[Senate Hearing 111-597]
[From the U.S. Government Publishing Office]
S. Hrg. 111-597
THE FISCAL YEAR 2011 BUDGET FOR
VETERANS' PROGRAMS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
FEBRUARY 26, 2010
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Lindsey O. Graham, South Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Roger F. Wicker, Mississippi
Jim Webb, Virginia Mike Johanns, Nebraska
Jon Tester, Montana Scott P. Brown, Massachusetts\1\
Mark Begich, Alaska
Roland W. Burris, Illinois
Arlen Specter, Pennsylvania
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
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\1\ Hon. Scott P. Brown was recognized as a minority Member on March
24, 2010.
C O N T E N T S
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February 26, 2010
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 2
Johanns, Hon. Mike, U.S. Senator from Nebraska................... 4
Begich, Hon. Mark, U.S. Senator from Alaska...................... 6
WITNESSES
Shinseki, Hon. Eric K., Secretary, U.S. Department of Veterans
Affairs; accompanied by Hon. Robert A. Petzel, M.D., Under
Secretary for Health; Michael Walcoff, Acting Under Secretary
for Benefits; Steve L. Muro, Acting Under Secretary for
Memorial Affairs; Hon. Roger W. Baker, Assistant Secretary for
Information and Technology; and W. Todd Grams, Acting Assistant
Secretary for Management....................................... 7
Prepared statement........................................... 9
Response to pre-hearing questions submitted by Hon. Daniel K.
Akaka...................................................... 17
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka..................................... 21
Hon. Richard Burr........................................ 26
Hon. Jon Tester.......................................... 155
Hon. Mark Begich......................................... 158
Independent Budget Representatives
Blake, Carl, National Legislative Director, Paralyzed Veterans of
America........................................................ 178
Prepared statement........................................... 180
Wilson, John, Assistant National Legislative Director, Disabled
American Veterans.............................................. 182
Prepared statement........................................... 184
Kelley, Raymond C., National Legislative Director, AMVETS........ 196
Prepared statement........................................... 197
Hilleman, Eric A., Director, National Legislative Service,
Veterans of Foreign Wars of the United States.................. 200
Prepared statement........................................... 202
Other Veterans Service Organizations
Robertson, Steve A., Director, National Legislative Commission,
The American Legion............................................ 211
Prepared statement........................................... 212
Weidman, Rick, Executive Director for Policy & Government
Affairs, Vietnam Veterans of America........................... 224
Prepared statement........................................... 226
THE FISCAL YEAR 2011 BUDGET FOR VETERANS' PROGRAMS
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FRIDAY, FEBRUARY 26, 2010
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:32 a.m., in
room 418, Russell Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
Present: Senators Akaka, Begich, Burr, and Johanns.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. The hearing will come to order, and aloha
to all of you this morning, this hearing on the fiscal year
2011 budget for the Department of Veterans Affairs. I want to
extend a warm welcome to Secretary Eric K. Shinseki. Secretary
Shinseki, I look forward to our continued work together on
behalf of our Nation's veterans, and thank you for having your
staff here as well, as we discuss the budget for the Veterans
Administration.
A strong VA budget moves beyond the rhetoric of supporting
veterans and provides actual support by providing the funding
to make VA's programs work. The President's budget for VA for
the next fiscal year is indeed a strong one. Although many
agencies are facing budget cuts, I am pleased that the VA
budget--critical for meeting the health care and benefit needs
of so many of this Nation's veterans--is increasing. Many of
the initiatives in the President's budget request, such as the
commitment to end veterans' homelessness and increase staffing
to help eliminate the claims backlog, are designed to make
responsible investments now in order to reduce Federal
spending.
The President has requested a budget for VA of $125
billion, including a total discretionary request of $60.3
billion. For fiscal year 2011, the administration is requesting
$51.5 billion in resources for VA medical care, including
collections. This funding level is an increase of $4.1 billion
over fiscal year 2010 levels. It is a good thing, too, since
for the first time the number of patients is predicted to
exceed 6 million. With this budget, we also see the fruits of
our labor in passing the Veterans Health Care Budget Reform and
Transparency Act. We have before us a budget that includes a
funding request for VA medical care into fiscal year 2012.
Last year, both President Obama and Secretary Shinseki
stated their commitment to ending homelessness among veterans--
a commitment that I share. With VA's objective to meet this
goal in 5 years, it is encouraging to see that this budget
calls for nearly $800 million in additional spending for
homeless veteran programs. This represents a significant effort
by VA to reduce the number of homeless veterans and prevent
those ``at risk'' from becoming homeless.
The administration is also requesting nearly $1.75 billion
for construction programs. This includes the cost of
initiatives designed to help VA better manage its physical
infrastructure. I am pleased to see that VA continues to make
health care more accessible for veterans living in rural areas.
On the benefits side of the ledger, timely and accurate
adjudication of disability claims and appeals remains a
significant problem. I know that the President and Secretary
Shinseki are committed to addressing this issue, and I am
pleased by the proposal to add significant staff and resources
to that effort. The President's budget responds to the rapid
rise in the number of disability claims being filed by veterans
and prepares for an increased workload due to the recent
extension of new Agent Orange presumptive conditions. I hope to
hear from VA in detail how it intends to handle these workload
increases.
We must be candid about the backlog. It appears that this
situation will get worse before it gets better. It can take
years for new staff to become skilled at processing complicated
claims, and technology and pilot programs can only do so much
in the short term. VA must be able to absorb new court
decisions, changes in legislation and regulation, and other
unforeseen events so that when new circumstances arise, the
system is not paralyzed.
I am encouraged that the administration has included what
it believes will be adequate resources to continue to press
forward with the prompt and accurate delivery of education
benefits under the new GI bill. I know that there have been
some difficult moments over the last several months, but I
believe that VA has made progress toward improving the payment
delivery process. I will continue to do whatever I can to help
in this area.
I look forward to working with my colleagues on the
Committee and in Congress, the executive branch, and leaders
from the veterans' community to adopt a viable budget for
veterans and for the system designed to serve them.
And now let me ask our Ranking Member for him to deliver
his opening statement. Senator Burr, aloha.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Aloha, Senator. Thank you. General, welcome.
I welcome you this morning as well as your senior leadership
team and the representatives of all the various veterans'
service organizations that are here.
We are here to review the President's fiscal year 2011
budget for the Department of Veterans Affairs. Each Member of
the Committee and each Member of Congress will have their own
criteria by which they judge this $125 billion request. My own
judgment will be guided by three core principles.
First, we remain a nation at war. We have men and women
thousands of miles away from home, away from their families,
away from their friends, putting themselves in harm's way on a
daily basis. They and their families command our highest
obligation. We must have a VA health and benefits system that
meets their needs, is responsive to their expectations, and
appropriately expresses the gratitude of the Nation for their
tremendous sacrifice.
Second, we are a country that values the service of all
generations of veterans who have worn the Nation's uniform. We
must not forget our obligations to them, their families, and
their survivors. We must care for their injuries resulting from
service, extend a helping hand during tough economic times, and
honor and memorialize the memory of our fallen heroes.
Third, we need to be accountable for what we spend. We have
a deficit and a debt of staggering proportions. All Americans--
and especially veterans--deserve the assurance that every tax
dollar going to the VA is spent to improve the lives of
veterans.
With those as my guiding principles, here are my initial
thoughts on the President's budget.
The budget represents a 10-percent increase in spending
overall and an 8-percent increase in discretionary spending.
Significant investments are proposed to end homelessness,
increase mental health treatment access, and care for returning
OEF/OIF veterans. I am looking forward to asking you, Mr.
Secretary, as to how these investments will translate into
improved outcomes for our veterans, and I applaud you for
making these priorities.
There are some aspects of this budget, however, that do
leave me puzzled. Whether it is throwing more money at a
problem like the claims backlog--a strategy that has clearly
not worked--or whether it is throwing money at administrative
functions that may be nice to have, but may rank low on a
priority list, I think that we owe it to the American people to
make sure that every dollar we spend translates into improved
services for our veterans and their families.
Let me first talk about the backlog issue. Mr. Secretary,
your budget proposes to increase permanent staffing for claims
adjudication by roughly 4,000 FTEs. If you look at the chart
that I had put up, you will see that the claims staffing has
exploded in recent years. Every year we have been told that the
system needs more staff, but when the resources for staff are
provided, clearly productivity goes down.
Let me say that again. As we increase the staffing,
productivity goes down per FTE.
Let me talk about a couple of other items that jump out,
and I will just raise these as questions for everyone to
consider.
If this budget is approved, there will be a 38-percent
increase in the General Administration account since 2009,
nearly $130 million. Now, where is this money going and, in a
time of massive deficits and debt, is this responsible? Here
are some highlights: a 2-year increase of 65 percent in the
Office of Congressional and Legislative Affairs; a 2-year
increase of 97 percent in the Office of Policy and Planning;
and a 2-year increase of 51 percent for the Office of the
Secretary.
Now, are these requests essential? How will they help
improve the lives of veterans and their families? How is it
that the Office of Inspector General, the office tasked to do
the oversight of a $125 billion Department, is slated for a
funding freeze, but these support offices are getting huge
bumps?
Just a couple more examples in this budget, Mr. Chairman.
How about an initiative to put printers on the desks of all VBA
employees, especially when VBA is going paperless? Or the
publication of an annual Veterans Law Review containing
articles and book reviews?
Mr. Chairman, these line items may seem like pocket change,
but these dollars add up, and they have real consequences for
whether we will be able to meet some of the core obligations to
our veterans. I for one believe that we must provide more
support for our family caregivers of our wounded warriors. It
is my hope Congress passes the family caregiver bill as soon as
possible. If Congress does, will the VA have the money to fund
this program under this budget?
We also have a moral obligation to provide VA health care
to veterans and family members who were exposed to contaminated
drinking water during their service at Camp Lejeune. Will we do
this for our veterans and their families, or will we fritter
these dollars away on printers on every desk and book reviews?
I will end on this point: If we waste money on bureaucrats
and shopping sprees at Staples, we may not have the funds to
follow through on the promises we have made and we need to
keep. We should not be giving false hope to the family
caregivers of severely wounded veterans or the marines and
their families who drank toxic water at Camp Lejeune that the
VA is going to be there for them and we are not. They deserve
better.
We have got to prioritize the money our taxpayers entrust
us with so that veterans and their families will have the
benefits and services they need and they earned. I am looking
forward to asking several questions in these areas.
Mr. Chairman, I thank you. Mr. Secretary, I applaud your
leadership at the Veterans Administration and, more
importantly, your service to this country.
I thank the Chair. I yield.
Chairman Akaka. Thank you very much, Senator Burr.
Now I would like to call on Senator Johanns for his
statement.
STATEMENT OF HON. MIKE JOHANNS,
U.S. SENATOR FROM NEBRASKA
Senator Johanns. Mr. Chairman, thank you very much. My
comments this morning will be relatively brief because I am
anxious to hear from the witnesses. Let me, if I might, start
out in a very positive vein and offer some words of gratitude.
First, I would like to thank the Chairman and the Ranking
Member. Last summer, as we were preparing for the August recess
and planning our month's schedule back home, we asked for the
opportunity to do a hearing in Omaha at the VA hospital. And,
Mr. Chairman, you granted that request, and we had an excellent
hearing. It was excellent because the VA staff really, really
stepped up and tried to do everything they could to make sure
that we made a very, very positive record. So, I thank you for
that opportunity. It meant a lot to the people back home in
Nebraska.
Mr. Secretary, I also want to compliment you on your
leadership. As you know, you have many fans on my staff,
including a former adjutant general who heads up my military
affairs issues. We think you are the right guy to do the job
that you are doing, and you have surrounded yourself with very
good people.
Dr. Petzel, a special thanks to you. You helped us organize
our thinking and our efforts as we tried to figure out what to
do about the VA hospital in Omaha and how best to proceed. I
just cannot express enough how we feel that process was handled
very fairly, in a very open way, and in a very transparent way.
I think that is in large part because of your leadership.
That brings me to something in the budget that I do want to
acknowledge, and that is that we are starting to take some
initial steps on that hospital in Omaha, which is in pretty
dire condition, as you know. I think that is a step in the
right direction. During my questioning I will probe a little
bit more as to other needs across the country and how those
will be addressed.
I do not think we have had a hearing where I have not
raised the issue of mental health and trying to do all we can
to provide the services necessary for our veterans as they
return home. The mental health issues are every bit as real as
the physical issues that some of our veterans face, and so I
really applaud the efforts to deal with that and to try to
address those issues. Again, I will probably be asking some
questions on what we are doing there, what difference will that
make, is it a good investment, and where do we go from here.
The final thing I want to highlight--and then I will wrap
up--is this: All of us have been very, very concerned about the
claims backlog. At times, as I have listened to the testimony
and tried to get my head around the size of this backlog, it
almost seems like it is insurmountable, but it is not. It can
be addressed. This budget, I think, does a number of very
positive things. The important thing about it, though, is that
it sends the message to those who have been waiting for us to
get to their claim that we are serious about dealing with the
backlog; we are going to do everything we can to address it.
In that vein, I was very pleased to see that this is not
just about muscling our way through it, you know--throwing
staff in the midst of it. Mr. Secretary, as you know, you
stopped by my office, and you talked about some of the
innovative things that you are doing. I have great optimism
that we can learn from some of the positive things that are
happening out there.
As I mentioned to you and as General Lemke mentioned to you
during that meeting, we think there are some good things
happening in Lincoln, Nebraska, and at least our experience in
my office there (my Senate office), is this is a focused,
determined group who has a tremendous amount of spirit and
orientation toward providing first-class quality services in
working with the veterans. So I would just ask again that you
take a look at some of the things they are doing there. It is
very possible that we will see they are doing some very
positive, innovative things.
I will wrap up with those comments and say that we are all
going to look at these budgets with close scrutiny. We should.
That is why we are here. But, on the other hand, what I have
really enjoyed about this Committee and the Chairman's
leadership is that at the end of the day we are focused on one
thing, and that is, how do we care for the veterans. They have
given us a lot, and we want to do everything we can to try to
make sure that not only are we providing the resources, but
that we are handling those resources in a smart way, in an
efficient way, and in a way that we can justify to our
constituents and the taxpayers.
So I look forward to our continued work in that vein. And,
Mr. Chairman, thank you for the opportunity to say a few words.
Chairman Akaka. Thank you very much, Senator Johanns. I am
glad you mentioned mental health--that we have had hearings on
that. And just to let you know, we are planning to have a
hearing on mental health next week.
Senator Johanns. Good.
Chairman Akaka. Thank you so much.
Senator Begich, your opening statement.
STATEMENT OF HON. MARK BEGICH,
U.S. SENATOR FROM ALASKA
Senator Begich. Mr. Chairman, I am looking forward to the
presentation of the budget. First, I want to thank the
Secretary for the insightful conversation we had on VA health
care yesterday. And thank you for sending some of your folks to
the field hearings in Alaska.
Mr. Chairman, I'd like to thank you once again for allowing
me to hold hearings in my home State with your staff's support.
I really felt we tackled employment issues, as well as VA
health care issues. As you and I discussed yesterday, most of
my concerns today will most likely touch on the importance of
rural health care and VA's plans in the fiscal year to provide
better access in these hard to reach areas.
So, again, I appreciate your being here and your leadership
within the VA. As a couple folks have mentioned, while in
Alaska, Ray Jefferson from the Department of Labor, Under
Secretary for Veterans Employment and Training, said you have a
hefty job by moving a large ship--a large budget of $100
billion plus, you know, tons of employees--to move that in a
new direction and while becoming more and more responsive to
our veterans. So you have a big task ahead of you. I know you
have only been there a year, as I have only been here a year.
I am looking forward to your presentation, and then, as we
discussed yesterday, some additional follow-up on rural health
care and the unique situation in Alaska.
Thank you, Mr. Secretary. Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Begich.
I would like to welcome back to the Committee Secretary
Eric Shinseki. I thank you for joining us today to give your
perspective on the Department's fiscal year 2011 budget. I look
forward to your testimony.
Secretary Shinseki is accompanied by Dr. Robert Petzel, who
was just sworn in as Under Secretary for Health. And we also
have Michael Walcoff, Acting Under Secretary for Benefits;
Steve Muro, Under Secretary for Memorial Affairs; Roger Baker,
Assistant Secretary for Information and Technology; and W. Todd
Grams, Acting Assistant Secretary for Management. Thank you
very much for being here.
Mr. Secretary, your prepared statement will, of course,
appear in the record of the Committee. Will you please begin
with your statement?
STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT
OF VETERANS AFFAIRS; ACCOMPANIED BY HON. ROBERT A. PETZEL,
M.D., UNDER SECRETARY FOR HEALTH; MICHAEL WALCOFF, ACTING UNDER
SECRETARY FOR BENEFITS; STEVE L. MURO, ACTING UNDER SECRETARY
FOR MEMORIAL AFFAIRS; HON. ROGER W. BAKER, ASSISTANT SECRETARY
FOR INFORMATION AND TECHNOLOGY; AND W. TODD GRAMS, ACTING
ASSISTANT SECRETARY FOR MANAGEMENT
Secretary Shinseki. Well, thank you very much, Mr.
Chairman, Ranking Member Burr, other distinguished Members of
the Committee. Good morning. Good to see all of you.
Mr. Chairman, thank you for introducing the members on the
panel with me, all great VA leaders who are very happy to be
here to participate in the testimony.
Thank you for this opportunity to present the President's
2011 budget and the advance appropriations request for the
Department of Veterans Affairs. I am pleased to report a good
start in 2009, and I have covered some of that with you as I
came around to make my office calls. I think we have a
tremendous opportunity here in 2010 and the President's
continued strong support of veterans and veterans' needs in
2011 and 2012. I regret that the intervention of some bad
weather precluded my visiting all the Members of the Committee,
as I like to do. These opportunities are always valuable for
me, and I appreciate the generosity of time of those Members I
was able to call on.
Let me also acknowledge, as Senator Burr did, the
representatives from some of our veterans' service
organizations who are in attendance today. Their insights for
the year that I have been here have been very helpful in
helping us to meet our obligations to veterans and framing our
thoughts and understanding of what the needs were.
Mr. Chairman, thank you for accepting my written statement
for the record. I appreciate that.
This Committee's longstanding commitment to our Nation's
veterans has always been unequivocal and unwavering. That is
the reputation of this Committee. Such commitment and the
President's own steadfast support of veterans resulted in a
2010 budget that provides this Department the resources to
begin renewing itself in fundamental and comprehensive ways.
And some of this goes to some of the questions you posed,
Senator Burr, which I would be very happy to elaborate on
during questioning. We are well launched on that effort.
As I remind all in VA, 2009 was a congressionally enhanced
budget, and we are well launched on the basis of that set of
resources provided to us. That effort continues, and we are
determined to continue transforming VA in 2011 and 2012, well
begun this year, and the next 2 years are important.
We have crafted a new strategic framework organized around
three governing principles--principles that I have mentioned
for the past year now. It is about transforming VA, and to do
that, there's nothing magical here. Take a good, hard look at
your mission, understand what your mission is, focus on that,
and then fundamentally and comprehensively go back and
challenge all the assumptions on how you are doing that. Go
back and review how you do this.
In doing that, we are looking at being people-centric, and
that is both veteran-centric and also developing the workforce
to better serve those veterans. It is about results-driven. A
lot of promises made. We do not get graded until the results
are in, so we intend to have metrics to be able to measure our
progress. Then forward-looking we know there is a history here
where we have had some problems, and claims may be a good
example to talk about. How do we take what we know and then
transform ourselves for the future?
So this new strategic plan delivers on President Obama's
vision for VA. It is in the final stages of review. Its
strategic goals will do several things: improve the quality of
and increase access to VA care and benefits, while optimizing
their value for veterans; heighten readiness to protect our
people, both our clients, our veterans, as well as our
workforce, and our resources day-to-day and in times of crisis;
enhance veteran satisfaction with our health, education,
training, counseling, financial, and burial benefits and
services--it is a very large charter that goes with VA; and
finally, invest in our human capital, both in their well-being
and in their development as leaders to drive excellence over
the long term in everything we do--everything day-to-day--and
toward the objectives we are trying to achieve, from management
to IT systems to support services.
This goal is vital to mission performance if we are to
attain our goal--a model of good governance--in the next 4
years. These goals will guide our people daily and focus them
on producing the outcomes veterans expect and have earned
through their service to our country.
To support our pursuit of these goals, the President's
budget provides $125 billion, Mr. Chairman, as you pointed out,
in 2011--$60.3 billion in discretionary resources, $64.7
billion in mandatory funding. Our discretionary budget request
represents an increase of $4.2 billion, or a 7.6 percent
increase over the President's 2010 enacted budget, which was
the largest percentage budget increase in 30 years.
VA's 2011 budget focuses primarily on three critical
concerns that are of significant importance to veterans--at
least I hear about them as I travel: better access to benefits
and services; reducing the disability claims backlog and wait
time for the receipt of earned benefits; and, finally, ending
the downward spiral that often enough results in veterans'
homelessness.
Let me just touch on access. This budget provides the
resources required to enhance access to our health care system
and to our national cemeteries. We will expand access to health
care: through the activations of new and improved facilities;
by honoring the President's commitment to veterans who were
exposed to the toxic effects of Agent Orange 40 years ago; by
delivering on President Obama's promise to provide health care
eligibility to more Priority Group 8 veterans; and by making
greater investments in telehealth to extend our health care
deliveries into the most remote communities and, where
warranted, even into veterans' homes, which we are already
doing. And, finally, we will increase access to our national
shrines by establishing five new national cemeteries.
The backlog. We are requesting an unprecedented 27-percent
increase in funding for VBA--our Veterans Benefits
Administration--primarily for staffing, to address the growing
increase in disability claims receipts. That is the initial
investment. We are re-engineering our processes and developing
what we intend to achieve as a paperless system, integrated
with a virtual lifetime electronic record that the President
has mandated that both Defense and VA go to work on.
Ending homelessness. We are also requesting a substantial
investment in our homelessness program as part of our plan to
eliminate veterans' homelessness in 5 years through an
aggressive approach that includes housing, education, jobs, and
health care. In this effort, we partner with the Department of
Housing and Urban Development, probably our closest
collaborator, and also with the Departments of Labor,
Education, Health and Human Services, and Small Business
Administration, among others. Taken together, these initiatives
are intended to meet veteran expectations in each of these
three mission-focused areas: increase access; reduce the
backlog; and end homelessness.
We will achieve these objectives by developing innovative
business processes and delivery systems that not only better
serve veterans' and families' needs for many years to come, but
which will also dramatically improve the efficiency and cost
control of our operations.
Our budget and advanced appropriations request for 2011 and
2012 provide the resources necessary to continue our aggressive
pursuit of the President's two overarching goals for the VA
Department: transform and ensure client access to timely, high-
quality care and benefits without fail.
We still have much work to accomplish. Our efforts are well
begun, and I am very proud of the steps we have taken the past
year and where we are thus far in 2010--well begun. But there
is still, as Members of this Committee know, much yet to be
accomplished if we are going to meet our obligations to those
who have defended the Nation.
Again, thank you for this opportunity to appear before the
Committee and for your continued and unwavering support of our
mission on behalf of veterans. I look forward--we all look
forward--to your questions.
[The prepared statement of Secretary Shinseki follows:]
Prepared Statement of Hon. Eric K. Shinseki, Secretary,
U.S. Department of Veterans Affairs
Chairman Akaka, Ranking Member Burr, Distinguished Members of the
Senate Committee on Veterans' Affairs: Thank you for this opportunity
to present the President's Fiscal Year 2011 Budget and Fiscal Year 2012
Advance Appropriations request for the Department of Veterans Affairs
(VA). Our budget provides the resources necessary to continue our
aggressive pursuit of the President's two overarching goals for the
Department--to transform VA into a 21st Century organization and to
ensure that we provide timely access to benefits and high quality care
to our Veterans over their lifetimes, from the day they first take
their oaths of allegiance until the day they are laid to rest.
We recently completed development of a new strategic framework that
is people-centric, results-driven, and forward-looking. The path we
will follow to achieve the President's vision for VA will be presented
in our new strategic plan, which is currently in the final stages of
review. The strategic goals we have established in our plan are
designed to produce better outcomes for all generations of Veterans:
Improve the quality and accessibility of health care,
benefits, and memorial services while optimizing value;
Increase Veteran client satisfaction with health,
education, training, counseling, financial, and burial benefits and
services;
Protect people and assets continuously and in time of
crisis; and,
Improve internal customer satisfaction with management
systems and support services to achieve mission performance and make VA
an employer of choice by investing in human capital.
The strategies in our plan will guide our workforce to ensure we
remain focused on producing the outcomes Veterans expect and have
earned through their service to our country.
To support VA's efforts, the President's budget provides $125
billion in 2011--almost $60.3 billion in discretionary resources and
nearly $64.7 billion in mandatory funding. Our discretionary budget
request represents an increase of $4.3 billion, or 7.6 percent, over
the 2010 enacted level.
VA's 2011 budget also focuses on three concerns that are of
critical importance to our Veterans--easier access to benefits and
services; reducing the disability claims backlog and the time Veterans
wait before receiving earned benefits; and ending the downward spiral
that results in Veterans' homelessness.
This budget provides the resources required to enhance access in
our health care system and our national cemeteries. We will expand
access to health care through the activations of new or improved
facilities, by expanding health care eligibility to more Veterans, and
by making greater investments in telehealth. Access to our national
cemeteries will be increased through the implementation of new policy
for the establishment of additional facilities.
We are requesting an unprecedented increase for staffing in the
Veterans Benefits Administration (VBA) to address the dramatic increase
in disability claim receipts while continuing our process-reengineering
efforts, our development of a paperless claims processing system, and
the creation of a Virtual Lifetime Electronic Record.
We are also requesting a substantial investment for our
homelessness programs as part of our plan to ultimately eliminate
Veterans' homelessness through an aggressive approach that includes
housing, education, jobs, and health care.
VA will be successful in resolving these three concerns by
maintaining a clear focus on developing innovative business processes
and delivery systems that will not only serve Veterans and their
families for many years to come, but will also dramatically improve the
efficiency of our operations by better controlling long-term costs. By
making appropriate investments today, we can ensure higher value and
better outcomes for our Veterans. The 2011 budget also supports many
key investments in VA's six high priority performance goals (HPPGs).
hppg i: reducing the claims backlog
The volume of compensation and pension rating-related claims has
been steadily increasing. In 2009, for the first time, we received over
one million claims during the course of a single year. The volume of
claims received has increased from 578,773 in 2000 to 1,013,712 in 2009
(a 75% increase). Original disability compensation claims with eight or
more claimed issues have increased from 22,776 in 2001 to 67,175 in
2009 (nearly a 200% increase). Not only is VA receiving substantially
more claims, but the claims have also increased in complexity. We
expect this level of growth in the number of claims received to
continue in 2010 and 2011 (increases of 13 percent and 11 percent were
projected respectively even without claims expected under new
presumptions related to Agent Orange exposure), which is driven by
improved access to benefits through initiatives such as the Benefits
Delivery at Discharge Program, increased demand as a result of nearly
ten years of war, and the impact of a difficult economy prompting
America's Veterans to pursue access to the benefits they earned during
their military service.
While the volume and complexity of claims has increased, so too has
the productivity of our claims processing workforce. In 2009, the
number of claims processed was 977,219, an increase of 8.6 percent over
the 2008 level of 899,863. The average time to process a rating-related
claim fell from 179 to 161 days in 2009, an improvement of 11 percent.
The progress made in 2009 is a step in the right direction, but it
is not nearly enough. My goal for VA is an average time to process a
claim of no more than 125 days. Reaching this goal will become even
more challenging because of additional claims we expect to receive
related to Veterans' exposure to Agent Orange. Adding Parkinson's
disease, ischemic heart disease, and B-cell leukemias to the list of
presumptive disabilities is projected to significantly increase claims
inventories in the near term, even while we make fundamental
improvements to the way we process disability compensation claims.
We expect the number of compensation and pension claims received to
increase from 1,013,712 in 2009 to 1,318,753 in 2011 (a 30 percent
increase). Without the significant investment requested for staffing in
this budget, the inventory of claims pending would grow from 416,335 to
1,018,343 and the average time to process a claim would increase from
161 to 250 days. If Congress provides the funding requested in our
budget, these increases are projected to be 804,460 claims pending with
an average processing time of 190 days. Through 2011, we expect over
228,000 claims related to the new presumptions and are dedicated to
processing this near-term surge in claims as efficiently as possible.
This budget is based on our plan to improve claims processing by
using a three-pronged approach involving improved business processes,
expanded technology, and hiring staff to bridge the gap until we fully
implement our long-range plan. We will explore process and policy
simplification and contracted service support in addition to the
traditional approach of hiring new employees to address this spike in
demand. We expect these transformational approaches to begin yielding
significant performance improvements in fiscal year 2012 and beyond;
however, it is important to mitigate the impact of the increased
workload until that time.
The largest increase in our 2011 budget request, in percentage
terms, is directed to the Veterans Benefits Administration as part of
our mitigation of the increased workload. The President's 2011 budget
request for VBA is $2.149 billion, an increase of $460 million, or 27
percent, over the 2010 enacted level of $1.689 billion. The 2011 budget
supports an increase of 4,048 FTEs, including maintaining temporary FTE
funded through ARRA. In addition, the budget also includes $145.3
million in information technology (IT) funds in 2011 to support the
ongoing development of a paperless claims processing system.
hppg ii: eliminating veteran homelessness
Our Nation's Veterans experience higher than average rates of
homelessness, depression, substance abuse, and suicides; many also
suffer from joblessness. On any given night, there are about 131,000
Veterans who live on the streets, representing every war and
generation, including those who served in Iraq and Afghanistan. VA's
major homeless-specific programs constitute the largest integrated
network of homeless treatment and assistance services in the country.
These programs provide a continuum of care for homeless Veterans,
providing treatment, rehabilitation, and supportive services that
assist homeless Veterans in addressing health, mental health and
psychosocial issues. VA also offers a full range of support necessary
to end the cycle of homelessness by providing education, jobs, and
health care, in addition to safe housing. We will increase the number
and variety of housing options available to homeless Veterans and those
at risk of homelessness with permanent, transitional, contracted,
community-operated, HUD-VASH provided, and VA-operated housing.
Homelessness is primarily a health care issue, heavily burdened
with depression and substance abuse. VA's budget includes $4.2 billion
in 2011 to prevent and reduce homelessness among Veterans--over $3.4
billion for core medical services and $799 million for specific
homeless programs and expanded medical programs. Our budget includes an
additional investment of $294 million in programs and new initiatives
to reduce the cycle of homelessness, which is almost 55 percent higher
than the resources provided for homelessness programs in 2010.
VA's health care costs for homeless Veterans can drop in the future
as the Department emphasizes education, jobs, and prevention and
treatment programs that can result in greater residential stability,
gainful employment, and improved health status.
hppg iii: automating the gi bill benefits system
The Post-9/11 GI Bill creates a robust enhancement of VA's
education benefits, evoking the World War II Era GI Bill. Because of
the significant opportunities the Act provides to Veterans in
recognition of their service, and the value of the program in the
current economic environment, we must deliver the benefits in this Act
effectively and efficiently, and with a client-centered approach. In
August 2009, the new Post-9/11 GI Bill program was launched. We
received more than 397,000 original and 219,000 supplemental
applications since the inception of this program.
The 2011 budget provides $44.1 million to complete the automated
solution for processing Post-9/11 GI Bill claims and to begin the
development and implementation of electronic systems to process claims
associated with other education programs. The automated solution for
the Post-9/11 GI Bill education program will be implemented by December
2010.
In 2011, we expect the total number of all types of education
claims to grow by 32.3 percent over 2009, from 1.70 million to 2.25
million. To meet this increasing workload and complete education claims
in a timely manner, VA has established a comprehensive strategy to
develop an end-to-end solution that utilizes rules-based, industry-
standard technologies to modernize the delivery of education benefits.
hppg iv: establishing a virtual lifetime electronic record
Each year, more than 150,000 active and reserve component
servicemembers leave the military. Currently, this transition is
heavily reliant on the transfer of paper-based administrative and
medical records from the Department of Defense (DOD) to the Veteran,
the VA or other non-VA health care providers. A paper-based transfer
carries risks of errors or oversights and delays the claim process.
In April 2009, the President charged me and Defense Secretary Gates
with building a fully interoperable electronic records system that will
provide each member of our Armed Forces a Virtual Lifetime Electronic
Record (VLER). This virtual record will enhance the timely delivery of
high-quality benefits and services by capturing key information from
the day they put on the uniform, through their time as Veterans, until
the day they are laid to rest. The VLER is the centerpiece of our
strategy to better coordinate the user-friendly transition of
servicemembers from their service component into VA, and to produce
better, more timely outcomes for Veterans in providing their benefits
and services.
In December 2009, VA successfully exchanged electronic health
record (EHR) information in a pilot program between the VA Medical
Center in San Diego and a local Kaiser Permanente hospital. We
exchanged EHR information using the Nationwide Health Information
Network (NHIN) created by the Department of Health and Human Services.
Interoperability is key to sharing critical health information.
Utilizing the NHIN standards allows VA to partner with private sector
health care providers and other Federal agencies to promote better,
faster, and safer care for Veterans. During the second quarter of 2010,
the DOD will join this pilot and we will announce additional VLER
health community sites.
VA has $52 million in IT funds in 2011 to continue the development
and implementation of this Presidential priority.
hppg v: improving mental health care
The 2011 budget continues the Department's keen focus on improving
the quality, access, and value of mental health care provided to
Veterans. VA's budget provides over $5.2 billion for mental health, an
increase of $410 million, or 8.5 percent, over the 2010 enacted level.
We will expand inpatient, residential, and outpatient mental health
programs with an emphasis on integrating mental health services with
primary and specialty care.
Post-Traumatic Stress Disorder (PTSD) is the mental health
condition most commonly associated with combat, and treating Veterans
who suffer from this debilitating disorder is central to VA's mission.
Screening for PTSD is the first and most essential step. It is crucial
that VA be proactive in identifying PTSD and intervening early in order
to prevent chronic problems that could lead to more complex disorders
and functional problems.
VA will also expand its screening program for other mental health
conditions, most notably Traumatic Brain Injury (TBI), depression, and
substance use disorders. We will enhance our suicide prevention
advertising campaign to raise awareness among Veterans and their
families of the services available to them.
More than one-fifth of the Veterans seen last year had a mental
health diagnosis. In order to address this challenge, VA has
significantly invested in our mental health workforce, hiring more than
6,000 new workers since 2005.
In October 2009, VA and DOD held a mental health summit with mental
health experts from both departments, and representatives from Congress
and more than 57 non-government organizations. We convened the summit
to discuss an innovative, wide-ranging public health model for
enhancing mental health for returning servicemembers, Veterans, and
their families. VA will use the results to devise new innovative
strategies for improving the health and quality of life for Veterans
suffering from mental health problems.
hppg vi: deploying a veterans relationship management system
A key component of VA's transformation is to employ technology to
dramatically improve service and outreach to Veterans by adopting a
comprehensive Veterans' Relationship Management System to serve as the
primary interface between Veterans and the Department. This system will
include a framework that provides Veterans with the ability to:
Access VA through multiple methods;
Uniformly find information about VA's benefits and
services;
Complete multiple business processes within VA without
having to re-enter identifying information; and,
Seamlessly access VA across multiple lines of business.
This system will allow Veterans to access comprehensive online
information anytime and anywhere via a single consistent entry point.
Our goal is to deploy the Veterans Relationship Management System in
2011. Our budget provides $51.6 million for this project.
In addition to resources supporting these high-priority performance
goals, the President's budget enhances and improves services across the
full spectrum of the Department. The following highlights funding
requirements for selected programs along with the outcomes we will
achieve for Veterans and their families.
delivering world-class medical care
The Budget provides $51.5 billion for medical care in 2011, an
increase of $4 billion, or 8.5 percent, over the 2010 level. This level
will allow us to continue providing timely, high-quality care to all
enrolled veterans. Our total medical care level is comprised of funding
for medical services ($37.1 billion), medical support and compliance
($5.3 billion), medical facilities ($5.7 billion), and resources from
medical care collections ($3.4 billion). In addition to reducing the
number of homeless Veterans and expanding access to mental health care,
our 2011 budget will also achieve numerous other outcomes that improve
Veterans' quality of life, including:
Providing extended care and rural health services in
clinically appropriate settings;
Expanding the use of home telehealth;
Enhancing access to health care services by offering
enrollment to more Priority Group 8 Veterans and activating new
facilities; and,
Meeting the medical needs of women Veterans.
During 2011, we expect to treat nearly 6.1 million unique patients,
a 2.9 percent increase over 2010. Among this total are over 439,000
Veterans who served in Operation Enduring Freedom and Operation Iraqi
Freedom, an increase of almost 57,000 (or 14.8 percent) above the
number of Veterans from these two campaigns that we anticipate will
come to VA for health care in 2010.
In 2011, the budget provides $2.6 billion to meet the health care
needs of Veterans who served in Iraq and Afghanistan. This is an
increase of $597 million (or 30.2 percent) over our medical resource
requirements to care for these Veterans in 2010. This increase also
reflects the impact of the recent decision to increase troop size in
Afghanistan. The treatment of this newest generation of Veterans has
allowed us to focus on, and improve treatment for, PTSD as well as TBI,
including new programs to reach Veterans at the earliest stages of
these conditions.
The FY 2011 Budget also includes funding for new patients resulting
from the recent decision to add Parkinson's disease, ischemic heart
disease, and B-cell leukemias to the list of presumptive conditions for
Veterans with service in Vietnam.
Extended Care and Rural Health
VA's budget for 2011 contains $6.8 billion for long-term care, an
increase of 858.8 million (or 14.4 percent) over the 2010 level. In
addition, $1.5 billion is included for non-institutional long-term
care, an increase of $276 million (or 22.9 percent) over 2010. By
enhancing Veterans' access to non-institutional long-term care, VA can
provide extended care services to Veterans in a more clinically
appropriate setting, closer to where they live, and in the comfort and
familiar settings of their homes.
VA's 2011 budget also includes $250 million to continue
strengthening access to health care for 3.2 million enrolled Veterans
living in rural and highly rural areas through a variety of avenues.
These include new rural health outreach and delivery initiatives and
expanded use of home-based primary care, mental health, and telehealth
services. VA intends to expand use of cutting edge telehealth
technology to broaden access to care while at the same time improve the
quality of our health care services.
Home Telehealth
Our increasing reliance on non-institutional long-term care
includes an investment in 2011 of $163 million in home telehealth.
Taking greater advantage of the latest technological advancements in
health care delivery will allow us to more closely monitor the health
status of Veterans and will greatly improve access to care for Veterans
in rural and highly rural areas. Telehealth will place specialized
health care professionals in direct contact with patients using modern
IT tools. VA's home telehealth program cares for 35,000 patients and is
the largest of its kind in the world. A recent study found patients
enrolled in home telehealth programs experienced a 25 percent reduction
in the average number of days hospitalized and a 19 percent reduction
in hospitalizations. Telehealth and telemedicine improve health care by
increasing access, eliminating travel, reducing costs, and producing
better patient outcomes.
Expanding Access to Health Care
In 2009 VA opened enrollment to Priority 8 Veterans whose incomes
exceed last year's geographic and VA means-test thresholds by no more
than 10 percent. Our most recent estimate is that 193,000 more Veterans
will enroll for care by the end of 2010 due to this policy change.
In 2011 VA will further expand health care eligibility for Priority
8 Veterans to those whose incomes exceed the geographic and VA means-
test thresholds by no more than 15 percent compared to the levels in
effect prior to expanding enrollment in 2009. This additional expansion
of eligibility for care will result in an estimated 99,000 more
enrollees in 2011 alone, bringing the total number of new enrollees
from 2009 to the end of 2011 to 292,000.
Meeting the Medical Needs of Women Veterans
The 2011 budget provides $217.6 million to meet the gender-specific
health care needs of women Veterans, an increase of $18.6 million (or
9.4 percent) over the 2010 level. The delivery of enhanced primary care
for women Veterans remains one of the Department's top priorities. The
number of women Veterans is growing rapidly and women are increasingly
reliant upon VA for their health care.
Our investment in health care for women Veterans will lead to
higher quality of care, increased coordination of care, enhanced
privacy and dignity, and a greater sense of security among our women
patients. We will accomplish this through expanding health care
services provided in our Vet Centers, increasing training for our
health care providers to advance their knowledge and understanding of
women's health issues, and implementing a peer call center and social
networking site for women combat Veterans. This call center will be
open 24 hours a day, 7 days a week.
advance appropriations for medical care in 2012
VA is requesting advance appropriations in 2012 of $50.6 billion
for the three medical care appropriations to support the health care
needs of 6.2 million patients. The total is comprised of $39.6 billion
for Medical Services, $5.5 billion for Medical Support and Compliance,
and $5.4 billion for Medical Facilities. In addition, $3.7 billion is
estimated in medical care collections, resulting in a total resource
level of $54.3 billion. It does not include additional resources for
any new initiatives that would begin in 2012.
Our 2012 advance appropriations request is based largely on our
actuarial model using 2008 data as the base year. The request continues
funding for programs that we will continue in 2012 but which are not
accounted for in the actuarial model. These initiatives address
homelessness and expanded access to non-institutional long-term care
and rural health care services through telehealth. In addition, the
2012 advance appropriations request includes resources for several
programs not captured by the actuarial model, including long-term care,
the Civilian Health and Medical Program of the Department of Veterans
Affairs, Vet Centers, and the state home per diem program. Overall, the
2012 requested level, based on the information available at this point
in time, is sufficient to enable us to provide timely and high-quality
care for the estimated patient population. We will continue to monitor
cost and workload data throughout the year and, if needed, we will
revise our request during the normal 2012 budget cycle.
After a cumulative increase of 26.4 percent in the medical care
budget since 2009, we will be working to reduce the rate of increase in
the cost of the provision of health care by focusing on areas such as
better leveraging acquisitions and contracting, enhancing use of
referral agreements, strengthening DOD/VA joint ventures, and expanding
applications of medical technology (e.g. tele-home health).
investments in medical research
VA's budget request for 2011 includes $590 million for medical and
prosthetic research, an increase of $9 million over the 2010 level.
These research funds will help VA sustain its long track record of
success in conducting research projects that lead to clinically useful
interventions that improve the health and quality of life for Veterans
as well as the general population.
This budget contains funds to continue our aggressive research
program aimed at improving the lives of Veterans returning from service
in Iraq and Afghanistan. This focuses on prevention, treatment, and
rehabilitation research, including TBI and polytrauma, burn injury
research, pain research, and post-deployment mental health research.
sustaining high quality burial and memorial programs
VA remains steadfastly committed to providing access to a dignified
and respectful burial for Veterans choosing to be buried in a VA
national cemetery. This promise to Veterans and their families also
requires that we maintain national cemeteries as shrines dedicated to
the memory of those who honorably served this Nation in uniform. This
budget implements new policy to expand access by lowering the Veteran
population threshold for establishing new national cemeteries and
developing additional columbaria to better serve large urban areas.
VA expects to perform 114,300 interments in 2011 or 3.8 percent
more than in 2010. The number of developed acres (8,441) that must be
maintained in 2011 is 4.6 percent greater than the 2010 estimate, while
the number of gravesites (3,147,000) that will be maintained is 2.6
percent higher. VA will also process more than 617,000 Presidential
Memorial Certificates in recognition of Veterans' honorable military
service.
Our 2011 budget request includes $251 million in operations and
maintenance funding for the National Cemetery Administration. The 2011
budget request provides $36.9 million for national shrine projects to
raise, realign, and clean an estimated 668,000 headstones and markers,
and repair 100,000 sunken graves. This is critical to maintaining our
extremely high client satisfaction scores that set the national
standard of excellence in government and private sector services as
measured by the American Customer Satisfaction Index. The share of our
clients who rate the quality of the memorial services we provide as
excellent will rise to 98 percent in 2011. The proportion of clients
who rate the appearance of our national cemeteries as excellent will
grow to 99 percent. And we will mark 95 percent of graves within 60
days of interment.
The 2011 budget includes $3 million for solar and wind power
projects at three cemeteries to make greater use of renewable energy
and to improve the efficiency of our program operations. It also
provides $1.25 million to conduct independent Facility Condition
Assessments at national cemeteries and $2 million for projects to
correct safety and other deficiencies identified in those assessments.
leveraging information technology
We cannot achieve the transformation of VA into a 21st Century
organization capable of meeting Veterans' needs today and in the years
to come without leveraging the power of IT. The Department's IT program
is absolutely integral to everything we do, and it is vital we continue
the development of IT systems that will meet new service delivery
demands and modernize or replace increasingly fragile systems that are
no longer adequate in today's health care and benefits delivery
environment. Simply put, IT is indispensable to achieving VA's mission.
The Department's IT operations and maintenance program supports
334,000 users, including VA employees, contractors, volunteers, and
researchers situated in 1,400 health care facilities, 57 regional
offices, and 158 national cemeteries around the country. Our IT program
protects and maintains 8.5 million vital health and benefits records
for Veterans with the level of privacy and security mandated by both
statutes and directives.
VA's 2011 budget provides $3.3 billion for IT, the same level of
funding provided in 2010. We have prioritized potential IT projects to
ensure that the most mission-critical projects for improving service to
Veterans are funded. For example, the resources we are requesting will
fund the development and implementation of an automated solution for
processing education claims ($44.1 million), the Financial and
Logistics Integrated Technology Enterprise project to replace our
outdated, non-compliant core accounting system ($120.2 million),
development and deployment of the paperless claims processing system
($145.3 million), and continued development of HealtheVet, VA's
electronic health record system ($346.2 million). In addition, the 2011
budget request includes $52 million for the advancement of the Virtual
Lifetime Electronic Record, a Presidential priority that involves our
close collaboration with DOD.
enhancing our management infrastructure
A critical component of our transformation is to create a reliable
management infrastructure that expands or enhances corporate
transparency at VA, centralizes leadership and decentralizes execution,
and invests in leadership training. This includes increasing investment
in training and career development for our career civil service and
employing a suitable financial management system to track expenditures.
The Department's 2011 budget provides $463 million in General
Administration to support these vital corporate management activities.
This includes $23.6 million in support of the President's initiative to
strengthen the acquisition workforce.
We will place particular emphasis on increasing our investment in
training and career development--helping to ensure that VA's workforce
remain leaders and standard-setters in their fields, skilled,
motivated, and client-oriented. Training and development (including a
leadership development program), communications and team building, and
continuous learning will all be components of reaching this objective.
capital infrastructure
VA must provide timely, high-quality health care in medical
infrastructure which is, on average, over 60 years old. In the 2011
budget, we are requesting $1.6 billion to invest in our major and minor
construction programs to accomplish projects that are crucial to right
sizing and modernizing VA's health care infrastructure, providing
greater access to benefits and services for more Veterans, closer to
where they live, and adequately addressing patient safety and other
critical facility deficiencies.
Major Construction
The 2011 budget request for VA major construction is $1.151
billion. This includes funding for five medical facility projects in
New Orleans, Louisiana; Denver, Colorado; Palo Alto and Alameda,
California; and Omaha, Nebraska.
This request provides $106.9 million to support the Department's
burial program, including gravesite expansion and cemetery improvement
projects at three national cemeteries--Indiantown Gap, Pennsylvania;
Los Angeles, California; and Tahoma, Washington.
Our major construction request includes $51.4 million to begin
implementation of a new policy to expand and improve access to burial
in a national cemetery. Most significantly, this new policy lowers the
Veteran population threshold to build a new national cemetery from
170,000 to 80,000 Veterans living within 75 miles of a cemetery. This
will provide access to about 500,000 additional Veterans. Moreover, it
will increase our strategic target for the percent of Veterans served
by a burial option in a national or state Veterans cemetery within 75
miles of their residence from 90 percent to 94 percent.
VA's major construction request also includes $24 million for
resident engineers that support medical facility and national cemetery
projects. This represents a new source of funding for the resident
engineer program, which was previously funded under General Operating
Expenses.
Minor Construction
The $467.7 million request for 2011 for minor construction is an
integral component of our overall capital program. In support of the
medical care and medical research programs, minor construction funds
permit VA to realign critical services; make seismic corrections;
improve patient safety; enhance access to health care; increase
capacity for dental care; enhance patient privacy; improve treatment of
special emphasis programs; and expand our research capability. Minor
construction funds are also used to improve the appearance of our
national cemeteries. Further, minor construction resources will be used
to comply with energy efficiency and sustainability design
requirements.
summary
Our job at the VA is to serve Veterans by increasing their access
to VA benefits and services, to provide them the highest quality of
health care available, and to control costs to the best of our ability.
Doing so will make VA a model of good governance. The resources
provided in the 2011 President's budget will permit us to fulfill our
obligation to those who have bravely served our country.
The 298,000 employees of the VA are committed to providing the
quality of service needed to serve our Veterans and their families.
They are our most valuable resource. I am especially proud of several
VA employees that have been singled out for special recognition this
year.
First, let me recognize Dr. Janet Kemp, who received the ``2009
Federal Employee of the Year'' award from the Partnership for Public
Service. Under Dr. Kemp's leadership, VA created the Veterans National
Suicide Prevention Hotline to help Veterans in crisis. To date, the
Hotline has received almost 225,000 calls and rescued about 6,800
people judged to be at imminent risk of suicide since its inception.
Second, we are also very proud of Nancy Fichtner, an employee at
the Grand Junction Colorado Medical Center, for being the winner of the
President's first-ever SAVE (Securing Americans Value and Efficiency)
award. Ms. Fichtner's winning idea is for Veterans leaving VA hospitals
to be able to take medication they have been using home with them
instead of it being discarded upon discharge.
And third, we are proud of the VA employees at our Albuquerque, New
Mexico Clinical Research Pharmacy Coordinating Center, including the
Center Director, Mike R. Sather, for excellence in supporting clinical
trials targeting current Veteran health issues. Their exceptional and
important work garnered the center's recognition as the 2009 Malcolm
Baldrige National Quality Award Recipient in the nonprofit category.
The VA is fortunate to have public servants that are not only
creative thinkers, but also able to put good ideas into practice. With
such a workforce, and the continuing support of Congress, I am
confident we can achieve our shared goal of accessible, high-quality
and timely care and benefits for Veterans.
______
Response to Pre-Hearing Questions Submitted by Hon. Daniel K. Akaka to
Hon. Eric Shinseki, Secretary, U.S. Department of Veterans Affairs
Question 1. Since the population threshold for the purposes of
locating future National Cemeteries has been lowered from 170,000 to
80,000 veterans, what impact will this have on the sizing of new
cemeteries in the future?
Response. The revised Veteran population threshold will result in
the construction of five new national cemeteries in the areas of
Melbourne/Daytona, FL; Omaha, NE; Buffalo, NY; Tallahassee, FL; and
Southern Colorado. The new threshold will not alter VA's approach to
the purchase of land for new national cemeteries. We will continue to
seek large parcels that will ensure uninterrupted service into the
foreseeable future and accommodate the necessary infrastructure. In
addition, future budget requests will reflect Phase One cemetery
development projects sufficient to accommodate interments for a ten
year period. The number of acres to be developed in Phase One will
depend on estimated death and usage rates for Veterans and eligible
family members.
Question 2. The Independent Budget (IB) notes that given the
increased reliance on contract services, VR&E needs an additional 50
FTE's dedicated to management and oversight of contract counselors and
rehabilitation and employment service providers. Please comment on the
FTE dedicated to this management and oversight function envisioned in
the President's budget.
Response. VR&E Service currently has dedicated 24 contract
specialists throughout the country to provide oversight and support of
contracting activities in each regional office. The number of contracts
varies by office, with the average office supporting two local
contracts. Structured guidance was provided to the regional offices,
reducing associated complexity of development and procurement of
contracts at the local level. Because contracting activity varies by
office, contract specialist support has been placed in offices with the
highest usage. Where the use of contracts does not warrant a full-time
contract specialist, the specialist is responsible to support multiple
offices. VR&E Service works with the Office of Field Operations to
evaluate the need for additional contract specialists, and staff has
been added when appropriate.
In addition, VR&E Officers are required to complete basic contract
warrant and contracting officer technical representative training. This
training provides VR&E managers with the knowledge to effectively
administer contracts. Working in collaboration with VA's Office of
Acquisition, Logistics, and Construction, VR&E Service also provides
routine training and oversight to field offices to ensure consistent
compliance with Federal acquisition regulations.
Question 3. At VA's budget briefing on February 1, a decrease of
nine FTE for the VR&E program was justified on the basis of
``efficiencies''. Please provide more detail on the precise nature of
these efficiencies.
Response. The following chart displays the VR&E budget for 2010 and
2011. Direct FTE remains constant at 1,155 for both 2010 and 2011, with
VBA management support FTE allocated to the VR&E Program reduces by
nine FTE in 2011. VBA management support FTE provide support to program
management and operations. This includes but is not limited to offices
such as Resource Management and Human Resources. Unlike direct FTE,
management support FTE are not responsible for program administration
and operations.
The reduction of nine management support FTE for VR&E does not have
direct program impact. VBA management support FTE for all VBA programs
(such as human resources or financial management FTE) are allocated by
formula across all business lines based on the level of direct program
FTE to VBA's total direct FTE. Since direct FTE increased for the
Compensation and Pension (C&P) Program, a larger portion of the total
management support FTE was allocated to C&P Program, and support FTE
decreased for other programs.
The 2011 budget includes an $8.3 million GOE increase for VR&E
contract counseling services, some or all of which can be utilized to
support up to 130 additional direct FTE for VR&E. During execution of
the 2011 budget, other upward staffing adjustments will be made, if
needed.
Question 4. A number of increased outreach initiatives are
discussed in connection with the VR&E program including enhanced DTAP
efforts, the Coming Home to Work program, and the VetSuccess on Campus
pilot program. Can you provide a breakout of the number of FTE who will
be supporting these efforts?
Response. The Disability Transition Assistance Program (DTAP) ,
Coming Home to Work, and the VetSuccess on Campus pilot provide
outreach and assistance to transitioning servicemembers and new
Veterans. VR&E is working with the Office of Acquisition, Logistics,
and Construction to award a contract for redesign of the DTAP program.
This redesign will result in an enhanced DTAP model tailored to the
needs of active duty Servicemembers and Guard and Reserve members. The
enhanced DTAP model is expected to increase awareness of VR&E benefits
and applications for VR&E services. Staffing resources will be
evaluated as a part of the DTAP redesign process.
The Coming Home to Work Program was expanded in 2008 to increase
outreach and early intervention services. VA has 13 full-time
counselors at Military Treatment Facilities and also assigned
counselors on a part-time basis in each regional office to provide
outreach to VA medical centers, Warrior Transition Units, and Coming
Home events.
The VetSuccess on Campus program is currently in the pilot stage.
It is designed to provide outreach and assistance to Veterans utilizing
Post-9/11 GI Bill education benefits to assist them in successfully
transitioning from military to campus life and ultimately to successful
employment. Three full-time staff are dedicated to the VetSuccess
pilot. Staffing requirements to implement the program will be
determined as a part of the pilot project analysis.
Question 5. The IB supports an increase of 200 FTE for VR&E's
Independent Living Program. The President's Budget notes some positive
improvements made to the program by virtue of the Veterans' Benefits
Improvement Act of 2008 but fails to discuss in any detail how these
improvements might have an impact on the effective management of it.
Please provide a detailed discussion of the resources that will be
available for this initiative and comment on the IB's proposal for an
increase of 200 FTE.
Response. The Veterans' Benefits Improvement Act of 2008 (VBIA)
increased the cap on new Independent Living (IL) cases that may be
developed each year from 2,500 to 2,600. In addition, the VBIA removed
the time limitation on IL services for the most seriously disabled
Veterans who have served in the Iraq and Afghanistan conflicts. These
changes allow VR&E managers to ensure that appropriate services may be
provided to the most seriously disabled Veterans suffering from such
conditions as Traumatic Brain Injury, PTSD, or polytrauma injuries.
The IL workload represents less than three percent of the open VR&E
workload, with only 2,600 new cases developed each year. VA's model
supports Rehabilitation Counselors (VRCs) providing a full scope of
services for Veterans who need assistance to work, to live
independently, or a combination of both. This allows an integrated
service delivery approach in which the VRCs serve as experts who
provide services tailored to each Veteran's needs. This comprehensive
model supports the provision of IL services during a plan of employment
services. Conversely, it supports the progression of Veterans' plans
from IL to employment, when they are ready to pursue job goals. In lieu
of adding specialized staffing to meet the varying and individually
tailored IL needs of Veterans, VA counselors work with community
resources, such as the national network of Centers for Independent
Living (CILs) and/or procure services from specialized community
professionals. Through the establishment of agreements with CILs and
the expenditure of contract funds to meet specialized needs for the
small population of Veterans requiring independent living assistance,
VA is able to ensure resources are available when and where they are
needed, ensuring that counselors in regional offices may quickly
respond to additional service needs for Veterans who require
extraordinary support to achieve IL goals.
Question 6. The President's Budget notes that $1.2 million was
redirected from VR&E's resources for the Veterans Benefits Management
System (VBMS) Initiative to the Compensation and Pensions program. What
effect will this action have on the VBMS Initiative within VR&E and to
what purpose will the funds be used within the C&P program?
Response. The $1.2 million redirected from VR&E to C&P in the FY
2011 budget submission was originally allocated for VR&E-specific
paperless processing capabilities in the FY 2010 President's Budget.
Subsequent to the formulation of the FY 2010 budget, the strategy for
the paperless claims processing initiative was refined with a greater
emphasis on delivering near-term capabilities for C&P claims
processing.
The Veterans Benefits Management System (VBMS) initiative is a
business transformation initiative supported by technology and designed
to improve VBA service delivery, beginning with the C&P business line.
VBMS is a holistic solution that integrates a business transformation
strategy to address process, people and organizational structure
factors, and an information technology solution to provide a 21st
century paperless claims processing system. The technology investment
in VBMS is reflected in the VA Information Technology Budget
submission.
During FY 2010, VR&E funding associated with VBMS was redirected to
contribute to several contracts that enable VBA to acquire the
technical and professional expertise required for the VBMS initiative.
Services acquired through these contracts include strategic and
tactical program management support services, business transformation
and organization change management services, and commercial scanning
services. For FY 2011, the VR&E budget request does not include funds
for VBMS, which is a direct reflection of the VBA strategy to focus on
improving C&P claims processing. The $1.2 million will be used for
strategic and tactical program management support services, business
transformation, and organization change management services specific to
the C&P program.
Question 7. What is the percentage of Vietnam veterans who are
service-connected due to a presumptive condition?
Response. VA cannot provide this percentage because our data
systems do not store the basis of an award of service connection. VA
cannot distinguish whether a Vietnam Veteran was awarded a disability
rating due to presumed exposure to Agent Orange or due to a direct
disability while in service.
Question 8. In 2009, over 169,000 veterans received an increase to
their disability benefits. On average, how long did it take for those
re-opened claims to be adjudicated?
Response. VA does not separately track the average days to complete
reopened claims that are granted or denied. However, VA does track this
information for all reopened claims. The average number of days to
complete a reopened claim was 172.6 in FY 2009 and 164.7 in FY 2010
through January.
Question 9. Does the Department anticipate needing additional funds
to pay benefits to Filipino World War II veterans and eligible
survivors as mandated in Pub. L. 110-329?
Response. The deadline to submit claims was February 16, 2010. VA
is still determining the number of new and duplicate claims. Based on
the current approval rate, additional funding may be required. VA is
currently evaluating funding requirements to ensure all eligible
Veterans are compensated. VA will advise Congress when this evaluation
is completed.
Question 10. The FY 2008 NDAA required the DOD and the VA to
accelerate their exchange of health information and to develop
capabilities that allow for interoperability (generally, the ability of
systems to exchange data) by September 30, 2009. It also required
compliance with Federal standards and the establishment of a joint
interagency program office to function as a single point of
accountability for the effort. In a January 2010 report, the GAO noted
that the DOD/VA interagency program office is not yet positioned to
function as a single point of accountability for the implementation of
interoperable electronic health record systems or capabilities. In
addition GAO also stated that if the program office does not fulfill
key management responsibilities as GAO previously recommended, it may
not be positioned to function as a single point of accountability for
the delivery of future interoperable capabilities, including the
development of the virtual lifetime electronic record.
Response. On January 22, 2010, the Department offered GAO an update
report RE: Electronic Health Records: DOD and VA Interoperability
Efforts Are Ongoing; Program Office Needs to Implement Recommended
Improvements (GAO-10-332). This report addresses key issues sited above
in Question #10. Please see attachment for full copy of the updated
report signed and dated by Mr. John R. Gingrich, Chief of Staff.
Question 11. What is the status of the virtual lifetime electronic
record? What is your assessment of the progress being made and when do
you expect to launch this system? What are your thoughts on how VA
should proceed?
Response. ``VA has begun to lay the groundwork necessary to meet
the President's directive for a Virtual Lifetime Electronic Record, or
VLER, to contain the entire health and administrative data for our
Nation's Service Members and Veterans. To achieve that goal, we have
begun to connect the Department to the Nationwide Health Information
Network (NHIN) for the purposes of securely exchanging health
information with other public and private health care providers. In
December 2009, we successfully began exchanging health information
between the Department and Kaiser Permanente in San Diego, CA, for
those patients who are seen in both organizations and who have opted
into the exchange program. The Department of Defense (DOD) took the
steps needed to join the effort in a three-way exchange by successfully
implementing the technical capacity for NHIN based health data exchange
at the end of January, 2010. We plan to increase the functionalities of
this initial pilot and to deploy to additional sites around the country
during 2010. We will soon begin to lay out the approach to guide future
years planning and budgeting. The lessons learned from these pilots
will position the Department to be able to securely exchange health
information with any organization that also joins the NHIN. These first
efforts represent the cornerstone building block of designing the
Virtual Lifetime Electronic Record (VLER).''
Question 12. The President's budget provides $51.6 million the
Veterans Relationship Management System. This system will allow
Veterans to access comprehensive online information anytime and
anywhere via a single consistent entry point, among other things. What
is the timeline for this project and when will it operational?
Response. VA will use an iterative approach and a phased
implementation to integrate the capabilities that will leverage all the
initiatives in the Veterans Relationship Management (VRM) Program. The
iterative framework of the VRM Program assumes that all initiatives
will be conducted in parallel and will incorporate the multi-phased and
multi-years implementation strategy.
The VRM Program has three phases with milestones and deliverables
in 2010, 2011, and 2012. The focus in 2013 and 2014 will be to ensure
that the solutions implemented will continue to evolve with the
changing needs of Veterans and the agencies that serve them. This agile
approach will facilitate continuous improvement in our processes and
technology and ensures that the transformational vision is realized.
Question 13. This President's budget provides funds to meet the
need of women veterans which includes full-time Women Veterans Program
Managers serving at all VA medical facilities. However, on July 14,
2009, VA testified before this Committee that, ``As of June 2009, each
of the VA's 144 health care systems has appointed a full-time Women
Veterans' Program manager.'' What does the FY 2011 budget providing for
exactly with regard to the full-time Women Veterans Program Managers?
Response. VA recognizes that the position of the Women Veterans
Program Manager is key to the implementation and delivery of primary
care women Veteran's health services. As previously stated, each of
VA's 144 health care systems has appointed a full-time Women Veterans
Program Manager. The positions are funded in FY 2010. The FY 2011
budget continues the funding for these positions. As any of these
positions becomes vacant through the normal turn over process, the
vacancies will be filled in a timely manner through the established
personnel hiring processes.
Question 14. Of the carryover funds in the Medical Services account
from 2009, $200 million is designated for rural health initiatives.
Have these funds been obligated yet, and for what purposes? If not, why
are they still unobligated?
Response. Congress provided VHA's Office of Rural Health (ORH) with
$250 million in two-year funds (FY 2009/2010) for rural health care
initiatives. The majority of these funds were allocated in FY 2009 for
rural health initiatives; however, at the end of the year $223 million
was unobligated and carried over to FY 2010 to continue this dedicated
funding for rural health. These funds support a variety of projects
including, but not limited to: mobile clinics, rural Telehealth and
tele-mental health initiatives, home based primary care (HPBC)
programs, rural health outreach clinics, mental health intensive care
management (MHICM) programs and expansions, as well as enhancements to
existing community based outpatient clinics in rural areas. VA plans to
have the full $250 million obligated by the end of FY 2010.
There are several reasons why rural health care dollars have been
delayed in obligation, which fall into three broad categories. First,
the pool of qualified bidders willing to contract with VA to provide
health care in rural communities is limited. The second is human
resources. Identifying qualified individuals in highly rural areas has
proven difficult, and finding employees willing to move to isolated
areas has also been a challenge. And third, identifying appropriate
physical space for clinical activities in rural areas that meet privacy
standards has been a challenge, as well. Frequently, the space has
required significant alteration, thus causing delays in construction
and obligating dollars for completion of these projects.
------
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs
Question 1. For FY 2010, the Department requested $70 million more
than the previous year in medical and prosthetics research. For FY
2011, the request is for only an additional $9 million. Does the
Department anticipate any reduction in the amount of research carried
out as a result of what is essentially a flat-lined request?
Response. There is a 15.7% increase in research funding from FY
2009 to FY 2011. This is significantly higher than the rate of research
inflation which was 3.1% in FY 2010 and 3.2% in FY 2011. With this
level of funding, VA does not anticipate any reduction in the amount of
research.
Question 2. There was an error in printing the budget wherein the
IG's funding request to OMB was not printed; having corrected this, is
the Department prepared to support the IG's request for nearly $12
million in additional funding?
Response. VA supports the need for strong management oversight, and
the Office of Inspector General (OIG) plays an important role in
performing its investigative and audit responsibilities. When the
budget was developed recent budget increases were taken into account
for all VA accounts, including the IG, Information Technology, and NCA.
While these programs do not have increases in 2011, their two-year
total increases in resources provide for very significant real program
growth.
More specifically, the 2011 budget request for IG is a 25% increase
over the 2009 level. IG staffing has increased by 13% between 2009-2011
(509 FTE to 576 FTE), and the 2011 budget sustains the 2010 staffing
level of 576. The OIG has indicated that the 2011 budget will support a
current services level of workload.
Question 3. The Department's budget request shows a 30 percent
increase in funding for OEF/OIF services. What new or expanded services
will be provided as a result of this increase? Are there any programs
or services you would like to expand or create, but did not request due
to the cost of the increased workload?
Response. The budget requests a funding increase of 30% for OEF/OIF
Veterans in FY 2011 to accommodate an estimated 15% increase in the
number of patients. We will continue to provide a full range of
services to meet all of their medical needs. There are no new or
expanded services and there are no programs or services that were not
included in this budget request.
Question 4. VA must deal with the most serious of Traumatic Brain
Injuries (TBI), as well as the less severe injuries. Does the 13
percent increase for the TBI program reflect the increased need for
occupational therapy and support services for veterans who chose to
transition to the civilian workforce?
Response. Yes, the needs for increased occupational therapy are
included in the 13 percent increase for the TBI program (i.e., the
difference between the FY 2010 and FY 2011 funding). Funding for
vocational and occupational training and similar support services for
Veterans are provided by the Veterans Benefits Administration through
the Vocational Education and Employment program.
Question 5. VA is proposing to reduce obligations for rural health
initiatives in Fiscal Years 11 and 12. Improving health care for
veterans residing in rural areas is a major priority of many Members of
the Committee, and the veteran population. What is the rationale for
the proposed reduction?
Response. There is no reduction. In FY 2009, Congress provided $250
million in two-year funds (fiscal year 2009/2010) for rural health care
initiatives. The majority of these funds were allocated in FY 2009 for
rural health initiatives; however, at the end of the year $223 million
was unobligated and carried over to FY 2010 to continue this dedicated
funding for rural health. These funds support a variety of projects
including, but not limited to: mobile clinics, rural tele-health and
tele-mental health initiatives, home based primary care (HBPC)
programs, rural health outreach clinics, mental health intensive care
management (MHICM) programs and expansions, as well as enhancements to
existing community based outpatient clinics in rural areas. We plan to
have the full $250 million obligated by the end of FY 2010. In
addition, FY 2010, FY 2011, and FY 2012 each continue the commitment of
$250 million being dedicated to rural health initiatives.
Question 6. VA's budget request cited a study which found a 19
percent reduction in hospitalizations, and a 25 percent reduction in
days hospitalized, for patients enrolled in home telehealth programs.
What will be the cost savings in dollars expected from the $40 million
investment that VA has requested for telehealth?
Response. VA's focus on preventative medicine is reflected in the
health care trends developed for VA and integrated into the actuarial
model. Health care practices, like home telehealth, are also reflected
in the assumptions to the extent that they prevent an avoidable
inpatient admission or result in more efficient utilization of office
visits. However, the impact of specific practices and/or technology
cannot be separately identified and quantified.
Question 7. Of the $179 million that VA has requested for
readjustment counseling for fiscal year 2011, how much of this amount
will be allocated to provide care for returning servicemembers and how
much will be allocated to provide care for their family members?
Response. Resources are not allocated specifically between services
for Veterans and services for their family members. In FY 2009, Vet
Centers provided 62,747 visits to 13,903 Veteran families for military
related issues. 95% of these family services were provided conjointly
with the Veteran present. A very small number (<1%) of the total Vet
Center visits are provided to a Veteran's family member without the
Veteran present.
Question 8. Given the fact that the President's budget projects a
nearly 5 percent increase in workload for the New GI Bill yet--at the
same time--proposes nearly a 20 percent decrease in FTE devoted to the
program, how confident are you that you will have sufficient resources
to implement the program in an effective and timely fashion?
Response. Post-9/11 GI Bill claims are currently reviewed and
approved through a manual process augmented by limited automated
support. Claims examiners must manually enter data into several
systems. The long term solution, which will be fully deployed in
December 2010, will automate many of manual processing steps. We are
confident the new automated process will result in the need for fewer
FTE.
Question 9. The budget includes a 9 percent increase in funding for
women veterans from fiscal year 2010 to 2011. Does this reflect an
increase in the number of women veterans seeking VA care or an
expansion of the services provided to women veterans?
Response. The 9.7 percent increase in Gender Specific health care
for Women Veterans in 2011 is being driven almost entirely by the
influx of new women veterans. The number of active duty women in the
military is at all time high and the number of enrolled women veterans
has been increasing and is anticipated to increase steadily over the
next decade. VHA will continue to ensure a broad range of health care
services are available to these women including female specific
diagnoses and services.
Question 10. In the President's budget proposal there is no
increase in budget dollars or total FTE from FY 2010 in the area of
Information Technology. What impact will this have on VA's 21st Century
technology initiatives such as implementing the Virtual Lifetime
Electronic Record?
Response. Within the $3.307 billion budget request, funding for
maintenance and operations costs will be sustained to keep the systems
at current capability and acceptable performance level. Potential risks
are:
Systems supporting critical business functions will not be
refreshed, potentially affecting performance and availability of
services.
Significantly reduced funding for Regional Data Processing
Centers (RDPCs) may affect efficiency and reliability of operations.
The Project Management Accountability System (PMAS) with an
incremental development and fiscally responsible approach will better
manage development spending and ensure early identification and
correction of failing IT programs. Halting programs that fail to meet
their delivery milestones will prevent wasteful spending and manage
with accountability in delivering technologies to help transform VA.
Our Major Investments will continue to increase above the FY 2010
level to meet the on-going demands for our Veterans and transforming
VA:
Veterans Benefits Management System (VBMS) with $145.3
million requested, is a 104% increase of above 2010, and is designed to
transition from paper-intensive claims processing to a paperless
environment.
The Post-9/11 GI Bill (Chapter 33) with $44 million
requested, is a 28% increase above 2010, will provide the long term
solution to deliver an end-to-end solution to support the delivery of
tuition, university fee payments, housing allowance and yearly books
and supply stipend.
Financial and Logistics Integrated Technology Enterprise
(FLITE) with $120 million requested, is a 52% increase above 2010, and
will effectively integrate and standardize financial/asset management
data and processes across VA.
Virtual Lifetime Electronic Record (VLER) with $52 million
requested, is a 23.42% increase above 2010, and will create the
capability for VA and DOD to electronically access and manage the
health, personnel, benefits, and administrative information needed to
efficiently deliver seamless health care, services, and benefits to
Servicemembers and Veterans.
Tele-health and Home Care Model with $48.6 million
requested, enables VA to become a national leader in transforming
primary care services to a medical home model of health care delivery
with a new generation of communication tools that can be used to
disseminate and collect information related to health, benefits and
other services.
Question 11. As part of VA's efforts to end homelessness among
veterans, what long term solutions do you envision the Department will
undertake to address homelessness among severely and chronically
mentally ill veterans?
Response. VA addresses the needs of homeless Veterans with severe
and chronic mental illness through a continuum of care that includes
Mental Health Residential Rehabilitation and Treatment services,
transitional housing services through the Homeless Providers Grant &
Per Diem Program, and VA Health Care for Homeless Veterans Contract
Residential Treatment. In the very near future, VA will expand the
continuum by adding homeless prevention services particular to this
population. Historically, VA mental health and social services have
played an important role in preventing homelessness among Veterans with
mental illness. Interventions such as the Veterans Benefits
Administration's (VBA) benefits assistance programs, compensated work
therapy, recovery oriented treatment, residential rehabilitation,
outpatient mental health and substance abuse programs have served many
Veterans who are homeless or at risk for homelessness. In its mission
of ending homelessness among Veterans, VA has enhanced its existing
emphasis on prevention by the recent development or planning of several
national initiatives that will serve chronically mentally ill Veterans.
These include Supportive Services for Low Income Veterans and Families
and Housing and Urban Development VA Supported Housing Program (HUD-
VASH).
The HUD-VASH program is one of the core initiatives directed at
ending homelessness among chronically mentally ill Veterans, in that it
provides these Veterans with both permanent housing and supportive
services on an ongoing basis. In this collaborative initiative between
the U.S. Housing and Urban Development (HUD) and the VA, HUD provides
housing vouchers and the VA provides case management services to assist
Veterans' access and maintain permanent housing. HUD-VASH is
specifically targeted to address the needs of chronically homeless
Veterans, many of whom have a serious mental illness. At present, VA
has 20,000 vouchers with case management services and anticipates the
authorization of an additional 30,000 vouchers with case management
services through 2014 to better meet the needs of our Veterans who are
chronically homeless and also suffering from a serious mental illness.
VA also intends to intensify the case management ratio to better
address the housing and treatment needs of this most vulnerable
population. Additionally, VA intends to implement emerging best
practice models including Housing First approaches to more rapidly link
chronically homeless Veterans to housing and treatment services.
Question 12. The President's budget would provide over $15 billion
in mandatory entitlements in FY 2010 and FY 2011 for new presumptions
related to Agent Orange exposure. In arriving at this cost estimate,
did the Department project how much more likely Vietnam veterans are to
suffer from these conditions--such as heart disease--as compared with
Vietnam era veterans who did not serve in Southeast Asia and their non-
veteran counterparts?
Response. The cost estimate and methodology for the newly
presumptive conditions related to Agent Orange exposure includes $15
billion in mandatory funding, $12.3 billion of which is associated with
86,069 known Nehmer retroactive claims. Under Nehmer, VA must
readjudicate previously denied claims for newly added herbicide-related
presumptive diseases filed by Nehmer class members (generally Vietnam
Veterans and their survivors) and provide retroactive benefits from the
date of the prior claim to such individual pursuant to 38 C.F.R.
Sec. 3.816. Of those previously denied, 52,918, or nearly 76 percent,
are currently on the rolls for other service-connected disabilities.
The remaining $2.7 billion is associated with new claims from both
Veterans who will be added to the compensation rolls and Veterans who
will receive an increase to their current disability rating. For these
new claims, prevalence rates for the general population were applied to
the in-country Vietnam Veteran population. Other factors such as
mortality and application rates were applied to generate total
caseload.
Question 13. In addition to the over $15 billion to fund mandatory
entitlements for new presumptions related to Agent Orange exposure,
what is the Department's estimate of the related costs for medical care
for veterans who will now become service-connected from these
presumptions? Are these costs reflected in the budget?
Response. The estimate for medical care costs in FY 2011 related to
the new presumptions for Agent Orange exposure and Amyotrophic Lateral
Sclerosis (ALS) is $205 million.
Question 14. The highlights of the VA's budget for FY 2011 claim
that, ``The budget proposal includes $4.2 billion in 2011 to reduce and
help prevent homelessness among Veterans. That breaks down into $3.4
billion for core medical services and $799 million for specific
homeless programs and expanded medical care, which includes $294
million for expanded homeless initiatives.'' Can you please clarify
what this $3.4 billion for core medical services represents? Is that
amount solely for homeless veterans' services?
Response. The $3.4 billion contains all core medical services costs
for homeless veterans, including acute, rehabilitative, mental,
prosthetics, and dental care.
Question 15. Besides expanding existing programs, VA's 5 year plan
to end homelessness among veterans includes the development of new
programs--New HUD/VA Prevention Program, National Referral Call Center,
and Supportive Services for Veterans and Families. Does VA have a
breakdown in the budget for funding these new programs? When will these
programs be up and running?
Response. The proposed funding for these new programs is shown in
the table below.
------------------------------------------------------------------------
(Dollars in Thousands)
Description --------------------------------------
FY 2010 FY 2011 FY 2012
------------------------------------------------------------------------
HUD-VASH Prevention Pilots....... $5,000 $5,175 $5,366
National Referral Call Center.... $2,500 $3,000 $3,000
Support Svcs Low Income Vets & $20,000 $50,560 $50,560
Families........................
------------------------------------------------------------------------
New HUD/VA Prevention Pilot: This new prevention initiative is a
multi-site three-year pilot project designed to provide early
intervention to recently discharged Veterans and their families to
prevent homelessness. Site selection for this pilot project will give
priority to communities with high concentrations of returning OEF/OIF
soldiers, and to rural communities. Implementation of this program is
expected to provide services to nearly 250 Veterans and their families
in 2010. A total of 750 Veterans are projected to receive services from
this program between 2010 and 2014.
Supportive Services for Veterans and Families: VA will also use the
authority mandated in Public Law 110-387 to establish programs with
community-based non-profit and co-op agencies to provide supportive
services specifically designed to prevent homelessness. These pilots
will encompass both rural and urban sites with the goal of preventing
homelessness and maintaining housing stability for the Veteran's
family. This new homeless prevention initiative will establish and
provide grants and technical assistance to community non-profit
organizations to provide supportive services to Veterans and their
families in order to maintain them in their current housing. Program
regulations are currently under review; grants will be awarded in 2010.
Approximately 5,000 Veterans and their families will receive services
in 2010.
National Referral Call Center: This new prevention initiative will
establish a National Call Center that will provide linkages for
homeless Veterans, their families and other interested parties to
appropriate VA and community-based resources. It is anticipated that in
2010 the Call Center will provide information and referral to 15,000
Veterans and other interested parties. The National Referral Call
Center will be a primary vehicle for VA to communicate with Veterans
and community providers assisting them in connecting to local VA and
community resources that will assist the Veteran in avoiding falling
into homelessness or exiting homelessness.
Question 16. The Independent Budget noted that in its latest 5-Year
Capital Plan, VA has estimated the total cost of repairing all D-rated
and F-rated facilities in the Facilities Conditions Assessment to be a
staggering $8 billion. Please comment on this.
Response. The FCA backlog has risen over the past few years due to
various reasons: higher focus on identifying and reporting
deficiencies; addition of special studies to FCA backlog, such as
hurricane hardening, seismic, facade repairs; and the inclusion of
assessments of all buildings and their associated infrastructure within
VA. During the last several years, VA has devoted approximately $1.8
billion to reducing the FCA backlog which currently stands at $9.6
billion. The largest component of VA's FCA backlog of deficiencies
belongs to VHA, which is primarily addressed through the Non-Recurring
Maintenance (NRM) Program funds. A focus on reducing the backlog is
balanced with other critical infrastructure needs such as sustainment,
infrastructure improvements, high priority clinical initiatives (HPCI),
and green management in order to meet VHA's mission, congressional
direction, and energy mandate. The total FY 2011 VHA NRM budget request
totals $1.11 billion, the largest request in Department history. This
includes $400 million to ensure sustainability, $358 to reduce the FCA
backlog in infrastructure improvements, $252 million for energy, and
$100 million for HPCI.
Question 17. The Committee has received reports from several small
businesses which serve as distributors of products from manufacturers
to VA facilities that their FSS contract renewal awards have been
unnecessarily delayed by interference of VA's Office of Inspector
General. During these delays, VA has been unable to obtain discounts
which would be available under a standard contract, often resulting in
more costly purchases on the open market. In just one case alone, VA
lost more than $1 million in discounts due to IG-induced delays in
making a contract award to one company, as it was forced to make
necessary purchases on the open market. Most recently, VA has failed to
meet yet another anticipated contract determination date of January 1,
a determination process that began nearly 22 months ago. GSA completed
a similar renewal in less than 60 days. Will you take the necessary
actions to ensure that small businesses seeking the ability to compete
for VA task orders are treated fairly and in accordance with GSA
policy?
Response. The VA is fully committed toward ensuring acquisition
processes are fair and equitable to all vendors, including small
businesses.
VA processes all Federal Supply Schedule (FSS) offers in accordance
with applicable regulations, laws and policies, especially FSS policies
and provisions set forth by the General Services Administration. All
FSS offers, whether received from manufacturers or dealers/
distributors, small or large businesses, are processed in the same
manner and all offerors are treated fairly and equitably, regardless of
a firm's socioeconomic status. Some FSS offers may take additional time
to complete due to the value of the offer, which may meet certain
thresholds requiring a more thorough evaluation or review such as a
pre-award review (typically performed on FSS offers valued annually at
$5 million or more for pharmaceuticals, $3 million or more for non-
pharmaceutical). These reviews protect the government's interests by
ensuring favorable pricing for the government.
VA solicits early submission of ensuing FSS offers at least 24
months before the current FSS contract expires. Periodic reminders are
sent every six months. Many FSS contractors wait until the final months
of their current contract's performance before submitting. In an effort
to avoid disruptions, FSS contractors seeking an ensuing FSS contract
are afforded the opportunity to extend their current contract until a
new and ensuing FSS contract can be awarded. The only time this option
is not extended is when a FSS contractor has waited until the final
months of the performance period to renew, at which time VA has no
legal authority to extend beyond the prescribed performance period of
the FSS contract.
Because the FSS program is a multiple award program, which means
more than one contract source could be awarded for ``same'' or
``similar'' products and/or services, VA, like other Federal customers,
have other contract source options under the FSS program should a
particular FSS offeror's products be unavailable due to an on-going
evaluation/negotiation process. If the particular product/service
sought is only available on the ``open market'', VA facilities may
request a waiver, including the proper ``sole source'' justification,
through the proper channels to procure the needed item or service. The
waiver process is quick and the requesting office normally receives a
response within 24 to 48 hours.
VA is firmly committed to ensuring the acquisition process is fair
and equitably to all vendors while ensuring the awarded contracts are
in the best interest of the government and ultimately our taxpayers.
______
Response to Post-Hearing Questions Submitted by Hon. Richard Burr to
Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs
veterans benefits administration--general
Question 1. The fiscal year (FY) 2011 budget request refers to an
initiative to provide individual printers to employees throughout the
Veterans Benefits Administration (VBA) so they will be able to print
documents at their own desks. The explanation for this initiative is
that it will ``increase employee efficiency * * * and also reduces the
possibility of incorrectly mailing personally identifiable
information.''
A. How much has the Department of Veterans Affairs (VA) already
spent on this initiative and how much more does VA plan to spend in
fiscal years 2010 and 2011 for this purpose?
Response. The Office of Information & Technology (OI&T) spent
approximately $47,000 on desktop printers for VBA to pilot this
initiative at the Lincoln Regional Office. Upon further study, VBA
determined that the costs to implement this initiative nationwide
significantly outweigh the benefits, and no additional funds will be
spent to pursue this effort.
OI&T promotes the use of network printers, which are more cost-
effective, as they use less ink, paper, and require less maintenance.
VBA leadership canceled the pilot in January 2010 after re-evaluating
the costs/benefits of proceeding with the initiative and its future
relevancy with the procession of the Veterans Benefits Management
System (VBMS).
Final decisions have not been made on the reallocation of funds
designated for this effort. VBA leadership will review the needs of the
organization in the execution year for reallocation. VBA will place a
priority on initiatives that directly align with VA's strategic,
integrated, and high-performance goals for FY 2011.
B. In total, how many printers and print cartridges are being
purchased as part of this initiative?
Response. OI&T purchased 130 desktop printers for the Lincoln RO
pilot. These printers are being reallocated to replace older, existing
desktop printers still needed to support management, human resources,
and finance functions, and to meet the needs of employees requiring job
accommodations. No print cartridges were purchased.
VBA did not progress beyond the initial purchase of the desktop
printers at the Lincoln Regional Office pilot site. VBA leadership
canceled the pilot in January 2010 after re-evaluating the costs/
benefits of proceeding with the initiative against its future relevancy
with the procession of the Veterans Benefits Management System (VBMS)
initiative.
C. What is the cost per employee for this initiative?
Response. The cost was estimated at $360 per employee for the
initial purchase of printers and printer maintenance kits.
D. Please quantify the expected improvements in efficiency for each
VBA business line, such as the number of additional claims the
Compensation and Pension service would be expected to complete per
year.
Response. VBA determined that nationwide implementation of this
initiative would not significantly improve efficiency or productivity.
E. Is expanding the availability of printers consistent with VA's
goal to ``move the claims process to a paperless environment''?
Response. No. As such, the organization is no longer pursuing this
initiative.
F. Did VA examine whether there are less expensive means of
protecting against the inadvertent mailing of personally identifiable
information?
Response. The safeguarding of Veterans' information is paramount.
VBA continually seeks improvement in mailroom efficiency and
effectiveness through enhancements in process, technology, and quality.
vocational rehabilitation and employment
Question 1. The fiscal year 2011 budget request for the Vocational
Rehabilitation and Employment (VR&E) program includes $32.8 million for
Other Services, which is 51% higher than the amount expended during
fiscal year 2009 ($21.7 million) and 34% higher than the amount
expected to be expended during fiscal year 2010 ($24.4 million).
According to the budget request, this increase ``reflects contracted
services.''
A. Please provide an itemized list of how these funds would be
expended.
Response. The 2011 budget includes an $8.4 million GOE increase for
VR&E contract counseling services, which will be utilized for contract
counseling services or to for additional service that support FTE in
the VR&E program. Specific services provided to Veterans through this
funding, either by contract counselors or VR&E direct FTE will include
the following: initial evaluations, case management, employment, and
discrete services. Discrete services include specialized services for
the most seriously disabled such as life skills coaching, job coaching,
independent living assessment, and job site analysis.
B. What specific services would be provided through contractors?
Response. Services are procured from professional counselors in the
community to supplement services provided by VA staff. Services include
vocational counseling and testing, case management, and employment
readiness and job placement assistance.
C. What metrics would be used to gauge whether funds for contract
services are used effectively?
Response. Effectiveness of the use of FTE and contract resources is
based on timeliness of entitlement determinations and rehabilitation
plan development, quality of program services, and rehabilitation
outcomes.
Question 2. The President's budget request for FY 2011 allows for
an increase of over $7.3 million for personal services, yet reduces the
Full Time Equivalents (FTEs) by 9.
A. What is the average current workload of vocational
rehabilitation counselors, both VA full-time employees and contracted
counselors?
Response. Currently, Vocational Rehabilitation counselors are
assisting an average of 145 Veterans each. Contracted services are also
utilized as necessary to supplement VR&E staffing in cases when
Veterans live in remote geographic regions or where VA has staff
turnover or workload growth due to deployments in certain regions. The
use of contractors allows VA to respond quickly to workload
fluctuations, ensuring services are provided in a timely and quality
manner. Because contractors hire a combination of staff and
subcontractors and may provide services to other customers, it is not
possible to quantify the number of cases per contract provider.
However, contracts limit vendors to no more than a 1:125 counselor to
Veteran ratio when serving Veterans in all phases of the program and to
no more than a 1:150 ratio when the contract counselor is providing
only case management assistance.
B. VA anticipates a 10% increase in actual VR&E workload; how will
the President's budget ensure that the best possible services are
provided to these disabled veterans given the current staffing levels?
Response. To ensure support is in place to serve new Veterans in
the VR&E program, the FY 2011 budget includes an increase of VR&E's
budget to allow an additional $8.4 million in funding that may be used
to fund contracting support.
C. In light of the fact that Vocational Rehabilitation & Employment
FTEs will be reduced by 9 in between the FY 2010 estimate and the FY
2011 estimate, what accounts for the increased funds for personal
services?
Response. The FY 2011 FTE allocation for VR&E is 9 fewer than in FY
2010 as a result of an adjustment in the overhead allocation of VBA
management support across all business lines. There is no reduction in
VR&E direct program staffing for 2011. Personal services increases by
$7.3 million to fund the budgeted pay raise, the associated level of
fringe benefits costs, e.g., health care, the government's share of
employee retirement, and Thrift Savings contributions (which increase
at rates above the pay raise rate).
Question 3. Travel obligations for Vocational Rehabilitation &
Employment in FY 2009 were $1.9 million. The FY 2011 request asks for
$2.9 million.
A. The budget request for FY 2011 constitutes a 53% increase over
FY 2009. How many VA employees are anticipated to travel for their
duties during FY 2011?
Response. VRE's FY 2011 travel request, at the time the budget was
developed (May 2009), was based upon the budgeted FY 2009 level of
$2.78 million and included a modest increase of approximately $105
thousand. FY 2009 actual expenditures of $1.93 million, available after
the completion of the budget, were approximately $850 thousand less
than the budgeted level. While the comparison of FY 2011 to FY 2009
actuals (an atypically low year), in hindsight, seems a large
percentage increase, the request is very consistent over the last
several years. Due to the nature of the VR&E program, all
(approximately 874) professional and employment field staff will travel
to some degree to provide direct services to Veterans and to
participate in training activities. A total of approximately 53 Staff
in central office will also travel to provide training and support to
the field.
B. What is the average cost per employee for work-related travel?
Response. Of our 2011 staff of 1,289 we expect 927 (874 field staff
and 53 central office staff) to travel. Our total travel request for
2011 is $2.884M which averages out to approximately $3,100 per person.
C. What portion of these additional funds will go toward training
for vocational rehabilitation counselors?
Response. Approximately 60 percent or more than $1.72 million of
the travel budget is for centralized counselor training. The remaining
40% is for program travel, oversight, outreach and local training.
Program travel in the field includes the cost for counselors and
employment coordinators to travel to provide direct services to
Veterans. Outreach includes travel to provide Disabled Transition
Assistance Program (DTAP) briefings, and targeted outreach at other
venues such as Yellow Ribbon and Post Deployment Health Reassessment
events. Central Office program travel includes provision of oversight,
initiatives and support to field offices.
housing
Question 1. The budget request for Housing programs for FY 2011
includes $29 million for Other Services, including an Appraisal
Management Service/Automated Valuation Model, a workload measurement
study, and an audit of property management contractor, which is 67%
more than the amount expended on Other Services during FY 2009 ($17.4
million), and $5.4 million more than the FY 2010 current estimate
($23.7 million).
A. What specific performance outcomes are anticipated with the
purchase of an Appraisal Management Service/Automated Valuation Model?
Response. Appraisal Management services, including Automated
Valuation models, have become prevalent in the industry over the past
10 years. These services and models support standardized operations and
better management of financial decisions in a cost-effective manner
through the use of statistically valid and reliable risk indicators.
Similar to the industry, VA expects to transform its appraisal
oversight operations through the purchase of this service. VA's primary
goal is to improve the quality and efficiency of its appraisal
oversight program. To achieve this goal, VA expects to:
Automate first-level reviews of appraisals using pre-
defined business rules and statistically valid and reliable risk
indicators
Shift from a random to a risk-based selection process to
perform oversight activities
Maximize fraud prevention efforts through the automation
of the appraisal review process, as well as the application of national
databases with up-to-date valuations and statistically proven risk
indicators
Decrease travel costs for field reviews of appraisals and
appraisers
Standardize appraisal policies and processes across the
nation
Gain the ability to assign work so that it can be evenly
distributed nationwide, when geographic demands necessitate it
Accelerate payments to appraiser panel
Tailor training program to appraisers and lenders' staff
appraisal reviewers
These outcomes will greatly improve VA's ability to estimate the
collateral value of VA's portfolio and will reduce its corresponding
financial portfolio risk. Since most Veterans using the program do so
because of the no-down payment feature, it is especially critical in
protecting the government's interests to have an accurate appraisal of
the property being secured with the VA guaranty. Additionally, these
outcomes will make the loan guaranty program more appealing to VA's
lending and servicing industry partners and, in turn, Veteran
borrowers.
B. How will performance measures be determined on the Appraisal
Management Service/Automated Valuation Model?
Response. VA plans to contract with a service provider to acquire
the services of an appraisal management system, including automated
valuation models, in FY 2010. During this time, VA will work with the
contractor to identify relevant, meaningful performance measures by
leveraging industry best practices. VA anticipates being able to
maximize many of the measures currently being used in the industry
since, similar to the conventional market, VA abides by the Appraisal
Foundation's Uniform Standards of Professional Appraisal Practice
(USPAP) in the completion of its appraisals. Possible performance
measures may include:
Risk and fraud rate by appraiser, geographical area, and
appraisal type
Timeliness by appraiser, geographical area, and appraisal
type
Appraiser error rates resulting from USPAP violations
Bias rate (appraiser's determined value compared to AVM's
projected value)
Percentage of appraisals below/at/above contract price by
appraiser
Average appraiser fees by geographic area and appraisal
type
C. How will the workload measurement study be used by the VA Home
Loan program to ensure the most efficient approval and oversight of
home loan guarantees?
Response. Since the last workload measurement study in 2000,
significant changes in operational procedures have occurred as a result
of legislative activity, managerial or organizational decisions, and IT
developments. Some of these changes include the addition of the
multiple-use provision and increased grant amounts to the Specially
Adapted Housing (SAH) program and the implementation of the Veterans
Affairs Loan Electronic Reporting Interface (VALERI) system.
Accurate information on the amount of time devoted to the work
performed in administration of Loan Guaranty benefits is necessary to
evaluate performance in terms of productivity and effectiveness. The
data from the workload measurement study will better enable Loan
Guaranty to make successful management decisions affecting staffing,
organization, procedures, and technology in this environment.
Question 2. The Home Loan Guaranty program anticipates a decrease
of almost 60,000 home loan guarantees from FY 2009 (323,812) to FY 2010
(267,900). This amount is further decreased in the estimated FY 2011
workload, which indicates that approximately 240,100 loans will be
guaranteed.
A. In light of the anticipated reduction in overall participation
in the program, why are an additional 39 FTE requested during a time of
decreased workload?
Response. The additional FTE are targeted for the Specially Adapted
Housing (SAH) program, which has experienced significant workload
increases over the last few years. As noted in the FY 2011 Budget, the
number of SAH grant applications received has increased from 3,159 in
2008 to 4,283 in 2009, and is expected to continue increasing in 2010
and 2011. The number of SAH grants approved has also increased from
1,017 in 2008 to 1,270 in 2009, and is expected to continue increasing
to 1,512 in 2010 and 1,801 in 2011. These increases are largely due to
recent legislative changes to the SAH program, which made over 14,000
Veterans potentially eligible to re-use their SAH grants. Recent
legislation also expanded eligibility criteria, increased grant
amounts, and allowed for yearly adjustments of the grant amount based
on a cost-of-construction index. Because of these changes, it is more
important than ever that we regularly and aggressively reach out to
these Veterans to ensure they are aware of and take advantage of the
benefits to which they are entitled.
It is true that we anticipate a decrease in the total number of
loans guaranteed by VA between FY 2009 and FY 2011. However, this
decrease will be due to an estimated 79 percent reduction in refinance
loans, and specifically, the volume of interest-rate-reduction-
refinance loans (IRRRLs). IRRRLs are refinances of previously VA-
guaranteed loans where borrowers are seeking to reduce their interest
rate. VA's processing and oversight work required for loans of this
type is significantly less than what is required for purchase loans,
since IRRRLs require neither full underwriting nor an appraisal.
In contrast, purchase loans, which are the primary driver of VA's
loan oversight workload, are expected to increase nearly 14 percent
over the same time period. VA's increase in purchase loan volume will
be largely due to a tightened lending environment for home mortgages
and the fact that the VA guaranteed loan program is possibly the only
no-down payment option remaining in the marketplace. VA borrowers
typically purchase homes in the $205,000 price range and have median
liquid assets of $6,800. As a result, for most of these Veterans, their
only route to home ownership is through a VA-guaranteed loan. These
loans do require greater scrutiny by VA employees to ensure appraisal,
underwriting and credit guidelines are followed, and that Veterans are
charged appropriately for the costs associated with obtaining and
closing purchase loans.
As a result of the expected increase in VA-guaranteed loans used to
purchase homes as opposed to those used for refinance, it will not be
feasible to reallocate FTE from the loan origination portion of the
program to serve those Veterans in need of Specially Adapted Housing
benefits.
Question 3. The FY 2010 budget request for the Housing Program
Interagency Motor Pool ($559,000) has almost doubled from $288,000
expended in FY 2009.
A. What constitutes the nature and purpose of this increase?
Response. The 2009 enacted budget contained $538,000 for Loan
Guaranty's motor pool obligations. This amount was used as a basis for
developing the 2011 request of $559,000. Actual expenditures for 2009
were considerably lower than anticipated. As a result, we will lower
our 2011 anticipated obligations to $305,000 within this account.
compensation and pension
Question 1. The fiscal year 2010 budget request from VA included a
chart regarding the workload and resource needs for the Compensation,
Pension, and Burial programs. That chart included information on
``Output per FTE.'' A chart with similar information had been included
in previous budget requests. The fiscal year 2011 budget also includes
that chart but does not include information on the ``Output per FTE.''
A. For fiscal year 2009, what was the level of output per FTE,
including both permanent employees and employees hired with funds from
the American Recovery and Reinvestment Act?
Response. The total direct FTE in 2009 was 11,868, resulting in
977,219 rating-related claims completed. The calculated output per FTE
is 82.3. However, the 420 ARRA FTE only began coming on board in May
2009, and the net effect on productivity in 2009 was insignificant.
Therefore, the effective output per permanent FTE (exclusive of ARRA
employees) was approximately 85.4.
B. For fiscal year 2010, what is the expected level of output per
FTE, including both permanent employees and employees hired with funds
from the American Recovery and Reinvestment Act?
Response. In fiscal year 2010 the estimated output per Compensation
and Pension direct labor FTE is 78 processed claims.
C. For fiscal year 2011, what is the expected level of output per
FTE?
Response. In fiscal year 2011 the estimated output per Compensation
and Pension direct labor FTE is 79 processed claims.
D. Is that information contained in the fiscal year 2011 budget
request?
Response. While this category is not explicitly stated in the
fiscal year 2011 budget as it has been in previous budget requests, the
expected level of output per FTE can be derived by dividing
`Production' by `C&P Direct Labor FTE.' These categories are included
in the fiscal year 2011 budget request.
E. If not, please explain why that information was eliminated from
this portion of the budget request, while at the same time ``Claims
Completed Per FTE'' was added to the budget request with regard to
education claims.
Response. The Compensation and Pension program direct labor FTE
includes administrative, public contact, fiduciary, managerial, and
other employees assigned non-rating workload such as pension
maintenance and burial claims in addition to those processing
disability rating claims. VA has found that reporting an output per FTE
measure that attributes all direct FTE in the program to only a portion
of the Compensation and Pension workload is difficult to analyze and
understand, and therefore subject to misinterpretation.
Question 2. According to the fiscal year 2011 budget request, VA
seeks funding to retain over 1,800 employees hired with funds from the
American Recovery and Reinvestment Act and to hire more than 2,000
additional claims processing staff. In a January 2010 report, the
Government Accountability Office (GAO) made these observations
regarding VA's recent hiring initiatives:
We have reported that adding staff has the potential to improve
VA's capacity to complete more claims, but an infusion of a large
number of new staff will also likely pose human capital challenges for
VA in the near term. VA has processed more claims and appeals decisions
annually since hiring the additional staff; however, as it has
acknowledged, individual staff productivity has decreased.
Specifically, the number of rating-related claims processed per staff
person declined from 101 in fiscal year 2005 to 88 in fiscal year 2008.
A. What is a reasonable goal for rating-related claims processed
per employee?
Response. VA is currently undergoing a metric study associated with
rating-related claims processed based upon employee experience levels.
One key factor being analyzed is the average number of issues addressed
for rating-related claims. We expect this study to provide us with
baseline information that will enable us to establish appropriate
measures and goals for claims processing employees.
B. What impact would a massive hiring initiative during fiscal year
2011 have on individual productivity?
Response. The gross production of claims will continue to increase;
however, the average individual productivity will decline while new
employees undergo extensive training. Training and experience will
increase productivity and gross production.
C. What specific steps would VA take during fiscal year 2011 to
deal with the ``human capital challenges'' posed by another hiring
initiative?
Response. VBA's training curriculum will be utilized as employees
are hired in FY 2011. VBA will have appropriate facilities, staff, and
other resources available for training new hires and will maintain
consistency with ongoing training programs for existing employees.
VBA is actively assessing the availability of space to accommodate
the additional employees. A short-term solution will involve shift work
in existing facilities until additional space accommodations can be
arranged.
D. What factors were considered by VA in deciding to seek large
increases in employees in fiscal year 2011 rather than focusing on
increasing productivity of the existing employees?
Response. VA anticipates continued growth in incoming disability
claims. VBA experienced a 14.1 percent increase in 2009, and we project
a 13.1 percent increase in 2010 and 11.3 percent in 2011. Along with
the addition of three new presumptive conditions, VA determined that
focusing on increasing productivity of existing employees alone would
not be sufficient to keep up with the growing workload. By hiring and
training additional employees now, VA will have a stronger and more
productive workforce to offset the impact of the expected workload
increases over the next two fiscal years.
Question 3. Between fiscal year 2001 and fiscal year 2008 the year-
end inventory of pending rating-related claims never exceeded 400,000.
According to the fiscal year 2011 budget request, the year-end
inventory is now expected to increase by 68% from fiscal year 2009 to
2010 (from 416,335 claims to 700,669 claims) and to increase by 93% by
the end of fiscal year 2011 (to 804,460 claims). On top of that, the
time it takes to process claims is expected to deteriorate by nearly 30
days (from 161 days in fiscal year 2009 to 190 days in fiscal year
2011). This is despite the fact that staff has more than doubled since
fiscal year 2005 and a 29% two-year increase in claims processing staff
is requested between fiscal year 2009 and 2011.
A. What metrics are used to determine whether these infusions of
staff are effective?
Response. While VBA uses a combination of workload management
indicators to gauge performance, we will closely monitor rating
quality, inventory, and completed claims to determine the effectiveness
of our recent hiring initiatives.
VBA continues to experience a significant increase in new claims
requiring rating decisions, which adds to the high volume in the
pending rating inventory. The increased staffing has led to increased
organizational productivity. VBA aggressively hired across the Nation,
adding nearly 4,200 new permanent employees between January 2007 and
September 2009. Additionally, VBA hired 2,000 employees under the
American Recovery and Reinvestment Act of 2009, many on temporary
appointments.
Disability claims received have increased from 838,141 in FY 2007
to 1,013,712 in FY 2009, an increase of 20 percent. At the same time,
the number of claims completed has continued to rise. In FY 2009, VBA
completed 977,219 claims, an 18 percent increase in productivity over
the 824,844 claims completed in 2007.
B. What indicators would lead VA to determine that further staffing
increases should be put on hold?
Response. Given the dramatic increases in projected workload as
well as the decision to add three new presumptive conditions for
Vietnam Veterans exposed to Agent Orange, VA does not believe that
further staffing increases should be put on hold. At the same time, we
recognize that infusion of additional staffing alone is not the
solution to fixing disability claims processing. Our business
transformation initiative therefore includes policy and process
changes, as well as new technologies, to address the claims workload.
We will closely monitor rating quality, inventory, and completed
claims to determine the need for additional hiring and the overall
effectiveness of our business transformation initiative.
C. Do these trends suggest that a new approach is needed now?
Response. Such dramatic increases in workload will require VBA to
employ innovative measures to be successful in meeting Veterans' needs.
VBA is actively engaged with industry leaders to explore process and
policy simplification and technology initiatives as elements of an
overall business transformation strategy addressing the growing
inventory of claims. The Veterans Benefits Management System (VBMS)
initiative is a large-scale effort to develop an IT solution that is
built on a scalable, agile architecture. Coupled with VBA's business
transformation strategy, the VBMS initiative will enable our
organization to reach its goal of a benefits delivery model that
provides world-class service to our Nation's Veterans.
Question 4. According to the January 2010 GAO report, VA has
reported that some declines in productivity have been due to ``new
staff who have not yet become fully proficient at processing claims and
to the loss of experienced staff due to retirements.''
A. In fiscal years 2010 and 2011, how many claims processing staff
are expected to retire?
Response. Approximately 21 percent of the claims processing staff
(2,300 claims processors) are eligible to retire. In another year, an
additional 1,700 claim processors will be eligible to retire. However,
our recent experience is that only 25 percent of those eligible to
retire actually retire in a given year.
B. What is the current overall attrition rate for claims processing
staff?
Response. From FY 2005 through FY 2009, the attrition rate for VBA
claims examiners (i.e., personnel in job categories of Veterans Service
Representative [VSR] and Rating Veterans Service Representative [RVSR])
was approximately 10 percent per year.
C. Since large-scale hiring began in 2007, what has been the
attrition rate with regard to newly hired staff?
Response. VBA conducted a review of the attrition rates of
probationary employees in the VSR and RVSR job categories in February
2009 for employees hired in FY 2007 through February 2009.
FY 2007
1,367 claims processors hired
12 (1%) terminated
49 (3.6%) resigned
FY 2008
1,785 claims processors hired
37 (2%) terminated
110 (6%) resigned
FY 2009 (through February)
327 claims processors hired
5 (1.5%) terminated
6 (1.8%) resigned
VBA strives to recruit and select candidates for claims processor
positions that meet the experience, knowledge, skill, and ability
requirements necessary to successfully perform in these positions.
Claims processing is a complex process, and the type of work involved
is not a good fit for every candidate selected. The Department makes
every effort to provide probationary employees with the opportunity to
develop and demonstrate their proficiency.
D. Of the employees hired since 2007, how many have completed
initial training and how many have remained with VA until they have
become fully proficient?
Response. VBA hired 6,423 Veterans Service Representatives (VSRs)
and Rating Veterans Service Representatives (RVSRs) between FY 2007 and
FY 2009. Of the employees hired since 2007, 842 no longer worked for
VBA after FY 2009 for reasons such as retirement, termination, and
transfer. VBA considers VSR and RVSR employees initially trained and
fully proficient based on 24 or more months of experience. Of the
employees that continued to work for VBA, 2,355 had 24 or more months
of experience, and 3,226 did not have 24 months of experience at the
end of FY 2009.
E. For fiscal year 2011, please provide a breakdown of how many
claims processing staff are expected to have 0 to 6 months of
experience, 6 to 12 months of experience, 12 to 18 months of
experience, 18 to 24 months of experience, and more than 24 months of
experience.
Response. As of November 21, 2009, the experience levels of VBA
claims processors were:
4,916 VSRs on board:
i. 0-6 months experience = 380
ii. 7-12 months experience = 442
iii. 13-18 months experience = 713
iv. 19-24 months experience = 640
v. 24+ months experience = 2,741
2,288 RVSRs on board:
i. 0-6 months experience = 156
ii. 7-12 months experience = 298
iii. 13-18 months experience = 245
iv. 19-24 months experience = 283
v. 24+ months experience = 1,306
Based on the 10% attrition rate per year, VBA anticipates turnover
of approximately 490 VSRs and 220 RVSRs positions. These claims
processors would have varying levels of experience depending on when
hired, but all less than 12 months in FY 2011. Direct compensation FTE
will increase from approximately 10,700 in FY 2009 to 14,100 in FY
2011. These 3,400 employees will also have varying levels of experience
depending on when they are hired.
Question 5. In 2001, a task force chaired by Admiral Daniel Cooper
recommended that VA allocate employees ``to those Regional Offices that
have consistently demonstrated high levels of quality and productivity
in relation to workload and staffing levels.''
A. If the fiscal year 2011 budget request is adopted, would
additional staff be allocated predominantly to offices that have
consistently performed well?
Response. VBA continues to consider consistent high performance in
allocating staffing to regional offices, as well as factors such as
support for special missions, participation in pilots and initiatives,
and physical space limitations. VBA also employs a ``brokering''
strategy, which balances the workload by sending cases from regional
offices with high inventories to regional offices and resource centers
with additional processing capacity.
B. Over the past five years, which regional offices have
consistently performed well and which have consistently underperformed?
Response. Performance is evaluated against both national and
individual targets that are established at the beginning of each fiscal
year. Regional office performance varies as a result of a number of
factors including workforce experience, local economic and employment
environment, high cost of living, and staff turnover. Regional offices
that consistently perform well are in areas where VA is an employer of
choice, and we are therefore able to recruit and retain high-performing
employees. Regional offices that have difficulties in meeting
performance targets are predominantly in high-cost metropolitan areas
with high employee turnover.
C. What steps will be taken to deal with offices that consistently
underperform?
Response. VBA aggressively monitors regional office performance and
develops specific action plans to improve identified problem areas.
Oversight is provided through site visits conducted by both the
Compensation and Pension Service and the Area Directors. Regional
office directors are held accountable for performance though annual
performance evaluations. Special missions such as the processing of
Benefits Delivery at Discharge and Quick Start claims are assigned to
regional offices that consistently perform well, creating growth
opportunities for offices that have proven the ability to handle
additional workload.
Question 6. In the fiscal year 2010 budget request, which was
submitted to Congress in May 2009, VA estimated that, with the
temporary staff hired with funds from the American Recovery and
Reinvestment Act, the ``increase in production in 2010 is expected to
be 10,000 cases.'' Then, in its FY 2009 Performance and Accountability
Report, which was submitted to Congress in November 2009, VA estimated
that those temporary employees ``increase[d] by 10,000 the number of
compensation and pension (C&P) claims processed per month'' (emphasis
added).
A. Please clarify the expected increase in productivity per month
and in total during fiscal year 2010 as a result of employees hired
with funds from the American Recovery and Reinvestment Act.
Response. VBA estimated in its May 2009 ARRA program-specific plan
that 10,000 more claims will be processed in FY 2010 as a result of
hiring 1,500 claims processors under the American Recovery and
Reinvestment Act of 2009. The statement in the FY 2009 Performance and
Accountability Report regarding the increase of 10,000 claims per month
is misquoted from our original productivity estimate. Our best estimate
of increased rating-related productivity as a result of the ARRA hires
continues to be a total of 10,000 claims over the course of the fiscal
year.
B. What is the estimated cost per additional case that will be
processed by the employees hired with funds from the American Recovery
and Reinvestment Act?
Response. The additional cost per claim is approximately $12,300,
when considering an additional 10,000 cases expected to be processed
and the $123 million carried over into FY 2010 for this program. ARRA
hires were trained to complete less complex claims processing and
support activities, removing these administrative duties from
experienced claims processors who now focus on more difficult claims
and increased productivity.
Question 7. For many years, experts have stressed the need to
modernize the VA disability compensation system, by taking such steps
as updating the VA Disability Rating Schedule. According to VA's FY
2009 Performance and Accountability Report, ``VA will contract an
ongoing review of the VA Schedule for Rating Disabilities beginning in
2010.'' Also, in a recent response to my questions, VA indicated that
``[a]s part of the ongoing effort to update at least one to two body
systems per year, VA developed a Project Management Plan.'' In
addition, that response indicates that ``[s]even additional medical
officers and a psychologist will be hired in the future'' to support
the effort to modernize the Rating Schedule.
A. Has a contract been entered into for the purpose of conducting
an ongoing review of the Rating Schedule?
Response. No; a draft Statement of Work is currently under review
at VBA.
B. How much does VA anticipate spending on this review in fiscal
year 2010?
Response. VA anticipates spending $750,000 in FY 2010.
C. How much does VA anticipate spending on this review in fiscal
year 2011?
Response. VA anticipates spending $750,000 in FY 2011.
D. Please provide a copy of the Project Management Plan and any
other information about what milestones have been set for fiscal years
2010 and 2011 in terms of updates to the Rating Schedule.
Response. The Project Management Plan is currently under
development and will be submitted to Congress as soon as completed.
E. When will the additional seven employees be hired?
Response. VBA plans to hire the 7 FTE in FY 2010.
F. In total, how much funding from the fiscal year 2011 budget
would be dedicated to updating the VA disability rating schedule?
Response. VBA plans to dedicate $2.2 million (includes FTE) in FY
2011 to update the rating schedule.
G. Does the fiscal year 2011 budget request contain sufficient
funding for all employees, contracts, and other expenses necessary to
keep the Rating Schedule up to date?
Response. Yes, we believe the FY 2011 budget contains sufficient
funding.
Question 8. At a Senate Committee on Veterans' Affairs hearing in
September 2009, the Committee discussed a report prepared by Economic
Systems, Inc., entitled ``A Study of Compensation Payments for Service-
Connected Disabilities,'' which in part discussed options for
compensating veterans for loss of quality of life caused by their
service-related injuries. The Under Secretary for Benefits at that time
indicated that further study would be necessary before moving forward
with most of the options in that report. After that, I sent questions
to VA asking what additional studies would be needed to move forward
with compensating veterans for loss of quality of life, whether VA has
sufficient funding to conduct the necessary studies, and when VA would
move forward with those studies. VA recently provided this response:
The Advisory Committee on Disability Compensation is currently
reviewing and analyzing potential models for compensating for
Quality of Life (QOL) loss * * *. Due to the on-going work of
the Advisory Committee on Disability Compensation, VA does not
believe that additional studies to create a separate system to
compensate for [quality of life] loss should be considered at
this time. There are existing benefits within VA's current
benefits package that implicitly address the [quality of life]
of Veterans * * *. For example, one such benefit that provides
Veterans with payments over and above the benefits amounts
computed from the [Rating Schedule] is Special Monthly
Compensation.
A. Does VA agree that the VA disability system should finally be
updated to compensate for lost quality of life, as recommended by
numerous experts over the past five decades, including the Veterans'
Disability Benefits Commission, the Dole-Shalala Commission, and the
President's Commission on Veterans' Pensions?
Response. VA believes there is a statutory framework in place for
providing compensation based on non-economic loss. This framework is
codified at title 38, U.S.C. Sec. 1114, and provides special monthly
compensation that is not linked to average loss in earnings capacity.
As such, VA believes there is already a mechanism in place for
additional non-wage-related compensation. However, VA is looking to the
Advisory Committee on Disability Compensation for input regarding areas
where additional non-wage-related compensation may be in order. We do
not believe that fundamental change in the wage-related component of
VA's disability compensation program is advisable given the inherent
difficulty in defining overall quality of life across the spectrum of
disabilities and individuals.
B. Does VA agree that, particularly for mental impairments, the
current system of special monthly compensation does not adequately
compensate for loss of quality of life?
Response. Veterans with service-connected mental disorders of such
severity as to require assistance in performing activities of daily
living may receive special monthly compensation under the current
statutory framework. The Advisory Committee on Disability Compensation
is looking at that framework to determine if there are other outcomes
associated with mental disorders that should receive the benefit of
special monthly compensation.
C. What does VA view as a reasonable timeline for the Advisory
Committee to complete its work on quality of life issues?
Response. The Committee is required by statute to provide a report
to the Secretary no later than October 31, 2010, and not less
frequently than two years thereafter. Given the inherent difficulties
associated with defining quality of life across the spectrum of
disabilities and individuals, VA believes that the Committee should
have a section in that report concerning preliminary findings with
respect to quality of life compensation.
D. What steps will VA take to ensure that the Advisory Committee's
work is completed in a timely manner, and who specifically at VA will
be charged with monitoring the progress of the Advisory Committee?
Response. VA's Compensation and Pension Service provides direct
support to activities of the Advisory Committee. As such, the Director,
C&P Service, has responsibility for ensuring that the Advisory
Committee is meeting its charge as outlined in their charter.
E. What resources will VA make available to the Advisory Committee
to assist with its efforts?
Response. VA provides a minimum of two FTE to support the
activities of the Committee while the Committee meets. In addition, VA
provides the Committee with information and meets with the Committee as
requested.
F. Once the Advisory Committee provides its recommendations
regarding quality of life, will VA make it a priority to implement all
appropriate changes, including providing proposed legislation to
Congress if appropriate?
Response. VA will make it a priority to implement recommendations
of the Advisory Committee on quality of life, provided those
recommendations are appropriate and consistent with the
Administration's position on this issue. A legislative proposal would
be developed if necessary to implement any recommendations.
Question 9. In the portion of the budget request regarding the
Compensation, Pensions, and Burial programs, it is noted that
``increased funding for contract medical examinations'' is being
requested.
A. How much funding in total will be used in fiscal year 2011 for
contract examinations?
Response. In FY 2011, VBA contract exams are estimated to cost
approximately $189.1 million, including $169.1 million in mandatory
funding and $20 million in discretionary funding.
B. Please describe VA's policy for reimbursing contract examination
providers and the extent to which reimbursement is based on the payment
system used by Medicare to reimburse health care providers for
treatment.
Response. VA does not reimburse the examiners. VA contracts with a
primary contractor, and the primary contractor then enters into
separate subcontracts with examination providers. The prime contract
with VA is a fixed price contract.
C. Please explain why VA believes the system used by Medicare to
reimburse health care providers for treatment should also be used to
reimburse contractors for VA compensation and pension examinations that
are not being conducted for purposes of treatment.
Response. The actual examination is billed according to a
negotiated contract price between VA and the prime contractor, not VA
and the subcontracted provider. VA only uses the Medicare rates as a
basis for billing of diagnostic testing and procedures (such as x-
rays), which are billed according the current procedural terminology
code assigned to each test. A fixed-rate for tests is in VA's best
interest financially. The Medicare rate is issued by the Federal
Government, which has already determined the rates for tests and
procedures to be fair and reasonable according to the region of the
country.
D. Is VA aware of any inconveniences or frustrations this practice
has caused for veterans? For example, if a veteran who requires a
hearing test has ears that need to first be cleaned and drained, is it
possible the veteran would be required to make two separate
appointments with the contractor because the Medicare system would not
allow reimbursement for cleaning and testing on the same day?
Response. In cases where a test or procedure would require initial
or additional work, the contract is amended so the prime contractor is
allowed to bill VA for the additional labor and preparatory work. This
type of amendment allows for the tests and procedures to be completed
the same day so the Veteran will not have to reschedule the
appointment.
E. Is VA aware of any complications or frustrations this
reimbursement practice has caused for contractors?
Response. There have not been any complications identified by the
contractor that have caused a delay in services to Veterans related to
the reimbursement practices under the contracts.
F. Has VA examined whether an alternative method of compensating
contract examination providers, such as using a firm fixed price, could
lead to better customer service and efficiency?
Response. The contracts currently are firm-fixed price for the
examination costs. The only portions that are not firm-fixed price are
the diagnostic tests, which are based on Medicare rates.
G. Is VA aware of other Federal agencies that use a firm fixed
price to reimburse contract examinations?
Response. VA is not aware of any other Federal agency that uses a
firm-fixed price to reimburse contract examinations.
Question 10. In addition to processing claims in a timely manner,
it is essential that decisions are accurate in order to avoid delays
and frustrations for veterans and their families.
A. In fiscal year 2011, what level of funding will be dedicated to
the Systematic Technical Accuracy Review (STAR) program?
Response. The Systematic Technical Accuracy Review (STAR) program
is a component of VBA's national quality assurance program that
assesses the accuracy of disability benefit determinations. This
national quality assurance program is administered by VBA's C&P
Service. The FY 2011 allowance for administering this program is 52
FTE. This represents an increase in staff of 42 percent since FY 2007.
B. How many full-time employees would be dedicated to that program
in fiscal year 2011 and how many cases would be reviewed?
Response. As mentioned above 52 FTE will be dedicated to the STAR
program in FY 2011.
C. Will the number of cases reviewed by the STAR program be
increased further as the level of claims VA is receiving per year
increases?
Response. The increase to VBA's Quality Assurance Program staff has
enabled increased sampling, consistency reviews, and special focused
reviews in support of the national quality assurance program. The
Quality Assurance staff is targeted to complete 48,919 reviews for FY
2011. This is an increase of 30,562 reviews from FY 2007.
The current level of review is sufficient to provide a 95% level of
confidence with a 5% margin of error. While VA does not intend to
increase the sampling, we are considering additional more focused
reviews. We are also looking forward to the Institute for Defense
Analyses review of the quality assurance program as mandated by Pub. L.
110-389, The Veterans' Benefits Improvement Act of 2008, to inform of
us of areas to improve our national quality assurance program.
D. What steps would VA take to ensure that quality of
decisionmaking is not negatively affected by an influx of inexperienced
claims processing staff?
Response. In addition to training and coaching received at the
regional offices, VA is taking steps to ensure the quality of claims
processing staff through a comprehensive national training program.
This training program includes pre-requisite, centralized, and home
station training phases. The integration of a national training program
has resulted in standardized training modules for all phases of claims
processing. Additionally, the VA has created training modules for
recurring training for journey level claim processors.
Question 11. In light of the Secretary's decision to create
presumptions of service connection for three additional disabilities,
VA is requesting a supplemental fiscal year 2010 appropriation of $13.4
billion to pay for additional disability benefits, including an
estimated 86,000 retroactive awards based on the Nehmer litigation.
A. Please provide an overview of what the Nehmer litigation
requires.
Response. Nehmer is a long-standing class action (originated in
1986) on behalf of all Veterans eligible to claim VA disability
compensation based on alleged exposure to herbicides during military
service in Vietnam. In 1989, the U.S. District Court for the Northern
District of California (District Court) invalidated the 1985 VA
regulation governing claims based on herbicide exposure. Under Nehmer,
VA must readjudicate previously denied claims for newly added
herbicide-related presumptive diseases filed by Nehmer class members
(generally Vietnam Veterans and their survivors) and provide
retroactive benefits from the date of the prior claim to such
individual pursuant to 38 C.F.R. Sec. 3.816. This requirement involves
claims filed or denied during the period from September 25, 1985, to
the effective date of the VA's final regulation establishing a
presumption of service connection for the disease(s) claimed.
B. How are retroactive Nehmer awards calculated? For example, are
staged ratings assigned?
Response. Retroactive benefits under Nehmer are calculated based
primarily upon the 1991 Stipulation and Order requirements providing
for the readjudication of Nehmer claims, a 2001 Stipulation and Order
setting forth a timetable for promptly paying Nehmer class members
retroactive benefits, and VA's corresponding Nehmer regulation at 38
CFR Sec. 3.816. The regulation sets forth a process for payment of
benefit claims under the Nehmer court orders. Pursuant to the effective
date provisions contained in 38 CFR Sec. 3.816(c), benefits are
generally paid retroactive from the date VA received the original
service connection claim for the presumptive disease. Death benefit
claims are handled in a similar fashion. In cases where the disability
increases or decreases, staged ratings may be assigned.
C. If a veteran covered by Nehmer is deceased, who would receive
the retroactive award and how would VA determine what disability rating
to assign?
Response. VA's Nehmer regulation at 38 CFR 3.816(f)(1) states that
if a Nehmer beneficiary is deceased, payment will be made to the first
individual or entity that is in existence at the time of payment, in
the following order of priority: (1) spouse, (2) children, (3) parents,
and (4) estate. Thus, if there is no immediate survivor in categories
(1)-(3), VA must pay the estate if there is an estate in existence.
Payments made to estates can result in relatives further removed than
those in categories (1)-(3) receiving the retroactive benefits. The
requirement to pay estates, notwithstanding the accrued benefits
limitations in 38 U.S.C. Sec. 5121(a)(2), is based on judicial
decisions in Nehmer mandating such payments.
D. How long will it take to process those 86,000 retroactive
awards?
Response. VA currently cannot estimate how long it will take to
readjudicate these claims. Nehmer claims are more complex than other
claims, and generally require analysis of VA records that span several
decades. VBA is therefore taking action to prepare for adjudication of
these claims as soon as the new regulation becomes effective. A
training guide and schedule have been completed and are ready for field
distribution. The Nehmer cases will be adjudicated by 13 VA resource
centers. Training for personnel assigned to the resource centers began
May 3, 2010, in Nashville. Upon completion of training, the resource
centers will begin development of the claims. VBA completed a records
match with VHA to identify Veterans who received treatment for the
three new presumptives and therefore reduced the need for VA
examinations. In addition, VBA has prepared a pre-printed medical exam
template for Veterans to take to their primary care physician. These
templates will allow VA to expedite rating decisions based on these
records without requiring a VA medical examination.
E. Which VA offices will handle those 86,000 awards and how will
that work be prioritized?
Response. VBA currently plans on using 13 Resource Centers to
consolidate all Nehmer claims. The priority of processing Nehmer claims
is under development. VBA is seeking every avenue available to
determine which claims will require the most development, the least
development, or possibly no development to facilitate the
prioritization of this workload.
F. Has VA put out any guidance on how to adjudicate those claims?
If so, please provide a copy.
Response. As previously stated, VBA's action plan for
readjudicating these claims is still under development. Once complete,
and upon final promulgation of VA's amended regulation adding the three
new disabilities to the list of other diseases presumptively related to
herbicides, VBA will provide a copy of its action plan. In the interim,
VBA provided guidance, whether or not Nehmer applies, on handling
claims for the new presumptive disabilities prior to implementation of
a final regulation. That guidance is contained in Compensation and
Pension Service Fast Letter 09-50, dated November 19, 2009.
Question 12. Since 2003, cases remanded by the Board of Veterans'
Appeals have been handled at a centralized entity called the Appeals
Management Center. In recent years, before a leadership change at the
Appeals Management Center, veterans' organizations and others had been
highly critical of this entity.
A. What level of funding is requested for the Appeals Management
Center in fiscal year 2011?
Response. Funding for the AMC is included in the Compensation and
Pension (C&P) FY 2011 budget request. Resources are determined and
allocated to the AMC, as appropriate, in the execution year. In FY
2009, the AMC obligated $11.2 million in payroll and $1.2 million in
non-payroll expenses.
B. How many employees will that level of funding support?
Response. The Appeals Management Center has an assigned staffing
level of 200 full-time employees for FY 2010. Funding allocations for
FY 2011 will be determined in the execution year.
C. What were the key performance outcomes for the Appeals
Management Center in fiscal year 2009 (such as timeliness and accuracy)
and what are the expected performance outcomes for fiscal years 2010
and 2011?
Response. During FY 2009, the Appeals Management Center (AMC)
completed 15,396 appeals, the highest production since its
establishment in 2003. Actual performance exceeded the AMC's production
target of 12,000 appeals.
By focusing on the oldest appeals, the AMC reduced the average age
of its pending inventory from 373 days to 291 days (22 percent
reduction) during FY 2009. Processing time increased as a result of
this focus. At the beginning of FY 2009, the average number of days to
complete an appeal was 437 days. This measure peaked at 578 days in May
2009, but fell to 477 days by the end of FY 2009.
D. How many remands is the Appeals Management Center expected to
receive in fiscal year 2011 and how many remands are expected to be
completed?
Response. Estimates for fiscal year 2011 have not been
determined.
E. With the requested level of funding, will the Appeals Management
Center reduce its backlog of pending cases?
Response. The AMC was authorized to hire an additional 50 employees
in FY 2010, increasing its staffing from 150 to 200 full-time
employees. As these employees complete their training and gain work
experience, the AMC anticipates increased production, with a resulting
decrease in inventory.
F. Does the fiscal year 2011 budget request outline the resource
requirements and performance of the Appeals Management Center? If not,
will that information be included in future budget requests?
Response. The FY 2011 budget does not contain a specific line item
for the Appeals Management Center (AMC). Resources and funding will be
determined and allocated to the AMC in the execution year. VA does not
plan to add facility-level resource requirements or performance to the
budget request.
G. What factors should be considered in determining whether to
continue or disband this entity?
Response. The AMC was established to process appeals remanded from
the Board of Veterans' Appeals (BVA). Processing remands is the AMC's
sole mission. All staff members receive specialized training and are
dedicated to processing these complex claims. One of the primary
reasons for locating the AMC in Washington, DC was to maintain a close
physical proximity to BVA, which has improved communications and
facilitated the identification and resolution of issues. The
specialized mission of the AMC ensures that trained resources remain
directed toward completing these complex cases.
Question 13. In recent years, VA has increased its practice of
brokering claims between regional offices. However, GAO recently
reported that VA ``has not collected data to evaluate the effect of
this practice.''
A. How many cases does VA expect to broker during fiscal years 2010
and 2011?
Response. During the first quarter of FY 2010, 6,143 claims were
brokered between VBA regional offices. If annualized, VBA projects to
broker 24,572 rating-related claims between regional offices in FY
2010. We also expect to send approximately 105,000 rating-related
claims to VBA's nine resource centers for completion in FY 2010. In
total, VBA projects to broker approximately 130,000 disability claims.
Estimates for FY 2011 have not been developed.
B. How much does VA expect to spend in fiscal year 2010 and fiscal
year 2011 on shipping brokered cases between offices?
Response. VBA is unable to provide this information, as we do not
separate shipping costs associated with brokering from the regional
offices' overall FedEx allocation.
C. To what extent would brokering cases be expected to reduce
delays in providing veterans with decisions or increase the accuracy of
decisions?
Response. The brokering strategy is designed to move work from
offices experiencing workload and/or performance challenges to national
resource centers and other offices with productive capacity. Brokering
plans identify and leverage productive capacity to support offices
where workload assistance is most needed. Regional offices experiencing
the greatest workload challenges are assisted in regaining a more
manageable workload balance.
D. What metrics are in place to gauge the effectiveness of
brokering?
Response. Brokering effectiveness is measured through VBA Resource
Center Performance Standards. Production and timeliness are measured
locally by brokered sites, and monitored by VBA's area directors.
Accuracy is measured both internally at brokering sites as well as
nationally through Systemic Technical Accuracy Review (STAR).
Question 14. According to the fiscal year 2011 budget request, VA's
fiduciary program currently supervises over 104,000 incompetent
beneficiaries and the program ``continues to grow.
A. In total, what level of funding would be used to support the
fiduciary program during fiscal year 2011 and how many employees would
that level of funding support?
Response. The Fiduciary program level of funding is estimated to be
$36 million. This supports the salary and benefits of 475 FTE, notable
programs such as the Accuity Asset Verification System, and planned
conferences. Accuity Asset Verification System is a secure web-based
network that automates the processing of financial asset verification
requests for funds on deposit at financial institutions. Training
conferences are planned with key staff in FY 2010. These conferences
and on-site training will significantly enhance oversight and
protection of beneficiaries' funds
B. With this level of funding, what size caseloads would individual
fiduciary program employees carry?
Response. A standard caseload is not used across all regional
offices for fiduciary activities. Caseload is based on density of
population, distance traveled to reach a beneficiary, and the
experience of the employee. For example, greater caseload can be
assigned in a metropolitan area because reduced travel time allows more
time for employees to complete fiduciary activities.
C. Will the Western Area Fiduciary Hub be continued during fiscal
year 2011? If so, what impact is that expected to have on the quality
of fiduciary work?
Response. The Western Area Fiduciary Hub will continue in FY 2011.
The Western Area Fiduciary Hub is fully expected to meet or exceed the
90 percent accuracy rate provided in the budget submission.
Question 15. According to the budget request, a total of 2,543
examinations and 1,194 ratings had been completed through the
Disability Evaluation System (DES) Pilot process as of September 30,
2009.
A. How much in total has VA expended with regard to the DES Pilot?
Response. The joint VA/DOD Disability Evaluation System (DES) Pilot
program is currently operational at 26 locations, with site 27 entering
the Pilot on March 31, 2010. VBA spent approximately $11.6 million in
2009, which included payroll and benefits for 106 FTE, contract medical
exams, travel, FedEx charges, and space requirements.
VA and the Department of Defense (DOD) are currently developing
plans to institute the DES Pilot model as the normal DES process for
the military services.
B. How much does VA intend to expend during fiscal years 2010 and
2011 on the DES Pilot?
Response. VBA estimates $18.5 million and $28.4 million will be
spent in 2010 and 2011, respectively. These funds will be used for
payroll and benefits for 181 FTE in 2010 and 285 FTE in 2011, contract
medical exams, travel, FedEx charges, and space requirements.
Additional discretionary funds of approximately $70 thousand will be
used in 2010 for travel, shipping, and other miscellaneous expenses.
One-time startup costs such as space and IT infrastructure are
estimated to cost $5.4 million as the pilot expands. Mandatory funding
for contract examinations is estimated to be $6.7 million in 2010 and
$20.3 million in 2011. Examination costs for VHA are estimated to be
$3.5 million in 2010 and $4.0 million in 2011, with the assumption that
a cost-sharing agreement will be in place between VA and DOD.
C. How many servicemembers are expected to complete the DES Pilot
during fiscal year 2011?
Response. In 2011 we expect approximately 14,800 new entrants to
the DES pilot, although not all will actually complete the process
during the same year.
D. Please provide any customer satisfaction data that has been
collected regarding the satisfaction levels with the Pilot process
compared to satisfaction levels with the traditional process.
Response. The Defense Manpower Data Center (DMDC) is conducting
customer satisfaction surveys for the Department of Defense. Through
January 31, 2010, 4,098 surveys were completed by servicemembers going
through various stages of the DES Pilot process, and 3,309
servicemembers going through various stages of the legacy DES process.
76 percent of DES Pilot members were satisfied with the medical care,
case management and the general DES process. In comparison, 70 percent
reported satisfaction with the legacy DES process. Across DOD, 82
percent of DES Pilot members were satisfied with the fairness of the
process. In comparison, 67 percent reported satisfaction with fairness
of the legacy DES process.
E. What metrics will be used to determine whether the DES Pilot
process is successful?
Response. Three metrics have been established to determine the DES
Pilot success:
1. Percent of military members participating in a single disability
evaluation/transition medical exam to determine fitness for duty and
disability rating.
2. Average time for wounded, ill, or injured (WII) servicemembers
to complete the joint DOD/VA disability evaluation system (DES).
3. Average time after separation/retirement for wounded, ill, or
injured (WII) participants in the joint DOD/VA disability evaluation
system (DES) to receive a VA benefits notification letter.
Question 16. The budget request for Compensation, Pension, and
Burial programs for fiscal year 2011 includes $38.2 million for travel,
which is 126% higher than the amount expended on travel during fiscal
year 2009 ($16.9 million), 108% higher than the amount requested for
fiscal year 2010 ($18.3 million), and 91% higher than the amount now
expected to be expended on travel during fiscal year 2010 ($20
million). According to the budget request, ``[i]ncreased travel funds
are required for new employee Challenge training.''
A. How many employees attended Challenge training during fiscal
year 2009 and how many are expected to attend Challenge training during
fiscal years 2010 and 2011?
Response. In FY 2009, 1,161 employees completed Challenge training.
In FY 2010, approximately 1,500 and in FY 2011, approximately 3,610
employees will complete Challenge training.
B. What portion of the $38 million will be used for travel to
Challenge training?
Response. Approximately $22 million will be used for Challenge
training in 2011.
C. What accounts for any remaining portion of the $38 million?
Response. The remaining portion is for the base (core) program
travel.
D. What is the average travel cost per employee who attends
Challenge training?
Response. For three weeks of training, the cost is estimated to be
approximately $6,000 per employee.
E. Has VA considered any less expensive alternatives to providing
necessary training?
Response. VA considered less expensive alternatives to providing
necessary training and implemented training with the best balance of
cost and quality. Nearly three weeks of home-station training is
completed using standardized lesson materials and computer-based
training before Challenge participants travel. Home-station follow-on
training continues after centralized Challenge Training, utilizing
additional standardized lessons and computer-based training.
Question 17. The budget request for Compensation, Pension, and
Burial programs for fiscal year 2011 includes $340 million for Other
Services, which is 40% higher than the amount expended during fiscal
year 2009 on Other Services ($242 million), 22% higher than the amount
requested for fiscal year 2010 ($277 million), and 9% higher than the
amount now expected to be expended during fiscal year 2010 ($309
million). According to the budget request, ``[t]he increase to other
services supports the [Veterans Benefits Management System] Initiative
and increased funding for contract medical examinations.'' Please
provide an itemized list of what expenditures would be made with this
level of funding.
Response. Increases from 2010 to 2011 to support the Veterans
Benefits Management System (VBMS) and contract medical exams follow:
VBMS--An increase is required due to increased scanning and related
services needed for VBMS pilot activities and additional technical,
analytical, and engineering support provided by MITRE.
Contract Medical Exams--An increase is required due to the
anticipated 6 percent increase in price due to inflation and increased
Medicare rates, as well as an anticipated 12 percent increase in the
quantity of exams.
Question 18. The budget request for Compensation, Pension, and
Burial programs for fiscal year 2011 includes $32.5 million for
Supplies and Materials, which is 200% higher than the amount expended
during fiscal year 2009 ($10.9 million), 168% higher than the amount
requested for fiscal year 2010 ($12.2 million), and 145% higher than
the amount now expected to be expended during fiscal year 2010 ($13.3
million). According to the budget request, ``The increase to supplies
and materials supports the new 2,050 FTE and the VBA-wide initiative to
supply employees with a printer to print claims-related documents at
their desks. The increased funding will be used to purchase printer
cartridges associated with this effort.''
A. What factors, if any, other than new employees and printer
cartridges account for this increase in supplies and materials?
Response. The increase is attributable only to new employees and
printer cartridges.
B. What portion of that over $19 million increase from fiscal year
2010 to 2011 will be used to provide supplies and materials for new
employees and what is the expected cost per new employee for those
supplies and materials?
Response. Approximately $13 million will be used to provide
supplies and materials for new employees. The budgeted cost per
employee is approximately $4,000, which includes not only general
office supplies, but also increased needs for cubicles and office
furniture. At the time of the submission of the budget, exact
requirements of supplies and materials versus equipment was unknown due
to the uncertainty of the regional office distribution of new FTE and
the space needs at each location. As such, there may be a shift from
the supplies and materials category to equipment in the year of
execution.
C. What types of supplies and materials would be purchased with the
requested level of funding?
Response. Standard office supplies will be purchased, such as
notebooks, pens, pencils, printer-paper, and toner cartridges.
Equipment purchases will include employee work stations, which consist
of cubicles and furniture.
Question 19. From the fiscal year 2011 budget request, it appears
that the Compensation and Pension Service carried over more than $19
million in General Operating Expenses from fiscal year 2009 to 2010.
How will those funds be used during fiscal year 2010?
Response. These funds will be applied to additional 21st century
transformational improvements to VBA's business processes, such as the
Veteran's Benefits Management System Initiative.
board of veterans' appeals
Question 1. According to the fiscal year 2011 budget request, the
Board of Veterans' Appeals (Board or BVA) expects to receive 60,000 new
appeals during fiscal year 2010. It also reflects that additional
funding is sought to ``reverse the trend of a growing backlog, and
reduce case disposition time.''
A. What is the current backlog of appeals at the Board and what is
it projected to be with funding requested for fiscal year 2011?
Response. The backlog of appeals at the Board effective March 1,
2010, is 19,464 cases. The funding requested in FY 2011 supports 557
employees on board. Assuming the current trend of the growing backlog
(300 additional cases per month), the projected backlog is 21,564 cases
at the beginning of fiscal year 2011 and 25,164 cases at the end of
fiscal year 2011.
VA has forwarded several legislative proposals to Congress to help
reduce the backlog and improve the timeliness of appeals processing as
part of the draft ``Veterans Benefit Program Improvement Act of 2010.''
Attached are copies of Secretary Shinseki's letters to the Speaker of
the House and the Vice President transmitting the proposed legislation
to Congress, together with a copy of the draft statutory language and a
description of the proposals. The draft statutory language pertaining
to appeals is included in Sections 202-207 of the attached draft bill.
Descriptions of these proposals are included on pages 10-17 of the
section-by-section analysis.
B. During fiscal year 2011, how many appeals is the Board expected
to receive and how many decisions are expected to be issued?
Response. As previously reported, the Board expects to receive
60,000 new appeals in fiscal year 2011. Assuming the Board remains
staffed at 557 employees, the Board expects to issue 46,800 decisions
in fiscal year 2011.
It is important to note that when the Board submitted the FY 2011
Budget in early 2009, the backlog had been decreasing over an 18 month
period at what appeared to be a predictably steady rate of 350 cases
per month, or 4,200 cases per year. That trend reversed unpredictably
in April and May 2009, and since then the backlog has been increasing
at the relatively steady rate of 300 cases per month, or 3,600 cases
per year. A potential cause for this trend is a substantial increase in
staffing at the Veterans Benefits Administration (VBA), which has
resulted in an increase in the number of claims adjudicated at the
Regional Office level. While the appeal rate has remained stable, the
larger pool of cases adjudicated in the field has resulted in a
corresponding increase in the number of appeals received by the Board.
Question 2. The Board submitted several legislative proposals with
the budget request.
A. What impact would these legislative proposals have on the
average time it takes to resolve an appeal?
Response. The Board of Veterans' Appeals (BVA or Board) submitted
the following six legislative proposals, all of which are aimed at
improving timeliness in the processing of Veterans' benefits appeals:
(1) reduce the time period for initiating an appeal from one year to
180 days; (2) allow initial Board consideration of evidence submitted
by a claimant after a substantive appeal has been filed, rather than
having to remand the case back to the agency of original jurisdiction;
(3) allow the Board more flexibility in scheduling video conference
hearings in order to reduce the wait time for Veterans and to minimize
travel time and expenses related to conducting in-person travel board
hearings; (4) amend the statute requiring the Board to provide reasons
and bases for findings and conclusions of law to place more emphasis on
the Board's ultimate findings of fact and conclusions of law; (5) amend
the definition of ``prevailing party'' for purposes of establishing
eligibility to receive fees under the Equal Access of Justice Act
(EAJA) to protect claimants from attorneys who seek to use the judicial
process for pecuniary gain without directly benefiting claimants; and,
(6) amend the statute to make it clear that the filing of a substantive
appeal within 60 days from the date of the mailing of the statement of
the case is a requirement for Board jurisdiction over an appeal.
Collectively, the Board's legislative proposals will result in
improved timeliness and efficiency of VA's adjudication of claims and
appeals both at the Regional Office level and at the Board level. The
Board's cycle time is currently 95 days. This means that on average,
the Board is able to resolve an appeal within 95 days from the time it
arrives at the Board, not counting the time that the case may be under
review by a Veterans Service Organization representative. However, the
Appeals Resolution Time, which is the time that it takes to resolve an
appeal beginning with the filing of a Notice of Disagreement at a VA
Regional Office (RO), is currently 656 days. By reducing the time
period for initiating an appeal from one year to 180 days, we will see
more expeditious adjudication of final decisions on appeal because data
show that appeals in which a Notice of Disagreement is filed more than
180 days after an adverse decision require on average more development
than earlier filed appeals, thus delaying appellate resolution for
later appeals. Additionally, the establishment of an automatic waiver
of new evidence received after the substantive appeal would also
improve the timeliness of appeals processing as a whole because many
more appeals could be more quickly transferred to the Board following
the receipt of a substantive appeal, and the RO would have to spend
less time responding to appellants who submit additional evidence
following the filing of a substantive appeal.
The Board's proposed changes regarding hearings would allow the
Board to serve more Veterans, reduce the waiting time for a hearing on
appeal, and allow increased productivity by the Board in issuing final
decisions on appeal. By clarifying the ``reasons or bases'' requirement
for Board decisions, the Board will be able to issue more final
decisions as the Board would not be required to address factual
determinations and legal conclusions in such a highly detailed and
painstaking manner that the decision becomes confusing to a lay reader
but that is currently required to withstand judicial scrutiny. Changing
the law to permit an award of EAJA fees only if an appellant actually
prevails on the merits of a claim and not merely for obtaining a remand
to correct an administrative error would discourage unnecessary remands
and encourage more cases to be litigated on the merits before the
Veterans Court. Because this remand practice fuels the ``hamster
wheel'' phenomenon (the cycle of appealing, remanding, and appealing
again claims from the Board to the Veterans Court, from the Veterans
Court to the Board, from the Board to regional offices, and back again
to the Board and to the court), this proposal would reduce the number
of claims remanded to the Board and result in more timely decisions on
appeal. This proposal is intended to protect claimants from attorneys
who seek to use the judicial process for pecuniary gain without
directly benefiting claimants. It would eliminate the incentive for
appellants' counsel to seek remands only for the purpose of obtaining
an EAJA award. However, this proposal does not alter the award of EAJA
fees for a Veterans Court remand that ultimately results in an award of
VA benefits.
Finally, by limiting the Board's jurisdiction to timely appeals in
which the claimant adequately identifies alleged errors by the RO,
these changes would promote effective and efficient management of the
VA appeals process by clearly delineating when a decision by the RO
becomes final, thereby eliminating confusion if a subsequent claim is
filed.
B. Would these legislative proposals hinder the ability of veterans
or their family members to prevail on their claims?
Response. No, these legislative proposals are designed to help
Veterans and their families by enhancing efficiency in the appeals
process. For example, VA must currently wait one year to determine if a
claimant disagrees with a decision on a claim for benefits. If a
claimant waits until the end of the one-year period to file a NOD, the
record becomes stale. VA is often required to re-develop the record to
ensure the evidence of record is up to date, and this takes more time.
By reducing the appeal period from one year to 180 days, VA would be
working with a more current record and the claim would not become
stagnant. Additionally, because the majority of claimants are able to
quickly determine if they are satisfied with VA's decision on their
claim, and because the NOD is a relatively simple document for
claimants to complete, enactment of this provision would not adversely
affect claimants for VA benefits.
The proposed legislative amendment establishing an automatic waiver
of AOJ review of new evidence received after a substantive appeal would
allow appeals to move through the system much more quickly, as the AOJ
would not be required to conduct a fresh review of the appellate
record, and readjudicate the same claim, each time an appellant
submitted new evidence following receipt of a substantive appeal. The
case could instead be transferred to the Board without additional
delay, where the newly-submitted evidence would be considered by the
Board in its adjudication of the claim. Thus, the newly-submitted
evidence would still receive consideration by the Board, but without
duplicative review by the AOJ following perfection of an appeal. Under
the Board's proposal, appellants would still be able to request AOJ
review of the newly-submitted evidence by requesting such review in
writing. Absent a request for initial AOJ review from the claimant,
however, the appeal could proceed to the Board without unneeded delay.
The legislative proposal giving the Board greater flexibility in
scheduling hearings would also help Veterans by ensuring that
appellants are scheduled for the type of hearing (in-person or
videoconference) that can be scheduled the most expeditiously. For
those appellants dissatisfied with the Board's choice of hearing, the
legislative proposal includes a good cause exception that allows
appellants to request an alternative hearing type where there is a
genuine objection to the type of hearing selected by the Board.
Notably, there is no statistically significant difference in the
allowance rate of appeals in which hearings were held in person versus
those held via videoconference.
The Board's legislative proposal clarifying the definition of
``reasons and bases'' as used in 38 U.S.C. Sec. 7104(d)(1) would still
ensure that Board decisions are more than sufficient to fully explain
to the appellant and any reviewing court why the Board decided a
particular case the way that it did, but without the need for the Board
to address all factual determinations and legal conclusions in such a
highly detailed and painstaking manner that the decision becomes
confusing to a lay reader. Thus, appellants would have clearer and more
concise decisions, while at the same time significantly reducing the
number of remands from the Veterans Court that do not translate into a
grant of benefits.
The Board's EAJA proposal is intended to protect claimants from
attorneys who seek to use the judicial process for pecuniary gain
without directly benefiting claimants. While our proposal would still
ensure that EAJA fees would potentially be available for attorneys
representing Veterans before the Veterans Court, it would eliminate any
undue incentive for appellants' counsel to pursue a negotiated remand,
for which EAJA attorney fees are immediately paid by the government,
instead of seeking a final answer from the Veterans Court as to a claim
for benefits. The proposal would therefore assist Veterans by ensuring
that the efforts of counsel are directed at obtaining benefits, instead
of securing remands that do not ultimately result in the grant of the
appeal.
Our proposal making the timely filing of a substantive appeal a
jurisdictional requirement for Board review would also promote
efficiency, and is consistent with the Board's longstanding Rules of
Practice, which require that a substantive appeal be filed within 60
days of the statement of the case. Because the Substantive Appeal is a
relatively simple document to complete, the vast majority of appellants
have historically had no difficulty with filing this document in a
timely manner. The proposed changes also allow for an extension to be
obtained with respect to the 60-day period for filing a substantive
appeal where good cause is shown, thus providing appellants with a
mechanism to request additional time where there is a genuine need to
extend the filing period.
Question 3. In 2009, the Board published a Veterans Law Review,
which reflects that it is ``published yearly by appropriated funds by
authority of the Department of Veterans Affairs and the volunteer
efforts of attorneys working at the Board of Veterans' Appeals.''
A. Does the Board plan to publish a law review during fiscal years
2010 or 2011?
Response. Yes. We plan to publish one issue in each of those years.
B. If so, what is the legislative authority relied upon by the
Board for using appropriated funds for this activity?
Response. The Veterans Law Review is intended to increase the
professionalism of attorneys practicing in the Veterans law area, and
to enhance the professional relationships between different
constituencies concerned with service to Veterans and Veterans' rights.
The Veterans Law Review serves a training function for the Board's
attorneys and Veterans Law Judges and enhances career development and
professionalism among the Board's employees. The use of appropriated
funds for this activity is consistent with 38 U.S.C.A. Sec. 7101(a) as
a function of the Chairman's administrative control and supervision of
the Board. Greater knowledge shared within the Veterans' bar assists
all in representing Veterans' interests more effectively.
C. How much per year does VA anticipate spending on the operation
and publication of the Veterans Law Review and how many copies are
expected to be printed?
Response. The cost of publishing the first issue was approximately
$34,000 with 3000 copies printed. The cost for the second issue will be
slightly higher due to increased printing costs. Copies have been
distributed free of charge to Members of Congress and their staffs,
senior officials within the Department, the Veterans bar, the Court of
Appeals for Veterans Claims, the Court of Appeals for the Federal
Circuit, the VSO community, and interested law school and court
libraries.
D. How many Board employees are involved with this activity and how
much time on an individual and total basis do these employees devote to
this activity?
Response. Approximately 70 attorneys and Veterans Law Judges
volunteer their non-duty time to edit and publish the Veterans Law
Review each year. All employees involved in the publication of the
Veterans Law Review are expected to meet all the expectations of their
jobs at the Board including productivity and quality. All of the
participants have met those goals.
E. How does this activity advance the Board's mission to ``conduct
hearings and dispose of appeals properly before the Board in a timely
manner''?
Response. All attorneys who participate in creating the Veterans
Law Review and those reading its well-respected articles gain insight
into important and developing issues and decisions that impact cases
affecting Veterans. The insight gained increases awareness in the
Veterans bar and will increase the quality of the arguments before the
Board, the Court of Appeals for Veterans Claims, and the Court of
Appeals for the Federal Circuit. The Veterans Law Review has also
raised the interest in Veterans law among legal practitioners and has
assisted in recruiting the best of our young attorneys to seek
employment at the Department. Last, the Veterans Law Review provides
the Board's attorneys and Veterans Law Judges with additional
experience in researching, editing, and writing, as well as experience
with the management of a complex project. The training aspect of
participation in the Veterans Law Review is of great value to the Board
in accomplishing its mission.
F. How would VA respond to criticism that articles written by Board
employees and published by the Board may cause these employees to
prejudge claims and issues that may come before them?
Response. All attorneys are bound by their oath to follow the law
and represent their clients vigorously within the constraints of the
law. The Veterans Law Review assists in the process of better preparing
attorneys and judges for this task by addressing complex and important
issues in peer-reviewed articles, notes, and book reviews. Professional
reading is a requirement of attorneys for currency in their practice in
all subject matter areas, not exclusively Veterans law. All appeals
that come before the Board are judged on the factual basis of that
appeal, and the state of the law at the time. Since the Board's
decisions cannot be cited as precedent all of our employee know to
judge each appeal on its factual and legal merits and there is no
reason that writing an article will change that, just as there is no
reason to think that a denial of one appeal, will cause a later
Veteran's appeal to also be denied.
Question 4. In 2009, VA began an initiative called Expedited Claims
Adjudication (ECA) in order to try to speed up the processing time for
some claims and appeals. In a recent report, GAO found that VA ``has
not yet established an evaluation plan with specific criteria and
methods to help assess ECA's impact on non-ECA claims and appeals
processing and on whether ECA is worthy of expansion.''
A. How many cases are expected to be processed in fiscal years 2010
and 2011 through the ECA initiative?
Response. As of February 22, 2010, the Veterans Benefits
Administration (VBA) has completed 1,311 ECA claims since the inception
of the program, with 624 additional ECA claims still pending before one
of the four pilot VA Regional Offices (ROs). A Substantive Appeal has
been filed in a total of 41 ECA cases, and 10 ECA appeals have been
certified and transferred to the Board of Veterans' Appeals (Board).
The number of appeals certified to the Board should be expected to
increase as initial appeals processing is completed at the four pilot
ROs.
Under governing regulations, claimants may elect ECA participation
for eligible claims through December 5, 2010. See 38 CFR
Sec. 20.1500(d) (2009). While claimants may not elect ECA participation
after that date, claims for which ECA participation has been elected
will continue to be processed under applicable ECA rules until a final
decision is issued.
B. What metrics will be used to gauge whether this initiative is
successful?
Response. As recommended by the GAO's Report, the Board is
currently working with VBA to finalize an ECA evaluation plan. We will
primarily be evaluating the success of the ECA by comparing the time
needed to complete each stage of the claims and appeals process for ECA
claims and non-ECA claims. Our comparison will focus on similar program
areas (i.e. similar types of cases). In identifying benchmarks for
success, special attention will be paid to weighing the processing time
saved for claimants with any potential administrative burdens on VA. We
are also exploring the ECA's impact on non-ECA claims and appeals
processing.
As part of these efforts, VBA currently prepares weekly reports
comparing the average days to completion for ECA and non-ECA claims. As
of February 22, 2010, average days to completion was 133 days for ECA
claims versus 165 for non-ECA claims. These numbers are encouraging,
representing an almost 20 percent faster processing time for ECA claims
and coming significantly closer to VBA's strategic target of processing
rating claims in 125 days on average. More of the time savings built
into the ECA occurs at the appellate level. We anticipate even greater
time savings in the appeals process as opposed to the processing of
initial claims.
We are also able to track the time needed to complete each stage of
the appeals process for ECA appeals versus non-ECA appeals by
enhancements made to the Veterans Appeals Control Locator System
(VACOLS), the electronic database VA uses to track appeals. Once a
Notice of Disagreement (NOD) is filed, RO personnel are able to
essentially check a box in VACOLS indicating that an appeal is an ECA
appeal. Since ECA appeals are specifically identified in VACOLS, we are
able to run reports showing the time elapsed between each stage in the
appeals process for all ECA appeals and compare it to non-ECA appeals.
Time periods we are able to measure include, but are not limited to:
the time between the filing of an NOD and the issuance of a Statement
of the Case (SOC); the time between issuance of an SOC and receipt of a
Substantive Appeal; the time between receipt of a Substantive Appeal
and transfer of the appellate record to the Board; and the time between
the Board's receipt of an appeal and the issuance of a Board decision.
In addition to gathering quantitative data, we are currently
soliciting qualitative feedback from RO personnel responsible for
implementing the program, and from Veterans Service Organization (VSO)
representatives that have shepherded claimants through the program.
Such feedback will be critical in determining what parts of the pilot
program worked well, and which did not. Board personnel will also be
conducting site visits to each of the four participating ROs to solicit
additional feedback from VSOs and RO adjudicators in the coming months.
Based on the data obtained from our ongoing evaluation, both
quantitative and qualitative, the Board will make recommendations to
the Secretary regarding potentially expanding the pilot or permanently
incorporating successful aspects of it. The Board's goal is to have our
formal evaluation complete, and recommendations to the Secretary,
before the conclusion of fiscal year 2010. GAO expressed their support
for the above plan in their recent January 2010 Report, titled
Veterans' Disability Benefits: Further Evaluation of Ongoing
Initiatives Could Help Identify Effective Approaches for Improving
Claims Processing (page 27).
Question 5. According to the fiscal year 2011 budget request, the
Board expects to spend $2.9 million for Other Services during fiscal
year 2010, which is over $960,000 higher than anticipated in the fiscal
year 2010 budget request. Please provide an itemized list of how these
funds are expected to be spent.
Response. The expected expenditure of Other Services for FY 2010 is
as shown in the table below:
Question 6. In fiscal year 2009, there were 525 FTE at the Board
and VA's fiscal year 2010 budget request included funding for 529 FTE.
Now, the fiscal year 2011 budget request reflects that the Board has
552 FTE, which is explained as follows: ``BVA was able to increase
staffing in FY 2010 through carryover.''
A. In total, how much in carryover funds would be used during
fiscal year 2010 to support these additional 23 FTE?
Response. As a result of not reaching hiring targets in FY 2009,
BVA was able to carryover $4 million into FY 2010 which will allow BVA
to fund an increase of FTE up to 552 in FY 2010. Because of retirements
and normal turnover, we anticipate BVA will be able to carryover some
funding into FY 2011 to sustain the FTE levels.
B. How many additional appeals does BVA expect to decide during
fiscal year 2010 as a result of those employees?
Response. BVA anticipates that 23 employees will result in an
additional 3,588 decisions.
C. What is the Board's plan with regard to these 23 FTE in
subsequent years? Does the Board plan to make permanent this increase
made with carryover?
Response. As of June 16, 2010, VBA has recouped approximately 13
percent of the advance payments made to ineligible individuals.
Question 7. According to the budget request, the Board expects to
spend $812,000 more in fiscal year 2010 for travel, supplies and
materials, and equipment than projected in the fiscal year 2010 budget
request.
A. What factors account for those increases?
Response. The Board is increasing the number of travel boards held
which increases travel, supply and materials cost. We are also
experiencing an increase in supply, material and equipment costs to
deal with the unexpected increase in the number of cases that we are
receiving. We are also coordinating and paying for an interim solution
on how to store the additional cases prior to an expected move within
the next 18 months.
B. Will any carryover funds be used to pay for those increases?
Response. At this time we anticipate that all carryover funds will
be used to pay for salary expenses.
general counsel
Question 1. For fiscal year 2011, VA has requested funding to
establish two additional litigation teams in Professional Staff Group
(PSG) VII, which represents VA before the U.S. Court of Appeals for
Veterans Claims. VA projects that, with these additional resources,
``it can bring the average active caseload of PSG VII attorneys to a
number which historically equates to approximately 90% timeliness.''
A. Currently, what is the average caseload handled by PSG VII
attorneys?
Response. For the week ending February 19, 2010, there were 57.9
active cases per attorney, on average. An active case is defined as one
in which the Secretary's dispositive pleading is yet to be filed with
the Court.
B. What is the projected caseload for these attorneys if the
requested level of funding is provided?
Response. We project that the caseload per attorney will average 50
or fewer active cases.
C. What would be considered an optimal caseload per attorney?
Response. Cases continue to evolve and become more complex, so
there remains some uncertainty. However, based upon our current
experience, we believe an optimal number of cases per attorney would be
in the range of 45 to 50 cases, but certainly no more than that.
D. How many motions for extension of time did PSG VII file with the
U.S. Court of Appeals for Veterans Claims during the past year, and how
many additional days did cases remain pending on average as a result of
those requests?
Response. PSG VII filed approximately 6,481 extension motions in FY
2009. We currently do not have a report of the average number of days
that a case remained pending owing to those extension motions. However,
the Court's Rules of Procedure provide that a party will not be granted
more than 45 days of extension time in order to meet a deadline, except
under extraordinary circumstances. Consequently, the average extension
motion would have sought no more than 45 days extension time.
E. How many motions for extension of time does PSG VII project to
file in fiscal year 2011 if the requested funding is provided and what
would be the impact on the number of days that cases remain pending?
Response. We do not have such a projection. Extension motions, by
their nature, are sought only when an unpredictable event has delayed
the preparation of a particular pleading. It is inherently difficult to
predict the unpredictable. However, our attorneys cannot effectively
manage caseloads above 50. When forced to they must request extensions
to file pleadings, delaying the resolution of veterans' cases. We are
currently contributing to delays in court decisions because we are
meeting our filing deadlines only 75% of the time, as compared to an
82% timeliness rate by veterans' attorneys. Two more litigation teams
would allow us to file timely pleadings 90% of the time (see chart that
follows).
Question 2. The Independent Budget for Fiscal Year 2011 points out
that the U.S. Court of Appeals for Veterans Claims encourages parties
to resolve appeals through its medication process, but in the view of
the authors of The Independent Budget ``VA general counsel routinely
fails to admit error or agree to remand at this early stage, yet later
seeks a remand.''
A. What percentage of cases handled by PSG VII over the past year
went through the mediation process without resolution of the appeal and
later resulted in VA seeking a remand?
Response. We currently do not have a report showing that
information.
To put the question in context, though, we note that there are
numerous reasons that a case might go through the mediation process
without resolution, only later to be the subject of a remand motion
once the case is briefed. For example, the governing law might change
subsequent to the mediation process, such that an initially defensible
case might ultimately become indefensible due to the change in law.
Alternatively, the appellant might offer unpersuasive arguments for
remand during mediation, but then refine those arguments or offer
additional arguments in the appellant's brief that produce a remand at
a later stage. Also, there are times when an appellant will spring an
argument on the Secretary's counsel during mediation that cannot be
answered extemporaneously. For example, many cases involve voluminous
evidentiary and procedural records, and the rule of nonprejudicial-
error offers a potent defense to many alleged errors, so it would be
incumbent upon the Secretary's counsel in these circumstances to defer
at the mediation stage in order to review the factual record in detail
and determine the merits of appellant's argument. Finally, there are
times when an appellant will demand concessions or relief that the
Secretary's counsel cannot agree to during mediation, but the
Secretary's counsel will nonetheless be aware of an alternative basis
for remand. If, in such circumstances, the appellant does not agree to
a more limited remand during mediation, then the Secretary's counsel
will submit a brief to the Court that candidly identifies the
remandable error, even though the parties could not resolve the case
during mediation.
In addition to participating in the Court's mediation process, it
should be noted that PSG VII also triages all new appeals in order to
determine, among other things, whether a case should be remanded at the
earliest stage of litigation, prior to the parties devoting time and
resources in needlessly preparing the record and briefs. Each of our
nine existing litigation teams includes a senior attorney who is
dedicated to the triage function. As a result of successful triage,
numerous cases are remanded even before the Court's mediation process
begins.
The Court's annual report reflects that counsel for the Secretary
filed 1,758 joint motions for remand in FY 2009. In the previous year,
counsel for the Secretary filed 1,625 joint motions for remand. These
joint motions for remand generally signify that counsel for the
Secretary has conceded administrative error and offered to remand the
case on grounds agreeable to both parties, thereby expediting
resolution of the case without the delay involved were the case
submitted to a judge for decision. Given the magnitude of these
statistics, there is no cause for concern that counsel is foot-
dragging. Indeed, we are confident that by increasing staff levels in
PSG VII and reducing caseloads, we will be able to improve upon the
success of the mediation program even more.
B. If this is a common occurrence, what steps could be taken to
resolve additional cases during the mediation process?
Response. It is not a common occurrence.
Question 3. The Office of General Counsel's fiscal year 2011 budget
request includes over $900,000 for Other Services, which is more than
58% higher than in fiscal year 2009 ($569,000), 29% higher than
requested for fiscal year 2010 ($699,000), and 26% higher than now
expected to be expended during fiscal year 2010 ($714,000). Please
provide an itemized list of what that request would fund in fiscal year
2011.
Response. It should be noted that the Other Services account
comprises less than 1% of OGC's total requested budget authority. Refer
to the attached sheet for a list of funded accounts under Other
Services. In FY 2011, our request for Other Services funding is $186K
(26%) above our FY 2010 Current Estimate. The increase will buy the
following:
An increase of $15K to maintain and repair equipment &
furniture
An additional $58K to move our PSG VII offices to new
space due to expiration of current leases
Payment of a $45K increase in OGC's share of Office of
Resolution Management (ORM) funding
$65K more for increased costs of training courses
Question 4. The Office of General Counsel's fiscal year 2011 budget
request includes over $2.9 million for travel, which is 73% higher than
in fiscal year 2009 ($1.7 million) and 13% higher than the amount
expected to be expended during fiscal year 2010 ($2.6 million).
A. What accounts for that increase in requested travel funds?
Response. The 13% increase ($300K) in OGC's FY 2011 request for
Travel is due to a projected rise in travel costs, including the trend
for airlines to charge for checked bags, as well as increased travel
for the 34 additional FTE OGC requested in FY 2011.
B. How many employees are expected to travel during fiscal year
2011 and how many trips would this level of funding support?
Response. OGC travel costs include those incurred as part of
representing the Secretary in a variety of practice areas and also
costs associated with employees receiving training. When local travel
costs are considered, nearly every OGC employee travels at some point
during a fiscal year, with many traveling multiple times.
Question 5. The Office of General Counsel's fiscal year 2011 budget
request reflects that, for fiscal year 2010, average employment was 9
employees lower than originally estimated but expenditures for personal
services ``is estimated to be $2 million above the original budget
estimate.'' According to the budget request, this increase ``was
created in part due to an annualized 2009 pay raise that was higher
than budgeted.''
A. What portion of the $2 million increase was due to the higher
than expected annual pay raise?
Response. $1.4M (70%)
B. What factors account for the remainder of the $2 million
increase?
Response. The remainder is primarily due to average salaries and
benefits that are now higher than originally projected.
Question 6. The Office of General Counsel's fiscal year 2011 budget
request includes over $1.7 million for Equipment, which is 243% higher
than the amount spent in fiscal year 2009 ($518,000), 265% higher than
the amount requested for fiscal year 2010 ($486,000), and 124% higher
than the estimated expenditures for fiscal year 2010 ($793,000).
According to the budget request, the fiscal year 2010 estimate is
higher than originally projected because ``[e]quipment has increased to
cover the additional furniture and office equipment required for the
planned relocation of the Bay Pines and Cleveland Regional Counsel
Offices.''
A. What factors account for the increase from fiscal year 2010 to
2011?
Response. In FY 2011, OGC will consolidate the core and satellite
offices of its Veterans Court Litigation Group which represents the
Secretary before the U.S. Court of Appeals for Veterans Claims. Rather
than move furniture, most of which is at least 10 years old and in need
of replacement, OGC will purchase new furniture for over 100 existing
and 20 new employees. In addition, OGC will replace furniture and
carpeting in some of its 22 Offices of Regional Counsel to maintain a
modest but professional appearance.
B. Please provide an itemized list of what would be purchased with
the requested funds in fiscal year 2011.
Response:
Professional Staff Group VII (DC)...... $920K (New furniture, including
delivery and installation for
over 100 existing employees
and 20 new employees)
Professional Staff Groups I-V (DC)..... $38K (New furniture, delivery
and Installation for 5 new
attorneys)
Region 7 (Cleveland* & Clarksburg)..... $53K (New furniture, delivery
and installation at the
Cleveland core office and
Clarksburg area office.)
Region 8 (Nashville)................... $41K (New furniture, delivery
and installation)
Region 13 (Waco)....................... $31K (New carpeting)
Region 18 (San Francisco).............. $98K (New furniture, delivery
and installation)
Region 19 (Phoenix).................... $30K (New carpeting)
Region 23 (Winston-Salem).............. $155K (New furniture, delivery
and installation)
Region 23 (Winston-Salem & Roanoke).... $42K & 15K, respectively (New
carpeting)
* The FY 2010 new furniture request for Cleveland was actually for its
Huntington area office.
Note: The $300K balance would be available for any emergent needs that
arise during the year.
C. Please explain how these expenditures will help improve benefits
or services to veterans, their families, or their survivors.
Response. The Office of General Counsel seeks to maintain modest
but professional work spaces to convey the significance of representing
the Secretary and to aid in recruiting and retaining talented
attorneys, paralegals and staff. The more skilled the workforce, the
better OGC can perform its representational responsibilities. OGC
moderates its furniture and equipment purchases, including authorizing
repairs whenever possible to extend the useful life of these items and
delay purchasing replacements.
education
Question 1. In 2009, VA provided advanced payments of education
benefits to approximately 122,000 individuals. Since then, VA has
acknowledged that some individuals may have mistakenly applied for and
received these advanced payments.
A. How many individuals received advanced payments and were later
determined not to be eligible to receive the payments?
Response. Eligibility for VA education benefits for the fall 2009
enrollment period had not been established for approximately 34 percent
of the advance pay recipients.
B. How much in total was disbursed to individuals who were not
entitled to advanced payments?
Response. Approximately $120 million was issued to advance payment
recipients who had not established their benefits eligibility for the
fall enrollment period.
C. How much of the funds that were mistakenly paid out have since
been recouped?
Response. As of June 16, 2010, VBA has recouped approximately 13
percent of the advance payments made to ineligible individuals.
D. Does VA intend to provide advanced payments in the future? If
so, what additional precautions will be implemented to prevent the
mistaken disbursement of funds?
Response. Because spring enrollment certifications are being
processed timely, VA is not making advance payments for the spring 2010
semester.
Question 2. VA created an Education Call Center at the Muskogee
office to centralize education-related telephone calls. Generally, the
Call Center accepts calls between 7 a.m. and 5 p.m. (central), Monday
through Friday. In December 2009, VA began diverting Call Center
employees to claims processing on Thursdays and Fridays.
A. During fiscal year 2011, how many full-time employees will be
assigned to the Education Call Center?
Response. In February, VA resumed Education Call Center operations
Monday through Friday. VA also increased the Education Call Center
staff by 71 percent, raising the staffing level to 297 employees.
B. Will that staffing level allow the Call Center to expand the
hours during which calls are accepted, so that it may be more
accessible to callers living west of the central time zone or living
overseas?
Response. The Education Call Center hours were extended to 5:00
p.m. CST to provide additional accessibility for the West Coast. VA
temporarily expanded Call Center hours to 6:00 p.m. CST and also opened
on Saturdays during the heavy fall enrollment period when VA initiated
the advance payment program. However, there are no current plans to
expand during the spring term, as timeliness of enrollment processing
has significantly improved. VA constantly monitors call volumes during
and outside of business hours. The Call Center has the capability to
expand hours of operation if the volume reflects sufficient need.
C. Does the fiscal year 2011 budget request include funding for
sufficient education claims processing staff so that Education Call
Center employees will not be redirected to claims processing?
Response. Yes, the 2011 budget requests funding for additional
education claims processors. We do not anticipate the need to redirect
Education Call Center employees to claims processing in 2011.
Question 3. The fiscal year 2011 budget request for the Education
Service includes $19 million for Other Services, which is 94% higher
than the amount expended during fiscal year 2009 ($9.8 million), 131%
higher than the amount requested for fiscal year 2010 ($8.3 million),
and 58% higher than the amount now expected to be expended during
fiscal year 2010 ($12.1 million). According to the budget request, this
increase ``reflects program management support, contracts, and training
costs.''
A. Please provide an itemized list of the expenditures this funding
would be used to support.
Response. The 2011 budget request contains funding for contracts to
provide strategic management and oversight services as well as systems
engineering support for implementation of the Post-9/11 GI Bill and
long-term solution, contracts for customer satisfaction surveys to
measure claimants' satisfaction with the delivery of education
benefits, and contracts for instructional systems development
methodology to train and support employee performance of job tasks.
The increase to other services is due to the allocation of
management support costs. Management support costs associated with
human resources, financial management, and centralized training do not
directly support any specific program. Management support costs for all
VBA programs are allocated by formula across all business lines based
on the ratio of direct program FTE to VBA's total direct FTE. Since
there was a large increase to Education's 2011 direct FTE, a larger
portion of the total 2011 management support costs were allocated to
the Education program, resulting in this increase.
B. What would be the purpose of contracts this funding would be
used to support and what metrics would be used to gauge whether those
funds are used effectively?
Response. Education Service's FY 2011 budget request includes
funding to support the following contracts:
A contract with MITRE Corporation's Center for Enterprise
Modernization federally-Funded Research and Development Center. This
cost-plus-fixed fee contract has an estimated level of effort of 20,000
hours for $4.1M. MITRE provides strategic management and oversight
services as well as systems engineering support. MITRE is responsible
for a multitude of on-going management tasks as well as a conducting
special projects and assessments of organizational and business
processes.
An indefinite delivery indefinite quantity contract (currently with
Associated Veterans, Inc) to be competitively awarded in Q4 FY 2010.
Nine (9) contractor resources will be supported, with an estimated cost
of approximately $1.3M.
The primary responsibilities of the program management support
contracts include developing and managing project schedules in
Microsoft Project, tracking, recording and reporting on task/objective
achievement, facilitating information transmission between disparate
project teams and sites, and ensuring that management has sufficient
information to make informed program management decisions. Other key
tasks include providing output products to communicate program status,
tracking program risks, issues and action items, and recommending and
implementing new tools or methods for managing program implementation.
VBA gauges the effectiveness of these contracts through regular
communication with the business line receiving support. The quality
assurance surveillance plan established by VBA specifies this
monitoring based upon negative or positive feedback from the various
business lines. The contract's value can also be measured tangibly
through program management and strategic planning artifacts produced
and maintained during program implementation. VBA can also estimate
value by tracking the number of contract staff engaged in vital program
implementation roles throughout VBA.
Outcome and Customer Satisfaction Survey, $312,413: The purpose of
this contract is to measure claimants' satisfaction with the delivery
of education benefits by VA and whether or not those benefits were
helpful or very helpful in achieving their educational goal. The metric
used to gauge whether funding is used effectively will be the
successful completion of the survey and delivery of the results to VA.
Information is needed for Program Assessment Rating Tool (PART).
Training Performance Support Systems (TPSS) $578,525: TPSS is a
web-based multimedia training technology. TPSS is an implemented
national training system for Veterans Claims Examiners, Education Case
Managers, Education Liaison Representatives, and Education Compliance
and Survey Specialist, and TIMS Clerks and applies instructional
systems development methodology to train and support employee
performance of job tasks. The metric used to gauge whether funding is
used effectively will be the successful delivery and acceptance of the
training technology at our Regional Processing Offices.
National Student Clearinghouse Match (MGIB Benefit Completion
Rate), $52,748: The Office of Management and Budget required Education
Service to develop a Program Assessment Rating Tool (PART) outcome
measure that identifies a rate or percentage of veterans that use their
educational assistance benefit to readjust to civilian life. VA
contracted with the National Student Clearinghouse to complete an
analysis report that generates degree completion characteristics based
on a population of 5,000 beneficiaries.
Education State Approving Agency Contract Review, $111,540: The
contract between Education Service and the State Approving Agencies
must be reviewed and revised to ensure that it complies with all
Federal Acquisition Regulations (FAR), VA Regulation, and title 38
U.S.C. Performance measures must be also be added to ensure that VA
receives the most value for each contract dollar spent. This project
will update the current SAA Contract to include all attachments,
develop performance measures and consequences for non-performance, and
ensure that everything in the contract is accurate and correct.
Question 4. The fiscal year 2011 budget request for the Education
Service includes $3.1 million for Supplies and Materials, which is 154%
higher than the amount expended during fiscal year 2009 ($1.2 million)
and 183% higher than the amount expected to be expended during fiscal
year 2010 ($1.1 million). According to the budget request, this
``increased funding will be used to purchase printer cartridges.''
A. Is the Education Service expecting to expend nearly $2 million
on printer cartridges during fiscal year 2011?
Response. Education Service's share of the printer cartridges
initiative is $1.2 million.
B. If not, what other factors account for the increased funding for
Supplies and Materials?
Response. In addition to increased supplies and materials funds for
printer cartridges, additional resources are allocated to Education
program based upon increased share of management support costs (see
response above to question 3A).
C. After the long-term solution for the Post-9/11 GI Bill is in
place, how often will individual employees of the regional processing
offices print and mail documents to education benefits recipients?
Response. The Post-9/11 GI Bill long-term solution (LTS) will not
eliminate the need for employees to print and mail documents to benefit
recipients. The fourth and final release of the LTS will include a
Veteran self-service interface that will display benefit related
information; however, VA is still required to provide written
notification of all actions taken.
general administration
Office of the Secretary
Question 1. In fiscal year 2009, there were 32 FTE in the Office of
the Secretary, and VA's fiscal year 2010 budget request included
funding for 40 FTE. Now, the fiscal year 2011 budget request reflects
that the Office of the Secretary has 50 FTE, which is explained as
follows: ``The current estimate for obligations is greater than the
original 2010 budget due to available carryover to support an
additional 10 FTE within the Immediate Office of the Secretary.''
A. In total, how much in carryover funds would be used during
fiscal year 2010 to support these additional 10 FTE?
Response. $1.4 million will be used in FY 2010 to support the FTE
and necessary travel, training, supplies and required equipment.
B. What justifies an over 56% increase in staffing for the Office
of the Secretary since fiscal year 2009?
Response. In previous administrations, staff from other VA offices
were detailed to the Office of the Secretary of Veterans Affairs (OSVA)
to assist the Secretary in overseeing the workload and programs within
the office. After his arrival, Secretary Shinseki mandated that the
budget for the OSVA be an accurate reflection of the salaries, travel
and all other expenses for the immediate office, as well as for the
subsidiary offices that report to the Secretary. The FY 2011 budget
request now accurately reflects the costs and number of employees
working in the immediate Office of the Secretary. Approximately half of
the staff increase reflected since 2009 was required to directly
support VA's ongoing effort to transform itself into a 21st century
organization. These positions are engaged in the direct oversight and
coordination of the VA's strategic plan and major initiatives.
C. What is the average salary for personnel within the Office of
the Secretary?
Response. The average salary for employees in the Office of the
Secretary is $109,000. The remainder of the funding in personal
services is for retirement and health insurance and other related
Federal personnel benefits. This average salary includes the higher
salaries of senior officials such as the Secretary, as well as the
General Schedule (GS) salaries of program and administrative support
staff. The average salary falls within the overall range of average
salaries within the General Administration account.
D. What specific functions would be performed by the additional 10
FTE if funding for those positions is continued in fiscal year 2011?
Response. The FY 11 budget continues the work from FY 2010, when
the Office of the Secretary was realigned to fit the Secretary's new
strategic framework that is people-centric, results-driven, and
forward-looking. These positions are engaged in the direct oversight
and coordination of the Secretary's effort to transform VA into a 21st
Century organization to ensure that the Department cares for Veterans
over a lifetime, from the day the oath is taken until the day they are
laid to rest. The Secretary's transformational efforts include 13 major
initiatives and 75 other organizational specific initiatives.
E. Will this staffing level, which was attained using one-time
carryover funds, also be requested in future years?
Response. Yes, the funding requested in the FY 2011 budget would
remain in the base in order to continue accurately reflecting the
number of employees working in the Office of the Secretary.
Question 2. The fiscal year 2011 budget request for the Office of
the Secretary includes a request for $592,000 for travel, which is 28%
higher than the funding requested for fiscal year 2009 ($464,000). What
accounts for that increase?
Response. Travel increases in FY 2011 are directly related to the
Secretary's initiatives to transform VA into a 21st Century
organization. Consistent with direction from the Secretary, the OSVA
travel budget was reviewed carefully in order to ensure the request was
an accurate reflection of program needs. In developing the FY 2011
budget, the OSVA carefully reviewed travel requirements and budgets of
prior years to determine appropriate levels to accomplish the
Secretary's new integrated strategies to transform the Department. It
should be noted that Secretary's 2011 travel request is only 2% higher
than the actual travel expenses of this office in FY 2008.
Question 3. According to the budget request, VA is seeking $576,000
for the Center for Faith-Based and Neighborhood Partnerships. In part,
that funding would be used for ``[p]romoting responsible fatherhood.''
Please explain how this would further VA's mission of caring for
veterans, their families, and their survivors.
Response. Of the $576,000 budgeted in the Center for Faith-Based
and Neighborhood Partnerships, $497,000 is for salaries and personnel
benefits for 3 FTE. The remaining $79,000 is for equipment, supplies
and contracts, including funding for VA's Fatherhood Mission. In FY
2010, VA is conducting a Fatherhood Forum--A National Conversation on
Responsible Fatherhood and Healthy Families to provide a venue for
military and veteran fathers and families to share the challenges they,
their families, and communities face in reintegrating into their roles
as fathers, mothers, spouses, etc. The Forum brings together local and
national leaders and community organizations to discuss programs
available and research being conducted that can inform public policy
and programs that will better serve the needs of Veterans. The Forum
allows the VA, in very tangible ways, to provide information and
resources to Veterans and their families.
Office of Management
Question 1. The fiscal year 2011 budget request for the Office of
Management includes the following paragraph:
VA completed the initiative to centralize payments of certified
invoices at the FSC in 2008. This centralization resulted in an 8
percent improvement in interest paid per million dollars disbursed from
$51 per million in 2008 to $47 per million in 2009. At the same time,
VA earned nearly 94% ($8.5 million) of its available discounts--a 33
percent increase in discounts earned over 2008 levels.
A. In total, how much did VA spend on these interest payments
during fiscal year 2009?
Response. Total VA interest paid was $899,541. Of this total,
$547,745 was related to commercial payments; the remainder of $351,796
was related to Veterans Health Administration purchased care payments.
B. In total, how much is expected to be spent during fiscal years
2010 and 2011 on these interest payments?
Response. Total VA interest for FY 2010 is projected to be
$989,300. Of this amount, $516,900 is related to commercial payments;
the remainder of $472,400 relates to VHA purchased care payments.
Total VA interest for FY 2011 is projected to be $974,600. Of this
amount, $509,100 is related to commercial payments; the remainder of
$465,500 relates to VHA purchased care payments.
C. What is VA's goal for discounts earned during fiscal years 2010
and 2011?
Response. VA's goal is 91.5 percent. Process improvements already
undertaken leave little opportunity for additional improvements in
discounts earned percentage. If VA is able to replicate FY 2009 results
in FY 2010, we will adjust this goal in the future.
Question 2. The fiscal year 2011 budget request for the Office of
Management includes over $37.8 million for Other Services. It also
reflects that the current estimated expenditures for Other Services
during fiscal year 2010 will be more than $13 million higher than the
original estimate. Please provide an itemized list of what expenditures
these funds would be used to support during fiscal years 2010 and 2011.
Response. The Office of Management estimates $46.2M in Other
Services obligations in FY 2010 which includes $27M for the Defense,
Finance and Accounting Services (DFAS) contract with DOD for payroll
processing, $2.6M for A-123, Appendix A Testing and Remediation
Contracts, $3.6M for the Audit Readiness Contract. Other contracts
include Department level transformation initiatives, annual recurring
contracts, Department wide billings and staff training.
The office of Management has budgeted $37.8 million in FY 2011
including $27M for DFAS payroll processing, $2.6M for A-123, Appendix A
Testing and Remediation Contracts, $1.2M for a contract for the Non VA
Care (Fee) Program, and other contracts which include recurring
billings and annual contracts.
Question 3. The fiscal year 2011 budget request for the Office of
Management includes over $2 million for travel, which would be 48%
higher than the amount expended during fiscal year 2009 ($1.4 million),
29% higher than the amount requested for fiscal year 2010 ($1.6
million), and 14% higher than the amount now estimated to be expended
during fiscal year 2010 ($1.8 million). The budget request indicates
that some increases are due to travel related to FLITE testing and
deployment.
A. How many Office of Management employees are expected to travel
during fiscal year 2011 and how many trips would this level of funding
support?
Response. In FY 2011, 293 employees are expected to travel for a
total of 491 trips.
B. In total, how much is expected to be spent during fiscal years
2010 and 2011 on travel related to FLITE?
Response. FY 2010 travel to support the FLITE Program is estimated
to be $688,000. FY 2011 travel to support the FLITE Program is
projected to be $1,105,000.
C. Other than travel related to FLITE, what accounts for this two-
year increase in travel funds?
Response. The vast majority of the travel increases are related to
FLITE for increased preparation of BETA site implementation. Other
smaller levels of travel increases are related to field site reviews
and financial oversight visits.
D. Has VA considered whether there are alternatives that could help
VA oversee this project without extensive travel?
Response. Teleconferences and video teleconferences are used to the
maximum extent possible. Face-to-face meetings are used specifically to
address complex issues requiring an in-depth exchange of information or
data between government and contractors to ensure precise information
required to be communicated is clearly understood so the project
schedule can be maintained and the risk to re-work is minimized.
Question 4. The budget request indicates that the Office of
Management carried over about $12 million from fiscal year 2009 to
fiscal year 2010.
A. During fiscal year 2010, does the Office of Management plan to
expend those carryover funds?
Response. Yes.
B. If so, please provide an itemized list of how those funds are
expected to be expended.
Response. Carryover within the Office of Management will be used
for the Audit Readiness contract and other contracts that support
transformation initiatives, such as Cost Accounting and fiscal
oversight.
Office of Human Resources & Administration
Question 1. In fiscal year 2009, there were 505 FTE in the Office
of Human Resources and Administration and VA's fiscal year 2010 budget
request included funding of $64.8 million for 539 FTE. The budget
request reflects that during fiscal year 2010 the Office of Human
Resources and Administration expects 715 FTE and expects to expend over
$87 million, over $22.2 million more than originally requested.
A. What funds are being used for this 34% increase in staffing
during fiscal year 2010? Are any carryover funds being used?
Response. The staffing level of 715 FTE in 2010 will not only
provide the ongoing services of HR&A, but also provide 165 FTE funded
from reimbursements to support implementation of the Human Capital
Investment Plan (HCIP) and 18 FTE funded from VA Learning University
(VALU) reimbursements. Carry over funds are not being used for the
payroll costs associated with new FTE.
B. What is the average salary of the 176 additional employees VA
now plans to have on board during fiscal year 2010?
Response. The FY 2010 average salary for the additional HCIP and
VALU employees is $96,681.
C. Please provide a breakdown of what types of positions are
included in that 176-employee increase, where the employees will be
located, and what specific goals VA plans to accomplish with the
additional staff.
Response. These positions include the following types: Training
Consultants, eLearning Specialists, Instructor/Course Designers, H.R.
Specialists, Training Evaluators, Content Quality Assurance
Coordinators, Career Development Managers, EEO Specialists, Labor
Relation Specialists, Delegated Examiners, Strategic Planners,
Management Analysts, and Program Analysts. Of this increase, 64 FTE are
projected for field facilities and the remainder for VACO. Please see
page 5F-8 in Volume 3 of the FY 2011 Budget Submission for a
description of each initiative associated with the staffing increase.
Question 2. The fiscal year 2011 budget request for the Office of
Human Resources and Administration includes over $17.6 million for
travel, which would be 820% higher than the amount expended during
fiscal year 2009 ($1.9 million), 630% higher than the amount requested
for fiscal year 2010 ($2.4 million), and 5% more than the amount now
expected to be expended during fiscal year 2010 ($16.8 million).
A. How many employees are now expected to travel during fiscal year
2010 and how many trips would $16.8 million support?
Response. Over 150,000 ``training instances'' are projected using
various modalities. The travel increase is allocated for travel
associated with training programs sponsored by the HCIP. Training will
be conducted through various modalities including online training,
training hubs in the field, and at various existing VA training
facilities (such as the VA Acquisition Academy, IT Training Academy,
etc.)
B. What accounts for the over $14 million increase in travel
expenditures for fiscal year 2010?
Response. See response to question 2A.
C. How many employees are expected to travel during fiscal year
2011 and how many trips would the requested level of funding support?
Response. See response to question 2A.
D. What accounts for this increase in travel funds from fiscal year
2010 to 2011?
Response. See response to question 2A.
E. Has VA considered whether there are alternatives that could
accomplish the intended goals without the need for extensive travel?
Response. See response to question 2A.
Question 3. For fiscal year 2010, VA requested $425,000 for
Equipment for the Office of Human Resources and Administration. Now,
the fiscal year 2011 budget request reflects that VA expects to expend
over $2.8 million during fiscal year 2010 for equipment for that
office.
A. What factors account for this 567% increase in the amount
expected to be spent during fiscal year 2010 on equipment?
Response. The equipment increase reflects $2.8 million required for
the purchase of commercial software to support workforce management and
workforce planning of managers throughout VA. This software will be
used along with developed occupational competencies to identify groups
of employees in the most need of training and development.
B. Please provide an itemized list of how that $2.8 million would
be expended.
Response. The entire $2.8 million will be expended on tools and
services for workforce planning and workforce management.
VA is not looking for OI&T to build or develop a new system. The
contractor will assess our current workforce planning system as it
applies to each Administration and Staff Office, benchmark VA against
best practice public and private sector organizations and systems
recommend ``enhancements'' to our current system as well as a corporate
approach to VA Workforce planning--contractor will be working closely
with OI&T to ensure compatibility to PAID system and movement to the
new HRIS system once it has been selected. Software will not be
developed by OI&T, VA is looking for COTS software or ProClarity/VSSSC
data cubes to be created to enhance current reports and provide
forecasting capabilities. Software will be available to managers on
desktop to assist in assessing performance and developmental status
needs.
C. Please explain how these expenditures will help improve benefits
or services to veterans, their families, or their survivors.
Response. Workforce planning tools will be used in the training and
development of employees within occupational series shown to have the
most need. Training funds can then be focused on areas where needs are
greatest, thus strengthening VA's workforce and capacity to meet the
needs of Veterans and their families. This supports transformation of
VA. This integrated workforce planning initiative is based on
identifying and managing competencies and skills required to serve
Veterans in some 300 occupations. VA will be able to effectively plan
for its future workforce by determining the skill-mix of the current
workforce, the skills likely needed n the future and skills VA needs to
focus on developing or recruiting for. This initiative will directly
impact VA's ability to achieve its mission.
D. If VA were asked to prioritize its budget request, how high
would this $2.8 million for office equipment be on that priority list?
Response. Inclusion of this $2.8 million in the department's budget
request already reflects the deliberate reprioritization of needs
within the Human Resource management domain and its importance relative
to our strategic goal of improving internal customer satisfaction with
management systems and support services to achieve mission performance
and make VA an employer of choice by investing in human capital.
Question 4. The fiscal year 2011 budget request includes $7.6
million for a ``Corporate Senior Executive Management Office.''
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this office is
effective?
Response:
Stand up office through transfer of staff from VBA/BHA
plus hiring of new employees.
Transfers completed
Vacancies/new hires
Train staff on use of USA Staffing and utilize USA
Staffing for all SES announcements and hiring
# of staff trained
# of SES announcements through USA Staffing
Standardize forms and procedures; develop SES orientation
program and conduct orientations for new SES personnel
# of forms standardized
# of procedures standardized
Completion of the development of the SES orientation
program
# of orientations conducted for new SES Personnel
# of highly qualified candidates selected for positions (
quality)
Question 5. The fiscal year 2011 budget request includes $83.7
million for an initiative called the ``Development and Certification of
Leaders.''
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this initiative is
successful?
Response:
Development of program completed
# successfully certified
Positive assessment of the application of skills learned
to the operational environment, and retention of those skills overtime.
Demonstrated reduction of skill gaps in the targeted
population
Detail of quality control and assurance, risk planning and
appropriateness of risk mitigation
Viewpoint survey results
Reduction in EEO Complaints
Question 6. The fiscal year 2011 budget request includes $98.5
million for a ``Mission Critical Training'' initiative.
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this initiative is
successful?
Response:
Mission critical and key occupations are identified
Available training is assessed
# of COTS training
# of specific designed training
% of employees in mission critical and key occupations who
completed a competency-based training program within 12 months
# of trained professional retained
Reduction in the number of occupations on mission critical
list
Question 7. The fiscal year 2011 budget request includes $31.8
million for a ``Program Based training'' initiative.
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this initiative is
successful?
Response:
Timely delivery of quality, instructionally effective
final training products
Adherence to agreed upon product delivery schedules
Adherence to project cost estimates
Adherence to agreed upon design standards and test
protocols
Completion of training project/task order in accordance
with plans and specifications.
Final eLearning products to function without problem
within the VA LMS operating environment
Timely implementation of training program curriculum that
teaches content that is compliant with relevant lesson or course
objectives
Positive assessment of the application of skills learned
to the operational environment, and retention of those skills overtime.
Demonstrated reduction of skill gaps in the targeted
population
Detail of quality control and assurance, risk planning and
appropriateness of risk mitigation
Question 8. The fiscal year 2011 budget request includes $661,000
for a ``Knowledge Management office.''
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this office is
effective?
Response:
Adherence to agreed upon product delivery schedules
Adherence to project cost estimates
Adherence to agreed upon design standards and test
protocols
Completion of training project/task order in accordance
with plans and specifications.
Detail of quality control and assurance, risk planning and
appropriateness of risk mitigation
Question 9. The fiscal year 2011 budget request includes $6.5
million for an ``Enhancement of VA's Learning Management System''
initiative.
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this initiative is
successful?
Response:
Track expenditure of funds, courses and personnel trained
# of competencies entered in VA LMS
# of courses mapped to competencies
# of employees using VA LMS electronic Individual
Development Plans
# of employees using VA LMS 360 degree assessment tool
Question 10. The fiscal year 2011 budget request includes $14.5
million for ``the Evaluation initiative.''
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this initiative is
successful?
Response. VA established an Intra agency Agreement (IA) with the
National Center for Organization Development (NCOD), Veterans Health
Administration (VHA), both Department of Veterans Affairs (VA)
organizations, to evaluate projects that achieve goals for HRA related
to VA's organizational health and transformation and to make most
efficient use of VA resources. NCOD will evaluate the human capital
investment activities to develop supervisors, managers, and mid and
entry level leaders through the analyses of self-report of candidates,
progress on closing gaps on their 360 degree assessments pre-, during,
and post- training, and through analysis of organizational performance
metrics effected by the candidates.
For details regarding metrics for each of the underlying
initiatives, please see the corresponding Part B. for each question.
Question 11. The fiscal year 2011 budget request includes $23.5
million for a ``Workforce Planning'' initiative.
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this initiative is
successful?
Response:
Expedited implementation of T21 with cooperation of our
Labor Partners
Reduction in traditional indicators of a challenged labor
environment to include ULP's or Unfair Labor Practices, Local and
National Grievances
Employee Satisfaction and Attrition Rates.
# of Labor Management training sessions for managers
# of joint Labor/Management training sessions
# of participants
# of Labor-management forums for managers, employees and
union reps
# of participants
# of local level interventions
# of service agreements w/internal customers
Question 12. The fiscal year 2011 budget request includes $3
million for a ``Health and Wellness initiative.''
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether that initiative is
successful?
Response:
# of employees using online health and wellness tools
# of employees using health and wellness coaching services
FOH will provide evaluation of aggregate Health Risk
Assessment (HRA) data and health promotion programming to meet the
specific needs of the population.
Evaluation of program, progress and utilization reports
will be provided quarterly.
Decrease in rate of absenteeism
Question 13. The fiscal year 2011 budget request includes $2.7
million to ``focus on labor-management partnership.''
A. Please provide an itemized list of how these funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether this initiative is
successful?
Response:
Expedited implementation of T21 with cooperation of our
Labor Partners
Reduction in traditional indicators of a challenged labor
environment to include ULP's or Unfair Labor Practices, Local and
National Grievances
Employee Satisfaction and Attrition Rates.
# of Labor Management training sessions for managers
# of joint Labor/Management training sessions
# of participants
# of Labor-management forums for managers, employees and
union reps
# of participants
# of local level interventions
# of service agreements w/internal customers
Question 14. The fiscal year 2011 budget request includes $1.2
million for the Office of Occupational Safety and Health to conduct
various initiatives.
A. Please provide an itemized list of how those funds would be
expended.
Response. The budget request included descriptions of the Human
Capital Investment Plan initiatives along with the 2010 resource
requirements (beginning on page 5F-8 of Volume 3). A breakdown of these
costs is provided below.
B. What metrics would be used to gauge whether those initiatives
are successful?
Response:
Implement functional improvements to the Workers'
Compensation-Occupational Safety and Health/Management Information
System
Launch new training for Workers' Compensation Best
Practices
Complete Safety Benchmarking/Perception Survey
Increased # of employees returning to work capacity
Improved case management of workers compensation files
Office of Policy and Planning
Question 1. The fiscal year 2011 budget request for the Office of
Policy and Planning includes over $16.8 million for Personal Services,
which is over 84% higher than the amount expended during fiscal year
2009 ($9.1 million), 26% higher than the amount requested for fiscal
year 2010 ($13.3 million), and 19% higher than the amount now expected
to be expended during fiscal year 2010 ($14.1 million). That level of
funding for fiscal year 2011 is projected to support 10 more FTE than
the fiscal year 2010 level (93 FTE) and 41 more FTE than the fiscal
year 2009 level (62 FTE).
A. What specifically accounts for the $830,000 increase in personal
services expenditures expected during fiscal year 2010?
Response. The FY 2010 current estimate is now a more accurate
depiction of the types and level of personnel required to implement the
Secretary's transformation initiatives described in the President's
Budget. More recent average salary data is also contributing to the
difference between the original and current estimates.
B. How much in carryover funds will be used to fund that increase
in personal services expenditures during fiscal year 2010?
Response. No carryover funds will be used to fund the increase in
personal services expenditures during FY 2010. The carryover funds are
allocated for contracts in support of the newly established
Transformation and Innovation Service; the contract support will be
used to help stand up the new office.
C. What is the average salary of employees of the Office of Policy
and Planning?
Response. The average salary (without benefits) of an employee in
the Office of Policy and Planning (OPP) is $116,000.00.
D. Other than salaries for new staff, what factors account for the
$2.7 million increase in expenditures on personal services from fiscal
year 2010 to 2011?
Response. The $2.7 million is for salaries and associated benefit
costs for the 10 new staff in FY 2011; to fully fund the existing 93
staff including normal benefits increases; and to support the budgeted
2.0 percent pay raise for existing personnel.
E. What factors were considered in determining that a 66% two-year
increase in personnel should be requested for this office?
Response. The Office of Policy and Planning (OPP) is using these
new resources to drive the Department transformation; to facilitate the
implementation of the Department of Veterans Affairs (VA) strategic
plan across the Department; to execute the Secretary's policy,
management, and programmatic priorities; and to collaborate with the
Department of Defense (DOD) to enhance services and benefits to
Servicemembers as they transition to civilian status. The increase in
personnel permits the development of two new services that provided new
capabilities to the Department. In addition the increase augments
existing services. OPP is standing up a Corporate Analysis and
Evaluation Service to provide new planning capabilities that will allow
VA to better anticipate demand for its services. OPP is also standing
up the Transformation and Innovation Service which will manage the
Department transformation efforts and lead the Departmental innovation
process to identify and anticipate new trends among policy issues
affecting Veterans. The increase in FY 2010 has allowed the VA to
expand the VA/DOD Collaboration Office. Last, the increase will permit
VA to acquire predictive modeling capabilities.
F. Please explain how these increased expenditures would improve
benefits or services for veterans, their families, or their survivors.
Response. The Office of Policy and Planning (OPP) is using these
new resources to drive the Department transformation into a people-
centric, results-driven, forward-looking organization. The Corporate
Analysis and Evaluation (CA&E) Service will analyze investment options
for the Department and provide an analytical basis for deciding among
investments in ongoing programs as well as new investments to ensure
that funds are going to programs that are results driven and effective
at meeting Veterans needs. The Transformation and Innovation Service
(TIS) will ensure that the initiatives identified by the
Administrations and staff offices are Veteran-centric, forward-looking
and results-driven and that these initiatives have valid operating
plans and that those operating plans are implemented. TIS will also
ensure that innovations are identified that anticipate the future needs
of Veterans and that those needs are institutionalized through policy
and program design and implementation. The expansion of the VA/DOD
Collaboration Office will improve the support that a wounded warrior is
provided throughout recovery, rehabilitation and reintegration; as well
as address the needs of Servicemembers as they transition to civilian
status. OPP will also establish a Business Intelligence Program
Management Office which will implement a set of VA-wide tools,
technologies, and processes to turn data into information and
information into knowledge that optimizes VA's services to Veterans.
Question 2. VA requested $10.2 million for Other Services for the
Office of Policy and Planning for fiscal year 2010. The fiscal year
2011 budget now reflects that VA expects to expend over $13.5 million
on Other Services during fiscal year 2010, a 33% increase.
A. What factors account for that $3.3 million increase in Other
Services for fiscal year 2010?
Response. The upward revision in other services reflects an
increased need to use contractor support in setting up the two new
offices (CA&E and TIS) within OPP. OPP used carryover from FY 2009 to
help fund these additional services.
B. Please provide an itemized list of how that $13.5 million would
be expended.
Response. See table that follows.
Question 3. For fiscal year 2010, the Office of Policy and Planning
requested $2 million for rent, communications, and utilities. Now, the
fiscal year 2011 budget request reflects that the amount that office
expects to expend on rent during fiscal year 2010 is ``lower than
anticipated'' and those funds ``will be directed to Other Services to
support Secretarial transformation initiatives.''
A. How much in total is expected to be spent on rent during fiscal
year 2010?
Response. The total we are expecting to spend on rent,
communications, and utilities during FY 2010 is $850,000.
B. How much in total is VA planning to redirect to the Other
Services account?
Response. VA is planning on redirecting $1,150,000 to the other
services account.
C. Please explain the ``transformation initiatives'' that these
funds would be used to support.
Response. The $3,000,000 carryover is more in direct support of the
transformation initiatives, while the $1,150,000 that is being
redirected will be used to support the Business Intelligence
Implementation. Contractor support will be acquired to provide data
asset inventory commercial best practice expertise and assist the
inventory activities.
Question 4. The fiscal year 2011 budget request for the Office of
Policy and Planning reflects that ``[c]arryover funding will be used *
* * to support Secretarial initiatives.''
A. Please provide an itemized list of how any carryover funds from
fiscal year 2009 will be expended for that purpose.
Response. The $3,000,000 in carryover funds are allocated for
contracts in support of the newly established Transformation and
Innovation Service; the contract support will be used to help stand up
the new office. The contractor will provide support in developing and
initiating the Operational Management Review Process. This is the
process by which the progress of the major Departmental initiatives is
tracked, and provides detailed assessments of the major initiatives as
needed.
B. Please explain the ``Secretarial initiatives'' that these funds
would be used to support.
Response. The carryover funds are currently allocated for contracts
in support of Transformation and Innovation Service; the contract
support will be used to help stand up the new office.
Office of Operations, Security & Preparedness
Question 1. The fiscal year 2011 budget request for the Office of
Operations, Security, and Preparedness includes $12.6 million to
support 102 FTE, which is 55% higher than the level of staffing in
fiscal year 2009 (66 FTE) and 7% higher than in fiscal year 2010 (95
FTE).
A. What factors were considered in determining that a 55% two-year
increase in staff should be requested for this office?
Response. In FY 2010 and continuing in FY 2011, the Office of
Operations, Security, and Preparedness identified increased mission
requirements to comply with various Homeland Security Presidential
Directives to include: HSPD (5, 8, 12, 20); Executive Orders (10450 and
12968); 5 CFR 731 (Suitability Regulations); 5 CFR 732 (National
Security Positions); and CIA Directive 6/4. There were 24 new FTE's
authorized in FY 2010 appropriations act. The final 7 FTE are requested
in FY 2011 to complete the staffing of the HSPD-12 Program Office. In
FY 2009 there was one FTE added during this execution period.
B. What is the average salary of employees of this office?
Response. The average salary (without benefits) for the Office of
Operations, Security, and Preparedness is $90.4K
Question 2. The fiscal year 2011 budget request for the Office of
Operations, Security, and Preparedness includes over $1 million for
travel, which is 56% higher than the expenditures on travel during
fiscal year 2009 ($655,000) and 5% higher than the amount expected to
be expended during fiscal year 2010 ($980,000).
A. What factors account for that increase?
Response. For FY 2010-2011, the factors for this increase include
participation in VA and Federal Interagency Continuity of Operations
and Continuity of Government Exercises. In addition, this increase
involves mission requirements which will include program inspections of
police units and executive protection service for leadership.
B. How many employees are expected to travel during fiscal year
2011 and how many trips would that level of funding support?
Response. An estimated 85 employees are planned to travel during FY
2011, with an estimated number of trips to equal 485.
Question 3. The fiscal year 2011 budget request for the Office of
Operations, Security, and Preparedness includes over $8 million for
Other Services, which is 121% higher than the level of funding for
fiscal year 2009 ($3.6 million), 176% higher than the amount originally
requested for fiscal year 2010 ($2.9 million), and 29% higher than the
amount now expected to be expended during fiscal year 2010 ($6.2
million). The budget request reflects that the increase during fiscal
year 2010 is for contractual costs.
A. Please provide an itemized list of how these funds would be
expended.
Response. Funds will be expended on:
Current working estimate for FY 2011 Guards Contract is
$4.2 Million
Contracted support for the HSPD-12 Program Office is
budgeted for $3.3 Million in FY 2011
B. What factors account for the expected $1.8 million increase in
expenditures from fiscal year 2010 to 2011?
Response:
An increase in the Department of Homeland Security Federal
Protection Service contract for security guards at VA Central Office.
National Security planning, testing, training and
contractual support.
Increased contractual support for the HSPD-12 Program
Office to ensure compliance with various directives and regulatory
requirements.
Inflation.
C. How much would be expended on contractor services during fiscal
years 2010 and 2011 and what services would be performed by those
contractors?
Response. Expenditures for FY 2010 are planned at $6.2 million and
$8.0 million for FY 2011. Services obtained include guard's security
from Federal Protection Service, program support for the HSPD-12
Program Office, and National Level Exercises.
D. What metrics would be used to gauge whether those funds for
contractors are used effectively?
Response. The metrics for the Federal protective service includes
the number of post checks per day on each guard post, the number of
complaints received, and time and attendance evaluated daily. The
metrics for the HSPD-12 includes the number of PIV cards processed
daily in accordance with regulations.
Office of Public and Intergovernmental Affairs
Question 1. The fiscal year 2011 budget request for the Office of
Public and Intergovernmental Affairs includes $11.8 million to support
82 FTE, which is 21% higher than the level of staffing in fiscal year
2009 (68 FTE) and 9% higher than the level of staffing expected during
fiscal year 2010 (75 FTE).
A. What factors were considered in determining that a 21% two-year
increase in staff should be requested for this office?
Response. OPIA's request reflects Secretary Shinseki's priorities.
Principally, OPIA is leveraging technology and improving partnerships
to educate and empower Veterans and their families.
B. Please explain how this increase in staff would improve benefits
or services for veterans, their families, or their survivors.
Response. The increase in staff is central to OPIA's mission to
make sure Veterans and their families are aware of the benefits and
services to which they are entitled. It is essential that VA continue
to pursue aggressive outreach strategies to connect Veterans and their
families to all appropriate VA services.
The Office of New Media will provide additional avenues to
communicate with Veterans--especially OEF/OIF--and their families. By
utilizing the most current technology VA will continue to broaden our
audience and reach Veterans.
The Office of Tribal Government Relations will work with tribal
leaders, Indian Health Service (IHS), the Bureau of Indian Affairs, and
VA's three Administrations to improve service delivery and access to
services on tribal lands.
Question 2. The budget request for the Office of Public and
Intergovernmental Affairs includes funding to ``establish an Office of
New Media.'' The budget request indicates that this office would
``manage VA's social and new media presence.''
A. What specific functions would employees of this office perform?
Response. The specific functions to be performed by the employees
of this office are:
Support VA presence on social media sites like Facebook
and Twitter where Veterans and their families will be able to get up-
to-the-minute news from VA.
Place VA informational videos, training guides (e.g. GI
Bill Hip Pocket Guide) and photos on sites such as YouTube and Flickr.
Blog on sites where Veterans and their families visit.
Develop and implement strategies and establish unified
policies and procedures to help VA administrations and staff offices
use new media to communicate with Veterans and their families.
Conduct outreach to online media outlets to ensure the
Department's message to Veterans is disseminated as widely as possible.
Monitor and report on coverage of the Department
throughout the blogosphere and social media sphere so that VA can
better target its efforts to reach Veterans and make sure accurate,
timely information about benefits and services is reaching Veterans.
Research, develop, and produce content for all of VA's
online communications platforms.
B. How many employees now perform those tasks?
Response. OPIA has only one employee working in new media.
C. What is the expected salary for the requested employees?
Response. New Media Technologist GS-13 ($100,000) and New Media
Communications Officer GS-9/11 ($70,000).
D. What are the expected accomplishments of this office and what
types of metrics are in place to gauge the effectiveness of this new
office?
Response. The office is expected to increase use of VA services by
Veterans by creating new media and social networking tools to reach
Veterans and their families; organizing the feedback VA receives via
new media and social networking and funnel this information to the
appropriate VA offices; and developing new online techniques for
soliciting feedback from Veterans. To gauge metrics, the office tracks
its reach across all social media platforms by measuring the number of
followers, fans, etc., that it gains from the targeted population in
relation to comparable organizations.
Question 3. The fiscal year 2011 budget request for the Office of
Public and Intergovernmental Affairs includes $800,000 for travel,
which is 85% higher than the amount expended on travel during fiscal
year 2009 ($435,000), 35% higher than the funding level requested for
fiscal year 2010 ($595,000), and 15% higher than the amount now
expected to be expended during fiscal year 2010 ($700,000).
A. What factors account for this expected increase in travel funds
during fiscal year 2010?
Response. OPIA's FY 2009 budget underestimated travel costs.
Several key leadership positions within OPIA remained unfilled in FY
2008 and FY 2009 so travel expenditures were less, as necessary travel
was postponed. Because of her personal story as a disabled Iraq War
Veteran, and as a Veteran who has undergone the transition from DOD to
VA, Assistant Secretary Duckworth is asked to speak to Veterans, their
families, and people who provide services to Veterans across the
country. Part of the Assistant Secretary's responsibility is to travel
and communicate VA services, goals and priorities to Veterans, VSO's,
State and local governments, and other stakeholders. Due to her
extensive disability, she is accompanied by a staff person to ensure
accessibility and staffing support. Additionally, OPIA staff are
traveling more as part of our new priority to conduct outreach to
encourage greater use of VA services by Veterans and their families.
B. What factors account for the expected increase from fiscal year
2010 to 2011?
Response. Native Americans and Pacific Islanders have the highest
per capita of Veterans, yet live in some of the most remote regions of
our Nation. In order to better serve these Veterans, OPIA will expand
the Office of Tribal Government Relations in FY 2011. The FTE in this
office will spend much of their time traveling to remote tribal lands.
C. How many employees are expected to travel during fiscal year
2011 and how many trips would this level of funding support?
Response. Approximately 30 FTE will travel for a total of over 500
trips (single-day and multiple-day) during FY 2011.
Question 4. The fiscal year 2011 budget request for the Office of
Public and Intergovernmental Affairs includes $834,000 for Other
Services, which is 319% higher than the expenditures on Other Services
during fiscal year 2009 ($199,000) and 34% higher than the amount now
expected to be expended during fiscal year 2010 ($622,000). Please
provide an itemized list of how these funds would be expended during
fiscal year 2011.
Response. See table below.
Question 5. For fiscal year 2010, the Office of Public and
Intergovernmental Affairs requested $9.1 million to support 76
employees. Now, the fiscal year 2011 budget request reflects that this
office expects to have 75 employees during fiscal year 2010 but expects
to expend an additional $1.3 million for personal services, a 15%
increase. According to the budget request, this increase reflects ``an
average salary adjustment.'' Please explain what salary adjustments led
to this $1.3 million increase.
Response. The increase in personal services was due to pay raises,
normal personnel benefits and career ladder increases, and the salaries
associated with an additional 7 FTE requested in the budget to help
implement OPIA's transformation initiatives--specifically 5 new FTE for
the Office of Tribal Government Relations and 2 new FTE for the Office
of the New Media.
Office of Congressional & Legislative Affairs
Question 1. The fiscal year 2011 budget request for the Office of
Congressional and Legislative Affairs includes funding for 50 FTE,
which is 52% higher than the staffing level in fiscal year 2009 (33
FTE) and 19% higher than the staffing level expected during fiscal year
2010 (42 FTE).
A. What factors were considered in determining that a 52% two-year
increase in staffing should be requested for this office?
Response. The principal factor that drives VA's need to increase
the Office of Congressional and Legislative Affairs (OCLA) staffing
level is a recognized need to enhance this office's ability to perform
its primary mission--improving the lives of Veterans and their families
by advancing legislative communication and relationships with Congress.
We do this primarily by supporting the Committee's execution of its
congressional oversight responsibilities. Congressional relations
activities--meetings, briefings, site visits, and hearings--are people-
intensive. However, Congress is on pace to request approximately 120
hearings, over 240 briefings, and nearly 100 escorted visits in fiscal
year 2010. This tempo places a strain on our current workforce, and we
anticipate that our pace for communicating and engaging with Congress
at all levels will exceed the same period last year. Expanding
congressional relations capacity by building from an FY 2009 executed
level of 33 personnel to a 50-person team of professionals at end state
in FY 11 will properly position this organization to more effectively
execute OCLA's mission and dramatically improve communications between
the Department and Congress.
B. Please explain how this increase in staff would improve benefits
or services for veterans, their families, or their survivors.
Response. Additional staffing would allow VA to be more responsive
to congressional requests and, in turn, help Congress to better assist
the VA in improving benefits and services to Veterans, their families,
or their survivors. The top two strategic priorities underpinning VA's
2011-2012 budget request are: (1) improving the quality and
accessibility of health care, benefits, and memorial services while
optimizing value; and (2) increasing Veteran client satisfaction with
health, education, training, counseling, financial, and burial benefits
and services. These strategic goals cannot be achieved without the
necessary authorities and funding enacted by Congress. OCLA enables the
Department to progress toward these goals by coordinating the
development of pro-Veteran legislation by maintaining healthy and
effective relationships with the Congress and the Government
Accountability Office, its investigative arm.
Question 2. For fiscal year 2010, the Office of Congressional and
Legislative Affairs requested $5.46 million to support 50 employees.
Now, the fiscal year 2011 budget request reflects that this office
expects to have less employees (now estimated at 42) during fiscal year
2010 but expects to spend more than originally estimated (now estimated
at $5.54 million). According to the budget request, estimates were
changed ``due to average salary re-estimates.''
A. Please explain the original salary estimates for fiscal year
2010 and how those estimates were changed.
Response. The change in salary estimates was the direct result of
the deliberate decision to transform OCLA.
When the original salary estimates for the FY 10 budget were
developed in fall of 2008, OCLA's organizational design distributed
staffing resources as follows: (1) 29% toward congressional relations
work; (2) 29% toward executive correspondence and reporting work; (3)
20% performing liaison work from offices located in the Rayburn and
Russell buildings; (4) 11% fulfilling executive leadership
responsibilities of the Assistant Secretary and; (5) 11% to execute the
administrative support functions of the office.
At the time, the size and composition of the organizational design
was deemed sufficient to meet the projected workload needs of OCLA at
an average salary of $81,900. This average salary is roughly equal to
the annual earnings of a GS-12/Step 4 employee in the Washington, DC
area. As recent experience informs us, the department is under-
performing relative to the performance goals that we have set for
ourselves in the area of effective and responsive communication with
Congress (see page 5J-5, Volume 3, of VA's FY 2011 Budget Submission).
The FY 2011 budget request demonstrates our commitment to improving our
performance in this important area.
The FY 2011 budget request demonstrates our commitment to improving
communications between VA and Congress through an organizational
transformation designed to build the capacity necessary to meet
anticipated increases in workload by shifting staffing resources toward
congressional relations functions and away from tasks that are viewed
as being administrative in nature. Upon completion of OCLA's
transformation, more than 60% of the workforce will be aligned against
OCLA's primary mission of congressional relations and executive
correspondence and reporting work, with another 24% performing liaison
duties, 7% in executive leadership roles, and 7% in administrative
support.
As discussed in the response to Question 1.a. above, Congressional
relations activities are people-intensive. To efficiently coordinate
these activities while building and sustaining effective relationships
with congressional staff requires management and interpersonal
competencies generally found above the journeyman-level of the Federal
workforce. Skilled and seasoned professionals command higher salaries.
The net result is a shift in average salary estimates for FY 2010 from
$81,900 (submitted budget request) to $98,900, which is the average
salary level we expect to execute this year. This dollar amount closely
approximates the annual salary a GS-13 (Step 5) Federal employee earns
in the National Capital Region.
B. What is the average salary for employees of this office
projected to be in fiscal year 2011?
Response. The average salary projected for employees in 2011 is
$100,400. To better understand the justification for this number, it is
useful to view OCLA's work and the services we provide--effective
communications and responsive support of Congress--through the lens of
the classic project management concept known as the ``triple
constraint'' paradigm. This paradigm describes the choices that must be
made between cost, schedule and performance, and in the business of
OCLA, performance is defined as the sharing of quality information. If
you want good service cheap, it won't be fast; if you want cheap
service fast it won't be good; and if you want good service fast it
won't be cheap.
In the context of congressional relations, schedule and performance
are paramount--the value of information diminishes if not available to
congressional decisionmakers when needed.
With Congress on pace to request approximately 120 hearings, over
240 briefings, and nearly 100 escorted visits in fiscal year 2010, the
demands placed on our current workforce have increased, and we
anticipate that our pace for communicating and engaging with Congress
at all levels will exceed the same period last year.
As we strive to improve the timeliness and quality of our work
product, we have requested sufficient funding to hire and retain
qualified employees to provide Congress with timely and accurate
information.
Question 3. The fiscal year 2011 budget request for the Office of
Congressional and Legislative Affairs includes $270,000 for travel,
which is 143% higher than the amount expended during fiscal year 2009
($111,000) and 23% higher than the amount requested for fiscal year
2010 ($220,000).
A. What factors account for this increase?
Response. Staff from the Senate Veterans Affairs' Committee and
House Veterans' Affairs committee travel extensively throughout the
country to visit VA medical facilities and Regional Offices in their
oversight. The majority of this travel is paid from OCLA's general
operations funding, as is authorized by law, 31 U.S.C. 1108(g).
The basic factors driving travel costs are: (1) the number of
congressional staff travelers; (2) duration of visits; and (3) location
and venue of congressional staff visit. Travel is mostly within the
Continental United States but several trips have been made to Hawaii,
Samoa, and other remote locations.
In addition, it is advantageous for the Department to have an OCLA
representative accompany congressional staff on their oversight visits
in order to hear firsthand what is discussed, what issues and concerns
are raised, and what information will be brought back to the Committee
Chairmen, Ranking Members, and VA leadership.
B. How many employees would travel during fiscal year 2011 and how
many trips would this level of funding support?
Response. The number of VA employees that will travel in FY 2011 is
dependent upon the number of trips requested by Congress. Accompanying
congressional staff on their oversight visits in order to hear
firsthand what is discussed, what issues and concerns are raised, and
what new information is learned improves OCLA's ability to support the
congressional committees in the performance of their oversight duties.
Generally, one congressional relations officer will accompany each
congressional staff delegation on site visits and field hearings. In FY
2009, however, several congressional member and staff delegations were
not joined by an OCLA employee due to the personnel resource
limitations of OCLA. Travel increases contained in OCLA's FY 2011
budget request assumes sufficient OCLA employee participation in
congressional member and staff visits will be achieved as a result of
enhanced staffing levels of OCLA.
Question 4. The fiscal year 2011 budget request reflects that the
Office of Congressional and Legislative Affairs ``created an internal
tracking system for use as a management tool to determine the status
and timeliness of questions for the record to Congress.''
A. How many responses currently are past due?
Response. Since January, 2010, the OCLA staff has intensely managed
33 sets of post-hearing questions through internal and OMB
concurrences. As of May 7, 2010, 21 sets of post-hearing questions have
been completed and transmitted to the Committees. Of the 12 sets in the
Department, 10 are past due.
B. When will those responses be submitted to Congress?
Response. The Department is making a concerted effort to deliver
these responses to the Committee not later than May 31, 2010.
Question 5. Part of my job as Ranking Member is to conduct
oversight regarding VA's activities. I do this both in the context of
Committee hearings and throughout the course of the year as events
unfold. That frequently leads me or my staff to request information
from VA. During the confirmation process for various VA nominees, I was
assured that I would receive timely answers to these requests.
Unfortunately, that has not always been the case. In fact, some
responses are long overdue. As just one example, back in October 2009 I
sent VA a number of questions after a hearing on various exposures and
I have not yet received a response. I believe these types of delays are
simply unacceptable.
A. When will I receive a response to those questions?
Response. VA's responses to the questions received from the Senate
Veterans' Affairs Committee on October 22, 2009 regarding the October
8, 2009 hearing on VA/DOD Responses to Certain Military Exposures was
delivered to the Committee on May 7, 2010.
B. What efforts will be made to ensure that I, and other Members of
the Committee, receive timely responses to our requests?
Response. OCLA has already implemented procedures to intensely lead
the improvement of the department's responsiveness to congressional
requests, with VA responsiveness to post-hearing questions being one of
the focus areas. Additionally, the deliberate shift in mission focus--
more congressional relations capacity and commensurate addition of
resources (funding and FTEs)--will enable OCLA's execution of its
mission and dramatically improve communications between the Department
and Congress. Technology tools are being sought that will allow member
requests to be easily accessed and process improvements will ensure
more timely sharing of status of deliverables with members and
committees.
C. What efforts will be made to determine who is responsible for
these delays and to hold them accountable?
Response. Responsibility and accountability are essential elements
of OCLA's plan to improve the timely delivery of responses to the
Committee's oversight inquiries. By providing OCLA employees with the
manpower and tools to succeed in aggressively responding to an
increasing workload, we will eliminate the structural deficiencies that
currently prevent OCLA from satisfying the needs of the Committee.
Doing so will allow OCLA to isolate potential future problems and
resolve them once identified in a responsible and accountable manner.
Office of Acquisition, Logistics, and Construction
Question 1. The fiscal year 2011 budget request for the Office of
Acquisition, Logistics, and Construction includes $6.3 million for
travel, which is 179% higher than the amount expended on travel during
fiscal year 2009 ($2.3 million) and 72% higher than the amount
projected to be expended during fiscal year 2010 ($3.7 million).
A. What accounts for this increase?
Response. The FY 2011 budget request for the Office of Acquisition,
Logistics, and Construction includes an increase of 165 FTE over the FY
2010 budget. The implementation of the VA Facilities Management T-21
initiative increases Office of Construction and Facilities Management
(CFM) staff to expand regional and local support for planning,
construction, leasing, and engineering support. The increase in FTE
will be predominantly for staff who provide support to VA medical
centers, Regional Offices and National Cemeteries and who will often
travel to those sites to deliver that support. Six regional offices
will be located throughout the country, and field staff will travel
between various locations to provide these additional supporting
services. The expansion of these services is the basis for the increase
in travel costs. In addition, a large percentage of the new staff will
require Permanent Change of Station (PCS) moves, which also contributed
to the increase in this account.
B. How many employees are expected to travel during fiscal year
2011 and how many trips would this level of funding support?
Response. On average, up to 80 percent, or 306 field staff, travel
six times per year at an average of $2,500 per trip totaling
approximately $4.6M. Fifty-four percent, or 71 FTE, Central Office
staff are likely to travel three times a year at an average cost of
$2,500 for a total of $533,000.
Question 2. According to the budget request for the Office of
Acquisition, Logistics, and Construction, that office expects to spend
over $9 million more during fiscal year 2010 than originally projected.
The budget request indicates that these increases are ``a result of
additional reimbursements and funds carried over from 2009.'' Please
provide an itemized list of how any 2009 carryover funds would be
expended.
Response. The majority of the $2.4M in FY 2009 carryover funds will
be expended for contracts related to the implementation of the VA
Facilities Management T-21 initiative including the following:
Contract to identify IT needs related to the VAFM T-21
initiative--Approximately $500,000.
Personnel support/competency contract to implement the
competency model for CFM in support of the enterprise solution--
Approximately $400,000.
National Institute of Building Sciences (NIBS) contract
for the development of the plan to implement the VAFM T-21 initiative
and process map across the enterprise--Approximately $850,000.
The remainder of the carryover will be used for additional
contracts not specifically related to the VAFM T-21 transformation.
Question 3. The fiscal year 2011 budget request for the Office of
Acquisition, Logistics, and Construction includes $23.6 million for an
``Acquisition Improvement Initiative.''
A. Please provide an itemized list of how those funds would be
expended.
Response. Funds will allow for execution of key facets of this
initiative which are:
Continue to hire additional experienced and well qualified
Acquisition professionals to strengthen the competence of the
Acquisition workforce.
Improve the availability, quality, and delivery of
Acquisition training to the career acquisition workforce to maximize
knowledge standardization and enhance core contract specialist and
program project management competencies.
Support Acquisition professionals with the right tools to
provide the flexibility and agility in the delivery of products,
systems, and services to our VA customer.
Develop and stand up a strategic acquisition center to
strengthen the management and control in the support of enterprise wide
VA programs.
B. What metrics would be used to gauge whether this initiative is
successful?
Response. Measuring success of this initiative will be accomplished
as follows:
Procurement Administrative Lead Time (PALT) reporting
would be used to identify the effectiveness of the initiative.
User satisfaction surveys will gauge improvement to
service provided to the VA customer.
Workload reporting will identify the management of the
acquisition workforce to balance the incoming VA customer workload.
Utilization of competency assessments to enhance training
programs and career development plans.
information and technology--benefits
Question 1. The budget request for Information and Technology for
fiscal year 2011 includes $145 million for the Paperless Delivery of
Veterans Benefits initiative, now called the Veterans Benefits
Management System. According to the budget request, this investment
will help ``improve the benefits claims process and ensure VA's claims
decisions are timely, accurate, fair, and consistent.''
A. How much in total has already been expended on this initiative?
Response:
B. How much in total will be expended on this initiative?
Response:
C. How many VA employees will be dedicated to this effort in fiscal
years 2010 and 2011?
Response. 48 employees in FY 2010 and 60 employees in FY 2011.
D. Please describe the major milestones of this initiative that are
expected to be accomplished during fiscal years 2010 and 2011.
Response:
E. Once the Veterans Benefits Management System is in place, what
impact is it projected to have on the time to complete decisions on
claims for disability benefits and the quality of those decisions?
Response. Projected effects of VBMS are:
Reducing the average days to complete a case to the
strategic target of 125 days and zero cases backlogged by 2015.
Better timeliness and consistency of delivery of veteran
services with anticipated 21% reduction in processing time.
Improved veteran access to VBA services through enhanced
web-based information processing.
Improved claims adjudication processes through file
redundancy, efficient workflow management, and workforce flexibility.
Heightened control over the acquisition and movement of
veteran data throughout VBA and among stakeholders.
Reduced costs through the use of imaged folders and data
in an electronic repository to mitigate the risks associated with the
shipment and storage of irreplaceable records.
Enhanced secure and private access to health care and
benefits information across VBA, VHA, Veterans Service Organizations,
and Department of Defense (DOD).
Question 2. The fiscal year 2011 budget request for Information and
Technology includes the following information:
The planned Chapter 33 [Service Oriented Architecture]
infrastructure improvements overlapped the planned developments
of The Education Expert System (TEES). Thus the monies and
requirements for TEES were redirected into the Chapter 33
development effort.
A. How much in total had been previously expended on The Education
Expert System?
Response:
B. Has all work related to The Education Expert System been
discontinued?
Response. TEES development requirements have been integrated into
Chapter 33 development efforts as this is the long term environment for
education applications. Chapter 33 includes the $1.937M of FY 2010
funds originally budgeted for TEES development. Existing systems
produced under the TEES investment that are currently live are
maintained under the Education Application Maintenance line of the
Benefits IT Support investment. This line is a sub-component of the
larger Benefits IT Support investment.
Education Application Maintenance is broken out as follows:
C. What value was gained through the prior expenditures?
Response. TEES produced multiple applications. These systems
include the Work Study Management System (WSMS), the Flight-On the Job
Training-Correspondence and Apprenticeship System (FOCAS), Electronic
Certification Automated Processor (ECAP), The Image Management System
(TIMS), VA Online Certification of Enrollment (VA ONCE), Web Automated
Verification of Enrollment (WAVE), the National Education WAVE Mass
Address Navigator (NEWMAN), and the Web Enabled Approval Management
System (WEAMS).
TEES also formed the basis for requirements that are now a part of
the Chapter 33 investment. TEES as an investment no longer exists, but
the systems produced are still active and the requirement work products
are still in use.
Question 3. VA is in the process of developing a long-term solution
for processing education claims under the Post-9/11 GI Bill.
A. Please provide a detailed description of the major milestones
expected for this initiative during fiscal years 2010 and 2011.
Response:
B. In total, how much is expected to be expended on developing and
implementing the long-term solution for the Post-9/11 GI Bill?
Response:
C. What is the expected output per direct education FTE before the
long-term solution for the Post-9/11 GI Bill is in place and after it
is in place?
Response. Production per direct FTE includes Education staff
engaged in all activities, not only those engaged in processing claims.
For FY 2010, estimated production is approximately 1,100 completed
claims per FTE. This annual rate of productivity will continue until
the long-term solution is deployed in December 2010. Estimated annual
productivity per FTE is expected to rise to an overall production per
FTE in FY 2011 of approximately 1,500 claims per FTE.
general medical care/medical construction/information technology
Question 1. VA's FY 2011 appropriation for VA medical care was
provided in advance. It was based on estimates provided to Congress in
June 2009 that included very little detail on the programs and
initiatives which justified the advance appropriation. For FY 2011, the
budget simply reflects the appropriation Congress provided but, in
contrast to the June 2009 justification, it includes detailed spending
plans for that money, to include new spending, i.e., spending above
baseline projections, on homeless veteran programs, rural health
initiatives, and programs that require legislative enactment (such as
health care for family caregivers).
A. Because the request for FY 2011 is the same as what was provided
in advance appropriation, is it safe to assume that the detail about
how that money was to be spent was also known last year, but was simply
not transmitted to the Congress? If so, why not?
Response. The FY 2011 estimates provided to Congress in June 2009
only included the top-line estimates for each of the three medical
appropriations and did not include any additional detail at that time.
The FY 2011 President's Budget request includes the additional details
for both the FY 2011 budget and the FY 2012 advance appropriations
request.
B. Is the advance request for FY 2012 simply a baseline estimate
based on projected user demand, or are there specific policy
initiatives contemplated that go above what baseline demand is? If so,
what are those initiatives?
Response. The FY 2012 advanced appropriations request is based
largely on our actuarial estimates using FY 2008 data as the base year.
The request does not include additional resources for any new
initiatives that would begin in FY 2012.
Question 2. One of the challenges of advance funding is getting the
number ``right'' using data that are relatively old by the time the
fiscal year being funded begins. Again, your estimate for VA medical
care in FY 2011 has not changed from what was provided to the Congress
in June 2009.
A. Please outline any differences in projections from using the
Enrollee Health Care Projection model in June 2009 versus projections
from the model for the 2011 budget submission.
Response. There are no differences in the model projections in June
2009 and the budget submission in February 2010. Both estimates are
based on the same actuarial estimates using FY 2008 data as the base
year. The actuarial model is updated in the Spring of each year.
B. Please outline differences, if any, in any non-model
projections.
Response. The differences in the non-model projections for Long-
Term care ($5 million), Civilian Health and Medical Program of the VA
(CHAMPVA) ($77 million), and Readjustment Counseling ($-23 million)
were revised based on the best information available at the time of the
submission which included FY 2009 actuals.
Question 3. VA's budget assumes that no money for medical care will
be carried over from fiscal year 2010 to fiscal year 2011.
A. Is that correct?
Response. Yes, that is correct.
B. Is that a rational assumption given VA's past experience?
Response. Yes, VA's budget assumes that no medical care funds will
be carried over from fiscal year (FY) 2010 to FY 2011. This is because
the budget request for FY 2011 represents VA's estimate of the
resources needed to meet the actuarially projected demands of health
care services for Veterans in that year. Even though VA may carry over
some funds from FY 2010 to FY 2011, those funds are related to the
projected demands for health care services related to FY 2010, not FY
2011. It would not be appropriate to reduce the FY 2011 request by any
funds carried over from FY 2010 unless we also increased the FY 2011
request for funds anticipated to be carried over to FY 2012; otherwise,
the resources in FY 2011 would not be sufficient to meet the projected
demand for health care services.
Question 4. VA's fiscal year 2010 budget request assumed a 6%
increase in the number of unique veteran users, and Congress provided
funding for fiscal year 2010 based on that assumption. However, based
on the actual number of users so far, VA now projects that the increase
in users will be just over 3%.
A. If Congress provided VA funding based on an assumed 6% increase
in the number of unique veteran users, but the increase is only 3%, how
does VA account for the excess funding in the budget?
Response. The FY 2010 submission estimated a 6% increase in unique
patients from FY 2008 (5,576,689) to FY 2009 (5,929,059). The FY 2009
actual (5,744,693) represents a 3% increase over the FY 2008 actual
(5,576,689). Nearly $1.9 billion in unobligated funds was carried over
into FY 2010 of which almost $739 million were from the American
Recovery and Reinvestment Act of 2009.
B. The FY 2010 budget assumed no carryover of funds but, as you
know, there was considerable carryover from fiscal year 2009 into 2010.
Does the combination of unbudgeted carryover and a downward reestimate
of the number of users suggest that VA has a surplus of appropriation?
If so, how was the surplus considered in this budget?
Response. Over half of the carryover funds were attributable to
funds provided by the American Recovery and Reinvestment Act of 2009 or
for the Congressionally-directed rural health initiative. Both were
appropriated as two-year funds with the expectation that some of these
funds would be carried over to FY 2010. The remaining amount of
carryover funds are typically for certain planned expenditures are not
fully obligated due to unanticipated delays in acquisition, personnel
recruiting, or other reasons. This does not mean that the funds are
available for new requirements in the subsequent fiscal year, because
they have already been committed to existing requirements that could
not be obligated at the end of the current year but will be obligated
early in the next fiscal year and were not included in the formulation
of the budget request for that subsequent year.
Question 5. VA has revised the estimate on the number of Priority
1-6 veterans in fiscal year 2010 so that growth in this population of
users is just over .5% from 2009 to 2010. However, VA estimates growth
in this population of 2.4% in 2011 and 2.1% in 2012. To what does VA
attribute the increase in Priority 1-6 users in 2011 and 2012 given
that the increase in 2010 was minimal?
Response. The 2011/2012 patient projections in the 2011 Budget were
developed from the base year (BY) 2008 Model, which was based on the
2008 actual patients. Actual patients in Priorities 1-6 in 2009 were
slightly higher than the BY 2008 Model had projected for 2009. This
reflects a significant shift in the actual distribution of enrollees
between Priority Groups 1-6 and 7 and 8, which occurred in FY 2009. One
possible explanation for the shift was a spike in the number of current
enrollees who were re-assessed at a higher service-connected status.
Question 6. For fiscal year 2010, VA estimates approximately $145
million more in collections than the original budget estimate. What is
VA's plan for this money?
Response. The $145 million increase in collections is the result of
a 9% increase in the 3rd party insurance collections. These collections
will be used at the medical centers that generate the collections as
part of their operating budget.
Question 7. VA has yet to provide views to comprehensive
legislation on homelessness (S. 1547) the Committee received testimony
on in October 2009. Notwithstanding the absence of views, the Committee
favorably reported many provisions of that bill as part of S. 1237. The
President's budget has since proposed significant investments in
homeless programs for FY 2011.
A. Does VA support the provisions of S. 1547?
Response. The Administration will provide an official position on
S. 1547 shortly.
B. Are the legislative provisions of S. 1547 necessary to effect
the spending proposed in the President's budget request? If so, which
provisions?
Response. At this time the Administration cannot comment of the
provisions of S. 1547.
C. Do any of the legislative requests proposed in the budget seek
increases in any of the chapter 20, title 38, authorized levels for
homeless veteran programs?
Response. There are no legislative requests in the budget that
address chapter 20, title 38.
Question 8. VA has a legislative proposal that seeks to impose a
requirement on 3rd party insurance companies, such as health
maintenance organizations, to reimburse VA for the cost of non-service-
connected care provided to veterans. What analysis was done on the
effect this policy might have on premiums veterans pay for insurance?
Response. In forecasting the effects this proposal may have on
premiums Veterans pay for insurance, VA analyzed data from both the
Centers for Medicaid and Medicare (CMS) and Milliman USA and concluded
that this policy change will not have a significant impact on premiums
Veterans pay for insurance. VA is a relatively small part of the
overall number of claims that insurance companies pay each year and the
expected revenues from this proposal should not present a significant
change for the insurance industry. Similar concerns regarding the
potential impact of VA's revenue program on insurance premiums were
raised when VA first initiated its medical care collections fund (MCCF)
program in 1986. However, even as VA revenues have increased over the
years, there has been no indication that these concerns have become
issues for insured Veterans receiving health care from VA and is not
correlated with changes in health insurance premiums based on data
provided by CMS. Additionally, a study conducted by Milliman shows that
since at least 1965 health insurance premium increases exhibit a
pattern of ``several years of gains followed by several years of
losses--a phenomenon often referred to as the underwriting cycle of
insurance.'' A major factor contributing to this cycle is competition
among insurers to gain market share. In periods of underwriting gains,
some insurers may seek to build market share by reducing premiums.
Other insurers will follow suit to protect their market share. As
premiums fall relative to health care costs, many insurers may
experience underwriting losses. Premiums will continue to decline
relative to medical benefits until a lead insurer with market power
raises premiums to restore at least ``break even'' revenues. Finally,
38 U.S.C. Sec. 1729 requires insurance companies to provide evidence
that they are paying the VA the same as non-governmental providers for
the same service in the same geographic area. Actual amounts collected
may be less than projected if legislative authority does not clearly
state third party payers, including Health Maintenance Organizations,
have an obligation to pay VA for all non-service-connected care.
Question 9. In fiscal year 2003, VA spent $334 million on its HIV/
AIDS program. In fiscal year 2011, the budget projects spending of over
$900 million.
A. What accounts for the near tripling of program spending in such
a short time period?
Response. The estimated cost for patients identified with HIV
infection is based on the most recent four years of actual data with FY
2009 being the most recent year. Based on this data, the number of
patients and the cost of care are projected for each separate
enrollment priority group to produce the estimates in the budget. VA
also changed policy to enhance HIV testing availability.
B. Please provide a breakdown of the number of patients treated
during this period, the cost of medicines, and any other costs which
explain this increase.
Response. The requested data will take longer to produce and will
be provided when available.
Question 10. The ``Energy/Green Management'' Program is slated to
increase funding from $53 million in fiscal year 2010 to $252 million
in fiscal year 2011.
A. Please detail the justification for such a large increase.
Response. Including NRM projects that incorporated energy
efficiency, the FY 2010 amount for Energy/Green Management is $132M.
The Energy/Green Management program also received $204M under the
American Recovery & Reinvestment Act. The FY 2011 level is $252
million, a change of $120 million, including approximately $93M that
are NRM projects that incorporate energy efficiency. As VA's physical
infrastructure is over 60 years old and needs repair, so does VA's
energy infrastructure.
Together, with all Federal agencies, VA must comply with the Energy
Policy Act of 2005 (EPAct 2005); Executive Order 13423: Strengthening
Federal Environmental, Energy, and Transportation Management; Energy
Independence and Security Act of 2007 (EISA 2007); and most recently
the requirements of Executive Order 13514: Federal Leadership in
Environmental, Energy, and Economic Performance. VA will implement
energy efficiency and renewable energy projects to meet the
requirements of energy efficiency, renewable energy, sustainable
building mandates, and Greenhouse Gas emissions reduction goals in a
timely manner.
B. Is it imperative that all of this spending occur immediately or,
in light of a tough fiscal climate, is there an alternative plan to
phase in this initiative?
Response. Early investment in these programs will likely reduce
out-year energy costs. The proposed funding is needed to make
sufficient progress in meeting existing laws and executive order
requirements, mandates, and goals referenced above. Volume 4 of the FY
2011 budget submission, Chapter 7.2: Management Initiatives, details
the many efforts under way in the Energy/Green Management Program to
increase renewable energy and energy efficiency. The Energy/Green
Management Program will enable VA to reduce energy consumption and
lower energy costs, which totaled $517 million in 2009. Each year, VA
procures energy related projects to meet energy related Federal
mandates as identified in Table 1-6: Real Property Performance Results
in Volume 4 of the FY 2011 budget submission, Chapter 7.1: VA's Capital
Asset Management Program.
Question 11. For fiscal year 2010 it appears there was a dramatic
overestimation of the ``Home & Community Based Care'' Average Daily
Census (ADC). What was an estimated ADC of 90,654 is now projected to
be 38,240.
A. Why did VA expect such a large ADC increase from fiscal year
2009 to 2010?
Response. The increase from FY 2009 to FY 2010 was driven by
anticipated double digit growth in State Home and Contract Adult Day
Health Care, Home-Based Primary Care, Other Home Based Programs,
Homemaker/Home Health Aide Programs, and Care Coordination/Home Tele-
health and is the result of emphasis being placed on Non-Institutional
Long-Term Care. Individuals needing long-term care, including Veterans,
have clearly indicated their desire to receive these services at home
or in their community, rather than in a nursing home. Therefore,
expansion of Home and Community Based Care services will assist in
reducing VA's reliance and demand for nursing home care.
B. Why did that estimate appear to be so far off the mark?
Response. The estimate is not off of the mark. The FY 2010 Average
Daily Census estimate for Non-Institutional Long-Term Care in the FY
2010 submission was 90,654 and 93,935 in the FY 2011 submission, an
increase of 3.6% from the earlier estimate (reference Volume 2, Medical
Programs and Information Technology Programs, page 1K-15).
C. What funding was attached to this overestimation?
Response. There was no overestimation.
D. How do you account for the excess funding in the budget?
Response. There was no excess funding in the budget.
Question 12. As mentioned, VA forecast 6% growth in the number of
unique veteran users of the health care system in FY 2010, but VA has
revised it downward to approximately 3% growth. However, despite the
downward reestimate in users, it appears VA has revised upward its
estimate in the number of outpatient visits and patients treated in
inpatient facilities.
A. How does VA explain the number of unique users growing at a rate
slower than expected, but the number of outpatient and hospital visits
increasing above the number that was projected (a projection that was
based on 6% growth in unique veteran users, not 3%)?
Response. The FY 2010 submission estimated a 6% increase in unique
patients from FY 2008 (5,576,689) to FY 2009 (5,929,059). The FY 2009
actual (5,744,693) represents a 3% increase over the FY 2008 actual
(5,576,689). Outpatient visits increased by 10% from FY 2008 to FY 2009
(67.640 million to 74.662 million). The Outpatient visits estimate
increases of 5% from FY 2009 to FY 2010 and FY 2010 to FY 2011 are
based on historical trends. Patients treated increased by 4% from FY
2008 to FY 2009 (804,859 to 877,093). The Patients treated estimates
increases of 3% from FY 2009 to FY 2010 and FY 2010 to FY 2011 are also
based on historical trends.
B. If the answer is that unique users are making more frequent
visits, what does VA attribute that to?
Response. The ratio of outpatient visits to unique patients was 12
visits per unique patient in FY 2008 and 13 visits per unique patient
in FY 2009. The ratio of outpatient visits to unique patients remains
steady at 13 visits per unique patient in FY 2010 and FY 2011.
Question 13. For the FY 2012 advance funding request it appears
that VA projects similar increases in the number of unique users,
outpatient visits, and patients treated in inpatient facilities, that
it projects for FY 2011. Please explain what factors influenced this
projection.
Response. Factors influencing workload projections are net
enrollment growth, demographic mix changes, utilization and intensity
trends.
Question 14. Why is the Average Daily Census for the FY 2012
Advance Appropriation set at ``0'' for Home and Community Based Care?
Response. The Average Daily Census for Non-Institutional Long-Term
Care in FY 2012 was not ``0'' but 116,198 (reference Volume 2, Medical
Programs and Information Technology Programs, page 1K-15).
Question 15. The ADC for State Home Domiciliary Care was expected
to increase substantially from FY 2009 to FY 2010, yet has been revised
downward to remain flat through FY 2012. Please explain what happened
here.
Response. VA adopted an improved method and data source for
counting State Home Domiciliary workload. The revised estimate is based
on past census trends, existing census levels and estimates for future
changes.
Question 16. Please explain the expected 74% increase in ``State
Nursing Home'' obligations from FY 2009 to FY 2012.
Response. The 74% increase is based on a 4% increase in Average
Daily Census and reflects a per diem increase of 21% from FY 2008 to FY
2009 which is accounted for in subsequent years. The substantial
increase in the State Nursing Home per diem is largely due to higher
per diem payments made to State Homes for P1A Veterans. Since the
Federal law came into effect mid-fiscal year 2009 (April 29, 2009), VA
estimates that approximately 50% of the State Homes have begun to
request higher per diem payments for P1A Veterans. These payments are
not a separate line item in the budget and are rolled into the overall
State Home Nursing obligations. Prior to FY 2009, the State Home
expenditures and per diem only reflected the lower per diem rate paid
to State Homes. Beginning in FY 2009 and onward, the State Home
expenditures and per diem will capture both the lower per diem for non-
P1A Veterans and the higher per diem for P1A Veterans.
Question 17. The budget proposes a 9% increase for VA mental health
programs, including $309 million for Post Traumatic Stress Disorder
(PTSD) treatment for Operation Enduring Freedom/Operation Iraqi Freedom
(OEF/OIF) veterans.
A. Are the investments made in this area working to improve the
mental health of veterans? What metrics does VA use to measure these
improvements?
Response. Enhanced mental health funding is focused on programmatic
improvements and staffing enhancements designed to improve services to
Veterans. We have not created metrics to specifically measure the
impact of enhanced funding, since it becomes a part of overall mental
health services, not something specific and separate. Rather, our
metrics primarily measure overall mental health care, not
subcomponents. For example, the metric to assess timeliness of
appointments was affected by enhanced mental health staffing, but in
the context of staffing that was already addressing mental health care.
That metric demonstrates that over 96 percent of all new mental health
referrals are sent for a full diagnostic evaluation and, when
indicated, initiation of treatment within 15 days of the referral being
made. Certainly mental health enhanced funding has contributed to the
level of staffing that allows us to set and meet this metric, which
goes well beyond community standards in other health care settings.
However, the impact of enhanced staffing as compared to the continued
staffing of overall mental health providers cannot be disentangled to
demonstrate the specific impact of increased mental health funding.
Two examples of funded service enhancements are the dissemination
of evidence based psychotherapies for PTSD and other mental disorders,
and the establishment of the Suicide Prevention Hotline. Details on
each of those follow.
One major investment being made is the national dissemination and
implementation of evidence-based psychotherapies for PTSD, depression,
and serious mental illness in VHA. As part of this effort, VA has
developed centralized, competency-based training programs for VA mental
health staff in Cognitive Processing Therapy (CPT) and Prolonged
Exposure Therapy (PE) for PTSD, Cognitive Behavioral Therapy and
Acceptance and Commitment Therapy for depression and Social Skills
Training for serious mental illness.
Significantly, CPT and PE for PTSD are recommended in the VA/
Department of Defense (DOD) Clinical Practice Guidelines for PTSD at
the highest level, indicating ``a strong recommendation that the
intervention is always indicated and acceptable.'' Moreover, in 2007,
the Institute of Medicine (IOM) conducted a review of the literature on
psychological and pharmacological treatments for PTSD and concluded
that CPT and PE were efficacious treatments for PTSD, thereby
validating VA's dissemination of these treatments, which had already
begun as part of an effort to bring these treatments to Veterans who
can benefit from them as soon as possible. As of April 30, 2010, VA has
trained more than 2,700 mental health staff in the delivery of CPT or
PE. This has greatly increased VA's capacity to offer these efficacious
treatments to returning Veterans.
A part of initial monitoring efforts conducted by the Office of
Mental Health Services (OMHS) regarding these efforts were process
metrics: a survey was sent in February 2009, to all VA medical centers
to assess the extent to which CPT and PE were available at and being
provided by medical centers to OEF/OIF Veterans with PTSD. The results
of the survey revealed that 94 percent of facilities were providing CPT
or PE, and 72 percent were providing both therapies. This level of
availability is considerably higher than that documented within VHA
prior to VHA's Evidence-Based Practice (EBP) dissemination efforts
(Rosen et al., 2004). Furthermore, standardized medical record template
progress notes have been developed for documenting the delivery and
impact of the treatments and are currently being piloted, with national
deployment planned for this summer.
In addition, in FY 2010, VHA began routinely administering the PTSD
Checklist (PCL), a well-validated PTSD assessment and outcomes measure
as a clinical outcome measure including both impact of treatment; in
particular evidence based psychotherapies on symptoms and also on
patient function. Returning OEF/OIF Veterans will be administered this
assessment tool at the beginning of their treatment for PTSD, and will
have it re-administered periodically while they remain in active
treatment. The change in the severity of the assessed symptoms will be
used to determine if the Veteran is benefiting from the current
treatment, or if the current treatment plan needs to be changed.
The VA Suicide Prevention Hotline, an initiative developed in
conjunction with the Department of Health and Human Services (HHS), is
designed to reinforce increased suicide prevention staffing in VA
medical centers and improve care for Veterans at risk for suicide. A
key metric for this initiative is number of calls to the Hotline which,
as of March 31, 2010, was over 250,000 calls since its inception almost
3 years ago. The professional staff at the Hotline also has provided
thousands of referrals back to facility Suicide Prevention Coordinators
for on-going care. Most important are over 4,000 rescues of imminently
suicidal Veterans based on Hotline contacts. In July 2009, a Suicide
prevention online Chat Service was established, through which Veterans
can send text messages to Hotline professional staff, rather than
placing a call. This Chat Service has had over 4,000 chatters and over
400 transfers to the Hotline.
B. For the service-connected population, is VA seeing a
stabilization, or even a reduction, in disability levels for PTSD?
Response. Between fiscal years 2005 and 2008, the number of
Veterans receiving compensation for PTSD increased by more than 40
percent. A special data run is required to identify changes in average
degree of disability for PTSD. Information will be provided as soon as
it is available.
C. For service-connected veterans, does VA track whether
investments made to treat any health condition, e.g., diabetes, are
improving their health?
Response. Yes. VA tracks health care and health status broadly and
has a number of systems that track performance measures/results
relative to different diseases and procedures. We track over time the
Healthcare Effectiveness Data and Information Set (HEDIS) measures
related to diabetes and can demonstrate improvement.
Question 18. In the medical services appropriation (Volume 2, Page
1C-20), please explain the justification for ``Employee Travel and
Transportation of Persons'' increasing by 43% from FY 2009 to FY 2010,
and the proposed increase of 43% for FY 2011, and another 43% increase
for FY 2012. What justification is there for this type of spending to
triple in a 3-year period?
Response. The increase in travel referenced above includes all
patient and employee travel. From FY 2008 to FY 2009 overall travel
increased by 60% and was driven in most part by a 69% increase in
beneficiary travel (patient travel). This reflected the increase in the
beneficiary travel mileage reimbursement rate from 28.5 cents to 41.5
cents per mile, a 46% increase. The subsequent increase in FY 2010
through FY 2012 takes into consideration the increase in beneficiary
travel mileage reimbursement rate from 28.5 cents to 41.5 cents per
mile and anticipated usage by Veterans.
Question 19. In the medical services appropriation (Volume 2, Page
1C-20), please explain the justification for Communications increasing
by 12% from FY 2009 to FY 2010, and the proposed increase of 12% for FY
2011, and another 12% increase for FY 2012.
Response. The 12% increase is based on historical trends from FY
2005 through FY 2009 (a 4-year average from FY 2005 to FY 2009). The
percent change from FY 2005 to FY 2006 was 25%, since that time the
percent has decreased and remained relatively steady at 12%.
Question 20. I am going to highlight obligations found on Volume 2,
Page 1C-20, and would like VA's comments on each. I then would like an
explanation as to why the proposed increases in these areas have
identical percentage increases for each fiscal year.
A. Please explain why ``Outpatient dental fees'' is expected to
increase 30% from FY 2009 to FY 2010; 30% from FY 2010 to FY 2011; and
30% from FY 2011 to FY 2012.
B. Please explain why ``Medical and Nursing Fees'' is expected to
increase 22% from FY 2009 to FY 2010; 22% from FY 2010 to FY 2011; and
22% from FY 2011 to FY 2012.
C. Please explain why ``Repairs to furniture/equipment'' is
expected to increase by 22% from FY 2009 to FY 2010; 22% from FY 2010
to FY 2011; and 22% from FY 2011 to FY 2012.
D. Please explain why ``Contract hospital'' is expected to increase
by 18% from FY 2009 to FY 2010; 18% from FY 2010 to FY 2011; and 18%
from FY 2011 to FY 2012.
E. It would appear that the budgeting for these items (and others
on that page) was not done based on a historical trend but, rather, by
simply taking the percentage increase projected for the current year
and applying it to the subsequent two fiscal years. Is that common
practice?
Response to A-E: The percentage increase from FY 2009 to FY 2010 of
30 percent for Outpatient dental fees, 22 percent for Medical and
Nursing Fees, 22 percent for Repairs to furniture/equipment, and 18
percent for Contract hospital is based on a review of the actual
historical spending trends from FY 2005 to FY 2009 for each of these
separate items to develop the estimated percentage increase from FY
2009 to FY 2010. We then use that same estimated rate of increase for
FY 2011 and FY 2012 because there is no more current actual information
available to suggest, or inform, a different estimate. These annual
estimated rates of increase will be updated annually in each budget
submission based on the most recent actual historical experience
available at that time.
Question 21. In Volume 2, Page 1D-4, the budget shows two tables
associated with obligations for Medical Support and Compliance.
A. Please explain why the first table shows an obligation increase
of 28%, over $600 million, for ``Outpatient Care,'' but the table below
shows an FTE decrease for ``Outpatient Care.''
Response. The increase of $600 million from the FY 2009 actual
($2,257,790,000) to FY 2010 estimate ($2,884,966,000) reflects a 58%
increase to Other Services, the bulk of which would be provided through
contract services, not VA FTE.
B. What is the relationship between those two tables and why does
it appear as if there is no correlation with respect to Outpatient
Care?
Response. The Summary of Obligations by Activity chart depicts by
activity break the sum of pay and non-pay costs. The Summary of FTE by
Activity chart shows the FTE associated with each activity. The two
charts do not depict the individual line items which constitute pay and
non-pay. These individual line items are shown on the Obligations by
Object table (reference page 1D-7).
Question 22. Referencing Volume 2, Page 1D-7, please explain the
justification within the Medical Support and Compliance account for the
20% increase in ``Employee Travel'' from FY 2009 to FY 2010; the 20%
increase proposed for FY 2011; and the 20% increase proposed for FY
2012.
Response. The percentage increase from FY 2009 to FY 2010 of 20
percent for employee travel is based on a review of the actual
historical spending trends from FY 2005 to FY 2009. We then use that
same estimated rate of increase for FY 2011 and FY 2012 because there
is no more current actual information available to suggest, or inform,
a different estimate. These annual estimated rates of increase will be
updated annually in each budget submission based on the most recent
actual historical experience available at that time.
Question 23. Referencing Volume 2, Page 1D-7, please explain the
justification within the Medical Support and Compliance account for the
24% increase in Communications from FY 2009 to FY 2010; the 24%
increase proposed for FY 2011; and the 24% increase proposed for FY
2012.
Response. The percentage increase from FY 2009 to FY 2010 of 24
percent for communications in the medical support and compliance
appropriation is based on a review of the actual historical spending
trends from FY 2005 to FY 2009. We then use that same estimated rate of
increase for FY 2011 and FY 2012 because there is no more current
actual information available to suggest, or inform, a different
estimate. These annual estimated rates of increase will be updated
annually in each budget submission based on the most recent actual
historical experience available at that time.
Question 24. After expenditure of the remaining American Recovery
and Reinvestment Act appropriation for non-recurring maintenance (NRM)
projects, and assuming enactment of the requested funding level for FY
2011, what is the remaining backlog of NRM projects (in number and
dollar amount)?
Response. On a rotating basis over a three year period, VA performs
a Facility Condition Assessment (FCA) of all its facilities. Based on
these assessments, VA estimates the ``backlog'' cost of addressing all
the deficiencies rated as ``D'' (Poor Condition) and ``F'' (Critical
Condition). This FCA backlog is the best measure we have available of
future requirements for maintenance and restoration of VA facilities as
it covers items in need of maintenance or items that have reached the
end of useful life and require modernization or restoration. These
restorations and maintenance items are primarily funded using the Non-
Recurring Maintenance program, but also can be addressed through the
major and minor construction programs. As of February 2010, VA had a
total of 34,313 deficiencies graded with a ``D,'' costing $8.1 billion,
and a total of 3,432 deficiencies graded with an ``F,'' costing $1.4
billion, for a total remaining backlog cost of $9.5 billion.
Question 25. At a June 10, 2009, Committee hearing a VA witness
testified that ``within the next few months we anticipate to award at
least 40% of the stimulus funding.'' However, I see that roughly $738
million of the $1 billion allocated for emergency stimulus was carried
over into FY 2010.
A. As of today, how much of the $1 billion has been obligated?
Response. As of January 31, 2010 over $432 million or 43% of the $1
billion appropriated for this purpose has been obligated. Veterans
Health Administration American Recovery and Reinvestment Act State
Construction Grant obligations as of January 31, 2010 were over $140
million or 94% of the $150 million appropriated for this purpose.
B. What is the schedule for the remainder?
Response. The remainder is scheduled to be obligated by the end of
FY 2010.
Question 26. For the medical facilities appropriation (Volume 2,
Page 1E-9), please explain why ``employee travel'' is proposed to
increase by 28% from FY 2009 to FY 2010, by 28% in FY 2011, and by
another 28% in FY 2012.
Response. The percentage increase from FY 2009 to FY 2010 of 28
percent for employee travel is based on a review of the actual
historical spending trends from FY 2005 to FY 2009. We then use that
same estimated rate of increase for FY 2011 and FY 2012 because there
is no more current actual information available to suggest, or inform,
a different estimate. These annual estimated rates of increase will be
updated annually in each budget submission based on the most recent
actual historical experience available at that time.
Question 27. For medical facilities, please explain why
Communications is proposed to increase by 50% from FY 2009 to FY 2010;
by another 50% in FY 2011, and by yet another 50% in FY 2012.
Response. The percentage increase from FY 2009 to FY 2010 of 50
percent for communications in the medical facilities appropriation is
based on a review of the actual historical spending trends from FY 2005
to FY 2009. We then use that same estimated rate of increase for FY
2011 and FY 2012 because there is no more current actual information
available to suggest, or inform, a different estimate. These annual
estimated rates of increase will be updated annually in each budget
submission based on the most recent actual historical experience
available at that time.
Question 28. In Volume 2, beginning on Page 4A-7, there are 20
``Transformation into the 21st Century'' initiatives proposed for FY
2010 and FY 2011. For FY 2010, the $354 million proposed for these
initiatives was carried over from FY 2009.
A. Were any of these initiatives ever officially requested? If so,
when and to whom?
Response. The FY 2011 Congressional Budget Justification (CBJ)
served as the initial notification to Congress of some new information
technology initiatives related to transforming the VA into a 21st
century organization. The 2011 CBJ provides estimates for both FY 2010
and FY 2011. Consistent with the FY 2010 Consolidated Appropriations
Act, VA submitted to the Committees on Appropriations, on February 22,
2010, its FY 2010 Baseline Reprogramming notification. This
notification details, by budget and program line, the application of
funding sources to these initiatives.
B. If they were not requested, and in light of the current fiscal
climate, why does it make sense to simply find a use for unobligated
money that was carried over into the current fiscal year? Shouldn't
that money have been returned to the Treasury or, at least, requested
for the specific use VA now assumes it will be used for?
Response. Notification to Congress of changes in FY 2010
information technology projects and costs was accomplished through the
FY 2011 budget justification and submission of the baseline
reprogramming notification to Congress. As noted in the 2011
Congressional Budget Justification, President Obama charged Secretary
Shinseki with transforming VA into a high-performing 21st century
organization. The VA will release information on the VA's Strategic
Plan for achieving this goal by improving access, increasing quality,
lowering or controlling costs, and enhancing performance of the VA very
soon. These goals are being addressed now through immediate investments
in an ongoing transformation of the VA, and the Department's
information technology budget reflects those emerging priorities.
The VA FY 2010 budget provides a significant increase in resources
for information technology projects and is a down payment for
transforming VA into a 21st Century organization. Our largest
transformation investments are in direct services to Veterans. These
initiatives will help to transform the VA in order to better serve our
Nation's Veterans.
What follows is a description of some of the VA's transformation
initiatives that begin in FY 2010 and for which funding continues in FY
2011:
Quality initiatives are underway with a focus on such
goals as providing better preventative care, rolling out a new Veteran-
Centric Care Model, and dramatically increasing VA services for women
Veterans.
Access is being increased through opening the VA to
Priority 8 Veterans, as well as newer initiatives that include expanded
tele-health and home care and a plan to end homelessness among
Veterans.
Performance will improve. Veterans can expect to see their
VA perform better when we implement a truly interoperable electronic
records system that will provide each member of our Armed Forces a
Virtual Lifetime Electronic Record (VLER) that will serve them from the
day they put on the uniform through their time as Veterans, enabling
better continuity of care and healthier outcomes. We are also working
with the President's top technology and performance professionals in
developing a records system that will revolutionize our claims process
and eventually connect Veterans to their complete account with us,
covering health care, education, insurance, home loans, counseling,
employment, and cemetery services.
Cost remains a critical component in a transformed VA so
that we can direct more of our resources to better healthcare and
benefits for Veterans. Transformation of the VA is incomplete if we do
not take a hard look at how we steward taxpayers dollars for the
greatest outcomes by controlling costs. VA will initiate new
initiatives in 2010 that address VA's massive energy costs by shifting
to renewable energy sources and implementing energy efficiency
measures, as well as enhanced management controls that protect privacy
and reduce the costs of operating the VA in the 21st century.
C. The description of each of these initiatives is sparse. For
example, $65 million is proposed for the ``Veteran Relationship
Management Program'' in fiscal year 2010, but only one sentence is used
to describe the initiative. Please provide greater detail on exactly
what these initiatives are, how exactly the money will be spent, and
what deliverables VA has for each of them.
Response. Details of IT support to Transformation Initiatives
follow:
corporate analysis and evaluation
Description: This initiative will provide objective, data-driven,
transparent analysis to facilitate strategic investment decisions by
senior leadership. Successful implementation will incorporate VA
programs into a multi-year program where outcome based analysis and
resource recommendations can be provided to VA leaders.
In late February 2009, the Office of Policy and Planning was
assigned responsibility for establishing a Program Analysis and
Evaluation (PA&E) capability within the Department of Veterans Affairs.
This capability would be similar to the Department of Defense PA&E that
has been in place for decades. As part of the analysis process,
interviews were conducted with senior subject matter experts and
leaders representing the largest and most complex Federal departments.
Additionally, a cross-functional team was established which produced an
inventory of current VA analysis and evaluation capabilities as well as
corporate PA&E capability development recommendations.
The Office of Corporate Analysis and Evaluation (CA&E) is an
independent body dedicated to aligning VA resource allocations with
investments that best serve our Veterans, their families, dependents
and survivors. CA&E informs capital investment decisionmaking
activities and enables development of resourcing options and
priorities. Specific missions include:
Multi Year Programming
Analytic Agenda
Independent Cost Analysis
Long Term Projections
CA&E provides the objective, data-driven, transparent analysis to
facilitate strategic investment decisions by VA Secretary and Deputy
Secretary.
Benefit to the VA Organization: Successful implementation of the
Office of Corporate Analysis and Evaluation (CA&E) will result in the
near-term ability to effectively analyze programs and allow VA leaders
to consider investment options and prioritize resources to deliver
results consistent with the Secretary's Vision for a 21st Century VA.
CA&E would provide the Secretary and Deputy Secretary the analytical
basis for deciding among investments not only in ongoing programs but
also in new initiatives.
Longer term, a CA&E capability will allow VA leaders to identify
and address long-term trends in resource requirements and explore
excursions from a baseline based on changes in assumptions on Veteran
health and benefits needs as well as changes in the national health
care environment.
Deliverables:
Analytic Agenda:
Conformity to fiscal guidance
Executability
Cost/Benefit Analyses
New Starts
Current Programs
Develop alternative programmatic courses of action
Analyze effectiveness of current operations
Independent Cost Analysis:
Selected Acquisition Programs
corporate ses office
Description: Information and Technology (IT) infrastructure will
establish a Corporate Senior Executive Management Office, in support of
the VA initiative to standardize, streamline and enhance staffing
actions for Senior Executive Service and Title 38 positions. This
office will assist the VA with the selection, development, utilization
and management of our strategic human capital to lead the Department
and most effectively serve our Nation's Veterans. The establishment of
this office the Corporate Senior Executive Management Office is
consistent with the need for centralized management and has been vetted
through the appropriate governance structures (Senior Review Group,
Strategic Management Council, and VA Executive Board). A single office
provides a corporate, standardized approach to the recruitment,
selection, and management of senior executives and Senior Executive
Service positions in VA, which will ensure consistency and excellence
in VA's leadership ranks.
This initiative will be designed to create a regional IT network to
allow data sharing and aggregation along a continuum that involves VA,
DOD and the private sector. It will have a proof of concept to be
scaled to other regions prior to full development and integration. This
initiative aligns to VA Strategies to build our internal capacity to
serve Veterans, their families, our employees, and other stakeholders
efficiently and effectively and to recruit, hire, train, develop,
deploy, and retain a diverse VA workforce to meet current and future
needs and challenges.
enterprise energy cost reduction efforts (greening va)
Description: VA's Departmental Green Management Program has a FY
2009 budget of $ 278.9 M ($73.4 M Program, $205.5 M in ARRA).
VA purchases large quantities of commodities such as natural gas,
electricity and water to operate healthcare and other facilities at a
cost of approximately $550M annually. Individual facilities purchase
commodities locally without taking advantage of regional and other
opportunities that could save VA operating dollars annually.
VA facility and regional energy managers serve as stewards of VA
facility energy operation, maintenance, and physical enhancement.
Increased organizational visibility is needed to ensure the greening of
VA, including green awareness education for all staff.
An objective of this initiative is to optimize Clean-Energy
investments in physical and knowledge infrastructure to reduce VA's
dependence on fossil fuels while supporting the VA mission of serving
the Nation's Veterans and their families.
Benefit to the Veteran: As part of the clean-energy transformation,
the following Veteran benefits are key steps in reducing VA's carbon
footprint:
Purchase commodities from competitive suppliers where
possible, creating new opportunities for Veteran-owned and service-
connected disabled Veteran-owned businesses.
Green investments helps to reduce adverse impacts to the
environment, conserve energy and other natural resources, improve
public health and safety, and create new markets and jobs.
Construction initiatives support the establishment of
complex Medical Centers requiring a substantial investment in IT
Systems and infrastructure in order to provide effective long-term
healthcare service delivery to Veterans.
Benefit to the VA Organization: In conjunction with the investments
in green projects that VA is making through its clean-energy
transformation, these benefits are key steps in reducing VA's carbon
footprint:
Reduction in VA's dependency on fossil fuels through
energy infrastructure improvements and renewable energy projects with
the same level of investment to continue and enhance the greening of
VA.
Enhanced training for energy managers in energy efficiency
and renewable energy technologies and best practices in energy
management.
Strengthen program Departmental oversight to ensure best
use of skills and abilities in service to all VA facilities in the
greening of VA.
Improved Department energy performance as cost-effectively
as possible.
Establishment of regionally-based boards comprised of
internal technical experts to advise individual facilities on
negotiating for the best possible utility rates, terms and conditions.
Make continuing investments in educating energy managers
and VA staff in Green Management.
Optimize investments in physical and knowledge
infrastructure to reduce VA's dependence on fossil fuels while
supporting the VA mission of serving the Nation's Veterans and their
families.
enterprise-wide cost accountability
Description: VA must increase the cost-effectiveness of VA programs
by enabling strategic financial decisionmaking with a robust activity
based cost accounting system. Key steps will generate and integrate all
activity based cost accounting information into VA's Decision Support
System in order to standardize costing, as well as assist in budget
execution and forecasting within VA.
This effort will provide resources for both employees and
contractors to support the consistent implementation of cost accounting
methodology. Uniform implementation across VA ensures cost accounting
outcomes are understood by decisionmakers and furnish VA Leadership
with performance measurement information to make data-driven decisions.
This cost accounting system will ensure that senior leadership has
access to accurate cost data for budget formulation, as well as
providing effective and flexible tools for overall management analyses.
Benefit to the Veteran: This initiative provides Veterans and their
families with integrated access to the most appropriate services from
VA and our partners.
Benefit to the VA Organization: It will provide resources for both
employees and contractors to support the consistent implementation of
cost accounting methodology. Uniform implementation across VA ensures
cost accounting outcomes are understood by decisionmakers and furnish
VA Leadership with performance measurement information to make data-
driven decisions. This cost accounting system will ensure that senior
leadership has access to accurate cost data for budget formulation, as
well as providing effective and flexible tools for overall management
analyses.
fiscal responsibility review
Description: Fiscal Responsibility Review is an initiative to
realize savings by improving management processes throughout the
organization. It consists of four parts, Organizational Structure,
Cost, Transparency and Accountability Review, VA Employee Payments
Review, Management Process Savings, and VA Innovative Processes Board.
This multi-faceted initiative has five parts that enable an ongoing
review and improvement effort of management processes throughout the
organization including: structure, cost, transparency, and
accountability reviews; VA employee payments; management process
savings; and an innovative processes board. This initiative will help
to realize savings by improving management processes throughout VA. The
Department will conduct a comprehensive assessment of current practices
and spending, establish new and consistent management standards, roll
out improved process management, and provide tracking of progress and
meaningful cost reductions.
Objective: Large organizations in the public sector are prone to
expansion, duplication, and redundancies with few opportunities to
assess the fit between organizational structure and mission
effectiveness in the political economy of the Federal Government.
Fiscal Responsibility Review's primary objective is to improve the
efficiency and effectiveness of VA operations by employing the optimal
organization supported by well-functioning components.
Benefit to the Veteran: The Fiscal Responsibility Review aligns
with the Secretary's guiding principal of being a forward-looking
organization. It looks to eliminate waste and inefficiency and seeks
opportunities to deliver the best services with available resources.
Benefit to the VA Organization: The Fiscal Responsibility Review
initiative will reduce organizational redundancies and low visibility
into costs and will create opportunities to streamline both
organizational units and processes that produce cost savings or cost
avoidance. It will also increase accountability across all
organizational components by evaluating organizational duplications and
redundancies in functional areas and associated costs of operating.
hospital quality transparency
Description: The Hospital Quality Transparency (HQT) initiative is
designed to allow consumers to make informed choices about obtaining
health care services by promoting transparency with regard to the
quality and safety of health care. VA is making a commitment to provide
Veterans with information about the care they can receive. We will make
the quality and safety of health care more transparent, allowing
Veterans to make the best choices for their care. This initiative
provides Veterans and health care providers with important information
about VA's health care quality, outcomes, patient safety, and patient
satisfaction. This will make it easier for Veterans to compare VA
quality and safety performance with other medical care providers.
Objective: HQT has three main objectives. The first is to increase
internal and external communications. The second is to develop metrics
to allow VA to benchmark against existing external quality and safety
dashboards or when not available, internal benchmarks. The final
objective of HQT is to develop an organizational risk management
structure to manage large scale disclosures.
Benefit to the Veteran: HQT will address policymakers' desire that
VA become more transparent about the quality and safety of health care.
HQT will also provide a better understanding of gaps in the quality and
safety of health care services provided. This information will allow
targets for quality improvement activities within facilities, VISNs or
nationally to be identified.
Benefit to the VA Organization: With increased transparency
regarding the quality and safety of health care services, HQT will
enhance the knowledge base of VA health care providers and create an
appreciation by the American people and Congress of the scope and
quality of the health care provided by Veterans Health Administration.
HQT will also improve relationships with private sector and
community organizations in order to negotiate an exchange of quality
and safety data. The infrastructure required to support the increased
technical support necessary to implement this plan is already in place
within the Office of Quality and Safety.
integrated operation center
Description: The VA IOC provides a fusion point for Unified
Command, integrated planning, and predictive analysis to present
recommendations to VA Senior Leaders and to coordinate with
stakeholders, Federal, State, and local partners. The VA IOC will
support VA's strategic goals by ensuring that the Department can
continue mission essential functions during an all hazard disaster. The
Department of VA is the second largest Federal Agency with nearly
300,000 employees. The Department provides emergency support in regards
to mass care and several emergency functions in support of the National
Response Frame Work. In addition, as a TIER II agency the Department
must be ready to respond to All Hazard Events including the Continuity
of Government. The Department of VA would not be able to perform its'
Primary Mission Essential functions effectively during a crisis if the
VA IOC is not successfully established.
The VA IOC will be the nucleus for information gathering.
Nontraditional collectors such as public safety entities and private
sector organizations possess important information (e.g., risk
assessments and suspicious activity reports) that can be ``fused'' with
law enforcement data to provide meaningful information and intelligence
about threats and criminal activity. It is recommended that the fusion
of public safety and the private sector information with law
enforcement data be electronic through networking and utilizing a
search function. Examples of the types of information incorporated into
these processes are threat assessments and information related to
public safety, law enforcement, public health, social services, and
public works. Federal data that contains personally identifiable
information should not be combined with this data until a threat,
criminal predicated, or public safety need has been identified. The Ops
Center normally (routine, non-crisis basis) hosts 8-12 VA staff, mostly
24x7. During a crisis, there will be a total of 20-30 staff, not
including additional Principals. VA Office of Information and
Technology will provide the necessary IT equipment for the operation of
this command center with desktops, laptops, blackberries, audio visual
monitors and network support.
preventive care program
Description: To accommodate the expectations of our newest
generation of Veterans and their families, VA will need to expand
health promotion and wellness services tailored to their specific
needs. Such services are primarily delivered through health coaches to
provide activation, support, and on-going contact, including serving as
a referral liaison to community health resources that support healthy
behaviors. Such services are oriented to the person as a whole, rather
than targeting these changes for management of a specific disease,
which has been the traditional focus of most lifestyle or self-
management programs. These programs have the opportunity to be aligned
with the Veteran-centered medical home model. This program will
establish the infrastructure, policies, and procedures to implement
comprehensive health promotion and wellness programs within VA.
MyHealtheVet (MHV) is a nationwide initiative intended to improve
the overall health of all Veterans. It provides an eHealth portal, a
secure environment where Veterans can view and manage their Personal
Health Record (PHR), as well as access their health information, health
assessments, and electronic services. On-line health resources will
enable and encourage patient/provider collaboration, as clinicians will
be able to communicate with Veterans more easily. The on-line
environment will complement existing VA clinical business practices,
and transform the way healthcare is delivered and managed.
Veterans will be able to view key portions of their VA electronic
health record and store it in a secure, personalized eVault. They will
be able to delegate viewing and managing all or part of the information
in their accounts to healthcare providers, both inside and outside VA,
as well as to family members or others of their choosing. MHV also
provides a secure eHealth portal where Veterans can view and manage
their PHRs and access their health information (treatment locations,
health insurance information, military health history, medications
(e.g., prescription and over-the-counter), allergies, tests, medical
events, immunizations, etc.), health assessments, and electronic
services. MHV provides them the ability to access care that is better
tailored to their specific individual needs, especially in the area of
preventive healthcare services. MHV has the potential to dramatically
improve the quality and outcome of care available to our Nation's
Veterans through increased access, information, education, co-
management and advocacy.
Benefit to the Veteran: Veterans will be better served through an
interactive health risk assessment as a starting point for assessing
individual patient strength and opportunities with respect to general
health, comprehensive health promotion and wellness services with the
structure and support to make healthy lifestyle choices that will
improve their overall health.
Benefit to the VA Organization: The goal is to conduct clinical
demonstration projects at 10-15 sites to establish optimized structure,
policies, and processes before national dissemination. As the Health
Promotion and Wellness needs of Veterans continue to expand and be
standardized, increased access and increasing awareness are criteria
for success.
readjustment counseling for women
Description: There are currently over 1.8 million Women Veterans in
the US, and approximately 270,000 of these used VA healthcare in 2008.
Women comprise the fastest growing cohort of Veterans utilizing VA
health care services. Over 400,000 women have been deployed to recent
conflicts and the overall number of women, as well as their
proportional representation, is increasing in both the military and
Veteran populations. The number of women serving in combat zones is
increasing significantly and there is a greater need for personal,
confidential services to treat these Veterans. This initiative also
reviews and modifies, as needed, readjustment counseling for women
Veterans at Vet Centers to ensure sufficient scope and intensity of
specialized services that help women experiencing trauma from combat
situations, reporting military sexual trauma, and contemplating
suicide.
Women Veterans entering the VA system are younger and have health
needs distinct from their male counterparts. Women Veterans have higher
physical and mental health burdens than their female civilian
counterparts and health burdens comparable to or worse than that of
male Veterans. Women have substantial chronic disease and mental health
burdens with higher rates of mental health diagnoses when compared to
men.
This shift in demographics has presented a challenge to VA. The
provision of routine primary care to Women Veterans is fragmented
across multiple providers and sites of care, resulting in uncoordinated
and underutilized VA healthcare services compared to men. The current
delivery model for Women Veterans is fragmented, requiring multiple
appointments with different providers to receive basic annual health
services.
Transformation of the delivery of women's health care as it
comprehensively prepares for high quality continuum of care delivery to
eligible women Veterans will become the delivery model for national
benchmarking.
This new definition and redesign of comprehensive women's health
delivery places a strong emphasis on Comprehensive Primary Care Clinic
Models: 1) achievement of Comprehensive Primary Care for Women Veterans
within General Primary Care Clinics, 2) Comprehensive Primary Care for
Women Veterans in Separate but Shared Space, and 3) Comprehensive
Primary Care for Women Veterans in a Women's Health Center. The
redesign is in line with the care platform concept addressed in the
Universal Services Task Force Report of April 2009, which focuses on
improved coordination of care for Women Veterans, continuity, and
patient-centeredness.
Benefit to the Veteran: High-Quality Continuum of Health Care for
Women Veterans can be achieved through defined actions which ensure
that every Woman Veteran has access to a VA primary care provider who
can meet all of her primary care needs, including gender-specific and
mental health care, in the context of a continuous patient-clinician
relationship. Veteran-centered treatment plans and self management,
create a safe and secure environment that assures privacy and dignity.
Fully implemented comprehensive primary care for Women Veterans
will significantly improve as a result of eliminating and reducing
fragmented primary care, raising the proficiency of providers,
implementing state-of-the art technology, and creating an
infrastructure that is constructed and equipped based on specialized
needs.
Improvements in gender quality can be achieved by increasing the
number of women Veteran counselors at RCS/Vet Centers and providing a
range of emergency, acute, and chronic healthcare services, sun-
specialty care, tele-health/telemental health, and medical and IT
equipment needed by women.
Benefit to the VA Organization: Decreased fragmentation of
comprehensive primary health care for women will lead to increased
women Veteran satisfaction with clinical care and is critical to build
a cadre of interested and proficient women's health providers.
safety and security initiative (piv for hspd 12)
Description: Homeland Security Presidential Directive-12 (HSPD-12)
mandated a ``Policy for a Common Identification Standard for Federal
Employees and Contractors'', secure and reliable identification issued
by Federal agencies for their employees and contractors. The VA PIV
program is to establish an enterprise standards-based authentication
and authorization infrastructure framework to support secure and
seamless transmission of business transactions and information through
the use of smart card technology and Public Key Infrastructure (PKI).
PIV addresses the expanded E-Government PMA through the use of an
electronic credential (identity) used for identification such as PKI
for digital signing, E-Authentication, and physical and logical access
through the use of various factors such as PINS, biometrics, and PKI.
PIV deployment will complete in July 2010. The expenses outlined in
this IT Activity Resource Proposal (ITARP) are for operation and
maintenance (O&M) through 2014 to include contract support for Verizon
card management (PKI certificates) infrastructure and enhancements,
software licensing and maintenance for CA tools and card management
solution (CMS). Technology refresh covers workstations, printer,
biometric readers, cameras and central server systems (production and
DR).
The Safety and Security Initiative supports improvements needed in
the quality and safety of VA health care by providing more transparency
in the health care provided to Veterans. By the use of external
dashboards and new quality metrics, VA will readily identify targets
for improving quality within facilities, VISNs and nationally. This
initiative aligns with VA Strategies to improve and integrate services
across the Department in addition to increasing reliability, speed, and
accuracy of delivering services. This initiative will provide Veterans
and their families with integrated access to the most appropriate
services from VA and our partners. The Safety and Security Initiative
will provide clear, accurate, consistent, and sensitive messages to
build awareness of VA's benefits among our employees, Veterans and
their families, and other stakeholders.
Benefit to the Veteran: The compliance of agencies with Homeland
Security Presidential Directive 12 and the FIPS-201 standard ensures
interoperability across the Federal Government.
Benefit to the VA Organization: As outlined in M-05-24 memorandum
from OMB, PIV protects access to information by providing ``Secure and
reliable forms of identification for purposes of this directive means
identification that (a) is issued based on sound criteria for verifying
an individual employee's identity; (b) is strongly resistant to
identity fraud, tampering, counterfeiting, and terrorist exploitation;
(c) can be rapidly authenticated electronically; and (d) is issued only
by providers whose reliability has been established by an official
accreditation process.''
Cost avoidance includes the costs of each facility to develop and
maintain an independent infrastructure for controlling logical and
physical access. These costs are replaced by the ROI benefits of an
enterprise standard for credentialing, identification, background
investigation, and controlling access to both logical and physical
Federal property.
sterile processing & distribution (spd) scope action plan
Description: The Sterile Processing and Distribution (SPD) Scope
Action Plan initiative will ensure that SPD functions consistently meet
the standards and documentation required for high reliability systems.
This plan promotes a well-controlled SPD process allowing consistent
performance--day to day, facility to facility, and employee to
employee. All biomedical procedures must be performed to exacting
standards to ensure that sterile processing and distribution of VA
medical equipment consistently meets the highest standards and most
thorough documentation. This initiative ensures that such standards are
met and creates a highly controlled environment with uniform practices
for reprocessing across our medical facilities.
Objective: The objective of the SPD Scope Action Plan is to create
a highly controlled environment with uniform practices for
reprocessing. Exacting standards to perform all biomedical procedures
will include: highly controlled workflow processes, meticulous
documentation including document change control tracking and
verification, education, training and competency management, quality
management systems and functional preventive and corrective action
systems.
Benefit to the Veteran: Implementation of the Sterile Processing
and Distribution Scope Action Plan will provide strict adherence to new
systems and a carefully documented decrease in incidents resulting from
sub-standard reprocessing. Veterans will directly benefit from highly
trained and qualified employees performing reprocessing.
Benefit to the VA Organization: Veterans Affairs will benefit from
the Sterile Processing and Distribution (SPD) Scope Action Plan
initiative through the implementation of a VHA system-wide standardized
software solution that ensures regulatory compliance, quality
assurance, improvement efficiency/effectiveness, and risk mitigation
for all SPD processes. SPD ensures good manufacturing processes are in
place and that they support/sustain an organizational migration toward
ISO 9001 certification for the SPD enterprise at all facilities.
strategic human capital investment plan
Description: The Strategic Human Capital Investment Plan (HCIP)
initiative will cultivate a 21st Century Workforce to serve our
nations' Veterans by creating and deploying learning systems to support
employees' development and training and their workforce and succession
planning. HCIP will provide high-quality service to Veterans by
recruiting, hiring, developing, and retaining the best employees. VA's
workforce includes nearly 300,000 employees, volunteers, and
contractors. Investing in them is to invest in our mission. To serve
our Veterans, this workforce needs to have the skills and tools
necessary to meet Veterans' needs today and in the future. This VA-wide
initiative helps to offer the highest quality in medical care,
benefits, and memorial services by creating a talent pool of trained,
certified, and inspired employees to ensure high-level care and
services. VA will develop training needs assessments, recruitment
programs, certification programs, leadership assessments, and on-line
training platforms.
Objective: The objective of the Human Capital Investment Plan is to
create the talent pool of trained, certified, and inspired employees
necessary to ensure the high-level of care and services to Veterans and
their families.
Benefit to the Veteran: VA's workforce must have the skills and
tools necessary to serve those who have served our Nation. The Human
Capital Investment Plan will increase VA's capacity to better serve
Veterans and their families by offering the highest quality in medical
care, benefits, and memorial services.
Benefit to the VA Organization: The benefits to VA of the Strategic
Human Capital Investment Plan are numerous and include improved
internal and external customer satisfaction; increased scores on three
key indicators (leadership, performance, and tools to do job well) on
the ``Best Places to Work'' survey; increased employee technical
proficiency and; increased applicant pool desiring employment in
mission critical positions.
transformed construction facility management
Description: VA Facility Management Transformation initiative
involves the establishment of an enterprise method for managing VA
Facilities. The enterprise system will address life cycle costing;
recapitalization; sustainment; acquisition of facilities and real
property and disposal of VA real property. The transformation will
integrate the minor and major construction programs for each
administration with the sustainment effort to allow VA to assure
dollars are allocated strategically to the most critical areas. The
initiative will also address facility funding required to effectively
manage life cycle cost.
The initiative includes a corporate system of policies and
processes and a decentralized approach to project execution. The
selection of software tools to facilitate the transformation is a
critical element.
The benefit to the VA is effective management of resources. These
resources are allocated to advance VA's strategic goals and effective
life cycle management of facilities. The benefit to the Veteran is the
right facilities in the right locations to deliver the health care
needed.
Benefit to the VA Organization: Under this structure, VA will
integrate facilities management functions to maximize life-cycle
performance. This will include a corporate system of policies and
processes and a decentralized approach to project execution. This
approach will help VA achieve the following:
1. Effectively Meet Facilities Needs (Current and Future)
Locate facilities to best support service delivery
Provide highly functional facilities
Provide highly adaptable facilities
Support ``new mission'' requirements
2. Effectively Manage Existing Facility Assets
Right Size facility footprint
Recapitalize overage infrastructure
Eliminate life-safety deficiencies
Sustain existing infrastructure
Programmatic investment to meet requirements
3. Reduce Cost
Minimize life-cycle cost
Minimize energy consumption
Business case for own vs. lease
transport for immobilized and remote va patients
Description: Those Veterans who are visually impaired, elderly, or
immobilized due to disease or disability--particularly those living in
remote and rural areas--may have limited ability to travel to receive
health care. This initiative will provide transportation to immobilized
and remote Veterans to facilitate access to health care using a range
of transportation opportunities including contracts, joint ventures
and/or partnerships with local communities.
va point of service (kiosks)
Description: The Kiosks System has automated the patient check-in
process. The system allows a patient to self-check in for appointments
by using his or Veteran Identification Card and touch screen input at a
kiosk. The veteran answers a series of prompts regarding next of kin,
date of birth, and insurance carrier. If the information is correct,
the patient merely responds by pressing ``yes'' and a printout with the
name, location, and time of the patient's clinic appointment for that
day is printed. This initiative will enable Veterans to take care of
important administrative activities when visiting a VA facility. To
achieve this, a system of Self-Service Kiosks will interface with VistA
and other national VA systems to help manage patient flow, provide
patient education, and capture vitals and patient administrative
information. This system will empower Veterans with greater access to
their information, their medical records, and scheduling data.
Objective: By using the Kiosks System, VA will implement a
standard, efficient method for performing streamlined check-in. The
system will improve accuracy of VA insurance, demographics and patient
information (medications, allergies). The Kiosks will reduce VA staff's
efforts performing administrative functions, and reliance on collecting
patient information. Veterans will have a simpler, faster access to
their electronic health records and take care of other VA business at
the same time. VA plans to install simple, user-friendly automated
kiosks--similar to ATMs--at all VA health-care facilities. This will
reduce lines--unless you get behind a slow reader--and increase
privacy.
Benefit to the Veteran: This investment improves the direct
delivery of quality health care by providing a secure, reliable mode of
veteran self service at all medical facilities. A standard product will
improve the veterans' ability to manage his/her own appointment related
information including demographic, insurance, appointment specific
medical questionnaires, and related information. Improved data quality
will also positively affect the billing and collection figures by
identifying insurance and patient billing information.
va tele-health and home care model
Description: VA Tele-health and Home Care Model initiative will use
technology to remove barriers to Veterans and increase access to and
use of VA services. This initiative will enable VA to become a national
leader in transforming primary care services to a medical home model of
health care delivery that improves patient satisfaction, clinical
quality, safety and efficiencies. This initiative will help Veterans
gain better access to and use of VA services by enhancing the ability
to deliver care in the Veteran's home. The goal of VA's Tele-health and
Home Care Model is to achieve increased Veteran satisfaction with
clinical care, reduce the need for hospitalizations by patients with
chronic disease, and increase Veteran contact with VA through
electronic measure and other communications tools.
VA Tele-health and Home Care Model will develop a new generation
communication tools (i.e. social networking, micro-blogging, text
messaging, and self management groups) that can be used to disseminate
and collect information related to health, benefits and other VA
services. An extensive expansion of the OneVA Enterprise network is
necessary to provide adequate infrastructure and capabilities for the
ever-growing communication and collaboration needs supporting VA
veteran-facing functions. This project supports improved access for
veterans for a greater variety of VA services from formerly single-
purpose VA offices and from remote, rural, home locations. The enhanced
telecommunications infrastructure will improve home health care
delivery for real-time vital statistics monitoring and other purposes,
provide rapid access to emergency or critical information and services,
enable real-time medical data flow and video consultations, and improve
data exchange with the Department of Defense (DOD) and other agencies
through the Federal Health Information Exchange (FHIE). Veteran Service
Center connectivity is also enhanced through this effort.
The technology developed or expanded with this initiative will
increase Veteran connectivity with VA, improve satisfaction, increase
clinical quality, promote efficiency and provide tools for 21st century
primary care. The VA Tele-health and Home Care Model will provide a
clinic team supporting the Veteran.
It is a virtual medical home model that deploys secure messaging
within My HealtheVet to empower Veterans with the ability to
communicate with their VA health care providers and staff for non-
urgent and administrative needs.
This initiative will increase current home monitoring of chronic
disease programs through increased investment in tele-health. Online
interactive health assessments and other resources will be provided to
Veterans which will enable them to receive personalized information and
recommendations on health promotion and disease prevention services.
Use of simulation training will increase in order to expand and promote
provider expertise for critical services. The virtual home care model
will optimize primary health care delivery systems by fully integrating
VHA and community resources to enhance the focus on the Veteran. It
will provide IT support for primary care tools including ability to
analyze patient panels, robust collection and use of quality and safety
data in decisionmaking. Purchased care guidelines will change to allow
the medical home team to refer Veterans outside of VA to anywhere in
the country, if the analysis shows better outcomes in the private
sector and also provide the means to access, analyze, and track that
care.
Benefit to the Veteran: The goals of this project are directly
related to providing services to veterans: 7,500 home-serviced patients
utilizing real-time encrypted, secure G3 video technology and data
transport by 2011, 68,000 patients with active home monitoring using
traditional analog phone service by FY 2011, 150,000 patient encounters
for remote tele-health between medical centers and their associated
community based outpatient clinics (CBOCs) by FY 2011, and 30,000
patient encounters using non-VA consultative services through secure
remote video telecommunications by FY 2011. VA Tele-health and Home
Care Model supports the development of new generation communication
tools to empower veterans with the ability to communicate with their VA
health care providers and staff for non-urgent and administrative needs
through electronic measures (texts, web traffic, etc.) This initiative
will have the capabilities to provide online health assessments,
simulation training, and primary care tools to assess, analyze and
track patient care.
Benefit to the VA Organization: VA Tele-health and Home Care Model
directly supports the mission by enhancing access to and quality of
health care for veterans and improving data exchange capability between
VA, DOD, and other Federal agencies. It will improve the efficiency and
quality of remote communications with veterans. It will improve and
integrate services across VA which will increase reliability, speed,
and accuracy in delivering healthcare services. This initiative will
use clear, accurate, consistent, and sensitive messages to build
awareness of VA's benefits among our employees, Veterans and their
families, and other VA stakeholders.
veteran centered care model
Description: The Veteran Centered Care Model will improve health
outcomes and the care experience for Veterans and their families. The
model will standardize health care policies, practices and
infrastructure to consistently prioritize Veterans' health care over
any other factor without increasing cost or adversely affecting the
quality of care. Veteran-Centered Care delivers better health outcomes
through a fully engaged partnership between Veteran, family, and health
care team, established through healing relationships and provided in
optimal healing environments.
In 2010, VA will establish the programmatic standards, operational
policies, and other support services and materials to implement the
Veteran Centered Care Model.
Objective: The Veteran Centered Care Model will help VA accomplish
the following strategic business objectives:
Programmatic standards, operational policies, and other
support services/materials to roll out the Veteran Centered Care model.
Pilot field-based Centers that will serve as expert
consultants in Veteran Centered Care to local facilities, assist in
ongoing training, and scientifically evaluate patient outcomes and
effectiveness in an effort to determine best practices. These centers
will systematically evaluate and implement patient preferences (e.g.,
evening and weekend clinics).
National Clinical Inventory that details services
availability at each care delivery site and use it to standardize
infrastructure requirements and services.
Customized handbook/web information which is
individualized and tailored for each Veteran.
Benefit to the Veteran: Deploy a patient centered care model called
Veteran Centered Care, based on best practices in private sector health
care, which will result in a fully engaged partnership between veteran,
family, and health care team, established through healing relationships
and provided in optimal healing environments.
veteran innovation initiative
Description: The purpose of the Veteran Innovation Initiative (VII)
is to improve support of VA's core business processes with IT platforms
that are coherent, cohesive, and cost-effective. VII is designed to
create a transferable process to ensure a steady pipeline of new
innovations (including organic initiatives) by creating management
mechanisms that incentivize and support forward leaning service
delivery and by establishing and supporting an innovation investment
fund.
Objective: The objectives of the Veteran Innovation Initiative are
timely identification of Web-based resources that will improve
productivity and reliability, rapid evaluation to determine
applicability, rapid evaluation to determine use-models, rapid
determination of business case and return on investment (ROI), and
tighter integration of more flexible production platforms.
Benefit to the Veteran: In order to provide better service at lower
cost, VA must be able to surface, qualify, and invest in promising
information and technology (IT) based process innovations. VII aligns
with the strategic mission of OI&T to better meet the Secretary's
vision of ``veteran-centered'' services.
Benefit to the VA Organization: From strategic planning to project
management, and from remote configuration to social networking, there
are a host of new IT support tools--many very inexpensive or free--that
when properly implemented can have a tremendous impact on IT
infrastructure availability and reliability, project visibility and
scale, and workforce productivity and effectiveness. VII will
substantially improve up-time, security, and accessibility of core IT
functions. Additionally, it will create platforms for VA employees that
provide easy-to-use self-service and self-care.
veteran relationship management program
Description: The Veterans Relationship Management Program (VRM)
will provide the capabilities required to achieve on-demand access to
comprehensive VA services and benefits in a consistent, user-centric
manner to enhance Veterans, their families, and their agents' self-
service experience through a multi-channel customer relationship
management approach. This transforming initiative is designed to
improve the speed, accuracy, and efficiency in which information is
exchanged between Veterans and the VA, regardless of the communications
method (phone, web, email, social media). This focus will include
modernization of voice telephony, unification of public contact
representative desktops, implementation of Identity and Access
Management (IAM), development of cross VA knowledge management systems,
implementation of customer relationship management systems (CRM), and
integrating self-service capabilities with multiple communication
channels.
The VRM initiative is led by VBA's Director, Office of Facilities,
Access, and Administration, who shares business sponsor
responsibilities with VHA's Deputy Chief Business Officer for Member
Services, NCA's Associate Director, Office of Field Programs, OI&T's
Assistant Deputy CIO for Program Management, Office of Enterprise
Development, Board of Veterans' Appeals, and VBA's Executive Management
Officer, Office of Policy and Program Management.
The VRM initiative is a multi-year effort that will provide the
full range of services and benefits by June 2014, with initial
capabilities being delivered in FY 2010. These initial FY 2010
capabilities include:
Expansion of web-based self-service capabilities for
veterans through the eBenefits portal. There are multiple releases
planned for FY 10 to enhance personalized access to benefits
information. Access will be provided for information maintained by VA
and DOD, including access to VA benefit claims for housing,
compensation, and pension. In addition, single-sign-on for My
HealtheVet users will be enabled, and veterans will have self-service
capability to update mailing and payment addresses. In addition,
capabilities will be put in place to enhance outreach (for example,
notifications to states as servicemembers separate from active duty).
Implementation of telephony enhancements to the contact
call centers. This will include changing providers to deliver higher
quality service and adding capabilities to transfer calls. Call
recording, national queue, and Health Resource Center phase 1
capabilities will be incrementally rolled out beginning in September
2010 through December 2010.
Initiation of common identity management services. VA will
adopt common identity-management patterns (to include person identity
management) and begin to incorporate that common identity with
standardized authentication and authorization capabilities so that
access to sensitive information is consistently controlled throughout
the enterprise. VA will establish a VA/DOD correlation framework where
VA and DOD can link Veterans and beneficiaries with enterprise
identifiers, providing seamless coordination of services from accession
through all stages of life. VA will allow Veterans and beneficiaries to
access VA applications using DOD-issued credentials, and support
integration efforts between VA and DOD for a common identity and access
management framework (pilot North Chicago, Nationwide Health
Information Network, and eBenefits). A framework will be established
for development of a pilot to expand the eBenefits in-person proofing
process to VHA and VBA.
The VRM Program will help VA accomplish the following strategic
business objectives:
Improve VA's ability to successfully resolve Veterans and
beneficiaries' issues on the first call.
Streamline and improve internal business processes in
order to provide high quality experiences for Veterans and their
beneficiaries.
Improve transparency and provide seamless support across
all touch points.
Improve consistency and quality across all Veteran
interfaces through the sharing of knowledge.
Become more veteran-focused and information-centric by
providing a single 360 view of the Veteran to all stakeholders.
Ensure that Veterans and beneficiaries have access to
timely, accurate, and consistent information on benefits and services.
Improve ability to measure service quality.
VA will use an iterative approach and a phased implementation to
integrate the capabilities that will leverage all the initiatives in
the VRM Program. The iterative framework of the VRM Program assumes
that Phase 1 will be complete at the end of fiscal year 2010, Phase 2
will be complete at the end of fiscal year 2011, and Phase 3 will be
complete at the end of fiscal year 2012. The focus of the 2013 and 2014
fiscal years will be to fine tune and maintain the VRM Program.
This program will leverage numerous principals and subject
matter experts from programs within VA to include joint initiatives
between the Veterans Benefits Administration (VBA), Veterans Health
Administration (VHA), National Cemetery Administration (NCA), Board of
Veterans Appeal (BVA), and the Department of Defense (DOD). The
initiatives include Customer Relationship Management, Voice Access
Modernization, Knowledge Management, Unified Desktop, and Veteran and
Beneficiary Self-Service.
Contributions from outside the agency include initiatives
that will continue to leverage joint programs conducted with DOD under
the auspices of the Joint Executive Council and the Benefits Executive
Council.
A multi-organizational VRM governance strategy and
management structure will need to be established. Once established,
oversight will be conducted by internal chains of command within each
business line, and elevated to committees established by the multi-
organizational governance strategy, to include the Joint Executive
Council and the Benefits Executive Council.
Benefit to the Veteran: It will provide veterans, their families
and agents with greater awareness of the full range of VA programs and
direct, easy access to those programs through an efficient, effective
and responsive multi-channel program.
It will expand opportunities for VA client self-service. This
initiative will achieve significant cost efficiencies across benefit
programs. It will provide significant improvement in timely, efficient
and effective service delivery and improved delivery of benefits across
the VA enterprise. In addition to providing Veterans with accurate,
complete, and consistent answers to VA program questions.
Benefit to the VA Organization: The VRM Plan will transform VA into
a forward-looking, 21st century organization focused on meeting
emerging needs that will change the way VA accomplishes its mission.
Implementing VRM will result lower costs by eliminating unnecessary
data entry while enhancing the delivery of services by reducing errors
in both health care and benefits delivery. Further, it will streamline
the ``reuse'' and usability of data to lessen the burden on VA
employees and veterans.
VBA, NCA and VHA will effectively integrate their major contact
centers, allowing for a Veteran's call to be received at one center and
to be seamlessly resolved at another center without requiring the
Veteran to call another number and without losing the context of the
Veteran's issue. VA envisions a framework that provides Veterans with
the ability to: