[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON H.R. 4062, H.R. 4465, H.R. 4505, AND DRAFT
LEGISLATION
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
MAY 27, 2010
__________
Serial No. 111-81
__________
Printed for the use of the Committee on Veterans' Affairs
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57-025 WASHINGTON : 2010
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COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY McNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia
Malcom A. Shorter, Staff Director
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
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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
__________
May 27, 2010
Page
Legislative Hearing on H.R. 4062, H.R. 4465, H.R. 4505, and Draft
Legislation.................................................... 1
OPENING STATEMENTS
Chairman Michael Michaud......................................... 1
Prepared statement of Chairman Michaud....................... 23
Hon. Henry E. Brown, Jr., Ranking Republican Member.............. 5
Prepared statement of Congressman Brown...................... 23
Hon. Harry E. Teague............................................. 5
WITNESSES
U.S. Department of Veterans Affairs, Robert Jesse, M.D., Ph.D.,
Acting Principal Deputy Under Secretary for Health, Veterans
Health Administration.......................................... 15
Prepared statement of Dr. Jesse.............................. 38
______
Adler, Hon. John, a Representative in Congress from the State of
New Jersey..................................................... 3
Prepared statement of Congressman Adler...................... 28
American Legion, Barry A. Searle, Director, Veterans Affairs and
Rehabilitation Commission...................................... 6
Prepared statement of Mr. Searle............................. 29
Iraq and Afghanistan Veterans of America, Tim Embree, Legislative
Associate...................................................... 11
Prepared statement of Mr. Embree............................. 36
Kissell, Hon. Larry, a Representative in Congress from the State
of North Carolina.............................................. 2
Prepared statement of Congressman Kissell.................... 23
Thornberry, Hon. Mac, a Representative in Congress from the State
of Texas....................................................... 3
Prepared statement of Congressman Thornberry................. 24
Veterans of Foreign Wars of the United States, Eric A. Hilleman,
Director, National Legislative Service......................... 8
Prepared statement of Mr. Hilleman........................... 32
Vietnam Veterans of America, Richard F. Weidman, Executive
Director for Policy and Government Affairs..................... 10
Prepared statement of Mr. Weidman............................ 33
SUBMISSIONS FOR THE RECORD
Disabled American Veterans, Adrian Atizado, Assistant National
Legislative Director, statement................................ 42
Paralyzed Veterans of America, statement......................... 45
Gold Star Wives of America, Inc., Vivianne Cisneros Wersel,
Au.D., Chair, Government Relations Committee, statement........ 47
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 Hon. Eric K. Shinseki, Secretary, U.S.
Department of Veterans Affairs, letter dated June 14, 2010, and
VA responses................................................... 49
LEGISLATIVE HEARING ON H.R. 4062, H.R. 4465,
H.R. 4505, AND DRAFT LEGISLATION
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THURSDAY, MAY 27, 2010
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:02 a.m., in
Room 334, Cannon House Office Building, Hon. Michael Michaud
[Chairman of the Subcommittee] presiding.
Present: Representatives Michaud, Teague, Rodriguez, Brown
of South Carolina, and Boozman.
OPENING STATEMENT OF CHAIRMAN MICHAUD
Mr. Michaud. I would like to call the Subcommittee to
order. It is my understanding we have votes as early as 11:00
or 11:30, so we will get started, and Mr. Brown is on his way
down. I would ask unanimous consent that my full statement be
submitted for the record. Without objection, so ordered.
I would like to thank everyone for coming today. Today's
legislative hearing is an opportunity for Members of Congress,
veterans, the U.S. Department of Veterans Affairs (VA), and
other interested parties to provide their views and discuss the
legislation that has been introduced within this Subcommittee's
jurisdiction in a clear and orderly fashion. This is an
important part of the legislative process that will encourage
frank and open discussion of new ideas.
We have five bills before us, which address a number of
important issues. First, we have a radiation safety bill that
requires proper training of all employees at VA hospitals.
Second, we have a bill that will require the VA to consider
children under legal guardianship of veterans when determining
the veterans' copayment amount for medical treatment. And we
also have a bill that would allow Gold Star Parents access to a
State Veterans Home if they have had any children who died
while serving in the armed forces. Then finally we have two
draft pieces of legislation on improving VA's outreach to
veterans and another bill that would allow VA to provide
hearing aids to World War II veterans.
I want to thank our first panel for coming here today to
discuss this legislation, as well as the draft legislation that
we will hear afterwards. On the first panel we have
Representative Adler from New Jersey, Representative Thornberry
from Texas, and Representative Kissell from North Carolina. And
we will start with Mr. Kissell and his legislation.
[The prepared statement of Chairman Michaud appears on p.
23.]
STATEMENTS OF HON. LARRY KISSELL, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF NORTH CAROLINA; HON. MAC THORNBERRY, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS; AND HON.
JOHN ADLER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
JERSEY
STATEMENT OF HON. LARRY KISSELL
Mr. Kissell. Thank you, Mr. Chairman, and to my friends and
colleagues on this Subcommittee. I thank you for the
opportunity to come to you today to talk about H.R. 4465. And
in light of time and recognizing that we need to move on, and
in talking to the Chairman earlier that maybe the language of
our bill might be a little bit confusing. But the intent is
not, I am going to stick, Mr. Chairman, with the intent.
In today's society, if we ever did have a nuclear family
and structured a certain way, certainly today that has changed.
We know that for many reasons grandparents and great-
grandparents are involved, and oftentimes in their late stages
of life, in raising their grandchildren or great-grandchildren.
We have a particular case in our district where a couple aged
in their seventies, on low income, fixed income, had a
situation within their family where they took legal
guardianship of their great-grandchildren 5 years ago. They
still have that legal guardianship. The children are now 5 and
10 years old, and once again these are their great-
grandchildren.
In all ways, by the Internal Revenue Service (IRS), the
schools, in all ways within society they are recognized as the
legal guardians of these children. But however, with the VA
rules when it comes to figuring copays and the income versus
dependents, they are not given consideration for these being
dependents and, therefore, they do have to pay a copay. Very
clearly, if these children were recognized as being the
dependents that they are, once again in all other aspects of
society but with this, then they would not have to pay the
copayment. With such fixed income we are asking within H.R.
4465 that this legal guardianship with grandparents and great-
grandparents or other relationships be recognized for our
veterans. If they have legal guardianship for more than 1 year,
we ask that it be recognized that this is a dependency and it
should be taken into account.
We recognize this will not affect many people. The
Congressional Budget Office has said that this will not affect
many people. But the ones it will affect, we feel that we need
to make this change in recognition for their status, and in
trying to take care of some of our children in whatever way it
came to them. And I thank you, Mr. Chairman, and the Committee
for the opportunity to discuss this with you.
[The prepared statement of Congressman Kissell appears on
p. 23.]
Mr. Michaud. Thank you very much, Mr. Kissell. Mr.
Thornberry.
STATEMENT OF HON. MAC THORNBERRY
Mr. Thornberry. Thank you, Mr. Chairman. And I do
appreciate you having this hearing. I appreciate Dr. Snyder,
who introduced this legislation, H.R. 4505, with me, and I
appreciate your cosponsorship of it as well.
With your permission I would like to make my full statement
with some attachments part of the record.
Mr. Michaud. Without objection, so ordered.
Mr. Thornberry. And then I would just summarize. Mr.
Chairman, as you know there are 137 State Veterans Homes in all
50 States around the country, and they serve something over
28,000 veterans and dependents.
We all know of Gold Star Parents and think of Gold Star
Parents as someone who has lost a child in the military. But
for the purposes of being admitted to one of these State
Veterans Homes the definition of a Gold Star Parent is you have
to have lost all your children. So theoretically, you could
have had three of your children die in the military, if you
have one still surviving you are not eligible. And so what this
bill does, it just changes that definition and says a Gold Star
Parent is someone who has lost a child in the military, and
would then be eligible for one of these State Veterans Homes.
That is the basis of what this legislation does.
Now, these State Veterans Homes have an occupancy rate that
is about 86 percent, 87 percent, so there is room for
additional people. The admissions criteria is still run by the
States. So the States will decide if you have a veteran who
wants to get in, and a Gold Star Parent, they still make that
decision. But it just, this bill would just eliminate that
Federal regulation that makes it very difficult for any parent
to get into one of these State Homes.
I might mention that the Consolidated Appropriations Act of
2010 asked the VA to study this issue and figure out how much
it would cost to allow a Gold Star Parent who has lost a child
to get in one of these homes. VA came back and said, ``It is
not going to cost us anything so there is no use for us to do a
study on it.'' But they did say in their response that
legislation is required to change this, indicating they cannot
do it with a regulatory change, the burden is on our shoulders
to make a change. And so this bill is supported by the American
Legion, the National Association of State Veterans Homes, and
other who I think you will hear from. I know of no opposition
to it, Mr. Chairman. I think it is a basic issue of fairness.
When you have capacity, you have some folks who would like to
be admitted to these homes, to just remove this really Federal
restriction that makes no sense, I think, to any of us. And I
would appreciate the Committee's consideration of it.
[The prepared statement and attachments of Congressman
Thornberry appear on p. 24.]
Mr. Michaud. Thank you very much. Mr. Adler.
STATEMENT OF HON. JOHN ADLER
Mr. Adler. I thank you, Chairman Michaud, and Ranking
Member Brown, and Members of the Subcommittee for the
opportunity to testify on behalf of H.R. 4062. The need for
H.R. 4062 came from a very serious matter that occurred at the
Philadelphia Veterans Affairs Medical Center. Starting in 2003,
the brachytherapy program at the Philadelphia VA was operated
by a rogue doctor who botched approximately 86 percent of the
prostate cancer treatment procedures he was contracted to
perform on our veterans. These multiple failures, which went
undetected year after year, highlighted significant problems in
the VA's oversight system. The VA failed until 2008 to catch
this pattern of failure.
H.R. 4062, the ``Veterans' Health and Radiation Safety
Act,'' is a comprehensive piece of legislation that seeks to
remedy many of the mistakes that led to the problems
surrounding the brachytherapy program at the Philadelphia VA
Medical Center. This bill has three major components. First,
the bill mandates that the VA conduct an evaluation of all of
the low volume programs that are currently operating in its
medical facilities to ensure that they are meeting their safety
standards. The brachytherapy program at the Philadelphia VA was
not subjected to independent peer review due to the fact that
it was such a low volume program, serving only 116 patients
over a 6-year period. Because of this lack of oversight errors
that should have been caught and rectified, were allowed to
continue for 6 years unnoticed.
Second, H.R. 4062 requires that every VA employee and
independent contractor working in a VA medical facility be
trained in what constitutes a medical event, as that term is
defined by the Nuclear Regulatory Commission (NRC), as well as
when such an event should be reported, and to whom. Over the
course of the 6-year period in which the brachytherapy program
at the Philly VA was in operation, 86 percent of the patients
were subjected to reportable medical events. However, because
many of the medical personnel in the program, including the
independent contractors, were not trained in what constitutes a
medical event as that term is defined by the NRC, or to whom
such an event should be reported, these errors were allowed to
continue, and our veterans remained susceptible to substandard
medical care for far too long.
Lastly, this bill requires the Secretary to evaluate all
medical services provided pursuant to a contract with a
nongovernment entity. Such evaluations shall include
independent peer reviews of such medical services, and written
evaluations of a independent contractor's performance by that
contractor's supervisors. The bill also states that before a
contract for medical services can be renewed, the above
evaluations must be conducted. In Philly one of the problems
was that year after year that contracts were renewed every 6
months without any review by anybody, and this doctor continued
to hurt good veterans.
The veterans who sought treatment for prostate cancer at
the Philadelphia VA did not receive the quality of care they
deserve. Such mistreatment of our veterans is not only
unacceptable, it violates the bond our country made with them
when they agreed to fight for our safety and security. It is my
hope that H.R. 4062 will ensure that the failures that occurred
at the Philadelphia VA will never happen again.
I thank the Chairman, and the Ranking Member, for letting
me speak on this bill.
[The prepared statement of Congressman Adler appears on p.
28.]
Mr. Michaud. Thank you very much. And once again I would
like to thank all three of you for bringing forward these very
important pieces of legislation. Having reviewed them, and
pending the next couple of panels, I think we can actually work
on all three of them, because I think all three are very
important, I look forward to working with my Ranking Member Mr.
Brown to see how we can move forward these pieces of
legislation. I have no questions. Mr. Brown.
OPENING STATEMENT OF HON. HENRY E. BROWN, JR.
Mr. Brown of South Carolina. Thank you, Mr. Michaud. I
apologize for being late. We had about 35 businessmen from
Canada come by my office at 10:00 for a tour. And, you know,
Canada is a big trading partner with us. And so, I am sorry I
am late.
But let me just make a brief statement. Thank you all for
coming today. When we honor the bravery and service of our
military members and veterans, we must also honor the sacrifice
and selflessness of their families. I do not think the loss of
a child, whether one or many, can be differentiated, and I
thank Mac for introducing his legislation. We look forward to
further proceedings on these bills. Thank you.
[The prepared statement of Congressman Brown appears on p.
23.]
Mr. Michaud. Thank you. Mr. Teague, do you have any
questions or opening statement?
OPENING STATEMENT OF HON. HARRY TEAGUE
Mr. Teague. Yes. Chairman Michaud, thank you. Ranking
Member Brown, thank you for allowing me a few moments to speak
on my draft legislation, the ``World War II Hearing Aid
Treatment Act'' and its importance to the veterans of our
country.
While many look back at World War II as one of the most
significant events that the Unites States and humanity was ever
involved in, it has only been recently as many of yesterday's
soldiers are passing away that we as a country have really
reflected on its importance and what it meant to us as a
Nation. I do not know why that is. I do not know why it has
taken so long to recognize the sacrifices that were made in
North Africa, Europe, and the Pacific Theater. Maybe it is
because those individuals never wanted to make a big fuss over
what they had done. They were just doing their job.
As the son of a World War II veteran, my father talked
about the War occasionally. It was not something he bragged on.
Instead, it was something that he would mention as part of his
story. It was just a part of what he was supposed to do. He
felt it was his duty to go when called. Maybe that is why we
have taken so long to recognize the many sacrifices of this
War, because those that fought it were humble and did not want
to make a big deal about it.
What I do know is that, as was said by President Clinton,
``when these men and women were young they saved the world.''
That is no exaggeration. That is not just us saying something
to be nice. That is the truth. Now we are losing World War II
veterans at a faster rate than any other veteran group. It is
important that we make sure that we are doing all that we can
to honor these men and women now while they are still with us.
I believe that the ``World War II Hearing Aid Treatment
Act'' is one of the ways we can do that. It will authorize the
Secretary to furnish a hearing aid device to any veteran who
served in the active military, naval, or air service during
World War II, and who is being diagnosed with a hearing
impairment. It is a simple act that can ensure that we are
taking care of these historic veterans that did so much for us.
Thank you, Mr. Chairman. That concludes my statement.
Mr. Michaud. Thank you, Mr. Teague. Mr. Rodriguez, do you
have any questions, or a statement? If not, once again I want
to thank all three of you for coming today and I look forward
to working with you as we markup these pieces of legislation.
So once again, thank you very much.
I would like to call the second panel forward, and while
they are coming forward I will introduce them. It is Barry
Searle, who is the Director of the Veterans Affairs and
Rehabilitation Commission for the American Legion; Eric
Hilleman from the Veterans of Foreign Wars (VFW); Rick Weidman,
who is with the Vietnam Veterans of America (VVA); and Tim
Embree, who is with the Iraq and Afghanistan Veterans of
America (IAVA). I want to thank all four of you for coming this
morning, and look forward to your testimony. We will start with
Mr. Searle.
STATEMENTS OF BARRY A. SEARLE, DIRECTOR, VETERANS AFFAIRS AND
REHABILITATION COMMISSION, AMERICAN LEGION; ERIC A. HILLEMAN,
DIRECTOR, 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 TIM EMBREE, LEGISLATIVE ASSOCIATE, IRAQ AND
AFGHANISTAN VETERANS OF AMERICA
STATEMENT OF BARRY A. SEARLE
Mr. Searle. Mr. Chairman and Members of the Subcommittee,
thank you for the opportunity to present the views of the
American Legion on legislation and proposed legislation
important to veterans.
H.R. 4062, the ``Veterans' Health and Radiation Safety
Act,'' this legislation would require the Secretary of Veterans
Affairs to ensure that all employees at a VA hospital where
radioactive isotopes are used in the administration of medical
services receive appropriate training on what constitutes a
medical event and when to whom a medical event should be
reported. It would require specific evaluations and peer review
of all medical services provided under contract with a
nongovernment entity. The American Legion's System Worth Saving
Task Force annually conducts site visits at the VA medical
centers nationwide to assess quality and timeliness of VA
health care. During task force visits, we have found that
turnover of personnel and shortage of personnel require renewed
emphasis on standardized procedures, quality review, and
individual training as well as documentation of that training.
As technologies continue to change and treatments and
procedures continue to develop, it is critical that the VA
staff delivering care be properly trained and are accountable.
The American Legion supports not only the specified training
and accountability highlighted in H.R. 4062 but also the
standardization of all patient care delivered across the VA
system.
H.R. 4505, expansion of State Home care for parents of
veterans who died while serving in the armed forces. The
legislation permits a State Home to provide VA nursing home
care to parents who suffered the loss of a child who died
during service in the armed forces. The American Legion
believes that a commitment is made not only by servicemembers
who commit to the service of their country but also family
members who must say goodbye to their loved ones. The American
Legion believes that when a servicemember is killed in the line
of duty and a dependent parent is deemed medically eligible for
nursing home admission, that parent should be entitled to VA
Nursing Home Care. We believe the current regulation imposes
too high a threshold of suffering on surviving parents when it
requires that all children must have died in the service while
on active duty. We understand that currently the occupancy rate
of the nursing homes remains at approximately 85 percent
nationally. It is felt that the number of parents who would
utilize the opportunity is small enough to not significantly
impact occupancy. The American Legion supports H.R. 4505.
H.R. 4465, the determination of attributable income for
veterans with children. This legislation would direct the VA
Secretary, when examining a veteran's attributable income, to
treat as a dependent child of such a veteran any other person
who is placed in the legal custody of the veteran and has not
attained 21, or has not attained age 23 and is enrolled in a
full-time course of study, or is incapable of self-support due
to mental or physical incapacity. The American Legion supports
H.R. 4465.
Proposed legislation, the ``World War II Hearing Aid
Treatment Act.'' The American Legion recently adopted a
resolution acknowledging current advances in scientific
research, which require review of prior and potential
environmental threats to servicemembers. It is understood that
past acceptable norms in environmental exposure for noise have
been found to be unacceptable in today's environment.
Especially in the case of World War II veterans the state of
the art for working environment protection of servicemembers
had not evolved to the current levels. The fact of service and
exposure to these environmental exposures would imply the
potential for hearing loss. The American Legion supports this
proposed legislation to furnish World War II veterans with
hearing aids.
We would further submit, for the Subcommittee's
consideration, the fact that environmental issues for hearing
loss were in existence through the Vietnam War. It was not
until recently that significant efforts have been made to
protect the hearing of servicemembers. The American Legion
suggests expanding this bill to cover veterans for the Korean
and Vietnam War eras also.
Improved ``VA Outreach Act of 2010,'' the American Legion
has testified concerning improvements VA could make to further
outreach to veterans. VA continues to make progress to improve
its outreach to program veterans. Currently the VA in many
cases informs veterans service organizations (VSOs) on system
improvements accomplished. VSOs in turn advise veterans on
these efforts. This partnership between VA and the VSOs in
informing veterans is critical to the success in the VA's
outreach program.
However, issues remain with the VA's outreach to veterans.
Earlier this month the American Legion testified that the VA
continues to struggle with informing veterans of entitlements
such as efforts to assist transitioning servicemembers through
the Benefits Delivery at Discharge Program, and the Transition
Assistance Programs. In particular, Reserve component members
released from active duty mobilizations at times are rubber
stamped and returned home with little or no understanding of
what entitlements they have earned due to their honorable
service. The American Legion also understands that policies
developed at Central Office with the best of intentions are for
the most part executed at the discretion of the director at the
local level, and therefore, vary in local implementation. For
example, VA has a veteran employment hiring program policy to
recruit veterans as outlined in Secretary Shinseki's Memorandum
dated 21 October, 2009. However, the American Legion has seen a
variation of hiring from about 25 percent to 79 percent. We
feel this variation is due to the Director's emphasis on
outreaching to veterans.
Many veterans are moving to rural and extremely rural
areas. Nevertheless, these veterans have earned the right to
receive information and updates on changes that impact their
earned benefits. While the VA has made efforts to become more
user friendly we continue to hear, especially from older
veterans, that the system requires documentation that is still
too complicated.
We are concerned that the VA does not consistently utilize
this proven partnership between veterans service organizations
and the VA to optimize outreach to veterans. The establishment
of a VA Advisory Committee on Outreach as proposed in draft
legislation requiring representation from members of the VSO
community and reporting to the VA Secretary will enhance VA's
outreach program and ultimately better serve America's
veterans. The American Legion supports the outreach to
veterans, and in particular Improved VA Outreach Act of 2010.
Thank you.
[The prepared statement of Mr. Searle appears on p. 29.]
Mr. Michaud. Thank you, Mr. Searle. Mr. Hilleman.
STATEMENT OF ERIC A. HILLEMAN
Mr. Hilleman. Thank you, Mr. Chairman, Ranking Member
Brown, Members of the Subcommittee. On behalf of the 2.1
million men and women of the VFW and our auxiliaries, it is my
pleasure to be here representing them before you today. Due to
the number of bills before this Committee today, I would like
to limit the bulk of my remarks to two bills and briefly
comment on the remaining bills.
H.R. 4505, a bill to enable State Veterans Homes to furnish
nursing home care to parents whose children died while serving
in the armed forces. The VFW is proud to support this
legislation, which would authorize State-run nursing homes to
accept surviving parents of a child who died while serving in
the armed forces. Current law requires that a parent must have
lost all of their children to military service to qualify for
nursing home care. The VFW believes the care of a Gold Star
Parent is a sacred trust, and this bill would provide a
critical benefit at a time when they may need the long-term
care State Homes offer. We ask Congress to act quickly to enact
this legislation.
The next bill is the draft bill, ``World War II Hearing Aid
Treatment Act.'' The VFW admires the goal of this legislation,
but cannot support it as written. Millions of Americans
participated in combat in World War II, where over 416,000 were
killed, and hundreds of thousands were wounded. Almost
everything about modern warfare involves loud and often
incredibly loud noise. Acoustic trauma is a major cause of
hearing loss. Those who fought in the island campaigns of the
Pacific, North Africa, Normandy, and the Battle of the Bulge,
or flew through the flak and fighter filled skies over Germany
and France were exposed to incredibly loud noises that left
damage throughout their lives.
However, training for and fighting a war in terms of noise
exposure is virtually identical in younger veterans, who
trained and fought in every other war from Korea, Vietnam, to
the current conflicts in Iraq and Afghanistan. The Institute of
Medicine (IOM) studied hearing loss in the military.
Essentially they said servicemembers are exposed to a wide
range of noise, from occupational, i.e. trucks, generators,
planes, to acoustic trauma, machine gun fire, artillery, and
improvised explosive devices. Their recommendations focused on
prevention in the military. But they suggested, ``given the
likely occurrence of maximum noise included hearing loss at
6,000 hertz, include the measurement of hearing thresholds at
8,000 hertz in all audiograms to allow for detection of the
noise notch pattern of hearing loss associated with noise
exposure.''
The military widely recognizes that servicemembers are
exposed to potential hearing damage throughout their training
and average duties. In addition to exchange of gunfire,
mortars, and explosions, and those associated with combat, the
Army has rated and recognizes the basic acoustic trauma that is
caused by machinery, equipment, and weapons as well. For
example, a basic Humvee produces between 75 to 100 decibels of
noise, while a mortar operator endures 180 decibels of noise
with every mortar fired. The VFW cannot support this
legislation between the only factual difference World War II
veterans' exposure to noise and that of every other generation
are the age of the veterans.
H.R. 4062, Veterans' Health and Radiation Safety Act, the
VFW supports the legislation that would amend title 38 of the
U.S. Code to make certain improvements in the administration of
medical facilities within the Department of Veterans Affairs.
H.R. 4465, to amend title 38 of the U.S. Code to direct the
Secretary of the VA to take into account dependent children
when determining a veteran's financial status when receiving
hospital care or medical services. The VFW supports this
legislation to allow certain dependents to be counted in
determining earnings threshold for the purposes of seeking
services with VA.
Finally, draft bill Improved VA Outreach Act of 2010, the
VFW supports this Act which would improve outreach within the
Department of Veterans Affairs by coordinating the efforts
among the Secretary of Public Affairs, the Veterans Health
Administration, the Veterans Benefits Administration, and the
National Cemetery Administration.
Thank you, Mr. Chairman. This concludes my testimony, and I
am happy to answer any questions this Committee may have.
[The prepared statement of Mr. Hilleman appears on p. 32.]
Mr. Michaud. Thank you. Mr. Weidman.
STATEMENT OF RICHARD F. WEIDMAN
Mr. Weidman. Mr. Chairman, thank you for the opportunity
for Vietnam Veterans of America to present our views here
today.
In regard to H.R. 4062, ``Veterans' Health and Radiation
Safety Act,'' one would think that this piece of legislation
would not be needed but clearly demonstrated by the situation
at Philadelphia VA Medical Center, it is. VVA is generally in
favor of anything that promotes greater reporting and is
accompanied by greater accountability for quality assurance by
the VA health care system. And in this particular instance you
can code the metrics into VistA, and do so without additional
burdens on the clinician, which takes away from patient-centric
care. And so we favor this legislation at this point. And to
add to the analysis of the annual report would also add
something that we do not talk about very often.
The size of the staff at the VA has swollen enormously
since 1994. But the staff, numbers of staff working for the
Congress and for the Committees on both sides of the Hill is
less today than it was in 1994. And you need the organization
capacity here to be able to go through all of the reporting
mechanisms that you put in place, to be able to absorb that
information and assimilate it, and work with the Members of the
Committee to help them understand what situations need more
close monitoring and oversight hearings. And so we would just
put in a pitch for, and we will reiterate that to the Speaker
and to the Republican Leader as well.
H.R. 4505, which authorizes the VA Secretary to authorize
VA State Nursing Homes to take in Gold Star Parents is
something we are very much in favor of. Of all weeks in the
year, this is the most appropriate week that we all should be
thinking about Gold Star Families. Not just the moms and dads,
but also the spouses and the children who are left behind, as
well as siblings. We very much favor this. The Gold Star Manor
in California cannot possibly handle most of the folks whose
sons, primarily, and daughters are not around to care for them
in their later years. And so this is a needed step. It is not a
heavy lift. And we very much favor early passage.
The draft to Improve VA Outreach Act of 2010, we do favor
this. VA's testimony this morning, written statement says it is
redundant. But gosh, we cannot see it. There is so little
outreach and education of the veterans' community as to what
are the benefits and services available to them, and what are
the long-term health care risks that result from military
service depending on what branch did you serve in, when did you
serve, where did you serve, that we at VVA started Veterans
Health Council. VVA, it is www.veteranshealth.org. And we are
partnered with a number of other organizations, more than 50
organizations, primarily medical societies, like the American
Academy of Ophthalmology, American Psychiatric Association,
disease advocacy groups, like American Diabetes Association,
Men's Healthcare Network, and other veterans service
organizations like National Association of Black Veterans, the
United Spinal Cord Association, Veterans First Project, and
National Association of Uniformed Services, in order to do
outreach directly to those folks. We have given out over
100,000 brochures and are getting about 5,000 hits a month on
our Web site because people are not getting that information in
a succinct form from VA, one. Two, is to do the outreach
through the U.S. Department of Health and Human Services (HHS).
The reason why that is so important is we have to reach out to
civilian medicine. Less than 20 percent of the VA population
eligible, potentially eligible, uses the VA medical system as
their primary health care system. We have to reach that 80
percent outside in order that they understand what is available
to them. So we are very much in favor of this.
Last but not least, I see I am out of time, the WWHAT bill,
which is, love the name. But we would like to commend you. The
IOM study that was cited before that was September 2005 that
looked in depth basically said there was no recordkeeping,
there was no longitudinal study of any human beings, much less
military veterans of World War II. Therefore, trying to prove
that you were exposed to those kinds of noises in World War II,
they are all octogenarians now, and nonagenarians. It is time
to give them a hearing aid to improve the quality of their
lives in the time that they have left. In regard to other
comments about including the Korean War, we would concur with
that, as well as other military service. But the bill as it is,
we favor.
Thank you very much, Mr. Chairman, for the opportunity.
[The prepared statement of Mr. Weidman appears on p. 33.]
Mr. Michaud. Thank you very much, Mr. Weidman. And Mr.
Embree.
STATEMENT OF TIM EMBREE
Mr. Embree. Thank you, sir. Mr. Chairman, Ranking Member,
and Members of the Subcommittee, on behalf of Iraq and
Afghanistan Veterans of America's 180,000 members and
supporters, I would like to thank you for inviting us to
testify before your Subcommittee today.
My name is Tim Embree. I am from St. Louis, Missouri. I
served two combat tours in Iraq with the United States Marine
Corps Reserve. This legislation being considered today will
profoundly affect veterans of all generations and their
families. We appreciate this opportunity offer our feedback.
IAVA proudly supports the Improved VA Outreach Act of 2010.
Too many men and women discharging from the military are not
enrolling in the Department of Veterans Affairs for their well
earned benefits. Currently, the burden is on the veteran to
seek out their benefits within a passive VA. This is
unacceptable. The VA must develop a relationship with the
servicemembers while they are still in the military, not after
the servicemember has traded in his uniform for a t-shirt and
blue jeans. The VA should learn from successful college alumni
associations. Those folks did not wait until graduation day to
find their newest members. They greeted on the 1st day of
freshman year, and repeatedly engaged them throughout their
education with planned activities and social events. The VA
should do the same.
They should greet servicemembers once they complete basic
training and build on that relationship throughout the
servicemember's time in uniform. When a person leaves the
service the VA should create a regular means of communicating
with them about events, new programs, and opportunities. The VA
must aggressively promote VA programs to veterans who have not
yet accessed their Department of Veterans Affairs benefits. If
I have half as many letters and emails from the VA as I do from
my college alumni association that would be a good start.
To transfer the VA from reactive to proactive, IAVA
believes the Department of Veterans Affairs must invest in
aggressive, modern, and innovative outreach. This is not
happening now and veterans are clearly suffering as a result.
IAVA was disappointed when there were only a few brief mentions
of outreach activities in the President's VA budget submission,
none of which were for a dedicated outreach campaign. We
believe the VA must include a distinct line item for outreach
within each VA appropriation account. This line item should
fund outreach programs such as the Operating Iraqi Freedom/
Operation Enduring Freedom (OIF/OEF) outreach coordinators,
mobile Vet Centers, and the VA's new social media presence on
Facebook and Twitter.
The VA's current outreach campaign is disappointing. When
the VA announced it had placed ads on more than 21,000 buses
nationally in order to spread the word about the suicide
prevention lifeline, we were initially enthusiastic. But then
we saw the ad. We saw another missed opportunity. The VA bus ad
had over 30 small print words. The average bus ad is limited to
five to 10 words. In the short time when a bus passes, a
veteran would have to go by the bus repeatedly to even read the
hotline number.
IAVA has run one of the largest nongovernmental outreach
campaigns in history. We have partnered with the Ad Council and
some of the world's best advertising firms. We have learned a
lot about the best ways to communicate complex and series
issues through television and print, and we are ready to work
with the VA to share our expertise.
The Improved VA Outreach Act will help the VA take their
current outreach efforts to a whole new level. This bill
requires the VA to effectively coordinate outreach efforts
among the different parts of the Department, as well as other
agencies offering services to returning servicemembers. To work
closely with HHS in order to promote community health centers.
These community health centers may be the only medical facility
a rural vet can reasonably access without spending a full day
riding in a car or bus. To set up an outreach committee tasked
with coordinating efforts, which currently are being done on an
ad hoc basis among many of the VA's separate departments, and
to submit a 2-year plan fully explaining their outreach
activities.
To bring America's next generation of veterans into the VA
to receive the benefits they have earned will require an
unprecedented VA outreach program. The Improved VA Outreach Act
of 2010 is the first step in getting us there.
Stories about veterans leaving VA facilities sicker than
when they entered cast a cloud over the confidence veterans
place in the system charged with their care. Therefore, IAVA
endorses H.R. 4062, the ``Veterans' Health and Radiation Safety
Act.'' Improper use of medical equipment, especially
radioactive isotopes, can lead to unexplained illness, cancer,
and even death. The VA was recently issued the largest fine by
the Nuclear Regulatory Commission for misuse of radioactive
isotopes in the treatment of nearly 100 veterans in
Philadelphia. H.R. 4062 mandates the proper oversight of these
treatments so veterans can be confident in the safety of the
care they receive.
It is common sense to support of Gold Star Parents, who
have given so much to our Nation. That is why IAVA supports
H.R. 4505. This bill expands access for Gold Star Parents to
State Nursing Homes. H.R. 4505 changes the requirements to
include Gold Star family members who have no remaining sons or
daughters, but have lost one of their children in service to
their country.
IAVA is proud to continue working with this Committee on
the many issues facing today's veterans. Thank you very much
for your time today and I look forward to answering any
questions you may have.
[The prepared statement of Mr. Embree appears on p. 36.]
Mr. Michaud. Thank you very much, Mr. Embree. Mr. Brown, do
you have any questions for the panel?
Mr. Brown of South Carolina. Thank you, Mr. Chairman, no I
do not. I appreciate the input on these bills. I know we are
pretty much in agreement, except maybe on the hearing aid
issue. And we will certainly look forward to further discussion
on that. Thank you all for being here.
Mr. Michaud. Mr. Teague.
Mr. Teague. No, I do not have any questions at this time.
And for the sake of speed, we will save them for later. Thank
you.
Mr. Michaud. Mr. Boozman.
Mr. Boozman. No, I also do not have any questions. Again,
we appreciate your guys' hard work, and all that you represent,
and giving us your opinion regarding this. So thank you very
much.
Mr. Michaud. Mr. Rodriguez.
Mr. Rodriguez. Yes, let me also just take this opportunity
to thank you and maybe inquire about one comment. The 84
percent vacancies in the nursing home, is this nationwide?
Because I know in Texas we only have about six or seven of
them, and we do not have too many nursing homes for veterans. I
am not sure if we even have any vacancies. Does anybody want to
make any comments on that? I know we usually have a waiting
list.
Mr. Searle. Yes, sir. Those come from VA's numbers
themselves that they reported on average that that is where
their numbers are. There are some homes that are less. But on a
national average it is about an 84 percent occupancy rate in
the nursing homes.
Mr. Rodriguez. Yes, because I know in Texas we never had
them until just in the last decade or so, perhaps the last two
decades. I do not have any in my district, and in my previous
district, I only had one. Okay, thank you.
Mr. Michaud. Thank you. I have a question for everyone on
the panel, and which some of you touched upon in your
testimony. VA states in their written testimony that they do
not support H.R. 4062, the ``Veterans' Health and Radiation
Safety Act,'' because they either met or are working to meet
the recommendations provided in the May 2010 Inspector General
(IG) report. What is your response to VA's rationale for not
supporting this legislation? And can you explain whether you
believe the VA has made sufficient progress in improving the
handling of radioactive isotopes at the VA medical facilities?
I know some of you have touched upon this question in your
opening remarks. Mr. Searle, do you want to start?
Mr. Searle. Again, through our System Worth Saving Task
Force we have gone to the various medical centers. We have
found that there are, and we can forward to you in detail some
of the results, but we have found that there is a turnover of
personnel, and that the training of the personnel needs to be
standardized and it needs to be reinforced. Because new
personnel with the activities that are going on need to be
reinforced.
Mr. Hilleman. Mr. Chairman, thank you for this question. In
the mind of the VFW it is a confidence issue. Here we had an
incident where a number of veterans were harmed by medical
procedures that they trusted, doctors that they had faith in.
And that faith has been undermined. So Congress taking action
to ensure that an event like this never happens again is
something we strongly support. Not only that, but the reporting
mechanisms in the bill will help to ensure that the steps VA is
already taking are followed through on. Thank you, sir.
Mr. Weidman. Much of what happens in this room and with the
distinguished Members of this Committee that you focus on are
things that all you have to do is have common sense and VA
would already be doing. And in some instances they do not have
the authority to move forward, but in many others they do. And
this is one of those instances. Clearly, there has not been put
in place the metrics to measure this systemwide and to report
on it. And once again, as I said in both our written statement
and in the oral statement, it can be designed to have metrics
that are not onerous on the service providers that will allow
VA to know what is going on at X, Y, and Z service delivery
point.
The biggest problem within the VA systemwide, and certainly
with in the medical health care system, is what you measure and
how do you measure it, and how well do you measure it? It is
the quality assurance that is the primary failure of this
system. To know where there are deficiencies, one, and two,
holding people accountable at the supervisory and management
level has been lacking, in our view, for a very long time and
that is where we need to go with this system. To ensure that we
are getting the bang for the buck, we have had over a third
increase in the health care budget in the last 4 years. And the
question is whether or not we are getting the bang for the
buck. We are not convinced that we are yet, but it is certainly
possible. But it is going to take a lot of oversight on a
bipartisan basis but this Committee and we encourage you to do
that. And this is one more step in that road.
Mr. Embree. Mr. Chair, thank you for the question.
Actually, this kind of ties into the VA outreach. Right now
from the OIF and OEF era veterans, it is tough enough to get
these folks into the VA system, for them to learn about the VA
system. And to learn about the quality of VA health care. VA
health care is very, very good. Unfortunately, when situations
like this arise where it breaks down the trust, and it hurts
the appearance of the VA health, then we need to fix that right
away. And there needs to be strong oversight. And we need to
restore confidence in this system. And that helps with the
outreach to these young veterans that are now coming from the
battlefields of Afghanistan and Iraq.
So it is so important for programs like this to have strong
oversight to instill confidence in the new veterans that are
now trying to come into the system. Because we want to bring
these new veterans into the system, but we want them to have
confidence in the system that we are trying to convince them to
enter.
Mr. Michaud. Great. Once again, I want to thank each of you
for your testimony this morning. I look forward to working with
you as we move forward with the legislation that we heard this
morning. And I am sure there will probably be additional
questions that staff will submit to you in writing. So once
again, thank you very much.
I would like to ask the third panel to come forward. And
while they are coming forward, the third panel includes Dr.
Jesse, who is the Acting Principal Deputy Under Secretary for
Health with the VHA. He is accompanied by Walter Hall, who is
the Assistant General Counsel to the VA. I want to thank you
both for coming this morning. And we will turn it over to Dr.
Jesse.
STATEMENT OF ROBERT JESSE, M.D., PH.D., ACTING PRINCIPAL DEPUTY
UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION,
U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY WALTER A.
HALL, ASSISTANT GENERAL COUNSEL, OFFICE OF GENERAL COUNSEL,
U.S. DEPARTMENT OF VETERANS AFFAIRS
Dr. Jesse. Yes, good morning Mr. Chairman and Members of
the Subcommittee. It is a pleasure to appear before you for the
first time today as Acting Principal Deputy Under Secretary for
Health. I am accompanied by Mr. Walter Hall, the Assistant
General Counsel. We appreciate the opportunity to testify on
five pending bills and offer VA's views.
H.R. 4062, the ``Veterans' Health and Radiation Safety
Act,'' would require VA to submit an annual report to Congress
on low volume programs, require employees working at VA
hospitals where radioactive isotopes are used to receive
training in recognizing medical events, and require VA to
provide frequent evaluations of nongovernment medical service
contractors. While we appreciate the intent of H.R. 4062, there
are a number of reasons why VA does not support it at this
time.
Mr. Chairman, we all acknowledge the lapses that occurred
at a brachytherapy program at one of our facilities and as a
result the Office of the Inspector General has issued a report
with five recommendations. VA has taken specific actions to
comply with all of these recommendations, which are detailed in
my written statement. Consequently, we believe we have
addressed most of Congress' concerns that are reflected in H.R.
4062. We have other issues with the legislation that are
specifically related to terminology, the scope of the
legislation, and reporting requirements, and these are also
expanded in my written testimony.
VA would like to work with the Committee to better
understand the intent of H.R. 4465, which would change the
attributable income for the purposes of determining
eligibility. On its face the bill benefits only a small
population, namely those persons placed in the legal custody of
a veteran as a result of a court order. Such persons would be
considered children under more generous criteria than the
veteran's natural children. If this differentiation was not
Congress' intent, and it does not appear that it is, VA is
ready to work with the Committee to develop a proposal that
would achieve its objective.
VA supports H.R. 4505, which would permit a State Home
constructed with VA's resources to provide services to the
parents of veterans if any of the parents' children died while
serving in the armed forces. The legislation provides for fair
and more equitable treatment of all parents whose son or
daughter died while on active military duty. There are not
additional costs to the VA for this.
The first draft bill under consideration is the Improved VA
Outreach Act of 2010. I am pleased to report that VA is already
meeting the intent of the legislation. VA recently created a
National Outreach Office in the Office of Public and
Intergovernmental Affairs, which is responsible for ensuring
the effective coordination of outreach activities across all VA
sectors. In addition, VA has five advisory committees on
homeless veterans, minority veterans, women veterans,
readjustment, and rural health that provide outreach direction
in their annual reports to the Secretary and to Congress. VA
has already established a work group to better coordinate
services between Indian Health Service and VA, and is working
on a memorandum of agreement to improve that coordination.
The final bill on the docket today is a draft bill that
would expand eligibility for hearing aids to all veterans of
active duty service in World War II, even if those veterans are
not otherwise entitled to compensation under title 38 of the
United States Code. We currently have authority to provide
hearing aids to veterans with service-connected hearing loss as
well as to veterans whose hearing loss is not service-connected
but is so severe that it impedes their communication and
participation in their medical care.
While hearing loss can be frustrating and dangerous,
especially for older adults, VA does not support the
legislation as it would result in inequitable treatment of non-
World War II veterans with hearing loss. The legislation would
also create special benefits for veterans needing hearing aids
in relation to veterans needing other prosthetic appliances
that are equally crucial to the veterans, well being and
quality of life. The discretionary cost of this legislation
would be approximately $14.8 million in the 1st year, $350
million over 5 years, and $509.7 million over 10 years.
This concludes my statement, Mr. Chairman. I would be
pleased at this time to answer any questions you or other
Members of the Subcommittee may have.
[The prepared statement of Dr. Jesse appears on p. 38.]
Mr. Michaud. Thank you very much, doctor. I have a question
concerning the facts that you just stated, about all the
veterans who are eligible for hearing aids. There are
approximately 2.4 million World War II veterans who are
service-connected. You mentioned even those that might not be
service-connected still access hearing aids?
Dr. Jesse. Yes, sir.
Mr. Michaud. How did you come up with that outrageous
number? The cost?
Dr. Jesse. I would have to go back through the math of all
that. But we can certainly get that to you for the record.
Mr. Michaud. I would hope so, and I would hope that it is
very explicit, because that math does not seem to add up. Once
you exclude those veterans who are not service-connected, it
just does not add up. There are currently, as I mentioned, I
think 2.4 million World War II veterans. How many are non-
service-connected out of that amount? Do you know that number
off the top of your head?
Dr. Jesse. I do not know that number, no sir.
[The VA subsequently provided the following information:]
According to VA's latest official estimate of the veteran
population, VetPop2007, approximately 2.0 million World War II
Veterans were alive in September 2010. In FY 2010, 11 percent
(217,449) of World War II Veterans received disability
compensation benefits.
Mr. Michaud. Because I think once we exclude those veterans
who are non-service-connected, I think we can have a better
idea. I believe a hearing aid costs approximately, $6,000? Or
less? I am not sure of the exact number. But I question very
much the fiscal note on this legislation.
As another issue, one of the frustrations that I know a lot
of us have, including the VSOs at both the national level and
the State level, is the difficulty of trying to get veterans to
sign up for VA health care. Part of it is due to some mistrust
about the quality of service that veterans might receive when
they go to the VA. I think the other part is, quite frankly,
they do not know what they are eligible for. And it is
confusing. To give you a good example from my neck of the
woods; when Great Northern Paper Company filed bankruptcy and
closed their doors, the drugs companies actually offered some
programs within their respective companies on how the members
or individuals could access prescription drugs at low or no
cost. The problem was there were over 300-some odd programs
between all of the drug companies. There were 11 or 12 pages of
applications you would have to fill out. And if you are
unemployed, you are not going to do that. However, with the
efforts of Senator Snowe and myself, we were able to get the
drug companies to narrow the applicaton down to four questions,
and the computer system figured out which programs they were
eligible for. That is manageable.
There must be a way where VA can help educate or encourage
veterans to participate in the VA. For instance, working with
the IRS to simplify something that the IRS or social security
can send out to taxpayers to see whether they qualify for VA
benefits. I think between the IRS and social security you are
going to be able to hit the bulk of the American population.
And there has to be a way for VA to do more of that type of
outreach. Have you thought about anything in that regard?
Dr. Jesse. A couple of things. One of the major roles of
the Office of Public and Intergovernmental Affairs was to
really begin at the VA level to not just address this but to
actually coordinate all of the other activities that are going
on. I actually take to heart the comment about college alumni,
and how they try and engage people earlier on. And I think that
the real key to outreach is to start before they get discharged
from the military, even to the point that they are enlisting,
to understand that there are clear benefits that come along
with this commitment to serve their country. And, at the time
of separation from the service, to be much more robust in
ensuring that the veterans understand their benefits. A lot of
effort is going on now in coordinating this with the U.S.
Department of Defense, including coordinating some of the
discharge exams with the eligibility exams for VA, and the
attempt to make sure that these are coordinated. This is the
first impression many of these veterans will get of VA. And
then those delays, any issues there, may actually turn people
off. And we are spending a tremendous amount of energy to work
in that regard as well.
Mr. Michaud. Those are good efforts. I appreciate Secretary
Shinseki's and Secretary Gates' efforts to work for those who
are newly sworn in to the military. I think that those efforts
are going to work. But we also have a huge amount who have
already gone through the process. And we have to look at trying
to get those individuals into the VA system. I think one area
where we can have the biggest outreach impact on the American
people is either through the IRS, social security, or through
HHS for those who are on Medicare or Medicaid. I think there
definitely has to be a real concerted effort to get individuals
into the system. I can understand that there is some reluctance
in doing that because ultimately that would mean that there
would be more cost to the VA, and Congress would probably have
to appropriate more funding to take care of those individuals.
But that is what we are here for, to take care of the veterans.
Dr. Jesse. Well, absolutely, sir. And it is really our
explicitly stated goal that we want to be the health care
system that they want to belong to, and we feel this is very
important.
Mr. Michaud. Thank you. Mr. Boozman.
Mr. Boozman. Thank you, Mr. Chairman. In regard to H.R.
4062, the IG came out I think with five things that they feel
like needed to be implemented. I guess the question I would
have, do you agree with those five? Do you have some concerns
about them? If so, what? If not, how are we doing in regard to
implementing the five things that they suggest?
Dr. Jesse. Well actually, we agree with all five of those
recommendations. We have been working diligently to get all
those components in place and, you know, very much appreciate
their input in identifying the problems and moving those
forward. Most of these, I think, are well along the way. It
will take some time to get all of these components in place.
But we, you know, we agreed on the, Dr. Petzel, the Under
Secretary, had agreed to their recommendations, and we are
moving forward.
Mr. Boozman. And so we do have a timeline that we are
moving towards to get implementation?
Dr. Jesse. Yes, in the sense that we have, you know, we do
have a meeting with the NRC.
Mr. Boozman. Kind of yes and no?
Dr. Jesse. Well, have we set an exact date for this piece
and this piece and this piece? The answer is no. But we----
Mr. Boozman. This is something I think, Mr. Chair that we
might ask you all to maybe come up with a timeline so that we
can----
Dr. Jesse. Certainly.
Mr. Boozman [continuing]. Check in periodically as to what
is happening in that regard.
Dr. Jesse. We would be glad to do that.
[The VA subsequently provided the following information:]
The Department of Veterans Affairs (VA) Office of Inspector
General (OIG), in VA OIG Report 09-02815-143, published May 3,
2010, identified five recommendations to improve brachytherapy
treatment of prostate cancer at the Philadelphia VA Medical
Center and other VA Medical Centers.
Recommendation 1:
``VHA's National Director of Radiation Oncology Programs
should have sufficient resources, to ensure that VHA provides
one high quality standard of care for the prostate
brachytherapy population. To achieve this end, VHA should
standardize, to a practical extent, the privileging, delivery
of care, and quality controls for the procedures required to
provide this treatment.''
VA issued standard procedures for training, written directives
and clinical requirements in January 2009 and implemented them
in May 2009. All service chiefs, medical physicists, and
Radiation Safety Officers (RSO) in prostate brachytherapy
program completed mandatory training in January 2009. The
Veterans Health Administration (VHA) finished adapting
Radiation Oncology (RO) guidelines from the American College of
Radiology (ACR) in September 2009. On September 27, 2010, VA's
Radiologic Physics Center awarded a contract for medical
physics quality assurance. VA's National Health Physics Program
(NHPP) completed its annual inspections of seed implant
programs in August 2009, January 2010, and September 2010. The
inspections for all active programs in this annual cycle should
be complete by February 2011. VA continues to track and monitor
progress to ensure all RO programs are ACR inspected and
accredited; as of September 2010, 22 facilities have received
ACR site surveys, 10 of these facilities have received
accreditation, 8 facilities submitted ACR applications, and 6
of 22 facilities deferred pending corrective action plan
approval. By December 2010, VA will expand National Cancer
Institute Radiation Policy Council medical physics quality
assurance coverage to all RO programs, including an inspection
of linear accelerators every year and on-site peer review of
physics practice every 3 years.
Recommendation 2:
``VHA should take the steps required to ensure that
patients who received low radiation doses in the course of
brachytherapy be evaluated to ensure that their cancer
treatment plan is appropriate.''
VA reviewed all 114 brachytherapy cases and notified and
reevaluated under-dosed Veterans for possible additional
treatment by the Philadelphia VA Medical Center (VAMC). VA
referred 18 patients to the VA Puget Sound Health Care System
for the placement of additional seeds. VA referred patients to
Puget Sound if the patients had completed their brachytherapy
treatment within the past year of discovery and had been
considered to have been under-dosed. Eight Veterans were
identified as needing additional treatment, and these Veterans
received treatment consisting of a second procedure to boost
areas of low dose implantation at the Puget Sound facility.
Seven of the eight Veterans are being followed by the
Philadelphia VAMC, and the eighth is being followed by the Erie
VAMC. The remaining 10 Veterans did not have a second prostate
brachytherapy procedure as VA determined it was not necessary
or the Veteran refused this treatment. VA continues to provide
health care to these Veterans.
Each Veteran is seen every 6 months for followup cancer care.
The Philadelphia VAMC's RO Service performs these evaluations,
and continues to provide ongoing evaluations for 5 years of
cancer-free survival, after which the primary care clinic
follows the Veteran at least annually for the lifetime of the
Veteran.
Recommendation 3:
``VHA should review the controls that are in place to
ensure that VA contracts for health care comply with applicable
laws and regulations, and where necessary, make the required
changes in organization and/or process to bring this
contracting effort into compliance.''
All VA facilities are required to ensure contractors comply
with applicable regulations and standard procedures. VA
established this requirement in standard procedures and
implemented it in May 2009. VA is revising VA Directive 1663,
``Health Care Resources Contracting--Buying,'' based on section
8153 of title 38, United States Code, to clarify some areas of
the previous directive. The goal is to define the requirements
so that contracting officers will be able to comply in a timely
manner. Service Area Training Officers will be working with the
Contracting Officer's Technical Representatives (COTR) to
establish a more formal program and to develop specialized COTR
training by types of contracts. While the rewrite of VA
Directive 1663 is ongoing, all new contracts are consistently
being reviewed and all areas of concern are being addressed
prior to the solicitation to ensure the contracts are
technically sufficient. The National RO Program Office reviews
all solicitations for RO contracts before the contract begins.
Beginning in December 2010, standard language for RO contracts,
including quality assurance programs, will be posted on VHA's
Procurement and Logistics Office intranet Web site.
VHA supports the Veterans Affairs Acquisition Academy (VAAA) in
implementing the newly developed Medical Sharing (1663) course.
This Academy will begin holding a Medical Sharing Training
Class in fiscal year (FY) 2011.
Recommendation 4:
``Senior VA leadership should meet with Senior NRC
leadership to determine if there is a way forward that will
ensure the goals of both organizations are achieved.''
VA's Under Secretary for Health and National Director for
Radiation Oncology met with the Nuclear Regulatory Commission
(NRC) Chairman and officials on June 8, 2010. VA's National
Director for Radiation Oncology presented VHA's position on the
proposed medical events rules at the NRC Commission Meeting on
Part 35, Proposed Rule on Medical Events Definitions, on July
8, 2010. The Commissioners disapproved the proposed rule and
have requested VHA and other stakeholders to assist in this
process. VA is working with a group of experts representing the
relevant professional societies to help NRC staff draft new
rules concerning medical events.
Recommendation 5:
``VHA should work with the OIG to develop a list of
documents that should routinely be provided to the OIG when an
outside agency is notified of a (possible) untoward medical
event.''
VHA has surveyed its program offices to compile a list of
events that are possibly reported to other agencies, and
discussions are ongoing in regard to coordinating the reporting
of incidents to OIG.
Mr. Boozman. Are there provisions in the bill that go
beyond the actions that you are currently taking?
Dr. Jesse. The provision in the bill that goes beyond the
actions we are currently taking, and the one that I think has
the greatest concern to us, is one that is, I think maybe is a
little bit lost in the definition. But there is a requirement
that we review all medical services contracts weekly. We have
looked, and that does not specifically refer just to nuclear
medicine related contracts. So as we look at that, and not
including contracts related to the Community-Based Outpatient
Clinics, and other things along those lines, we currently have
just under 1,000, I think 971 medical services contracts. If we
review them weekly, that is 50,000 reports a year. Which I
think would basically pull our people away from doing clinical
work and we would be a reporting agency.
Mr. Boozman. Okay.
Dr. Jesse. So I think, you know, that piece is probably one
of the greatest concerns. The other is the terminology related
to training of all personnel in nuclear related, what are
called reportable medical events. Currently, all personnel who
work in nuclear medicine receive that training. And that is
where that training needs to be. To say that we would have to
train all medical center employees would be a huge burden, a
huge cost, and probably not productive. Those are the main
concerns we have.
Mr. Boozman. And that would be different from the typical
hospital setting? Or the typical setting in, out there in the
private sector versus the----
Dr. Jesse. Oh, the private sector? I think what we do is in
line with what happens in the private sector, yes. It is the
people who work in nuclear medicine and with these patients
that are trained and recognize that.
Mr. Boozman. Right. Very good. One more thing, H.R. 4505 is
seeking to modify a regulation. Is that something that VA could
look and do without----
Dr. Jesse. Yes, sir. We have actually discussed that. We
could change that through regulation----
Mr. Boozman. And I guess my comment is would you be willing
to look at it, and kind of come back and----
Dr. Jesse. No, absolutely, we would be very glad to do
that. The one, as I understand it, if we do it through
regulation it will take about a year. If it is done through
legislation it could be facilitated. But either way, we fully
support this. We think this is a gap in current regulations.
Mr. Boozman. Right.
Dr. Jesse. We think it needs to be corrected, and our
preference would be to correct it as expediently as possible.
Mr. Boozman. Good. Well maybe you and us working with Mr.
Thornberry can figure out what is the best way to pursue it.
Dr. Jesse. We would be happy to.
Mr. Boozman. Okay. Thank you, Mr. Chair.
Mr. Michaud. Thank you very much, and I appreciate that.
And having dealt with the VA, particularly on the nursing home
issues, the length of time that it takes them to go through the
regulatory process would be a concern. And I agree with
Representative Thornberry that we should look to work with VA
on this. But I think we ought to try to deal with that as soon
as possible, and I know the regulatory process sometimes does
not work that swiftly. And sometimes that outcome might not be
what we want, either.
Mr. Boozman. Will the gentleman yield? No, I agree. If we
can get a statement from VA and a strong statement from the
Committee, then perhaps we can go ahead and get that done.
Mr. Michaud. Great. Thank you. I have no further questions.
I want to thank you both for coming. I want to thank you both
for your testimony. I look forward to working with you, and I
am sure there will be some additional questions as we move
forward with the two draft pieces of legislation and the three
bills that we have before us today. Thank you for your
continued service working with our veterans and your employees.
We still have a ways to go. As you heard from the previous
panel, there are some concerns with the perception of what VA
is doing and not doing, and I look forward to working with you
to make sure that we do have and improve on the system we
currently have today. So once again, I want to thank both of
you for coming today. If there are no further questions, I will
close this hearing. Thank you.
Dr. Jesse. Thank you, sir.
[Whereupon, at 11:05 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 introduced legislation within the
Subcommittee's jurisdiction in a clear and orderly process. This is an
important part of the legislative process that will encourage frank
discussions and new ideas.
We have five bills before us today which address a number of
important issues. First, we have a radiation safety bill that requires
proper training of all employees at VA hospitals where radioisotopes
are used to provide medical care. Next, we have a bill which requires
the VA to consider children under the legal guardianship of a veteran
when determining the veteran's co-payment amount for medical treatment.
We also have a bill which would allow gold star parents access to the
state veterans homes if they had any child who died while serving in
the Armed Forces. Finally, we have draft legislations on improving the
VA's outreach to veterans and the provision of hearing aids to World
War II veterans.
I look forward to hearing the views of our witnesses on the bills
before us today.
Prepared Statement of Hon. Henry E. Brown, Jr., Ranking Republican
Member, Subcommittee on Health
Thank you, Mr. Chairman, and thank you for holding this legislative
hearing.
I am pleased to be here and eagerly anticipate consideration of the
five bills before us that cover a variety of issues regarding our
veterans.
I want to thank all of the Members who have sponsored these bills
and taken the time to participate in our hearing today.
I am particularly interested in hearing about H.R. 4505, which was
introduced by my friend and colleague from Texas, Mac Thornberry.
In order to receive VA per diem payments, a State Veterans Home
must maintain an occupancy rate of 75 percent veterans. However,
veteran spouses or parents who have lost all of their children due to
military service are also eligible for admission, if allowed by State
policy. H.R. 4505 would permit a State Home to also provide services to
a parent if one of their children died while serving in the Armed
Forces.
When we honor the bravery and service of our military members and
veterans, we must also honor the sacrifice and selflessness of their
families. And, I do not think the loss of a child--whether one or
many--can be differentiated. I thank Mac for introducing this
legislation.
As we continually attempt to improve services and increase the
well-being of our veterans, it is vital that we continue to work
together and have candid discussions about the best ways to improve
services and move forward with legislation to benefit our veterans.
And, I look forward to hearing more about all of the bills on our
calendar this morning.
I want to thank our witnesses for being here and in the interest of
moving forward with our discussion, I yield back the balance of my
time.
Prepared Statement of Hon. Larry Kissell, a Representative in
Congress from the State of North Carolina
Chairman Michaud and Ranking Member Brown, thank you for your
invitation to this hearing and allowing me to share with you the
importance of H.R. 4465. As I am sure all Congressional members
experience in their various states and districts, our constituents'
concerns come in a wide range of shapes and sizes. Some of these
concerns require major legislation to address the issues, while others
may require incremental changes to bring relief to those hurting the
most.
As our Nation's socio-economic dynamic changes, we as a Congress
must ensure we address the emerging needs of our veterans. This
Committee does an outstanding job of identifying needs and providing
legislation to honor those who served our Nation. Today I present to
you H.R. 4465. This bill provides assistance to the growing number of
veterans who are accepting custody of additional dependents.
H.R. 4465 acknowledges the efforts of veterans who accept legal
custody of a child that is not their own. This bill amends the current
law so that the VA considers children placed in the legal custody of a
veteran as dependents when determining if a veteran must pay a co-
payment for medical treatment. Although not all veterans are required
to pay co-payments, those that do receive additional consideration
based on their household income and number of dependents. Dependent
children are defined as biological, adopted, and step-children. The
current law does not address veterans who voluntarily assume the
parenting role for a child and receive full custody from the courts.
I am not sure of the number of veterans that are accepting these
roles. When CBO scored the bill they reported only a few veterans would
be affected and the bill would have an insignificant effect on spending
pending appropriations. I became aware of the problem after Robert and
Miriam Preiser approached me. The Preisers have been married for 13
years. Robert is 70 and Miriam is 79 years old. Between the two of them
they have 10 children, 24 grandchildren, and 17 great-grandchildren.
They are on a fixed income. Because of his 2 year tour in the Army
about 60 years ago, Robert receives a great deal of his care through
the Veterans Administration.
About 5 years ago a number of unfortunate events resulted in Child
Protective Services assuming custody of two of the Preiser's great
grandchildren, a 5 year old boy and a 2.5 month old girl. I will not go
into the details of the case, but ultimately CPS determined the parents
were not fit to raise the children. The Preisers immediately stepped in
and volunteered to become the children's guardian. After about a year
of court proceedings, the courts granted the Preisers full custody.
The Internal Revenue Services, the courts, the local school
district, Child Protective Services, and other state and federal
entities consider the children as dependents. The IRS allows the
Preisers to claim the children as dependents due to the court documents
they possess. If you choose to proceed with this bill and it eventually
passes, it will ensure that the VA considers children in the legal
custody of a veteran are considered as dependents when determining if
the veteran must pay a co-payment for medical treatment.
Prepared Statement of Hon. Mac Thornberry, a Representative in
Congress from the State of Texas
I appreciate the opportunity to testify before the Subcommittee
today on H.R. 4505.
There are 137 State Veterans Homes located in all 50 States and in
Puerto Rico that provide hospital and skilled nursing care to
approximately 28,500 veterans and dependents. State Veterans Homes are
institutions that many of our veterans and their dependents have relied
upon for nearly 150 years.
Gold Star Parents are parents who have lost a son or daughter who
died while serving our country in the military. However, to be eligible
for admission to a State Veterans' Home, a Gold Star Parent must have
lost all of his or her children while in military service. State
Veterans' Homes must deny admission to a Gold Star Parent if they have
any surviving children.
H.R. 4505 would allow State Veterans Homes to admit the parents of
service-members who died while serving our Nation to VA Nursing Homes.
My legislation would permit admission into a State Veterans' Home to
any parent who lost at least one son or daughter while serving our
Nation to protect our freedoms and way of life.
Those we ask to fight and die in our wars should have the assurance
that their families will be cared for by their country.
Losing a child to war is a stunning and life altering event, which
is why I am pushing for this bipartisan legislation to become law in
the coming weeks.
Additionally, the financial impact to the Federal Government will
be minimal, since the VA does not pay a per diem to state homes for
Gold Star Parents. In our conversations with state officials, they
expect that the impact to state budgets would be minimal as well.
The Consolidated Appropriations Act of 2010 required the VA to
conduct a feasibility study to identify the potential impact of
providing State Veterans' Home care to Gold Star Parents. The VA
determined that such feasibility study would be useless because there
would be no additional cost to the VA by providing this service.
The bill is supported by the American Legion and the National
Association of State Veterans Homes, and I know of no opposition.
In closing, I appreciate your consideration of this bill and ask
for your support to ensure that Gold Star Parents are able to receive
the support they need. I look forward to answering any questions you
might have about my bill.
Again, thank you for holding this hearing and allowing me to
testify.
__________
Department of Veterans Affairs (VA)
Report to Congress on State Home Care
Issue: The Joint Explanatory Statement accompanying Public Law 111-
117, Transportation, Housing and Urban Development and Related Agencies
Appropriation Act, 2010, urges the Department to undertake a
feasibility study to identify any potential impacts of permitting State
Home Care facilities to provide services to non-Veterans who have had a
child die while serving in the Armed Forces, as long as such services
are not denied to a qualified Veteran seeking those services. The
Department is directed to report back to the Committees on
Appropriations of both Houses of Congress within 90 days of enactment
of this Act on what steps, if any, have been taken to undertake the
feasibility study and any findings, should the study be completed.
Background Information:
General eligibility requirements for admission to a State Veterans
Home: Veterans in need of skilled nursing care and who have a general
honorable military discharge are given admission priority. Spouses,
surviving spouses, and Gold Star parents in need of skilled nursing
care are also eligible for admission, if allowed by state policy. VA is
prohibited by law from exercising any supervision or control over the
operation of a State Veterans Home, including setting admission
criteria. Admission requirements are determined exclusively by the
state. The states also establish and manage operating procedures,
personnel practices, and other operational matters.
Discussion:
VA Medical Centers of jurisdiction and State Veteran
Homes must comply with the 75 percent Veteran residency rule (title 38
U.S.C. 8131-8137), i.e., State Homes are required to maintain an
occupancy rate of 75 percent Veterans to be eligible for VA per diem
payments.
Admission requirements for State Veterans Homes are
determined exclusively by the state.
Current authority does not allow VA per diem payments for
services provided in a State Veterans Home to Gold Star parents or any
other non-Veteran residents.
The Veterans Health Administration believes it is
feasible to permit State Home Care facilities to provide services to
non-Veterans who have had a child die while serving in the Armed
Forces, as long as such services are not denied to qualified Veterans
seeking those services. Legislative authority would need to be enacted.
There would likely be some financial impact on the states
to support non-Veterans in State Veterans Homes.
Recommendation:
A feasibility study is not required because there would be no
additional cost to VA by permitting State Home Care facilities to
provide services to non-Veterans who have had a child die while serving
in the Armed Forces.
Veterans Health Administration
April 2010
__________
The American Legion
Washington, DC.
January 26, 2010
Honorable Mac Thornberry
U.S. House of Representatives
2209 Rayburn House Office Building
Washington, DC 20515-4313
The American Legion fully supports your proposed legislation to
enable State Veterans' Homes to furnish nursing home care to parents
any of whose children died while serving in the Armed Forces of the
United States. Such parents are respectfully referred to as Gold Star
parents.
Currently, Gold Star parents may receive care in a State Veterans'
Home only if they have lost all of their children in service to the
country. The loss of a single servicemember brings much grief and
sadness to a grateful nation. The American Legion believes this benefit
was granted with good intention, but unrealistic expectations of
personal sacrifice. As a nation at war, to maintain such a standard for
an earned benefit is unacceptable. The pain of loss for parents of an
only child is just as unbearable as the loss for parents with more than
one child.
Thank you Representative Thornberry for offering legislation that
would extend the heartfelt gratitude of a grieving nation to parents of
a fallen hero. The American Legion fully supports your proposed
legislation to address this injustice. The American Legion appreciates
your continued leadership in addressing the issues that are important
to veterans, members of the Armed Forces, and their families.
Sincerely,
Steve Robertson
Director, National Legislative Commission
__________
Texas General Land Office
Austin, TX.
January 26, 2010
Honorable Mac Thornberry
U.S. House of Representatives, District 13
2209 Rayburn House Office Building
Washington, D.C. 20515-4313
Dear Congressman Thornberry:
I am writing you to express my complete support of S.1450, a bill
to allow the parents of service-members who died while serving the
Nation access to VA Nursing Homes. Currently, an individual is allowed
admission into a State Veterans Home if the individual is an eligible
veteran, the spouse of an eligible veteran, or a Gold Star parent. The
problem that arises is the way the term ``Gold Star parent'' is
currently defined in the Code of Federal Regulations (CFR) administered
by the VA. According to the CFR, Gold Star parents are eligible for
admission to State VA Nursing Homes if they have lost all of their
children who were serving our country on active duty military service.
This legislation would rectify this and permit admission into a State
VA Nursing Home to any parent that lost at least one son or daughter,
while fighting to protect our freedoms and way of life.
As chairman of the Texas Veterans Land Board, I oversee our Texas
State Veteran Nursing Home program where we provide skilled nursing
care to over 1,000 Texas veterans and their family members in one of
our seven facilities. As most people are aware, State Veterans Homes
were founded for wounded and homeless veterans following the American
Civil War and have become institutions that many of our veterans and
their dependents have come to rely on for nearly 150 years. Currently
there are 137 State Veterans Homes located in all 50 States and in
Puerto Rico that on a daily basis provide hospital, skilled nursing,
rehabilitation, long-term, dementia and Alzheimer's, domiciliary,
respite, end of life, and adult day health care, to approximately
28,500 veterans and dependents.
I believe that it is only fair that the parents who lost a son or
daughter in military service have access to these first class
facilities. This legislation is strongly supported by the National
Association of State Veterans Homes.
Please join me in supporting our parents who have given more than
we as a nation could ever ask of them by changing the definition of a
Gold Star Parent.
If you have any additional questions, please contact my federal
liaison Jim Darwin at 512-463-2623 or email at
jim.darwin@glo.state.tx.us.
Sincerely,
JERRY PATTERSON, Commissioner
Texas General Land Office
__________
National Association of State Veterans Homes
RESOLUTION 2010-2
SUPPORT FOR ADMISSION TO STATE VETERANS HOMES OF ANY
PARENT WHOSE CHILD PERISHED WHILE SERVING ON ACTIVE DUTY
IN THE ARMED FORCES OF THE UNITED STATES
WHEREAS, State Veterans Homes were founded for soldiers and sailors
following the American Civil War, and have ably served veterans and
some of their immediate dependents and survivors for nearly 150 years;
and
WHEREAS, currently there are 140 State Veterans Homes in all States
and in Puerto Rico, on a daily basis providing hospital, skilled
nursing, skilled rehabilitation, long-term care, dementia and
Alzheimer's care, domiciliary care, respite care, end of life care, and
Adult Day Health Care to 28,500 veterans and dependents; and
WHEREAS, Title 38, United States Code, authorizes State Veterans
Homes to care for non-veteran residents, but only to the extent that
non-veteran residents constitute no more than twenty-five percent of
bed capacity at Such State Veterans Homes; and
WHEREAS, Title 38, Code of Federal Regulations, defines eligible
non-veteran residents of State Veterans Homes as immediate dependents
and survivors of veterans with antecedent residence in State Veterans
Homes, and parents, all of whose children died while serving in active
military service to the United States; and
WHEREAS, recognizing the contemporary trend of the all-volunteer
military force, the wide array of career paths available to American
citizens, and modern asymmetrical wars and military conflicts that
require both periodic and episodic deployments to combat engagements
throughout the world, a post-World War II policy that requires all of a
parent's children to have perished in war as a precondition of eligible
residence of a parent in a State Veterans Home under Title 38, United
States Code, as interpreted in its Code of Federal Regulations, is
unwarranted and exhibits an exclusionary intent toward parents who have
suffered irreparable loss of a child, or children, who served their
Nation in uniform.
NOW, THEREFORE, BE IT RESOLVED, that the National Association of
State Veterans Homes (NASVH) supports an amendment to Title 38, Code of
Federal Regulations, or in absence of such revision, amendment to Title
38, United States Code, to authorize admission to State Veterans Homes
of any parent whose child perished in active military service to the
United States; and fully supports the legislative objectives of the
National Association of State Veterans Homes (NASVH) to receive from VA
a per diem payment that equals 50 percent of the national average cost
of providing care in a State Veterans Home.
------------------------------------------------------------------------
------------------------------------------------------------------------
Adopted
------------------------------------------------------------------------
With Change
------------------------------------------------------------------------
Rejected
------------------------------------------------------------------------
COLLEEN RUNDELL, M.S., LNHA
President
National Association of State Veterans Homes
Dated this __ day of _____, 2010
Prepared Statement of Hon. John Adler, a Representative in
Congress from the State of New Jersey
I would like to thank Chairman Michaud, Ranking Member Brown, and
Members of the Subcommittee for the opportunity to testify on behalf of
H.R. 4062, the Veterans' Health and Radiation Safety Act. This
Subcommittee has been integral in ensuring that the health care needs
of our veterans are being met. I commend you on your leadership.
The need for H.R. 4062 came from a very serious matter that
occurred at the Philadelphia Veterans Affairs Medical Center. Starting
in 2003, the brachytherapy program at the Philadelphia VA Medical
Center was operated by a rogue doctor who botched approximately 86
percent of the prostate cancer treatment procedures he was contracted
to perform on our veterans. These multiple failures, which went
undetected year after year, highlighted significant problems in the
VA's oversight system. The VA failed until 2008 to catch this pattern
of failure.
Upon learning of these glaring oversights, I became outraged that
the brave men who so selflessly served our country had been subjected
to such poor treatment and were neglected by a hospital and system
created to protect them.
H.R. 4062, the Veterans' Health and Radiation Safety Act is a
comprehensive piece of legislation that seeks to remedy many of the
mistakes that led to the problems surrounding the brachytherapy program
at the Philadelphia VA Medical Center.
This bill has three major components centered on increasing
oversight and ensuring reform throughout the VA Health Care System.
First, my bill mandates that the VA conduct an evaluation of all of
the low-volume programs that are currently operating in its medical
facilities to ensure that they are meeting their safety standards. The
brachytherapy program at the Philadelphia VA Medical Center was not
subjected to independent peer review due to the fact that it was such a
low volume program, serving only 116 patients over a 6-year period.
Because of this lack of oversight, errors that should have been caught
and rectified were allowed to continue for 6 years unnoticed.
Second, H.R. 4062 requires that every VA employee and independent
contractor working in a VA medical facility be trained in what
constitutes a ``medical event,'' as that term is defined by the Nuclear
Regulatory Commission, as well as when such an event should be reported
and to whom. The bill also provides that if a VA hospital has failed to
administer such training, the use of radioactive isotopes at that VA
medical facility may be suspended by the Secretary.
Over the course of the 6-year period in which the brachytherapy
program at the Philadelphia VA was in operation, 86 percent of the
patients were subjected to ``reportable medical events.'' However,
because many of the medical personnel in the program, including the
independent contractors, were not trained in what constitutes a
``medical event,'' as that term is defined by the NRC, or to whom such
an event should be reported, these errors were allowed to continue and
our veterans remained susceptible to substandard medical care for far
too long.
Lastly, my bill requires the Secretary to evaluate all medical
services provided pursuant to a contract with a non-government entity.
Such evaluations shall include independent peer reviews of such medical
services and written evaluations of an independent contractor's
performance by that contractor's supervisor. The bill also states that
before a contract for medical services can be renewed, the above
evaluations must be conducted.
One of the biggest problems that occurred at the Philadelphia VA
was the lack of oversight and supervision VA officials had over the
independent contractors they contracted with to provide medical
services in their brachytherapy department. What is particularly
troubling is that these contracts were re-upped every 3 to 6 months
with little to no scrutiny as to the performance of the independent
contractors. It is my hope that this provision in the bill will
increase oversight throughout the VA Health care system.
The veterans who sought treatment for prostate cancer at the
Philadelphia VA Hospital did not receive the quality health care their
selfless service to our country earned them. Such mistreatment of our
veterans is not only unacceptable; it violates the bond our country
made with them when they agreed to fight for the safety and security of
this Nation. It is my hope that H.R. 4062 will help ensure that the
failures that occurred at the Philadelphia VA Medical Center will never
happen again within the VA.
I would again like to thank Chairman Michaud, Ranking Member Brown,
and Members of the Subcommittee for allowing me the time to testify on
this important matter. I would be happy to answer any questions you
might have.
Prepared Statement of Barry A. Searle, Director, Veterans Affairs and
Rehabilitation Commission, American Legion
Mr. Chairman, Ranking Member and Members of the Subcommittee:
Thank you for the opportunity to present the views of The American
Legion on H.R. 4062: The Veterans' Health and Radiation Safety Act;
H.R. 4505: Expansion of State Home Care for Parents of Veterans Who
Died While Serving in the Armed Forces; H.R. 4465: Determination of
Attributable Income for Veterans with Children; and two pieces of
proposed legislation: ``Improve VA Outreach Act of 2010'' and ``The
World War II Hearing Aid Treatment Act''.
H.R. 4062--Veterans' Health and Radiation Safety Act
This legislation would require the Secretary of Veterans Affairs to
report annually to Congress on the low-volume (treating 100 patients or
less) programs at each VA medical facility. It would further direct the
Secretary to ensure that all employees at a VA hospital where
radioactive isotopes are used in the administration of medical services
receive appropriate training on what constitutes a medical event and
when and to whom a medical event should be reported. It would prohibit
such isotopes from being used at a VA hospital where such training is
not provided. Finally, H.R. 4062 would require the Secretary to carry
out specified evaluations and peer reviews of all medical services
provided under contract with a non-government entity.
The American Legion's ``System Worth Saving'' Task Force annually
conducts site visits at VA Medical Centers nationwide to assess the
quality and timeliness of VA health care. In preparing for these
visits, The American Legion team researches Government Accountability
Office (GAO) reports, VA's Office of Inspector General (VAOIG) reports,
and news articles relating to potential breakdowns in a system that we
consider, ``The Best Care Anywhere.''
During The American Legion ``System Worth Saving'' Task Force
visits, and in our research, we have found that turnover of personnel
and the shortage of personnel at most facilities require renewed
emphasis on standardized procedures, quality review and individual
training, as well as documentation of that training. Further, The
American Legion believes that VA must maintain proper oversight of
medical care, utilization of facilities and resources in order to
ensure veterans receive the highest quality of care.
In a May 2010, VAOIG report concerning the review of Brachytherapy
Treatment of Prostate Cancer at Philadelphia, PA and other VA Medical
Centers, a recommendation was made for VHA to ``standardize to a
practical extent, the privileging, delivery of care, and quality
controls for the procedures required to provide treatment.'' As
technologies continue to change and treatments and procedures continue
to develop, it is critical that VA staff delivering care be properly
trained and are accountable. H.R. 4062, ``Veterans' Health and
Radiation Safety Act,'' continues and enhances protections for veterans
through required reporting, training, and evaluation of services
provided by Veterans' Health Administration (VHA). The American Legion
supports not only the specified training and the accountability
highlighted in H.R. 4062, but also the standardization of all patient
care delivered across the VHA system.
The American Legion supports H.R. 4062.
H.R. 4505--Expansion of State Home Care for Parents of Veterans Who
Died While Serving in the Armed Forces
This legislation would authorize the Secretary of Veterans Affairs
to permit a state home to provide VA nursing home care to parents who
suffered the loss of a child who died while serving in the Armed
Forces.
The American Legion is well known for its long history of
advocating on behalf of veterans and their families. We believe firmly
that a commitment is made not only by the servicemembers who raise
their hand in service to this country, but also their family members
who must say good bye to their loved ones who head into combat to
protect the freedoms of this Nation. President Lincoln, during his
Second Inaugural Address made the statement that would later become the
mission of VA, ``To care for him who shall have borne the battle and
for his widow, and his orphan.'' The American Legion strongly believes
that when a servicemember is killed in the line of duty and a dependent
parent is deemed medically eligible for nursing home admission, that
parent be entitled to VA nursing home care. Currently, Title 38 Code of
Federal Regulations (CFR) imposes too high a threshold of suffering on
surviving parents when it requires that all children must have died
while serving on active duty. H.R. 4505 amends section 51.210(d) of
Title 38, CFR, to provide services to ``a non-veteran any of whose
children died while serving in the Armed Forces.''
The American Legion at its 2009 Convention approved a resolution
which recommends amending section 51.210(d) Title 38, CFR, ``To
authorize admission to State Veterans Homes the parents of any
servicemember who perished while on active military service to the
United States.''
Additionally, in January 2010, The American Legion sent letters to
Members of Congress to express full support of this legislation. The
American Legion believes the original intent and wording of section
51.210(d) of Title 38, CFR, was granted with good intention. But
unrealistic expectations of personal sacrifice exist when requiring
that all children of a parent must die in the service to this Nation in
order to qualify for admission to a nursing home.
The American Legion supports H.R. 4505.
H.R. 4465--Determination of Attributable Income for Veterans with
Children
This legislation would direct the VA Secretary, when examining a
veteran's attributable income for purposes of determining whether a
veteran is unable to defray the necessary expenses of hospital, nursing
home, and domiciliary care, to treat as a dependent child of such
veteran any unmarried person who:
1. Is placed in the legal custody of the veteran for at least 12
consecutive months;
2. Either has not attained age 21, has not attained age 23 and is
enrolled in a full-time course of study at an institution of higher
learning, or is incapable of self-support due to mental or physical
incapacity;
3. Is dependent on the veteran for over one-half of the person's
support; or
4. Resides with the veteran, unless separated to receive
institutional care.
The American Legion believes a pension is an earned and defined
benefit for a veteran through their honorable service to the Nation. We
do not believe that pension should be reduced or offset based upon
other income earned by the dependent children of a veteran.
The American Legion supports H.R. 4465.
Proposed Draft Legislation--``World War II Hearing Aid Treatment Act''
The American Legion recently adopted a resolution acknowledging
current advancements in scientific research to review prior and new
potential environmental threats to servicemembers. It was resolved
that, ``The American Legion's comprehensive policy on environmental
exposures be an all inclusive policy and vigorously support the
liberalization of the rules relating to the evaluation of studies
involving exposure to any environmental hazard.''
It is understood that past acceptable norms of environmental
exposure for noise, for example weapon's qualification in basic
training conducted without proper hearing protection, have been found
to be unacceptable in today's environment. These instances could lead
to the possibility of a service connection for hearing loss if claimed.
Also, especially in the case of WWII veterans the ``state of the art''
for working environmental protection of servicemembers had not evolved
to the current levels. The fact of service and exposure to these
environmental exposures would imply the potential for hearing loss.
Furthermore, the only measure of assessing hearing loss on
separation from service in this era was the so-called ``Whisper Test,''
which has been found insufficient to measure actual hearing loss by
both medical experts and the courts. As VA's procedures for
adjudication of benefits claims rely heavily on the status of hearing
at separation, these inadequate exams unfairly prejudice the system
against the veterans who clearly suffered traumatic noise exposure
during their service. The fact that hearing loss can have a gradual
onset and is not always immediately detectable after traumatic noise
further contributes to the difficulties that veterans of earlier eras
face in becoming service connected for their loss.
The bill could potentially save VA development time related to
determining the etiology of hearing loss conditions and could alleviate
some of the workload contributing to the claims backlog.
The American Legion supports this proposed legislation to furnish
WWII veterans with hearing devices.
We would further submit for this Subcommittee's consideration the
fact that environmental noise exposure issues that this proposed
legislation is attempting to address were in existence through the
Vietnam War and that it was not until relatively recently that
significant efforts were made to protect the hearing of servicemembers.
Therefore, The American Legion recommends this Subcommittee consider
expanding the bill to cover veterans from the Korean and Vietnam War
eras also.
``Improve VA Outreach Act of 2010''
In May 2008, The American Legion testified concerning improvements
VA could make to improve outreach to veterans. VA had made progress at
that time and continues to make progress to improve its outreach
program to veterans. Currently, in the case of the Veterans' Benefits
Administration (VBA), efforts have been made to inform and involve
Veterans' Service Organizations (VSOs) in finding solutions to improve
the claims process. VSOs, in turn, advise veterans on efforts made by
VA to assist them. This partnership between VA and VSO's in informing
veterans is critical to the success of VA's outreach program.
However, while VA has made improvements in outreach significant
issues remain and there is much work to be done. Earlier this month,
The American Legion testified that VA continues to struggle with
informing veterans of entitlements. The joint efforts of the Department
of Defense (DoD) and VA to assist transitioning servicemembers through
the Benefits Delivery at Discharge (BDD) program and the Transition
Assistance Program (TAP) briefings are laudable. Progress is being
made, but outreach efforts vary both in quality and effectiveness. In
particular, Reserve component members released from active duty
mobilizations are often rubber stamped and returned to their home
station with little or no understanding of what entitlements they have
earned due to their honorable service.
The American Legion understands that policies developed at VA
Central Office, with the best of intentions, are for the most part
executed at the discretion of the Regional Office Director or the
Veterans Integrated Service Network (VISN) Director; and therefore,
vary in local implementation. For example, VA has a veteran employment
hiring program policy to recruit veterans, as outlined in Secretary
Shinseki's Memorandum dated 21, October 2009. However, The American
Legion has seen a wide variation in hiring of veterans at the Regional
Office level. The variation ranges from about 25 percent to 79 percent
depending on the Regional Office. We feel that this is due to the
discretion given to the Regional Office Director in interpreting the
policy. It further depends on that individual's emphasis on hiring
veterans. We do not believe that there is a substantial difference in
qualified veterans in one area as compared to another. The American
Legion feels that a greater amount of accountability for success in
outreach to veterans to identify opportunities for employment should be
required for the subordinate offices in VA.
Many veterans are moving to rural and extremely rural areas.
Nevertheless, these veterans have earned the right to receive
information and updates on changes that impact their earned benefits.
While VA has made efforts to become more ``user friendly'' we continue
to hear, especially from older veterans and those in rural areas, that
the system and required documentation is still too complicated.
The American Legion urges strong improvements to outreach. In
addition to upgrading our Web site www.legion.org to make it more user
friendly, The American Legion Magazine and the Web site have regular
updates on such issues as the new Post-9/11 GI Bill and recent changes
to veterans' entitlements. Additionally, The American Legion's
Veterans' Affairs and Rehabilitation Commission publishes periodic
``Bulletins'' based on VA information, which are utilized by the
Department (State) Service Officers to further assist with VA's
outreach to veterans. As a recent example, a ``Bulletin'' was
distributed after receiving a request for information from VA
concerning ``brown water Navy veterans'' concerning vessels that were
in inland waters of Vietnam and whose crews may be impacted by Agent
Orange.
The American Legion is also assisting VA to improve its outreach to
Priority Group 8 veterans. This endeavor is focused on advising
veterans of new regulations that allow VA to enroll certain Priority
Group 8 veterans who have been previously denied enrollment in the VA
health care system because their income exceeded VA's income
thresholds.
These successful partnerships between VA and VSOs continue to
benefit the veteran population. This demonstrates that extended VA
outreach has an immediate impact on the lives of veterans, and VA must
not lag behind in the modernization and scope of their own outreach to
veterans.
The establishment of a VA Advisory Committee on Outreach as
proposed in the draft legislation, with representation from members of
the VSO community reporting to the VA Secretary, will enhance VA's
outreach program and ultimately better serve America's veterans.
Requiring an analysis of the recommendations of the Advisory Committee,
as part of the strategic plan submitted to Congress, will enhance the
value of these recommendations.
The American Legion supports all reasonable efforts toward
improving outreach to veterans and The Improved VA Outreach Act of
2010, in particular.
As always, The American Legion thanks this Subcommittee for the
opportunity to testify and represent the position of the over 2.5
million veteran members of this organization and their families. This
concludes my testimony.
Prepared Statement of Eric A. Hilleman, Director, National Legislative
Service, Veterans of Foreign Wars of the United States
MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:
On behalf of the 2.1 million men and women of the Veterans of
Foreign Wars of the U.S. and our Auxiliaries, I want to thank you for
the opportunity to testify at today's legislative hearing.
H.R. 4062, Veterans' Health and Radiation Safety Act
VFW supports legislation that would amend Title 38, United States
Code, to make certain improvements in the administration of medical
facilities within the Department of Veterans Affairs.
Section II mandates that VA conduct annual reporting to Congress on
low volume programs, treating less than 100 patients a year. Section
III demands adequate training for employees and contractors on
appropriate reporting of medical services and programs where the use of
radioactive isotopes is present. Section IV requires all contractors
and contracting offices to adhere to rigorous guidelines when using
this method of health care treatment.
The use of radioisotopes at VA hospitals has increased the levels
of risk to patients who undergo these potentially life-saving
treatments and tests. Diagnostic techniques in nuclear medicine allow a
non-invasive method of detecting and evaluating most cancers. Further,
some cancerous growths can be controlled or eliminated by irradiating
the detected growth.
VFW asks Congress and VA to strongly demonstrate that safety and
training are provided to all employees, contractors, and non-government
entities who are employed at VA where radioactive isotopes are used. We
believe this bill is the correct step toward this goal.
H.R. 4465, to amend Title 38, United States Code, to direct the
Secretary of VA to take into account dependent children when
determining the veteran's financial status when receiving
hospital care or medical services
The VFW supports this legislation to allow certain dependents to be
counted in determining earnings thresholds for the purpose of seeking
benefits and services at VA.
This legislation requires VA to recognize children placed in the
legal custody of the veteran as a result of a court order. Under the
bill, in order for the child to be counted as eligible, they must be in
the custody of the veteran for at least 12 consecutive months, require
support at least 50 percent of the time, and/or be under the age of 21
(or 23 if enrolled as a full-time student). Currently, children placed
in the legal custody of a veteran are not counted for the purposes of
health care categories or qualification for pension or benefits. VFW
believes H.R. 4465 will correct that inequity and passing it is the
right thing to do.
H.R. 4505, to enable State homes to furnish nursing home care to
parents, whose children died while serving in the Armed Forces
VFW supports this legislation, which would authorize state-run
nursing homes to accept the surviving parents of a child who died while
serving in the armed services. The VFW believes the care of all Gold
Star parents is a sacred trust and this bill would provide a critical
benefit at a time when they may need long-term care. We ask Congress to
enact this legislation quickly.
Draft Bill, World War II Hearing Aid Treatment Act
VFW admires the goal of this legislation but cannot support it as
written. Millions of Americans participated in combat where nearly
300,000 were killed and 671,000 were wounded. Almost everything about
modern warfare involves loud, often incredibly loud, noise. Acoustic
trauma is a major cause of hearing loss. Those who fought in the island
campaigns of the Pacific, North Africa, Normandy, the Battle of the
Bulge to the River Elbe, or flew through the flak and fighter filled
skies of France and Germany were exposed to incredible amounts of
hearing damaging noise. However, their experiences in training for and
fighting a war are, in terms of noise exposure, virtually identical to
their younger brothers and sisters who trained and fought in every
other war from Korea to Vietnam to the current conflicts in the Middle
East.
We cannot support this legislation because the only factual
difference between their exposure to noise and that of all veterans is
that they are older. We believe the bill is inequitable as it
discriminates against other veterans based on age. We would be happy to
work with the Committee on clarifying hearing aid benefits for all
veterans.
Draft Bill, Improved VA Outreach Act of 2010
The VFW supports the Improved VA Outreach Act of 2010. This bill
aims to improve outreach activities within the Department of Veterans
Affairs by coordinating the efforts among the offices of the Secretary,
Public Affairs, Veterans Health Administration, Veterans Benefits
Administration and the National Cemetery Administration.
In order to increase the effectiveness of VA outreach, it also
directs the Secretary to annually review activities performed by VHA,
VBA, state veterans agencies, county veterans agencies, VSOs and other
federal departments (referred to in section 6306), to include the
National Guard and Reserve component bureaus under Section 561 of Title
38, CFR
The VFW has always encouraged and supported increased awareness of
benefits and services provided by VA to veterans. We believe that all
veterans and their survivors should have access to up-to-date
information about services and benefits for which they may be eligible.
However, a key component missing in the language of this bill is
training. We believe that effective outreach can only be achieved
through the proper training of individuals performing outreach
activities. We also note that since any successful initiative will
result in increased claim submissions to VA, funding for VBA
adjudication must keep pace with increases in the number of claims
filed as a result of greater outreach.
We applaud sections 4 and 5, which establish an advisory committee
to provide a biennial report on outreach activities. The Committee will
bring together various experts in veterans' issues to make
recommendations on how to improve VA benefits, services and programs.
Reaching out to Federal, state and local stakeholders encourages the
sharing of best practices and helps VA in identifying the needs of
eligible veterans and their families. This is especially critical now
with many injured servicemembers returning from the current conflicts
unaware of their benefits.
Mr. Chairman, Members of the Committee, this concludes my
testimony. I would be happy to address any questions you may have.
Thank you.
Prepared Statement of Richard F. Weidman, Executive Director for Policy
and Government Affairs, Vietnam Veterans of America
Mr. Chairman, Ranking Member Miller, Distinguished Members of the
House Veterans' Affairs Subcommittee on Health and honored guests,
Vietnam Veterans of America (VVA) thanks you for the opportunity to
present our views regarding H.R. 4062, H.R. 4505, the draft legislation
on Outreach, and the draft legislation entitled the WHAT Act. With your
permission, I shall keep my remarks brief and to the point.
H.R. 4062 Veterans' Health and Radiation Safety Act
Requires the Secretary of Veterans Affairs to report annually to
Congress on the low-volume (treating 100 patients or less) programs at
each medical facility of the Department of Veterans Affairs (VA); and,
Directs the Secretary to ensure that all employees at a VA hospital
where radioactive isotopes are used in the administration of medical
services receive appropriate training on what constitutes a medical
event and when and to whom a medical event should be reported.
Prohibits such isotopes from being used at a VA hospital where such
training is not provided; and, requires the Secretary to carry out
specified evaluations and peer reviews of all medical services provided
under contract with a non-government entity.
The recent events at the Philadelphia VA Medical Center where
veterans were harmed over an extended period by clinicians and
technicians who were not properly trained have quite naturally caused
great concern in the veterans' community about both efficacy and
safety.
The provisions of H.R. 4062 will take sensible and prudent steps to
require the VHA to ensure that quality assurance mechanisms are in
place so that those who are engaged in nuclear medicine activities
anywhere within the Veterans Health Care system are properly trained,
understand proper reporting of untoward incidents and record keeping
with a view toward quality assurance in general, have proper
supervision, have in place written procedures for quality assurance,
and require periodic peer reviews to ensure that the treatments
provided are at the proper dosing to actually work, but not so high as
to cause the individual being treated harm.
VVA always favors sensible reporting that does not place undue
burdens on the practicing clinician at the service delivery level. If
the VHA sets up proper metrics all of the reporting that is necessary
to accomplish the objective in this case (and most others) can be
programmed to pick up the salient data on the VistA electronic health
care records system. Therefore, requiring that a synopsis of activity
over the course of a year, as well as an analysis of the program, be
included in the VA's Annual Report is a potentially useful step. VVA
does not generally favor more staff for the sake of more staff in any
branch of government, but it is key that the Committees on Veterans
Affairs on both sides of the Hill have the organizational capacity to
dig into the Annual Report, the Strategic plan for VA, and other key
reporting mechanisms to be able to assist the distinguished Members of
this Committee to hold the VA much more accountable than it has been in
the past.
VVA favors passage of H.R. 4062.
H.R. 4505, Authorizes the Secretary of Veterans Affairs (VA) to permit
a state home to provide VA nursing home care to parents who had
any children who died while serving in the Armed Forces.
It is fitting that this proposed legislation should come for a
hearing this week proceeding Memorial Day. Of all weeks in the year,
this is when we should all be thinking about the terrible price of
freedom in lives lost early, cut down in the early prime of life by
virtue of service to country.
Each of the young people lost early left a web of bother and sister
war fighters, as well as family and friends for whom the loss is
particularly harsh. This is especially true for the Gold Star parents,
the mothers and fathers who have lost their son or daughter in military
service to country. What this proposed bill would do is give the
Secretary of Veterans Affairs the authority to permit states who wish
to do so to provide any needed care to these Gold Star Mothers and Gold
Star fathers.
VVA certainly hopes that most states, if not all, would choose to
provide such care as needed to these fine Americans who have suffered a
loss so great that most of us cannot even imagine how great the pain
must be. When they age their son or daughter is not there to care for
them as the years take their toll. It is incumbent on the rest of us in
our society to then step up and fill the void left by the early death
of our comrade in arms. Insofar as possible those of us in veterans
service organizations should and do step up to assist Gold Star
families, and particularly gold star mothers. Supporting this move to
cover nursing care as needed is the minimum we can and should do, as
this is something that is beyond the span of control of the things we
already do for and with the families.
VVA strongly supports early passage of this legislation.
Draft to Improve VA Outreach Act of 2010 Legislation
The fact is, only 20 percent of veterans actively use the VA for
their health care, and even many of these are not familiar with the
health care and other benefits to which they are entitled by virtue of
their service. What of the other eighty percent who never go to a VA
regional office or medical center? Most of them are, quite simply,
ignorant of these benefits--ignorant because they are uninformed. And
they are uninformed because the VA has not in the past even tried to do
a concerted, coordinated, comprehensive job of reaching out to them.
VVA believes 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, and of the possible
long-term health risks and problems they may experience due to where
and when they served. Populating kiosks in VA medical centers with
booklets and pamphlets is fine for those who make it to a VA medical
facility. However, these do not get into the hands of either the very
poor who do not use the system or the better off who do not need to use
the system.
What is needed is a real strategic plan, one that will employ TV
and radio ads, billboards, and public service announcements, as well as
cooperative efforts with civilian organizations and entities in a
coordinated effort, yet one that adapts to regional and local
realities. The proposed legislation would mandate such a comprehensive
plan. What VVA suggests is requiring the Secretary of Veterans Affairs
to establish a separate account for the funding of the outreach
activities of the Department. This would establish a separate
subaccount for the funding of the outreach activities of each element
of the Department of Veterans Affairs.
The way to make things happen at the VA is to make sure that they
plan for it, and then require that they specifically provide the line
item budget for it, and then to monitor the dickens out them to ensure
that it is done, and done correctly.
VVA has specifically started a project called the Veterans Health
Council (www.veteranshealth.org) because the VA does such a poor job of
informing veterans and their families as to the wounds, maladies,
injuries, diseases, and other adverse health risks they may be subject
to depending on what branch of the military they served, when and where
they served, their military occupational specialty, and what actually
happened to them while in military service. The primary mission of the
VHC is to partner with medical societies, professional medical
organizations, disease advocacy groups, other veterans organizations,
and interested parties to inform civilian medicine about these special
health risks of veterans, so they can provide better care to the their
patients, and so we can educate the veteran and their families through
their civilian provider.
While we are making some progress with the work of the Veterans
Health Council, we are under no illusion that we have or are likely to
ever have the resources or the reach to get this job done correctly.
But at least we have started, whereas the VA has not done so. This bill
would require them to start doing what they should have been doing all
along.
VVA strongly favors early passage of this much needed legislation.
Draft World War II Hearing Aid Treatment WHAT Act Legislation
The dangers and risks of military service to hearing, because of
the loud noises that are so prevalent in every branch of the military,
have been so well known for so long that we have tended to either
ignore this important subject or to joke about aspects of it with wry
military humor. Until recently we have not seriously looked at the very
serious medical conditions of irreversible damage to one of the five
basic human senses that is so often resulting from military service.
Earlier in this decade the Congress, led by the Members on this
distinguished Subcommittee, mandated that VA contract with the
Institute of Medicine of the National Academy of Sciences to take a
comprehensive look at the damage to hearing as well as the generally
thought of as being closely associated with hearing loss, but equally
debilitating condition of tinnitus. That mandate led to a project of
the little known but quite extraordinary Medical Follow Up Agency
(MFUA) convening a panel of experts and conducting a consensus study
that resulted in a report being issued in September of 2005.
Noise-Induced Hearing Loss and Tinnitus Associated with Military
Service from World War II to the Present
Type: Consensus Study
Topics: Veterans Health (http://
www.iom.edu/Global/Topics/
Veterans-Health.aspx)Boards: Medical Follow-Up Agency http://
www.iom.edu/About-IOM/
Leadership-Staff/Boards/
Medical-Follow-Up-Agency.aspx
Activity Description
A congressionally mandated study by the Institute of Medicine
assessed noise-induced hearing loss and tinnitus associated with
military service from World War II to the present, the effects of noise
on hearing, and the availability of audiometric testing data for active
duty personnel.
The expert committee was charged with providing recommendations to
the Department of Veterans Affairs (VA) on the assessment of noise-
induced hearing loss and tinnitus associated with service in the Armed
Forces. The Committee was asked to
review staff-generated data on compliance with
regulations regarding audiometric testing in the services at specific
periods of time since World War II,
review and assess available data on hearing loss,
identify sources of potentially damaging noise during
active duty,
determine levels of noise exposure necessary to cause
hearing loss or tinnitus,
determine if the effects of noise exposure can be of
delayed onset,
identify risk factors for noise-induced hearing loss, and
identify when hearing conservation measures were adequate
to protect the hearing of servicemembers.
Staff of the Medical Follow-up Agency identified populations of
veterans from each of the armed services (Army, Navy, Air Force, Marine
Corps, and Coast Guard) and from each of the time periods from WWII to
the present. The service medical records of a sample of these
individuals were obtained and reviewed for records of audiometric
surveillance (including reference and termination audiograms).
The Committee's final report, Noise and Military Service:
Implications for Hearing Loss and Tinnitus, was released in September
2005. That report can be accessed at the link below:
http://www.iom.edu/Reports/2005/Noise-and-Military-Service-
Implications-for-Hearing-Loss-and-Tinnitus.aspx
Essentially what this report detailed is what we already knew and
what was not known, because there were no significant longitudinal
studies of humans and audionomic hearing loss, much less such studies
of military personnel. Moreover, the study confirmed that there was
little if any attention made to protecting the hearing of military
personnel until the 1970s, and even then the efforts were minimal and
usually restricted to highly controlled training situations (e.g., the
rifle ranges used in basic training). For obvious reasons, soldiers in
combat situations were (and are today) unlikely to wear hearing
protective gear because it does not allow them to be at the highest
state of situational awareness of the enemy or potential enemies (i.e.,
what you can't hear can and will hurt/kill you).
World War II veterans are now in their eighties and nineties. It is
clear that there are no good records to research to prove service
connection for hearing loss for these men and women who still survive
today. It is as likely as not that many, if indeed not most, of them
first suffered damage that led to greater hearing loss than they would
have otherwise experienced started in military service. For most who
experience hearing loss today being able to have access to use of
decent hearing aids and devices is perhaps the one single thing that
would improve the quality of life for the most of these veterans. It is
long past the time when these folks should be subjected to the
adversarial system of proving service connection to the satisfaction of
VBA personnel (and it is adversarial, despite the assertions of VBA
officials). We urge you to pass this legislation to provide the hearing
devices to these men and women who need and want them without cost on a
no fault basis, without making them have to prove a nexus in military
service more than sixty 5 years ago.
VVA commends the Chairman, Ranking Member, and the other
distinguished Members of this Committee for moving to assist these men
and women with early passage of the WHAT act.
I shall be glad to answer any questions you might have. Again, I
thank you on behalf of the Officers, Board, and members of VVA for the
opportunity to speak to this vital issue on behalf of America's
veterans.
Prepared Statement of Tim Embree, Legislative Associate, Iraq and
Afghanistan Veterans of America
Mr. Chairman, Ranking Member, and Members of the Subcommittee, on
behalf of Iraq and Afghanistan Veterans of America's one hundred and
eighty thousand members and supporters, I would like to thank you for
inviting us to testify before your Subcommittee. My name is Tim Embree.
I am from St Louis, MO and I served two tours in Iraq with the United
States Marine Corps Reserves. The legislation being considered today
will profoundly affect veterans of all generations and their families.
We appreciate this opportunity to offer our feedback.
Executive Summary:
Three bills being considered today will positively affect our
members and their families so IAVA supports them. The ``Improve VA
Outreach Act'' addresses the need for a concerted VA effort to reach
out to veterans and their families to promote the services and benefits
available to them. H.R. 4062, the ``Veterans' Health and Radiation
Safety Act,'' insures the safety of veterans receiving specialized
treatments involving radioactive isotopes. H.R. 4505 expands access for
gold star parents to state nursing homes.
Full Testimony:
H.R. XXXX, Improve VA Outreach Act of 2010
IAVA proudly supports the ``Improve VA Outreach Act of 2010.'' Too
many men and women, discharging from the military, are not enrolling in
the Department of Veterans Affairs (VA) for their well earned benefits.
Currently, the burden is on them to seek out their benefits, within a
passive VA. This is unacceptable. It is long overdue for the VA to
aggressively recruit veterans and their families into VA programs.
``The VA could be more aggressive in contacting OIF/OEF
veterans and at least talking to them before the veteran has a
mental health crisis. They need to be proactive instead of
reactive.''--IAVA Member
The VA must develop a relationship with the servicemember while
they are still in the military, not after the servicemember has traded
their uniform for a t-shirt and jeans. The VA should learn from
successful college alumni associations, which do not wait until
graduation day to find their newest members. Instead, they greet them
on the first day of freshman year and stay with them throughout school
with engagement activities and social events. The VA should do the
same: greet servicemembers as they complete basic training and build on
that relationship throughout the servicemember's time in uniform.
When a person leaves the service, the VA should create a regular
means of communicating with them about events, new programs and
opportunities. And the VA must reach out to aggressively promote VA
programs to veterans who have not yet accessed their VA benefits. If I
got half as many letters and emails from the VA, as I do from my
college alumni association, that would be a great start.
To transform the VA from ``reactive'' to ``proactive,'' IAVA
believes the VA must invest in aggressive, modern, innovative outreach.
This is not happening now--and veterans are clearly suffering as a
result. IAVA was disappointed that there were only a few brief mentions
of outreach activities in the President's VA budget submission; none of
which were for a dedicated outreach campaign. We believe the VA budget
must include a distinct line item for outreach within each VA
appropriation account. This line item should fund successful outreach
programs such as the OEF/OIF Outreach Coordinators, Mobile Vet Centers
and the VA's new social media presence on Facebook and Twitter.
The VA's current outreach campaign is disappointing. When the VA
announced that it had placed ads on more than 21,000 buses
nationally,\1\ to spread the word about the suicide prevention
lifeline, we were initially enthusiastic; an image of the ad is below.
When we saw the ad, it was clearly a failure. The ad has over 30 small
print words; the average bus ad is limited to 5-10 words. In the short
time in which a bus passes, a veteran would have to go by the bus
repeatedly to even read the hotline number.
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\1\ http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1707.
IAVA has run one of the largest non-governmental outreach campaigns
in history, through a partnership with the Ad Council and some of the
world's best advertizing firms. We have learned a lot about the best
ways to communicate complex and serious issues through television and
print. We are ready to work with the VA and share our expertise.
The ``Improve VA Outreach Act'' will help the VA take their current
outreach efforts to a whole new level. It requires the VA to:
1. Effectively coordinate outreach efforts among the different
parts of the department as well as other agencies offering services to
returning servicemembers;
2. Work closely with the Department of Health and Human Services
to promote community health centers. These community health centers may
be the only medical facility a rural veteran can reasonably access
without spending a full day riding in a car or bus;
3. Set up an outreach committee tasked with coordinating efforts
which currently are being done on an ad hoc basis among many of the
VA's separate departments; and
4. Submit a 2-year plan fully explaining their outreach
activities.
To bring America's next generation of veterans into the VA, to
receive the benefits they have earned, will require an unprecedented VA
outreach program. The ``Improve VA Outreach Act of 2010'' is the first
step in getting us there.
H.R. 4062, Veterans' Health and Radiation Safety Act (Adler)
IAVA endorses H.R. 4062, the Veterans' Health and Radiation Safety
Act. Improper use of medical equipment, especially radioactive
isotopes, can lead to unexplained illness, cancer and even death. The
VA was recently issued the second largest fine by the Nuclear
Regulatory Commission for misuse of radioactive isotopes in the
treatment of nearly 100 veterans in Philadelphia. Stories about
veterans leaving VA facilities sicker than when they entered casts a
cloud over the confidence veterans place in the system charged with
their care. H.R. 4062 mandates the proper oversight of these treatments
so veterans will be confident in the safety of the care they receive.
H.R. 4465, Adjusting veterans financial status based on the number of
their dependents (Kissell)
IAVA does not take a position on H.R. 4465 because it appears to be
duplicative of current law. This bill requires the VA to take into
consideration that veterans seeking care in a state nursing home may
have children and therefore the veteran's ``attributable income''
should be adjusted accordingly, when deciding whether a veteran can pay
for nursing home care. Section 1722 of title 38 establishes this
eligibility and already accounts for each dependent a veteran might
have by increasing the ``attributable income'' threshold for free care
for each dependent the veteran has. If H.R. 4465 somehow expands or
clarifies the definition of dependent, IAVA would gladly support it.
H.R. 4505, Authorizing state homes to provide services to gold star
parents (Thornberry)
IAVA supports H.R. 4505, and stands with Gold Star mothers (or
whoever carries weight from that community) which expands access for
gold star parents to state nursing homes. Previously, a gold star
family member would only be eligible for these services only if all
their sons and daughters died in combat. This bill changes that
requirement to include a gold star family member, who has no remaining
sons and daughters, but has lost one of their children in the service
of their country. It is a common-sense way to support our Gold Star
parents--who have given so much for our Nation.
H.R. XXXX, World War II Hearing Aid Treatment Act (Teague)
IAVA supports the draft legislation known as the ``WHAT Act-WWII
Hearing Aid Treatment Act.'' We believe that any veteran with a
diagnosed hearing impairment, whether they served in Baghdad or
Normandy, should have access to free hearing aid devices from the VA.
Again, this seems like common sense.
Prepared Statement of Robert Jesse, M.D., Ph.D., Acting Principal
Deputy
Under Secretary for Health, Veterans Health Administration,
U.S. Department of Veterans Affairs
Mr. Chairman, thank you for inviting me here today to present the
Department of Veterans Affairs' (VA) views on pending legislation.
Accompanying me this morning is Assistant General Counsel Walter A.
Hall. We appreciate the Committee's support of Veterans and VA, and we
appreciate being able to comment on these bills as we both work to
improve the benefits provided to those who served.
H.R. 4062
H.R. 4062, the ``Veterans' Health and Radiation Safety Act,'' would
require VA to submit an annual report to Congress on low-volume
programs (defined as programs that treat 100 patients or fewer
annually) at VA medical facilities. The report would have to include
the Secretary's evaluation and findings with respect to such programs.
Additionally, H.R. 4062 would require that employees working at VA
hospitals where radioactive isotopes are used receive training on
recognizing and reporting medical events. Hospitals failing to provide
this training would be prohibited from using radioactive isotopes for a
period of time determined by the Secretary. Lastly, VA would be
required to evaluate non-government medical services contractors
through weekly independent peer reviews, written evaluations, and other
evaluations VA determines are appropriate. A contracting officer must
review and consider the results of these evaluations before VA renews
any contracts with non-government medical service contractors.
Mr. Chairman, we all are aware of a very unfortunate lapse that
occurred at a brachytherapy program at one of our facilities. We
testified about this incident before this Committee on July 22, 2009.
On May 3, 2010, the Office of the Inspector General (OIG) issued a
report on this incident with five recommendations. Specifically, OIG
recommended that the Veterans Health Administration (VHA) standardize,
to a practical extent, the privileging, delivery of care, and quality
controls for the procedures required to provide this treatment. This
has been accomplished. Standardized procedures have been developed and
site visits have verified they are uniformly in place at all facilities
and steps have been taken to ensure that patients who received low
radiation doses in the course of brachytherapy be evaluated to ensure
that their cancer treatment plan is appropriate. We have contacted all
Veterans that were potentially impacted for follow-up testing and
monitoring at other VA and private facilities and are reviewing the
controls that are in place to ensure that VA contracts for health care
comply with applicable laws and regulations, and where necessary, will
make the required changes in organization and/or process to bring this
contracting effort into compliance. A template that outlines basics
requirements for all contracts is currently in development.
The report also recommended that senior VA leadership meet with
senior Nuclear Regulatory Commission (NRC) leadership to determine if
there is a way forward that will ensure the goals of both organizations
are achieved. VA is currently working to arrange this meeting. Finally,
the report recommended that VHA should work with the OIG to develop a
list of documents that should routinely be provided to the OIG when an
outside agency is notified of a possible untoward medical event. VHA
will work closely with OIG to meet this recommendation.
We appreciate the intent of H.R. 4062 but for a number of reasons
we do not support it. First we note that section 2 requires the
Secretary to submit annual reports to Congress on low volume programs.
However, the definition of a ``program'' is not clear. Any treatment
``program'' could be defined so narrowly that no facility treats 100
patients or more a year in a particular program, or so broadly that
almost every program includes more than 100 patients annually.
Moreover, treatment quality is not always related to patient volume or
patient volume just within a given VA facility. Many VA facilities have
on staff specialist providers who also work elsewhere in the community.
When you combine all care provided by a specialist, the volume can be,
and many times is, significantly more than can be accounted for just
within VA workload. In addition, standard credentialing, privileging,
and review of quality of care are required at every facility regardless
of the size of a program.
All procedures that are performed and all medical care provided at
all VA facilities involve quality assessment (QA) and oversight. The
first procedure each year has precisely the same QA requirements as the
last, whether the annual procedure total is 5, 50 or 500. Further, each
procedure is performed by a fully credentialed and privileged
physician. Instead of the requirement to provide an annual report on
``low volume'' programs, we would like to work with Congress to
identify what information would be useful for Congress to receive on an
annual basis.The mandatory training that would be required by section 3
would apply to all VHA staff and would not be limited to staff directly
involved in the use of radioactive materials. The NRC regulations
already require all staff involved in the use of radioactive materials
to have training and further require that facilities provide evidence
of that training. Competency and training requirements for staff are
based upon their defined duties and risks associated with those duties.
In VHA, radiation safety training and education are provided annually,
through the VA Learning Management System, to all staff involved in the
use or handling of radioactive material. This includes all contract
staff or physicians working in VA Nuclear Medicine services as a
condition of their authorization to practice at a VA medical center.
The definition of a medical event and reporting requirements are taught
to and reviewed annually with all Nuclear Medicine technologists and
physicians. VA's National Health Physics Program provides a mechanism
to ensure that the training provided is completed as required by VA
policy. In addition, VA currently supports and trains all staff in
reporting any untoward events or potential events consistent with
guidance provided by the National Center for Patient Safety and the
facility safety programs. As a result, many of the requirements of
section 3 are duplicative of current VA policy.
The requirement in section 4 to obtain weekly independent peer
review of all medical services provided pursuant to a contract, and
written evaluations of the services carried out by the supervisor or
manager of the employee providing the services, are excessive and would
add unwarranted cost in staff time spent procuring and developing the
reports. The requirement to undertake peer reviews each week may be
ineffective if there are an insufficient number of procedures to carry
out a statistically valid review. The requirement for additional
reporting and oversight of all medical services provided by contract,
most of which have not reported adverse events, would be a waste of
resources. Given current VA procedures related to peer review and
reporting, some of the provisions in this bill are not necessary. We
are available to meet with Committee staff to discuss these issues in
more detail.
While VA appreciates the Committee's focus on this issue, we
believe with the above regulatory requirements, safeguards, and
training, these additional measures are not necessary. We are still
developing costs for this bill and will provide them for the record.
H.R. 4465
This bill would amend 38 U.S.C. 1722, which describes how VA
determines that Veterans are considered unable to defray the expenses
of necessary care for purposes of determining eligibility for health
care under 38 U.S.C. 1705 and 1710. Section 1722 states that the term
``attributable income'' is determined in the same manner that
eligibility for pension is determined under 38 U.S.C. 1521. H.R. 4465
would amend section 1722 to provide that the term ``attributable
income'' is determined in the same manner that eligibility for pension
is determined under section 1521 except that the Secretary shall treat
as a child an unmarried person who is placed in the legal custody of
the Veteran for a period of at least 12 consecutive months; either has
not attained the age of 21, has not attained the age of 23 and is
enrolled in a full time course of study at an institution of higher
learning approved by the Secretary, or is incapable of self support
because of a mental or physical incapacity that occurred while the
person was considered a child of the Veteran; is dependent on the
Veteran for over one-half of the person's support; and resides with the
Veteran unless separated to receive institutional care as a result of
disability or incapacitation or under such other circumstances as the
Secretary may prescribe by regulation.
VA would like to work with the Committee to better understand the
intent of this legislation. On its face it would affect only a person
placed in the legal custody of a Veteran as a result of an order of a
court and would count the person as a child of a Veteran until age of
21 unless he or she is a full-time student or incapacitated. Currently
all other persons (other than full-time students or those who are
incapacitated) are not considered children once they reach 18 years of
age. Thus, the effect of the bill would be that persons placed in the
legal custody of a Veteran by a court would be considered children
under more generous criteria than the Veteran's natural children. The
purpose of this differentiation is unclear.
If the intention is to extend the broader criteria (the age 21 cut-
off) to all children of Veterans, the language should be clarified.
Moreover, all conditions in the bill as it is drafted are conjunctive
so that it may also be read to provide that only persons placed in the
custody of a Veteran by a court shall be treated as a child.
VA currently neither tracks nor has access to databases that would
provide numbers of individuals, or Veterans (either currently enrolled
or potential users of VA health care) with a child (or children) as
defined in the proposed legislation. Thus, we are unable to determine
the potential financial impact the passage of this legislation would
have upon VA health care enrollment, expenditures, and first and third
party collections.
H.R. 4505
Pursuant to VA regulations (38 CFR 51.210), state homes constructed
with VA grants are required to maintain an occupancy rate of 75 percent
Veterans to be eligible to receive VA per diem payments. The only non-
Veterans who are authorized to reside at state homes are either spouses
of Veterans or parents of Veterans if all of their children have died
while serving in the armed forces of the United States. H.R. 4505 would
require that in administering section 51.210, VA permit a State home to
provide services to the parents of Veterans if any of the parents'
children died while serving in the armed forces.
VA supports this bill. There should be no additional costs to VA.
Draft Legislation--Improve VA Outreach Act of 2010
Section 2 of the draft outreach bill would require VA to establish
and maintain procedures to effectively coordinate outreach activities
of VA between internal departments, Federal, state and local agencies,
and Veterans Service Organizations (VSOs). This bill would require VA
to annually review the procedures in place to conduct these activities
and modify them as needed. Section 3 would require VA to consult with
the Department of Health and Human Services (HHS) regarding outreach to
Veterans who receive medical care through HHS community health centers
or facilities of the Indian Health Service (IHS). Section 4 would
establish an advisory committee on outreach comprised of
representatives from VSOs, individuals with expertise in Veterans'
issues, marketing, branding, advertising, and communication, and
representatives from State and county Veterans agencies. The Committee
would also include representatives from the Center for Minority
Veterans, Center for Women Veterans, VHA, Veterans Benefits
Administration (VBA) and National Cemetery Administration (NCA) to
serve as ex-officio members. Terms of service and pay for the Committee
members would be decided by the Secretary. The Committee's
responsibilities would include providing advice to the Secretary on
outreach matters, reviewing the strategic plan for outreach, preparing
biennial reports for the Secretary, and providing the Secretary with
any other reports that the Committee considers appropriate. The Federal
Advisory Committee Act would apply to this committee.
Section 5 would require the Secretary to submit to Congress a
biennial strategic plan for outreach activities, including plans to
identify and inform Veterans and dependents of available benefits and
services; plans to enroll or register eligible Veterans; and goals,
objectives, tasks, and performance measures for the above-mentioned
plans. The strategic plan would be sent to the Advisory Committee on
Outreach for recommendations prior to being submitted to Congress.
Because the bill would require duplication of existing programs, VA
does not support it. We note that the requirements set forth in section
2 are already being met. VA recently created the National Outreach
Office in the Office of Intergovernmental Affairs, Office of Public and
Intergovernmental Affairs. This new office is responsible for ensuring
the effective coordination of the outreach activities of the Department
between and among the Office of the Secretary, the Office of Public and
Intergovernmental Affairs, VHA, VBA, NCA, staff offices, and external
stakeholders. Further, VA already has a workgroup established to better
coordinate services between IHS and VA and is working on a memorandum
of agreement to improve collaboration.
We believe Section 4, while well-intended, would be redundant.
There are currently five advisory committees that provide outreach
direction in their annual reports to the Secretary and Congress. These
committees include the Advisory Committee on Homeless Veterans, the
Advisory Committee on Minority Veterans, the Advisory Committee on the
Readjustment of Veterans, the Veterans' Rural Health Advisory
Committee, and the Advisory Committee on Women Veterans. Finally,
pursuant to 38 U.S.C. 6302, VA is already required to develop a
biennial plan on outreach activities.
The annual discretionary cost of this bill would be approximately
$400,000.
Draft Legislation--World War II Hearing Aid Treatment Act
VA currently has authority to provide hearing aids to certain
Veterans receiving VA health care. Specifically, 38 U.S.C section
1717(c) authorizes VA to provide them to any Veteran who is profoundly
deaf and is entitled to compensation on account of hearing impairment.
This draft bill would extend eligibility for hearing aids to all
Veterans of active-duty service in World War II, even if those Veterans
are not otherwise entitled to compensation under title 38, United
States Code.
Hearing loss can be frustrating and dangerous, especially for older
adults. Further, the added effects of hearing loss and aging can
combine to create a significant communication handicap and negatively
impact the ability to communicate effectively. The negative effect of
stress and communication difficulties can contribute to poor quality of
life. In addition, untreated hearing loss among the older adult
population is linked to emotional and social consequences such as
depression and social isolation. Use of hearing aids has been shown to
be effective for hearing loss remediation and is an important element
of life quality for all of our Veterans with hearing loss.
VA does not support the draft legislation because we currently have
authority to provide hearing aids to Veterans with service-connected
hearing loss. In addition to the statutory authority found section
1717(c), 38 USC 1707(b) authorizes the Secretary to provide sensori-
neural aids in accordance with guidelines prescribed by the Secretary.
These guidelines are found in 38 CFR 17.149 and list a number of
different categories of Veterans who are eligible for hearing aids,
including Veterans with significant functional or cognitive impairment
evidenced by deficiencies in activities of daily living and Veterans
with hearing impairments resulting from the existence of another
medical condition for which the Veteran is receiving VA care. VA also
believes the legislation would cause inequitable treatments of non-
World War II Veterans with hearing loss. Furthermore, the legislation
would create unequal benefits for hearing aids in relation to other
prosthetic appliances that are also crucial to Veterans' well-being and
quality of life.
The discretionary cost of this legislation would be approximately
$14.8 million in the first year, $350 million over 5-years and $509.7
million over 10 years. This concludes my statement, Mr. Chairman. I
would be happy to entertain any questions you or the other Members of
the Committee may have.
Statement of Adrian Atizado, Assistant National Legislative Director,
Disabled American Veterans
Mr. Chairman and Members of the Committee:
Thank you for inviting the Disabled American Veterans (DAV) to
submit our views for the record of this important hearing of the
Subcommittee on Health. DAV is an organization of 1.2 million service-
disabled veterans, and devotes its energies to rebuilding the lives of
disabled veterans and their families.
Mr. Chairman, the DAV appreciates your leadership in enhancing
Department of Veterans Affairs (VA) health care programs that many
service-connected disabled veterans rely upon. At the Committee's
request, the DAV is pleased to present our views on the bills pending
before the Committee today.
H.R. 4062, the Veterans Health and Radiation Safety Act
Section 2 of this measure would require an annual report on low
volume patient programs--specifically, programs with fewer than 100
participants in a calendar year--at all VA medical facilities.
Section 3 of the bill would require the VA to ensure that all
health care employees, including contract employees, receive
appropriate training related to the use of radioactive isotopes and on
what constitutes a medical event and to whom it should be reported
should such an event occur. Failure to provide such training would
require the VA to stop the use of radioactive isotopes at a VA facility
until such time the Department deems appropriate.
Section 4 mandates VA to establish specific requirements such as
independent peer review of such services, written evaluations by the
manager of the employee providing such services and evaluation review
prior to extension of any existing contracts with non-government
entities.
The genesis of this bill appears to be the recent finding by the VA
Office of the Inspector General (OIG) related to application of
prostate brachytherapy in the treatment of prostate cancer patients at
the Philadelphia, Pennsylvania VA Medical Center, when the wrong
strength of implanted radioactive seeds was discovered.
The OIG made five recommendations, with all of which the Veteran
Health Administration (VHA) Under Secretary for Health concurred:
1. VHA's National Director of Radiation Oncology Programs should
have sufficient resources, to ensure that VHA provides one high quality
standard of care for the prostate brachytherapy population. To achieve
this end, VHA should standardize, to a practical extent, the
privileging, delivery of care, and quality controls for the procedures
required to provide this treatment.
2. VHA should take the steps required to ensure that patients who
received low radiation doses in the course of brachytherapy be
evaluated to ensure that their cancer treatment plan is appropriate.
3. VHA should review the controls that are in place to ensure that
VA contracts for health care comply with applicable laws and
regulations, and where necessary, make the required changes in
organization and/or process to bring this contracting effort into
compliance.
4. Senior VA leadership should meet with Senior U.S. Nuclear
Regulatory Commission leadership to determine if there is a way forward
that will ensure the goals of both organizations are achieved.
5. VHA should work with the OIG to develop a list of documents
that should routinely be provided to the OIG when an outside agency is
notified of a (possible) untoward medical event.
DAV has no specific resolution with respect to H.R. 4062, the
Veterans Health and Radiation Safety Act; however, we concur with the
OIG that proper training, oversight and following all mandates and
established procedures for radiation therapies are necessary for VA and
non-VA contracted health personnel to ensure patient safety. We ask the
Committee to provide oversight to ensure VA carries out all of the
recommendations made by the OIG in this case and we have no objection
to passage of H.R. 4062 to ensure Congress is properly informed about
smaller, ``low volume'' VA treatment programs and that proper training
of health personnel administering radioactive isotope treatment is
mandated along with appropriate training for identifying and reporting
a medical event that could be harmful to veteran patients.
H.R. 4505--To enable State homes to furnish nursing home care to
parents any of whose children died while serving in the Armed Forces
Mr. Chairman, H.R. 4505 would empower State Veterans homes to
furnish nursing home care to parents, any of whose children died while
serving in the armed forces. Parents who lose a child to a military
death are normally and generally referred to as ``Gold Star Parents.''
In this instance, nevertheless, their losing fewer than ``all'' of
their children to military deaths serves as a bar to their admissions
to State Veterans homes under the non-veteran eligibility standards
both in the law and in the regulations.
This bill would require the Secretary of Veterans Affairs to amend
existing regulations (title 38, Code of Federal Regulations, Chapter 1,
Part 51, Paragraph 51.210(c), with the following policy:
``In administering section 51.210(d) of title 38, Code of Federal
Regulations, the Secretary of Veterans Affairs shall permit a State
home to provide services to, in addition to non-veterans described in
such subsection, a non-veteran any of whose children died while serving
in the Armed Forces.''
Mr. Chairman, DAV does not have a national resolution from our
membership on the specific matter entertained by this bill; however, we
believe the current statutory eligibility limitation on non-veteran
admissions to State Veterans homes (not to exceed 25 percent of
operating bed capacity, or 50 percent of that capacity in the case of a
home that was constructed by a State without federal matching funds) is
a sufficient guard to ensure that veterans receive proper priority for
admission to State home residence. Therefore, while DAV would offer no
objection to the passage of this bill in its current form, we ask the
Committee to consider amending the bill further to subject this non-
veteran population to the same limitation that applies to other non-
veterans who are eligible for admission to State Veterans homes.
Draft Bill--Improve VA Outreach Act of 2010
Section 2 of this bill would require VA to establish, maintain, and
annually review procedures for ensuring the effective coordination of
the outreach activities within VA, state and county veterans agencies,
veterans service organizations, Department of Labor, National Guard
Bureau, and each of the reserve components of the Armed Forces.
Section 3 would amend title 38, United States Code, Sec. 6306 to
require VA to consult with the Department of Health and Human Services
to seek to better serve veterans who receive medical care through
community health centers or through facilities of the Indian Health
Service.
Section 4 would establish an 11-member VA Advisory Committee on
Outreach with ex officio members from the Department's Centers for
Minority Veterans and Women Veterans, VHA, the Veterans Benefits
Administration and the National Cemeteries Administration. The
Committee would be required to provide a report to Congress with an
analysis of and recommendations to improve VA's strategic plan for
outreach.
Section 5 of this measure would amend title 38, United States Code,
Sec. 6302 by changing the required biennial plan to a strategic plan
for outreach activities and for such plan to be reported to Congress.
Rather than a summary of outreach plans VA is undertaking, the
strategic plan would be a single outreach plan that includes the goals,
objectives, tasks and performance measures for implementation. In
addition, the strategic plan is to identify and inform eligible
veterans and dependents not enrolled for benefits and services provided
by the Department, and to enroll or register veterans eligible for VA
benefits and services. Consultation by VA with outside entities for the
purposes of developing the biennial plan would be substituted with the
Department's consideration of the Advisory Committee on Outreach's
analysis and recommendations of the strategic plan required under
Section 4 of this draft bill.
As this Subcommittee is aware, VA has a statutory mandate to
perform outreach activities to certain categories of veterans. For
example, title 38, United States Code, Sec. 2022 requires VA's Mental
Health and Readjustment Counseling Service to conduct joint outreach
efforts to veterans at risk of homelessness. Title 38, United States
Code, Sec. Sec. 7722 and 7727 require the Veterans Benefits
Administration to conduct outreach activities, which include sending
letters to separating servicemembers, distributing full information
about veterans' benefits to veterans and their dependents, and outreach
to assist claimants with the preparation and presentation of claims for
benefits.
Public Law 108-454, the Veterans Benefits Improvement Act of 2004,
requires VA to prepare and submit to Congress a report containing a
detailed description of the Department's outreach efforts to inform
members of the uniformed services and veterans (and their family
members and survivors) of the benefits and services to which they are
entitled and the current level of awareness of those benefits and
services. The report is also to include the results of a national
survey to ascertain servicemembers' and veterans' level of awareness of
VA benefits and services and whether they know how to access those
benefits and services.
While this law did not address the lack of an annual strategic plan
from VA to conduct its outreach activities, Public Law 109-233 added
Chapter 63 to Part IV of title 38 to ensure all veterans, especially
those who have been recently discharged or released from active
military service, are provided timely and appropriate assistance to aid
and encourage them in applying for and obtaining such benefits and
services in order that they may achieve a rapid social and economic
readjustment to civilian life and obtain a higher standard of living
for themselves and their dependents. In addition, the outreach services
program authorized in Chapter 63 is for the purpose of charging the
Department with the affirmative duty of seeking out eligible veterans
and eligible dependents and providing them with such services.
This law requires a biennial plan for outreach activities by VA to
identify and notify eligible veterans and dependents not enrolled for
benefits and services provided by the Department. In addition, a
biennial report to Congress is required that includes implementation of
the biennial plan, recommendations for the improvement of VA outreach
activities, and incorporation of the recommendations of the report
mandated by Public Law 108-454.
DAV has had the opportunity to review the December 1, 2008, VA
biennial outreach activities report to Congress. Clearly VA is
conducting numerous outreach activities to veterans of all eras and has
a special emphasis on veterans of Operations Enduring and Iraqi
Freedom. However, we note the report lacks an overarching plan as well
as any parameters or statistical evidence to determine whether outreach
efforts, individually or collectively, are achieving the desired
results. Strategic planning is essential for successful business
operations and a full understanding of the veteran population is an
important element in providing education and outreach.
The mission of VA would be incomplete and its programs would be
ineffective if it only passively received applications from those who
may by chance learn of benefits available to them. When veterans and
their programs are brought together, utilization is optimized,
economies of scale are attained, program goals are achieved, and
program outcomes are improved. An essential part of VA's mission is
therefore to seek out and educate veterans about the special programs
created for their benefit, and incidentally, the ultimate benefit of
society. Thus, VA must maintain, and adjust based on experience, an
active, ongoing, and systematic project to create awareness among
potentially eligible veterans of the special benefits and services
provided for them. This bill would reinforce the authority and
congressional mandate for VA outreach and would benefit veterans
suffering from service-related disabilities who may be unaware of the
range of benefits and services available to them. DAV has no resolution
from our membership to support this draft bill; however, its purpose
appears beneficial, and we have no objection to the Committee's
favorable consideration.
Draft Bill--To provide hearing aid devices to veterans of World War II
Section 2 of this draft bill would allow the VA to provide a
hearing aid device to any World War II era veteran diagnosed with a
hearing impairment regardless of whether the veteran is entitled to VA
compensation benefits.
Prior to enactment of the Veterans' Health Care Eligibility Reform
Act of 1996, Public Law 104-262, VA's authority to furnish prosthetic
devices and appliances to veterans on an outpatient basis was very
limited. The law significantly changed the eligibility of veterans to
receive hospital care and outpatient medical services, including
prosthetics, medical equipment, and supplies to any veteran otherwise
receiving health care services from VA. Unfortunately, sensori-neural
aids, which are a type of prosthetic device including eye glasses and
hearing aids, were not included when providing prosthetic devices and
appliances by VA was expanded.
Section 103(a) of Public Law 104-262 provides that VA could furnish
needed sensori-neural aids only in accordance with guidelines
promulgated by the Secretary.\1\ Subsequently, the Department published
regulations (38 CFR Sec. 17.149) in the Federal Register establishing
such guidelines. In 2002, the VHA issued Directive 2002-039 to
establish uniform policy for the provision of hearing aids and
eyeglasses. This directive was revised on October 28, 2008 as VHA
Directive 2008-070.
---------------------------------------------------------------------------
\1\ 38 U.S.C. 1707(b).
---------------------------------------------------------------------------
Current VHA policy on the prescription and provision of hearing
aids (and eyeglasses) is to furnish such sensori-neural aids to the
following veterans:
1. Those with a compensable service-connected disability;
2. Those who are former prisoners of war;
3. Those awarded a Purple Heart;
4. Those in receipt of benefits under title 38, United States Code
1151;
5. Those in receipt of increased pension based on the need for
regular aid and attendance or by reason of being permanently
housebound;
6. Those who have a visual or hearing impairment that resulted
from the existence of another medical condition for which the veteran
is receiving VA care, or which resulted from treatment of that medical
condition;
7. Those with a significant functional or cognitive impairment
evidenced by deficiencies in activities of daily living, but not
including normally occurring visual or hearing impairments; and
8. Those visually or hearing impaired so severely that the
provision of sensori-neural aids is necessary to permit active
participation in their own medical treatment.
Moreover, VA will furnish needed hearing aids to those veterans who
have service-connected hearing disabilities rated 0 percent if there is
organic conductive, mixed, or sensory hearing impairment, and loss of
pure tone hearing sensitivity in the low, mid, or high-frequency range
or a combination of frequency ranges which contribute to a loss of
communication ability; however, hearing aids are to be provided only as
needed for the service-connected hearing disability.
Clearly, veterans in Priority Groups 1-5 are eligible for hearing
aids. Nonservice-connected veterans (Priority Groups 6, 7, and 8) must
receive a hearing aid evaluation prior to determining eligibility for
hearing aids to establish medical justification for provision of these
devices. These veterans must be enrolled or exempt from enrollment for
VA health care and the device must be determined to be necessary to
permit the veteran's active participation in their own medical
treatment
Hearing impairment is the most common body system disability in
veterans. It is apparent that section 103(a) of Public Law 104-262 is
aimed at reducing the cost of providing sensori-neural aids. Top-of-
the-line hearing aids are costly, but that is always true of the newest
technology. Conversely, the cost of hearing aids employing older
technology has actually decreased over the years. For example, in 1996
when Public Law 104-262 was enacted, a top of the line two-channel
digital aid cost $2,500. The equivalent two-channel behind the ear
hearing aid today can be purchased for $495. For VA in 2008 (using six
companies on contract for different technology), the average cost for
hearing aid devices it has furnished was $355, whereas in the private
sector, the cost per aid was $1,500 to $2,500.
In 2008, there were nearly 520,000 veterans that had a VA
disability for hearing loss. While changes in eligibility for hearing
aid services, along with the aging population, contributed to a greater
than 300 percent increase in the number of hearing aids dispensed from
1996 to 2006, the cost of hearing aid devices has decreased. DAV has no
resolution from our membership to support this draft bill; however, its
purpose appears beneficial.
Mr. Chairman, this concludes my statement. Thank you for allowing
the DAV to present its views before the Subcommittee today.
Statement of Paralyzed Veterans of America
Chairman Michaud and Members of the Subcommittee, Paralyzed
Veterans of America (PVA) would like to thank you for the opportunity
to present our views concerning pending legislation. PVA appreciates
the effort and cooperation this Subcommittee demonstrates as they
address the problems of today's veterans and the veterans of tomorrow.
H.R. 4062, the ``Veterans' Health and Radiation Safety Act''
PVA supports H.R. 4062, the ``Veterans' Health and Radiation Safety
Act,'' which would require an annual report on low volume programs at
the Department of Veterans Affairs (VA) medical facilities and
establish a requirement for training of employees and contractors
wherever radioactive isotopes are used.
Under the provisions of this legislation, the Department of
Veterans Affairs (VA) will be required to ensure training is provided
in the proper handling and use of radioactive isotopes in VA
facilities. While PVA does not believe Congress should be in the
business of legislating good medical practice, the incidents at VA
facilities demonstrate that there sometimes is a need for directed
guidance. Radioactive materials can never be taken for granted and
ensuring VA employees, and more specifically their contractors, are
required to have adequate and appropriate training is clearly
necessary. PVA also thinks it is wise to have contracting officers
review contracts prior to extension or renewal to ensure these
requirements are met. The dangerous nature of radioactive materials
makes this critical for both the safety and health of the employees and
the veterans they serve.
H.R. 4465, a bill to properly determine a veteran's financial status
PVA supports H.R. 4465 to properly account for a veteran's children
when determining financial status. While this may seem like a minor
issue, it can have a tremendous impact on those that this legislation
will affect.
In today's society, more and more extended families are taking
responsibility for children. Grandparents and sometimes great
grandparents are taking care of the children of their children.
Invariably these ``new'' parents are older, often with much lower
income, and are gaining custody of these children and providing for a
family.
While the Internal Revenue Service (IRS) recognizes the financial
challenge custody of these children can create when determining
financial status, VA does not. The IRS considers someone a dependent
when a person has custody of the child. Social Security includes
grandchildren in its definition of a child, making them eligible for
dependent benefits. But for VA, a dependent is identified as the
biological, adopted, or step-child of a veteran only. If a veteran has
sole custody of a child and is enrolled in the VA, PVA believes that
the child should be considered when calculating the financial status of
the veteran. While the veteran could go through the burdensome adoption
process, this expense will create only greater challenges for the
custodial parents and it should not be necessary. The challenge of a
grandparent or great grandparent taking on the care of a child is
significantly difficult already and VA should not add to that burden.
Additionally, PVA supports consistency across Federal Agencies when
considering similar benefit calculations.
H.R. 4505, a bill to furnish nursing home care to parents of children
who died serving in the armed forces
PVA supports H.R. 4505 to furnish nursing home care to parents of
children who died serving in the armed forces. This legislation
corrects an injustice that requires parents to lose all their children
before being eligible for State Veterans Home residency. While this may
have made sense in the past when children often remained home with
their parents to tend the farm or family business, it does not make
sense in today's mobile economy.
The ``Improve VA Outreach Act of 2010''
PVA welcomes legislation to improve outreach to our Nation's
veterans. There are still many veterans who may not realize they are
eligible for VA benefits. This particularly includes women veterans who
are traditionally underserved, and those veterans that may erroneously
believe that because they did not serve in combat that they are not
eligible for VA benefits. The Secretary should make every effort to
reach out to these veterans, especially homeless veterans and those
suffering in poverty who may be significantly helped by VA services.
However, this outreach cannot simply be an empty slogan or program that
allows VA to proclaim how much they are doing to reach veterans.
PVA is concerned that this legislation may be headed in that
direction. It is unfortunate that Congress must direct VA to
``establish and maintain procedures for ensuring the effective
coordination of outreach activities of the Department between and
among'' Federal agencies. This is a basic task that VA should be doing
and should have been doing since its inception, and while PVA welcomes
the creation of the Advisory Committee on Outreach, establishing a
committee is often a way to demonstrate action when no actual action is
taking place. This committee is meant to advise the Secretary on
outreach matters, but this advisory process is already available
through meetings the Secretary has with various congressionally
chartered Veterans Service Organizations (VSO). We are not sure that a
formal committee will improve this function.
Formalizing this process may provide a stronger voice to the
Advisory Committee and its membership. The requirement that the
Advisory Committee conduct ``an analysis of the strategic plan'' and
make recommendations ``for improving the plan'' is welcome, but if the
Secretary chooses to ignore these recommendations, he can. The
Secretary is only required to submit a ``summary of all reports and
recommendations of the Committee'' to Congress and this summary can be
slanted in any way the Secretary sees fit. If Congress truly wishes the
Secretary to consider recommendations of the Advisory Committee, this
committee should request testimony from the Advisory Committee itself
or the members represented on the Committee, at the time of the
Secretary's report. It can be expected that Congressional Committees
may request testimony in the event of significant disagreements with
the Secretary, but by compelling testimony in the legislation it sends
the message that the Advisory Committee should be heeded and not simply
serve as a sounding board or one more empty gesture.
PVA supports all efforts of VA to reach out to its constituents.
With the ever increasing number of veterans from the wars in
Afghanistan and Iraq, and the increasing age of veterans from previous
conflicts, greater needs are being created. It is the hope of PVA that
this outreach program can be an effort that will truly reach those who
are in need. But this will not happen if sufficient resources are not
committed to the effort. Simply establishing an Advisory Committee will
not do it and PVA implores the Secretary to do more.
Draft Legislation to ``authorize the Secretary to provide hearing aid
devices to veterans of World War II''
PVA does not support the legislation to authorize the Secretary to
provide hearing aid devices to veterans of World War II as currently
written. PVA believes that if a veteran is enrolled in the VA health
system that they should be eligible for a hearing aid. This would
simply be another service provided to enrollees. However, PVA does not
believe that a World War II veteran should be able to bring in a
hearing aid prescription from their private doctor and have VA supply
the device. PVA expressed similar objections in the past to non-VA
prescriptions being filled by a VA pharmacist. PVA would support the
legislation if it were clarified to clearly state its intent to provide
for those who are enrolled in the VA health care system. In addition,
PVA is concerned that the costs associated with this new benefit be
supported with newly appropriated funds. The VA should not be expected
to supply this new service with current appropriations which could have
detrimental effects on care provided to other veterans.
Statement of Vivianne Cisneros Wersel, Au.D. Chair, Government
Relations Committee, Gold Star Wives of America, Inc.
The members of Gold Star Wives of America are the widows\1\ of
military servicemembers who served during World War II, the Korean War,
the Vietnam War, the Gulf War, the wars in Iraq and Afghanistan and in
the periods between these wars. Our husbands died on active duty and/or
as the result of a service connected cause.
---------------------------------------------------------------------------
\1\ Although widowers are more than welcome in GSW, GSW's
membership is primarily widows. Use of the word widows or other gender
specific language is meant to include widowers.
---------------------------------------------------------------------------
We are those to whom Abraham Lincoln referred when he made the
government's commitment ``. . . to care for him who shall have borne
the battle, and for his widow, and his orphan.''
H.R. 4505
H.R. 4505 would grant nursing home care in state veterans' homes to
the parents of those who died while serving the Armed Forces of the
United States.
Gold Star Wives of America (GSW) believes that this legislation
needs to be amended to include:
The widows of those who died while serving in the Armed
Forces
The parents and widows of those who died of a service
connected cause
Many of these parents, wives and widows have spent or will spend
much of their lives as the caregivers of severely disabled veterans. If
anyone deserves nursing home care in a Department of Veterans Affairs
(VA) or VA subsidized nursing home, it is the parents, wives and widows
who have provided care to severely disabled servicemembers and
veterans.
The recent bill which provides for benefits to caregivers included
only the caregivers of those who were injured in Iraq and Afghanistan.
The caregivers of veterans from previous war eras were not included in
these benefits.
Survivor benefits during earlier war eras were less than adequate.
Many of the widows from the World War II and Korean War eras receive
Dependency and Indemnity Compensation (DIC) and $200-$300 in Social
Security. Many of these widows live on $1500 a month or less and are
financially challenged.
Some of the widows of the Vietnam era receive only DIC and are not
entitled to Social Security Widows' Pension because their husbands died
very young and had not accumulated enough quarterly work credits for
them to receive a Social Security Widows' Pension. (This oversight also
needs to be fixed.)
Congress has not been able to fund H.R. 2243, the bill to increase
DIC or H.R. 775, the bill to repeal the DIC offset to SBP for widows
who have not remarried.
As a result of this lack of funding many of our widows are in
significant financial need now and they would have no means to pay for
nursing home care should the need arise.
As an alternative to providing care for parents, wives, and widows
in a VA or VA subsidized nursing home, Congress should consider
providing subsidized long term care insurance. Long term care insurance
would be far less expensive and would allow these proposed
beneficiaries to obtain nursing home care while remaining in their own
communities close to friends and family. An exception might be made so
that if a veteran is already in a nursing home, his family members
would be eligible for care in the same VA or VA subsidized nursing
home.
Subsidized long term care insurance would also relieve the burden
to the VA of providing care to additional family members when the VA is
already staggering under the current burden of caring for veterans.
``Taking care of survivors is as essential as taking care of our
Veterans and military personnel. By taking care of survivors, we are
honoring a commitment made to our Veterans and military members.''--
Secretary of Veterans Affairs Eric Shinseki
MATERIAL SUBMITTED FOR THE RECORD
Committee on Veterans' Affairs
Subcommittee on Health
Washington, DC.
June 14, 2010
Hon. Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20240
Dear Secretary Shinseki:
Thank you for the testimony of Dr. Robert Jesse, Acting Principal
Deputy Under Secretary for Health and Walter A. Hall, Assistant General
Counsel, at the U.S. House of Representatives Committee on Veterans'
Affairs Subcommittee on Health Legislative Hearing on H.R. 4062, H.R.
4505, H.R. 4465, and Draft Legislation entitled, the ``Improve VA
Outreach Act of 2010,'' and the ``World War II Hearing Aid Treatment
Act,'' which took place on June 9, 2010.
Please provide answers to the following questions by Monday, July
26, 2010, to Jeff Burdette, Legislative Assistant to the Subcommittee
on Health.
1. Dr. Jesse testified that the definition of a low volume
``program'' in H.R. 4062 is unclear so that it can be narrowly defined
to include all facilities or no facility. Please explain further by
providing some specific examples of how VA can potentially define a
``program''.
2. VA's testimony requested clarification on H.R. 4465. It is my
understanding that the goal of H.R. 4465 is to help veterans who
receive pension for non-service connected disability and are in
priority group 5. For this sub-group of veterans, their medical co-
payments are reduced by the number of dependents they have. The current
law narrowly defines dependents to include biological, step, and
adopted children. This bill would newly include children who are under
the guardianship of the veteran. This means that the veteran can have a
higher income level and not exceed the VA national income threshold,
which means free VA prescriptions and travel benefits, as well as free
VA health care for the veteran. In light of this information, are you
able to share VA's position on this bill?
3. The Gold Star Wives of America submitted a statement for the
record recommending that H.R. 4505 be amended to make eligible for
state nursing home care widows of individuals who died while serving in
the Armed Forces, as well as parents and widows of those who died of a
service-connected cause. Would VA continue to support this bill if it
were amended to include the Gold Star Wives' recommendations? Please
explain.
4. VA states that the draft legislation on outreach is largely
duplicative of existing efforts. We've also heard our VSO panel testify
about the need to greatly improve VA's current outreach efforts. Given
this clear need and if the draft legislation is duplicative, what other
legislative authorities can help VA be more successful in outreaching
to our veterans?
5. VA estimates the cost of the draft hearing aid bill as $350
million over 5 years and $510 million over 10 years. Please explain the
underlying assumptions that you used to develop this cost estimate. In
other words, how many beneficiaries and cost per hearing aid did VA
assume in this estimate?
Thank you again for taking the time to answer these questions. The
Committee looks forward to receiving your answers by Monday, July 26,
2010.
Sincerely,
MICHAEL H. MICHAUD
Chairman
__________
Committee on Veterans' Affairs
U.S. House of Representatives
Post-Hearing Questions for the Honorable Robert A. Petzel, M.D., Ph.D.
Under Secretary for Health, U.S. Department of Veterans Affairs
From the Honorable Michael H. Michaud
H.R. 4062, H.R. 4505, H.R. 4465, and Draft Legislation entitled,
the ``Improve VA Outreach Act of 2010'' and the ``World War II
Hearing Aid Treatment Act''
May 27, 2010
Question 1: Dr. Jesse testified that the definition of a low volume
``program'' in H.R. 4062 is unclear so that it can be narrowly defined
to include all facilities or no facility. Please explain further by
providing some specific examples of how VA can potentially define a
``program.''
Response: H.R. 4062 defined a low volume program as a program that
treats 100 patients or fewer during a calendar year. Clinical programs
within the Veterans Health Administration (VHA) provide a wide range of
services comprised of clinical assessments, treatments, and procedures.
In most cases this is aligned around a medical specialty or a
subspecialty provider that has received training to provide a variety
of assessments, treatments or procedures based upon his or her training
and education. As Dr. Jesse stated, this can be a clinical offering
that is within a single VA Medical Center, a Veterans Integrated
Service Network (VISN), or at the national level. VA believes a better
approach is to use a definition to be ``a group of practitioners who
collaborate closely to perform a procedure or collection of procedures
that require the same skill sets.''
VA does however, believe it best to address the concern presented
in H.R. 4062 through VA's existing credentialing and privileging
process. After initial credentialing, which focuses on the identified
clinician's training and experience, each individual medical center is
required to complete privileging of the provider. The privileging
process includes both experience in performing an identified procedure
and a review of the clinical outcomes. This process requires a review
every 2 years for cause. The overall number of procedures performed
within VA may not be the best predictor of competency, as many VA
providers also perform procedures within community and academic
settings, which may be included in the re-privileging process. The
overall number of procedures performed may be extended to the person's
overall performance at various clinical sites.
The overall review of the quality of care provided by an individual
clinician requires both evidence of continued experience and the
overall results of his or her clinical outcomes. Defining the overall
competency of the individual and outcomes of a system-wide performance
of procedures or treatments requires much more than volume triggers; VA
must and does take into consideration quality outcomes and risk-
adjusted factors.
The following are examples:
An Imaging Program consists of general and specialty
procedures, including neuroradiology, interventional
procedures, and nuclear medicine. At the facility level, each
individual clinical service may be a separate program (nuclear
medicine and radiology, for example).
Radiation Oncology Program may include a variety of treatment
and services such as external beam treatments, prostate
brachytherapy seed implant services, and other brachytherapy
treatments.
Cardiology Program may include outpatient evaluations,
procedures clinics, cardiac invasive procedures
(catherization), and open heart surgery.
Question 2: VA's testimony requested clarification on H.R. 4465. It
is my understanding that the goal of H.R. 4465 is to help Veterans who
receive pension for non-service connected disability and are in
priority group 5. For this sub-group of Veterans, their medical co-
payments are reduced by the number of dependents they have. The current
law narrowly defines dependents to include biological and adopted
children, and stepchildren. This bill would newly include children who
are under the guardianship of the Veteran. This means that the Veteran
can have a higher income level and not exceed the VA national income
threshold, which means free VA prescriptions and travel benefits, as
well as free VA health care for the Veteran. In light of this
information, are you able to share VA's position on this bill?
Response: The effect of the bill would be that persons placed in
the legal custody of a Veteran by a court would be considered children
under more generous criteria than the Veteran's natural children; the
purpose of this differentiation is unclear. If the intention is to
extend the broader criteria (the age 21 cut-off) to all children of
Veterans, we suggest clarifying the language. In addition, all
conditions in the bill as drafted are conjunctive and could be
interpreted to read that only persons placed in the custody of a
Veteran by a court shall be treated as a child. VA is available to work
with Committee Staff to provide clarity and technical assistance.
Question 3: The Gold Star Wives of America submitted a statement
for the record recommending that H.R. 4505 be amended to make eligible
for state nursing home care widows of individuals who died while
serving in the Armed Forces, as well as parents and widows of those who
died of a service-connected cause. Would VA continue to support this
bill if it were amended to include the Gold Star Wives' recommendation?
Please explain.
Response: Current law limits state home beds to spouses and parents
if all of their children have died while serving in the Armed Forces of
the United States. Historically, the reason for permitting spouses was
to make it possible for the Veteran to continue to live with the spouse
if both required nursing home care. Spouses living in a state home at
the time of death of a Veteran may continue to live in the home. The
proposal by the Gold Star Wives to make widows of individuals who died
while serving in the Armed Forces eligible for admission to State
Veterans Homes would treat those spouses more equitably. Since VA does
not pay a per diem to the state for any non-Veteran residents of State
Veterans Homes, this proposal would not have any effect on VA's costs.
Accordingly, VA has no objection to the proposal.
Question 4: VA states that the draft legislation on outreach is
largely duplicative of existing efforts. We've also heard our VSO panel
testify about the need to greatly improve VA's current outreach
efforts. Given this clear need and if the draft legislation is
duplicative, what other legislative authorities can help VA be more
successful in outreaching to our Veterans?
Response: VA already has adequate legislative authority to conduct
outreach to all Veterans and is aggressively working towards that end.
VA is taking steps to align and synchronize its outreach efforts across
VA business lines to ensure outreach activities employ clear, accurate,
consistent, and targeted messages to inform Veterans and their families
of the benefits and services available to them.
VA has established an outreach office within the Office of Public
and Intergovernmental Affairs (OPIA) and is in the process of hiring
staff. The office will promote uniform messaging across the Department,
reduce cost, and share the fiscal responsibility of researching,
analyzing, and measuring our efforts. The three Administrations and
Staff Offices will continue to execute outreach activities, but the
overall Department outreach strategy will be coordinated across all
organizations by OPIA.
As a result, OPIA will ensure necessary and valuable information is
delivered timely to Veterans and their families; will leverage
technology and partnerships with our stakeholders; will unify outreach
messages and measure tangible outcomes nationwide. VA will report the
success of these activities to Veterans, Congress, stakeholders, and
the American public. The outreach office is expected to be fully
functional by the end of the year.
Question 5: VA estimates the cost of the draft hearing aid bill as
$350 million over 5 years and $510 million over 10 years. Please
explain the underlying assumptions that you used to develop this cost
estimate. In other words, how many beneficiaries and cost per hearing
aid did VA assume in the estimate?
Response: VA's earlier estimate of the draft bill included baseline
costs for the WWII veterans who are already eligible under current law.
Excluding these baseline costs, the draft bill would cost $40 million
over 5 years and $56 million over 10 years. Under the draft bill, VA
estimates that 13,260 additional World War II (WWII) Veterans will
utilize hearing aids at the end of 5 years, and 2,508 additional WWII
Veterans will utilize hearing aids at the end of 10 years. The cost
assumed for hearing aids was $729 (per pair) at the end of 5 years, and
$757 (per pair) at the end of 10 years.
These projections are based on historical facts that VA has
provided hearing aids to more than 700,000 WWII Veterans who were
eligible for hearing aids in accordance with VA policy. This Veteran
population will decrease over time, and more than half will have
hearing loss based on published epidemiological studies. Not all WWII
Veterans with hearing loss will seek VA hearing aid services.
The following assumptions are based on VA data and Veteran health
utilization information:
Average Veteran receives 2 hearing aids at a time
(current average contract cost is $349 each = $700 rounded);
Hearing aids are replaced on average every 4 years;
First 2 years hearing aids are under warranty with no
repair or replacement cost;
One repair per 4 year life span of hearing aids; average
repair cost is $102 in 2010 (per VA Remote Order Entry System data);
Consumer Price Index inflation factors for repairs and
hearing aid cost;
710,000 WWII Veterans currently are in receipt of hearing
aids;
Half of WWII Veterans have sufficient hearing loss
requiring hearing aids;
20 percent of eligible WWII Veterans meeting hearing aid
loss criteria and not in receipt of VA hearing aids will request VA
hearing aids at some time;
Half of the 20 percent of eligible WWII Veterans who
request hearing aids will do so within the first year; and
New requests in outlying years will be 50 percent of the
new requests for the previous year.
Table 1. 10-year cost projections based on current VA data and WWII Veteran population
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New Hearing
FY WWII Veteran Hearing Aid Hearing Aid Cost/ Hearing Aid Average # Repair Repair Cost Total Cost
Population Users Aid Users Pair Total Cost of Repairs Cost Total
--------------------------------------------------------------------------------------------------------------------------------------------------------
2011 1,517,404 567,900 21,200 $700 $14,840,000 0 $102 $0 $14,840,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2012 1,294,133 493,315 10,600 $700 $7,420,000 0 $102 $0 $7,420,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2013 1,091,800 419,685 5,300 $700 $3,710,000 0 $102 0 $3,710,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
2014 1,034,727 401,351 2,650 $729 $1,931,850 14,380 $106 $1,524,280 $3,456,130
--------------------------------------------------------------------------------------------------------------------------------------------------------
2015 855,070 334,446 13,260 $729 $9,666,540 7,021 $106 $744,226 $10,410,766
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5-YR .............. ........... .......... .......... $37,568,390 .......... ......... $2,268,506 $39,836,896
--------------------------------------------------------------------------------------------------------------------------------------------------------
2016 697,806 274,909 6,420 $729 $4,680,180 3,427 $106 $363,262 $5,043,442
--------------------------------------------------------------------------------------------------------------------------------------------------------
2017 562,022 223,007 3,107 $729 $2,265,003 1,461 $106 $154,866 $2,419,869
--------------------------------------------------------------------------------------------------------------------------------------------------------
2018 446,469 176,342 1,320 $757 $999,240 6,958 $110 $765,380 $1,764,620
--------------------------------------------------------------------------------------------------------------------------------------------------------
2019 349,623 137,630 5,510 $757 $4,171,070 3,204 $110 $352,440 $4,523,510
--------------------------------------------------------------------------------------------------------------------------------------------------------
2020 269,721 106,016 2,508 $757 $1,898,556 1,474 $110 $162,140 $2,060,696
--------------------------------------------------------------------------------------------------------------------------------------------------------
10-YR .............. ........... .......... .......... $51,582,439 .......... ......... $4,066,594 $55,649,033
--------------------------------------------------------------------------------------------------------------------------------------------------------