[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
THE U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FISCAL YEAR 2010
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
MARCH 10, 2009
__________
Serial No. 111-6
__________
Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE
48-420 WASHINGTON : 2009
-----------------------------------------------------------------------
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800
Fax: (202) 512�092104 Mail: Stop IDCC, Washington, DC 20402�090001
COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY MCNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia
Malcom A. Shorter, Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
March 10, 2009
Page
U.S. Department of Veterans Affairs Budget Request for Fiscal
Year 2010...................................................... 1
OPENING STATEMENTS
Chairman Bob Filner.............................................. 1
Prepared statement of Chairman Filner........................ 57
Hon. Steve Buyer, Ranking Republican Member...................... 2
Hon. Brian P. Bilbray............................................ 15
WITNESSES
U.S. Department of Veterans Affairs, Hon. Eric K. Shinseki,
Secretary, U.S. Department of Veterans Affairs................. 5
Prepared statement of Secretary Shinseki..................... 57
______
American Legion, Steve Robertson, Director, National Legislative
Commission..................................................... 47
Prepared statement of Mr. Robertson.......................... 96
American Veterans (AMVETS), Raymond C. Kelley, National
Legislative Director........................................... 35
Prepared statement of Mr. Kelley............................. 79
Disabled American Veterans, Kerry Baker, Assistant National
Legislative Director........................................... 32
Prepared statement of Mr. Baker.............................. 63
Iraq and Afghanistan Veterans of America, Paul Rieckhoff,
Executive Director............................................. 43
Prepared statement of Mr. Rieckhoff.......................... 89
Paralyzed Veterans of America, Carl Blake, National Legislative
Director....................................................... 30
Prepared statement of Mr. Blake.............................. 61
Veterans of Foreign Wars of the United States, Dennis M.
Cullinan, Director, National Legislative Service............... 34
Prepared statement of Mr. Cullinan........................... 70
Veterans for Common Sense, Paul Sullivan, Executive Director..... 42
Prepared statement of Mr. Sullivan........................... 83
Vietnam Veterans of America, Richard F. Weidman, Executive
Director for Policy and Government Affairs..................... 45
Prepared statement of Mr. Weidman............................ 90
SUBMISSION FOR THE RECORD
Mitchell, Hon. Harry E., a Representative in Congress from the
State of Arizona............................................... 142
MATERIAL SUBMITTED FOR THE RECORD
Letters:
Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans
Affairs, to Hon. Phil Roe, U.S. House of Representatives,
letter dated April 20, 2009, Regarding Percentages of
Budget Funding for Care of World War II, Vietnam Veterans,
and Veterans of Other Eras................................. 143
Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans
Affairs, to Hon. Bob Filner, Chairman, Committee on
Veterans Affairs, letter dated April 20, 2009, Regarding
Advocacy Training.......................................... 143
Post-Hearing Questions and Responses for the Record:
Hon. Steve Buyer, Ranking Republican Member, Committee on
Veterans' Affairs, to Hon. Eric K. Shinseki, Secretary,
U.S. Department of Veterans Affairs, letter dated March 18,
2009, and VA responses..................................... 144
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to
Hon. Eric K. Shinseki, Secretary, U.S. Department of
Veterans Affairs, letter dated March 23, 2009, transmitting
questions from Chairman Filner, Hon. Michael Michaud and
Hon. Joe Donnelly, and VA responses........................ 147
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to
Carl Blake, National Legislative Director, Paralyzed
Veterans of America, Kerry Baker, Assistant National
Legislative Director, Disabled American Veterans, Dennis
Cullinan, National Legislative Director, Veterans of
Foreign Wars of the United States, Raymond C. Kelley,
National Legislative Director, AMVETS, letters dated March
23, 2009, and joint response letter from The Independent
Budget, letter dated April 30, 2009........................ 150
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to
Paul Sullivan, Executive Director, Veterans for Common
Sense, letter dated March 23, 2003, and VCS responses...... 155
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Paul Rieckhoff, Executive Director and Founder, Iraq and
Afghanistan Veterans of America, letter dated March 23,
2009, and IAVA responses................................... 159
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Richard Weidman, Executive Director for Policy and
government Affairs, Vietnam Veterans of America, letter
dated March 23, 2009, and VVA responses.................... 160
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Steve Robertson, Director, National Legislative Commission,
American Legion, letter dated March 23, 2009, and response
letter dated March 26, 2009................................ 161
Reports:
U.S. Department of Veterans Affairs American Recovery and
Reinvestment Act (ARRA) Agency Plans and Reports:
FY 2009 Veterans Health Administration--Medical Facilities
Non-Recurring Maintenance (NRM) and Energy Projects--
Expenditures Plan........................................ 164
Expenditure Plan by Category............................. 244
Expenditure Plan by State................................ 245
FY 2009 Veterans Health Administration--Grants for State
Extended Care--
Expenditure Plan......................................... 247
Expenditure Plan by State................................ 251
Veterans Benefits Administration--Hiring Temporary Claims
Processors.................................................
Expenditure Plan............................................. 252
Veterans Benefits Administration--Support for Economic
Recovery Payments Expenditure Plan......................... 253
FY 2009 National Cemetery Administration Monument and
Memorial Repairs--
Expenditure Plan......................................... 254
Expenditure Plan by Category............................. 281
Expenditure Plan by State................................ 282
Information Technology Expenditure Plan...................... 284
The Independent Budget for the Department of Veterans Affairs,
Fiscal Year 2010, a Comprehensive Report and Policy Document
Created by Veterans for Veterans............................... 285
THE U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FISCAL YEAR 2010
----------
TUESDAY, MARCH 10, 2009
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 2:33 p.m., in
Room 345, Cannon House Office Building, Hon. Bob Filner
[Chairman of the Committee] presiding.
Present: Representatives Filner, Snyder, Michaud, Herseth
Sandlin, Hall, Perriello, Teague, Donnelly, Space, Walz, Buyer,
Moran, Boozman, Bilbray, Bilirakis, and Roe.
OPENING STATEMENT OF CHAIRMAN FILNER
The Chairman. Well, everybody is quiet for an Army General.
I have never seen it like this, Mr. Secretary. I want to wait
for some of our colleagues to show up. We apologize for keeping
you waiting, we had a series of votes just at the time the
hearing was scheduled to start. I will wait for some of my
Republican colleagues and then we will get started. Mr. Buyer
is here now so we will begin this hearing.
Mr. Secretary, we thank you for joining us. I know you are
used to going to battle alone, and I see you have nobody on
your wings here today, so good luck.
I want to make sure, before we start, that I ask unanimous
consent that all Members may have 5 legislative days to revise
and extend their remarks, and that written statements be made
part of the record. Hearing no objection, so ordered.
Today's hearing is on the preliminary budget submission
from the U.S. Department of Veterans Affairs (VA) for our next
fiscal year.
A few weeks ago the Administration submitted a preliminary
budget, and it is a document that provides what they call ``top
line'' budget numbers and brief discussions regarding
Administration priorities.
I must say, Mr. Secretary, we are pleased to see that, even
with this summary you had about a 10-percent increase in
discretionary funding, and about a 20-percent increase in the
mandatory accounts, for a 15-percent increase over all.
I will say to you, sir, that since The Independent Budget
(IB) was first put out, a budget put together by our veterans
service organizations (VSOs), yours is the first Administration
budget to exceed The Independent Budget, and we are very happy
that has occurred. I hope you can be proud of that. I have been
using The Independent Budget as my bible for the last 17 years.
We know that the budget request calls for $25 billion increase
over the next 5 years. We haven't had an Administration budget
like that for a long, long time, so thank you, sir, and it
looks like you understand, and the Administration understands,
the importance of veterans in the budget.
We know these out-year numbers are not binding figures, but
they are a good start. You put some interesting things in
there, and I think the Committee shares your policy
formulations.
For example, the decision to bring in the Priority 8
veterans, 500,000 as I understand it, is what many of us have
wanted for a long time.
I think you also expand concurrent receipt, and again, many
Members on this Committee have been working on this issue for a
long, long time, so we thank you for that. We are looking
forward to meeting the needs of our veterans in the coming
year.
From looking at your Senate testimony and the testimony of
some of the veterans' organizations, there is a controversial
policy recommendation in the budget concerning collections--
third-party collections.
We believe, Mr. Secretary, that you can meet your numbers
for revenue, income, and third-party collections, without any
policy changes, that is, by using existing authorities. We
believe we can do that with the numbers you have created,
without having to get into policy recommendations on third-
party collections, and still meet the revenue needs that you
have forecast in your budget.
In fact, both Mr. Buyer and I have been talking over the
last several years with people who think that we are leaving
hundreds of millions, if not billions, on the table from third-
party collections, and we are both committed to seeing that you
realize that without going into any policy shifts with regard
to service-connected veterans.
Again, thank you for being here, thank you for the
leadership that you have shown in your short time on the job.
We are looking forward to working with you over the next 4
years, and I will now yield to the Ranking Member, Mr. Buyer.
[The prepared statement of Chairman Filner appears on p.
57.]
OPENING STATEMENT OF HON. STEVE BUYER
Mr. Buyer. Thank you, Mr. Chairman, and good afternoon. It
is my pleasure once again to welcome Secretary Shinseki back to
the Committee, and thank you for appearing here today. I look
forward to your testimony. I also look forward to hearing from
the second panel of witnesses from the veteran service
organizations.
Mr. Secretary, the funding increases outlined in your
budget is welcomed. Overall, it is also a move in the right
direction.
I do have some concerns, particularly with regard to the
out-year numbers, and that is the gamesmanship that occurs in
this town. And so when all is put together, the budget views
and estimates, I will also try to make these projections with
regard to the out-years.
It is a gamesmanship that is occurring through the Office
of Management and Budget (OMB), and not that you haven't lived
with this when you were over at U.S. Department of Defense
(DoD), but if we are going to put together a budget, we want to
be realistic with regard to those out-years, we really need to
prepare for them. And kind of what is happening is, there is so
much lumped on the front end it is trying to make it look as
though they are more fiscally responsible in the out-years.
I want to die in the out-years, okay? That way I will live
forever. That is just the way we do budgets in this town.
The Chairman. I want to make an amendment to that.
Mr. Buyer. So I can live forever?
[Laughter.]
Mr. Buyer. Well, maybe you will be right there with me and
we will create a lot of energy for a lot of years for somebody.
A number of factors, I believe, are going to place great
demand, Mr. Secretary, on the VA, and so when I am talking
about the out-years I think we have to prepare to handle it.
President Obama announced the draw down of the combat
troops in Iraq, which will contribute to an increase in
veterans seeking VA benefits and services over the next 2 to 3
years, the Priority 8's being enrolled, and I know we are
moving incrementally what type of political pressures are there
going to be from the veterans service organizations to even
make--to accelerate that, especially at a time when we have the
economic circumstances that we do. You couple that with medical
inflation, that tells me that the outline--the out-year numbers
are too low in the budget that you have submitted to us.
Regardless of what the numbers are, it will require, I
believe, bold action to ensure that the VA's health and
disability systems are effective in delivering timely and
quality service to our veterans.
I am also concerned about a proposal, and I have spoken to
you about it, reportedly considering the billing of third-party
insurers for the treatment of service-connected disabilities.
I told you in private, which I will also say public, I will
be a good listener to your proposal; however, I believe that
the proposal is contrary to our basic national obligation, and
that is just how I feel. But that is my opinion, and I want to
be a good listener to what you are proposing to us, and we will
have it properly vetted.
So we will treat your proposal with respect, and we will
figure out where it lies.
I also have a growing concern about the VA's ability to
handle the thousands of claims it will receive next fall for
the new GI Bill benefits.
As you know, I requested the VA Office of Inspector General
assessment of the system being implemented to administer the
new program. We must have a candid view of any problems as far
in advance as possible, to ensure the VA is ready and capable
when the new delivery system comes online.
The men and women of our Armed Forces do not hesitate when
called upon to defend our Nation, and I think we, as the
government, owe them the timely delivery of the benefits that
they have earned.
Veterans will be relying on the VA to make timely GI Bill
payments to them and their schools next fall, and it is
incumbent on Congress and the VA to make sure the program works
as it was intended.
Also, when you appeared here last month, I expressed my
concern over varying quality of care standards with regard to
veterans' grave sites.
The Battle Monuments Commission sets, I believe, the gold
standard. It is followed closely by the National Cemetery
Administration. But I am not pleased, however, by the
appearance of two cemeteries that are maintained by the
National Park Service. Andersonville in Georgia and Andrew
Johnson Cemetery in Greenville, Tennessee.
They have improved--they have improved it, and I have
shared the pictures with you, but it is still--we should not
have three tiers of standards with regard to how we honor those
who came before us.
So I am close to the conclusion that the best solution
would be to transfer the jurisdiction of these two open
cemeteries to the VA, and I welcome your thoughts on that idea.
You had told me that you were going to be speaking with the
Secretary of the Interior, so I anticipate if you could share
that with the Committee, I would appreciate it.
I do want to note my particular agreement with the
provision in the budget summary that states that the highly
disabled veterans who are medically retired will be eligible
for concurrent receipt.
When I served on the Armed Services Committee and chaired
Personnel, I had $25 million and I took that and I popped the
lid off the issue of concurrent receipt, and did it for the 100
percent disabled combat veterans. And that was the beginning of
what you are now bringing to us, a budget for full concurrent
receipt and it has taken about 10 years for this to happen.
So I agree with your proposal, in fact it is similar to a
provision I have that is in one of the Noble Warrior
Initiatives I have introduced. I also introduced the Armed
Forces Disability Retirement Enhancement Act to simplify the
military disability retirement and ensure that those found
unable to serve will automatically receive retirement benefits
based on rank and years in service. This is another issue we
have discussed.
The Chairman has his ideas, I have mine, Danny Akaka has
his, everybody has got a lot of ideas on how to do this one. We
welcome your input.
And with that Mr. Secretary, I appreciate you being here,
there are a lot of issues to discuss today.
[Ron Walters, Director of Finance and Planning, National
Cemetery Administration, Department of Veterans Affairs,
provided the requested technical assistance by telephone to
Committee staff on March 30, 2009.]
The Chairman. Again, welcome Mr. Secretary. We are all, I
think, knowledgeable of your outstanding record of service and
personal sacrifice to our Nation having served with honor and
dignity for 38 years in the United States Army, in Vietnam, in
Bosnia, Afghanistan, Iraq, before your retirement as the 34th
Chief of Staff of the Army.
You have been called a ``soldier's soldier.'' We are
looking forward to you being the ``veterans' veteran.''
We welcome you today and the floor is yours.
STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY,
U.S. DEPARTMENT OF VETERANS AFFAIRS
Secretary Shinseki. Chairman Filner, thank you, and Ranking
Member Buyer, thank you for having me here today, and other
Members--distinguished Members of this Committee.
Thank you for this opportunity to present an overview of
the 2010 Budget for the Department of Veterans Affairs.
I appreciate also the opportunity I have had to speak with
a number of the Committee Members in preparation for testimony
during what has been a very busy legislative session, but
regret that I was not able to get to everyone, but that is
something I will correct in the future.
Let me also acknowledge and thank the leaders of our
veteran service organizations who are here today sitting in our
audience.
President Obama has charged me with transforming the VA
into a 21st century organization. Not change for the sake of
change, not nibbling around the edges, but a fundamental and
comprehensive review of all that we do for veterans before
moving boldly to acknowledge new times, new demographic
realities, and leveraging new technologies to renew our
commitment to veterans wherever they live.
I have been conducting that comprehensive and fundamental
review for about 7 weeks now, and would like to offer a quick
status about what I have learned since my last appearance
before this Committee.
New GI Bill. An outside consultant was hired to conduct a
quick-look study to validate our plans and procedures for
executing this large new program of educational benefits. The
quick look was completed on 27 February, and it validated what
we are doing and provided--validated the procedures and
processes that we have in place and are executing, but provided
us eight additional risk factors to consider. I have accepted
them all except for one, which I accommodated internally.
I am satisfied that we will get veterans who apply in time
into schools this fall. It remains high risk because of the
compressed timelines we have faced since legislation was
passed, but we have mitigated that risk responsibly, and at
this point I consider the risk an acceptable one.
The 2009 plan for the new GI Bill will be a computer-
assisted manual system. Computer assisted, but manual exercise.
We hope to move to a fully automated system in 2010. We are
just not able to get all the pieces in place this year.
But for 2009, user testing of the interim information
technology (IT) solution was completed, phase one training for
our newly hired 530 employees began yesterday, and I get
updates on how we are progressing there.
The final regulation is at OMB, the contingency plan is
finished, and final coordination is under way.
In my opinion all is in order to meet the August 2009
implementation date.
We still have multiple milestones to meet before then, and
I will continue to keep the Committee updated as we achieve
them.
Paperless. Our goal is to re-engineer the claims process
into a fully paperless environment by 2012.
A leads system integrator has been on board since October
2008 reviewing our business processes and beginning key design
deliverables, which we expect by August of this year.
Application developers will begin building specific
components in early fiscal year 2010, capitalizing on recent
successes with VETSNET and leveraging funding that should be
available in next year's budget.
We are already processing loan guarantees, insurance, and
education claims electronically, and plan to conduct a business
transformation pilot at the Providence Regional Office later
this fiscal year.
In conjunction with this paperless initiative DoD and VA
have met three times now to address the potential for
automatically enrolling all military personnel into the VA upon
entry into the armed forces. We call this initiative uniform
registration. We are in agreement about the goodness of such a
system and have people working toward making it a reality.
Uniform registration will push both of us, both DoD and VA,
to create a single electronic record that would govern how we
each acknowledge, identify, track, and manage each of our
clients, active and reserve component, who populate both of our
departments, from the moment they first take the oath of
allegiance in uniform.
Our management decisions will be better, faster, more
consistent and fair, and less subject to lost files or
destroyed claims. Such electronic records would have a
personnel component and a medical component.
We have benefited from the insights and experience and
advice of Secretary Gates and Deputy Secretary Lynn about not
trying to build a single large database, so we are committed to
doing this smartly and differently from some of our past hard
lessons learned.
Electronic health record. In the VA's experience the EHR,
electronic health record, has figured prominently in the growth
and quality of medical services.
In 1997, we rolled out an enterprise-wide update to our
EHR. We have been in EHR for about 20 years, but in 1997 we
rolled out this enterprise-wide update.
Two years later, by 1999, that update provided a clinical
data repository, including privacy protection, with real-time
data flow across the entire system with clinical decision
support and clinical alert templates, notification systems, and
disease management features.
Today it has an imaging capability, EKGs, any test that has
ever been taken as part of this, studies, procedures,
endoscopies, scan documents are--can be part of this file.
International observers have called it--I will say some
international observers have called it the gold standard in
clinical informatics.
What has been the impact? Between 1996 and 2004 this
updated electronic medical record enabled VA's ability to
handle a 69 percent-increase in patients and reduced the
workload by 35 percent, and hold the cost--the medical
treatment steady when the cost of health care across the
country was increasing significantly.
Now some would suggest that the VA's lower costs of
treatment were as much a function of its lean budget in some of
those years as they were of efficiencies and delivered
services, and I think that is fair. But lean budgets were not
just visited on the VA in those years, but at Medicare and
other institutions as well, where costs rose 26 percent. So
there is a variance between what our performance has been.
On the backlog. I have not made much headway in
understanding or solving this dilemma, other than to
acknowledge that it is a significant obstacle to building trust
with veterans and the organizations that represent them.
I am not sure that I have a valid working definition for
the backlog, but I am working personally to develop that valid
definition. Not to define myself out of a problem, but if a
claim is initiated today and I ask is it part of the backlog
tomorrow and the answer is yes, there is no way for me to fix
that. I have to define the backlog in a way that gives me an
opportunity to measure it and then to set about correcting it.
So this is what I am about. And unless I can validly define
and measure the backlog I would have a hard time fixing it, and
I am about fixing it.
Our efforts to institute uniform registration and create a
single electronic record will lay a foundation for eventually
controlling the inputs to the backlog dilemma, but I must find
ways to control and reduce the backlog as it exists today, and
for the time being it is a brute force exercise. I put more
people into handing these claims, because that is the only way
to get measurable process. I am not sure that is the solution
for the long term, and paperless becomes important to this
consideration.
So having provided you this quick update, let me now report
that our proposed 2010 budget is critical of realizing both the
President's vision for the 21st Century VA, and also my
opportunity to set about correcting some of these issues that I
have described for you.
The proposal would increase VA's budget. As the Chairman as
pointed out, $112.8 billion, up $15 billion, or a 15 percent-
increase from the 2009 enacted budget. This is the largest
dollar and percentage increase ever requested by a President
for veterans.
Nearly two-thirds of the increase, $9.7 billion, would go
to mandatory programs, which would increase it by 20 percent.
The remaining third, $5.6 billion, would be discretionary
funding and would increase that account by 11 percent.
The total budget would be almost evenly split between
mandatory funding, $56.9 billion, and discretionary funding,
$55.9 billion.
The 2010 budget funds the new GI Bill, and would allow a
gradual expansion of health care eligibility to Priority Group
8 veterans who have been excluded from VA care since 2003. An
expansion of up to 550,000 new enrollees by 2012. Further, it
contains sufficient resources to ensure that we will maintain
our quality of health care for veterans, which today sets a
national standard in my opinion, with no adverse impact on wait
times for those--or quality for those already enrolled.
The 2010 budget provides greater benefits for veterans who
are medically retired from active duty by phasing in an
expansion of concurrent receipt eligibility to military
disability retirees.
The proposal allows highly disabled veterans to receive
both their military retired pay and VA disability compensation
benefits.
The budget provides resources to effectively implement the
Post-9/11 GI Bill and streamline the disability claims process.
It supports additional specialty care in such areas as
aging, women's health, mental health, homelessness,
prosthetics, vision and spinal cord injury, and it helps extend
VA services to rural communities, which lack access to care
today.
The details of the President's budget are still being
finalized and should be available in April, at which time I am
happy to come back and address this Committee again.
So while I lack budgetary detail on specific programs and
activities today, I do however look forward to answering your
questions and am prepared to take those questions now.
Thank you, Mr. Chairman.
[The prepared statement of Secretary Shinseki appears on p.
57.]
The Chairman. Thank you, Mr. Secretary.
When I think about some of the issues that have been
brought up over the last decade, issues that were thrown on the
table and nobody listened to them, it is sort of scary to hear
you come back with all them--so we are really glad to have you
here today.
Mr. Michaud, I will recognize you for 5 minutes, please.
Mr. Michaud. Thank you very much, Mr. Chairman, Ranking
Member for having this hearing.
First, I also want to thank you, Mr. Secretary, for coming
here, and look forward to working with you as we move forward
over the next couple of years to make sure that we provide
adequate funding in a timely manner for our veterans.
I do have one question, but I also have a comment. I want
to follow up on Congressmen Buyer's remark.
You mentioned the backlog and building trust with veterans
organizations and with veterans. Having not seen the budget
language, I have heard the same rumors that I am sure a lot of
Members here have heard, about the Administration, whether it
is OMB, whether it is the President, whoever it is, I don't
know, want to have third-party payment on service-connected
disability.
If that is in the budget, I will not be supporting the
budget. It is unconscionable, and it is an insult to our
veterans who have been hurt overseas.
So hopefully you will give that message to OMB as it
relates to third-party collections for the disabled veterans.
It is just unbelievable that anyone would ever think of doing
that in this budget.
So hopefully it will not be in the budget, but that is what
the rumor is out there. Hopefully you will do everything you
can do to persuade those who are pushing this, if fact they
are, not to include it.
My comment is that I would like to commend everything that
you had mentioned about the budget outline that focuses on
access and services for post-traumatic stress disorder (PTSD),
traumatic brain injury (TBI), and our rural veterans.
As you know, Maine is a very rural state. We have a large
number of veterans in Maine, and I look forward to working with
you to provide our veterans with greater access to PTSD
services.
Can you offer the Committee your ideas on how VA plans to
make these services available to rural veterans? And could you
offer the Committee your assurance that the VA will work with
Congress to ensure that these priorities will be enacted into
law to take care of our veterans?
Secretary Shinseki. Certainly, Congressman.
I will tell you that I have been engaged in discussions
about the rural health issues with a number of Members of this
Committee, as well as other Committees, and I am sensitive when
I look at a map about how much of the country is either rural
or highly rural, and that provides challenges.
I think for us the movement in the VA away from singular
hospitals as the only measure of health care deliverability to
other options that included community-based outpatient centers
(CBOCs), outreach clinics, mobile clinics, and so forth is the
right move, and it has been under way for some time now, we are
just building more capacity here. But it does reach not only
the veterans who can't get to the hospital, but gets to those
areas where there are no hospitals, and I will continue to
treat this as a priority.
I think you know that we are implementing a rural health
pilot project involving mobile clinics at four of our Veterans
Integrated Network Services (VISNs), and we will look to the
goodness that comes out of that to inform us on how much faster
and what else we can do in that area, but I am sensitive to the
issue and this will continue to be a priority.
Mr. Michaud. Well, I want to thank you very much for making
it a priority, because those are a lot of the complaints that
we hear. For those of us who are from rural areas it is that
whole access issue, so I really appreciate your making that a
priority, look forward to working with you, and really
appreciate your willingness to meet with Members of Congress on
both sides of the aisle to get our concerns and hear them in
advance before you move forward with policy. I really
appreciate that.
And I realize that you have a boss as well, and you have to
deal with OMB, so hopefully you will deliver that message, and
when we meet--or when I meet with the OMB director I will be
delivering that message personally as it relates to collections
for soldiers who are injured on the battle field.
So thank you once again, Mr. Secretary, for coming here
today, appreciate it.
Secretary Shinseki. May I just add a point here? That is a
consideration. It is not in the budget, but it is a
consideration, and I will be sure that your concerns are
delivered.
And again, we are talking in health care the two aspects of
this are delivery of health care and the financing of it, and
this is about the financing.
I want to assure you that there should be no concern about
the delivery, that we will provide the best quality health care
we can to our veterans. That is not discussable.
Mr. Michaud. Thank you.
The Chairman. Thank you, Mr. Michaud.
Mr. Moran.
Mr. Moran. Mr. Chairman, thank you very much.
General, thank you for joining us today, and thank you for
the opportunity I had to visit with you in my office earlier
this year.
There are a couple of bills that are being implemented, or
should be implemented, by the Department of Veterans Affairs in
this current year.
One, you mentioned in your testimony, the GI Bill, and I
look forward to working with you on this bill. I hope you will
spend a lot of time with veterans and with financial aid
officers at universities and technical colleges trying to make
certain that we do this in a very effective manner.
Second is the implementation of a bill that I introduced
that became law last November.
You mentioned four VISNs in an implementation of mobile
vans in rural areas. There is also another rural program that
we created in the last Congress that you will be implementing,
and I want to stress that how it is implemented is so
important, because I want this program to succeed.
And that is that if there is no outpatient clinic or VA
hospital within a certain distance of our veterans, that in
four VISNs you are to implement a pilot program in which you
contract with local providers to provide those services to
veterans.
One of those VISNs is, in fact, the two VISNs that I
represent in the state of Kansas, are included in that pilot
program, and I would love to have the opportunity to visit with
the appropriate staff, personnel at the Department of Veterans
Affairs about this implementation if you could make that
possible.
In addition to those two implementations, I would be
delighted to hear your thoughts about health care provider
recruitment and retention.
As I listen to my VISN directors and hospital
administrators within the part of the VA that I represent or
the geography that I represent, the Department of Veterans
Affairs is no different than the private sector in many ways
regarding to the inability to attract and retain the necessary
health care professional. It is particularly true I think in
specialties, but specialties dealing with mental health, mental
illness, at a time in which the need seems to be a priority of
ours.
And finally, I would like your comments on advanced
appropriations. My understanding, from comments that you made
and that President Obama made, is that the Administration would
be supportive of legislation allowing for advanced
appropriations.
It is my understanding that there is some belief that you
are now talking about a timely funding as compared to advanced
appropriations, and I was interested in knowing the difference
between those two phrases. And I thank you, sir.
Secretary Shinseki. I am not sure I can answer the last
question there, but let me start with the beginning.
We need to be better at recruiting and retaining health
care professionals and workers for rural areas.
The VA is working with the National Rural Recruitment
Retention Network to one, to be linked in with them, but also
to get better at the business of training our people, our
recruiters on how to do this. So we are taking that on.
There are incentives for recruitments such as the Education
Debt Reduction Program. And besides that, we also look at the
opportunity to employ an outreach clinic, which is not a full-
time clinic in a given area, but we will go for a period of
time, set up a clinic, bring in all the health care
professionals we need, and conduct the clinic for a regular,
but limited time, and see as many patients as need to be seen.
The patient load is not enough to keep that clinic open
full-time, but it gives us an opportunity to one, see what the
needs are, and also address some of these issues.
Regarding advance appropriations. I believe a couple
testimonies ago I indicated that I think even then that I said
my preference was for timely budgets.
My experience with continuing resolutions always pointed up
some difficulties for those of us that had missions to execute,
especially where health care and other services were concerned,
and if timely budgets were not available, then advanced
appropriations may be an appropriate alternate way of looking
at this.
I now understand that timely budgets are what we are going
to do, and so that is what I am going to go to work on, my
piece of it.
Mr. Moran. Mr. Secretary, thank you.
It is pleasing to me that you are able to speak on behalf
of Congress, that we are going to do our work in a timely
fashion and avoid continuing resolutions. I hope your optimism
is founded.
The Chairman. Thank you, Mr. Moran.
Ms. Herseth Sandlin.
Ms. Herseth Sandlin. Thank you, Mr. Chairman.
Secretary Shinseki, thank you for being here today, thank
you for your testimony. We had a chance to visit again earlier
this week, and I look forward to continuing to work with you to
strengthen and transform the VA to meet the needs of our
Nation's veterans.
Thank you for helping craft the largest ever increase in VA
funding. I appreciate the VA's commitment to assuring that it
has the resources it needs to meet a very long list of
challenges; however, Congress must also conduct proper
oversight to ensure that taxpayer dollars are spent wisely and
that programs are implemented effectively, and more funding
can't alone guarantee better services, aggressive oversight is
also needed.
Now as you know I serve as the Chairwoman of the Economic
Opportunity Subcommittee, and along with the distinguished
Ranking Member, Mr. Boozman, we have been working closely in
our oversight capacity with Keith Wilson, Director of the
Education Service, and Stephen Warren, the Principal Deputy
Assistant Secretary for the Office of Information and
Technology. And just recently on February 26 we held yet
another oversight hearing to review the VA's process in
implementing in Post-9/11 GI Bill, which you addressed in your
opening remarks.
Now at that hearing, Mr. Wilson and Mr. Warren indicated
what you have indicated today, that the VA remains on schedule
to implement this new benefit by the August 1st, 2009 deadline.
And while we remain cautiously optimistic that the program will
continue to move ahead on schedule, we also know that any
disruptions to the plan will likely cause the VA to miss that
deadline.
Now in your opening statement, you indicated that the
fiscal year 2010 VA budget will fully implement both the short-
term and long-term goals of the Post-9/11 Veterans Education
Act, and I appreciate your continued support for the program,
and I encourage you to be up front and open with the Committee
if any problems arise or if any additional resources are
needed.
Could you perhaps address or share your thoughts on the
concerns that have been recently expressed regarding the
variance of the benefit by schools, by states, and how we can
go about addressing those concerns without disrupting the
August 1st deadline?
Secretary Shinseki. I understand there has been some
concern expressed. I am not totally familiar with all of them.
I am told they are not a single concern, but I am on a timeline
right now that is fairly precise.
New forms are going to be available on 28 April. Veterans
apply for certificates of eligibility, 1 May. VA processes
enrollment information from schools and authorizes payment, 8
July. Tuition fee payments are issued to schools beginning
first week in August. Housing allowance, books, supplies,
stipends, et cetera, 2 September.
It is a very tight timeline. I am willing to work these
issues. I am just concerned that if I have to pull back the
regulation that it has taken us 8 to 9 months to put in place
to adjust them and to undo some of the programs that we have
already put in place and have begun training on, that it risks
this timeline.
So I am happy to take on the concerns. I am not sure that I
can do it this year and also meet the August start dates.
Ms. Herseth Sandlin. I appreciate your thoughts.
Secretary Shinseki. I will analyze that.
Ms. Herseth Sandlin. Mr. Secretary, we look forward to
working with you on that.
Thank you, Mr. Chairman.
The Chairman. Thank you.
Mr. Boozman.
Mr. Boozman. Thank you very much.
Again, we appreciate your service, and I really look
forward to working with you in the future, and we appreciate
you being here.
The forward budgeting, again, that seems to me like it--I
know you have been in a situation where because of continuing
resolutions and things like that you start having to juggle
money around, but it does seem like if that were done
correctly, and I don't really have the answer to it, but it
does seem like something that we really ought to look to in the
sense that when you start juggling funds around like that when
we put the agencies in those situations, and Congress is the
one that is doing that, and I think, you know, if you look at
past Presidents, it is not a partisan thing, you know, it
happens on both sides regardless of who is in the White House,
regardless of who is controlling Congress, but it does seem
like that is a way to actually save some money. That, you know,
you would be in a situation where you could better look at your
budget and then again actually save some money from not
juggling around.
So that is something that is going to be coming up again. I
would just encourage you to really look at that and then give
us some good ideas and some good guidance as to, you know, if
that is possible to implement.
The other thing is--you know, I am excited about hearing
that we have the potential to increase our Category 8s as far
as serving them.
One of the concerns though, that we have had is that we
have worked really hard to get our times down and things, is
that we do that and then we don't put the resources in place,
the added personnel, the added infrastructure and things like
that, and so then we go back to the waiting times that we have
worked so hard.
I understand the importance of that. My dad was in the Air
Force for 20 years and was a recruiter, and a lot of these
individuals, you know, were told that they were going to get
health care and things, and so I think it is an important
commitment, something we need to do.
Can you comment on that? I guess at some point in time we
are going to have 525,000 additional Category 8s, so half a
million people. Can you talk to us a little bit how you are
prepared to do that?
Secretary Shinseki. Yes. The timeframe of establishing this
program, beginning in June of this year out to 2013 and hitting
that 550,000 potential enrollee mark is designed to let us get
it started, and then adjust as we go. I mean, if it is possible
to go faster then certainly we can do that, if not then we need
to slow things down.
The issue here is to ensure that we don't put at risk any
of the programs or any of the quality of services being
provided to enrollees today, to veterans who enroll today, and
so that--your question is appropriate. I will have to look at
this as we start and increase the program.
As I indicated, the first year up to 266,000, which is a
significant number. We think we can handle that.
Mr. Moran. I thank the gentleman from Arkansas for
yielding.
Mr. Secretary, is your philosophy or your belief that all
veterans should be covered? All Category 8 veterans should be
included in the health care delivery system, and it is just a
matter of getting us to that point in an orderly fashion that
doesn't cause a detriment to the rest of the system? Or do you
believe that under a certain set of criteria those veterans
should be served?
And I thank the gentleman for yielding.
Secretary Shinseki. Priority Group 8 veterans are veterans.
What distinguishes their entitlements right now is
circumstances that have to do with economics or location, but
they are veterans.
If it is within my ability to reach them, I don't know how
to not include them in the consideration.
Whether I can find ways to reach the affordability factor
here, I don't know, but this is why this program is phased in
over a period out to 2013. That will give us an opportunity to
assess how we are doing and ensure that we are maintaining the
quality standards I am describing here, and then make decisions
at some point down the road.
To answer your question, whether all Priority 8 Group
veterans should be included, today I can't tell you how many
are in the Priority Group 8. I need to come to some way of
estimating that before I can fully answer your question.
Mr. Moran. Thank you, Mr. Secretary, thank you, Mr.
Chairman.
The Chairman. Thank you.
Mr. Hall.
Mr. Hall. Thank you, Mr. Chairman and Ranking Member Buyer,
and thank you Mr. Secretary for your service, and for the
President and you showing the overwhelming support of veterans
that you have shown in this budget. The first time I believe in
our history where an Administration has proposed a budget that
exceeded the recommendation of The Independent Budget.
And I also want, as the representative from New York's 19th
District, home of your alma mater, West Point, to say that the
veterans in my district are especially proud of you and
supportive of your service now as Secretary.
In regards to the budget, I understand you can't go into
specifics, but I would like to ask you about PTSD in
particular.
As you know, I have a bill introduced in this Congress that
would establish service in the theater of combat as a
presumptive stressor for the occurrence of PTSD.
For too long, I believe veterans have had to leap through
hoops or over hurdles to prove specific events that caused
their trauma, and my bill would remove this burden if they
served in the uniform of this country in a war zone.
Can you tell us your thoughts on how the VA could
facilitate such treatment and compensation for PTSD and how the
budget would play a role in this?
Secretary Shinseki. Are you referring here to the
determination of precursor for PTSD based on----
Mr. Hall. A presumptive stressor being established in this
legislation.
Secretary Shinseki. I would start out by first pointing out
that I am not a clinician here, and so I rely on those experts
who help me understand what might be the precursors for
validating PTSD as a condition.
I do know firsthand that you don't have to be in combat to
go through trauma that could result in PTSD. I think there are
ample cases of assaults on women that give us an understanding
that that is enough of a traumatic experience to create the
conditions for PTSD.
So my sense here is this is an area that requires a
clinicians determination, but I would--I would also say that I
have been in operational zones where servicemembers have been
exposed to conditions that were horrific enough, they were not
involving combat, and PTSD determinations were made on those
individuals being in an operational environment.
I am willing to work with you in trying to understand how
we best address this issue, PTSD, and TBI issues, which we are
trying to put our arms around with regard to mental health as
an area for us to spend more effort in.
Mr. Hall. Thank you, sir.
And the legislation does require diagnosis of the symptom,
so it is not just having been there, and I appreciate your
comments on different people handling different experiences in
a different way, but I thank you and look forward to working
with you on developing and refining that legislation.
Regarding the IT progress that is being made in response to
legislation this Committee passed, can you tell us--give us an
update as to where the Department's efforts are in this area
and how confident you are that when the IT account level is
established it will be sufficient to meet the requirements
mandated by Congress?
Secretary Shinseki. You are looking for where we are going
to put our priorities?
Mr. Hall. Well and just sort of an update to tell us
somewhat about the paperless--moving toward a paperless claims
system.
You also talked about, you and the Secretary of Defense,
which I think is a terrific idea, having single enrollment so
that starting with new servicemen and women that record would
then hopefully continue and already be in the system, and that
will obviously help future cases. But in terms of our existing
veterans population, how is it being approached and what kind
of progress are you making so far in moving toward paperless
claims in particular I am concerned with?
Secretary Shinseki. In terms of just the IT arena, we are
strengthening our network security operation in terms of tools,
standardizing desktop systems and components, and beginning to
put into place our process for determining how to attack the
backlog.
Based on our experience with what the electronic health
record did for us in terms of health care between 1997 and
2004, we are looking to have the same kind of effect by smartly
introducing IT into this area of adjudication.
As I think I have mentioned before, 11,100 adjudicators
today--actually it is 11,300 since the last time I was here to
testify. That is a leadership issue, that is a training issue,
but it is still a brute force solution that right now the way I
get faster at this is to hire more people.
I am not sure that that is the solution, and I am looking
for a way to address this quickly, and IT is very much a part
of this.
Mr. Hall. Thank you, sir.
Thank you, Mr. Chairman.
The Chairman. Thank you.
Mr. Bilbray.
OPENING STATEMENT OF HON. BRIAN P. BILBRAY
Mr. Bilbray. Let me start all over again by saying I want
to thank you for your fresh approach.
But actually, Mr. Secretary, I want to say sincerely I
appreciate your fresh approach. There is a lot of people that
have had your hot seat, and believe me it will be tough, and I
just want to say that I think that we are starting off on a
good footing. I think it is something that both sides can
really hope for your success, pray for your success, but more
importantly work together for your success. And as son of a
veteran both of deceased veterans and a mother who still are
getting benefits from your organization, your department, I
appreciate your approach to this.
My only warning to you is that 2 years from now, let us
just hope we have that much of a positive, and that is a
challenge of all of us working together.
And I just have to tell you personally being a personal
friend of the Chairman, believe me, he can be a tough overseer.
He can be one of the toughest guys I have ever worked with,
especially when you are at your end of the dais, so I look
forward to your success. I look forward in a few years being
able to look the Chairman in the eye and matching him success
for success. So good luck, okay?
Secretary Shinseki. Thank you.
The Chairman. Thank you, I guess, Mr. Bilbray.
Mr. Perriello.
Mr. Perriello. Good afternoon.
Let me begin by thanking Chairman Filner and Ranking Member
Buyer for convening this important hearing on the Department of
Veterans Affairs. Let me also thank everyone on the Committee
for their prayers and thoughts for my family during my absence
over the last couple of weeks due to the loss of my father, who
was proud to have worn the uniform of the U.S. Army.
Secretary Shinseki, I want to echo the sentiments of my
colleagues in welcoming you back to the Committee, and for all
of your service to this country when you wore the uniform and
in your current capacity.
It is indeed exciting to see such an unprecedented
commitment to veterans, and it is a timely moment for this
leadership surge as we see the unprecedented convergence of
some very severe challenges. Veterans returning home to a very
bleak job market, returning home to a bleak housing market, and
dealing with the unprecedented mental health challenges of PTSD
and TBI.
It is a great time to have your leadership and a very
challenging time in terms of living up to the pledge we have
made to our veterans.
I would also like to recognize the VSOs present here today
for their work in preparing The Independent Budget, which has
been met, matched and exceeded. Thanks also for increasing
intergenerational cooperation between veterans past and
present. It has been very helpful to all of our offices to be
able to share your breath of wisdom.
As a representative of a rural district, I just wanted to
ask you two questions. One, specifically what commitments we
are ready to make to ensure we are taking care of those
veterans returning to rural areas? And two, the strategies for
addressing the specific challenges of the current economic
environment into which our veterans are returning.
Secretary Shinseki. Congressman, I think I will quote
President Obama here when he says, ``That veterans lead in lost
jobs, homelessness, substance abuse, and a tendency toward
being part of that suicide discussion.''
And so, my sense is that if we are able to help up front,
first order of things here matter. If veterans come home and we
have a good way to identify who they are, get them into our
programs. For those who are injured, get them safely and
completely through the vocational rehab process.
I know that right now we are not doing very well at that.
Many of them indicate interest, lesser numbers show up, and
even fewer complete the program. Some of that has to do with
economics, and I need to get inside of that. But we show that
if they will complete that program the opportunity for
placement and successfully getting a job is much higher.
Both Secretary Donovan from the U.S. Department of Housing
and Urban Development (HUD) and I have appeared before the
Coalition for Homeless Veterans to hear them primarily, but
then for the both of us to commit to working on the homeless
veteran issue in this country. It used to be about 240,000,
today it is 154,000.
I would like to tell you that there are some programs out
that there that we have found to have been successful in
reducing by 40 percent that number. And again, these are
estimates, so I am a little reluctant to put a hard pencil on
it, but I am told that we have reduced those numbers
significantly.
If we can get these veterans back and keep them from going
homeless I think we have a much better chance with our
programs. If it is substance, abuse to get them off of it. If
it is educational initiatives, to get them engaged in
vocational rehab training, and get them situated for turning a
page and being successful in the next phase of their lives.
These are all successful people, they were successful in
uniform, and our responsibility here is to get them back on
that track again.
If we can do that up front, and that requires the VA
working with DoD to get this transition into our programs,
working with education for those issues, working with the U.S.
Department of Health and Human Services (HHS) for the health
care issues, working with labor on jobs, and HUD for housing,
we have a much better opportunity to reduce the 154,000
homeless veterans today to something significantly less.
Mr. Perriello. Well, I just want to commend you for your
support of vocational and on-the-job training programs. For
many of the veterans in my district this is a top priority. The
GI Bill, expansion in education has been great.
I have authored a bill, which would expand on-the-job
training. Vocational and skills training programs are really a
lifeline to living wage jobs in my area, so I commend your
support of this and look forward to working with you on it.
The Chairman. Thank you.
Mr. Roe.
Mr. Roe. Thank you, Mr. Chairman, and thank you General for
coming by the other day and visiting my office.
And it just, as I was sitting here I remember when I was in
college when the entire budget of the United States was $100
billion, and now the VA budget is over $100 billion this year.
Just a couple of comments. One, on the Category 8 veterans.
I was glad to hear you say in your testimony, or your answer I
should say, that veterans are veterans.
And we may have talked, I think, last week in my office
about a veteran that I know that is a sheriff in a county, and
the county is so poor that they can't provide health benefits
for their county employees. No county employee has health
insurance. This veteran makes a little bit more money as a
sheriff of the county than is allowed apparently, and I am not
sure what that number is, and I don't know whether this 10
percent-boost will help him or not, but he should be able to go
to the VA medical center in his district, which is close by,
and I am glad to hear you say that, and I would like to work
with you to make that--and this Committee, to make that happen
for all veterans.
On the backlog. I was just wondering if you know any of
the--or do you know the demographics of our veterans population
now that they are currently using the VA?
And the reason I bring that up is because just looking at
this budget going forward it doesn't seem like that it is
realistic. If we raise it 10 percent this year and then look at
a 2 percent basically, which is not going to be inflation for
the next several years, that doesn't seem to be adequate to me
to do that.
Would you comment on that?
Secretary Shinseki. Well, I would just offer that timely
budgets allow us to work the budget that is being considered,
just as we did this one. And I think I would share the concern
looking out that more work needs to be done as we get to those
budget years to get resource levels where the priorities that I
think we will be facing will be appropriately addressed.
It also touches, I won't say directly, but it also touches
on the issue of advanced appropriations. Because sitting here
looking out several years and trying to figure out how to put
that in place I think is the reason that timely budgets become
discussable.
And I will accept Mr. Moran's caution here. I was not
suggesting that I could do this, I was just suggesting that I
will do my part.
Mr. Roe. I guess the question I am asking is, as we look at
the veterans that are currently using our facilities, 1,500 or
so World War II veterans are dying every day. And what percent
of the VA budget is going to caring for them and then the other
Vietnam veterans and so forth that we know are going to be
around a while longer?
Secretary Shinseki. I am sure there is a number, Mr. Roe. I
will try to go figure it out, but I don't have that detail
today.
Mr. Roe. Yeah, that is very important in going forward in
to know whether your resources are going to be--whether you may
have less demand, who would know.
Secretary Shinseki. Yes, our Vietnam veterans are today the
largest population of our veterans.
Mr. Roe. So that obligation is going to be going on for a
while.
Secretary Shinseki. Right.
[An April 20, 2009, follow-up letter from Secretary
Shinseki to Congressman Roe, regarding the percentage of the
budget going to care for World War II, Vietnam Veterans and
other veterans of other eras, appears on p. 143.]
Mr. Roe. I guess the other question we talked about we are
changing this electronic medical record. And to answer Mr.
Hall, it is going to be more money than you think it is going
to be. We did that in our own office and changing our medical
records to electronic medical records was a very expensive
undertaking and a lot more laborious than we thought it was
going to be, but I think it is essential that we do that.
And what I would recommend you looking at doing, it worked
for us, is any new veteran that comes in enter them into the
EHR system. And exactly what we were talking about, when a
soldier is signed up today enter them into the system. And then
as you have an active file open up do that person. One that is
working along just fine get to them later. And I think you will
find that works pretty--and of course the archive files, I
wouldn't fool with them unless something came up.
Mr. Bilbray. Would the gentleman yield on that point?
Mr. Roe. Yes, the gentleman yields.
Mr. Bilbray. Yes, I would have to echo that strongly.
Rather than having to go back and recapture old information,
actually phasing it in is by far a much more effective way to
be able to implement the program, and I just have to really
reinforce what the doctor is pointing out here, and I yield
back.
Mr. Roe. Thank you. Yes, that is the method we used and it
worked fairly well. It will be hard, it will be difficult any
way to do, but I look forward to getting that started and
getting done, because I think that is going to be part of being
able to get that information out there and handling it
appropriately to get this backlog of 900,000 people. And I
agree with you, are you a backlog when you just--are you
900,001 if you sign up today then you will be part of the
backlog.
So thank you.
Secretary Shinseki. If I might. Electronic health records
have other benefits, and I know there is cost associated with
it. But for example, in 1996 patient records were available to
the doctors about 60 percent of the time, today with our
electronic health records, 100 percent of the time a doctor has
a record with a patient, and not just the form, but every chest
x-ray, every brain scan, every blood test for the history of
this patient is available so that the doctor can make some
longitudinal decisions based on what has happened here.
In 1996, the VA lagged industry in terms of pneumonia
vaccinations for patients over age 65 at about 28 percent.
Today we are at 94 percent, and all of this is information
available to health care providers to make the right decisions.
And I think that this increases the quality of health care
and reduces the cost, because it is preventative. It also
allows us to do our part in reducing that figure that is out
there about 100,000 patients falling victim to medical errors
or poor decisions because of lack of current records. So there
are other returns here.
The Chairman. Thank you.
Mr. Walz.
Mr. Walz. Well thank you, Mr. Chairman, and thank you Mr.
Secretary once again for being here.
The Chairman mentioned it might be a little lonely there,
but you know there are plenty of people that have your back. I
see some friendly faces. I see Paul Rieckhoff and Rick Weidman
and Steve Robertson and others, they are always there for you.
They are always there and they speak for millions of veterans,
and we are all in this together.
So I really appreciate your assessment on the GI Bill, your
very candid assessment of this claims backlog. I think that is
refreshing to let us get at it. I think your assessment that it
is going to take brute force might be the only way to do it
right now, but it gets us back to how do we make sure that
start to reduce that and we start to get smart in the future?
I agree with you, and this electronic medical record is a
big one.
And I will throw one in on top of that, that you said that
there are people that believe that is the best. I represent the
Mayo Clinic, and they always echo that, that the way that the
VA handles their medical records is the best in the world, and
they pioneered the procedure, and they have done it on a
massive scale themselves too.
And so Dr. Roe's cautions about this, it is very--it is
much more difficult than creating a database, and it is much
more than just putting things into the computer, it is how we
use them and the ease of use to not only save money but to
improve patient care.
I just have one question. I am very excited too about your
opening comments. When you were here last time you talked about
a uniform approach to registering folks--when they raise their
hand to defend this Nation they have also raised their hand to
be part of the VA system--and a way to get to that.
So my question deals with seamless transition. I brought it
up before. The Chairman has been very proactive on this and has
allowed me to ask some of these questions, then to move
forward.
My question deals with how are we going to get to that?
Because the one thing I always know whenever I am in this
Committee room, nobody from DoD is ever here, and that poses
quite a problem. It is very difficult on interoperability, and
this is one of the questions I want to ask.
I, too, am very pleased with the budgeting and all that,
but I am also concerned, many of these issues do need the
funding, but it is more than just the funding, it is
intelligent funding, it is how we use them, it is how we force
that seamless transition in interoperability.
So I just want to ask maybe a generalized question on this.
How do we go about that?
In the National Defense Authorization Act last year, and
the year before, there were some initiatives in there to get
going on this. There was one very specific one on the Eye Care
Center of Excellence. And the VA, under Secretary Peake, I
think, took a very proactive forward-leaning approach and got
after it. DoD, I have a hard time getting phone calls returned,
and it takes a story in USA Today to start pushing, okay, we
are going to get going on this. I think they do a very good
job. You have been there; I have been there. They see
themselves as war fighters. They also have to understand with a
little bit of front help on this we can also take care of these
warriors during their lifetime.
So I would just like to ask, I know it is a bit subjective
and a general question. How do we bridge that gap? How do we
get interoperability? How do we--those of us in this room--make
sure that Chairman Skelton's Committee is ready to sit down
with Chairman Filner's Committee to figure this seamless
transition out once and for all? So please.
Secretary Shinseki. Well, the way I have approached this is
to take this on at Secretary Gate's and my level, and he is
been more than forthcoming. I have met with him personally
three times. We have discussed this issue. And I will tell you
not everybody in the room was necessarily in agreement on
whether to do this, but with his leadership and his
determination, we are moving forward on uniform registration,
and that will become the forcing function. If we agree to that,
then the electronic record becomes a by-product of that
decision.
Mr. Walz. And the timeline on that? You were looking at
2012, or did I hear that correctly? That is kind of the----
Secretary Shinseki. Well, that is for going paperless
inside our claims adjudication process.
Mr. Walz. Okay.
Secretary Shinseki. I don't know how soon. 2012 would be
well off the timeline.
Mr. Walz. How is that funding mechanism going to work? When
we fund for the VA and the DoD how do we ensure these--this
seamless part, this compatibility, these joint operations? How
do we ensure that funding is steady, and as I said,
intelligent, and we are not duplicating, we are not creating
our own silos and the things that we have done for years and
years and year? Do you have any vision on that?
Secretary Shinseki. Well, there is always the tendency for
that to happen.
This will require leadership on both of our parts to agree
on a single electronic record, and force the people that are
going to be the users of that record.
If it is our medical personnel, bring doctors and nurses
from both sides into a room, a small room, and have them define
for us what that electronic record ought to look like.
We each have one today. The problem is they are not
identical, and while you can extract information from each
other's systems, it is not fully open architecture where you
can pass the entire record, which is the problem we have today.
We can't take the record when an individual transitions.
So we need to get at that, but it is going--that is a
leadership issue here. And we both left our own systems with
probably design and upgrade to our current system, and that is
what we are against.
We want to come up with a system that is going to serve
both of us, and whatever it looks like that is the requirement
we should be building to.
Mr. Walz. Well, I appreciate that, and I feel great
confidence in the two leaders we have there, and so that is
comforting as a first start.
Thank you. I yield back.
The Chairman. Thank you.
Mr. Bilirakis.
Mr. Bilirakis. Appreciate it very much, and thank you for
your service, General.
I have one question regarding concurrent receipt. I
understand that the budget will expend funding for concurrent
receipt. Can you elaborate a little bit?
Thank you.
Secretary Shinseki. Concurrent retirement disability
compensation is going to be put into place over the next 4 or 5
years, but it begins 2010 with the highest disability
categories, and then incrementally, so that in the 2013, 2014
timeframe we are looking at the 10 and 20 percent military
disability retiree having that entitlement in place.
Mr. Bilirakis. As far as medical retirees, my understanding
is that if you have less than 20 years you will receive up to
50 percent of the VA rating; is that correct, General?
Secretary Shinseki. I don't have the details exactly of
what less than 20 years in this category, but I would be happy
to provide you the details that will address the entitlements
in 2010, and then each there after.
Mr. Bilirakis. Thank you. Thank you very much, we would
like that.
Secretary Shinseki. It is a cascading set of military
disability retiree from the highest categories down to 10 and
20 percent in the 2013, 2014 timeframe.
Mr. Bilirakis. Okay, I would like those details. Thank you,
sir.
Secretary Shinseki. Okay.
[The VA subsequently provided the following information:]
CONCURRENT RETIREMENT AND DISABILITY PAY
CRDP is a ``phased-in'' restoration of military retired
pay first authorized by the Defense Authorization Act of 2004,
effective January 1, 2004-retroactive payments started in September
2006.
The Defense Authorization Act of 2005 eliminated the
phase-in of veterans entitled to a schedular 100 percent-evaluation.
The Defense Authorization Act of 2008 eliminated the
phase-in requirement for individual unemployability recipients,
retroactive to January 1, 2005.
Retiree must have 20 years of service and be evaluated at
50 percent or more.
CRDP is retired pay, is taxable and enrollment is
automatic.
VA computes the CRDP amount based upon Base Rate and
Phase-in schedule.
------------------------------------------------------------------------
2004 Base Rate
-------------------------------------------------------------------------
Combined Disability Evaluation CRDP Payable
------------------------------------------------------------------------
100%............................... $750
------------------------------------------------------------------------
90%............................... $500
------------------------------------------------------------------------
80%............................... $350
------------------------------------------------------------------------
70%............................... $250
------------------------------------------------------------------------
60%............................... $125
------------------------------------------------------------------------
50%............................... $100
------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Phase-in Schedule
-----------------------------------------------------------------------------------------------------------------
Waived compensation payable in addition to
Year base year amount
----------------------------------------------------------------------------------------------------------------
2005............................................................ 10%
----------------------------------------------------------------------------------------------------------------
2006............................................................ 28%
----------------------------------------------------------------------------------------------------------------
2007............................................................ 49.60%
----------------------------------------------------------------------------------------------------------------
2008............................................................ 69.76%
----------------------------------------------------------------------------------------------------------------
2009............................................................ 84.88%
----------------------------------------------------------------------------------------------------------------
2010............................................................ 93.95%
----------------------------------------------------------------------------------------------------------------
2011............................................................ 98.18%
----------------------------------------------------------------------------------------------------------------
2012............................................................ 99.64%
----------------------------------------------------------------------------------------------------------------
2013............................................................ 99.96%
----------------------------------------------------------------------------------------------------------------
VA has released over 100,272 CRSC and CRDP retroactive
payments totaling over $286 million.
As of May 1, 2009, 256,329 military retirees are
receiving CRDP.
CRDP NEW CHAPTER 61 COHORT
2010 budget expands benefits to include chapter 61
disability retirees with less than 20 years of service at all
disability levels, not just 50 percent and above.
2010 budget for CRDP totals $47 million.
New chapter 61 cohort has separate phase-in schedule
based on combined degree of disability.
------------------------------------------------------------------------
Phase-in Schedule
-------------------------------------------------------------------------
Year Combined Degree of Disability
------------------------------------------------------------------------
2010 100% & 90%
------------------------------------------------------------------------
2011 80% & 70%
------------------------------------------------------------------------
2012 60% & 50%
------------------------------------------------------------------------
2013 40% & 30%
------------------------------------------------------------------------
2014 All Ratings
------------------------------------------------------------------------
Key point: The amount available for either CRSC or CRDP
is the amount of retired pay earned (2.5 percent years served
base pay).
The Chairman. Thank you.
Mr. Snyder.
Secretary Shinseki. Once the budget is completed.
Mr. Snyder. Thank you, Mr. Secretary. I am sorry I was not
here for your opening statement.
I wanted to just make one comment, and then give you your
softball question for the day so that--the only comment I want
to make is we are waiting on the details of the budget is, one
of the issues that has come up through the years is in a way, I
think, it has been a double counting of Federal research
dollars. And by that I mean, I will just use some numbers that
are not realistic, but let us suppose you have a pool of money
at National Institutes of Health (NIH) of $50 million and the
Veterans Health Administration is able to get $10 million of
that to help with their VA research, and then we see a budget
number that says oh, we have--they put $40 million, they have
$50 million of research dollars, and you add those numbers up
and you say we have $100 million of research going on, when in
fact we only have $90 million of research because the money
gets, you know, the NIH folks and the Congress that look at it
say oh, we have a good number here, and we look at this number
and say oh, it is a good number here, but in fact, it is a
double counting of money. And I would encourage you to sort
those numbers out in a way that is transparent.
I hope that the VA will be competitive, that VA researchers
will be competitive for other sources of funds, but let us not
try to fool anyone into thinking that somehow we have this
great plussed up number, if in fact what we are doing is
counting on good researchers to get dollars from other sources.
I think we need a good healthy number that involves your
dollars, and that is one of those issues that several of us
have been following along through the years, and have been
pleased with the quality of research that can come out of the
VA system.
My softball question is this. You are a guy who came out of
a system, a fairly dramatically different system, that you have
committed almost all of your adult life to and you are now into
a new system. You have had several months to get up to speed
and look at the culture that you are in and all the details.
What have been your biggest surprises, either good ones or
bad ones as you have spent the last several months getting up
to speed on the VA system?
Secretary Shinseki. I guess surprises, I guess would be the
number of reports I sign and send to Congress. I was surprised
at the number of reports I submit daily. And I think in time I
hope to earn the trust of the Committee that I am on a good
track and doing the right things, and where it meets your needs
I will provide every report, and where it is less useful I
would look for an opportunity to come to an agreement on how we
harmonize those requirements, because they are pretty
significant.
There are other surprises, but that was the one that stood
out.
Mr. Snyder. I think that is something that probably a lot
of us would be interested in working on. It is really easy for
us to include in some bill we need a report on this without--we
probably should have a requirement that they have a number on
it. You know, this is the 102nd report that is required by the
Secretary, but I think that is certainly something that a lot
of us would be interested in looking at to make the reporting
information more streamline.
Thank you, Mr. Secretary.
The Chairman. Mr. Buyer.
Mr. Buyer. We are going to have different interpretations
here, since Mr. Bilirakis asked his question. It is a very
complex issue, because we have multiple disability systems, and
trying the figure out who is in and who is going to be left out
of this type of proposal and their different interpretations by
what is out there. So I am at a little disadvantage.
Dr. Snyder is right, we don't have the details and it is
hard for us. Even this Friday, it is truly Friday the 13th for
us, because we have to deliver our budget views and estimates
without any details. And I am not picking on you, it is just
even when we changed Administrations in 2001, the same thing
happened. We just didn't have the details.
So I just want you to know we are going to come and do some
real questions for the record on the concurrent receipt so we
can better understand how you are going to implement this.
One of the other questions I have. The status of the VA
report on--the VA economic recovery report. Do you know what
the status is on that report?
Secretary Shinseki. I don't, but I will get you that.
Mr. Buyer. You have 30 days to get it to Congress when the
President signed it into law. Has it left your desk and gone to
OMB?
Secretary Shinseki. I don't know. I mean, it is not to
your----
Mr. Buyer. Well you would know if you have signed it, so it
is not to your----
Secretary Shinseki. I don't recall, but I will get you an
answer today.
[The VA Reports on the American Recovery and Reinvestment
Act were provided to the Committee and appear on p. 164.]
Mr. Buyer. Okay.
With regard to several initiatives, this--I have had a
couple discussions, and you know it is one of my pet peeves
now, is this multiple standards for cemeteries. And I would
love for the leadership of the VSOs to take on these kinds of
issues. I think they are important. And have you had a
discussion with the Secretary of Interior?
Secretary Shinseki. I have not had that opportunity as of
yet, but I do intend to do so. I have had my staff look into
the background of these two cemeteries that you have mentioned,
and others.
Mr. Buyer. Okay.
Secretary Shinseki. There is a difference in management and
a difference in standards. We are trying to assess what it
would cost if we were asked to assume responsibility for these
two cemeteries and what capabilities it would require at this
time.
Mr. Buyer. Okay.
Secretary Shinseki. And what it would take.
Mr. Buyer. Thank you for doing that, and I will wait for
your response.
[Ron Walters, Director of Finance and Planning, National
Cemetery Administration, Department of Veterans Affairs,
provided the requested technical assistance by telephone to
Committee staff on March 30, 2009.]
Mr. Buyer. With regard to the Priority 8s. We received a
briefing in a report from the VA. It is titled, ``Analysis of
the Requirements to Reopen Enrollment of Priority 8 Veterans.''
So this was dated January 1st, and they do--excuse me--of last
year, so this would be January 1st of 2008. And there was an
analysis done based off of--hold on--VA's actuarial model.
``The enrollee health care projection model projects that
reopening enrollment to Priority 8s will increase enrollment in
2013 by 1.4 million and patients by approximately 750,000 over
the current enrollment policy.''
So when I read your budget, you are going to do a target
opening up to 550,000. So when I look at this, when I compare
the VA's actuarial model to the target that is being projected
that it would be false then for anyone to infer that you are
planning on opening up the enrollment to everyone. Would that
be accurate?
Secretary Shinseki. At this point the enrollment target is
up to 550,000.
Mr. Buyer. All right. Well then all I can rely on, Mr.
Secretary, is the VA's actuarial model that shows that patients
would be enrolled potentially 750,000. And I just bring that up
as a point to make sure that no one believes that it is going
to be opened up to all the 8s.
The great caution has been is the issue on building
capacity.
Secretary Shinseki. Right.
Mr. Buyer. And even some of the VSOs have now been able to
voice concern for us to watch this and be very careful as the
8s come in.
The 8s are individuals who have 91 percent, who have access
to other forms of health care and so we want to make sure that
we do not diminish that timely and accurate high quality health
care that you have shared with all of us.
Secretary Shinseki. You have my assurance, I think I have
said that several times. The quality that we provide and access
we provide today is something we won't jeopardize.
Mr. Buyer. The last thing I wanted to make you aware of.
The Energy and Commerce Committee passed out legislation last
week dealing with tobacco. And because the Congress recently
passed an S-Chip Bill that increased taxes on cigarettes, in
order to pay for this new tobacco legislation by Mr. Waxman,
there is a hole in his bill. So he has come up now with a
quote, a pay-for. And one of the pay-fors is mandating Federal
employees enrollment in the Thrift Savings Plan.
So I just want to make you aware that Congress is
considering the mandating of all Federal employees in the
Thrift Savings Plan, and that is going to have an impact upon
your Department.
It will have a tremendous impact upon DoD, because I
authored the Thrift Savings Plan for DoD. And when I did that I
didn't have sufficient budget room and I made it an option for
members of the military, and there isn't a match.
So if Congress is about to do this, I have now alerted the
Armed Services Committee, they have joint referral here because
we are about to mandate on Federal, you know, the personnel
pension benefits of the military as a pay-for on smoking.
But I just want to make you aware of something that is
moving through Congress, because it is going to impact your
employees.
Secretary Shinseki. Thank you.
Mr. Buyer. I yield back.
The Chairman. Thank you, Mr. Buyer. Thank you, Mr.
Secretary.
I just want to make a few points. The first one is on the
GI Bill. We understand the pressures on you to do this on time
and the problem with any changes.
As Ms. Herseth Sandlin said, some inequities have come to
our attention. For example, if you live in the bay area of
California, and go to Stanford, the VA will pay $30,000; if you
go to Berkeley it will pay $10,000, if you go to San Francisco
State it will pay $4,000. It is a function of our system, but
there are some unfairness. If you live in a state that has
purposely kept tuition at public universities low as a way to
make sure that all of our young people do get education, they
are going to be reimbursed at a level that really does not
match their actual costs.
When the Senate passed the GI Bill, Senator Warner put in a
provision called the Yellow Ribbon provision, which essentially
gives an additional subsidy to high tuition, mainly private,
schools. Nobody thought, at the time, about a provision to help
those low-tuition schools who might be under funded.
I hope that we can get a recommended change very, very
quickly. If we can't we will have to wait until the following
year. This is an issue that is coming to the attention of many
of the Members, because their universities are now figuring out
how they will be affected.
If you live in Georgia, by your figures, the maximum public
grant is about $1,200. Not only is that probably too low for
real education costs since they are subsidizing it, but it
would be hard to get the full payment for any college in
Georgia under the formulas that we are using. This can be
multiplied all across the Nation.
I am not sure whether we have to have a major change in
terms of a standard fee that we are going to pay, or a floor,
or a reverse Yellow Ribbon provision for the low tuition
states. I think we are heading into a real problem that we have
to fix fast. As I have told you, we need to work to get a quick
formula to make it more equitable and maybe work on a long-term
fix later. That is one thing that I think we have to try to do
quickly.
On the claims backlog, I think you put it very elegantly,
when you said, ``right now I am using brute force, I am not
sure whether that is the actual way to go.''
If you want to use the word transformative for this system,
I think you have to have a whole different approach. I have
suggested a couple that can get us pretty far down the road.
Number one, our Vietnam veterans who are suffering from
Agent Orange disabilities have suffered for three decades or
more. First, we said Agent Orange didn't do anything to you.
Then we said well maybe, and maybe if you stepped a foot in
this province, and now there is a whole, you know, bureaucratic
presumptive thing about which diseases are covered. So if you
were in the blue waters off the shore and the blue skies above
are on the boarder of Laos, and you know, Cambodia or even in
Guam handling cargo, you are ineligible.
I think we have to breakthrough that and say, ``if you were
there we should care.'' Maybe define the field of action and
just honor those claims. Get them off our books and off the
shoulders of these veterans. People walk around for decades
fighting the VA. They think the VA means ``veterans
adversary,'' and we have to say thank you for your service,
stop fighting us, we are going to honor those claims. Because
we know too much about Agent Orange now and how much damage it
causes to start going through all the bureaucratic procedures.
You don't have to comment on this now, sir, but at some point I
would like to hear your thoughts on this.
Additionally, however we count those backlog claims and I
would refer you to the so-called Linda Bilmes proposal based on
the IRS model, the Internal Revenue Service (IRS) which used to
be one of the most dysfunctional agencies in America. When you
file your 1040, and you have a refund coming, you get your
check in weeks. That is amazing, 3 weeks. Subject to audit. So
they will look at it at some time in the future. Why not have
VA do the same thing? If a veteran submits a claim with the
required medical documentation and aided by a certified
veterans service officer, let VA accept the claim, subject to
audit.
You could get all those claims off the books very quickly
and change the function of thousands of workers who appear that
their sole job is to call veterans a liar once they submit
their claim. They are looking for problems. Let us have them
look for answers.
I think there is a whole transformative, if I may steal
your word, sir, way of looking at the backlog of claims and
starting a new system.
On the subject of PTSD, I ask that when you meet with
Secretary Gates, you let him know that the quickest thing DoD
can do to help us do our job is a mandatory physical evaluation
before they leave the service for PTSD and TBI. It is simple to
say, but it doesn't happen. There are different rules if you
are in the Guard and Reserves or active duty.
Right now they claim they have mandatory screening, and the
VA does when a veteran comes into the hospital, but it is a do-
it-yourself questionnaire. There is no real discussion with
competent medical personnel. And, if they are in denial or they
don't want to be bothered and they want to get home, they know
which boxes to check no and yes to get out of there quickly.
So a do-it-yourself form does not do the job for us. I
think Secretary Gates can order it pretty quickly, because it
varies widely and some are getting it done, but most are not.
That is a disservice to all of these young men and women when
they leave the Armed Forces.
One last thing if I may, sir. You mentioned to Mr. Snyder,
when he asked you about surprises in your new role, and you
said one of the things you want to do is work cooperatively
with the Committee with regards to reporting requirements. We
are very grateful for that and what that means.
It is one of those issues that I think many of us get
frustrated about in Congress. It is important that the VA and
the Committee work together to find solutions.
I think you have to see us as a good source of expertise
and help. The VSOs are on the frontline every day, and when
they report things, we can take it to the bank. We know that is
what is happening.
We are out there in the same way. We get information from
the VSOs, but we are out at the hospitals, we are at the
clinics, we are talking to our constituents all the time, and
people come to us--we are a magnet.
When talking about interoperability of the electronic
records, for example, we have been in discussions with
Microsoft and other companies that know how to solve this
problem, and yet the VA has not been very open to their
suggestions.
On the subject of third-party collections, we have vendors
who have showed us simple systems at no cost to the VA which
could increase our collections dramatically. Unfortunately,
when we get this information, the VA tends to close itself off
from these ideas, but we believe they are good ideas.
We know how to separate the chaff from the wheat too, even
though we are not in your organization.
I, and every one of my Committee Members, get presentations
of new technologies to deal with the problems your organization
faces every day--our organization, I should say. For example,
we have seen a non-invasive procedure for veterans who have had
TBI or other problems with vision, to expand their field 50
percent and allow them to read, and yet they can't get the VA
to talk to them.
I just had a visit today from a company whose products are
used all around the Nation, but they can't get into the VA to
share their product for early detection of oral cancer. If you
can detect oral cancer, and a doctor knows more than I do,
right away or in its early stages, it is going to be far
cheaper and far more effective to treat than if you have to
wait and see it only by visual inspection. This company has a
method of dealing with it that can give very early detection.
The company can't even get in the front door with the VA.
So we come with a lot of this information, and I hope that
you will be very open. I know you have visited us personally,
you have shown that you will listen, and I just want to say
again, use us as a resource.
We are not here to beat you over the head, we are not here
just to oversee, we are part of a group that can help. Our
constituents are on the line every day and we come committed to
the service of our veterans. I hope you will look at those as
helpful suggestions some time, not political interference.
Thank you. I will give you the last word or as much time as
you would like for your conclusion. We appreciate your candor
and your willingness to listen and your effectiveness in the
future.
Secretary Shinseki. Thanks, Mr. Chairman.
Again, as I said in the beginning, thank you for this
opportunity to be here. I always look at this as an opportunity
to establish a good dialog and solve some of the issues that we
are both wrestling with that are focused on just one thing and
that is our veterans and what more and better we can do for
them.
For the comments about the backlog. Advocacy training, you
know, as small as that might be does make a difference. I mean
if the approach to performing that responsibility is favoring
the veteran, it will make a lot of difference on how people see
the outcomes. So I will take that on.
[An April 20, 2009, follow-up letter from Secretary
Shinseki, regarding advocacy training appears on p. 143.]
Secretary Shinseki. And I would ask you not to misconstrue
my response to Mr. Snyder as any kind of complaining about the
reports I submit. I am happy to submit reports if they are
useful. I was just surprised at the volume of reports, some of
them going back a long time that I wondered whether we were
addressing current issues. That was the point of my
observation.
But again, I thank you for this opportunity to appear
before the Committee, and my opportunity to work with each of
you, and then all of you collectively in helping me with this
mission.
Thanks, Mr. Chairman.
The Chairman. Thank you. And I think Secretary Rumsfeld
heard you say that and he called up President Bush and--oh,
that was your last testimony.
Thank you, sir. It was great to have you here.
We will start with our second panel right away. Thank you.
We are very pleased to have our second panel here today. I
don't think you have heard testimony where you got so many
compliments as the VSOs who have helped us, so we thank you for
being here, and thank you for continuing to do your jobs.
We have representatives from the Paralyzed Veterans of
America (PVA), Disabled American Veterans (DAV), the Veterans
of Foreign Wars (VFW), and American Veterans (AMVETS). Carl
Blake is the National Legislative Director for PVA.
Welcome, Carl. You have the floor.
STATEMENTS OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR,
PARALYZED VETERANS OF AMERICA; KERRY BAKER, ASSISTANT NATIONAL
LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; DENNIS M.
CULLINAN, DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF
FOREIGN WARS OF THE UNITED STATES; AND RAYMOND C. KELLEY,
NATIONAL LEGISLATIVE DIRECTOR, AMERICAN VETERANS (AMVETS)
STATEMENT OF CARL BLAKE
Mr. Blake. Thank you, Mr. Chairman.
On behalf of the co-authors of The Independent Budget
seated here I would like to thank you for the opportunity to
present our views regarding the funding requirements for the
Department of Veterans Affairs Health care System for fiscal
year 2010.
We are pleased to see that the initial information provided
by the Administration suggests a very good budget for the
fiscal year 2010.
The discretionary funding levels provide for a truly
significant increase.
I find it a little amusing that you say we got so much
praise, because I felt like The Independent Budget got beat up
a little bit there.
A number of people made the comment that the
Administration's budget actually came out above The Independent
Budget, which is great, I am not down playing that at all, but
given my interest in budget matters, I would be interested in
having the opportunity to dig a little deeper into the details
and make up the one single number that we have from the VA
right now and see where we are actually at when we get to April
and May and June and on down the line in the budget process,
but we certainly look forward to the opportunity.
For fiscal year 2010 The Independent Budget recommends
approximately $46.6 billion for total medical care, an increase
of $3.6 billion over the fiscal year 2009 operating budget
level.
The IB recommends approximately $36.6 billion for medical
services. This recommendation includes approximately $34.6
billion for current services, $1.2 billion for the projected
increase in patient workload, and $800 million for policy
initiatives. And I won't explain those in much detail because
they are laid out in more detail in the full IB.
For medical support and compliance the IB recommends
approximately $4.6 billion, and for medical facilities
approximately $5.4 billion.
The amount for medical facilities includes an additional
$150 million for non-recurring maintenance (NRM) for the VA to
begin addressing the massive backlog of infrastructure needs
beyond those addressed through the recently passed stimulus
bill. And again, we appreciate Congress providing that
additional funding. It is a known fact that the infrastructure
needs in the VA are probably one of the biggest needs that
there are.
The IBVSO's contend that despite the recent increases in VA
health care funding, VA does not have the resources necessary
to completely remove the prohibition on enrollment of Priority
Group 8 veterans who have been blocked from enrolling in VA
since January 2003 at this time.
However, we believe that it is time for the VA and the
Congress, with our assistance, and with the Committee's
assistance, to develop a workable solution to allow all
eligible Priority Group 8 veterans to begin enrolling in the
system.
For medical and prosthetic research, The Independent Budget
recommends approximately $575 million. This represents a $65
million increase over the fiscal year 2009 appropriation level.
We are particularly pleased that Congress has recognized
this critical need for funding in the medical and prosthetic
research account in the last couple of years.
Research is a vital part of veterans health care and an
essential mission for our national health care system.
Mr. Chairman, we would like to express our sincere thanks
for your instruction of H.R. 1016, the ``Veterans Health Care
Budget Reform and Transparency Act of 2009.''
Moreover we would like to extend our thanks to the Members
of the Committee who have agreed to cosponsor this important
legislation. I look forward to working with the Committee to
move this legislation forward.
This funding mechanism will provide an option that the
IBVSOs believe is politically more viable than mandatory
funding and is unquestionably better than the current process.
Finally, Mr. Chairman, I would like to express our serious
concerns that we have regarding the policy proposal that has
been discussed here today, elegantly referred to as third-party
reimbursement for veterans with service-connected conditions.
I think the Secretary's testimony before the Senate this
morning sort of affirmed our worst fears that this is something
that the Administration is seriously considering, and I am not
so certain that the overall budget number that has been
presented thus far does not include, or does include, the
funding, which the Secretary testified is soon to be about $500
million in that additional budget for fiscal year 2010.
We just simply find it unacceptable that a veteran would
have his third-party insurance billed for conditions and
disabilities and injuries that were incurred while in service
of this Nation.
We understand the fiscal difficulties that this country
faces right, I think we all understand that, but placing the
burden of those fiscal problems on the men and women who have
already served and sacrificed a great deal for this country is,
as I believe Dr. Snyder or Mr. Michaud put, unconscionable.
We strongly urge Congress to investigate whether such
proposal is actually moving forward, I get the sense that it
is, and to forcefully reject it if it is brought before you.
With that, Mr. Chairman, I would be happy to answer any
questions.
Thank you for the opportunity to testify.
[The prepared statement of Mr. Blake appears on p. 61.]
The Chairman. Thank you.
Kerry Baker is the Assistant National Legislative Director
for the DAV.
Welcome Mr. Baker.
STATEMENT OF KERRY BAKER
Mr. Baker. Mr. Chairman, Ranking Member, and Members of the
Committee.
It is a pleasure to be here today on behalf of The
Independent Budget. Today I will focus on issues affecting the
Veterans Benefits Administration (VBA).
On behalf of VBA, we have come before you for many years
requesting additional funding to reverse its chronic history of
under staffing. You have answered that call.
In just the past few years VA has hired over three thousand
additional claims processors and more continue to be hired as
we speak.
This year the IBVSOs recommend that Congress adopt both
short and long-term strategies for improvements. Strategies
focused on VBA's IT infrastructure, as well as the claims and
appeals process.
We are also seeking improvements in training,
accountability, and quality assurance.
To improve the claims process VBA must do more to upgrade
its IT infrastructure. It must also be given more flexibility
to manage those improvements.
Despite growing problems with the claims process, Congress
has steadily reduced funding for IT initiatives over the past
several years.
In fiscal year 2001, Congress provided $82 million for IT
initiative. By 2006, that funding had fallen to $23 million.
Congress has however noticed the disconnect between IT and
improvements in claims processing.
Section 227 of the Veterans Benefits Improvement Act of
2008 places new requirements on VA to closely examine all uses
of current IT and comparable outside IT systems with respect to
claims processing.
Following that examination, VA is required to develop a new
plan to use these and other relevant technologies to reduce
subjectivity, avoid remands, and reduce variances in VA
Regional Office disability ratings.
Section 227 will require VBA to examine IT systems that it
has been attempting to implement and improve for years.
We believe this examination will reveal the progress that
has been impeded due to lack of direct funding to underwrite IT
development.
The IBVSOs believe a conservative increase of at least 5
percent annually in IT initiatives is warranted.
VA should give the highest priority to the review required
by the Benefits Improvement Act of 2008, and double its efforts
to ensure these ongoing initiatives are fully funded and
establish their goals.
Further, the Secretary should examine the impact of IT
centralization under the Chief Information Officer (CIO), and
if warranted, shift the responsibility for their management
from the CIO to the Under Secretary for Benefits.
Additionally, as long stated by the IBVSOs, VA must invest
more in training adjudicators and decisionmakers. It should
also hold them accountable for higher standards of accuracy.
The VBA's problems, caused by a lack of accountability, do
not begin in the claims and development process nor the rating
process, they begin in the training program.
A lack of accountability during training reduces, or even
eliminates, employee motivation to excel.
The VA should undertake an extensive training program to
educate its adjudicators on how to weigh and evaluate medical
evidence, and should require mandatory and comprehensive
testing by all trainees, as well as the claims process and
appellate staff.
In addition to training, accountability is the key to
quality, however, there is a gap in quality assurance for
purposes of individual accountability and decision making.
In the STAR Program, the sample drawn each month from a
Regional Office workload is simply too inadequate to determine
individual quality.
The Veterans Benefits Improvement Act of 2008 requires VA
to conduct a study on the effectiveness of the current employee
work credit system and work management system. The legislation
requires VA to submit a report to Congress which must explain
how to implement a system for evaluating VBA employees no later
than October 31st, 2009.
This is a historic opportunity for VA to implement a new
methodology, a new philosophy by developing a system with
primary focus on quality through accountability. Probably
undertaking the outcome would result in a new institutional
mindset across VBA, one that achieves excellence and changes a
mind set focused on quantity to one focused on quality.
The IBVSOs believe the VA's upcoming report must
concentrate on how the VA will establish a quality assurance
and accountability program that will detect, track, and hold
responsible those employees who commit errors.
VA should generate this report in consultation with veteran
service organizations most experienced in the claims process.
That concludes my statement. It has been an honor to
testify before you today.
[The prepared statement of Mr. Baker appears on p. 63.]
The Chairman. Thank you, sir.
Dennis Cullinan, is the National Legislative Director of
the VFW. Welcome, Mr. Cullinan
STATEMENT OF DENNIS M. CULLINAN
Mr. Cullinan. Thank you very much, Mr. Chairman.
Distinguished Members of the Committee, it is certainly a
pleasure to be here today, and I want to extend a thanks of the
men and women of the Veterans of Foreign Wars in including us
in today's most important discussion.
As you are aware, the VFW handles the construction portion
of the IB budget, and I will limit my remarks to that.
VA's most recent asset management plan provides an update
of the state of Capital Asset Realignment for Enhanced Services
(CARES) projects, including those only in the planning or
acquisition process. It shows a need of future appropriations
to complete these projects of $2.195 billion.
Meanwhile VA continues to identify and re-prioritize
potential major construction projects. In a November 17, 2008,
letter to the Senate Veterans' Affairs Committee, Secretary
Peak said that the Department estimates that the total funding
requirement for major medical facility projects over the next 5
years would be in excess of $6.5 billion.
One thing that is clear, the VA needs a significant
infusion of cash for its construction priorities. VA's own
studies validate this.
In light of these things, the IB recommendations for fiscal
year 2010, major construction, is $1.123 billion. With respect
to minor construction we recommend $827 million. We need to
increase spending on non-recurring maintenance. For years the
IBVSOs have highlighted the need for increased funding for the
non-recurring maintenance account. Projects in this area are
essential because if left undone it can really take their toll
on a facility, leading to more costly repairs in the future,
and the potential of a need for a minor construction project,
perhaps even major.
Beyond the fiscal aspects, facilities that fall into
disrepair can create access difficulties and impair patient and
staff health and safety. And if things do develop into a larger
construction projection, because their repairs were never done,
it creates an even larger inconvenience and safety issues for
veterans and staff.
VA must dramatically increase funding for non-recurring
maintenance in line with a two to 4 percent-total that is
industry standard so as to maintain clean, safe, and sufficient
facilities.
VA needs an NRM budget of at least $1.7 billion. Portions
of NRM accounts should continue to be funded outside of the
bureau formula so that funding is allocated to facilities that
actually have the greatest maintenance needs.
Congress should also consider the strengths of allowing VA
to carryover some maintenance funds from one fiscal year to
another so as to reduce the temptation some VA hospital
managers have of inefficiently spending their NRM money at the
end of the fiscal year.
It has come to our attention that something like 60 percent
of NRM funding is expended in the final quarter of the fiscal
year. That just is not good management.
VA must protect the deterioration of its infrastructure and
declining capital asset value. The last decade of under funded
construction budgets has meant that the VA has not adequately
recapitalized its facilities. Recapitalization is necessary to
protect the value of VA's capital assets through the renewal of
physical infrastructure. This ensures safe and fully functional
facilities long into the future.
VA's facilities have an average of over 55 years and it is
essential that funding be increased to renovate, repair, and
replace these aging structures and physical systems.
Accordingly, using the five to 8 percent-industry standard,
VA's capital budget should be between $4.24 and $6.8 billion
per year in order to maintain its infrastructure.
Congress and the Administration must ensure that adequate
funds for VA's capital budget so that VA can properly invest in
its physical assets, product their value, and to ensure that
the departments can continue to provide health care in safe and
functional facilities long into the future.
I would add here that the IBVSOs and the VFW are very
appreciative of Congress' actions in the additional funding
they have provided over at the past several fiscal years to
tend to VA's physical infrastructure needs.
The last thing I want to mention here is the IBVSOs are
concerned with VA's recent attempts to back away from the
capital infrastructure blueprints laid out by CARES.
To put it briefly, there has been an increased interest on
privatization in providing contract care. The IBVSO support
contract care were necessary; however, we wish that the
Congress would guard jealously against over excessive use of
private facilities. VA's capital infrastructure and its own
resources must be protected.
Thank you Mr. Chairman, that concludes my statement.
[The prepared statement of Mr. Cullinan appears on p. 70.]
The Chairman. Thank you.
Raymond Kelley is the Legislative Director for AMVETS.
Thank you for being here, sir.
STATEMENT OF RAYMOND C. KELLEY
Mr. Kelley. Thank you, Mr. Chairman, thank you for holding
this hearing today and inviting AMVETS to testify on behalf of
The Independent Budget.
As a partner of The Independent Budget, AMVETS devotes a
majority of its time with the concerns of the National Cemetery
Administration, and I would like to speak directly to the
issues and concerns surrounding NCA.
In fiscal year 2008, $195 million was appropriated for the
operations and maintenance of NCA, $28.2 million over the
Administration's request, with only $220,000 in carryover. NCA
awarded 39 of 42 minor construction projects that were in the
operating plan. The state cemetery grant service awarded $37.3
million of the $39.5 million dollars that was appropriated.
Additionally, $25 million was invested in the National Shrine
Commitment.
NCA has done an exceptional job of providing burial options
for 88 percent of all veterans who fall within the 170,000
veteran within 75-mile radius threshold model. However, under
this model no new geographical area will become eligible for a
national cemetery until 2015.
An analysis shows that five areas with the highest veteran
population will not become eligible for national cemeteries
because they will not reach the 170,000 person threshold.
Lowering the population threshold to 100,000 veterans would
immediately make several areas eligible for a national
cemetery, regardless of any change in the mile radius
threshold.
A new threshold model must be implemented so more of our
veterans will have access to this earned benefit.
The Independent Budget recommends an operations budget of
$241.5 million for NCA for fiscal year 2010 so it can meet the
increasing demands of interment, grave site maintenance, and
related essential elements of cemetery operations.
Congress should include as part of NCA's appropriations $50
million for a first stage of a $250 million 5-year program to
restore and improve the condition and character of existing NCA
cemeteries.
The Independent Budget recommends that Congress
appropriates $52 million for the State Cemetery Grant Program.
This funding level would allow the program to establish six new
cemeteries that will provide burial options for 179,000
veterans who live in regions that currently have no reasonable
access to state or national cemeteries.
The national average cost for funeral and burial in private
cemeteries has reached $8,555, and the cost of a burial plot is
$2,133.
Based on accessibility and the need to provide quality
burial benefits, theIndependent Budget recommends that VA
separate burial benefits into two categories. Veterans who live
within the inside VA accessibility threshold model and those
who live outside the threshold.
For veterans who live inside the threshold the service-
connected burial benefit should be increased to $6,160. Non-
service connected veterans burial benefit should be increased
to $1,918. And the plot allowance should increase to $1,150 to
match the original value of the benefit. For veterans who live
inside the threshold the benefits for service connected burial
should be $2,793. The amount provided for non-service connected
burial will be $854, and the plot allowance will be $1,150.
This will provide a burial benefit at equal percentages,
but based on the average cost of a VA funeral and not on a
private funeral cost that will be provided for those veterans
who do not have access to state or national cemeteries.
The new model will provide a meaningful benefit for those
veterans whose access to state and national cemetery is
restricted, as well as provide an improved benefit for eligible
veterans who opt for private burial.
Congress should also enact legislation to adjust these
burial benefits for annual inflation.
This concludes my testimony, and I am happy to answer any
questions at this time.
[The prepared statement of Mr. Kelley appears on p. 79.]
The Chairman. Thank you, Mr. Kelley.
Mr. Boozman.
Mr. Boozman. Thank you, Mr. Chairman. The panel, can you
guys talk--first of all, thank you all for being here and thank
you for your testimony.
Can you talk to us a little bit about how you feel like--we
have heard the plans to significantly increase the Category 8s,
Priority 8s, which is a very good thing. Can you tell us,
though, any concerns about perhaps by what you feel like we
need to do as far as capacity, concerns about maybe unwanted
consequences that we don't realize it might have on some of
your membership?
The Chairman. Mr. Cullinan.
Mr. Cullinan. Mr. Boozman, if I might first.
A big concern of ours is that VA not be inundated with
Category 8 veterans. We want to see them flow into the system,
we want to make sure that the quality and timeliness of care is
maintained, and we also view it as essential that this be a
cooperative venture between the Department and the Congress.
And it is funny, Chairman Filner, you mentioned that
earlier, that at times it seems that the executive branch views
the Legislative Branch's expertise as being somehow different
than theirs, and I suppose it is different, but it is essential
as well, so that is what got to be--we need close oversight of
what is going on, and a cooperative venture with the Secretary
and VA.
Mr. Blake. Mr. Boozman, can I add something?
Let me say that I think just at first glance the
Administration's plan as it relates to this roll out of
$500,000 additional through the next I think 5 fiscal years
essential is how it is laid out without any real details seems
like a doable solution budget wise, because I think it can be
much easier managed that way.
Interestingly, as we were developing The Independent Budget
one of the troubles we had is sort of pinning down this
Priority 8 Group number, because I don't think anybody really
knows what the number may actually be. But from what we have
been told by some officials at the VA, the actual number of
folks who have been turned away from the VA physically since
this enrollment ban went into place is pretty close to the
$550,000 that is apparently the target for the next 5 fiscal
years.
So I can easily see where the idea that this is where the
initial target would come from, but going forward I think there
are a lot of dynamics that by rolling it out will allow us to
better judge this going forward. Because I am not sure that the
utilization patterns, at least in the short term, would be like
what Priority Group 8 may have been in the past, and we just
don't know what the current economic state of the country might
have.
I mean, there are so many factors, but I think that without
a lot of information the Administration has at least outlined a
good plan that seems reasonable, and if managed correctly, and
as Dennis mentioned with that adequate oversight, could be
done.
Mr. Boozman. Okay. Again, I guess the only thing I think we
have to be careful, it just doesn't seem like the out-year
budget numbers really seem to--are a little bit questionable,
you know, when you start.
Again, you know, it is good news that we are in the process
of moving forward, but I would agree with you all in a sense
that it is just something that we need to work together to make
sure that it is done in a way such that, you know, we have
worked so hard to get ourselves in a much better situation
where we were a few years ago with everyone working together,
and I would hope that we would continue in that regard.
Let me just ask one other thing real quick. The VA budget
request assumes a 33 percent-increase in the medical care
collections fund for a total of $3.4 billion. VA estimates only
about $2.5 billion in collections for fiscal year 2009 and
2010. That seems a little bit optimistic.
Did you all notice that in regard to the budget?
Mr. Blake. I would say it definitely stands out, which I
think is relevant as it relates to the discussion we had about
third-party reimbursements for service-connected veterans.
Now again, the devil is in the details, we don't know what
makes up that estimate. It is a significant jump, given what we
have seen sort of the recent history as we have gotten into
this area of the $2 billion dollar realm for collections. There
have been sort of marginal increases in estimates year after
year, and it seems like a pretty significant jump.
But again, I go back to my point from my testimony that
what the Secretary said this morning was that they have
estimated that under this third-party billing for service
connected they could generate as much as $500 million. Now
whether that is actually in, that $3.4 billion or not is
unclear. I think the Secretary sort of said it wasn't, but I
find it hard to believe with that significant of an increase
that it would not be. So it is sort of remains to be seen.
Mr. Cullinan. Mr. Boozman and Mr. Chairman, we were
startled too in reviewing the numbers when we saw this. It was
over $1 billion increase, and that is before we heard the
rumors about the possible inclusion of this abhorrent idea of
charging insurance companies for service-connected care.
And I would have to say too, that in recent fiscal years,
VA has been doing very well with respect to collections, so a
33 percent-increase is inexplicable without something pretty
extraordinary.
Mr. Boozman. Thank you, Mr. Chairman.
The Chairman. Mr. Walz.
Mr. Walz. Well thank you all again for everything you do
and for coming here. And as I have said, the last 2 years and I
need to say it again and I also will as long as I am in this
job, a Presidential budget is a suggestion. Article 1 of the
Constitution puts it here. So I share your concern too.
The third-party billing thing does not fly, and I am not
deaf to the need to make sure we use every dollar wisely,
making sure we are cutting down on waste and getting
efficiencies, but as I have said it, and I will continue to say
it, we are not going to balance this fiscal mess on the backs
of veterans, so this is a bad idea at a bad time. It would be
bad at any time.
But with that being said, here is a conundrum I want you to
help me with a little bit. I too share your concerns of making
sure this issue on private contracting and some of those types
of things.
The thing I hear about coming from a rural district is that
it is easier access to care, and I literally have veterans who
say I live in the shadow of the Mayo Clinic, but I've got to
get on the bus to go to Minneapolis.
Now my concern is making sure, just like you and you have
stressed it very clearly, keeping the core issues of the VA
funded and working. We have expanded some CBOCs. We are going
to get one in my district, another one which I think is on the
right track.
I would like to ask you, how do we go back and talk to
those veterans about it?
And I want to thank each and every one of your
organizations for bringing this out there, because you can see
from a veteran's perspective where they are saying heck, I just
wish I had a card and could walk in the Mayo and get everything
done.
That is the way they see it. They don't realize, well, that
is maybe because you could walk in the Mayo and do it, you are
not one of our veterans who has the core issues that need to be
cared for at the VA, the research dollars and everything else.
So I just want to hear from each of you maybe on that, if
you have some--just some ideas on what you think and how do we
talk about that.
Mr. Cullinan. Mr. Walz, I would say, first of all right now
VA has authority to provide contract care in certain rural
areas, and we think they should use it more, and we would ask
this Committee and the Congress to ensure that they do.
There is a pilot program going on now that was just
initiated. We think there could be some valuable results coming
out of that. That remains to be seem, what ideas come out of
that. And of course in certain parts of the country, while a
mobile clinic and that kind of thing isn't the equivalent of a
CBOC, we are certainly not a hospital, it is a lot better than
nothing, and greater utilization of these should be made as
well.
With respect to the Mayo Clinic that is a tough one.
Mr. Blake. Mr. Walz, one thing I would suggest too is we
have all sorts of advocated for supporting the Office of Rural
Health and the VA, and yet I am not sure that that office has
been really given a fighting chance. It has had a very small
budget, a very small staff, and yet from my perspective the
rural health care issue, while maybe not targeting the biggest
population of veterans, is dealing with what is maybe one of
the biggest--maybe the biggest access related issue.
And so I think there needs to be some focus on plussing up
the operations of the Office of Rural Health and giving them
the ability to sort of manage this. That is not the say that
they force things into the VA, but figure out the best ways to
work about these problems.
I agree with Dennis entirely, the VA has the authority as
it relates to fee basis for contract care in rural setting, and
for years since I have been here we have batted around the idea
of what constitutes rural and that sort of thing.
As far as getting at the veterans themselves, Dennis
mentioned mobile clinics. Another thing, some of this is an
outreach effort to these folks out there, and particularly in
the extremely rural areas.
I would say we have been pleased to see how the VA has
rolled out their mobile Vet Centers, and what the capabilities
of those are, and I believe there may be a desire to expand
that program further, but you get at these folks and figure out
where the needs are and you can kind of use that as an arm to
adjust its access and the delivery of care going forward also.
Mr. Walz. And I just had one final thing if I could, just
that I am really focused on this seamless transition thing.
It sounds like to me that maybe we are getting close. I
know many of you have said yeah, I have heard that for 20
years. It seems different this time, and I have watched this
for a long time too.
Do you see any concerns or areas that you think need to be
addressed first, or are you optimistic after you heard what the
Secretary had to say today? From each of you as far as seamless
transition goes and making sure that we see that as a way to
cut down some of the systemic problems.
Mr. Kelley. Mr. Walz, Ray Kelly from AMVETS.
There has been a continuation of we are 2 years away from
having an IT solution or a transition solution. I will believe
it when I see it. I take it to heart that he says he is going
to do it, I believe that he is going to put every effort into
making that happen, but again, I will believe it when I see it.
Mr. Baker. There are a lot of things that sound promising
to us. I don't believe we have had the chance to discuss the
idea about enrolling somebody in VA as soon as they come into
the military. That is something I would like to discuss with
everybody. I know the Benefits Delivery at Discharge program
has become paperless. I know that assisted in the seamless
transition. The VONAP system, while not necessarily restricted
to people coming off of active duty, it is paperless.
You know, the key thing is right now transferability with
the medical files between the VA and the DoD. If that could
become seamless--somebody mentioned the DoD is never in this
room--you need them here for that. But if you could accomplish
that, then you have just taken a very large step.
Mr. Blake. Mr. Walz, I would say that through the Senior
Oversight Committee I think we have seen at least the biggest
stab at trying to fix seamless transition since I have been
here. I mean, I feel like there is a real commitment to
addressing this now because of that entity and the level of
focus being placed on it, but again, I go back to what my
colleagues have said about seeing it and believing it, so.
Mr. Walz. We can quote President Reagan on this one, ``We
will trust but verify.'' That needs to be our manta around
here.
Well thank you all, thank you Mr. Chairman.
The Chairman. Thank you, and again, we thank you for being
here.
My sense is, and this is just from my political
understanding, the message that you have been sending out about
the third-party issue has been received at the White House. I
don't think, frankly, that you should spend too much time
worrying about it. That is my sense. You have other more
important things to do.
You were wondering where the money is coming from, for
example, if they didn't have a policy change. I think I
mentioned several times in the earlier hearing that we believe
there are systems available to the VA that will dramatically
increase their collection rate, but they have just not taken
them up. I hope the new Secretary will look at it differently.
Both Mr. Buyer and I have been involved with this issue
together. We think there are hundreds of millions of dollars on
the table, if not more, and that we hope to really dramatically
increase that without the kind of policy change you were
worried about.
Just one last question. I mentioned within the context of
the GI Bill, the situation of the inequity of low tuition
states. Have you all been in contact about this? Has that been
expressed by anybody? Any of the colleges? Do you see it as a
real problem that we need to correct right away?
Mr. Cullinan. Mr. Chairman, we are aware of the problem.
And the real issue comes down, there are certain states where
this in-state tuition is low, but since the money for the GI
Bill tuition flows directly to the university it doesn't impact
the veteran directly. However, if a veteran wants to go to a
private institution in that state he or she are out of luck,
unless the Yellow Ribbon Program, which is an opt in if the
university cuts in, it still represents an inequity.
We would like to see some kind of--this addressed somehow.
I mean, one approach may be to establish a different floor for
those veterans in those particular states that are going to
private institutions.
So I am not saying that an institution that charges $1,200,
I think that was the sum that was cited earlier, should get
more than that. However, if a veteran wants to go to a pricier
and private institution that say costs $1,200 a year, that
difference should somehow be accommodated.
The Chairman. I mean, you have two big problems. One, some
of the high tuition established rates are not really the rates.
Mr. Cullinan. Yeah.
The Chairman. I mean, it is artificial. There is tuition
discounting in there that we have to be careful of.
On the other hand, California is one state that I know very
well, the tuition rates are artificially low. As you said, they
shouldn't get more than their public tuition, but it costs more
to educate a student in those states than the public published
tuition.
We have to watch for abuse at one end, but I think we have
to help the universities at the other end.
Mr. Cullinan. And the veterans they serve, sir.
The Chairman. Yes, sir.
Thank you very much, we appreciate your testimony, and as
always, we will continue to keep in touch.
We will now hear from the third panel. Please come forward.
Mr. Sullivan, the Executive Director of Veterans for Common
Sense (VCS) will be the first to testify. We look forward to
your testimony.
STATEMENTS OF PAUL SULLIVAN, EXECUTIVE DIRECTOR, VETERANS FOR
COMMON SENSE; PAUL RIECKHOFF, EXECUTIVE DIRECTOR, IRAQ AND
AFGHANISTAN VETERANS OF AMERICA; RICHARD F. WEIDMAN, EXECUTIVE
DIRECTOR FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM VETERANS OF
AMERICA; AND STEVE ROBERTSON, DIRECTOR, NATIONAL LEGISLATIVE
COMMISSION, AMERICAN LEGION
STATEMENT OF PAUL SULLIVAN
Mr. Sullivan. Veterans for Common Sense thanks the Chairman
and the Ranking Member for inviting Veterans for Common Sense
to testify here today about the 2010 VA budget. Last month,
President Barack Obama and VA Secretary Eric Shinseki announced
they would increase VA's budget to a new record high of $113
billion. This $15 billion increase far exceeds or highest
expectations.
With that money, Veterans for Common Sense urges Congress
to focus on five key measures to monitor VA during 2010. Maybe
cut down some of those reports.
Those five areas are health care mental health care suicide
prevention, reducing homelessness, and eliminating the
disability benefit claim backlog.
VCS asks you to focus on three budget questions when
dealing with the VA.
First, we ask you to ask VA, does VA have enough funding,
staffing, and legislative guidance to accurately process all
disability claims within 30 days?
Second, does VA have enough funding, staffing, and
legislative guidance to provide all patients with quality
physical and mental health care within 30 days?
And the third question, does VA have enough information to
answer both of those two questions.
This is bottom up budgeting that we support. We want VA to
say yes, we can provide this information. And asking these
questions is essential because of VA's past history of failing
to plan properly and VA's continual underestimation of the
number of Iraq and Afghanistan war veterans seeking care.
In February 2008, VA told this Committee it expected to
treat about 333,000 Iraq and Afghanistan War veterans in 2009;
however, by September 2008 VA had already treated more than
400,000.
Based on the current rate of more than 10,000 first time
patients flooding into VA each month, VA may expect a total of
520,000 Iraq and Afghanistan War veteran patients by September
2009.
In contrast, Secretary Shinseki's testimony a little while
ago said that the VA expects 419,000 patients this year.
Summarized from our written statement, VCS recommends five
priorities for VA's 2010 budget.
First, VCS urges Congress to streamline VA's claim system
and quickly pass Chairman Hall's Combat PTSD Act, H.R. 952.
There are more than 105,000 Iraq and Afghanistan war veterans
already diagnosed by VA with PTSD; however, only 42,000 receive
service-connected disability compensation for PTSD.
In 2008, the Institute of Medicine concluded there is a
link between deployment to a war zone and PTSD. With a new law
or a regulation based on science, VA can improve the lives of
1910s of thousands of disabled veterans with PTSD during an
economic crisis when their needs are most acute.
Second, in a manner similar to PTSD, VCS urges Congress to
streamline claims for TBI.
Third, we urge you to improve seamless transition and bring
VA to our veterans by expanding VBA.
VA should open permanent offices at military bases and at
more cities so veterans can meet face to face with VA staff
about claims, including their new GI Bill benefits.
Fourth, Congress needs to expand research to better
understand Gulf War illnesses.
In 2008, the Research Advisory Committee on Gulf War
veterans' illnesses confirmed up to 210,000 Gulf War veterans
remain ill.
We ask you to please support $30 million for competitive
research in the Congressionally directed medical research
program to search for treatments, which is what the Gulf War
veterans want.
Fifth and finally, VCS would like Congress to insist that
veterans play a key role in any proposed truth commission
suggested by Senator Leahy investigating Administration actions
between 2001 and 2008.
In 2008, the Houston Chronicle editorialized that
servicemembers and veterans bore the brunt of the enormous
policy failures of the last Administration.
If we are to truly understand the mental health needs of
our war veterans, then we must make sure our history books
accurately reflect the fact that the Vietnam War, the Gulf War,
and the Iraq War were each initiated by the executive branch
using misleading statements and without preparing a plan to
care for veterans when they came home, and this is a betrayal
of our veterans who are serving our country and our
Constitution.
Thank you.
[The prepared statement of Mr. Sullivan appears on p. 83.]
The Chairman. Mr. Paul Rieckhoff is from the Iraqi and
Afghanistan Veterans of America (IAVA). Mr. Reickhoff?
STATEMENT OF PAUL RIECKHOFF
Mr. Rieckhoff. Thank you, sir.
On behalf of IAVA and our more than 125,000 members and
supporters, I want to thank you for inviting Iraq and
Afghanistan Veterans of America to testify today regarding the
VA budget for fiscal year 2010.
I would also like to thank you for your commitment to our
Nation's veterans. From the passage of the new GI Bill to the
dramatic increases in veterans health care funding, the
remarkable legislative victories we have seen for veterans in
the last 3 years would not have been possible without your
leadership.
At IAVA we are committed to making sure that no
servicemember and/or veteran is ever left behind. Our mission
is to improve the lives of the more than 1.8 million Iraq and
Afghanistan veterans and their families. And as veterans are
coming home from Iraq and Afghanistan to the worst economy in
decades, we need to show real support for our troops and
veterans.
Over all, we are pleased with the limited information
currently available about the 2010 budget. The top line numbers
for veterans discretionary funding is about $1.2 billion higher
than the amount recommended by the leading veterans services
organizations, including IAVA in The Independent Budget.
The budget plans increases funding by $25 billion over 5
years, and this funding will be critical if we are to provide
proper care and support for the surge of new veterans who will
be coming home from combat in the coming years.
We are also pleased to see the renewed focus on mental
health care in the DoD budget, including comprehensive TBI
registry and the roll back of concurrent receipt limitations
that unfairly cut benefits available to disabled military
retirees.
We are also pleased to see the Administration's plan to
expand VA health care access to about 500,000 moderate income
veterans. It is a good first step, although we would like to
see it happen faster.
About 1.8 million veterans lack health insurance, and over
500,000 have been denied VA health care because their income
level was too high. IAVA believes that every single veteran
should be eligible for VA health care.
From what we have seen the budget looks strong, but the
devil is in the details. Until we have had the opportunity to
go through this budget line by line in April we cannot entirely
endorse the plan.
Above all, we must ensure that this budget does not rest on
increased co-pays, premiums, and fees for veterans.
Our biggest disappointment about the current budget is that
the President has not opted to include advance appropriations
to the VA in this proposal.
Advanced appropriations doesn't cost any additional money.
It gives VA hospitals and clinics advance notice of the funding
they will receive for the following year. Right now VA
hospitals have no way of knowing what their budget will be next
year, and when the budget is passed late, and it usually is,
they often have to ration the care they give to veterans.
The bottom line is that VA budget delays hurt veterans,
veterans of all generations. And I want to tell you about one
of those veterans that would definitely benefit from advanced
appropriations.
Ray Leal served as a marine in Fallujah during some of the
heaviest fighting earning a bronze star with valor as a private
first class almost unheard of for a troop of that rank. When he
returned to southern Texas his VA hospital was over 5 hours
away. He is a tough marine and he is a boxer, but he shouldn't
have to fight to get care at a veteran's hospital.
At his nearest outpatient clinic there is just one
psychologist taking appointments only 2 days a week. The
psychologist only works 2 days because that Texas clinic, like
many VA clinics and hospitals, has to stretch its funding to
make sure the money lasts the whole year. They don't know how
much funding they will have next year because the VA budget is
routinely passed late. For the millions of veterans like Ray we
must fix this broken funding system.
Advanced appropriations is a common sense solution that
President Obama supported as a candidate, and it is something
we would have liked to have seen in the budget.
If the Obama Administration is not going to lead on the
fight for advanced appropriations, we need Congress to step in.
A number of Members on this Committee, including of course
Chairman Filner, have already proven to be key allies in the
fight for advanced appropriations, and we thank them for their
leadership and support.
IAVA is proud to endorse H.R. 1016 and S. 423.
We will work with Committees in any way we can to move this
legislation forward. With your help we can ensure that veterans
are not kept waiting, as they have been in the 19 of the last
22 years while Congress plays politics with the budget.
Last month President Obama traveled to Camp Lejeune to
announce the eventual draw down of combat troops in Iraq. And
no matter what you think about this plan, one thing is clear,
the new strategy in Iraq will create a surge of new veterans
coming home in 2009 and 2010.
America needs to be ready, and the 2010 veterans budget
will be a crucial first step.
Thank you for your time, and we look forward to working
with you.
[The prepared statement of Mr. Rieckhoff appears on p. 89.]
The Chairman. Thank you, Mr. Rieckhoff, and thank you for
representing our newer veterans when they come back.
Richard Weidman, Executive Director for Policy and
government Affairs of Vietnam Veterans of America (VVA).
Welcome.
STATEMENT OF RICHARD F. WEIDMAN
Mr. Weidman. Thank you, Mr. Chairman, and thank you to your
distinguished colleagues on both sides of the aisle for the
opportunity for us to represent our views here today. Over all,
first let me say that we endorse The Independent Budget and
associate ourselves with their figures, particularly when it
comes to construction, which needs to be speeded up and not
slowed down. And those within VHA who take the attitude that we
will never again build a free-standing hospital need to be--
find another way to contribute to the good of the world and be
replaced with people who understand what the core mission of
the VA is.
We looked at, as we do every year, the Center for Medicare
and Medicaid services and the inflation rate that they are
projecting for medical inflation, and they are upping theirs by
3.6 percent. And so we use that in calculating that we need a
$1.4 billion, assuming that there were no more people that came
into the VA and that VA had adequate staff to meet the full
needs of people at this point, which in fact they don't.
So we recommend another $2 billion on top of that just for
just VHA in order to expand organizational capability and front
load the staff needed to take care of the new veterans coming
through the door. Not just those who serve in Iraq and
Afghanistan and elsewhere within the world, but of new
registrants who are qualified with moving forward with
restoration of ability of Category 8--so-called Category 8s to
be about to use this system.
We had asked VA repeatedly for 4 years now to do a
migration study about people who were refused treatment who
were Category 8s, how many of those ended up either being led
into the VA hospital eventually because they became service
connected but were much sicker and, therefore, more expensive
to treat when they came in, and how many of those people ended
up indigent because they couldn't work and therefore gained
admission that way? And they continue to come up with excuses,
and perhaps when the Committee asks you will get the answer to
that question looking back to January of 2003.
We recommend a significant increase in research and
development to $750 million for the next fiscal year for 2010,
and moving up in increments to bring that research total to
well over a billion dollars by the end of 5 years on an
annualized basis with ordinary inflation increases from that
point forward.
NIH does not do veteran health research. They flat won't do
it. Even the grants they give to VA they do not take a person's
military history as a variable and a possible confounder in the
studies that they conduct at the VA. And therefore we know DoD
is not going to do it because they always want to continue to
have deniability, particularly about the environmental wounds;
therefore, all we have left is the VA.
For the first time in many years, VA has not--VVA has not
signed on to the Friends of VA Medical Research and Health
Care. And the reason is they pledge not to ask for any
earmarks.
It would be irresponsible of us not to ask for earmarks in
a changing of the course of the leadership of research and
development when they are not funding a single study related to
the long-term health care of Agent Orange at the moment, nor I
might add, except for those earmarked items and studies are
they funding--looking at the long-term health care effects of
environmental hazards in the first Gulf War.
So we have a real problem with the way in which they are
going, and ask that you again ask Mr. Edwards to include an
earmark in the budget legislation requiring the VA to obey the
law and complete the National Vietnam Veteran Readjustment
Study replication, thereby making it a robust mortality,
morbidity study of Vietnam veterans, and that they set aside
$20 million additionally out of R&D funds, specifically for
study of long-term consequences of Agent Orange, and in
addition to that $15 million to go to MFUA or the Medical
Follow-up Agency of the Institute of Medicine of the National
Academy of Sciences, which is the repository for all of the
wealth of data of the ranch hand study, which has now ended,
but all that data needs to be put into modern computerized
format in order to make it accessible for research.
Mr. Chairman, I am over time, and I appreciate your
indulgence. I would just add two things if I may.
One is the idea of having a specific line item for outreach
is important.
We just started and launched last month the Veterans Health
Council initiative working with the private sector to inform
providers and through providers to inform veterans, 80 percent
of whom don't go anywhere near the VA, of their rights and
benefits, and more importantly, what are the health care
dangers that they should be looking for in themselves, and what
their family should be looking for in their health based on
when and where they serve? But if it is everybody's
responsibility, it is nobody's responsibility, and outreach
continues to be very haphazard from VA.
Last but not least, we appreciate all of your leadership on
getting the advanced funding, Advanced Appropriations Act
through, and we look forward to working with you on that, and
hope that this year you will, despite the fact of having new
leadership at the very top of VA, look to his own words, that
what is wrong with the VA at almost every level is leadership
and accountability, and we need to have much more stringent and
much more in-depth oversight of VA's function in the coming
year.
Thank you very much, Mr. Chairman.
[The prepared statement of Mr. Weidman appears on p. 90.]
The Chairman. Thank you.
Steve Robertson is Director of National Legislative
Commission for the American Legion.
Welcome, Mr. Robertson.
STATEMENT OF STEVE ROBERTSON
Mr. Robertson. Thank you, Mr. Chairman and Members of the
Committee.
The American Legion appreciates the opportunity to be able
to participant in this hearing on President Obama's top line
budget request, and in fact the American Legion has sent a
letter to the White House telling them that we support the top
line numbers that they have recommended.
I would be remiss if we too did not express our
appreciation to you and your colleagues for passing the fiscal
year 2009 budget on time at the start of the fiscal year.
I am sure when Secretary Shinseki sits around the cabinet
table he realizes what an advantage he has in this transition
period with having a budget, while many of his colleagues at
that table are still waiting on theirs. We have been there
before and we understand the situation.
Speaking of the budget, we too want to thank you Mr.
Chairman for your leadership on the Advanced Appropriation
Legislation, and I assure you we will do everything we can in
our power to make that a reality.
We also want to thank you for the stimulus package and the
many provisions that were in there that specifically related to
veterans. But one particular thing I would like to highlight is
the money that was set aside for construction within the VA, a
lot of the non-recurring maintenance, and we would hope that
service of veteran-owned businesses and especially those
businesses owned by disabled veterans would be given some
consideration in awarding a lot of the contracts that will be
done in VA facilities.
With the President's budget outline that we have of two
pages, which is a lot easier to read than the five or six
volumes that we normally get, looking at the highlights the
American Legion supports all of the highlighted items based
upon seeing the final details.
The area that is dealing with Priority Group 8 veterans.
The American Legion has always advocated that every veteran be
entitled to their earned benefit. And a lot of people don't
realize it, but there has been continuous flow of Priority 8
veterans into the system even though the prohibition is in
place.
Veterans that are Operation Enduring Freedom (OEF),
Operation Iraqi Freedom (OIF) veterans initially show up as a
Priority Group 6, and then as their 5 years expires they are
reassigned to whatever priority group that they are supposed to
go to, so many of them will wind up into 8s, which brings up an
interesting point.
If an OEF or OIF veteran does not enroll in the VA during
this 5-year period, has a seamless transition that is the
smooth transition, and at some point later on down the road
decides that they want to come to the VA under the prohibition
if they made a successful transition, they probably wouldn't be
allowed into the VA system because they would be a Priority 8
veteran. So we are basically punishing them for a seamless
transition.
The other area that we are really concerned about is the
homelessness of our veterans. We keep talking about the
homelessness of your veterans and we are forgetting about the
families, especially the children.
We have a lot of single parents that are now in the
military, and when they become homeless they have children, and
I am not sure that the VA is adequately prepared to deal with a
family--a homeless family situation.
The GI Bill, the exchange we have had about the equity and
the inequity. I am having problems grasping what the situation
is. As long as the tuition is going straight to the university,
if I decide to go to Louisiana Tech or Louisiana College or LSU
or Tulane that is my decision. The goal is to get a college
education. And I am not worried about somebody going to
Stanford and getting more money sent to their university, that
does not bother me, I want to get a degree. And I think that is
what we need to stay focused on.
The original GI Bill paid the university full tuition
wherever you got accepted. So if you went to Louisiana Tech,
yeah you got a little less money than if you went to Harvard.
The Chairman. But Steve, the way the system is set up, let
us assume you have no money. If the cap in a state is low, you
may not be able to go to any of the higher tuition colleges you
want to, because it doesn't pay enough based on the formula.
You are limited to the cap and the addition from the Yellow
Ribbon provision. You can't necessarily go to the college you
want if it has a high tuition. If you are going to a lower
tuition school, the services provided may be more than you are
paying, which hurts that university.
Mr. Robertson. Well, I am not worried about the university,
sir, I am worried about the student.
The Chairman. Well, it hurts the services. If they are not
getting the money that it really costs to educate they are not
going to provide the services, whether it is rapid movement in
the admissions department or counseling services, they just may
not be able to provide it. I think it affects the quality to
the veteran of how we are going to reverse the institution.
Mr. Robertson. Well, we will look into it more, sir, but I
would rather get this thing done on time than trying to tinker
with it, and possibly----
The Chairman. It may be the situation for the first year,
but I don't think we should neglect these inequities.
Mr. Robertson. Yes, sir.
The third-party reimbursement rumor concerning service-
connected disabilities, we are adamantly against that. We
signed the letter along with many of the other organizations to
the White House expressing our deep concerns about that
concept.
We have been asked many, many times if there is a short
fall where is the money going to come from? And the American
Legion still believes that when the whole concept of
eligibility reform was passed in 1996 many of the veteran
service organizations believed that the concept was to bring
veterans in along with their health insurance.
Right now over half of the VA patient populations, if you
asked them who is your primary health care provider, the answer
is Medicare. I have Part A, I have Part B, why can't I bring my
dollars to the VA?
Right now the VA is subsidizing Medicare in the billions of
dollars. Medicare is not a health care provider. Medicare is an
insurance company, and I do not understand why VA cannot be
reimbursed for treatment of non-service connected medical
conditions that are allowable under the VA--I mean, under the
Medicare reimbursement. And it just seems that we are just
giving Medicare a windfall.
The Chairman. I agree with you, Steve. Should we take on
this issue right now?
Mr. Robertson. If you are bringing in Priority Group 8
veterans and you are trying to figure out how to pay for them
and you are trying to figure out to have the resources to hire
extra doctors, nurses, providers, et cetera, that is a logical
revenue train.
The Chairman. If you all are willing to work with us we
will take that on, I will agree with you.
There is the argument from the average American, that we
are just taking it from one pocket and putting in the other,
because they are both government programs. But, as you know, we
are hurting the Department of Veterans Affairs in that
situation.
Mr. Robertson. Sir, I have been paying Medicare since the
day I started working. That is a benefit that I am entitled to.
If I don't go to the VA and I go down the street it works, the
reimbursements are going to be made. That is when I become
Medicare eligible. But I can go down the street and use my
benefits.
If I choose to go to a VA, I should be able to take my
health care dollars with me. And if I have a supplemental, then
VA should be allowed to bill the supplemental, as it currently
does.
So I believe that this----
The Chairman. I think that we have to take on that fight.
Mr. Robertson. Well, I would prefer that over charging a
triple amputee for his medical costs. And a lot of insurance
companies have caps, and once you have reached that cap, what
is his family going to do if they have a medical condition and
the veterans' services are so severe that----
The Chairman. I understand. Again, I think that is off the
table, but I believe we still have to figure out how we are
going to bring in those dollars.
Mr. Robertson. Yes, sir. Well again, we look forward to
working with you and your staff--your capable staff on
addressing these problems.
The Chairman. Were you familiar with the previous bills
that we did on this so-called Medicare Subvention? Was that
inadequate or do we have to re-look at that?
Mr. Robertson. Sir, the problem was that it was a false
assumption. They said that before you could collect money you
had to render the services that you would have rendered any
way.
There is nothing in the entire title 38 that you qualify
for VA because you are Medicare eligible. That is not a
criteria. Somebody in OMB or Congressional Budget Office or
some puzzle palace came up with this idea that it was an
obligation of the VA to treat Medicare eligible patients. There
is nothing.
What qualifies you for treatment in the VA is honorable
military service. I don't care if you are 21 or 121, there
shouldn't be any veteran ever turned away from a VA hospital if
that is their best choice.
The Chairman. Yes, I agree. I was just wondering when there
was previous legislation on Medicare Subvention if it was
adequate, or do we have to re-look at that too?
Mr. Robertson. You have to re-look at it because of the way
that it was--the assumption was that VA would have to treat all
of the patients that they are currently treating that are
Medicare eligible before they could bill anybody else, and that
is just a false--somebody made the law, somebody can change it.
The Chairman. All right, we look forward to working with
you on that, because as you know, it is a win-win for America.
The cost is cheaper in the VA than it is for private care.
Mr. Robertson. I will be making another bet with you, Mr.
Chairman, it would probably reduce the amount of fraud, waste,
and abuse in Medicare billing, because VA has no incentive to
try to falsely bill Medicare for services. It is a government
to government agency.
The Indian Health Services has been doing it for years. It
is the principal behind TRICARE For Life.
So for somebody to tell me one government agency can't bill
another government agency, that is false, and I am sure the
Public Health Service probably does it as well.
The Chairman. Thank you, sir.
Mr. Robertson. Yes, sir.
[The prepared statement of Mr. Robertson appears on p. 96.]
The Chairman. Mr. Boozman.
Mr. Boozman. Thank you, Mr. Chairman, and again we
appreciate you all being here and the testimony today was
excellent.
I think that the good news I am hearing from today is that
it seems like there is starting to get real consensus that we
have to do something about the budgeting process. And as I told
the Secretary, I think that is something that doesn't cost us
anything, we are actually going to save a lot of money in doing
that and reap the savings. And again, it doesn't matter
whichever party is in power, that has just been a real problem
for many, many years.
As you know we are, Ms. Herseth Sandlin and I, really are
working hard to try and get, with your all's help and everybody
else's help, trying to get things implemented. We have some
things arises, you know, like we have been discussing today. I
think the key though is we have to get the thing on plan, you
know, without tinkering too much. It is too much to ask as they
go forward.
So I guess my thing is, you know, we need to help and go
forward. I can say that because I was a supporter of Ms.
Herseth Sandlin's bill that I think was much easier, and we
wouldn't have, you know, the complexity that we are in now, and
yet, you know, this is just a very difficult thing to
implement, and it really is going to take all of us working
together, and yet the good news is it is a tremendous benefit
and it is going to make a real difference in the lives of lots
of veterans.
You mentioned, Mr. Robertson, about homeless children, you
know, in the--are you aware of H.R. 293? It is the homeless
women veterans and homeless veterans--I am sorry--H.R. 293, but
it addresses homeless. Are you aware of that bill at all?
Mr. Robertson. My concern is that VA, it is going to take
legislation to prompt them to start focusing on the homeless
family as opposed to the homeless veteran. And sometimes, you
know, my guess, it is my military background, I believe you
lead rather than follow, and I think that that is the mindset
that the VA needs to take is how do we address the problem that
exists? Not, you know, ignore it until somebody tells us to do
it.
Mr. Boozman. No, I agree, and I think again, I have not--we
are in the process, you know, of really looking hard at that
bill. I was wondering if any of you all had any--if you feel
like that bill would help address that particular problem.
Mr. Robertson. I believe it would push the VA in that
direction. But again, a lot of what I am hearing is that a lot
of the homeless veterans with families are winding up in
grandma and grandpa's house, and they are not showing up in
homeless shelters per se. But I think it is something that
needs to be addressed, and I am not sure it is being properly
addressed at the right level.
Mr. Boozman. Okay, thank you all.
Yes, sir.
Mr. Rieckhoff. We are seeing Iraq and Afghanistan vets walk
into our office, and it is hard to get a grasp on the numbers.
But the numbers at this point are manageable and there is a
definite shortage of transitional housing. There is definitely
a lack of a comprehensive understanding of what these folks are
facing as a family. We are seeing single parents, sometimes
both parents deployed, which is really unprecedented.
But I also want to address the issue of the GI Bill
oversight if I could, sir, for a second.
I think we have two issues. One we have the execution
piece, and I think Mr. Chairman, you were right to focus on
that and Ms. Herseth Sandlin was as well. Your questions were
dead on, and we have to work out this issue of the fee and
tuition disparity, and we have to have a fair, simple way of
addressing this, but there is a larger problem, and it is a
communications problem. And I think all of us here are kind of
at the tip of the spear facing veterans who have serious
questions about where this legislation stands, where this
benefit stands. Is it going to be ready by August? How is it
going to be implemented? And the VA's got an opportunity here
to get ahead of the curve.
When August hits we are preparing for a boatload of phone
calls and e-mails from vets who don't understand this benefit.
So we have a communications problem, and I think that that is
an area where the VA could sort of reframe the way they look at
technology.
The conversation here today focusing on technology was
outstanding, but it is largely focused on the backlog and
internal operations. If the VA has an opportunity now to
utilize technology to look at it as an outreach opportunity and
a communications tool, and that is how your generation looks at
it. So you know, General Shinseki's got some new folks coming
in that have an understanding of that element, and that may be
an opportunity for them to really break some ground.
Our generation is going to look to the GI Bill, for some of
them as their only point of contact with the VA. It is going to
make or break I think the VA's relationship with huge
percentages of my population, guys and women who served in Iraq
and Afghanistan. And if they mess it up, they are going to be
dealing with a reputation issue for a long time to come.
Mr. Boozman. Excuse me, I will let you in a second, but I
would agree with that, and yet again, in being pretty close to
this thing as you all know and both sides working very hard,
because what we all want is when that, you know, when that
August date comes that we have a very successful transition
into the new system. And right now it is, you know, we have had
several hearings, you know, we are pushing forward, and those
are really--those are updates, those aren't adversarial at all.
I mean, that is just how can we help you? You know, what can we
do? As are I think you all are. You know, how can we help? How
can the VSOs push this thing forward?
But I think right now a lot of those questions, to be
honest, they are really formulating right now, they are
figuring it out, and so it is difficult to communicate, you
know, what you are really not sure of yet, but that is the next
step.
We have asked them to do a tremendous amount, and the good
news is I think that they really are rising to the occasion. I
can't speak for them, but I do think that is part of it, and I
know Ms. Herseth Sandlin, you know, is committed to doing
whatever it takes to get it done.
Mr. Rieckhoff. Yeah, I think it is a tremendous opportunity
for us all to work together, sir, but if you look at the VA's
Web site it looks like it was created in the Gulf War, and if
you look for GI Bill resources and how to navigate this new
benefit you are probably going to come to one of our Web sites,
rather than to the VA.
Mr. Boozman. I think that is a point well taken.
Mr. Rieckhoff. And I think the VSOs have stepped up and are
trying to fill a critical gap right there.
The Chairman. Mr. Walz.
Mr. Walz. Thank you, Mr. Chairman, and thank all of you for
sticking it out late here. I thought when the Chairman left
earlier he was going to pick the pizza up for us or something,
so I appreciate you being here.
I have to tell you your advocacy for veterans is something
I am truly appreciative of. As a dues paying member of some of
these organizations that have testified today I am getting my
money's worth, I can tell you that, so thank you very much.
A couple of questions. Of course the advanced
appropriations issue is a big one for several reasons. One is
we think it obviously allows for the programming and the care
of our veterans, which is our first and foremost concern, but I
think all of us realize too in these challenging economic times
it is a way to be efficient with our resources, and I think we
need to continue to push the Administration.
If this is truly about a change and not business as usual,
I think this is smart, I think it is efficient, I think it
could work. And I think one of the things is, is that with any
deliberative body having a deadline is important, because
otherwise nothing gets done until everybody asks, how come we
don't get anything done until right before we recess or
whatever? That is the nature of it because it is the give and
take on all that. But if there is no drop dead deadline there,
no one gets really serious about it.
And I can tell you, I have been absolutely ashamed as we
finished the appropriations process for the VA and sat on it as
leverage against 12 other appropriation bills. We could deliver
this if we work together and put the pressure on and you help
us put the pressure on each one of us, deliver the darn thing
by October 1st.
Since I have been here the last 2 years it was ready to go,
it wasn't delivered when it should have been. So I don't think
we should back away 1 inch from asking this to happen. I think
it is the right thing to do. I think it is obviously the right
thing for veterans, and it is good stewardship to the public's
money.
So I thank all of you for taking that one up.
Rick, I just had a question on this, because I am very
curious about this. This is the type of stuff again being data
driven, this migration study. Am I right to understand we never
got an answer on that? We don't know what those numbers are?
Mr. Weidman. That is correct, sir.
Mr. Walz. And you were talking about in January of 2003.
Was that something that VA took it upon themselves to do, or
were they directed by Congress to do that?
Mr. Weidman. No, it was a decision by the Secretary of
Veterans Affairs to temporarily limit the registration of new
Category 8s, that is what I was talking about.
Mr. Walz. Okay.
Mr. Weidman. And at a briefing 4 weeks later of the VSOs on
the CARES process we saw the projections for 2023, and it was
no Category 8s, and I said whoa, go back to that slide.
Mr. Walz. Okay.
Mr. Weidman. Why are you using those figures? We were told
to. By whom? And it turns out that it didn't become temporary
anymore, it was built into the long-term planning and into the
CARES plan for the physical plant of freezing out Category 8s.
And so basically we were sold a pig in a poke.
Mr. Walz. Okay, well very good, I am very appreciative of
that.
Last question I just throw out as you heard me ask the last
panel on this. The two questions I had, this conundrum of
trying to deliver care, especially in rural areas, without
diminishing the core services and delivery at the VA, and also
this idea of seamless transition, the commitment that seems to
be there to start alleviating some of these problems.
I will just let you just randomly comment if you would,
just your perspective.
Mr. Robertson. First of all, you know, the VA is affiliated
with over I think it is 108 medical schools right now. I have
never understood why VA did not reach out to rural community
hospitals and try to work out partnerships with the--I mean,
where would be a better place to send them than in New Town,
North Dakota, rather than building in a CBOC? Work out some
kind of an agreement with the hospital that you would contract
the services there where they wouldn't have to make the trip
all the way to Fargo.
Today Rick made a comment at an earlier hearing about the
difference between remote areas versus rural areas, and that is
a serious problem that I had never really thought of in that
capacity where there are some places where you can't get to a
VA hospital that are part of the continental United States. And
I think that that is something that needs to be seriously
addressed.
But the question you had about the Mayo Clinic. Why doesn't
VA have a partnership with Mayo Clinic to be able to take
people that are in that catchment area under some kind of a
contract? That would seem a wise use of resources.
Mr. Weidman. It would, and it has certainly been a lot of
concern in a lot of the leadership exercise, particularly by
this Committee in regard to dealing with rural health care and
the distinction that Steve is talking about is actually--our
Alaska state president has written a paper that is almost ready
for release to the Hill on remote versus rural health care and
it will help in our thinking and planning.
However, you all passed a number of laws having to do with
rural health care and there is basically nobody at home at VA.
They still have not staffed up that office, and it is--
everybody is talking about the new team at VA. This is a pretty
lonely team, because you have General Shinseki and you have
John R. Gingrich, who is his Chief of Staff, and that are it,
and I think there is a couple of speech writers, but other than
that, he hasn't been able to get anybody else on board.
So in regard to rural health it would be helpful to us and
the VSOs to--for you all to press hard about why the heck
haven't you staffed up and done what we told you to back in
110th Congress?
Mr. Rieckhoff. And other than pile on to what these
gentlemen have already said. I think when we deal with remote
and rural areas we look to technology. I am going to sound like
a broken record, but this is an opportunity for innovation, and
I think the VA has made good process, for example, in the
suicide prevention hot line and finding new ways to do
outreach, but as some of you know we have launched a massive
public service announcement campaign with the ad counsel. We
are going where the veterans are, and I think that is a
critical way to reaching the newest generation of veterans
especially. We have to be online, we have to be innovating, and
I think that is an area where they can really utilize new
technology to bridge some of these gaps and create programs
that work.
And when it comes to DoD and VA, you know, Congressman
Walz, I share your optimism, and I think we have an opportunity
here with General Shinseki and Secretary Gates to really bridge
that gap. The GI Bill will be a good test. I mean, they have to
work out transferability, they have to be communicating
effectively. We get a lot of calls from recruiters who want to
know how does the new GI Bill compare to the old GI Bill, how
do I communicate to this incoming recruits? So I think that
will be a critical test there as well.
Mr. Walz. Well thank you all.
Thank you, Mr. Chairman.
Mr. Sullivan. And Congressman to add on to what they said.
The Vet Center's new mobile Vet Centers, those are fantastic.
We encourage those, and in fact expanding Vet Centers when it
comes to mental health otherwise we agree with that they have
said.
On seamless transition, the goal here is to bring VA to the
veterans. And when a servicemember is about to get out of the
military and become a veteran, they are at their military base,
they are there already. By putting Benefits Delivery at
Discharge at all VA facilities, making them permanent offices,
and also at some of the National Guard permanent facilities, we
can make a great step forward so that there is a good
presentation, an initial contact with these servicemembers on
their way out the door. And it is one stop shopping: GI Bill,
disability compensation, home loan guarantee, their insurance,
all of that can be done walking out the door with a permanent
VA facility. That is when we truly have seamless transition is
when that happens.
Mr. Walz. Thanks so much.
Mr. Chairman, may I just add one other comment about
transition, and transition, there is nothing seamless about it,
and I hate it, because it is new speak. I would settle for a
decent transition, period.
The combined physical that is happening at Walter Reed is
not working well. It seems to be better at Bethesda, but Walter
Reed it is not working well, and they are not doing it properly
according to their other standard operating procedures. And the
soldiers that I am in contact with regularly are really
unhappy.
We brought it to the attention of the previous Secretary
last fall several times, to current Under Secretary several
times, to the Deputy Under Secretary a number of times, and it
is still not really fixed, and it is to the point where many of
the young people are turning to JAG, and JAG is getting
involved in it because what happens is if they say that Form
3947 is wrong, then they say too bad. If you don't sign this it
goes to hearing, and if it is hearing it is de novo and you may
get nothing, and that is it.
So many of the less sophisticated ones cave in, and so they
get a disability rating from the military that is much less
than it should have been in the first place, and that is all
because they are not doing what they are supposed to be doing,
is the army person sitting down with the military medical file
and going over it with the soldier and then a separate process,
the VA person sitting down with that same medical file and
going over it with the soldier and filling out the Form 3947
again to make sure it is correct, and it ain't happening.
And we don't know what to say except I know that the Armed
Services Committee, perhaps the Joint Oversight on this.
Because they are about to expand this thing to 17 major
military installation separation points and it is not even
working for the people who are housed in Malone House right
now.
The Chairman. We thank you all.
Mr. Robertson. Mr. Chairman, before you hit the gavel, our
commander testified last September on our ``Joint Views and
Estimates for Fiscal Year 2010 Budget.'' Do you mind if I
submit this to the record?
The Chairman. No, that will be added to the record. Thank
you.
Mr. Robertson. Thank you, sir.
[The American Legion's ``Joint Views and Estimates for
Fiscal Year 2010 Budget'' is attached to Mr. Robertson's
prepared statement, and appears on p. 105.]
The Chairman. As a concluding note, I notice that several
things are still on the plate from previous Administrations.
You might want to give us a summary of those issues or a
list and we will give it to the new Administration. Not that
you would get instant return, but let us restart it all, reset
the button as Mrs. Clinton said.
Thank you all, this hearing is adjourned.
[Whereupon, at 5:27 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Bob Filner, Chairman,
Committee on Veterans' Affairs
Welcome to the hearing on the Department of Veterans Affairs Budget
Request for Fiscal Year 2010. Today's hearing is on the preliminary
budget submission of the Department of Veterans Affairs for Fiscal Year
2010.
On February 26, 2009, the Administration submitted a preliminary
budget to Congress. This 134-page document provides only top-line
budget numbers and brief discussions regarding Administration
priorities.
For FY 2010, the Administration proposes a VA discretionary budget
number of $52.5 billion, an increase of $4.9 billion, or 10.3 percent,
above FY 2009 levels.
In total discretionary resources (including collections), the
Administration requests $55.9 billion, which exceeds The Independent
Budget request by $1.3 billion.
This budget marks the first time any President has submitted a
budget that exceeds the recommendations of The Independent Budget. I
have often referred to The Independent Budget as the funding ``bible''
for the VA, and I am pleased that its recommendations are being
accorded the weight they deserve.
This year's budget also marks a sharp departure from the previous
Administration in that the budget includes increased funding over a 5-
year period, in this instance an increase of $25 billion above
baseline, as compared to last year's budget that included a net cut of
$20 billion. Although we understand these numbers are not binding on
future years, and the levels are lower than the amounts that will be
needed, we applaud this move toward presenting an honest and accurate
look at our financial picture.
I applaud the Administration's commitment to high priority areas of
interest, which are shared by this Committee, including caring for our
returning servicemembers, improving the VA's ability to provide mental
heath care and services, addressing homelessness among veterans, and
not forgetting the veterans of previous generations. We are committed
to assisting the VA in their goal of turning the VA into a model
organization of the 21st Century that puts the needs of veterans first.
We understand that VA cannot provide specific account-level funding
details at this time, and we await more detailed information in April.
We note that this Committee will fight diligently to ensure that
veterans receive the funding they need and that this funding is
provided in a timely fashion.
We applaud this Administration for this proposed robust funding
increase for veterans, and look forward to hearing from our witnesses.
Prepared Statement of Hon. Eric K. Shinseki,
Secretary, U.S. Department of Veterans Affairs
Mr. Chairman, Congressman Buyer, distinguished Members of the
Committee:
Thank you for this opportunity to present an overview of the 2010
budget for the Department of Veterans Affairs (VA). President Obama has
charged me with transforming VA into a 21st century organization--a
transformation demanded by new times, new technologies, new demographic
realities, and new commitments to today's Veterans.
The VA's proposed 2010 budget demonstrates the President's
commitment to our Nation's Veterans and a transformed VA that is
people-centric, results-driven, and forward-looking. The proposal would
increase VA's budget to $113 billion--up $15 billion, or 16 percent,
from the 2009 enacted budget. This is the largest one-year dollar and
percentage increase for VA ever requested by a President.
Nearly two thirds of the increase ($9.7 billion) would go to
mandatory programs (up 20 percent); the remaining third ($5.6 billion)
would be discretionary funding (up 11 percent). The total budget would
almost evenly split between mandatory funding ($56.9 billion) and
discretionary funding ($55.9 billion).
The President's 2010 budget is the first step toward increasing VA
funding by $25 billion over the baseline over the next 5 years. This
strong financial commitment will ensure Veterans receive timely access
to the highest quality benefits and services we can provide and which
they earned through their sacrifice and service to our Nation.
These resources will be critical to our mission of addressing
Veterans' changing needs over time. This funding pledge ensures we can
deliver state-of-the-art health care and benefits; grow and maintain a
skilled, motivated, and client-oriented workforce; and implement a
comprehensive training and leader development program for long-term
professional excellence at VA.
The Administration is still developing the details of the
President's 2010 budget request, to be released in late April. As a
result, I cannot address today the funding for any specific program or
activity. However, I want to summarize this budget's major focus areas
that are critical to realizing the President's vision and fulfilling my
commitment to Veterans.
Dramatically Increasing Funding for Health Care
VA's request for 2010 provides the funds required to treat more
than 5.5 million Veteran patients. This is 9.0 percent above the
Veteran patient total in 2008 and is 2.1 percent higher than the
projected number in 2009. The number of patients who served in
Operations Enduring Freedom and Iraqi Freedom will rise to over 419,000
in 2010. This is 61 percent higher than in 2008 and 15 percent above
the projected total this year.
The 2010 budget request enables VA to achieve the President's
pledge of strengthening the quality of health care for Veterans. We
will increase our emphasis on treating those with vision and spinal
cord injury and meet the rising demand for prosthetics and sensory
aids. We will respond to the needs of an aging population and a growing
number of women Veterans coming to VA for health care. The delivery of
enhanced primary care for women Veterans is one of VA's top priorities.
The number of women Veterans is growing rapidly. In addition, women are
becoming increasingly dependent on VA for their health care. More than
450,000 women Veterans have enrolled for care and this number is
expected to grow by 30 percent in the next 5 years. We will soon have
144 full-time Women Veterans Program Managers serving at VA medical
facilities. They will serve as advisors to and advocates for women
Veterans to help ensure their care is provided with the appropriate
level of privacy and sensitivity.
The Department will continue to actively collaborate with the
Department of Defense (DoD) to establish a DoD/VA vision center of
excellence in the prevention, diagnosis, mitigation, treatment, and
rehabilitation of eye injuries. The FY 2010 budget request provides
resources to continue development of a network of eye and vision care
specialists to assist with the coordination and standardization of
vision screening, diagnosis, rehabilitative management, and vision
research associated with traumatic brain injury (TBI). This network
will ensure a continuum of care from DoD military treatment facilities
to VA medical facilities.
Expanding Health Care Eligibility
For the first time since 2003, the President's budget expands
eligibility for VA health care to non-disabled Veterans earning modest
incomes. This commitment recognizes that economic conditions have
changed and there are many lower income Priority 8 Veterans who are now
facing serious financial difficulties due to the rising cost of health
care. This year VA will open enrollment to Priority 8 Veterans whose
incomes exceed last year's geographic and VA means test thresholds by
no more than 10 percent. We estimate that 266,000 more Veterans will
enroll for care in 2010 due to this policy change. Furthermore, the
budget includes a gradual expansion of health care eligibility that is
expected to result in nearly 550,000 new enrollees by 2013. The
Department's 2010 budget contains sufficient resources to ensure we
will maintain our quality of care, which sets the national standard of
excellence. Further, there will be no adverse impact on wait times for
those already enrolled in our system.
Enhancing Outreach and Services Related to Mental Health Care and
Cognitive Injuries, including Post-Traumatic Stress Disorder (PTSD)
and Traumatic Brain Injury (TBI), with a Focus on Access
for Veterans in Rural Areas
The Department's 2010 budget provides the resources VA needs to
expand inpatient, residential, and outpatient mental health programs. A
key element of VA's program expansion is integrating mental health
services with primary and specialty care. Veterans receive better
health care when their mental and physical needs are addressed in a
coordinated and holistic manner.
This budget allows us to continue our effort to improve access to
mental health services across the country. We will continue to place
particular emphasis on providing care to those suffering from PTSD as a
result of their service in Operations Enduring Freedom and Iraqi
Freedom. The Department will increase outreach to these Veterans as
well as provide enhanced readjustment and PTSD services. Our strategy
for improving access includes expanding our telemental health program,
which allows us to reach thousands of additional mental health patients
annually, particularly those living in rural areas.
To better meet the health care needs of recently discharged
Veterans, the 2010 budget enables VA to expand its screening program
for depression, PTSD, TBI, and substance use disorders. The Department
will also enhance its suicide prevention advertising campaign to raise
awareness among Veterans and their families of the services available
to them.
In 2010, VA will expand the number of Vet Centers providing
readjustment counseling services to Veterans, including those suffering
from PTSD. The Department will also improve access to mental health
services through expanded use of community-based mental health centers.
We will continue to place VA mental health professionals in community-
based programs to provide clinical mental health services to Veterans.
Where appropriate, we will provide fee-basis access to mental health
providers when VA services are not reasonably close to Veterans' homes.
We will also expand use of Internet-based mental health services
through ``MyHealtheVet,'' which provides an extensive degree of health
information to Veterans electronically. These steps are critical to
providing care to Veterans living in rural areas.
The 2010 budget provides resources for vital research projects
aimed at improving care and clinical outcomes for Veterans of
Afghanistan and Iraq. Some of this key research will focus on TBI and
polytrauma, specifically studies on blast-force--related brain
injuries, enhancing diagnostic techniques, and improving prosthetics.
We will strengthen our burn injury research to improve the
rehabilitation and daily lives of Veterans who have suffered burns. VA
will also enhance research on chronic pain, which afflicts one of every
four recently discharged Veterans. And the Department will also advance
research on access to care, particularly for Veterans in rural areas,
by studying new telemedicine efforts focused on mental health and PTSD.
Investing in Better Technology to Deliver Services and Benefits
to Veterans with the Quality and Efficiency They Deserve
Leveraging information technology (IT) is crucial to achieving the
President's vision for transforming VA into a 21st Century organization
that meets Veterans' needs. This is critical not only for today's
demands, but also for laying a foundation for high-quality, timely, and
accessible service to Veterans, whose use of VA services is expected to
grow year to year.
IT is an integral component of VA's health care and benefits
delivery systems. They enable VA's ability to deliver high-quality
health care, ranging from emergency treatment to routine exams in
medical centers, outpatient clinics, and in-home care and telehealth
settings. These technologies are also the foundation of our benefits
delivery systems, to include, for example, compensation, pensions,
education assistance, and burial benefits. VA depends on a reliable and
accessible IT infrastructure, a high-performing IT workforce, and
modernized information systems that are flexible enough to meet both
existing and emerging service delivery requirements. Only in this way
can we ensure system-wide information security and the privacy of our
clients. The President's 2010 budget for VA provides the resources
necessary to meet these vital IT requirements.
This budget strongly supports the most critical IT development
program for medical care--advancement of VA's ``HealtheVet'' program,
which is the future foundation of our electronic health record system.
This system includes a health data repository, a patient scheduling
system, and a reengineered pharmacy application. ``HealtheVet'' will
equip our health care providers with the modern technology and tools
they need to improve the safety and quality of care for Veterans.
The Secretary of Defense and I are collaborating to simplify the
transition of military personnel into civilian status through a uniform
approach to both registering into VA and accessing electronic records
data. Through a cooperative effort, we seek to improve the delivery of
benefits and assure the availability of medical data to support the
care of patients shared by VA and DoD. This will enhance our ability to
provide world-class care to Veterans, active-duty servicemembers
receiving care from both health care systems, and our wounded warriors
returning from Iraq and Afghanistan.
The 2010 budget provides the funds necessary to continue moving
toward the President's goal of reforming the benefits claims process to
ensure VA's claims decisions are timely, accurate, fair, and consistent
through the use of automated systems. VA's paperless processing
initiative expands on current paperless claims processing already in
place for some of our benefits programs and will improve both the
timeliness and accuracy of claims processing. It will strengthen
service to Veterans by providing them the capability to apply for and
manage their benefits online. It will also reduce the movement of paper
files and further secure Veterans' personal information. The initial
features of the paperless processing initiative will be tested in 2010,
and by 2012 we expect to complete the implementation of a fully
electronic benefits delivery system.
Providing Greater Benefits to Veterans Who Are
Medically Retired from Service
The President's 2010 budget provides for the first time concurrent
receipt of disability benefits from VA in addition to DoD retirement
benefits for disabled Veterans who are medically retired from service.
Presently, only Veterans with at least 20 years of service who have
service-connected disabilities rated 50 percent or higher by VA are
eligible for concurrent receipt. Receipt of both VA and DoD benefits
for all who were medically retired from service will be phased in
starting in 2010.
Combating Homelessness by Safeguarding Vulnerable Veterans
The President has committed to expanding proven programs and
launching innovative services to prevent Veterans from falling into
homelessness. The 2010 budget includes funds for VA to work with the
Departments of Housing and Urban Development, Labor, Education, Health
and Human Services, and the Small Business Administration, in
partnership with non-profit organizations, to improve the well-being of
Veterans. This effort focuses on reducing homelessness and increasing
employment opportunity among Veterans, and includes a pilot program
aimed at maintaining stable housing for Veterans at risk of
homelessness while also providing them with ongoing medical care and
supportive services.
Facilitating Timely Implementation of the Comprehensive Education
Benefits Veterans Earn through their Dedicated Military Service
The Department is on target to implement the Post-9/11 Veterans
Educational Assistance Act starting August 1, 2009. VA is pursuing two
parallel strategies to successfully implement this new education
program, both of which are fully supported by the resources presented
in the 2010 budget.
The short-term strategy relies upon a combination of manual claims
processing and modifications to existing IT systems. Until a modern
eligibility and payment system can be developed, VA will adjudicate
claims manually and use the existing benefits delivery network to
generate recurring benefit payments to schools and program
participants. This budget includes funds to hire and maintain the
additional staff required.
The long-term strategy is the development and implementation of an
automated system for claims processing. The Department has teamed with
the Space and Naval Warfare Systems Command to address the necessary IT
components of this strategy. They are the premier systems engineering
command for the Department of the Navy, and they have extensive
experience in building state-of-the-art IT systems. The automated
solution will be available by the end of calendar year 2010, by which
time full operational control of the automated system will be in VA's
hands.
Closing
Veterans are VA's sole reason for existence and my number one
priority--bar none. I am inspired by this Committee's unwavering
commitment to Veterans, and I look forward to working with you to
transform VA into an organization that reflects the change and
commitment our country expects and our Veterans deserve.
Prepared Statement of Carl Blake,
National Legislative Director, Paralyzed Veterans of America
Chairman Filner, Ranking Member Buyer, and Members of the
Committee, as one of the four co-authors of The Independent Budget
(IB), Paralyzed Veterans of America (PVA) is pleased to present the
views of The Independent Budget regarding the funding requirements for
the Department of Veterans Affairs (VA) health care system for FY 2010.
PVA, along with AMVETS, Disabled American Veterans, and the
Veterans of Foreign Wars, is proud to come before you this year to
present the 23rd edition of The Independent Budget, a comprehensive
budget and policy document that represents the true funding needs of
the Department of Veterans Affairs. The Independent Budget uses
commonly accepted estimates of inflation, health care costs and health
care demand to reach its recommended levels. This year, the document is
endorsed by over 60 veterans' service organizations, and medical and
health care advocacy groups.
The process leading up to FY 2009 was extremely challenging. For
the second year in a row, VA received historic funding levels that
matched, and in some cases exceeded, the recommendations of the IB.
Moreover, for only the third time in the past 22 years, VA received its
budget prior to the start of the new fiscal year on October 1. However,
this funding was provided through a combination continuing resolution/
omnibus appropriations act. The underlying Military Construction and
Veterans Affairs appropriations bill for FY 2009 was not actually
completed by Congress in the regular order. While the House passed the
bill in the summer, the Senate never brought its bill up for a floor
vote. This fact serves as a continuing reminder that, despite excellent
funding levels provided over the last two years, the larger
appropriations process is completely broken.
PVA is pleased to see that the initial information provided by the
Administration suggests a very good budget for the VA in FY 2010. The
discretionary funding levels provide for a truly significant increase.
However, we will withhold final judgment on the budget submission until
we have much more details about the FY 2010 budget. Moreover, we would
like to highlight our concern that the out year projections for VA
funding do not seem to reflect sufficient budgets to serve the needs of
veterans. In fact, the projected increases in all cases are less than 3
percent. We would be very interested in an explanation and
justification for the small out year spending increases.
For FY 2010, The Independent Budget recommends approximately $46.6
billion for total medical care, an increase of $3.6 billion over the FY
2009 operating budget level established by P.L. 110-329, the
``Consolidated Security, Disaster Assistance, and Continuing
Appropriations Act of 2009.'' Our recommendation reinforces the long-
held policy that medical care collections should be a supplement to,
not a substitute for, real dollars. Until Congress and the
Administration fairly address the inaccurate estimates for Medical Care
Collections, the VA operating budget should not include these estimates
as a component.
The medical care appropriation includes three separate accounts--
Medical Services, Medical Support and Compliance, and Medical
Facilities--that comprise the total VA health care funding level. For
FY 2010, The Independent Budget recommends approximately $36.6 billion
for Medical Services. Our Medical Services recommendation includes the
following recommendations:
Current Services Estimate $34,608,814,000
Increase in Patient Workload $1,173,607,000
Policy Initiatives $790,000,000
-----------------
Total FY 2010 Medical Services $36,572,421,000
Our increase in patient workload is based on a projected increase
of 93,000 new unique patients--Priority Group 1-8 veterans and covered
non-veterans. We estimate the cost of these new unique patients to be
approximately $639 million. The increase in patient workload also
includes a projected increase of 90,000 new Operation Iraqi Freedom and
Operation Enduring Freedom (OIF/OEF) veterans at a cost of
approximately $279 million. Finally, our increase in workload includes
the projected increase of new Priority Group 8 veterans who will use
the VA health care system as a result of the recent decision to expand
Priority Group 8 enrollment by 10 percent. The VA estimated that this
policy change would allow enrollment of approximately 265,000 new
enrollees. Based on a historic Priority Group 8 utilization rate of 25
percent, we estimate that approximately 66,250 of these new enrollees
will become users of the system. This translates to a cost of
approximately $255 million.
Our policy initiatives include a continued investment in mental
health and related services, returning the VA to its mandated long-term
care capacity, and meeting prosthetics needs for current and future
generations of veterans. For mental health and related services, the IB
recommends approximately $250 million. In order to restore the VA's
long-term care average daily census (ADC) to the level mandated by P.L.
106-117, the ``Millennium Health Care Act,'' we recommend $440 million.
Finally, to meet the increase in demand for prosthetics, the IB
recommends an additional $100 million.
For Medical Support and Compliance, The Independent Budget
recommends approximately $4.6 billion. This new account was established
by the FY 2009 appropriations bill, replacing the Medical
Administration account. Finally, for Medical Facilities, The
Independent Budget recommends approximately $5.4 billion. This amount
includes an additional $150 million for non-recurring maintenance for
the VA to begin addressing the massive backlog of infrastructure needs
beyond those addressed through the recently enacted Stimulus bill.
The IBVSOs contend that despite the recent increases in VA health
care funding VA does not have the resources necessary to completely
remove the prohibition on enrollment of Priority Group 8 veterans, who
have been blocked from enrolling in VA since January 17, 2003. In
response to this continuing policy, the Congress included additional
funding to begin opening the VA health care system to some Priority
Group 8 veterans. In fact, the final approved FY 2009 appropriations
bill included approximately $375 million to increase enrollment of
Priority Group 8 veterans by 10 percent. This will allow the lowest
income and uninsured Priority Group 8 veterans to begin accessing VA
health care.
The Independent Budget believes that providing a cost estimate for
the total cost to reopen VA's health care system to all Priority Group
8 veterans is a monumental task. That being said, we have developed an
estimate based on projected new users and based on second hand
information we have received regarding numbers of Priority Group 8
veterans who have actually been denied enrollment into the health care
system. We have received information that suggests that the VA has
actually denied enrollment to approximately 565,000 veterans. We
estimate that such a policy change would cost approximately $545
million in the first year, assuming that about 25 percent (141,250) of
these veterans would actually use the system. If, assuming a worst-case
scenario, all of these veterans who have actually been denied
enrollment were to become users of the VA health care system, the total
cost would be approximately $2.2 billion. These cost estimates reflect
a total cost that does not include the impact of medical care
collections. We believe that it is time for VA and Congress to develop
a workable solution to allow all eligible Priority Group 8 veterans to
begin enrolling in the system.
For Medical and Prosthetic Research, The Independent Budget
recommends $575 million. This represents a $65 million increase over
the FY 2009 appropriated level. We are particularly pleased that
Congress has recognized the critical need for funding in the Medical
and Prosthetic Research account in the last couple of years. Research
is a vital part of veterans' health care, and an essential mission for
our National health care system. VA research has been grossly
underfunded in contrast to the growth rate of other Federal research
initiatives. At a time of war, the government should be investing more,
not less, in veterans' biomedical research programs.
The Independent Budget recommendation also includes a significant
increase in funding for Information Technology (IT). For FY 2010, we
recommend that the VA IT account be funded at approximately $2.713
billion. This amount includes approximately $130 million for an
Information Systems Initiative to be carried out by the Veterans
Benefits Administration. This initiative is explained in greater detail
in the policy portion of The Independent Budget.
Paralyzed Veterans of America is pleased that the ``American
Recovery and Reinvestment Act of 2009'' (also the Stimulus bill)
included a substantial amount of funding for veterans programs. The
legislation identified areas of significant need within the VA system,
particularly as it relates to infrastructure needs. While we were
disappointed that additional funding was not provided for major and
minor construction in the Stimulus bill, we recognize that the funding
that was provided will be critically important to the VA going forward.
As explained in The Independent Budget, there is a significant
backlog of major and minor construction projects awaiting action by the
VA and funding from Congress. We have been disappointed that there has
been inadequate follow through on issues identified by the Capital
Asset Realignment for Enhanced Services (CARES) process. In fact, we
believe it may be time to revisit the CARES process all together. For
FY 2010, The Independent Budget recommends approximately $1.123 billion
for Major Construction and $827 million for Minor Construction. The
Minor Construction recommendation includes $142 million for research
facility construction needs.
Mr. Chairman, we would like to express our sincere thanks for your
introduction of H.R. 1016, the ``Veterans Health Care Budget Reform and
Transparency Act.'' For more than a decade, the Partnership for
Veterans Health Care Budget Reform (Partnership), made up of nine
veterans service organizations including PVA, and our IB co-authors,
has advocated for reform in the VA health care budget process. The
Partnership worked with the House and Senate Committees on Veterans'
Affairs last year to develop this alternative proposal that would
change the VA's medical care appropriation to an ``advance
appropriation,'' guaranteeing funding for the health care system up to
1 year in advance of the operating year. This alternative proposal
would ensure that the VA received its funding in a timely and
predictable manner. Furthermore, it would provide an option the IBVSOs
believe is politically more viable than mandatory funding, and is
unquestionably better than the current process.
Moreover, to ensure sufficiency, our advance appropriations
proposal would require that VA's internal budget actuarial model be
shared publicly with Congress to reflect the accuracy of its estimates
for VA health care funding, as determined by a government
Accountability Office (GAO) audit, before political considerations take
over the process. This feature would add transparency and integrity to
the VA health care budget process. We ask this Committee in your views
and estimates for FY 2010 to recommend to the Budget Committee an
advance appropriations approach to take the uncertainties out of health
care for all of our Nation's wounded, sick and disabled veterans.
In the end, it is easy to forget, that the people who are
ultimately affected by wrangling over the budget are the men and women
who have served and sacrificed so much for this Nation. We hope that
you will consider these men and women when you develop your budget
views and estimates, and we ask that you join us in adopting the
recommendations of The Independent Budget.
Finally, Mr. Chairman, I would like to express PVA's serious
concern that we have regarding a policy proposal that we have been told
may be included in the budget submission later this year, and that may
be one of the factors that allowed for the increased budget request for
FY 2010, released on February 26. We have been told that the
Administration may be considering a proposal that would allow the VA
health care system to bill a veteran's insurance for the care and
treatment of a disability or injury that was determined to have been
incurred in or the result of the veteran's honorable military service
to our country. Such a consideration is wholly unacceptable. This
proposal ignores the solemn obligation that this country has to care
for those men and women who have served this country with distinction
and were left with the wounds and scars of that service. The blood
spilled in service for this Nation is the premium that service-
connected veterans have paid for their earned care.
While we understand the fiscal difficulties this country faces
right now, placing the burden of those fiscal problems on the men and
women who have already sacrificed a great deal for this country is
unconscionable. We strongly urge Congress to investigate whether such a
proposal is being considered and to forcefully reject it if it is
brought before you.
This concludes my testimony. I will be happy to answer any
questions you may have.
Prepared Statement of Kerry Baker,
Assistant National Legislative Director, Disabled American Veterans
Mr. Chairman and Members of the Committee:
I am pleased to have this opportunity to appear before you on
behalf of the Disabled American Veterans (DAV), one of four National
veterans' organizations that create the annual Independent Budget (IB)
for veterans programs, to summarize our recommendations for fiscal year
(FY) 2009.
As you know Mr. Chairman, the IB is a budget and policy document
that sets forth the collective views of DAV, AMVETS, Paralyzed Veterans
of America (PVA), and Veterans of Foreign Wars of the United States
(VFW). Each organization accepts principal responsibility for
production of a major component of our IB--a budget and policy document
on which we all agree. Reflecting that division of responsibility, my
testimony focuses primarily on the variety of Department of Veterans
Affairs' (VA) benefits programs available to veterans.
In preparing this 23rd IB, the four partners draw upon our
extensive experience with veterans' programs, our firsthand knowledge
of the needs of America's veterans, and the information gained from
continuous monitoring of workloads and demands upon, as well as the
performance of, the veterans benefits and services system.
Consequently, this Committee has acted favorably on many of our
recommendations to improve services to veterans and their families. We
ask that you give our recommendations serious consideration again this
year.
The Veterans Benefits Administration and its Claims Process
To improve administration of VA's benefits programs, the IB
veterans' service organizations (IBVSOs) recommend that Congress adopt
both short- and long-term strategies for improvements within the
Veterans Benefits Administration (VBA). These strategies focus on the
VBA's information technology (IT) infrastructure as well as the claims
and appeals process, to include the resulting backlog. Consequently, we
are also seeking improvements in VBA's training programs and
enhancements in accountability and quality assurance with respect to
disability ratings. If Congress accepts our recommendations, VBA will
be better positioned to serve all disabled veterans and their families.
VBA Information Technology
To maintain and improve efficiency and accuracy of claims
processing, the VBA must continue to upgrade its information technology
(IT) infrastructure. Also, VBA must be given more flexibility to
install, manage and plan upgraded technology to support claims
management improvement.
To meet ever-increasing demands while maintaining efficiency, the
VBA must continually modernize the tools it uses to process and resolve
claims. Given the current challenging environment in claims processing
and benefits administration, and the ever-growing backlog, the VBA must
continue to upgrade its IT infrastructure and revise its training to
stay abreast of program changes and modern business practices. In spite
of undeniable needs, Congress has steadily reduced funding for VBA
initiatives over the past several years. In fiscal year 2001, Congress
provided $82 million for VBA-identified IT initiatives. In FY 2002, it
provided $77 million; in 2003, $71 million; in 2004, $54 million; in
2005, $29 million; and in 2006, $23 million.
Funding for FY 2006 was only 28 percent of FY 2001 funding, without
regard to inflation. Moreover, some VBA employees who provided direct
support and development for VBA's IT initiatives have been transferred
to the VA Chief Information Officer (CIO) when VA centralized all IT
operations, governance, planning and budgeting. Continued IT
realignment through FY 2007 and 2008 shifted more funding to VA's
agency IT account, further reducing funding for these VBA initiatives
in the General Operating Expenses account to $11.8 million. It should
be noted that in the FY 2007 appropriation, Public Law 110-28, Congress
provided $20 million to VBA for IT to support claims processing, and in
2009 Congress designated $5 million in additional funding specifically
to support the IT needs of new VBA Compensation and Pension Service
personnel--also authorized by that appropriations act.
All IT initiatives are now being funded in the VA's IT
appropriation and tightly controlled by the CIO. However, needed and
ongoing VBA initiatives include expansion of web-based technology and
deliverables, such as web portal and Training and Performance Support
Systems (TPSS); ``Virtual VA'' paperless processing; enhanced veteran
self-service and access to benefit application, status, and delivery;
data integration across business lines; use of the corporate database;
information exchange; quality assurance programs and controls; and,
employee skills certification and training.
We believe VBA should continue to develop and enhance data-centric
benefits integration with ``Virtual VA'' and modification of The
Imaging Management System (TIMS). All these systems serve to replace
paper-based records with electronic files for acquiring, storing, and
processing claims data.
Virtual VA supports pension maintenance activities at three VBA
pension-maintenance centers. Further enhancement would allow for the
entire claims and award process to be accomplished electronically. TIMS
is the Education Service's system for electronic education claims
files, storage of imaged documents, and work flow management. The
current VBA initiative is to modify and enhance TIMS to make it fully
interactive and allow for fully automated claims and award processing
by Education Service and VR&E nationwide.
The VBA should accelerate implementation of Virtual Information
Centers (VICs). By providing veterans regionalized telephone contact
access from multiple offices within specified geographic locations, VA
could achieve greater efficiency and improved customer service.
Accelerated deployment of VICs will more timely accomplish this
beneficial effect.
With the effects of inflation, the growth in veterans' programs,
and the imperative to invest more in advanced IT, the IB veterans
service organizations (IBVSOs) believe a conservative increase of at
least 5 percent annually in VBA IT initiatives is warranted. Had
Congress increased the FY 2001 funding of $82 million by 5 percent each
year since then, the amount available for FY 2010 would be nearly $130
million. Unfortunately, these programs have been chronically
underfunded, and now with IT centralization, IT funding in VBA is even
more restricted and bureaucratic.
Congress has taken notice of the chronic disconnect between VBA IT
and lagging improvements in claims processing. Section 227 of Public
Law 110-389 places new requirements on VA to closely examine all uses
of current IT and comparable outside IT systems with respect to VBA
claims processing for both compensation and pension. Following that
examination, VA is required to develop a new plan to use these and
other relevant technologies to reduce subjectivity, avoid remands and
reduce variances in VA Regional Office ratings for similar specific
disabilities in veteran claimants.
The act requires the VA Secretary to report the results of that
examination to Congress in great detail, and includes a requirement
that the Secretary ensure that the plan will result, within 3 years of
implementation, in reduction in processing time for compensation and
pension claims processed by VBA. The requirements of this section will
cause heavy scrutiny on IT systems that VBA has been attempting to
implement, improve and expand for years. We believe the examination
will reveal that progress has been significantly stymied due to lack of
directed funding to underwrite IT development and completion, and lack
of accountability to ensure these programs work as intended.
Recommendations:
Congress should provide the Veterans Benefits
Administration adequate funding for its IT initiatives to improve
multiple information and information-processing systems and to advance
ongoing, approved and planned initiatives such as those enumerated in
this section. We believe these IT programs should be increased annually
by a minimum of 5 percent or more.
VA should ensure that recent funding specifically
designated by Congress to support the IT needs of VBA, and of new VBA
staff authorized in fiscal year 2009, are provided to VBA as intended,
and on an expedited basis.
The Chief Information Officer and Under Secretary for
Benefits should give high priority to the review and report required by
Public Law 110-389, and redouble their efforts to ensure these ongoing
VBA initiatives are fully funded and accomplish their stated
intentions.
The Secretary should examine the impact of the current
level of IT centralization under the Chief Information Officer on these
key VBA programs, and, if warranted, shift appropriate responsibility
for their management, planning and budgeting from the CIO to the Under
Secretary for Benefits.
The Claims Process
In order to make the best use of newly hired personnel resources,
Congress must focus on the claims process from beginning to end. The
goal must be to reduce delays caused by superfluous procedures, poor
training, and lack of accountability.
During the past couple of years, the VA hired a record number of
new claims adjudicators. Unfortunately, as a result of retirements by
senior employees, an increase in disability claims, the complexity of
such claims, and the time required for new employees to become
proficient in processing claims, VA has achieved few noticeable
improvements.
The claims process is burdensome, extremely complex, and often
misunderstood by veterans and many VA employees. Numerous studies have
been completed on claims-processing delays and the backlog created by
such delays, yet the delays continue. The following suggestions would
simplify the claims process by reducing delays caused by superfluous
procedures, inadequate training, and little accountability. Other
suggestions will provide sound structure with enforceable rights where
current law promotes subjectivity and abuses rights.
The subjectivity of the claims process results in large variances
in decision making, unnecessary appeals, and claims overdevelopment. In
turn, these problems contribute to the duplicative, procedural chaos of
the claims process. Congress and the Administration should seek to
simplify, strengthen, and provide structure to the VA claims process.
In order to understand the complex procedural characteristics of
the claims process, and how these characteristics delay timely
adjudication of claims, one must focus on the procedural
characteristics and how they affect the claims process as a whole.
Whether through expansive judicial orders, repeated mistakes, or
variances in VA decisionmaking, some aspects of the claims process have
become complex, loosely structured, and open to the personal discretion
of individual adjudicators. By strengthening and properly structuring
these processes, Congress can build on what otherwise works.
These changes should begin by providing solid, nondiscretionary
structure to VA's ``duty to notify.'' Congress meant well when it
enacted VA's current statutory ``notice'' language. It has nonetheless
led to unintended consequences that have proven detrimental to the
claims process. Many Court of Appeals for Veterans Claims (Court)
decisions have expanded upon VA's statutory duty to notify, both in
terms of content and timing. However, with the recent passage of P.L.
110-389, the ``Veterans Benefits Improvement Act of 2008,'' Congress,
with the Administration's support, took an important step to correct
this problem. However, the IBVSOs believe VA can do more.
The VA's administrative appeals process has inefficiencies. The
delays caused by these inefficiencies force many claimants into drawn-
out battles for justice that may last for years. Delays in the initial
claims development and adjudication process are insignificant when
compared to delays that exist in VA's administrative appeals process.
The IBVSOs believe VA can eliminate some of the delays in this process
administratively, and we urge VA to do so. For example, VA can amend
its official forms so that the notice VA sends to a claimant when it
makes a decision on a claim includes an explanation about how to obtain
review of a VA decision by the Board of Veterans' Appeals (Board) and
provides the claimant with a description of the types of reviews that
are available.
Another problem that seems to plague the VA's claims process is its
apparent propensity to overdevelop claims. One possible cause of this
problem is that many claims require medical opinion evidence to help
substantiate their validity. There are volumes of Veterans Appeals
Reporters filled with case law on the subject of medical opinions,
i.e., who is competent to provide them, when are they credible, when
are they adequate, when are they legally sufficient, and which ones are
more probative, etc.
There is ample room to improve the law concerning medical opinions
in a manner that would bring noticeable efficiency to VA's claims
process, such as when VA issues a Veterans Claims Assistance Act (VCAA)
notice letter. Under current notice requirements and in applicable
cases, VA's letter to a claimant normally informs the claimant that he
or she may submit a private medical opinion. The letter also states
that VA may obtain a medical opinion. However, these notice letters do
not inform the claimant of what elements render private medical
opinions adequate for VA rating purposes. To correct this deficiency,
we recommend to VA that when it issues proposed regulations to
implement the recent amendment of title 38, United States Code, section
5103 that its proposed regulations contain a provision that will
require it to inform a claimant, in a VCAA notice letter, of the basic
elements that make medical opinions adequate for rating purposes.
We believe that if a claimant's physician is made aware of the
elements that make a medical opinion adequate for VA rating purposes,
and provides VA with such an opinion, VA no longer needs to delay
making a decision on a claim by obtaining its own medical opinion. This
would reduce the number of appeals that result from conflicting medical
opinions--appeals that are ultimately decided in an appellant's favor--
more often than not. If the Administration refuses to promulgate
regulations that incorporate the foregoing suggestion, Congress should
amend VA's notice requirements in section 5103 to require that VA
provide such notice regarding the adequacy of medical opinions.
Congress should consider amending section 5103A(d)(1) to provide
that when a claimant submits private medical evidence, including a
private medical opinion, that is competent, credible, probative, and
otherwise adequate for rating purposes, the Secretary shall not request
such evidence from a department health care facility. Some may view
this suggestion as an attempt to tie VA's hands with respect to its
consideration of private medical opinions. However, it does not. The
language we suggest adding to section 5103A(d)(1) would not require VA
to accept private medical evidence if, for example, VA finds that the
evidence is not credible and therefore not adequate for VA rating
purposes.
The IBVSOs also believe that other procedures add unnecessary
delays to the claims process. For example, we believe VA routinely
continues to develop claims rather than issue decisions even though
evidence development appears complete. These actions result in numerous
appeals and unnecessary remands from the Board and the Court. Remands
in fully developed cases do nothing but perpetuate the hamster-wheel
reputation of veterans law. In fact, the Board remands an extremely
large number of appeals solely for unnecessary medical opinions. In FY
2007, the Board remanded 12,269 appeals to obtain medical opinions. Far
too many were remanded for no other reason but to obtain a VA medical
opinion merely because the appellant had submitted a private medical
opinion. Such actions are, we respectfully submit, a serious waste of
VA's resources.
The suggested rulemaking actions and recommended changes to
sections 5103 and 5103A(d)(1) may have a significant effect on
ameliorating some problems. But to further improve these procedures,
Congress should amend title 38, United States Code, section 5125.
Congress enacted section 5125, for the express purpose of eliminating
the former title 38, Code of Federal Regulations, section 3.157(b)(2)
requirement that a private physician's medical examination report be
verified by an official VA examination report before VA could award
benefits. However, Congress enacted section 5125 with discretionary
language. This discretionary language permits, but does not require, VA
to accept medical opinions from private physicians. Therefore, Congress
should amend section 5125 by adding new language that requires VA to
accept a private examination report if the VA determines that the
report is (1) provided by a competent health care professional; (2)
probative to the issue being decided; (3) credible; and (4) otherwise
adequate for adjudicating the claim.
Recommendations:
VA should amend its notification forms to inform
claimants of the procedures that are available for obtaining review of
a VA decision by the Board of Veterans' Appeals along with providing an
explanation of the types of reviews that are available to claimants.VA
should issue proposed regulations to implement the recent amendment of
title 38, United States Code, section 5103 as quickly as possible. The
VA's proposed regulations should include provisions that will require
VA to notify a claimant, in appropriate circumstances, of the elements
that render medical opinions adequate for rating purposes.
Congress should amend section 5103A(d)(1) to provide that
when a claimant submits a private medical opinion that is competent,
credible, probative, and otherwise adequate for rating purposes, the
Secretary shall not request another medical opinion from a department
health care facility.
Congress should amend title 38, United States Code,
section 5125, insofar as it states that a claimant's private
examination report ``may'' be accepted. The new language should direct
that the VA ``must'' accept such report if it is (1) provided by a
competent health care professional, (2) probative to the issue being
decided, (3) credible, and (4) otherwise adequate for adjudicating such
claim.
Training:
The IBVSOs have consistently maintained that VA must invest more in
training adjudicators and decisionmakers, and should hold them
accountable for higher standards of accuracy. VA has made improvements
to its training programs in the past few years; nonetheless, much more
improvement is required in order to meet quality standards that
disabled veterans and their families deserve.
Training has not been a high enough priority in VA. We have
consistently asserted that proper training leads to better quality
decisions, and that quality is the key to timeliness of VA
decisionmaking. VA will only achieve such quality when it devotes
adequate resources to perform comprehensive and ongoing training and
imposes and enforces quality standards through effective quality
assurance methods and accountability mechanisms.
The VBA's problems caused by a lack of accountability do not begin
in the claims development and rating process--they begin in the
training program. There is little measurable accountability in the
VBA's training program.
The VBA's unsupervised and unaccountable training system results in
no distinction existing between unsatisfactory performance and
outstanding performance. This lack of accountability during training
further reduces, or even eliminates, employee motivation to excel. This
institutional mindset is further epitomized in VBA's day-to-day
performance, where employees throughout VBA are reminded that optimum
work output is far more important than quality performance and accurate
work.
The effect of VBA's lack of accountability in its training program
was demonstrated when it began offering skills certification tests to
support certain promotions. Beginning in late 2002, VSR job
announcements began identifying VSRs at the GS-11 level, contingent
upon successful completion of a certification test. The open book test
consisted of 100 multiple-choice questions. VA allowed participants to
use online references and any other reference material, including
individually prepared notes in order to pass the test.
The first validation test was performed in August 2003. There were
298 participants in the first test. Of these, 75 passed for a pass rate
of 25 percent. The VBA conducted a second test in April 2004. Out of
650 participants, 188 passed for a pass rate of 29 percent. Because of
the low pass rates on the first two tests, a 20-hour VSR ``readiness''
training curriculum was developed to prepare VSRs for the test. A third
test was administered on May 3, 2006, to 934 VSRs nationwide. Still,
the pass rate was only 42 percent. Keep in mind that these tests were
not for training; they were to determine promotions from GS-10 to GS-
11.
These results reveal a certain irony, in that the VBA will offer a
skills certification test for promotion purposes, but does not require
comprehensive testing throughout its training curriculum. Mandatory and
comprehensive testing designed cumulatively from one subject area to
the next, for which the VBA then holds trainees accountable, should be
the number one priority of any plan to improve VBA's training program.
Further, VBA should not allow trainees to advance to subsequent stages
of training until they have successfully completed such testing.
The Veterans' Benefits Improvement Act of 2008 mandated some
testing for claims processors and VBA managers, which is an
improvement; however, it does not mandate the type of testing during
the training process as explain herein. Measurable improvement in the
quality of and accountability for training will not occur until such
mandates exist. It is quite evident that a culture of quality neither
exists, nor is much desired, in the VBA.
Recommendation:
VA should undertake an extensive training program to educate its
adjudicators on how to weigh and evaluate medical evidence. In
addition, to complement recent improvements in its training programs,
VA should require mandatory and comprehensive testing of the claims
process and appellate staff. To the extent that VA fails to provide
adequate training and testing, Congress should require mandatory and
comprehensive testing, under which VA will hold trainees accountable.
Stronger Accountability
In addition to training, accountability is the key to quality, and
therefore to timeliness as well. As it currently stands, almost
everything in the VBA is production driven. Performance awards cannot
be based on production alone; they must also be based on demonstrated
quality. However, in order for this to occur, the VBA must implement
stronger accountability measures for quality assurance.
The quality assurance tool used by the VA for compensation and
pension claims is the Systematic Technical Accuracy Review (STAR)
program. Under the STAR program, VA reviews a sampling of decisions
from regional offices and bases its national accuracy measures on the
percentage with errors that affect entitlement, benefit amount, and
effective date.
However, there is a gap in quality assurance for purposes of
individual accountability in quality decisionmaking. In the STAR
program, a sample is drawn each month from a regional office workload
divided between rating, authorization, and fiduciary end-products.
However, VA recognizes that these samples are only large enough to
determine national and regional office quality. Samples as small as 10
cases per month per office are woefully inadequate to determine
individual quality.
While VA attempts to analyze quality trends identified by the STAR
review process, claims are so complex, with so many potential
variables, that meaningful trend analysis is difficult. As a
consequence, the VBA rarely obtains data of sufficient quality to allow
it to reform processes, procedures, or policies.
As mentioned above, STAR samples are far too small to allow any
conclusions concerning individual quality. That is left to rating team
coaches who are charged with reviewing a sample of ratings for each
rating veteran service representative (RVSR) each month. This review
should, if conducted properly, identify those employees with the
greatest problems. In practice, however, most rating team coaches have
insufficient time to review what could be 100 or more cases each month.
As a consequence, individual quality is often under-evaluated and
employees with quality problems fail to receive the extra training and
individualized mentoring that might allow them to be competent raters.
In the past 15 years the VBA has moved from a quality-control
system for ratings that required three signatures on each rating before
it could be promulgated to the requirement of but a single signature.
Nearly all VA rating specialists, including those with just a few
months' training, have been granted some measure of ``single
signature'' authority. Considering the amount of time it takes to train
an RVSR, the complexity of veterans disability law, the frequency of
change mandated by judicial decisions, and new legislation or
regulatory amendments, a case could and should be made that the routine
review of a second well-trained RVSR would avoid many of the problems
that today clog the appeals system.
The Veterans' Benefits Improvement Act of 2008 (section 226)
required VA to conduct a study on the effectiveness of the current
employee work-credit system and work-management system. In carrying out
the study, VA is required to consider, among other things: (1) measures
to improve the accountability, quality, and accuracy for processing
claims for compensation and pension benefits; (2) accountability for
claims adjudication outcomes; and (3) the quality of claims
adjudicated. The legislation requires VA to submit the report to
Congress, which must include the components required to implement the
updated system for evaluating VBA employees, no later than October 31,
2009.
This is a historic opportunity for VA to implement a new
methodology--a new philosophy--by developing a new system with a
primary focus of quality through accountability. Properly undertaken,
the outcome would result in a new institutional mindset across the
VBA--one that focuses on the achievement of excellence--and change a
mindset focused mostly on quantity-for-quantity's sake to a focus of
quality and excellence. Those who produce quality work are rewarded and
those who do not are finally held accountable.
Recommendation:
The VA Secretary's upcoming report must focus on how the
Department will establish a quality assurance and accountability
program that will detect, track, and hold responsible those VA
employees who commit errors while simultaneously providing employee
motivation for the achievement of excellence. VA should generate the
report in consultation with veterans service organizations most
experienced in the claims process.
We invite your attention to the IB itself for the details of the
remaining recommendations, but the following summarizes a number of
suggestions to improve benefit programs administered by VBA:
allow veterans eligible for benefits under title 38,
United States Code, sections 31 and 33 to choose the most favorable
housing allowance from the two programs
support legislation to clarify the intent of Congress
concerning who is considered to have engaged in combat
repeal in whole the offset between disability
compensation and military retired pay
provide cost-of-living adjustments for compensation,
specially adapted housing grants, and automobile grants, with
provisions for automatic annual increases in the housing and automobile
grants based on increases in the cost of living
propose a rule change to the Federal Register that would
update the mental health rating criteria
provide a presumption of service connection for hearing
loss and tinnitus for combat veterans and veterans who had military
duties involving high levels of noise exposure who suffer from tinnitus
or hearing loss of a type typically related to noise exposure or
acoustic trauma
increase the maximum coverage and adjustment of the
premium rates for Service-Disabled Veterans' Life Insurance
increase the maximum coverage available in policies of
Veterans' Mortgage Life Insurance
enforce VA's benefit of the doubt rule in judicial
proceedings
appoint judges to the Court of Appeals for Veterans
claims who are advocates experienced VA law
support legislation to increase Dependency and Indemnity
Compensation (DIC) for certain survivors of veterans, and to no longer
offset DIC with Survivor Benefit Plan payments. And
authorize rates of DIC for surviving spouses of
servicemembers who die while on active duty to the same rate as those
who die while rated totally disabled.
We hope the Committee will review these recommendations and give
them consideration for inclusion in your legislative plans for FY 2009.
Mr. Chairman, thank you for inviting the DAV and other member
organizations of the IB to testify before you today.
Prepared Statement of Dennis M. Cullinan,
Director, National Legislative Service,
Veterans of Foreign Wars of the United States
Mr. Chairman and Members of the Committee:
On behalf of the 2.4 million men and women of the Veterans of
Foreign Wars of the U.S. (VFW) and our Auxiliaries, I would like to
thank you for the opportunity to testify today. The VFW works alongside
the other members of The Independent Budget (IB)--AMVETS, Disabled
American Veterans and Paralyzed Veterans of America--to produce a set
of policy and budget recommendations that reflect what we believe would
meet the needs of America's veterans. The VFW is responsible for the
construction portion of the IB, so I will limit my remarks to that
portion of the budget.
On May 5, 2008, VA released the final results of its Capital Asset
Realignment for Enhanced Services (CARES) business plan study for
Boston, Massachusetts. The decision to keep the four Boston-area
medical campuses open was the culmination of many years of work and
1910s of millions of dollars as it marked the final step of the CARES
planning process.
CARES--VA's data-drive assessment of VA's current and future
construction needs--gave VA a long-term roadmap and has helped guide
its capital planning process over the past few fiscal years. CARES
showed a large number of significant construction priorities that would
be necessary for VA to fulfill its obligation to this Nation's veterans
and over the last several fiscal years, the Administration and Congress
have made significant inroads in funding these priorities. Since FY
2004, $4.9 billion has been allocated for these projects. Of these
CARES-identified projects, VA has completely five and another 27 are
currently under construction. It has been a huge, but necessary
undertaking and VA has made slow, but steady progress on these critical
projects.
The challenge for VA in the post-CARES era is that there are still
numerous projects that need to be carried out, and the current backlog
of partially funded projects that CARES has identified is large, too.
This means that VA is going to continue to require significant
appropriations for the major and minor construction accounts to live up
to the promise of CARES.
VA's most recent Asset Management Plan provides an update of the
state of CARES projects--including those only in the planning of
acquisition process. Appendix E (pages 93-95) shows a need of future
appropriations to complete these projects of $2.195 billion.
------------------------------------------------------------------------
Future Funding Needed
Project ($ In Thousands)
------------------------------------------------------------------------
Pittsburgh 62,400
Orlando 462,700
San Juan 91,620
Denver 580,900
Bay Pines 156,800
Los Angeles 103,864
Palo Alto 412,010
St. Louis 122,500
Tampa 202,600
----------------------
TOTAL 2,195,394
------------------------------------------------------------------------
This amount represents just the backlog of current construction
projects. It also does not reflect the additional $401 million Congress
gave VA as part of the FY 2009 appropriation, which did not earmark
specific construction projects.
Meanwhile, VA continues to identify and reprioritize potential
major construction projects. These priorities, which are assessed using
the rigorous methodology that guided the CARES decisions are released
in the Department's annual Five Year Capital Asset Plan, which is
included in the Department's budget submission. The most recent one was
included in Volume IV and is available on VA's Web site: http://
www.va.gov/budget/summary/2009/index.htm
Pages 7-12 of that document shows the priority scoring of projects.
Last year's budget request sought funding for only three of the top
scored projects. No funding was requested for any other new project,
including those in Seattle, Dallas, Louisville or Roseburg, Oregon. In
addition to the already-identified needs from that table, page 7-86
shows a long list of potential major construction projects the
department plans to evaluate from now through FY 13. These 122
potential projects demonstrate the continued need for VA to upgrade and
repair its aging infrastructure, and that continuous funding is
necessary for not just the backlog of projects, but to keep VA viable
for today's and future veterans.
In a November 17, 2008 letter to the Senate Veterans Affairs
Committee, Secretary Peake said that ``the Department estimates that
the total funding requirement for major medical facility projects over
the next 5 years would be in excess of $6.5 billion.''
It is clear that VA needs a significant infusion of cash for its
construction priorities. VA's own words and studies show this.
Major Construction Account Recommendations
------------------------------------------------------------------------
Recommendation ($ in
Category Thousands)
------------------------------------------------------------------------
VHA Facility Construction $900,000
NCA Construction $80,000
Advance Planning $45,000
Master Planning $20,000
Historic Preservation $20,000
Miscellaneous Accounts $58,000
----------------------
TOTAL $1,123,000
------------------------------------------------------------------------
VHA Facility Construction--this amount would allow VA to
continue digging into the $2 billion backlog of partially funded
construction projects. Depending on the stages and ability to complete
portions of the projects, any additional money could be used to fund
new projects identified by VA as part of its prioritization methodology
in the Five-Year Capital Plan.
NCA Construction--page 7-143 of VA's Five-Year Capital
Plan details numerous potential major construction projects for the
National Cemetery Association throughout the country. This level of
funding would allow VA to begin construction on at least three of its
scored priority projects.
Advance Planning--helps develop the scope of the major
construction projects as well as identifying proper requirements for
their construction. It allows VA to conduct necessary studies and
research similar to planning processes in the private sector.
Master Planning--a description of our request follows
later in the text.
Historic Preservation--a description of our request
follows later in the text.
Miscellaneous Accounts--these include the individual line
items for accounts such as asbestos abatement, the judgment fund and
hazardous waste disposal. Our recommendation is based upon the historic
level for each of these accounts.
Minor Construction Account Recommendations
------------------------------------------------------------------------
Funding ($ in
Category Thousands)
------------------------------------------------------------------------
Veterans Health Administration $550,000
Medical Research Infrastructure $142,000
National Cemetery Administration $100,000
Veterans Benefits Administration $20,000
Staff Offices $15,000
----------------------
TOTAL $827,000
------------------------------------------------------------------------
Veterans Health Administration--Page 7-95 of VA's Capital
Plan reveals hundreds of already identified minor construction
projects. These projects update and modernize VA's aging physical plant
ensuring the health and safety of veterans and VA employees.
Additionally, a great number of minor construction projects address
FCA-identified maintenance deficiencies, the backlog of which was
nearly $5 billion at the start of FY 08 (page 7-64).
Medical Research Infrastructure--a description of our
request follows later in the text.
National Cemetery Administration--Page 7-145 of the
Capital Plan identifies numerous minor construction projects throughout
the country including the construction of several columbaria,
installation of crypts and landscaping and maintenance improvements.
Some of these projects could be combined with VA's new NCA nonrecurring
maintenance efforts.
Veterans Benefits Administration--Page 7-126 of the
Capital Plan lists several minor construction projects in addition to
the leasing requirements VBA needs. This funding also includes $2
million it transfers yearly for the security requirements of its Manila
office.
Staff Offices--Page 7-166 lists numerous potential minor
construction projects related to staff offices, including increased
space and numerous renovations for VA's Inspector General's office.
Increase Spending on Nonrecurring Maintenance
The deterioration of many VA properties requires increased spending on
nonrecurring maintenance
For years, The Independent Budget Veteran Service Organizations
(IBVSOs) have highlighted the need for increased funding for the
nonrecurring maintenance (NRM) account. NRM consists of small projects
that are essential to the proper maintenance of and preservation of the
lifespan of VA's facilities. NRM projects are one-time repairs such as
maintenance to roofs, repair and replacement of windows and flooring or
minor upgrades to the mechanical or electrical systems. They are a
necessary component of the care and stewardship of a facility.
These projects are so essential because if left unrepaired, they
can really take their toll on a facility, leading to more costly
repairs in the future, and the potential of a need for a minor
construction project. Beyond the fiscal aspects, facilities that fall
into disrepair can create access difficulties and impair patient and
staff health and safety, and if things do develop into a larger
construction projection because early repairs were not done, it creates
an even larger inconvenience for veterans and staff.
The industry standard for medical facilities is for managers to
spend from 2 percent-4 percent of plant replacement value (PRV) on
upkeep and maintenance. The 1998 PriceWaterhouseCoopers study of VA's
facilities management practices argued for this level of funding and
previous versions of VA's own Asset Management Plan have agreed that
this level of funding would be adequate.
The most recent estimate of VA's PRV is from the FY 08 Asset
Management Plan. Using the standards of the Federal Government's
Federal Real Property Council (FRPC), VA's PRV is just over $85 billion
(page 26).
Accordingly, to fully maintain its facilities, VA needs a NRM
budget of at least $1.7 billion. This number would represent a doubling
of VA's budget request from FY 2009, but is in line with the total NRM
budget when factoring in the increases Congress gave in the
appropriations bill and the targeted funding included in the
supplemental appropriations bills.
Increased funding is required not to just to fill current
maintenance needs and levels, but also to dip into the extensive
backlog of maintenance requirements VA has. VA monitors the condition
of its structures and systems through the Facility Condition Assessment
(FCA) reports. VA surveys each medical center periodically, giving each
building a thorough assessment of all essential systems. Systems are
assigned a letter grade based upon the age and condition of various
systems, and VA gives each component a cost for repair or replacement.
The bulk of these repairs and replacements are conducted through
the NRM program, although the large increases in minor construction
over the last few years have helped VA to address some of these
deficiencies.
VA's 2009 5-Year Capital Plan discusses FCAs and acknowledges the
significant backlog, noting that in FY 2007, the number of high
priority deficiencies--those with ratings of D or F--had replacement
and repair costs of over $5 billion. Even with the increased funding of
the last few years, VA estimates that the cost for repairing or
replacing the high priority deficiencies is over $4 billion.
VA uses the FCA reports as part of its Federal Real Property
Council (FRPC) metrics. The department calculates a Facility Condition
Index, which is the ratio of the cost of FCA repairs to the cost of
replacement. According to the FY 08 Asset Management Plan, this metric
has gone backward from 82 percent in 2006 to just 68 percent in 2008.
VA's strategic goal is 87 percent, and for it to meet that, it would
require a sizeable investment in NRM and minor construction.
Given the low level of funding the NRM account has historically
received, the IBVSOs are not surprised at the metrics or the dollar
cost of the FCA deficiencies. The 2007 ``National Roll Up of
Environment of Care Report,'' which was conducted in light of the
shameful maintenance deficiencies at Walter Reed further prove the need
for increased spending on this account. Maintenance has been neglected
for far too long, and for VA to provide safe, high-quality health care
in its aging facilities, it is essential that more money be allocated
for this account.
We also have concerns with how NRM funding is actually apportioned.
Since it falls under the Medical Care account, NRM funding has
traditionally been apportioned using the Veterans Equitable Resource
Allocation (VERA) formula. This model works when divvying up health
care dollars, targeting money to those areas with the greatest demand
for health care. When dealing with maintenance needs, though, this same
formula may actually intensify the problem, moving money away from
older hospitals, such as in the northeast, to newer facilities where
patient demand is greater, even if the maintenance needs are not as
high. We were happy to see that the conference reports to the VA
appropriations bills required NRM funding to be apportioned outside the
VERA formula, and we would hope that this continues into the future.
Another issue related to apportionment of funding came to light in
a May 2007 Government Accountability Office (GAO) report. They found
that the bulk of NRM funding is not actually apportioned until
September, the final month of the fiscal year. In September 2006, GAO
found that VA allocated 60 percent of that year's NRM funding. This is
a shortsighted policy that impairs VA's ability to properly address its
maintenance needs, and since NRM funding is year-to-year, it means that
it could lead to wasteful or unnecessary spending as hospital managers
rushed in a flurry to spend their apportionment before forfeiting it
back. We cannot expect VA to perform a year's worth of maintenance in a
month. It is clearly poor policy and not in the best interest of
veterans. The IBVSOs believe that Congress should consider allowing
some NRM money to be carried over from one fiscal year to another.
While we would hope that this would not resort to hospital managers
hoarding money, it could result in more efficient spending and better
planning, rather than the current situation where hospital managers
sometimes have to spend through a large portion of maintenance funding
before losing it at the end of the fiscal year.
Recommendations:
VA must dramatically increase funding for nonrecurring maintenance
in line with the 2 percent-4 percent total that is the industry
standard so as to maintain clean, safe and efficient facilities. VA
also requires additional maintenance funding to allow the department to
begin addressing the substantial maintenance backlog of FCA-identified
projects.
Portions of the NRM account should be continued to be funded
outside of the VERA formula so that funding is allocated to the
facilities that actually have the greatest maintenance needs.
Congress should consider the strengths of allowing VA to carryover
some maintenance funding from one fiscal year to another so as to
reduce the temptation some VA hospital managers have of inefficiently
spending their NRM money at the end of a fiscal year for fear of losing
it.
Inadequate Funding and Declining Capital Asset Value
VA must protect against deterioration of its infrastructure and a
declining capital asset value
The last decade of underfunded construction budgets has meant that
VA has not adequately recapitalized its facilities. Recapitalization is
necessary to protect the value of VA's capital assets through the
renewal of the physical infrastructure. This ensures safe and fully
functional facilities long into the future. VA's facilities have an
average age of over 55 years, and it is essential that funding be
increased to renovate, repair and replace these aging structures and
physical systems.
As in past years, the IBVSOs cite the Final Report of the
President's Task Force to Improve Health Care Delivery for Our Nation's
Veterans (PTF). It found that from 1996-2001, VA's recapitalization
rate was just 0.64 percent. At this rate, VA's structures would have an
assumed life of 155 years.
The PTF cited a PriceWaterhouseCoopers study of VA's facilities
management programs that found that to keep up with industry standards
in the private sector and to maintain patient and employee safety and
optimal health care delivery, VA should spend a minimum of 5 to 8
percent of plant replacement value (PRV) on its total capital budget.
The FY 08 VA Asset Management Plan provides the most recent
estimate of VA's PRV. Using the guidance of the Federal Government's
Federal Real Property Council (FRPC), VA's PRV is just over $85 billion
(page 26).
Accordingly, using that 5 to 8 percent-standard, VA's capital
budget should be between $4.25 and $6.8 billion per year in order to
maintain its infrastructure.
VA's capital budget request for FY 2009--which includes major and
minor construction, maintenance, leases and equipment--was just $3.6
billion. We greatly appreciate that Congress increased funding above
that level with an increase over the Administration request of $750
million in major and minor construction alone. That increased amount
brought the total capital budget in line with industry standards, and
we strongly urge that these targets continue to be met and we would
hope that future VA requests use these guidelines as a starting point
without requiring Congress to push them past the target.
Recommendation:
Congress and the Administration must ensure that there are adequate
funds for VA's capital budget so that VA can properly invest in its
physical assets to protect their value and to ensure that the
Department can continue to provide health care in safe and functional
facilities long into the future.
Maintain VA's Critical Infrastructure
The IBVSOs are concerned with VA's recent attempts to back away
from the capital infrastructure blueprint laid out by CARES and we are
worried that its plan to begin widespread leasing and contracting for
inpatient services might not meet the needs of veterans.
VA acknowledges three main challenges with its capital
infrastructure projects. First, they are costly. According to a March
2008 briefing given to the VSO community, over the next 5 years, VA
would need $2 billion per year for its capital budget. Second, there is
a large backlog of partially funded construction projects. That same
briefing claimed that the difference in major construction requests
given to OMB was $8.6 billion from FY 03 through FY 09, and that they
have received slightly less than half that total. Additionally, there
is a $2 billion funding backlog for projects that are partially but not
completely funded. Third, VA is concerned about the timeliness of
construction projects, noting that it can take the better part of a
decade from the time VA initially proposes a project until the doors
actually open for veterans.
Given these challenges, VA has floated the idea of a new model for
health care delivery, the Health Care Center Facility (HCCF) leasing
program. Under the HCCF, VA would begin leasing large outpatient
clinics in lieu of major construction. These large clinics would
provide a broad range of outpatient services including primary and
specialty care as well as outpatient mental health services and
ambulatory surgery.
On the face of it, this sounds like a good initiative. Leasing has
the advantage of being able to be completed quickly, as well as being
adaptable, especially when compared to the major construction process.
Leasing has been particularly valuable for VA as evidenced by the
success of the Community Based Outpatient Clinics (CBOCs) and Vet
Centers.
Our concern rests, however, with VA's plan for inpatient services.
VA aims to contract for these essential services with affiliates or
community hospitals. This program would privatize many services that
the IBVSOs believe VA should continue to provide. We lay out our
objections to privatization and widespread contracting for care
elsewhere in The Independent Budget.
Beyond those objections, though, is the example of Grand Island,
Nebraska. In 1997, the Grand Island VA Medical Center closed its
inpatient facilities, contracting out with a local hospital for those
services. Recently, the contract between the local facility and VA was
canceled, meaning veterans in that area can no longer receive inpatient
services locally. They must travel great distances to other VA
facilities such as the Omaha VA Medical Center. In some cases, when
Omaha is unable to provide specialized care, VA is flying patients at
its expense to faraway VA medical centers, including those in St. Louis
and Minneapolis.
Further, with the canceling of that contract, St. Francis no longer
provides the same level of emergency services that a full VA Medical
Center would provide. With VA's restrictions on paying for emergency
services in non-VA facilities, especially for those who may have some
form of private insurance, this amounts to a cut in essential services
to veterans. Given the expenses of air travel and medevac services, the
current arrangement in Grand Island has likely not resulted in any cost
savings for VA. Ferrying sick and disabled veterans great distances for
inpatient care also raises patient safety and quality concerns.
The HCCF program raises many concerns for the IBVSOs that VA must
address before we can support the program. Among these questions, we
wonder how VA would handle governance, especially with respect to the
large numbers of non-VA employees who would be treating veterans? How
would the non-VA facility deal with VA directives and rule changes that
govern health care delivery and that ensure safety and uniformity of
the quality of care? Will VA apply its space planning criteria and
design guides to non-VA facilities? How will VA's critical research
activities, most of which improve the lives of all Americans and not
only veterans, be affected if they are being conducted in shared
facilities, and not a traditional part of VA's first-class research
programs? What would this change mean for VA's electronic health
record, which many have rightly lauded as the standard that other
health care systems should aim to achieve? Without the electronic
health record, how would VA maintain continuity of care for a veteran
who moves to another area?
But most importantly, CARES required years to complete and consumed
thousands of hours of effort and millions of dollars of study. We
believe it to be a comprehensive and fully justified roadmap for VA's
infrastructure as well as a model that VA can apply periodically to
assess and adjust those priorities. Given the strengths of the CARES
process and the lessons VA learned and has applied from it, why is the
HCCF model, which to our knowledge has not been based on any sort of
model or study of the long-term needs of veterans, the superior one? We
have yet to see evidence that it is and until we see more convincing
evidence that it will truly serve the best needs of veterans, the
IBVSOs will have a difficult time supporting it.
Recommendation:
VA must resist implementing the HCCF model without fully addressing
the many questions the IBVSOs have and VA must explain how the program
would meet the needs of veterans, particularly as compared to the
roadmap CARES has laid out.
Research Infrastructure Funding
The Department of Veterans Affairs must have increased funding for its
research infrastructure to provide a state-of-the-art research and
laboratory environment for its excellent programs, but also to ensure
that VA hires and retains the top scientists and researchers.
VA Research Is a National Asset
Research conducted in the Department of Veterans Affairs has led to
such innovations and advances as the cardiac pacemaker, nuclear
scanning technologies, radioisotope diagnostic techniques, liver and
other organ transplantation, the nicotine patch, and vast improvements
in a variety of prosthetic and sensory aids. A state-of-the-art
physical environment for conducting VA research promotes excellence in
health professions education and VA patient care as well as the
advancement of biomedical science. Adequate and up-to-date research
facilities also help VA recruit and retain the best and brightest
clinician scientists to care for enrolled veterans.
VA Research Infrastructure Funding Shortfalls
In recent years, funding for the VA Medical and Prosthetics
Research Program has failed to provide the resources needed to
maintain, upgrade, and replace VA's aging research facilities. Many VA
facilities have exhausted their available research space. Along with
space reconfiguration, ventilation, electrical supply, and plumbing
appear frequently on lists of needed upgrades in VA's academic health
centers. In the 2003 Draft National Capital Asset Realignment for
Enhanced Services (CARES) plan, VA included $142 million designated for
renovation of existing research space and build-out costs for leased
researched facilities. However, these capital improvement costs were
omitted from the Secretary's final report. Over the past decade, only
$50 million has been spent on VA research construction or renovation
nationwide, and only 24 of the 97 major VA research sites across the
Nation have benefited.
In House Report 109-95 accompanying the FY 2006 VA appropriations,
the House Appropriations Committee directed VA to conduct ``a
comprehensive review of its research facilities and report to the
Congress on the deficiencies found and suggestions for correction of
the identified deficiencies.'' In FY 2008, the VA Office of Research
and Development initiated a multiyear examination of all VA research
infrastructure for physical condition and capacity for current
research, as well as program growth and sustainability of the space
needed to conduct research.
Lack of a Mechanism to Ensure VA's Research Facilities Remain
Competitive
In House Report 109-95 accompanying the FY 2006 VA appropriations,
the House Appropriations Committee expressed concern that ``equipment
and facilities to support the research program may be lacking and that
some mechanism is necessary to ensure the Department's research
facilities remain competitive.'' A significant cause of research
infrastructure's neglect is that there is no direct funding line for
research facilities.
The VA Medical and Prosthetic Research appropriation does not
include funding for construction, renovation, or maintenance of
research facilities. VA researchers must rely on their local facility
managements to repair, upgrade, and replace research facilities and
capital equipment associated with VA's research laboratories. As a
result, VA research competes with other medical facilities' direct
patient care needs--such as medical services infrastructure, capital
equipment upgrades and replacements, and other maintenance needs--for
funds provided under either the VA Medical Facilities appropriation
account or the VA Major or Minor Medical Construction appropriations
accounts.
Recommendations:
The Independent Budget veterans service organizations anticipate
VA's analysis will find a need for funding significantly greater than
VA had identified in the 2004 Capital Asset Realignment for Enhanced
Services report. As VA moves forward with its research facilities
assessment, the IBVSOs urge Congress to require the VA to submit the
resulting report to the House and Senate Committees on Veterans'
Affairs no later than October 1, 2009. This report will ensure that the
Administration and Congress are well informed of VA's funding needs for
research infrastructure so they may be fully considered at each stage
of the FY 2011 budget process.
To address the current shortfalls, the IBVSOs recommend an
appropriation in FY 2010 of $142 million, dedicated to renovating
existing VA research facilities in line with the 2004 CARES findings.
To address the VA research infrastructure's defective funding
mechanism, the IBVSOs encourage the Administration and Congress to
support a new appropriations account in FY 2010 and thereafter to
independently define and separate VA research infrastructure funding
needs from those related to direct VA medical care. This division of
appropriations accounts will empower VA to address research facility
needs without interfering with the renovation and construction of VA
direct health-care infrastructure.
Program for Architectural Master Plans:
Each VA medical facility must develop a detailed master plan.
The delivery models for quality health care are in a constant state
of change. This is due to many factors including advances in research,
changing patient demographics, and new technology.
The VA must design their facilities with a high level of
flexibility in order to accommodate these new methods of patient care.
The department must be able to plan for change to accommodate new
patient care strategies in a logical manner with as little effect as
possible on other existing patient care programs. VA must also provide
for growth in already existing programs.
A facility master plan is a comprehensive tool to look at potential
new patient care programs and how they might affect the existing health
care facility. It also provides insight with respect to possible
growth, current space deficiencies, and other facility needs for
existing programs and how VA might accommodate these in the future.
In some cases in the past, VA has planned construction in a
reactive manner. After funding, VA would place projects in the facility
in the most expedient manner--often not considering other projects and
facility needs. This would result in shortsighted construction that
restricts, rather than expands options for the future.
The IBVSOs believe that each VA medical Center should develop a
comprehensive facility master plan to serve as a blueprint for
development, construction, and future growth of the facility. Short and
long-term CARES objectives should be the basis of the master plan.
Four critical programs were not included in the CARES initiative.
They are long-term care, severe mental illness, domiciliary care, and
Polytrauma. VA must develop a comprehensive plan addressing these needs
and its facility master plans must account for these services.
VA has undertaken master planning for several VA facilities; most
recently Tampa, Florida. This is a good start, but VA must ensure that
all facilities develop a master plan strategy to validate strategic
planning decisions, prepare accurate budgets, and implement efficient
construction that minimizes wasted expenses and disruption to patient
care.
Recommendation:
Congress must appropriate $20 million to provide funding for each
medical facility to develop a master plan.
Each facility master plan should include the areas left out of
CARES; long-term care, severe mental illness, domiciliary care, and
Polytrauma programs as it relates to the particular facility.
VACO must develop a standard format for these master plans to
ensure consistency throughout the VA health care system.
Empty or Underutilized Space
VA must not use empty space inappropriately and must continue
disposing of unnecessary property where appropriate Studies have
suggested that the VA medical system has extensive amounts of empty
space that the Department can reuse for medical services. Others have
suggested that unused space at one medical center may help address a
deficiency that exists at another location. Although the space
inventories are accurate, the assumption regarding the feasibility of
using this space is not.
Medical facility planning is complex. It requires intricate design
relationships for function, but also because of the demanding
requirements of certain types of medical equipment. Because of this,
medical facility space is rarely interchangeable, and if it is, it is
usually at a prohibitive cost. For example, VA cannot use unoccupied
rooms on the eighth floor to offset a deficiency of space in the second
floor surgery ward. Medical space has a very critical need for inter-
and intra-departmental adjacencies that must be maintained for
efficient and hygienic patient care.
When a department expands or moves, these demands create a domino
effect of everything around it. These secondary impacts greatly
increase construction expense, and they can disrupt patient care.
Some features of a medical facility are permanent. Floor-to-floor
heights, column spacing, light, and structural floor loading cannot be
altered. Different aspects of medical care have different requirements
based upon these permanent characteristics. Laboratory or clinical
spacing cannot be interchanged with ward space because of the needs of
different column spacing and perimeter configuration. Patient wards
require access to natural light and column grids that are compatible
with room-style layouts. Labs should have long structural bays and
function best without windows. When renovating empty space, if the area
is not suited to its planned purpose, it will create unnecessary
expenses and be much less efficient.
Renovating old space rather than constructing new space creates
only a marginal cost savings. Renovations of a specific space typically
cost 85 percent of what a similar, new space would. When you factor in
the aforementioned domino or secondary costs, the renovation can end up
costing more and produce a less satisfactory result. Renovations are
sometimes appropriate to achieve those critical functional adjacencies,
but it is rarely economical.
Many older VA Medical Centers that were rapidly built in the 1940s
and 1950s to treat a growing veteran population are simply unable to be
renovated for modern needs. Most of these Bradley-style buildings were
designed before the widespread use of air conditioning and the floor-
to-floor heights are very low. Accordingly, it is impossible to
retrofit them for modern mechanical systems. They also have long,
narrow wings radiating from a small central core, which is an
inefficient way of laying out rooms for modern use. This central core,
too, has only a few small elevator shafts, complicating the vertical
distribution of modern services.
Another important problem with this unused space is its location.
Much of it is not located in a prime location; otherwise, VA would have
previously renovated or demolished this space for new construction.
This space is typically located in outlying buildings or on upper floor
levels, and is unsuitable for modern use.
VA Space Planning Criteria/Design Guides:
VA must continue to maintain and update the Space Planning Criteria
and Design Guides to reflect state-of-the-art methods of health care
delivery.
VA has developed space-planning criteria it uses to allocate space
for all VA health care projects. These criteria are organized into
sixty chapters; one for each health care service provided by VA as well
as their associated support services. VA updates these criteria to
reflect current methods of health care delivery.
In addition to updating these criteria, VA has utilized a computer
program called VA SEPS (Space and Equipment Planning System) it uses as
a tool to develop space and equipment allocation for all VA health care
projects. This tool is operational and VA currently uses it on all VA
health care projects.
The third component used in the design of VA health care projects
is the design guides. Each of the sixty space planning criteria
chapters has an associated design guide. These design guides go beyond
the allocation of physical space and outline how this space is
organized within each individual department, as well as how the
department relates to the entire medical facility.
VA has updated several of the design guides to reflect current
patient delivery models. These include those guides that cover Spinal
Cord Injury/Disorders Center, Imaging, Polytrauma Centers, as well as
several other services.
Recommendation:
The VA must continue to maintain and update the Space Planning
Criteria and the VA SEPS space-planning tool. It also must continue the
process of updating the Design Guides to reflect current delivery
models for patient care. VA must regularly review and update all of
these space-planning tools as needed, to reflect the highest level of
patient care delivery.
Design-build Construction Delivery System
The VA must evaluate use of the Design-build construction delivery
system.
For the past 10 years, VA has embraced the design-build
construction delivery system as a method of project delivery for many
health care projects. Design-build attempts to combine the design and
construction schedules in order to streamline the traditional design-
bid-build method of project delivery. The goal is to minimize the risk
to the owner and reduce the project delivery schedule. Design-build, as
used by VA, places the contractor as the design builder.
Under the contractor-led design build process, VA gives the
contractor a great deal of control over how he or she designs and
completes the project. In this method, the contractor hires the
architect and design professionals. With the architect as a
subordinate, a contractor may sacrifice the quality of material and
systems in order to add to his own profits at the expense of the owner.
Use of design-build has several inherent problems. A short-cut
design process reduces the time available to provide a complete design.
This provides those responsible for project oversight inadequate time
to review completed plans and specifications. In addition, the
construction documents may not provide adequate scope for the project,
leaving out important details regarding the workmanship and/or other
desired attributes of the project. This makes it difficult to hold the
builder accountable for the desired level of quality. As a result, a
project is often designed as it is being built, which often compromises
VA's design standards.
Design-build forces the owner to rely on the contractor to properly
design a facility that meets the owner's needs. In the event that the
finished project is not satisfactory to the owner, the owner may have
no means to insist on correction of work done improperly unless the
contractor agrees with the owner's assessment. This may force the owner
to go to some form of formal dispute resolution such as litigation or
arbitration.
Recommendation:
VA must evaluate the use of Design-build as a method of
construction delivery to determine if design-build is an appropriate
method of project delivery for VA health care projects.
The VA must institute a program of ``lessons learned''. This would
involve revisiting past projects and determining what worked, what
could be improved, and what did not work. VA should compile and use
this information as a guide to future projects. VA must regularly
update this document to include projects as they are completed.
Preservation of VA's Historic Structures:
The VA must further develop a comprehensive program to preserve and
protect its inventory of historic properties.
The VA has an extensive inventory of historic structures that
highlight America's long tradition of providing care to veterans. These
buildings and facilities enhance our understanding of the lives of
those who have worn the uniform, and who helped to develop this great
Nation. Of the approximately 2,000 historic structures, many are
neglected and deteriorate year after year because of a lack of funding.
These structures should be stabilized, protected and preserved because
they are an integral part our Nation's history.
Most of these historic facilities are not suitable for modern
patient care. As a result, a preservation strategy was not included in
the CARES process. For the past 6 years, the IBVSOs have recommended
that VA conduct an inventory of these properties; classifying their
physical condition and their potential for adaptive reuse. VA has been
moving in that direction and historic properties are identified on
their Web site. VA has placed many of these buildings in an ``Oldest
and Most Historic'' list and these buildings require immediate
attention.
At least one project has received funding. The VA has invested over
$100,000 in the last year to address structural issues at a unique
round structure in Hampton, VA. Built in 1860, it was originally a
latrine and the funding is allowing VA to convert it into office space.
The cost for saving some of these buildings is not very high
considering that they represent a part of history that enriches the
texture of our landscape that once gone cannot be recaptured. For
example, VA can restore the Greek Revival Mansion in Perry Point, MD,
which was built in the 17fifties, to use as a training space for about
$1.2 million. VA could restore the 1881 Milwaukee Ward Memorial Theater
for use as a multi-purpose facility at a cost of $6 million. This is
much less than the cost of a new facility.
As part of its adaptive reuse program, VA must ensure that the
facilities that it leases or sells are maintained properly. VA's legal
responsibilities could, for example, be addressed through easements on
property elements, such as building exteriors or grounds.
We encourage the use of P.L. 108-422, the Veterans Health Programs
Improvement Act, which authorized historic preservation as one of the
uses of a new capital assets fund that receives funding from the sale
or lease of VA property.
Recommendation:
VA must further develop a comprehensive program to preserve and
protect its inventory of historic properties.
Mr. Chairman, this concludes my statement. I would be happy to
answer any questions that you or the Members of the Committee may have.
Prepared Statement of Raymond C. Kelley,
National Legislative Director, American Veterans (AMVETS)
Chairman Filner, Ranking Member Buyer, and Members of the
Committee:
AMVETS is honored to join our fellow veterans service organizations
and partners at this important hearing on the Department of Veterans
Affairs budget request for fiscal year 2010. My name is Raymond C.
Kelley, National Legislative Director of AMVETS, and I am pleased to
provide you with our best estimates on the resources necessary to carry
out a responsible budget for VA.
AMVETS testifies before you as a co-author of The Independent
Budget. This is the 23rd year AMVETS, the Disabled American Veterans,
the Paralyzed Veterans of America, and the Veterans of Foreign Wars
have pooled our resources to produce a unique document, one that has
stood the test of time.
In developing The Independent Budget, we believe in certain guiding
principles. Veterans should not have to wait for benefits to which they
are entitled. Veterans must be ensured access to high-quality medical
care. Specialized care must remain the focus of VA. Veterans must be
guaranteed timely access to the full continuum of health care services,
including long-term care. And, veterans must be assured accessible
burial in a state or national cemetery in every state.
The VA health care system is the best in the country and
responsible for great advances in medical science. VHA is uniquely
qualified to care for veterans' needs because of its highly specialized
experience in treating service-connected ailments. The delivery care
system provides a wide array of specialized services to veterans like
those with spinal cord injuries, blindness, traumatic brain injury, and
post traumatic stress disorder.
Mr. Chairman, I want to thank you for introducing H.R. 1016, the
Veterans Health Care Budget Reform and Transparency Act of 2009.
Providing sufficient, predictable and timely funding for VA health care
will go a long way in ensuring our veterans receive the care they need
from fully staffed, state of the art VA medical centers. I also want to
thank each Member of the Committee who has co-sponsored this act, and
for those how still have questions I look forward to further
discussions so we can solve the problems of the current funding system.
As a partner of The Independent Budget, AMVETS devotes a majority
of its time with the concerns of the National Cemetery Administration
(NCA) and I would like to speak directly to the issues and concerns
surrounding NCA.
The National Cemetery Administration
The Department of Veterans Affairs National Cemetery Administration
(NCA) currently maintains more than 2.9 million gravesites at 125
national cemeteries in 39 states and Puerto Rico. Of these cemeteries,
65 will be open to all interments; 20 will accept only cremated remains
and family members of those already interred; and 40 will only perform
interments of family members in the same gravesite as a previously
deceased family member. NCA also maintains 33 soldiers' lots and
monument sites. All told, NCA manages 17,000 acres, half of which are
developed.
VA estimates that about 27 million veterans are alive today. They
include veterans from World War I, World War II, the Korean war, the
Vietnam War, the Gulf War, the conflicts in Afghanistan and Iraq, and
the Global War on Terrorism, as well as peacetime veterans. With the
anticipated opening of the new national cemeteries, annual interments
are projected to increase from approximately 100,000 in 2007 to 111,000
in 2009. Historically, 12 percent of veterans opt for burial in a state
or national cemetery.
The most important obligation of the NCA is to honor the memory of
America's brave men and women who served in the armed forces.
Therefore, the purpose of these cemeteries as national shrines is one
of the NCA's top priorities. Many of the individual cemeteries within
the system are steeped in history, and the monuments, markers, grounds,
and related memorial tributes represent the very foundation of the
United States. With this understanding, the grounds, including
monuments and individual sites of interment, represent a national
treasure that deserves to be protected and cherished.
The Independent Budget veterans service organizations (IBVSOs)
would like to acknowledge the dedication and commitment of the NCA
staff who continue to provide the highest quality of service to
veterans and their families. We call on the Administration and Congress
to provide the resources needed to meet the changing and critical
nature of NCA's mission and fulfill the Nation's commitment to all
veterans who have served their country honorably and faithfully.
In FY 2008, $195 was million appropriated for the operations and
maintenance of NCA, $28.2 million over the Administration's request,
with only $220,000 in carryover. NCA awarded 39 of the 42 minor
construction projects that were in the operating plan. The State
Cemetery Grants Service awarded $37.3 million of the $39.5 million that
was appropriated. This carryover was caused by the cancellation of a
contract that NCA had estimated to be $2 million but the contractor's
estimation was considerable higher. Additionally, $25 million was
invested in the National Shrine Commitment.
NCA has done an exceptional job of providing burial options for 88
percent of all veterans who fall within the 170,000 veterans within a
75 mile radius threshold model. However, under this model, no new
geographical area will become eligible for a national Cemetery until
2015. St. Louis, Mo. will, at that time, meet the threshold due to the
closing of Jefferson Barracks National Cemetery in 2017. Analysis shows
that the five areas with the highest veteran population will not become
eligible for a national Cemetery because they will not reach the
170,000 threshold.
NCA has spent years developing and maintaining a cemetery system
based on a growing veteran population. In 2010 our veteran population
will begin to decline. Because of this downward trend, a new threshold
model must be developed to ensure more of our veterans will have
reasonable access to their burial benefits. Reducing the mile radius to
65 miles would reduce the veteran population that is served from 90
percent to 82.4 percent, and reducing the radius to 55 miles would
reduce the served population to 74.1 percent. Reducing the radius alone
to 55 miles would only bring two geographical areas in to 170,000
population threshold in 2010, and only a few areas into this revised
model by 2030.
Several geographical areas will remain unserved if the population
threshold is not reduced. Lowering the population threshold to 100,000
veterans would immediately make several areas eligible for a national
Cemetery regardless of any change to the mile radius threshold. A new
threshold model must be implemented so more of our veterans will have
access to this earned benefit.
National Cemetery Administration (NCA) Accounts
The Independent Budget recommends an operations budget of $241.5
million for the NCA for fiscal year 2010 so it can meet the increasing
demands of interments, gravesite maintenance, and related essential
elements of cemetery operations.
The NCA is responsible for five primary missions: (1) to inter,
upon request, the remains of eligible veterans and family members and
to permanently maintain gravesites; (2) to mark graves of eligible
persons in national, state, or private cemeteries upon appropriate
application; (3) to administer the state grant program in the
establishment, expansion, or improvement of state veterans cemeteries;
(4) to award a presidential certificate and furnish a United States
flag to deceased veterans; and (5) to maintain national cemeteries as
national shrines sacred to the honor and memory of those interred or
memorialized.
The national cemetery system continues to be seriously challenged.
Though there has been progress made over the years, the NCA is still
struggling to remove decades of blemishes and scars from military
burial grounds across the country. Visitors to many national cemeteries
are likely to encounter sunken graves, misaligned and dirty grave
markers, deteriorating roads, spotty turf and other patches of decay
that have been accumulating for decades. If the NCA is to continue its
commitment to ensure national cemeteries remain dignified and
respectful settings that honor deceased veterans and give evidence of
the Nation's gratitude for their military service, there must be a
comprehensive effort to greatly improve the condition, function, and
appearance of all our national cemeteries.
Therefore, in accordance with ``An Independent Study on
Improvements to Veterans Cemeteries,'' which was submitted to Congress
in 2002, The Independent Budget again recommends Congress establish a
5-year, $250 million ``National Shrine Initiative'' to restore and
improve the condition and character of NCA cemeteries as part of the FY
2008 operations budget. Volume 2 of the Independent Study provides a
systemwide, comprehensive review of the conditions at 119 national
cemeteries. It identifies 928 projects across the country for gravesite
renovation, repair, upgrade, and maintenance. These projects include
cleaning, realigning, and setting headstones and markers; cleaning,
caulking, and grouting the stone surfaces of columbaria; and
maintaining the surrounding walkways. Grass, shrubbery, and trees in
burial areas and other land must receive regular care as well.
Additionally, cemetery infrastructure, i.e. buildings, grounds, walks,
and drives must be repaired as needed. According to the Study, these
project recommendations were made on the basis of the existing
condition of each cemetery after taking into account the cemetery's
age, its burial activity, burial options and maintenance programs.
The IBVSOs is encouraged that $25 million was set aside for the
National Shrine Commitment for FY 07 and 08. The NCA has done an
outstanding job thus far in improving the appearance of our National
cemeteries, but we have a long way to go to get us where we need to be.
By enacting a 5-year program with dedicated funds and an ambitious
schedule, the national cemetery system can fully serve all veterans and
their families with the utmost dignity, respect, and compassion.
In addition to the management of national cemeteries, the NCA is
responsible for the Memorial Program Service. The Memorial Program
Service provides lasting memorials for the graves of eligible veterans
and honors their service through Presidential Memorial Certificates.
Public Laws 107-103 and 107-330 allow for a headstone or marker for the
graves of veterans buried in private cemeteries who died on or after
September 11, 2001. Prior to this change, the NCA could provide this
service only to those buried in national or state cemeteries or to
unmarked graves in private cemeteries. Public Law 110-157 gives VA
authority to provide a medallion to be attached to the headstone or
marker of veterans who are buried in a private cemetery. This benefit
is available to veterans in lieu of a government furnished headstone or
marker.
The IBVSOs call on the Administration and Congress to provide the
resources required to meet the critical nature of the NCA mission and
fulfill the Nation's commitment to all veterans who have served their
country so honorably and faithfully. Congress should provide NCA with
$241.5 million for fiscal year 2010 to offset the costs related to
increased workload, additional staff needs, general inflation and wage
increases and Congress should include as part of the NCA appropriation
$50 million for the first stage of a $250 million 5-year program to
restore and improve the condition and character of existing NCA
cemeteries.
The State Cemetery Grants Program
The State Cemeteries Grant Program faces the challenge of meeting a
growing interest from states to provide burial services in areas that
are not currently served. The intent of the SCGP is to develop a true
complement to, not a replacement for, our Federal system of national
cemeteries. With the enactment of the Veterans Benefits Improvements
Act 1998, the NCA has been able to strengthen its partnership with
states and increase burial service to veterans, especially those living
in less densely populated areas not currently served by a national
cemetery. Currently there are 55 state and tribal government cemetery
construction grant pre-applications, 34 of which have the required
state matching funds necessary totaling $120.7 million.
The Independent Budget recommends that Congress appropriate $52
million for SCGP for FY 2010. This funding level would allow SCGP to
establish six new state cemeteries that will provide burial options for
179,000 veterans who live in a region that currently has no reasonably
accessible state or national cemetery.
Burial Benefits
In 1973 NCA established a burial allowance that provided partial
reimbursements for eligible funeral and burial costs. The current
payment is $2,000 for burial expenses for service-connected (SC) death,
$300 for non-service-connected (NSC) deaths, and $300 for plot
allowance. At its inception, the payout covered 72 percent of the
funeral cost for a service-connected death, 22 percent for a non-
service-connected death, and 54 percent of the burial plot cost. In
2007 these benefits eroded to 23 percent, 4 percent, and 14 percent
respectively. It is time to bring these benefits back to their original
value.
Burial allowance was first introduced in 1917 to prevent veterans
from being buried in potters' fields. In 1923 the allowance was
modified. The benefit was determined by a means test, and then in 1936
the allowance was changed again, removing the means test. In its early
history, the burial allowance was paid to all veterans, regardless of
the service-connectivity of their death. In 1973 the allowance was
modified to reflect the relationship of their death as service
connected or not.
The plot allowance was introduced in 1973 as an attempt to provide
a plot benefit for veterans who did not have reasonable access to a
national cemetery. Although neither the plot allowance nor the burial
allowances were intended to cover the full cost of a civilian burial in
a private cemetery, the increase in the benefit's value indicates the
intent to provide a meaningful benefit by adjusting for inflation.
The national average cost for a funeral and burial in a private
cemetery has reached $8,555, and the cost for a burial plot is $2,133.
At the inception of the benefit the average costs were $1,116 and $278
respectively. While the cost of a funeral has increased by nearly seven
times the burial benefit has only increased by 2.5 times. To bring both
burial allowances and the plot allowance back to its 1973 value, the SC
benefit payment will be $6,160, the NSC benefit value payment will be
$1,918, and the plot allowance will increase to $1,150. Readjusting the
value of these benefits, under the current system, will increase the
obligations from $70.1 million to $335.1 million per year.
Based on accessibility and the need to provide quality burial
benefits, The Independent Budget recommends that VA separate burial
benefits into two categories: veterans who live inside the VA
accessibility threshold model and those who live outside the threshold.
For those veterans who live outside the threshold, the SC burial
benefit should be increased to $6,160, NSC veteran's burial benefit
should be increased to $1,918, and plot allowance should increase to
$1,150 to match the original value of the benefit. For veterans who
live within reasonable accessibility to a state or national cemetery
that is able to accommodate burial needs, but the veteran would rather
be buried in a private cemetery the burial benefit should be adjusted.
These veterans' burial benefits will be based on the average cost for
VA to conduct a funeral. The benefit for a SC burial will be $2,793,
the amount provided for a NSC burial will be $854, and the plot
allowance will be $1,150. This will provide a burial benefit at equal
percentages, but based on the average cost for a VA funeral and not on
the private funeral cost that will be provided for those veterans who
do not have access to a state or national cemetery.
The recommendations of past legislation provided an increased
benefit for all eligible veterans but it currently fails to reach the
intent of the original benefit. The new model will provide a meaningful
benefit to those veterans whose access to a state or national cemetery
is restricted as well as provides an improved benefit for eligible
veterans who opt for private burial. Congress should increase the plot
allowance from $300 to $1,150 for all eligible veterans and expand the
eligibility for the plot allowance for all veterans who would be
eligible for burial in a national cemetery, not just those who served
during wartime. Congress should divide the burial benefits into two
categories: veterans within the accessibility model and veterans
outside the accessibility model. Congress should increase the service-
connected burial benefit from $2,000 to $6,160 for veterans outside the
radius threshold and $2,793 for veterans inside the radius threshold.
Congress should increase the non-service-connected burial benefit from
$300 to $1,918 for veterans outside the radius threshold and $854 for
veterans inside the radius threshold. Congress should enact legislation
to adjust these burial benefits for inflation annually.
The NCA honors veterans with a final resting place that
commemorates their service to this Nation. More than 2.8 million
soldiers who died in every war and conflict are honored by burial in a
VA national cemetery. Each Memorial Day and Veterans Day we honor the
last full measure of devotion they gave for this country. Our national
cemeteries are more than the final resting place of honor for our
veterans; they are hallowed ground to those who died in our defense,
and a memorial to those who survived.
Mr. Chairman, this concludes my testimony. I thank you again for
the privilege to present our views, and I would be pleased to answer
any questions you might have.
Prepared Statement of Paul Sullivan,
Executive Director, Veterans for Common Sense
Veterans for Common Sense (VCS) thanks Chairman Filner and Members
of the Committee for inviting us to testify about the Department of
Veterans Affairs' (VA) budget request for Fiscal Year 2010.
VCS applauds VA's fiscal year 2010 budget submission. President
Barack Obama and VA Secretary Eric Shinseki plan to increase VA's
budget by $15 billion for 2010. This enormous increase is fantastic and
far exceeds our highest expectations. This dramatic improvement in
funding should provide a desperately needed shot in the arm for VA to
increase capacity, streamline policies, and resolve years of chronic
underfunding. VCS awaits further details about VA's 2010 budget request
expected to be released in April.
VCS thanks the Committee for your hearings and for your landmark
legislation during the 110th Congress. We especially thank you for the
``Joshua Omvig Veterans Suicide Prevention Act,'' the ``Dignity for
Wounded Warriors Act,'' and Chairman John Hall's landmark legislation
launching an overhaul of the Veterans Benefits Administration (VBA).
Other key legislation passed in the past 2 years includes significant
budget increases, major cost of living increases, and a lift on VA's
ban on advertising.
Measuring Success in Five Key Areas
As described in our recent report, ``Looking Forward: The Status
and Future of VA,'' http://www.veteransforcommonsense.org/files/vfcs/
VCS_Looking_Forward_Report_02-09-2009.pdf, VCS urges Congress to focus on a narrow set of five key measures to monitor VA. We ask you to work with VA to
consistently, accurately, and transparently define these terms and then
monitor their quality and timely assistance:
1. Health care--excluding mental health
2. Health care--mental health
3. Suicide prevention
4. Reducing homelessness
5. Benefits (compensation, pension, education, vocational
rehabilitation, home loan guaranty, and insurance), especially the
disability compensation backlog
Key Budgeting Questions
VCS asks Congress to require that VA answer these key budgeting
questions:
1. Does VA have enough funding, staffing, and legislative guidance
to process all disability claims within 30 days?
2. Does VA have enough funding, staffing, and legislative guidance
to provide all patients (physical health care and mental health care)
with care within 30 days?
3. Does VA have enough information gathered at each point-of-
service to answer questions one and two?
VA's 2008 Significant Estimation Failure
VCS begins our testimony by spotlighting an enormous red flag at VA
in 2008. During the last Administration, VA repeatedly failed to
accurately estimate the number of Iraq and Afghanistan war veteran
patients. We hope we can look forward to a time when VA properly
estimates demand so VA is not caught a day late and a dollar short. To
the best of our knowledge, VA has never estimated the number of Iraq
and Afghanistan war veteran disability compensation claims and the
number of issues per claim. We look forward to learning about VA's
estimates in the coming months.
VA's pattern of planning failures has caused enormous harm to our
veterans by creating massive delays obtaining health care and
disability benefits. In 2005, VA testified before Congress that the
agency had sufficient money to provide timely and high-quality health
care and benefits. This turned out to be a vicious game of smoke and
mirrors--a tragic game which our veterans always lose. A few months
later, former VA Secretary Jim Nicholson returned to Congress, hat in
hand, to request billions of dollars in emergency appropriations.
VA's planning errors were caused by the prior Administration's
failure to consider the long-term health care and disability benefit
needs of returning Iraq and Afghanistan war veterans. VA's planning
errors continued through 2008, a trend we hope ends with the new
Administration. In February 2008 statement by former VA Secretary James
Peake. He told this Committee, ``We expect to treat about 333,000
veterans in 2009 who served in Operation Enduring Freedom and Operation
Iraqi Freedom.'' Not only was he wrong, he was wildly off the mark. In
reality, as of September 30, 2008, VA had already treated more than
400,000 Iraq and Afghanistan war veterans. As of 6 months ago, VA had
already underestimated the number of recent combat veteran patients by
20 percent.
The situation continues to worsen. Based on the current rate of
more than 10,000 new Iraq and Afghanistan war veteran patients flooding
into VA each month, VA may expect a total of 520,000 recent war
patients by September 30, 2009. That would mean VA underestimated the
number of new patients by nearly 187,000. VA's estimate may be off by
as far as 56 percent. While VCS supports opening VA health care to
Priority Group 8 veterans and those previously denied enrollment since
2003, we are concerned that VA may not accurately forecast demand,
leading to additional challenges for an already overburdened system.
VA has not yet provided an estimate for Iraq and Afghanistan war
veteran patients for FY 2010. We hope VA planners are monitoring the
situation carefully so as to avoid repeating the same mistake over and
over again. VCS asks Congress to require that VA produce accurate
estimates for new patients and claims for the Iraq and Afghanistan wars
so that VA leaders adequately prepare budget requests and so our
veterans receive prompt and high-quality care and benefits. In
addition, VA should provide more information about VA activities so the
public can learn the total human and financial costs of the two wars--
and be prepared to support significant increases in VA's budgets for
the next several decades.
Important Facts About VA
Any discussion about VA and veterans must be based on the best
available current information. VCS uses FOIA to obtain documents about
VA policies and activities in order to better inform Congress,
journalists, and the public about VA.
The information VCS obtained under FOIA provides incontrovertible
evidence that VA's capacity crisis requires more active monitoring and
significantly increased funding. We believe the Iraq and Afghanistan
wars, as well as the current severe and worsening economic recession,
have created extraordinary challenges to VA's future responsibilities.
VA expects to treat 5.8 million patients this year. VCS
supports President Obama's plan to open up VA to all eligible veterans,
including Category 8. With proper planning, this transition can be
accomplished within a few years.
VA's Office of the Inspector General reported 25 percent,
or as many as 1.5 million veterans per year, wait more than 1 month to
see a VA doctor. This is unacceptable, as no veteran should ever wait
more than 1 month for care. We also insist that emergent mental health
patients be treated as equal to physical injuries--there should be no
delay, especially for suicidal patients or new patients with symptoms
of PTSD.
VA regional offices are still working on 672,000 claims
of all types. As the Afghanistan War expands, as Iraq War veterans
return home, as VA and DoD conduct more PTSD and TBI screenings, as
stigma is reduced, and as the 5 years of free VA health care for new
war veterans begins to expire, VA may see an increase in new claims
that will further exacerbate the existing claims backlog.
According to VA, 21 percent of the rating-related claims,
or 86,000 of all veterans with a claim pending, have already waited
more than 6 months for a decision. This is an improvement of 4 percent
compared with last year.
Here are salient facts regarding Iraq and Afghanistan war veterans:
DoD reported 82,000 battlefield casualties: nearly 5,000
deaths plus more than 77,000 non-fatal casualties.
VA hospitals already treated more than 400,000 veteran
patients, including 178,000 diagnosed with at least one mental health
condition.
VA regional offices received 329,000 veterans' disability
claims
54,000 veterans, or 16 percent, wait, on average 6
months, for a VA decision.
VA diagnosed more than 105,000 veterans with PTSD
VA approved 43,000 veterans' claims for PTSD, or 41
percent of those diagnosed.
We are also awaiting a Congressionally mandated review of
discrepancies in claim adjudication outcomes, particularly among
National Guard and Reserve who are half as likely to file a claim, yet
twice as likely to be denied. At the request of Congress, VA is also
reviewing the reason why only 41 percent of Iraq and Afghanistan war
veterans diagnosed with post traumatic stress disorder (PTSD) by VA
receive disability compensation for PTSD from VA.
Planning is critical during these difficult economic times. In a
worst case scenario based on VA data reporting 10,000 new Iraq and
Afghanistan war patients per month, VA may treat up to one million Iraq
and Afghanistan war veterans as
soon as the end of 2013. For more information about VA's significant
challenges related to the Iraq and Afghanistan wars, please read our
report, ``Looking Forward:
The Status and Future of VA,'' that can be viewed at: http://
www.veteransforcommonsense.org/files/vfcs/
VCS_Looking_Forward_Report_02-09-2009.pdf
VCS Budget Priorities for Fiscal Year 2010 and Beyond
VCS would like to share our top 15 priorities for VA's Fiscal Year
2010 budget and beyond. Each of these priorities addresses key items
described in our report, ``Looking Forward: The Status and Future of
VA,'' published in February 2009. VCS supports implementing as many of
these proposals as possible because of VA's current capacity crisis and
because many of these initiatives overlap.
1. Streamline and Expedite Veterans' PTSD Claims
According to a 2008 report by RAND, as many as 338,000 Iraq and
Afghanistan war veterans are expected to return home and develop post
traumatic stress disorder (PTSD). VCS urges Congress to pass the
``COMBAT PTSD Act,'' H.R. 952. Chairman John Hall's superb new bill
properly defines deployment to combat in order to streamline disability
compensation claims for PTSD. Our VCS analysis of health care use and
claims activity among Iraq and Afghanistan war veterans revealed a
serious discrepancy that demands immediate action by Congress.
According to VA statistics released to VCS under the Freedom of
Information Act (FOIA), more than 105,000 Iraq and Afghanistan war
veterans were diagnosed by VA with PTSD. However, only 42,000 of those
veterans are receiving disability compensation from VA for PTSD. The
scientific evidence is conclusive: In 2008, the Institute of Medicine
concluded there is a link between deployment to a war zone and the
development of PTSD.
Now is the time to fix the problem of unreasonable PTSD claim
delays so that our veterans can receive the PTSD disability benefits
they earned. With a new law or regulation, VA should be able to quickly
approve 1910s of thousands of PTSD claims filed by Iraq and Afghanistan
war veterans. VA would be putting disability benefits in the hands of
deserving veterans during an economic crisis when their need is most
acute. Although this proposal may cost billions of dollars in the next
year, these are entitlement payments VA will eventually pay.
Furthermore, VA may realize a cost savings when VA employees working on
PTSD claims are freed up to process other claims of equally deserving
veterans.
2. Streamline and Expedite Veterans' TBI Claims
According to the same 2008 RAND report, as many as 357,000 Iraq and
Afghanistan war veterans are expected to return home diagnosed with
traumatic brain injury (TBI). In a manner similar to PTSD, VCS urges
Congress and the VA to implement new rules designed to create a
presumption for a concussive blast in order to streamline and expedite
veterans' claims for TBI. VCS thanks VA for issuing new TBI regulations
that improved the rating schedule for veterans suffering from this
disabling signature physical wound of the wars. However, VA and
Congress can go further by streamlining the claims process by presuming
that veterans diagnosed with TBI were exposed to blasts and other TBI-
causing injuries while deployed to the Iraq and Afghanistan wars
(absent any other finding). We have a quickly closing window of
opportunity to address this issue before it gets worse. If Congress and
VA fail to streamline PTSD and TBI claims, VA faces the very real
prospect of becoming overwhelmed by 600,000 to 700,000 of these
difficult to process claims, thus further exacerbating VA's disability
claim backlog. In a related matter, VCS became alarmed at VA plans to
close the Central Texas Veterans Health Care System Brain Imaging and
Recovery Laboratory (BIRL), located on the University of Texas campus
in Austin, Texas. VCS strongly supports continued funding of scientific
research to better understand TBI and to find treatments for TBI,
including the BIRL.
3. Open Hundreds of New VBA Offices
Now is the time to bring VA to our veterans and beneficiaries so
they can meet face-to-face with VA claims processing staff and begin
reversing the isolationist culture of VA. VCS urges Congress to
significantly expand the Veterans Benefits Administration (VBA) and
bring VA benefits to locations where our servicemembers leave the
military and cities where our veterans live. VBA can do this by placing
permanent claims processing staff at all active duty military
facilities and in cities throughout the United States in a manner
similar to the Social Security Administration. Congress should also
allow VA to place VBA staff at VHA facilities and Vet Centers. VCS
continues to support a massive expansion of VBA's successful Benefits
Delivery at Discharge (BDD) program. We especially support VBA's
efforts to transform BDD into a paperless process. During the 1990s,
Under Secretary Ken Kizer restructured and reformed the Veterans Health
Administration, a strong precedent that a new Under Secretary for
Benefits can and must follow to reform VBA. Attached for the record is
a one-page briefing paper VCS provided to the Presidential Transition
Team.
4. Expand Scientific Research, Especially for Gulf War Veterans
The Research Advisory Committee on Gulf War Veterans' Illnesses
(RAC), report published in 2008 confirms that between 175,000 and
210,000 Gulf War veterans remain ill. We are still waiting for
treatment and benefits from VA. VCS urges Congress to expand research
to better understand Gulf War Illness. VCS urges Congress to fully fund
all $30 million for the Department of Defense for competitive research
in the Congressionally Directed Medical Research Program to search for
treatments, as recommended by the RAC. We also ask Congress to fund a
new set of VA--Institute of Medicine contracts to review scientific
research related to Gulf War toxic exposures that considers both human
and animal studies. We especially ask that depleted uranium (DU) be re-
examined based on animal studies linking DU exposure in laboratory
animals to birth defects and cancer. Veterans for Common Sense
encourages Members of Congress to read the full RAC report, especially
the recommendations.
5. Better Long-Term Planning
Never again should VA be caught off guard to the point where VA is
short billions of dollars in desperately needed funds to provide health
care to our veterans. VCS urges Congress to continue consolidating VA's
information technology so VA can collect and analyze more data more
transparently at the local and national level. VA should be asked to
provide Congress with a specific plan to collect, report, analyze, and
share data so that VA, Congress, veterans groups, and academics can
better monitor the situation for planning, staffing, and budgeting
purposes over the long-term. Better planning also means better
training. VCS urges VA to expand training for new employees who will be
using the data at the local and national level to assist veterans and
plan for the future, especially with the advent of advanced funding for
VA.
6. Ending Homelessness
According to VA, one-in-four homeless people are veterans, and this
is a national disgrace. Iraq and Afghanistan war veterans are already
showing up in homeless shelters, a sign of VA's challenges as well as
the overall dismal state of our economy. VCS believes VA and Congress
should learn a lesson from the Vietnam War, where our Nation lied to
send our troops to war and then failed to provide for their return. In
2003, the prior Administration misled us into another war, and again
failed to plan for our veterans' homecoming. There should be zero
tolerance for homeless veterans. We have an opportunity now to prevent
a national tragedy from happening again by instituting aggressive
homeless prevention initiatives for all veterans, especially Iraq and
Afghanistan war veterans. A full compliment of supportive services
includes employment assistance, drug and alcohol counseling, and mental
health treatment, as well as VA health care and benefits assistance.
Please read the entire statement prepared by Swords to Plowshares that
we ask to be placed into the record.
7. Advanced Funding and Mandatory Full Funding
VCS supports advanced funding for VA as well as mandatory full
funding for VA's health care budget. VA needs advanced funding so VA is
properly prepared to handle changes in patient demand at the local and
national levels. VA needs mandatory full funding so veterans don't wait
for medical care--for physical or psychological conditions. VCS
supports transparent VA budgeting from the bottom up so veterans,
legislators, and the public are aware of VA's financial needs at the
local and national levels.
8. Ending Stigma and Discrimination
One of our top priorities is ending the stigma that often blocks
servicemembers and veterans from seeking mental health treatment early,
when it is most effective and least expensive. VCS urges Congress to
fund anti-stigma programs that
allow VA to collaborate with the Department of Defense (DoD) and the
Depart-
ment of Labor (DOL). VCS salutes the new DOL Web site, http://
www.americasheroesatwork.gov, and recommends that VA and DoD launch
similar public education efforts. VCS urges Congress to investigate why
DoD has not fully implemented the 1997 Force Health Protection laws
(Public Law 105-85, section 701), a law intended to prevent a repeat of
the Gulf War illness debacle. VCS believes DoD must begin providing
pre- and post-deployment medical exams to all servicemembers as a way
to de-stigmatize mental health conditions. VA needs the pre- and post-
deployment exam records as part of the veteran's medical history for
treatment and disability benefits.
9. Open a Polytrauma Center at Every VA
VCS believes every VA medical center should be capable of treating
polytrauma patients in order to meet the growing demand that more than
6 years of on-going warfare requires. All VA medical centers should
have this ability so veterans can be treated near their homes where
family members and friends can provide comfort and support. This is
especially important since RAND estimated up to 19.5 percent of our
returning Iraq and Afghanistan war veterans may suffer from TBI.
According to the Department of Defense, they have already identified
more than 180,000 TBI cases from the two wars (Associated Press,
10. Ending Veteran Suicide Epidemic
VCS thanks VA for implementing their toll-free suicide prevention
hotline, a tremendously successful effort that received 100,000 calls
and performed more than 2,600 ``rescues''--saving the lives of
thousands of distraught veterans. VCS supports a full and prompt
implementation of VA's Mental Health Strategic Plan. We also support
VA's new Suicide Prevention Coordinators and Local Recovery
Coordinators. VCS urges Congress to fund a state-of-the-art suicide
data collection, reporting, and analysis office at VA that can
collaborate with the Department of Defense, Department of Health and
Human Services, and other government agencies. The national office
should identify local, state, and Federal data about veterans who
attempted or committed suicide so VA can implement the best policies to
reduce suicide among all veterans, especially recent war veterans. This
should include monitoring of specific cohorts of veterans by period of
war, gender, race, number of deployments, length of deployments, use of
VA medical centers, use of VA Vet Centers, and use of VA disability
benefits. VCS remains alarmed at the anecdotal evidence from press
reports of veterans, often in the National Guard or Reserve, who
complete suicide shortly after notification of a second or subsequent
deployment to the combat zone.
11. Expanding Vet Centers
Congress should enact legislation to expand VA's highly successful
Vet Centers. VCS urges Congress to allow Vet Centers to provide mental
health services to active duty servicemembers, either at existing VA
facilities or at new offices on military bases. This expanded service
might first be targeted at military installations that have shortages
of mental health care providers and bases expecting large redeployments
from the war zones. Congress should allow families to participate in
the readjustment counseling process at all Vet Centers. Congress should
also allow Vet Centers to house VBA staff to assist veterans with
disability claims. This should be part of an overall long-term VA
strategic plan to bring all of VA to our veterans so veterans are not
required to visit several locations for assistance.
12. Supporting Vietnam War Veterans
VCS continues to support research and treatments for Vietnam War
veterans poisoned by dioxin contained in Agent Orange. VCS also
supports VA advertising and outreach to veterans with diabetes,
prostate cancer, and other war-related medical conditions so they are
aware of new VA health care and disability benefits available for those
conditions. VCS urges Congress to declare ``Blue Water'' veterans
eligible for VA health care and benefits related to Agent Orange.
13. Due Process
VCS believes all veterans should have the right to full due process
and the right to retain an attorney to assist them with obtaining VA
health care or disability benefits starting from the first day a
veteran or beneficiary seeks any VA benefit. Sound legal advice is
especially critical when a veteran has a serious injury, such as TBI or
PTSD, or where the veteran may have diminished capacity to wage a
complex and protracted legal battle against VA. Legal assistance means
the ability to hire an experienced and trained advocate who will fight
for you, an advocate who will explain VA's complicated and adversarial
process, an advocate who will to obtain military and other documents
for your claim, and an advocate who can quickly obtain your VA
benefits. While Veteran Service Organization (VSO) assistance is often
beneficial to veterans and beneficiaries filing claims against VA, VCS
also strongly supports the right of veterans and beneficiaries to
obtain competent and compensated legal counsel for those who defended
our Constitution. Due process also means that VCS supports efforts by
VA to cooperate with local law enforcement and legal systems to offer
treatment programs to veterans arrested for minor offenses. We believe
that pro-active action to identify veterans in our legal system and
offer VA treatment may mitigate the long-term social consequences of
untreated PTSD and TBI.
14. Outreach
VCS urges VA to begin more advertising to increase awareness about
VA. The most important outreach effort should be to reduce stigma
against veterans with mental health conditions and to publicize VA's
suicide prevention hotline. VCS is pleased with Chairman Harry
Mitchell's successful effort to allow VA to conduct advertising about
health care and benefits. This change represents a progressive policy
improvement. VCS believes VA should consider broadcasting public
service announcements describing VA services especially for members of
the National Guard and Reserve. An analysis by VCS found that they are
using VA services less than their Active Duty peers. VCS believes
Congress should fund VA training and outreach to universities so law
students are encouraged to learn about laws designed to assist
veterans, plus ongoing education to remain current on changes in the
laws. If the military can spend billions recruiting new soldiers, then
VA should be able to spend some money making sure veterans and their
families know what they earned and making sure they can quickly obtain
it.
15. Transparency
VCS is pleased with VA's handling of recent challenges by providing
greater information earlier. For example, in the past few weeks, VA
informed the public about a problem with a contractor conducting
transcriptions. Transparency in government should be applauded. This is
why VCS urges Congress to review VA's handling of Freedom of
Information Act (FOIA) requests so that more information about VA is
more readily available to the public. Much of the information VCS
presents to Congress came from our extensive FOIA research efforts. VCS
provided Congress, veterans, and the public with critical information
at a time when VA intentionally concealed bad news.
For the Committee
VCS provides four documents related to our testimony for the
Committee's files:
Swords to Plowshares, Statement to Presidential
Transition Team (PTT), Dec. 2008.
VCS, ``Proposal to Restructure Veterans Benefits
Administration Facilities,'' presented to the PTT on Dec. 6, 2008.
Nora Eisenberg, ``Why the Dark Secrets of the Gulf War
are Still Haunting Us,'' AlterNet, Feb. 27, 2009.
VCS, ``Looking Forward: The Status and Future of VA,''
Feb. 2009.
[The documents are being retained in the Committee files.]
Prepared Statement of Paul Rieckhoff,
Executive Director, Iraq and Afghanistan Veterans of America
On behalf of IAVA and our more than 125,000 members and supporters,
thank you for inviting Iraq and Afghanistan Veterans of America to
testify today regarding the VA's budget for Fiscal Year 2010. I would
also like to thank you for your commitment to our Nation's veterans.
From the passage of the new GI Bill to the dramatic increases in
veterans' health care funding, the remarkable legislative victories for
veterans we've seen in the last 3 years would not have been possible
without your leadership.
At IAVA, we are committed to making sure that no servicemember, and
no veteran, is ever left behind. The mission of IAVA is to improve the
lives of the more than 1.7 million Iraq and Afghanistan veterans and
their families. As veterans come home from Iraq and Afghanistan to the
worst economy in decades, we need to show real support for our troops
and veterans.
Overall, we are pleased with the limited information currently
available about the FY 2010 Budget. The top line number for veterans'
discretionary funding is about $1.2 billion higher than the amount
recommended by leading veterans' organizations, including IAVA, in The
Independent Budget. The budget plans increases in VA funding by $25
billion over 5 years. This funding will be crucial if we are to provide
proper care and support to the surge of veterans who will be coming
home from combat in the coming years.
We are also pleased to see the renewed focus on mental health care
in the DoD budget, including the comprehensive TBI registry, and also
the rollback of concurrent receipt limitations that unfairly cut the
benefits available to disabled military retirees. We were also pleased
to see the Administration's planned expansion of VA health care access
to about 500,000 moderate-income veterans. This is a good first step,
although we'd like to see it happen faster. About 1.8 million veterans
lack health insurance, and about 565,000 veterans have been denied VA
care because their income level was too high. IAVA believes every
single veteran should be eligible for VA health care.
From what we've seen so far, the budget looks strong. But the devil
is in the details. Until we have had the opportunity to go through this
budget line-by-line in April, we can not entirely endorse the plan.
Above all, we must ensure that this budget does not rest on increased
copays, premiums and fees for veterans.
Our biggest disappointment about the current budget is that the
President has not opted to include advance appropriations for the VA in
his proposal. Advance appropriations doesn't cost any additional money,
it just gives VA hospitals and clinics advance notice of the funding
they will receive the following year. Right now, VA hospitals have no
way of knowing what their budget will be next year, and when the budget
is passed late (and it usually is), they often have to ration the care
they give veterans.
The bottom line is, VA budget delays hurt veterans. I want to tell
you about one of the thousands of veterans of all generations who would
benefit from advance appropriations. Rey Leal served as a Marine in
Fallujah during some of the heaviest fighting, earning a Bronze Star
with valor as a Private First Class, an almost unheard of
accomplishment for a soldier of his rank. But when he returned to
southern Texas, his closest VA hospital was over 5 hours away. Rey's a
tough Marine, and a boxer, but he shouldn't have to fight to get care
at a veterans' hospital. And at his nearest outpatient clinic, there
was just one psychologist, taking appointments only 2 days a week.
The psychologist only works 2 days because that Texas clinic, like
many VA clinics and hospitals, has to stretch it's funding to make sure
the money lasts the whole year. They don't know how much funding
they'll have next year because the VA budget is routinely passed late.
For the millions of veterans like Rey, we must fix this broken VA
funding system. Advance appropriations is a common-sense solution that
President Obama supported as a candidate, and it's something we would
have liked to see in the budget.
If the Obama Administration is not going to lead the fight for
advance appropriations, we will need Congress to step in. A number of
Members of this Committee, including, of course, Chairman Filner, have
already proven themselves to be key allies in the fight for advance
appropriations, and we thank you for your support. IAVA is a proud
endorser of H.R. 1016/S. 423, and we will work with the Committees in
any way we can to move this legislation forward. With your help, we can
ensure that veterans are not kept waiting, as they have in 19 of the
last 22 years, while Congress plays politics with the budget.
Last month, President Obama traveled to Camp Lejeune to announce
the eventual drawdown of combat troops in Iraq. No matter what you
think of his plan, one thing is clear: the new strategy in Iraq will
create a surge of new veterans coming home in 2009 and 2010. America
needs to be ready, and the 2010 veterans' budget will be a crucial
first step.
Thank you for your time.
Sincerely,
Paul Rieckhoff
Prepared Statement of Richard F. Weidman,
Executive Director for Policy and Government Affairs,
Vietnam Veterans of America
Chairman Filner, Ranking Member Buyer, and distinguished Members on
the Committee, on behalf of Vietnam Veterans of America (VVA) National
President John Rowan and all of our officers, Board of Directors, and
members, I thank you for giving Vietnam Veterans of America (VVA) the
opportunity to testify today regarding the President's fiscal year 2010
budget request for the Department of Veterans Affairs. VVA thanks each
of you on this distinguished panel, on both sides of the aisle, for
your strong leadership on issues and concerns of vital concern to
veterans and their families.
I want to thank you for recognizing that caring for those who have
donned the uniform in our name is part of the continuing cost of the
national defense. Caring for veterans, the essential role of the VA
and, for specific services other Federal entities such as the
Department of Labor, the Small Business Administration, and the
Department of Health and Human Services, must be a national priority.
This is poignantly clear when we visit the combat-wounded troops at
Walter Reed Army Medical Center and Bethesda Naval Hospital.
Mr. Chairman, VVA thanks you for sponsoring advanced Appropriations
legislation in the Senate (H.R. 1016). As you know, VVA and other major
veterans' service organizations have been long-time supporters of
legislation to achieve assured funding. When the VA budget is late 19
or of the last 22 times, it is clear that there is a need for a new
mechanism to correct the problems in the current system of funding.
While VVA remains committed to the assured funding concept, we
currently strongly support the Advanced Appropriations legislation
contained in H.R. 1016 as being so much better than what we currently
have in place. As we have this discussion in regard to the FY 10 budget
for the VA, the readily apparent need for this legislation has never
been more pressing. We look forward to working with you to ensure its
enactment, as it will move us toward our common goal of predictable,
fully adequate, and timely funding for VA health care that is
sufficient to truly meet the needs of all veterans in vital need of
such care.
Overview
Concerning the proposal at hand, the President's FY 10 budget for
the VA, VVA is pleased with the overall amount of the request, which is
for a $5.5 Billion overall increase over the FY 2010 budget. It is
unclear how much of that is slated for the Veterans Health
Administration (VHA), and how much for other purposes given the sketchy
outline of the VA budget thus far available. However, it is clear that
the bulk of those funds needs to VHA to meet the rising needs of
medical inflation continue the process of adding needed organizational
capacity as the population served expands, and for modernizing
equipment and facilities.
Using the Center for Medicare & Medicaid Services (CMS) figure of
3.6 percent-inflation, that would mean that the Congress needs to add a
minimum figure of about $1.4 Billion to VHA just to keep up with
increases in fixed costs, even if no more veterans entered the system.
Further, there is a need to ``front load'' staff to increase
organizational capacity to be ready to handle additional numbers of
veterans allowed to seek health care from the VHA as the system is re-
opened to those who were frozen out of the system by the actions of the
previous Administrations beginning in January of 2003. There will be
further increases of our youngest veterans from the current conflicts
seeking services from VHA as well as more older veterans seeking
services, particularly Vietnam veterans whose medical problems are now
coming to the fore due to age and manifestation of long term effects of
exposure to Agent Orange and other herbicides and toxins in Vietnam and
elsewhere during their military service.
While VVA is adamant that VA needs to allow these veterans to
register and to receive health care, it needs to be done in a manner
that avoids overwhelming the system all at once leading to long delays
in receiving care. The system is in many cases too ``thin'' to be able
to accommodate more people for more than a brief amount of time. VVA
believes that these staff enhancements and increases in organizational
capacity will require at least another $2 Billion for VHA to increase
the size of permanent staff.
Vet Centers
This would include significantly increasing the number of staff in
the highly successful VA Vet Center (Readjustment Counseling) program
to not just open and provide staff for new centers and to do rural
outreach, as important as these two efforts are, but to enlarge the
size of existing teams. Perhaps the most pressing need, beyond ensuring
that staff members at Vet Centers are not so over-worked that they
``burn out,'' is the need for more certified family counselors and more
counselors professionally trained and certified to deal with military
sexual trauma in veterans of both genders. The Vet Centers are our
first line of defense against suicides, and we must make sure they have
the organizational capacity to continue doing what they do so well on a
long term sustainable basis.
Research
VVA calls for an increased outlay for Research and Development.
Traumatic Brain Injuries, or TBI, needs to be better understood for
treatment to be more effective. Other mental health issues, too, that
are afflicting too many of our returning troops, need to be better
understood. Research, for which VA scientists and epidemiologists can
be justifiably proud, benefit not only troops who are forever changed
by their experiences in combat but the general populace as well. VVVA
believes that we must become more serious about research at the VA,
given that the National Institutes of Health (NIH) continues to totally
ignore veterans and the long term health effects of military service.
Other than one head injury study, we know of no other NIH research
project that even tangentially asks about military service and uses
that as a variable (and possible confounder). VVA recommends that
Research & Development be provided at least $ 750 million for FY 2010
and commensurately large increases in the out years, so that over 5
years this activity is funded at least at the $1 Billion level.
For the first time in many years, VVA has NOT signed on to the
Friends of VA Health Care & Medical Research (FOVA) although we
strongly believe that there needs to be a significant increase in R&D
funding. VVA did not sign on to FOVA because of a required pledge not
to push for any earmarks in Research & Development funds. It would be
irresponsible of VVA to sign this pledge and not seek ear marks given
that we have been unable to discover ANY research programs into the
long term health effects of Agent Orange and other toxins, despite
repeated inquiries to the current Undersecretary for Health and the
current occupant of the office of Director of Research & Development,
as well as the previous two occupants of the office of Secretary of
Veterans Affairs. Obviously we need ear marks for research into the
environmental wounds of Vietnam, as well as into the deleterious health
effects of service in other periods of time and theaters of operation,
such as the first Gulf War. It would be a betrayal of our members and
their families if we did not urgently seek ear marks for further
research into the terrible health long term effects of exposure to the
herbicides and other toxins (including pesticides, PCBs, etc.) used in
Vietnam during the war.
NVVRS
This lack of such research projects is compounded by VHA's adamant
refusal to obey the law and complete the replication of the ``National
Vietnam Veterans Readjustment Study'' (NVVRS) as a robust mortality and
morbidity study from the only existing statistically valid random
sample of Vietnam veterans in existence. Frankly, this study in needed
not only to document the long term course of post traumatic stress
disorder, but also to document physiological problems in this
population (which we know to be many). Their refusal says a great deal
about their bias and determinedly continued willful ignorance.
Mr. Chairman, VVA thanks this Committee and the Appropriations
Committee for using the power of the purse in the FY 2008 and FY 2009
Appropriations act to compel VA to obey the law (Public Law 106-419)
and conduct the long-delayed National Vietnam Veterans Longitudinal
Study. VVA asks that you schedule a hearing and/or a Members briefing
for the second half of March for VA to outline their plan as to how
they are going to complete this much needed study for delivery of the
final results to the Congress by April 1, 2010, as a comprehensive
mortality and morbidity study of Vietnam veterans, the last large
cohort of combat veterans prior to those now serving in OIF/OEF.
VVA is concerned that previous leadership at VA felt they were
above the law and ignored this mandate, and were unapologetic about
being scofflaws. We hope this provision will again be included in the
Appropriations act and that General Shinseki will see to it that VA
obeys the law and gets this done on his watch.
Further, VVA strongly urges the Congress to mandate and fund
longitudinal studies to begin virtually immediately, using the exact
same methodology as the NVVRS, for the following cohorts: a) Gulf War
1991; b) Operation Iraqi Freedom; and, c) Operation Enduring Freedom.
Please take action now so that these young veterans are not placed
into the same predicament Vietnam veterans find themselves today.
Military History Needed on CPRS
Further, the continued refusal of VHA to take a complete military
record as part of the electronic medical records, known as he
Computerized Patient Records System or CPRS at VA, means that there is
no way to do needed epidemiological research on veterans who use the VA
system that looks into exposures they may have been subject to in
military service, depending on the branch of service, when, where, and
MOS. Further, this would enable mortality studies based on when and
where one served for those who have already died. It's almost as if our
government does not want to know about these ailments so that it won't
be burdened with Dependency Indemnity Compensation (DIC) payments.
VVA asks that $25 million be specifically designated for
replication of the NVVRS, $20 million for research into the health care
effects of Agent Orange and other toxins, $15 million to the Medical
Follow Up Agency (MFUA) at the Institute of Medicine (IOM) at the
National Academies of Sciences, to finish translating all of the data
from the now closed Ranch Hand Study into modern computer language and
properly catalogue it to make this data accessible to credentialed
researchers. This potentially enormously valuable trove of research
data should not be allowed to perish for want of these minimal funds.
In 2009, VA and DoD is supposed to complete the pilot of a new
disability evaluation system for wounded returnees at major medical
facilities in the Washington, D.C. area, and expand it to most other
large military medical centers. We hope that what results from this
effort ``to eliminate the duplicative and often confusing elements of
the current disability process of the two departments'' will lead to
less confusion and a single, viable disability rating determined by the
VA. However the process is currently not working as it is supposed to
work. VVA repeatedly brought this to the attention on the former
Secretary of Veterans Affairs and the current Undersecretary for
Benefits and his staff since last November. There is a real need for
joint oversight of this process by the Veterans Affairs Committee and
the Armed Services Committee to ensure that wounded and ill soldiers
are treated fairly in their waning days of military service.
We are also concerned that there still will not be enough resources
to deal with the flood of troops and veterans returning to our shores
and presenting with a range of mental health issues. The VA ramped down
for several years the numbers of mental health professionals it
employed. Now, seeing the error of its ways, it is hurriedly hiring
clinicians. The question is: Will there be enough of them to meet the
challenge? Will those staff be properly trained to deal with the needs
of veterans with heavy combat trauma and other problems?
Much more attention needs to be devoted to continuing medical
education, particularly for mental health providers and for primary
care physicians and other clinicians. One of the best kept secrets at
VA is the existence of the Veterans Health Initiative (VHI) curricula
about the wounds, maladies, illnesses, and conditions endemic to
military service depending on when and where one served. (www.va.gov/
vhi) VHA apparently makes no systematic effort to utilize this tool to
better educate these clinicians who can and will do an even better job
if properly trained and supported. As Secretary Shinseki has repeatedly
stated, what is lacking is primarily a matter of leadership and
accountability. We hope and trust that he can and will meet that lack,
particularly if the rest of his team gets on board quickly.
Mental Health--Need to Restore Organizational Capacity for Substance
Abuse Treatment
VVA urges that language be inserted in the Appropriations bill the
Congress to express concern that substance use disorders among our
Nation's veterans is not being adequately addressed by the Veterans
Health Administration (VHA). The relatively high rate of drug and
alcohol abuse among our Nation's veterans (much of which is self-
medication to deal with untreated PTSD), especially those returning
from service in Operation Enduring Freedom and Operation Iraqi Freedom,
is causing significant human suffering for veterans and their families.
These folks can and will be stronger for their experience if we
only will deliver the effective care they need when they need it in a
way they will accept.
Further delay in moving to restore effective mental health and
substance abuse services will lead to poorer health and more acute
health care utilization in the out years, not to mention economic
opportunity cost to the Nation and needless suffering by these
veterans, and their families.
Last year, VVA urged the Congress to direct the Secretary to make
concerted efforts to reduce the overall incidence of drug and alcohol
abuse and dependence among enrollees in the Veterans Health
Administration by meeting the performance measurements included in ``A
Comprehensive VHA Strategic Plan for Mental Health Services,'' VA's
current and adopted plan to reform its mental health programs, with the
hallmark of recovery. To its credit, VA has developed a strategy to
``restore VHA's ability to consistently deliver state of the art care
for veterans with substance abuse disorders,'' as a milestone within
that reform plan, but to date has yet to fulfill the promise of its
commitment to recovery, and establishing the goal of every veteran
being able to obtain and sustain meaningful employment at a living wage
as the ultimate goal for all VA mental health programs, including its
substance use disorder programs. It should now no longer be a case of
lacking resources, so we need much better oversight and accountability
in the coming year. In addition it is clear that we need new leadership
in the Mental Health area, as the Chairman has noted on several
occasions. We hope Secretary Shinseki will heed the Chairman and others
in this regard.
VVA urges the Congress to direct the Secretary to provide quarterly
reports beginning with a baseline report by each Veterans Integrated
Service Network (VISN) on the initiatives set forth in the VHA
Strategic Plan for Mental Health Services, specifically to improve VA's
treatment of substance use disorders. These reports will provide an
ongoing indication of VHA's progress in the implementation of its
adopted Strategic Plan as described in section 1.2.8 of ``A
Comprehensive VHA Strategic Plan of Mental Health Services'', May 2,
2005. In addition to baseline information, at minimum these reports
should include: the current ranking of networks on their percentage of
substance abuse treatment capacity along with plans developed by the
lowest quartile of networks to bring their percentage up to the
national average; and, the locations of VA facilities that provide 5
days or more of inpatient/residential detoxification services, either
on site, at a nearby VA facility, or at a facility under contract to
provide such care; and, the locations of VA health care facilities
without specialized substance use disorder providers on staff, with a
statement of intentions by each such facility director of plans to
employ such providers or take other actions to provide such specialized
care.
The decade long diminishment of VA mental health programs that we
experienced in the 1990s did level out by 2001, and VA all too slowly
started to rebuild capacity that has been accelerated in recent years.
However, we must continue to restore capacity to deal with mental
disorders, particularly with Post Traumatic stress Disorder and the
often attendant co-morbidity of substance abuse. In particular,
substance abuse treatment needs to be expanded greatly, and be more
reliant on evidence based medicine and practices that are shown to
actually be fruitful, and be held to much higher standards of
accountability, as noted above. The 21 day revolving door or the old
substance abuse wards is not something we should return to, but rather
treatment modalities that can be proven to work, and restore veterans
of working age to the point where they can obtain and sustain
meaningful employment at a living wage, and therefore re-establish
their sense of self-esteem.
VVA also urges that additional resources explicitly be directed in
the appropriation for FY 2009 to the National Center for PTSD for them
to add to their organizational capacity under the current fine
leadership. The signature wounds of this war may well be PTSD and
Traumatic Brain Injury and a complicated amalgam of both conditions.
VVA believes that if we provide enough resources, and hold VA managers
accountable for how well those resources are applied, that these fine
young veterans suffering these wounds can become well enough again to
lead a happy and productive life.
Up until recently, VA has not made enough progress in preparing for
the needs of troops returning from Iraq and Afghanistan--particularly
in the area of mental health care. In addition to the funds VVA is
recommending elsewhere, we specifically recommend an increase of an
additional $500 million dollars over and above the $3.9 Billion that VA
now says they will allocate to assist VA in meeting the mental health
care needs of all veterans. These funds should be used to develop or
augment with permanent staff at VA Vet Centers (Readjustment Counseling
Service or RCS), as well as PTSD teams and substance use disorder
programs at VA Medical Centers and clinician who are skilled in
treating both PTSD and substance abuse at the CBOC, which will be
sought after as more troops (including demobilized National Guard and
Reserve members) return from ongoing deployments. VVA also urges that
the Secretary be required to work much more closely with the Secretary
of Health and Human Services, and the states, to provide counseling to
the whole family of those returning from combat deployments by means of
utilizing the community mental health centers that dot the Nation.
Promising work is now going on in Connecticut in and possibly elsewhere
in this regard that could possibly be a model. In addition, VA should
be augmenting its nursing home beds and community resources for long
term care, particularly at the state veterans' homes.
To allow the staffing ratios that prevailed in 1998 for its current
user population, VA would have to add more than 15,000 direct care
employees--MDs, nurses, and other medical specialists--at a cost of
about $2 billion. This level, because the system can and should be more
efficient now, would allow us to end the shame of leaving veterans out
in the cold who want and are in vital need of health care at VA, and
who often have no other option.
Blind and Low Vision Veterans Need Much Greater Resources and Attention
The President's request contains a significant reduction in the
efforts to strengthen services for blind veterans. With the number of
blind and very low vision veterans of the Nation's latest wars in need
of services now, VVA strongly recommends the Congress explicitly direct
an additional $35 million for FY 2010 to increase staffing and
programming at the VA's Blind and Visually Impaired Service Centers,
and to add at least one new center.
Further, VVA recommends that the Congress directs the Secretary to
implement an employment and independent living project modeled on the
highly successful ``Project Amer-I-Can'' that so successfully placed
blind and visually impaired veterans into work and other situations
that resulted in them becoming much more autonomous and independent.
That program was a cooperative venture of the New York State Department
of Labor, the Veterans Employment & Training Service (VETS), and the
Blind Veterans Association.
In a system in which so much of the infrastructure would be deemed
obsolete by the private sector (in a 1999 report GAO found that more
than 60 percent of its buildings were more than 25 years old), this has
and may again lead to serious trouble. We are recommending that
Congress provide an additional $1.5 billion to the medical facilities
account to allow them to begin to address the system's current needs.
We also believe that Congress should fully fund the major and minor
construction accounts to allow for the remaining CARES proposals to be
properly addressed by funding these accounts. This would be in addition
to the almost $ 1 Billion contained in the stimulus package.
Homeless Veterans
As we all know, homelessness is a significant problem in the
veterans' community and veterans are disproportionately represented
among the homeless population. While many effective programs assist
homeless veterans to become productive and self-sufficient members of
their communities and Congress must ensure that the Department of
Veterans Affairs has adequate funding to meet the needs of the over
154,000 homeless veterans who served this country so proudly in past
wars and veterans of our modern day war. VVA recommends the following
in VA FY 2010 budget for homeless programs.
Homeless Provider Grant and Per Diem Program
The Department of Veterans Affairs Homeless Grant & Per Diem
Program has been in existence since 1994. These programs address the
needs of homeless veterans and support the development of transitional,
community-based housing and the delivery of supportive services.
Because financial resources available to HGPD are limited, the number
of grants awarded and the dollars granted are restrictive and hence
many geographic areas in need suffer a loss that HGPD could address.
The Consolidated Appropriations Act of 2008, Public Law 110-161
provides $130 million, the fully authorized level, to be expended for
the GPD program. Based on GAO's findings, and VA's projected needs for
additional GPD beds, VVA believes that for FY 2010 a level of at least
$200 million authorization is required. An increase in the funding
level for the next several years would help ensure and expedite VA's
program expansion targets. It would provide critical funding for
service, or drop-in, centers--the primary portal that links veterans in
need with the people who can help them. It would guarantee continued
declines in veteran homelessness, and provide for scaling back the
funding as warranted by the VA's annual Community Homelessness
Assessment, Local Education and Networking Group (CHALENG) reports
The VA provides grants to VA health care facilities and existing
GPD recipients to assist them in serving homeless veterans with special
needs including women, women who have care of dependent children,
chronically mentally ill, frail elderly and terminally ill veterans.
Initiated in FY 2004, VA has provided special needs funding to 29
organizations totaling $15.7 million. The VA Advisory Committee on
Homeless Veterans 2007 report states the need and complexity of issues
involving women veterans who become homeless are increasingly
unexpected. Recognizing women veterans are one of the fastest growing
homeless populations, the Committee recommended future notices of
funding availability target women veteran programs including special
needs grant offerings. P.L. 109-461 authorizes appropriations of $7
million for FY 2007 through FY 2011 for special needs grants.
VVA estimates approximately $45 million will be needed to
adequately serve 7,500 or more clients in HUD-VASH housing units.
Rigorous evaluation of this program indicates this approach
significantly reduces the incidence of homelessness among veterans
challenged by chronic mental and emotional conditions, substance abuse
disorders and other disabilities.
VVA also strongly urges you to actively help us seek an
appropriation for the full $50 million authorized for the Homeless
Veterans Reintegration Program (HVRP) for FY 2010.
Veterans Benefits Administration
The Veterans Benefits Administration (VBA) continues to not only
need additional resources and enhanced accountability measures, but a
total paradigm shift and re-tooling of the business processes.
Compensation & Pension
VVA recommends adding one hundred staff members above the level
requested by the President for the Compensation & Pension Service (C&P)
specifically to be trained as adjudicators. Further, VVA strongly
recommends adding an additional $80 million dollars specifically
earmarked to create ``express lines'' at all VARO and not just the ten
pilot sites, for additional training for all of those who touch a
veterans' claim, institution of a competency based examination that is
reviewed by an outside body that shall be used in a verification
process for all of the VA personnel, veteran service organization
personnel, attorneys, county and state employees, and any others who
might presume to at any point touch a veterans' claim.
Vocational Rehabilitation
Last year (and the year before that), VVA recommended adding an
additional two hundred specially trained vocational rehabilitation
placement specialists to work with returning servicemembers who are
disabled to ensure their placement into jobs or training that will
directly lead to meaningful employment at a living wage. VA only added
60 such counselors. It still remains clear that the system funded
through the Department of Labor simply is failing these fine young men
and women when they need assistance most in rebuilding their lives.
It is clear VA needs to add several hundred of these employment
placement specialists for disabled veterans specifically called for in
past years' funding measures, and there is clearly a need for
additional training to ensure they are effective in assisting disabled
veterans, particularly profoundly disabled veterans, to obtain decent
jobs.
VVA has always held that the ability to obtain and sustain
meaningful employment at a living wage is the absolute central event of
the readjustment process. Adding additional resources and much greater
accountability to the VA Vocational Rehabilitation process is essential
if we as a nation are to meet our obligation to these Americans who
have served their country so well, and have already sacrificed so much.
Computerization of the Claims Process
VVA agrees with Secretary Shinseki's statement that computerization
in and of itself will not fix the mess in the Compensation & Pension
program, but rather to re-think and straighten out the business
processes first before we ``put garbage in to get garbage out.'' While
the Secretary and his new team figure out what those new business
processes will be, VVA also believes that Congress needs to set aside
funds for putting all of the VBA records into digital form. This is
essentially an investment in computer infrastructure every bit as
important as buildings. We do not know what that figure is, but we have
to believe there are existing platforms that can be adapted for this
use that are already successfully being used in other branches of the
Federal Government.
Accountability at the VA
There is no excuse for the dissembling and lack of accountability
in so much of what happens at the VA. It is certainly better than it
used to be, but there is a long way to go in regard to cleaning up that
corporate culture to make it the kind of system that it can be with
existing resources, and even largely the same personnel as they
currently have on board. It can be cleaned up and done right the first
time, if there is the political will to hold people accountable for
doing their job properly.
The almost quarter of a million VA personnel consist of fine hard
working people who are by and large committed to doing a good job for
the veterans whom they serve. What is needed is leadership that is
worthy of those fine workers, and a better system of accountability
(especially for managers) and the system will work much better.
Thank you again, Mr. Chairman, for allowing VVA to be heard at this
forum. We look forward to working with you and this distinguished
Committee to obtain an excellent budget for the VA in this fiscal year,
and to ensure the next generation of veterans' well-being by enacting
H.R. 1016 at the earliest possible time. I will be happy to answer any
questions you or your distinguished colleagues may have.
Prepared Statement of Steve Robertson,
Director, National Legislative Commission, American Legion
Mr. Chairman and Members of the Committee:
The American Legion welcomes this opportunity to comment on
President Obama's ``top line'' budget request for Fiscal Year 2010. The
American Legion is pleased by the $113 billion total appropriations for
the Department of Veterans Affairs (VA) in FY 2010 and the projected
$57 billion in mandatory appropriations and $56 billion in
discretionary appropriations.
As a nation at war, America has a moral, ethical and legal
commitment to the men and women of the Armed Forces of the United
States and their survivors. These current defenders of democracy will
eventually join the ranks of their 23.5 million comrades, we refer to
as veterans. The active-duty, Reserve components and veterans continue
to make up the Nation's best recruiters for the armed forces. Young men
and women across the country see servicemembers and veterans as role
models. Chances are before enlisting in the armed forces, these young
people will seek the advice of those they see in uniform or family
members who served in the armed forces for their recommendations on
military service.
Therefore, it is absolutely critical that the entire veterans'
community (active-duty, Reserve component, and veterans) continue to
remain supportive of honorable military service. No servicemember
should ever be in doubt about:
the quality of health care he or she will receive if
injured;
the availability of earned benefits for honorable
military service upon discharge; or
the quality of survivors' benefits should he or she pay
the ultimate sacrifice.
The American Legion and many other veterans' and military service
organizations are united in advocating enactment of timely, predictable
and sufficient budgets for VA medical care. In FY 2009, Congress passed
and the President signed this budget at the start of the fiscal year.
Clearly, Secretary Shinseki is much more fortunate than many of his
colleagues in the Cabinet because he has a timely, predictable and
sufficient budget with which to administer. The American Legion urges
Congress to once again pass the VA budget for FY 2010 prior to the
start of the fiscal year--it does make a difference!
Mr. Chairman, The American Legion sincerely appreciated your
introduction of H.R. 1016, Veterans Health Care Budget Reform and
Transparency Act of 2009. This legislation should help achieve the
timeliness and predictability goals, while giving us the remainder of
the budget cycle to assure the sufficiency goal. Working together, the
veterans' community is actively seeking additional cosponsors to this
legislation.
Mr. Chairman and Members of the Committee, The American Legion
greatly appreciates the provisions contained in the American Recovery
and Reinvestment Act:
A Tax Credit for Hiring Unemployed Veterans: Provides a
tax credit to businesses for hiring unemployed veterans. Specifically,
veterans would qualify if they were discharged or released from active
duty from the Armed Forces during the previous 5 years and received
unemployment benefits for more than 4 weeks before being hired.
Disabled Veterans Payment of $250: Provides a payment of
$250 to all disabled veterans receiving benefits from the Department of
Veterans Affairs. VA Medical Facilities: Provides $1 billion for non-
recurring maintenance, including energy efficiency projects, to address
deficiencies and avoid serious maintenance problems at the 153 VA
hospitals across the country.
Increase the Number of VA Claims Processors: Provides
$150 million for an increase in VA claims processing staff, in order to
address the large backlog in processing veterans' claims. This backlog
has been a key complaint of veterans across the country.
Improve Automation of VA Benefit Processing: Provides $50
million to improve the automation of the processing of veterans'
benefits, to get benefits out sooner and more accurately.
Construction of Extended Care Facilities for Veterans:
Provides $150 million for state grants for the construction of
additional extended care facilities for veterans.
After reviewing the Office of Management and Budget's Web site with
regards to the President's ``top line'' Budget Request for the
Department of Veterans Affairs, The American Legion renders its support
as follows:
Increases funding for the Department of Veterans Affairs
by $25 billion above baseline over the next 5 years.--Supported by The
American Legion*
Dramatically increases funding for veterans health
care.--Supported by The American Legion*
Expands eligibility for veterans health care to over
500,000 veterans by 2013.--Supported by The American Legion*
Enhances outreach and services related to mental health
care and cognitive injuries, including post-traumatic stress disorder
and traumatic brain injury, with a focus on access for veterans in
rural areas--Supported by The American Legion*
Invests in better technology to deliver services and
benefits to veterans with the quality and efficiency they deserve.--
Supported by The American Legion*
Provides greater benefits to veterans who are medically
retired from service.--Supported by The American Legion*
Combats homelessness by safeguarding vulnerable
veterans.--Supported by The American Legion*
Facilitates timely implementation of the comprehensive
education benefits that veterans earn through their dedicated military
service.--Supported by The American Legion*
* All support is contingent upon the release of the budget request
in April.
On September 11, 2008, The American Legion National Commander David
Rehbein testified before a joint session of the congressional
Committees on Veterans' Affairs. In that testimony, he clearly outlined
the funding recommendations for FY 2010. I am here today to re-
emphasize that support for certain specific areas.
Medical Care Collections Fund
The Balanced Budget Act 1997, Public Law (P.L.) 105-33, established
the VA Medical Care Collections Fund (MCCF), requiring amounts
collected or recovered from third-party payers after June 30, 1997, be
deposited into this fund. The MCCF is a depository for collections from
third-party insurance, outpatient prescription copayments and other
medical charges and user fees. Funds collected may only be used to
provide VA medical care and services, as well as VA expenses for
identification, billing, auditing and collection of amounts owed the
Federal Government.
The American Legion supported legislation to allow VA to bill,
collect, and reinvest third-party reimbursements and copayments;
however, The American Legion adamantly opposes the scoring of MCCF as
an offset to the annual discretionary appropriations since the majority
of these funds come from the treatment of non-service-connected medical
conditions. Previously, these collection goals have far exceeded VA's
ability to collect accounts receivable.
Since FY 2004, VHA's total collections increased from $1.7 billion
to $2.2 billion; a 29.4 percent-increase. The third-party component of
VA's collections also increased from $960,000 to $1.26 million; a 31.3
percent-increase.
VA's ability to capture these funds is critical to its ability to
provide quality and timely care to veterans. Miscalculations of VA
required funding levels result in real budgetary shortfalls. Seeking an
annual emergency supplemental is not the most cost-effective means of
funding the Nation's model health care delivery system. Government
Accountability Office (GAO) reports continue to raise the issue of
VHA's ability to capture insurance data in a timely and correct manner.
In addition, they continue to express concerns of VHA's ability to
maximize its third-party collections.
According to a 2008 GAO report, VA lacks policies and procedures
and a full range of standardized reports for effective management
oversight of VA-wide third-party billing and collection operations.
Further, although VA management has undertaken several initiatives to
enhance third-party revenue, many of these initiatives are open-ended
or will not be implemented for several years. Until these shortcomings
are addressed, VA will continue to fall short of its goal to maximize
third-party revenue, thereby placing a higher financial burden on
taxpayers. In addition, GAO recommended an improvement of third-party
billings; follow-up on unpaid amounts, and management oversight of
billing and collections.
The American Legion opposes offsetting annual VA discretionary
funding by the MCCF goal.
Third-Party Reimbursements for Treatment of Service-Connected Medical
Conditions
Recently, there has been some talk about VA seeking third-party
reimbursements from private health care insurers for the treatment of
service-connected medical conditions. The American Legion believes that
this would be inconsistent with the mandate ``. . . to care for him who
shall have borne the battle. . . .'' The U.S. government sent these men
and women into harm's way, not private insurance companies.
Should private insurance companies be required to reimburse VA for
the treatment of service-connected medical conditions, The American
Legion has grave concerns over the adverse impact such a policy change
would have on service-connected disabled veterans and their families.
Depending on the severity of the medical conditions, those medical
insurance policies with a calendar year benefit maximum or a life-time
benefit maximum could result in the rest of the family not receiving
any health care benefits. Many health insurance companies require
deductibles to be paid before any benefits are covered.
In addition, there is concern as to what premiums would be to cover
service-connected disabled veterans and their families with private
health insurance, especially those who are small businessowners or
self-employed. The American Legion is also concerned with employers who
would be reluctant to hire service-connected disabled veterans because
of the impact their employment might have on company health care
benefits.
The American Legion adamantly opposes any legislative initiative
that would require third-party reimbursements from private health
insurance providers for the treatment of service-connected disabled
veterans by VA.
Medicare Reimbursements
As do most American workers, veterans pay into the Medicare system,
without choice, throughout their working lives, including while on
active duty or as active service Reservists in the Armed Forces. A
portion of each earned dollar is allocated to the Medicare Trust Fund
and, although veterans must pay into the Medicare system, VA is
prohibited from collecting any Medicare reimbursements for the
treatment of allowable, non-service-connected medical conditions. Since
over half of VA's enrolled patient population is Medicare-eligible,
this prohibition constitutes a multi-billion dollar annual subsidy to
the Medicare Trust Fund.
The American Legion would support a legislative initiative to allow
VHA to bill, collect and reinvest third-party reimbursements from the
Centers for Medicare and Medicaid Services for the treatment of
allowable, non-service-connected medical conditions of enrolled
Medicare-eligible veterans. This legislative change would generate
approximately $3--5 billion in new third-party collections annually.
The Congressional Budget Office predicts that enrolled veterans in
Priority Groups 7 and 8 alone would generate $12 billion from 2010 to
2014 and $26 billion from 2010 to 2019.
State Extended Care Facility Construction Grants Program
Since 1984, nearly all planning for VA inpatient nursing home care
has revolved around State Veterans' Homes (SVHs) and contracts with
public and private nursing homes. The reason for this is obvious: for
FY 2004, VA paid a per diem of $59.48 for each veteran it placed in
SVHs, compared to the $354 VA claims it cost in FY 2002 to maintain a
veteran for 1 day in its own nursing home care units (NHCUs).
Under the provisions of title 38, USC, VA is authorized to make
payments to states to assist in the construction and maintenance of
SVHs. Today, there are 133 SVHs in 47 states with over 27,000 beds
providing nursing home, hospital, and domiciliary care. Grants for
Construction of State Extended Care Facilities provide funding for 65
percent of the total cost of building new veterans' homes. Recognizing
the growing LTC needs of older veterans, it is essential the State
Veterans' Homes Program be maintained as an important alternative
health care provider to the VA system.
The American Legion opposes attempts to place a moratorium on new
SVH construction grants. State authorizing legislation has been enacted
and state funds have been committed. Delaying projects will result in
cost overruns and may result in states deciding to cancel these much
needed facilities.
The American Legion supports increasing the amount of authorized
per diem payments to 50 percent for nursing home and domiciliary care
provided to veterans in State Veterans' Homes; providing prescription
drugs and over-the-counter medications to State Homes Aid and
Attendance patients along with the payment of authorized per diem to
State Veterans' Homes; and allowing full reimbursement of nursing home
care to 70 percent or higher service-connected disabled veterans, if
those veterans reside in a State Veterans' Home.
The American Legion recommends $275 million for the State Extended
Care Facility Construction Grants Program in FY 2010.
Medical and Prosthetics Research
The American Legion believes VA's focus in research must remain on
understanding and improving treatment for medical conditions that are
unique to veterans. servicemembers are surviving catastrophically
disabling blast injuries due to the superior armor they are wearing in
the combat theater and the timely access to quality combat medical
care. The unique injuries sustained by the new generation of veterans
clearly demand particular attention. It has been reported that VA does
not have state-of-the-art prostheses like DoD and that the fitting of
prostheses for women has presented problems due to their smaller
stature.
The American Legion also supports adequate funding of other VA
research activities, including basic biomedical research and bench-to-
bedside projects for FY 2010. Congress and the Administration should
continue to encourage acceleration in the development and initiation of
needed research on conditions that significantly affect veterans, such
as prostate cancer, addictive disorders, trauma and wound healing,
post-traumatic stress disorder, rehabilitation, and other research that
is conducted jointly with DoD, the National Institutes of Health (NIH),
other Federal agencies, and academic institutions.
The American Legion recommends $532 million for Medical and
Prosthetics Research in FY 2010.
Blinded Veterans
There are currently over 35,000 blind veterans enrolled in the VA
health care system. Additionally, demographic data suggests that in the
United States, there are over 160,000 veterans with low-vision problems
who are eligible for Blind Rehabilitative services. Due to staffing
shortages, over 1,500 blind veterans will wait months to get into one
of the 10 blind rehabilitative centers.
VA currently employs approximately 164 Visual Impairment Service
Team (VIST) Coordinators, to provide lifetime case management to all
legally blind veterans and all Operation Enduring Freedom/Operation
Iraqi Freedom (OEF/OIF) patients, and 38 Blind Rehabilitative
Outpatient Specialists (BROS) to provide services to patients who are
unable to travel to a blind rehabilitation center. The training
provided by BROS is critical to the continuum of care for blind
veterans. In addition, the DoD medical system is dependent on VA to
provide blind rehabilitative services.
Given the critical skills a BROS teaches to help blind veterans and
their families adjust to such a devastating injury, The American Legion
urges VA to recruit more specialists and continue with expansion of
Blind Rehabilitation Outpatient Specialists and Visual Impairment
Services Teams.
Major VHA Construction
The CARES process identified approximately 100 major construction
projects throughout the VA Medical Center System, the District of
Columbia, and Puerto Rico. Construction projects are categorized as
major if the estimated cost is over $10 million. Now that VA has
disclosed the plan to deliver health care through 2022, Congress has
the responsibility to provide adequate funds. The CARES plan calls for
the construction of new hospitals in Orlando and Las Vegas and
replacement facilities in Louisville and Denver for a total cost
estimated over $1 billion for these four facilities.
VA has not had this type of progressive construction agenda in
decades. Major construction costs can be significant and proper
utilization of funds must be well planned. However, if timely
completion is truly a national priority, The American Legion continues
to have concerns due to inadequate funding.
In addition to the cost of the proposed new facilities, there are
many construction issues that have been ``placed on hold'' for the past
several years due to inadequate funding and the moratorium placed on
construction spending by the CARES process. One of the most glaring
shortfalls is the neglect of the buildings sorely in need of seismic
correction. This is an issue of safety. The delivery of health care in
unsafe buildings cannot be tolerated and funds must be allocated to not
only construct the new facilities, but also to pay for much needed
upgrades at existing facilities. Gambling with the lives of veterans,
their families and VA employees is absolutely unacceptable.
The American Legion believes VA has effectively shepherded the
CARES process to its current state by developing the blueprint for the
future delivery of VA health care--we urge Congress to adequately fund
the implementation of this comprehensive and crucial undertaking.
The American Legion recommends $1.8 billion for Major Construction
in FY 2010.
Minor VHA Construction
VA's minor construction program has also suffered significant
neglect over the past several years. Maintaining the infrastructure of
VA's buildings is no small task, due to the age of these buildings,
continuous renovations, relocations and expansions. When combined with
the added cost of the CARES program recommendations, it is easy to see
that a major increase over the previous funding level is crucial and
overdue.
The American Legion recommends $1.5 billion for Minor Construction
in FY 2010.
Information Technology Funding
Since the data theft occurrence in May 2006, the VA has implemented
a complete overhaul of its Information Technology (IT) division
nationwide. The American Legion is hopeful VA takes the appropriate
steps to strengthen its IT security to regain the confidence and trust
of veterans who depend on VA for the benefits they have earned.
Within VA Medical Center Nursing Home Care Units, it was discovered
there was conflict with IT and each respective VAMC regarding provision
of Internet access to veteran residents. VA has acknowledged the
Internet would represent a positive tool in veteran rehabilitation. The
American Legion believes Internet access should be provided to these
veterans without delay for time is of the essence in the journey to
recovery. In addition, veterans should not have to suffer due to VA's
gross negligence in the matter.
The American Legion hopes Congress will not attempt to fund the
solution to this problem with scarce fiscal resources allocated to the
VA for health care delivery. With this in mind, The American Legion is
encouraged by the fact that IT is its own line item in the budget
recommendation.
The American Legion believes there should be a complete review of
IT security government wide. VA isn't the only agency within the
government requiring an overhaul of its IT security protocol. The
American Legion urges Congress to exercise its oversight authority and
review each Federal agency to ensure that the personal information of
all Americans is secure.
The American Legion supports the centralization of VA's IT. The
amount of work required to secure information managed by VA is immense.
The American Legion urges Congress to maintain close oversight of VA's
IT restructuring efforts and fund VA's IT to ensure the most rapid
implementation of all proposed security measures.
The American Legion recommends $2.7 billion for Information
Technology.
State Approving Agencies
The American Legion is deeply concerned that veterans, especially
returning wartime veterans, receive their education benefits in a
timely manner. Annually, approximately 300,000 servicemembers (90,000
of which belong to the National Guard and Reserve) return to the
civilian sector and use their earned educational benefits from the
Department of Veterans Affairs (VA).
Any delay in receipt of education benefits or approval of courses
taken at institutions of higher learning can adversely affect a
veteran's life. There are time restrictions on most veterans' education
benefits; significantly, the National Guard and Reserve must remain in
the Selected Reserve to use their earned benefits.
The American Legion believes that every effort should be made to
ensure the New GI Bill education benefits are delivered without
problems or delays. Veterans are unique in that they volunteer for
military service; therefore, these educational benefits are earned as
the thanks of a grateful Nation. The American Legion believes it is a
national obligation to provide timely oversight of all veterans'
education programs to assure they are administered in a timely,
efficient, and accurate manner.
GAO report entitled ``VA Student Financial Aid; Management Actions
Needed to Reduce Overlap in Approving Education and Training Programs
and to Assess State Approving Agencies'' (GAO-07-384) focuses on the
need to ``ensure that Federal dollars are spent efficiently and
effectively.'' GAO recommends VA require State Approving Agencies
(SAAs) to track and report data on resources spent on approval
activities, such as site visits, catalog review, and outreach in a
cost-efficient manner. The American Legion agrees. GAO recommends VA
establish outcome-oriented performance measures to assess the
effectiveness of SAA efforts. The American Legion fully agrees.
Finally, GAO recommends VA collaborate with other agencies to identify
any duplicate efforts and use the agency's administrative and
regulatory authority to streamline the approval process. The American
Legion agrees. VA Deputy Secretary Gordon Mansfield responded at the
time to GAO that VA would initiate contact with appropriate officials
at the Departments of Education and Labor to help identify any
duplicate efforts.
The American Legion strongly recommends SAA funding at $19 million
in FY 2010.
Make TAP and DTAP Mandatory
The American Legion is deeply concerned with the timely manner in
which veterans, especially returning wartime veterans, transition into
the civilian sector.
The Department of Defense (DoD) estimates that 68 percent of
separating active-duty servicemembers attend the full Transitional
Assistance Program (TAP) seminars, but only 35 percent of Reserve
components' servicemembers attend. The American Legion believes these
low attendance numbers are a disservice to all transitioning
servicemembers, especially Reserve component servicemembers. In
addition, many National Guard and Reserve troops have returned from the
wars in Iraq and Afghanistan only to encounter difficulties with their
Federal and civilian employers at home, and the number of destroyed and
bankrupt businesses due to military deployment is still being realized.
In numerous cases brought to the attention of The American Legion
by veterans and other sources, many returning servicemembers have lost
jobs, promotions, businesses, homes, and cars and, in a few cases,
become homeless. The American Legion strongly believes all
servicemembers would benefit greatly by having access to the resources
and knowledge that TAP/Disabled Transitional Assistance Program (DTAP)
provide. TAP/DTAP also needs to update their programs to recognize the
large number of National Guard and Reserve business owners who now
require training, information and assistance while they attempt to
salvage or recover a business which they abandoned to serve their
country.
The American Legion strongly recommends DoD require all separating
servicemembers, including those from Reserve component units,
participate in TAP and DTAP training not more than 180 days prior to
their separation or retirement from the Armed Forces.
TAP Employment Workshops provided to transitioning servicemembers
at most military installations in the United States as well as in eight
overseas locations consist of two and one-half day employment
workshops. The training helps servicemembers prepare a plan for
obtaining meaningful civilian employment when they leave the military.
The workshop focuses on skills assessment, resume writing, job
counseling and assistance, interviewing and networking skills, labor
market information, and familiarization with America's workforce
investment system.
Studies show servicemembers who participate in TAP employment
workshops find their first civilian job 3 weeks earlier than veterans
who do not participate in TAP. The Department of Labor's Veterans
Employment Training Services (DOL-VETS) ensures every TAP participant
leaves the program with a draft resume, a practice interview session,
and a visit to their state job board.
VETS only received a modest 4 percent-increase since 2002.
Transition assistance, education, and employment are each a pillar of
financial stability. They will prevent homelessness; assist the veteran
to compete in the private sector, and allow our Nation's veterans to
contribute their military skills and education to the civilian sector.
By placing veterans in suitable employment quickly, the country
benefits from increased income tax revenue and reduced unemployment
compensation payments, thus greatly offsetting the cost of TAP
training.
The American Legion recommends $404.2 million to DOL-VETS for FY
2010.
Military Occupational Specialty Transition (MOST) Program
The American Legion supports legislation to reauthorize and fund
$60 million for the next 10 years for the servicemembers' Occupational
Conversion and Training Act (SMOCTA). SMOCTA is a training program
developed in the early 1990's for those leaving military service with
few or no job skills transferable to the civilian marketplace. SMOCTA
was renamed the Military Occupational Specialty Transition (MOST)
program in legislation proposed last year, but the language and intent
of the program still apply.
If enacted, MOST would be the only Federal job training program
designed strictly for veterans and the only Federal job training
program available for use by state veterans' employment personnel to
assist veterans with barriers to employment.
Veterans eligible for MOST assistance are those with a primary or
secondary military occupational specialty that DoD has determined is
not readily transferable to the civilian workforce, or those veterans
with a service-connected disability compensation rating of 30 percent
or higher. MOST is a unique job training program because there is a job
waiting for the veteran upon completion of training.
The American Legion recommends reauthorization of MOST and $60
million in funding for the program.
Homelessness
The American Legion notes there are approximately 154,000 homeless
veterans on the street each night. This number, compounded with 300,000
servicemembers entering the civilian sector each year since 2001 with
at least a third of them potentially suffering from mental illness,
indicates that programs to prevent and assist homeless veterans are
needed.
The Homeless Veterans Reintegration Program (HVRP) is a competitive
grant program. Grants are awarded to states or other public entities
and non-profit organizations, including faith-based organizations, to
operate employment programs that reach out to homeless veterans and
help them become gainfully employed. HVRP provides services to assist
in reintegrating homeless veterans into meaningful employment in the
labor force and stimulates the development of effective service
delivery systems that will address the complex problems facing
veterans. HVRP is the only nationwide program focused on assisting
homeless veterans to reintegrate into the workforce.
The American Legion recommends $50 million for this highly
successful grant program in FY 2010.
NVTI
The National Veterans' Employment and Training Services Institute
(NVTI) was established to ensure a high level of proficiency and
training for staff that provide veterans employment services. NVTI
provides training to Federal and state government employment service
providers in competency-based training courses. Current law requires
all DVOPs and LVERs to be trained within three years of hiring. We
recommend these personnel be trained within one year.
The American Legion recommends $4.2 million for NVTI in FY 2010.
Veterans Workforce Investment Program
VWIP grants support efforts to ensure veterans' lifelong learning
and skills development in programs designed to serve most-at-risk
veterans, especially those with service-connected disabilities, those
with significant barriers to employment, and recently separated
veterans. The goal is to provide an effective mix of interventions,
including training, retraining, and support services, that lead to long
term, higher wage and career jobs.
The American Legion recommends $20 million for VWIP in FY 2010.
Employment Rights and Veterans' Preference
The Uniformed Services Employment and Reemployment Rights Act
(USERRA) protects civilian job rights and benefits of veterans and
members of the armed forces, including National Guard and Reserve
servicemembers. USERRA prohibits employer discrimination due to
military obligations and provides reemployment rights to returning
servicemembers. VETS administers this law; it conducts investigations
for USERRA and Veterans' Preference cases, conducts outreach and
education, and investigates complaints by servicemembers.
Since September 11, 2001, nearly 600,000 National Guard and Reserve
servicemembers have been activated for military duty. During this same
period, DOL-VETS provided USERRA assistance to over 410,000 employers
and servicemembers.
Veterans' Preference is authorized by the Veterans' Preference Act
of 1944. The Veterans' Employment Opportunity Act (VEOA) 1998 extended
certain rights and remedies to recently separated veterans. VETS has
the responsibility to investigate complaints filed by veterans who
believe their Veterans' Preference rights have been violated and to
conduct an extensive compliance assistance program.
Veterans Preference is being unlawfully ignored by numerous
agencies. Whereas figures indicate a decline in claims by veterans of
the current conflicts compared to Gulf War I, the reality is that
employment opportunities are not being properly publicized. Federal
agencies, as well as Federal Government contractors and subcontractors,
are required by law to notify the Office of Personnel Management (OPM)
of job opportunities, but more often than not these job opportunities
are never made available to the public. The VETS program investigates
these claims and corrects unlawful practices.
The American Legion recommends $40 million for Program Management
that encompasses USERRA and VEOA in FY 2010.
Veteran-Owned and Service-Connected Disabled
Veteran-Owned Small Businesses
The American Legion views small businesses as the backbone of the
American economy. It is the driving force behind America's past
economic growth and will continue to be the major economic growth
factor as we move into the 21st Century. Currently, more than nine out
of every ten businesses are small firms. They produce almost one-half
of the Gross National Product. Veterans' benefits have always included
assistance in creating and operating veteran-owned small businesses.
The impact of deployment on self-employed National Guard and
Reserve servicemembers is tragic, with a reported 40 percent of all
businesses owned by veterans suffering financial losses and, in some
cases, bankruptcy. Many other small businesses have discovered they are
unable to operate and suffer some form of financial loss when key
employees who are members of the Reserve Components are activated. The
Congressional Budget Office report, ``The Effects of Reserve Call-Ups
on Civilian Employers,'' stated that it ``expects that as many as
30,000 small businesses and 55,000 self-employed individuals may be
more severely affected if their Reservist employee or owner is
activated.'' The American Legion supports legislation that would
require the Federal Government close the pay gap between Reserve and
National Guard servicemembers civilian and military pay and would also
provide tax credits up to $30,000 for small businesses with
servicemembers who are activated.
The Office of Veterans' Business Development within the Small
Business Administration (SBA) is crippled and ineffective due to a
token funding of $750,000 per year. This amount, which is less than the
office supply budget for the SBA, is expected to support an entire
Nation of veterans who are entrepreneurs. The American Legion feels
this pittance is an insult to American veterans who are small
businessowners. This token funding also undermines the spirit and
intent of P.L. 106-50 that provides small business opportunities to
veteran-owned businesses.
The American Legion strongly recommends increased funding of the
SBA's Office of Veterans' Business Development to provide enhanced
outreach and specific community-based assistance to veterans and self
employed members of the Reserves and National Guard. The American
Legion also supports legislation that would permit the Office of
Veterans Business Development to enter into contracts, grants, and
cooperative agreements to further its outreach goals and develop a
nationwide community-based service delivery system specifically for
veterans and members of the Reserve Components.
The American Legion recommends $15 million in FY 2010 to implement
a nationwide community-based assistance program to veterans and self
employed members of the Reserves and National Guard.
Homeless Providers Grant and Per Diem Program Reauthorization
In 1992, VA was given authority to establish the Homeless Providers
Grant and Per Diem Program under the Homeless Veterans Comprehensive
Service Programs Act of 1992, P.L. 102-590. The Grant and Per Diem
Program is offered annually (as funding permits) by the VA to fund
community agencies providing service to homeless veterans.
VA can provide grants and per diem payments to help public and
nonprofit organizations establish and operate supportive housing and/or
service centers for homeless veterans. Funds are available for
assistance in the form of grants to provide transitional housing (up to
24 months) with supportive services, supportive services in a service
center facility for homeless veterans not in conjunction with
supportive housing; or to purchase vans.
The American Legion recommends $200 million for the Grant and Per
Diem Program for FY 2010.
CONCLUSION
Mr. Chairman and Members of the Committee, The American Legion is
impressed by President Obama's initial ``top line'' budget request.
Like the rest of America, The American Legion waits to see the details,
legislative initiatives and other specifics in the budget request he
has promised to provide in April. The American Legion and VA Secretary
Shinseki cannot over emphasize the importance of enactment of the
Military Construction, Veterans' Affairs and Related Agencies
Appropriations for FY 2010 before the start of the new fiscal year.
The American Legion would greatly appreciate support of this
Committee for advance appropriations for VA medical care in FY 2010 and
FY 2011 in the FY 2010 Budget Resolution and the Military Construction,
Veterans' Affairs and Related Agencies Appropriations for FY 2010.
Once again, The American Legion can support President Obama's top
line budget request; however, that support is contingent upon review of
his budget request released in April:
Increases funding for the Department of Veterans Affairs
by $25 billion above baseline over the next 5 years.
Dramatically increases funding for veterans health care.
Expands eligibility for veterans health care to over
500,000 veterans by 2013.
Enhances outreach and services related to mental health
care and cognitive injuries, including post-traumatic stress disorder
and traumatic brain injury, with a focus on access for veterans in
rural areas.
Invests in better technology to deliver services and
benefits to veterans with the quality and efficiency they deserve.
Provides greater benefits to veterans who are medically
retired from service.
Combats homelessness by safeguarding vulnerable veterans.
Facilitates timely implementation of the comprehensive
education benefits that veterans earn through their dedicated military
service.
The American Legion welcomes the opportunity to work with this
Committee and the Administration on the enactment of a timely,
predictable and sufficient budget for the Department of Veterans
Affairs.
Mr. Chairman, that concludes my testimony and The American Legion
would welcome any questions you or your colleagues may have.
______
The American Legion, National Commander's Testimony,
Statement of David K. Rehbein, National Commander,
The American Legion, Before a Joint Session of
The Veterans' Affairs Committees, U.S. Congress
On The Legislative Priorities of The American Legion
SEPTEMBER 11, 2008
INTRODUCTION
The American Legion's National Commander, David K. Rehbein to the House
and Senate Committees on Veterans' Affairs
Messrs. Chairmen and Members of the Committees:
As The American Legion's newly elected National Commander, I thank
you for this opportunity to present the views of its 2.7 million
members on issues under the jurisdiction of your Committees. At the
conclusion of The American Legion's 90th National Convention in
Phoenix, Arizona, delegates adopted 242 organizational resolutions,
with 212 having legislative intent. These mandates create the
legislative portfolio of The American Legion for the remainder of the
110th Congress as well as the upcoming 111th Congress.
As the summer of 2008 turns to fall, America is poised at a
critical point in history. In just over 2 months, voters will usher in
a new Administration and a new Congress. There is no incumbent, not
even an incumbent vice president, running for the Nation's highest
office.
America's leadership will change after the general election of
2008. But what cannot change is The American Legion's obligation to
ensure that the brave men and women who have worn the uniform of this
Nation are not forgotten. The war on terrorism--Operations Iraqi
Freedom (OIF) and Enduring Freedom (OEF)--has already generated nearly
one million discharged veterans, all of whom are guaranteed access to
health care through the Department of Veterans Affairs (VA) for the
first 5 years after their return home. Hundreds of thousands of OIF and
OEF veterans are now using their VA health care benefits, increasing
the workload of a health care system that was overburdened before the
war began. It is a sacred and time honored obligation of The American
Legion to make sure these veterans have the services they need and
timely access to the care they have earned and deserve.
By working together, The American Legion and the Members of both
the House and Senate Veterans Affairs Committees have made considerable
progress in recent years to meet that obligation. We have fought for
better funding for the VA health care system, and received it. We have
argued for greater attention to mental health services, including Post
Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury care, which
have become known as the ``signature wounds'' of the wars we are
fighting today. We have offered up American Legion services across the
Nation, to care for those who come home severely wounded, through our
Heroes to Hometowns program, and through our corps of expert service
officers. We have worked with Congress, the White House, states and
local communities--at every level--to ensure that our government,
particularly VA, has what it needs to provide quality health care,
disability compensation, rehabilitation and transitional programs to
all eligible veterans. We have made progress. But we are not there yet.
The backlog of VA benefits claims remains a source of continuous
frustration nationwide. And while new attention has been given to
mental health care for returning veterans, VA providers themselves say
they cannot keep up with it all. In some communities, it's a crisis.
Funds have been budgeted for new VA medical facilities that have been
in blueprints far too long. VA must undertake a new future, with a new
generation of war veterans with unique needs entering the system, while
at the same time honoring the service of--and caring for--those of past
wars and conflicts.
The American Legion applauds the 110th Congress for recommending FY
2008 funding allocations for many VA accounts that meet or exceed
funding targets proposed by The American Legion in testimony presented
earlier this year. We are also thankful for the hard work of both
chambers in passing a comprehensive and effective GI Bill that more
accurately reflects the sacrifices of America's servicemembers--Active
Duty, Guard and Reserve.
The process of providing adequate and compassionate services to our
veterans is, as we all know, continuous. We must stay on top of the
changes in health care, in technology, and foremost, among the veterans
we serve. With that in mind and on behalf of The American Legion, I
offer the following budget recommendations for the Department of
Veterans Affairs for FY 2010:
BUDGET PROPOSALS FOR SELECTED DISCRETIONARY PROGRAMS FOR DEPARTMENT OF
VETERANS AFFAIRS FOR FISCAL YEAR 2009
----------------------------------------------------------------------------------------------------------------
Appropriations The American
Program FY 2008 H.R. 6599 Committee S. Legion's FY 2010
3301 Recommendations
----------------------------------------------------------------------------------------------------------------
Medical Services + $29.1 billion $30.9 billion $35.6 billion
(see + note.)
----------------------------------------------------------------------------
Medical Administration + $3.5 billion $4.4 billion (see + note.) $42.8 billion
----------------------------------------------------------------------------------------------
Medical Facilities $4.1 billion $5 billion $5 billion (includes medical
and prosthetics
research)
----------------------------------------------------------------------------------------------
Medical Care Total $36.7 billion $40.3 billion $40.6 billion
----------------------------------------------------------------------------------------------------------------
Medical Care Recovery Fund ($2.4 billion) ($2.5 billion) ($2.5 billion) *
----------------------------------------------------------------------------------------------------------------
Medical and Prosthetic Research $480 million $500 million $527 million $532 million
----------------------------------------------------------------------------------------------------------------
Major Construction $1.1 billion $923 million $1.2 billion $1.8 billion
----------------------------------------------------------------------------------------------------------------
Minor Construction $630 million $991 million $729 million $1.5 billion
----------------------------------------------------------------------------------------------------------------
State Veterans Homes Grants $165 million $165 million $250 million $275 million
----------------------------------------------------------------------------------------------------------------
State Veterans Cemetery Grants $40 million $45 million $42 million $49 million
----------------------------------------------------------------------------------------------------------------
National Cemetery Administration $195 million $240 million $230 million $249 million
----------------------------------------------------------------------------------------------------------------
Information Technology $2 billion $2.5 billion $2.5 billion $2.7 billion
----------------------------------------------------------------------------------------------------------------
General Operating Expenses $1.6 billion $1.8 billion $1.8 billion $2.8 billion
----------------------------------------------------------------------------------------------------------------
* The American Legion continues to support using Medical Care Recovery Funds as supplements, not offsets to
discretionary VA funding.
+ Medical Services and Medical Administration accounts--VA's FY 2009 budget request proposed merging the Medical
Services account and the Medical Administration account. The Senate concurred with this recommendation for
consolidation. The House renamed the Medical Administration account the ``Medical Support and Compliance'',
but maintained it as a separate account.
VETERAN'S HEALTH CARE
A System Worth Saving
In 2002, The American Legion initiated the ``I Am Not A Number''
campaign to ascertain the quality and timeliness of health care
delivery within VA. This program surveyed veterans on their personal
experiences with the VA health care system and provided The American
Legion with a clear snapshot of the needs of VA systemwide. These
actual accounts of veterans' experiences highlighted a trend within VA;
veterans reported the quality of care was exceptional, but criticized
the difficulty of access to treatment.
During that time, then National Commander Ronald Conley conducted
site visits to 60 VA Medical Centers nationwide and compiled a report
highlighting the issues affecting VA, which was a result of years of
inadequate funding. This report, titled, ``A System Worth Saving,''
covered issues from Medical Care Collection Fund (MCCF) targets; wait
times; budgetary shortfalls; and staffing levels.
By 2004, The American Legion had conducted a full cycle of site
visits to VA Medical Centers (VAMC) throughout VA's 21 Veterans
Integrated Service Networks (VISN). In 2005, The American Legion
conducted site visits to selected VAMC's, with attention on the
progression of the Capital Asset Realignment for Enhanced Services
(CARES). Due to the initial lack of headway from the CARES initiative,
The American Legion was prompted to conduct site visits with additional
focus on various medical areas within the VA Medical Center system to
ascertain the level of progression. The focus included Polytrauma
Centers and Vet Centers, and Nursing Home Care Units/Community Living
Centers (NHCU/CLC) in 2006 and 2007. Although emphasis was placed on
the aforementioned areas, The American Legion continued to focus on the
overall progress of VA Medical Centers.
Since 2002, these comprehensive reports, created from the
compilation of site visit reports, have been presented to Congress and
shared with VA in an attempt to bring attention to the budgetary needs
of the VA health care system. This year marks the printing of the sixth
``A System Worth Saving'' report. The American Legion's 2008 ``A System
Worth Saving'' report, a compilation of information gathered from site
visits conducted by field service representatives and the System Worth
Saving Task Force members, focuses on Nursing Home Care Units/Community
Living Centers (NHCUs/CLCs) located within the VA Medical Center
System. Of the total 134 Nursing Home Care Units/Community Living
Centers, approximately 49 were selected. The reports highlighted key
issues in determining quality care, staffing levels, funding, physical
plant, as well as obstacles and challenges to providing quality care.
Although it has been 6 years since the initial visits, The American
Legion continues to have concerns of the effects of current budgets on
VA's ability to deliver quality care in a timely manner. America's
veterans are turning to VA for their health care needs and, as we
welcome home injured veterans, it is forever our responsibility as
advocates to work together to ensure VA is indeed capable of treating
all eligible veterans.
Budget Reform for Veterans' HealthCare
The annual discretionary appropriations in Fiscal Year (FY) 2007
and FY 2008 represented a dramatic improvement over years of consistent
budgetary shortfalls, but these funding levels were achieved only
through dynamic leadership in both chambers. However, even these two
outstanding appropriations did not follow the normal appropriations
process--one was achieved through a year-long continuing resolution
with significant markups for VA medical care and the second required
the President to declare a need for emergency appropriations for VA
medical care.
As the current generation of young Americans sequentially answer
the Nation's call to arms, and deploying and returning from around the
world, their more complex issues warrant the demand for additional
support and accommodations, to include assured funding, clinical
providers, nurses, and space. Many have survived combat wounds that
were fatal to servicemembers in past conflicts; this is due to modern
technology in the combat zones and hot spots around the world.
Like so many brave men and women who honorably served before them,
these new veterans are fighting for the freedom and security of us all.
Therefore, today's veterans deserve the respect of a grateful Nation
upon their return home. Generations of wartime veterans of the past
were unconditionally welcomed at VA medical facilities until the 1980s.
The American Legion believes the absence of appropriate urgent
changes in Federal health care funding will continue to add to the
strife that has plagued the VA, as well as the veterans it serves. New
veterans may soon discover their battles are not over; that is, if the
aforementioned doesn't come to past. Instead, the Nation's newest
heroes will inevitably fight for the life of the VA health care system,
as veterans in the 20th century fought for care they were eligible to
receive.
With the influx of those returning from Iraq and Afghanistan, the
demand for various clinical providers, nurses, space, and structural
peripherals are mounting. As each fiscal year comes, assured funding is
essential to proactively meet various challenges faced at VA medical
facilities. The American Legion believes the time for serious reform of
the Federal appropriations for veterans' health care that would provide
timely, predictable, and sufficient appropriations for VA medical care.
We hereby urge Congress to act now to ensure that we, as a nation, will
always provide the funding necessary to ensure the complete care for
those who seek timely access to quality health care through the VA
health care delivery system.
The American Legion believes the solution to the Veterans Health
Administration's (VHA's) recurring fiscal difficulties will only be
achieved through meaningful reform of the Federal appropriations
process as recommended by the President's Task Force to Improve Health
Care Delivery for our Nation's Veterans (in 2003). This Task Force
clearly identified the consistent mismatch between VA health care
funding and the growing demand for health care services.
The American Legion and eight other major veterans' and military
service organizations have joined forces to urge Congress to provide
annual Federal appropriations that are timely, predictable, and
sufficient. These three components are critical for effective long- and
short-range decisionmaking by VA management. The Partnership for
Veterans Health Care Budget Reform has supported legislation that would
make VA health care funding mandatory rather than discretionary. Under
this concept, VA health care funding would be formula-based, much like
other mandatory benefits like Medicare, Social Security, and VA
compensation and pension.
This concept has met a great deal of resistance by many lawmakers
on Capitol Hill; so The American Legion and its colleagues now
recommends an alternative to mandatory funding--advanced
appropriations. The American Legion believes this change would assure
timeliness and predictability. Under advanced appropriations, VA
medical care discretionary appropriations would be approved prior to
the start of the next fiscal year. Should The American Legion have
concern about the sufficiency of the advanced appropriations, it would
have an opportunity to address any shortfalls while testifying for the
remainder of the VA appropriations for that fiscal year.
The American Legion recommends reform of the Federal appropriation
process with regard to VA health care that would guarantee timely,
predictable, and sufficient annual appropriations.
MEDICAL CARE COLLECTIONS
The Balanced Budget Act 1997, Public Law (PL) 105-33, established
the VA Medical Care Collections Fund (MCCF), requiring amounts
collected or recovered from third-party payers after June 30, 1997, be
deposited into this fund. The MCCF is a depository for collections from
third-party insurance, outpatient prescription copayments and other
medical charges and user fees. Funds collected may only be used to
provide VA medical care and services, as well as VA expenses for
identification, billing, auditing and collection of amounts owed the
Federal Government.
The American Legion supported legislation to allow VA to bill,
collect, and reinvest third-party reimbursements and copayments;
however, The American Legion adamantly opposes the scoring of MCCF as
an offset to the annual discretionary appropriations since the majority
of these funds come from the treatment of non-service-connected medical
conditions. Previously, these collection goals have far exceeded VA's
ability to collect accounts receivable.
Since FY 2004, VHA's total collections increased from $1.7 billion
to $2.2 billion; a 29.4 percent-increase. The third-party component of
VA's collections also increased from $960,000 to $1.26 million; a 31.3
percent-increase.
VA's ability to capture these funds is critical to its ability to
provide quality and timely care to veterans. Miscalculations of VA
required funding levels result in real budgetary shortfalls. Seeking an
annual emergency supplemental is not the most cost-effective means of
funding the Nation's model health care delivery system. Government
Accountability Office (GAO) reports continue to raise the issue of
VHA's ability to capture insurance data in a timely and correct manner.
In addition, they continue to express concerns of VHA's ability to
maximize its third-party collections.
According to a 2008 GAO report, VA lacks policies and procedures
and a full range of standardized reports for effective management
oversight of VA-wide third-party billing and collection operations.
Further, although VA management has undertaken several initiatives to
enhance third-party revenue, many of these initiatives are open-ended
or will not be implemented for several years. Until these shortcomings
are addressed, VA will continue to fall short of its goal to maximize
third-party revenue, thereby placing a higher burden on taxpayers. In
addition, GAO recommended an improvement of third-party billings;
follow-up on unpaid amounts, and management oversight of billing and
collections.
The American Legion opposes offsetting annual VA discretionary
funding by the MCCF goal, especially since VA is prohibited from
collecting any third-party reimbursements from the Nation's largest
federally-mandated health insurer, Medicare.
MEDICARE
As do most American workers, veterans pay into the Medicare system,
without choice, throughout their working lives, including while on
active duty or as Reservists in the Armed Forces. A portion of each
earned dollar is allocated to the Medicare Trust Fund and, although
veterans must pay into the Medicare system, VA is prohibited from
collecting any Medicare reimbursements for the treatment of allowable,
non-service-connected medical conditions.
Since over half of VA's enrolled patient population is Medicare-
eligible, this prohibition constitutes a multi-billion dollar annual
subsidy to the Medicare Trust Fund.
The American Legion is opposed to the current policy on Medicare
reimbursement and supports Medicare reimbursement for VHA for the
treatment of allowable, non-service-connected medical conditions of
enrolled Medicare-eligible veterans.
VET CENTERS
The American Legion is proud to have been involved with the Vet
Center program since its inception in 1979. During the developmental
phase, some Vet Centers operated from local American Legion posts
during their search for permanent locations. They were designed to
provide services exclusively for veterans who served in theaters of
conflict, or those who experienced military sexual trauma.
Vet Centers are community-based and veterans are assessed the day
they seek services. In addition, they also provide mental health
counseling to those within the veteran's support system, such as
spouses and children. Recently, VA announced the addition of 39 Vet
Centers, increasing the total to 278. These facilities are mandated for
completion by the fall of 2009.
During The American Legion's 2007 site visits to Vet Centers, it
was acknowledged their overall challenge included limited staffing,
which was a result of occurring and anticipated influx of returning
Operations Enduring Freedom/Iraqi Freedom (OEF/OIF) veterans. Services
have also expanded to provide bereavement counseling to family members
of those who have died while fighting in support of OEF and OIF.
The American Legion continues to acknowledge the success of Vet
Centers and the quality services they provide to the Nation's veterans
and their families. The Vet Centers' distinctive locations, personnel,
and overall growing missions continue to stand beyond other programs
offered by VA.
Vet Centers also provide services in a non-clinical environment,
which may appeal to those who would be reluctant to seek mental health
care in a medical facility. A high percentage of the staff, more than
80 percent, are combat veterans and can relate to the readjustment
issues experienced by the those seeking services.
The most important aspect of Vet Centers is the provision of timely
accessibility. Since Vet Centers are community-based and veterans are
assessed within minutes of their arrival, eligible veterans are not
subjected to long wait times for disability claims decisions to
determine eligibility for enrollment, or long wait times for available
appointments.
Although Vet Centers have an extensive outreach plan, more outreach
is required to reach other groups of veterans who are unaware they are
eligible to use Vet Centers or those who may not be familiar with the
program in general. According to VA, many veterans learn of Vet Centers
by word-of-mouth; reaching veterans residing in rural areas continues
to be a challenge.
VA has recently recognized the importance of Vet Centers and the
current and potential services they are capable of rendering veterans
within their respective communities. The plan to open 39 additional Vet
Centers validates their acknowledgement and commitment to ensure
veterans receive access to all VA related services. The completion date
for the project is the fall of 2009. This plan will also call for more
funding to operate and lease space for the new Vet Centers.
As more servicemembers return from theater, the demand for more
services will be required. Upon completion of Vet Centers in 2009, The
American Legion urges VA to assess the surrounding areas to ensure the
amount of Centers is adequate to accommodate these new veterans.
The American Legion believes all Vet Centers should be fully
staffed with qualified providers to ensure combat veterans seeking care
for readjustment are afforded the same standard of quality care, no
matter which Vet Center they use.
TRAUMATIC BRAIN INJURY (TBI)
A recent GAO report acknowledged VA's challenge of facing a number
of clinical challenges in its efforts to screen OEF/OIF veterans for
mild TBI and evaluate those who screen positive on the TBI screening
tool, to include the absence of no objective diagnostic tests, such as
laboratory tests or neuroimaging tests like MRI and computed tomography
(CT) scans that can definitively and reliably identify mild TBI. Other
challenges include the similarity of many symptoms of mild TBI to
symptoms associated with other conditions, which makes a definitive
diagnosis of mild TBI more difficult to reach; OEF/OIF veterans with
mild TBI might not realize that they have an injury and should seek
health care.
According to the New England Journal of Medicine, the U.S. Army
surveyed approximately 2525 soldiers three to 4 months after their
return from a year-long deployment in Iraq. Of the 2525 soldiers, 124
reported injuries with loss of consciousness, 260 reported injuries
with altered mental status, and 435 reported other injuries during
deployment. In addition, those who reported loss of consciousness, 43.9
percent met criteria for post-traumatic stress disorder (PTSD), in
comparison to 27.3 percent who reported an altered mental status.
Soldiers with mild traumatic brain injury were more likely to
report poor health, missed workdays, medical visits, and a high number
of somatic and post concussive symptoms than were soldiers with other
injuries. On the other hand, after adjustment for PTSD and depression,
mild traumatic brain injury was no longer significantly associated with
these physical health outcomes or symptoms, except for headache.
The report's conclusion stated mild traumatic brain injury
occurring among soldiers deployed in Iraq is strongly associated with
PTSD and physical health problems three to 4 months after the soldiers'
return home while PTSD and depression are important mediators of the
relationship between mild TBI and physical health problems.
In a July 2006, VA's Office of Inspector General (OIG) issued a
report entitled ``Health Status of and Services for Operation Enduring
Freedom and Operation Iraqi Freedom Veterans after Traumatic Brain
Injury Rehabilitation.'' The VA's OIG examined VHA's ability to meet
the needs of OEF/OIF veterans who suffered from TBI. It reports that 52
patients from around the country--including Montana, Colorado, North
Dakota, and Washington--were interviewed at least 1 year after
completing inpatient rehabilitation from a Lead Center (Minneapolis,
MN; Palo Alto, CA; Richmond, VA; and Tampa, FL) that included those who
lived in rural states.
Many of the obstacles for TBI veterans and their family members
were similar. Some 48 percent of the patients indicated that there were
few resources in the community for brain injury-related problems.
Approximately 38 percent indicated that transportation was a major
obstacle. Another 17 percent indicated that they did not have money to
pay for medical, rehabilitation, and injury-related services.
Some of the challenges noted by family members who care for these
veterans in rural settings include the necessity for complicated
special arrangements and the absence of VA rehabilitative care in their
communities. Case managers working at Lead Centers and several
secondary centers noted limited ability to follow patients after
discharge to rural areas and lack of adequate transportation.
These limitations place undue hardship on the veterans' families as
well. Those contributing to the report, as well as veterans who have
contacted The American Legion, have shared many examples of the manner
in which family have been devastated by caring for TBI injured
veterans. They have sacrificed financially, have lost jobs that
provided the sole income for the family, and have endured extended
separations from children.
POLYTRAUMA CENTERS
To date, VHA has designated five VA Medical Centers as Polytrauma
Rehabilitation Centers (PRC). These Centers provide specialized care
for returning servicemembers and veterans who suffer from multiple and
severe injuries. They also provide specialized rehabilitation to help
injured servicemembers or veterans optimize the level of independence
and functionality they are capable of achieving.
The Polytrauma Centers are located in Minneapolis, MN; Palo Alto,
CA; Richmond, VA; San Antonio, TX; and Tampa, FL. Another unique aspect
of the Polytrauma Center includes the administration of care for TBI,
amputations, blindness and psychosocial/mental health issues in one
location.
In addition to the five designated sites, VA has established 17
Polytrauma Network Sites (PNS)--one in each Veterans Integrated
Services Network (VISNs); and approximately 75 Polytrauma Support
Clinic Teams to augment the care for those with multiple injuries.
During the ``System Worth Saving'' site visits to the PRC Centers,
many of them had vacancies for highly specialized rehabilitative fields
and nursing. The major challenge to filling vacancies included the
inability to offer competitive salaries. It is the declaration of The
American Legion that VA must be adequately staffed to maintain or
enhance services provided to veterans and servicemembers recovering
from multiple injuries.
ACCESS TO CARE FOR RURAL VETERANS
Research conducted by VA indicated veterans residing in rural areas
are in poorer health than their urban counterparts. It was further
reported that nationwide, one in five veterans who enrolled to receive
VA health care lives in rural areas. Providing quality health care in a
rural setting has proven to be very challenging, given factors such as
limited availability of skilled care providers and inadequate access to
care. Even more challenging will be VA's ability to provide treatment
and rehabilitation to rural veterans who suffer from the signature
ailments of the on-going Global War on Terror--traumatic blast injuries
and combat-related mental health conditions. VA's efforts need to be
especially focused on these issues.
A vital element of VA's transformation in the 1990s was the
creation of Community Based Outpatient Clinics (CBOCs) that proximate
access to VA primary care within veterans' communities. Recently, VA
scheduled the opening of 44 additional CBOCs in 21 states. The new
clinics will be fully activated by 2009, increasing VA's network of
independent and community-based clinics to 782. The American Legion
believes the clinics are warranted due to the growing population of
veterans within rural areas of the Nation. More veterans are also
migrating to less populated areas with an abundance of automobiles,
which are the primary catalysts that transport Improvised Explosive
Devises (IED's) in Iraq.
While VA has taken the right step with the addition of more CBOCs,
The American Legion believes more are warranted. There continues to be
great difficulty serving veterans in rural areas, such as Nebraska,
Nevada, Utah, South Dakota, Wyoming, and Montana where veterans face
extremely long drives, a shortage of health care providers, and bad
weather. VISNs rely heavily upon CBOCs to close the gap.
Many veterans continue to express concerns to The American Legion
about their limited financial resources prohibiting travel, citing the
rising cost of gas, the limitations of the mileage reimbursement rate,
and the need to pay for overnight accommodations as obstacles.
Providing contracted care in highly rural communities--when VA health
care services are not possible--would alleviate the unwarranted
hardships these veterans encounter when seeking access to VA health
care.
SEAMLESS TRANSITION
VA has an Office of Seamless Transition that is available to
participate in Department of Defense (DoD), National Guard and Reserves
Transition Assistance Programs (TAP) and Disabled Transition Assistance
Programs (DTAP). However, The American Legion remains concerned that
many servicemembers returning home from OEF/OIF duty are not being
properly advised of the benefits and services available to them from VA
and other Federal and state agencies. This is especially true of
Reserve and National Guard units that are demobilized at hometown
Reserve Centers and National Guard armories, rather than at active duty
demobilization centers.
Legionnaires at the state level have briefed Guard and Reserve
units on VA's benefits and services. Many transitioning servicemembers
were unaware of the existence of the Office of Seamless Transition and
did not know the office has staff available to provide briefings to
their respective units that had recently returned from or planned to
deploy in support of GWOT.
The American Legion asserts the importance of improved
communication between VA and Reserve and National Guard units to ensure
eligible Reservists are aware of all entitled VA benefits. In addition,
there must be a concerted, proactive effort on behalf of DoD and VA to
ensure every veteran is thoroughly screened and properly handed off
from the former to the latter. In a recent GAO site visit to DoD
medical facilities, it was discovered that health care providers were
unaware a medical record review was required and that medical records
were not consistently reviewed by providers conducting the pre-
deployment health assessment.
Health assessment mistakes or inconsistencies occurring when
veterans are active servicemembers will follow them to civilian life
and eventually be overlooked. When those mistakes and inconsistencies
become routine, the numbers increase, which will continually give birth
to veterans with issues that could have been previously alleviated
before entering the civilian community.
The American Legion believes a stern system of checks and balances
underlined with current and future plans and policies will ensure
ongoing communication and successful transition of the Nation's heroes
from DoD to VA.
THE AGING OF AMERICA'S VETERANS
VA's Long-Term Care Mission
Public Law (PL) 106-117, the Millennium Health Care and Benefits
Act, enacted in November 1999, required VA to continue to ensure 1998
levels of extended care services (defined as VA nursing home care, VA
domiciliary, VA home-based primary care, and VA adult day health care)
in its facilities. Yet, VA has not consistently maintained the 1998 bed
levels mandated by law.
VA's inability to adequately address the long-term care problem
facing the agency was most notable during the Capital Assets
Realignment for Enhanced Services (CARES) process and continues. The
planning for the long-term care mission, one of the major services VA
provides to veterans, was not addressed in the initial CARES
initiative, which is touted as the most comprehensive analysis of VA's
health care infrastructure ever conducted.
The American Legion met with the Office of Geriatrics and Extended
Care (GEC) in November 2007 to discuss this rapidly changing and
demanding source of unique health care and the newly implemented
Cultural Transformation of its 134 Nursing Home Care Units (NHCU).
Initially implemented in 2004, the conversion to the Cultural
Transformation plan seeks to overcome barriers to change; create a peer
support network; and link providers with long-term care leaders to
establish evidence for best practices and models of care.
In addition, VA has reiterated the Joint Commission on
Accreditation of Health care Organizations' (JACHO) Standard Ethics,
Rights and Responsibility, which states, ``Residents have a right to an
environment that preserves dignity and contributes to a positive self
image.'' This includes appropriate accommodations for sufficient space
with access to personal living space and a home-like atmosphere.
During The American Legion's 2008 site visits, which focused on VA
Nursing Home Care Units, Task Force members and Field Service
representatives discussed VA long-term care, as well as its support
systems and all it supports. In this round table and physical tour
engagement, The American Legion sought to ascertain that all was being
carried out as discussed during the 2004 implementation of the cultural
transformation. Challenges which continue to impede full operation
include: the three budgets split along with the separation of
Information Technologies (IT), Cultural Transformation, and being
understaffed.
The American Legion continues to state its support for the
publishing and implementation of a Long-Term Care (LTC) strategic plan
that addresses the rising long-term care needs of America's veterans.
We remain disappointed it has now been over 4 years since the CARES
decision and no plan has been published. We assert VA should take
proactive steps to provide the care mandated by Congress. Congress
should in turn do its part and provide adequate mandatory funding to VA
to implement its mandates.
The American Legion will continue to support current legislation
that will ensure appropriate payments for the cost of LTC provided to
veterans in State Veterans' Homes, stronger oversight of payments to
State Veterans' Homes, full reimbursement for the treatment of veterans
70 percent service-connected or higher, and the more efficient delivery
of pharmaceuticals.
It is vital that VA meet the LTC requirements of the Millennium
Health Care and Benefits Act; we urge your Committees to support
adequate funding for VA to meet the LTC needs of America's veterans.
State Extended Care Facility Construction Grants Program
Since 1984, nearly all planning for VA inpatient nursing home care
has revolved around State Veterans' Homes (SVHs) and contracts with
public and private nursing homes. The reason for this is obvious: for
FY 2004, VA paid a per diem of $59.48 for each veteran it placed in
SVHs, compared to the $354 VA claims it cost in FY 2002 to maintain a
veteran for 1 day in its own nursing home care units (NHCUs).
Under the provisions of title 38, United States Code (USC), VA is
authorized to make payments to states to assist in the construction and
maintenance of SVHs. Today, there are 133 SVHs in 47 states with over
27,000 beds providing nursing home, hospital, and domiciliary care.
Grants for Construction of State Extended Care Facilities provide
funding for 65 percent of the total cost of building new veterans'
homes. Recognizing the growing LTC needs of older veterans, it is
essential the State Veterans' Home Program be maintained as an
important alternative health care provider to the VA system.
The American Legion opposes attempts to place a moratorium on new
SVH construction grants. State authorizing legislation has been enacted
and state funds have been committed. Delaying projects will result in
cost overruns from increasing building materials costs and may result
in states deciding to cancel these much needed facilities.
The American Legion supports:
Increasing the amount of authorized per diem payments to
50 percent for nursing home and domiciliary care provided to veterans
in State Veterans' Homes;
Providing prescription drugs and over-the-counter
medications to State Homes Aid and Attendance patients along with the
payment of authorized per diem to State Veterans' Homes; and
Allowing for full reimbursement of nursing home care to
70 percent service-connected veterans or higher, if veterans reside in
a State Veterans' Home.
The American Legion recommends $275 million for the State Extended
Care Facility Construction Grants Program in FY 2010.
Medical and Nursing School Affiliations
VHA and its medical school affiliates continue to enjoy a
longstanding and exemplary relationship that has endured for virtually
60 years. This relationship continues to thrive and evolve to present
day. Currently, there are 129 accredited medical schools in the United
States. Of these, 107 have formal affiliation agreements with VA
Medical Centers (VAMCs). More than 30,000 medical residents and 22,000
medical students receive a portion of their medical training in VA
facilities annually. VA estimates that 70 percent of its physician
workforce has university appointments.
VHA conducts the largest coordinated education and training program
for health care professions in the Nation. The medical school
affiliations allow VA to train new health professionals to meet the
health care needs of veterans and the Nation. Medical school
affiliations have been a major factor in VA's ability to recruit and
retain high quality physicians. It also affords veterans access to the
some of the most advanced medical technology and cutting edge research.
VHA research continues to make meaningful contributions to improve the
quality of life for veterans and the general population.
VHA's recent and numerous recognitions as a leader in providing
safe, high-quality health care to the Nation's veterans can be directly
attributed to the relationship that has been fostered through the
affiliates. The American Legion remains committed to this mutually
beneficial affiliation between VHA and the medical schools of this
Nation. We also believe that medical school affiliates should be
appropriately represented as a stakeholder on any national task force,
commission, or Committee established to deliberate on veterans' health
care.
VA recently established a Nursing Academy to address the nationwide
nursing shortage issue. The Nursing Academy has embarked on a 5-year
pilot program that will establish partnerships with a total of 12
nursing schools. The initial set of partnerships implemented this year
included nursing schools in Florida, California, Utah and Connecticut.
This pilot program will train nurses to understand the health care
needs of veterans and make more nurses available to allow VA to
continue to provide veterans with the quality care they deserve.
Academic Year (AY) 2007-08 was the first of a multi-year expansion
in order to address the recommendations of the federally Chartered
External Advisory Committee on VHA Resident Education. The Advisory
Committee was charged with an examination of the philosophy and
deployment of VA's residency training positions.
The Committee acknowledged the critical role VA plays in provision
of high-quality graduate medical education (GME) and recommended VA
increase its proportional support of the national GME enterprise. With
2008 being the second year of expansion, the VA Office of Academic
Affiliations has developed three Requests for Proposals (RFPs) which
will create about 400 new, permanent resident positions nationwide in
AY 2009-2010. In addition to the GME Enhancement initiative, 698
physician resident positions were awarded to 72 facilities in 61
specialty training programs.
The American Legion affirms its strong commitment and support for
the mutually beneficial affiliations between VHA and the medical and
nursing schools of this Nation.
MEDICAL AND PROSTHETICS RESEARCH
The American Legion believes VA's focus in research should remain
on understanding and improving treatment for conditions that are unique
to veterans. servicemembers are surviving catastrophically disabling
blast injuries due to the superior armor they are wearing in the combat
theater and the timely access to quality triage. The unique injuries
sustained by the new generation of veterans clearly demand particular
attention. It has been reported that VA does not have state-of-the-art
prostheses like DoD, and that the fitting of the prostheses for women
has presented problems due to their smaller stature.
The American Legion supports adequate funding of other VA research
activities, including basic biomedical research and bench-to-bedside
projects for FY 2010. Congress and the Administration should continue
to encourage acceleration in the development and initiation of needed
research on conditions that significantly affect veterans--such as
prostate cancer, addictive disorders, trauma and wound healing, post-
traumatic stress disorder, rehabilitation, and others jointly with DoD,
the National Institutes of Health (NIH), other Federal agencies, and
academic institutions.
The American Legion recommends $532 million for Medical and
Prosthetics Research in FY 2010
ENVIRONMENTAL EXPOSURES
Agent Orange
One of the top priorities of The American Legion has been to ensure
that long overdue major epidemiological studies of Vietnam veterans who
were exposed to the herbicide Agent Orange are carried out. In the
early 1980s, Congress held hearings on the need for such
epidemiological studies. The Veterans' Health Programs Extension and
Improvement Act 1979, Public Law 96-151, directed VA to conduct a study
of long-term adverse health effects in veterans who served in Vietnam
as a result of exposure to herbicides. When VA was unable to do the
job, the responsibility was passed to the Centers for Disease Control
(CDC). In 1986, CDC also abandoned the project, asserting that a study
could not be conducted based on available records.
The American Legion did not give up. Three separate panels of the
National Academy of Sciences have agreed with The American Legion and
concluded that CDC was wrong and that epidemiological studies based on
DoD records are possible.
The Institute of Medicine (IOM) report, Characterizing Exposure of
Veterans to Agent Orange and Other Herbicides Used in Vietnam, is based
on the research conducted by a Columbia University team. Headed by
principal investigator Dr. Jeanne Mager Stellman, the team has
developed a powerful method for characterizing exposure to herbicides
in Vietnam. The American Legion is proud to have collaborated in this
research effort. In its final report on the study, the IOM urgently
recommends that epidemiological studies be undertaken now that an
accepted exposure methodology is available. The American Legion
strongly endorses this IOM report.
The IOM's most recent report on veterans' herbicide exposure in
Vietnam, Veterans and Agent Orange: Update 2006, released July 27,
2007,added two new illnesses to the category of ``limited or suggestive
evidence of association,'' AL amyloidosis and hypertension. This is a
profound finding since many Vietnam War veterans suffer from
hypertension.
The ``limited or suggestive'' evidence finding meets the threshold
of a positive association between the exposure of humans to a herbicide
agent and the occurrence of a disease in humans, as set forth in title
38, United States Code Sec. 1116, and has been used by VA to add other
conditions, including type 2 diabetes, to the list of herbicide
presumptive disabilities. Although the Secretary of Veterans Affairs,
in violation of specific reporting requirements set forth in Sec. 1116,
has yet to publish his official determination regarding this latest IOM
report in the Federal Register, The American Legion received a letter
from the Secretary on June 26, 2008, informing our organization that AL
amyloidosis is the only condition, based on the July 2007 IOM report,
that would be added to the list of disabilities presumed to be service-
connected due to herbicide exposure. The Secretary specifically stated
that he has ``determined that the evidence available at this time does
not warrant the establishment of a new presumption of service
connection based on service in Vietnam for any additional diseases
reviewed in the NAS report.''
Since, at of the time of this writing, the Secretary has not
published a notice of his determination in the Federal Register, which
will include an explanation of the scientific basis for that
determination; The American Legion is unable to comment on the
reasoning behind VA's decision not to recognize hypertension as
presumptively service-connected to herbicide exposure among Vietnam
veterans. Rest assured, we will carefully review the Secretary's
determination once it is published in the Federal Register and will
take appropriate action, including, but not limited to, seeking a
legislative remedy to correct this injustice.
The American Legion is extremely concerned about the timely
disclosure and release of all information by DoD on the use and testing
of herbicides in locations other than Vietnam during the war. Over the
years, The American Legion has represented veterans who claim to have
been exposed to herbicides in places other than Vietnam. Without
official acknowledgement by the Federal Government of the use of
herbicides, proving such exposure is virtually impossible. Information
has come to light in the last few years leaving no doubt that Agent
Orange, and other herbicides contaminated with dioxin, were released in
locations other than Vietnam. This information is slowly being
disclosed by DoD and provided to VA.
In April 2001, officials from DoD briefed VA on the use of Agent
Orange along the Korean demilitarized zone (DMZ) from April 1968
through July 1969. It was applied through hand spraying and by hand
distribution of pelletized herbicides to defoliate the fields of fire
between the frontline defensive positions and the south barrier fence.
The size of the treated area was a strip 151 miles long and up to 350
yards from the fence to north of the civilian control line. According
to available records, the effects of the spraying were sometimes
observed as far as 200 meters downwind. DoD identified the units that
were stationed along the DMZ during the period in which the spraying
took place. This information was given to VA's Compensation and Pension
Service, which provided it to all of the regional offices. VA Central
Office has instructed its Regional Offices to concede exposure for
veterans who served in the identified units during the period the
spraying took place.
In January 2003, DoD provided VA with an inventory of documents
containing brief descriptions of records of herbicides used at specific
times and locations outside of Vietnam. The information, unlike the
information on the Korean DMZ, does not contain units involved or
individual identifying information. Also, according to VA, this
information is incomplete, reflecting only 70 to 85 percent of
herbicide use, testing and disposal locations outside of Vietnam. VA
requested that DoD provide it with information regarding the units
involved with herbicide operations or other information that may be
useful to place veterans at sites where herbicide operations or testing
was conducted. Unfortunately, as of this date, additional information
has not been provided by DoD.
Obtaining the most accurate information available concerning
possible exposure is extremely important for the adjudication of
herbicide-related disability claims of veterans claiming exposure
outside of Vietnam. For herbicide-related disability claims, veterans
who served in Vietnam during the period of January 9, 1962 to May 7,
1975 are presumed by law to have been exposed to Agent Orange. Veterans
claiming exposure to herbicides outside of Vietnam are required to
submit proof of exposure. This is why it is crucial that all
information pertaining to herbicide use, testing, and disposal in
locations other than Vietnam be released to VA in a timely manner.
Congressional oversight is needed to ensure that additional information
identifying involved personnel or units for the locations already known
by VA is released by DoD, as well as all relevant information
pertaining to other locations that have yet to be identified. Locating
this information and providing it to VA must be a national priority.
The American Legion endorses this IOM report and strongly urges VA
to make a timely decision on its recommendations and provide
notification of the decision to add or not add to the presumptive list.
Gulf War Illness
In the Research Advisory Committee on Gulf War Veterans' Illness
(RACGWI) initial report released in November 2004, it was found that,
for a large majority of ill Gulf War veterans, their illnesses could
not be explained by stress or psychiatric illness and concluded that
current scientific evidence supports a probable link between neurotoxin
exposure and subsequent development of Gulf War veterans' illnesses.
Earlier government panels concluded that deployment-related stress, not
the numerous environmental and other exposures troops were exposed to
during the war, was likely responsible for the numerous unexplained
symptoms reported by thousands of Gulf War veterans.
Gulf War research is moving away from the previous stress theories
and is beginning to narrow down possible causes. However, research
regarding viable treatment options is still lacking. The American
Legion applauds Congress for having the foresight to provide funding to
the Southwestern Medical Center's Gulf War Illness research program.
The Center, headed by Dr. Robert Haley at the University of Texas
Southwestern, was awarded $15 million, renewable for 5 years, to
further the scientific knowledge on Gulf War Veterans Illnesses
research. This research will not only impact veterans of the 1991 Gulf
War, but may prove beneficial for those currently serving in the
Southwest Asia Theater and the Middle East. The purpose of the research
is to fill in the gaps of knowledge where there is little, yet
suggestive information. Dr. Haley's research will further this
knowledge about Gulf War veterans' illnesses and hopefully help improve
the lives of ill Gulf War veterans and their families who suffer beside
them. We owe ill Gulf War veterans our exhaustive efforts in finding
treatments for their ailments.
VA must continue to fund research projects consistent with the
recommendations of the Research Advisory Committee on Gulf War
Veterans' Illness (RACGWI). It is important that VA continues to focus
its research on finding medical treatments that will alleviate
veterans' suffering as well as on figuring out the causes of that
suffering. The American Legion also recommends that your Committees
thoroughly review the RACGWI's second report, which will be released
this fall.
Public Law 103-210, which authorized the Secretary of Veterans
Affairs to provide priority health care to the veterans of the Persian
Gulf War who have been exposed to toxic substances and environmental
hazards, allowed Gulf War Veterans--and veterans of the Vietnam War--to
enroll into Priority Group 6. The last sunset date for this authority
was December 31, 2002. Since this date, information provided to
veterans and VA hospitals has been conflicting. Some hospitals continue
to honor Priority Group 6 enrollment for ill Gulf War veterans seeking
care for their ailments. Other hospitals, well aware of the sunset
date, deny Priority Group 6 enrollment for these veterans and notify
them that they qualify for Priority Group 8. To these veterans' dismay,
they are completely denied enrollment because of VA's restricted
enrollment for Priority Group 8 since January 2003. Even more
confounding is the fact that eligibility information disseminated via
Internet and printed materials does not consistently reflect this
change in enrollment eligibility for Priority Group 6. VA has assured
The American Legion that this issue will be rectified.
Although these veterans can file claims for these ailments and
possibly gain access to the health care system once a disability
percentage rate is granted, those whose claims are denied cannot
enroll. According to the May 2007 version of VA's Gulf War Veterans
Information System (GWVIS), there were 14,874 claims processed for
undiagnosed illnesses. Of those undiagnosed illness claims processed,
11,136 claims were denied. Due to their nature, these illnesses are
difficult to understand and information about individual exposures may
not be available, many ill veterans are not able to present strong
claims. They are then forced to seek care from private physicians who
may not have enough information about Gulf War Veterans' illnesses to
provide appropriate care.
NOTE: VA also published another negative presumption determination
in the Federal Register on July 21, 2008--Joe, you might want to add
something about this report.
VA published its comments on the IOM's Gulf War and Health, Volume
2: Insecticides and Solvents report, released in February 2003 in the
Federal Register. The Department decided not to establish a presumption
of service connection for any diseases, illnesses or health effects
considered in the report, based on exposure to insecticides or solvents
during service in the Persian Gulf during the Persian Gulf War. Many of
VA's justifications for not establishing presumption mirror the reasons
why ill Gulf War veterans have problems justifying their claims. The
IOM report notes that little information is known about the use of
solvents in the theater.
VA notes that veterans may still be granted service connection, if
evidence indicates an association between their diseases and their
exposures. This places the burden of proof on Gulf War veterans to
prove their exposures and that the level of exposure is sufficient
enough to warrant service connection. IOM and VA have acknowledged that
there is insufficient information on the use of the identified solvents
and pesticides during the Gulf War.
VA states that PL105-277 does not explain the meaning of the
phrase, ``known or presumed to be associated with service in the Armed
forces in the Southwest Asia theater of operations during the Persian
Gulf War'' and that there is no legislative history explaining the
meaning of the phrase. VA has had adequate time to get Congress to
clarify the statute's intent and should have clarified the intent prior
to delivering a charge to the IOM for the report. VA's interpretation
is that Congress did not intend VA to establish presumptions for known
health effects of all substances common to military and civilian life,
but that it should focus on the unique exposure environment in the
Persian Gulf during the war. The IOM was commissioned to ascertain
long-term health effects of service in the Persian Gulf during the war,
based on exposures associated with service in theater during the war as
identified by Congress, not exposures unique to the Southwest Asia
Theater. The determination to not grant presumption for the ailments
identified should be based solely on the research findings, not on the
legitimacy of the exposures identified by Congress.
The IOM has a similar charge to address veterans who served in
Vietnam during the war. Herbicides were not unique to the operations in
the Southeast Asia theater of conflict and there had not been, until
recently, a definitive notion of the amounts of herbicides to which
servicemembers had been exposed. Peer-reviewed, occupational studies
are evaluated to make recommendations on which illnesses are associated
with exposure the herbicides--and their components known to be used in
theater. For ailments that demonstrate sufficient evidence of a causal
relationship, sufficient evidence of an association, and limited
evidence of an association, the Secretary may consider presumption.
Gulf War and Health Volume 2 identifies several illnesses in these
categories. However the Secretary determined that presumption is not
warranted
VA needs to clearly define what type of information is required to
determine possible health effects, for instance clarification of any
guidance or mandate for the research. VA also needs to ensure that its
charge to the IOM is specific enough to help it make determinations
about presumptive illnesses. VA noted that neither the report, nor the
studies considered for the report identified increased risk of disease
based on episodic exposures to insecticides or solvents and that the
report states no conclusion whether any of the diseases are associated
with ``less than chronic exposure,'' possibly indicating a lack of data
to make a determination. If this was necessary, it should have been
clearly identified.
Finally, section 1118, title 38, USC, mandates how the Secretary
should respond to the recommendations made in the IOM reports. The
Secretary is required to make a determination of whether or not a
presumption for service connection is warranted for each illness
covered in the report no later than 60 days after the date the report
is received. If the Secretary determines that presumption is not
warranted for any of the illnesses or conditions considered in the
report, a notice explaining scientific basis for the determination has
to be published in the Federal Register within 60 days after the
determination has been made. Gulf War and Health, Volume 2 was released
in 2003, 4 years ago. Since then, IOM has released several other
reports and VA has yet to publish its determination on those reports as
well.
The American Legion urges VA to provide clarity in the charge for
the IOM reports concerning what type of information is needed to make
determinations of presumption of service connection for illnesses that
may be associated with service in the Gulf during the war.
The American Legion urges VA to get clarification from Congress on
the intent of the phrase ``known or presumed to be associated with
service in the Armed forces in the Southwest Asia theater of operations
during the Persian Gulf War,'' get clarification from the IOM Committee
to fill in as many gaps of information as possible, and re-evaluate the
findings of the IOM report with the clarification provided.
The American Legion also urges Congress to provide oversight to
ensure VA provides timely responses to the recommendations made in the
IOM reports.
Atomic Veterans
Since the 1980s, claims by Atomic Veterans exposed to ionizing
radiation for a radiogenic disease, for conditions not among those
listed in section 1112(c)(2), title 38, USC, have required an
assessment to be made by the Defense Threat Reduction Agency (DTRA) as
to nature and amount of the veteran's radiation dosing. Under this
guideline, when dose estimates provided are reported as a range of
doses to which a veteran may have been exposed, exposure at the highest
level of the dose range is presumed. From a practical standpoint, VA
routinely denied the claims by many atomic veterans on the basis of
dose estimates indicating minimal or very low-level radiation exposure.
As a result of the court decision in National Association of
Radiation Survivors v. VA and studies by GAO and others of the U.S.'s
nuclear weapons test program, the accuracy and reliability of the
assumptions underlying DTRA's dose estimate procedures have come into
question. On May 8, 2003, the National Research Council's Committee to
Review the DTRA Dose Reconstruction Program released its report. It
confirmed the complaints of thousands of Atomic Veterans that DTRA's
dose estimates have often been based on arbitrary assumptions resulting
in underestimation of the actual radiation exposures. Based on a
sampling of DTRA cases, it was found that existing documentation of the
individual's dose reconstruction, in a large number of cases, was
unsatisfactory and evidence of any quality control was absent. The
Committee concluded their report with a number of recommendations that
would improve the dose reconstruction process of DTRA and VA's
adjudication of radiation claims.
The American Legion was encouraged by the mandate for a study of
the dose reconstruction program; nonetheless, we are concerned that the
dose reconstruction program may still not be able to provide the type
of information that is needed for Atomic Veterans to receive fair and
proper decisions from VA. Congress should not ignore the National
Research Council's findings and other reports that dose estimates
furnished VA by DTRA over the past 50 years have been flawed and have
prejudiced the adjudication of the claims of 1910s of thousands of
Atomic Veterans. It remains practically impossible for Atomic Veterans
or their survivors to effectively challenge a DTRA dose estimate.
It is not possible to accurately reconstruct the radiation dosages
to which these veterans were exposed. The process prolongs claims
decisions on ionizing radiation cases, ultimately delaying treatment
and compensation for veterans with fatal diseases.
The American Legion believes the dose reconstruction program should
not continue. We urge the enactment of legislation to eliminate this
provision in the claim of veterans with a recognized radiogenic disease
who was exposed to ionizing radiation during military service.
Mustard Gas Exposure
In March 2005, VA initiated a national outreach effort to locate
veterans exposed to mustard gas and Lewisite as participants in
chemical warfare testing programs while in the military. The purpose of
the testing programs was to evaluate the effectiveness of various types
of protective clothing, ointments and equipment that could be used to
protect American soldiers on the battlefield. Some participants were
exposed during full-body exposure wearing various degrees of protective
gear and some were tested by having a droplet of the agent applied to
their forearms. For this recent initiative, VA is targeting veterans
who have been newly identified by DoD for their participation in the
testing, most of which had participated in programs conducted during
WWII. DoD estimated 4,500 servicemembers had been exposed.
Since the most recent VA outreach effort was announced, The
American Legion has been contacted by veterans who contend that the
number of participants identified was understated by 1910s of
thousands, and that participation in these clandestine chemical
programs extended decades beyond the World War II era. Investigators
have not always maintained thorough records of the events; adverse
health effects were not always annotated in the servicemember's medical
records; and participants were warned not to speak of the program.
Without adequate documentation of their participation, participants may
not be able to prove their current ailments are related to the testing.
It is important DoD commits to investigating these claims as they
arise to determine if they have merit. It is also important VA commit
to locating those identified by DoD in a timely manner, as many of them
are WWII era veterans. Congressional oversight may be necessary to
ensure these veterans are granted the consideration they deserve.
BLINDED VETERANS
There are currently approximately 38,000 blind veterans enrolled in
the VA health care system. Additionally, demographic data suggests that
in the United States, there are over 160,000 veterans with low-vision
problems and eligible for Blind Rehabilitative services. Due to
staffing shortages, over 1,500 blind veterans will wait months to get
into one of the 10 blind rehabilitative centers.
VA currently employs approximately 164 Visual Impairment Service
Team (VIST) Coordinators to provide lifetime case management to all
legally blind veterans, and all Operation Enduring Freedom/Operation
Iraqi Freedom (OEF/OIF) patients and 38 Blind Rehabilitative Outpatient
Specialists (BROS) to provide services to patients who are unable to
travel to a blind center. The training provided by BROS is critical to
the continuum of care for blind veterans. DoD medical system is
dependent on VA to provide blind rehabilitative services.
Given the critical skills a BROS teaches to help blind veterans and
their families adjust to such a devastating injury, The American Legion
urges VA to recruit more specialists.
MEDICAL CONSTRUCTION AND INFRASTRUCTURE SUPPORT
Major Construction
The CARES process identified approximately 100 major construction
projects in throughout the VA Medical Center System, the District of
Columbia, and Puerto Rico. Construction projects are categorized as
major if the estimated cost is over $10 million. Now that VA has
disclosed the plan to deliver health care through 2022, Congress has
the sequential responsibility to provide adequate funds. The CARES plan
continually calls for the construction of new hospitals in Orlando and
Las Vegas, and replacement facilities in Louisville and Denver for a
total cost estimated to be well over $1 billion for these four
facilities.
VA has not had this type of progressive construction agenda in
decades. Major construction money can be significant and proper
utilization of funds must be well planned. However, if timely
completion is truly a national priority, The American Legion continues
to have concerns due to inadequate funding.
In addition to the cost of the proposed new facilities are many
construction issues that have been ``placed on hold'' for the past
several years due to inadequate funding, and the moratorium placed on
construction spending by the CARES process. One of the most glaring
shortfalls is the neglect of the buildings sorely in need of seismic
correction. This is an issue of safety. The delivery of health care in
unsafe buildings cannot be tolerated and funds must be allocated to not
only construct the new facilities, but also to pay for much needed
upgrades at existing facilities. Gambling with the lives of veterans,
their families and VA employees is absolutely unacceptable.
The American Legion believes VA has effectively shepherded the
CARES process to its current state by developing the blueprint for the
future delivery of VA health care--we hereby continue to urge Congress
act equally and adequately fund the implementation of this
comprehensive and crucial undertaking.
The American Legion recommends $1.8 billion for Major Construction
in FY 2010.
Minor Construction
VA's minor construction program has also suffered significant
neglect over the past several years. Maintaining the infrastructure of
VA's buildings is no small task. Due to the age of these building,
continuous renovations, relocations and expansions are quite common. A
slight hesitation in provision of funding leaves a profound impact, as
it has in recent years. When combined with the added cost of the CARES
program recommendations, it is easy to see that a major increase over
the previous funding level is crucial and overdue.
The American Legion recommends $1.5 billion for Minor Construction
in FY 2010.
INFORMATION TECHNOLOGY FUNDING
Since the data theft occurrence in May 2006, the VA has implemented
a complete overhaul of its Information Technology (IT) division
nationwide. Although not quite from its beginning stages, The American
Legion is hopeful VA takes the appropriate steps to strengthen its IT
security to renew the confidence and trust of veterans who depend on VA
for the benefits they have earned.
Within VA Medical Center Nursing Home Care Units, it was discovered
there was conflict with IT and each respective VAMC regarding provision
of Internet access to veteran residents. VA has acknowledged the
Internet would represent a positive tool in the veteran's
rehabilitation. The American Legion believes Internet access should be
provided to these veterans without delay, for time is of the essence in
the journey to recovery. In addition, veterans should not have to
suffer due to VA's gross negligence in the matter.
The American Legion hopes Congress will not attempt to fund the
solution to this problem with scarce fiscal resources allocated to the
VA for health care delivery. With this in mind, The American Legion is
encouraged by the fact that IT is its own line item in the budget
recommendation.
The American Legion believes there should be a complete review of
IT security government wide. VA isn't the only agency within the
government requiring an overhaul of its IT security protocol. The
American Legion urges Congress to exercise its oversight authority and
review each Federal agency to ensure that the personal information of
all Americans is secure.
The American Legion supports the centralization of VA's IT. The
quantity of work required to secure information managed by VA is
immense. The American Legion urges Congress to maintain close oversight
of VA's IT restructuring efforts and fund VA's IT to ensure the most
rapid implementation of all proposed security measures.
The American Legion recommends $2.7 billion for Information
Technology.
COMPENSATION AND PENSION
VETERANS BENEFITS ADMINISTRATION
VA has a statutory responsibility to ensure the welfare of the
Nation's veterans, their families, and survivors. Providing quality
decisions in a timely manner has been, and will continue to be one of
VA's most difficult challenges.
CLAIMS BACKLOG & STAFFING
In FY 2007, more than 2.8 million veterans received disability
compensation benefits. Providing quality decisions in a timely manner
has been, and will continue to be, one of the VA's most difficult
challenges. A majority of the claims processed by the Veterans Benefits
Administration's (VBA) 57 regional offices involve multiple issues that
are legally and medically complex and time consuming to adjudicate.
As of August 9, 2008, there were 618,314 claims pending in VBA,
394,201 of which are rating cases. There has been a steady increase in
VA's pending claim backlog since the end of FY 2004 when there were
321,458 rating cases pending. At the end of FY 2007, there were more
than 391,000 rating cases pending in the VBA system, up approximately
14,000 from FY 2006. Of these, more than 100,000 (25.7 percent) were
pending for more than 180 days. Including non-rating claims pending,
the total compensation and pension claims backlog was more than
627,000, with 26.5 percent of these claims pending more that 180 days.
There were also more than 164,000 appeals pending at VA regional
offices, with more than 142,000 requiring some type of further
adjudicative action. At the end of FY 2007, the average number of days
to complete a claim from date of receipt (182.5 days) was up 5.4 days
from FY 2006.
Inadequate staffing levels, inadequate continuing education, and
pressure to make quick decisions, resulting in an overall decrease in
quality of work, has been a consistent complaint among regional office
employees interviewed by The American Legion staff during regional
office quality checks. It is an extreme disservice to veterans, not to
mention unrealistic, to expect VA to continue to process an ever
increasing workload, while maintaining quality and timeliness, with the
current staff levels. The current wartime situation provides an
excellent opportunity for VA to actively seek out returning veterans
from OEF and OIF, especially those with service-connected disabilities,
for employment opportunities within VBA. Despite the recent hiring
initiatives, regional offices will clearly need more personnel given
current and projected future workload demands.
However, VBA must be required to provide better justification for
the resources it says are needed to carry out its mission and, in
particular, how it intends to improve the level of adjudicator
training, job competency, and quality assurance.
PRODUCTION VS. QUALITY
Since 1996, The American Legion, in conjunction with the National
Veterans Legal Services Program (NVLSP), has conducted quality review
site visits at more than 40 regional offices for the purpose of
assessing overall operation. This Quality Review Team visits a regional
office for a week and conducts informal interviews with both VA and
veterans service organization (VSO) staff. The Quality Review Team then
reviews a random sample of approximately 30-40 recently adjudicated
American Legion-represented claims. The Team finds errors in
approximately 20-30 percent of cases reviewed.
The most common errors include the following:
Inadequate claim development leading to premature
adjudication of claim;
Failure to consider reasonably inferred claims based on
evidence of record;
Rating based on inadequate VA examination; and/or
Under evaluation of disability (especially mental
conditions).
These errors are a direct reflection of VA's emphasis of quantity
over quality of work. This seems to validate The American Legion's
concerns that emphasis on production continues to be a driving force in
most VA regional offices, often taking priority over such things as
training and quality assurance. Clearly, this frequently results in
premature adjudications, improper denials of benefits and inconsistent
decisions
VETERANS' DISABILITY BENEFITS COMMISSION
In October 2007, after almost 2\1/2\ years of study, the Veterans'
Disability Benefits Commission (VDBC or Commission), released its
extensive report, Honoring the Call to Duty: Veterans' Disability
Benefits in the 21st century, to the President and Congress. Due to the
history surrounding the establishment of the Commission, The American
Legion and others in the VSO community feared that it would be used as
a tool to restrict veterans' benefits. In fact, key Members of Congress
and other Federal Government officials publicly expressed their desire
to use the VDBC as a vehicle to institute radical changes in the VA
disability system that would negatively impact and restrict entitlement
to benefits for a large number of veterans.
Concerned about the questionable history surrounding the creation
of the VDBC and the impact its recommendations would undoubtedly have
on VA's disability compensation program, American Legion staff closely
monitored the Commission's activities and provided written and oral
testimony, as well as other input, on several occasions. From the very
beginning, Commission Chairman Terry Scott assured the VSOs and others
that the Commission did not have a hidden agenda and its purpose was
not to cut or otherwise restrict veterans' benefits. During the course
of the Commission's 2\1/2\-year study The American Legion's concerns
diminished and our skepticism turned to optimism as the release of its
final report approached. Our approach, however, is still ``trust, but
verify.''
The American Legion appreciates the Commission's hard work and
commitment and we are generally pleased with its recommendations. As
the final report contains 113 recommendations, this statement will
focus, for the most part, on recommendations that will directly impact
the disability compensation system as well as those addressed as high
priority in the Executive Summary.
EXECUTIVE SUMMARY PRIORITY RECOMMENDATIONS
Recommendation 4-23 (Chapter 4, Section I.5)
VA should immediately begin to update the current Rating Schedule,
beginning with those body systems addressing the evaluation and rating
of post-traumatic stress disorder and other mental disorders and of
traumatic brain injury. Then proceed through the other body systems
until the Rating Schedule has been comprehensively revised. There
vision process should be completed within 5 years. VA should create a
system for keeping the Rating Schedule up to date, including a
published schedule for revising each system.
American Legion Position: Most major body systems in the rating
schedule have been updated over the last few years. The American Legion
supports the updating of conditions such as traumatic brain injury that
have not been recently updated. We wish to also note that the rating
schedule is not the major cause of problems with the VA disability
compensation process. VA problems such as inadequate staffing,
inadequate funding, ineffective quality assurance, premature
adjudications, and inadequate training still plague the VA regional
offices. The American Legion wants to emphasize that, in most cases, it
would be inappropriate to reduce the value of a disability as long as
our troops are in harm's way.
Recommendation 5-28 (Chapter 5, Section III.3)
VA should develop and implement new criteria specific to post-
traumatic stress disorder in the VA Schedule for Rating Disabilities.
VA should base those criteria on the Diagnostic and Statistical Manual
of Mental Disorders and should consider a multidimensional framework
for characterizing disability due to post-traumatic stress disorder.
American Legion Position: The rating schedule currently uses one
set of rating criteria for all mental disorders. There are unique
aspects of PTSD that are not properly evaluated by the current rating
criteria and it makes sense to develop rating criteria that address the
specific symptoms involved with PTSD.
Recommendation 5-30 (Chapter 5, Section III.3)
VA should establish a holistic approach that couples posttraumatic
stress disorder treatment, compensation and vocational assessment.
Reevaluation should occur every 2-3 years to gauge treatment
effectiveness and encourage wellness.
American Legion Position: While The American Legion supports a
holistic approach to the treatment and compensation of post-traumatic
stress disorder (PTSD) that encourages wellness, we are concerned that
a mandatory reevaluation every 2-3 years could result in undue stress
among PTSD service-connected veterans. They may be fearful that the
sole purpose of such reevaluation would be to reduce compensation
benefits. This perception could undermine the treatment process. We
would, therefore, encourage study and review of possible unintended
consequences regarding this portion of the Commission's recommendation.
Recommendation 6-14 (Chapter 6, Section IV.2)
Congress should eliminate the ban on concurrent receipt for all
military retirees and for all servicemembers who separated from the
military due to service-connected disabilities. In the future, priority
should be given to veterans who separated or retired from the military
under Chapter 61 with:
fewer than 20 years service and a service-connected
disability rating greater than 50 percent, or
disability as the result of combat.
American Legion Position: The American Legion strongly supports
full concurrent receipt and we are pleased with that portion of the
recommendation.
Recommendation 7-4 (Chapter 7, Section II.3)
Eligibility for Individual Unemployability should be consistently
based on the impact of an individual's service-connected disabilities,
in combination with education, employment history, and medical effects
of an individual's age or potential employability. VA should implement
a periodic and comprehensive evaluation of Individual Unemployability-
eligible veterans. Authorize a gradual reduction in compensation for
Individual Unemployability recipients who are eligible to return to
substantially gainful employment rather than abruptly terminating
disability payments at an arbitrary level of earning.
American Legion Position: Although The American Legion supports the
provision of this recommendation calling for the gradual reduction in
compensation benefits for Individual Unemployability (IU) recipients
who are able to return to substantially gainful employment, we strongly
oppose the portion of the recommendation that could be interpreted as
requiring the consideration of age in determining eligibility to IU. It
is inherently unfair to punish an older veteran who would not be able
to work at any age because of a service-connected condition while
awarding the benefit to a similarly disabled younger veteran. The
current rule states (in essence) that the impact of a service-connected
condition on a veteran cannot be evaluated to a higher degree because
the veteran is old; 38 C.F.R. Sec. 3.341(a). The schedule is based on
the average impairment in earning capacity. If the veteran cannot work
because of service-connected disability(s) then IU should be awarded.
Moreover, we have found that younger veterans have to overcome VA bias
when they apply for IU because VA raters think that younger people have
a better chance of going back to work. Thus, allowing age to be used as
a factor in determining eligibility for IU purposes may end up
adversely impacting both older and younger veterans.
Recommendation 7-5 (Chapter 7, Section II.3)
Recognizing that Individual Unemployability is an attempt to
accommodate individuals with multiple lesser ratings but who remain
unable to work, the Commission recommends that as the VA Schedule for
Rating Disabilities is revised, every effort should be made to
accommodate such individuals fairly within the basic rating system
without the need for an Individual Unemployability rating.
American Legion Position: The American Legion is extremely leery of
any recommendation that would encourage the elimination of a specific
benefit program on the anticipation of a revised rating schedule which
would supposedly eliminate the need for that benefit. The current
policy as enunciated by 38 CFR Sec. 3.340 states, ``[T]otal disability
will be considered to exist when there is present any impairment of
mind or body which is sufficient to render it impossible for the
average person to follow a substantially gainful occupation.'' This
policy is fair and consistent with the non-adversarial nature of the VA
claims process. Therefore, this policy should not be altered.
38 CFR Sec. 4.16b states:
(b) It is the established policy of the Department of Veterans
Affairs that all veterans who are unable to secure and follow a
substantially gainful occupation by reason of service-connected
disabilities shall be rated totally disabled.
The bottom line is that veterans who are unable to work due to
service-connected disability should be compensated at the 100 percent-
level, whether it be based on a scheduler evaluation (either single
service-connected disability or a combined scheduler evaluation) or
based on Individual Unemployability. This has been a longstanding VA
policy and we see no need to change it. See 38 CFR Sec. 3.340.
Recommendation 7-6 (Chapter 7, Section III.2)
Congress should increase the compensation rates up to 25 percent as
an interim and baseline future benefit for loss of quality of life,
pending development and implementation of quality of life measure in
the Rating Schedule. In particular, the measure should take into
account the quality of life and other non-work related effects of
severe disabilities on veterans and family members.
American Legion Position: The American Legion supports an increase
in compensation benefits to adequately account for a service-connected
disability's impact on a veteran's quality of life. Before any change
is made, however, we would like to carefully analyze how this would
impact special monthly compensation, which is based in part on loss of
quality of life.
Recommendation 7-8 (Chapter 7, Section III.2)
Congress should consider increasing special monthly compensation
(SMC), where appropriate, to address the more profound impact on
quality of life by disabilities subject to special monthly compensation
and review ancillary benefits to determine where additional benefits
could improve a disabled veteran's quality of life.
American Legion Position: The American Legion fully supports
increasing special monthly compensation to address profound impacts on
quality of life for disabilities subject to SMC as well as reviewing
ancillary benefits for the purpose of determining where additional
benefits could improve a disabled veteran's quality of life.
Recommendation 7-12 (Chapter 7, Section V.3)
VA and DoD should realign the disability evaluation process so that
the Services determine fitness for duty, and servicemembers who are
found unfit are referred to VA for disability rating. All conditions
that are identified as part of a single, comprehensive medical
examination should be rated and compensated.
American Legion Position: The American Legion has long been
concerned with low disability ratings issued by the military's
disability evaluation system and we fully support limiting the
military's role to determination of fitness while leaving the rating
process to VA. However, we do have concerns as to how this extra work
for the VA would be funded.
Recommendation 7-13 (Chapter 7, Section VI)
Congress should enact legislation that would bring the ancillary
and special purpose benefits to levels originally intended considering
cost of living and provide for annual adjustments to keep pace with the
cost of living.
American Legion Position: This recommendation is appropriate as
ancillary and special purpose benefits, as reflected in the VDBC's
report, have not been adjusted to keep pace with cost of living changes
resulting in the failure of the benefits to fulfill their intended
purposes.
Recommendation 8-2 (Chapter 8, Section III.1B)
Congress should eliminate the Survivor Benefit/Dependency and
Indemnity Compensation offset for survivors of retirees and in-service
deaths.
American Legion Position: The American Legion fully supports this
recommendation.
Recommendation 9-1 (Chapter 9, Section II.6.A.b)
Improve claims cycle time by:
Establishing a simplified and expedited process for well documented
claims, using best business practices and maximum feasible use of
information technology; and Implementing an expedited process by which
the claimant can state the claim information is complete and waive the
time period (60 days) allowed for further development.
Congress should mandate and provide appropriate resources to reduce
the VA claims backlog by 50 percent within 2 years.
American Legion Position: While we are fully supportive of
initiatives to expedite the claims process and reduce the claims
backlog, The American Legion, however, is not supportive of imposing
arbitrary deadlines to reduce the claims backlog because experience has
shown that such production driven efforts have a tendency to sacrifice
quality for quantity, resulting in more errors and, ultimately, an
increase in appeals. Additionally, while we support an expedited
process to grant benefits, compliance with statutory duties to assist
and notify must be fully complied with in claims in which benefits
would be denied. An immediate reduction in the backlog could be
accomplished by VA management encouraging VA raters to grant benefits
when there is sufficient evidence in the record rather than developing
the record to support a denial.
Recommendation 10-11 (Chapter 10, Section VII)
VA and DoD should expedite development and implementation of
compatible information systems including a detailed project management
plan that includes specific milestones and lead agency assignment.
American Legion Position: The American Legion supports this
recommendation.
Recommendation 11-1 (Chapter 11)
Congress should establish an oversight group to ensure timely and
effective implementation of the Commission's recommendations. This
group should be co chaired by VA and DoD and consist of senior
representatives from appropriate departments and agencies. It is
further recommended that the Veterans' Affairs Committees hold hearings
and require annual reports to measure and assess progress.
American Legion Position: The American Legion has no objections to
this recommendation. We do, however, urge that this recommendation be
amended to specifically address VSO participation in this oversight
process.
Other Recommendations
Recommendation 5-1 (Chapter 5, Section I.1)
Congress should change the character-of--discharge standard to
require that when an individual is discharged from his or her last
period of active service with a bad conduct or dishonorable discharge,
it bars all benefits.
American Legion Position: The American Legion strongly opposes this
recommendation. The Commission voted twice not to recommend a change to
the current 30-year old policy that allows eligibility for VA benefits
based on separate honorable periods of service. The VDBC finally
decided on this position after a third vote of 8-4. We are disappointed
in not only the recommendation, but also the nature in which the
Commission arrived at its decision.
As noted in the VDBC's report, it is clear from a review of the
legislative history that Congress intended to liberalize the overly
strict requirement of discharge under honorable conditions when it
enacted the current ``under conditions other than dishonorable''
standard in 1944. The current standard correctly and fairly
acknowledges that those who were discharged for relatively minor
offenses should not be barred from receiving veterans' benefits.
Congress' intent was also clear when it amended the law in 1977 to
allow an individual who was discharged under dishonorable conditions,
or conditions otherwise precluding basic eligibility, to receive VA
benefits based upon a separate period of service if VA determined that
the individual was discharged from the other period of service under
conditions other than dishonorable or would have been discharged under
conditions other than dishonorable if not for reenlistment.
Endorsing a change in the character of discharge standard where one
period of service under other than honorable conditions would negate
other periods of service that were under conditions other than
dishonorable is both unfair and in direct conflict with the intent of
Congress when it enacted the current Character of Discharge standards.
Recommendation 5-2 (Chapter 5, Section I.2.B)
Maintain the present definition of line of duty: that
servicemembers are on duty 24 hours a day, 7 days a week.
American Legion Position: The American Legion fully supports this
position and we are hopeful that the Commission's recommendation
regarding this issue will end further debate calling for a line of duty
(LOD) definition that only covers injuries, diseases, or deaths
incurred while performing military duties.
The intent of Congress regarding the LOD definition and the equal
treatment of all veterans, no matter how, when or where a service
related condition was incurred, is clearly expressed in the legislative
history and current statutory provisions. Previous recommendations to
limit the line of duty definition to only those disabilities that are a
direct result of performance of military duties have not been acted on
by Congress, despite large potential savings touted by the recommending
agencies. The American Legion believes that there are very good reasons
previous recommendations to limit or restrict the current LOD
definition have not been implemented. First, there is the basic
question of fairness. Limiting the line of duty definition to only
those disabilities, deaths and illnesses incurred while actually
performing one's military duties, despite the fact that an active duty
servicemember is considered, under the Uniform Code of Military Justice
(UCMJ), to be on duty 24/7 is inherently unfair and fundamentally
wrong. Additionally, the message such a change would send to current
servicemembers and prospective members would undoubtedly have a
negative impact on both recruitment and retention. Finally, the
additional administrative costs and other burdens resulting from a
change in the line of duty definition would offset any projected
savings.
Recommendation 5-3 (Chapter 4, Section I.2.B)
Benefits should be awarded at the same level according to the
severity of the disability, regardless of whether the injury was
incurred or disease was contracted during combat or training, wartime
or peacetime.
American Legion Position: The American Legion fully supports this
recommendation. An injury, disease or death is just as debilitating and
traumatic to an individual and his or her family no matter how the
condition was incurred or where the veteran was at the time it was
incurred. Making a distinction between combat and non-combat
disabilities is fundamentally wrong and demeaning to the honorable
service of all veterans. Moreover, implementing such a provision would
add another level of complexity to an already overburdened and complex
adjudication system.
Recommendation 5-4 (Chapter 5, Section I.3.B)
Maintain the current reasonable doubt standard.
American Legion Position: The reasonable doubt standard is the
hallmark of VA's non-adversarial disability compensation program and we
fully support this recommendation.
Recommendation 5-5 (Chapter 5, Section I.4B)
Age should not be a factor for rating service connection or
severity of disability, but may be a factor in setting compensation
rates.
American Legion Position: The American Legion does not support the
use of age for establishing entitlement to service connection or for
determining severity of disability, nor do we support using age as a
factor in setting compensation rates. Although we understand the
reasoning behind the Commission's recommendation calling for age to be
used as a factor in setting service-connected disability compensation
rates, The American Legion maintains that compensation rates should be
based on the severity of disability and should not be applied
differently based on the age of the veteran.
Recommendation 5-6 (Chapter 5, Section I.5B)
Maintain the current standard of an unlimited time limit for filing
an original claim for service connection.
American Legion Position: The American Legion fully supports this
recommendation. Although we recognize that it is prudent for veterans
to file service connection disability claims as soon as possible after
separating from service, and we strongly encourage such action whenever
possible, that option, for various reasons, is not always feasible.
Therefore, if sufficient evidence to establish entitlement to service
connection is submitted, the benefit sought should be awarded,
regardless of how long after service the claim was filed.
Recommendation 5-7 (Chapter 5, Section I.5B)
DoD should require a mandatory benefits briefing to all separating
military personnel, including Reserve and National Guard components,
prior to discharge from service.
American Legion Position: The American Legion fully supports this
recommendation. It is extremely important that separating members
receive sufficient information regarding all VA benefits to which they
may be entitled after separation from service.
Recommendations 5-11, 5-12 & 5-14 (Chapter 5, Section II.1)
Recommendation 5-11
The goal of the presumptive disability decisionmaking process
should be to ensure compensation for veterans whose diseases are caused
by military service and this goal must serve as the foundation for the
work of the Science Review Board. The Committee recommends that the
Science Review Board implement its proposed two-step process.
[IOMRec.4]
Recommendation 5-12
The Science Review Board should use the proposed four-level
classification scheme, as follows, in the first step of its evaluation.
A standard should be adopted for ``causal effect'' such that if there
is at least as much evidence in favor of the exposure having a causal
effect on the severity or frequency of a disease as there is evidence
against, then a service-connected presumption will be considered.
[IOMRec.5]
Sufficient: The evidence is sufficient to conclude that a
causal relationship exists.
Equipoise and Above: The evidence is sufficient to
conclude that a causal relationship is at least as likely as not, but
not sufficient to conclude that a causal relationship exits.
Below Equipoise: The evidence is not sufficient to
conclude that a causal relationship is at least as likely as not, or is
not sufficient to make a scientifically informed judgment.
Against: The evidence suggests the lack of a causal
relationship.
Recommendation 5-14
When the causal evidence is at Equipoise and Above, an estimate
also should be made of the size of the causal effect among those
exposed. [IOMRec.7]
American Legion Position: The American Legion does not support
these recommendations because the ``association'' standard currently
used in the presumption determination process is consistent with the
non-adversarial and liberal nature of the VA disability claims process.
Moreover, as is the case of the 1991 Gulf War, there is often a lack of
specific or reliable exposure data. Due to improper recordkeeping,
resulting in a lack of reliable exposure data, during Operations Desert
Shield/Storm, there is insufficient information to properly determine
servicemember exposure to the numerous environmental and other hazards
U.S. troops were exposed to in the Southwest Asia theater of operations
during the war. A lack of such data would clearly diminish the value
and reliability of a ``causation'' standard as recommended by the IOM.
It should also be noted that despite its recommendation, the Commission
stated that it was concerned that ``causation rather than association
may be too stringent'' and encouraged further study of the matter.
Recommendation 7-15 (Chapter 7, section VIII.2)
Lump sum payments should not be considered to compensate veterans
for their disabilities.
American Legion Position: The Commission thoroughly studied this
issue and we are hopeful that this recommendation will put an end to
future proposals in favor of lump sum payments.
FILIPINO VETERANS' BENEFITS
The American Legion fully supports the Filipino Veterans Equity Act
and has testified in support of this legislation on a number of
occasions for several years. The American Legion's objection rests with
how Congress plans to pay for larger bill that contains the Filipino
Equity Act provision. In order to meet its PAY GO obligations, Congress
plans to repeal the Hartness v. Nicholson decision. In fact, some
Filipino veterans may very well benefit from the Hartness v. Nicholson
decision; especially should the Filipino Veterans Equity Act become
law.
By repealing this decision, Congress would be denying one group of
veterans (elderly, disabled homebound) an earned benefit to give
another group of veterans (the Filipino veterans and others) benefits.
The American Legion believes it is wrong and sets an unacceptable
precedence.
There is nothing that would prevent Congress from next year,
repealing the Filipino Equity Act to use that money to pay for some
other group of veterans. Such a ``rob Peter to pay Paul'' scheme
clearly dishonors and disrespects all veterans involved. Even worse, it
pits veterans against veterans.
In Hartness v. Nicholson, a veteran appealed a May 5, 2004,
decision of the Board of Veterans' Appeals that denied housebound (HB)
benefits because VA determined that the veteran did not meet either of
the two alternative criteria for HB benefits:
he did not have a single disability rated 100 percent
disabling combined with substantial confinement to the home; and
he did not have entitlement under the alternative basis a
100 percent-disability rating with an additional independently ratable
60 percent-disability.
The Court of Appeals for Veterans Claims agreed held that a wartime
veteran may be awarded housebound benefits if, in addition to being 65
years old, he or she has been rated at least 60 percent disabling or is
considered permanently housebound. Section 1513, Title 38, USC,
currently benefits many wartime veterans from the ``Greatest
Generation'' and other veterans from subsequent conflicts.
The American Legion strongly supports the Filipino Veterans Equity
Act, but cannot support this proposed PAYGO funding stream. The
American Legion believes the sacrifice of these heroes warrants relief.
Balancing the books on the backs of the very patriots that protected
and defended this Nation is unconscionable. Congress must not make a
grave mistake in the name of fairness, equality, or even fiscal
responsibility.
We urge Congress to do what is right. It has other funding
options--not just the repeal of Hartness v. Nicholson:
waive the budget rules, which Congress has already done
to fund other bills; or
pass the Filipino Veterans Equity Act as part of an
emergency supplemental appropriations.
VETERANS MEMORIALS
National Cemetery Administration
The mission of The National Cemetery Administration (NCA) is to
honor veterans with final resting places in national shrines and with
lasting tributes that commemorate their service to this Nation. The
National Cemetery Administration's mission is to serve all veterans and
their families with the utmost dignity, respect, and compassion. Every
national cemetery should be a place that inspires visitors to
understand and appreciate the service and sacrifice of our Nation's
veterans.
The American Legion recognizes NCA's excellent record in providing
timely and dignified burials to all veterans who opt to be buried in a
national Cemetery. Equally noteworthy is NCA's fine record in providing
memorial headstones, markers and Presidential Memorial Certificates
(PMC) to all who request such benefits. We also recognize the hard work
that is required to restore and maintain National Cemeteries as
national shrines and applaud NCA for its commitment and success toward
that endeavor.
The American Legion looks forward to evaluation results and
recommendations that VA is currently conducting, and which is expected
to be available by the end of the 2008 calendar year. The evaluation
will cover program outcomes and policies including the ``75-mile
service area/170,000 veteran population'' threshold that currently
serves as the benchmark for establishing a new national cemetery. The
American Legion is pleased that driving (commuting) times will also be
considered in this evaluation. Inner-city traffic can significantly
increase travel times to distant cemeteries. Driving time needs to be
factored in when trying to determine if the veteran population is being
served effectively.
National Cemetery Expansion
The requested overall budget for 2009 is $425 million, of which
$181 million and 1,603 full time equivalents (FTE) were requested for
Operations and Maintenance, and $83.4 million for cemetery expansion
and improvement. According to NCA's own estimates in the President's
budget request for FY 2009, which is also warranted by the opening of
new national cemeteries, annual interments will increase to 111,000, a
10 percent rise from FY 2007. Interments in FY 2013 are expected to be
about 109,000, a 9 percent-increase from FY 2007. The total number of
graves maintained is also expected to increase during the planning
timeframe from almost 2.8 million in FY 2007 to over 3.3 million in FY
2013.
NCA has only requested 6 additional FTEs to maintain its current
125 cemeteries and 30 FTEs to prepare for the activation of interment
operations of six new national cemeteries as directed by the National
Cemetery Expansion Act of 2003, Public Law 108-109. NCA has to complete
fast track parcels as part of Phase I construction of the new
cemeteries in the following areas: Bakersfield, CA; Birmingham, AL;
Columbia-Greenville, SC; Jacksonville, FL; Southeastern PA; and
Sarasota County, FL. Full Phase I operations are underway in each
cemetery now.
Since it takes approximately 20 to 30 FTEs to run a national
cemetery (depending on the size and workload); and whereas it takes 8
to 10 FTEs to run a newly opened cemetery (cemeteries are opened to
interments long before completion of the full site) it seems reasonable
to believe that at least 50 new employees would be needed to operate
the 6 new cemeteries that NCA plans to bring online in FY 2008. It is
likely that they will need the full 20 to 30 by FY 2009. The average
employee salary with benefits is $67,000.
The American Legion recommends that moneys for additional employees
also be included in the FY 2010 budget.
National Shrine Commitment
Maintaining cemeteries as national shrines is one of NCA's top
priorities. This commitment involves raising, realigning and cleaning
headstones and markers to renovate gravesites. Adequate funding is the
key to maintaining this very important commitment. The American Legion
supported NCA's goal of completing the National Shrine Commitment
within 5 years. VA assessed burial sections, roadways, buildings, and
historic structures and identified 928 potential improvement projects
at an estimated cost of $280 million. With the addition of six new
national cemeteries, of which five are included to be fast tracked
between late 2008 and early 2009, and the opening of the sixth in mid-
2009, resources will be strained. The American Legion recommends that
$60 million be put toward the National Shrine Commitment in order to
fulfill this commitment.
The American Legion recommends $249 million for the National
Cemetery Administration in FY 2010.
State Cemetery Construction Grants Program
VA's State Cemetery Grants Program complements VA's 126 national
cemeteries across the country. The program helps states establish,
expand or improve state veterans' cemeteries. To date, the VA program
has helped establish 66 veterans' cemeteries in 35 states, Saipan and
Guam, which provided more than 22,000 burials in FY 2006. Since the
program began in 1980, VA has awarded 156 grants totaling nearly $286
million.
NCA received $32 million for the current fiscal year to be used to
establish six new cemeteries (Abilene, TX; Des Moines, IA; Glennville,
GA; Fort Stanton, NM; Missoula, MT; and Williamstown, KY) and to expand
four others (Cheltenham, MD; Crownsville, MD; Jacksonville, NC; and
Kona Coast, HI). Determining an ``average cost'' to build a new state
cemetery or to expand an existing one is very difficult. Many factors
influence cost, such as location, size and the availability of public
utilities.
The American Legion believes states will increasingly use the State
Cemetery Grants Program to fill the needs of veteran populations that
are still not well served by the ``75-mile service area/170,000 veteran
population'' threshold that currently serves as the benchmark for
establishing a new national cemetery. New state cemeteries, and
expansions and improvements of existing cemeteries are therefore likely
to increase. With increasing costs, especially the high costs of land
in urban areas, and increased demand, The American Legion suggests that
the amount of money for the State Cemetery Grants Program be
substantially increased.
The American Legion recommends $49 million for the State Cemetery
Grants Program in FY 2010.
NATIONAL ECONOMIC COMMISSION
STATE APPROVING AGENCIES
The American Legion is deeply concerned with the timely manner that
veterans, especially returning wartime veterans, receive their
education benefits. Annually, approximately 300,000 servicemembers
(90,000 of them belonging to the National Guard and Reserve) return to
the civilian sector and use their earned education benefits from the
VA. Any delay in receipt of education benefits or approval of courses
taken at institutions of higher learning can adversely affect a
veteran's life.
S. 22, the Post-9/11 Veterans Education Assistance Act of 2008 is a
new benefit providing educational assistance to individuals who served
on active duty on or after September 11, 2001. This New GI Bill will be
fully implemented by August 2009. The American Legion strongly
supported the enhancements to the Montgomery GI Bill and is grateful
that the House and Senate passed this bill. The President in turn
signed this vital piece of legislation on June 30, 2008. This New GI
Bill is well deserved for the men and women who have protected,
sacrificed, and served our country honorably.
The American Legion will continue to believe and support every
effort to ensure that the GI Bill and related veterans' education
benefits are delivered without problems or delays. Furthermore,
veterans are unique, in that they volunteer for military service;
therefore, these educational benefits are earned as the thanks of a
grateful Nation. The American Legion believes it is a national
obligation to provide timely oversight of veterans' education programs
to assure they are administered in a timely, efficient, and accurate
manner.
GAO report entitled ``VA Student Financial Aid; Management Actions
Needed to Reduce Overlap in Approving Education and Training Programs
and to Assess State Approving Agencies'' (GAO-07-384) focuses on the
need to ``ensure that Federal dollars are spent efficiently and
effectively.''
GAO recommends that VA should require State Approving Agencies
(SAAs) to track and report data on resources spent on approval
activities, such as site visits, catalog review, and outreach in a
cost-efficient manner. The American Legion agrees. Additionally, GAO
recommended that VA establish outcome-oriented performance measures to
assess the effectiveness of SAAs efforts. The American Legion fully
agrees. In response, VA Deputy Secretary Mansfield plans to establish a
working group with SAAs to create a reporting system for approval
activities and develop outcome-oriented measures with a goal of
implementation in the FY 2008 budget cycle.
Finally, GAO recommended that VA should collaborate with other
agencies to identify any duplicate efforts and use the agency's
administrative and regulatory authority to streamline the approval
process. The American Legion agrees. VA Deputy Secretary Mansfield
responded that VA would initiate contact with appropriate officials at
the Departments of Education and Labor to help identify any duplicate
efforts.
Section 301 of PL 107-330 created increases in the aggregate annual
amount available for state approving agencies for administrative
expenses from FY 2003-FY 2007 to the current funding level of $19
million. The American Legion fully supports reauthorization of SAAs
funding.
The American Legion strongly recommends SAAs funding at $19 million
to assure current staffing and activities in FY 2010.
VOCATIONAL REHABILITATION AND EMPLOYMENT SERVICE (VR&E)
The mission of the VR&E program is to help qualified, service-
disabled veterans achieve independence in daily living and, to the
maximum extent feasible, obtain and maintain suitable employment. The
American Legion fully supports these goals. As a nation at war, there
continues to be an increasing need for VR&E services to assist
Operations Iraqi Freedom and Enduring Freedom veterans in reintegrating
into independent living, achieving the highest possible quality of
life, and securing meaningful employment. To meet America's obligation
to these specific veterans, VA leadership must focus on marked
improvements in case management, vocational counseling, and--most
importantly--job placement.
The success of the rehabilitation of our severely disabled veterans
is determined by the coordinated efforts of every Federal agency
involved in the seamless transition from the battlefield to the
civilian workplace. Timely access to quality health care services,
favorable physical rehabilitation, vocational training, and job
placement play a critical role in the ``seamless transition'' of each
veteran, as well as his or her family.
Administration of VR&E and its programs is a responsibility of the
VBA. Providing effective employment programs through VR&E must become a
priority. Until recently, VR&E's primary focus has been providing
veterans with skills training, rather than providing assistance in
obtaining meaningful employment. Clearly, any employability plan that
doesn't achieve the ultimate objective--a job--is falling short of
actually helping those veterans seeking assistance in transitioning
into the civilian workforce.
Vocational counseling also plays a vital role in identifying
barriers to employment and matching veterans' transferable job skills
with those career opportunities available for fully qualified
candidates. Becoming fully qualified becomes the next logical objective
toward successful transition. It is our observations from talking to
veterans, counselors, Disabled Veteran Outreach Program Specialists
(DVOPs) and Local Veteran Employment Representatives (LVERs) that it
would be beneficial if VR&E counselors take on an additional duty of
finding or assisting in employment of veterans. Because these
counselors deal directly with veterans on a full time basis, as opposed
to DVOPs and LVERs on a part time basis, they are more devoted and
specialized in their approach to an individual veteran. These
counselors may have input into the employability of a service-connected
veteran, but The American Legion asserts that the VA must rely on an
expert medical opinion from a qualified, competent physician to
determine unemployability.
We appreciate the significance of a vocational assessment in
establishing entitlement to total disability ratings for compensation
based on unemployability of the individual (TDIU) and we welcome the
participation of a vocational or rehabilitation specialist in this
process. However, a medical opinion is still extremely important in
determining unemployability and must be given proper consideration and
weight.
INTERAGENCY COOPERATION BETWEEN DOL-VETS AND VA
It is our experience that the interagency collaboration and
communication between the VR&E program, and the Department of Labor
(DOL) Veterans Employment and Training Service (VETS) is lacking.
In recent years, many states did not refer veterans from the VR&E
program to VETS for assistance in obtaining employment. Veterans with
high-tech skills and advanced education were referred to expensive
commercial placement agencies that do not specialize in employment
assistance for veterans, and difficult to place veterans were sent to
VETS. Therefore, to assist in the correction of these deficiencies a
memorandum of understanding between VA and DOL was developed and signed
in October 2005 stating that each agency would work for the smooth
transition of veterans to the civilian workforce. This agreement is
authorized in accordance with section 4102A (b) (3), title 38, U.S.C.
In discussions with numerous VETS representatives across the
country, The American Legion is hearing a variety of opinions on the
current implementation process and progress of the MOU. Some states
report a total lack of communication and information sharing while
other states already enjoy a strong relationship between the local VETS
and VR&E Offices.
A majority of VETS representatives contacted spoke of a markedly
improved level of communication between the two agencies, along with
other positive developments such as improvement in local data sharing
and combined training on the local and national levels. In addition,
national representatives from the two agencies are currently reporting
a close and cooperative relationship, and the expectation is that this
relationship will continue to improve over time.
In some states, however, it has been reported that the signing of
the MOU has not led to an improvement in cooperation between the two
agencies. Some problems cited were a difference in the perceptions of
the primary mission, differing education levels of VA case managers and
the DVOPs and LVERs, and the unenforceable mandate for the two agencies
to communicate and cooperate on a local level. The DVOPs and LVERs are
controlled by each individual state and have their own requirements,
making a state and Federal program difficult to synchronize.
Concerns such as education levels of VA's case managers and DOL
DVOPs and LVERs (case managers from the VA generally have BA or MA
degrees while the DVOPs and LVERs require only a high school
education), job philosophies, and performance standards are cited as
problems that affect the delivery of employment and rehab services to
veterans.
While poor coordination between VR&E counselors and their VETS
counterparts has contributed to the shortfalls of the VR&E program, a
number of states have begun to improve communications. The outlook is
not completely negative. A majority of VETS representatives have
commended their VR&E counterparts for their willingness to ensure the
successful implementation of the joint MOU that is designed to improve
rehabilitation, training and employment outcomes for disabled veterans.
The American Legion recommends exploring possible training programs
geared specifically for VR&E Counselors through the National Veterans
Training Institute (NVTI). Contracting for standardized or specialized
training for VR&E employees could very well strengthen and improve
overall program performance. NVTI serves as a valuable resource for
VETS employment specialists and has contributed to a marked improvement
in VETS performance.
Veterans' preference should play a large role in job placement
The Federal Government has scores of employment opportunities that
educated, well-trained, and motivated veterans can fill given a fair
and equitable chance to compete. Working together, all Federal agencies
should identify those vocational fields, especially those with high
turnover rates, suitable for VR&E applicants. Career fields like
information technology, claims adjudications, and debt collection offer
employment opportunities and challenges for career-oriented applicants
that also create career opportunities outside the Federal Government.
There are three ways veterans can be appointed to jobs in the
competitive civil service: by competitive appointment through an OPM
list of eligibles (or agency equivalent); by noncompetitive appointment
under special authorities that provide for conversion to the
competitive service; or, by Merit Promotion selection under the
Veterans Employment Opportunities Act (VEOA).
Provide military occupational skills and experience translation for
civilian employment counseling
The American Legion notes that due to the current demands of the
military, greater emphasis on the Reserve component of the Armed Forces
created employment hardships for many Reservists. The American Legion
supports amending Section 4101(5), title 38, USC, to add Subsection (D)
to the list of ``Eligible Persons'' for Job Counseling, Training, and
Placement Service for Veterans, to include members in good standing of
Active Reserve and Guard Units of the Armed Forces of the United States
who have completed basic and advanced Duty for Training (ACDUTRA) and
have been awarded a Military Occupation Specialty.
DoD provides some of the best vocational training in the Nation for
its military personnel and establishes measures and evaluates
performance standards for every occupation with the armed forces. There
are many occupational career fields in the armed forces that can easily
translate to a civilian counterpart. Many occupations in the civilian
workforce require a license or certification. In the Armed Forces,
these unique occupations are performed to approved military standards
that may meet or exceed the civilian license or certification criteria.
Upon separation, many former military personnel, certified as
proficient in their military occupational career, are not licensed or
certified to perform the comparable job in the civilian workforce, thus
hindering chances for immediate civilian employment and delaying career
advancement. This situation creates an artificial barrier to employment
upon separation from military service.
A study by the Presidential Commission on servicemembers' and
Veterans' Transition Assistance identified a total of 105 military
professions where civilian credentialing is required. The most easily
identifiable job is that of a Commercial Truck Driver in which there is
a drastic shortage of qualified drivers. Thousands of veterans must
venture through each state's laws instead of a single national test or
transfer of credentials from the military. We have testified alongside
members of the trucking industry to the U.S. House of Veterans' Affairs
Subcommittee on Economic Opportunity for the need for accelerated MGIB
payments for these courses and other matters.
The American Legion supports efforts to eliminate employment
barriers that impede the transfer of military job skills to the
civilian labor market, and supports efforts to DoD take appropriate
steps to ensure that servicemembers be trained, tested, evaluated and
issued any licensure or certification that may be required in the
civilian workforce. The American Legion supports efforts to increase
the civilian labor market's acceptance of the occupational training
provided by the military.
DEPARTMENT OF LABOR VETERANS EMPLOYMENT AND TRAINING SERVICE (DOL-VETS)
The American Legion's position regarding VETS programs is that this
is and should remain a national program with Federal oversight and
accountability. The American Legion is eager to see this program grow
and especially would like to see greater expansion of entrepreneurial
based, self-employment opportunity training. The mission of VETS is to
promote the economic security of America's veterans. This stated
mission is executed by assisting veterans in finding meaningful
employment. The American Legion believes that by strengthening American
veterans, we in turn strengthen America. Annually, DoD discharges
approximately 300,000 servicemembers. Recently separated service
personnel will seek immediate employment or increasingly have chosen
some form of self-employment. In order for the VETS program to assist
these veterans to achieve their goals, it needs to:
Improve by expanding its outreach efforts with creative
initiatives designed to improve employment and training services for
veterans;
Provide employers with a labor pool of quality applicants
with marketable and transferable job skills;
Provide information on identifying military occupations
that require licenses, certificates or other credentials at the local,
state, or national levels;
Eliminate barriers to recently separated service
personnel and assist in the transition from military service to the
civilian labor market;
Strive to be a proactive agent between the business and
veterans' communities in order to provide greater employment
opportunities for veterans; and
Increase training opportunities, support and options for
veterans who seek self-employment and entrepreneurial careers.
The American Legion believes staffing levels for DVOPs and LVERs
should match the needs of the veterans' community in each state and not
be based solely on the fiscal needs of the state government. Such
services will continue to be crucial as today's active duty
servicemembers, especially those returning from combat in Iraq and
Afghanistan, transition into the civilian world. Education, vocational
and entrepreneurial training and employment opportunities will enable
these veterans to succeed in their future endeavors. Adequate funding
will allow the programs to increase staffing to provide comprehensive
case management job assistance to disabled and other eligible veterans.
Section 4103A, title 38 USC requires that all DVOP specialists
shall be qualified veterans and preference be given to qualified
disabled veterans in appointment to DVOP specialist positions. section
4104(a)(4), title 38 USC states:
``[I]n the appointment of local veterans' employment
representatives on or after July 1, 1988, preference shall be
given to qualified eligible veterans or eligible persons.
Preference shall be accorded first to qualified service-
connected disabled veterans; then, if no such disabled veteran
is available, to qualified eligible veterans; and, if no such
eligible veteran is available, then to qualified eligible
persons.''
The American Legion believes that the military experience is
essential to understanding the unique needs of the veteran and that all
LVERs, as well as all DVOPs, should be veterans and should be
additionally educated to be able to address the needs of veterans who
desire entrepreneurial support.
The American Legion also supports legislation that will restore
language to Chapter 41, title 38, USC, that require that half time
DVOP/LVER positions be assigned only after approval of the DVET, and
that the Secretary of Labor would be required to monitor all career
centers that have veterans on staff assigned. PL 107-288 has eliminated
the requirement that DOL/VETS review all workforce centers annually and
this has minimized Federal oversight of the programs since the ASVET
has drastically cut funds allocated for this activity and established a
policy that only 10 percent of the centers operated under title 38,
USC, will be reviewed, and PL 107-288 has removed the job descriptions
of the DVOPs and LVERs from Title 38, USC, and given the states the
ability to establish the duties and responsibilities, thus weakening
the VETS program across the country by eliminating the language that
required these staff positions provide services only to veterans.
Veterans returning from Afghanistan, Iraq and other tours of duty
are not always coming back to a hero's welcome--at least from
employers. The jobless rate for veterans between ages 18 to 24 was 12
percent in 2007, almost three times the national unemployment rate of
4.6 percent. Numerous national publications have reported veterans are
having a more difficult time finding jobs than non-veterans. According
to a recent national survey, one in five veterans said finding a job
took 6 months or longer; one in 10 said it took more than a year. The
employment market is tougher for young veterans. This is a major key
reason why the funding for the VETS program is so critical.
Veterans need proper training and tools to begin new careers after
they leave military service. The VWIP account has only received $7.3
million in annual funding, which has allowed the program to operate in
only 11 states. This is absolutely unacceptable. There are thousands of
veterans available for work, but they lack marketable, technological
skills, especially for those jobs that exist in the Information Age
economy. The problem is clearly a lack of adequate funding for veterans
who are the only participants in this program. The budget baseline
needs to increase to allow VETS to train eligible veterans in all 50
states in FY 2010.
Make Transitional Assistance Program (TAP)/Disabled Transitional
Assistance Program (DTAP) a Mandatory Program
The American Legion is deeply concerned with the timely manner that
veterans, especially returning wartime veterans, transition into the
civilian sector. Annually, for the past 6 years, approximately 300,000
servicemembers, 90,000 of them belonging to the National Guard and
Reserve, enter the civilian sector each year.
DoD estimates that 68 percent of separating servicemembers attend
the full TAP seminars and only 35 percent of the Reserve components
attend. The American Legion believes this low attendance number is a
disservice to all transitioning servicemembers, especially the Reserve
component. Currently, numerous National Guard and Reserve troops have
returned from the war in Iraq and Afghanistan only to encounter
difficulties with their Federal and civilian employers at home, and the
number of destroyed and bankrupt businesses due to military deployment
is still being realized.
In numerous cases brought to the attention of The American Legion
by veterans and other sources, many of these returning servicemembers
have lost jobs, promotions, businesses, homes, and cars and, in a few
cases, become homeless. The American Legion strongly endorses the
belief that servicemembers would greatly benefit by having access to
the resources and knowledge that the Transitional Assistance Program
(TAP) and Disabled Transitional Assistance Program (DTAP) can provide
and the TAP/DTAP program needs to update their program to recognize the
large number of Guard and Reserve businessowners who now require
training, information and assistance while they attempt to salvage or
recover from a business which they abandoned to serve their country.
Any delay in reintegration into the civilian workforce can
adversely affect a veteran's life. Every effort should be made to
ensure that veterans are afforded all the opportunities that this great
country can offer without delay.
The American Legion strongly supports the Transition Assistance
Program and Disabled Transition Assistance Program. Additionally, The
American Legion supports that DoD require all separating, active-duty
servicemembers, including those from Reserve and National Guard units,
be given an opportunity to participate in Transition Assistance Program
and Disabled Transition Assistance Program training not more than 180
days prior to their separation or retirement from the Armed Forces.
The DoD Transition Assistance Program (TAP) was designed to help
smooth the transition of military personnel (and family members)
leaving active duty. TAP is a partnership among DoD, DOL, and VA. The
program consists of four components:
1. DoD Preseparation Counseling;
2. DOL Employment Workshops;
3. VA Benefits Briefing; and
4. Disabled Transition Assistance Program (DTAP).
Once a servicemember has completed the four workshops above, they
are eligible for one-on-one counseling and employment assistance
training through their service. For demobilizing Guard and Reserve: DoD
Preseparation Counseling, DOL Uniformed Services Employment and
Reemployment Rights Act (USERRA) Briefing, VA Benefits Briefing, and VA
DTAP Briefing are provided on major military installations by the
Transition Assistance Offices.
A new Web site designed to help all veterans was recently launched
on June 11, 2007. The ``TurboTap'' is intended to be a one-stop
transition center but not to replace the face-to-face interaction and
the assistance that the full programs can provide.
Transition Assistance Program (TAP) Employment Workshops are
provided to transitioning servicemembers at most military installations
in the United States as well as in eight overseas locations. The two
and one-half day employment workshops help servicemembers prepare a
plan for obtaining meaningful civilian employment when they leave the
military. The workshop focuses on skills assessment, resume writing,
job counseling and assistance, interviewing and networking skills,
labor market information, and familiarization with America's workforce
investment system.
Studies have shown that servicemembers who participate in TAP
employment workshops find their first civilian jobs 3 weeks earlier
than veterans who do not participate in TAP. According to DOL--VETS, it
is estimated that about 65 percent of servicemembers leaving active
duty do attend a TAP workshop. VETS is vital in ensuring that every TAP
participant leaves the session with a draft resume, a practice
interview session, and having visited their state job board.
DOL--VETS program is critical in supporting veterans as they
transition from the military and into the private sector, assisting
veterans to be awarded federal employment using their earned veterans
preference, and assisting veterans to achieve substantially gainful
employment.
At the end of the Cold war, DoD dramatically downsized its
personnel strength. In an attempt to assist separating servicemembers
in making a successful transition back into the civilian workforce,
Congress enacted PL 101-510 that authorized the creation of the TAP
that provides separating servicemembers with 3 days of comprehensive
training with emphasis on such topics as networking, how to conduct a
job search, resume writing, career decisionmaking, interview
techniques, as well as current occupational and labor market
conditions.
VETS provide professional veterans' employment personnel, DVOPs and
LVERs, to participate in the TAP program. Higher demands placed on
LVERs to deliver TAP modules, in addition to their normal employment
assistance programs, has the potential for weakening their overall
capability.
To ensure that all veterans, both transitioning and those looking
for employment assistance well past their discharge, receive the best
care; the DOL-VETS program must be adequately funded. However, we feel
that the current funding levels are inadequate.
On the contrary to the demands placed upon VETS, funding increases
for VETS since 9/11 do not reflect the large increase in servicemembers
requiring these services due to the Global War on Terror. In support of
this fact, the inflation rate from January 2002 to January 2007 is
14.29 percent and yet for State Grants alone, funding has only
increased a meek 1.19 percent ($158 million to $161 million).
More services and programs are needed and yet since 2002 the VETS
program has only received a modest 4 percent-increase. Transition
assistance, education, and employment are each a pillar of financial
stability. They will prevent homelessness, afford the veteran to
compete in the private sector, and allow our Nation's veterans to
contribute their military skills and education to the civilian sector.
By placing veterans in suitable employment sooner, the country
benefits from increased income tax revenue and reduced unemployment
compensation payments, thus greatly offsetting the cost of TAP
training. The necessity and severity of the situation is now.
The American Legion recommends $352 million to DOL-VETS for FY
2010.
MILITARY OCCUPATIONAL SPECIALTY TRANSITION (MOST) PROGRAM
The American Legion supports the new legislation, H.R. 6221 that
will authorize $60 million for the next 10 years to fund the
servicemembers' Occupational Conversion and Training Act (SMOCTA).
SMOCTA is a training program developed in the early 1990's for those
leaving military service with few or no job skills transferable to the
civilian marketplace. SMOCTA has been changed to the Military
Occupational Specialty Transition (MOST) program, but the language and
intent of the program still applies.
If enacted, MOST would be the only Federal job training program
available strictly for veterans and the only Federal job training
program specifically designed and available for use by state veterans'
employment personnel to assist veterans with barriers to employment.
Veterans eligible for assistance under MOST are those with a
primary or secondary military occupational specialty that DoD has
determined is not readily transferable to the civilian workforce or
those veterans with a service-connected disability rating of 30 per
cent or higher. MOST is a unique job training program because there is
a job waiting for the newly trained veteran upon completion of training
so that they can continue to contribute to the economic well-being of
the Nation.
In March 1993, DoD, VA, and DOL signed a Memorandum of
Understanding (MOU), which defined their roles and responsibilities in
the implementation of SMOCTA and DoD provided funding for SMOCTA. The
VA and DOL were responsible for administering the program. Many LVERs
and DVOPs publicly praised the effectiveness of this program because it
successfully returned veterans to the civilian workforce.
The American Legion recommends reauthorization of SMOCTA (now MOST)
and adequate funding for the program.
Employment
DVOPs provide outreach services and intensive employment services
to meet the employment needs of eligible veterans, with priority to
disabled veterans and special emphasis placed on those veterans most in
need. LVERs conduct outreach to local employers to develop employment
opportunities for veterans, and facilitate employment, training and
placement services to veterans. In particular, many LVERs are the
facilitators for the Transition Assistance Program employment
workshops.
There are inadequate appropriations to several states because of
policies and practices that cause these states to receive fewer
positions and/or less funding. This procedure caused a deterioration of
the available services provided to veterans in those states, and
adversely impacts the level of services provided.
HOMELESSNESS (DOL--VETS)
The American Legion notes that there are approximately 154,000
homeless veterans on the street each night. This number, compounded
with 300,000 servicemembers entering the private sector each year since
2001 with at least a third of them potentially suffering from mental
illness, requires that intensive and numerous programs to prevent and
assist homeless veterans are available.
Homeless Veterans Reintegration Program (HVRP) is a competitive
grant program. Grants are awarded to states or other public entities
and non-profits, including faith-based organizations, to operate
employment programs that reach out to homeless veterans and help them
become gainfully employed. The purpose of the HVRP is to provide
services to assist in reintegrating homeless veterans into meaningful
employment within the labor force and to stimulate the development of
effective service delivery systems that will address the complex
problems facing veterans. HVRP is the only nationwide program focused
on assisting homeless veterans to reintegrate into the workforce.
The American Legion recommends $40 million for this highly
successful grant program in FY 2010.
TRAINING
The National Veterans' Employment and Training Services Institute
(NVTI) was established to ensure a high level of proficiency and
training for staff that provide veterans employment services.
NVTI provides training to Federal and state government employment
service providers in competency based training courses. Current law
requires all DVOPs and LVERs to be trained within 3 years of hiring. We
believe that these personnel should be trained within 1 year.
The American Legion recommends $6 million of funding for NVTI in FY
2010.
Veterans Workforce Investment Program (VWIP)
VWIP grants support efforts to ensure veterans' lifelong learning
and skills development in programs designed to serve the most-at-risk
veterans, especially those with service-connected disabilities, those
with significant barriers to employment, and recently separated
veterans. The goal is to provide an effective mix of interventions,
including training, retraining, and support services, that lead to long
term, higher wages and career potential jobs.
The American Legion recommends funding of $20 million for VWIP in
FY 2010.
EMPLOYMENT RIGHTS AND VETERANS' PREFERENCE
The Uniformed Services Employment and Reemployment Rights Act
(USERRA) protects the civilian job rights and benefits of veterans and
members of the armed forces, including National Guard and Reserve
members. USERRA also prohibits employer discrimination due to military
obligations and provides reemployment rights to returning
servicemembers. VETS administers this law, conducts investigations for
USERRA and Veterans' Preference cases, as well as conducts outreach and
education, and investigates complaints by servicemembers.
Since September 11, 2001, nearly 600,000 National Guard and Reserve
members have been activated for military duty. During this same period,
DOL--VETS have provided USERRA assistance to over 410,000 employers and
servicemembers.
Veterans' Preference is authorized by the Veterans' Preference Act
of 1944. The Veterans' Employment Opportunity Act (VEOA) 1998 extended
certain rights and remedies to recently separated veterans. VETS were
given the responsibility to investigate complaints filed by veterans
who believe their Veterans' Preference rights have been violated and to
conduct an extensive compliance assistance program.
Veterans' Preference is being unlawfully ignored by numerous
agencies. Whereas figures show a decline in claims by veterans of this
conflict compared to Gulf War I, the reality is that employment
opportunities are not being broadcast. Federal agencies as well as
subcontractors are required by law to notify OPM of job opportunities
but more often than not these vacancies are never made available to the
public. The VETS program investigates these claims and corrects
unlawful practices.
The American Legion recommends funding of $61 million for Program
Management that encompasses USERRA and VEOA in FY 2010.
The American Legion also supports the strongest Veterans'
Preference laws possible at all levels of government. We believe that
the evidence compiled in this report will show the current state of
enforcing the Uniformed Services Employment and Reemployment Rights Act
(USERRA) and Veterans' Preference laws to the Nation's veterans.
The American Legion is deeply concerned with the protection of the
veteran and the prevention of illegal and egregious hiring practices.
Currently, veterans are filing claims after the non-compliance
employment event occurred and therefore may become financially
disadvantaged. Concurrent measures and continuous oversight must be
emplaced to protect veterans from unfair hiring practices, not just
reactionary investigations.
The following paragraphs are the perceived steps taken by the
Federal Government to protect veterans' employment and it demonstrates
reactionary measures to assist veterans that may take months to
resolve. Many veterans give up or do not file complaints because they
must seek employment elsewhere or face serious financial difficulties.
The Office of Personnel Management (OPM) administers entitlement to
Veterans' Preference in employment. DOL, through VETS, provides
assistance to all persons having claims under USERRA. DOL is the
enforcement authority for USERRA, and it processes all formal
complaints of violations of the law. The veteran may then request that
the Department of Justice (DoJ) litigate on their behalf but only after
a certain period has passed.
The following excerpt is from the DoJ Web site (www.usdoj.gov):
``If VETS is unsuccessful in resolving the complaint, the
claimant may request that VETS refer the complaint to Office of
Special Counsel (OSC). If the Special Counsel believes there is
merit to the complaint, OSC will initiate an action before the
Merit Systems Protection Board (MSPB) and appear on behalf of
the claimant.
``The DoJ is responsible for enforcing the provisions of the
USERRA against state and local government employers and private
employers. If the Department of Justice takes your case, it
will serve as your attorney if you work for a private employer
or a local government. If you work for a state government, the
Department of Justice may bring a lawsuit in the name of the
United States.''
The DoJ Web site continues to state:
``USERRA authorizes the Department of Justice Office of Special
Counsel (OSC) to investigate alleged violations of the act by
Federal Executive Agencies, and to prosecute meritorious claims
before the Merit Systems Protection Board on behalf of the
aggrieved person. Under the Veterans Employment Opportunities
Act 1998 (VEOA), in order to seek corrective action, a
preference eligible [veteran] is to file a written complaint
with the U.S. Department of Labor, Veterans Employment and
Training Service (VETS), within 60 days of the alleged
violation. If the Secretary is unable to resolve a complaint
within 60 days, the Secretary is to provide notification of an
unsuccessful effort to resolve the complaint to the
complainant.''
The American Legion reiterates its position that protection of
veterans' employment rights should be concurrent and continuous
oversight must be emplaced to protect veterans from unfair hiring
practices, not just reactionary investigations and lawsuits. We further
state that the veteran must be protected at the onset of the hiring
process, especially because corrective actions to remedy the veteran's
plight are not guaranteed.
Finally, we recommend to this Committee that the DoJ provide a
detailed description of their veterans' employment activities.
------------------------------------------------------------------------
Veterans' Preference Cases FY 2006 FY 2007
------------------------------------------------------------------------
Cases Carried over from previous FY 67 29
------------------------------------------------------------------------
Cases Opened 479 427
------------------------------------------------------------------------
Total cases 546 456
------------------------------------------------------------------------
Cases Closed 517 406
------------------------------------------------------------------------
Cases carried to next FY 29 50
------------------------------------------------------------------------
FY 2006
In 2006, VETS staff closed 1,377 USERRA complaints, recovering
$2,346,142.04 in lost wages and benefits.
FY 2007
In 2007, VETS staff closed 1,200 USERRA complaints, recovering
$1,886,572.95 in lost wages and benefits.
VETERAN AND SERVICE DISABLED VETERAN OWNED BUSINESSES
The American Legion views small businesses as the backbone of the
American economy. It is the driving force behind America's past
economic growth and will continue to be the major factor as we move
further into the 21st century. Currently, more than nine out of every
ten businesses are small firms, which produce almost one-half of the
Gross National Product. Veterans' benefits have always included
assistance in creating and operating veteran-owned small businesses.
The impact of deployment on self-employed Reservists is tragic with
a reported 40 percent of all businesses owned by veterans suffering
financial losses and in some cases bankruptcies. Many small businesses
have discovered they are unable to operate and suffer some form of
financial loss when key employees (who are members of the Reserve
component) are activated. The Congressional Budget Office in a report,
``The Effects of Reserve Call-Ups on Civilian Employers,'' stated that
it ``expects that as many as 30,000 small businesses and 55,000 self-
employed individuals may be more severely affected if their Reservist
employee or owner is activated.'' The American Legion is a strong
supporter of the ``Hope at Home Act of 2007,'' which is a bipartisan
bill that would not only require the Federal Government to close the
pay gap between their Reserves and National Guard servicemember's
civilian and military pay but it would also provide tax credits up to
$30,000 for small businesses with servicemembers who are activated.
Additionally, the Office of Veterans' Business Development within
the Small Business Administration (SBA) remains crippled and
ineffective due to a token funding of $750,000 per year. This amount,
which is less than the office supply budget for the SBA, is expected to
support an entire Nation of veterans who are entrepreneurs. The
American Legion feels that this pittance is an insult to American
military veterans who are small businessowners; consequently, this
undermines the spirit and intent of PL 106-50 and continues to be a
source of embarrassment for this country.
The American Legion strongly supports increased funding of the
efforts of the SBA's Office of Veterans' Business Development in its
initiatives to provide enhanced outreach and specific community based
assistance to veterans and self employed members of the Reserves and
National Guard. The American Legion also supports legislation that
would permit the Office of Veterans Business Development to enter into
contracts, grants, and cooperative agreements to further its outreach
goals and develop a nationwide community-based service delivery system
specifically for veterans and members of Reserve components of the
United States military.
The American Legion recommends $15 million in FY 2010 to enable to
implement a nationwide community-based assistance program to veterans
and self employed members of the Reserves and National Guard.
THE NATIONAL VETERANS BUSINESS DEVELOPMENT CORPORATION
Congress enacted the Veterans Entrepreneurship (TVC) and Small
Business Development Act 1999 (PL 106-50) to assist veterans and
service-connected disabled veterans who own small businesses by
creating the National Veterans Business Development Corporation.
Presently, the objectives of PL 106-50 (as originally envisioned) are
not being met at the present time due to the scope of the mission,
staffing and funding requirements.
The American Legion believes that with limited funding and
staffing, TVC should not try to duplicate or replicate preexisting
services such as those provided by the Small Business Development
Centers (SBDC). The American Legion recommends that the resource-
training centers that TVC is currently providing funding for be given
to the jurisdiction of the SBA's Veterans' Development Office.
The SBA's Veterans' Development Office is presently funding five
such centers around the country and should be given the additional
three. In addition, the SBA office should take on the responsibility of
partnering with military and VA hospitals, TAPs, State Department of
Veterans Affairs, Procurement technical Assistance Centers, Military
Family Support Centers, and VSOs to provide employment and
entrepreneurship programs along with the addition of funding and
necessary senior staff to oversee the implementation and development of
such a program.
TVC would operate more effectively acting as a liaison with
existing associations of small businessowners and, by working with SBA
programs, ensure the involvement of private and successful military
alumni from the business community to help support SBA's successful
reintegration of veterans and Reserve component entrepreneurs into the
private and public American marketplace.
The American Legion also supports restructuring of the organization
by replacing the current Chief Executive Officer position with a
congressionally appointed Director from the Senior Executive Service.
That move would allow Congress greater oversight of expenditures and an
enhanced ability to monitor performance. Restricting the role of the
Board of Directors to fundraising, marketing and branding which will
serve to increase small business opportunities to veterans along with
relieving board members with the challenges of operating such a
national outreach initiative, with only the guidance of the Chief
Executive Officer.
The American Legion reiterates the SBA's Office of Veterans'
Business Development should be the lead agency to ensure that veterans
returning from Iraq and Afghanistan are provided with Entrepreneurial
Development Assistance. Comprehensive training should be handled by the
SBA and augmented by TVC's online training. Resource Training Centers
should include DoD and VA faculties. Currently, many military families
are suffering financial hardship while their loved ones are
recuperating in military hospitals around the country. Many spouses
leave their jobs to be with that disabled servicemember only to watch
their finances deteriorate. Seamless transition in many cases is just a
wishful thought; however, if business development training was offered
to military members, a small home based business that is feasible could
be the answer in guaranteeing a constant source of revenue for the
family, in turn making them less dependent on the Federal Government.
The American Legion has encouraged Congress to require reasonable
``set-asides'' of Federal procurements and contract for businesses
owned and operated by veterans. The American Legion supported
legislation in the past that sought to add service-connected disabled
veterans to the list of specified small business categories receiving 3
percent set-asides. PL 106-50, ``The Veteran Entrepreneurship and Small
Business Development Act of 1999,'' included veteran small businesses
within Federal contracting and subcontracting goals for small
businessowners and within goals for the participation of small
businesses in Federal procurement contracts. It requires the head of
each Federal agency to establish agency goals for the participation by
small businesses owned and controlled by service-connected disabled
veteran, within that agency's procurement contracts.
Agency compliance with PL 106-50 has been minimal with only two
agencies self-reporting that they have met their goals (the Department
of Veterans Affairs and the Small Business Administration). In 2004,
President Bush issued Executive Order 13360 to strengthen opportunities
in Federal contracting for service-disabled veteran-owned businesses.
Recommendations
1. Incorporate Executive Order 13360 into SBA Regulations and
Standard Operating Procedures
The American Legion endorses these recommendations given from the
``SBA Advisory Committee on Veterans Business Affairs'' FY 2006 SBA
report:
``The SBA needs to reemphasize implementation of
Executive Order 13360 and establish it as a Federal procurement
priority across the entire Federal sector. Federal agencies need to be
held accountable, by the SBA, for their implementing Executive Order
13360 and their progress toward the 3 percent-goal. The SBA needs to
establish a means to monitor agencies progress and where appropriate,
establish a vehicle to report or otherwise identify those that are not
in compliance, and pursue ongoing follow-up.''
``To achieve the SDVOSB procurement goal contained in
Executive Order 13360, the SBA must identify all agencies affected by
the Executive Order under the directive of Congress. Then the SBA
should assist these agencies to develop a demonstrable, measured
strategic plan and establish realistic reporting criteria. Once the
information is received, disseminate this data to all agencies,
Veterans Organizations and post on SBA Web site as a bellwether of
program progress.''
2. Change to Sole Source Contracting Methods
``To provide parity among special emphasis procurement programs the
SBA should take immediate, appropriate steps to promulgate regulations
to revise 13 CFR 125.20. The proposed revision would eliminate existing
restrictions on the award of sole source contracts to SDVOSB such as
the ``Rule of Two''. The change should mirror 13 CFR 124.508(c) which
applies to 8 (a) Program participants and states--.In order to be
eligible to receive a sole source 8 (a) contract, a firm must be
current participant on the date of the award--Accordingly, adopting
this language would eliminate all restrictions on sole source awards to
SDVOSBs.''
3. Develop a User Friendly Veteran Procurement Database
The American Legion also urges that the Federal Government and DoD
utilize its available technology to create, fund and support a veteran
procurement-spending database within the DoD that would finally bring
veteran owned and service-disabled veteran owned businesses on equal
footing with all other small business special interest groups when it
comes to Federal procurement opportunities.
HOME LOAN GUARANTY PROGRAM
VA's Home Loan Guaranty program has been in effect since 1944 and
has afforded approximately 18 million veterans the opportunity to
purchase homes. The Home Loan programs offer veterans a centralized,
affordable and accessible method of purchasing homes in return for
their service to this Nation. The program has been so successful over
past years that not only has the program paid for itself, but has also
shown a profit in recent years. Administrative costs constitute a
relatively small portion--less than 10 percent--of the total capital
and operating costs. The predominant costs are claims costs and other
costs associated with foreclosure and alternatives taken to avoid
foreclosure. Each claim costs the Federal Government about $20,000.
However, revenues that VA collects from different sources, including
the funding fee that borrowers pay, property sales, and proceeds from
acquired loans and vendee loans, offset this cost.
The VA funding fee is required by law and is designed to sustain
the VA Home Loan Program by eliminating the need for appropriations
from Congress. Congress is not required to appropriate funding for this
program; however, because veterans must now `buy' in to the program, it
no longer serves the intent of helping veterans afford a home.
The fee, currently 2.15 percent on no-downpayment loans for a
first-time use, is intended to enable the veteran who obtains a VA home
loan to contribute toward the cost of this benefit, and thereby reduce
the cost to taxpayers. The funding fee for second time users who do not
make a downpayment is 3.3 percent. The idea of a higher fee for second
time use is based on the fact that these veterans have already had a
chance to use the benefit once, and also that prior users have had time
to accumulate equity or save money toward a down payment.
The following persons are exempt from paying the funding fee:
Veterans receiving VA compensation for service-connected
disabilities.
Veterans who would be entitled to receive compensation
for service-connected disabilities if they did not receive retirement
pay.
Surviving spouses of veterans who died in service or from
service-connected disabilities (whether or no tsuch surviving spouses
are veterans with their own entitlement and whether or not they are
using their own entitlement on the loan).
The funding fee makes the VA Home Loan program less beneficial than
compared to a standard, private loan, in some aspects. The current rate
for mortgages (July 2008) is 6.5 percent. The funding fee would be in
addition to the rate given by the lender. A $300,000 loan would
generate a fee in addition to any rate the veteran would achieve. The
funding fee mandates the participant to buy in to the program; however
that goes directly against the intention of the law, to provide
veterans a resource for obtaining a home.
The American Legion believes that it is unfair for veterans to pay
high funding fees of 2 to 3 percent, which can add approximately $3,000
to $11,000 for a first time buyer. The VA funding fee was initially
enacted to defray the costs of the VA guaranteed home loan program. The
current funding fee paid to VA to defray the cost of the home loan has
had a negative effect on many veterans who choose not to participate in
this highly beneficial program.
Therefore, The American Legion strongly recommends that the VA
funding fee on home loans be reduced or eliminated for all veterans
whether active duty, Reservist, or National Guard.
Specially Adaptive Housing
The American Legion is pleased to support the VA Secretary's
efforts to improve the housing arrangements to better suit disabled
veterans' needs, with specific emphasis on severe burn injuries. The
American Legion additionally applauds efforts to assist disabled
veterans to receive adaptive equipment for automobiles.
The American Legion conveys that specially adaptive housing should
also include those veterans suffering from Traumatic Brain Injury
(TBI), and other debilitating injuries. We are also concerned with the
ambiguity of the term ``severe'' in that there are many different
levels of injury where a severe injury to one individual may not be as
severe to another.
HOMELESS VETERANS
The American Legion supports the efforts of public and private
sector agencies and organizations with the resources necessary to aid
homeless veterans and their families. The American Legion supports
proposals that will provide medical, rehabilitative and employment
assistance to homeless veterans and their families.
Homeless veteran programs should be granted full appropriations to
provide supportive services such as, but not limited to outreach,
health care, habilitation and rehabilitation, case management, daily
living, personal financial planning, transportation, vocational
counseling, employment and training, and education.
The American Legion applauds the VA, HUD, and the Senate
Appropriations Committee for ensuring PL 110-161, the FY 2008
Consolidated Appropriations Act, included $75 million for the
Department of Housing and Urban Development (HUD)--Veterans Affairs
Supported Housing (VASH) program. This funding allowed HUD and VA to
make up to 10,000 supportive incremental housing vouchers available to
homeless veterans. Looking ahead to FY 2009 funding for veterans
permanent housing, HUD has requested another $75 million for up to
10,000 additional vouchers for the HUD-VASH program. The American
Legion urges the Appropriations Members to support this amount in new
legislation, and to double that amount in FY 2010.
Veterans need a sustained coordinated effort that provides secure
housing, nutritious meals, essential physical health care, substance
abuse aftercare and mental health counseling, as well as personal
development and empowerment. Veterans also need job assessment,
training and placement assistance. The American Legion believes all
programs to assist homeless veterans must focus on helping veterans
reach their highest level of self-management.
Homeless Providers Grant and Per Diem Program Reauthorization
In 1992, VA was given authority to establish the Homeless Providers
Grant and Per Diem Program under the Homeless Veterans Comprehensive
Service Programs Act of 1992, PL 102-590. The Grant and Per Diem
Program is offered annually (as funding permits) by the VA to fund
community agencies providing service to homeless veterans.
VA can provide grants and per diem payments to help public and
nonprofit organizations establish and operate supportive housing and/or
service centers for homeless veterans. Funds are available for
assistance in the form of grants to provide transitional housing (up to
24 months) with supportive services, supportive services in a service
center facility for homeless veterans not in conjunction with
supportive housing, or to purchase vans.
The American Legion strongly supports increasing the funding level
to $200 million annually for the Grant and Per Diem Program.
VBA has 20 full-time and 37 part-time homeless veteran outreach
coordinators to enhance prompt claims for homeless and at-risk
veterans. VBA identified and expedited more than 21,000 claims from
homeless veterans since 2003. Approximately 44 percent of compensation
claims and 77 percent of pension claims are approved annually.
Health Care for Homeless Veterans (HCHV) sites provide outreach,
physical and psychiatric treatment, referrals, and case management to
homeless veterans. HCHV staffs assist over 60,000 homeless veterans
each year and place homeless veterans into community-based facilities
under contract to local VA medical facilities.
Domiciliary Care for Homeless Veterans Program (DCHV) operates 34
sites, with 1,833 dedicated domiciliary beds, providing time limited
residential treatment with long-term physical, psychological, and
rehabilitative counseling and services including aftercare. This
program annually provides residential treatment to nearly 5,200
homeless veterans.
Veterans Industries/Compensated Work Therapy Program (VI/CWT)
offers vocational and rehabilitative services, ranging from evaluation
and counseling to participation in compensated work and vocational
training. Since 1994 over 32,000 veterans have been successfully
reintegrated into society as responsible members of the community
through this program.
Compensated Work Therapy/Transitional Residence (CWT/TR) program
operates in 64 community-based locations (with a total of 469
operational beds), provides residences to disadvantaged, at risk, and
homeless veterans, while they participate in the VI/CWT. Nearly 6000
veterans have been housed under this program.
Homelessness impacts every community in the Nation. Approximately
200 community-based veterans' service organizations across the country
have successfully reached homeless veterans through specialized
programs. Veterans who participate in these programs have a higher
chance of becoming productive citizens again.
A full continuum of care--housing, employment training and
placement, health care, substance abuse treatment, legal aid, and
follow-up case management--depends on many organizations working
together to provide services and adequate funding. The availability of
homeless veteran services, and continued community and government
support for them, depends on vigilant advocacy and public education
efforts on the local, state and Federal levels.
The FY 2007 Department of Veterans Affairs Community Homelessness
Assessment, Local Education and Networking Groups (CHALENG) report
estimates that approximately 154,000 veterans are homeless at any point
in time. Prior reports state that one out of every three homeless men
sleeping in doorways, alleys or boxes in our cities and rural
communities has put on a uniform and served this country. According to
the February 2007 Homeless Assessment Report to Congress (U.S.
Department of Housing and Urban Development 2007), veterans represent
19 percent of all homeless people in America.
For FY 2007, The VA Health Care for Homeless Veterans (HCHV)
reports that 68,000 homeless veterans are enrolled in their programs.
Community-based organizations are attempting to assist the overwhelming
remainder of veterans who are homeless.
In addition to the complex set of factors affecting all
homelessness (the extreme shortage of affordable housing, livable
income, and access to health care), a large number of displaced and at-
risk veterans live with lingering effects of Post Traumatic Stress
Disorder (PTSD), substance abuse, and a lack of family and social
support networks. Many times these veterans have mental health
disorders related to their honorable service to their country, are
unable to compensate for their condition. They unfortunately
deteriorate to unrecognizable individuals compared to their pre-
military experience.
Potential homeless veterans of Operation Iraq Freedom and Operation
Enduring Freedom (OIF/OEF)
Some OIF/OEF veterans are at high risk of becoming homeless. Combat
veterans of OIF/OEF and the Global War on Terror who need help--from
mental health programs to housing, employment training and job
placement assistance--are beginning to trickle into the Nation's
community-based homeless veterans' service organizations. Already
stressed by an increasing need for assistance by post-Vietnam Era
veterans and strained budgets, homeless services providers are deeply
concerned about the inevitable rising tide of combat veterans who will
soon be requesting their support.
Since 9/11, nearly 800,000 American men and women have served or
are serving in a war zone. Rotations of troops returning home from Iraq
are now a common occurrence. Military analysts and government sources
say the deployments and repatriation of combat veterans is unlike
anything the Nation has experienced since the end of the Vietnam War.
The signs of an impending crisis are clearly seen in VA's own
numbers. Under considerable pressure to stretch dollars, VA estimates
it can provide assistance to about 100,000 homeless veterans each year,
only 20 percent of the more than 500,000 who will need supportive
services. Hundreds of community-based organizations nationwide struggle
to provide assistance to as many of the other 80 percent as possible,
but the need far exceeds available resources.
VA's HCHV reports 1,049 OIF/OEF era homeless veterans with an
average age of 33 years young. HCHV further reports that nearly 65
percent of these homeless veterans experienced combat. Now receiving
combat veterans from Iraq and Afghanistan daily, the VA is reporting
that a high percentage of those casualties need treatment for mental
health problems. That is consistent with studies conducted by VA and
other agencies that conclude anywhere from 15 to more than 35 percent
of combat veterans will experience some clinical degree of PTSD,
depression or other psychosocial problems.
Homeless Women Veterans and Children
Homeless veterans' service providers' clients have historically
been almost exclusively male. That is changing as more women veterans
and women veterans with young children have sought help. Additionally,
the approximately 200,000 female Iraq veterans are isolated during and
after deployment making it difficult to find gender-specific peer-based
support. Access to gender-appropriate care for these veterans is
essential.
More women are engaging in combat roles in Iraq where there are no
traditional frontlines. In the past 10 years, the number of homeless
women veteran has tripled. In 2002, the VA began a study of women and
PTSD. The study includes subjects whose PTSD resulted from stressors
that were both military and non-military in nature. Preliminary
research shows that women currently serving have much higher exposure
to traumatic experiences, rape and assault prior to joining the
military. Other reports show extremely high rates of sexual trauma
while women are in the service (20-40 percent). Repeated exposure to
traumatic stressors increases the likelihood of PTSD. Researchers also
suspect that many women join the military, at least in part, to get
away from abusive environments. Like the young veterans, these women
may have no safe supportive environment to return to, adding yet more
risk of homeless outcomes.
CHALENG sites continue to report increases in the number of
homeless veterans with families (i.e., dependent children) being served
at their programs. It reports that 98 sites (71 percent of all sites)
reported a total of 1,038 homeless veteran families seen. This was a 5
percent-increase over the previous year's 989 homeless veteran
families. (FY 2007 VA CHALENG report)
Homeless veteran service providers recognize that they will have to
accommodate the needs of the changing homeless veteran population,
including increasing numbers of women and veterans with dependents.
Access to family housing through the distribution of the thousands of
new section 8 vouchers that will be made available through the HUD-VASH
program will offer an important new resource allowing VA staff to
assist the veteran and her family.
The American Legion supports adequate funding for all domiciliary
programs for all qualified veterans. More women veterans and women
veterans with young children have sought help. Additionally, the
approximately 200,000 female Iraq veterans are isolated during and
after deployment making it difficult to find gender-specific, peer-
based support. Access to gender-appropriate care for these veterans is
essential.
SUMMARY
The American Legion appreciates the strong relationship we have
developed with both Committees. With increasing military commitments
worldwide, it is important that we work together to ensure that the
services and programs offered through VA are available to the new
generation of American servicemembers who are returning home.
The American Legion is fully committed to working with each of you
to ensure that America's veterans receive the entitlements they have
earned. Whether it is improved accessibility to health care, timely
adjudication of disability claims, improved educational benefits or
employment services, each and every aspect of these programs touches
veterans from every generation. Together we can ensure that these
programs remain productive, viable options for the men and women who
have chosen to answer the Nation's call to arms.
Statement of Hon. Harry E. Mitchell,
a Representative in Congress from the State of Arizona
Chairman Filner, thank you for calling this hearing, and thank you
Secretary Shinseki for your willingness to appear before the Committee
again today. Thank you also to the Veterans Service Organizations for
agreeing to testify.
The task of examining the Administration's Budget and crafting the
Congressional Budget should be a little easier this year. For the first
time in the history of The Independent Budget--which is drafted by
veterans for veterans--the Administration's proposal has exceeded the
requests made by the veteran community.
According to the Administration, the 11 percent-increase in
discretionary funding is aimed at bringing 500,000 Priority 8 veterans
into the VA health care system, ensuring that the new GI Bill is ready
and active for the 2009 school year, and reaching out to veterans in
need. Many of my constituents and colleagues have raised concerns about
a proposal that would collect medical fees from veterans with service-
connected disabilities, but with this exception, I believe the
Administration's budget outline is headed in the right direction.
As the Administration finalizes the details of its budget proposal,
I wish to highlight two issues that I hope will be addressed.
We are all troubled by a startling spike in traumatic brain injury
and post-traumatic stress disorder. About one-fifth of all combat
casualties include TBI, and roughly the same proportion of troops will
develop PTSD after returning from combat. Recently, I met with a young
veteran from Arizona who suffers from PTSD, and he has been through the
ringer at the VA, trying to get the mental health care he needs. He is
working as hard as he can to recover, but he's been through four or
five jobs, a couple attempts at college, and he's fighting to keep his
second marriage together. His long-term success is by no means assured,
so we must assure him that the service and benefits he needs will be
there when he needs them.
I also expect increased transparency as the VA drafts its Priority
List of Pending State Home Construction Grant Applications for FY 2010.
This year, two facilities in one state received approximately $140
million of the $175 million available nationwide. While some states may
have more pressing needs than others, I hope that the rationale for
budgeting these funds will be made clear in FY 2010.
Thank you again to all of our witnesses. I look forward to hearing
your perspective on the budget outlook for the VA in the coming fiscal
year.
MATERIAL SUBMITTED FOR THE RECORD
U.S. Department of Veterans Affairs
The Secretary of Veterans Affairs
Washington, DC
April 20, 2009
The Honorable Phil Roe
U.S. House of Representatives
Washington, DC 20515
Dear Congressman Roe:
At the March 10, 2009, House Veterans' Affairs Committee hearing,
you asked for the percentage of the budget going to care for World War
II, Vietnam Veterans, and Veterans of other eras.
The Fiscal Year (FY) 2008 table below provides a breakdown of
obligation-based cost by combat, excluding state home patients and
Readjustment Counseling. Please note these figures only include costs
for Veteran care; costs for other beneficiaries (such as CHAMPVA) are
not included, but amount to approximately 1 percent of VA's health
obligation-based cost. Also note Veterans may have served in multiple
combat eras. However, 98 percent of Veterans have one period of service
listed in their FY 2008 encounter records. The remaining Veterans have
a period of service assigned consistent with their age.
------------------------------------------------------------------------
Percent of Percent of
Period of Service Cost Period of Service Cost
------------------------------------------------------------------------
Vietnam 46% Desert Storm 6%
------------------------------------------------------------------------
World War II 14% OEF/OIF 3%
------------------------------------------------------------------------
Korea 12% Pre-Korea 1%
------------------------------------------------------------------------
Post-Vietnam 12% Other* 1%
------------------------------------------------------------------------
Post-Korea 7% TOTAL 100%
------------------------------------------------------------------------
* Includes categories that do not fit within remaining definitive
categories. For example, a few records from World War I Veterans are
included among others.
Thank you for your and the Committee's support of our mission.
Sincerely,
Eric K. Shinseki
U.S. Department of Veterans Affairs
The Secretary of Veterans Affairs
Washington, DC
April 20, 2009
The Honorable Bob Filner
Chairman
Committee on Veterans' Affairs
U.S. House of Representatives
Washington, DC 20515
Dear Mr. Chairman Filner:
At the March 10, 2009, House Veterans' Affairs Committee hearing
when you made comments about a transformative approach to the claims
backlog,
I responded that advocacy training can make a difference.
Since that time the Veterans Benefits Administration (VBA) is
obtaining contractor support to assist in developing a Veteran-focused
strategy for improving client satisfaction and service delivery. VBA's
comprehensive approach includes collection and analysis of customer
satisfaction and other data and information; internal assessments of
VBA's client-services culture, processes, and issues; and development
of training programs and other process improvements to increase client
satisfaction.
I look forward to working with you and the Committee in our common
effort to meet the needs of Veterans who deserve the best care we can
provide.
Sincerely,
Eric K. Shinseki
Committee on Veterans' Affairs
Washington, DC
March 18, 2009
The Honorable Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Secretary Shinseki
In reference to our Committee hearing of March 10, 2009, I would
appreciate your response to the enclosed additional questions for the
record by close of business Wednesday, April 15, 2009.
It would be appreciated if you could provide your answers
consecutively on letter size paper, single spaced. Please restate the
question in its entirety before providing the answer.
Thank you for your cooperation in this matter.
Sincerely,
Steve Buyer
Ranking Republican Member
______
Questions for the Record
The Honorable Steve Buyer
Ranking Republican Member
House Veterans' Affairs Committee
March 10, 2009
U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2010
Question 1: I am concerned that the Administration's out-year
funding projections could result in serious budget shortfalls for
veterans' health care. Considering among other things health care
inflation and increased workloads due to the restoration of health care
eligibility for many priority 8 veterans, the drawdown in Iraq, and
increased demand for VA health care from the economic downturn, please
provide an explanation of how the funding levels were calculated for
the VA in the out-years of FY 2011 through FY 2014.
Response: The 2010 Budget is the first step in meeting the
Presidential initiative to increase VA's budget by $25 billion over the
baseline over the next 5 years. The 2010 Budget includes a large
increase for the Department of Veterans Affairs (VA) to invest in
improved quality care and services. While the currently projected out-
year estimates show more modest growth, the Department will continue to
evaluate its resource requirements annually to ensure full
consideration of its funding needs in the budget planning process.
Question 2: According to the budget information provided to the
Committee for FY 2010, VA is expecting an unprecedented increase in
collections. How does the Department anticipate reaching the goal? What
efficiencies do you intend to establish to reach these new collection
goals?
Response: The specific details of VA's projected collections
estimate for 2010 are still being finalized and will not be available
until the detailed 2010 budget documents are published. However, we are
constantly improving businesses associated with collections. For
example, the 2010 budget request makes investments in an accelerated
implementation of the consolidated patient accounting centers, in
critical training efforts for VA employees responsible for collections,
and internal reviews to identify opportunities for improved collections
efforts. Achieving the best results from our collections efforts is a
priority, but VA understands that Congress shares that priority. The
Department would welcome further discussions on how to continue
improving VA's ability to increase collections.
Question 3: The stimulus provided over a billion dollars for non-
recurring maintenance and energy projects at VHA. How much of the total
funding will be allocated toward energy projects? Have the projects
been identified? How many of these projects will include photovoltaic
solar roofs?
Response: About $400 million of the $1 billion (40 percent) that
Veterans Health Administration (VHA) received is allocated toward
energy improvement and renewable energy projects. VA has identified
these projects. The Department is conducting feasibility studies at
multiple sites and will then select the most beneficial projects based
on the study results. Regarding solar photovoltaic (PV) systems, VA is
assessing 31 sites and will select up to 8 sites to implement a solar
PV project. VA anticipates that most, if not all of these projects,
will be rooftop solar PV systems.
Question 4: For many years VA and DoD have told the Committee that
significant progress is being made to provide a seamless transition for
our servicemembers. While progress has been made, many servicemember
transitions are still not seamless. How does your budget reflect this
priority and what help do you need from Congress and DoD to make this a
reality?
Response: The seamless transition of servicemembers to civilian
life is a priority for VA and the 2010 budget will ensure this remains
a top priority. When the 2010 budget is released it will present
specifics on how the Department will advance its efforts both
internally and with the Department of Defense (DoD), to help ensure
that active duty services members' transition to civilian life is
smooth as possible. Some examples of key activities in support of the
seamless transition goal are presented below:
Compensation & Pension: Based on the success of the Joint DoD/VA
Disability Evaluation System (DES) pilot in the National Capital
Region, VA and DoD agreed to expand the pilot to 20 additional sites
across the Nation in 2009 to thoroughly test the new processes. Further
expansion in 2010 is planned.
VA will continue the following activities which help provide a
seamless transition for our servicemembers:
Benefits delivery at discharge and quick start programs
for those servicemembers who wish to file a claim while still on active
duty.
Expedited processing of initial and reopened claims from
seriously and very seriously injured Veterans, as well as initial
claims from all in-theater war Veterans and subsequent claims from
Veterans claiming post traumatic stress disorder.
Expanded outreach to newly discharged Veterans and Guard
and Reserve personnel.
The Department will pursue information technology modernization
efforts that support transition initiatives, including enhancements to
VA and DoD data exchange as well as integration of technologies to
enable Veterans and other claimants to interact with VA in the same
manner as the best private-sector service businesses.
Updating VA schedule for rating disabilities (VASRD) to reflect the
best medical information, and the signature conditions associated with
new conflicts, is a priority. New rating criteria for the assessment of
traumatic brain injury (TBI) became effective on October 23, 2008. The
Veterans Benefits Administration (VBA) is processing claims from very
seriously injured and seriously injured Operation Enduring Freedom and
Operation Iraqi Freedom (OEF/OIF) Veterans on a first priority basis.
VBA also conducts priority claims processing for all returning theater
Veterans and when post traumatic stress disorder (PTSD) is first
claimed by OEF/OIF Veterans.
Education: VA is conducting outreach activities to inform
servicemembers and Veterans of the Post-9/11 GI Bill education benefit.
As part of this outreach effort, VA identified approximately 2 million
individuals who have been discharged, including recently discharged
Veterans, with 30 days or more of service after September 10, 2001.
These individuals will receive a letter that explains the Post-9/11 GI
Bill and provides them with information on electing and applying for
the education benefit. While these initial letters will be sent in
April 2009, subsequent direct mailings containing education benefit
information will be sent to individuals on active duty throughout
fiscal 2010.
Insurance: The servicemembers' Group Life Insurance Traumatic
Injury Protection (TSGLI) provides critical transition support for
severely injured servicemembers and their families. TSGLI provides for
payment to servicemembers who suffer a traumatic injury that results in
a qualifying loss in the program. It helps servicemembers and their
families with financial burdens associated with recovering from a
traumatic injury as they transition into civilian life. A premium of $1
per month is charged to each servicemember insured under SGLI. This
premium covers the civilian incidence of such injuries. Any excess
program costs above the premiums collected are paid by DoD. The
administrative cost of processing TSGLI is covered under the
administrative expenses of the Office of servicemembers' Group Life
Insurance (OSGLI). For these reasons, TSGLI has no impact on
Insurance's budget.
All discharged Veterans who had servicemembers' Group Life
Insurance (SGLI) in the military receive a series of mailings advising
them of their right to convert the SGLI coverage to Veterans' Group
Life Insurance (VGLI). Since virtually all current servicemembers are
enrolled in SGLI, virtually all new veterans are covered by these
mailings. In addition, the Insurance Service staff conducts special
outreach to recently separated servicemembers who have a military or VA
disability rating of 50 percent or more. The purpose of this outreach
(which is conducted by phone calls) is to ensure that separated
servicemembers are aware of their eligibility for post-separation life
insurance benefits, including the SGLI Disability Extension, VGLI,
TSGLI, and Service-Disabled Veterans Insurance. The administrative
costs of the mailing are paid by OSGLI, and there are minimal costs
associated with the special outreach effort, so there is little impact
on Insurance's budget.
Loan Guaranty: The Specially Adapted Housing (SAH) Program helps
transitioning servicemembers and Veterans with certain permanent
service connected disabilities adapt a home they already own, or buy or
build a house and modify it to meet their disability-related needs. The
Department will continue the SAH program which provides valuable
assistance to severely disabled Veterans.
Vocational Rehabilitation & Employment: Vocational Rehabilitation &
Employment helps transitioning servicemembers through two programs:
Chapter 36, Educational and Vocational (Ed/Voc) counseling and Coming
Home to Work (CHTW). Ed/Voc counseling is available to servicemembers
during the 6-month period prior to discharge and to Veterans during the
1-year period following discharge. Ed/Voc counseling services include
academic and career counseling. VA will continue to provide appropriate
Education and Vocational Rehabilitation counseling services to Veterans
to help ease their transition from active military service to civilian
life.
The CHTW program is a cooperative effort with DoD that provides
opportunities for servicemembers and OEF/OIF Veterans to obtain work
experience, develop skills needed to transition to civilian employment,
determine potential career opportunities, and return to suitable,
gainful employment. There is a CHTW coordinator in each of the 57 VA
regional offices, with 13 of these positions being designated as
unique, full-time positions to support this effort. The remaining 44
regional office positions are filled by vocational rehabilitation
counselors who provide assistance as a collateral duty.
Benefits Executive Council: VA gets support from DoD through the
Benefits Executive Council (BEC), the official forum for senior level
interaction between the VBA and DoD. VBA's program offices regularly
report transition-related activities to the BEC. The transition-related
activities are included in the budget of the appropriate program
office.
Outreach: The Wounded Warrior Act (the FY 2008 National Defense
Authorization Act, Public Law 110-181) called for joint outreach
efforts to recovering servicemembers, Veterans, and their families. As
a result, web-based applications, assistance centers, and direct
outreach activities were developed.
The web-based National Resource Directory provides information on
services and resources available through: national, state and local
government agencies; Veterans' benefit, service, or advocacy
organizations; professional provider associations; community and faith-
based or non-profit organizations; academic institutions; and employers
and philanthropic activities of business and industry. The Directory
was developed jointly and is currently co-managed by DoD, VA, and the
Department of Labor.
The Yellow Ribbon Reintegration Program provides National Guard and
Reserve members and their families with information about services
throughout the entire deployment cycle. VA participates with
representation on the advisory board and assignment of a VA liaison
within the program office.
A compensation and benefits handbook was co-developed by DoD and VA
to help servicemembers and their families navigate the DoD and VA
systems. The handbook is available electronically or in book format.
Information Technology as an Enabler: DoD and VA have taken the
first crucial steps in creating a Joint Virtual Lifetime Electronic
Record (VLER), as announced by President Obama on April 9, 2009. Both
Secretaries are dedicated to ensuring strong executive oversight with
specific attention to the Interagency Program Office, mandated by NDAA
2008, on behalf of VA and DoD, to provide oversight for VA-DoD data
sharing initiatives. The emerging vision for the VLER initiative is for
all current and future servicemembers, Veterans, and eligible family
members to have a VLER that will encapsulate all data necessary to
uniquely identify them and ensure the delivery of care and benefits for
which they are eligible. This proactive delivery begins upon oath of
military service and continues beyond death to survivor benefits.
DoD and VA will develop workgroups to define the common services
used by information processes in both Departments as well as the common
functional processes within services unique to each Department. Joint
DoD/VA efforts have already begun to define the data and business
processes for this effort. The result will be an unprecedented unified
data sharing between the two Departments.
A MyeBenefits portal, currently under development, will provide
individualized information upon login for all servicemembers and
Veterans.
Committee on Veterans' Affairs
Washington, DC
March 23, 2009
Honorable Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. Secretary:
In reference to our full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
______
Questions for the Record
The Honorable Bob Filner
Chairman
House Committee on Veterans' Affairs
March 10, 2009
U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2010
Question 1: The proposed 5-year discretionary budget increases for
VA are relatively modest in the out-years, providing for an increase of
about $1.5 billion, or 3 percent, in each of the out-years. This
compares to the 10 percent-increase proposed in the FY 2010 budget.
This year marks a sharp departure from prior budgets such as last
year's budget submission which proposed cutting VA by $20 billion over
5 years. In light of criticism from some quarters that these modest
increases do not accurately reflect the funding needs of the VA in out-
years, can you explain how these estimates were developed?
Response: The 2010 Budget is the first step in meeting the
Presidential initiative to increase the Department of Veterans Affairs'
(VA) budget by $25 billion over the baseline over the next 5 years. The
2010 Budget includes a large increase for the Department to invest in
improved quality care and services. While the currently projected out-
year estimates show more modest growth, the Department will continue to
evaluate its resource requirements annually to ensure full
consideration of its funding needs in the budget planning process.
Question 2(a): VA has seen record funding increases for medical
care over the last few years and your budget request would seem to
accommodate another record increase. While VA has enjoyed these record
increases, the Committee has heard concerns raised by some local
medical facilities that suggest these facilities are not seeing these
increased resources in their budgets. Does this suggest a flaw in the
current resource allocation system, or how VISN budgets are handled?
Response: The concerns expressed early in the fiscal year (FY) by
the Veterans Integrated Service Networks (VISN) and medical centers
were a matter of timing. The funds allocated by the Veterans Equitable
Resource Allocation (VERA) process were released to the field within 2
weeks of enactment of the FY 2009 appropriation. However, a significant
amount of centrally managed funding was not included in that initial
allocation, including funding for prosthetics, clinical trainees, and
State Veterans homes. In addition, funding for two new congressional
initiatives, $250 million for rural health and $543 million for
expanded enrollment of Priority Group 8 Veterans, required planning,
analysis and preparation prior to allocation. The vast majority of
these funds were allocated by January 2009. VA is committed to ensuring
that sufficient funds reach critical points of care in a timely manner.
Question 2(b): What plans does VA have to better control and
account for health care spending while maintaining some level of
flexibility to respond to local needs?
Response: VA conducts monthly performance reviews of all its
activities, including actual execution of budgets as compared to plans.
In addition, the Veterans Health Administration (VHA) National
Leadership Board, through its subordinate finance committee, reviews
funding requirements and budget execution data in detail at least twice
each month. A portion of the annual VHA appropriations are held in
unallocated reserve each year, and are used at the discretion of the
Under Secretary of Health to address emerging funding requirements from
the field, as well as to provide funding for innovative proposals to
improve health care services for our Nation's Veterans.
Question 3: The budget seems to include a proposal to shift the
mandatory funding for contract examinations for disability compensation
eligibility to the discretionary side of the budget, specifically the
General Operating Expenses account. Can you explain to the Committee
the details of this proposal and the reasons for it and assure the
Committee that this will not place an undue strain on the account that
funds the claims processing system?
Response: The proposed transfer of funding from the compensation
and pension mandatory funding account to the General Operating Expense
(GOE) account is based on an analysis of the spending. Specifically,
the spending for medical examinations supports providing benefits, but
is not itself a payment of benefits to Veterans. As a result, funding
for these examinations more appropriately belongs in the discretionary
operational account, GOE.
Managing contract examination presents unique challenges whether
funded from the mandatory or discretionary accounts. Sufficient funding
for the examinations clearly must be provided to the Department.
Moreover, Veterans Benefit Administration (VBA) already manages some
contracted examinations through discretionary funding because an
existing contract with MES Solutions is paid from that account. The
current legislative authority for the MES Solutions contract, without
further Congressional action to extend it, will expire at the end of
2010.
VA is committed to the sound budgeting and management practices
required to provide for the needs of our Veterans with regard to
contract examinations. VA analyzed three key factors before
recommending this migration of funding source. The first and most
critical factor is that use of contractors typically means a loss or
lessening of capacity for examinations through internal sources as our
medical centers refocus resources to provide for more acute and chronic
patient care. Second, if the need for examinations or the mix of
examinations is underestimated or the requested funding is not
provided, VA's ability to provide needed examinations in a timely
manner may be adversely affected. New legislation, new presumptive
conditions, new outreach efforts, or new case law may result in an
unanticipated increased caseload. Finally, the growth in the cost of
examinations, as with health care generally, could exceed the budgeted
discretionary funding increase. However, these factors are inherent
across the core services that VA provides for Veterans. We are
monitoring for precisely these kinds of events so that we will not be
caught off guard, and will be able to adjust funding strategies as
necessary.
Question 4(a): The budget highlights investments in better
technology to deliver services and benefits to Veterans. There have
been concerns over the adequacy of previous VA budget requests for IT
spending and the speed with which the VA was reforming its efforts. Can
you provide an update to the Committee as to the Department's efforts
in this area and whether you feel confident that when the IT account
level is established it will be sufficient to meet the requirements
mandated by Congress?
Response: VA's goal is to build modern information technology (IT)
systems that will move us into the 21st century, enabling the delivery
of the highest quality health care and services to our Veterans. This
can only be done with a modern IT infrastructure, a high performing IT
workforce, and a state-of-the-art information system in health care and
benefits that will be flexible enough to meet both existing and
emerging service delivery requirements. With the FY 2010 IT funding
request, VA will develop an interagency interoperability plan with the
Department of Defense (DoD), with the goal of improving patient safety
and care; expedite benefit claims processing; automate the educational
benefits assistance system to handle the expanded benefits passed in
the Post 9/11 Veterans Educational Assistance Act of 2008; continue to
develop financial and logistics integrated technology as the next
generation core financial management system; and strengthen our IT
workforce as well as our aging and fragile IT infrastructure.
The budget increase we are requesting for FY 2010 recognizes that
IT touches all aspects of VA operations. IT provides standard equipment
of desktop computers, laptops, printers, phone systems, network
connections through regional servers, which hold the vital information
of our Veterans. The Office of Information and Technology supports a
workforce of 286,000 employees VA-wide who directly or indirectly serve
23 million Veterans and their families. Our nationwide health care
system is comprised of 153 medical facilities, 755 community-based
outpatient clinics, and 232 vet centers. Our benefits delivery system
for compensation, pension, housing loan guaranty, education and
insurance benefits support 55 regional offices nationwide. Our burial
system automates all necessary processes for interments efficiently and
effectively throughout 128 national cemeteries, and provides headstones
and markers worldwide. Our backbone corporate financial management
system provides steady and reliable data and performs financial
processing needed to monitor funds, and financially report our
operations throughout VA.
Question 4(b): Should the Committee expect the need for continued
large investments in this area, and if so, how can the Committee be
assured that such increases will truly accomplish the mission at hand?
Response: Transformational change of this scope and breadth is
always a challenge; however, we believe the FY 2010 funding request
supports a full budget requirement to right-size the IT budget request
and avoids transferring funds, as was the case over the last 2 years.
Congress approved the reprogramming of funds for FY 2008 and 2009 from
the Medical Care and General Operating Expenses accounts. These
transfers to our budget were needed to meet the demands of an aging IT
infrastructure, the investment in 21st century legacy systems, and to
ensure staffing a full workforce to support those current and future
systems.
The Honorable Michael Michaud
Question 1: During your testimony on March 10, you testified that,
``the number of patients who served in OEF/OIF will rise to over
419,000 in 2010.'' According to some VSO estimates, this number
significantly undercounts the amount of Iraq and Afghanistan war
Veterans who will seek VA treatment and services. How did VA come by
this estimate?
Response: Starting with the 2007 enrollee health care projection
model (EHCPM), VHA has used a future force deployment scenario
developed by the Congressional Budget Office (CBO) to estimate future
Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF)
Veterans. Based on this scenario, VHA created a separate model that
projects OEF/OIF total Veteran population, enrollment, patients,
utilization and expenditures.
The model recognizes the 5-year period of enrollment eligibility
for combat Veterans. In the beginning of the eligibility period, the
enrollment rates for OEF/OIF Veterans are assumed to be higher relative
to other Veteran populations. As time passes, enrollment becomes more
similar to that of other Veteran cohorts.
In addition, the model reflects the fact that OEF/OIF enrollees
have significantly different VA health care utilization patterns than
non-OEF/OIF enrollees. In particular:
OEF/OIF enrollees are expected to need more than eight
times the number of post-traumatic stress disorder (PTSD) residential
rehab services than non-OEF/OIF enrollees;
OEF/OIF enrollees have an increased need for dental
services, physical medicine, prosthetics, and outpatient psychiatric
and substance abuse treatment; but
On the other hand, experience indicates that OEF/OIF
enrollees seek about half as much inpatient acute surgery care from VA
as non-OEF/OIF enrollees.
VA recognizes projecting demand for health care services for OEF/
OIF Veterans has been challenging because many unknowns will influence
the number and type of services that VA will need to provide OEF/OIF
enrollees. For example, VA cannot project the duration of the conflict,
when OEF/OIF Veterans will be demobilized, or the ultimate total OEF/
OIF force strength at this time.
The Honorable Joe Donnelly
Question 1(a): Mr. Secretary, ensuring our Nation's Veterans have
access to the health care they earned is clearly a top priority, and
the VA budget requested by the President reflects that. However, many
Veterans across the country, including in my district, are forced to
drive hours each way to get specialty, diagnostic or re-current care.
While the budget does not get into specifics, do you anticipate a
considerable amount of funding to go toward enhancing and expanding the
health care services provided at some of the smaller VA health clinics?
Response: VHA engages in continuous strategic evaluation of its
health care delivery system and expands services based upon analysis of
the enrolled Veteran population and the projected demand for health
care services. VHA uses access guidelines to achieve one of its primary
goals of providing high quality health care to Veterans in their
communities.
The primary strategic goal of VISN 11 is to improve access to VA
health care for Veterans, and adequate funding is available to
accomplish that goal. The VISN strategy is following a dual course of
action to improve access by expanding the network of community-based
outpatient clinics (CBOC) available for Veterans, and identifying and
locating in existing VA medical center (VAMC) and CBOC sites, services
used by Veterans.
In Indiana, VISN 11 has reviewed the health care needs of Veterans
in the Fort Wayne and South Bend areas and determined that an expanded
array of services can be justified in both those cities. As recently
announced, VISN 11 will be developing a construction project to expand
the ambulatory services at the Fort Wayne VAMC and increase the
specialized services on site. At the same time, services will be
expanded at the South Bend CBOC site to include specialty care for
which Veterans now have to travel to Fort Wayne.
Question 1(b): Also, how will VA determine which clinics and areas
should receive expanded or enhanced VA health care services?
Response: Expansion of services is based on local Veteran
populations and demand for services. VA has established access
guidelines for primary care, acute care, and tertiary care, and VA uses
those standards to determine service delivery methods and ensure that
access to care is available close to home.
Committee on Veterans' Affairs
Washington, DC
March 23, 2009
Carl Blake
National Legislative Director
Paralyzed Veterans of America
801 18th Street, NW
Washington, DC 20006
Dear Carl:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
Committee on Veterans' Affairs
Washington, DC
March 23, 2009
Kerry Baker
Assistant National Legislative Director
Disabled American Veterans
807 Maine Avenue, SW
Washington, DC 20024
Dear Kerry:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
Committee on Veterans' Affairs
Washington, DC
March 23, 2009
Dennis Cullinan
National Legislative Director
Veterans of Foreign Wars of the United States
200 Maryland Avenue, NE
Washington, DC 20002-5724
Dear Dennis:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
Committee on Veterans' Affairs
Washington, DC
March 23, 2009
Raymond C. Kelley
Legislative Specialist
AMVETS
4647 Forbes Boulevard
Lanham, MD 20706
Dear Ray:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
______
The Independent Budget
Washington, DC
April 30, 2009
Honorable Bob Filner
Chairman
House Committee on Veterans' Affairs
335 Cannon House Office Building
Washington, DC 20515
Dear Chairman Filner:
On behalf of The Independent Budget, we would like to thank you for
the opportunity to present our views on the FY 2010 budget for the
Department of Veterans' Affairs (VA). We appreciate the Committee
recommending a substantial budget for the VA in its recently submitted
Views and Estimates. We also look forward to working with the Committee
to move your advance appropriations legislation. Only through
cooperation between the veterans' service organizations and the Members
of the Committee can we hope to attain a sufficient, timely, and
predictable budget for the VA.
We have included with our letter a response to each of the
questions that you presented following the hearing on March 10, 2009.
Thank you very much.
Sincerely,
Joseph A. Violante
Raymond C. Kelley
National Legislative Director
National Legislative Director
Disabled American Veterans
AMVETS
Dennis Cullinan
Carl Blake
National Legislative Director
National Legislative Director
Veterans of Foreign Wars of the United States
Paralyzed Veterans of America
______
Question 1: The FY 2010 Independent Budget was released prior to
the enactment of the American Recovery and Reinvestment Act of 2009 on
February 17, 2008. The law provides $1.4 billion in resources for the
VA, including funding for Medical Facilities; Grants for State Extended
Care Facilities; National Cemetery Administration; claims processing
for VBA; and the Office of Inspector General. In light of the resources
newly made available to the VA, do the VSOs recommend any modifications
to the FY 2010 Independent Budget request?
Response: The Independent Budget is pleased that the ``American
Recovery and Reinvestment Act of 2009'' (also the Stimulus bill)
included a substantial amount of funding for veterans programs. The
legislation identified areas of significant need within the VA system,
particularly as it relates to infrastructure needs. While we were
disappointed that additional funding was not provided for major and
minor construction in the Stimulus bill, we recognize that the funding
that was provided will be critically important to the VA going forward.
It is also important to note that we do not believe the funding
provided in the Stimulus bill should impact our recommendations for the
VA. We have been told that the VA intends to spend that funding in the
current fiscal year; therefore, the funding needs for FY 2010 will
still remain.
Question 2: The Independent Budget argues that amounts estimated
for medical collections should be fully appropriated and is silent as
to how medical collections should be used by the VA. Does you
organization support or oppose the current collections program? If
opposed, should Congress scrap the current Priority Group system and
not differentiate between service-connected and non-service-connected
veterans? If you support the current program but believe that these
funds should be appropriated, how does your organization specifically
propose to spend this nearly $3 billion amount, or 5 percent of current
VA medical care budget?
Response: Principally, the co-authors of The Independent Budget do
not support the current collections program. Historically, the purpose
of collections has not had a direct bearing on the utilization of such
funds throughout the evolution of what is now the Medical Care
Collections Fund (MCCF). When the VA collection authority was initially
established in 1986 to seek reimbursement from third-party health
insurers, collections were meant to be utilized as a deficit reduction
tool. It then evolved into a tool to offset VA's health care budget in
1997, and expanded to become a medical care utilization tool in 1999 by
allowing VA to increase cost-sharing on veterans. In doing so however,
such funds were supposed to be used to reduce medical care waiting
times and to reduce the burden of cost sharing on veterans for
medications and prosthetics. In 2003, MCCF was created to consolidate
revenue accounts, thus increasing the total amount of collections
available to further offset VA's health care budget.
While the purpose and utilization of collections has evolved we
continue to hold the belief that collections supplement the cost of
providing health care. Veterans' health care should not be dependent
upon an uncertain funding mechanism like medical care collections.
However, we realize that political considerations will not allow for
the policy by which The Independent Budget for FY 2010 believes funding
for VA health care services should be provided. In the meantime, we
cannot openly oppose the use of collections to provide for medical care
services so long as the total of appropriated dollars and actual
collected dollars meets the funding levels that we believe are
necessary to operate the VA health care system.
Moreover, we are not suggesting that we do not believe that medical
care collections are ``real dollars.'' It is simply meant to reflect
our belief that funding for Department of Veterans Affairs (VA) health
care programs should be provided in full with Federally appropriated
dollars. Our budget recommendations this year reflect this policy
position that we have long supported. The Administration, year-after-
year, chooses to include medical care collections as part of its
overall funding authority for Medical Services. In the past, the VA did
a very poor job of meeting collections estimates that it formulated its
operating budget on. We will not deny that in recent years, the VA has
done a much better job of meeting its collections estimates. However,
we remain concerned about a process that is grounded in so much
uncertainty, especially in light of the fact that shortages between
what the VA estimated it would collect and what it actually collected
have never been funded. As such, we believe that the cost of medical
care services should be provided for entirely through direct
appropriations.
As to the question about the Priority Group enrollment structure,
we do not support any suggestion to abolish this system. The Priority
Group system is not simply a tool to distinguish between who pays for
their care and who does not. The system also establishes priority for
care should there be a funding shortfall that may result in
restrictions to care, much like what happened to new Priority Group 8
veterans in 2003. Additionally, the existing Priority Group system
establishes varying degrees of care available to veterans, most notably
access to nursing home care and other long-term care services.
As for spending the additional funding, we believe that this money
could be reinvested in various programs that are part of the Veterans
Health Administration (VHA) or the entire VA. First and foremost, we
believe that a large portion of the money collected can be devoted to
capital investment projects. The VA has not adequately addressed the
long list of projects identified by the Capital Asset Realignment for
Enhanced Service (CARES) process. Moreover, as explained in the
Construction section of The Independent Budget, the VA should be
reinvesting five to 7 percent in its capital infrastructure each year.
However, the VA currently only reinvests about 2 percent.
We also remain concerned that the VA falls well below the
requirement for long-term care capacity (defined as average daily
census) as mandated by P.L. 106-117, the ``Millennium Health Care
Act.'' A portion of the money achieved through medical care collections
could be used to correct this deficiency. Additionally, the VA could
invest this money in State Extended Care facilities which support the
VA long-term care program. The VA could also use these additional
resources to address gaps that currently exist. For instance, VA
currently offers no assisted living services to any Priority Group of
veterans. And yet, this is certainly a model of non-institutional care
that can benefit many veterans as well as their spouses. This type of
service is also something that the newest generation of disabled
veterans is clamoring for. There is also a broad range of community
services including expanded home-based care such as homemaker services
and attendant care (services not currently authorized) that could be
provided with these additional dollars. These services would maximize
independence and preclude institutional care for both disabled and
aging veterans.
We also believe this money could be used to properly staff the
Office of Rural Health so that it can better fulfill its mission. The
Independent Budget believes that this new office has not lived up to
the expectations placed on it. However, the VA has not set this office
up for success. It is telling that the VA devoted only $1 million and
one new full-time employee (FTE) to this office in FY 2009. This
brought the Office of Rural Health up to three FTE. This is wholly
unacceptable, particularly given the fact that rural health care access
might be the single biggest health care issue facing the VHA.
Finally, we would suggest some of the resources generated through
medical care collections could be used to make the VA more competitive
in the market for hiring critical staff. The VA is at a significant
competitive disadvantage when trying to hiring certain health care
professionals. This is particularly true of nurses, rehabilitation
specialists, and specialized care doctors.
Question 3: The Administration has vowed to pore over the budgets
of every Federal Department and Agency line-by-line to make sure that
taxpayer dollars are spent wisely. The Administration has also signaled
that veterans' funding will be a high priority. In light of this need
for fiscal restraint, which programs and operations of the VA provide
the most cost-effective service to veterans and which programs and
services do you believe we should look closely at to see if it can be
reformed to provide better service at a lower cost?
Response: The Independent Budget would like to emphasize our
ongoing concern that the biggest factor in creating inefficient
spending of resources by the Department of Veterans Affairs (VA) is the
late approval of appropriations and insufficient budgets in previous
years. As we have pointed out many times, late passage of the VA's
appropriations bill has become the rule, not the exception. In fact, in
19 of the previous 22 years, the VA's appropriations bill was not
approved prior to the start of the fiscal year on October 1. Moreover,
while in the past couple of years Congress has provided very
significant increases in resources for the VA, we believe that previous
fiscal years were marked by marginal increases and even flat-line
budgets. This uncertainty about when and how much funding will be
provided hinders the ability of VA officials to efficiently plan and
responsibly manage VA health care.
The Independent Budget would also like to point to the management
of Medical Care Collections. Once again, while the VA has gotten much
better at meeting collections estimates in recent years, in the past
collection rates were terrible. Moreover, considering the fact that the
operating budget of the VA is based on collections estimates, it is
completely unacceptable that even one dollar of a given fiscal year's
estimate not be collected, since this has a direct impact on the
ability of the VA to provide care. As long as part of the operations of
the VA health care system are reliant on uncertain collections
outcomes, the system itself will be placed at a disadvantage.
We also believe that the Fee-for-Service program needs to be
reevaluated as well. Non-VA purchased care may be provided to eligible
veterans from non-VA health care providers when VA medical facilities
are incapable of providing necessary care; when VA medical facilities
are geographically inaccessible to a veteran for necessary care; when a
medical emergency prevents a veteran from receiving care in a VA
facility; to complete an episode of care; and for certain specialty
examinations to assist VA in adjudicating disability claims.
As you know, many of the veterans' service organizations (VSO) have
complained about the application of fee basis care in order to meet the
needs of veterans in rural settings. However, this concern can be taken
a step further. Veterans eligible for fee basis care are sometimes
unable to secure treatment from a community provider because of VA's
lower payment, less than full payment, and delayed payment for medical
services. In fact, as stated in The Independent Budget for FY 2010, we
are ``especially concerned that service-connected disabled veterans who
are authorized to use non-VA care are at times required by the only
provider in their community to pay for their care up front.'' We would
encourage the Committee to seriously examine the Fee-for-Service
program so as to affect real improvements to this service. With a
properly run fee basis care program, the VA can better meet the health
care needs of many veterans, particularly those veterans living in
rural communities.
As an example of a cost-effective program within the VA, we would
point to the operations of the Prosthetics and Sensory Aids program.
Because the prosthetics activities of the entire VA are managed through
a centralized funding structure, the program's leadership is better
able to monitor and adjust the budgetary needs of the service. Over
years of budget shortfalls, many of the VA hospitals had been forced to
hold down costs by cutting spending. This delayed provision of
wheelchairs, artificial limbs, and other prosthetic devices, which was
unacceptable. As a result, the VA established a policy that all funds
for prosthetics would be controlled from the VA Prosthetic Service in
the Central Office and that no prescription for prosthetics would fail
to be filled or delayed because of a lack of funds.
Committee on Veterans' Affairs
Washington, DC
March 23, 2009
Paul Sullivan
Executive Director
Veterans for Common Sense
P.O. Box 15514
Washington, DC 20003
Dear Paul:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
______
Committee on Veterans' Affairs
U.S. House of Representatives
Post-Hearing Questions from the Honorable Bob Filner
March 10, 2009
Hearing on the U.S. Department of Veterans Affairs
Budget Request for Fiscal Year 2010
Question: The Administration has vowed to pore over the budgets of
every Federal Department and Agency line-by-line to make sure that
taxpayer dollars are spent wisely. The Administration has also signaled
that veterans' funding will be a high priority. In light of this need
for fiscal restraint, which programs and operations of the VA provide
the most cost-effective service to veterans and which programs and
services do you believe we should look closely at to see if t can be
reformed to provide better service at a lower cost?
Response: We are very pleased the Administration has signaled that
funding for the Department of Veterans Affairs (VA) is a ``high
priority.''
VCS respectfully disagrees with the implied premise of the question
that Congress should limit oversight of VA programs based only on VA's
limited ability to measure cost effectiveness.
Here is a description of a meeting 11 years ago that describes how
using only the financial cost of a bill or a program to discuss and
decide the legitimacy of medical care and benefits for veterans is
wrong because it is incomplete:
During an advocacy meeting to discuss the ``Persian Gulf
Veterans Act 1998,'' a legislative aide told me that the
financial cost of providing medical care and benefits to the
hundreds of thousands of our ill Gulf War veterans would be
prohibitive. Therefore, he said, the legislator opposed the
bill due to the high cost--he did not want to spend billions of
dollars on health care and disability benefits for our ill Gulf
War veterans sickened by multiple toxic exposures during
deployment to Southwest Asia during Desert Shield and Desert
Storm.
I asked the aide if the legislator supported unlimited funding
for the military to fight and win wars. The aide quickly
responded that the legislator absolutely supported unlimited
appropriations for our military, especially during war. During
our conversation, we both agreed our number one national
security asset is our servicemembers who support and defend our
Constitution.
I asked the aide this question: If our Nation has an unlimited
budget for bullets, bombs, and bayonets for our military, and
since care for our veterans is part of the cost of fighting
wars, why then do we not have an unlimited budget for hospital
beds and disability benefits for our most important national
security asset--our disabled veterans who fought in and
survived combat? The legislative aide became speechless and
then abruptly left the room without answering.
In addition to our social contract that guides VA to take care of
our veterans who gave up the best years of our lives defending our
Constitution, Congress should follow the example of the burn unit at
the San Antonio Military Medical Center (SAMMC) in Texas.
The highly dedicated and exceptionally motivated medical staff at
Brooke Army Medical Center, part of SAMMC, spare no expense treating
Iraq and Afghanistan war casualties. Expensive skin grafts are provided
immediately without question and without regard to financial cost.
Nurses provide 24/7 medical care to each wounded warrior. Medical
professionals with expertise evaluating and treating burns are
frequently flown to Texas to provide the best available current
technology and treatments. In our view, this is the correct policy, as
everything possible is done to save lives.
VCS believes VA must have an equal standard--mandatory full funding
for VA health care. If we only count the lives lost and funds spent on
the battlefield for arms in order to determine the human and financial
costs of war, then we are counting only those things that are easily
counted, and we are ignoring those items that truly count--the quality
of life for disabled veterans (and their families) sent to war in our
name who return home, often in great need of assistance.
While VA often suffered from inefficiency, poor leadership, poor
training, chronic underfunding, chronic understaffing, complex rules,
and adversarial bureaucratic red tape, especially during the last
Administration, VA still usually provides high-quality assistance,
albeit sometimes with significant delays. VCS believes mandatory full
funding, strong leadership, and streamlined policies will assist VA
with evolving and improving the delivery of health care and benefits to
our veterans. VCS thanks VA for continuing to move forward under the
current Administration's new leaders and additional funding.
______
VCS is not familiar with every program administered by VA, so our
answer about specific VA programs is limited to the areas with which we
are most familiar. Here is a list of a seven areas VCS finds critical.
Many of these need significant and immediate improvement to meet a
sustained increased in demand caused by the current economic crisis and
the continuation of two simultaneous wars in Iraq and Afghanistan:
1. Medical Research. At a time of unprecedented demand for health
care related to highly toxic dioxin (agent orange) exposures associated
with the Vietnam War, VA has a moral and legal obligation to fund
scientific research immediately in order to better understand the
adverse health outcomes of toxic exposures and to develop desperately
needed treatments for veterans and our families. Our Vietnam War and
Gulf War veterans fought valiantly for answers and health care after
their return, yet VA took decades to respond adequately. While research
for toxic exposures during those wars remains important, VA must
immediately begin pro-actively collecting data, monitoring veterans,
and researching the impact of Iraq War and Afghanistan War toxic
exposures, starting with toxic exposures surrounding the enormous burn
pit near Balad, Iraq. By starting medical research now, we have a rare
window of opportunity to avoid prior VA mistakes that caused delays in
medical care and benefits for our Atomic veterans, Vietnam War
veterans, and Gulf War veterans.
2. Benefits Delivery at Discharge (BDD). This new and expanding
program is highly successful and efficient because it places Veterans
Benefits Administration (VBA) employees at military installations who
can expeditiously collect and review service and medical records before
discharge, thus saving VA staff months, and of10 years, of searching
for misplaced military records, especially for post traumatic stress
disorder claims. The government Accountability Office (GAO) and several
Congressional hearings have validated the success of this essential
program. Therefore, VCS recommends significantly expanding this
essential program so that as many servicemembers as possible have the
opportunity to participate in BDD, especially National Guard and
Reserve servicemembers who are usually excluded. During the March 10,
2009, hearing, VCS provided Congress with our modest proposal to expand
VA's BDD and bring VA to our veterans with one-stop shopping during and
after military service.
3. Readjustment Counseling Service's ``Vet Centers.'' This
seasoned and expanding program is also highly successful and efficient
because it places Veterans Health Administration (VHA) mental health
professionals in store front locations easily accessed by deployed
veterans seeking readjustment counseling. Several GAO reports about Vet
Centers have repeatedly shown this program to be among the most
successful entry points for veterans seeking mental health care
services. The low overhead of small store front offices makes these
points of care highly cost-effective. Therefore, VCS recommends
significantly expanding this program so that more veterans can utilize
equally valuable Vet Center counseling in addition to VHA out-patient
and in-patient care provided at VHA medical centers. VCS advocates
placing Vet Centers on or near military installations to meet the
mental health care crisis among our returning servicemembers as soon as
possible, when treatment is least expensive and most effective. Vet
Centers should also be expanded to provide counseling for
servicemembers' and veterans' families.
4. Mental Health. This includes VA's Suicide Prevention programs,
anti-stigma programs, and the National Center for Post Traumatic Stress
Disorder (NCPTSD). Specifically, VA has not provided consistent and
timely oversight of VA's Mental Health Strategic Plan. Although there
are some pilot programs, VA has yet to fully implement outreach and
anti-stigma campaigns. On a positive note, VA is now working closely
with DoD on the issue of suicide prevention. Unfortunately, while prior
VA leaders have often attempted to under-fund the NCPTSD during a time
of record demand for VA mental health care, we are pleased that
Congress consistently provided more funds for NCPTSD than requested by
the Administration. Based on VA's internal reports documenting
increased health care use, VCS estimates as many as 400,000 total new
mental health patients from the Iraq and Afghanistan wars by the end of
2013, out of one million estimated new VA patients from the two wars.
Therefore, VCS recommends increasing all facets of VA's mental health
care programs to develop processes designed at early identification,
intervention, and treatment of war-related mental health conditions. We
believe ramping up programs now for existing and returning
servicemembers, when treatment is least expensive and most effective,
is crucial. Increases should be made for Suicide Prevention
Coordinators and Local Recovery Coordinators to make sure there is a
coordinated effort between VA's many different mental health programs.
5. Office of the Actuary. This office could and should provide VA
leaders with far greater amounts of accurate, consistent, transparent,
and timely information for use in VA planning, policy development, and
long-term budgeting. A critical role of VA's Office of the Actuary is
to collaborate with other federal agencies, especially the Department
of Defense (DoD) and the Census Bureau, on the collection of data on
veterans for planning purposes. However, due to a lack of robust and
timely data for several years, VA leaders made several critical
decisions without complete information, resulting in dramatic multi-
billion dollar budget shortfalls. Poor data played a key role in the
large numbers of veteran patients and claimants waiting unreasonable
amounts of time for VA assistance. Therefore, VCS recommends that VA's
Office of the Actuary be significantly expanded to include more DoD,
Census Bureau, VHA, and VBA subject matter experts. VHA requires better
data to monitor and prepare for health care use demand. Similarly, VBA
requires better data to monitor and prepare for disability claim
activity. VHA and VBA must work more closely together to identify
veterans using VHA yet not VBA, and vice-versa, in order to understand
what drives health care and claim demand. At a time when Congress is
ready to provide VHA with advanced funding (and possibly mandatory full
funding), Congress should take a thorough and deliberate look at VA's
limited ability to prepare for and use the money Congress appropriates.
This becomes even more vital with the extension of free medical care,
from 2 years to five years, for deployed Iraq and Afghanistan war
veterans.
6. Office of Seamless Transition (STO) and related offices. These
offices perform vital roles within VA assisting veterans, collecting
data, and developing policies to assist servicemembers with seamlessly
transitioning from the military into civilian life as veterans. The
lack of single office with a single leader and streamlined processes
have significantly hampered VA's ability to provide prompt and high-
quality services to the tidal wave of returning Iraq and Afghanistan
war veterans. The lack of consistent data about individual
servicemembers (such as service and medical records) as well as data
about the entire cohort of all servicemembers (that would include
demographic and deployment data for planning purposes) has created
significant challenges in meeting the needs of our returning veterans
in an efficient manner. The office would realize a much higher
effectiveness if it was fully staffed, fully funded, and led by an
executive who interacted with DoD and the Department of Labor. VA is
currently unable to meet the needs of the existing one million current
war veterans, and the situation may deteriorate significantly as the
remaining one million servicemembers who have deployed or are deployed
prepare for discharge. Therefore, VCS recommends that VA develop a more
robust and efficient STO to meet the current and growing need of our
returning Iraq and Afghanistan war veterans.
7. Information Technology (IT). This VA office provides vital
hardware, software, and communications within VA and to the outside
world essential to the success of nearly every VA program--from
applications, claims processing, medical records, e-mail, and the
Internet, to name a few. VCS recommends modernizing VA's computer
equipment and computer programs as well as using new technologies to
assist veterans and beneficiaries with learning about and applying for
VA benefits and so that VA is more transparent and interactive for
veterans, family members, VA staff, journalists, elected officials, and
the public. VCS lists VA's IT efforts based on recent challenges
veterans faced applying for the new Post-9/11 GI Bill education
benefits, an outstanding VA program we strongly support.
Committee on Veterans' Affairs
Washington, DC
March 23, 2009
Paul Rieckhoff
Executive Director and Founder
Iraq and Afghanistan Veterans of America
770 Broadway, 2nd Floor
New York, NY 10003
Dear Paul:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
______
Response from Iraq and Afghanistan Veterans of America
Committee on Veterans' Affairs
U.S. House of Representatives
Post-Hearing Questions from the Honorable Bob Filner
March 10, 2009
Hearing on the U.S. Department of Veterans Affairs
Budget Request for Fiscal Year 2010
Question: The Administration has vowed to pore over the budget of
every Federal Department and Agency line-by-line to make sure that
taxpayer dollars are spent wisely. The Administration has also signaled
that veterans' funding will be a high priority. In light of this need
for fiscal restraint, which programs and operations of the VA provide
the most cost-effective service to veterans and which programs and
services do you believe we should look closely at to see if it can be
reformed to provide better service at a lower cost?
Response: Thank you for the opportunity to address this issue. IAVA
believes that the introduction of OIF/OEF outreach coordinators is a
highly successful and cost-efficient program. These coordinators,
themselves veterans of Iraq and Afghanistan, are for many returning
servicemembers the first point of contact with the VA. They provide an
invaluable personal connection that helps overcome the many
bureaucratic hurdles facing those seeking out support from the VA.
These outreach coordinators make up a crucial element of the excellent
Vet Centers, which have been proven for decades to be a low-cost, high-
impact answer to the mental health needs of combat veterans. We
wholeheartedly support the continuation and expansion of this and other
VA outreach programs.
In our legislative agenda, IAVA has called for a reformed and
streamlined VA budget. If the VA were to know their health care budget
a year in advance, we would see an end to the waste and inefficiency
brought about by poor planning. For instance, VA hospitals frequently
delay needed repairs while they are shifting funding to other accounts
to cover shortfalls. In the meantime, many of those infrastructure
problems are worsening and growing more expensive to repair. When
hospitals are operating under a continuing budget resolution, they are
forced to ration care, delaying appointments while patients get sicker
and their care becomes more expensive. No one at the VA wants these
problems to persist, but without action by Congress and the President
to appropriate VA funding in advance, these inefficiencies will
continue to unabated.
Committee on Veterans' Affairs
Washington, DC
March 23, 2009
Richard F. Weidman
Executive Director for Policy and Government Affairs
Vietnam Veterans of American
8605 Cameron Street, Suite 400
Silver Spring, MD 20910
Dear Rick:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
______
Vietnam Veterans of America
Silver Spring, MD
May 18, 2009
The Honorable Bob Filner
Chairman
House Committee on Veterans' Affairs
335 Cannon House Office Building
Washington, DC.
Dear Chairman Filner:
In response to your questions following the hearing on the Budget
Request for FY 2010 for the Department of Veterans Affairs, Vietnam
Veterans of America (VVA) offers the following:
Which programs and operations of the VA provide the most cost-
effective service?
The Vet Centers, since their inception, are the most
well-run--and cost-effective--entities within the VA. They are the only
VA service that can treat families as well as the veteran.
Preventive health programs run at different VA Medical
Centers certainly are cost-effective: they prevent far more costlier
treatments for health conditions that develop later on. We want to cite
the programs run by Dr. Lawrence Deyton and his staff at the VA Central
Office, and the programs run by Dr. Victor Wahby, both of which help
reduce illness.
Which programs and operations need to be reformed to provide
better, less costly service?
One out of ten VA health care dollars are expended for
so-called ``fee-basis'' care for services that either a VAMC or CBOC
are unable to provide in a timely manner or can be performed locally
and save a veteran, usually living in a rural or remote area, hours of
travel. In an attempt to get a handle on this, the VA is engaged in a
pilot program in four VISNs called ``Project HERO.'' This endeavor is
worth an oversight hearing. We believe it is resulting in less health
care for more money.
Pharmacy Service--the formulary is much too restrictive
(and much more restrictive than either DoD or Medicare) on the theory
that they are going to save a lot of money on medications. However,
they often save pennies and spend big dollars because they scrimp on
medications that could have prevented very costly acute care in-patient
stays. The method of evaluating pharmacists needs to be dramatically
changed from how much in ``savings'' they produce in comparison with
the national average (which becomes a ``race to the bottom'') to how
much did what they do in cooperation with the medical staff at a given
VA Medical Center to promote healing and wellness, and reduce in-
patient acute care stays in the hospital, and/or to prevent secondary
conditions from developing. VVA will be coming out with a paper on this
issue in the next 2 months.
The VA needs to develop a comprehensive ``wellness
program'' that brings together nutrition, the ``get Fit for Life''
program, the ``MOVE' program, the ``My Health-e-Vet'' program, and
other initiatives into an integrated model that is directly linked into
primary care at each VAMC, OC, or CBOC. Only by putting a major and
imaginative comprehensive effort together can VA reduce incidence and
severity of chronic diseases and create a sustainable model for VA
health care.
Mr. Chairman, VVA hopes these answers prove to be useful to you in
your deliberations. Again I wish to thank you for allowing VVA to
present our views to you on these vital veterans' issues.
Sincerely,
Richard F. Weidman
Executive Director for Policy and Government Affairs
Committee on Veterans' Affairs
Washington, DC.
March 23, 2009
Steve Robertson
The American Legion
Director, National Legislative Commission
1608 K Street, NW
Washington, DC 20006
Dear Steve:
In reference to our Full Committee hearing entitled ``The
Department of Veterans Affairs Budget Request for Fiscal Year 2010'' on
March 10, 2009, I would appreciate it if you could answer the enclosed
hearing questions by the close of business on May 5, 2009.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
______
The American Legion
Washington, DC.
March 26, 2009
Honorable Bob Filner, Chairman
Committee on Veterans' Affairs
U.S. House of Representatives
335 Cannon Office Building
Washington, DC 20515-6335
Dear Chairman Filner:
Thank you again for allowing The American Legion to testify at the
March 10 hearing entitled ``The Department of Veterans Affairs Budget
Request for Fiscal Year 2010.'' This letter is in response to your
Post-Hearing Question:
The Administration has vowed to pore over the budgets of every
Federal Department and Agency line-by-line to make sure that
taxpayer dollars are spent wisely. The Administration has also
signaled that veterans' funding will be a high priority. In
light of this need for fiscal restraint, which programs and
operations of the VA provide the most cost-effective service to
veterans and which programs and services do you believe we
should look closely at to see if it can be reformed to provide
better service at a lower cost?
Mr. Chairman, with all due respect, The American Legion has worked
closely with both the Department of Veterans Affairs and Congress for
many, many years. Clearly, The American Legion has never hesitated to
praise programs and operations that provide the most cost-effective
service to veterans nor identified programs and operations that needed
immediate attention and reform.
Each and every program and operation is an earned benefit due to
honorable military service. Fortunately, this grateful Nation continues
to strive toward meeting the needs of America's veterans and their
family members. Without question, the Veterans Health Administration
(VHA) continues to serve as the role model for the rest of the health
care industry. Its achievements in that industry truly illustrate a
solid return on investment dollars. From the electronic medical records
to the medical research to the patient safety to the customer
satisfaction, VHA is peerless within and outside the Federal
Government.
The American Legion still believes there is much room for
improvement in two significant areas within VHA, that of mental health
and long-term care. The American Legion believes that due to the high
cost of these specialized services, they have been neglected by VHA
leadership. During the Capital Assets Realignment for Enhanced Services
(CARES) process, VA did not address these two critical areas of
concentration. Therefore, a situation now exists where there exists a
growing demand for both mental health care services and long-term care
that VHA is not properly prepared to meet and the veterans' community
is underserved.
With the newest generation of wartime veterans and the aging
veterans' community turning to VHA for timely access to quality health
care, both of these areas of specialized service need to be closely
monitored and addressed via congressional oversight. ``Take a number
and we'll get back to you'' is absolutely unacceptable.
The challenges facing the Veterans Benefits Administration remain
although The American Legion remains optimistic. Newly hired claims
adjudicators must be properly trained and, more importantly, retained.
VBA leadership must develop an aggressive short- and long-term strategy
to recruit, train, and retain proficient claims processors and
adjudicators. The American Legion continues to support the recruitment,
training, and retention of service-connected disabled veterans in this
career field, especially those going through VA's Vocational
Rehabilitation Program.
With regards to construction projects, both major and minor, The
American Legion supported many of the CARES recommendations, but has
waited patiently for the aggressive funding to put those
recommendations into structures.
State Extended Care Facilities Grant Program remains a valuable
resource for the Department of Veterans Affairs; however, The American
Legion still believes VA should increase the amount of per diem paid to
these facilities, especially in light of the current economic downturn
and the increased fiscal pressures state legislatures continue to face.
The National Cemetery Administration continues to provide the
veterans' community with cemeteries that reflect the appreciation of a
grateful Nation toward those that served in the Armed Forces and their
family members.
Thank you for your continued commitment to America's veterans and
their families.
Sincerely,
Steve Robertson, Director
National Legislative Commission
______
FY 2009 Veterans Health Administration Non-Recurring Maintenance (NRM)/Energy ARRA Spend Plan
*Projects in BOLD ITALICS incorporate energy efficiency and renewable energy.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Location
-------------------------------------------------- Estimated Budget Prior Year
VISN Congressional Project Title Cost Obligations ARRA Funding
City State District
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Anchorage AK At Large Renovate Warehouse Space to Meet VA $300,000 $-- $300,000
Requirements
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Anchorage AK At Large Renovate Space for Clinical Programs, $200,000 $-- $200,000
Building 1.
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA Fort Richardson AK At Large Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA Sitka AK At Large Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Alaska $600,000 $-- $600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Montgomery AL 3 Renovate Inpatient Area to be $2,500,000 $-- $2,500,000
Residential Environment
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Montgomery AL 3 Renovate and Modernize the EKG Unit $220,000 $-- $220,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Montgomery AL 3 Upgrade Sprinkler and Fire Alarm $164,000 $-- $164,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Montgomery AL 3 Modernize Nursing Home $1,783,513 $283,513 $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*7 Montgomery AL 3 Renovate Restrooms with water $998,330 $90,800 $907,530
conservation measures
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Tuscaloosa AL 7 Upgrade Cabling and Telephone Closets $4,980,000 $480,000 $4,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Birmingham AL 7 Upgrade Research Labs 4 & 5 Floors $925,000 $-- $925,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Birmingham AL 7 Renovate Critical Care Unit $829,927 $129,927 $700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Tuscaloosa AL 7 Modernize Halls and Floors $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*7 Tuscaloosa AL 7 Replace Windows $905,000 $_ $905,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*7 Birmingham AL 7 Replace Windows $1,512,907 $126,988 $1,385,919
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Tuscaloosa AL 7 Replace Elevators $705,000 $54,000 $651,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Birmingham AL 7 Renovate Surgical Intensive Care Unit $1,700,000 $200,000 $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Tuscaloosa AL 7 Upgrade Quality Management and $1,072,041 $200,000 $872,041
Pharmacy
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Alabama $18,795,718 $1,565,228 $17,230,490
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 North Little Rock AR 2 Electrical Upgrade in Building 102 $750,000 $-- $750,000
for facility Computer Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 North Little Rock AR 2 Replace Boiler Plant $3,200,000 $_ $3,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 North Little Rock AR 2 Renovate/Repair Elevators $4,000,000 $-- $4,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Little Rock AR 2 Replace air Handling Equipment, Phase $4,000,000 $_ $4,000,000
2
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Fayetteville AR 3 Pave Gravel Parking Lot $98,000 $-- $98,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Fayetteville AR 3 Construct Security Control Center $252,000 $-- $252,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Fayetteville AR 3 Upgrade Lightning Protection Systems $190,000 $-- $190,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Fayetteville AR 3 Repair/Replace Existing Columns in $390,000 $-- $390,000
Building 1, 2, 3, and 4
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Fayetteville AR 3 Upgrade Air Conditioning System in $1,500,000 $_ $1,500,000
Building 2 for Dietetics
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Arkansas $14,380,000 $-- $14,380,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Prescott AZ 1 Fire and Life Safety/Security $546,125 $76,125 $470,000
Improvements
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Prescott AZ 1 Repair Building 14 Exterior $750,000 $-- $750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Prescott AZ 1 Replace Elevator Controls, Phase 1 $785,000 $110,000 $675,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Prescott AZ 1 Upgrade/Repair Elevators in Building $720,000 $-- $720,000
14 and 107
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Prescott AZ 1 Repair Foundation and Drainage System $750,000 $-- $750,000
for Building
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Prescott AZ 1 Upgrade/Replace Fire Alarm System $1,400,000 $-- $1,400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Prescott AZ 1 Repair/Replace Roofing Building 17 $450,000 $10,000 $440,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Prescott AZ 1 Implement Selected Conservation $1,142,857 $_ $1,142,857
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Prescott AZ 1 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Replace/Upgrade Patient Ward Windows $600,000 $_ $600,000
and Doors in Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Replace Building 1 and 16 Drain, $2,200,000 $200,000 $2,000,000
Sewer, and Water Lines, Phase 5
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Automatic Transfer Switch Replacement $1,600,000 $-- $1,600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Phoenix AZ 4 Renovate Supply, Processing and $750,000 $_ $750,000
Distribution to provide for proper
humidity control
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Renovate 6th Floor for Motivating $600,000 $-- $600,000
Overweight Veterans Everywhere
(MOVE) Program
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Bldg 1 & 16 Drain/Water Sewer $750,000 $-- $75,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Replace/Upgrade Electrical $2,750,000 $-- $275,000
Distribution Equipment, Phase 4
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Provide Backup Power per Regulation, $750,000 $-- $75,000
Phase 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Replace/Upgrade Electrical $3,500,000 $750,000 $2,750,000
Distribution System, Phase 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Environment of Care Corrections $550,000 $-- $550,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Phoenix AZ 4 Implement Selected Conservation $1,142,857 $_ $1,142,857
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Tucson AZ 7 Fire and Life Safety Corrections $757,950 $257,950 $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Tucson AZ 7 Install Fire Sprinklers in Building 3 $407,434 $57,434 $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Tucson AZ 7 Renovate Restrooms for Patient $750,000 $-- $750,000
Privacy in Building 60
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Tucson AZ 7 Renovate Building 60 for Polytrauma $350,000 $-- $350,000
Staff and Programs
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Tucson AZ 7 Implement Selected Conservation $1,142,857 $_ $1,142,857
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Arizona $25,155,080 $1,461,509 $19,868,571
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Sacramento (Mather) CA 3 Evaluate Feasibility of Direct $342,857 $_ $342,857
Geothermal\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Sacramento (Mather) CA 3 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Sacramento (McClellan) CA 3 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Vallejo CA 7 Evaluate Feasibility of Direct $342,857 $_ $342,857
Geothermal\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Martinez (OPC) CA 7 Evaluate Feasibility of Direct $342,857 $_ $342,857
Geothermal\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Vallejo CA 7 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Martinez CA 7 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 San Francisco CA 8 Renovate Building 9 and 10 to correct $400,000 $_ $400,000
Heating Deficiencies
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 San Francisco CA 8 Replace/Upgrade Building 8 Elevator $425,000 $-- $425,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 San Francisco CA 8 Campus Wide Elevator Study $225,000 $-- $225,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 San Francisco CA 8 Repair/Upgrade Water Tower Utility $2,000,000 $-- $2,000,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 San Francisco CA 8 Review American Disability Act $365,000 $-- $365,000
Compliance, and Pedestrian & Traffic
Flow
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Livermore CA 10 Renovate for the Installation of New $479,000 $-- $479,000
Patient Lift Equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Livermore CA 10 Renovate Building 26 Water Tank $650,099 $-- $650,099
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Livermore CA 10 Repair Below Grade Storm Drainage $25,000 $4,026 $20,974
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Livermore CA 10 Remediate Asbestos from Building $250,099 $-- $250,099
Exterior Walls and Lead Paint from
Bridge
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 San Francisco CA 10 Renovate for Pharmacy Relocation $2,000,000 $-- $2,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 San Francisco CA 10 Renovate for Parking Behind Building $300,000 $-- $300,000
11
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 San Francisco CA 10 Install Utilities Behind Building 11 $425,000 $-- $425,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 San Francisco CA 10 Evaluate Feasibility of a Solar $10,000 $_ $410,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 San Francisco CA 10 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 San Francisco CA 10 Evaluate Feasibility of Direct $342,857 $_ $342,857
Geothermal\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA Dixon CA 10 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA San Bruno CA 12 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Martinez CA 13 Renovate/Update Fire Sprinkler and $200,000 $-- $200,000
Life Safety Compliance, Building 29
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Renovate for Life Safety and Egress $30,000 $10,942 $19,058
Compliance per Regulation
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Review Facility for Fire and Life $10,800 $-- $10,800
Safety Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Install Fire Sprinkler Control Valve $15,099 $-- $15,099
Signs
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Renovate for the Installation of New $508,000 $-- $508,000
Patient Lift Equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Menlo Park CA 14 Repair/Upgrade Loop Road, Phase 1A $929,000 $-- $929,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Menlo Park CA 14 Replace Air Handlers, Building 322 $230,000 $_ $230,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Menlo Park CA 14 Renovate for Auto Shop and $650,099 $-- $150,000
Engineering Storage
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Menlo Park CA 14 Replace Exhaust Units $2,000,099 $_ $2,000,099
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Menlo Park CA 14 Loop Road--Design, Phase 3 $335,975 $-- $335,975
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Demolition of Building 23 $660,000 $-- $660,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Menlo Park CA 14 Expand Storm Drains $1,813,740 $613,740 $1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Replace Roof $131,084 $-- $131,084
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Menlo Park CA 14 Renovate Interior Floor Covering for $485,520 $-- $485,520
all buildings
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Menlo Park CA 14 Replace Condensing Units $384,672 $_ $384,672
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Palo Alto CA 14 Renovate Interior Lighting $249,854 $_ $249,854
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Replace Vinyl Floor Covering $75,000 $-- $75,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Palo Alto CA 14 Renovation of Exterior Windows $4,728 $_ $4,728
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Menlo Park CA 14 Loop Road, Phase 1B Construction $1,700,000 $-- $1,700,000
Parking Lot
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Menlo Park CA 14 Replace Exhaust Units, Building 324, $1,000,099 $_ $1,000,099
Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Menlo Park CA 14 Loop Road, Phase 2 Road and Parking $2,800,000 $-- $2,800,000
Construction
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Demolition of Building 23 $350,099 $-- $350,099
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Renovate Clinic B Bathrooms for $250,000 $-- $250,000
American Disability Act Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Palo Alto CA 14 Renovate for 64-slice CT & Relocate $800,099 $50,099 $750,000
Ultrasound
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Menlo Park CA 14 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Seaside CA 17 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Fresno CA 20 Remediate all known asbestos on $2,200,000 $-- $2,200,000
station
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Fresno CA 20 Replace Steam Boilers $1,570,000 $_ $1,570,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Fresno CA 20 Replace Cooling Tower 1 & 2 $1,600,000 $_ $1,600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Fresno CA 20 Replace Heating, Ventilation and Air $2,750,000 $_ $2,750,000
Conditioning, Buildings 10, 11, 12,
13, 14
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Fresno CA 20 Repairs/ Replace Sidewalks $1,100,000 $-- $1,100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Fresno CA 20 Repair/Upgrade Sidewalks and Parking $1,900,000 $-- $1,900,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 Sepulveda CA 27 Replace Heating, Ventilation and Air $1,125,000 $_ $1,125,000
Conditioning System for Building
B103, Animal Research
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Sepulveda CA 27 Repair Roads and Parking, Phase 1 $1,113,919 $-- $1,113,919
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Sepulveda CA 27 Repair Irrigation System $881,000 $-- $881,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 Sepulveda (ACC) CA 27 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 Sepulveda (Vet Center) CA 27 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Renovate Operating Rooms, Building $1,553,500 $-- $1,553,500
500
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Replace Roofs Building 218 and $1,050,000 $-- $1,050,000
Building 507
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Renovate Patient Bathrooms for $1,175,000 $-- $1,175,000
Handicap Access
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Renovate Nuclear Medicine for USP-823 $693,200 $-- $693,200
Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Renovate to provide adequate drainage $722,000 $-- $722,000
at Loading Dock, Building 508
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Renovate Building 158, various $3,025,000 $-- $3,025,000
systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Replace Nurse Call System, Building $1,100,000 $-- $1,100,000
500
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 W. Los Angeles CA 30 Retrofit Steam Piping, North Campus $1,225,000 $_ $1,225,000
Phase 6
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Renovate Radiology/Nuclear Medicine, $1,035,390 $-- $1,035,390
Building 500
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Retrofit Sewer System for Main $1,792,000 $-- $1,792,000
Hospital Building, Phase 4
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Retrofit Sewer System for Main $1,792,000 $-- $1,792,000
Hospital Building, Phase 5
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Replace Galvanized Piping in Building $1,493,100 $-- $1,493,100
212
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 W. Los Angeles CA 30 Renovate Restrooms and Correct $1,230,000 $_ $1,230,000
Accessibility Deficiencies
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 W. Los Angeles CA 30 Retrofit Sewer System for Main $1,792,000 $-- $1,792,000
Hospital, Phase 6
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 Los Angeles CA 30 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA Los Angeles CA 30 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Loma Linda CA 41 Renovate Isolation Rooms $1,500,000 $-- $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Loma Linda CA 41 Renovate Nursing Home Care Unit $600,000 $-- $600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Loma Linda CA 41 Renovate Laboratory $1,300,000 $-- $1,300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Loma Linda CA 41 Purchase Additional Emergency $5,000,000 $-- $5,000,000
Generator to meet load requirements
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA Riverside CA 44 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Replace/Repair Main Sewer Line $2,000,000 $-- $2,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Renovate Spinal Cord Injury Unit $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Renovate Interior Finishes, Building $800,000 $-- $800,000
126
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Site Install Emergency Management $5,500,000 $-- $5,500,000
Generator
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Renovate/Relocate Gait Lab $1,100,000 $-- $1,100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Replace Electrical Equipment in $2,200,000 $-- $2,200,000
Building 126, Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Replace Sanitation Piping, Phase 2, $2,000,000 $-- $2,000,000
Building 216
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Repair/Replace Fire Pump System $165,000 $-- $165,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 Long Beach CA 46 Repair/Resurface Roads and Parking, $3,000,000 $-- $3,000,000
Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA San Diego CA 52 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 San Diego CA 53 Upgrade Supply, Processing and $835,000 $_ $835,000
Distribution Heating, Ventilation
and Air Conditioning Systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 San Diego CA 53 Upgrade Heating, Ventilation and Air $2,125,000 $_ $2,125,000
Conditioning for Operating Rooms
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 San Diego CA 53 Renovate Emergency Room $2,022,402 $-- $2,022,402
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 San Diego CA 53 Emergency Generator Switchboard $2,275,000 $-- $2,275,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 San Diego CA 53 Renovate/Expand Prosthetics $150,000 $-- $150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 San Diego CA 53 Renovate administrative space for $2,150,000 $-- $2,150,000
Social Work and OEF/OIF
--------------------------------------------------------------------------------------------------------------------------------------------------------
*22 San Diego CA 53 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--California $93,880,105 $678,807 $92,701,199
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Denver CO 1 Repair/Upgrade Heating, Ventilation $600,000 $55,000 $545,000
and Air Conditioning in Sub-Basement
of Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Denver CO 1 Repair/Replace Heating, Ventilation $750,000 $70,000 $680,000
and Air Conditioning Components in
Buildings 19 and 21
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Denver CO 1 Replace Piping in Building 1 $750,000 $70,000 $680,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Denver CO 1 Replace/Upgrade Exterior Finishes and $660,000 $60,000 $600,000
Windows
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Denver CO 1 Improve Heating, Ventilation and Air $550,000 $50,000 $500,000
Conditioning System for Energy
Reduction
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Denver CO 1 Replace/Upgrade Heating Piping in $1,355,000 $55,000 $1,300,000
Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Denver CO 1 Repair Steam System Building 1 $387,000 $37,000 $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Grand Junction CO 3 Replace Site Underground Electrical $750,000 $75,000 $675,000
Feeds, Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Grand Junction CO 3 Replace Air Handling Unit $750,000 $70,000 $680,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Grand Junction CO 3 Replace Air Handling Unit, Building 5 $750,000 $75,000 $675,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Grand Junction CO 3 Renovate for Employee Locker Rooms $750,000 $75,000 $675,000
and Patient/Visitor Restrooms
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Grand Junction CO 3 Install Solar Photovoltaic Array $750,000 $75,000 $675,000
System, Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Colorado $8,802,000 $767,000 $8,035,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Newington CT 1 Correct Life Safety Deficiencies $557,000 $-- $557,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Newington CT 1 Repair and Replace Roofs, Phase 3 $732,075 $-- $732,075
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 West Haven CT 3 Repair and Replace the Chilled Water $1,087,000 $_ $1,087,000
Insulation
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 West Haven CT 3 Renovate for Construction of Semi- $8,841,000 $1,098,000 $7,743,000
Private and Private Inpatient Units
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Connecticut $11,217,075 $1,098,000 $10,119,075
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Washington DC At Large Replace Chiller in Main Hospital $2,500,000 $_ $2,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Washington DC At Large Renovate Pharmacy $3,000,000 $-- $3,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Washington DC At Large Renovate Area for Installation of Cat $560,000 $-- $560,000
Scanner
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Washington DC At Large Renovate Radiology $3,250,000 $-- $3,250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Washington DC At Large Upgrade Dental Area $1,000,000 $-- $1,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Washington DC At Large Renovate the Research Animal Facility $750,000 $-- $750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Washington DC At Large Replace the Sprinkler System $1,000,000 $-- $1,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Washington DC At Large Implement Selected Conservation $3,333,333 $_ $3,333,333
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--District of Columbia $15,393,333 $-- $5,393,333
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Wilmington DE At Large Upgrade and Replace the Heating, $2,200,000 $_ $2,200,000
Ventilation and Air Conditioning
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wilmington DE At Large Upgrade Secondary Electrical $2,750,000 $-- $2,750,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wilmington DE At Large Replace Elevator $450,000 $-- $450,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Wilmington DE At Large Upgrade and Replace Boiler Plant $466,440 $_ $466,440
Equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Wilmington DE At Large Upgrade Heating, Ventilation and Air $2,200,000 $_ $2,200,000
Conditioning System
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Delaware $8,066,440 $-- $8,066,440
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Lake City FL 4 Replace Air Handling Units $450,458 $_ $450,458
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Lake City FL 4 Replace Chiller $550,000 $_ $550,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Lake City FL 4 Replace Electrical Switches $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Lake City FL 4 Repair and Upgrade Operating Room $409,091 $_ $409,091
Heating, Ventilation and Air
Conditioning
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Gainesville FL 6 Relocate and Renovate for Vascular $285,000 $-- $285,000
Lab
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Gainesville FL 6 Construct an Intensive Care Step Down $830,000 $-- $830,000
Unit
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Gainesville FL 6 Upgrade Physical Security $450,000 $-- $450,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Gainesville FL 6 Replace Finishes $400,000 $-- $400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Gainesville FL 6 Repair and Upgrade Electrical $2,260,000 $-- $2,260,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Orlando FL 8 Construct New Medical Gas Bldg $250,000 $-- $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Orlando FL 8 Study for Electrical Distribution $150,000 $-- $150,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Orlando FL 8 Upgrade Heating, Ventilation and Air $350,000 $_ $350,000
Conditioning Controls
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Orlando FL 8 Replace Steam Pipes $700,000 $_ $700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Orlando FL 8 Upgrade Operating Room Heating, $350,000 $_ $350,000
Ventilation and Air Conditioning
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Orlando FL 8 Renovate and Upgrade Operating Room $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Orlando FL 8 Repair Steam Traps $195,000 $_ $195,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Orlando FL 8 Upgrade and Renovate Operating Room $605,000 $-- $605,000
Finishes
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Orlando FL 8 Renovate for Supply, Processing and $350,000 $-- $350,000
Distribution Cart Lift
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Orlando FL 8 Repair and Upgrade Fire Alarm System $625,000 $-- $625,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Orlando FL 8 Upgrade and Replace Heating, $500,000 $_ $500,000
Ventilation and Air Conditioning
Controls
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Orlando FL 8 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Bay Pines FL 10 Renovate Area for MRI Install $726,715 $-- $726,715
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Bay Pines FL 10 Renovate Kitchen $1,477,357 $-- $1,477,357
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Bay Pines FL 10 Replace and Upgrade Heating, $2,758,419 $_ $2,758,419
Ventilation and Air Conditioning
Systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Bay Pines FL 10 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Tampa FL 11 Renovate Area for Electro Physiology $1,000,000 $-- $1,000,000
Lab
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Tampa FL 11 Renovate Area for Electro Physiology $1,650,000 $-- $1,650,000
Lab Recovery
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Tampa FL 11 Upgrade Windows for Hurricane $1,250,000 $_ $1,250,000
Hardening
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Tampa FL 11 Renovate Area for Install of Gamma $750,000 $-- $750,000
Camera
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Tampa FL 11 Replace Research Exhaust Fan $750,000 $_ $750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Tampa FL 11 Renovate and Modernize for American $700,000 $-- $700,000
Disability Act Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Tampa FL 11 Repair and Replace Steam Pipe System $250,000 $_ $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Tampa FL 11 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Orlando FL 15 Upgrade Operating Room Heating, $350,000 $_ $350,000
Ventilation and Air Conditioning
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Miami FL 18 Repair Hallways for Life Safety $1,210,053 $-- $1,210,053
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Miami FL 18 Upgrade and Repair Electrical $330,674 $-- $330,674
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Miami FL 18 Study Fire and Smoke Damper $300,244 $-- $300,244
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Miami FL 18 Replace Chilled Water Valves $834,334 $_ $834,334
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 Miami FL 18 Upgrade Community Living Center $892,914 $-- $892,914
Elevators
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Miami FL 18 Upgrade Restrooms $4,214,923 $_ $4,214,923
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 Miami FL 18 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 W. Palm Beach FL 22 Construct Cooling Tower Walls $267,777 $_ $267,777
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 W. Palm Beach FL 22 Install Hurricane Shutters $112,713 $-- $112,713
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 W. Palm Beach FL 22 Replace and Upgrade Fire Alarm System $3,479,189 $-- $3,479,189
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 W. Palm Beach FL 22 Modernize Patient Bathrooms $497,402 $_ $497,402
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 W. Palm Beach FL 22 Upgrade Electrical Distribution $444,463 $-- $444,463
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Florida $34,996,726 $-- $34,996,726
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Dublin GA 3 Replace Sanitary Sewer Lines $610,308 $30,828 $579,480
--------------------------------------------------------------------------------------------------------------------------------------------------------
*7 Dublin GA 3 Replace and Upgrade Air Handling $834,747 $89,437 $745,310
Equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Dublin GA 3 Renovate for Inpatient Ward $877,500 $90,000 $787,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Dublin GA 3 Renovate for IT Space $753,750 $110,000 $643,750
--------------------------------------------------------------------------------------------------------------------------------------------------------
*7 Dublin GA 3 Implement Ground Source Heat Pumps\1\ $2,152,000 $_ $2,152,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Atlanta GA 5 Modernize Community Living Center $2,631,463 $-- $2,631,463
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Atlanta GA 5 Renovate Mental Health $490,000 $-- $490,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Atlanta GA 5 Upgrade and Replace Plumbing Systems $2,200,000 $200,000 $2,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Atlanta GA 5 Renovate Histology Lab $806,469 $170,512 $635,957
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Atlanta GA 5 Upgrade and Expand Emergency $1,766,856 $137,005 $1,629,851
Department
--------------------------------------------------------------------------------------------------------------------------------------------------------
*7 Augusta GA 10 Replace and Upgrade Heating, $548,550 $50,000 $498,550
Ventilation and Air Conditioning
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Augusta GA 12 Renovate Area for Position Electron $1,000,000 $-- $1,000,000
Transformation/Cat Scanner
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Augusta GA 12 Renovate and Modernize Inpatient $1,400,000 $-- $1,400,000
Wards
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Georgia $16,071,643 $877,782 $15,193,861
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Honolulu HI 1 Repair/Clean Ductwork $275,000 $_ $275,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Honolulu HI 1 Upgrade for Direct Digital Control $275,000 $_ $275,000
for Heating, Ventilation and Air
Conditioning on E-Wing
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Honolulu HI 1 Replace Air Conditioning Condensing $250,000 $_ $250,000
and Air Handling Roof Unit
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA Honolulu HI 1 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Hawaii $850,000 $-- $850,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Iowa City IA 2 Energy Upgrades to Heating, $660,000 $_ $660,000
Ventilation and Air Conditioning
System, Building 40 & 41
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Iowa City IA 2 Replace Roof for Building 7/Repair $220,000 $-- $220,000
Roof Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Iowa City IA 2 Update/Renovate Interior Finishes $480,000 $-- $480,000
Building 1, Phase I
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Iowa City IA 2 Renovate Inpatient Medical/Surgical $2,280,000 $-- $2,280,000
Ward 7E
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Correct Electrical Deficiencies, $1,020,000 $-- $1,020,000
Phase 5
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Des Moines IA 3 Renovate Basement of Building 3 for $1,100,000 $_ $1,100,000
Heating, Ventilation and Air
Conditioning
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Renovate Cardiac Cath Special $100,000 $-- $100,000
Procedure Patient Prep and Recovery
Rooms
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Des Moines IA 3 Relocate/Upgrade Air Intake for $115,000 $_ $115,000
Primary Care
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Renovate/Install Dental Suction $115,000 $-- $115,000
System in Clinical Annex Building
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Renovate Education Space in Building $280,000 $-- $280,000
3
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Renovate for additional storage $280,000 $-- $280,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Replace/Repair Steps for Building 3 $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Renovate/Repair Loading Dock $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Renovation for the Installation of $200,000 $-- $200,000
New Patient Lift Equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Des Moines IA 3 Joint Commission on Accreditation of $240,201 $-- $240,201
Health care Organizations Pre-Survey
Inspection
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Iowa $7,690,201 $-- $7,690,201
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Boise ID 2 Replace Underground Electrical System $1,820,000 $-- $1,820,000
and Generators
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Boise ID 2 Upgrade/Replace Electrical System and $2,040,000 $-- $2,040,000
Emergency Generators
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Boise ID 2 Replace Electrical Systems $1,090,000 $-- $1,090,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Boise ID 2 Renovate 1st and 2nd Floors for $800,000 $-- $800,000
Clinical Care, Building 110
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Boise ID 2 Evaluate Feasibility of Direct $342,857 $-- $342,857
Geothermal\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Idaho $6,092,857 $-- $6,092,857
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Chicago (WS) IL 7 Install American Disability Act $350,000 $-- $350,000
Automatic Fixtures in Bathroom
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Replace Electrical Distribution $8,000,000 $-- $8,000,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Chicago (WS) IL 7 Replace Ductwork $172,862 $_ $172,862
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Replace Water Main Lines $1,550,000 $-- $1,550,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Chicago (WS) IL 7 Design to Enclose Building $35,000 $-- $35,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Upgrade and Repair Medical Gas System $8,000,000 $-- $8,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Chicago (WS) IL 7 Install Ventilation in Dialysis $700,509 $_ $700,509
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Chicago (WS) IL 7 Relocate Psychology Suite $150,000 $-- $150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Chicago (WS) IL 7 Repair Exterior Masonry $564,200 $-- $564,200
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Chicago (WS) IL 7 Install New Electrical Cables $772,878 $-- $772,878
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Replace Roof $1,220,000 $-- $1,220,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Remodel Physical Rehab/Extended Care $6,000,000 $-- $6,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Chicago (WS) IL 7 Replace Air Handling Units $251,300 $_ $251,300
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Reconfigure Fire Dampers $400,000 $-- $400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Hines IL 7 Replace Boiler Plant Controls $85,000 $_ $85,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Hines IL 7 Install Boiler Flue Gas Analyzers $110,000 $_ $110,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Upgrade Tank Lining $60,000 $-- $60,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Install Natural Gas Emergency $50,000 $-- $50,000
Shutdown Valves
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Hines IL 7 Replace Heating, Ventilation and Air $200,000 $_ $200,000
Conditioning System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Hines IL 7 Upgrade and Repair Condensate Return $125,000 $_ $125,000
Lines
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Hines IL 7 Relocate Prosthetics, Neurology, and $4,000,000 $-- $4,000,000
Rehab Clinic
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Chicago (WS) IL 7 Renovate Area for Install of Gamma $241,000 $-- $241,000
Camera
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Replace Electrical Sub-Station $2,180,000 $-- $2,180,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 North Chicago IL 10 Upgrade Street Lights $1,200,000 $_ $1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 North Chicago IL 10 Replace Windows $2,850,000 $_ $2,850,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Repair and Replace Roads and $500,000 $-- $500,000
Sidewalks
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Repair Drainage System $1,500,000 $-- $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Expand Phone Switch Room $50,000 $-- $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Demolish Porch $95,000 $-- $95,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Upgrade Site for American Disability $750,000 $-- $750,000
Act Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Renovate Education Spaces $120,000 $-- $120,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Upgrade Electrical Distribution $575,000 $-- $575,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Abate Asbestos $750,000 $-- $750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 North Chicago IL 10 Renovate and Modernize Showers $82,000 $-- $82,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Marion IL 12 Water Tower Renovation--FCA $148,000 $-- $148,000
Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Marion IL 12 Mold Abatement & Water Intrusion $3,416,000 $496,000 $2,920,000
Prevention--FCA Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Marion IL 12 South Periphery Road Relocation $336,000 $-- $336,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*15 Marion IL 12 Chiller Plant Addition $1,097,600 $117,600 $980,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Marion IL 12 Relocate Generator and Electrical $952,000 $-- $952,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Marion IL 12 Repair and Recondition Building 15 $530,000 $-- $530,000
Exterior
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Marion IL 12 Renovate Halls and Replace Exit Doors $500,000 $-- $500,000
in Building 43
--------------------------------------------------------------------------------------------------------------------------------------------------------
*11 Danville IL 15 Replace Central Boiler Plant $12,000,000 $_ $12,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Danville IL 15 Replace Elevator Cabs & Controls $1,500,000 $-- $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Illinois $64,169,349 $613,600 $63,555,749
--------------------------------------------------------------------------------------------------------------------------------------------------------
*11 Indianapolis IN 7 Install New Chiller $2,100,000 $_ $2,100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Indianapolis IN 7 Upgrade Nurse Call System $1,870,000 $-- $1,870,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Indianapolis IN 7 Resurface Parking Lots $896,000 $-- $896,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Indiana $4,866,000 $-- $4,866,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Leavenworth KS 2 Building 21 Fire Safety Upgrades--FCA $380,000 $30,000 $350,000
Correction
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Topeka KS 2 Renovate Radiology Department--FCA $90,000 $-- $90,000
Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Leavenworth KS 2 Repair Concrete Sidewalks $100,000 $-- $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Topeka KS 2 Replace Roof Eyebrows--FCA $750,000 $-- $750,000
Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Topeka KS 2 Tuck point and Repair Roof of $1,100,000 $100,000 $1,000,000
Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Leavenworth KS 2 Renovate Pharmacy to meet ventilation $330,000 $30,000 $300,000
requirements
--------------------------------------------------------------------------------------------------------------------------------------------------------
*15 Leavenworth KS 2 Replace Windows in Buildings 88, 89, $1,000,000 $_ $1,000,000
90, and 91, Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Wichita KS 4 Correct Electrical Deficiencies $4,600,000 $-- $4,600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Wichita KS 4 Replace Roofs on Buildings 5-7, 10- $1,080,000 $80,000 $1,000,000
13, 19
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Kansas $9,430,000 $240,000 $9,190,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*9 Louisville KY 3 Replace Boilers $2,413,000 $259,000 $2,154,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Louisville KY 3 Renovate Mental Health $2,170,560 $232,560 $1,938,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Louisville KY 3 Replace Sewer Lines $250,000 $-- $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*9 Louisville KY 3 Repair and Replace Street Lighting $184,000 $_ $184,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Ft. Thomas KY 4 Renovate for Traumatic Brain Injury $1,591,000 $-- $1,591,000
and Post-Traumatic Stress Disorder
Program
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Lexington KY 6 Upgrade and Replace Electrical $2,100,000 $190,000 $1,910,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Lexington KY 6 Construct Additional Parking $1,650,000 $100,000 $1,550,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Lexington KY 6 Upgrade and Repair Electrical $770,000 $70,000 $700,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Lexington KY 6 Renovate Clinics $719,000 $55,000 $664,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Lexington KY 6 Renovate Police Dispatch $550,000 $50,000 $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Kentucky $12,397,560 $956,560 $11,441,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 New Orleans LA 2 Repair/Upgrade Energy Management $750,000 $_ $750,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Shreveport LA 4 Replace Kitchen Exhaust $500,000 $_ $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Shreveport LA 4 Renovate/Upgrade Operating Room--FCA $5,200,000 $-- $5,200,000
Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Shreveport LA 4 Replace Fan Coils to meet Heating, $550,000 $-- $550,000
Ventilation and Air Conditioning
requirements
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Alexandria LA 5 Renovate Kitchen and Lobby of $324,000 $-- $324,000
Building 9 for Mental Health Program
Offices
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Alexandria LA 5 Recondition Boiler #1 $246,000 $_ $246,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Alexandria LA 5 Renovate/Upgrade Canteen Dining Area $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Alexandria LA 5 Renovate Heating, Ventilation and Air $395,000 $_ $395,000
Conditioning in Laboratory, Building
7
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Louisiana $8,265,000 $-- $8,265,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Northampton MA 2 Upgrade Supply, Processing and $1,596,000 $196,000 $1,400,000
Distribution Heating, Ventilation
and Air Conditioning & Sterilizer
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Northampton MA 2 Repair and Upgrade Fire Protection $3,310,000 $250,000 $3,060,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Northampton MA 2 Correct American Disability Act $550,000 $50,000 $500,000
Building Access Deficiencies
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Leeds MA 2 Correct American Disability Act $839,000 $39,000 $800,000
Building Deficiencies
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Bedford MA 6 Renovate Inpatient Psychiatric Wards $7,165,000 $-- $7,165,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Bedford MA 6 Upgrade Heating, Ventilation and Air $765,000 $_ $765,000
Conditioning, Animal Research
Facility
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Bedford MA 6 Replace and Upgrade Electrical $4,033,000 $-- $4,033,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Bedford MA 6 Renovate Nursing Home Care Unit into $721,000 $-- $721,000
a Community Living Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Brockton MA 9 Replace Fire Alarm System $3,525,000 $-- $3,525,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 West Roxbury MA 9 Upgrade Supply, Processing and $975,000 $85,000 $890,000
Distribution Heating, Ventilation
and Air Conditioning System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 West Roxbury MA 9 Replace and Upgrade Air Handling $1,339,000 $120,000 $1,219,000
Equipment, Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Massachusetts $24,818,000 $740,000 $24,078,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Upgrade and Replace Electrical $1,870,000 $-- $1,870,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Perry Point MD 1 Replace and Upgrade Heating, $450,000 $_ $450,000
Ventilation and Air Conditioning
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Upgrade the Patient Security System $3,750,000 $-- $3,750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Replace Roof $548,000 $-- $548,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Perry Point MD 1 Replace Chilled Water Line $150,000 $_ $150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Replace Elevator and Shaft $550,000 $-- $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Perry Point MD 1 Replace Windows $150,000 $_ $150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Replace Elevators $90,000 $-- $90,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Upgrade Security for the Chemical $25,000 $-- $25,000
Storage Area
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Replace Dock Leveler Bldg 11W $20,000 $-- $20,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Upgrade and Replace Fire & Safety $475,000 $-- $475,000
Systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Repair Roads and Sidewalks $1,375,000 $-- $1,375,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Perry Point MD 1 Repair and Upgrade Heating, $1,540,000 $_ $1,540,000
Ventilation and Air Conditioning
Systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Replace Exterior for Buildings 4H and $1,000,000 $-- $1,000,000
5H
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Perry Point MD 1 Replace Exterior for Buildings 11H, $1,909,000 $-- $1,909,000
15H and 17H
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Perry Point MD 1 Implement Selected Conservation $3,333,333 $_ $3,333,333
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Baltimore MD 7 Replace Steam Traps $200,000 $_ $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Baltimore MD 7 Upgrade and Repair Electrical $200,000 $-- $200,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Loch Raven MD 7 Replace Fire Alarm System $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Baltimore MD 7 Construct Entrance Vestibule Parking $90,000 $-- $90,000
Garage P1
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Baltimore MD 7 Install Security Door 6A Mental $40,000 $-- $40,000
Health
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Baltimore MD 7 Upgrade Acquisitions and Materials $250,000 $_ $250,000
Management Service Heating,
Ventilation and Air Conditioning
Controls
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Loch Raven MD 7 Study and Provide Recommendations for $100,000 $-- $100,000
Loch Raven Drainage
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Loch Raven MD 7 Replace Dock Leveler $20,000 $-- $20,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Loch Raven MD 7 Construct a Low Vision Clinic $100,000 $-- $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Baltimore MD 7 Renovate Canteen Food Court $525,000 $-- $525,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Loch Raven MD 7 Relocate Campus Main Telephone Feed $50,000 $-- $50,000
Bldg 4
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Baltimore MD 7 Repair Roofs $450,000 $-- $450,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Baltimore MD 7 Upgrade and Repair Electrical $750,000 $-- $750,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Maryland $20,310,333 $-- $19,810,333
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Togus ME 1 Construct Private Bathrooms and $7,386,493 $696,000 $6,690,493
Showers for Inpatient Wards in
Building 200
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Togus ME 1 Repair and Upgrade Building 200 and $4,400,000 $-- $400,000
Building 200E Facade
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Augusta ME 1 Construct a Renewably Fueled $6,201,531 $31,531 $6,170,000
Cogeneration System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Maine $17,988,024 $727,531 $13,260,493
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Iron Mountain MI 1 Upgrade Electrical Distribution & $765,000 $-- $765,000
Generator
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Iron Mountain MI 1 Replace Fire Pump $130,000 $-- $130,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Iron Mountain MI 1 Replace Heating, Ventilation and Air $532,000 $_ $532,000
Conditioning Telephone Room
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Iron Mountain MI 1 Replace Kitchen Coolers/Freezers $50,000 $-- $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Iron Mountain MI 1 Construct Additional Parking and $400,000 $-- $400,000
Utilities
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Iron Mountain MI 1 Repair Exterior Masonry $350,000 $-- $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Iron Mountain MI 1 Repair Sidewalks $40,000 $-- $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Iron Mountain MI 1 Renovate and Modernize Outpatient $40,000 $-- $40,000
Lobby
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Iron Mountain MI 1 Replace Chiller $350,000 $_ $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Saginaw MI 5 Upgrade Primary Electrical $1,950,000 $-- $1,950,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Saginaw MI 5 Upgrade and Expand Electrical Closets $2,263,000 $-- $2,263,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*11 Saginaw MI 5 Replace Heating, Ventilation and Air $4,606,224 $_ $4,606,224
Conditioning System
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Battle Creek MI 7 Replace Roads, Curbs, Gutter $1,124,000 $-- $1,124,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Detroit MI 13 Renovate for Mental Health $4,950,000 $-- $4,950,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Ann Arbor MI 15 Renovate Inpatient and Outpatient $2,500,000 $-- $2,500,000
Pharmacy
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Ann Arbor MI 15 Renovate and Modernize Urgent Care $2,500,000 $-- $2,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
11 Ann Arbor MI 15 Upgrade Emergency Room $1,500,000 $-- $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Michigan $24,050,224 $-- $24,050,224
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Minneapolis MN 5 Repair/Upgrade Mechanical Systems $100,000 $_ $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Eyewash Upgrade ph. II $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Install Carpet, Mental Health $225,000 $-- $225,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Pneumatic Tube Expansion $200,000 $-- $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Replace Automatic Transfer Switch-- $35,000 $-- $35,000
Medical Intensive Care Unit
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Renovate for the Installation of $150,000 $-- $150,000
Operating Room Boom to support
equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Minneapolis MN 5 Replace Chilled Water Valves Ph. 2 $250,000 $_ $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Minneapolis MN 5 Replace/Repair Screens/Vents_Building $100,000 $_ $100,000
49 and 70
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Upgrade Waste Anesthesia Gas System $50,000 $-- $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Minneapolis MN 5 Replace Condensate Return Piping, Ph. $250,000 $_ $250,000
1
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Minneapolis MN 5 Replace Automatic Faucets $40,000 $_ $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Telephone Switch Room Upgrades $150,000 $-- $150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Replace Carpet--General $425,000 $-- $425,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Parking Lot and Road Upgrade $1,100,000 $-- $1,100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Install Security System for IT $250,000 $-- $250,000
closets
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Construct Hospice Unit, Building 70 $200,000 $-- $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Ward Renovation $200,000 $-- $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Life Safety Assessment $60,000 $-- $60,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Design Ramp Snow Melt System for $250,000 $-- $250,000
Building 70 and Loading Dock
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Design Transfer Switch Replacement $120,000 $-- $120,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Minneapolis MN 5 Replace Chiller #2 at Energy Center $1,200,000 $_ $1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Renovate Building 70 for Patient $350,000 $-- $350,000
Privacy
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Minneapolis MN 5 Communication Closet A/C Upgrades $300,000 $_ $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Extended Care Center Renovation, Ph. $450,000 $-- $450,000
1
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Minneapolis MN 5 Replace Heating, Ventilation and Air $300,000 $_ $300,000
Conditioning Coils ph. I
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Elevator upgrades ph. II $1,700,000 $-- $1,700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Replace Water Booster Pumps $250,000 $-- $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Minneapolis MN 5 Renovate for Provider Consultation $220,000 $-- $220,000
Area
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 St. Cloud MN 6 Install Heating, Ventilation and Air $775,000 $_ $775,000
Conditioning System in Basement
Building 29
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 St. Cloud MN 6 Renovate for Rehab Services $750,000 $-- $750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 St. Cloud MN 6 Replace Carpet in Domiciliary, $180,000 $-- $180,000
Building 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 St. Cloud MN 6 Repair/Upgrade Roads throughout $1,365,000 $-- $1,365,000
Campus, Phase 8
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 St. Cloud MN 6 Repair/Upgrade Nurse Call System in $650,000 $-- $650,000
Building 48, 49, 50 and 51
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 St. Cloud MN 6 Install Metering for Electrical, $240,000 $_ $240,000
Steam and Gas Lines
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 St. Cloud MN 6 Upgrade/Renovate Supply, Processing $1,300,000 $-- $1,300,000
and Distribution
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 St. Cloud MN 6 Upgrade Ground Source Heat Pumps $1,952,000 $_ $1,952,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Minnesota $16,637,000 $-- $16,637,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 St. Louis MO 3 Correct Sprinkler Deficiencies $1,411,000 $138,600 $1,272,400
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 St. Louis MO 3 Emergency Power for Building 60 Main $1,359,000 $146,000 $1,213,000
Kitchen
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 St. Louis MO 3 Correct Secondary Power Deficiencies, $1,723,000 $-- $1,723,000
Phase II
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 St. Louis MO 3 Replace Public Address System, $2,000,000 $180,000 $1,820,000
Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 St. Louis MO 3 Renovate Existing Clinics $4,570,000 $500,000 $4,070,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Kansas City MO 5 Renovate Building 2--FCA Corrections $2,189,710 $189,710 $2,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Kansas City MO 5 Site prep for install of new Cook/ $580,000 $-- $580,000
Chill Equipment in Kitchen
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Kansas City MO 5 Upgrade Emergency Power Building 1-- $3,900,000 $-- $3,900,000
FCA Correction
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Kansas City MO 5 Renovate Mental Health Building $900,000 $-- $900,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Columbia MO 9 Elevator Replacement/Renovation $1,320,000 $-- $1,320,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Columbia MO 9 Renovate Research $1,200,000 $-- $1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Columbia MO 9 Renovate and Relocate Specialty Care $500,000 $50,000 $450,000
to 6th Floor
--------------------------------------------------------------------------------------------------------------------------------------------------------
*15 Columbia MO 9 Replace Exhaust Fans_FCA Corrections $1,650,000 $_ $1,650,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
15 Columbia MO 9 Renovate Pathology Labs $2,000,000 $-- $2,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Missouri $25,302,710 $1,204,310 $24,098,400
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Jackson MS 3 Provide Back-Up Generator Capacity $4,700,000 $-- $4,700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Jackson MS 3 Replace Medical Center Windows_Phase $2,000,000 $_ $2,000,000
1
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Jackson MS 3 Clean and Recoat portions of Existing $300,000 $-- $300,000
Room on Building 1 & 7
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Biloxi MS 4 Replace Elevators in Building 2 &19 $1,300,000 $-- $1,300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Biloxi MS 4 Repair/Replace Elevators and $2,200,000 $-- $2,200,000
Dumbwaiters in Building 1&3
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Biloxi MS 4 Replace Building 5 Roof & Update $1,120,000 $-- $1,120,000
Exterior finish
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Biloxi MS 4 Renovate/Upgrade Building 17 Interior $820,000 $-- $820,000
for American Disability Act
accessibility
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Mississippi $12,440,000 $-- $12,440,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Helena MT At Large Repair Mechanical Deficiencies $705,000 $55,000 $650,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Helena MT At Large Convert Building 154 to Low Pressure $750,000 $70,000 $680,000
Steam
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Helena MT At Large Repair/Replace Masonry in Stairwells-- $550,000 $50,000 $500,000
FCA Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Helena MT At Large Remediate Lead Based Paint $750,000 $50,000 $700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Helena MT At Large Remediate Lead Based Paint $750,000 $50,000 $700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Helena MT At Large Implement Energy Conservation $750,000 $70,000 $680,000
Measures per regulation
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Fort Harrison MT At Large Evaluate Feasibility of Direct $342,857 $_ $342,857
Geothermal\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Montana $4,597,857 $345,000 $4,252,857
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Durham NC 4 Replace Air Handling Units $3,700,000 $_ $3,700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Durham NC 4 Upgrade and Install New Electrical $4,730,000 $-- $4,730,000
Distribution Systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Durham NC 4 Renovate and Expand Physical Therapy $800,000 $-- $800,000
and Occupational Therapy
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Durham NC 4 Resurface Roads and Parking Lots $1,150,000 $-- $1,150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Fayetteville NC 7 Upgrade Women's Clinic $925,000 $-- $925,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Fayetteville NC 7 Replace Elevators $600,000 $-- $600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Fayetteville NC 7 Upgrade Kitchen $700,000 $-- $700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Fayetteville NC 7 Upgrade Elevator $700,000 $-- $700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Asheville NC 11 Repair Dom Water System $878,000 $-- $878,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Asheville NC 11 Repair and Replace Exterior $560,000 $-- $560,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Asheville NC 11 Renovate for a Community Living $420,000 $-- $420,000
Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Asheville NC 11 Renovate Emergency Department, Phase $910,000 $-- $910,000
I
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Asheville NC 11 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Salisbury NC 12 Upgrade Elevators $1,800,000 $-- $1,800,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Salisbury NC 12 Upgrade and Replace Heating, $1,873,250 $_ $1,873,250
Ventilation and Air Conditioning
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Salisbury NC 12 Replace Water Pipes $857,250 $-- $857,250
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Salisbury NC 12 Modernize Patient Areas $1,210,500 $-- $1,210,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--North Carolina $21,864,000 $-- $21,864,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Fargo ND At Large Renovate Administrative Space for $1,901,855 $-- $1,901,855
Clinical Ambulatory Care Exam Rooms
and Support Space
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Fargo ND At Large Replace/Upgrade Chiller Compressors $370,000 $-- $370,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Fargo ND At Large Repair/Replace Sidewalk at Medical $260,000 $-- $260,000
Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Fargo ND At Large Renovate Inpatient Pharmacy $734,375 $-- $734,375
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--North Dakota $3,266,230 $-- $3,266,230
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Omaha NE 1 Repair/Replace Roofs Buildings 12, 24 $300,000 $-- $300,000
and 45
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Omaha NE 1 Repair/Upgrade Main Fire Alarm Panel $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Omaha NE 1 Repair/Update Condensate Pipes and $125,000 $_ $125,000
Pumps
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Omaha NE 1 Replace/Update Water Softeners for $150,000 $_ $150,000
Boilers and Domestic Water Systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Omaha NE 2 Remodel Operating Room/Post $2,520,000 $-- $2,520,000
Anesthesia Care Unit
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Omaha NE 2 Renovate Radiology for Position $1,920,000 $-- $1,920,000
Electron Transformation (PET) CT
Install
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Omaha NE 2 Renovate for New Coolers and Freezers $225,000 $-- $225,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Omaha NE 2 Repair/Replace Steam Condensate $300,000 $_ $300,000
Lines, Tanks and Pumps
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Omaha NE 3 Replace Air Handlers for Laboratory $500,000 $_ $500,000
Space
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Omaha NE 3 Replace Electrical Distribution $750,000 $-- $750,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Omaha NE 3 Replace/Upgrade Domestic Hot Water $210,000 $-- $210,000
Heaters
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Nebraska $7,500,000 $-- $7,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Manchester NH 1 Correct Corrosion and Upgrade Water $1,111,500 $95,000 $1,016,500
Tower
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Manchester NH 1 Renovate for Mental Health and $585,000 $50,000 $535,000
Primary Care
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--New Hampshire $1,696,500 $145,000 $1,551,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Cape May NJ 2 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA Salem NJ 2 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Fort Dix NJ 3 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*NCA Beverly NJ 3 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 East Orange NJ 10 Repave Parking Lots and Roads $2,500,000 $-- $2,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Lyons NJ 10 Repair and Upgrade the Storm Water $2,500,000 $-- $2,500,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 East Orange NJ 10 Install Access Security System $850,000 $-- $850,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 East Orange NJ 10 Renovate and Modernize the Inpatient $500,000 $-- $500,000
Ward Halls and Floors
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 East Orange NJ 10 Upgrade Heating, Ventilation and Air $275,000 $_ $275,000
Conditioning for Cardiac Cath Lab
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 East Orange NJ 10 Upgrade Pharmacy to 797 Code $207,000 $-- $207,000
Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 East Orange NJ 10 Renovate Nuclear Medicine for New $715,000 $-- $715,000
Gama Cameras
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 East Orange NJ 10 Renovate the Ear, Nose and Throat $330,000 $-- $330,000
Clinic
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 East Orange NJ 10 Renovate and Modernize Inpatient $2,500,000 $-- $2,500,000
Wards
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 East Orange NJ 10 Upgrade Heating, Ventilation and Air $2,500,000 $_ $2,500,000
Conditioning & Plumbing Systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Lyons NJ 11 Repair Structural Deficiencies in $385,000 $-- $385,000
Building
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Lyons NJ 11 Upgrade Security Project $1,200,000 $-- $1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--New Jersey $14,502,000 $-- $14,502,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Albuquerque NM 1 Renovate Operating Room #2 $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Albuquerque NM 1 Pave Overflow Patient Parking Lot $345,000 $20,000 $325,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Albuquerque NM 1 Replace Fuel Storage Tanks for $713,000 $73,000 $640,000
Emergency Generators in Buildings 1,
3, and 10.
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Albuquerque NM 1 Repair/Upgrade Steam and Condensate $775,000 $75,000 $700,000
systems, Phase I
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Albuquerque NM 1 Renovate 3rd Floor of Building 3 for $449,065 $49,065 $400,000
Telehealth
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Albuquerque NM 1 Renovate Operating Room and Supply, $600,000 $_ $60,000
Processing and Distribution in
Building 41
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Albuquerque NM 1 Renovate Primary Care Area, Building $750,000 $-- $75,000
41
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Albuquerque NM 1 Building 41, Handicap Accessible $500,000 $-- $500,000
Parking
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Albuquerque NM 1 Repair Chilled Water Loop Piping $750,000 $_ $75,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Albuquerque NM 1 Correct Fire and Life Safety $600,000 $-- $60,000
Deficiencies
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Albuquerque NM 1 Implement Selected Conservation $1,142,857 $_ $1,142,857
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Albuquerque NM 1 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--New Mexico $7,134,922 $217,065 $4,487,857
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Install Sprinklers, Building 1, Phase $350,000 $-- $350,000
3
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Install Sprinklers, Building 1A $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Install Sprinklers, Building 1, Phase $350,000 $-- $350,000
2
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Upgrade Elevators in Building 1D and $1,200,000 $-- $1,200,000
Dietetics
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Renovate Community Living Center, $650,000 $-- $650,000
Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Reno NV 2 Replace/Upgrade Air Handling Units $400,000 $_ $400,000
Building 10
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Reno NV 2 Replace/Upgrade Heating, Ventilation $400,000 $_ $400,000
and Air Conditioning Control System,
Building 12
--------------------------------------------------------------------------------------------------------------------------------------------------------
*21 Reno NV 2 Replace Heating, Ventilation and Air $400,000 $_ $400,000
Conditioning Control System,
Buildings 10 & 1D
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Replace Sidewalks Facility Wide $110,000 $-- $110,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Replace Flooring for Various $150,000 $-- $150,000
Buildings
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Renovate for Urgent Care Center and $975,000 $-- $975,000
Police Service
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 Reno NV 2 Replace Sewer Line, Building 1 $225,000 $-- $225,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Nevada $5,510,000 $-- $5,510,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Northport NY 2 Renovate and Relocate Warehouse $1,300,000 $-- $1,300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Northport NY 2 Renovate and Modernize Supply, $1,800,000 $-- $1,800,000
Processing and Distribution
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Northport NY 2 Renovate Research Wet Labs $865,000 $-- $865,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Northport NY 2 Upgrade Research Dry Labs to current $865,000 $-- $865,000
American Association for
Accreditation of Laboratory Animal
Care standards
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Northport NY 2 Replace Windows $1,500,000 $_ $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Northport NY 2 Install Sprinkler System $1,100,000 $-- $1,100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Northport NY 2 Renovate Research $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Northport NY 2 Relocate Sleep Lab $550,000 $-- $550,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Northport NY 2 Replace Outdoor Lighting Cables $500,000 $_ $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Northport NY 2 Renovate Pathology and Lab $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Northport NY 2 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Bronx NY 6 Renovate and Modernize for Geriatric $740,000 $-- $740,000
Research, Education and Clinical
Center (GRECC) and Geriatric Primary
Care
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 St Albans NY 6 Replace Boiler Plant Roof $400,000 $-- $400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 St Albans NY 6 Replace and Upgrade Heating, $650,000 $_ $650,000
Ventilation and Air Conditioning
Components and Controls
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 St Albans NY 6 Install New Medical Gas Systems $550,000 $-- $550,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 St Albans NY 6 Upgrade Light Fixtures to Energy $600,000 $_ $600,000
Efficient Fixtures
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 St Albans NY 6 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Castle Point NY 13 Repair and Upgrade Boilers $1,750,000 $_ $1,750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Brooklyn NY 13 Replace Light Fixtures and Upgrade $600,000 $_ $600,000
Heating, Ventilation and Air
Conditioning Components for Energy
Efficiency
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Upgrade the Electrical Distribution $600,000 $-- $600,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Brooklyn NY 13 Upgrade Heating, Ventilation and Air $395,000 $_ $395,000
Conditioning System
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Replace and Upgrade Main Water Line $400,000 $-- $400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Brooklyn NY 13 Upgrade Ventilation System in $350,000 $_ $350,000
Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Replace Sprinkler System $155,000 $-- $155,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Renovate Radiology $657,000 $-- $657,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Repair and Replace Sidewalks, Parking $495,000 $-- $495,000
Lots & Roads
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Repair Elevators $375,000 $-- $375,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Replace Roof on Building 91 $350,000 $-- $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 St Albans NY 13 Upgrade the Heating, Ventilation and $395,000 $_ $395,000
Air Conditioning System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 St Albans NY 13 Upgrade Bathrooms $605,000 $_ $605,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Abate Asbestos $45,000 $-- $45,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Brooklyn NY 13 Replace and Upgrade Light Fixtures $445,000 $_ $445,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 13 Renovate Supply, Processing and $7,125,000 $-- $7,125,000
Distribution
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 New York City NY 14 Upgrade and Modernize GI Lab $3,750,000 $175,000 $3,575,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Northport NY 14 Renovate and Upgrade Heating, $500,000 $_ $500,000
Ventilation and Air Conditioning for
Supply, Processing and Distribution
and Pharmacy Storage
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 New York City NY 14 Replace Generators, Ph 2 $4,755,383 $-- 4,755,383
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 New York City NY 14 Replace and Upgrade Heating, $1,623,800 $_ $1,623,800
Ventilation and Air Conditioning
Equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 New York City NY 14 Repair Parking Lot and Sidewalks $850,000 $-- $850,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 New York City NY 14 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Bronx NY 16 Replace and Upgrade the Heating, $1,348,000 $180,000 $1,168,000
Ventilation and Air Conditioning &
Controls
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Brooklyn NY 16 Replace and Upgrade the Dumbwaiter $475,000 $-- $475,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Bronx NY 16 Upgrade Boiler Controls $224,000 $_ $224,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Bronx NY 16 Upgrade Emergency Electrical, Ph 2 $3,620,000 $120,000 $3,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Bronx NY 16 Replace Mechanical Room Floor $627,000 $-- $627,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Montrose NY 19 Renovate for Patient Dining Area $3,300,000 $-- $3,300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Castle Point NY 19 Repair Exterior of Building to Tuck- $1,900,000 $-- $1,900,000
Point and Seal Masonry
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Montrose NY 19 Replace Steam Lines, Phase 2 $3,450,000 $_ $3,450,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Castle Point NY 19 Renovate for a Modern Community $510,000 $-- $510,000
Living Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Castle Point NY 19 Replace Fan Coils, Phase 1 $850,000 $_ $850,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Castle Point NY 19 Replace Roofs on Buildings 8 & 9 $1,000,000 $-- $1,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Castle Point NY 19 Replace Water Main Lines $2,500,000 $-- $2,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Castle Point NY 19 Replace Steam Traps $475,000 $_ $475,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Castle Point NY 19 Install Wind Turbine $80,000 $_ $80,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Castle Point NY 19 Install Utility Metering $380,000 $40,000 $340,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Castle Point NY 19 Replace Medical Gas Systems in $525,000 $-- $525,000
Patient Rooms
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Albany NY 21 Abate Asbestos in Sub Basement, Phase $5,400,000 $-- $5,400,000
2
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Albany NY 21 Renovate and Upgrade Dental Suite $3,700,000 $-- $3,700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Albany NY 21 Renovate and Expand Prosthetics $1,050,000 $-- $1,050,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Albany NY 21 Replace Windows $1,100,000 $100,000 $1,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Albany NY 21 Repair Warehouse Loading Docks $350,000 $-- $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Albany NY 21 Renovate Post Anesthesia Care Unit $997,500 $-- $997,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Albany NY 21 Remove Incinerator $900,000 $-- $900,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Albany NY 21 Demolish Buildings 6, 7, 11 and 35 $900,000 $-- $900,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Albany NY 21 Implement Selected Conservation $2,400,000 $_ $2,400,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Rome NY 24 Renovate and Modernize the Outpatient $250,000 $-- $250,000
Clinic, Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Rome NY 24 Replace and Upgrade Air Handling $775,000 $_ $775,000
Unit's
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Syracuse NY 25 Renovate 8th Floor for Community $200,000 $-- $200,000
Living Center, Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Syracuse NY 25 Replace Roofs $250,000 $-- $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Syracuse NY 25 Provide Emergency Power to Bldg 16 $100,000 $-- $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Syracuse NY 25 Renovate for Cardiology Suite $335,000 $-- $335,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Syracuse NY 25 Renovate Outpatient Exam Rooms $570,000 $-- $570,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Syracuse NY 25 Upgrade Electrical Panel Boards $635,000 $-- $635,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Syracuse NY 25 Upgrade the Electrical Distribution $190,000 $-- $190,000
System by Adding a Power Monitoring
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Syracuse NY 25 Replace Existing Chillers $2,000,000 $_ $2,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Syracuse NY 25 Upgrade Light Fixtures to Energy $580,000 $_ $580,000
Efficient Fixtures
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Syracuse NY 25 Implement Selected Conservation $2,400,000 $_ $2,400,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Batavia NY 26 Repair and Remove Boiler Plant Bunker $560,000 $-- $560,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Batavia NY 26 Repair Stairs in front of Building 2 $500,000 $-- $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Batavia NY 26 Renovate Primary Care for Patient $150,000 $-- $150,000
Privacy
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Batavia NY 26 Implement Selected Conservation $2,400,000 $_ $2,400,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Buffalo NY 28 Construct Private Inpatient Wards $3,600,000 $-- $3,600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Buffalo NY 28 Repave Parking Lot for Patients $700,000 $-- $700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Buffalo NY 28 Expand Dialysis Clinic $750,000 $-- $750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Buffalo NY 28 Replace Domestic Water Booster Pumps $560,000 $-- $560,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Buffalo NY 28 Repair Warehouse Roof $425,000 $-- $425,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Buffalo NY 28 Implement Selected Conservation $2,400,000 $_ $2,400,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Buffalo NY 28 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Bath NY 29 Replace Heating, Ventilation and Air $1,956,000 $106,000 $1,850,000
Conditioning in Building 92
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Bath NY 29 Replace Window Heating, Ventilation $1,084,000 $174,000 $910,000
and Air Conditioning units with
Central Air for Bldg 33
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Bath NY 29 Replace Elevator in Bldg 33 $350,000 $-- $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Canandaigua NY 29 Design for a new Fire Alarm System $75,000 $-- $75,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Bath NY 29 Replace and Upgrade the Electric $300,000 $40,000 $260,000
Distribution System in Bldg 41
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Bath NY 29 Replace and Upgrade Heating, $200,000 $20,000 $180,000
Ventilation and Air Conditioning in
Bldg 39
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Canandaigua NY 29 Upgrade and Modernize Patient $200,000 $-- $200,000
Corridors in Buildings 3 and 8
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Bath NY 29 Replace and Upgrade the Electrical $2,500,000 $250,000 $2,250,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Bath NY 29 Renovate for Women's Health Center $250,000 $-- $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Canandaigua NY 29 Replace and Upgrade the Panic Alarm $450,000 $-- $450,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Bath NY 29 Upgrade and Replace the Heating, $750,000 $_ $750,000
Ventilation and Air Conditioning and
Fire Suppression System
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Canandaigua NY 29 Replace Sanitary Sewer, B-36 & B-12 $250,000 $-- $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Bath NY 29 Relocate the Hospice and Gero- $750,000 $-- $750,000
Pyschiatric Unit
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Bath NY 29 Replace Main Drainage System for Bldg $1,800,000 $30,000 $1,770,000
76
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Canandaigua NY 29 Upgrade and Repair Fuel Tanks $200,000 $-- $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Canandaigua NY 29 Implement Selected Conservation $2,400,000 $_ $2,400,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*2 Bath NY 29 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--New York $110,797,683 $1,235,000 $109,562,683
--------------------------------------------------------------------------------------------------------------------------------------------------------
Cincinnati OH 1 Expand Cath Lab $2,200,000 $-- $2,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Cincinnati OH 1 Upgrade and Repair Exterior Facade $1,100,000 $-- $1,100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*10 Cincinnati OH 1 Implement Selected Conservation $2,500,000 $_ $2,500,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Dayton OH 3 Renovate Nursing Home Care Unit into $2,750,000 $-- $2,750,000
a Community Living Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Dayton OH 3 Renovate Domiciliary $1,100,000 $-- $1,100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*10 Dayton OH 3 Implement Selected Conservation $2,500,000 $_ $2,500,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*10 Chillicothe OH 7 Repair Steam Lines $2,500,000 $_ $2,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Chillicothe OH 7 Replace Elevators $1,200,000 $-- $1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Chillicothe OH 7 Renovate Physical Therapy $1,200,000 $-- $1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Chillicothe OH 7 Renovate Basement $680,000 $-- $680,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*10 Chillicothe OH 7 Implement Selected Conservation $2,500,000 $_ $2,500,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Cleveland OH 11 Renovate Surgery $8,500,000 $-- $8,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Cleveland OH 11 Renovate Elevator Lobby and Main $4,913,331 $-- $4,913,331
Lobby
--------------------------------------------------------------------------------------------------------------------------------------------------------
10 Cleveland OH 11 Renovate Canteen and Education $3,500,000 $-- $3,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*10 Cleveland OH 11 Implement Selected Conservation $2,500,000 $_ $2,500,000
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Ohio $39,643,331 $-- $39,643,331
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Muskogee OK 2 Expand Parking Lot 12 $550,000 $-- $550,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Muskogee OK 2 Replace Generators 26 & 46 $1,815,000 $-- $1,815,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Muskogee OK 2 Expand Parking Lot 14 $330,000 $-- $330,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Muskogee OK 2 Repair/Resurface Roads and Parking $699,000 $-- $699,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Oklahoma City OK 5 Replace Morgue Heating, Ventilation $80,000 $_ $80,000
and Air Conditioning
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Oklahoma City OK 5 Renovate for Primary Care Clinics $530,000 $-- $530,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Oklahoma City OK 5 Renovate for Medical Record Storage $264,000 $-- $264,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Oklahoma City OK 5 Renovate Police Training Room $276,000 $-- $276,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Oklahoma City OK 5 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Oklahoma $4,554,000 $-- $4,554,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Portland OR 1 Install New Chiller for Ambulatory $100,000 $_ $100,000
Surgery
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Renovate Lab $465,000 $-- $465,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Remodel Surgical Waiting Area $110,000 $-- $110,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Remodel Patient Exam Rooms $290,000 $-- $290,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Renovate for installation of New SPEC $100,000 $-- $100,000
CT
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Building 100 Expansion Survey for $25,000 $-- $25,000
Clinical Care
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Renovate Primary Care Space for $250,000 $-- $250,000
Women's Clinic, Building 103
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Upgrade/Repair Paging System, Phase 2 $473,223 $-- $473,223
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Upgrade Nitrogen Farm per Regulation $95,726 $-- $95,726
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Repair Safety Deficiencies $100,000 $-- $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Renovate for the installation of Hi- $150,000 $-- $150,000
Tech/Hi-Cost Equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Construct Retaining Wall for Building $225,000 $-- $225,000
16 Parking Lot
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Renovate Basement of Building 16 for $225,000 $-- $225,000
additional Exit
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Install Distributed Antenna, Building $287,889 $-- $287,889
100, Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Install New PIV Door Locking System $300,000 $-- $300,000
per Regulation
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Portland OR 1 Renovate Operating Room $580,000 $-- $580,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 White City OR 2 Repair/Resurface Main Roadways--FCA $1,203,000 $93,000 $1,110,000
Correction
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 White City OR 2 Renovate Building 212 $495,000 $-- $495,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 White City OR 2 Renovate Restrooms $225,000 $_ $225,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Roseburg OR 4 Renovate/Relocate Alzheimer Unit, $265,000 $-- $265,000
Building 81
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Roseburg OR 4 Upgrade Medical Gas System, Phase 2 $335,000 $-- $335,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Roseburg OR 4 Repair/Upgrade Nurse Call System for $475,000 $125,000 $350,000
Patient Safety
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Roseburg OR 4 Repair/Replace Sewer and Storm Lines $410,000 $40,000 $370,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Roseburg OR 4 Install Security Upgrades for Surgery $163,000 $20,000 $143,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Roseburg OR 4 Install Elevator Handrail and Replace $55,500 $-- $55,500
Roof, Building 1 Elevator Tower
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Oregon $7,403,338 $278,000 $7,125,338
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Philadelphia PA 1 Renovate Emergency Department $4,750,000 $-- $4,750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Philadelphia PA 1 Construct a New Computer Room $250,000 $-- $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Philadelphia PA 1 Upgrade the Boiler Plant Controls $466,440 $_ $466,440
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Coatesville PA 1 Renovate Pharmacy $1,740,000 $40,000 $1,700,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Philadelphia PA 1 Upgrade Behavioral Health Clinic $1,150,000 $-- $1,150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Coatesville PA 1 Upgrade Boiler Plant Controls $410,000 $_ $410,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Coatesville PA 1 Upgrade and Replace Electrical $1,750,000 $-- $1,750,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Philadelphia PA 1 Renovate and Modernize the Dental Lab $35,000 $-- $35,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Erie PA 3 Correct Boiler Plant Deficiencies $466,440 $_ $466,440
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Butler PA 3 Upgrade and Renovate the Electrical $2,556,000 $-- $2,556,000
Distribution Panels
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Butler PA 3 Replace Boilers $400,000 $_ $400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Butler PA 3 Improve Site Drainage $1,500,000 $-- $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Butler PA 3 Replace and Upgrade Electrical $2,500,000 $-- $2,500,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Butler PA 3 Renovate Supply, Processing and $126,000 $-- $126,000
Distribution for ETO Sterilizer
Installation
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Butler PA 3 Replace Windows $200,000 $_ $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Butler PA 3 Assess the Water Tower Renovation $50,000 $-- $50,000
Needs
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Butler PA 3 Renovate for Diagnostics $4,300,000 $-- $4,300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Pittsburgh PA 4 Upgrade Emergency Power Distribution $6,901,950 $-- $6,901,950
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Pittsburgh PA 4 Renovate Surgical Intensive Care Unit $2,400,000 $-- $2,400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Pittsburgh PA 4 Replace Main Plumbing System $2,200,000 $-- $2,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Altoona PA 9 Upgrade and Replace Electrical $1,470,000 $-- $1,470,000
Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Altoona PA 9 Upgrade and Replace Security Systems $330,000 $-- $330,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Altoona PA 9 Upgrade Heating, Ventilation and Air $51,000 $_ $51,000
Conditioning Deficiencies
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Altoona PA 9 Renovate and Modernize Outpatient $110,000 $-- $110,000
Areas for American Disability Act
Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Altoona PA 9 Renovate Canteen $825,000 $-- $825,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wilkes-Barre PA 10 Renovate the Cath Lab $315,000 $-- $315,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Lebanon PA 17 Construct New Consolidated $4,100,000 $-- $4,100,000
Rehabilitation Services
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Lebanon PA 17 Renovate Patient Check-in and $3,300,000 $-- $3,300,000
Appointment Area
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Lebanon PA 17 Install Chiller $250,000 $_ $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Lebanon PA 17 Renovate Bathrooms for American $1,570,000 $-- $1,570,000
Disability Act Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Pennsylvania $46,472,830 $40,000 $46,432,830
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 San Juan PR At Large Renovate Outpatient Care $1,432,043 $-- $1,432,043
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 San Juan PR At Large Repair and Upgrade Electrical $3,640,403 $-- $3,640,403
Substation
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 San Juan PR At Large Install New Emergency Generator $1,303,682 $-- $1,303,682
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 San Juan PR At Large Install Oxygen System $172,104 $-- $172,104
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 San Juan PR At Large Replace Cooling Towers $383,741 $_ $383,741
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 San Juan PR At Large Replace Community Living Center $390,390 $-- $390,390
Elevators
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 San Juan PR At Large Study to Address Life Safety Issues $126,500 $-- $126,500
on Main Water Distribution System
--------------------------------------------------------------------------------------------------------------------------------------------------------
8 San Juan PR At Large Replace Sanitary System $419,812 $-- $419,812
--------------------------------------------------------------------------------------------------------------------------------------------------------
*8 San Juan PR At Large Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Puerto Rico $7,878,675 $-- $7,878,675
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Providence RI 1 Add Heating, Ventilation and Air $2,375,000 $225,000 $2,150,000
Conditioning for Inpatient Wards
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Providence RI 1 Repair and Upgrade Electrical Wiring, $1,650,000 $-- $1,650,000
Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Providence RI 1 Repair and Replace the Exterior $5,600,000 $-- $5,600,000
Facade
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Providence RI 1 Convert High Pressure Steam Boilers $2,350,000 $200,000 $2,150,000
to Low Pressure Steam Boilers, Phase
2
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Rhode Island $11,975,000 $425,000 $11,550,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Charleston SC 1 Renovate Specialty Clinic $2,037,047 $-- $2,037,047
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Columbia SC 2 Renovate for Handicap Access $917,605 $-- $917,605
--------------------------------------------------------------------------------------------------------------------------------------------------------
7 Columbia SC 2 Renovate for Primary Care $1,700,000 $200,000 $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--South Carolina $4,654,652 $200,000 $4,454,652
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Sioux Falls SD At Large Elevator Upgrade $1,200,000 $-- $1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Sioux Falls SD At Large Renovate Pharmacy Consultation Rooms $502,476 $-- $502,476
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Sioux Falls SD At Large Renovate Dental Suites $326,181 $-- $326,181
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Sioux Falls SD At Large Construct Lead Lined Wall $90,000 $-- $90,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Sioux Falls SD At Large Tuck-Pointing Study $40,000 $-- $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Sioux Falls SD At Large Renovate for Mental Health Space $110,000 $-- $110,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Sioux Falls SD At Large Renovate/Upgrade Acute Patient Care $500,000 $-- $500,000
Area
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Renovate Quality Management Space in $275,000 $-- $275,000
Building 148
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Renovate/Upgrade Existing Police $225,000 $-- $225,000
Office
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Ft. Meade SD At Large Replace IRM A/C Systems $200,000 $_ $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Upgrade Security Systems for Medical $460,000 $-- $460,000
Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Renovate Supply, Processing and $150,000 $-- $150,000
Distribution
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Replace Corridor Floor Tile $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Renovate Nursing Home Care Unit $200,000 $-- $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Repair Historic Buildings on Campus $200,000 $-- $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Ft. Meade SD At Large Replace Hospital Windows $250,000 $_ $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Ft. Meade SD At Large Heating, Ventilation and Air $50,000 $_ $50,000
Conditioning Repairs Building 113
and 148
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Replace/Update Hospital Interior $50,000 $-- $50,000
Finishes
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ft. Meade SD At Large Renovate Mental Health Outpatient $450,000 $-- $450,000
Clinic, Phase 4
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ht Springs SD At Large Remodel Primary Care for Patient $665,000 $-- $665,000
Privacy
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Ht Springs SD At Large Replace Heating, Ventilation and Air $610,000 $_ $610,000
Conditioning System Building 4
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ht Springs SD At Large Road Replacement, Phase 1 $400,000 $-- $400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Ht Springs SD At Large Replace Boiler 2 $100,000 $_ $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*23 Ht Springs SD At Large Replace Hospital Steam Lines and $40,000 $_ $40,000
Regulators
--------------------------------------------------------------------------------------------------------------------------------------------------------
23 Ht Springs SD At Large Repair/Upgrade Water Line for $110,000 $-- $110,000
Quarters
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--South Dakota $7,503,657 $-- $7,503,657
--------------------------------------------------------------------------------------------------------------------------------------------------------
*EN TBD TBD TBD Construct a Solar Photovoltaic System $1,486,000 $_ $1,486,000
at up to 8 Locations\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*EN TBD TBD TBD Construct Wind Turbines for up to 6 $6,000,000 $_ $6,000,000
Locations\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*EN TBD TBD TBD Implement Direct Geothermal at up to $5,000,000 $_ $5,000,000
5 Sites
--------------------------------------------------------------------------------------------------------------------------------------------------------
*EN TBD TBD TBD Install Advanced Meters to Meet $110,000,000 $13,000,000 $97,000,000
Metering Mandates\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*EN TBD TBD TBD Construct Renewably Fueled $38,636,000 $7,400,000 $31,236,000
Cogeneration Systems at up to 9
Sites\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--TBD $161,122,000 $20,400,000 $140,722,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Mountain Home TN 1 Renovate Administrative Space $1,120,062 $99,062 $1,021,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Mountain Home TN 1 Construct New Electrical Distribution $950,000 $-- $950,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Mountain Home TN 1 Renovate Canteen $400,000 $36,000 $364,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Mountain Home TN 1 Renovate Pharmacy $400,000 $36,000 $364,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Mountain Home TN 1 Replace Nurses Stations $336,065 $23,000 $313,065
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Mountain Home TN 1 Replace Switch Board $549,000 $-- $549,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*9 Mountain Home TN 1 Repair and Upgrade Site Lighting $176,000 $16,000 $160,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*9 Mountain Home TN 1 Evaluate Feasibility of a Wind $50,000 $-- $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Nashville TN 5 Renovate Research Lab $4,303,000 $461,000 $3,842,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Nashville TN 5 Renovate Inpatient Ward $1,766,000 $140,000 $1,626,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Nashville TN 5 Repair and Replace Exterior $1,000,000 $-- $1,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Murfreesboro TN 6 Upgrade Electrical Distribution $3,560,000 $-- $3,560,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Murfreesboro TN 6 Construct New Pharmacy Code $1,826,000 $196,000 $1,630,000
Requirements
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Murfreesboro TN 6 Modernize and Upgrade Outpatient Area $1,000,000 $-- $1,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Memphis TN 9 Renovate for Cat Scanner and $969,973 $-- $969,973
Ultrasound
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Memphis TN 9 Repair and Upgrade Medical Gas System $668,000 $-- $668,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Memphis TN 9 Construct Intensive Care Unit Family $280,000 $-- $280,000
Waiting Rooms
--------------------------------------------------------------------------------------------------------------------------------------------------------
*9 Memphis TN 9 Replace Water Cooled Condensers $246,000 $-- $246,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Tennessee $19,600,100 $1,007,062 $18,593,038
--------------------------------------------------------------------------------------------------------------------------------------------------------
*17 Bonham TX 4 Install New Heating, Ventilation and $2,000,000 $_ $2,000,000
Air Conditioning System and Upgrade
Electrical in Building 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Houston TX 9 Repair/Replace Elevator Controls and $850,000 $-- $850,000
Motor
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Houston TX 9 Site Prep/Renovation for Supply, $500,000 $-- $500,000
Processing and Distribution
Equipment Replacement
--------------------------------------------------------------------------------------------------------------------------------------------------------
16 Houston TX 9 Renovate Existing Parking Lot $1,600,000 $-- $1,600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*16 Houston TX 9 Upgrade Heating, Ventilation and Air $3,250,000 $_ $3,250,000
Conditioning Controls
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Amarillo TX 13 Replace/Upgrade Fire Alarm Panels $560,000 $-- $560,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Amarillo TX 13 4th Floor Heating, Ventilation and $495,500 $50,000 $445,500
Air Conditioning Modifications
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Amarillo TX 13 Repair/Upgrade Water and Fire $400,000 $40,000 $360,000
Sprinkler System
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Amarillo TX 13 Renovate Nursing Home Care Unit $750,000 $75,000 $675,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Amarillo TX 13 Renovate Patient Rooms for Isolation $305,000 $30,000 $275,000
Rooms
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Amarillo TX 13 Renovate Nursing Home $900,000 $-- $900,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Amarillo TX 13 Repair/Upgrade Flooring in Patient $638,000 $-- $64,000
Care Areas of Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Amarillo TX 13 Renovate Intensive Care Unit Storage $550,000 $-- $55,000
and Patient/Family Waiting Area
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Amarillo TX 13 Replace Plumbing in Intensive Care $275,000 $-- $28,000
Unit
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Amarillo TX 13 Implement Selected Conservation $1,142,857 $_ $1,142,857
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Amarillo TX 13 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 El Paso TX 16 Replace Domestic and Heating Water $825,000 $72,000 $753,000
Valves
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 El Paso TX 16 Renovate Primary Care Space for $280,000 $-- $280,000
Behavioral Health
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 El Paso TX 16 Repair/Replace Site Lighting and $27,250 $2,250 $25,000
Ballasts_FCA Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 El Paso TX 16 Repair/Replace Damaged Heating, $239,000 $17,000 $222,000
Ventilation and Air Conditioning
Ducts
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 El Paso TX 16 Convert Site to Desert Xeriscape $550,000 $50,000 $500,000
Landscaping
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 El Paso TX 16 Renovate Patient Care Areas on 3rd $220,000 $20,000 $200,000
Floor, Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 El Paso TX 16 Implement Selected Conservation $1,142,857 $_ $1,142,857
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*17 Waco TX 17 Replace Heating, Ventilation and Air $2,500,000 $_ $2,500,000
Conditioning, Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Waco TX 17 Relocate Canteen from Building 8 to $500,000 $-- $500,000
Building 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Waco TX 17 Repair/Upgrade Electrical Feeder $760,000 $-- $760,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Waco TX 17 Renovate/Upgrade Existing Water Tower $745,081 $-- $745,081
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Waco TX 17 Improve/Enhance Storm Water Drainage $800,000 $-- $800,000
for Facility--FCA Correction
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Waco TX 17 Repair/Replace Roads, Phase 2 $900,000 $-- $900,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*17 Waco TX 17 Replace Windows in Building 1 $747,000 $_ $747,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Waco TX 17 Renovate Basement of Building 6 for $1,000,000 $-- $1,000,000
Rehabilitation Service
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Big Spring TX 19 Asbestos Abatement $750,000 $74,000 $676,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Big Spring TX 19 Renovate 2nd and 3rd Floors of $400,000 $40,000 $360,000
Building 1 patient care areas
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Big Spring TX 19 Renovate Main Entrance to include $750,000 $-- $750,000
asbestos abatement
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Big Spring TX 19 Repair/Upgrade Steam and Chiller $694,000 $67,000 $627,000
Pipes
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Big Spring TX 19 Ground Safety and Handicap $500,000 $64,000 $436,000
Accessibility Improvements
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Big Spring TX 19 Renovate Canteen in Building 1 $598,000 $58,000 $540,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Big Spring TX 19 Plumbing System Improvements, $750,000 $-- $750,000
Building 1, Phase 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
18 Big Spring TX 19 Replace/Repair Air, Oxygen, and $450,000 $-- $45,000
Vacuum System Piping
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Big Spring TX 19 Implement Selected Conservation $1,142,857 $_ $1,142,857
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*18 Big Spring TX 19 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 San Antonio TX 20 Renovate Operating Room #2 $600,000 $-- $600,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 San Antonio TX 20 Renovate for New Outpatient Clinic $3,525,000 $-- $3,525,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*17 Kerrville TX 21 Upgrade/Repair Boiler Plant, Building $756,173 $_ $756,173
19
--------------------------------------------------------------------------------------------------------------------------------------------------------
*17 Kerrville TX 21 Replace/Upgrade Air Handler Units in $1,900,050 $_ $1,900,050
various buildings throughout the
campus
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Kerrville TX 21 Replace/Upgrade Roofs on Buildings $1,184,000 $-- $1,184,000
11, 18, 46 & 47
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Dallas TX 30 Replace Campus Fire Alarm System $3,753,000 $-- $3,753,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
17 Dallas TX 30 Building 2 Ward Renovation for 2,200,000$ $-- $2,200,000
Patient Privacy
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Texas $45,425,625 $659,250 $43,045,375
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Salt Lake City UT 2 Replace/Repair of Primary Electrical $750,000 $75,000 $675,000
Panel for Building 14
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Salt Lake City UT 2 Replace Chilled Water Distribution $750,000 $75,000 $675,000
Line, Phase 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Salt Lake City UT 2 Expand Fiber and Networking $750,000 $-- $750,000
Capability, Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Salt Lake City UT 2 Upgrade Electrical Distribution $750,000 $75,000 $675,000
Substation
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Salt Lake City UT 2 Repair/Upgrade Domestic Water $750,000 $75,000 $675,000
Distribution, Phase 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Salt Lake City UT 2 Johnson Control Upgrade/Replacement $750,000 $75,000 $675,000
Phase 1 (energy)
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Salt Lake City UT 2 Evaluate Feasibility of Direct $342,857 $_ $342,857
Geothermal\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Salt Lake City UT 2 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Salt Lake City UT 2 Evaluate Feasibility of a Solar $10,000 $_ $10,000
Photovoltaic System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Utah $4,902,857 $375,000 $4,527,857
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Hampton VA 3 Replace Nurse Call $715,950 $-- $715,950
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Hampton VA 3 Upgrade Fire Alarm Various Buildings $1,118,500 $-- $1,118,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Hampton VA 3 Replace/Upgrade Electrical $6,216,000 $-- $6,216,000
Distribution Systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Richmond VA 3 Upgrade and Replace Heating, $782,000 $_ $782,000
Ventilation and Air Conditioning
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Richmond VA 3 Repair Exterior Facing with Caulk and $1,170,000 $-- $1,170,000
Sealing
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Richmond VA 3 Renovate Restrooms $650,000 $_ $650,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Salem VA 6 Renovate for Environmental Compliance $679,600 $-- $679,600
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Salem VA 6 Repair and Replace Elevators $1,567,720 $-- $1,567,720
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Salem VA 6 Replace Steam Piping, Phase 2 $723,243 $_ $723,243
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Salem VA 6 Replace Fire Alarm System $1,257,000 $-- $1,257,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Salem VA 6 Replace Light Fixtures $487,000 $_ $487,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Salem VA 6 Evaluate Feasibility of a Wind $50,000 $_ $50,000
Turbine\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Virginia $15,417,013 $-- $15,417,013
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 White River Junction VT At Large Upgrade Elevators $1,500,000 $-- $1,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 White River Junction VT At Large Upgrade Heating, Ventilation and Air $1,921,125 $180,000 $1,741,125
Conditioning in Building 1, Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 White River Junction VT At Large Construct a Renewably Fueled $5,675,531 $31,531 $5,644,000
Cogeneration System\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Vermont $9,096,656 $211,531 $8,885,125
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Vancouver WA 3 Install New Boilers $400,000 $_ $400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Vancouver WA 3 Repair/Install TV and Radio in $225,000 $-- $225,000
Patient Rooms
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Spokane WA 5 Replace/Upgrade Generators--FCA $3,300,000 $-- $3,300,000
Correction
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 Renovate Supply, Processing and $885,000 $-- $885,000
Distribution in Building 68
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Spokane WA 5 Replace/Upgrade Heating, Ventilation $158,865 $_ $158,865
and Air Conditioning in Building 32
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 Install Grease Trap for Canteen $212,000 $-- $212,000
Kitchen, Building 75
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 Replace Elevator, Repair Safety $485,103 $-- $485,103
Deficiencies, Building 69--FCA
Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 FCA--Replace Elevator B68 $404,500 $29,279 $375,221
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Spokane WA 5 Repair/Upgrade Electrical $75,000 $-- $75,000
Distribution
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 Replace Elevator, Building 80 $404,520 $41,503 $363,017
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Spokane WA 5 Repair/Replace Heating, Ventilation $75,000 $_ $75,000
and Air Conditioning Systems in
Building 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Walla Walla WA 5 Correct Steam Distribution $221,663 $_ $221,663
Systems_FCA Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Spokane WA 5 Replace/Upgrade Existing High Voltage $1,875,000 $75,000 $1,800,000
Substation
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Walla Walla WA 5 Replace Boiler Deaerator Tank and $170,000 $53,762 $116,238
Boiler Safety Devices
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Spokane WA 5 FCA--Upgrade Canteen Dining $190,000 $15,000 $175,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 Enhance Outpatient Security $204,464 $58,688 $145,776
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 Facility Asbestos Survey to ensure $20,000 $-- $20,000
Compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Spokane WA 5 Install new Heating, Ventilation and $660,000 $_ $660,000
Air Conditioning System
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Spokane WA 5 Community Living Center Renovation $26,000 $-- $26,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 Conduct Facility Lead Paint Survey to $30,000 $-- $30,000
ensure compliance
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Walla Walla WA 5 Paint water tower--FCA Correction $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*20 Seattle WA 7 Replace Heating, Ventilation and Air $618,000 $_ $618,000
Conditioning in Building 13
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate/Expand Prosthetics Clinic, $327,000 $-- $327,000
Building 100
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate for installation of MRI $168,000 $-- $168,000
Replacement
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate for Pulmonary Outpatient $500,000 $-- $500,000
Clinic
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate Basement for Lab, to include $1,600,000 $-- $1,600,000
Morgue and Hematology, Phase I--FCA
Corrections
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Remodel Outpatient Pharmacy for $300,000 $-- $300,000
Patient Privacy and Security
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Repair/Install Grease Traps for $100,000 $-- $100,000
Dietetics Kitchen
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate for Installation of Access $299,000 $-- $299,000
Control System
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Upgrade Traffic Circle for Security $495,000 $-- $495,000
Enhancements
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Repair/Upgrade Dumbwaiter for Supply, $540,000 $-- $540,000
Processing and Distribution and
Surgery
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate Emergency Room $596,000 $-- $596,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate existing Canteen for Chapel, $660,000 $-- $660,000
Building 100
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate Old Emergency Room for $2,000,000 $-- $2,000,000
Musculo-Skeletal Specialty Care
Clinic
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Relocate Canteen Food Service to $842,000 $-- $842,000
Basement Bldg. 100
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Relocate Canteen Retail Store to $426,000 $-- $426,000
Basement Building 100
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 Seattle WA 7 Renovate Existing Fiscal Space for $681,000 $-- $681,000
Education Offices
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 American Lake WA 9 Renovate Outpatient Pharmacy for $260,000 $-- $260,000
Patient Privacy/Security
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 American Lake WA 9 Renovate/Expand Gold Clinic, Building $100,000 $-- $100,000
81
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 American Lake WA 9 Upgrade Security/Rekey Locks at $213,000 $-- $213,000
American Lake
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 American Lake WA 9 Renovate for New Dispatch Room in $299,000 $-- $299,000
Building 19
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 American Lake WA 9 Renovate Warehouse for Medical $1,100,000 $-- $1,100,000
Records, Building 19
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 American Lake WA 9 Renovate Building 85 for Eye Clinic, $760,000 $-- $760,000
Compensation and Pension Exam
Program and Mental Health Research
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Washington $23,206,115 $273,232 $22,932,883
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Madison WI 2 Renovate Research $2,750,000 $-- $2,750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Madison WI 2 Renovate and Modernize Flooring and $475,000 $-- $475,000
Walls
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Madison WI 2 Renovate Clinical Space $430,000 $-- $430,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Tomah WI 3 Replace Medical Gas System $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Tomah WI 3 Construct Parking Lot & Pave Gravel $550,000 $-- $550,000
Lots
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Tomah WI 3 Renovate and Expand Rehabilitation $1,575,000 $-- $1,575,000
Service
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Tomah WI 3 Replace Windows $350,000 $_ $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Tomah WI 3 Install Central Air Conditioning $225,000 $_ $225,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Tomah WI 3 Renovate Urgent Care $1,625,000 $50,000 $1,575,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Tomah WI 3 Replace Nurse Call System $350,000 $-- $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Tomah WI 3 Upgrade Electrical Distribution $250,000 $-- $250,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Tomah WI 3 Upgrade Electrical Distribution $275,000 $-- $275,000
System
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Tomah WI 3 Renovate for Mental Health Clinics $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace and Upgrade Fire Alarm System $262,305 $-- $262,305
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace Fire Alarm System $389,681 $-- $389,681
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace Fire Alarm System $683,014 $-- $683,014
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace Fire Alarm System $1,516,013 $-- $1,516,013
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace Fire Alarm System $604,957 $-- $604,957
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace Roof $200,000 $-- $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace Roof $499,795 $-- $499,795
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace Operating Room Roofs $120,500 $-- $120,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
*12 Milwaukee WI 4 Replace Heating, Ventilation and Air $211,054 $_ $211,054
Conditioning Condenser
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Replace Roof $499,795 $-- $499,795
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Re-insulate Roof $111,060 $-- $111,060
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Repair and Upgrade Exterior $25,000 $-- $25,000
Modification
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Install Smoke Barrier Walls $203,914 $-- $203,914
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Milwaukee WI 4 Install Smoke Barrier Walls $152,936 $-- $152,936
--------------------------------------------------------------------------------------------------------------------------------------------------------
12 Madison WI 16 Renovate Clinical Space $3,040,000 $-- $3,040,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Wisconsin $17,975,024 $50,000 $17,925,024
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Clarksburg WV 1 Renovate Emergency Room Area $575,000 $-- $575,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*4 Clarksburg WV 1 Upgrade and Replace Boiler Plant $466,440 $_ $466,440
Equipment
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Clarksburg WV 1 Renovate Dental Lab $150,000 $-- $150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Martinsburg WV 2 Replace Heating, Ventilation and Air $2,800,000 $_ $2,800,000
Conditioning in Building 501B
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Martinsburg WV 2 Replace Main Transformer $750,000 $-- $750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Martinsburg WV 2 Replace Heating Plant Surge Tank $200,000 $_ $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Martinsburg WV 2 Replace Patient Wandering System $300,000 $-- $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Martinsburg WV 2 Replace Nurse Call/Code Blue System $750,000 $-- $750,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Martinsburg WV 2 Relocate the Mailroom to Mitigate $475,000 $-- $475,000
Security Vulnerability
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Martinsburg WV 2 Upgrade Environmental Monitoring $2,500,000 $-- $2,500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Martinsburg WV 2 Implement Selected Conservation $3,333,333 $_ $3,333,333
Measures\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
*6 Beckley WV 3 Replace Steam and Plumbing Line $980,000 $_ $980,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
6 Beckley WV 3 Modernize Patient Areas $665,000 $-- $665,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*9 Huntington WV 3 Replace Air Handling Units $4,000,000 $_ $4,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*9 Huntington WV 3 Replace Steam Distribution System $1,500,000 $160,000 $1,340,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Huntington WV 3 Renovate Prosthetics & Rehab Medicine $447,000 $47,000 $400,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Huntington WV 3 Renovate and Modernize Inpatient Ward $250,000 $-- $250,000
Finishes
--------------------------------------------------------------------------------------------------------------------------------------------------------
9 Huntington WV 3 Upgrade Outpatient Waiting $250,000 $-- $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--West Virginia $20,391,773 $207,000 $20,184,773
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Cheyenne WY At Large Renovate Surgery to include two $900,000 $-- $900,000
additional Operating Rooms
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Sheridan WY At Large Replace Secondary Electrical $550,000 $50,000 $500,000
Distribution, Phase 1
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Cheyenne WY At Large Replace Heating, Ventilation and Air $750,000 $70,000 $680,000
Conditioning Controls, Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Sheridan WY At Large Replace Water Tower Interior Coating $330,000 $30,000 $300,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Cheyenne WY At Large Repair/Upgrade interior finishes, $750,000 $70,000 $680,000
Phase 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Sheridan WY At Large Repair/Replace Sanitary Sewer System $650,000 $150,000 $500,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Cheyenne WY At Large Repair/Replace Roads, Sidewalks, and $750,000 $70,000 $680,000
Parking Lots, Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Cheyenne WY At Large Repair/Upgrade Exterior Finishes $750,000 $70,000 $680,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Sheridan WY At Large Expand Parking Lots to meet patient $820,000 $70,000 $750,000
and visitor demand
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Cheyenne WY At Large Repair/Upgrade Heating, Ventilation $750,000 $70,000 $680,000
and Air Conditioning
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Cheyenne WY At Large Expand Emergency Power $750,000 $70,000 $680,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Cheyenne WY At Large Install Renewable Energy Systems, $750,000 $70,000 $680,000
Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
*19 Sheridan WY At Large Energy Reduction Project Phase 1 $750,000 $70,000 $680,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
19 Cheyenne WY At Large Repair/Upgrade Interior Finishes, $560,000 $60,000 $500,000
Phase 2
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Total--Wyoming $9,810,000 $920,000 $8,890,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
...................... ....... ............... Cumulative Total $1,136,567,218 $37,918,467 $1,085,672,6522
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Projects are provided for with VISN wide contracts.
2 The total funding for projects included in these plans is slightly more than the ARRA funds provided in order to account for the potential slippage of
projects due to unforeseen technical issues.
FY 09 Veterans Health Administration Non-Recurring Maintenance (NRM)/ Energy ARRA Spending
Veterans Health Administration ARRA Spending Category
----------------------------------------------------------------------------------------------------------------
All Energy
Qty Totals Related Renewable Percentage of
Projects Energy Total
----------------------------------------------------------------------------------------------------------------
Renewable Energy (Solar, Wind, 62 $64,435,000 $64,435,000 $64,435,000 6%
Biomass, Geothermal)
----------------------------------------------------------------------------------------------------------------
Heating, Ventilation, and Air 170 $161,449,166 $161,449,166 -- 15%
Conditioning
----------------------------------------------------------------------------------------------------------------
Roads, Paving, and Grounds Projects 42 $37,627,919 -- -- 3%
----------------------------------------------------------------------------------------------------------------
Safety, Security and Fire Alarms 102 $109,614,712 -- -- 10%
----------------------------------------------------------------------------------------------------------------
Energy Conservation 56 $75,643,849 $75,643,849 -- 7%
----------------------------------------------------------------------------------------------------------------
Interior Renovation 276 $299,492,360 -- -- 28%
----------------------------------------------------------------------------------------------------------------
Exterior Renovations 47 $34,157,722 -- -- 3%
----------------------------------------------------------------------------------------------------------------
ADA Accessibility 45 $43,617,198 -- -- 4%
----------------------------------------------------------------------------------------------------------------
Building Infrastructure 106 $141,089,603 -- -- 13%
----------------------------------------------------------------------------------------------------------------
Metering 3 $97,580,000 $97,580,000 -- 9%
----------------------------------------------------------------------------------------------------------------
Other 47 $20,965,123 -- -- 2%
----------------------------------------------------------------------------------------------------------------
Total\1\ 956 $1,085,672,652 $399,108,015 $64,435,000 100%
----------------------------------------------------------------------------------------------------------------
1 The total funding for projects included in these plans is slightly more than the ARRA funds provided in order
to account for the potential slippage of projects due to unforeseen.
[GRAPHIC] [TIFF OMITTED] T8420A.001
FY 09 Veterans Health Administration Non-Recurring Maintenance (NRM)/
Energy ARRA Spend Plan--By State
AARA Overview
------------------------------------------------------------------------
Number of
State Projects ARRA Funding
------------------------------------------------------------------------
AK 4 $600,000
------------------------------------------------------------------------
AL 14 $17,230,490
------------------------------------------------------------------------
AR 9 $14,380,000
------------------------------------------------------------------------
AZ 25 $19,868,571
------------------------------------------------------------------------
CA 99 $92,701,199
------------------------------------------------------------------------
CO 12 $8,035,000
------------------------------------------------------------------------
CT 4 $10,119,075
------------------------------------------------------------------------
DC 8 $15,393,333
------------------------------------------------------------------------
DE 5 $8,066,440
------------------------------------------------------------------------
FL 46 $34,996,726
------------------------------------------------------------------------
GA 13 $15,193,861
------------------------------------------------------------------------
HI 4 $850,000
------------------------------------------------------------------------
IA 15 $7,690,201
------------------------------------------------------------------------
ID 5 $6,092,857
------------------------------------------------------------------------
IL 43 $63,555,749
------------------------------------------------------------------------
IN 3 $4,866,000
------------------------------------------------------------------------
KS 9 $9,190,000
------------------------------------------------------------------------
KY 10 $11,441,000
------------------------------------------------------------------------
LA 8 $8,265,000
------------------------------------------------------------------------
MA 11 $24,078,000
------------------------------------------------------------------------
MD 29 $19,810,333
------------------------------------------------------------------------
ME 3 $13,260,493
------------------------------------------------------------------------
MI 17 $24,050,224
------------------------------------------------------------------------
MN 36 $16,637,000
------------------------------------------------------------------------
MO 14 $24,098,400
------------------------------------------------------------------------
MS 7 $12,440,000
------------------------------------------------------------------------
MT 7 $4,252,857
------------------------------------------------------------------------
NC 17 $21,864,000
------------------------------------------------------------------------
ND 4 $3,266,230
------------------------------------------------------------------------
NE 11 $7,500,000
------------------------------------------------------------------------
NH 2 $1,551,500
------------------------------------------------------------------------
NJ 16 $14,502,000
------------------------------------------------------------------------
NM 12 $4,487,857
------------------------------------------------------------------------
NV 12 $5,510,000
------------------------------------------------------------------------
NY 104 $109,562,683
------------------------------------------------------------------------
OH 15 $39,643,331
------------------------------------------------------------------------
OK 9 $4,554,000
------------------------------------------------------------------------
OR 25 $7,125,338
------------------------------------------------------------------------
PA 30 $46,432,830
------------------------------------------------------------------------
PR 9 $7,878,675
------------------------------------------------------------------------
RI 4 $11,550,000
------------------------------------------------------------------------
SC 3 $4,454,652
------------------------------------------------------------------------
SD 25 $7,503,657
------------------------------------------------------------------------
TBD 5 $140,722,000
------------------------------------------------------------------------
TN 18 $18,593,038
------------------------------------------------------------------------
TX 48 $43,045,375
------------------------------------------------------------------------
UT 9 $4,527,857
------------------------------------------------------------------------
VA 12 $15,417,013
------------------------------------------------------------------------
VT 3 $8,885,125
------------------------------------------------------------------------
WA 43 $22,932,883
------------------------------------------------------------------------
WI 28 $17,925,024
------------------------------------------------------------------------
WV 18 $20,184,773
------------------------------------------------------------------------
WY 14 $8,890,000
------------------------------------------------------------------------
Total 956 $1,085,672,6521
------------------------------------------------------------------------
\1\ The total funding for projects included in these plans is slightly
more than the ARRA funds provided in order to account for the
potential slippage of projects due to unforeseen technical issues.
FY 2009 Grants for State Extended Care Facilities ARRA Spend Plan
----------------------------------------------------------------------------------------------------------------
Location
---------------------------------------------- Total Grant ARRA
VISN Congressional Project Title Cost Funding
City State District
----------------------------------------------------------------------------------------------------------------
18 Phoenix AZ 4 Facility Renovation, Phase 1 $364 $364
----------------------------------------------------------------------------------------------------------------
18 Tucson AZ 7 180-Bed NHC (New) & 35 $18,671 $18,671
Participant ADHC
----------------------------------------------------------------------------------------------------------------
Total--Arizona $19,035 $19,035
----------------------------------------------------------------------------------------------------------------
19 Walsenburg CO 3 General Renovations $2,045 $2,045
----------------------------------------------------------------------------------------------------------------
Total--Colorado $2,045 $2,045
----------------------------------------------------------------------------------------------------------------
1 Rocky Hill CT 1 Domiciliary Renovations-- $5,397 $5,397
Buildings 2, 3 and 4
----------------------------------------------------------------------------------------------------------------
Total--Connecticut $5,397 $5,397
----------------------------------------------------------------------------------------------------------------
8 Daytona Beach FL 7 General Renovation & Facility $3,250 $3,250
Upgrade
----------------------------------------------------------------------------------------------------------------
Total--Florida $3,250 $3,250
----------------------------------------------------------------------------------------------------------------
7 Milledgeville GA 12 Dietary Facility Renovation $715 $715
----------------------------------------------------------------------------------------------------------------
Total--Georgia $715 $715
----------------------------------------------------------------------------------------------------------------
23 Marshalltown IA 4 Dining & Activity Room Expansion $2,377 $2,377
----------------------------------------------------------------------------------------------------------------
23 Marshalltown IA 4 Renovate Medical Clinic Space $727 $727
----------------------------------------------------------------------------------------------------------------
Total--Iowa $3,104 $3,104
----------------------------------------------------------------------------------------------------------------
12 Manteno IL 11 Construct Storage Building $1,610 $1,610
----------------------------------------------------------------------------------------------------------------
12 Manteno IL 11 Convert/Upgrade Resident Outdoor $2,320 $2,320
Activity Space & Staff Offices
----------------------------------------------------------------------------------------------------------------
12 LaSalle IL 11 80-Bed NHC Addition $8,308 $8,308
----------------------------------------------------------------------------------------------------------------
23 Quincy IL 17 Bus & Ambulance Garage $565 $565
----------------------------------------------------------------------------------------------------------------
Total--Illinois $12,803 $12,803
----------------------------------------------------------------------------------------------------------------
11 Lafayette IN 4 Facility Upgrade $869 $869
----------------------------------------------------------------------------------------------------------------
Total--Indiana $869 $869
----------------------------------------------------------------------------------------------------------------
1 Chelsea MA 8 Roof Replacement--Quigley $793 $793
Building
----------------------------------------------------------------------------------------------------------------
Total--Massachusetts $793 $793
----------------------------------------------------------------------------------------------------------------
1 Caribou ME 2 Multipurpose Room Addition $354 $354
----------------------------------------------------------------------------------------------------------------
1 South Paris ME 2 Replace Flooring $353 $353
----------------------------------------------------------------------------------------------------------------
Total--Maine $707 $707
----------------------------------------------------------------------------------------------------------------
11 Grand Rapids MI 3 Code Fire Suppression, Nurse $704 $704
Call Replacement
----------------------------------------------------------------------------------------------------------------
Total--Michigan $704 $704
----------------------------------------------------------------------------------------------------------------
23 Fergus Falls MN 7 Dementia--Special Care Unit--(24 $4,799 $4,799
Beds--New)
----------------------------------------------------------------------------------------------------------------
Total--Minnesota $4,799 $4,799
----------------------------------------------------------------------------------------------------------------
15 St. Louis MO 1 Emergency Generator, Etc. $944 $944
----------------------------------------------------------------------------------------------------------------
15 Warrensburg MO 4 Emergency Generator, Etc. $372 $372
----------------------------------------------------------------------------------------------------------------
15 Cameron MO 6 Emergency Generator, Etc. $372 $372
----------------------------------------------------------------------------------------------------------------
16 Mt. Vernon MO 7 Emergency Generator, Etc. $372 $372
----------------------------------------------------------------------------------------------------------------
15 St. James MO 8 Emergency Generator, Etc. $372 $372
----------------------------------------------------------------------------------------------------------------
15 Cape Girardeau MO 8 Fire Lane, Hydrant and Lighting $708 $708
----------------------------------------------------------------------------------------------------------------
15 Mexico MO 9 Emergency Generator, Etc. $372 $372
----------------------------------------------------------------------------------------------------------------
Total--Missouri $3,512 $3,512
----------------------------------------------------------------------------------------------------------------
6 Pending--Eastern NC 1 & 3 100-Bed NHC (New) $8,147 $8,147
----------------------------------------------------------------------------------------------------------------
6 Pending--Western NC 11 100-Bed NHC (New) $8,147 $8,147
----------------------------------------------------------------------------------------------------------------
Total--North Carolina $16,294 $16,294
----------------------------------------------------------------------------------------------------------------
3 Paramus NJ 5 Multipurpose Room Addition $1,415 $1,415
----------------------------------------------------------------------------------------------------------------
3 Paramus NJ 5 HVAC Replacement, Phase 2 $475 $475
----------------------------------------------------------------------------------------------------------------
Total--New Jersey $1,890 $1,890
----------------------------------------------------------------------------------------------------------------
3 Stony Brook NY 1 Emergency Generator and System $470 $470
Upgrade
----------------------------------------------------------------------------------------------------------------
Total--New York $470 $470
----------------------------------------------------------------------------------------------------------------
10 Georgetown OH 2 Security Upgrades, Phase 1 $330 $330
----------------------------------------------------------------------------------------------------------------
10 Georgetown OH 2 Security Upgrades, Phase 2 $331 $331
----------------------------------------------------------------------------------------------------------------
10 Sandusky OH 9 Kitchen Upgrade--Secrest Hall $260 $260
----------------------------------------------------------------------------------------------------------------
10 Sandusky OH 9 Corridor Renovation $325 $325
----------------------------------------------------------------------------------------------------------------
Total--Ohio $1,246 $1,246
----------------------------------------------------------------------------------------------------------------
4 Spring City PA 6 112-Bed DOM Replacement + 8 $17,109 $17,109
Additional Beds
----------------------------------------------------------------------------------------------------------------
Total--Pennsylvania $17,109 $17,109
----------------------------------------------------------------------------------------------------------------
1 Bristol RI 1 General Renovations $1,204 $1,204
----------------------------------------------------------------------------------------------------------------
Total--Rhode Island $1,204 $1,204
----------------------------------------------------------------------------------------------------------------
17 Tyler TX 1 160-Bed NHC (New) $8,680 $8,680
----------------------------------------------------------------------------------------------------------------
16 Houston TX TBD 160-Bed NHC (New) $8,680 $8,680
----------------------------------------------------------------------------------------------------------------
Pending TX TBD 160-Bed NHC (New) $8,680 $8,680
----------------------------------------------------------------------------------------------------------------
Pending TX TBD 160-Bed NHC (New) $8,680 $8,680
----------------------------------------------------------------------------------------------------------------
Total--Texas $34,720 $34,720
----------------------------------------------------------------------------------------------------------------
19 Ogden UT 1 120-Bed NHC (New) $12,573 $12,573
----------------------------------------------------------------------------------------------------------------
19 Salt Lake City UT 2 General Renovations $645 $645
----------------------------------------------------------------------------------------------------------------
Total--Utah $13,218 $13,218
----------------------------------------------------------------------------------------------------------------
6 Roanoke VA 6 General Renovations $372 $372
----------------------------------------------------------------------------------------------------------------
Total--Virginia $372 $372
----------------------------------------------------------------------------------------------------------------
12 Union Grove WI 1 Upgrade Main Electrical $263 $263
Switchgear
----------------------------------------------------------------------------------------------------------------
12 Union Grove WI 1 Aboveground Building Connectors $2,217 $2,217
----------------------------------------------------------------------------------------------------------------
12 Union Grove WI 1 24-Bed DOM Addition (New) $1,625 $1,625
----------------------------------------------------------------------------------------------------------------
12 King WI 8 Replace Resident Wandering $386 $386
Monitoring System
----------------------------------------------------------------------------------------------------------------
12 King WI 8 Ceiling Resident Lift System $1,892 $1,892
----------------------------------------------------------------------------------------------------------------
12 King WI 8 Remodel Laundry Facility $283 $283
----------------------------------------------------------------------------------------------------------------
Total--Wisconsin $6,666 $6,666
----------------------------------------------------------------------------------------------------------------
Cumulative Total $150,922 $150,922\1\
----------------------------------------------------------------------------------------------------------------
1\1\ Grant costs exceed ARRA funding because they are estimates and may be adjusted based upon actual costs as
projects are completed.
FY 2009 Grants for State Extended Care Facilities ARRA Spend Plan
ARRA Overview
------------------------------------------------------------------------
Number of
State Projects ARRA Funding
------------------------------------------------------------------------
AZ 2 $19,035
------------------------------------------------------------------------
CO 1 $2,045
------------------------------------------------------------------------
CT 1 $5,397
------------------------------------------------------------------------
FL 1 $3,250
------------------------------------------------------------------------
GA 1 $715
------------------------------------------------------------------------
IA 2 $3,104
------------------------------------------------------------------------
IL 4 $12,803
------------------------------------------------------------------------
IN 1 $869
------------------------------------------------------------------------
MA 1 $793
------------------------------------------------------------------------
ME 2 $707
------------------------------------------------------------------------
MI 1 $704
------------------------------------------------------------------------
MN 1 $4,799
------------------------------------------------------------------------
MO 7 $3,512
------------------------------------------------------------------------
NC 2 $16,294
------------------------------------------------------------------------
NJ 2 $1,890
------------------------------------------------------------------------
NY 1 $470
------------------------------------------------------------------------
OH 4 $1,246
------------------------------------------------------------------------
PA 1 $17,109
------------------------------------------------------------------------
RI 1 $1,204
------------------------------------------------------------------------
TX 4 $34,720
------------------------------------------------------------------------
UT 2 $13,218
------------------------------------------------------------------------
VA 1 $372
------------------------------------------------------------------------
WI 6 $6,666
------------------------------------------------------------------------
Total 49 $150,9221
------------------------------------------------------------------------
\1\ Grant costs exceed ARRA funding because they are estimates and may
be adjusted based upon actual costs as projects are completed.
Veterans Benefits Administration--Hiring Temporary Claims Processors
Expenditure Plan
VBA: $150M Recovery Act Hiring Temporary Claims Processors Operating Plan
TAFS: 0150B1
(Dollars in thousands--000s)
----------------------------------------------------------------------------------------------------------------
Total Monthly Payroll Monthly Non Monthly Total
FY 2009 Cumulative FTE ($K) Payroll ($K) Obligations ($K)
----------------------------------------------------------------------------------------------------------------
Apr 248 $2,009 $2,729 $4,738
----------------------------------------------------------------------------------------------------------------
May 539 $3,029 $4,379 $7,408
----------------------------------------------------------------------------------------------------------------
Jun 831 $4,296 $4,379 $8,675
----------------------------------------------------------------------------------------------------------------
Jul 1,133 $5,656 $4,379 $10,034
----------------------------------------------------------------------------------------------------------------
Aug 1,435 $6,312 $4,379 $10,691
----------------------------------------------------------------------------------------------------------------
Sep 1,5002 $6,824 $4,379 $11,203
----------------------------------------------------------------------------------------------------------------
FYTD (SEP) 476 $28,125 $24,623 $52,748
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Total Monthly Payroll Monthly Non Monthly Total
FY 2010 Cumulative ($K) Payroll ($K) Obligations ($K)
FTE
----------------------------------------------------------------------------------------------------------------
Oct 1,500 $6,953 $955 $7,908
----------------------------------------------------------------------------------------------------------------
Nov 1,500 $6,718 $956 $7,673
----------------------------------------------------------------------------------------------------------------
Dec 1,500 $7,260 $956 $8,216
----------------------------------------------------------------------------------------------------------------
Jan 1,500 $6,965 $956 $7,921
----------------------------------------------------------------------------------------------------------------
Feb 1,500 $6,708 $956 $7,664
----------------------------------------------------------------------------------------------------------------
Mar 1,500 $7,556 $956 $8,512
----------------------------------------------------------------------------------------------------------------
Apr 1,500 $7,289 $956 $8,244
----------------------------------------------------------------------------------------------------------------
May 1,500 $7,020 $956 $7,975
----------------------------------------------------------------------------------------------------------------
Jun 1,500 $7,311 $956 $8,267
----------------------------------------------------------------------------------------------------------------
Jul 1,500 $7,323 $956 $8,279
----------------------------------------------------------------------------------------------------------------
Aug 1,500 $7,335 $956 $8,291
----------------------------------------------------------------------------------------------------------------
Sep 1,500 $7,347 $956 $8,302
----------------------------------------------------------------------------------------------------------------
FYTD (SEP) 1,500 $85,784 $11,467 $97,252
----------------------------------------------------------------------------------------------------------------
Grand Total $113,910 $36,090 $150,000
----------------------------------------------------------------------------------------------------------------
$150M 0150B1
U.S. Department of Veterans Affairs, Veterans Benefits Administration
Veterans Benefits Administration--Support for Economic Recovery
Payments Expenditure Plan
VBA: $7.1M Recovery Act Veteran Economic Recovery Payments
TAFS: 0150R1
(Dollars in thousands--000s)
----------------------------------------------------------------------------------------------------------------
Total Monthly Payroll Monthly Non Monthly Total
FY 2009 Cumulative FTE ($K) Payroll ($K) Obligations ($K)
----------------------------------------------------------------------------------------------------------------
Apr 5 $198 $198
----------------------------------------------------------------------------------------------------------------
May 9 $189 $4,729 $4,918
----------------------------------------------------------------------------------------------------------------
Jun 12 $198 $1,260 $1,458
----------------------------------------------------------------------------------------------------------------
Jul 13 $156 $156
----------------------------------------------------------------------------------------------------------------
Aug 13 $81 $81
----------------------------------------------------------------------------------------------------------------
Sep 14 $85 $85
----------------------------------------------------------------------------------------------------------------
FYTD (SEP) 14 $907 $5,989 $6,896
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Total Monthly Payroll Monthly Non Monthly Total
FY 2010 Cumulative ($K) Payroll ($K) Obligations ($K)
FTE
----------------------------------------------------------------------------------------------------------------
Oct 8 $45
----------------------------------------------------------------------------------------------------------------
Nov 7 $25
----------------------------------------------------------------------------------------------------------------
Dec 6 $28
----------------------------------------------------------------------------------------------------------------
Jan 5 $15
----------------------------------------------------------------------------------------------------------------
Feb 5 $14
----------------------------------------------------------------------------------------------------------------
Mar 5 $16
----------------------------------------------------------------------------------------------------------------
Apr 4 $12
----------------------------------------------------------------------------------------------------------------
May 4 $9
----------------------------------------------------------------------------------------------------------------
Jun 4 $10
----------------------------------------------------------------------------------------------------------------
Jul 4 $10
----------------------------------------------------------------------------------------------------------------
Aug 3 $10
----------------------------------------------------------------------------------------------------------------
Sep 3 $8
----------------------------------------------------------------------------------------------------------------
FYTD (SEP) 3 $203
----------------------------------------------------------------------------------------------------------------
Grand Total $1,110 $5,989 $7,100
----------------------------------------------------------------------------------------------------------------
$7.1M 0150R1
U.S. Department of Veterans Affairs, Veterans Benefits Administration
FY 2009 National Cemetery Administration (NCA)/Energy ARRA Spend Plan
*Projects in BOLD ITALICS incorporate energy efficiency and renewable energy.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Location
------------------------------------------------------ Estimated
MSN Congressional Project Title Budget Cost ARRA Funding
Cemetery State District
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Ft Richardson AK At Large Slurry Seal Roads $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Alaska $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Mobile AL 1 Paint Wall and Fences $45,000 $45,000
(Repair)
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Mobile AL 1 Maint Bldg--Paint $5,000 $5,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Ft Mitchell AL 3 Mower $20,000 $20,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Alabama $70,000 $70,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Little RocAR 2 Admin and Maint Bldgs--Paint $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Little RocAR 2 Minnesota Monument,1916 $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Fayetteville AR 3 Bldgs--Paint $20,000 $20,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Fayetteville AR 3 Reseal Roads $15,000 $15,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Fayetteville AR 3 Riding Mower $25,000 $25,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Ft Smith AR 3 Mower $1,300 $1,300
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Ft Smith AR 3 Mower $1,300 $1,300
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Arkansas $82,600 $82,600
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Prescott AZ 1 Slurry Seal New Road at $20,000 $20,000
Columbarium
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 NMC of Arizona AZ 3 Repair Columbaria Floors $165,000 $165,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 NMC of Arizona AZ 3 Street Sweeper $90,427 $90,427
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 NMC of Arizona AZ 3 Articulated Dumper $53,852 $53,852
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 NMC of Arizona AZ 3 Sand Rake $20,643 $20,643
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 NMC of Arizona AZ 3 Utility Vehicle (trade-in) $2,083 $2,083
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Arizona $352,005 $352,005
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 San Francisco CA 8 Pacific Coast GAR Monument, $15,000 $15,000
1897
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Sacramento CA 10 Electric Cart $9,145 $9,145
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Sacramento CA 10 Electric Cart $9,145 $9,145
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Golden Gate CA 12 Install Spoils Bay Cover $18,000 $18,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Golden Gate CA 12 Replace Damaged Floor $6,000 $6,000
Covering In Admin
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Golden Gate CA 12 Replace Doors $12,000 $12,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Golden Gate CA 12 Slurry Seal Roads $50,000 $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Golden Gate CA 12 Shredder $40,137 $40,137
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 San Joaquin Valley CA 18 Rooftop solar photovoltaic $1,448,000 $1,448,000
power
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 San Joaquin Valley CA 18 Utility Vehicle $16,237 $16,237
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 San Joaquin Valley CA 18 Utility Vehicle $16,237 $16,237
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Los Angeles CA 30 Headstones/Markers and $4,310,068 $4,310,068
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Los Angeles CA 30 Utility Vehicle $18,900 $18,900
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Los Angeles CA 30 National Home for Disabled $75,000 $75,000
Veteran Soldiers (NHDVS)
Monument, ca. 1900
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Riverside CA 44 Headstones/Markers and $1,306,295 $1,306,295
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Riverside CA 44 Slurry Seal Roads $200,000 $200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Riverside CA 44 Mower $83,271 $83,271
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Riverside CA 44 Turf VAC/Sweeper $18,995 $18,995
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Riverside CA 44 Hydraulic Excavator $155,666 $155,666
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Ft Rosecrans CA 52 Headstones/Markers and $2,000,000 $2,000,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Ft Rosecrans CA 52 Compact Excavator $60,500 $60,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Ft Rosecrans CA 52 Utility Vehicle $28,167 $28,167
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Ft Rosecrans CA 52 Chipper $9,649 $9,649
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Ft Rosecrans CA 52 USS Bennington Monument, $250,000 $250,000
1907
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--California $10,156,412 $10,156,412
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Logan CO 1 Renovate lakeside erosion $50,000 $50,000
near Public Information
Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Logan CO 1 Utility Vehicle $26,500 $26,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Logan CO 1 Electric Cart $9,860 $9,860
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Logan CO 1 Lowering Dev$4,000 $4,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Logan CO 1 Compact Excavator $65,000 $65,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Logan CO 1 Utility Vehicle $26,200 $26,200
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Logan CO 1 Landscape Ra$5,900 $5,900
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Logan CO 1 Dumper $34,000 $34,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Lyon CO 4 Install equipment shelter $45,000 $45,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Colorado $266,460 $266,460
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Barrancas FL 1 Maint Bldg--Paint $5,000 $5,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Barrancas FL 1 Mower $18,000 $18,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florida FL 5 Admin and Maint Bldgs--Paint $50,000 $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florida FL 5 Carillon--Paint $5,000 $5,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florida FL 5 Reseal Roads $50,000 $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florida FL 5 Mower $45,000 $45,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florida FL 5 Utility vehicle $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florida FL 5 Backhoe $80,000 $80,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florida FL 5 Articulated Dumper $70,000 $70,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florida FL 5 Articulated Dumper $55,000 $55,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 St. Augustine FL 7 Maint Bldg and Wall--Paint $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 St. Augustine FL 7 Dade's Pyramids(3), 1 842 $100,000 $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Bay Pines FL 10 Riding Mower $25,000 $25,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Florida $543,000 $543,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Marietta GA 11 Monumental Arch, c.1870 $100,000 $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Georgia $100,000 $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 NMC of the Pacific HI 1 Slurry Seal Roads $80,000 $80,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 NMC of the Pacific HI 1 Compact Sweeper $103,774 $103,774
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 NMC of the Pacific HI 1 3-Way Dump Trailer $8,800 $8,800
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Hawaii $192,574 $192,574
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Keokuk IA 2 Mower, Lawn, Ridin$12,381 $12,381
Mulch Kit
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Keokuk IA 2 Vacuum, Leaf, Pull B$3,500 $3,500
Trac Vac
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Iowa $15,881 $15,881
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Oak Woods IL 1 Confederate Mound Monument, $250,000 $250,000
1893
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Abraham Lincoln IL 11 Replace Asphalt Roadways $350,000 $350,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Abraham Lincoln IL 11 Truck, Utility, 4 WD, Casket $39,000 $39,000
Carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Abraham Lincoln IL 11 Harrow, Disc., Pull Behind, $2,000 $2,000
3-Point Hitch
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Mound City IL 12 Illinois State Soldiers & $150,000 $150,000
Sailors Monument, 1874
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 North Alton IL 12 Confederate POW Dead $250,000 $250,000
Monument, 1910
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Danville IL 15 Headstones/Markers and $704,000 $704,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Danville IL 15 Replace Chain Link Fence $75,000 $75,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Danville IL 15 Loader, Uti$37,000ompact,$37,000
Attach
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Danville IL 15 Soldiers (NHDVS) Monument, $15,000 $15,000
1917
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Rock Island IL 17 Truck, Utility, 4 WD, with $43,000 $43,000
Lift Kit
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Rock Island IL 17 Truck, Utility, 4 WD, w/ $39,000 $39,000
Attach.
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Rock Island IL 17 Truck, Utility, 4 WD $28,000 $28,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Butler IL 18 Headstones/Markers and $431,935 $431,935
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Butler IL 18 Attachments, Dozer & Snow $9,690 $9,690
Blade & Bucket
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Butler IL 18 Carriage, Casket, Stainless $1,995 $1,995
Steel
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Butler IL 18 Street Sweeper $43,000 $43,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Illinois $2,468,620 $2,468,620
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Headstones/Markers and $124,000 $124,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 New Asphalt Road at section $75,000 $75,000
11/12
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Replace Gravel Road w/ $65,000 $65,000
Asphalt Paving at section 2/
4-3/6
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Vacuum, Leaf, Gas P$30,875 $30,875
Pull Behind
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Truck, Utility $9,762 $9,762
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Tiller, Pull Behind, 51'', $2,300 $2,300
Med. Grade
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Scraper, Box, Pull Behind, $490 $490
48''
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Mower, Lawn, Ridin$17,091 $17,091
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Screener, Dirt, Pull Behind, $22,919 $22,919
Gas Powered
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Trailer, Utility, 12,000 lb, $4,000 $4,000
81-1/2'' Wide, 2 Axles
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Marion IN 5 Soldiers (NHDVS) Monument, $10,000 $10,000
1914
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 New Albany IN 9 Headstones/Markers and $320,000 $320,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 New Albany IN 9 Generator, Electric, $1,000 $1,000
Portable, Gas Powered
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 New Albany IN 9 Generator, Electric, $1,000 $1,000
Portable, Gas Powered
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Indiana $683,437 $683,437
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft LeavenwortKS 2 Paint maintenance shop $8,000 $8,000
exterior
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft LeavenwortKS 2 Resurface Roadways and $200,000 $200,000
replace curbing
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft LeavenwortKS 2 Lowering Dev$4,000 $4,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Scott KS 2 Repair and resurface all $250,000 $250,000
roadways
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 LeavenwortKS 2 Repair/replacement of stone $250,000 $250,000
lined drainage ditches
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 LeavenwortKS 2 Paint Maintenance Shop $15,000 $15,000
exterior
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 LeavenwortKS 2 Replace windows in $12,000 $12,000
Maintenance Bldg
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 LeavenwortKS 2 Utility Vehicle $33,000 $33,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 LeavenwortKS 2 NHDVS Obelisk, 1919 $35,000 $35,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 LeavenwortKS 2 NHDVS Chapel Fountain, ca. $15,000 $15,000
1900
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Kansas $822,000 $822,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Lebanon KY 2 Roof Covered Material Bins $70,000 $70,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Lebanon KY 2 Truck, Utility, 4WD, Diesel $22,000 $22,000
Engine
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Lebanon KY 2 Generator, Electric, $1,000 $1,000
Portable, Gas Powered
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Lebanon KY 2 Mower, Riding, Lawn, 60'' $11,000 $11,000
Mulching Deck
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Zachary Taylor KY 3 Truck, Utility, 4 WD, w/ $39,000 $39,000
Attach.
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Zachary Taylor KY 3 Zachary Taylor Monument (& $50,000 $50,000
secondary small obelisk & a
memorial sundial), 1 930s
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Headstones/Markers and $591,540 $591,540
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Emergency Generator for $10,000 $10,000
Admin Bldg
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Loader, Bac$82,000 $82,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Auger, 12'' & 18'' Bits, $5,500 $5,500
Hydraulic, Attachment
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Truck, Utility, 4WD, Diesel $22,000 $22,000
Engine
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Roller, Lawn, Self $35,000 $35,000
Propelled, Vibrator Enhanced
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Mower, Riding, Lawn, 34'' $4,127 $4,127
Cross Cut
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Bucket, Loader, Atta$1,500 $1,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Aerator, Core, Hydraulic, $1,100 $1,100
Pull Behind
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Nelson KY 6 Generator, Electric, $1,000 $1,000
Portable, Gas Powered
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Kentucky $946,767 $946,767
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Alexandria LA 5 Maint Bldg--Paint $4,000 $4,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Baton Rouge LA 6 Massachusetts Monument, 1909 $15,000 $15,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Port Hudson LA 6 Articulated Dumper $55,000 $55,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Louisiana $74,000 $74,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Massachusetts MA 10 Wind turbine $1,610,000 $1,610,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Massachusetts MA 10 Soil Screener $76,500 $76,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Massachusetts MA 10 Dump Truck $87,522 $87,522
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Massachusetts MA 10 Tractor w/front loader $35,780 $35,780
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Massachusetts $1,809,802 $1,809,802
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Point Lookout MD 5 Soldiers & Sailors Monument, $250,000 $250,000
1911
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Baltimore MD 7 Remove Stone Sidewalks--Repl $70,000 $70,000
w/ Stamped Concrete
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Baltimore MD 7 4x4 Stake Body truck w/ $47,635 $47,635
towing, plow & lift gate
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Baltimore MD 7 Tractor $20,350 $20,350
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Loudon ParMD 7 Maryland Sons Monument, 1884 $60,000 $60,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Loudon ParMD 7 Unknown Dead Monument, 1895 $50,000 $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Loudon ParMD 7 GAR Monument, 1898 $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Loudon ParMD 7 Maryland Naval Monument, $10,000 $10,000
1896
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Maryland $517,985 $517,985
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Togus ME 1 Headstones/Markers and $732,000 $732,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Togus ME 1 Soldiers & Sailors Monument $60,000 $60,000
(1 of 2), 1889
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Togus ME 1 Soldiers & Sailors Monument $50,000 $50,000
(2 of 2), 1916
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Maine $842,000 $842,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Custer MI 6 Truck, Pickup, 2 WD, Stake $49,944 $49,944
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Custer MI 6 Exchanger, Coolant, Recycle, $2,390 $2,390
Radiator Fluid
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Custer MI 6 Box, Tool, Mechanic's Set $4,901 $4,901
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Custer MI 6 Vacuum, Leaf, Pull $36,000 $36,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Custer MI 6 Trailer, Utility, Pull $8,550 $8,550
Behind, 8.5' X 24'
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Custer MI 6 Saw, Table, Portable, $550 $550
Electric
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Great Lakes MI 8 Lowering De$12,369ault, $12,369
Hydraulic
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Great Lakes MI 8 Truck, Utility, 4 WD, Casket $39,000 $39,000
Carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Great Lakes MI 8 Cultivator, Soil, Attachment $4,948 $4,948
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Great Lakes MI 8 Breaker, Hydraulic, $5,762 $5,762
Attachment
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Great Lakes MI 8 Saw, Chain, Gas Powered, $407 $407
20''
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Great Lakes MI 8 Saw, Pole, Pruning, 1 Each $520 $520
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Michigan $165,341 $165,341
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Snelling MN 5 Replace Asphalt Paving at $300,000 $300,000
Various Areas
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Snelling MN 5 Truck, Dump, 4 WD, Diesel $96,000 $96,000
Eng.
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Snelling MN 5 Loader, Bac$82,000 $82,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Snelling MN 5 Sweeper, Street, Gas Powered $96,000 $96,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Snelling MN 5 Tractor, Utility, 4 WD $58,000 $58,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Snelling MN 5 Truck, Utility, 4 WD $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ft Snelling MN 5 Truck, Utility, 4 WD $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Minnesota $692,000 $692,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Replace Chapel Siding $150,000 $150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Enclosed Pole Barn w/ $75,000 $75,000
concrete slab
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Replace Asphalt Roads $1,000,000 $1,000,000
Various Locations
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Sweeper, Street, Gas $126,109 $126,109
Powered, Broom Bear
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Tampers, 2 Cycle Engine $15,748 $15,748
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Winch, Electric Power, 12 $1,548 $1,548
Volt
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Box, Tool, Mechanic's Set, $996 $996
Upper/Lower
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Truck, Pickup, 4 WD, W/Box $81,000 $81,000
Bed
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Screener, Dirt, Pull Behind $89,000 $89,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Tractor, Utility, 4 WD $26,000 $26,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Truck, Utility, 4 WD $28,000 $28,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Truck, Utility, 4 WD, Casket $39,000 $39,000
Carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 Truck, Utility, 4 WD, Casket $39,000 $39,000
Carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson Barracks MO 3 35th Division Water Fountain $10,000 $10,000
Memorial, 1952
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Jefferson City MO 4 39th MO Infantry Regiment $10,000 $10,000
Monument, 1873
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Springfield MO 7 Replace Chain Link Fence $40,000 $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Missouri $1,731,401 $1,731,401
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Natchez MS 3 Utility Vehicle $25,000 $25,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Biloxi MS 4 Tamper $3,400 $3,400
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Biloxi MS 4 Mini Truck $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Biloxi MS 4 National Cemetery Memorial, $100,000 $100,000
1941
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Mississippi $138,400 $138,400
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 New Bern NC 1 Reseal Roads $5,000 $5,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 New Bern NC 1 Rhode Island Monument, 1909 $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 New Bern NC 1 Massachusetts Monument, 1908 $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Raleigh NC 2 Maint Bldg--Paint $2,000 $2,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Wilmington NC 7 Replace Fence $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Salisbury NC 12 Reseal Roads $50,000 $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Salisbury NC 12 Riding Mower $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Salisbury NC 12 Maine Monument, 1908 $40,000 $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Salisbury NC 12 Unknown Dead Monument, 1875 $40,000 $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Salisbury NC 12 Pennsylvania Monument, 1909 $75,000 $75,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--North Carolina $312,000 $312,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft McPherson NE 3 Headstones/Markers and $687,112 $687,112
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft McPherson NE 3 Concrete pad under fill pile $50,000 $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft McPherson NE 3 Install new floral and $4,000 $4,000
activities signage
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Ft McPherson NE 3 Modify Public Information $10,000 $10,000
Center lighting
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft McPherson NE 3 Repair sidewalk at Committal $5,000 $5,000
Shelter
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Ft McPherson NE 3 Replace windows in $20,000 $20,000
Maintenance Building
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft McPherson NE 3 Challenger Lifts $2,600 $2,600
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft McPherson NE 3 Utility Vehicle w/Casket $32,500 $32,500
Carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft McPherson NE 3 Tire Changer $1,500 $1,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft McPherson 3 NE Mower $22,600 $22,600
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Nebraska $835,312 $835,312
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Finn's Point NJ 2 Union Monument, 1879 $40,000 $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Finn's Point NJ 2 Confederate POW Dead $250,000 $250,000
Monument, 1910
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--New Jersey $290,000 $290,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bayard NM 2 Top Dresser $9,539 $9,539
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bayard NM 2 Tamper $3,200 $3,200
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bayard NM 2 Lowering Dev$4,000 $4,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Santa Fe NM 3 Install mezzanine in $15,000 $15,000
Maintenance Bldg
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Santa Fe NM 3 Renovate spoils area (remove $25,000 $25,000
excess materials)
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Santa Fe NM 3 Repair cracking in $75,000 $75,000
columbaria structure
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Santa Fe NM 3 Resurface Roadways and $350,000 $350,000
replace curbing
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Santa Fe NM 3 Snow blower $3,500 $3,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Santa Fe NM 3 Backhoe $58,355 $58,355
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Santa Fe NM 3 Utility Vehicle $22,500 $22,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Santa Fe NM 3 Aerator $22,300 $22,300
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--New Mexico $588,394 $588,394
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Calverton NY 1 Headstones/Markers and $2,000,000 $2,000,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Calverton NY 1 Rooftop solar photovoltaic $582,000 $582,000
power
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Calverton NY 1 Replace Facade on Admin and $211,500 $211,500
Committal Bldgs
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Calverton 1 NY Replace Admin Oil USD with $40,920 $40,920
Convault AST
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Calverton NY 1 Mini excavator & trailer $49,350 $49,350
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Calverton NY 1 Two burners to thaw frozen $10,800 $10,800
ground
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Calverton NY 1 Two 4x4 dump trucks $79,600 $79,600
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Calverton NY 1 Air compressor w/jackhammer $12,000 $12,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Long IslanNY 2 5 Utility Vehicles $80,000 $80,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Long IslanNY 2 Interment vehicle $22,726 $22,726
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Cypress Hills NY 12 Remove/Repl All Roads at $85,800 $85,800
Cypress Hills & Union Plot
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Cypress Hills NY 12 Remove/Repl All Roads at $1,009,000 $1,009,000
Cypress Hills & Union Plot
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Cypress Hills NY 12 Eagle Monument, 1934 $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Cypress Hills NY 12 French Monument, ca. 1920 $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Saratoga NY 20 Utility vehicle $25,700 $25,700
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Saratoga NY 20 Mower $16,029 $16,029
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Bath NY 29 Mower $18,000 $18,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Bath NY 29 Dump Truck $47,000 $47,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Woodlawn NY 29 Utility Tractor $38,163 $38,163
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Woodlawn NY 29 Snow blower attachment for $3,700 $3,700
Utility Tractor
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--New York $4,352,288 $4,35$2,288
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Dayton OH 3 Lowering Dev$7,900asket, $7,900
Pull Behind
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Dayton OH 3 Tamper, Pneumatic, Portable, $3,640 $3,640
Gas Powered
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Dayton OH 3 Truck, Utility, 4 WD $36,788 $36,788
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Dayton OH 3 National Soldiers (NHDVS) $510,000 $510,000
Monument, 1877
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Camp Chase OH 15 Memorial Boulder & Arch, $25,000 $25,000
1880 & 1902
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ohio Western Reserve OH 16 Truck, Utility, 4 WD, Casket $39,000 $39,000
Carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ohio Western Reserve OH 16 Dump, Articulating, 4 WD $39,600 $39,600
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ohio Western Reserve OH 16 Truck, Utility, 4 WD, w/ $39,000 $39,000
Attach.
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ohio Western Reserve OH 16 Broom, Angle, 84'' $4,400 $4,400
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ohio Western Reserve OH 16 Aerator, Core, 6' Wide, Pull $3,000 $3,000
Behind, Heavy Duty
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Ohio Western Reserve OH 16 Truck, Utility, 4 WD $28,000 $28,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Ohio $736,328 $736,328
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Gibson OK 2 Front entrance sign and $10,000 $10,000
planting bed
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Gibson OK 2 Repair/Replace concrete $8,000 $8,000
sidewalk to flag pole
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Gibson OK 2 Renovate existing flag pole $35,000 $35,000
and lighting
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Gibson OK 2 Tamper $3,700 $3,700
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Gibson OK 2 Utility Loader $2,400 $2,400
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Gibson OK 2 Utility Loader $40,000 $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Gibson OK 2 Backhoe Loader $50,900 $50,900
--------------------------------------------------------------------------------------------------------------------------------------------------------
*3 Ft Sill OK 4 Repair defective gaskets in $4,000 $4,000
glazing at Public
Information Center
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sill OK 4 Dumper $55,000 $55,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sill OK 4 Compact Roller $4,950 $4,950
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Oklahoma $213,950 $213,950
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Eagle Point OR 2 Replace Windows In Committal $35,000 $35,000
Shelter
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Eagle Point OR 2 Slurry Seal Roads $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Eagle Point OR 2 Utility Vehicle $26,978 $26,978
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Eagle Point OR 2 Utility Vehicle $26,978 $26,978
--------------------------------------------------------------------------------------------------------------------------------------------------------
*5 Willamette OR 3 Upgrade Admin Bldg Lighting $13,000 $13,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Willamette OR 3 Install Electric Gate/Side $6,000 $6,000
Two
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Willamette OR 3 Install Maintenance Shop Oil $27,000 $27,000
and Grease Dispensers
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Willamette OR 3 Slurry Seal Roads, Ph I & II $150,000 $150,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Willamette OR 3 Articulated Dumper $53,852 $53,852
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Willamette OR 3 Fertilizer Spreader $6,834 $6,834
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Willamette OR 3 Fertilizer Spreader $6,834 $6,834
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Willamette OR 3 Diesel Utility Vehicle $15,680 $15,680
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Willamette OR 3 Over seeder $8,437 $8,437
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Oregon $406,593 $406,593
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Indiantown Gap PA 17 Repair Admin HVAC System $60,720 $60,720
--------------------------------------------------------------------------------------------------------------------------------------------------------
*1 Indiantown Gap PA 17 Replace Glass Windows & $80,000 $80,000
Doors, B-1 (Admin Bldg)
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Indiantown Gap PA 17 Turf vac $16,490 $16,490
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Indiantown Gap PA 17 Lawn Tractor$8,956 $8,956
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 NC of the Alleghenies PA 18 Utility Vehicle w/casket $40,896 $40,896
carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 NC of the Alleghenies PA 18 Utility Loader w/ s$19,274 $19,274
auger power head and bit
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Prospect Hill PA 19 Soldiers Monument, 1874 $100,000 $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Pennsylvania $326,336 $326,336
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Puerto Rico PR At Large Lowering dev$2,700 $2,700
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Puerto Rico PR At Large Utility Vehicle w/hydraulic $30,000 $30,000
lift
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Puerto Rico PR At Large Utility vehicle w/2 ft $15,000 $15,000
extension
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Puerto Rico PR At Large Rotary Brush for Tractor $6,550 $6,550
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Puerto Rico PR At Large Street sweeper $88,000 $88,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Puerto Rico PR At Large Articulated Dumper $55,000 $55,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Puerto Rico $197,250 $197,250
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 Admin Bldg--Repair $20,000 $20,000
Electrical System
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 Electric Maint Truck $7,500 $7,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 Turbine Blower $7,000 $7,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 Parts Cleaner $1,000 $1,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 Pressure Washer $1,000 $1,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 MIG Welder Kit $500 $500
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 Mower $15,000 $15,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 Casket Truck $1,500 $1,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Beaufort SC 2 Union Dead Box Tomb, 1870 $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florence SC 6 Backhoe $70,000 $70,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florence SC 6 Articulated Dumper $55,000 $55,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florence SC 6 Street sweeper $28,000 $28,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florence SC 6 Mower $20,000 $20,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Florence SC 6 Mower $20,000 $20,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--South Carolina $256,500 $256,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Provide protection for IT $10,000 $10,000
equipment in Admin basement
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Repair/Replace domestic $35,000 $35,000
water line
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Re-paint wood trim and $5,000 $5,000
surfaces on Admin and Maint
Bldgs
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Establish section P for in- $15,000 $15,000
ground cremain sites
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Replace irrigation control $5,000 $5,000
valve solenoids
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Road repair/ renovation $897,000 $897,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Hydraulic Breaker $3,700 $3,700
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large 4X4 Dump Truck $46,900 $46,900
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Vehicle, Casket Carrier $28,500 $28,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Mower $20,000 $20,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Black Hills SD At Large Snow blower $3,900 $3,900
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Hot Springs SD At Large Headstones/Markers and $70,000 $70,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Hot Springs SD At Large Replace old wire fence $15,000 $15,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Hot Springs SD At Large Battle Mountain Sanitarium $35,000 $35,000
Monument, 1914
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--South Dakota $1,190,000 $1,190,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Mountain Home TN 1 Admin & Maint Bldgs--Paint $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Mountain Home TN 1 Mower $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Knoxville TN 2 Union Soldiers Monument, $250,000 $250,000
1906
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Chattanooga TN 3 Admin Bldg and Maint Bldg-- $20,000 $20,000
Paint interior and exterior
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Chattanooga TN 3 Admin Bldg--Repair Bldg and $15,000 $15,000
Renovate Cabinets
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Chattanooga TN 3 Utility vehicle $25,000 $25,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Chattanooga TN 3 Monumental Arch, c.1870 $100,000 $100,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Chattanooga TN 3 Andrew's Raiders Monument, $10,000 $10,000
1890
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Nashville TN 5 Admin and Maint Bldgs--Paint $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Nashville TN 5 Monumental Arch, c. 1870 $250,000 $250,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Nashville TN 5 Minnesota Monument, 1920
-----------------------------------------------------------------------------------------------------------------------------------$10,000-------$10,000
2 Memphis TN 9 Admin and Maint Bldgs--Paint $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Memphis TN 9 Utility Vehicle $27,000 $27,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Memphis TN 9 State of Illinois Memorial, $40,000 $40,000
1928
--------------------------------------------------------------------------------------------------------------------------------------------------------
2 Memphis TN 9 Minnesota Monument, 1916 $25,000 $25,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Tennessee $832,000 $832,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Reroof and Renovate Pump $8,000 $8,000
House
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Repair/Replace storm $250,000 $250,000
drainage throughout cemetery
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Update signage to reflect $5,000 $5,000
Xeroscaping
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Replace existing fencing $10,000 $10,000
around storage area.
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Resurface Roadways and $400,000 $400,000
replace curbing
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Electric Cart $8,503 $8,503
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Utility Vehicle $22,500 $22,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Utility Vehicle $22,500 $22,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Bliss TX 16 Sand rake $17,800 $17,800
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Headstones/Markers and $3,183,980 $3,183,980
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Remove, repair, and $100,000 $100,000
resurface Hemicycle assembly
areas
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Repair & repaint 3 committal $15,000 $15,000
shelter metal roofs
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Road Maintenance $450,000 $450,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Utility Cart $5,500 $5,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Utility Cart $5,500 $5,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Tractor $16,700 $16,700
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Utility Cart $6,300 $6,300
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Utility Cart $6,300 $6,300
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Houston TX 18 Excavator $52,700 $52,700
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 Headstones/Markers and $4,916,846 $4,916,846
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 Repair/Recondition/Repaint $8,000 $8,000
casket biers at 5 committal
shelters
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 Resurface Roadways and $650,000 $650,000
replace curbing
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 Utility Vehicle $29,000 $29,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 1 Ton Dump Truck $40,000 $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 1 Ton Truck $40,000 $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 2 Each Water Tank 300 Gallon $10,000 $10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 Utility Vehicle $29,000 $29,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 Hoist Lift Frame $5,000 $5,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 Utility Vehicle w/Casket $32,500 $32,500
Carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Ft Sam Houston TX 21 Sweeper $11,900 $11,900
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Kerrville TX 23 Headstones/Markers and $280,000 $280,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Kerrville TX 23 Install irrigation system $50,000 $50,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Dallas TX 24 Utility Vehicle w/Casket $29,900 $29,900
Carrier
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Dallas TX 24 Mower $29,900 $29,900
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Dallas TX 24 Utility Vehicle $22,500 $22,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Dallas-Ft Worth TX 24 Install additional $5,000 $5,000
irrigation at section 27
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 Dallas-Ft Worth TX 24 Establish sections 16 thru $25,000 $25,000
19 for in-ground cremain
sites
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 San Antonio TX 28 Headstones/Markers and $350,000 $350,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
3 San Antonio TX 28 Renovate and expand existing $150,000 $150,000
irrigation system
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Texas $11,300,828 $11,300,828
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Quantico VA 1 Headstones/Markers and $898,091 $898,091
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Quantico VA 1 Replace Gutters Committals $24,362 $24,362
A, B, C, Admin, & Public
Restroom
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Quantico VA 1 Replace All Brick Paver $60,720 $60,720
Walkways w/Concrete
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Quantico VA 1 Street Sweeper $146,500 $146,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Quantico VA 1 Turf vac with dethatching $31,000 $31,000
wheel
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Hampton VA 3 Replace Maintenance Bldg $84,000 $84,000
Roofs (2)
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Hampton VA 3 Union Soldiers (NHDVS) $250,000 $250,000
Monument, 1868
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Culpeper VA 7 Pennsylvania Monument, 1909 $40,000 $40,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Culpeper VA 7 Restore Brick Walls $228,690 $228,690
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Culpeper VA 7 Utility tractor $26,000 $26,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Culpeper VA 7 Utility vehicle $17,000 $17,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 Winchester VA 10 Headstones/Markers and $642,520 $642,520
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Virginia $2,448,883 $2,448,883
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Tahoma WA 8 Road Repairs $30,000 $30,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Tahoma WA 8 Street Sweeper/Vacuum $75,619 $75,619
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Tahoma WA 8 Compact Dual Drum Roller $18,000 $18,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
5 Tahoma WA 8 Electric Cart $11,600 $11,600
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Washington $135,219 $135,219
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Replace Water System $250,000 $250,000
throughout Cemetery
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Replace Chain Link Fence $90,000 $90,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Replace Asphalt Roads @ $220,000 $220,000
Sections A-C
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Loader, Bac$51,869ompact $51,869
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Articulated Dumper, Turf $35,000 $35,000
Track
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Sprayer, Water, 200 Gallon, $2,250 $2,250
Skid Mount
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Bucket, Front, Loader, 68'', $794 $794
Skid Steer
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Headstones/Markers and $81,000 $81,000
Gravesites
--------------------------------------------------------------------------------------------------------------------------------------------------------
4 Wood WI 4 Civil War Soldiers & Sailors $250,000 $250,000
Monument, 1903
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--Wisconsin $980,913 $980,913
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 West Virginia WV 1 Provide-Install Irrigation $20,460 $20,460
Booster Pump
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 West Virginia WV 1 Repair Roadway $16,500 $16,500
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 West Virginia WV 1 4x4 dump truck w/snow plow $34,562 $34,562
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--West Virginia $71,522 $71,522
--------------------------------------------------------------------------------------------------------------------------------------------------------
* NCA wide TBD Implement selected energy $345,000 $345,000
and water conservation
measures
--------------------------------------------------------------------------------------------------------------------------------------------------------
* NCA wide TBD 150 Facilities_Environmental $1,500,000 $1,500,000
management systems
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total--NCA wide $1,845,000 $1,845,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Cumulative Total $50,000,000 $50,000,000\
1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ The following NCA activities are included under the general heading of ``Monument and Memorial Repairs and Energy Projects'': (1) national shrine
projects to raise, realign, and clean headstones/markers and repair sunken graves at various locations across the country; (2) repairs to historic
monuments and memorials at national cemeteries; (3) projects for repairing roads, buildings, and other cemetery infrastructure at locations
nationwide; (4) equipment purchases for cemetery operations; and (5) projects that conserve energy and water through the use of wind turbines, solar
power and other measures.
FY 09 National Cemetery Administration (NCA)/Energy ARRA Spend Plan
National Cemetery Administration ARRA Spending by Category
----------------------------------------------------------------------------------------------------------------
All Energy
Qty Totals Related Renewable Percentage
Projects Energy of Total
----------------------------------------------------------------------------------------------------------------
Renewable Energy (Solar, Wind, Biomass, 3 $3,640,000 $3,640,000 $3,640,000 7%
Geothermal)
----------------------------------------------------------------------------------------------------------------
Heating, Ventilation, and Air Conditioning 1 $60,720 $60,720 -- 0%
----------------------------------------------------------------------------------------------------------------
Roads, Paving, and Grounds Projects 52 $8,376,480 -- -- 17%
----------------------------------------------------------------------------------------------------------------
Safety, Security and Fire Alarms 2 $16,000 -- -- 0%
----------------------------------------------------------------------------------------------------------------
Energy Conservation 9 $2,019,000 $2,019,000 -- 4%
----------------------------------------------------------------------------------------------------------------
Building Infrastructure 3 $305,000 -- -- 1%
----------------------------------------------------------------------------------------------------------------
Monument and Memorial Repair 49 $4,380,000 -- -- 9%
----------------------------------------------------------------------------------------------------------------
National Shrine 19 $23,629,386 -- -- 47%
----------------------------------------------------------------------------------------------------------------
Interior Renovation 12 $516,920 -- -- 1%
----------------------------------------------------------------------------------------------------------------
Exterior Renovations 25 $970,552 -- -- 2%
----------------------------------------------------------------------------------------------------------------
Equipment 216 $5,970,942 -- -- 12%
----------------------------------------------------------------------------------------------------------------
Other 4 $115,000 -- -- 0%
----------------------------------------------------------------------------------------------------------------
Total 395 $50,000,000 $5,719,720 $3,640,000 100%
----------------------------------------------------------------------------------------------------------------
[GRAPHIC] [TIFF OMITTED] T8420A.002
FY 2009 National Cemetery Administration (NCA)/Energy ARRA Spend Plan1
ARRA Overview
------------------------------------------------------------------------
Number of
State Projects ARRA Funding
------------------------------------------------------------------------
AK 1 $10,000
------------------------------------------------------------------------
AL 3 $70,000
------------------------------------------------------------------------
AR 7 $82,600
------------------------------------------------------------------------
AZ 6 $352,005
------------------------------------------------------------------------
CA 24 $10,156,412
------------------------------------------------------------------------
CO 9 $266,460
------------------------------------------------------------------------
CT 0 --
------------------------------------------------------------------------
DC 0 --
------------------------------------------------------------------------
DE 0 --
------------------------------------------------------------------------
FL 13 $543,000
------------------------------------------------------------------------
GA 1 $100,000
------------------------------------------------------------------------
HI 3 $192,574
------------------------------------------------------------------------
IA 2 $15,881
------------------------------------------------------------------------
ID 0 --
------------------------------------------------------------------------
IL 17 $2,468,620
------------------------------------------------------------------------
IN 14 $683,437
------------------------------------------------------------------------
KS 10 $822,000
------------------------------------------------------------------------
KY 16 $946,767
------------------------------------------------------------------------
LA 3 $74,000
------------------------------------------------------------------------
MA 4 $1,809,802
------------------------------------------------------------------------
MD 8 $517,985
------------------------------------------------------------------------
ME 3 $842,000
------------------------------------------------------------------------
MI 12 $165,341
------------------------------------------------------------------------
MN 7 $692,000
------------------------------------------------------------------------
MO 16 $1,731,401
------------------------------------------------------------------------
MS 4 $138,400
------------------------------------------------------------------------
MT 0 --
------------------------------------------------------------------------
NC 10 $312,000
------------------------------------------------------------------------
ND 0 --
------------------------------------------------------------------------
NE 10 $835,312
------------------------------------------------------------------------
NH 0 --
------------------------------------------------------------------------
NJ 2 $290,000
------------------------------------------------------------------------
NM 11 $588,394
------------------------------------------------------------------------
NV 0 --
------------------------------------------------------------------------
NY 20 $4,352,288
------------------------------------------------------------------------
OH 11 $736,328
------------------------------------------------------------------------
OK 10 $213,950
------------------------------------------------------------------------
OR 13 $406,593
------------------------------------------------------------------------
PA 7 $326,336
------------------------------------------------------------------------
PR 6 $197,250
------------------------------------------------------------------------
RI 0 --
------------------------------------------------------------------------
SC 14 $256,500
------------------------------------------------------------------------
SD 14 $1,190,000
------------------------------------------------------------------------
TBD 2 $1,845,000
------------------------------------------------------------------------
TN 15 $832,000
------------------------------------------------------------------------
TX 39 $11,300,828
------------------------------------------------------------------------
UT 0 --
------------------------------------------------------------------------
VA 12 $2,448,883
------------------------------------------------------------------------
VT 0 --
------------------------------------------------------------------------
WA 4 $135,219
------------------------------------------------------------------------
WI 9 $980,913
------------------------------------------------------------------------
WV 3 $71,522
------------------------------------------------------------------------
WY 0 --
------------------------------------------------------------------------
Total 395 $50,000,000
------------------------------------------------------------------------
1 The following NCA activities are included under the general heading of
``Monument and Memorial Repairs and Energy Projects'': (1) national
shrine projects to raise, realign, and clean headstones/markers and
repair sunken graves at various locations across the country; (2)
repairs to historic monuments and memorials at national cemeteries;
(3) projects for repairing roads, buildings, and other cemetery
infrastructure at locations nationwide; (4) equipment purchases for
cemetery operations; and (5) projects that conserve energy and water
through the use of wind turbines, solar power and other measures.
______
Information Technology Recovery Expenditure Plan
U.S. Department of Veterans Affairs
------------------------------------------------------------------------
Chapter 33--Post-9/11 GI Bill
-------------------------------------------------------------------------
Funding Requirement Cost Description
------------------------------------------------------------------------
Project infrastructure, $46,925,000 SPAWAR to provide the
configuration management, necessary resources
application development, and support
testing, and training infrastructure to
manage the
strategic, tactical,
business and
technical components
of the program
execution; to
design, procure,
install, and
configure the
necessary hardware,
operating systems,
and network
infrastructure; to
design, develop,
implement, and
maintain the
necessary data
integration
infrastructure; and
to develop and
execute all testing
efforts to support
the end-to-end
development,
deployment, and
maintenance of the
system.
------------------------------------------------------------------------
Operations $1,075,000 Provide on-going life
cycle solution
management and
maintenance support
for the solution.
------------------------------------------------------------------------
New Hires for VA $500,000 Additional IT staff
will be hired to
support field
station and program
management personnel
in planning and
administering the
execution of the
Chapter 33 program.
------------------------------------------------------------------------
------------------------------------------------------------------------
Chapter 33 Subtotal $48,500,000 .....................
------------------------------------------------------------------------
------------------------------------------------------------------------
Paperless Processing of Veterans Benefits
------------------------------------------------------------------------
Funding Requirement Cos Descrip
tion
------------------------------------------------------------------------
------------------------------------------------------------------------
Network upgrades for VBA $1,500,000 Partial funding for
infrastructure the required network
upgrades to
stabilize the VBA
network. Redesign
continues with the
upgrade of DS3
circuits to all
regional offices and
selected outbased
sites.
------------------------------------------------------------------------
------------------------------------------------------------------------
Paperless Subtotal $1,500,000 .....................
------------------------------------------------------------------------
------------------------------------------------------------------------
VETSNET--Economic Recovery Payment Capabilities
------------------------------------------------------------------------
Funding Requirement Cos Descrip
tion
------------------------------------------------------------------------
------------------------------------------------------------------------
Modifications to existing $100,000 Modifications to the
Compensation and Pension existing application
payment application in the Veterans
Service Network
(VETSNET), VA's
primary Compensation
and Pension payment
system.
------------------------------------------------------------------------
VETSNET Subtotal $100,000 .....................
------------------------------------------------------------------------
------------------------------------------------------------------------
Grand Total $50,100,000 .....................
------------------------------------------------------------------------