[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON H.R. 1017,
H.R. 1036, H.R. 2504, H.R. 2559, H.R. 2735,
H.R. 3073, H.R. 3441, H.R. 2506, AND DRAFT
DISCUSSIONS ON HOMELESSNESS,
GRADUATE PSYCHOLOGY EDUCATION,
AND PSYCHIATRIC SERVICE DOGS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
OCTOBER 1, 2009
__________
Serial No. 111-47
__________
Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE
53-432 WASHINGTON : 2010
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC
area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC
20402-0001
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
______
Subcommittee on Health
MICHAEL H. MICHAUD, Maine, Chairman
CORRINE BROWN, Florida HENRY E. BROWN, JR., South
VIC SNYDER, Arkansas Carolina, Ranking
HARRY TEAGUE, New Mexico CLIFF STEARNS, Florida
CIRO D. RODRIGUEZ, Texas JERRY MORAN, Kansas
JOE DONNELLY, Indiana JOHN BOOZMAN, Arkansas
JERRY MCNERNEY, California GUS M. BILIRAKIS, Florida
GLENN C. NYE, Virginia VERN BUCHANAN, Florida
DEBORAH L. HALVORSON, Illinois
THOMAS S.P. PERRIELLO, Virginia
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
__________
October 1, 2009
Page
Legislative Hearing on H.R. 1017, H.R. 1036, H.R. 2504, H.R.
2559, H.R. 2735, H.R. 3073, H.R. 3441, H.R. 2506, and Draft
Discussions on Homelessness, Graduate Psychology Education, and
Psychiatric Service Dogs....................................... 1
OPENING STATEMENTS
Chairman Michael Michaud......................................... 1
Prepared statement of Chairman Michaud....................... 26
Hon. Henry E. Brown, Jr., Ranking Republican Member.............. 14
Prepared statement of Congressman Brown...................... 26
WITNESSES
U.S. Department of Veterans Affairs, Peter H. Dougherty,
Director, Homeless Veterans Programs, Office of Public and
Intergovernmental Affairs...................................... 23
Prepared statement of Mr. Dougherty.......................... 45
______
American Legion, Joseph L. Wilson, Deputy Director, Veterans
Affairs and Rehabilitation Commission.......................... 16
Prepared statement of Mr. Wilson............................. 34
Arcuri, Hon. Michael A., a Representative in Congress from the
State of New York.............................................. 5
Prepared statement of Congressman Arcuri..................... 29
Filner, Hon. Bob, Chairman, Committee on Veterans' Affairs, and a
Representative in Congress from the State of California........ 8
Prepared statement of Congressman Filner..................... 31
Hare, Hon. Phil, a Representative in Congress from the State of
Illinois....................................................... 2
Prepared statement of Congressman Hare....................... 27
Herseth Sandlin, Hon. Stephanie, a Representative in Congress
from the State of South Dakota................................. 3
Prepared statement of Congresswoman Herseth Sandlin.......... 28
Nye, Hon. Glenn, a Representative in Congress from the State of
Virginia....................................................... 11
Prepared statement of Congressman Nye........................ 32
Paralyzed Veterans of America, Blake C. Ortner, Senior Associate
Legislative Director........................................... 21
Prepared statement of Mr. Ortner............................. 42
Rodriguez, Hon. Ciro D., a Representative in Congress from the
State of Texas................................................. 9
Prepared statement of Congressman Rodriguez.................. 31
Teague, Hon. Harry, a Representative in Congress from the State
of New Mexico.................................................. 12
Prepared statement of Congressman Teague..................... 33
Veterans of Foreign Wars of the United States, Justin Brown,
Legislative Associate, National Legislative Service............ 18
Prepared statement of Mr. Brown.............................. 26
Vietnam Veterans of America, Richard F. Weidman, Executive
Director for Policy and Government Affairs..................... 19
Prepared statement of Mr. Weidman............................ 39
SUBMISSIONS FOR THE RECORD
American Chiropractic Association, Rick A. McMichael, DC,
President, letter.............................................. 49
American Physical Therapy Association, statement................. 50
American Tinnitus Association, statement......................... 53
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
Hon. Michael Michaud, Chairman, Subcommittee on Health,
Committee on Veterans' Affairs, to Joseph L. Wilson, Deputy
Director, Veterans Affairs and Rehabilitation Commission,
American Legion, letter dated October 1, 2009, and Mr.
Wilson's responses......................................... 55
Hon. Michael Michaud, Chairman, Subcommittee on Health,
Committee on Veterans' Affairs, to Justin Brown,
Legislative Associate, National Legislative Service,
Veterans of Foreign Wars of the United States, letter dated
October 1, 2009, and Mr. Brown's responses, dated October
8, 2009.................................................... 57
Hon. Michael Michaud, Chairman, Subcommittee on Health,
Committee on Veterans' Affairs, to Richard F. Weidman,
Executive Director for Policy and Government Affairs,
Vietnam Veterans of American, letter dated October 1, 2009,
and VVA responses.......................................... 58
Hon. Michael Michaud, Chairman, Subcommittee on Health,
Committee on Veterans' Affairs, to Blake Ortner, Senior
Associate Legislative Director, Paralyzed Veterans of
America, letter dated October 1, 2009, and response from
Carl Blake, National Legislative Director, Paralyzed
Veterans of America, letter dated October 6, 2009.......... 62
Hon. Michael Michaud, Chairman, Subcommittee on Health,
Committee on Veterans' Affairs, to Hon. Eric K. Shinseki,
Secretary, U.S. Department of Veterans Affairs, letter
dated October 1, 2009, and VA responses.................... 65
LEGISLATIVE HEARING ON H.R. 1017,
H.R. 1036, H.R. 2504, H.R. 2559, H.R. 2735,
H.R. 3073, H.R. 3441, H.R. 2506, AND DRAFT
DISCUSSIONS ON HOMELESSNESS,
GRADUATE PSYCHOLOGY EDUCATION,
AND PSYCHIATRIC SERVICE DOGS
----------
THURSDAY, OCTOBER 1, 2009
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:06 a.m., in
Room 334, Cannon House Office Building, Hon. Michael H. Michaud
[Chairman of the Subcommittee] presiding.
Present: Representatives Michaud, Teague, Rodriguez,
Donnelly, Nye, Brown of South Carolina, Boozman, and Bilirakis.
OPENING STATEMENT OF CHAIRMAN MICHAUD
Mr. Michaud. I would like to call the hearing to order. I
know Congressman Hare has another meeting he has got to run off
to, so I appreciate you being here. And I want to thank
everyone for coming today.
Today's legislative hearing is an opportunity for Members
of Congress, the veterans, the U.S. Department of Veterans
Affairs (VA), and other interested party to provide their views
and discuss recently introduced legislation within the
Subcommittee's jurisdiction. I don't necessarily agree or
disagree with any of the bills before us today, but I believe
it is an important part of the legislative process to hear the
testimony of individuals who submitted legislation or draft
concepts.
We have 13 individual bills or drafts for us today, so I
would like to start now, and I would ask unanimous consent that
my full statement be submitted into the record. Hearing none,
so ordered.
Does Representative Rodriguez have an opening statement? If
not then I would like to begin the hearing starting off with
Congressman Phil Hare's piece of legislation before us, H.R.
2559, to direct the Secretary of the VA to carry out a national
media campaign directed at the homeless veterans and veterans
at risk for becoming homeless veterans. So without any further
ado, Mr. Hare.
[The prepared statement of Chairman Michaud appears on p.
26.]
STATEMENTS OF HON. PHIL HARE, A REPRESENTATIVE IN CONGRESS FROM
THE STATE OF ILLINOIS, HON. STEPHANIE HERSETH SANDLIN, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF SOUTH DAKOTA; HON.
MICHAEL A. ARCURI, A REPRESENTATIVE IN CONGRESS FROM THE STATE
OF NEW YORK; AND HON. BOB FILNER, CHAIRMAN, COMMITTEE ON
VETERANS' AFFAIRS, AND A REPRESENTATIVE IN CONGRESS FROM THE
STATE OF CALIFORNIA
STATEMENT OF HON. PHIL HARE
Mr. Hare. Thank you, Mr. Chairman, and let me thank the
Ranking Member and the members of staff of the House Veterans'
Affairs Subcommittee on Health for inviting me to testify this
morning. As a former Member of this Subcommittee it is always a
pleasure to be in this room among friends who are so dedicated
to the welfare of our Nation's heroes.
And if I may, Mr. Chairman, as just a side note, the
veterans of this Nation are very, very fortunate to have you
Chair the Subcommittee on Health. I can't think of a person who
fights harder for the health of our veterans than you, and I
appreciate your work.
I come before you today to present testimony on legislation
that I have introduced, H.R. 2559, the ``Help Our Homeless
Veterans Act.'' This bill directs the Secretary of the
Department of Veterans Affairs to carry out a national media
campaign directed at homeless veterans and veterans who are at
risk of becoming homeless to help in this growing problem. The
number of homeless veterans is rising and must be addressed in
our Nation's homeless population. In fact, they make up about
one-third of our Nation's homelessness. On any given night this
year, 131,000 veterans are sleeping on our streets. This year
alone, 300,000 veterans will experience homelessness. Vietnam
Veterans represent the largest segment of the homeless veterans
population.
Now, at a time with the highest unemployment rate in 26
years, with more and more servicemembers returning home from
the conflicts in Iraq and Afghanistan, the number of veterans
who are unable to make ends meet and face the prospect of
homelessness is growing. The VA estimates that it is already
providing services to 916 veterans from the conflicts in Iraq
and Afghanistan. Additionally, the VA has identified over 2,986
veterans that are at risk of becoming homeless.
Additionally, there has been an alarming increase in the
number of female homeless veterans. The VA estimates that 10
percent of all homeless veterans are now women. This means that
about 740 female veterans from the Iraq and Afghanistan
conflicts are homeless, or have been identified at risk of
becoming homeless. These numbers are simply unacceptable.
Addressing the National Coalition for Homeless Veterans
National Conference, Secretary Shinseki said, ''We have a moral
duty to prevent and eliminate homelessness among veterans.'' I
could not agree more and I applaud the Secretary for his
commitment to end veterans' homelessness in the next 5 years.
In order to meet this goal, I strongly believe that the VA
must immediately begin conducting media outreach to connect
homeless veterans to available programs, services, and
benefits. That is why I introduced the ``Help Our Homeless
Veterans Act.''
This bill will mandate that the Secretary dedicate funding
to establish a national media outreach campaign on
homelessness. This campaign will be designed to educate
veterans about where they can turn if they are homeless or at
risk of becoming homeless.
Mr. Chairman, since the VA's internal ban on paid public
advertising has been lifted, the VA has carried out one media
campaign about the availability of an emotional crisis hotline,
which I understand has been remarkably successful in preventing
suicide among Nation's veterans. Thus, I believe that using the
media to educate veterans about available services has proven
to be effective, and I believe we can use it as a tool to reach
out to those who are at risk of becoming homeless, as well as
those who have already found themselves on the streets.
Ultimately, it is my hope that with the increased awareness
and information about VA homelessness prevention and homeless
services among veterans themselves, advocacy groups, families
and the public, we can prevent veterans from becoming homeless,
and inform those who are homeless about services that are
available to them.
We owe a tremendous debt to those who have served our
country in uniform, and it is time that we show these heroes
the appropriate respect. With the enactment of the ``Help Our
Homeless Veterans Act,'' I believe that we can make a strident
effort in ending homelessness among our Nation's veterans.
Mr. Chairman and Members of the Committee, I thank you
again for this opportunity to testify, and will be happy to
answer any questions that you may have.
Thank you again, Mr. Chairman.
[The prepared statement of Congressman Hare appears on p.
27.]
Mr. Michaud. Thank you, Mr. Hare, and thanks again for all
your advocacy for our veterans. You definitely have been a true
leader in the veterans arena taking up the mantel of the former
Ranking Member, Lane Evans, of this Committee, so I really
appreciate your willingness to continue to fight for our
veterans.
And I know you have another Committee you got to go to, so
I will ask if there are any questions of the Subcommittee of
Mr. Hare. Hearing none, thank you very much Mr. Hare for
coming.
Mr. Hare. Thank you, Mr. Chairman.
Mr. Michaud. I appreciate it. Next I would like to
recognize the Chairwoman of the Economic Opportunity
Subcommittee of Veterans' Affairs who also has been a very
strong advocate of veteran issues, especially women's veteran
issues, and look forward to hearing your testimony on H.R.
1036. Ms. Herseth Sandlin?
STATEMENT OF HON. STEPHANIE HERSETH SANDLIN
Ms. Herseth Sandlin. Well good morning, Mr. Chairman, I
thank you for holding today's hearing. Good morning to the
other Members of the Subcommittee. I appreciate having the
opportunity to be here to discuss H.R. 1036, the ``Veterans
Physical Therapy Services Improvement Act.''
At the outset, I would also like to thank the American
Physical Therapy Association for their continued leadership on
this issue and their support of this important legislation.
And, I would also like to thank the Iraq and Afghanistan
Veterans Association for their endorsement of this bill.
The ``Veterans Physical Therapy Services Improvement Act,''
which I introduced on February 12th, 2009, along with the
original co-sponsor support of Health Subcommittee Chairman Mr.
Michaud, and full Veterans' Affairs Committee Chairman Mr.
Filner, will take important steps to expand and improve
Department of Veterans Affairs health care services by
improving the ability of veterans to access physical therapy
services throughout the VA.
As your Subcommittee knows, the VA is presented today with
a unique and challenging patient population. There are large
numbers of aging veterans, as well as men and women returning
from Iraq and Afghanistan with complex impairments. Both of
these groups require a full range of physical therapy services
that can keep pace with modern advancements and techniques in
the field.
I would like to share just a few statistics with you that
highlight the need for enhancing physical therapy services and
administration at the VA.
Currently, over 1,000 physical therapists are employed by
the Veterans Health Administration (VHA) providing care to our
Nation's veterans. These physical therapists practice across
the continuum of care from primary care settings and wellness
programs to disease prevention and post-trauma rehabilitation,
and play critical roles in a veteran's care team.
Approximately 9.2 million veterans are age 65 or older,
which is currently 38 percent of veterans, and by 2033, older
veterans will represent 45 percent of the total veterans
population. For these older veterans, physical therapists are
integral in fall prevention and Type 2 diabetes prevention
strategies.
Over 33,000 servicemembers have been wounded in Operation
Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Many
of these brave men and women have multiple serious injuries,
such as amputations and traumatic brain injury (TBI) that
require complex rehabilitation provided by physical therapists.
Competition is high for physical therapy graduates. The
Department of Labor (DOL) recognizes two health care
occupations, nurses and physical therapists, that are
experiencing a significant shortage under its labor shortage
determination authority. The DOL also projects an increasing
need for physical therapists and physical therapist job growth
of more than 25 percent over the next decade.
Given the shortage of physical therapists and the increased
demand for these services, it is clear that the VA needs to be
competitive in the current marketplace to recruit and retain an
adequate number of physical therapists to provide services to
our Nation's veterans.
This legislation works to solve this challenge through a
number of initiatives.
First, the legislation creates the position of Director of
Physical Therapy Services at the Veterans Health
Administration. This position would report directly to the
Undersecretary for Health. Currently, physical therapists at
the VA do not have a seat at the Director-level table. Having a
voice at this level will help ensure that as the profession of
physical therapy advances, the VA keeps its requirements up to
date with regard to educational requirements, qualifications,
clinical privileges, and scope of practice.
The legislation also creates the Department of Veterans
Affairs Geriatric, Amputee, Polytrauma, and Rehabilitation
Research Fellowships Program to assist in the recruitment and
retention of qualified physical therapists.
With strong competition in the marketplace for the services
of experienced and qualified physical therapists, the VA needs
to be aggressive in recruiting and retaining physical
therapists. This fellowship will allow the VA to be more
competitive in recruiting and retaining physical therapists
that specialize in crucial areas of need such as amputee
rehabilitation and polytrauma care.
This legislation also includes requirements that the VA
update its degree and license requirements for the appointment
of individuals to the physical therapist position. I am pleased
that the VA already has taken some steps to improve its
physical therapy policies. The VA has recently approved new
regulations that allow VA facilities to use special salary
rates, recruitment bonuses, retention allowances, and other pay
flexibilities to enhance recruitment and retention of physical
therapists based on the local labor market. My legislation
would help codify these standards.
In closing, Mr. Chairman, this legislation will help ensure
that veterans have access to the full range of physical therapy
services they need and deserve.
I thank you again for inviting me to testify. I look
forward to answering any questions you or other Members of the
Subcommittee may have.
[The prepared statement of Congresswoman Herseth Sandlin
appears on p. 28.]
Mr. Michaud. Thank you very much, Ms. Herseth Sandlin for
your thoughtful legislation before us today. Are there any
questions from the Committee?
Mr. Boozman. I also would echo that. I thank you--again,
you bring forth something that we really do need to look at,
and we appreciate your hard work.
Mr. Michaud. Are there any other questions? If not, thank
you very much for your testimony this morning.
Next I would like to recognize Mr. Arcuri from New York,
who has also been very active in looking after our veterans. He
will present to us today H.R. 3441, a bill to provide for
automatic enrollment of veterans returning from combat zones
into the VA medical system and for other purposes. Mr. Arcuri?
STATEMENT OF HON. MICHAEL ARCURI
Mr. Arcuri. Thank you, Mr. Chairman, Ranking Member, and
Members of the VA Subcommittee on Health. I first wish to thank
you for scheduling this legislative hearing today and inviting
me to speak on H.R. 3441.
This legislation would automatically enroll veterans who
are already eligible for free VA health care into the VA system
while providing a chance to opt-out of the system both at the
time of separation from the Armed Services and 6 months
following.
My bill references the statute passed in fiscal year 2008,
National Defense Authorization Act. As you know, this law
extends the eligibility period for free VA medical care from 2
to 5 years for veterans who served in a combat theater of
operations after November 11th, 1998. It applies to active
duty, National Guard, Reserve, and servicemen returning from
Operation Enduring Freedom and Operation Iraqi Freedom for
conditions that may be related to their combat service.
Following this initial 5-year period, these veterans may
continue their enrollment in the VA health care system, but
they may be subject to applicable copayments for non-service-
connected conditions.
My legislation takes this same group eligible for free
health care under Fiscal Year 2008 Act and instructs the
Department of Defense (DoD), in conjunction with the VA, to
automatically enroll these veterans in VA health care, should
these veterans so choose.
This bill does not create new classes of veterans eligible
for free VA health care, but simply changes the process by
which these veterans would become part of the system upon
separation from the DoD.
Importantly, this bill includes an opt-out provision at the
time of separation and again at 6 months after separation to
preserve the veteran's right to choose his or her own health
care.
This bill would also issue a standard VA veterans'
identification card to an auto-enrolled veteran, and provide a
listing of VA medical facilities within 100 miles of the
veteran. It would also require the VA to attach a description
of Federal veterans benefits and programs, such as educational
benefits, job training, and placement programs, for which the
veteran may be eligible.
The reason we are proposing this legislation is to make
sure that acceptance into the VA is as simple and effortless as
possible for the tens of thousands who will likely seek access
in the coming months.
Most of us here recognize the VA's efforts to track down
veterans weeks and even months after their return, yet
unfortunately, we still have a system that doesn't sufficiently
reach all soldiers. It places responsibility fully on a soldier
who has just returned from war and must step back into his or
her normal life. Dealing with this single experience is
difficult enough, we shouldn't place another burden on our
veterans by requiring them to actively pursue the care they may
want or need.
The opportunity to improve our present VA enrollment system
is reflected by the sheer demand of returning servicemembers
who are accessing the system at record rates. The VHA Office of
Public Health reported this January that between fiscal year
2002 and the last quarter of fiscal year 2008, 42 percent of
the roughly 950,000 separated veterans have sought VA health
care. The report also predicts that the percentage of veterans
receiving health care from the VA, as well as the percentage
given any type of diagnosis, will tend to increase over time as
these veterans continue to enroll in VA health care and develop
new health problems.
Clearly the demand for VA care will only continue to grow
in the coming years. Unfortunately, these higher enrollment
numbers also indicate a trend toward more cases of joint and
back disorders, mental disorders, and what the VA characterizes
as symptoms, signs, and ill-defined conditions. These three
categories are what the VA has determined the most common
health problems of war veterans, and represent our collective
responsibility to improve our delivery of good, efficient care
to all those who risked everything for this country.
Let me first say that I acknowledge the outreach efforts
that the VA has performed during this time. An extensive
outreach effort has been developed to inform veterans of their
benefits, including the mailing of a personal letter from the
VA Secretary to war veterans identified by the DoD when they
separate from active duty and become eligible for VA benefits.
These efforts have undoubtedly contributed to the higher VA
enrollment rates. Yet while the VA attempts to reach out to
returning soldiers and educate them about available resources,
it is still presently incumbent upon the veteran to initiate
and complete the application and registration process with the
VA, and we know that some veterans fall through the cracks.
In many cases, a soldier's primary focus during his or her
last few weeks of deployment is simply getting back home, not
spending more time away from loved ones by studying the VA
application process, filling out paperwork, and undergoing
evaluation. These servicemembers often forego necessary
screening or care leading to the critical situations weeks or
months later when the symptoms begin to manifest or intensify.
I commend the VA for its commitments and its efforts to
reach each veteran; however, I see a chance to change the
system so that veteran care can no longer centrally involve
tracking down those we have missed, and no longer leaves many
veterans finding themselves months or even years later without
proper treatment.
By implementing the auto-enrollment and accepting returning
soldiers at the outset, this bill would allow the VA to shift
time and resources away from tracking the follow up, and
instead focus on delivering health care right away.
I thank you again for holding this hearing on my
legislation to provide auto-enrollment for veterans returning
from combat zones. This bill is endorsed by the American Legion
and the Iraq and Afghanistan Veterans of America.
I look forward to working together to honor and protect our
veterans, and I would be happy to answer any questions you may
have on this bill.
[The prepared statement of Congressman Arcuri appears on
p. 29.]
Mr. Michaud. Thank you very much, Mr. Arcuri for your
testimony and for submitting this legislation before us today.
Are there any questions? Mr. Boozman?
Mr. Boozman. No, I also would like to echo that, and we
appreciate you coming forward and we appreciate your testimony.
Mr. Arcuri. Thank you, sir.
Mr. Michaud. If there are no other questions, thank you
very much, Mr. Arcuri.
Mr. Arcuri. Thank you, Mr. Chairman.
Mr. Michaud. I am pleased to recognize the Chairman of the
full Veterans' Affairs Committee, one who has definitely been a
vocal supporter of veterans' issues and is not bashful in
giving his thoughts on how we should improve health care for
our veterans, Mr. Filner, who is presenting H.R. 1017.
Mr. Boozman. Mr. Chairman, I do reserve the right to
question Chairman Filner.
STATEMENT OF HON. BOB FILNER
Mr. Filner. I do reserve the right to throw Mr. Boozman off
the Committee. Thank you, Mr. Chairman, and I thank you and Mr.
Boozman for their leadership on these issues. I think in the
last 3 years, this Subcommittee and the membership that is so
active has been probably the most productive Subcommittee of
the most productive Committee in the Congress, and it is your
leadership, your jointness, your bipartisan approach I think
has helped us all, and we appreciate your efforts and all the
Members of the Committee.
I am here to talk about H.R. 1017, the ``Chiropractic Care
Available To All Veterans Act.'' Many of you know that
musculoskeletal conditions are the number one reason that
returning veterans from Iraq and Afghanistan seek care at the
Department of Veterans Affairs. The current statute however is
such that each Veteran Integrated Service Network or each VISN
director is only responsible for ensuring that a minimum of one
VA medical center provides on-station chiropractic care. We all
know that an individual VISN often encompasses multiple States,
and so it is fair to say that on-site chiropractic care is not
readily accessible to all of our veterans.
I introduced H.R. 1470 and H.R. 1471 last Congress, which
would have expanded on-site chiropractic care and services to
veterans at the VA medical centers. It would have included
chiropractic services and counseling, as well as periodic and
preventive chiropractic exams and services amongst the medical,
rehabilitative, and preventive health services available for
our veterans.
We passed H.R. 1470 in 2007, but H.R. 1471 did not see
further action after it was referred to the Subcommittee.
So what I have done is introduced H.R. 1017, the
``Chiropractic Care Available To All Veterans Act,'' which
merges the provisions of H.R. 1470 and H.R. 1471 from the last
Congress. It simply updates the time frame for expansion of on-
site chiropractic care to all VA medical centers. It removes a
provision from H.R. 1471, which would have established
chiropractic practitioners on the same level as VA medical
doctors in the direct provision of primary care services. That
decision was based on the helpful feedback I received from the
VSO community and the American Chiropractic Association.
So I think that we have taken care of one of the major
concerns of the bill last year, as someone who has personally
experienced the positive results of chiropractic care and both
its cost effectiveness of chiropractic care and the feedback
from patients, including veterans that shows the high level of
satisfaction with this care. I think we need to provide this to
all of our veterans, and that is what H.R. 1017 does.
I will reserve the right to throw bombs at Mr. Boozman.
[The prepared statement of Congressman Filner appears on
p. 31.]
Mr. Michaud. Thank you very much, Mr. Chairman for your
testimony, and I will ask Mr. Boozman if he dares have any
questions for the Chairman.
Mr. Boozman. Since your testimony was brief we will let
you--no, I appreciate----
Mr. Filner. Did you say brief or brilliant?
Mr. Michaud. Brilliantly brief.
Mr. Boozman. But I do appreciate your leadership in so many
ways. Not only in that area, but with many other things
regarding veterans, so we appreciate you being here.
Mr. Filner. Just for the record so that nobody thinks that
this is real. In one survey I answered I chose Mr. Boozman as
my favorite Republican. So he has since suffered in his caucus
as a result, but----
Mr. Boozman. No, we do appreciate you.
Mr. Filner [continuing]. He certainly appreciates the--we
appreciate your working with all of us in so many ways and your
ability to bring us all together, Mr. Boozman. Thank you so
much.
Mr. Boozman. Thank you very much.
Mr. Michaud. Are there any other questions or comments? If
not, thank you very much, Mr. Chairman for coming forward
today.
On the second panel we actually have three of the four
Members who are on this Subcommittee, so if they want to give
their testimony from here that is fine, and I will recognize
them in order of their attendance.
The first one is Mr. Rodriguez who presents us with H.R.
2735, an bill to amend title 38, the United States Code to make
certain improvements to the Comprehensive Service Programs for
homeless veterans. Mr. Rodriguez?
STATEMENTS OF HON. CIRO D. RODRIGUEZ, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS; HON. GLENN NYE, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF VIRGINIA; AND HON.
HARRY TEAGUE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW
MEXICO
STATEMENT OF HON. CIRO D. RODRIGUEZ
Mr. Rodriguez. Mr. Chairman, thank you very much for
allowing me to speak today on H.R. 2735, which will improve our
Homeless Veterans Grant and Per Diem Program.
The purpose of the Grant and Per Diem Program is to
encourage community agencies to develop and provide supportive
housing as well as supportive services to our homeless
veterans.
The program is administered by the Veterans Administration
Health Care for Homeless Veterans Program, which funds
community agencies to provide transitional housing, as well as
health services, personal counseling, and other supportive
services to homeless veterans.
Eligible grantees are those who operate programs with
supportive housing for up to 24 months, or veteran service
centers also that offer services such as case management,
education, crisis intervention, counseling, and services
targeted toward specialized populations such as women veterans.
This bill improves the Grant and Per Diem Program in three
ways.
First, it would create a separate grant fund for the
grantee service center personnel. The per diem component of the
Grant and the Per Diem Program funds operational costs,
including the salaries of service center personnel who provide
supportive services to homeless veterans. However, the current
per diem amount is $34.40 for organizations with service
centers and supportive housing, and it is not sufficient to
fund adequately the number of staff that is needed. A separate
grant fund for personnel would end the competition between
staff salaries versus supportive services.
Second, the bill would change the rate of payment from a
per diem daily cost of care to an annual cost of furnishing
services. This would allow guarantees to draw down funds in
anticipation of allowable and contractual expenses, and it
would also address the cash shortfall problems faced by these
individuals that creates and incurs debt in their behalf and
creates a real problem in terms of the reimbursement from the
VA, which makes extreme delays occur, and then receiving the
resources needed for them to provide the service.
This would allow the proper business planning and
forecasting in order to provide the best and most cost-
effective services possible for our veterans. And this is
really a problem that is created for these agencies and a
headache where they have to wait months in order to get the
reimbursement for services already provided.
And finally the bill would allow the VA to increase the
rate of payment to reflect anticipated changes in the cost of
providing the services, which take into account geographic
differences. Because the per diem rate is far less than the
actual daily cost of care that is provided for our veterans.
The organizations in high cost service areas typically decide
not even to participate as a result of the low reimbursement
rates. Allowing the VA to increase the payment rates to account
for the changes in service costs and geographic differences
makes this program more attractive for potential guarantees.
And thirdly it would allow providers to use the per diem
funds to match other Federal funding sources. Under the current
law, providers are unable to use the per diem funds to match
other Federal funding sources. The current system penalizes the
Grant and Per Diem Program providers that are successful in
securing other sources of income for services to homeless
veterans by reducing their per diem payment rate. And
consequently, providers are discouraged from developing
partnerships with the Federal and State and local and non-
profit agencies and other private funding sources because of
that, and so that is a real disadvantage.
The proposed fix would encourage leveraging of the VA funds
to secure additional financial resources from other entities.
This would maximize the potential benefits and resources
available to these providers and increase the ability of the
provider to provide high quality care to more homeless
veterans.
And so I am proud to say that this bill is endorsed by the
National Coalition for Homeless Veterans, it is also endorsed
by the Veterans of Foreign Wars (VFW). And so I want to thank
them for their support.
And Mr. Chairman, I also want to thank the Committee and
your leadership in these efforts in trying to streamline the
type of services that we provide and to reduce some of the
cumbersome system that we have out there and that handicaps
these organizations that are operated with very little
resources in trying to provide the maximum for our veterans.
So thank you very much. I would ask for your consideration
in this particular piece of legislation. Thank you, sir.
[The prepared statement of Congressman Rodriguez appears on
p. 31.]
Mr. Michaud. Thank you, Mr. Rodriguez, and thank you for
all your support and efforts that you have done over the years
on this Committee to help our veterans. Are there any questions
for Mr. Rodriguez? Hearing none, thank you very much.
I would like to now recognize a freshman Member of this
Committee, one who is definitely also very concerned about our
veterans. I appreciate Mr. Nye bringing forward H.R. 3073, a
bill to amend title 38 of the United States Code to direct the
Secretary of Veterans Affairs to establish a grant program to
provide assistance to veterans who are at risk of becoming
homeless.
Thank you very much, Mr. Nye, for bringing this forward, I
look forward to your testimony this morning.
STATEMENT OF HON. GLENN NYE
Mr. Nye. Thank you, Mr. Chairman, it is an honor for me to
testify in support of this legislation, H.R. 3073, which I have
had the privilege of working on as you mentioned during my
first term in Congress, along with Congressman Duncan Hunter of
California. And I want to say that I am especially grateful to
you, Mr. Chairman Michaud, Members of this Committee, also to
the veterans' service organizations, and indeed to the veterans
themselves for their hard work and support in helping bring
this critical legislation to the forefront.
Just this past August, the Bureau of Labor Statistics
released unemployment data showing a dramatic increase in the
number of unemployed veterans of OIF and OEF. In fact, the
number is at an all time high of 185,000 unemployed, or 11.3
percent. Putting this into perspective, there are only 9,000
more servicemembers currently serving in both Iraq and
Afghanistan then there are unemployed Iraq and Afghanistan
veterans in the United States.
This recession is impacting every corner of our Nation, yet
nowhere is it more demoralizing than in our veteran population.
The men and women who have served our country in uniform
sacrificed life and limb to protect the freedoms that we all
enjoy, yet when they return some veterans are just a paycheck
or two away from losing their homes.
That is why I have introduced H.R. 3073, a common sense
measure that will provide temporary financial support to
veterans who are unable to make rental or mortgage payments and
are in imminent danger of eviction or foreclosure. Instead of
waiting for them to lose their homes before giving them a hand
up, I want to prevent veterans from becoming homeless in the
first place and keep them on their feet.
This bill authorizes a new program in the Department of
Veterans Affairs that will provide short-term assistance to
veterans in danger of losing their homes. Veterans who
demonstrate that they are on the verge of losing their homes
because they are unable to make mortgage or rental payments
will be eligible to apply for this support. Payments will be
made on behalf of the veteran to the landlord, mortgage
company, or utility company for a period of up to 3 months.
Veterans will also be provided with support services to prevent
future homelessness, including job training, mental health, and
substance abuse treatment.
We can never fully repay a veteran for the sacrifices they
have made for this country, but the least we can do is to
provide them with a sense of stability when they are having
troubles searching for a job. This bipartisan bill will help
bridge the gap for veterans who are struggling and give them
the chance to get back on their feet.
Again, I thank you, Mr. Chairman, for allowing me to
testify on behalf of this critical legislation, and I am
confident that we can take this positive step forward to help
our veterans in need and urge my colleagues to support the
legislation. Thank you.
[The prepared statement of Congressman Nye appears on p.
32.]
Mr. Michaud. Thank you very much, Mr. Nye, for that
enlightening testimony on this piece of legislation, and thank
you for bringing it forward. I really appreciate it very much.
Are there any questions for Mr. Nye? There are none. Thank you.
The last individual we have on panel two actually has two
pieces of legislation, also a freshman Member, and who is not
bashful about bringing forward legislation to help improve our
veterans' lives is Mr. Teague, who is bringing forward H.R.
2504 and H.R. 2506. Mr. Teague.
STATEMENT OF HON. HARRY TEAGUE
Mr. Teague. Thank you. Mr. Chairman and Ranking Member and
fellow Subcommittee Members, thank you for this opportunity to
speak on behalf of two bills that are before the Subcommittee
today, H.R. 2504 and H.R. 2506.
H.R. 2504 addresses one of our greatest national
travesties. On any given night in our beloved country there are
roughly 70,000 to 130,000 veterans that are homeless. They have
no shelter from the elements, they sleep on the street of the
very cities that they fought to defend, and after they have
served our country faithfully they are mostly forgotten and
left behind. The fact that this is allowed to happen is
shameful.
Luckily these veterans are not completely abandoned. The
Department of Veterans Affairs and numerous State, local, and
non-governmental entities have stepped up to the plate and
created numerous programs to combat the problems of homeless
veterans across the country. These groups conduct operations
that are aimed not only at getting veterans off of the streets
and into a shelter, but at finding ways to help veterans find
employment, secure their own housing, and stay in that housing.
Veterans transitional facilities do more than offer a
short-term solution to a homeless veteran, they hold true to
the old proverb, ''Give a man a fish and you feed him for a
day. Teach a man to fish and you feed him for a lifetime.''
My bill, H.R. 2504, amends section 2013 of title 38 and
increases the funding for these programs by $50 million in the
next fiscal year. It only makes sense that the programs that do
the most good to give our veterans a home should receive more
resources so that we can work toward what should be our goal,
eradicating homelessness among our veterans.
I am honored to say that this bill is also supported by the
National Coalition of Homeless Veterans. I believe that it is a
noble effort, and I hope that my colleagues and this
Subcommittee and Congress agree, and I hope that they will
support this legislation.
The second bill that I have before the Committee is H.R.
2506, the ``Veterans Hearing and Assessment Act.'' This bill
addresses a new health factor that is facing our troops,
tinnitus. Until recently tinnitus, better known as ringing in
the ears, was little understood and even less addressed by the
medical community. People suffering with tinnitus were often
thought to have anxiety disorders, or in some cases to be
delusional. Fortunately those misperceptions have changed and
tinnitus is now recognized as a serious clinical syndrome that
impacts 12 million individuals on a chronic basis, 2 million
who are virtually incapacitated by the disorder. Tinnitus has
generally become more common among our Nation's soldiers and
veterans, particularly those who have been exposed to blast
injuries in Iraq and Afghanistan.
In addition to the personal impact of tinnitus on our
veterans' lives and well being, the cost of tinnitus and its
continuing rise in instance is extremely alarming. Since 2001,
service-connected disability payments for tinnitus has
increased by 18 percent per year, and tinnitus is currently
ranked by the Department of Veterans Affairs as the number one
service-connected disability for returning soldiers. If current
trends continue, tinnitus compensation for veterans will exceed
$1 billion by the year 2011.
My bill, H.R. 2506, takes some important common sense steps
to address this problem. It requires that each Member of the
Armed Forces receive a hearing evaluation that includes
screening for tinnitus before and after deployment. Why is this
important? Certain forms of sensory impairment are clearly
visible to casual observation; however, hearing impairment,
including tinnitus, may often go undetected or be misdiagnosed,
yet along with vision, a soldier relies most on his or her
hearing in order to remain safe when in a combat situation.
Impaired hearing, including tinnitus, impacts the soldiers
ability to respond appropriately in combat situations,
jeopardizing not only the soldier's life, but those around him
or her, and compromising the safety of the mission itself.
We need to ensure that pre- and post-deployment screening
include an assessment of tinnitus to help ensure a soldier's
safety while in the field and to assess the extent to which a
soldier may have tinnitus as a result of their exposure to
blasts or other high noise level.
Mr. Chairman, my legislation also would ensure that
tinnitus will be recognized as a mandatory condition for
research and treatment by the Department of Veterans Affairs
Auditory Research Center of Excellence. Recent studies strongly
suggest a direct link between tinnitus in both post-traumatic
stress disorder (PTSD) and traumatic brain injury. For this
reason, improved understanding of the neurological mechanisms
that trigger tinnitus and research into its treatment may also
directly advance other ongoing research efforts to address the
equally serious challenges of PTSD and TBI.
We know that tinnitus is a condition of the auditory
system, not a disease of the ear. Existing therapies may help
mitigate the effects of tinnitus for some patients, but the
extent of relief afforded to patients with tinnitus varies
greatly. In short, they do not work for all individuals and
they do not cure tinnitus.
Scientific research into tinnitus has made some dramatic
advances over the last decade, but we still have a long ways to
go to improve prevention and treatment for tinnitus in order to
help the millions of American veterans who have experienced
tinnitus as a chronic ongoing condition, and hopefully to find
a cure for this debilitating condition.
I thank the Committee for its time and consideration. I
would like to take this time to thank the staff Members of the
Health Subcommittee who lent their expertise during the
drafting of this bill, and thank Chairman Michaud and Ranking
Member Brown for the opportunity to advance these two important
pieces of legislation.
This concludes my testimony, but I would like to submit a
statement for the record from the American Tinnitus Association
(ATA), if I may. Thank you.
[The prepared statement of Congressman Teague, and the
statement from ATA, appear on pp. 33 and 53.]
Mr. Michaud. Without objection, so ordered. Thank you very
much Mr. Teague for bringing both of these bills before us
today. I really appreciate your testimony. Are there any
questions for Mr. Teague? Hearing none, thank you very much,
and once again, thank you Mr. Nye as well for your legislation.
And I would like to recognize Mr. Brown before we bring
forward the third panel. I know Mr. Brown actually was tied up
in the Transportation Committee hearing and was delayed getting
over here.
So I want to thank you, Mr. Brown, for your friendship and
for your willingness for work in a strong bipartisan manner
dealing with veterans' issues. Both you and I have served and
switched seats here over the past 7 years as Ranking and
Chairman of this Subcommittee and the Benefits Subcommittee, so
I really appreciate your willingness to work in a bipartisan
manner and do what is right for our veterans. So I would
recognize you for your opening statement.
OPENING STATEMENT OF HENRY E. BROWN, JR.
Mr. Brown of South Carolina. Well thank you, Mr. Michaud,
and certainly the admiration is mutual. It has been a pleasure
working with you on this Committee in both roles, and we always
said early on that when you open--come through those doors this
is a non-partisan Committee, and I think it pretty well
reflects that among all the membership, and particularly our
relationship, because it is all about the veteran and not about
politics.
But I do have a bill that I would like to introduce, and I
apologize for not being here earlier. The Secretary of
Transportation was in the meeting this morning, and I certainly
wanted to listen to his report as to how the stimulus is being
carried out and how the jobs are being created across the
Nation. But anyway, I apologize for not being here earlier.
But I want to also thank you for including on the agenda a
bill that I intend to introduce, the ``Veterans Dog Training
Therapy Act.''
This legislation would require VA to conduct a pilot
program at three sites modeled after an innovative mental
health initiative that is currently being piloted at the VA
Medical Center in Palo Alto, California.
I know that Members and the witnesses have not had
sufficient time to comment on this bill, so I would appreciate
it if you would take time to respond later on for the record.
The intent of the program is to help veterans with post-
deployment mental health and post-traumatic stress disorder
through a therapeutic medium of training service dogs. After
training the dogs, the dogs are placed with veterans that have
combat-related physical disabilities.
Although this program has only been going on in one site,
veterans participation in the dog training program have seen
some spectacular success in addressing symptoms associated with
PTSD. Participating veterans are seeing improvements in sleep
patterns, mood, patience, and sense of purpose. But because the
program is only going on in one location, we need to see some
further evidence of these results.
I would like to read you what a veteran who has already
gone through the Paws for Purple Hearts Program had to say
about it, because I think his testimony means the most, and I
quote:''
``To Whom It May Concern:
I was introduced to the Dog Training Program, veterans
training service dogs for veterans with mobility disabilities
while I was a patient at the Men's Trauma Recovery Program at
the Menlo Park VA facility. I am receiving treatment for post-
traumatic stress disorder. I understand I am part of the pilot
program in working with these service dogs in training. For me,
this opportunity has been a Godsend.
The dog has provided me with the opportunity to work on
patience, as we work on training him to do new tasks. I have
learned that dogs have personalities like humans and they go
through times when they are stubborn or distracted and don't
want to do what they are told. But when that happens, I have
learned to be assertive with the dog instead of aggressive. I
give positive reinforcement and reward him for making progress
rather than getting angry and yelling. When I am patient and
assertive, he always comes around and gets rewarded for
performing a commanded task. It feels good to see him succeed.
My family has noticed a difference in the way I interact
with them as a result of working with my service dog in
training. I am patient with my children when they are around, I
haven't yelled at them in several months, and they aren't
afraid of me when I am around. I think that is a direct result
of working with my dog.
I have also benefited from the association with my service
dog in training as we spend time on bonding every day. I feel
loved by him and feel comforted when he is around. It has been
nearly 4 years since I have felt comforted. When the dog is
with me, people that I pass come up and talk to me and I have
social interactions that I wouldn't have had without the dog.
I am grateful the VA here in Menlo Park started this
program and I got to be part of it. I wish more veterans got
the opportunity I have been given to work with these amazing
animals.
Please consider this program on a larger scale so more
veterans can benefit from training or receiving a service dog.
Thank You. Staff Sergeant Warren Price.''
It is vitally important that we explore new and innovative
ways to help the increasing number of our returning veterans
who are experiencing post-deployment and PTSD symptoms. I hope
my colleagues will join me in supporting this legislation. And
with that, Mr. Chairman, I yield back the remainder of my time.
[The prepared statement of Congressman Brown appears on
p. 26.]
Mr. Michaud. Thank you very much, Mr. Brown. Are there any
questions of Mr. Brown on the ``Veterans Dog Training Therapy
Act?`` If not, thank you very much.
I would like to ask the third panel to come forward. And
while they are coming forward I would also like to point out
that H.R. 2506 and the ``Veterans Dog Training Therapy Act,''
was added at the last minute to our agenda, so I would like to
ask both the third and the fourth panel to submit your views on
these two pieces of legislation if you could.
On the third panel we have Joe Wilson who is from the
American Legion; Justin Brown, the Veterans of Foreign Wars;
Rick Weidman from the Vietnam Veterans of American (VVA); and
Blake Ortner from the Paralyzed Veterans of America (PVA).
I want to thank the four of you gentlemen for coming this
morning to talk about the legislation you heard earlier, as
well as the draft piece of legislation, and look forward to
your testimony. So we will start off with Mr. Wilson.
STATEMENTS OF JOSEPH L. WILSON, DEPUTY DIRECTOR,
VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN
LEGION; JUSTIN BROWN, LEGISLATIVE ASSOCIATE, NATIONAL
LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED
STATES; RICHARD F. WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY AND
GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA; AND BLAKE C.
ORTNER, SENIOR ASSOCIATE LEGISLATIVE DIRECTOR, PARALYZED
VETERANS OF AMERICA
STATEMENT OF JOSEPH L. WILSON
Mr. Wilson. Mr. Chairman and Members of the Subcommittee,
thank you for this opportunity for the American Legion to
present its views on the broad list of veterans' legislation
being considered by this Committee. The American Legion
commends this Committee for holding a hearing to discuss these
very important and timely issues.
I will begin with H.R. 1017, the ``Chiropractic Care
Available To All Veterans Act.'' The purpose of this bill is to
direct the Secretary of Veterans Affairs to require the
provisions of chiropractic care and services to veterans at all
Department of Veterans Affairs Medical Centers and to expand
access to such care and services.
The American Legion supports this bill as it is an
enhancement of an existing benefit provided to veterans.
H.R. 1036, the ``Veterans Physical Therapy Services
Improvement Act of 2009.'' The purpose of this bill is to
establish a Director of Physical Therapy Services within VA to
ensure these programs have effective oversight and management.
Previously, the American Legion expressed a position
supporting the establishment of a Director of Physician
Assistant within VA to ensure efficient utilization of the
programs and initiatives relating to this field.
The American Legion continues to support the intent of this
bill.
H.R. 2504--Increase in Amount Authorized to be Appropriated
for Comprehensive Service Programs for Homeless Veterans. This
bill would increase the funding going to homeless veterans
programs that are desperately needed. These programs will
assist the homeless veteran community with their
rehabilitation, recovery, health, and community integration.
The American Legion fully supports this bill.
H.R. 2559, the ``Help Our Homeless Veterans Act.'' This
bill would direct the Secretary of Veterans Affairs to carry
out a national media campaign directed at homeless veterans and
veterans at risk of becoming homeless. This bill would provide
outreach to our homeless veterans and those who are at high
risk of becoming homeless.
This bill would also place a special emphasis on a special
subgroup of veterans, women veterans. According to VA, the
number of homeless women veterans has doubled in the past
decade, up from 3 percent to 5 percent.
The American Legion supports this bill.
H.R. 2735--Availability of Grant Funds to Service Centers
for Personnel. This bill seeks to provide a service center for
homeless veterans that could be used to provide funding for
staffing in order to meet the service availability. This bill
will provide the maximum amount of finances to organizations
that are on the frontlines of assisting our most vulnerable
veterans.
The American Legion supports this important piece of
legislation.
H.R. 3073--Grant Program to Provide Assistance to Veterans
at Risk of Becoming Homeless. This bill seeks to establish a
Grant Program to provide assistance to veterans who are at risk
of becoming homeless. To date approximately 3,000 veterans from
Iraq and Afghanistan have been treated at VA Medical Centers.
This bill could help veterans and their families avoid
extraordinary stresses and damages that occur when they become
homeless.
The American Legion fully supports this bill.
H.R. 3441--Automatic Enrollment of Veterans Returning from
Combat Zones into the VA Medical System. The purpose of this
bill is to amend title 38 of the United States Code relating to
the automatic enrollment of honorably discharged combat
veterans.
The American Legion recently passed Resolution No. 29,
Improvements to Implement a Seamless Transition, which
recognized the gaps in services, and has consistently advocated
improvements be made to the transition process.
The American Legion fully supports H.R. 3441 and its
efforts to improve coordination between DoD and VA during the
seamless transition process of wounded servicemembers and
veterans.
Draft Discussions on Homelessness Among Veterans--This
draft seeks to amend title 38, United States Code, to improve
per diem grants payments for organizations assisting homeless
veterans.
The American Legion supports this piece of draft
discussion.
Draft Discussions on Graduate Psychology Education Transfer
of Funds to Secretary of Health and Human Services for Graduate
Psychology Education Program--The purpose of this bill is to
transfer $5 million from accounts of the Veterans Health
Administration to the Secretary of the Department of Health and
Human Services for the Graduate Psychology Education Program.
The American Legion approved Resolution No. 150, the
American Legion Policy on Department of Veterans Affairs Mental
Health Services, which urges Congress to annually appropriate
funds to VA to ensure comprehensive mental health services are
available to veterans. The American Legion believes funding
must be appropriated to treat the invisible wounds of war.
The American Legion has supported VA's strong commitment to
medical and nursing school affiliations to recruit and retain
high quality medical specialists; however, we do not have an
official position on an affinity relationship between the
training of VA psychologists through the U.S. Department of
Health and Human Services (HHS).
Mr. Chairman, thank you for allowing the American Legion to
present--this opportunity to present its views on the
aforementioned issues. We look forward to working with the
Committee to help increase and improve access to quality care
for our Nation's veterans.
[The prepared statement of Mr. Wilson appears on p. 34.]
Mr. Michaud. Thank you very much, Mr. Wilson. Mr. Brown?
STATEMENT OF JUSTIN BROWN
Mr. Brown. Thank you Chairman. Mr. Chairman, Ranking Member
Brown, and Members of this Subcommittee, on behalf of the 2.2
million Members of the Veterans of Foreign Wars and our
Auxiliaries, I would like to thank this Committee for the
opportunity to testify. The issues under consideration today
are of great importance to our Members and the entire veteran
population.
As the majority of the bills are dealing with homelessness,
I am going to limit my remarks to the issue in general.
As we speak, more than 131,000 homeless veterans are
walking the streets of the country they fought so bravely to
defend. A great number of these men and women are likely
walking these streets due to their injuries, physical or
mental, resulting from their service to their country.
There is no one causative factor for homelessness, but
there are many aggravators. Substance abuse, lack of familial
ties, physical and mental health issues, lack of access to
affordable housing, lack of employment, and other issues can
all eventually lead a person to being either temporarily or
chronically homeless. We must consider these factors and be
proactive in consideration of homeless policy now and into the
future.
As Representative Nye represented in his testimony, there
are only 9,000 fewer unemployed Post-9/11 veterans in the
United States than there are servicemembers in Iraq and
Afghanistan. That is 185,000 unemployed Post-9/11 veterans
compared to 194,000 servicemembers in Iraq and Afghanistan.
Unemployment, combined with high rates of mental health and
physical injuries due to multiple deployments, is a recipe for
disaster.
If we are not proactive in our approach to solving
homelessness, all of the aggravating factors will combine to
leave many thousands of my era of veteran homeless. We must act
immediately to alleviate the problem before it explodes.
President Obama addressed the VFW at our national
Convention last month. He stated, and I quote, ``I have
directed Secretary Shinseki to focus on a top priority,
reducing homelessness among veterans. After serving their
country, no veteran should be sleeping on the streets. No
veteran. We should have zero tolerance for that.''
We have full faith that this administration and this
Congress will fully address this issue today and not tomorrow,
by eradicating homelessness for America's heroes of past,
current, and future wars forever.
As America's largest group representing combat veterans, we
thank you for allowing the Veterans of Foreign Wars to present
its views on the bills in question to which we have submitted
testimony pertaining our views and opinions on them.
Mr. Chairman, this concludes my testimony, and I will be
pleased to respond to any questions you or the Members of this
Subcommittee may have. Thank you.
[The prepared statement of Mr. Brown appears on p. 37.]
Mr. Michaud. Thank you very much, Mr. Brown for your
testimony. Mr. Weidman?
STATEMENT OF RICHARD F. WEIDMAN
Mr. Weidman. Thank you, Mr. Chairman, for allowing Vietnam
Veterans of America to present testimony here this morning.
There are a diverse group of bills.
First let me just say in regard to the Chairman's bill on
chiropractic, it was clear, at least to some of us, the intent
of the bill already passed, I believe it was 2 years ago, and
there is no reason for VA not to have it available in every
facility.
Yes, very much on the tinnitus bill. It is a series
problem. The Institute of Medicine did a study that they
released 3 1/2 years ago that was excellent on this, and should
have been already taken care of by action, by the Secretary,
but it hasn't been, so I applaud you, Mr. Teague, for
introducing that legislation.
Auto-enrollment makes all the sense in the world that
people should be automatically enrolled in the VA when they
separate from military service, particularly those who are
returning from a combat deployment, and that will help a great
deal.
Part of the problem also, is I would encourage that we also
at the same time that we reach out to those who are deployed,
we need to reopen this system and take the strictures of
January 2003 off. The rate of enrollment of those who were
denied during that
5-, 6-year hiatus is not going well. I mean people are not
flooding in the gates, because having been burned once they are
not coming back, and we need to up the income levels and open
it up to category eights much more quickly.
In regard to physical therapy and the various scholarships,
particularly for graduate work and getting clinical psychology
degrees, VVA, in 1982, proposed on the Readjustment Advisory
Committee of Vietnam Veterans, which is now the Readjustment
Advisory Committee on Combat Veterans, that we establish a PTSD
scholarship for returning combat veterans from Vietnam. Those
who show a natural propensity let us train them and then have
them give back on a year-by-year basis the same as you give
back to military service, if in fact you have participated in
ROTC or in one of the service academies. And it still makes
sense today.
It makes sense for physical therapists, it makes sense for
clinical psychologists, it makes sense for physician
assistants, particularly for returning core men and medics who
have had more extensive experience on a battle field than
residents and interns would ever have.
And so I am suggesting that the Committee look at what are
the needs of the future in establishing a broad authority for
the Secretary to establish scholarships where people would give
back year for year. Those who serve with families can't afford
to go out on a GI Bill. It is not the question of paying for
school, it is a question of being able to support their family
at the same time, and hiring those people so that they are
already working at least on a part-time basis and on breaks at
the VA would make a great deal of sense.
Increasing H.R. 2504, which would increase to $200 million,
the Grant and Per Diem Program, is something that is much
needed, and VVA strongly favors that, and strongly favors fully
funding that authorization.
The ``Help Our Homeless Vets Act'' is about the media
campaign. No, the VA does not do a good job of reaching out to
homeless veterans, but they don't do a good job of reaching out
to anybody to inform them about their risks of health problems,
et cetera. And so creating a line item for outreach in every
single program frankly is something that we would encourage the
Committee, both the Subcommittee and the full Committee to
mandate that VA do such a thing. Because if you don't plan for
it, you are not going to get it done. If it is an after
thought, then it is never going to be done very well.
The Comprehensive Service Programs. I think we all know
that while we need decent housing and we need transitional
housing that is decent and clean of drugs and alcohol, we also
need support of services at those, and also transition section
eight housing, low-cost housing after people have finished in
the transition housing is needed as well, but supportive
services once again must be available, and H.R. 2735 moves in
that direction and we would encourage you to even increase that
bill.
H.R. 3073, which directs the Secretary to fund at $100
million, a grant program to provide assistance to veterans at
risk of becoming homeless. We would applaud that. There is much
talk about the numbers here this morning, but there always is
when we talk about homeless veterans. And we are curious about
all the numbers supplied by VA. How did we go from 3 1/2 years
ago of an estimate of 240-to 260,000 down to 173,000 who are
homeless down to an estimate today that is much lower than
that? So I would just warn the Committee, if I may, about
taking those numbers too seriously. Any veteran who is
homeless, and there are a lot, is too much. And so we shouldn't
rely on just the raw numbers, however they are figured out, to
gauge whether or not we are making progress.
Mr. Chairman, I thank you for holding this hearing, and I
see I am out of time so I will end there, sir.
[The prepared statement of Mr. Weidman appears on p. 39.]
Mr. Michaud. Thank you. Mr. Ortner?
STATEMENT OF BLAKE C. ORTNER
Mr. Ortner. Mr. Chairman, Ranking Member Brown, and Members
of the Subcommittee, on behalf of Paralyzed Veterans of America
I would like to thank you for the opportunity to present PVA's
position on the legislation pending before the Subcommittee.
Due to limits on time, I will only address some of the bills in
detail.
PVA has always been a strong supporter of helping homeless
veterans. VA estimates that hundreds of thousands of veterans
are homeless on any given night or experience homelessness in a
year. While exact numbers may vary, this is a tragedy that
continues to plague our Nation.
PVA strongly supports H.R. 2504, to provide for an increase
in the annual amount authorized by the Secretary of VA to carry
out homeless programs, and H.R. 2559, the ``Help Our Homeless
Veterans Act,'' to increase outreach which is critical to
reducing homelessness.
We are particularly pleased that the legislation not only
targets veterans who are homeless, but those that are at risk
of becoming homeless, with a special emphasis on our women
veterans who face so many additional challenges on the street.
PVA supports H.R. 2735, a bill that will make improvements
to the Comprehensive Programs for homeless veterans. However,
we do have some concerns about the long-term effects of the
legislation. Section two allows the Secretary of VA to increase
the rates of payment to reflect anticipated changes in the cost
of services and takes into account the cost of providing these
services in particular geographic areas.
While we welcome this consideration by adjusting the
payments for geographic areas, which we believe is aimed at
providing greater funding to high cost localities, this may
actually reduce the total number of homeless veterans that can
be served if future increases in program funding are
insufficient. Funding levels provided for homeless programs are
seldom sufficient to provide for all the veterans who may need
to take advantage of these critical services.
In conjunction with H.R. 2735 are the discussion drafts to
improve per diem grant payments for organizations assisting
homeless veterans and to eliminate the required reduction of
per diem payments provided to entities furnishing services due
to other sources of income.
One bill would set the per diem rate at an amount equal to
the greater of the daily cost of care or a fixed per diem rate
of $60 and essentially set a floor. PVA supports this floor and
has consistently opposed reductions of per diem due to other
income sources. However, PVA is concerned about other aspects
of the draft.
The legislation proposes that the Secretary of VA ensure 25
percent of funds for payments be available for recipients or
entities which furnish services to homeless veterans of which
less than 75 percent are veterans. This means an entity which
provides services to the homeless, and only 1 percent, or for
that matter zero percent, of those receiving services are
veterans who are eligible for VA funding. At least this is how
we understand the wording of the bill.
While we understand some homeless providers may serve a
minimal number of veterans, VA homeless veterans funding should
be targeted toward veterans' providers who provide for homeless
veterans.
PVA also welcomes the discussion draft legislation to
reform and expand VA Supportive Housing Program carried out by
the U.S. Department of Housing and Urban Development (HUD), VA,
which may return a homeless veteran to housing.
PVA does have one concern. The draft calls for specific set
aside for OEF and OIF veterans. Though we understand the desire
of Congress to help our most recent veterans, the scourge of
homelessness is so serious that to potentially limit resources
for non-OEF/OIF veterans is a mistake. All our homeless
veterans should have an equal chance at any help that may be
available.
PVA supports H.R. 3441, to provide for automatic enrollment
of veterans returning from combat zones into the VA medical
system. However, absent from the legislation is a clear
consideration of our mobilized National Guard and Reservists as
they are demobilized from wartime service. We would ask that
the Subcommittee consider including specifics in the
legislation.
PVA supports provisions of H.R. 1017, the ``Chiropractic
Care Available To All Veterans Act;'' H.R. 1036, the ``Veterans
Physical Therapy Services Improvement Act of 2009;'' and H.R.
3073 as introduced.
However, PVA does not support the draft legislation as
currently written to transfer funds from VA to the Secretary of
HHS for a Graduate Education Program. PVA recognizes the value
of HHS due to their established programs for graduate
education, but the provision that when awarding grants the
Secretary of HHS is only required to give a preference to
health care facilities of the VA when these funds are coming
from VA seems beyond comprehension.
We would sincerely hope that only in the event VA did not
apply for the grant would it be awarded to a non-VA program or
facility.
PVA appreciates the opportunity to comment on the bills
being considered by the Subcommittee, and we would be happy to
answer questions you may have. Thank you.
[The prepared statement of Mr. Ortner appears on p. 42.]
Mr. Michaud. Thank each of you for your testimony. I know
they called for the votes, but there are still about 400
members who have not voted yet. So are there any questions from
the Committee? If not, we will be submitting questions, and
hopefully you will respond, due to the votes being open.
So once again, I want to thank all four of you for coming
this morning to give your thoughts on the pending legislation
we currently have before us. So thank you.
I will now call and hopefully we can get through this last
panel before we have to run off to votes, is Peter Dougherty,
who is the Director of the Homeless Veterans Program. He is
accompanied by Paul Smits from the Department of Veterans
Affairs, as well as Jane Clare Joyner, who is also from the
Department of Veterans Affairs.
I want to thank you for coming, Mr. Dougherty, and we do
have your written testimony, so if you could try to sum up your
written testimony. Thank you.
STATEMENT OF PETER H. DOUGHERTY, DIRECTOR, HOMELESS VETERANS
PROGRAMS, OFFICE OF PUBLIC AND INTERGOVERNMENTAL AFFAIRS, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY PAUL E. SMITS,
ASSOCIATE CHIEF CONSULTANT, HOMELESS AND RESIDENTIAL
REHABILITATION AND TREATMENT PROGRAMS, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND JANE
CLARE JOYNER, DEPUTY ASSISTANT GENERAL COUNSEL, OFFICE OF
GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Dougherty. Thank you, Mr. Chairman. Good morning to you
and to the Members of the Subcommittee. Thank you for inviting
me here today. We will address the four bills, specifically
that deal with homeless veterans, and we will provide our views
and cost estimates on the others as soon as they are available.
H.R. 2504 would amend title 38, section 213, to raise the
authorized amount to be appropriated for the Homeless Grant and
Per Diem Program from $150 million to $200 million beginning in
fiscal year 2010 and each fiscal year thereafter.
VA supports H.R. 2504; however, we would also recommend
that the Committee consider that there is an increased need for
appropriations, and we would suggest that the amount of
appropriations simply be allowed to be set by the needs as we
see them in the Department as opposed to an appropriated dollar
level.
H.R. 2559 asks for a national media campaign targeted to
veterans who are homeless and at risk, with special emphasis on
women veterans. The VA supports outreach to homeless veterans.
We have authority under Public Law 110-389, section 539 to
promote awareness of veterans' benefits and services through
the Secretary.
We believe that we have a plan that will start in fiscal
year 2010 that will do specific targeting and advertising, if
you will, for veterans who are homeless, and we would welcome
the opportunity to talk to the Committee and the Committee's
staff about those issues at a later time.
H.R. 2735 would make improvements to the ``Comprehensive
Services Act.'' Section 1 of that bill would add a new
subsection, specifically allowing service centers receiving
grants from the Department to use those staffing grants to
ensure services are provided and to change the basis from a
daily rate of care to an annual cost of furnishing those
services. VA supports section one of that bill.
Section 2 would direct the Secretary to increase the rate
of payment to reflect changes of cost of furnishing services
and cost of services based upon geographic areas. It would
remove the requirement that the Secretary consider other
sources available, and would leave it to his or her discretion.
And it would allow grant recipients to use VA grants to match
other payments or grants from other providers.
VA continues to evaluate section two and the implications
of the shift from per diem to annual cost of furnishing
services.
VA generally supports the concept of the bill and this
provision, but we are apprehensive that this legislation may
have policy problems leading to higher costs and more detailed
auditing and increased oversight by us.
VA does not oppose removing the existing cap, but we are
concerned that the language in the bill is restrictive in that
it only authorizes the VA to increase the rate of payment from
year to year. VA could be unable to respond to situations or
developments that might lower the operating costs for grant
recipients. As a result, VA can be forced to pay costs above
rates to providers.
We consequently recommend that the language be modified to
say ``adjust,'' instead of ``increase.'' The bill would also no
longer require the Secretary to consider the availability of
other sources of income to grant recipients. VA suggests that
the language be amended to prohibit duplication and allow for
adjustment rather than solely increased funding.
Again, we would welcome the opportunity to discuss these
issues with you and the Committee staff, and we will be happy
to provide additional details to the Committee as we further
evaluate the impact of this proposal.
Regarding H.R. 3073, this would create a new grant program
that would require the Secretary to provide grants to public
entities and private non-profit organizations to provide
financial support to veterans at risk of or homelessness,
specifically to those veterans in eminent danger of eviction or
foreclosure who demonstrate a compromised ability to make
rental or mortgage payments and who meet eligibility
requirements established by the grant recipient. This would
allow up to 3 months to be provided assistance.
VA supports preventive measures for homeless veterans and
those at risk, but we have some serious concerns about the
bill.
Let me briefly explain, Mr. Chairman. Section 604 of Public
Law 110-187 provides VA with the authority to provide grants to
organizations offering supportive services that are similar to
this legislation for low-income veterans and their families
that are living in permanent housing. VA is currently
developing regulations to implement this legislation and we
expect to do it this fiscal year.
We also believe that the 3-month eligibility for services
under this bill is too short, and we would think that that is
an issue we need to address as well.
Again, Mr. Chairman, we understand we are very quick here.
We would welcome the opportunity to discuss this with you and
answer any questions you or the Committee may have.
[The prepared statement of Mr. Dougherty appears on p. 45.]
Mr. Michaud. Thank you very much, Mr. Dougherty, and look
forward to working with you on these pieces of legislation, and
we definitely will have follow-up questions, but due to the
fact that we have only got less than a minute to get over to
vote, we will have to adjourn the hearing, but we will
definitely followup with the questions both for the third and
fourth panel.
So once again thank you very much for testifying.
Mr. Dougherty. Thank you, Mr. Chairman.
Mr. Michaud. The hearing is now adjourned.
[Whereupon, at 11:21 a.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Michael H. Michaud,
Chairman, Subcommittee on Health
I would like to thank everyone for coming today.
Today's legislative hearing is an opportunity for Members of
Congress, veterans, the VA and other interested parties to provide
their views on and discuss recently introduced legislation within the
Subcommittee's jurisdiction in a clear and orderly process.
I do not necessarily agree or disagree with the bills before us
today, but I believe that this is an important part of the legislative
process that will encourage frank discussions and new ideas.
We have thirteen bills before us today. Of this, eight bills have
been introduced and cover a wide range of issues including homeless
veterans, chiropractic care, physical therapy, screening for hearing
loss, and automatic enrollment of veterans in the VA medical system.
The remaining five bills are drafts for discussion and would support
the training of psychologists in the treatment of veterans with PTSD,
TBI, and other combat-related disorders; create a pilot program using
psychiatric service dogs; and build on the homeless bills which already
have been introduced to provide additional assistance to homeless
veterans.
While today's hearing covers a wide range of issues, it focuses on
homeless veterans with seven of the thirteen bills before us today
addressing issues of homelessness. According to the VA, about one-third
of the adult homeless population has served their country in the Armed
Services. Current population estimates suggest that about 130,000
veterans are homeless on any given night and twice as many experience
homelessness at some point during the course of a year. Given these
staggering statistics, it is clear that we must do better by our
veterans and this legislative hearing is a step in the right direction
as it provides an opportunity to hear different points of views and
ideas on how best to serve our homeless veterans.
I look forward to hearing the views of our witnesses on these bills
before us.
Prepared Statement of Hon. Henry E. Brown, Jr.,
Ranking Republican Member, Subcommittee on Health
Thank you, Mr. Chairman.
I appreciate your holding this legislative hearing today to discuss
a number of bills that seek to improve and enhance the quality of care
and services we provide to our veterans, especially those veterans who
are homeless and at-risk for homelessness.
I also want to thank you for including on the agenda a bill that I
intend to introduce, the Veterans Dog Training Therapy Act.
This legislation would require VA to conduct a pilot program at
three sites modeled after an innovative mental health initiative that
is currently being piloted at the VA medical center in Palo Alto, CA.
I know that Members and the witnesses have not had sufficient time
to comment on this bill, so I would appreciate if you would take time
to respond later on, for the record.
The intent of the program is to help veterans with post deployment
mental health and Post Traumatic Stress Disorder (PTSD) through a
therapeutic medium of training service dogs. After training the dogs,
the dogs are placed with veterans that have combat-related physical
disabilities.
Although this program has only been going on in the one site,
veterans participating in the dog training program have seen some
spectacular success in addressing symptoms associated with PTSD.
Participating veterans are seeing improvements in sleep patterns, mood,
patience, and sense of purpose. But because the program is only going
on in the one location, we need to see some further evidence of these
results.
I'd like to read you what a veteran who has already gone through
the Paws for Purple Hearts program had to say about it, because I think
his testimony means the most
``To Whom It May Concern:
I was introduced to the dog training program, veterans training
service dogs for veterans with mobility disabilities, while I was a
patient at the Men's Trauma Recovery Program at the Menlo Park VA
facility. I am receiving treatment for Post Traumatic Stress Disorder.
I understand I am part of the pilot program in working with these
service dogs in training. For me, this opportunity has been a Godsend.
The dog has provided me with the opportunity to work on patience as
we work on training him to do new tasks. I've learned that dogs have
personalities like humans and they go through times when they are
stubborn or distracted and don't want to do what they're told. But when
that happens I've learned to be assertive with the dog instead of
aggressive, I give positive reinforcement and reward him for making
progress rather than getting angry and yelling. When I am patient and
assertive he always comes around ad gets rewarded for performing a
commanded task. It feels good to see him succeed.
My family has noticed a difference in the way I interact with them
as a result of working with my service dog in training. I am patient
with my children when they are around, I haven't yelled at them in
several months and they aren't afraid of me when I'm around. I think
that is a direct result of working with my dog.
I have also benefited from the association with my service dog in
training as we spend time on bonding every day. I feel loved by him and
I feel comforted when he is around. It's been nearly 4 years since I
have felt comforted. When the dog is with me people that I pass come up
and talk to me and I have social interaction that I wouldn't have had
without the dog. I'm grateful the VA here in Menlo Park started this
program and I got to be part of it. I wish more veterans got the
opportunity I've been given to work with these amazing animals.
Please consider this program on a larger scale so more veterans can
benefit from training or receiving a service dog.
Thank You.
(SSG)
OIF 2003-2005''
It is vitally important that we explore new and innovative ways to
help the increasing number of our returning veterans who are
experiencing post deployment and PTSD symptoms. I hope my colleagues
will join me in supporting this legislation.
With that, Chairman, I yield back the remainder of my time.
Prepared House Statement of Hon. Phil Hare,
a Representative in Congress from the State of Illinois
Thank you Chairman Michaud, Ranking Member Brown, Members and staff
of the House Veterans Affairs Committee Subcommittee on Health for
inviting me here today. As a former Member of this Subcommittee, it's
always a pleasure to be in this room among friends who are so dedicated
to the welfare of our Nation's heroes.
I come before you today to present testimony on legislation I
introduced, H.R. 2559, the Help Our Homeless Veterans Act. This bill
directs the Secretary of the Department of Veterans Affairs (VA) to
carry out a national media campaign directed at homeless Veterans and
Veterans who are at risk of becoming homeless to help end this growing
problem.
The number of homeless Veterans is rising and must be addressed.
Veterans are overrepresented in our Nation's homeless population. In
fact, they make up about one-third of our country's homeless. On any
given night this year, 131,000 Veterans are sleeping on the streets.
This year alone, 300,000 Veterans will experience homelessness.
Vietnam Veterans represent the largest segment of the homeless
Veteran population. Now, at a time with the highest unemployment rate
in 26 years, with more and more servicemembers returning home from the
conflicts in Iraq and Afghanistan, the number of Veterans who are
unable to make ends meet and face the prospect of homelessness is
growing. The VA estimates that it already provides services to 916
Veterans from the conflicts in Iraq and Afghanistan. Additionally, the
VA has identified over 2,986 Veterans that are at risk of becoming
homeless.
Additionally, there has been an alarming increase in the number of
female homeless Veterans. The VA estimates that 10 percent of all
homeless Veterans are now women. This means that about 740 female
Veterans from the Iraq and Afghanistan conflicts are homeless, or have
been identified as being at risk of becoming homeless. These numbers
are simply unacceptable.
Addressing the National Coalition for Homeless Veterans National
Conference, Secretary Shinseki said, ``We have a moral duty to prevent
and eliminate homelessness among Veterans.'' I could not agree more and
I applaud the Secretary for his commitment to end Veterans homelessness
in the next 5 years.
In order to meet this goal, I strongly believe that the VA must
immediately begin conducting media outreach to connect homeless
Veterans to available programs, services and benefits.
That is why I introduced the Help our Homeless Veterans Act. This
bill will mandate that the Secretary dedicate funding to establish a
national media outreach campaign on homelessness. This campaign will be
designed to educate Veterans about where they can turn if they are
homeless or at risk of becoming homeless.
Mr. Chairman, since the VA's internal ban on paid public
advertising has been lifted, the VA has carried out one media campaign
about the availability of an emotional crisis hotline, which I
understand has been remarkably successful in preventing suicide among
Veterans. Thus, I believe that using the media to educate Veterans
about available services has proven to be effective, and I believe we
can use it as a tool to reach those who are at risk of becoming
homeless, as well as those who have already found themselves on the
streets.
Ultimately, it is my hope that with increased awareness and
information about VA homelessness prevention and homeless services
among Veterans themselves, advocacy groups, families and the public, we
can prevent Veterans from becoming homeless, and inform those who are
homeless about services available to them.
We owe a tremendous debt to those who have served our country in
uniform, and it is time that we show these heroes the appropriate
respect. With the enactment of the Help Our Homeless Veterans Act, I
believe that we can make a strident effort in ending homelessness among
our Veterans.
Mr. Chairman and Ranking Member, I thank you again for this
opportunity to testify and will be happy to answer any questions that
you may have.
Prepared Statement of Hon. Stephanie Herseth Sandlin,
a Representative in Congress from the State of South Dakota
Good morning, Chairman Michaud and Ranking Member Brown. Thank you
for holding today's hearing. I appreciate having the opportunity to be
here to discuss the ``Veterans Physical Therapy Services Improvement
Act.''
At the outset, I'd also like to thank the American Physical Therapy
Association for their continued leadership on this issue and their
support for this important legislation. And, I'd also like to thank the
Iraq and Afghanistan Veterans Association for their endorsement of this
bill.
The ``Veterans Physical Therapy Services Improvement Act,'' which I
introduced on February 12, 2009, along with the original cosponsor
support of Health Subcommittee Chairman Michaud, and full Veterans'
Affairs Committee Chairman Filner, will take important steps to expand
and improve Department of Veterans' Affairs health care services by
improving the ability of veterans to access physical therapy services
throughout the VA.
As your Subcommittee knows, the VA is presented today with a unique
and challenging patient population. There are large numbers of aging
veterans as well as men and women returning from Iraq and Afghanistan
with complex impairments. Both of these groups require a full range of
physical therapy services that can keep pace with modern advancements
and techniques in the field.
I would like to share just a few statistics with you that highlight
the need for enhancing physical therapy services and administration at
the VA.
Currently, over 1,000 physical therapists are employed by the
Veterans Health Administration providing care to our Nation's veterans.
These physical therapists practice across the continuum of care from
primary care settings and wellness programs to disease prevention and
post-trauma rehabilitation, and play critical roles in a veteran's care
team.
Approximately 9.2 million veterans are age 65 or older (38 percent
of veterans) and, by 2033, older veterans will represent 45 percent of
the total veterans population. For these older veterans, physical
therapists are integral in fall prevention and type 2 diabetes
prevention strategies.
Over 33,000 servicemembers have been wounded in Operations Enduring
Freedom and Iraqi Freedom. Many of these brave veterans have multiple
serious injuries such as amputations and traumatic brain injury (TBI)
that require complex rehabilitation provided by physical therapists.
Competition is high for physical therapy graduates. The Department
of Labor (DOL) recognizes two health care occupations--nurses and
physical therapists--that are experiencing a significant shortage under
its labor shortage determination authority. The DOL also projects an
increasing need for physical therapists and physical therapist job
growth of more than 25 percent over the next decade.
Given the shortage of physical therapists and the increased demand
for these services, it is clear that the VA needs to be competitive in
the current marketplace to recruit and retain an adequate number of
physical therapists to provide services for our Nation's brave
veterans.
This legislation works to solve this challenge through a number of
initiatives.
First, the legislation creates the position of Director of Physical
Therapy Services at the Veterans Health Administration. This position
would report directly to the Undersecretary for Health. Currently,
physical therapists at the VA do not have a seat at the Director-level
table. Having a voice at this level will help ensure that, as the
profession of physical therapy advances, the VA keeps its requirements
up to date with regard to educational requirements, qualifications,
clinical privileges and scope of practice.
The legislation also creates the Department of Veterans Affairs
Geriatric, Amputee, Polytrauma and Rehabilitation Research Fellowships
Program to assist in the recruitment and retention of qualified
physical therapists. With strong competition in the marketplace for the
services of experienced and qualified physical therapists, the VA needs
to be aggressive in recruiting and retaining physical therapists. This
fellowship will allow the VA to be more competitive in recruiting and
retaining physical therapists that specialize in crucial areas of need
such as amputee rehabilitation and polytrauma care.
This legislation also includes requirements that the VA update its
degree and license requirements for the appointment of individuals to
the physical therapist position. I'm pleased that the VA already has
taken some steps to improve its physical therapy policies. The VA has
recently approved new regulations that allow VA facilities to use
special salary rates, recruitment bonuses, retention allowances and
other pay flexibilities to enhance recruitment and retention of
physical therapists based on the local labor market. My legislation
would help codify these standards.
In closing, Mr. Chairman, this legislation will help ensure
veterans have access to the full range of physical therapy services
they need and deserve.
Thank you again, Mr. Chairman, for inviting me to testify. I look
forward to answering any questions the Committee may have.
Prepared Statement of Hon. Michael A. Arcuri,
a Representative in Congress from the State of New York
Good morning Chairman Michaud, Ranking Member Brown, and all
Members of the VA Subcommittee on Health. I first wish to thank you for
scheduling this legislative hearing today and inviting me to speak on
my bill, H.R. 3441. This legislation would automatically enroll
veterans who are already eligible for free VA health care into the VA
system, while providing a chance to opt-out of the system both at the
time of separation from the Armed Services and 6 months following.
My bill references the statutes passed in FY08 National Defense
Authorization Act. As you know, this law extends the eligibility period
for free VA medical care from 2 to 5 years for veterans who served in a
combat theater of operations after November 11, 1998. It applies to
active duty, National Guard, and Reserve servicemembers returning from
Operation Enduring Freedom and Operation Iraqi Freedom (or OEF/OIF) for
conditions that may be related to their combat service. Following this
initial 5-year period, these veterans may continue their enrollment in
the VA health care system, but they may be subject to applicable
copayments for nonservice-connected conditions.
My legislation takes this same group eligible for free health care
under the FY08 Act and instructs the Department of Defense, in
conjunction with the VA, to automatically enroll these veterans in VA
health care, should these veterans so choose. This bill does not create
new classes of veterans eligible for free VA health care, but simply
changes the process by which these veterans would become part of the
system upon separation from the DoD.
Importantly, this bill includes an opt-out provision at the time of
separation and again at 6 months after separation to preserve the
veteran's right to choose his or her own health care.
My bill would also issue a standard VA veterans' identification
card to an auto-enrolled veteran, and provide a listing of VA medical
facilities within 100 miles of the veteran. It would also require the
VA to attach a description of Federal veterans benefits and programs,
such as educational benefits, job training, and placement programs, for
which the veteran may be eligible.
The reason we are proposing this legislation is to make sure that
acceptance into the VA is as simple and effortless as possible for the
tens of thousands who will likely seek access in the coming months.
Most of us here recognize the VA's efforts to track down veterans weeks
and even months after their return. Yet unfortunately, we still have a
system that doesn't sufficiently reach all soldiers. It also places
responsibility fully on a soldier who has just returned from war and
must step back into his or her ``normal'' life. Dealing with this
single experience is difficult enough. We shouldn't place another
burden on our veterans by requiring them to actively pursue the care
they may want or need.
The opportunity to improve our present VA enrollment system is
reflected by the sheer demand of returning servicemembers who are
accessing the system at record rates. The VHA Office of Public Health
reported this January that between FY02 and the last quarter of FY08,
42% of the roughly 950,000 separated OEF/OIF veterans have sought VA
health care. The report also predicts that the percentage of OEF/OIF
veterans receiving health care from the VA--as well as the percentage
given any type of diagnosis--will tend to increase over time as these
veterans continue to enroll in VA health care and develop new health
problems.
In its April 2009 report, the VA Office of Policy and Planning
further broke down the exceptional VA usage patterns of OEF/OIF
veterans. An overwhelming 53% of these veterans used VA health care in
FY08. Additionally, when compared to all other veterans, OEF/OIF
veterans also more frequently turned to the VA to access multiple
programs. 44%--or roughly 221,000 returning servicemembers--sought some
combination of education, pension, insurance, health, or loan guaranty
services from the VA.
Clearly, the demand for VA care will only continue to grow in the
coming years. Unfortunately, these higher enrollment numbers also
indicate a trend toward more cases of joint and back disorders, mental
disorders, and what the VA characterizes as ``Symptoms, Signs, and Ill-
Defined Conditions.'' These three categories are what the VA has
determined the most common health problems of war veterans, and
represent our collective responsibility to improve our delivery of
good, efficient care to all those who risked everything for this
country.
While these figures represent the specific experiences of OEF/OIF
veterans, I believe that we must re-evaluate entry into the VA for all
returning servicemembers.
Let me first say that I acknowledge the outreach efforts that the
VA has performed during this time. An extensive outreach effort has
been developed to inform veterans of their benefits, including the
mailing of a personal letter from the VA Secretary to war veterans
identified by DoD when they separate from active duty and become
eligible for VA benefits. These efforts have undoubtedly contributed to
higher VA enrollment rates.
Yet while the VA attempts to reach out to returning soldiers and
educate them about available resources, it is still presently incumbent
upon the veteran to initiate and complete the application and
registration process with the VA. In many cases, a soldier's primary
focus during his or her last few weeks of deployment is simply getting
back home - not spending more time away from loved ones by studying the
VA application process, filling out paperwork, or undergoing
evaluation. These servicemembers often forego necessary screening or
care, leading to critical situations weeks or months later when
symptoms begin to manifest or intensify. Frankly, despite all of our
efforts, some are still falling through the cracks.
I commend the VA for its committed efforts to reach each veteran.
However, I see a chance to change the system so that veteran care no
longer centrally involves tracking down those we've missed, and no
longer leaves many veterans finding themselves months or even years
later without proper treatment options and unaware of how to navigate
the VA system.
By implementing auto-enrollment and accepting returning soldiers at
the outset, this bill would allow the VA to shift time and resources
away from tracking and follow-up and instead focus on delivering health
care right away. The bill would also inform every servicemember of the
many VA resources available to him or her as an enrolled veteran with
the resource card. This legislation is critical toward realizing the
``seamless transition,'' a common goal of the administration's, various
veterans' service organizations, and veterans themselves for years.
Thank you again for holding this hearing on my legislation to
provide auto-enrollment for veterans returning from combat zones. This
bill is endorsed by American Legion and the Iraq and Afghanistan
Veterans of America. I look forward to working together to honor and
protect our veterans, and I would be happy to answer any questions you
may have on this bill.
Prepared Statement of Hon. Bob Filner Chairman,
Committee on Veterans' Affairs, and a Representative in Congress from
the State of California
Musculoskeletal conditions are the number one reason that returning
veterans from OEF/OIF seek care at the Department of Veterans' Affairs.
However, the current statute is such that each Veteran Integrated
Service Network director is only responsible for ensuring that a
minimum of one VA medical center provides on-station chiropractic care.
We all know that an individual VISN often encompasses multiple states
and so, it is fair to say that on-site chiropractic care is not readily
accessible for our veterans.
This is why I introduced H.R. 1470 and H.R. 1471 in the last
Congress. These bills would have expanded on-site chiropractic care and
services to veterans at VA medical centers.
In addition, it would have included chiropractic services and
counseling, as well as periodic and preventive chiropractic exams and
services among the medical, rehabilitative, and preventive health
services available for veterans.
H.R. 1470 passed the House on May 23, 2007, but H.R. 1471 did not
see further action after it was referred to the Subcommittee on Health.
In this Congress, I introduced H.R. 1017, the Chiropractic Care
Available to All Veterans Act. This act merges the provisions in H.R.
1470 and H.R. 1471 from the last Congress.
H.R. 1017 simply updates the time frame for expansion of on-site
chiropractic care to all VA medical centers. H.R. 1017 also removes a
provision from H.R. 1471 of the 110th Congress, which would have
established chiropractic practitioners on the same level as VA medical
doctors in the direct provision of primary care services. This decision
was based on the helpful feedback I received from our VSO community and
the American Chiropractic Association.
I hope that you will support H.R. 1017 so that we can better
provide chiropractic care to our veterans.
Prepared Statement of Hon. Ciro D. Rodriguez,
a Representative in Congress from the State of Texas
Thank you Mr. Chairman for allowing me to speak today on my bill,
H.R. 2735, which will improve our Homeless Veteran Grant and Per Diem
program.
The purpose of the Grant and Per Diem program is to encourage
community agencies to develop and provide supportive housing and/or
supportive services to homeless veterans.
The program is administered by the Veterans Administration Health
Care for Homeless Veterans Program which funds community agencies to
provide transitional housing, health services, personal counseling, and
other supportive services to homeless veterans.
Eligible grantees are those who operate programs with supportive
housing for up to 24 months, or veteran service centers offering
services such as case management, education, crisis intervention,
counseling, and services targeted toward specialized populations
including homeless women veterans.
This bill would improve the Grant and Per Diem program in the
following ways:
First, it would create a separate grant fund for grantee
service center personnel. The per-diem component of the Grant and Per
Diem program funds operational costs, including the salaries of service
center personnel who provide supportive services to homeless veterans.
However, the current per-diem amount, which is $34.40 for organizations
with service centers and supportive housing, is not sufficient to fund
an adequate number of staff. A separate grant fund for personnel would
end the competition between staff salaries versus supportive services.
Second, it would change the rate of payment from a per
diem daily cost of care to an annual cost of furnishing services. This
would allow grantees to draw down funds in anticipation of allowable
and contractual expenses. It would also address the cash shortfall
problem faced by grantees where the organization must incur debt and
then apply for reimbursements from the VA which often makes delayed
payments. This would allow for proper business planning and forecasting
in order to provide the best and most cost-effective services possible
to our homeless veterans.
Next, this bill would allow the VA to increase the rate
of payment to reflect anticipated changes in the cost of providing
services, which take into account geographic differences. Because the
per-diem rate is far less than the actual daily cost of care for
homeless veterans, organizations in high cost service areas typically
decide not to apply for Grant and Per Diem program funding. Allowing
the VA to increase the payment rate to account for the changes in
service costs and geographic differences makes this program more
attractive for potential grantees.
Finally, it would allow providers to use Per Diem funds
to match other Federal funding sources. Under current law providers are
unable to use Per Diem funds to match other Federal funding sources.
The current system penalizes Grant and Per Diem program providers that
are successful in securing other sources of income for services to
homeless veterans by reducing their per diem payment rate.
Consequently, providers are discouraged from developing partnerships
with other Federal, state, local and non-profit agencies and other
private funding sources. The proposed fix would encourage leveraging of
VA funds to secure additional financial resources from other entities.
This would maximize the potential benefits and resources available to
these providers and increase the ability of the provider to provide
high quality care to more homeless veterans.
I'm proud to say that this bill is endorsed by the National
Coalition for Homeless Veterans and the Veterans of Foreign Wars. I
certainly appreciate their endorsement.
Mr. Chairman, fellow Members of the Health Subcommittee--this is
the right thing to do. Many homeless veterans have benefited from the
Grant and Per Diem program through veteran support organizations, but
it is still a cumbersome system that needs these improvements. We must
make it less difficult for these organizations to lend a hand.
I appreciate your consideration of this bill and ask for your
support as we try to help our homeless veterans.
Thank you.
Prepared Statement of Hon. Glenn Nye,
a Representative in Congress from the State of Virginia
I am honored to testify in support of my legislation, H.R. 3073,
which I have had the privilege of working on during my first term in
Congress.
I am especially grateful to Chairman Michaud, the Members of this
Committee, the veterans' service organizations, and veterans themselves
for their hard work and support in helping me bring this critical
legislation to the forefront.
Just this past August the Bureau of Labor Statistics released
unemployment data showing a dramatic increase in the number of
unemployed veterans of OIF and OEF. In fact, the number is at an all
time high of 185,000 unemployed, or 11.3 percent. To put this into
perspective, there are only 9,000 more servicemembers currently serving
in both Iraq and Afghanistan then there are unemployed Iraq and
Afghanistan veterans in the United States.
This recession is impacting every corner of this nation, yet
nowhere is it more demoralizing than in our veteran population. The men
and women who have served their country in uniform sacrificed life and
limb to protect the freedoms we enjoy, yet when they return, some
veterans are just a paycheck or two away from losing their homes.
This is why I have introduced H.R. 3073, a common sense measure
that will provide temporary financial support to veterans who are
unable to make rental or mortgage payments, and are in imminent danger
of eviction or foreclosure. Instead of waiting for them to lose their
homes before giving them a hand up, I want to prevent veterans from
becoming homeless in the first place and keep them on their feet.
The bill authorizes a new program in the Department of Veterans
Affairs that will provide short-term assistance to veterans in danger
of losing their homes. Veterans who demonstrate that they are on the
verge of losing their homes because they are unable to make mortgage or
rental payments, will be eligible to apply for support. Payments will
be made on behalf of the veteran to the landlord, mortgage company, or
utility company for up to 3 months. Veterans will also be provided with
support services to prevent future homelessness, including job
training, mental health, and substance abuse treatment.
We can never fully repay a veteran for the sacrifices they made for
this country, but the least we can do is provide them a sense of
stability when they are having troubles searching for a job. This
bipartisan bill will help bridge the gap for veterans who are
struggling and give them the chance to get back on their feet.
Again, I thank the Chairman for allowing me to testify on behalf of
this critical legislation, and I am confident that we can take this
positive step forward to help our veterans in need. I urge my
colleagues to support this legislation.
Prepared Statement of Hon. Harry Teague,
a Representative in Congress from the State of New Mexico
Mister Chairman and Ranking Member and fellow Subcommittee Members.
I would like to take this opportunity and use my opening statement to
speak on behalf of two bills that are before the Committee today, H.R.
2504 and H.R. 2506.
H.R. 2504 addresses one of our greatest national travesties.
On any given night in our beloved country, there are roughly 70,
000 to 130,000 veterans that are homeless. They have no shelter from
the elements; they sleep on the streets of the very cities that they
fought to defend. After they have served our country faithfully, they
are mostly forgotten and left behind.
The fact that this is allowed to happen is shameful.
Luckily, these veterans are not completely abandoned. The
Department of Veterans Affairs and numerous state, local and non-
governmental entities have stepped-up to the plate and created numerous
programs to combat the problem of homeless veterans across the country.
These groups conduct operations that are aimed not only at getting
veterans off the streets and into a shelter, but at finding ways to
help veterans find employment, secure their own housing and stay in
that housing. Veterans transitional facilities do more than offer a
short-term solution to a homeless veteran; they hold true to the old
proverb: ``Give a man a fish and you feed him for a day. Teach a man to
fish and you feed him for a lifetime.''
My bill, H.R. 2504, amends section 2013 of title 38 and increases
the funding for these programs by $50 million dollars in the next
fiscal year. It only makes sense that the programs that do the most
good to give our veterans a home should receive more resources so that
we can work toward what should be our goal: eradicating homelessness
among our veterans.
I am honored to say that this bill is also supported by the
National Coalition for Homeless Veterans.
I believe that is a noble effort, and I hope that my colleagues in
the Subcommittee and the Congress agree and I hope that they will
support this legislation.
The second bill that I have before the Committee is H.R. 2506, the
``Veterans Hearing and Assessment Act.'' This bill address an new
health factor that is facing our troops--tinnitus.
Until recently, tinnitus--better known as `ringing in the ears'--
was little understood and even less addressed by the medical community.
People suffering with tinnitus were often thought to have anxiety
disorders, or, in some cases, to be delusional.
Fortunately, those misperceptions have changed, and tinnitus is now
recognized as a serious clinical syndrome that impacts 12 million
individuals on a chronic basis, 2 million of who are virtually
incapacitated by the disorder. Tinnitus is generally becoming more
common among our Nation's soldiers and veterans, particularly those who
have been exposed to blast injuries in Iraq and Afghanistan.
In addition to the personal impact of tinnitus on our veterans'
lives and well-being, the cost of tinnitus and its continuing rise in
incidence is extremely alarming. Since 2001, service-connected
disability payments for tinnitus has increased by 18 percent per year,
and tinnitus is currently ranked by the Department of Veterans Affairs
(VA) as the #1 service connected disability for returning soldiers. If
current trends continue, tinnitus compensation for veterans will exceed
$1 billion by the year 2011.
My bill, H.R. 2506, takes some important, common sense steps to
address this problem. It requires that each member of the Armed Forces
receives a hearing evaluation that includes screening for tinnitus
before and after deployment. Why is this important?
Certain forms of sensory impairment are clearly visible to casual
observation. However, hearing impairment, including tinnitus, may often
go undetected or be misdiagnosed. Yet, along with vision, a soldier
relies most on his or her hearing in order to remain safe when in a
combat situation.
Impaired hearing, including tinnitus, impacts a soldier's ability
to respond appropriately in combat situations, jeopardizing not only
the soldier's life but those around him or her, and compromising the
safety of the mission itself. We need to ensure that pre--and post--
deployment screening includes an assessment of tinnitus, to help ensure
a soldier's safety while in the field and to assess the extent to which
a soldier may have tinnitus as a result of their exposure to blast or
other high noise levels.
Mr. Chairman, my legislation also would ensure that tinnitus will
be recognized as a mandatory condition for research and treatment by
the Department of Veterans Affairs Auditory Research Centers of
Excellence. Recent studies strongly suggest a direct link between
tinnitus and both Post Traumatic Stress Disorder (PTSD) and Traumatic
Brain Injury (TBI). For this reason, improved understanding of the
neurological mechanisms that trigger tinnitus and research into its
treatment may also directly advance other ongoing research efforts to
address the equally serious challenges of PTSD and TBI treatment.
We now know that tinnitus is a condition of the auditory system,
not a `disease' of the ear. Existing therapies may help mitigate the
effects of tinnitus for some patients, but the extent of relief
afforded to patients with tinnitus varies greatly. In short, they do
not work for all individuals, and they do not cure tinnitus.
Scientific research into tinnitus has made some dramatic advances
over the last decade, but we still have a long way to go to improve
prevention and treatment for tinnitus, in order to help the millions of
American veterans who experience tinnitus as a chronic, ongoing
condition and hopefully, to find a cure for this debilitating
condition. I thank the Committee for its time and consideration.
I would like to take this time to thank the staff Members of the
Health Subcommittee who lent their expertise during the drafting of
these bills, and I thank Chairman Michaud and Ranking Member Brown for
the opportunity to advance this two important pieces of legislation.
This concludes my testimony.
Prepared Statement of Joseph L. Wilson, Deputy Director,
Veterans Affairs and Rehabilitation Commission, American Legion
Mr. Chairman and Members of the Subcommittee:
Thank you for this opportunity for The American Legion to present
its views on the broad list of veterans' legislation being considered
by this Committee. The American Legion commends this Committee for
holding a hearing to discuss these very important and timely issues.
H.R. 1017, Chiropractic Care Available to All Veterans Act
The purpose of this bill is to direct the Secretary of Veterans
Affairs to require the provision of chiropractic care and services to
veterans at all Department of Veterans Affairs (VA) Medical Centers and
to expand access to such care and services.
The American Legion supports this bill as it is an enhancement of
an existing benefit provided to veterans.
H.R. 1036, Veterans Physical Therapy Services Improvement Act of 2009
The purpose of this bill is to establish a Director of Physical
Therapy Services within VA to ensure these programs have effective
oversight and management.
Previously, The American Legion expressed a position supporting the
establishment of a Director of Physician Assistant within VA to ensure
efficient utilization of the programs and initiatives relating to this
field.
The American Legion continues to support the intent of this bill.
H.R. 2504, Increase in Amount Authorized to be Appropriated for
Comprehensive Service Programs for Homeless Veterans
Community Homelessness Assessment, Local Education and Networking
Groups (CHALENG) sites continue to report increases in the number of
homeless veterans with families (i.e. dependent children) being served
by their programs. CHALENG reports that 118 sites (85 percent of all
sites) have seen a total of 1,282 homeless veteran families. This was a
24-percent increase over last year's 1,038 homeless veteran families.
Homeless veteran service providers recognize that they will have to
accommodate the needs of the changing homeless veteran population,
which include the increasing numbers of women veterans and veterans
with dependents. This bill would increase the funding going to homeless
veterans programs that are desperately needed. These programs will
assist the homeless veteran community with their rehabilitation,
recovery, health, and community integration.
The American Legion fully supports this bill.
H.R. 2559, Help Our Homeless Veterans Act
This bill would direct the Secretary of Veteran Affairs to carry
out a national media campaign directed at homeless veterans and
veterans at risk of becoming homeless.
This bill would provide outreach to our homeless veterans and those
who are at high risk of becoming homeless. This bill would also place a
special emphasis on a special subgroup of veterans: women veterans. The
number of homeless women veterans has doubled in the past decade, up
from 3 percent to 5 percent according to the VA. This increase of women
veterans is due to their exposure to combat related situations. With
the continuance of the wars in Iraq and Afghanistan, it is widely known
that psychological illnesses, such as Post Traumatic Stress Disorder
(PTSD), Traumatic Brain Injury (TBI) and other mental illnesses play a
significant role in pushing a certain population of veterans into
homelessness. With the enactment of H.R. 2559, these veterans will be
targeted and given the proper information that will help them either
avoid homelessness or assist them in readjusting from chronic
homelessness.
The American Legion supports this bill.
H.R. 2735, Availability of Grant Funds to Service Centers for Personnel
This bill seeks to provide a Service Center for homeless veterans
that could be used to provide funding for staffing in order to meet the
service availability. This Service Center is essential in providing
outreach to the community and will play an integral part in serving the
many needs of homeless veterans. This bill seeks to amend section 2012
of title 38, United States Code (U.S.C.) by allowing a Grant and Per
Diem award to be considered as matching funds for other grants for
which organizations that provide assistance to homeless veterans, may
be eligible for. This award will match, in combination with other
payments for which they are eligible. Last, this bill will provide the
maximum amount of financing to organizations that are on the frontlines
of assisting our most vulnerable veterans.
The American Legion supports this important piece of legislation.
H.R. 3073, Grant Program to Provide Assistance to Veterans at Risk of
Becoming Homeless
This bill seeks to establish a grant program to provide assistance
to veterans who are at risk of becoming homeless. This grant program
would fill a tremendous need for veterans who are looking for
assistance before their situations worsen. Approximately 3,000 homeless
veterans from Iraq and Afghanistan have been treated at VA Medical
Centers. This bill could help veterans and their families to avoid the
extraordinary stresses and damages that occur when they become
homeless. It could take several years for a veteran to get back on his/
her feet and properly reintegrate back into the community. However,
this legislation could assist veterans with funds to fill a temporary
financial need. With VA and other homeless care service providers
continuing to focus on the various needs (i.e., health issues, economic
issues, lack of safe, affordable housing, and lack of family and social
support networks) of homeless veterans, and the enactment of this
legislation, The American Legion believes that homelessness rates will
continue to drop among the veteran community. It is vital that homeless
veterans receive the care and treatment they so deserve.
The American Legion fully supports this bill.
H.R. 3441, Automatic Enrollment of Veterans Returning from Combat Zones
into the VA Medical System
The purpose of this bill is to amend title 38, U.S.C., relating to
the automatic enrollment of honorably discharged combat veterans. This
bill proposes to do so by enrolling veterans automatically with the VA
and providing them with an ID card and full access to the VA medical
facilities within their respective geographical areas.
The American Legion recently passed Resolution No. 29,
``Improvements to Implement a Seamless Transition,'' which recognized
the gaps in services and has consistently advocated improvements be
made to the transition process. H.R. 3441 will assist in assuring
veterans are provided with the immediate use of VA facilities, creating
a seamless transition from Department of Defense (DoD) to the VA
system. The American Legion has noted servicemembers and their families
are easily overwhelmed when dealing with the bureaucracy of multiple
departments, but with the passage of H.R. 3441, servicemembers and
veterans will be provided with timely, accessible care within VA.
H.R. 3441 also provides the servicemember an option to not seek VA
enrollment at the time of discharge and The American Legion is
concerned that servicemembers may reject enrollment and perhaps slip
through the cracks during and after their transition from DoD to the VA
system.
The American Legion fully supports H.R. 3441 and its efforts to
improve coordination between DoD and VA during the seamless transition
process of wounded servicemembers and veterans.
Draft Discussions on Homelessness Among Veterans
This bill seeks to amend title 38, U.S.C., to improve per diem
grants payments for organizations assisting homeless veterans.
This bill would increase the current rate of $33 per bed to $60 per
bed to assist in the care and treatment of homeless veterans. The
homeless veteran needs counseling, health care, job training, and
affordable housing in order to properly reintegrate into the community.
This increase in funding will allow the homeless care providers to
better serve these homeless so they can become physically, emotionally,
and financially capable of sustaining themselves.
The American Legion supports this bill.
Draft Discussions on Graduate Psychology Education Transfer of Funds to
Secretary of Health and Human Services for Graduate Psychology
Education Program
The purpose of this bill is to transfer $5 million from accounts of
the Veterans Health Administration (VHA) to the Secretary of the
Department of Health and Human Services for graduate psychology
education program. This bill supports the training of psychologists in
the treatment of veterans with PTSD, TBI and other combat-related
disorders and gives preference to VA health care facilities and
graduate programs affiliated with the VA.
The American Legion approved Resolution No. 150, ``The American
Legion Policy on Department of Veterans Affairs Mental Health
Services,'' which urges Congress to annually appropriate sufficient
funds to VA to ensure comprehensive mental health services are
available to veterans. The American Legion believes funding must be
appropriated to treat the invisible wounds of war.
The American Legion has supported VA's strong commitment to Medical
and Nursing School Affiliations to recruit and retain high quality
medical specialists. However, we do not have an official position on an
affinity relationship between the training of VA psychologists through
the Department of Health and Human Services.
GPD Surplus Fix Draft Bill
This draft bill would amend title 38, U.S.C., to direct the
Secretary of Veteran Affairs to eliminate the required reduction in the
amount of per diem payments provided to entities furnishing services to
homeless veterans to account for other sources of income.
This bill would allow homeless care providers who may end up with
some surplus at the end of the fiscal year, due to receiving other
sources of income, the authorization to keep this surplus. This would
allow these homeless care providers to use these leftover moneys for
continued services for their homeless veteran population in the
upcoming fiscal year.
The American Legion supports this bill.
HUD-VASH Draft Bill
This draft bill seeks to reform and expand the Veteran Affairs
Supportive Housing Program carried out by the Department of Housing and
Urban Development and the Department of Veteran Affairs.
Homeless veteran service providers recognized 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 eight vouchers that have been made available through the
Housing and Urban Development--Veterans Affairs Supported Housing (HUD-
VASH) program, which offers an important new resource allowing VA staff
to assist the veteran and their family. HUD-VASH program was
established in 1992, where HUD and housing and VA provided case
management to homeless veterans. VA's services are designed to improve
the veteran's physical and mental health, and enhance the veteran's
ability to live in safe and affordable permanent housing in the
community of his/her choosing. Less than 1,000 units were available in
2006. Public Law 110-161, enacted December 26, 2007, provided funding
for 10,000 new vouchers for homeless veterans and their families. In
March 2009, Congress funded an additional 10,000 vouchers. This
legislation would help ensure that more homeless veterans receive
permanent housing through the supportive housing program and provide
more training for HUD and VA personnel to improve the effectiveness of
the program. In addition, this bill instructs VA to outreach to
landlords to encourage and facilitate participation in this program.
With the reform and expansion of HUD-VASH, homeless veterans will be
able to continue on their path to health, fulfillment and reintegration
back into mainstream society.
The American Legion fully supports this legislation.
Thank you again, Mr. Chairman for allowing The American Legion this
opportunity to present its views on the aforementioned issues. We look
forward to working with the Committee to help increase and improve
access to quality care for our Nation's veterans.
Prepared Statement of Justin Brown,
Legislative Associate, National Legislative Service,
Veterans of Foreign Wars of the United States
Mr. Chairman and Members of this Subcommittee:
On behalf of the 2.2 million members of the Veterans of Foreign
Wars of the United States and our Auxiliaries, I would like to thank
this Committee for the opportunity to testify. The issues under
consideration today are of great importance to our members and the
entire veteran population.
As we speak, more than 131,000 homeless veterans are walking the
streets of the country they fought so bravely to defend. A great number
of these men and women are likely walking these streets due to
injuries, physical or mental, resulting from their service to their
country.
There is no one causative factor for homelessness but there are
many aggravators. Substance abuse, lack of familial ties, physical and
mental health issues, lack of access to affordable housing, lack of
employment and other issues can all eventually lead a person to being
either temporarily or chronically homeless. We must consider these
factors and be proactive in consideration of homeless policy now and
into the future.
The most recent monthly survey from the Bureau of Labor Statistics
highlighted the dire situation facing America's newest veterans. There
are only 9,000 fewer unemployed post-9/11 servicemembers in the United
States than there are servicemembers in Iraq and Afghanistan (185,000
unemployed compared to 194,000 in OEF & OIF). Unemployment combined
with high rates of mental health and physical injuries due to multiple
deployments is a recipe for disaster. If we are not proactive in our
approach to solving homelessness, all of the aggravating factors will
combine to leave many thousands of my era of veteran homeless. We must
act immediately to alleviate the problem before it explodes.
President Obama addressed us at our national Convention last month.
He stated ``I've directed Secretary Shinseki to focus on a top
priority--reducing homelessness among veterans. After serving their
country, no veteran should be sleeping on the streets. No veteran. We
should have zero tolerance for that.''
We have full faith that this administration, and this Congress,
will fully address this issue, today and not tomorrow, by eradicating
homelessness for America's heroes of past, current, and future wars--
forever.
H.R. 1017, to amend the Department of Veterans Affairs Health Care
Programs Enhancement Act of 2001 and Title 38, United States Code, to
require the provision of chiropractic care and services to veterans at
all Department of Veterans Affairs medical centers and to expand access
to such care and services.
The VFW supports this legislation that would provide veterans with
direct access to chiropractic health care. Currently, chiropractic care
is rarely, if ever, offered to veterans with injuries that would likely
receive such referrals from private medical facilities. In many
instances, veterans are paying for chiropractic care from service-
related injuries out of their own pocket.
This important legislation would require 75 VA medical centers to
provide such services no later than December 31, 2010, and at all VA
medical centers by no later than December 31, 2012. We believe this
legislation to be of great importance in consideration of the various
injuries veterans have received and the known benefits for chiropractic
care.
H.R. 1036, to amend title 38, United States Code, to establish the
position of Director of Physical Therapy Service within the Veterans
Health Administration and to establish a fellowship program for
physical therapists in the areas of geriatrics, amputee rehabilitation,
polytrauma care, and rehabilitation research.
The VFW strongly supports H.R. 1036. This important legislation
would create a Director of Physical Therapy Service within the VHA.
Also, of great importance, this legislation would create a fellowship
program for physical therapists in the areas of geriatrics, amputee
rehabilitation, polytrauma, and rehabilitation research. Increasing the
physical therapy programs at the VA will enhance the health care for
all generations of injured veterans. Injured servicemembers returning
from Iraq and Afghanistan often rely on the special and unique services
provided by physical therapists to rehabilitate from minor or
catastrophic injuries. Physical therapists also help the aging
population of veterans with new or enhanced disabilities that result
with age. Therefore, the VFW sees the value in the VA enhancing these
services to better serve their customers.
H.R. 2504, to amend title 38, United States Code, to provide for an
increase in the annual amount authorized to be appropriated to the
Secretary of Veterans Affairs to carry out comprehensive service
programs for homeless veterans.
The VFW is in strong support of H.R. 2504. This important
legislation would increase VA funding to carry out crucial service
programs for homeless veterans. H.R. 2504 would expand funding to
services such as case management, education opportunities, crisis
intervention, counseling, job training, etc. This important bill would
assist our homeless veterans in returning to the job force and would
restore order and hope to their lives.
H.R. 2559, to direct the Secretary of Veterans Affairs to carry out
a national media campaign directed at homeless veterans and veterans at
risk for becoming homeless.
The VFW strongly supports H.R. 2559. This important proactive
legislation would work to advise homeless veterans, and veterans at
risk of homelessness, of available benefits and services. The VFW
believes that no veteran should be homeless in the streets of the
country they fought so valiantly for. However, in too many instances
veterans are unaware of benefits and services available to them. This
legislation would create an outreach campaign aimed at addressing these
very veterans.
H.R. 2735, to amend title 38, United States Code, to make certain
improvements to the comprehensive service programs for homeless
veterans.
The VFW strongly supports H.R. 2735. This important legislation
would change the Grant and Per Diem Program from a daily care cost
payment system to one based on the annual cost of the services provided
to homeless veterans. These annual costs would be distributed by the VA
Secretary based on predicted changes in the cost of care and the cost
of care by geographic regions. When distributing this funding, the VA
Secretary would also take into account other sources of income to these
centers such as payments from other departments or agencies of the
United States, payments from State or local governments, or payments
from private entities or organizations. H.R. 2735 would also make grant
funds available to pay for the personnel and staff of homeless veteran
service centers. Such grant funds would make it easier for service
centers to meet the service availability requirements and help these
centers provide the help and care that our homeless veterans
desperately need.
H.R. 3073, to amend title 38, United States Code, to direct the
Secretary of Veterans Affairs to establish a grant program to provide
assistance to veterans who are at risk of becoming homeless.
The VFW is in strong support of this important legislation, which
would provide funding to public entities and to non-profit
organizations to help veterans who are in imminent danger of becoming
homeless. These organizations would be able to make utility, rent and
mortgage payments as well as security deposits on behalf of the
eligible veterans for up to 3 months. H.R. 3073 would also ensure that
the eligible veteran is receiving further services such as job training
and counseling to prevent homelessness.
H.R. 3441, to provide for automatic enrollment of veterans
returning from combat zones into the VA medical system, and for other
purposes.
The VFW currently has no formal position on this legislation.
H.R. ____, to direct the Secretary of Veterans Affairs to transfer
funds to the Secretary of Health and Human Services for a graduate
psychology education program.
The VFW strongly supports this important legislation that would
increase funding for the Graduate Psychology Education program under
the purview of Health and Human Services. The need for mental health
services continues to grow as the wars in Iraq and Afghanistan
continue. Recent reports issued by GAO, the DoD Mental Health Task
Force, the Institute of Medicine, and others, have identified shortages
of trained mental health providers. This important legislation would
begin to address this shortfall by increasing the numbers of trained
mental health counselors.
H.R. ____, to amend title 38, United States Code, to improve per
diem grant payments for organizations assisting homeless veterans.
The VFW supports this important legislation that establishes an
increased rate at which crucial per diem payments are made to
organizations that assist homeless veterans. Such rates would equal the
daily cost as estimated by the grant recipient or $60 per bed. This
legislation also provides an organized and detailed priority list for
those organizations assisting our Nation's homeless veteran population.
This new priority list allows smaller non-profit organizations to
receive 25% of the supportive services for homeless veterans funding.
Currently, these organizations are deemed ineligible and receive no
funding yet they still provide crucial care to our homeless veterans.
This legislation would provide funding to these organizations so that
they can continue to provide America's homeless servicemembers the help
they need. The 25% funding to these smaller non-profit organizations
would be distributed by the Secretary and priority would be given to
the organizations meeting the most supportive services requirements of
the current law.
H.R. ____, to amend title 38, United States Code, to direct the
Secretary of Veterans Affairs to eliminate the required reduction in
the amount of per diem payments provided to entities furnishing
services to homeless veterans to account for other sources of income,
and for other purposes.
The VFW currently has no formal position on this legislation.
H.R. ____, to reform and expand the Veterans Affairs Supportive
Housing Program carried out by the Department of Housing and Urban
Development and the Department of Veterans Affairs.
The VFW currently has no formal position on this legislation.
As America's largest group representing combat veterans, we thank
you for allowing the Veterans of Foreign Wars to present its views on
these bills.
Mr. Chairman, this concludes my testimony and I will be pleased to
respond to any questions you or the Members of this Subcommittee may
have. Thank you.
Prepared Statement of Richard F. Weidman,
Executive Director for Policy and Government Affairs,
Vietnam Veterans of America
Good morning, Congressman Michaud, Congressman Miller, and other
Members of this distinguished Subcommittee. Vietnam Veterans of America
appreciates this opportunity to offer our comments about several very
significant pieces of legislation up for consideration by this
Subcommittee today. Let me give our assessment of them in order.
H.R. 1017, the Chiropractic Care Available to All Veterans Act.
This bill would require the provision of chiropractic care and services
to veterans at no fewer than 75 VA medical centers and would expand
access to such care and services.
While VVA supports the enactment of this bill, we would suggest
that this body consider looking into other alternative health care
options that have shown varying degrees of effectiveness. These might
include acupuncture, yoga, and ancient healing arts (such as ayurveda)
and meditation/ relaxation techniques (such as qu gong) from India and
China. These might include as well such modern relaxation techniques as
biofeedback, which has proven successful in treating fibromyalgia,
hypertension and certain heart conditions, and even traumatic brain
injuries (TBI).
H.R. 1036, the Veterans Physical Therapy Services Improvement Act.
This bill would establish the position of Director of Physical Therapy
Service, as well as degree and license requirements for appointments to
a physical therapist position. Additionally, this bill would establish
VA Geriatric, Amputee, Polytrauma, and Rehabilitation Research
Fellowships Program to assist in the recruitment of qualified physical
therapists specializing in these areas.
VVA enthusiastically endorses this bill. VVA has long advocated
that the Department of Veterans Affairs must offer ``veteran-centric''
health care that takes cognizance of the special health issues that
afflict veterans far more than the civilian populace. We believe that,
if enacted and properly staffed, it will add expertise in critical
areas of health care treatment that are veteran-centric.
H.R. 3441 would provide for automatic enrollment into the VA
medical system for veterans returning from combat zones.
For years, we have been hearing about the ``seamless transition''
of veterans from their branch of service to the VA, and specifically
concerning their medical/health records. In reality, the transition has
been anything but seamless, although there is a light at the end of the
tunnel. Enactment of H.R. 3441 might bring us closer to the end of the
tunnel.
However, the provision in this bill permitting a veteran to
``disenroll'' can potentially impact that veteran if, at some point in
the future, s/he develops a health condition that derives from their
time in service, e.g., from exposure to a toxic substance, for
instance; or if that veteran, because of economic circumstances, needs
to enroll in the VA health care system. We would suggest that counsel
insert provisions into this bill to ensure that such a scenario could
not happen should H.R. 3441 become the law of the land.
Draft legislation that would direct the Secretary of Veterans
Affairs to transfer funds to the Secretary of Health and Human Services
for a graduate psychology education program.
On the surface, VVA would have no objections to such legislation.
VVA first proposed ``PTSD Scholarships'' for Vietnam combat veterans in
1982. It was a good idea then, and it is a good idea for the young
people returning from OIF/OEF today. However, we would suggest that it
add provisions that would ensure that any student who benefits from
such a program ``owe'' the VA a set number of years of service, much
like the program(s) in the military in which a branch of service will
pay for the training of a nurse or a lawyer in return for 4 or 5 years
of service.
The next several bills address the persistent problem of
homelessness among veterans.
H.R. 2504 would provide for an increase in the authorization from
$150 million to $200 million to be appropriated for comprehensive
service programs (Grant and Per Diem Program) for homeless veterans.
In testimony in April 2008, VVA recommended that Congress go above
the authorizing level for the Homeless Grant and Per Diem program and
fund the program at $200 million and not the $150 million authorized.
This bill, if enacted, would fulfill that recommendation and would, we
believe, help provide services to our veterans who are without homes.
H.R. 2559, the Help Our Homeless Veterans Act. This bill would
direct the Secretary of Veterans Affairs to carry out a national media
campaign aimed at homeless veterans and veterans at risk of becoming
homeless, with special emphasis on women veterans.
The VA has both a legal responsibility and an ethical obligation to
reach out to all veterans and their families to inform them of the
benefits to which they are entitled. While providing VA medical centers
with booklets and pamphlets is fine, these do little good if they do
not get into the hands of the very poor who do not use the system, the
``middle class'' who use private physicians and who may be living from
paycheck to paycheck, and some who, for so many reasons, either choose
to or are forced to dissociate from society.
To reach these folks, the VA has had no real strategic plan. In
fact, VA outreach to those who do not use VA facilities is negligible,
and has been for a long, long time.
So, a strategic plan, aided perhaps by the Ad Council with input
from the veterans' service organizations, needs first to be well
thought out, and then implemented. How much such an outreach effort
will cost will be dependant on the media (TV and radio, billboards,
electronic media) that are used. Part of such an outreach effort ought
to include a ``help line'' modeled after the VA's suicide hot line.
We would offer, too, that a plan that targets the homeless, or
those at risk of incipient homelessness, ought to be part of a larger,
more inclusive VA outreach strategy that informs veterans of the
benefits they have earned by virtue of their military service, and that
informs veterans of any health conditions that might derive from their
time, and place, in service.
We maintain as well that there needs to be a separate line for
``outreach'' in the VA budget, including separate lines for outreach in
the budgets of the various entities of the VA.
H.R. 2735 would make certain improvements to the comprehensive
service programs for homeless veterans, to include: Creating a separate
grant fund for service center personnel; changing the rate of payment
from a per diem daily cost of care to an annual cost of providing
services, allowing the VA to increase the rate of payment to reflect
the cost of providing services; and allowing providers to use per diem
funds to match other funding sources.
One of the frontline outreach programs funded by the VA is Day
Service Centers, sometimes referred to as Drop In Centers. These
centers reach deep into the homeless veteran population that are still
on the streets and in the shelters of our cities and towns. These
centers receive rates based on an hourly calculation per diem ($4.30)
for the time that a homeless veteran is actually on site in the center.
While this amount may cover the cost of the coffee and food, it does
not come close to covering the cost of the professional staff that must
provide the assistance the veterans need long after they leave the
facility.
Why should there be separate facilities to service veterans who are
homeless? The reality is that most city and municipality social
services simply do not have the knowledge or capacity to provide
appropriate supportive services that directly involve the treatment,
care, and entitlements of veterans. Hence, homeless veterans' service
centers are vital in any effort to get homeless veterans off the
streets and into programs that they need to conquer homelessness and
give them a fighting chance of integrating back into society.
Why not create ``Service Center Staffing/Operational'' grants, much
like the VA ``Special Needs'' grants already in existence? VVA supports
establishing Supportive Services Assistance Grants for VA Homeless
Grant and Per Diem Service Center Grant awardees, which we would hope
enactment of H.R. 2735 might accomplish.
H.R. 3073 would direct the Secretary of Veterans Affairs to
establish and fund at $100 million for each of fiscal years 2011, 2012,
and 2013 a grant program to provide assistance to veterans at risk of
becoming homeless. The program would provide funding to public entities
and private non-profit organizations to make payments for up to 3
months to an eligible veteran's landlord, mortgage company, or utility
company for amounts of rent, mortgage, or utility bills that are in
arrears, as well as security deposits for rental properties. The
programs also would provide supportive services, including job training
and mental health and substance abuse treatment, to prevent these
veterans from becoming homeless.
Such a program is no long-term solution. If enacted into law and
properly translated from concept to reality, it could help stanch the
descent of hundreds if not thousands of low-income veterans who, in
this uncertain economy, are in fact in imminent danger of eviction or
foreclosure and at risk of becoming homeless.
Draft Legislation to improve per diem payments for organizations
assisting homeless veterans.
VVA has long contended that VA Homeless Grant and Per Diem funding
must be considered a payment rather than a reimbursement for expenses,
an important distinction that will enable the community-based
organizations that deliver the majority of these services to operate
more effectively.
We have wondered why this funding has not been considered a ``fee-
for-service'' instead of a reimbursement. Such a change would pay
existing and future grant awardees in a per diem program as
contractors, much like that of the past programs. However now there
would be a process for defined oversight in regard to annual
inspections, services offered, and goals attained.
The amount of work and the staff time required to accommodate the
current system for grant and per diem programs is a drain not only on
staff time but, in many instances, on the fiscal solvency of an agency
receiving such funding.
A key element in this bill notes that 25 percent of funds available
for per diem grant payments would go to entities that must do more than
just provide ``three hots and a cot.'' They must offer ``transitional
and supportive services'' as prescribed by the Secretary of Veterans
Affairs. VVA would suggest that far more than 25 percent of available
funds ought to go to agencies that provide such services. The danger is
that cities and towns and counties that provide shelters for their
homeless populations will wind up competing with agencies that are
actively working to bring
services and assistance to veterans with the goal of successful communit
y reintegration.
VVA would also add that an important per diem funding issue be
added to this bill that addresses funding to an existing program for
the expansion of its original program. In the past, some successful VA
residential programs for homeless veterans identified a need for
increased bed space based on the number of veterans requesting
admission. These programs requested additional beds under a ``per diem
only,'' or PDO, grant process and were awarded funds to increase their
overall program beds.
However, because the original grant and the PDO grant were awarded
at different times they have separate ``project numbers,'' even though
both grants were for the same program with the same expenses. Hence,
they are required to divide out by percentage the number of beds, and
the per diem rates, under each project number in the required reporting
to the VA. And everything related to the program has to be divided by
percentages and every veteran who changes bedrooms has to be tracked by
project number in applying for every month's per diem reimbursement
request. This is a bookkeeping nightmare. It can be alleviated, and
some trees can be saved in the process, if the system insists on a
single project number rather than the two it now requires.
Draft Bill, The End Veteran Homelessness Act. This bill would
reform and expand the VA's Supportive Housing Program carried out in
concert with the Department of Housing and Urban Development (HUD).
VVA applauds the Senate Appropriations Committee for having funded
$75,000,000 for the HUD-VASH Program in Public Law 110-161. There is,
however, a gap in HUD-VASH and the veterans eligible to receive the
vouchers. This gap is hurting homeless veterans who need the most
intensive intervention to help deal with the conditions that have
rendered them homeless. Though HUD-VASH and the case management
provided by the VA are significant, in far too many instances they are
not intensive enough for those homeless veterans with severe mental
health illnesses. Many of these veterans do not meet the criteria for
Mental Health Intensive Case Management (MHICM) through the VA because
they have not had multiple admissions to mental health facilities; they
do not meet the criteria of HUD-VASH because they need such intensive
case management. Hence, they are left with few, if any, chances or
opportunities for independent living.
VVA certainly supports continued, and increased, funding for the
existing HUD/VASH voucher program. This program is critical if we as a
nation are to significantly reduce, if not necessarily eliminating,
homelessness among our Nation's veterans. Oversight of the HUD/VASH
program will prove to be an invaluable tool in the continuance and
expansion of this program.
Oversight is necessary to ensure that these vouchers, and any
additional vouchers, will be administered, distributed, and utilized to
the fullest extent possible. By tracking the outcomes of the current
HUD/VASH voucher program, a full annual evaluation of their
effectiveness will, we believe, illustrate the effectiveness of the
program, and the need for additional vouchers.
This concludes my testimony Mr. Chairman. I will be pleased to
answer any questions you may have at this time.
Prepared Statement of Blake C. Ortner, Senior Associate Legislative
Director, Paralyzed Veterans of America
Chairman Michaud and Members of the Subcommittee, on behalf of
Paralyzed Veterans of America (PVA), I would like to thank you for the
opportunity to present PVA's position on the legislation pending before
the Subcommittee, as well as four draft bills you are preparing.
PVA has always been a strong supporter of helping homeless
veterans. As has been stated many times, the VA estimates that nearly
200,000 veterans are homeless on any given night, and that
approximately 400,000 veterans experience homelessness in a year. While
these numbers are lower than they have been reported in the past, this
is clearly a massive problem that the VA, veterans service
organizations, homeless providers, and similarly interested parties,
have all tried to help overcome. This is a tragedy that continues to
plague our Nation. PVA believes that the legislation discussed here
today may help to continue to reduce these unfortunate numbers.
H.R. 2504
PVA strongly supports H.R. 2504, to provide for an increase in the
annual amount authorized the Secretary of Veterans Affairs to carry out
homeless veterans programs from $150 million to $200 million. With
large numbers of veterans still on the streets at night, and the
troubled economy increasing the risk for more people becoming homeless,
not just veterans, this increase will provide much needed funds to
continue the reduction of homelessness. But we ask that the members
work with the appropriators to ensure this funding is made available or
it simply becomes an empty gesture.
H.R. 2559, the ``Help Our Homeless Veterans Act''
PVA strongly supports H.R. 2559, the ``Help Our Homeless Veterans
Act.'' Outreach is critical to reducing homelessness. We are
particularly pleased that the legislation not only targets veterans who
are homeless, but those who are at risk of becoming homeless with a
special emphasis on our women veterans who face so many additional
dangers on the street. To be effective, this program should use a wide
variety of techniques including billboards and outdoor advertising in
locations that the homeless may frequent. It should also include use of
the Internet. While the homeless and those at risk may not have access
to the Internet, friends and family may. Providing this information
will inform them of programs that they may be able to use to steer
their friends and loved ones toward getting the help they need.
H.R. 2735
PVA supports H.R. 2735, a bill that will make improvements to the
comprehensive programs for homeless veterans. However, we do have some
concerns about the long-term effects of the legislation. PVA has always
supported the idea of comprehensive care for homeless veterans. Seldom
is there one issue that leads veterans to become homeless.
Additionally, often homeless veterans reside in urban areas where the
cost of living is very high and there are limited opportunities for
help. Section two of H.R. 2735 allows the Secretary of Veterans Affairs
to increase the rates of payment to reflect anticipated changes in the
cost of services and takes into account the cost of providing these
services in particular geographic areas.
While we welcome this consideration, PVA is concerned about the
long-term effects of this legislation on VA homeless program funding.
By adjusting the payments for geographic areas, which we believe is
aimed at providing greater funding to high cost localities, this may
actually reduce the total number of homeless veterans that can be
served if future increases in overall program funding are insufficient.
While the argument could be made that ``reductions'' in funding for low
cost areas may offset increases to high cost areas, the funding levels
provided for homeless programs are seldom sufficient to provide for all
the veterans who may need to take advantage of these critical services.
Discussion Draft of legislation to improve per diem grant payments for
organizations assisting homeless veterans
Discussion Draft of legislation to direct the Secretary of VA to
eliminate the required reduction of per diem payments due to other
sources of income
In conjunction with H.R. 2735 are the discussion drafts of
legislation to improve per diem grant payments for organizations
assisting homeless veterans and to eliminate the required reduction of
per diem payments provided to entities furnishing services due to other
sources of income. The first bill would set the per diem rate at an
amount equal to the greater of the daily cost of care or a fixed per
diem rate of $60. This legislation would have the advantage of setting
a ``floor'' and allow for planning by homeless veteran providers. PVA
supports this idea, however, is concerned about other aspects of the
draft.
The legislation proposes that the Secretary of VA ensure that 25
percent of funds available for payments shall be made available for
grant recipients or eligible entities which ``furnish services to
homeless individuals, of which less than 75 percent are veterans.'' PVA
understands this to mean that an entity which provides services to the
homeless, and only 1 percent, or for that matter 0 percent, of those
receiving services are veterans, will get funding from the VA. While we
understand that there are homeless providers that may serve a minimal
number of veterans, VA funding should be targeted toward veterans'
providers who provide for veterans.
The second bill would eliminate the reduction in the amount of per
diem payments to entities furnishing services to homeless veterans to
account for other sources of income. PVA has consistently opposed these
reductions and supports this legislation. In June 2007, PVA testified
in favor of H.R. 2699 which also would have done away with the offset
of per diem payments against other sources of income for homeless
veterans' service providers. It makes no sense to take away resources
from an entity that devotes its time and resources to overcoming a
significant problem among the veterans population. Homeless service
providers need to be able to take advantage of every resource available
to them in order to successfully assist at risk veterans.
H.R. 3073
PVA welcomes H.R. 3073, which directs the Secretary of Veterans
Affairs to establish a grant program to assist veterans at risk of
becoming homeless. With few exceptions, veterans do not suddenly become
homeless. It is often a long path that leads to the tragedy of
homelessness. H.R. 3073 may go a long way toward interceding in this
cycle and we sincerely thank Mr. Nye for introducing this forward
thinking legislation. We are particularly pleased that as part of the
legislation, one of the requirements to receive the grant includes
ensuring that at the onset of providing assistance, the veteran is
receiving the supportive services that may prevent homelessness. Of
particular note is that this includes job training and substance abuse
treatment. It is much easier to prevent a veteran from becoming
homeless than it is to return them to normalcy after they are on the
streets.
Discussion Draft of legislation to reform and expand VA Supportive
Housing Program carried out by HUD
PVA also welcomes the discussion draft legislation to reform and
expand the VA Supportive Housing Program carried out by the Department
of Housing and Urban Development and VA. As with H.R. 3073, programs
that can help keep or return a homeless veteran to housing set the
stage for providing the other programs to support the homeless veteran.
Providing housing voucher assistance to the chronically homeless
veteran can be the first step to recovery.
Often one of the greatest challenges the homeless have is a stable
address at which they can be contacted for benefits, follow-up or even
to place on a job application or bank account. This legislation may
provide that important first step for a veteran to end their cycle of
homelessness. This legislation, just as with H.R. 3073, requires the
veteran receiving the voucher to agree to continued treatment for the
conditions that may have led to their homelessness. This may start them
on the path to employment, permanent residency and a significantly
increased quality of life.
PVA also is glad to see a program of training and technical
assistance included in the legislation. Educating medical center case
management workers on inspections and lease processes can both make
these caseworkers more effective and build the critical partnerships
between those who provide homeless services.
PVA does have one concern. The draft calls for a specific set-aside
for Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF)
veterans. Though we understand the serious desire of Congress to help
our most recent veterans, the scourge of homelessness is so serious
that to potentially limit resources for non OEF/OIF veterans is a
mistake. All our homeless veterans should have an equal chance at any
help that may be available.
H.R. 1017, the ``Chiropractic Care Available to All Veterans Act''
PVA supports the provisions of H.R. 1017, the ``Chiropractic Care
Available to All Veterans Act.'' Chiropractic care has become a widely
accepted and used medical treatment. It is a treatment covered by
TRICARE and it is only appropriate that it should be provided at VA
facilities. But it is also important for the Subcommittee to recognize
that by providing this treatment benefit to veterans, it will entail a
new type of care which is currently not considered in funding. When new
treatments are authorized at VA facilities, they must be considered
when determining VA appropriations to prevent those becoming unfunded
mandates.
H.R. 1036, the ``Veterans Physical Therapy Services Improvement Act of
2009''
PVA strongly supports H.R. 1036, the ``Veterans Physical Therapy
Services Improvement Act of 2009'' and we thank Ms. Herseth Sandlin for
introducing this legislation. As the wars in Afghanistan and Iraq
continue, more and more veterans of the War on Terrorism are in need of
physical therapy. As the language of the legislation indicates, the
aging veteran population is also increasing the need for these
services. Creating a Director of Physical Therapy Service position will
provide the Secretary with someone to oversee and guide this
increasingly important program. In addition, dictating the
qualifications for appointment of physical therapists will help ensure
the quality of the physical therapists hired by VA.
PVA is also supportive of creating a fellowship program for
physical therapists in the areas of geriatrics, amputee rehabilitation,
particularly for our returning Afghanistan and Iraq war veterans, and
polytrauma and rehabilitation research. With the coming potential
critical shortage of these care professionals, efforts must be made now
to recruit and retain these needed specialists.
H.R. 3441
PVA supports H.R. 3441, to provide for automatic enrollment of
veterans returning from combat zones into the VA medical system. During
the hectic activities of discharge, many military members leaving
active duty may not consider the importance of enrolling in the VA.
They may not think it is important if they have already identified
employment that will provide health care benefits. Automatic
enrollment, with the option not to enroll, is a benefit that should be
afforded to these heroes as they leave service to this nation.
Absent from the legislation is a clear consideration for our
mobilized National Guard and Reservists as they are demobilized from
wartime service. The period when a member of the Reserves demobilizes
is an extremely hectic time when the main thought of the servicemember
is to get back home to their family. They are no less deserving of
automatic enrollment and it may be even more important as they do not
have the long period of preparation often afforded to those being
discharged from active service. We would ask that the Subcommittee
consider including this in the legislation.
Draft of legislation to transfer funds from VA to the Secretary of
Health and Human Services for a graduate education program
PVA does not support the draft legislation from Chairman Michaud to
transfer funds from VA to the Secretary of Health and Human Services
(HHS) for a graduate education program as it is currently written. PVA
recognizes the value of transferring funds to HHS due to their
established programs for graduate education, but we do not believe in
this time of tight budget allocations that VA should be transferring
funds to another agency without a better guaranteed benefit for VA. The
provision that when awarding grants the Secretary of HHS is only
required to give a ``preference'' to health care facilities of the VA,
when these funds are coming from VA, seems beyond comprehension. We
would sincerely hope that only in the event VA did not apply for the
grant would it be awarded to a non-VA program or facility.
PVA appreciates the opportunity to comment on the bills being
considered by the Subcommittee. We look forward to working with you to
further improve the health care services available to veterans, in
particular homeless veterans and those at risk of becoming homeless. I
would be happy to answer any questions that you might have. Thank you.
Prepared Statement of Peter H. Dougherty Director,
Homeless Veterans Programs, Office of Public and Intergovernmental
Affairs, U.S. Department of Veterans Affairs
Good morning, Mr. Chairman, and Members of the Subcommittee.
Thank you for inviting me here today to present views on several
bills that would affect Department of Veterans Affairs (VA) programs of
benefits and services. Joining me today are Jane Clare Joyner, Deputy
Assistant General Counsel, and Paul E. Smits, Associate Chief
Consultant, Homeless and Residential Rehabilitation and Treatment
Programs, veterans Health Administration. We appreciate the opportunity
to address four bills that would affect the Department's programs for
homeless veterans. Unfortunately, we did not receive H.R. 1017, H.R.
1036, H.R. 3441, or two draft bills in time to provide our views and
costs. We will forward these as soon as they are available.
H.R. 2504--``To Increase the Amount Authorized to Be Appropriated for
Comprehensive Service Programs for Homeless Veterans''
H.R. 2504 would amend 38 U.S.C. 2013 to raise the authorized amount
to be appropriated from $150,000,000 to $200,000,000 beginning in FY
2010 and each fiscal year thereafter.
VA supports H.R. 2504 in principle but has concerns about the
proposed annual authorization level. 38 U.S.C. 2013 currently
authorizes an appropriation up to $150,000,000 for the Grant-and-Per-
Diem (GPD) program. The Administration and the Department have a goal
of ending homelessness among our Nation's veterans within 5 years. To
achieve this goal, VA will assist every eligible homeless veteran
willing to accept services. We will help them acquire safe housing and
obtain needed treatment, services, and benefits assistance, while also
providing opportunities to return to employment. VA's plan includes
education, job training, substance abuse and mental health care, and an
assortment of other benefits. It will require close partnership with
Federal and State agencies, local, non-profit and private groups;
outreach and education to veterans, people and organizations providing
services to veterans, and the general public; universal and targeted
prevention; treatment focused on recovery and tailored to individual
veterans' needs; housing and supportive services; and income,
employment and benefits assistance. For example, we will continue our
collaborative efforts with the Department of Labor to provide
employment services. We will leave no opportunity unexplored, and we
will continue this pursuit until every veteran has safe housing
available and access to needed treatment services. We are eager to work
with Congress to provide these services to veterans.
VA estimates that the proposed maximum annual authorization level
of $200 million would be inadequate for the amounts of VA projects
delivering comprehensive services through this important program. We
recommend that a specific authorization funding level be dropped from
the statute. This is a well established program in VA and need not be
constrained.
If the specific authorization ceiling in H.R. 2504 is enacted, VA's
resources to execute this program would be limited to $146.3 million in
FY 2010, $189.2 million in FY 2011, $935.5 million over 5 years, and
$1.9 billion over 10 years.
H.R. 2559--``Help Our Homeless Veterans Act''
H.R. 2559 would require VA to carry out a national media campaign
targeting veterans who are homeless or who are at risk of becoming
homeless, with special emphasis on women veterans. The Secretary would
be required to inform veterans of their rights and benefits under the
laws administered by the Secretary and would advise them where to turn
for help if they are already homeless or at risk of becoming so.
VA supports outreach to homeless veterans but H.R. 2559 duplicates
existing statutory authority. We would welcome the opportunity to work
with Committee staff in order to address this concern.
Congress already provided this authority last year in Public Law
110-389, which created section 532 of title 38. That authorized the
Secretary to purchase advertising in national media outlets to promote
awareness of benefits administered by the Secretary, including programs
to assist homeless veterans. This extant authority is preferable to
H.R. 2559 as it does not require VA to target only veterans. Targeting
veterans alone will not be sufficient to achieve the goal of ending
veteran homelessness, while a coordinated national campaign reaching
veterans, those who provide benefits and services, as well as the
general public can help achieve this goal. If new legislation
nevertheless goes forward, it should support advertising and media
outreach directly to public and private, State, tribal and community
agencies that serve the homeless population to enhance referrals to VA.
We estimate that a national media program targeting veterans, those
who provide benefits and services to the homeless, as well as the
general public would cost $600,000 in FY 2010, $618,000 in FY 2011,
$3.2 million over 5 years, and $6.9 million over 10 years.
H.R. 2735--``To Make Certain Improvements to the Comprehensive Service
Programs for Homeless Veterans''
Section 1 of H.R. 2735 would add a new subsection to 38 U.S.C. 3011
to specifically allow service centers receiving grants from VA to use
these funds for staffing to ensure services are provided during
specified hours, as well as on an as-needed, unscheduled basis. Section
2 would eliminate all references to ``per diem'' in 38 U.S.C. 2012 and
change the basis of grants from the ``daily cost of care'' to the
``annual cost of furnishing services.'' It would also remove the
prohibition on VA providing a rate in excess of the rate authorized for
State domiciliaries and grant the Secretary the discretion to set a
maximum amount payable to grant recipients. Section 2 would also direct
the secretary to increase the rate of payment to reflect anticipated
changes in the cost of furnishing services and take into account the
cost of services in different geographic areas. It would remove the
requirement that the secretary consider other available sources of
funding and would leave it to his or her discretion. Finally, it would
allow grant recipients to use VA grants to match other payments or
grants from other providers. In sum, this bill would dramatically
change VA's grant-and-per-diem (GPD) program, which has been a key
factor in reducing veteran homelessness from 195,000 to 131,000 over
the last 3 years. GPD is designed to support transitional housing for
veterans; however, in the last several years the program has expanded
its range of services toward permanent housing to provide veterans
stable and continuous care. VA generally supports this bill, but is
apprehensive that this legislation will result in policy problems and
lead to significantly higher costs.
VA supports section 1. GPD has 35 operational service centers (18
in rural areas, 17 in urban areas), and billing among these service
centers varies significantly. Although service centers are currently
not the most robust intermediaries for delivering services, these
partners have played a vital role in VA's success in combating veteran
homelessness over the last several years and will continue offering
essential services as we work toward the goal of ending veteran
homelessness. We believe that this legislation may make these entities
more fiscally solvent as the additional funding would offset the needed
staffing costs. VA's Advisory Committee on Homeless veterans has
recommended for several years that this authority be given to grant
recipients.
VA estimates the cost of section 1 of H.R. 2735 would be $5.2
million in FY 2010, $6.1 million in FY 2011, $35.6 million over 5 years
and $101.6 million over 10 years.
Concerning section 2, VA is currently evaluating the impact of
section 2, which shifts from the ``per diem'' or ``daily cost of care''
approach to an ``annual cost of furnishing services.'' Though this
change may offer VA's partners needed capital and funds at the
beginning of the fiscal year to support their work, it would require
significantly more detailed auditing as well as increased direct
oversight by VA. We would welcome the opportunity to discuss these
issues with Committee staff, and ask the Committee to defer on this
provision until we have fully evaluated the impact of this proposal.
VA does not oppose removing the existing rate cap. Currently, the
statute limits VA's GPD payments to the rate for state domiciliary
care, and the difference between what VA pays and the actual cost of
expenditures is absorbed by the provider. Allowing the Secretary to
establish the basis and the formula for payment based on cost and
geographic location would increase the sustainability of community-
based providers and promote increased and more comprehensive services
for veterans. However, the language of the bill is restrictive in that
it only authorizes VA to increase the rate of payment from year to
year; VA would be unable to respond to any situation or development
that might lower the operating costs for grant recipients. As a result,
VA could be forced to pay above-cost rates to providers. We
consequently recommend the language be modified to say ``adjust''
instead of ``increase.''
The bill would also no longer require the Secretary to consider the
availability of other sources of income for grant recipients. The
difference between ``may,'' as the bill specifies, and ``shall,'' as
the statute currently provides, is in this instance insignificant as
the Secretary would in all likelihood consider the availability of
other funds in any event. H.R. 2735 would allow providers to use VA
funds to secure matching amounts from other agencies or organizations.
VA believes that multiple agencies should not contribute funding for
the same objective or project, and that overlapping funds can introduce
waste and inefficiency. VA has no objection to this provision; however,
it suggests that the language be amended to prohibit duplication and
allow for adjusted rather than solely increased funding.
VA estimates the cost of enacting section 2 of H.R. 2735 would be
$455.9 million in FY 2010, $542.2 million in FY 2011, $3.2 billion over
5 years and $8.1 billion over 10 years.
H.R. 3073--``To Establish a Grant Program to Provide Assistance to
Veterans Who Are At Risk of Becoming Homeless''
H.R. 3073 would create a new grant program that would require the
Secretary to provide grants to public entities and private non-profit
organizations to provide financial support for veterans at risk of
homelessness. The bill defines these veterans as those in ``imminent
danger of eviction or foreclosure,'' who demonstrate a ``compromised
ability'' to make rental or mortgage payments, and who meet eligibility
requirements established by grant recipients. Specifically, the bill
would require grant recipients to make payments for up to 3 months on
behalf of veterans for mortgage, rental or utility payments and to
ensure these veterans receive supportive services such as job training,
mental health and substance abuse treatment, and other services
including support from the Department of Labor and the Department of
Housing and Urban Development. Grant recipients would apply for these
funds as per diem providers currently do. The bill would allow recovery
of unused funds at the end of a 3-year period and would authorize up to
$100,000,000 for FY 2011, 2012 and 2013.
VA supports preventive measures for at-risk veterans in principle
but does not support H.R. 3073 because certain portions of this bill
duplicate existing statutory authority and others would not make the
best use of Department resources. We would welcome the opportunity to
discuss these issues with Committee staff in order to develop language
that addresses these concerns.
Section 604 of Public Law 110-387, codified at 38 U.S.C. 2044,
provides VA with authority to offer grants to organizations offering
supportive services of the kind described in H.R. 3073 for low-income
veterans and their families. VA is currently developing regulations to
implement this legislation. We also note the 3-month eligibility for
the services offered under H.R. 3073 is too short to effectively remove
the risk of homelessness for many veterans and their families. For
veteran homeowners with non-VA mortgages, temporary relief for 3 months
would likely prove insufficient to resolve the underlying conditions
contributing to their potential homelessness if the terms of the
mortgage have changed, as they would under an adjustable-rate mortgage,
rather than as a result of changes in their personal situations. The
Administration has pursued a number of initiatives to keep such
homeowners, including veterans, in their residences. H.R. 3073 may
duplicate those efforts as well.
In addition, the Veterans Benefits Administration offers assistance
to veterans who encounter problems making their mortgage payments. When
a VA-guaranteed home loan becomes delinquent, the loan servicer has the
primary responsibility of servicing the loan to help cure the default.
VA provides financial incentives for servicers who arrange reasonable
repayment plans or pursue other home retention options for veterans. In
some cases loan modification may help make payments more affordable,
and VA made extensive rule changes in early 2008 to make loan
modifications easier for servicers to arrange. However, in cases where
the servicer is unable to help the veteran borrower retain the home or
find a suitable alternative to foreclosure, VA's Loan Guaranty Service
has Loan Technicians in nine Regional Loan Centers and the Hawaii
Regional Office who review all cases prior to foreclosure to evaluate
the adequacy of the loan servicing. Loan Technicians may initiate
supplemental servicing by contacting the veteran to determine whether
any further assistance is possible, and veterans may also call a
nationwide toll-free contact number at any time during the process to
receive loan counseling from VA. In some cases, VA will purchase a loan
from the holder and modify the terms so that a veteran can retain his
or her home. The Regional Loan Centers can also provide advice and
guidance to veterans with non-VA guaranteed home loans, but VA does not
have the legal authority or standing to intervene on the borrower's
behalf in these situations. Under the Veterans' Benefits Improvement
Act of 2008 (Public Law 110-389), veterans with non-VA guaranteed home
loans have new options for refinancing to a VA guaranteed loan.
Veterans who wish to refinance their subprime or conventional mortgage
may do so for up to 100 percent of the value of the property, generally
up to a maximum of $417,000. High-cost counties have even higher
maximum guaranty amounts, which can result in higher maximum loan
limits. These changes allow more qualified veterans to refinance
through VA, allowing for savings on interest costs and avoiding
foreclosure. Additionally, some veteran borrowers may be able to
request relief pursuant to the Servicemembers Civil Relief Act (SCRA).
In order to qualify for certain protections available under the Act,
the veteran's obligation must have originated prior to the current
period of active military service. SCRA may provide a lower interest
rate or forbearance, or prevent foreclosure or eviction, even after the
borrower's period of military service ends.
VA estimates there would be no costs associated with H.R. 3073 in
FY 2010, with $100 million in costs for FY 2011 through FY 2014, for a
5 and 10 year total of $300 million.
This concludes my prepared statement. I would be pleased to answer
any questions you or any of the Members of the Subcommittee may have.
American Chiropractic Association
Arlington, VA.
October 8, 2009
Hon. Michael H. Michaud, Chairman
House Committee on Veterans' Affairs
Subcommittee on Health
338 Cannon House Office Building
Washington, DC 20515
Hon. Henry E. Brown Jr.,
Ranking Member
House Committee on Veterans'
Affairs
Subcommittee on Health
338 Cannon House Office
Building
Washington, DC 20515
RE: Statement of the American Chiropractic Association in Support of
H.R. 1017, the Chiropractic Care Available to All Veterans Act
Dear Chairman Michaud and Ranking Member Brown:
On behalf of the American Chiropractic Association (ACA), we thank
you for providing an opportunity to submit a statement for the official
subcommittee record on H.R. 1017, the Chiropractic Care Available to
All Veterans Act.
ACA provides professional and educational opportunities for doctors
of chiropractic (DCs), supports research regarding chiropractic and
health issues, and offers leadership for the advancement of the
profession. With approximately 15,000 members, ACA promotes the highest
standards of ethics and patient care, contributing to the health and
well-being of millions of chiropractic patients.
ACA wholeheartedly supports H.R. 1017 and believes it will assist
millions of veterans in receiving quality care, especially for the
treatment of musculoskeletal injuries and conditions. Painful and
disabling joint and back disorders are the top health problems of
veterans returning from Iraq and Afghanistan, according to Department
of Veterans Affairs (VA) statistics from earlier this year (``Analysis
of VA Health Care Utilization Among U.S. Global War on Terrorism
Veterans, Jan. 2009'').
In recent years, after decades of inaction and neglect, the VA
finally began the long-overdue process of providing veterans access to
chiropractic care by placing doctors of chiropractic on staff at VA
hospitals. The process of integrating chiropractic care in the VA
system was initiated after Congress enacted a series of statutes (P.L.
108-170 and P.L. 107-135) including specific directives to hire doctors
of chiropractic and place them at VA health care facilities.
Although a chiropractic benefit has theoretically been available
within the VA system for many years, Congress took action when it
became apparent that VA had failed to take any reasonable steps to
provide veterans with chiropractic care. As a result of the
congressional directives cited earlier, as well as recommendations
issued by a congressionally mandated advisory committee, the VA
currently provides chiropractic care (via hired or contracted staff) at
32 major VA treatment facilities within the United States.
In VA facilities where they are available, chiropractic services
have become an integrated and appreciated part of patient treatment.
Doctors of chiropractic in the VA are treated as peers and colleagues,
and are regarded as a valuable source of information in the care of VA
patients.
By all accounts, the treatment provided by DCs in the VA is
regarded as a highly effective, cost-efficient course of treatment with
positive outcomes and a high level of patient satisfaction.
Additionally, doctors of chiropractic in the VA bring new ideas and
viewpoints to patient-centered care, clinical research and education.
These new perspectives help strengthen the VA by fostering innovative
approaches and strategies.
Numerous veterans' service organizations agree that chiropractic
care is an essential component of the VA health care system. Among
those that support the inclusion of chiropractic in the VA are the
Vietnam Veterans of America, the American Legion, the Paralyzed
Veterans of America and the Veterans of Foreign Wars, which stated,
``We believe this legislation to be of great importance in
consideration of the various injuries veterans have received and the
known benefits for chiropractic care.''
Despite this progress, the overwhelming majority of America's
eligible veterans continue to be denied access to chiropractic care
because the VA has failed to take steps to provide chiropractic care at
approximately 120 additional VA treatment facilities--comprising the
major sites where VA care is offered. Detroit, Denver, and Chicago are
just a few examples of major metropolitan areas still lacking a doctor
of chiropractic at the local VA medical facility.
Shockingly, this disparity continues despite important data
demonstrating a critical need within the VA for the specific and
specialized type of health care services that doctors of chiropractic
provide. ACA believes that integrating chiropractic treatment into the
VA health care system would not only be cost-effective, it would also
speed the recovery of many of the veterans returning from current
operations in Iraq and Afghanistan.
As mentioned earlier, a January 2009 VA report indicates that more
than 49 percent of veterans returning from the Middle East and
Southwest Asia who have sought VA health care were treated for symptoms
associated with musculoskeletal ailments--the top complaint of those
tracked for the report.
These patients commonly suffer musculoskeletal injuries from combat
due to heavy gear and body armor, motor vehicle accidents, and of
course blast injuries or polytrauma. Clearly, the need for expanded
access to services delivered by doctors of chiropractic has never been
more crucial.
To correct this disparity, Congressman Bob Filner, Chairman of the
House Committee on Veterans Affairs, introduced H.R. 1017, the
Chiropractic Care Available to All Veterans Act, which aims to expand
the number of chiropractic physicians at major VA medical centers.
Without a congressional directive, further expansion to VA facilities
will happen on a case-by-case basis and more than likely will be
excruciatingly slow.
H.R. 1017 will codify chiropractic as a covered service throughout
the VA health care system, requiring the VA to have a doctor of
chiropractic on staff at all VA medical facilities by 2012. It also
amends the current statute, the Department of Veterans Affairs Health
Care Programs Enhancement Act of 2001, ensuring that chiropractic
benefits cannot be denied.
Veterans want, need and deserve access to chiropractic care, and
our goal should be to ensure that chiropractic is available and
accessible at every major VA health care facility. The chiropractic
profession welcomes the opportunity to serve our Nation's veterans. It
is an honor to give back to those who have given so much for us.
Passage of the Chiropractic Care Available to All Veterans Act will
ensure that our veterans receive the highest level of care possible in
some of the world's finest medical settings. The American Chiropractic
Association urges Congress to pass this legislation immediately.
Sincerely,
Rick A. McMichael, DC
President
Statement of American Physical Therapy Association
On behalf of the more than 72,000 members of the American Physical
Therapy Association (APTA), we appreciate this opportunity to provide
our statement in support of H.R. 1036, the Veterans Physical Therapy
Services Improvement Act of 2009. This bill would amend title 38,
United States Code, to establish the position of Director of Physical
Therapy Service within the Veterans Health Administration and to
establish a fellowship program for physical therapists in the areas of
geriatrics, amputee rehabilitation, polytrauma care, and rehabilitation
research. APTA would like to thank Representative Stephanie Herseth-
Sandlin for her leadership in introducing this important legislation.
APTA would also like to thank Chairman Filner, Chairman Michaud,
Representatives Sestak, Brown, Hare, Carnahan, Griffith, and
Kirkpatrick for cosponsoring H.R. 1036.
APTA is a professional organization representing the interests of
physical therapists (PTs), physical therapist assistants, and students
of physical therapy with a mission to advance physical therapy
research, practice and education. Physical therapists are licensed
health care professionals who diagnose and treat individuals of all
ages, from newborns to the elderly, with medical problems or health
related conditions that limit their ability to move and perform
functional activities in their daily lives. PTs examine each individual
and develop a plan of care using treatment techniques to promote the
ability to move, reduce pain, restore function and prevent disability.
Physical therapists practice in a variety of settings, including
hospitals, home health, private practices, and a number of Federal
agencies, such as the Veterans Administration (VA). Physical
therapists, at a minimum, receive a master's degree from an accredited
physical therapist education program before taking a national
examination that permits them to practice under state licensure laws. A
vast majority of physical therapists now graduate with a clinical
doctorate in physical therapy.
The primary challenge to meeting the rehabilitation needs of
veterans is the recruitment and retention of physical therapists. This
challenge is compounded by two trends that increase the need for
physical therapy services: chronic conditions associated with an aging
veteran population and the complex impairments associated with
returning veterans from Operation Enduring Freedom (OEF) in Afghanistan
and Operation Iraqi Freedom (OIF) in Iraq.
There is an increased need for physical therapists in the VA
system. The current challenges with recruitment and retention of PTs
within a changing environment only increases the need for
rehabilitation lead by these professionals. The three specific
recommendations APTA would make are outlined in H.R. 1036; the
establishment of a Director of Physical Therapy Service within the VA,
updating and codifying qualification standards for physical therapists,
and the establishment of a fellowship program to encourage the
recruitment and retention of specialized physical therapists within the
VA system.
Physical Therapists in the VA: An Increasing Need for Rehabilitation Ser
vices
With more than 1,000 \1\ physical therapists on staff, the VA is
one of the largest employers of physical therapists nationwide.
Physical therapists have a long history of providing care to our active
duty military and to our Nation's veterans. In fact, our professional
roots started by rehabilitating soldiers as they began returning from
World War I. Back then, physical therapists were known as
``reconstruction aides.'' Today, physical therapists in the VA render
evidence-based, culturally sensitive care and many have been recognized
leaders in clinical research and education. Physical therapists in the
VA practice across the continuum of care, from primary care and
wellness programs to disease prevention and post-trauma rehabilitation.
Clinical care practice settings that incorporate physical therapists
include inpatient acute care, primary care, comprehensive inpatient and
outpatient rehabilitation programs, spinal cord injury centers and
geriatric/extended care.
---------------------------------------------------------------------------
\1\ At the end of fiscal year 2006, 1024 physical therapists were
employed by the VA. Department of Veterans Affairs.
---------------------------------------------------------------------------
The need for high quality rehabilitation provided by physical
therapists has never been greater with the dual challenges of caring
for the chronic diseases faced by aging veterans and the multifaceted
profile of many of today's wounded warriors. According to the VA, 9.2
million veterans are age 65 or older, representing 38 percent of the
total veteran population. By 2033, the proportion of older veterans
will increase to 45 percent of the total population.\2\
---------------------------------------------------------------------------
\2\ Department of Veterans' Affairs Web site ``VA Health Care Atlas
FY2000'', Accessed September 29, 2009 http://www.rorc.research.va.gov/
atlas/Chapter_1_Veteran_Population.pdf.
---------------------------------------------------------------------------
The second trend that highlights the need to recruit and retain
physical therapists in the VA is the changing profile of injuries and
impairments of our returning service personnel. Enhancements in
battlefield medicine have helped a larger portion of soldiers survive
their injuries, compared to previous wars our Nation has fought.\3\
Many of our Nation's recent veterans are facing unique injuries that
require complex rehabilitation including spinal cord injury, amputee
rehabilitation and traumatic brain injury. Physical therapists are a
key part of the VA's Polytrauma Rehabilitation Centers (PRC) caring for
TBI patients in Tampa, Palo Alto, Richmond and in Minneapolis. PRCs
have clinical expertise and include an interdisciplinary team to
provide care for complex patterns of injuries, including TBI, traumatic
or partial limb amputation, nerve damage, burns, wounds, fractures,
vision and hearing loss, pain, mental health and readjustment problems.
Physical therapists are also part of the specialized amputee
rehabilitation center at the Brooke Army Medical Center at Fort Sam
Houston, Texas.
---------------------------------------------------------------------------
\3\ Atul Gawande, ``Casualties of War-Military Care for the Wounded
from Iraq and Afghanistan,'' The New England Journal of Medicine,
vol.351, issue 24 (December 2004) p. 2471.
---------------------------------------------------------------------------
Physical therapists at these facilities have been at the forefront
in developing programs to care for our wounded warriors prior to the
creation of the PRC designation. Minneapolis, for example, has had a
TBI program with dedicated staff in TBI rehabilitation for over 10
years including physical therapists who have received the American
Board of Physical Therapy Specialties (ABPTS) specialist certification
in neurological, clinic specialists in geriatric and orthopedic
physical therapy. Jeffrey Newman, a PT who testified in front of this
Committee in 2007, has a clinical background in amputation
rehabilitation. He has cared for a generation of veterans and has seen
the growing need for physical therapist services through the years.
Current Recruitment and Retention Challenges for Physical Therapists in
the VA
Given the increasing number of aging veterans and the number of
OEF/OIF veterans needing physical therapy services, recruitment and
retention of qualified physical therapists is vital to ensuring our
veterans have access to the physical therapist services they need in a
timely fashion. The number one obstacle to both the recruitment and
retention of physical therapists serving in the VA was the severely
outdated qualification standards that governed the salary and
advancement opportunities for physical therapists employed by the VA.
The physical therapy profession has evolved as the need for our
services has expanded. The current minimal requirement to become a
physical therapist is to graduate with a master's degree (approximately
95 percent of programs now are graduating at the doctoral level \4\)
and pass a licensure test. The VA qualification standards that existed
only required a physical therapist to obtain a bachelor's degree and do
not recognize the doctorate of physical therapy, or DPT, degree. Not
only was this severely out of date with current minimal education
requirements but it was not competitive with clinical settings outside
of the VA system.
---------------------------------------------------------------------------
\4\ ``Doctor of Physical Therapy (DPT) Degree Frequently Asked
Questions'' American Physical Therapy Association. April 2008, Date
Accessed: September 29, 2009. http://www.apta.org/AM/
Template.cfm?Section=Professional_PT&TEMPLATE=/CM/
ContentDisplay.cfm&CONTENTID=16984
---------------------------------------------------------------------------
APTA began working with the VA to update the qualification
standards over 8 years ago and supports the following changes to
establish consistency between the VA and the current professional
practice of physical therapy as defined by the Guide to Physical
Therapist Practice:
Recognition of Educational and Clinical Training of the
Physical Therapist
Clarification of a career ladder in the Department of
Veterans Affairs for Physical Therapists
Recognition of the Doctoral Degree in Physical Therapy,
and
Expanded opportunities for career advancement for
physical therapists.
APTA received feedback from the VA that changes needed to be made
to update the qualification standards. These standards were updated in
February by General Shinseki. We commend the Secretary for implementing
these updated qualification standards and urge the Committee to make
them law. The establishment of appropriate and up to date qualification
standards will make it easier to both recruit and retain physical
therapists to serve our Nation's veterans.
The need for permanent codification of these revised standards is
due to several factors. First, with the demand for physical therapist
services on the rise, the outdated qualification standards made it
difficult to recruit physical therapists to the VA system. Second, the
increased need for services provided by qualified physical therapists
in the VA due to our aging veterans and meeting the complex
rehabilitation needs of our returning soldiers. Third, the outdated
qualification standards also limited the ability of a physical
therapist to advance within the VA system once they joined. The
standards did not recognize physical therapists that achieve specialty
certification such as those needed in the polytrauma centers. Fourth,
it had been approximately 8 years since the VA first recognized that
the standards needed to be updated.
In addition to the immediate approval and implementation across the
board--not just in select facilities--of the revised qualification
standards, APTA recommends enhancements to the current VA fellowship
and scholarship programs for physical therapists to help in both
recruitment and retention. Many new graduates are concerned with a high
amount of student loan debt when leaving school, scholarship and loan
repayment programs are an important tool in recruiting additional
physical therapists to meet the VA's need.
In the early 1990's, Mr. Jeffrey Newman, PT had the opportunity to
serve on the Committee to review scholarship program applicants when
the VA had a scholarship incentive program to attract new graduates.
Over the course of that particular program, his facility in Minneapolis
had five recipients. Of those original recipients, one was still in the
facility in late 2007 and two of the others stayed for several years;
only two left directly after their required service was complete. Mr.
Newman argued that the previous scholarship program provided an
incentive to serve right out of school whereas the new incentive
program, including the debt reduction program, is poorly advertised and
cumbersome for the potential applicants. In 2007, only 19 physical
therapists have participated in the Education Debt Reduction Program
and only 14 physical therapists have participated in the Employee
Incentive Scholarship Program.\5\
---------------------------------------------------------------------------
\5\ According to information on physical therapists from the HRRO
Education Database provided to APTA by the Department of Veterans'
Affairs on October 15, 2007.
---------------------------------------------------------------------------
With this in mind, APTA supports the establishment of fellowships
for physical therapists in the areas of geriatrics, amputee
rehabilitation, polytrauma care, and rehabilitation research. These
four areas, three clinical and one research, will attract specialized
physical therapists to the VA. As is stated above, this will not only
help recruit physical therapists to the VA to assist with debt burden,
but with training the PT receives under existing professionals they
will be able to provide the care veterans require upon their return
from conflicts overseas.
APTA also supports the creation of a new position, Director of
Physical Therapy Services. This new position would report to the
undersecretary of health of the Veterans Health Administration. It
would ensure that as the PT profession advances, the agency would keep
current with issues related to the physical therapy profession's
education, qualifications, clinical privileges, and scope of practice.
Given the high number of physical therapists practicing within the VA
system, the Director position can ensure that all PTs have the best and
most up to date tools to give our Nation's veterans the best care
possible.
APTA recommends the codification of the qualification standards for
physical therapists in the VA, the creation of new programs and the
enhancement of current programs offering fellowships, scholarships,
loan support and debt retirement for physical therapists choosing to
serve in the VA, and the establishment of a Director of Physical
Therapy Service. These will assist in both the recruitment and
retention of qualified physical therapists to meet the needs of our
veterans today and tomorrow.
Physical therapists are a vital part of the health care network
that provides services to our Nation's veterans. Ensuring that the
qualification standards that govern the salary and advancement
opportunities for physical therapists in the VA are up to date and
reflective of the current professional practice of physical therapy as
well as enhancing current scholarship opportunities will help recruit
and retain more physical therapists to the VA system.
APTA would like to thank the Chairman, Ranking Member, the
Committee and Representative Herseth-Sandlin for the opportunity to
submit testimony in support of H.R. 1036, the Veterans Physical Therapy
Services Improvement Act of 2009. APTA is eager to work with the House
Committee on Veterans Affairs Subcommittee on Health to improve the
quality of, and the access to care for our Veterans.
Statement of American Tinnitus Association
The American Tinnitus Association (ATA), the largest member-based
tinnitus research funding organization in the United States, which
exists to cure tinnitus through the development of resources that
advance tinnitus research, strongly supports Representative Harry
Teague's efforts on behalf of America's veterans to properly assess,
treat and conduct research toward a cure for tinnitus, as outlined in
H.R. 2506.
Noise is the leading cause of tinnitus, commonly referred to as
``ringing in the ears.'' Head and Neck trauma are the second known
cause of tinnitus. Operations Enduring and Iraqi Freedom (OEF/OIF) are
some the noisiest battlegrounds yet. Roadside bombs--the signature
weapon of the insurgency--regularly hit patrols, and can cause hearing
loss and tinnitus instantaneously. In addition, Traumatic Brain Injury
(TBI), one of the signature wounds of these conflicts, is producing a
whole new generation of soldiers with both mild and severe head
injuries that are often accompanied by tinnitus.
For millions of Americans, tinnitus becomes more than an annoyance.
Chronic tinnitus can leave an individual feeling isolated and impaired
in their ability to communicate with others. This isolation can cause
anxiety, depression, and feelings of despair. Tinnitus affects an
estimated 50 million, or more, people in the United States to some
degree. Ten million to 12 million are chronically affected and one to
two million are incapacitated by their tinnitus.
Tinnitus disproportionately impacts veterans from all periods of
service. According to the Department of Veterans Affairs own
statistics, the number of veterans who are receiving service-connected
disability compensation for tinnitus has risen steadily over the past
10 years and spiked sharply in the past five. Since 2001, service-
connected disability for tinnitus has increased alarmingly by 18
percent per year. In 2006, the cost to compensate veterans for tinnitus
was $539 million. Based on that 5-year trend, the total cost of
veterans receiving service-connected disability compensation for
tinnitus alone will top $1 billion by the year 2011. Veterans with
tinnitus may be awarded up to a 10 percent disability, which currently
equals about $120 a month.
Servicemembers are exposed to extreme noise conditions on a daily
basis during both war and peacetime. During present-day combat, a
single exposure to the impulse noise of an Improvised Explosive Device
(IED) can cause tinnitus and hearing damage immediately. An impulse
noise is a short burst of acoustic energy, which can be either a single
burst or multiple bursts of energy. Most impulse noises, such as the
acoustic energy emitted from an IED, occur within 1 second. However,
successive rounds of automatic weapon fire are also considered impulse
noise. According to the NationalInstitute for Occupational Safety and
Health prolonged exposure from sounds at 85+ decibel levels (dBA) can
be damaging, depending on the length of exposure. For every 3-decibel
increase, the time an individual needs to be exposed decreases by half,
and the chance of noise-induced hearing loss and tinnitus increases
exponentially. A single exposure at from and IED at 140+ dBA may cause
tinnitus and damage hearing immediately. Experiencing tinnitus on the
battlefield also compromises situational awareness, which ``in
theater'' can very literally mean the difference between life and
death.
The Role of Medical Research
Research has increased our knowledge about tinnitus, particularly
within the past 10 years. The scientific community now understands that
tinnitus is a condition of the auditory system, with its origins in the
brain, and believes that a cure is possible. Over the past 10 years,
the discoveries by the medical research community on tinnitus and its
neurological origins have increased dramatically. The use of imaging
technologies like Positron Emission Tomography (PET) scans, functional
Magnetic Resonance Imaging (fMRI), Magnetic Resonance Spectroscopy
(MRS) have allowed researchers to ``see'' tinnitus when it is present
or active in a patient. Because of these discoveries we also now know
that tinnitus a condition of the auditory system, not a disease of the
ear, with many contributing factors to its onset, persistence and
recurrence. Researchers now are developing ways to treat the origins of
tinnitus, instead of treating the symptoms of tinnitus as they had done
for many years before they knew about the brain's involvement.
In the U.S. in 2008, there was only $3 million available between
all public and private funding for tinnitus research. Compared with the
staggering cost of simply compensating our veterans for tinnitus, this
amount of research funding is woefully inadequate. We know that the
existing therapies for tinnitus do not cure tinnitus. At best, they can
help mitigate tinnitus. However these therapies do not work for every
person afflicted with tinnitus. By continually increasing the
opportunity for tinnitus research, better treatments for our veterans
with tinnitus will be discovered on the road to a cure.
With so many of our brave men and women in uniform returning from
combat with tinnitus, this will only continue to be an unresolved
problem if we don't work together on solutions for tinnitus. H.R. 2506
will not only provide proper assessment of tinnitus for America's
veterans but commit to researching this condition to help further the
knowledge toward a cure. We offer our full support and expertise to any
member of this panel who might like to know more about tinnitus.
MATERIAL SUBMITTED FOR THE RECORD
Committee on Veterans' Affairs
Subcommittee on Health
Washington, DC.
October 1, 2009
Mr. Joseph L. Wilson
Deputy Director, Veterans Affairs and Rehabilitation Commission
The American Legion
1608 K Street, NW
Washington, D.C. 20006
Dear Mr. Wilson:
Thank you for your testimony at the U.S. House of Representatives
Committee on Veterans' Affairs Subcommittee on Health legislative
hearing on H.R. 1017, H.R. 1036, H.R. 2504, H.R. 2559, H.R. 2735, H.R.
3073, H.R. 3441, H.R. 2506, and Draft Discussions on Homelessness,
Graduate Psychology Education, and Psychiatric Service Dogs that took
place on October 1, 2009.
Please provide answers to the following questions by 6:00 P.M. on
Wednesday, October 7, 2009, to Jeff Burdette, Legislative Assistant to
the Subcommittee on Health,
1. The majority of the bills at this legislative hearing focused
on homeless legislation. Are there other legislative ideas to help
homeless veterans that you would like to recommend?
2. Please give me your organization's views on the effectiveness
of VA's outreach efforts to the Homeless community. Do you believe that
enough is being done to target the homeless veteran population? Also,
if you could, please comment on the current program VA has for
preventing at-risk veterans from becoming homeless.
3. You expressed your support for H.R. 2735 and the draft
discussion bill to improve per diem grant payments.
H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily cost of care as estimated by the grantee or $60 per bed,
per day.
Which of the two approaches to increasing per diem funding do you
support and why?
Thank you again for taking the time to answer these questions. The
Committee looks forward to receiving your answers by October 7, 2009.
Sincerely,
MICHAEL H. MICHAUD
Chairman
__________
The American Legion's answers to questions from October 1, 2009 Hearing
Question 1: The majority of the bills at this legislative hearing
focused on homeless legislation. Are there other legislative ideas to
help homeless veterans that you would like to recommend?
Response: The American Legion supports legislation that would
authorize the Department of Housing and Urban Development (HUD) to
provide housing assistance to private nonprofit organizations and
consumer cooperatives to expand the supply of permanent affordable
housing for homeless veterans and their families along with:
Expanding the highly successful HUD-VA Supportive Housing
(HUD-VASH) Program, by authorizing 20,000 vouchers annually and making
the program permanent;
Establishing a grant program that would provide
assistance to veterans who are at-risk of being homeless; and,
Requiring HUD to submit a comprehensive annual report to
Congress on the housing needs of homeless veterans.
The American Legion has no other recommendations at this time.
Question 2: Please give me your organization's views on the
effectiveness of VA's outreach efforts to the Homeless community. Do
you believe that enough is being done to target the homeless veteran
population? Also, if you could, please comment on the current program
VA has for preventing at-risk veterans from becoming homeless.
Response: In recent years, VA has done a respectable job in
responding to the needs of homeless veterans. In addition, there has
been a significant drop in the homeless veterans' numbers over the last
couple of years due to VA's homeless programs and their outreach to
homeless care service providers. Please note that adequate funding and
staffing are still obstacles to VA better serving our homeless veteran
community.
VA has to do a better job at assisting homeless women veterans and
those individuals with families. Homeless veterans' service providers'
clients have historically been almost exclusively male. That is
changing as more women veterans, especially those 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. Reports show that one of
every ten homeless veterans under the age of 45 is now a woman. Access
to gender appropriate care of these veterans is essential. These
homeless women and families have unique challenges and needs in getting
reintegrated back into mainstream society that should be addressed by
VA.
Another group of veterans in need of VA assistance is those who are
at-risk of becoming homeless. VA has been working on implementing
programs to assist at-risk veterans, to prevent them from losing their
homes; however, these programs have yet to come to fruition.
Question 3: You expressed your support for H.R. 2735 and the draft
discussion bill to improve per diem grant payments.
H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily cost of care as estimated by the grantee or $60 per bed,
per day.
Which of the two approaches to increasing per diem funding do you
support and why?
Response: The American Legion supports rate increases which will
enable homeless care service providers to provide more supportive
services to homeless veterans. We recognize the benefits of both H.R.
2735 and the draft discussion bill. The passage of either one of these
pieces of legislation would increase the funds available to assist
homeless veterans; however, The American Legion does not believe the
homeless care service provider should be locked into the $60 per bed in
the drafted legislation due to the volatile economy.
Please feel free to contact me @ 202-861-2700 ext. 2998 or
[email protected] if you have questions.
Thank you,
Joseph L. Wilson
Deputy Director, Veterans Affairs and Rehabilitation Commission
Committee on Veterans' Affairs
Subcommittee on Health
Washington, DC.
October 1, 2009
Mr. Justin Brown
Legislative Associate, National Legislative Service
Veterans of Foreign Wars of the United States
200 Maryland Avenue, SE
Washington, D.C. 20006
Dear Mr. Brown:
Thank you for your testimony at the U.S. House of Representatives
Committee on Veterans' Affairs Subcommittee on Health legislative
hearing on H.R. 1017, H.R. 1036, H.R. 2504, H.R. 2559, H.R. 2735, H.R.
3073, H.R. 3441, H.R. 2506, and Draft Discussions on Homelessness,
Graduate Psychology Education, and Psychiatric Service Dogs that took
place on October 1, 2009.
Please provide answers to the following questions by 6:00 P.M. on
Wednesday, October 7, 2009, to Jeff Burdette, Legislative Assistant to
the Subcommittee on Health.
1. The majority of the bills at this legislative hearing focused
on homeless legislation. Are there other legislative ideas to help
homeless veterans that you would like to recommend?
2. Please give me your organization's views on the effectiveness
of VA's outreach efforts to the Homeless community. Do you believe that
enough is being done to target the homeless veteran population? Also,
if you could, please comment on the current program VA has for
preventing at-risk veterans from becoming homeless.
3. You expressed your support for H.R. 2735 and the draft
discussion bill to improve per diem grant payments.
H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily cost of care as estimated by the grantee or $60 per bed,
per day
Which of the two approaches to increasing per diem funding do you
support and why?
Thank you again for taking the time to answer these questions. The
Committee looks forward to receiving your answers by October 7, 2009.
Sincerely,
MICHAEL H. MICHAUD
Chairman
__________
Prepared Statement of Justin Brown, Legislative Associate,
National Legislative Service, Veterans of Foreign Wars of the
United States, Response to Questions Submitted by Chairman Michaud,
Committee on Veterans' Affairs, Subcommittee on Health United States
House of Representatives with Respect to H.R. 1017, H.R. 1036,
H.R. 2504, H.R. 2559, H.R. 2735, H.R. 3073, and H.R. 3441
Submitted October 08, 2009
Question 1: The majority of the bills at this legislative hearing
focused on homeless legislation. Are there other legislative ideas to
help homeless veterans that you would like to recommend?
Response: The Veterans of Foreign Wars is fully supportive of the
zero-tolerance stance President Obama has taken on veterans'
homelessness. There are a number of legislative fixes being proposed.
However, the VFW believes that none of these pieces of legislation
adequately address the issue of veterans' homelessness in its totality.
For these reasons, the VFW suggests the administration introduce its
plan, and the requisite requirements necessary, to end and prevent
homelessness for America's veterans. A complete and thorough approach
to eradicating homelessness is the new direction in which we should be
progressing. A piece by piece approach will not solve the larger
problem at hand--prevention and eradication of veterans' homelessness.
One particular concern of the VFW's in regards to preventing
veterans' homelessness is the need to revamp VA's VR&E program for
disabled veterans. We have attached five primary recommendations for
doing so below. We believe that if these recommendations were adopted,
the VR&E program would have better results, prevent at-risk disabled
veterans from becoming homeless, and provide increased investment for
veterans and our government.
1. The Delimiting Date for VR&E Needs to be Removed
2. VR & E's Educational Stipend Needs Parity in Comparison to
Chapter 33
3. For Many Disabled Veterans with Dependents VR&E Education
Tracks are Insufficient
4. VR&E Performance Metrics Need to be Revised to Emphasize Long-
term Success
5. VR&E Needs to Reduce Time from Enrollment to Start of Services
Question 2: Please give me your organization's views on the
effectiveness of VA's outreach efforts to the Homeless community. Do
you believe that enough is being done to target the homeless veteran
population? Also, if you could, please comment on the current program
VA has for preventing at-risk veterans from becoming homeless.
Response: The VFW has no substantiated data to suggest VA's
outreach efforts are effective. While VA's data suggests the numbers of
homeless veterans has fallen in recent years, the VFW remains concerned
that due to the current economic situation these numbers will rise.
Nearly one million veterans are currently unemployed and the need for
increased services for at risk and homeless veterans has never been
greater.
Question 3: You expressed your support for H.R. 2735 and the draft
discussion bill to improve per diem grant payments.
Response: H.R. 2735 would provide for an increase in per diem
payments to reflect anticipated changes in the cost of furnishing
services and to take into account the cost of providing services in a
particular geographic area. It would also make these payments based on
annual costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily cost of care as estimated by the grantee or $60 per bed,
per day.
Which of the two approaches to increasing per diem funding do you
support and why?
The VFW supports both pieces of legislation because they both
substantially increase funding to provide relief for homeless veterans.
However, the VFW believes this question would be better answered by
those who receive Federal assistance for providing assistance to our
Nation's homeless veterans.
Committee on Veterans' Affairs
Subcommittee on Health
Washington, DC.
October 1, 2009
Mr. Richard F. Weidman
Executive Director for Policy and Government Affairs
Vietnam Veterans of America
8605 Cameron Street, Suite 400
Silver Spring, MD 20910
Dear Mr. Weidman:
Thank you for your testimony at the U.S. House of Representatives
Committee on Veterans' Affairs Subcommittee on Health legislative
hearing on H.R. 1017, H.R. 1036, H.R. 2504, H.R. 2559, H.R. 2735, H.R.
3073, H.R. 3441, H.R. 2506, and Draft Discussions on Homelessness,
Graduate Psychology Education, and Psychiatric Service Dogs that took
place on October 1, 2009.
Please provide answers to the following questions by 6:00 P.M. on
Wednesday, October 7, 2009, to Jeff Burdette, Legislative Assistant to
the Subcommittee on Health.
1. The majority of the bills at this legislative hearing focused
on homeless legislation. Are there other legislative ideas to help
homeless veterans that you would like to recommend?
2. Please give me your organization's views on the effectiveness
of VA's outreach efforts to the Homeless community. Do you believe that
enough is being done to target the homeless veteran population? Also,
if you could, please comment on the current program VA has for
preventing at-risk veterans from becoming homeless.
3. You expressed your support for H.R. 2735 and the draft
discussion bill to improve per diem grant payments.
H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily cost of care as estimated by the grantee or $60 per bed,
per day.
Which of the two approaches to increasing per diem funding do you
support and why?
4. In your testimony, you recommended creating a ``service center
staffing/operational'' grant.
Wouldn't H.R. 2735 accomplish this, as there is language creating a
separate grant fund for service center personnel? Please provide
clarification.
5. In your testimony, you question whether the grant and per diem
funding should be considered ``fee for service'' instead of a
``reimbursement''.
a. Is distinction between the two a matter of when the GPD
grantee would get paid? In other words, the grantee would get
paid before delivering the services based on an estimated cost
under the ``fee-for-service'' model, whereas the grantee gets
paid after delivering the services under the ``reimbursement''
model?
b. If the above understanding is accurate, how would you
respond to potential concerns about the VA's diminished ability
to oversee the program under the ``fee-for-service'' model?
Thank you again for taking the time to answer these questions. The
Committee looks forward to receiving your answers by October 7, 2009.
Sincerely,
MICHAEL H. MICHAUD
Chairman
__________
Responses to questions from October 1, 2009
U.S. House of Representatives
Committee on Veterans' Affairs
Subcommittee on Health
1. The majority of the bills at this legislative hearing focused
on homeless legislation. Are there other legislative ideas to help
homeless veterans that you would like to recommend?
Comments to this question are included in many of the comments
found below.
2. Please give me your organization's views on the effectiveness
of VA's outreach efforts to the Homeless Community. Do you believe that
enough is being done to target the homeless veteran population? Also,
if you could, please comment on the current program VA has for
preventing at-risk veterans from becoming homeless.
The VA needs to develop a strategic plan focusing on outreach to
homeless veterans. There needs to be a separate line in the VA budget
for outreach to homeless and at-risk veterans, in addition to a
separate line item for outreach and education of all veterans and their
families.
Attention to ensuring the continuance of Day Service Centers and
the creation of new service center for homeless veterans are a vital
component to outreach. Veterans spread the word. If there is the
legislative creation of staff/operational grants for Service Centers,
care must be taken to include the operational and administrative
dollars required to provide full service.
The VA could encourage cities and municipalities to carve our
specific shelters or beds in one specific shelter to accommodate
homeless veterans in an effort to consolidate VA outreach and manpower,
making this effort more efficient and effective.
VVA would strongly support added verbiage to this legislation that
would establish a ``hot line'' for homeless or at-risk veterans. This
hotline could be modeled after the VA's Suicide Hotline. Additionally,
it could be ``manned'' by homeless or formerly homeless veterans
through the utilization of the Compensated Work Therapy program
participants. We ask, who better to assist someone who is homeless or
at-risk than someone who has actually been there seeking the same
assistance.
There needs to be a grassroots media ``blitz'' by the VA focusing
on the city and municipality shelter systems throughout the country.
Many homeless veterans in the shelter systems don't know there is help
out there for them from the VA.
3. You expressed your support for H.R. 2735 and the draft
discussion bill to improve per diem grant payments.
H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily care as estimated by the grantee or $60 per bed, per day.
Which of the two approaches to increasing per diem funding do you
support and why?
VVA would support any increase in per diem payments, so long as the
per diem is based on actual anticipated budgetary expenses, not based
on past year expenses. Non-profits cannot enhance services or hire
additional staff before they are able to access the dollars of
increased per diem. It sets in place a vicious cycle of need. The
agencies have a set per diem; they require more staff; they haven't
shown it as an expense on the approved per diem they are receiving;
they can't afford to hire staff. To do so would place them at high risk
and this action could be suicidal for a small non-profit. It places
them at risk with creditors or the agency has to pay interest on the
use of its line of credit until they can be approved for higher per
diem. This interest is then an added expense to the program--a cost
they cannot recoup.
4. In your testimony, you recommended creating a ``service center
staffing/operational'' grant. Wouldn't H.R. 2735 accomplish this, as
there is language creating a separate grant fund for service center
personnel? Please provide clarification.
Absolutely. VVA has long supported and advocated for the creation
of ``service center staffing/operational'' grants. Just as GPD
residential programs can cover some operational costs with its limited
per diem, these service centers need the enhanced staffing/operational
grants in order to provide quality and comprehensive services. This
will ultimately increase the successful outcomes of the programs and
the veterans. It can easily be funded in the exact way as the
previously created Special Needs Grants.
5. In your testimony, you question whether the grant and per diem
funding should be considered ``fee-for-service'' instead of a
``reimbursement''.
a. Is distinction between the two a matter of when the GPD
grantee would get paid? In other words, the grantee would get
paid before delivering the services based on an estimated cost
under the ``fee-for-service'' model, whereas the grantee gets
paid after delivering the services under the ``reimbursement''
model?
There are several sides to this question.
Yes, it is a matter of when the GPD grantee would get paid. Under
the current per diem systems, many GPD grantees wait for months to
receive their ``reimbursement''.
However there also exist other hurdles. Presently per diem is based
on previous year expenses, not anticipated expenses, which causes the
program to fall short in the agencies operating year. This leaves the
agencies without the funds to increase the services or staffing because
they do not have the money to do any advanced or ``real time''
enhancements to the program.
In actuality, GPD is ``fee for service''. The only drawback is that
it is not set up as a contract agreement as utilized in the past by the
VA where agencies were paid as contractors. Today's methodology works
on the approach that grantees are paid based on past accounted and
audited expenses, not anticipated expenses.
Another thought is to review the process that HUD uses for its
grantees. One solution to consider would be to set up GPD disbursements
in a ``draw down'' account similar to the system utilized by the U.S.
Department of Housing and Urban Development, whereby agencies submit
their projected budgets, are allocated the funds, and draw down on the
allocated funds throughout the year. At the end of year reconciliations
and adjustments as made.
VVA suggests the Committee also review the process utilized by
state veterans' homes in providing them per diem.
b. If the above understanding is accurate, how would you
respond to potential concerns about the VA's diminished ability
to oversee the program under the ``fee-for-service'' model?
With the requirement for intensive annual inspections by the VA on
all GPD programs, VVA does not see any potential diminished ability by
the VA in the oversight of the programs. The method by which funds are
paid has no effect on the VA's ability to provide oversight.
Additional Comments:
With regard to the draft discussion bill to eliminate the required
reduction in the amount of per diem payments provided to entities
furnishing services to homeless veterans to account for other sources
of income, VVA strongly supports this legislation. It is our contention
that many small non-profit agencies must find outside funding to assist
in providing and enhancing services to homeless veterans. In fact, non-
profits are encouraged to seek additional funding and are very creative
in acquiring additional funding.
Presently, those agencies that charge a ``residential fee'' to the
veterans in transitional housing must include those nominal fees as
``income'' even though those funds are turned back into the program to
enhance or improve services. These dollars are also needed by the
agency to cover expenses in other related veteran programs that were
created under grant awards from other Federal agencies but do not have
operational or appropriate administrative funding. These other programs
ultimately are available and utilized by the homeless veterans in the
agencies GPD programs.
The inclusion of these ``fees'' as income to the GPD program often
times reduces the amount of per diem a grantee will receive because it
decreases the overall cost of the program thereby reducing the per diem
for which the agency is eligible. This does not help in creating an
atmosphere of creativity. VVA believes that these ``fees'' should not
be included as income
Under the draft discussion legislation to improve per diem payments
for organizations assisting homeless veterans, VVA strongly supports
the inclusion of verbiage that would address funding to an existing
program for the expansion of its original program. In the past, some
very successful GPD programs identified a need for increased bed space
based on the number of veterans requesting admission. Requesting
program expansions was done because in the original grant the agency
could not know or anticipate with true accuracy the reality of the need
for bed space. They were forced to make educated guesses. (If you build
it they will come) These programs requested additional beds under a
``per diem only'' (PDO) grant process and were awarded funds to
increase their overall program beds.
However, because the original grant and the PDO grant were awarded
at different times they have separate ``project numbers,'' even though
both grants were for the same program with the same expenses. Hence,
they are required to divide out, by percentage, the number of beds, and
the per diem rates, under each project number in the required reporting
to the VA. This calculation of percentage for each project number also
is a hindrance in calculating the per diem rate for each project.
Everything related to the program must be divided by percentage and
every veteran who changes bedrooms has to be tracked by project number
in applying for every month's per diem reimbursement request. It causes
one whole program to be calculated for per diem in two separate and
unequal parts which results in one program have two different per diem
rates. This is an accounting, bookkeeping, and records keeping
nightmare.
VVA strongly supports the consolidation of PDO grants into the
capital grant under which it was awarded, combining them into one
Project Number.
Regarding the draft bill, The End Veteran Homelessness Act, VVA
strongly urges that language addressing those veterans who do not meet
the criteria for Mental Health Intensive Case Management (MHICM) be
included in this legislation. Many of these veterans do not meet the
criteria for HUD-VASH because they require intensive case management.
They also do not meet the criteria for MHICM. They are, in essence, too
sick for one, but not sick enough for the other.
These compromised veterans are left without recourse to fend for
themselves in the community. They are targets; easy prey for the
ruthless. They will return to homelessness. Or they may not live to do
even that. VVA strongly urges inclusion in this bill that would have
provided the necessary case management for those individuals who would
otherwise be eligible for HUD-VASH.
Committee on Veterans' Affairs
Subcommittee on Health
Washington, DC.
October 1, 2009
Mr. Blake Ortner
Senior Associate Legislative Director
Paralyzed Veterans of America
801 18th Street, NW
Washington, D.C. 20006
Dear Mr. Ortner:
Thank you for your testimony at the U.S. House of Representatives
Committee on Veterans' Affairs Subcommittee on Health legislative
hearing on H.R. 1017, H.R. 1036, H.R. 2504, H.R. 2559, H.R. 2735, H.R.
3073, H.R. 3441, H.R. 2506, and Draft Discussions on Homelessness,
Graduate Psychology Education, and Psychiatric Service Dogs that took
place on October 1, 2009.
Please provide answers to the following questions by 6:00 P.M. on
Wednesday, October 7, 2009, to Jeff Burdette, Legislative Assistant to
the Subcommittee on Health.
1. The majority of the bills at this legislative hearing focused
on homeless legislation. Are there other legislative ideas to help
homeless veterans that you would like to recommend?
2. Please give me your organization's views on the effectiveness
of VA's outreach efforts to the Homeless community. Do you believe that
enough is being done to target the homeless veteran population? Also,
if you could, please comment on the current program VA has for
preventing at-risk veterans from becoming homeless.
3. You expressed your support for H.R. 2735 and the draft
discussion bill to improve per diem grant payments.
H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily cost of care as estimated by the grantee or $60 per bed,
per day.
Which of the two approaches to increasing per diem funding do you
support and why?
4. You expressed PVA's concerns with the draft discussion bill to
provide 25 percent of the per diem funding for organizations that do
not meet the VA's current per diem requirements. The intent of this
bill was to target smaller non-profits with less capacity than the
bigger organizations. This would also have the effect of the money
following the veteran so that the veteran has more choice and is not
limited to help from the current list of organizations receiving per
diem funding. Do you have suggestions on how we can help the smaller
non-profits who help, let's say 70 percent instead of the required 75
percent of homeless veterans without opening the door to non-profits
that do not serve any or just 1 percent of homeless veterans?
Thank you again for taking the time to answer these questions. The
Committee looks forward to receiving your answers by October 7, 2009.
Sincerely,
MICHAEL H. MICHAUD
Chairman
__________
Paralyzed Veterans of America
Washington, DC.
October 6, 2009
Honorable Michael Michaud
Chairman
House Committee on Veterans' Affairs
Subcommittee on Health
338 Cannon House Office Building
Washington, D.C. 20515
Dear Chairman Michaud:
On behalf of Paralyzed Veterans of America (PVA), I would like to
thank you for the opportunity to present our views on the various
pieces of legislation considered by the Subcommittee at the hearing on
October 1, 2009. We are particularly pleased that the Subcommittee
continues to focus a great deal of interest on assisting homeless
veterans overcome their situations in order to become productive
members of society again.
Due to the short suspense for this reply, PVA has only been able to
conduct a limited analysis of the questions to prepare our response. We
would ask that as the Subcommittee staff continues the refinement of
this valuable legislation, they continue to permit PVA to provide input
to assist in overcoming the tragic problem facing many of our veterans.
We have included with our letter a response to each of the
questions that you presented following the hearing on October 1, 2009.
Thank you very much.
Sincerely,
Carl Blake
National Legislative Director
______
Question 1: The majority of the bills at this legislative hearing
focused on homeless legislation. Are there other legislative ideas to
help homeless veterans that you would like to recommend?
Response: PVA has been a long time supporter of homeless veterans
and legislation to reduce the number of veterans living on the street.
The legislation addressed during the hearing dealt with many issues PVA
is interested in. At this time, there are no additional issues that PVA
would like to recommend; however, we look forward to working with the
Subcommittee staff on future legislation that we may determine would be
a benefit to homeless veterans.
Question 2: Please give me your organization's views on the
effectiveness of VA's outreach efforts to the Homeless community. Do
you believe that enough is being done to target the homeless veterans'
population? Also, if you could, please comment on the current program
VA has for preventing at-risk veterans from becoming homeless.
Response: VA's outreach programs have had limited effectiveness,
though PVA believes this may have more to do with limited funding
rather than bad programs. This was part of the reason for PVA's support
of H.R. 2559, the ``Help Our Homeless Veterans Act.'' While VA argues
that they already have this authority and resist the idea of a program
targeting only veterans as prescribed in the legislation, in particular
women veterans, PVA believes that a program narrowly focused at
veterans is appropriate. Veterans are a unique population with unique
perspectives. A program that specifically addresses the characteristics
of veterans, for example the idea that ``veterans do not leave their
comrades behind'' or that veterans ``take care of their own,'' may
appeal to veterans resistant to coming in off the street. They may see
it as a more understanding or welcoming environment. While these are
only two examples, PVA believes that a targeted program may be more
effective than one aimed generally at homelessness.
In addition, outreach that uses non-standard media outlets may
better reach those who are at risk of becoming homeless, or as
explained in our testimony, approaches aimed at family or friends of
those at risk of homelessness. These may be the people who can best
encourage an at-risk veteran to seek assistance or benefits they may be
entitled to.
Question 3: You expressed your support for H.R. 2735 and the draft
discussion bill to improve per diem grant payments.
H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily cost of care as estimated by the grantee or $60 per bed,
per day.
Which of the two approaches to increasing per diem funding do you
support and why?
Response: PVA does not have a preference for either bill. Both are
approaches that may increase the number of veterans served and the
quality of services for homeless veterans. VA's homeless veterans'
programs have historically been underfunded and increases are needed.
PVA's greatest concern with H.R. 2735 was with the possible impact
on the total number of veterans served if increased funds are provided
to geographic areas with no additional funds available to offset the
reduced funds for other localities.
PVA recommends an analysis be conducted to determine the impact on
total number of veterans served by these changes in funding methods.
The Subcommittee should then recommend an increase in funding to
maintain the level of services for homeless veterans to offset any
reduction in total services due to increased payments to high cost
geographic areas or by the establishment of the $60 guarantee per bed
per day.
Question 4: You expressed PVA's concerns with the draft discussion
bill to provide 25 percent of the per diem funding for organizations
that do not meet the VA's current per diem requirements. The intent of
this bill was to target smaller non-profits with less capacity that the
bigger organizations. This would also have the effect of the money
following the veterans so that the veteran has more choice and is not
limited to help from the current list of organizations receiving per
diem funding. Do you have suggestions on how we can help the smaller
on-profits who help, let's say 70 percent instead of the required 75
percent of homeless veterans without opening the door to non-profits
that do not serve any or just 1 percent of homeless veterans?
Response: While PVA understands the interest in providing homeless
services to a wider range of homeless veterans including those served
by the smaller non-profits, requiring that the Secretary ``shall ensure
that 25 percent of funds available'' to these providers will force the
Secretary to provide 25 percent of the already limited VA homeless
funds in a less efficient manner. As a minimum, the legislation should
be changed from ``shall ensure that'' to ``may provide for.'' This
would give the Secretary the flexibility to possibly fund these smaller
homeless veteran providers if it will provide greater benefits to
veterans. However, PVA firmly believes that some minimum floor for
services to homeless veterans should be established. For example, if
the homeless services provider must ``furnish services to homeless
individuals, of which not less than 25 percent are veterans,'' this may
encourage the provider to conduct additional outreach to locate greater
numbers of homeless veterans. For smaller providers, with limited
numbers of beds, these numbers should not prove overly burdensome.
Committee on Veterans' Affairs
Subcommittee on Health
Washington, DC.
October 1, 2009
Honorable Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, D.C. 20240
Dear Secretary Shinseki:
Thank you for the testimony of Peter H. Dougherty, Director of
Homeless Veterans Programs in the Office of Public and
Intergovernmental Affairs at the U.S. House of Representatives
Committee on Veterans' Affairs Subcommittee on Health legislative
hearing on H.R. 1017, H.R. 1036, H.R. 2504, H.R. 2559, H.R. 2735,
H.R. 3073, H.R. 3441, H.R. 2506, and Draft Discussions on Homelessness,
Graduate Psychology Education, and Psychiatric Service Dogs that took
place on October 1, 2009.
Please provide answers to the following questions by November 12,
2009, to Jeff Burdette, Legislative Assistant to the Subcommittee on
Health.
1. Mr. Dougherty's testimony noted that the increase in
authorization level for the GPD program provided in H.R. 2504 is
insufficient to meet the goal of ending homelessness among our veterans
within 5 years. What is your estimate of the funding needed for the GPD
program to help meet the goal of ending veteran homelessness?
2. With regard to H.R. 2559, we recognize the broad statutory
authority that the VA has for outreach. In addition to section 532, the
VA has an entire chapter dedicated to outreach. The problem is that
despite this broad outreach authority, we still have not seen much
outreach materials from the VA in the way of a media campaign. This is
why H.R. 2559 specifically directs the VA to target the issue of
homelessness. Can you tell us whether the VA already has plans in place
for a national media campaign addressing homelessness among veterans?
3. In Mr. Dougherty's testimony on H.R. 2735 he stated that ``GPD
is designed to support transitional housing for Veterans; however, in
the last several years the program has expanded its range of services
toward permanent housing to provide veterans stable and continuous
care. VA generally supports this bill, but is apprehensive that this
legislation will result in policy problems and lead to significantly
higher costs.'' My question is two fold:
What are the policy problems you are speaking of and please
explain how it would lead to significantly higher costs.
4. The intent of H.R. 3073 was to help veterans who are in
imminent danger of being homeless by providing payments for rent,
mortgage, and/or utilities arrears for 3 months. Mr. Dougherty noted in
his testimony that 3 months is too short of a time frame to remove the
risk of homelessness. What is your recommended time frame for providing
short-term assistance? Are you confident that the VA's existing efforts
and authorities are sufficient to target and help veterans who are just
one rent payment away from being homeless? Please explain what the VA's
current preventive measures are for at-risk veterans.
5. I understand that the VA did not have sufficient time to
comment on
H.R. 3441, which would result in veterans automatically enrolling for
VA health care. Earlier this year, Secretary Shinseki talked about
wanting to create a database which would make it easier for the veteran
to enroll and apply for VA services. Please provide a status update and
explain whether the VA has made progress on this.
6. Please comment on VVA's idea of having only one project number
in the case where residential programs wish to expand on original
program. It seems that there is an added burden placed on the
organizations because of the separate project numbers. Is there some
barrier that exists that would preclude VA from streamlining this
process so it is not so burdensome to those that wish to help homeless
veterans?
7. You expressed your support for section ome of H.R. 2735.
H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs.
The draft discussion bill to improve per diem grants takes a
different approach. It would maintain the payments based on daily
costs, but would increase the reimbursement rates to the higher of the
cost of daily cost of care as estimated by the grantee or $60 per bed,
per day.
Which of the two approaches to increasing per diem funding do you
support and why?
Additionally, please answer the following question for Congressman
Donnelly:
What specifically is the VA doing to assess and meet the
psychiatric needs of our wounded warriors? Please identify any
shortcomings in the current training of psychologists. Is there
a shortage in trained personnel? The HHS has a proven graduate
program for psychologists--can VA work with them and if not,
why?
Thank you again for taking the time to answer these questions. The
Committee looks forward to receiving your answers by November 12, 2009.
Sincerely,
MICHAEL H. MICHAUD
Chairman
Questions for the Record
Hon. Bob Filner, Chairman
Subcommittee on Health
House Committee Veterans' Affairs
Legislative Hearing on H.R. 1017, H.R. 1036, H.R. 2559, H.R. 2735,
Homelessness, H.R. 3073 H.R. 3441, H.R. 2506 and Draft Discussions
on Graduate Psychology Education, and Psychiatric Service Dogs
October 1, 2009
Question 1: Mr. Dougherty's testimony noted that the increase in
authorization level for the GPD program provided in H.R. 2504 is
insufficient to meet the goal of ending homelessness among our veterans
within 5 years. What is your estimate of the funding needed for the GPD
program to help meet the goal of ending veteran homelessness?
Response: At the hearing, VA testimony stated: ``VA estimates that
the proposed maximum annual authorization level of $200 million would
be inadequate for the amounts of VA projects delivering comprehensive
services through this important program. We recommend that a specific
authorization funding level be dropped from the statute. This is a well
established VA program and need not be constrained.''
The Homeless Providers Grant and Per Diem Program (GPD) has
assisted tens of thousands of Veterans reconnect with employment and
families, while serving as a bridge to community independent living. VA
has found that there are numerous communities and many Veterans that
benefit from this program and we find, particularly in small and rural
communities, that this program has served to bring together a multitude
of service providers as it has aided these homeless Veterans. We hope
to add additional transitional housing for Veterans in our attempt to
end homelessness among Veterans as part of a comprehensive plan for the
next 5 years. An increased authorization of appropriations would allow
the GPD Program to continue to be one of the cornerstone programs of
VA's efforts.
Under current law, per diem payments under this program are tied to
the domiciliary care rate under the State Home Program. As VA attempts
to ensure that the level of services in the existing program remains
high and expands the availability to women Veterans, Veterans living on
tribal lands and in rural areas, we will need additional funding to
support the more than 600 existing community organizations that provide
transitional housing services to Veterans.
Question 2: With regard to H.R. 2559, we recognize the broad
statutory authority that the VA has for outreach. In addition to
section 532, the VA has an entire chapter dedicated to outreach. The
problem is that despite this broad outreach authority, we still have
not seen much outreach materials from the VA in the way of a media
campaign. This is why H.R. 2559 specifically directs the VA to target
the issue of homelessness. Can you tell us whether the VA already has
plans in place for a national media campaign addressing homelessness
among veterans?
Response: Congress has already provided the needed authority under
Public Law 110-389, which created section 532 of title 38. This section
authorized the Secretary to purchase advertising in national media
outlets to promote awareness of benefits administered by the Secretary,
including programs to assist homeless Veterans. VA believes this
authority is preferable to H.R. 2559 as it does not require VA to
target only Veterans. Targeting Veterans alone will not be sufficient
to achieve the goal of ending Veteran homelessness, while a coordinated
national campaign reaching Veterans, those who provide benefits and
services, as well as the general public can help achieve this goal.
The effort to reach homeless Veterans has multiple factors
including having personal contact not only by VA staff but in
coordination with national, state and local partners. VA actively
coordinates with our partners to engage and serve Veterans who are
homeless.
To enhance current outreach efforts, a call center is being
developed, which will provide homeless/at risk Veterans with timely and
coordinated access to VA services and disseminate information to
concerned family members and non-VA providers about all the programs
and services available to serve these Veterans. Information and
promotion for the call center will be disseminated through a national
media campaign that will reach both community service providers and
Veterans. This campaign will be comprised of an outreach and awareness
public service effort, focused on increasing the public's awareness of
services provided through VA, and the VA's efforts to end homelessness
among Veterans.
Question 3: In Mr. Dougherty's testimony on H.R. 2735 he stated
that ``GPD is designed to support transitional housing for Veterans;
however, in the last several years the program has expanded its range
of services toward permanent housing to provide veterans stable and
continuous care. VA generally supports this bill, but is apprehensive
that this legislation will result in policy problems and lead to
significantly higher costs.'' My question is two fold: What are the
policy problems you are speaking of and please explain how it would
lead to significantly higher costs.
Response: VA is supportive of H.R. 2735, however, as we expressed
at the hearing, we support section one to allow service centers
receiving grants from VA to use these funds for staffing to ensure
services are provided during specified hours, as well as on an as-
needed, unscheduled basis; however, we continue to have concerns
regarding section two, which shifts from the ``per diem'' or ``daily
cost of care'' approach to an ``annual cost of furnishing services.''
Though this change may offer VA's partners needed capital and funds at
the beginning of the fiscal year to support their work, it would
require significantly more detailed auditing as well as increased
direct oversight by VA.
As we testified, VA does not oppose removing the existing rate cap.
Current law limits VA's GPD payments to the rate for state domiciliary
care, and the difference between what VA pays and the actual cost is
absorbed by the provider. Allowing the Secretary to establish the basis
and the formula for payment based on cost and geographic location would
increase the sustainability of community-based providers and promote
increased and more comprehensive services for Veterans. We remain
concerned the language of the bill is restrictive in that it only
authorizes VA to increase the rate of payment from year to year; VA
would be unable to respond to any situation or development that might
lower the operating costs for grant recipients. As a result, VA could
be forced to pay above-cost rates to providers. We continue to
recommend the language be modified to say, ``adjust,'' instead of
``increase.''
In addition, the bill would no longer require the Secretary to
consider the availability of other sources of income for grant
recipients potentially providing more funding than needed.
We would welcome the opportunity to discuss these issues with
Committee staff so we can assist the Committee to fully evaluate the
impact of this proposal.
Question 4: The intent of H.R. 3073 was to help veterans who are in
imminent danger of being homeless by providing payments for rent,
mortgage, and/or utilities arrears for 3 months. Mr. Dougherty noted in
his testimony, ``that 3 months is too short of a time frame to remove
the risk of homelessness.'' What is your recommended time frame for
providing short-term assistance? Are you confident that the VA's
existing efforts and authorities are sufficient to target and help
veterans who are just one rent payment away from being homeless? Please
explain what the VA's current preventive measures are for at-risk
veterans
Response: VA continues to support preventive measures for at-risk
Veterans in principle, but does not support H.R. 3073 due to certain
portions being duplicative of existing statutory authority and because
we think it would not make the best use of Department resources. We
continue to welcome the opportunity to assist the Committee staff to
develop language that addresses these concerns.
The VA's Northeast Program Evaluation Center (NEPEC) states that in
each of the past 2 years approximately 27,000 new users entered VA's
specialized homeless services. Prevention efforts designed to reduce
this influx will be important to VA's ability to meet its goal of
ending homelessness among Veterans. Prevention focused programs
include:
1. Veterans Justice Outreach (VJO): The purpose of the VJO
initiative is to avoid the unnecessary criminalization of mental
illness and extended incarceration among Veterans by ensuring that
eligible justice-involved Veterans have timely access to VHA mental
health and substance abuse services when clinically indicated, and
other VA services and benefits as appropriate.
2. Health Care for Re-Entry Veterans (HCRV): HCRV's goals are to
prevent homelessness, reduce the impact of medical, psychiatric, and
substance abuse problems upon community re-adjustment, and decrease the
likelihood of re-incarceration for those leaving prison. HCRV provides
outreach and pre-release assessments services for Veterans in prison;
referrals and linkages to medical, psychiatric, and social services,
including employment services upon release; short term case management
assistance upon release.
3. Veterans Homeless Prevention Demonstration Program (VHPD): In
the current fiscal year VA expects to issue a $10 million NOFA for
VHPD. VHPD will provide short term housing assistance, first and last
month's rent rental assistance, rent and utility arrearages and case
management to coordinate these and other community base supportive
serves appropriate for veterans and their families including but not
limited to, child care, and family services.
4. Supportive Services for Veteran Families (SSVF): Next year VA
expects to issue a Notice of Funding Availability for SSVF. Grantees
will provide eligible Veteran families with outreach, case management,
and assistance in obtaining VA and other benefits, which may include a
wide range of services that promote housing stability. In addition,
grantees may also provide time-limited payments to third parties (e.g.,
landlords, utility companies, moving companies, and licensed child care
providers) if these payments help Veterans' families stay in or acquire
permanent housing on a sustainable basis. In addition, VA is developing
links with the Office of Child Support Enforcement in the Department of
Health and Human Services (HHS).
In addition to the VA programs specifically designed to address
prevention efforts, many VA services have integrated important
prevention components. VA understands that many of the homeless it
serves have significant mental health needs. In FY 2009, the VA's
specialized homeless services worked with 92,625 Veterans. Of the
55,711 who completed formal intakes, half had a serious psychiatric
illness and 62 percent were dependent on drugs and/or alcohol problem
(NEPEC, 2010). Mental health and substance use disorders play a
significant role, particularly in chronic homelessness.
VA has also sought to codify and implement best practices at mental
health programs throughout the country, thereby strengthening efforts
to successful treat the chronically homeless who are more likely to
struggle with serious mental illness. National policies on suicide
prevention and medication management have improved safety while the new
Uniform Mental Health Services Handbook and the Mental Health
Residential Rehabilitation Treatment Programs (MHRRTP) Handbook have
expanded access by aiming ``to ensure that all Veterans, wherever they
obtain care in VHA, have access to needed mental health [and
specialized mental health homeless] services''. Drawn from best
practices, these Handbooks give detailed guidance on how services
should be structured.
These preventative measures will be part of the VA's Plan to work
toward ending homelessness among Veterans within 5 years. We continue
to remain concerned that the 3-month eligibility for the services
offered under H.R. 3073 is too short to effectively remove the risk of
homelessness for many Veterans and their families. For many Veteran
homeowners with non-VA mortgages, temporary relief for 3 months would
likely prove insufficient to resolve the underlying conditions
contributing to their potential homelessness if the terms of the
mortgage have changed, as they would under an adjustable-rate mortgage,
rather than as a result of changes in their personal situations. It is
suggested that a range be established (with more flexible time limits)
so that each individual Veteran can be reviewed on a case-by-case
basis, and provided with assistance to meet their particular needs. The
Administration has pursued a number of initiatives to keep such
homeowners, including Veterans, in their residences.
Question 5: I understand that the VA did not have sufficient time
to comment on H.R. 3441, which would result in Veterans automatically
enrolling for health care. Earlier this year, Secretary Shinseki talked
about wanting to create a database which would make it easier for the
Veteran to enroll and apply for VA services. Please provide a status
update and explain whether VA has made progress on this.
Response: The Veterans Benefits Administration has several
initiatives underway to improve service delivery and make it easier for
Veterans to access benefits and services. The initiatives include the
Veterans Benefits Management System, the Veterans Relationship
Management Program, and the eBenefits portal.
The Veterans Benefits Management System initiative is an internal
business transformation initiative supported by technology and designed
to improve the delivery of Veterans benefits and services administered
by VBA. It is a holistic solution that integrates a business
transformation strategy to address process, people, and organizational
structure and a 21st century paperless claims processing system--the
Veterans Benefits Management System (VBMS).
This initiative is focused on five key elements: (1) Business
process re-engineering will streamline and improve claims workflows and
enable continuous improvement; (2) Communications and change management
will address the ``people and organizational structure'' sides of the
transformation effort; (3) Technology modernization will provide
secure, end-to-end electronic claims workflow and data storage
technology (VBMS); (4) Metrics and measurement systems will enable
continuous feedback and improvement and increase accountability for
performance; and (5) Enhanced data mining and predictive capabilities
will help VBA anticipate Veterans' needs.
The Veterans Relationship Management Program (VRM) will leverage
technological advances to learn more about the needs and preferences of
our clients and allow VA to become more proactive in serving them in an
integrated fashion. VRM will provide on-demand access to comprehensive
VA services and benefits through a multi-channel (web-based,
interactive voice response, etc.) client relationship management
approach. Our employees will be empowered with rich, consistent data on
our clients, while our clients will be empowered to perform self-
service, on demand. VA will ensure that all channels through which
Veterans choose to access our services are convenient, easy-to-use, and
provide the same high level of quality service with privacy and
security safeguards in place.
The eBenefits portal is a joint effort of VA and the Department of
Defense (DoD). The eBenefits portal has been certified and accredited
with user access to information controlled through the National
Institute of Standards and Technology (NIST) standard credentials and
the physical structure located within a secure Global Secure Systems
(GSS) environment. The portal provides servicemembers, Veterans,
families, and care providers with a secure, single sign-on process to
their benefits and related services online (such as military personnel
records and status of VA claims). Servicemembers will use this
eBenefits account while on active duty and as Veterans following
separation, allowing both DoD and VA to provide benefit updates and to
deploy the right benefit information at the right time. Future
eBenefits releases will provide additional self-service capabilities
that empower users to electronically communicate with VA and DoD about
their benefits and services from anywhere at anytime.
Question 6: Please comment on VA's idea of having only one project
number in the case where residential programs wish to expand on
original program. It seems that there is an added burden placed on the
organizations because of the separate project numbers. Is there some
barrier that exists that would preclude VA from streamlining this
process so it is not so burdensome to those that wish to help homeless
veterans?
Response: The Grant & Per Diem (GPD) Program currently has 550
projects with community providers which offer a total of 11,300 beds.
Each grant-funded organization is inspected annually, which includes a
review of the services provided as put forth in the original grant
application. Occasionally those organizations awarded several grants
request that the projects are consolidated into one award and project
numbers combined. VA has accommodated these grantees as much as
possible by allowing, in some cases, grant services to overlap when it
is beneficial to Veteran participants in the program. However, to
ensure that each grantee is performing according to the grant agreement
and that payments for services are segregated by year and project, the
GPD Program requires that these project numbers remain unique to the
year awarded and services that are to be provided. The requirement to
track both services and funding is necessary for compliance with
Federal grant rules. VA is required to ensure that services are
provided under each grant award, according to these rules. Without
separate project numbers, these awards would not be adequately
monitored. Additionally, retaining individual identified project
numbers allows VA to monitor the number of Veterans receiving services
and Veteran outcomes of each program. This monitoring helps VA ensure
that Veterans are getting quality services under all grant awards.
Question 7: You expressed your support for section one of H.R.
2735. H.R. 2735 would provide for an increase in per diem payments to
reflect anticipated changes in the cost of furnishing services and to
take into account the cost of providing services in a particular
geographic area. It would also make these payments based on annual
costs instead of daily costs. The draft discussion bill to improve per
diem grants takes a different approach. It would maintain the payments
based on daily costs, but would increase the reimbursement rates to the
higher of the cost of daily cost of care as estimated by the grantee or
$60 per bed, per day. Which of the two approaches to increasing per
diem funding do you support and why?
Response: It seems prudent to ensure that all resources to support
community providers are given in the most appropriate manner. Given the
choices offered we would be supportive of providing payments related to
the specific costs related to providing those services to Veterans in a
given geographic area. A rate of $60 may be warranted in some areas but
exceeds costs for many areas based on our experience.
Questions from Congressman Donnelly
Question 1: What specifically is VA doing to assess and meet the
psychiatric needs of our wounded warriors?
Response: The Department of Veterans Affairs (VA) has a
comprehensive plan for wounded warriors and provides a full array of
services to address their psychiatric needs. Specifically for the
treatment of Post-Traumatic Stress Disorder (PTSD), VA operates an
internationally recognized network of more than 200 specialized
programs through its medical centers and clinics. Every VA medical
center has outpatient PTSD specialty capability. PTSD programs provide
a comprehensive continuum of care from outpatient PTSD Clinical Teams
(PCT) through specialized inpatient units, brief-treatment units, and
residential rehabilitation treatment programs. All PTSD Teams have a
substance use disorder specialist assigned to them to provide care for
concurrent substance use disorders. All Veterans Integrated Service
Networks (VISNs) must have specialized residential or inpatient care
programs to treat Veterans with severe symptoms and impairments related
to PTSD. In addition, there are increasing numbers of PTSD programs or
tracks within PTSD programs to meet special needs such as Veterans who
are survivors of military sexual trauma. Mental health programs,
especially those for Operation Enduring Freedom/Operating Iraq Freedom
(OEF/OIF) Veterans, have ties to the national, regional and local
rehabilitation programs for polytrauma and traumatic brain injury. VA
increased funding for post-traumatic stress disorder (PTSD) treatment
by more than 13 percent for FY 2010, for a total of over $354 million.
VA has focused efforts on the early identification and management
of stress related disorders in order to decrease the long term disease
burden on returning troops. OEF/OIF Veterans coming to VA for the first
time are screened for the presence of symptoms of PTSD, depression and
alcohol abuse. The same screening for these conditions is repeated on
an annual basis for new or existing Veterans of any service era. Should
the Veteran screen positive for any of these conditions, further
evaluation and appropriate treatment are provided. VA has established
Serving Returning Veterans-Mental Health (SeRV-MH) Teams in over 90 VA
Medical Centers to provide care specifically for returning OEF/OIF
Veterans. SeRV-MH Team and PTSD Clinical Team staff provide
collaborative, co-located care for Veterans in Primary Care Post
Deployment Health Clinics. Mental health clinicians are also part of
the staff of each of the Level 1 Polytrauma Centers across the nation.
VA is disseminating across the system both Cognitive Processing
Therapy and Prolonged Exposure, which are evidence-based therapies
cited by the Institute of Medicine Committee on Treatment of PTSD as
proven effective treatments for PTSD. More than 2,500 providers are
trained in this type of treatment including 81 Vet Center staff. VA
requires that all facilities make this therapy available to any
eligible Veteran who may benefit.
VA's National Center for PTSD is conducting an ongoing
teleconference seminar series on best practices in pharmacotherapy for
PTSD. As a separate initiative, a PTSD Mentor system has been
established across every VISN to ensure coordination of care within
facilities, VISNs and the nation. The PTSD Mentor program is
coordinated by VA's National Center for PTSD.
Question 2: Please identify any shortcomings in the current
training of psychologists.
Response: VA is proud of its clinical training programs in
Psychology and knows no identifiable shortcomings in its training
programs.
VA sponsors 90 psychology internship programs, with 435 full time,
year-long, paid positions. The internship is the last phase of training
required for completion of the doctorate in psychology; it must be
completed in a clinical setting where there are strong training
opportunities and quality education and supervision. VA also sponsors
200 postdoctoral fellowship positions in 54 programs. Supervised
postdoctoral experience makes a candidate license-eligible and allows
specialized training in areas critical to VA such as PTSD, Traumatic
Brain Injury (TBI), Polytrauma, or Primary Care health psychology.
There are two primary indicators of quality for VA's training
programs. First, all of our internship programs are fully accredited or
in the final stages of obtaining accreditation by the American
Psychological Association. Second, VA's training programs are in high
demand. All of them have many applications for each opening and are
thereby able to select very highly qualified candidates for each
position. VA training programs are highly respected in the national
psychology community and are seen as a valuable national resource.
Their focus on Veteran needs ensures that VA has a highly regarded
pipeline of well trained, Veteran focused psychologists from which to
recruit and hire for its mental health treatment needs.
Question 3: Is there a shortage in trained personnel?
Response: While there is no evidence of a widespread shortage of
trained mental health professionals, it has been VA's experience that
in certain localities, particularly highly rural regions, there may be
a limited number of particular mental health professionals, namely
psychiatrists. Specific incentives have been developed and used in such
situations. In addition to opportunities for education debt reduction,
VHA has established opportunities for facilities to engage in local
advertising and recruitment activities, and to cover interview-related
costs, relocation expenses, and provide hiring bonuses for certain
applicants. Moreover, flexibility is provided to hire providers of
other appropriate disciplines or to utilize fee-basis or contract care,
when indicated, so that Veterans have continuous access to the full
continuum of mental health services.
Question 4: The HHS has a proven graduate program for
psychologists--can VA work with them and, if not, why?
Response: Yes, VA could work directly with HHS to provide graduate
psychology education. However, HHS's and VA's training programs serve
different purposes, so it would be inefficient and counter-productive
to merge the programs.
Based on their respective missions, there is a fundamental
difference in how HHS and VA approach psychology training. HHS's
Graduate Psychology Education (GPE) program provides grants to
universities, professional schools, and hospitals to subsidize
psychology training in targeted content areas at the graduate program
level and at the internship level. VA, on the other hand, provides
stipends directly to trainees in VA internship and post-doctoral
programs in psychology. The GPE program serves HHS's purposes by
enhancing general psychology training, whereas VA's program funds
education and training that is specialized and specific to the needs of
veterans.
VA psychology training plays a crucial role in VA's operation.
Seventy percent of VA psychologists are products of our own training
programs. With the current emphasis on mental health needs of Veterans,
it would be unwise to disrupt this very important, specifically
tailored, recruitment pipeline.