests.
Returning soldiers are briefed on programs provided by the
Vet Center and about the potential impact of deployment on
individuals and families. We provide monthly briefings to the
ADH RRC in Forest Park, to the General Jones Armory, to
Northwest Armory, and to North Riverside Armory. We also
facilitate monthly support groups for family members of
deployed service members.
Our collaboration with family support representatives
ensures that the Oak Park Vet Center is involved in addressing
the readjustment needs of returning service members. Thank you.
[The prepared statement of Jeanne Douglas follows:]
Prepared Statement of Dr. Jeanne Douglas, Team Leader, Vet Center,
Oak Park, IL
My name is Dr. Jeanne Douglas, PhD, team leader of the Oak Park,
Illinois Vet Center. Thank you for taking my testimony, I am honored to
be here and provide testimony pertaining to the operations of the Oak
Park, Illinois Vet Center.
The Department of Veterans' Affairs, Readjustment Counseling
Service (Vet Centers) was established in 1979 under Public Law 96-22 to
address the readjustment needs of Vietnam veterans. Additional
legislation extended program eligibility to veterans of other combat
theaters, and to veterans who experience sexual trauma as a result of
their military service. Vet Centers are traditionally located in
communities to provide access to veterans in a setting that is as
stress-free as possible. There are currently 207 Vet Centers in the
United States and Puerto Rico.
The Oak Park, Illinois Vet Center was opened in January of 1980 and
offers services to veterans who live on the Westside of Chicago and
Cook county extending through the far western communities in Kane,
DeKalb and DuPage Counties. Our staff consists of five mental health
professionals including veterans from Vietnam and Operation Desert
Storm. Currently located at 155 South Oak Park Avenue, Oak Park,
Illinois 60302, our Vet Center provides direct clinical services to
combat veterans and veterans who have experienced sexual trauma and
harassment during their time in the military. These clinical services
may include individual, group, marital or family therapy. In addition,
we provide outreach to homeless veterans, employment assistance to
underemployed and unemployed veterans, referrals to veterans seeking
disability, education for community mental health professionals, pre-
release planning for incarcerated veterans, bereavement counseling for
family members, and we are present at programs for returning OIF
veterans and their families. Our catchment area covers an array of
ethnic and racial compositions, and includes a wide variety of social
economic conditions. It is our intent to understand the needs of
veterans from different backgrounds so our services reflect our efforts
to engage our clients with openness and sensitivity. Therefore, we have
worked hard to become a part of a network of agencies that reach
veterans in our community, creating a continuum of care that provides
medical, dental, optical services: employment, legal, and housing
assistance; benefits and educational information and a full range of
psychological and trauma counseling. We have collaborative
relationships with the Veterans Health Administration (VHA), the
Veterans Benefits Administration (VBA), County Health Departments,
County Veterans Assistance offices, and veteran's service organizations
to help us as we work to ensure a quality lifestyle for all returning
veterans.
In addition, there are four other Vet Centers in the Chicago
Metropolitan area (Beverly, Evanston and Chicago Heights in Illinois;
Merriville, Indiana). The staff at all five Vet Centers work well
together planning city wide events such as the upcoming Supermarket of
Veterans Services, Standdowns, and various educational opportunities
for our staff. We are able to share tasks when we need representation
at National Guard and Reserve events or to providing a presence at job
fairs, health fairs, or school programs. This Vet Center team effort
makes it possible for us to direct veterans to the most convenient and
appropriate facility to meet their needs.
Since the Oak Park Vet Center opened, we have served over 12,000
veterans and their families. In fiscal year 2004, we provided over 4453
visits, and in fiscal year 2005, we have provided over 3612 veteran
visits. We are actively serving service members who are returning from
the Global War on Terrorism and their families by providing briefings
and materials upon their unit request. Returning soldiers are briefed
on programs provided by the Vet Center, and about the potential impact
of deployment on individuals and families. We provide monthly briefings
to the 88th RRC (Forest Park, IL), to General Jones Armory, to
Northwest Armory, and to North Riverside Armory. We also facilitate
monthly support groups to family members of deployed service members.
Our collaboration with family support representatives ensures that the
Oak Park Vet Center is involved in addressing the readjustment needs of
returning service members.
Again, thank you for taking my testimony pertaining to the service
delivery of the Oak Park, Illinois Vet Center.
Senator Obama. Thank you very much, Doctor.
Next, Mr. Hetrick, Director of VA Hines Hospital.
STATEMENT OF JACK HETRICK, DIRECTOR,
HINES VA HOSPITAL
Mr. Hetrick. Thank you, Senator Obama and Members of the
Committee. I appreciate the opportunity to appear before you
today regarding your question, ``Is VA prepared to meet the
needs of our returning veterans?'' I can address that question
as it relates to the Edward Hines, Jr. VA Hospital.
The Edward Hines, Jr. VA Hospital is located 12 miles west
of downtown Chicago and offers primary, extended and specialty
care, and serves as a care referral center for a network of VA
hospitals in the area. Hines represents the entire spectrum of
VA health care and clinical programs. Specialized clinical
programs include blind rehabilitation, spinal cord injury,
neurosurgery, radiation therapy, and cardiovascular surgery.
Nearly 512,000 patient visits occurred in fiscal year 2004,
providing care to 52,647 unique veterans, primarily from Cook,
DuPage and Will Counties. So far this year we have provided
care to 6 percent more veterans than we did last year at this
time.
Hines offers the full spectrum of mental health services,
including inpatient, outpatient, psychiatric care, post-
traumatic stress disorder program, and a homeless chronically
mental ill program which outreachs to homeless veterans in the
Chicago area. Hines provides mental health service at all of
its seven community-based clinics.
Through initiatives such as advanced clinical access, Hines
is committed to providing timely and accessible care to our
veterans. All priority veterans who request a primary care
visit and are new enrollees are being scheduled for an
evaluation by a primary care provider within 30 days of the
veteran's requested date.
Hines providers support UBA process by providing timely
compensation and pension, often called C&P, examinations by
consistently staying within VHA time standards, 35 days. To
make certain we never take for granted our current veterans or
returning veterans, I recently established an awareness program
entitled ``It's all about the Vet'' at the Hines VA. That was
designed to reconnect each employee at Hines with our mission
to care for veterans. Hines Hospital staff and veteran
volunteers served as instructors for the class. At the end of
the program, each employee was challenged to write down how
they individually contribute to our mission.
Hines is committed to ensuring a smooth transition from DOD
health care to VA health care for Chicago area soldiers
returning from Iraq and Afghanistan. As part of VA's seamless
transition process, Hines has increased the number of outreach
activities to returning service members and new veterans,
including Reserve and National Guard units. In fiscal year
2004, Hines saw 308 OIF/OEF patients, and we expect to exceed
this number this year, as we have already treated 290 of these
patients in the first 9 months of this fiscal year.
Hines has a special office set up to coordinate activities
locally and to assure that health care needs of the newest
veterans are fully met. Hines has made a commitment to assure
the returning OIF/OEF veterans have full and timely access to
mental health care. We are able to schedule returning Iraqi
veterans for a mental health evaluation immediately upon
request, and have established a special support group
specifically for veterans returning from Iraq with post-
traumatic stress disorder issues.
Many service members returning from combat with severe
injuries require extensive hospitalization and rehabilitation.
Since Hines offers specialized services not provided by DOD in
this region of the country, we have received a number of active
duty soldiers for spinal cord injury rehabilitation and blind
orientation and mobility.
Presently in the Hines Blind Rehabilitation Program, a
young OEF OIF active duty soldier that was blinded in combat is
undergoing intense rehabilitation. When I met this soldier, he
told me how committed he was to learn how to deal with his
condition. He went on to say he has researched blind rehab
programs available around the country, and determined that
Hines was the best and that was where he wanted to go.
In our spinal cord injury program, we recently received
another active duty service member injured stateside. His home
is outside the Chicago area. His wife accompanied him to be
with him during this critical period. Knowing their home was
outside the Chicago area, our social work staff offered
assistance in finding a place for her to stay and continues to
follow up to show her that we will help in any way possible.
The importance of these two programs was spotlighted this
past May 20, when Secretary Nicholson was on hand to dedicate
two new state-of-the-art buildings to serve our blind
rehabilitation and spinal cord injury programs. These two new
facilities will allow us to continue the fine tradition of high
quality care for these two special needs programs.
I will say in summary, the staff at the Hines VA Hospital
works extremely hard to provide top quality health care to all
of our veterans. Our patient satisfaction scores are a direct
reflection of this commitment and hard work. Over the past 3
years, our inpatient satisfaction scores have consistently been
on the rise, with the majority of our patients rating their
overall care as excellent or very good.
The first half of this year, we had served over 47,000
unique veterans as outpatients. During this first quarter of
fiscal year 2005, our overall patient satisfaction scores was
in the top 10 scores nationwide.
We are proud of this first rate health care we provide
America's veterans and are fully committed to meeting this
challenge in the future. I believe the Hines VA Hospital has
demonstrated and can promise that we are prepared to meet the
needs of returning veterans. Thank you, Senator, and this
concludes my formal remarks.
[The prepared statement of Jack Hetrick follows:]
Prepared Statement of Jack Hetrick, Director, Hines VA Hospital
Mr. Chairman and Members of the Committee, I appreciate the
opportunity to appear before you today regarding your question, ``Is
the VA Prepared to Meet the Needs of Our Returning Vets.'' I can
address this question as relates to the Edward Hines Jr. VA Hospital.
The Edward Hines, Jr. VA Hospital is located 12 miles west of
downtown Chicago and offers primary, extended and specialty care and
serves as a tertiary care referral center for a network of VA hospitals
in the area. Hines represents virtually the entire spectrum of VA
healthcare and clinical programs. Specialized clinical programs include
Blind Rehabilitation, Spinal Cord Injury, Neurosurgery, Radiation
Therapy and Cardiovascular Surgery. The hospital also serves as the
area's hub for pathology, radiology, radiation therapy, human resource
management and fiscal services. Hines currently operates 472 beds and
seven community-based outpatient clinics (CBOC) in Oak Park, Manteno,
Elgin, Oak Lawn, Aurora, LaSalle, and Joliet. Nearly 512,000 patient
visits occurred in fiscal year 2004, providing care to 52,647 veterans,
primarily from Cook, DuPage and Will counties. So far this year, we
have provided care to 6 percent more veterans than we did last year at
this time.
Hines offers the full spectrum of mental health services, including
inpatient and outpatient psychiatric care, Post-Traumatic Stress
Disorder Program, and a Homeless Chronically Mentally Ill Program,
which outreaches to homeless veterans in the Chicago area. Hines
provides mental health services at all of its seven CBOCs.
Through initiatives such as Advanced Clinical Access (ACA), Hines
is committed to providing timely and accessible care to our veterans.
All priority veterans who request a primary care visit and are new
enrollees are being scheduled for an evaluation by a primary care
provider within 30 days of the veteran's requested date. Hines
providers support the VBA process by providing timely compensation and
pension (C&P) examinations by consistently staying within the VHA time
standard of 35 days. To make certain we never take for granted our
current veterans and returning veterans, I recently established an
awareness program entitled ``It's All About the Vet at the Hines VA''
that was designed to reconnect each employee at Hines with our mission
to care for veterans. Hospital staff and veteran volunteers served as
instructors for the class. At the end of the program each employee was
challenged to write down how they individually contribute to our
mission.
Hines is committed to ensuring a smooth transition from DoD
healthcare to VA healthcare for Chicago-area soldiers returning from
Iraq and Afghanistan. As part of VA's seamless transition process,
Hines has increased the number of outreach activities to returning
service members and new veterans, including Reserve and National Guard
units. In fiscal year 2004, Hines saw 308 OIF/OEF patients and we
expect to exceed this number this year as we have already treated 290
of these patients through the first 9 months of this fiscal year. Hines
has a special office set up to coordinate activities locally and to
assure that the health care needs of the newest veterans are fully met.
Hines has made a commitment to assure that returning OIF/OEF veterans
have full and timely access to mental health care. We are able to
schedule returning Iraqi veterans for a mental health evaluation
immediately upon request and have established a special support group
specifically for veterans returning from Iraq with post-traumatic
stress disorder issues.
Many service members are returning from combat with severe
injuries, requiring extensive hospitalization and rehabilitation. Since
Hines offers specialized services not provided by DoD in this region of
the country, we have received a number of active duty soldiers for
spinal cord rehabilitation and blind orientation and mobility.
Presently in the Hines Blind Rehabilitation program, a young OEFIOIF
active duty solider that was blinded in combat is undergoing intense
rehabilitation. When I met this soldier he told me how committed he was
to [earn how to deal with his condition. He went on to say that he
researched Blind Rehab programs available around the country and
determined that Hines was the best and that is where he wanted to go.
In our Spinal Cord Injury program we recently received another active
duty service member injured stateside. His home is outside the Chicago
area and his wife accompanied him to be with him during this critical
period. Knowing their home was outside the Chicago area; our Social
Work staff offered assistance in finding a place for her to stay and
continues to follow-up to assure her we will help in anyway possible.
The importance of these two programs was spotlighted this past May
20th when Secretary Nicholson was on hand to dedicate two new state-of-
the-art buildings that serve our Blind Rehabilitation and Spinal Cord
injury programs. These two new facilities will allow us to continue the
fine tradition of high quality care for these two special needs
programs.
Hines is fully accredited by the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO), as well as National Committee for
Quality Assurance (NCQA), and the Commission on Accreditation of
Rehabilitation Facilities (CARF).
VHA's performance measurement system enables us to hold ourselves
accountable for providing high quality of care for veterans. Hines
meets or exceeds the private sector benchmarks in industry recognized
performance measures in the care of heart attacks, heart failure and
pneumonia. Hines has been recognized as a leader in patient safety and
has been identified for best practices in JCAHO publications and the
Annual Patient Safety Forum. For example, the Hines patient safety
program was recognized in the May 2004 JCAHO publication ``Patient
Safety'' and in the November 2004 JCAHO publication ``Source''.
The Secretary of Veterans Affairs has approved and signed an
enhanced use agreement allowing Catholic Charities of the Archdiocese
of Chicago to renovate and establish a transitional living center and a
low-income senior living center that will occupy two previously unused
buildings on the Hines campus. These two ``Faith Based'' initiatives
will serve veterans without added cost to the hospital and will
renovate unused buildings without utilizing limited capital resources.
In summary, the staff at the Hines VA Hospital works extremely hard
to provide top quality health care to all our veterans. Our patient
satisfaction scores are a direct reflection of this commitment and hard
work. Over the past 3 years our inpatient satisfaction scores have
consistently been on the rise, with the majority of our patients rating
their overall care as ``Excellent'' or ``Very Good.'' In the first half
of this year, we have served over 47,000 veterans as outpatients and
during the first quarter of fiscal year 2005 our overall outpatient
satisfaction score was in the top ten scores nationwide. We are proud
of the first-rate healthcare we provide to America's veterans, and are
fully committed to meeting this challenge in the future. I believe the
Hines VA Hospital has demonstrated and can promise that we are prepared
to meet the needs of returning vets.
Thank you, Mr. Chairman. This concludes my formal remarks. I
welcome any questions the Committee Members may have.
Senator Obama. Good, thank you very much.
We only have a few minutes left, so I want to just dive in
on a couple of issues. If we don't get to all of them, the
Committee may submit some written questions that you can
respond to in writing.
Mr. Petrosky, I just want to touch on something that you
brought up, and I have heard already. As we have seen I think
from some of the testimony here today, there's a feeling at
times that the VA's trying to keep people out of the system
instead of figuring out how to bring them into the system.
What I am understanding from your testimony is that some of
our returning veterans have been refused access to the health
care system in the first 2 years when they are back, despite
the fact that as I understand it, at least, it doesn't matter
if you're priority eight or not. In those first 2 years, you
have uniform unimpeded access to the VA health care system.
Is that your understanding of what the rules are and, in
fact, are you saying that despite those rules, certain veterans
have been turned away?
Mr. Petrosky. That's right. We have had to at times bring
that up to the enrollment personnel that, you know, they have 2
years. We have the individual show his discharge document, and
the paperwork proceeds on to Georgia so they can get their
enrollment.
The problem we see, it's not everyone in the system, but
certain individuals of VA medical center personnel who turn
these veterans away. At Westside we have made contact with the
Chief of MCCR and she has assured us, if you have that problem
please call her. At the other facilities where we have service
officers, they take them by the hand down and remind the VA
medical center personnel of enrollment process for the now
returning military personnel.
It's not blatantly done, but enough people have complained
that they'd like to get into the system and they are told no
because they are priority eight, and they do not enroll
priority eight veterans anymore. That is the key of the system
that categorizes veterans into health care.
When you've got a priority category, and you already know
that a certain number of veterans are not going to get into the
system, you're always going to have people that are not paying
attention and say you're not eligible instead of going through
the requirements. That goes back to when priority eight was
established and when the VA said they are not letting priority
eight into the system.
Senator Obama. Right.
Mr. DiGrazia.
Mr. DiGrazia. Yes, sir.
Yes, I agree here with Mr. Petrosky on this. There are
instances where the veterans come to us and say, I was refused
medical care because they say I would fit in category eight. We
usually find out what facility was involved and we contact that
particular director and assure that this veteran would be taken
care of.
What we have a problem with is how many are out there that
have been refused and just don't go back any more and are
entitled to this. Now, you know, the 2 year, as we call it,
scott free of co-pays, that's great. But I think all of the
employees that address these veterans when they come in should
be made aware of that. Look at the man's discharge papers, and
if he qualifies, by God, give it to him. He sure the heck
earned it. He or she, by the way. I think they earned it.
Senator Obama. Absolutely.
Mr. Hetrick, we haven't heard specific complaints of Hines,
but my assumption is you are making aware and training all your
personnel to be knowledgeable about the fact that in the first
2 years of discharge, issues like priority eight don't come
into play?
Mr. Hetrick. Absolutely, Senator. I think when we first
started to see a return, there was initially some confusion
about eligibility. But as time has moved on and we have become
better at it, and had more training and appointed seamless
transition coordinators, that this is really a rare exception
as opposed to the rule now. Of course, we would strive for no
exceptions as our goal.
I think in health care, when anyone presents for care and
if there's evidence that it's an emergent need, we take care of
them regardless of asking about eligibility and worry about
that the next day or as soon as they are able to answer certain
questions.
Senator Obama. Dr. Douglas, I have seen some recent
studies, there was one in the New England Journal of Medicine,
indicating that up to 17 percent of our veterans returning from
Iraq will suffer post-traumatic stress disorder. I am just
wondering, based on your experience at the Vet Center, do you
think that is an accurate estimate, or is it too high, or too
low? Do you have any anecdotal sense or statistical sense at
your center of the degree in which some of the newly returning
vets are experiencing some of these issues?
Dr. Douglas. You have to clarify whether you're talking
about acute PTSD or chronic PTSD. I would assume that the
numbers for acute PTSD would be quite a bit higher than that.
Senator Obama. Could you help us with that distinction?
What is the difference between acute and chronic PTSD?
Dr. Douglas. Acute would be a person who's having symptoms
that last 3 to 6 months. Then through treatment, therapy,
whatever, are able to recover and come back to a normal kind of
lifestyle. Chronic means someone whose PTSD symptoms are
disabling.
Senator Obama. Your impression would be that if it had to
do with acute symptoms, that the 17 percent number might be a
little low?
Dr. Douglas. We were thinking more like 25 to 30 percent
for acute symptoms.
Senator Obama. Are these symptoms ones that can be treated
effectively in sort of an outpatient setting, such as the one
that you're discussing? They basically need counseling,
somebody to talk to, work through some of these issues with
them? Is that accurate?
Dr. Douglas. Yes. I think it's really important that they
be treated promptly, so they can be treated at the Vet Centers
very quickly with medical support from the VA hospitals. What
we know from the Vietnam era is that it's the delay in
treatment that causes the long-term difficulties.
Senator Obama. People feel isolated. They feel lonely. It's
difficult to make an adjustment. If they don't have a sense
that there's somebody there to help them return to civilian
life, then it will actually compound the problem and what could
have been acute might turn into----
Dr. Douglas. Exactly.
Senator Obama [continuing]. Something that ends up being
chronic.
Mr. Hetrick, have we started preparing for this influx of
veterans from Operation Iraqi Freedom?
Mr. Hetrick. Absolutely, we have. We have been working over
the past several months to improve our staffing in mental
health areas, looking at where the workload demands are, and
making certain that we are prepared to address what we believe
is going to be a growing number of individuals seeking those
services. As I said earlier in my testimony, that we have a
number of programs in place right now that we are dealing with
folks, but we are getting new referrals on an ongoing basis
each week. As I said, there's a steady increase and we are
adjusting accordingly.
Senator Obama. I guess part of my concern here is last year
the VA's own special committee on PTSD came to the conclusion,
and this is a quote, ``The VA does not have sufficient capacity
to meet the needs of new combat veterans while still providing
for veterans of past wars.'' Now, Hines by all accounts is
doing an outstanding job, and you should be congratulated for
that. But I am concerned with having a static amount of
resources dealing with more patients. Has the VA to your
knowledge made any projection for the number of veterans that
are expected to return from Iraq and Afghanistan in 2006? Are
they specific to Illinois? Is this data shared with you for
planning purposes, budgetary purposes, and so forth?
Mr. Hetrick. I don't recall having seen any specific
projections related to that for 2006. I am basing more of my
comments on actual experience and what we believe will continue
to be a growing demand.
Senator Obama. How are you dealing with that growing
demand? Are you getting more money to deal with that growing
demand? Are you able to staff up or are you having to shift
resources from some areas to others?
Mr. Hetrick. Well, I think like, in a complex hospital
environment that I operate with many different specialized
programs and a number of--and extended care programs, mental
health programs, I have to look at everything on an ongoing
basis to see where the demand is. Wherever I can, I sometimes
shift resources, regardless of the budget picture, in order to
meet our growing needs.
It's not always the answer to add more or spend more money,
but sometimes we have to shift internally. That's how I have
been addressing the situation this year, working with our
mental health providers and leadership in mental health, and
knowing that this is particular priority. We have been making
steadily improvements and I know that even, starting in June,
as of June 1, we have actually narrowed down our appointment
time to 10 days from request.
And if you need emergency services, that's taken care of
right away.
Senator Obama. Dr. Douglas, the Vet Center's on the front
lines. Are there things that we should be looking at or
anticipating, based on what you're seeing on a day-to-day
basis, that we are not doing now? Improvements that need to be
made. Areas, in terms of outreach to veterans, bringing them
in, where we are falling short.
Dr. Douglas. Well, I think what we are trying to do now is
very important. We are trying to be present when soldiers
return so that they are aware of what their opportunities are
right from the get go, when they return from Iraq.
We also want to be very present for families. Families take
a huge amount of the toll, the emotional toll, when a soldier
is deployed. We want that family to be as strong as possible,
so that they are able to work with the veteran and whatever
needs he has.
Senator Obama. Gentlemen, do you have anything to add on
this matter?
Mr. Petrosky. We would like to thank Dr. Douglas for what
the Vet Centers have done and continue doing so in supporting
veterans throughout Illinois.
Yes, they might be told what's available for them when they
are coming back, but a lot of people have on their mind the
separation of family and want to get back together. The Vet
Centers have been very helpful in utilizing that when a
returning soldier comes home and he doesn't remember, that when
somebody sends him down there they welcome him with open arms
to make sure he is taken care of. To give us, service
organizations, the documentation necessary to support veterans
in their claims with the VA.
Senator Obama. Well, if there's nothing further, I just
want to thank the second panel. You've been extraordinarily
helpful to us.
I want to state that the record on this hearing will remain
open to any Members of the Committee or if Senator Durbin would
like to submit written questions for the record to the
witnesses. It's possible that both the witnesses for the first
panel and the second panel may receive some additional written
questions and we will then get your responses into the record.
I appreciate everybody taking the time, and I appreciate
Chief Judge Kocoras for making these chambers available. Thank
you very much.
[Whereupon, at 11:48 a.m., the Committee was adjourned.]