[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FISCAL YEAR 2012
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
FIRST SESSION
__________
FEBRUARY 17, 2011
__________
Serial No. 112-2
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
GUS M. BILIRAKIS, Florida BOB FILNER, California, Ranking
CLIFF STEARNS, Florida CORRINE BROWN, Florida
DOUG LAMBORN, Colorado SILVESTRE REYES, Texas
DAVID P. ROE, Tennessee MICHAEL H. MICHAUD, Maine
DAN BENISHEK, Michigan LINDA T. SANCHEZ, California
ANN MARIE BUERKLE, New York BRUCE L. BRALEY, Iowa
JEFF DENHAM, California JERRY McNERNEY, California
BILL FLORES, Texas JOE DONNELLY, Indiana
TIM HUELSKAMP, Kansas TIMOTHY J. WALZ, Minnesota
BILL JOHNSON, Ohio JOHN BARROW, Georgia
JON RUNYAN, New Jersey RUSS CARNAHAN, Missouri
MARLIN A. STUTZMAN, Indiana
Vacancy
Vacancy
Helen W. Tolar, Staff Director and Chief Counsel
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
February 17, 2011
Page
U.S. Department of Veterans Affairs Budget Request for Fiscal
Year 2012...................................................... 1
OPENING STATEMENTS
Chairman Jeff Miller............................................. 1
Prepared statement of Chairman Miller........................ 52
Hon. Bob Filner, Ranking Democratic Member....................... 3
Prepared statement of Congressman Filner..................... 53
Hon. Doug Lamborn................................................ 4
Hon. Michael H. Michaud.......................................... 5
Hon. Dan Benishek................................................ 5
Hon. Bruce L. Braley............................................. 6
Hon. Ann Marie Buerkle........................................... 6
Prepared statement of Congresswoman Buerkle.................. 53
Hon. Jerry McNerney.............................................. 6
Hon. Jeff Denham................................................. 7
Hon. Silvestre Reyes, prepared statement......................... 54
WITNESSES
U.S. Department of Veterans Affairs, Hon. Eric K. Shinseki,
Secretary...................................................... 8
Prepared statement of Secretary Shinseki..................... 54
______
American Veterans (AMVETS), Christina M. Roof, National Acting
Legislative Director........................................... 41
Prepared statement of Ms. Roof............................... 86
American Legion, Timothy M. Tetz, Director, National Legislative
Commission..................................................... 42
Prepared statement of Mr. Tetz............................... 92
Disabled American Veterans, Joseph A. Violante, National
Legislative Director........................................... 40
Prepared statement of Mr. Violante........................... 79
Paralyzed Veterans of America, Carl Blake, National Legislative
Director....................................................... 36
Prepared statement of Mr. Blake.............................. 64
Veterans of Foreign Wars of the United States, Raymond C. Kelley,
Director, National Legislative Service......................... 38
Prepared statement of Mr. Kelley............................. 67
MATERIAL SUBMITTED FOR THE RECORD
Background Material:
U.S. Court of Appeals for Veterans Claims, FY 2012 Budget
Estimate..................................................... 96
Pre-Hearing Questions and Responses for the Record:
Pre-Hearing Budget Questions, Honorable Jeff Miller, Chairman,
U.S. Department of Veterans Affairs Budget Request for Fiscal
Year 2012.................................................... 109
Post-Hearing Questions and Responses for the Record:
Hon. Jeff Miller, Chairman, Committee on Veterans' Affairs to
Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans
Affairs, letter dated March 16, 2011, also forwarding
questions from Hon. Jeff Denham, Hon. Bill Flores, and Hon.
Jon Runyan, and VA responses................................. 121
Hon. Bob Filner, Ranking Democratic Member, Committee on
Veterans' Affairs to Hon. Eric K. Shinseki, Secretary, U.S.
Department of Veterans Affairs, letter dated March 7, 2011,
and VA responses............................................. 160
Hon. Bob Filner, Ranking Democratic Member, Committee on
Veterans' Affairs to Carl Blake, National Legislative
Director, Paralyzed Veterans of America, Raymond C. Kelley,
Director, National Legislative Service, Veterans of Foreign
Wars of the United States, Joseph A. Violante, National
Legislative Director, Disabled American Veterans, and
Christina M. Roof, National Acting Legislative Director,
AMVETS, letter dated March 7, 2011, and Response from the
Members of The Independent Budget, letter dated April 7, 2011 169
Hon. Bob Filner, Ranking Democratic Member, Committee on
Veterans' Affairs to Tim Tetz, Director, National Legislative
Commission, American Legion, letter dated March 7, 2011, and
response letter dated April 11, 2011......................... 172
U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FISCAL YEAR 2012
----------
WEDNESDAY, FEBRUARY 17, 2011
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10:03 a.m., in
Room 334, Cannon House Office Building, Hon. Jeff Miller
[Chairman of the Committee] presiding.
Present: Representatives Miller, Bilirakis, Lamborn, Roe,
Benishek, Buerkle, Denham, Flores, Huelskamp, Johnson, Runyan,
Stutzman, Filner, Reyes, Michaud, Braley, McNerney, Donnelly,
Walz, Barrow, and Carnahan.
OPENING STATEMENT OF CHAIRMAN MILLER
The Chairman. And I now turn the Committee's attention to
today's scheduled budget hearing. Thank you very much.
As the Secretary and his folks make their way forward, I
would like to add that we do have votes that are going to be
called within the next few minutes. I apologize for that. We
were hoping that we would be able to get the bulk of this
meeting done without the interruption. But in order to get our
business done, we need to have early votes today.
So I would ask folks when they do their opening statements
this morning to please bear that in mind so that we can get to
the Secretary for his opening statement, his testimony, and
also for us to have the opportunity to ask questions.
Mr. Secretary, thank you so much for being here today,
bringing your team to present the President's 2012 Budget for
the Department.
I also recognize all the veterans service organizations
(VSOs) that are represented here today and we look forward to
working with each of the VSOs very closely and the U.S.
Department of Veterans Affairs (VA) as we all work to improve
the delivery of benefits and health care to those who have been
in service to our country.
Everybody knows this is a tighter budget year and it is
going to be very difficult to measure because right now we do
not have a full appropriations for every VA account for the
current fiscal year.
That being said, if the numbers in the House Continuing
Resolution (CR) bill are carried forward, the President's
budget is roughly a three and a half percent increase in
discretionary spending relative to the current spending,
needless to say, this is a much more measured increase.
I think what is important for us to all remember is it is
not necessarily the percentage of the increase, but it is, in
fact, whether we are meeting our obligations to American
veterans and to the taxpayers of this country. And to that end,
I have a couple of observations that I just want to bring
forward.
First, I am interested in learning how this budget will
chart a path to address the broken disability claims system.
Staffing compensation since the late 1990s has tripled.
Numerous information technology (IT) tools have been utilized.
There have been different organizational models attempted and
nothing has appeared to work. And so I want to know what this
budget will do in taking a new approach to meeting this
challenge.
Second, I am interested, as you and I have already
discussed, Mr. Secretary, how this budget is prioritized to
meet the needs of the family caregivers of the severely wounded
Iraq and Afghanistan veterans. The reaction to the initial
plan, as most of us have seen, has been negative. And I want to
explore ways we might be able to refocus resources for this
important, very important initiative.
Third, I want to know what energy went into eliminating
wasteful, redundant spending. The bipartisan Deficit Reduction
Commission suggested that every agency, VA included, step up to
the plate to meet the challenges of eliminating wasteful and
redundant spending.
Mr. Secretary, I have to say when I look at this budget and
I see that it proposes a funding level for the Office of the
Secretary that is 41 percent higher than 2009 levels, 50
percent higher for the Office of Congressional and Legislative
Affairs, 96 percent higher for the Office of Policy and
Planning, and 140 percent higher for the Office of Public and
Intergovernmental Affairs, it does raise questions and red
flags.
Also, there is some curious budgeting mechanisms that have
been requested and put in place, the contingency fund that is
in there is one. I want to know how Congress can appropriate
money for this contingency fund how exactly it will be used.
Also, the budget proposes that we appropriate money that
you can save through management efficiencies so that it can
carry that money forward into another fiscal year. These are
new concepts and I think each Committee Member is anxious to
get details on those.
Look, we are acutely aware of the fiscal and economic
crisis that this country faces, a debt of $14 trillion, a
deficit this year of $1.55 trillion, and unemployment hovering
at just under 10 percent on the average and with veterans, a
higher number than that. We have work to do. Together we have
work to do.
I want to borrow a quote from recent history because it
touches on the challenges that we face in finding a balance
between meeting our obligations to veterans and keeping in mind
fiscal limitations. ``The Committee Members have kept in mind
the fiscal limitations within which we must operate if we are
to get Federal spending under control and thereby reduce the
Federal deficit and debt. We believe that the government can be
fiscally responsible while still fulfilling its commitments to
the most deserving among us, including our Nation's veterans.
We are also mindful that uncontrolled Federal spending
threatens the long-term health of the Nation's economy and in
turn could adversely affect the provision of veterans'
benefits. Thus, we recognize those who have worn the uniform in
defense of the Nation seek, as we do, to protect the health of
the Nation's economy.''
You might think that comes from a tea party group. It
really does not. This was a letter that was sent in 1997 signed
by every Member of the Senate Veterans' Affairs Committee both
Democrat and Republican, including the current Chairman of the
Senate Veterans' Affairs Committee. Times are different. The
deficit then was $128 billion. Now it is 10 times higher.
Moving forward, I think that every one of us can work
together to find common ground on difficult choices that are
ahead.
I would like to turn the microphone now over to the Ranking
Member, Mr. Filner.
[The prepared statement of Chairman Miller appears on p.
52.]
OPENING STATEMENT OF HON. BOB FILNER
Mr. Filner. Thank you, Mr. Chairman.
If I may spend 2 minutes on something we did last week
because I think you and this Committee ought to be
congratulated.
I have been in politics for over 30 years and I have never
seen such a quick and profound reaction to a hearing than we
had from JPMorgan Chase. We had a hearing that you called, Mr.
Chairman, on some of the actions taken by JPMorgan Chase that
were adverse to both the law and to the interest of our
fighting troops.
They responded within a few days. They have lowered their
interest rate below what is required by law. They made all
active duty eligible even though they did not have a loan
before they were on active duty. If they foreclosed on people
improperly, they are giving the homes debt free, I mean, no
payments to the servicemembers. They formed a Veterans Advisory
Council. They are hiring veterans. They are making a thousand
homes available over the next few years to our veterans.
The hearing was incredible. I appreciate what you have
done, and I think we have helped a lot of servicemembers and
made their lives more secure. So thank you, Mr. Chairman. It
was an incredible response to a hearing.
Secretary Shinseki, thank you for being here. I do
associate myself with the remarks of the Chairman. I am also
looking forward to our Independent Budget panel. But, you know,
Mr. Secretary, like the Chairman, I have questions regarding
some of your assumptions and estimates. But if you tell me and
tell this Committee that this is what you need to get the job
done in this fiscal year, then I am going to offer you, and I
hope we all do, our support and fight to get the funding levels
that you say you need.
Like the Chairman, I have concerns about the contingency
fund, the operational improvements that are built in there and
whether they will work. But the bottom line is that we have to
work with you to assure that all our veterans get the care they
need.
I am looking forward to The Independent Budget, also. Many
of you know that for years, I have been waving this around as
my Bible and we will continue to take what they have said very
seriously. I hope you will be here to also hear that, Mr.
Secretary. We look forward to your testimony.
I think we are having votes and probably we will come back
afterward. It is up to you, Mr. Chairman.
[The prepared statement of Congressman Filner appears on
p. 53.]
The Chairman. We have 11 minutes on the clock right now. I
would ask the Committee, what is your pleasure? I know that
everybody probably has a statement that they would like to read
or present. Would you like to start that process or would you
like to hear from the Secretary?
Guys, you want to go ahead and do your opening statements
or let the Secretary begin?
Mr. Johnson. I would rather do our statements so he is not
interrupted when he makes his.
The Chairman. Okay. Very well. We will recognize Mr.
Lamborn for his opening statement.
OPENING STATEMENT OF HON. DOUG LAMBORN
Mr. Lamborn. Thank you, Mr. Chairman. And I will make a
very brief opening statement.
I want to thank you, Secretary Shinseki and Members of the
panel, for your service and hard work on behalf of the men and
women of our Armed Forces and veterans. Your tireless efforts
have made it possible for our veterans and families to secure a
better future in terms of health care and compensation.
I want to personally thank Secretary Shinseki for his
personal involvement in bringing a community-based outpatient
clinic (CBOC) and a veterans' cemetery to Colorado District 5.
We look forward to hearing the results of these endeavors in
the near future.
We also eagerly await the start of the new VA medical
center in Denver and we are hoping that the level of funding
will keep the construction on track. There are over 100,000
veterans in my district and they look forward to the new
services that it brings to Colorado.
To the veterans' support organizations, I thank you for
your work on behalf of veterans. Your advocacy gives millions
of veterans a voice and a sounding board for many of their
issues.
And, distinguished Members of the panels, I salute you and
I look forward to your testimony today.
Thank you, Mr. Chairman. I yield back.
The Chairman. Thank you, Mr. Lamborn.
Mr. Reyes.
Mr. Reyes. Thank you, Mr. Chairman.
Mr. Secretary and members of your team, welcome.
And I will just insert my statement for the record. Thank
you.
[The prepared statement of Congressman Reyes appears on
p. 53.]
The Chairman. Thank you very much.
Dr. Roe.
Mr. Roe. Welcome, General Shinseki. Look forward to your
comments.
And I yield back.
The Chairman. Thank you very much.
Mr. Michaud.
OPENING STATEMENT OF HON. MICHAEL H. MICHAUD
Mr. Michaud. Thank you, Mr. Chairman and Ranking Member,
for having this hearing.
I, too, want to thank you, Mr. Secretary, for your
unwavering support in service and commitment to our veterans of
this Nation and everyone on this panel.
Looking at the Administration's budget, it actually
reflects a lot of the shared priorities of Members of this
Committee such as rural health, mental health, and homeless
veterans' issues.
I do want to single out your commitment to investing in
innovation and technology to better serve our veterans. I had
an opportunity earlier this week to actually meet members of
your staff that head up the VA information technology (IT)
Program and am impressed with the exciting work that they are
undertaking and want to thank you for moving forward in
technology.
With that, Mr. Chairman, I yield back.
The Chairman. Dr. Benishek.
OPENING STATEMENT OF HON. DAN BENISHEK
Mr. Benishek. I just want to say that I am looking forward
to working with you on this Committee. And I think we will be
able to make some progress in the care of our veterans. And I
think it is going to be an exciting time going forward.
And I would just like to yield back the remainder of my
time.
The Chairman. Mr. Braley.
OPENING STATEMENT OF HON. BRUCE L. BRALEY
Mr. Braley. Thank you, Mr. Chairman.
As the Ranking Member of the Economic Opportunity
Subcommittee, I am very excited about working with Chairman
Stutzman on creating economic opportunities for veterans across
the country. I think at a hearing like this, it is important to
put a human face on what the Veterans Administration does.
I just want to share, especially with my new colleagues,
this is a young family in Dubuque, Iowa, Andrew, Jenny, and
Brody Connolly, who moved into a new home on November of 2010
with a specially adapted housing grant. Andrew served honorably
in Iraq, came home with a service-related disability, and that
program which we help oversee has made an enormous impact in
their lives, especially with their profoundly disabled son,
Brody.
This is the housewarming party that they had. And they are
wearing sweatshirts, Mr. Chairman, that say this house was
built on hope and love. That is what the VA does for people.
This is a young man from Dubuque, Iowa, Christopher
Billmeyer, who lost both of his legs above the knee and is
recovering at Bethesda right now.
This is another young man in my district, Staff Sergeant
Ian Ralston, who went to school with my daughter, Lisa, and was
paralyzed from the neck down because of an improvised explosive
device (IED) explosion.
And this is why the Chairman's comment about the Caregivers
and Veterans Omnibus Health Services Act is so important. We
have thousands of disabled veterans who depend on those
caregivers. And in rural places like Iowa, it is increasingly
difficult to find qualified caregivers.
And I had the opportunity to speak with the Secretary about
that. I look forward to his comments about what we will do
together to get that program off the ground.
And I yield back.
The Chairman. Thank you very much.
Members, I am watching the clock, so we are in good shape.
We are at 6 minutes right now.
Ms. Buerkle.
OPENING STATEMENT OF HON. ANN MARIE BUERKLE
Ms. Buerkle. Thank you, Mr. Chairman.
As a freshman Member of the Committee and as the Chair of
the Subcommittee on Health, I take very seriously my
responsibilities to ensure that the Department of Veterans
Affairs is adequately funded to provide our veterans with the
benefits that their service afforded them.
We are all aware of the current economic situation in our
country, our $14 trillion debt, our unemployment rate. There is
no doubt we have to take a critical look at how our country
spends our tax dollars.
However, the laws providing care to our veterans were some
of the first laws enacted by Congress and because our founding
fathers understood and had the foresight that America's
veterans deserve the gratitude of a grateful Nation and
providing care and benefits for those who have proved so worthy
will make our country stronger.
I hope that our hearing this morning will point the way
towards close cooperation among all of us who advocate for our
Nation's veterans to respond to their evolving needs and to
those of their families.
Thank you, Mr. Secretary, for your service and for being
here this morning.
Also, thank you to the veterans service organizations for
being here as well.
I yield back.
[The prepared statement of Congresswoman Buerkle appears on
p. 53.]
The Chairman. Mr. McNerney.
OPENING STATEMENT OF HON. JERRY McNERNEY
Mr. McNerney. Thank you, Mr. Chairman.
On Monday night, I had the honor of having dinner with two
severely-wounded veterans, one with a traumatic brain injury
(TBI) that is very similar to the injury that Ms. Gifford
suffered in January. He was recovered, did not have much use of
his right side. And so when I shook hands with the left side,
he was very excited. But he is absolutely determined to get to
college and learn history so that he can teach high-schoolers
about our Nation's history. That is why I am here today. That
is why this Committee is so important.
So thank you for your work and thank all the Members for
working together to serve our veterans.
The Chairman. Mr. Denham.
OPENING STATEMENT OF HON. JEFF DENHAM
Mr. DENHAM. Thank you, Mr. Chairman.
Chairman Miller, Ranking Member Filner, thank you for
holding this hearing. I think that this will most likely be the
most important hearing that we hold this year. I do not say
that lightly because I know that we are going to be addressing
a number of very, very important topics for our veterans.
But at a time when we are going to see more veterans return
home than we have since Vietnam, we had better be prepared to
be able to fulfill our commitment to our servicemembers and
make sure that the benefits that they so deserve are there and
available.
With that, I also want to welcome Secretary Shinseki. Thank
you for spending a lot of your time with various new Members.
We certainly appreciate your openness.
Also, I am impressed with your plan to reduce the backlog
of disability claims in my district especially. It is one of
the top casework issues that we have and probably one of the
most important. Our disabled veterans, we need to make sure as
Members of Congress that they are receiving the benefits that
they need and deserve and at the same time, the process that
you are putting in place or that you put in place not only will
better serve those veterans, but, as I understand, reduce costs
as well.
So, you know, again with the budget, you know, we are
looking at reducing spending in every area of the budget. I
believe that there is justification here for an increase, but
that also comes with a great deal of responsibility, oversight.
We want to make sure that the money that is allocated goes
exactly where it is needed and that is to our huge influx of
veterans that will be coming home, many of which have suffered
different issues than previous veterans. Whether you have lost
a home, you know, maybe a relationship, or a job, we need to be
prepared not only with economic development but those health
benefits and making sure that we can reintegrate them back into
civilian life.
Thank you.
The Chairman. We are down to 2 minutes, so we will recess
at this point. We have 14 votes. They are going to be 2-minute
votes, so we will return as quickly as we can.
The Committee stands in recess.
[Recess.]
The Chairman. Bear with us for just one more second. The
Ranking Member is here and he will be right with us.
Again, Mr. Secretary, we apologize for the votes, but thank
you for coming today.
And on the first panel, we are going to hear from the
Honorable Eric Shinseki, Secretary of the United States
Department of Veterans Affairs. The Secretary is accompanied by
the Honorable Robert Petzel. He is the Under Secretary for
Health for the Veterans Health Administration (VHA); Mr.
Michael Walcoff, Acting Under Secretary for Benefits in the
Veterans Benefits Administration (VBA); Steve Muro, the Acting
Under Secretary for Memorial Affairs in the National Cemetery
Administration (NCA); and the Honorable Roger Baker, Assistant
Secretary for Information and Technology and Chief Information
Officer; and, finally, W. Todd Grams, the Acting Assistant
Secretary for Management.
Mr. Secretary, as usual, your written statement will be
made a part of the record and you are now recognized.
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, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; MICHAEL
WALCOFF, ACTING UNDER SECRETARY FOR BENEFITS, VETERANS BENEFITS
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; STEVE L.
MURO, ACTING UNDER SECRETARY FOR MEMORIAL AFFAIRS, NATIONAL
CEMETERY ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS;
HON. ROGER W. BAKER, ASSISTANT SECRETARY FOR INFORMATION AND
TECHNOLOGY AND CHIEF INFORMATION OFFICER, OFFICE OF INFORMATION
AND TECHNOLOGY, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND W.
TODD GRAMS, ACTING ASSISTANT SECRETARY FOR MANAGEMENT, OFFICE
OF MANAGEMENT, U.S. DEPARTMENT OF VETERANS AFFAIRS
Secretary Shinseki. Thank you, Chairman Miller.
Ranking Member Filner, other distinguished Members of the
House Committee on Veterans' Affairs, thanks for this
opportunity to present the President's 2012 budget and 2013
advanced appropriation request for the Department of Veterans
Affairs.
I will just speak in general to the Members of the
Committee. It was helpful for me to meet with so many Members
of this Committee prior to the hearing. I did not get to visit
every Member because of schedule alignments, but I assure you
that I will follow-up and complete those visits.
Members were generous with their time, Mr. Chairman, and I
appreciate it very much.
This Committee's support for our Nation's veterans has been
unequivocal and unwavering. I have said that before. I say it
again. And that support has never been more necessary or
appreciated.
Let me also acknowledge, as you did, the representatives
from some of our veterans service organizations in attendance
today. They provide insights into veterans' needs and how VA
might consider better addressing them. Those insights are
always helpful to our workforce, our great folks who come to
work each and every day to serve veterans, but there is more
that we can all do to even better serve them within the
resources we have. And we are always open to new ideas here.
Mr. Chairman, thank you for introducing the members of the
VA leadership team who are here with me. I will just point them
out, Roger Baker on the extreme left; Todd Grams, our Chief
Financial Officer (CFO) here; I think most know Dr. Petzel, our
Chief Medical Officer, Under Secretary for Health; Mr. Mike
Walcoff from Veterans Benefits; and Steve Muro from our
National Cemetery Administration, who is also the President's
nominee to fill the position of Under Secretary for NCA.
Thank you for accepting my written statement, Mr. Chairman.
Let me just say that the VA budget is large and complex,
and I think you alluded to that in your opening comments,
important enough to be sure because it cares for those who have
safeguarded the Nation so that others can do what Americans do
best and that is out-create, out-work, and out-produce the rest
of the world.
Maybe the economy has lost a bit of sparkle for the moment,
but I trust the instincts, the ingenuity, the intelligence, and
the intellectual power of the American people. Less than 1
percent of our citizens who serve in the military enable the
rest of us, the rest of the Nation to unleash the economic
engine to do what we have historically done and that is win.
And when members of the military transition back into their
communities to add their time and talent to that economic
engine, VA's mission is to care for those who have borne the
battle and their spouses and orphans as President Lincoln
reminded us 146 years ago now.
And to do that, VA is a large integrated health care
system, perhaps the largest in the Nation. It is also our
largest national cemetery system with credentials as the top-
performing institution in the country over the past 10 years as
reflected in the American Customer Survey Satisfaction Index.
VA also manages the country's second-largest education
assistance program. It guarantees nearly 1.4 million
individuals home loans at zero down payment with the lowest
foreclosure rates in all categories of mortgage loans.
Finally, VA is the eighth largest life insurance entity in
the country with a 96 percent customer satisfaction rating.
Why is the VA enterprise so large and complex? Mr.
Chairman, I would just offer simply because in times past,
those who wore the Nation's uniforms were often unable to
either acquire or afford these services on their own.
Our mission--to provide or arrange for the care of veterans
who need us once the uniforms come off--is rooted in President
Lincoln's promise of 1865. We deliver on the promises of
presidents and fulfill the obligations of the American people
through those who have borne the battle.
Today, the Nation's military remains deployed in two
different operational theaters, conflicts that have been
underway for most of the past decade in Afghanistan and Iraq.
And we are all very familiar with the results that we see as
our youngsters come home.
The burden on our magnificent all-volunteer force and their
families in accomplishing every mission without failure,
without fanfare, or complaint has been enormous. VA's
requirements have grown over that time as we address long-
standing issues from past wars and watch the requirements for
those fighting the current conflicts grow significantly.
These numbers will continue to rise, perhaps for several
decades, after the last American combatant departs Iraq and
Afghanistan and we must be prepared to absorb them.
This budget request is the Department's plan for meeting
our obligations to all generations of veterans effectively,
accountably, and efficiently.
At present, about 8.3 million veterans depend on VA for
medical care and benefits, but over 22 million veterans and
another 35 million spouses and adult children see themselves as
veterans, a part of veterans' families whether or not they
visit one of our medical centers or apply for benefits.
Lots of people are counting on us to get things right for
veterans. We need your continued support, Mr. Chairman, and I
look forward to working with you to serve them.
To resource VA's efforts, the President's budget request
would provide $132.2 billion in 2012, almost $61.9 billion in
discretionary resources, and $70.3 billion in mandatory
funding. Our discretionary budget request represents an
increase of $5.9 billion or 10.6 percent over the 2010 enacted
level.
Since I appeared before this Committee last year, we have
published and implemented our strategic plan to continue
transforming VA into an innovative 21st Century organization
that is people-centric, results-driven, and forward-looking.
Our 2012 and 2013 budget plans are based on four goals in
that strategic plan. First, continue improving the quality and
accessibility of VA health care, benefits, and services;
second, increase veterans' satisfaction with the care and
services we provide them now; third, raise readiness to
continue the provision of care and services at a time of
crisis; and, finally, improve VA internal management systems.
Achievement of these goals mandates our constant and
consistent good stewardship of the financial resources
entrusted to us by the Congress both in the current constrained
fiscal environment and during less stressful times.
We have designed management systems and initiatives to
maximize efficiency and effectiveness and eliminate waste,
including VA's project management accountability system, P-M-A-
S, PMAS as it is often referred to, a new acquisition strategy
to make more effective use of our IT resources.
Second, VA's transformation 21 total technology, T4. T4
consolidates our IT requirements into 15 prime contracts and
leverages economies of scale to save time and money, enabling
greater oversight and accountability.
Our strategic capital investment plan, S-C-I-P, SCIP,
defines and assesses VA's capital portfolio and enables
improved efficiency of operations.
Last November, we launched two on-line metric systems, one
called LinKS, standing for Linking Information, Knowledge, and
Systems, LinKS, and the other one Aspire. Together these
systems allow VA to transparently increase our quality of
health care against private sector benchmarks.
VA successfully remediated three of four long-standing
material weaknesses in 2010 and earned our 12th consecutive
clean audit opinion on our consolidated financial statements.
Finally, we have implemented Medicare standard payment
rates and consolidated contracting requirements to reduce cost
and waste within the system.
A recent independent study, which covered a 10-year period,
found that VA's health IT investments between 1997 and 2007
were $4 billion while savings from those investments were more
than $7 billion. More than 86 percent of the savings resulted
from the elimination of duplicated tests and reduced medical
errors.
Furthermore, reduced workload and lowered operating
expenses were additional byproducts resulting in cost savings.
The 2012 budget continues to focus on our three key
transformational priorities: expanding veteran, family, and
survivor access to benefits and services; reducing and
ultimately eliminating the claims backlog; and ending veterans'
homelessness by 2015, three visible and urgent issues for VA.
A comprehensive review is underway to reuse VA's inventory
of vacant or under-utilized buildings to house homeless and at-
risk veterans and their families where practical.
Congress allocated $50 million to renovate unused VA
buildings and VA has identified 94 sites with the potential to
add approximately 6,300 units of housing through public and
private ventures using VA's enhanced use lease authority.
The enhanced use lease legislative authority is scheduled
to lapse at the end of calendar year 2011, this year, and its
reauthorization is needed to continue to increase housing for
homeless veterans and their families.
The most flexible and responsive housing option remains the
U.S. Department of Housing and Urban Development-Veterans
Affairs Supportive Housing (HUD-VASH) voucher on which we work
quite closely with the Department of Housing and Urban
Development. Both Secretary Donovan and I endorse the
importance of this joint effort to care for our homeless
veterans. Right now our only option is the HUD-VASH voucher for
housing veterans with families.
As advocates for veterans and their families, VA is
committed to providing the very best services to all veterans.
I will do everything possible to ensure that we wisely use the
funds that Congress appropriates to VA to improve the quality
of life for veterans innovatively and transparently as we
deliver on the enduring promises of presidents and the
obligations of the American people.
Again, thank you for this opportunity to appear before this
Committee. And I look forward to your questions, Mr. Chairman.
[The prepared statement of Secretary Shinseki appears on p.
54.]
The Chairman. Thank you very much, Mr. Secretary.
And with the Members' indulgence, I know we did not finish
opening statements. But in view of the fact the Secretary has
had to wait during our votes, I would like to ask if we can go
ahead and continue on and everybody will have an opportunity if
they wish to have their opening statements.
Mr. Secretary, one of the first things the leadership did
in this new Congress was to require a 5 percent budget cut on
our staffs and Committees, including this one, as a matter of
fact. And in looking in the budget, I see tremendous increases
and I alluded to them in my opening statement.
So, you know, I think the thing this Committee wants to
know is, number one, does the agency understand, and I know you
do, but explain to us, that you understand the current fiscal
condition that this country is in? And these increases that are
being made to support staff that do not directly impact the
veterans and their benefits, just explain to us why such large
increases.
Secretary Shinseki. Thank you, Mr. Chairman.
Let me call on our Chief Financial Officer to provide some
details on some of the offices you covered. I will speak about
the Office of the Secretary and then I will wrap up at the end.
Mr. Grams. Thank you, Mr. Chairman.
The increases that you are referring to I believe are in
the staff offices at the Department level at the VA. In total,
those increases from 2011, which we are assuming a freeze under
a Continuing Resolution until we actually see what comes out of
that, to the request in 2012 is about 13 percent.
Half of that increase is for the President's initiative. It
is about $24 million to strengthen and enhance the acquisition
workforce. And this is part of a government-wide initiative
that is across all departments, not only in the VA.
This is important to us because part of our plan for
decreasing waste and getting more efficient and having savings
lies in our ability to reduce the spending in the $16, $17
billion that we have every year in VA acquisitions.
Of the remaining increases in the staff offices that are
left, it is around 6 or 7 percent. Those increases are to help
us strengthen and finish up the requirements of Homeland
Security HSPD-12, which relates to the safety and security of
our employees as well as the veterans who come to our
facilities.
We are also looking to enhance our General Counsel's office
so that we can more timely publish regulations and deal with
issues in front of the U.S. Court of Appeals for Veterans
Claims (CAVC).
There are also increases requested in our ability to do
modeling and data analysis so that we can better project future
needs of veterans and then also provide better oversight as we
go forward.
Secretary Shinseki. Mr. Chairman, I think one of the points
you made was the Office of the Secretary also showed an
increase. That increase is $834,000, about a 9 percent
increase.
There was an arrangement where in the past, people have
been detailed from outside the office to work in the Office of
the Secretary and so they are paid for elsewhere and, yet, they
work in my location. I ended that this year. I said if they are
going to work in my office, we are going to pay for it and that
is what you see reflected here, so that accountability for how
that money is being spent is properly accounted.
I would say when we get around to talking about things like
the savings we are generating, some of this overhead, if you
will, is designed to drive the better results of our
expenditure funds and we can demonstrate what savings we have
been able to realize.
The Chairman. Mr. Grams, you, I think, were talking about
expected CR levels off 2011. And if we go back to 2009, I think
the number is 33\1/2\ percent increase from 2009.
Mr. Secretary, if we go back to 2009 with the Office of the
Secretary, we have seen a 41 percent increase. So while the
numbers may appear small as compared to the line in the CR, we
are still talking about an increase on top of a very large
increase; is that correct?
Mr. Grams. Yes, sir. I think there has been growth through
2009. When you look at the Office of the Secretary, and it
relates to what the Secretary said earlier in terms, let's say,
straightening out who is detailed or who is actually on the
Secretary's rolls, which is what he was referring to, my
understanding is that, I believe it was in 2009, there was a
decision made to put certain organizations in the Office of the
Secretary that had previously been in some of the other
Assistant Secretaries' offices. And that is part of the growth
from 2009 through 2012 as well.
The Chairman. Okay. Thank you.
I see my time is expired. Mr. Filner.
Mr. Filner. Thank you, Mr. Chairman.
Mr. Secretary, you rightly pointed out the importance of
the HUD-VASH Program. The HUD-VA Supported Housing Program
provides permanent housing and ongoing treatment service to
hard to serve homeless veterans with chronic mental illness,
substance abuse, and other disabilities. And you pointed out
how important this is.
The Continuing Resolution that is on the floor that was
sponsored by the majority party eliminates the HUD-VASH Program
for the rest of this fiscal year.
Do you have the numbers of how many veterans that might cut
off from vouchers? Do you have any numbers there that can help
us?
I may propose an amendment later on today that tries to
restore that funding, but I think it is disgraceful that it was
eliminated from the budget.
Secretary Shinseki. Congressman Filner, I believe that the
allocation for this year would have been about 10,000 which is
the number of HUD-VASH vouchers we have been provided in the
past, but that exact number is----
Mr. Filner. Okay. Again, you and the Administration have
devised what you called a zero tolerance for veterans'
homelessness over the next 5 years. That is the disgrace of
having those who have served our Nation on the streets without
getting the kind of help you want to eliminate. I greatly
applaud you for that and we are going to try to do everything
we can to support that.
But when one of the cornerstones of that program, the HUD-
VASH Program, is cut, it makes it that much more difficult. I
am sorry that it is going ahead in the CR. I hope the Senate
does not accept that.
The Chairman. Will the gentleman yield time?
Mr. Filner. Yes.
The Chairman. Actually, the HUD-VASH Voucher Program is not
being eliminated from the CR; is that correct, Mr. Secretary?
Secretary Shinseki. I am not current.
The Chairman. Well, as I understand, there are, I think,
30,000 that were already done. You have 19,000 that have
already been allocated. I think there are 11,000 out there that
have not been and they are still in the CR. So, again, I think
the important thing is they are not being eliminated.
Mr. Filner. I do not know how you could say that, if I can
reclaim my time. If you eliminate the funding, how many
vouchers are left? We are talking, of course, for the remainder
of the fiscal year. Those that you have said were allocated
were not. But the funding is zeroed out. So how do you expect
any vouchers to be given out later?
The Chairman. There will be 11,000 vouchers still left to
be issued.
Please continue. And that was on my time.
Mr. Filner. But the funding has been zeroed out, so I am
not sure how we reconcile that. We will try to figure that out.
But in any case, I think it is disgraceful that we are
moving in that direction. These are folks, again, who have
served our Nation.
The one subject that has concerned us over the years, Mr.
Secretary, is the elimination of the claims backlog. You have
taken an approach since you have been Secretary to get the
numbers down by force, by hiring--you have hired, I do not
know, over 10----
Secretary Shinseki. Brute force.
Mr. Filner. Brute force. You have hired over 10,000 new
people, roughly that, and, yet, we have not brought down the
backlog at all. It has increased. I do not know if you want to
try to defend that brute force. You know, you are not an Army
Secretary anymore. You are into peaceful stuff.
But it seems, and just for the new Members here, I have
advocated a brute force approach that eliminated the backlog
rather quickly by using the so-called Linda Bilmes approach to
mainly recognize the claims if they have been prepared with a
veterans service officer.
I am thinking of a compromise where you do not need to
comment on now, but you might think about, that we do the
Bilmes approach maybe for a year or two. Similar to the way an
organization that wants to reduce its overhead so they buy out
people and let them retire early. If we buy out or give an
offer of a buy-out and say it offers people 30 percent, which
is a little bit above the average of their disability, and they
will not go further in the system, but they get their check
now, we might eliminate half a million of those claims right
away.
I think we ought to figure out an outside the box thinking
of going after those claims. We are never going to do it by
this brute force. I do not know, over 10,000 new hires and we
have not broken into backlog that at all.
I think we are going to have to cut the backlog down as far
as we can go with one swift buy-out and then take all the new
things that you have been developing in the last couple of
years to speed things up. You can start from a base of
somewhere near zero, and you may be able to keep up with it.
I do not want to give up on all those new things that you
have been doing, but I do not think we are ever going to get it
down to a reasonable number unless you take a meat ax on the
brute force approach. I cannot think of the right metaphor
here.
Secretary Shinseki. May I comment?
Mr. Filner. Please.
Secretary Shinseki. We look at every opportunity to take on
a new idea. And you and I have discussed this before,
Congressman Filner, and I am happy to continue this. We will
look at this option you offer us.
May I just call on a couple of our folks here to give you
an update on where we are with regard to the investments we
have made here? I will call, first of all, on Mike Walcoff to
talk about the business processes we are doing and then on
Roger Baker for the IT piece of this.
And very quickly, please.
Mr. Walcoff. Thank you.
Mr. Filner, there certainly has been very generous support
from Congress over the last several years and we have hired a
number of people. The number when you look at our compensation
and pension (C&P) workforce, has gone from about 7,500 in 2005
to around 14,000 now. So that gives you some idea. It is a
pretty big increase.
And I believe that the hiring of those people has made it
so that the elimination of the backlog is a reasonable goal.
Through efforts to address not only people but also our process
as well as technology, our production over the last year went
over a million for the first time. We had an increase of 10
percent in production for 2009.
The receipts, however, were 1.2 million. They went up 18
percent last year and 14 percent the year before. So the
question is, how do we eliminate that. And the fact is that
there are problems with our capabilities that we have to
address, and the things that we are doing to address that
involve technology.
The Veterans Benefits Management System, which is our
paperless system, we need to complete development of that. This
is going to improve our efficiency. It is going to improve our
quality and it is going to improve our timeliness.
The veterans relationship management initiative is going to
make it so that veterans can communicate with us on their
terms. And the Virtual Lifetime Electronic Record (VLER)
Project, the development with VA and U.S. Department of Defense
(DoD), is the third piece of the technology that we really need
in order to eliminate that backlog.
The good news is that in 2012, this budget year, we will
get to the point where we are producing more cases than we are
getting in. And that is the beginning of the elimination of the
backlog.
The other thing that is going to happen in 2012 is we begin
rolling out the Veterans Benefits Management System (VBMS) so
that paperless technology begins going to our regional offices.
Secretary Shinseki. Secretary Baker.
Mr. Baker. Just quickly, Congressman Filner, I would tell
you that the VBMS Program is on track. We are using the very
successful techniques that we use to deliver the new GI Bill
system on time to meet the VBMS system. And so we look forward
to deploying that in conjunction with VBA. It will take
technology to break the back of the backlog.
Mr. Filner. My time is up and I will yield back. I just
want to say for all of the freshmen, if we look at the
transcripts from this hearing over the last 10 years, over 20
years, we have heard the exact same issues. We are going to
break the back next year, we are going to break the back. So I
hope you are right, but I do not see it happening.
Secretary Shinseki. Mr. Filner, I share your frustration. I
do not take it lightly. But in the past, I think we have said
that for the first time in this year, 2011, a 27 percent
increase to the VBA budget gives them the resources to go get
the tools. And we are on the verge of getting those tools. I
will continue to look at this option of how to cut back on the
processing time and perhaps see how the Linda Bilmes model
fits.
Mr. Filner. Yes.
Secretary Shinseki. We are in a big numbers game. When we
arrived 2 years ago, we produced 977,000 decisions and
everybody was celebrating. We got a million claims in. And as
Mr. Walcoff just suggested, last year----
Mr. Filner. Make up for it.
Secretary Shinseki [continuing]. We exceeded a million and
got a million two in. So we are in a numbers game and----
Mr. Filner. Okay. Will the Chairman allow me just 1 more
minute.
Another issue that I don't have the exact numbers, if
somebody has it please tell me. This Nation has been saying for
the last year or two, it is time to say welcome home to our
Vietnam vets who we never really welcomed home as a Nation.
There must be hundreds of thousands of them that have Agent
Orange claims that get sicker fighting the VA bureaucracy than
they did from the original illness probably. I believe we ought
to think about saying thank you and welcome home finally by
granting these Agent Orange claims, get those out of the
system.
It is another way to break the back. I do not know how many
you have. I would guess a couple hundred thousand, but I do not
know for sure. But I would ask the Committee to think about
finally saying welcome home to the Vietnam vets.
Do you have any numbers there?
Secretary Shinseki. I can provide numbers----
Mr. Filner. Okay.
Secretary Shinseki [continuing]. From where we are in
processing claims of Vietnam veteran Agent Orange claims. We
have a count and we are pushing them out just not as fast as we
would like.
[The VA subsequently provided the following information:]
As of April 4, VA has received over 189,000 Agent Orange claims
based on the newly established presumptive conditions. Of the
approximately 93,000 previously denied claims from Veterans
with Vietnam service (Nehmer claims), 26,955 claims have been
completed thru April 4. Of the nearly 60,000 claims received
from October 2009 announcement through publication of the final
rule, 45,787 claims have been completed thru April 4. VA was
required to hold all claims based on the new Agent Orange
presumptive disabilities until publication of the final
regulation and expiration of the 60-day Congressional review
period on October 30, 2010.
Mr. Filner. I thank the Chairman for his indulgence.
The Chairman. Thank you very much.
And very quickly, Mr. Grams, again, in the CR, is it your
understanding that the HUD-VASH has been zeroed out?
Mr. Grams. I have not personally seen the legislation, sir.
What I have been advised----
The Chairman. You are the CFO.
Mr. Grams. I am.
The Chairman. Okay. I will answer for you.
Mr. Grams. Okay.
The Chairman. It has not been zeroed out. And I would like
to ask my colleague to provide me where it has been. The
baseline is 30,000. Those that are in the system stay in the
system. There are 11,900 left. Those can still be allocated. We
have been told that that is more than enough. I say more than
enough. More than what VA can actually handle between now and
the end of the fiscal year.
So with that, Mr. Lamborn.
Mr. Lamborn. Thank you, Mr. Chairman.
Secretary Shinseki, we had a really good visit in my office
recently. You gave me the courtesy of giving me a personal
call. And we were able to talk about a lot of issues.
So with that in mind, Mr. Chairman, and for the sake of
time, I will yield back.
The Chairman. Mr. Reyes.
Mr. Reyes. Thank you, Mr. Chairman. And may I say it is
good to be back on the Committee.
Mr. Secretary, this goes back along the same lines what the
Ranking Member was talking about. You and I have discussed this
many times, including before I temporarily left the Committee.
The issue pertains to DoD and VA's inability to establish a
system, an electronic system that facilitates the transfer of
records. Records pertaining to whatever claims an individual
may have when they come out of active duty and become part of
the VA system.
We had Secretary Gates in our Armed Services Committee
yesterday and I mentioned it to him, encouraging him to work
with you to finally establish a system that, as the Ranking
Member and the Chairman have said, is seamless in terms of how
we handle a servicemember's information.
We know when individuals are going to end their service. We
know that in many cases, at least, well at least in El Paso and
Fort Bliss, areas that, as you know, I represent, many soldiers
will be going to the VA. It would be very helpful and it would
likely save money, to be able to settle on a system, which
would allow the VA and the DoD to talk to each other.
We still have, as Mr. Filner mentioned, we still have many
Vietnam veterans, and I am particularly sensitive because I am
a Vietnam veteran, that are still struggling with the claims
under Agent Orange and others. It seems to me, for the sake of
being able to provide better service, there ought to be a
better way for the VA and the DoD to computerize and at least
serve those veterans that are coming out of Iraq and
Afghanistan and other parts of the world.
And I know, believe me, I appreciate your efforts. You are,
I think, our best champion in terms of taking care of veterans.
But can you speak to the point of creating a singular digital
network?
Secretary Shinseki. Absolutely, Congressman. I am going to
call on Mr. Baker for a technical update. But let me just say
that, and I mentioned it before this Committee before, 2 years
ago as I was waiting to be sworn in, both Secretary Gates and
I, we shook hands and agreed that we were going to go to work
on this seamless transition, of which the electronic health
record was a key part.
Following that, in April of 2009, the President stood on
the stage with both of us and said we are going to develop
something call LVER, the virtual lifetime electronic record,
which has a medical piece and a personnel piece, in order to
get to this seamless transition we all talk about.
What it is for me is when a youngster raises his right hand
and takes oath of office upon entering the military, Air Force,
Navy, whatever, with this system, a duplicate record will be
created in VA so as that individual is deployed, gets sick, is
promoted, goes to school, all of that is being replicated in
VA.
And when the uniform comes off, if that individual chooses
not to come and enroll with us right away, which is a choice,
we will at least have captured the key data so that when they
do come back, if they do, 20 years later and say there is
something wrong here, we have a way to establish identity and
tie it to an event that might have occurred during their
service. This is the intent.
I just met with Secretary Gates again the first week in
February. We renewed our pledge to go after the single
electronic health record.
I think in Chicago where VA and the DoD have combined our
efforts to produce an integrated hospital with the Navy and VA,
we have an opportunity to do a proof of principle to put in
place an electronic health record that both sides would use and
then find out whether it serves, and what needs to be done to
improve it.
I am out of time here. Mr. Chairman, may I have just a
minute to provide an update on the electronic health record?
The Chairman. Yes, sir.
Mr. Baker. Thank you, Mr. Secretary. I will make this
quick.
We have, over the last year, made great progress on the
President's virtual lifetime electronic record initiative and I
will just highlight two things for you in that program.
The first is DoD and VA are jointly moving forward as the
implementers of the nationwide health information network,
which will then tie the private sector and other Federal
agencies like the Social Security Administration into the
provision of information that will let us provide better
service at the benefits end as an example there.
We have also moved forward with a single, common Web portal
for servicemembers. As the Secretary referenced, when they
raise their right hand and are sworn in, now in their left
hand, they are handed the log-in to that Web portal. That stays
with them through their lifetime. Whether they are a
servicemember or a veteran, all of the information about their
service is put on to that portal. And so everything new we
bring in is brought together there so they can constantly have
access to it as can we so as to provide that information.
Those are the sort of things that we are doing inside the
lifetime electronic program to achieve the President's vision
of that lifetime electronic record.
As the Secretary said, the most substantial thing we can do
to make that happen is a single common electronic health record
system with DoD. We are close at this point. The Secretary and
Secretary Gates have driven the two Departments to come to that
agreement. We have had a lot of work over the last 4 or 5
months to come to agreement on what that is.
I believe that will happen with strong guidance from the
secretaries in the next month or two and that will be a very
substantial push forward on the LVER front.
Mr. Reyes. Can I just ask one follow-up? When you say
close, what does that mean and, secondly, of the whole realm,
what percentage is computerized as you describe it right in
your records?
Mr. Baker. As to the percentage computerized, I believe
that anyone who is seen now has a large percentage of what they
do computerized.
The issue you spoke to--going back to Vietnam-era vets--is
primarily paper and the records that come out there are then
dealt with from a paper standpoint. That is why the Veterans
Benefits Management System is so important to this. It is
bringing them in, even if we get them as paper, bringing them
in, turning them into electronic and turning them into data
that we can really use when we access those.
As to the definition of close, we have recently had a
series of meetings at the highest levels to make that decision
and determine what the path forward will be.
I believe that the two departments have never had a greater
opportunity to nail this down and nail it shut. And I believe
that it should happen in the next month or two to come to final
agreement that this is where we are going, we will have a
single record, and it will be along this path.
Mr. Reyes. Thank you.
The Chairman. Dr. Roe.
Mr. Roe. To continue with what Congressman Reyes was
talking about you know you are a freshman Congressman when you
go to Great Lakes, Illinois, in January for your Codel. We went
there at Great Lakes where the Navy trains their folks. And it
was a VA and the military had a hospital there. This was over a
year ago.
The Secretary and I talked about this. Thank you for coming
by the other day, and we had a great conversation. The problem
with it was, as you were pointing out, I am a physician and
here we have a troop over here and we have two sets of medical
records. The DoD and VA systems cannot talk to each other. A
lot of smart people have tried. We spent $10 billion and they
still cannot talk to each other.
I was on the Oversight and Investigations Subcommittee at
that time. I want to go back and revisit that because that was
over a year ago and they were supposed to make the systems able
to talk to each other.
To Congressman Filner's point, we have heard this before. I
really thank the Secretary, and I agree, somebody has to blink
and there is going to have to be one record because right now
with two, we will be sitting here 20 years from now doing the
same thing. So great point that you made. And we will talk
about this after.
And I know Mr. Baker is as good as there is in technology.
I do know that. He is spot on. But somebody, either the
Secretary of the VA or Secretary Gates, is going to have to
make a decision and pick one record, a winner or a loser, and
then go with it. And people are going to have to deal with it.
Otherwise, we will be sitting here 10 years from now and spend
another $10 billion. I think the point that the Chairman made
is a very good one.
In the county I live in, we have just cut 5 percent of our
county budget. In the State I live in, Tennessee, we have a $1
billion budget hole that Congress running this Committee has
cut 5 percent.
And I was looking at the amounts of money we have spent on
VA, which is a good thing, the Post-9/11 G.I. benefit, but we
have gone in fiscal year 2008 from $90 billion to $126 billion
this is a substantial increase in spending in the VA. And I
think the thing that I am most concerned with is if we are
getting a bang for our buck. And I will give just an example.
I saw there was another $6 million in funding included in
the budget for the the Vision Center of Excellence. We heard
all the testimony in the last year or two about the Vision
Center of Excellence, and I still do not know whether it works
or not. I do not have a clue.
So I would like to see that brought up. And when we spend
this money, are we getting value for the money. I think that
was the thing. And I think everybody wants that. Do we have
metrics out there we can measure and are we getting value for
our money?
Secretary Shinseki. Dr. Petzel.
Dr. Petzel. Thank you, Mr. Secretary and Dr. Roe.
The Vision Center for Excellence, as I hope everybody
knows, is a VA/DoD enhanced care initiative. We have spent in
the VA about $1.5 million and are in the process of executing
an obligation for the remaining $5.4 million of the initial
commitment that was made in support of this through fiscal year
2014.
That total commitment was $6.9 million. The staffing that
we are supporting there are deputy directors, some vision
rehabilitation analysts, and an administrative assistant that
provides support.
They have developed their eye injury registry. They
continue to expand their capabilities to store data, keep track
of the transit of the veteran, of combat soldiers that are
injured, veterans and their transition from that status into
our organization.
And I do believe that we are getting value for the limited
amount of money we are spending there, Dr. Roe.
Mr. Roe. And we will have time for that later.
Another thing that I have noticed in my home area where our
VA hospital is, we have the CBOCs, which I think are a
tremendous asset. I cannot say enough good things about the
CBOCs. I think they need to be expanded. Certainly in this
budget, I do not know whether you can, but I think they should
be.
But in most of our CBOCs that we have, there are waiting
lists for veterans to get in. One in Morristown, Tennessee, has
over 500 veterans who cannot get in that CBOC. They still have
to go to the main VA not near their home. And Knoxville,
Tennessee, has huge waiting lists as well.
The other question, and, again, my time is running short,
and I am in a rural district like Mr. Michaud is, we both serve
rural areas, we have $250 million last year that was supposed
to be spent on rural access to care, I guess, I do not know how
it was spent. And that is what I would like to know. I did not
see the value in my local district about how that $250 million
in rural health was spent.
And I do not know whether you did, Mike or not.
Dr. Petzel. That is an excellent question. As Congress has
generously over the last several years given us $250 million a
year to spend on rural initiatives and a good portion of that
money went to support new CBOCs, Congressman, a good portion of
that money went for telehome health, that is where we put tools
into the home, connect them directly to the medical
professionals.
Mr. Roe. Can a Veterans Integrated Services Network (VISN)
director request money from this $250 million for a CBOC
because those are great investments?
Dr. Petzel. Oh, absolutely. The way this was done in the
first 2 years is that we sent out a request for proposals to
every one of the networks. They came back to us with proposals
on how they would like to spend that rural money. We funded it.
We kept track of how the money was spent. And, again,
telehealth, telemedicine, transportation networks, new CBOCs,
all of those things were included in the grants.
Mr. Roe. My time is expired, but I would like to talk
further about that, and I yield back.
Secretary Shinseki. Congressman Roe, I will close the loop
with you. I mean, we owe you a sharper point on the pencil here
on specifically CBOCs if you are talking about if we have that
many veterans waiting to get in. We will find out what was
requested and how it was addressed.
The Chairman. Mr. Michaud.
Mr. Michaud. Thank you very much, Mr. Chairman.
And, Mr. Secretary, I have several questions and actually
part of it was what Mr. Roe has talked about. And the problem
when you look at the rural health initiative, if they are able
to get money for a CBOC, the problem comes in the maintenance
of those CBOCs. I do not think you can get those operating
funds out of the rural health and that is where the problem
comes in.
A couple of questions and I will ask them in the order that
hopefully you can answer them in because of the time limit.
Last year, as you know, I raised serious concerns about the
VA implementing the regulations with the new payment schedule
for State veterans' nursing homes. These payment rates actually
have put some State veterans' nursing homes in a financial
liability situation where they have actually stopped taking
veterans, especially for those veterans' homes that are States
that have high Medicare, Medicaid patients.
This year, the VA is implementing new regulations that may
have similar impact on veterans in need of dialysis care,
especially those living in rural areas. I understand that the
patient access issues were raised at the stakeholders during
the regulation process. I would like to better understand VA's
plans to address the access issue as it relates to the
dialysis.
The second question, you mentioned in your testimony that,
and Congress is concerned, about the resources we are giving.
We are trying to make sure we, you know, make the best of
whatever dollars that we do give. You point out in your written
testimony a method by which you can save millions of dollars
eliminating redundant evaluations. I was just kind of curious
if you could elaborate a little about that.
Another question would come up over and over again when you
look at the Veterans Equitable Resource Allocation (VERA) model
as far as the VISN distributing money within a VISN, a big
issue that has come up over and over again, for instance, the
increased funding we have given veterans for mileage
reimbursement.
For instance, Togus gets $1.5 million, $1.6 million from
the VISN to reimburse veterans in Maine. However, it costs
between $5 and $6 million. So, automatically, a health care
facility in a rural area is operating in the red because of the
model that is given them as they distribute the money.
And my last question, you mentioned earlier the strategic
capital investment planning process. Does that process take
into consideration where you might have some facilities that
are on the historic list and they might not be able to actually
renovate the facilities as need be? So those are my four
initial questions.
Secretary Shinseki. Mr. Michaud, let me ask Dr. Petzel to
address the State veterans' homes arrangements and then the
rural aspects of this.
Mr. Michaud. Yeah. But, actually, it was on the dialysis
issue.
Secretary Shinseki. And dialysis as well.
Mr. Michaud. Yes.
Dr. Petzel. Thank you, Mr. Secretary.
Congressman Michaud, what the Congressman is referring to
is that we are going to a reimbursement system for fee-basis
dialysis that uses a Medicare rate and there was some thought
that there were some providers who would not be willing to
accept the Medicare rate and would not be willing to
participate.
We did a survey. We looked. We did not find anyone at the
level of providing services in a town was threatening to do
that. We left open the possibility that if there are existing
contracts, those can stay in place and we will use those rates.
And if we need to contract above the Medicare rate in an
ongoing fashion in order to get the services, we will do that.
We absolutely share your concern and we do not want any
veteran in rural America or any place that needs dialysis not
to have access to that.
Secretary Shinseki. State veterans' homes.
Mr. Michaud. The second one was on the savings, limiting
redundant evaluations. Can you elaborate.
Secretary Shinseki. Evaluations, redundant evaluations.
Dr. Petzel. Are you talking about Integrated Disability
Evaluation System (IDES) or are you talking about the
Disability Evaluation System that we are doing in DoD?
Mr. Michaud. No. I thought you were looking at doing some
work with Centers for Medicare and Medicaid Services (CMS).
Well, CMS, actually, they evaluate nursing homes. And it is my
understanding that VA also evaluates nursing homes. You have a
check-off list and I think there is only eight questions
difference between what CMS does and the VA does. And I was
wondering what is happening in that effort.
Dr. Petzel. We are trying to accommodate ourselves,
Congressman, to the CMS process. We do not want to have
redundant evaluations that basically are finding the same
things using almost, as you point out, virtually the same tool.
And that is being worked through.
But then my hope is that in the not too distant future, we
will have that settled and we will be using the same tool or we
will be relying on CMS evaluations and not having to do our
own. That is an excellent idea.
Mr. Michaud. Okay. Thank you.
And the VERA model, have you looked at that as far as the
inequities in rural areas?
Secretary Shinseki. VERA, like any model, responds to
quality input. And I must say when you get into the rural area,
they are unique and we have to be sensitive to this. But the
VERA model responds to use. A number of people come in and
establish a pattern of requirement. Then the VERA model will
respond to that.
And the challenge to the rural areas is dispersion. It is
hard to get to see that population. And we need to be sensitive
to this, Mr. Michaud, and figure out a way to see whether or
not we have tweaked the model sufficiently.
Mr. Michaud. Well, I mean, it gets back to Mr. Roe's
concern and my concern is, the VERA model is there, but if we
are required by law that we reimburse veterans with 41 cents a
mile and you have a rural area that are getting reimbursed a
mile, but they only get from the VISN office a third of what it
actually costs to provide the service, it puts an inequity upon
that health care facility.
As I mentioned earlier, Maine, we spend between $5 and $6
million at Togus. They only get $1.5 million. They are at a
disadvantage. Rural areas are getting hurt. The model is right,
but they are not getting the money for it and, therefore, they
have to actually cut back on services in rural areas, which
actually could hurt when you look at CBOCs and funding those
programs in rural areas because they are not getting the
adequate funding that they are supposed to get.
Dr. Petzel. Congressman Michaud, just to respond to that
question. We have established a different mechanism for
distributing money from the networks to the facilities. VERA
takes the money from Central Office and distributes it to the
network. We have a different model with much more flexibility
in it that distributes money from the network to the individual
medical centers.
I will talk with Dr. Mayo Smith on the opportunity for them
to do what they need to do to accommodate that discrepancy. I
certainly do not want a medical center in Maine or any other
rural area to be disadvantaged because the veterans have larger
travel distances and there is a larger travel bill for those
people. So we will look into that, sir.
The Chairman. Ms. Buerkle.
Ms. Buerkle. First of all, I want to start by saying that
several weeks ago when I was in the district, I had the
pleasure of touring our VA hospital. Syracuse, New York has a
very large VA facility there. And Mr. Cody took me on a tour. I
had the pleasure of meeting the senior staff there. And I just
want to tell you the senior staff and Mr. Cody, it is apparent
to me that this is just not a job. It is a mission to them. The
facility was topnotch. We had an excellent tour.
And, most importantly, when I had the opportunity to talk
to patients, they were pleased with their care, the services
they were receiving. And I think you should know that it was a
very positive meeting and we look forward to working together.
Also, several weeks ago when we met in my office, one of my
concerns that we discussed was the payment methodology issue,
the inconsistencies and the various reimbursement formulas that
were a little confusing because there was no consistency.
I see here in your testimony that you are going to apply
the Medicare payment methodology, which will be a more--it will
be more consistent and it will be less confusing for everyone.
You talk about saving $275 million in 2011 and then $315
million in 2012. But this system has not been put in place yet
is my understanding. You are just rolling out.
And so I would like to ask you to explain to us how you,
you just made this decision in February, how you would expect
that we would have that much of a savings in 2011 when it has
not been implemented yet.
Secretary Shinseki. Fair enough. It is a fair question. We
just put it in place this month and the system is running. And
the estimates are that we are going to achieve those outcomes.
They are estimates. We will have to see how we progress here to
see whether we achieve those savings. We are pretty
comfortable. It is a conservative model.
Ms. Buerkle. Do you have a time table for when all the
hardware and all the software will be and you will be able to
do the automatic payments and get away from the manual?
Mr. Baker. I do not off the top of my head have that one.
We just had a review and I am trying to recall that, but we
will have to get back with the specifics on the date for that.
It is in the near term, but I do not have the specific dates in
my head.
Ms. Buerkle. Thank you.
The other question I had was with regards to the Caregiver
Assistance Program. I have heard from veterans, and you rolled
out a plan last week. Can you just talk to us a little bit
about your expectation for the program and how many veterans
you would anticipate and families being eligible for that
program and then beyond that, if you think that that number is
consistent with the number Congress intended?
Secretary Shinseki. First, Congresswoman, I regret the
delay that occurred in transmitting the implementation plan to
the Congress. There was an expectation it would be here
November. Did not get here until February. All kinds of reasons
why all those things happened that way. They are my
responsibilities. And so I apologize for that.
Let me just assure you that even as the legislation was
being crafted, we began in a parallel way in VA writing what we
thought were going to be potential regulations that we might
need. At the time, our proposal was to use, in trying to get
the payments going as quickly as possible, an existing
mechanism that is there today called Aid and Attendance. And we
have been using Aid and Attendance for eight decades now and
providing that kind of support to veterans.
Our position did not prevail and so we were required to
create a new payment methodology. This time, for the first time
in my understanding, we provide this support directly to the
caregiver. We have never done that before. And so we are in the
process of creating regulations that do not exist.
And, unfortunately, the regulation process is a long and
involved one and requires legal review. Congress has an
opportunity to review it as well. We put our thoughts out for
public comment and stakeholders have an opportunity to make
comment. And then we have to address each one of them. So it is
an involved process which we were hoping to avoid.
That said, we are going as fast as we can. What we were
asked to do was to look at the Iraq and Afghanistan population
and address the caregiver requirements there. As we did that,
we came to understand because we held sensing sessions with
veterans' caregivers and others, including DoD, that there was
some interest in caregivers of previous generations, World War
II and Vietnam, whose families have been dealing with the same
problems for decades.
And we are trying to write a regulation that meets the
immediate requirement and that is to get payments going to the
Iraq and Afghanistan veterans and caregivers and, yet, keep the
opportunity open that if Congress says there is a better way to
do this that we can also address the requirement over time.
A good policy we arrive at here would also have the
capability of addressing veterans and caregivers of the next or
yet to be determined conflict in the future. So it is an issue
of fairness. We are trying to get it right. And then we will
await the comments from folks that suggest that we ought to,
you know, look more closely at this.
I think we have established a population for the immediate
requirements of the Iraq and Afghanistan population. I think
that number is about 840, I think, is my understanding. But
that is a start point. That number is subject to review. And we
are, as I say, going as fast we can. We would like to turn this
quickly.
Ms. Buerkle. Thank you, Mr. Secretary.
Thank you, Mr. Chairman.
The Chairman. Mr. Carnahan.
Mr. Carnahan. Thank you, Mr. Chairman.
I first want to say it is a pleasure to join this Committee
and take a special assignment here for this Congress. And I
want to thank you and Ranking Member Filner for coming to St.
Louis last year when we were looking at issues at the Cochran
VA Medical Center. So it is great to be here with you.
I took this assignment because in my district, we have a
number of great facilities, the VA facility there at Jefferson
Barracks, really the national treasure there, the national
cemetery which we take great pride in.
And, Mr. Muro, we look forward to working with you.
But the number one reason that I am on this Committee right
now is to work with turning around Cochran.
And I appreciate our discussions we have been able to have,
Mr. Secretary. And as we wait for some of the national
investigations that are going on with the administrative
investigative board, the Inspector General, the U.S. Government
Accountability Office (GAO) to really pull together those
results to really engage with our veterans there locally, to
engage with the employees.
I had a great conversation with the Director there, Rima
Nelson, this past week about how to put that together in a
turnaround plan. We want to work with you to help do that.
So we look forward to doing that. And I really want to be
sure that we can address some of these negative issues that
have come up in substance, but also in perception of the
community and veterans.
So I wanted to ask, you know, how we can work together, how
these resources are going to help focus on those needs there,
and how you all are going to focus some of the leadership of
the Department to do that.
Secretary Shinseki. Let me call on Dr. Petzel and then I
will wrap up.
Dr. Petzel. Thank you, Mr. Secretary.
Thank you, Congressman Carnahan. We are also concerned
about St. Louis.
I want to first say that we are very supportive of the
present Director, Rima Nelson. She has done an excellent job
since she acquired that job, first of all as an acting, and
then was given it permanently just around the time that the
initial problem occurred with the dental processing.
She has put together with our help and cooperation a four-
part plan that is going to, we believe, turn St. Louis into one
of our quality and safety and satisfaction leaders. It involves
what we would call tiger teams composed of people from the
medical center, from the network surrounding, and with national
support to look at patient satisfaction, to look at employee
satisfaction, to look at quality and safety issues within the
medical center, and then finally to develop a process of
continuous improvement where they are continuously evolving and
improving.
Since Ms. Nelson arrived there, the employee perceptions of
the medical center have changed dramatically. There is no
question that 2 or 3 years ago employees did not feel their
voices were heard. They did not feel as if when they had a
problem to bring forward, it was being listened to and acted
on. And now that has changed dramatically.
Ms. Nelson has set up a process, several processes, in
fact, where employees can both meet with her regularly and can
go through a number of different pathways to make their
concerns known and feedback provided for them to see what has
actually happened as a result of what they said.
The union is very supportive of her. The veterans service
organizations in the community are supportive of what is
happening there right now. And I am very optimistic that over a
period of time, it does not happen over night, but over a
period of time, this is going to be one of our leading
hospitals, sir.
Secretary Shinseki. Congressman, you have my assurance that
we are going to get Cochran where it needs to be and both Dr.
Petzel and I are committed to doing that with you and anyone
else who has veterans that come to Cochran for care.
The first incident that occurred about a year ago was a
failure in leadership in my opinion, not the leadership at the
director level, but inside the dental department. That
individual has been replaced.
This latest event where a nurse in the surgical ward saw
spots on an instrument and did what we would expect anyone to
in that position, called it to the attention of her superiors
and they suspended surgery until they could figure out what
caused them.
What is clear is that it is not a result of unsanitary
conditions. It is not blood. It is not pathogens. It is not
tissue. Discoloration on the instrument, we are still
investigating exactly what caused them. We think there may be a
chemical basis for this. As soon as we have that answer, we
will begin surgeries again.
Mr. Carnahan. Great. Thank you.
And I see I am out of time, but if I could indulge just one
15-second comment. The other issue just is critical. And we
recently lost one of our veterans who served on my veterans
advisory panel back home from suicide. And the dramatic rise we
have seen in suicides nationally among our veterans, I hope
that we can all again redouble our commitment and our focus to
those issues because it has really been a national problem. And
I hope that these additional funds for mental care and so forth
within the VA can really help turn that around.
Thank you.
Thank you, Mr. Chairman.
The Chairman. Mr. Huelskamp.
Mr. Huelskamp. Thank you, Mr. Chairman.
And thank you, Secretary, for being here today and being by
my office earlier in the week. And we discussed there that
Pratt, Kansas, was selected as one of the sites for the pilot
program you are calling Project Arch. And I know Pratt is
scheduled to be up and providing services hopefully by mid
2011.
Is VA on track to meet that targeted date?
Dr. Petzel. Congressman, thank you very much for the
question.
As you pointed out, Project ARCH was passed by Congress and
there are five sites that we are beginning a pilot in each one
of them. And Pratt, Kansas is indeed one of them. These are on
track. We are calling this phase one. These are all on track to
be hopefully up and running by the end of fiscal year 2011.
We will evaluate those initial efforts and then begin based
on the evaluation to open up other sites in those five networks
that are part of the pilot. The networks, just for your
information, Network 1, northern Maine; Network 6, Virginia;
Network 15, Kansas; Flagstaff, Arizona, Network 18; and
Billings, Montana, Network 19.
Mr. Huelskamp. Thank you.
How quickly do you think you will be able to provide an
assessment of how that is working?
Dr. Petzel. The plan is that 6 months into the operating
pilot, we would assess the impact, assess the cost, and make
decisions about whether or not we are going to proceed with
other sites and, if so, where.
Secretary Shinseki. By this fall, we expect to have the
analysis done.
Mr. Huelskamp. Okay.
Secretary Shinseki. We have set aside sufficient funds to
do this.
Mr. Huelskamp. In addition to that, I appreciate that
answer and look forward to hopefully the success of that pilot
program.
In addition, just in general, how does this budget assist
veterans in rural areas that have limited access to facilities?
How does this initiative protect those veterans in that
situation?
Dr. Petzel. That is an excellent question. I come
originally from Minneapolis where I ran a network that was
incredibly rural, and I have great empathy for the inability
that we have sometimes to reach people in these remote
communities.
First of all, there is a 69 percent increase in the amount
of telemedicine and telehealth money that we are spending. We
believe that telehome health particularly is the wave of the
future in terms of reaching the particular remote areas. The
ability to monitor patients at their home, have a television,
computer connection with them, the instruments to measure their
blood pressure, their EKG, their heart rate, is going to be a
major modality for reaching rural America.
Secondly, there is again $250 million worth of rural health
money that is going to be used for pilot projects, perhaps a
clinic in Tennessee.
And then the third component of this is contracting and fee
basis. In many communities, we just are not able to provide VA
owned and operated facilities. And we use fee-basis care quite
substantially, $4 billion of it actually each year, to try and
reach remote rural areas.
While we are trying to get and will get a handle on our
fee-basis cost and expenditures, I am expecting that there will
be an increase in our use of this modality in the rural parts
of this country.
Mr. Huelskamp. And how is the provider response to the fee
basis that you mentioned? A lot of folks involved in that or--
--
Dr. Petzel. I think it is excellent. When we use fee basis
in the community, we are working with the other community
providers. We are not a competitor. We are not seen as a
competitor by them. We are seen as a partner. So it is often
very successful.
Mr. Huelskamp. All right. Thank you, Mr. Chairman.
Secretary Shinseki. Congressman, I would just add on fee
basis, non-VA care where we pay a fee for care downtown, in
2011, based on what comes out of the CR, we had estimated $4
billion going into caring for veterans who get their care in
other than VA facilities, about a million people.
And then in the rural discussion we just had prior to that,
there are about three million veterans who live in these rural
and highly rural areas and the challenge for us is how do we
ensure that one of those rural veterans has the same
opportunity as someone living in, you know, suburbs of
Washington, DC, to have their health care needs met. And it is
something we pay attention to.
Mr. Huelskamp. Thank you, Mr. Secretary. I appreciate that
recognition.
Thank you, Mr. Chairman.
The Chairman. Mr. Johnson.
Mr. Johnson. Thank you, Mr. Chairman.
And, Mr. Secretary, thank you to you and your team for
being here with us today.
I am very grateful to the brave men and women who have
served our country and I believe that our veterans, as I had
mentioned to you, are the segment of our society that most
deserves our sincere gratitude and assistance. So I applaud
what you and your team are trying to do.
The Department of Veterans Affairs has the most important
and singular responsibility of caring for our Nation's veterans
and that is a promise that we made to them for their sacrifice
to our country and for the cause of freedom.
In turn, it is the role of the Congress to ensure that the
VA is both effectively carrying out that responsibility and
that it has the funding necessary to fulfill that promise.
It is also our responsibility to ensure that veterans
returning home are made aware of the benefits that they are
entitled to and that they receive the necessary assistance to
ease their transition back into civilian life and the
workforce.
We have, in that regard, a very difficult task ahead us to
create a budget that holds spending in line in order to bring
down the national debt while simultaneously providing veterans
with the quality health care benefits and services they
deserve.
In order to efficiently provide these services, we must
also ensure that programs provided by the VA are not only cost
effective but are managed with discipline and accountability.
And I know your team is trying to do that.
I welcome this opportunity to discuss the budget the
President has proposed and to work with your team and my
colleagues to ensure that the needs of our veterans will be met
in this upcoming fiscal year. So thank you again for being
here.
The virtual lifetime electronic record, is there a timeline
for achieving that? Is this an active program? I mean, what is
the status of that?
Mr. Baker. The VLER Program we break into four different
what we call capability areas. Each one of those will have an
initial operating capability by 2012.
So, for example, in the first area, which is health
information for health purposes, we will have rolled out the
nationwide health information network across the country at all
VA facilities from an IT perspective by 2012. And the
facilities will be implementing their connectivity to their
local health information exchanges in that time frame. So each
of them has an initial operating capability in the 2012 time
frame.
As you can imagine, it is, inside of VA and DoD, what we
call a pervasive program. It touches everything. So as an
example, what we did very early on was agree with DoD that
there would be a single identifier for every servicemember and
it would be the DoD's Electronic Data Interchange Personal
Identifier (EDIPI), getting into the vernacular, but the number
that they issue that identifies every servicemember.
We have then also said that all of our databases will
contain that identifier. It will take a long time to convert
all of those databases to that, but the effect is that all of
our applications, when they go to look for information for a
veteran, can rely on that identifier being there to find the
information on the veteran.
So a lot of capabilities that we have, if you will, kicked
off and started to work on will take quite a number of years to
really roll that through all of the various systems at agencies
like the VA and the DoD.
Mr. Johnson. But is there a formal project manager that is
overseeing this and is there a timeline and a project plan and
a strategic plan to get from point A to point Z?
Mr. Baker. Yes. There is a very detailed project plan on
this one. It is actually in our vernacular called an operating
plan. It is one of the major initiatives overseen by the deputy
Secretary. So there is a detailed plan, detailed timelines. I
am happy to provide that to you. It may be more than you want
to read, but happy to provide it from that standpoint.
[The VA subsequently provided the following the operating
plan entitled, ``FY11-13 Virtual Electronic Record (VLER)
Initiative Operations Plan,'' by the Office of Information and
Technology, U.S. Department of Veterans Affairs, which will be
retained in the Committee files.]
Mr. Johnson. Shifting gears just a bit, does the VA charge
veterans for a service-connected visit such as an annual exam?
I am not sure who should answer that.
Dr. Petzel. Thank you, Congressman.
No. If a veteran is seen for a service-connected problem,
they are not charged.
Mr. Johnson. They are not. Okay. Okay. All right. I think I
have used up most of my time.
Thank you, Mr. Chairman.
The Chairman. You have 17 seconds left.
Mr. Johnson. I am good. Thank you.
The Chairman. Mr. Stutzman.
Mr. Stutzman. Thank you, Mr. Chairman.
And first of all, I would like to thank Secretary Shinseki
for, first of all, his service and also service to our vets as
well as everybody that is here today.
I appreciate your visit as well a couple of weeks ago. I
thoroughly enjoyed it and appreciate the information that you
were able to get to us as well as getting to know you and
looking forward to working with you in the future.
We have almost 51,000 plus veterans in my district back in
Indiana and it is a privilege to serve them. And I know that in
these tough economic times, it is those folks who are willing
to serve us that I believe should be standing in the front of
the line for taxpayer dollars because they were willing to put
their life on the line as well as those who are serving us
currently.
So I am looking forward to working with you in the future.
Our visit a couple of weeks ago answered a lot of questions for
me, but I did want to just kind of follow-up with a proposal
out of the budget.
In the Fort Wayne facility there in Indiana, the northern
Indiana facility, it looks like there are a couple of different
options. And I do not know if you can share or give us any more
details on what might possibly be coming out of it. I know that
there are several alternative possibilities there.
Dr. Petzel. Thank you, Mr. Secretary.
Congressman Stutzman, right now in the fiscal year 2012
budget, there is a proposal for leasing 27,000 net square feet
in Fort Wayne for expansion of primary care, mental health,
post-traumatic stress disorder (PTSD), substance abuse, and
some ancillary services to take pressure off of the major
facilities there.
Mr. Stutzman. Okay. I mean, as we know, that facility, it
is an aging facility and one that we have tried to upgrade and
even rebuild a new facility.
Looking down the road, is the facility going to be on the
same campus? Is it going to be close in proximity to the campus
and then how also does that relate to the mental health to the
facility in Merriam as well which is just to the south of Fort
Wayne? Is that going to be taking any services away from that
facility and bringing it to Fort Wayne? Are these new services
that are going to be provided in Fort Wayne?
Dr. Petzel. Congressman, these are services that were
formerly in the main building and are going to be done in a
different setting. So these would be things that were already
being done in that area, but we are going to do them in a new
modern building in a different way to, again, relieve some of
the pressure that is on the Fort Wayne facility.
I would have to get back to you about Marion, Indiana, and
its relationship to this. I do not have that information at the
tip of my tongue, but we can certainly get back to you about
that.
[The VA subsequently provided the following information:]
FY 2012 Budget included a proposal for leasing space for an
expansion of primary care, mental health, PTSD, substance abuse
and some ancillary services in the Fort Wayne area. At this
time, it is unknown where the additional clinic space will be
located. Congressman Stutzman was informed in a conference call
on January 12, 2011, that a competitive solicitation will
determine the location of the clinic.
Fort Wayne, Indiana, is approximately 1 hour from Marion,
Indiana. Moving the mental health clinic, PTSD clinic,
substance abuse clinic, clinic based home care, telephone
triage and fee services to an off-site location from the
current Fort Wayne facility will not impact the Marion campus.
No new services will be provided, however, access to Veterans
for these services, as well as primary care will be improved as
capacity for those services is increased.
Mr. Stutzman. Okay. All right. I appreciate that a lot. And
we look forward to working with you some more on this and some
of the ideas that have been proposed. And hopefully, you know,
our office can be helpful and appreciate the information.
Dr. Petzel. Absolutely.
Mr. Stutzman. Okay. Thank you, Mr. Chairman. I will just
yield back.
The Chairman. Thank you very much.
Vice Chairman of the Committee, Mr. Bilirakis.
Mr. Bilirakis. Thank you, Mr. Chairman.
Thank you, General. Thank you for your service to our
veterans, and thank you for your entire service to our Nation.
We had an opportunity to talk about some of the local
interests in my district yesterday, so I want to focus on this.
I want to ask this question. It really does not pertain to the
budget.
But are there any particular areas or employees maybe in
vet clinics, CBOCs, hospitals if the veteran decided to enter
to the facility to find out general information with regard to
services and benefits? I know there is a lot of information--
you can get on the Web site and also on the phone and ask
particular questions. But maybe is there space available for
certified veterans service officers to see veterans in any type
of need----
Secretary Shinseki. Congressman----
Mr. Bilirakis [continuing]. And is it permitted?
Secretary Shinseki [continuing]. That is our intent. That
has not been our history, but that is our intent. We are moving
that way where our medical facilities also have a
representative from our benefits administration who can deal
with those questions.
Mr. Bilirakis. Is it a budget issue or----
Secretary Shinseki. It is not. It is culture. We grew up as
two separate administrations and now we are forcing a marriage
here. And so I would say in the future that you will probably
look at collocation of our VBA and VHA facilities so that
veterans have an opportunity to go to one location and take
care of business----
Mr. Bilirakis. Very good.
Secretary Shinseki [continuing]. With ample parking, which
is always an issue, ample parking. But these are plans that we
are right now beginning to consider how we bring this about
within the budgets we have.
Mr. Bilirakis. I appreciate that very much because
sometimes a lot of times, they do not know where to turn to
and----
Secretary Shinseki. Just let me call----
Mr. Bilirakis. Yes.
Secretary Shinseki [continuing]. Mr. Walcoff to add to
that.
Mr. Walcoff. Yes, sir. Just using Florida as an example,
Veterans Benefits Administration is located in about 15
different places throughout the State. And in most of those
places, we are located at a VHA facility. So when a veteran
comes in for treatment, there is a VBA person right there to
work with them.
Mr. Bilirakis. Very good. Common sense. Very good. Thank
you.
Every day I hear from my constituents about difficulties
and delays that are encountered in VA claims. You hear this all
the time.
In your testimony, Mr. Secretary, you mentioned the
accelerated claims process being used for the influx of new
claims associated with the exposure to Agent Orange.
Is there a way to expand such an accelerated process to
reduce the current system-wide backlog and then, if so, what is
the timeline that we can anticipate realizing such an
accelerated system and how do you plan to end the current
backlog through the system that the system faces and what is
your ideal turnaround time for claims processing and when do
you think this goal may be realized?
Mr. Walcoff. Yes, sir. We have several initiatives that are
aimed at expediting the claims process. An example would be our
benefits delivery at discharge initiative where we are located
at bases when veterans are getting out. We take their
application 60 days before they get out and have their claim
adjudicated shortly thereafter from when they are discharged.
We have several programs that are modeled like that.
In terms of what is our idea of how long it should take,
our answer to that is we believe that no claim should take more
than 125 days. And the primary way that we are going to get to
that is through the technology that we are currently
developing. The Veterans Benefits Management System, VBMS, is
the key to us being able to eliminate the backlog. And we
define that backlog as any case that is over 125 days.
Mr. Baker. If I could just touch on your point about the
Agent Orange fast-track system, we have had a good experience
with that. The main focus there is on establishing what are
called Disability Benefit Questionnaires (DBQs) or forms that
ensure that the veteran has an opportunity to provide us all
the information necessary to process the claim and it can then
be processed automatically to the point of automatically
generating a recommended adjudication for the adjudicator to
then review.
My understanding is that to fully do the benefits, it would
be about 79 of those DBQs, all of which need to go through the
standard forms to be able to be put public. We are working
those. It is an approach that we like and we believe is going
to, in conjunction with VBMS, both turn all the paper we
receive into electronic images, but even more importantly make
certain that the originating information is electronic, making
it even easier to deal with and more automatic.
I believe we said that we are going to put VBMS live in the
2012 time frame. We see adding more and more of those DBQs to
the fast-track system as we go along. It is live today, as you
know, working for Agent Orange.
Mr. Bilirakis. Thank you very much.
Thank you, Mr. Secretary.
Thank you, Mr. Chairman.
The Chairman. Dr. Benishek, do you have questions?
Mr. Benishek. Yes. I am sorry I missed quite a bit of the
question and answering, but I do have some questions.
You may know I have spent quite a bit of time at a VA
hospital and I have some concerns about the answers to the
questions here. There were five answers reducing indirect
costs, reducing the costs, you know, the answers to the, you
know, how are you going to identify waste in that.
And it was two of the costs that are actually decreasing
payments to the people that actually do the care or changing
the mix of health care professionals to the veterans. In other
words, to me, that means there are going to be less doctors and
more, you know, adjunct personnel. So I just wondered how that
relates to quality.
Similarly with the dialysis, implementing Medicare standard
payment rates, which is obviously a decrease in the payment
rate and how difficult it is to, you know, for dialysis to--
that amount is not very much money to pay for dialysis. And
that is sort of the standard of care. But dialysis payments are
so low that it is just a bare minimum of what can be done to
treat dialysis patients.
So I am just a little upset about the fact that, you know,
the people that are actually providing the care are two of the
ways of saving the money. And there is nothing in there about,
you know, the ratio of people in the VA that do not actually
care for patients, that are a part of the administrative,
bureaucratic side of the VA. It does not say anything about
cutting those people.
You understand what I am saying?
Dr. Petzel. Yes, Congressman, and let me respond to that,
please.
First of all, we appreciate the fact that you did work at
the Iron Mountain VA Medical Center. That is a good experience
and hopefully it is going to be helpful for our interactions
with the Committee.
First, the dialysis regulation, the rest of this country
pays for dialysis using the Medicare rates almost exclusively.
We are a relatively small portion, I believe it is less than 5
percent, of the total dialysis business that occurs in this
country. And the rates that were previously being charged were
sometimes two to two and a half times the Medicare rate.
We did not believe that was appropriate. And we think that
the providers are able to survive, make a profit on the
Medicare reimbursement rate. It means that veterans or the
people that care for veterans are not paying anything more than
the rest of the community is paying to provide those rates.
So I feel quite comfortable that this is a fair
reimbursement and a fair way to do it. If we are not able, as I
said earlier in response to another question, to provide the
care using Medicare rates, we have the freedom and the
flexibility to contract for higher rates.
So if there is a rural community where the provider refuses
to take Medicare, then we are in a position to contract for a
higher price.
In terms of the staff realignments, what we are doing with
staff realignments is looking to see that the work is being
done by the most appropriate person so that if a nurse's aide
can do the work as opposed to a licensed practical nurse (LPN)
and is trained to do that, they should be doing it. If an LPN
can do some of the work that an RN was doing and is trained to
do it, they should be doing that. Same thing applies to
physicians. We certainly do not want physicians taking blood
pressures, doing the other things that other people can do just
as competently.
Mr. Benishek. I do not think physicians take blood
pressures anymore. I am just saying----
Dr. Petzel. I am just using this as an example, sir.
Mr. Benishek. I know, but that is a bad example. Would you
rather see a doctor or a nurse when you go to see your health
care provider? There is a certain something to that, don't you
think?
Dr. Petzel. Oh, absolutely. And we are not saying that
there are not going to be physicians seeing the patients. We
are saying that we are going to be using people that can do the
tasks physicians are doing by using other people to do it in a
more appropriate fashion.
Mr. Benishek. Oh, I understand that. But the point of my
question was, you know, there were two things about patient
care in the cost reduction and there was not anything about
bureaucratic cuts. I mean, you know, reducing the cost by
adopting uniform standards for administrative and support
services, reducing the cost by----
Dr. Petzel. The item there is all administrative costs.
That is the indirect cost of care and we are reducing
substantially the indirect costs of care.
Mr. Benishek. I just did not see anything about reducing
the costs if an administration is adopting uniform standards.
You know, reducing the cost of the administrative portion of
the thing is my biggest concern, you know, the bureaucracy
involved with running the system.
Secretary Shinseki. Congressman Benishek, in our tables
here, we show a line for medical and administrative support
savings. In the 2012, the estimate is $150 million. And I
believe that is sort of the topic area you are looking in.
Mr. Benishek. Okay.
Secretary Shinseki. We are happy to provide more detail
here for you.
[The VA subsequently provided the following information:]
The cost savings of $150 million will be achieved by more
efficiently employing the resources in various medical care,
administrative, and support activities at each medical center
and will be achieved by targeting the following areas to
improve overall operational efficiency:
High missed outpatient appointments/no show rates
Observed to Expected Length of Stay
Diagnostic colonoscopy (CPT code 45378) cost per
procedure
Cardiac catheterization cost per procedure
Primary care cost per encounter
Mr. Benishek. Well, I guess you understand the point of my
question. I just see the bureaucratic side of the budget cut
and the people that are actually delivering the care, those
people should be the last people to be cut.
Dr. Petzel. Right. I understand your concern.
The Chairman. Thank you.
Mr. Secretary, there are numerous questions that I think
each of us will probably put together. We will do them
collectively from the Committee to submit to you for the
record.
Are there any other questions that people want to ask in
the public forum?
[No response.]
The Chairman. If not, we thank you for being here and you
are recognized again, Mr. Secretary.
Secretary Shinseki. Thank you, Mr. Chairman, for very, very
helpful testimony.
We began with a discussion about overhead and staff and we
never really got to talk about savings because part of the
responsibility of having that kind of overhead is to have
something to show for it.
We are estimating that this year, we will generate about a
$1.1 billion in savings. What we would like to work on with the
Committee is taking $600 million of that and reinvesting it in
our 2012 budget, take the second $500 million and reinvest it
in the 2013 budget so that with these monies, we are able to
generate additional savings. And we are targeting with this
carryover, this is the carryover discussion, we anticipate
another $1.2 billion in 2012. And it is still a fuzzy estimate,
but we are looking at about the same kind of savings in 2013.
We think this is the return on the investment for some of
this additional overhead where we can put in place processes,
business plans, and follow-up that are going to outlast
everyone here at the table where the behaviors at VA are the
ones that we would all expect about good business.
The Chairman. Again, Mr. Secretary, we thank you for your
indulgence. We apologize again for the delay. Thank you for
those people that were here with you to help in answering the
questions. We appreciate that as well. Each of us on this
Committee is dedicated to working with you to help those whom
we are supposed to be serving from the veteran community. Thank
you, sir.
And as the Secretary and his party depart, I would like to
go ahead and invite the second panel to make their way to the
table.
The second panel with us today includes Mr. Carl Blake,
National Legislative Director of the Paralyzed Veterans of
America (PVA); Mr. Raymond Kelley, the Director of the National
Legislative Service for Veterans of Foreign Wars of the United
States (VFW); Mr. Joseph Violante, the National Legislative
Director of the Disabled American Veterans (DAV); Ms. Christina
Roof, the National Acting Legislative Director for AMVETS; and
Mr. Timothy Tetz, the Director of the National Legislative
Commission for the American Legion.
As customary, each of your written statements will be
entered into the record and you will each be recognized for 5
minutes. And I do not know who has been selected to go first,
but you are on.
Mr. Blake. We did not select, but I am just going to go
first, Mr. Chairman.
The Chairman. Mr. Blake.
STATEMENTS OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR,
PARALYZED VETERANS OF AMERICA; RAYMOND C. KELLEY, DIRECTOR,
NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE
UNITED STATES; JOSEPH A. VIOLANTE, NATIONAL LEGISLATIVE
DIRECTOR, DISABLED AMERICAN VETERANS; CHRISTINA M. ROOF,
NATIONAL ACTING LEGISLATIVE DIRECTOR, AMERICAN VETERANS
(AMVETS); AND TIMOTHY M. TETZ, DIRECTOR, NATIONAL LEGISLATIVE
COMMISSION, AMERICAN LEGION
STATEMENT OF CARL BLAKE
Mr. Blake. Chairman Miller, Ranking Member Filner, Members
of the Committee, on behalf of the four co-authors of The
Independent Budget (IB), I would like to thank you for the
opportunity to be here to testify today. I will focus my
comments on the health care budget of the VA for fiscal year
2012.
Before I begin the rest of my statement, I would just like
to say thank you to your staff and to Ranking Member Filner's
staff for giving us the opportunity last week to come over and
sit down and talk about The Independent Budget in advance and
sort of, you know, lay out what we are looking at going forward
before the President's budget was actually released on Monday.
With that, Mr. Chairman, we are pleased that it appears
that the fiscal year 2011 appropriations process may be
actually nearing an end as last week, the House Committee on
Appropriations introduced H.R. 1. And as you well know, it is
being considered on the floor as we speak.
While we have some minor concerns with the details of H.R.
1, we appreciate the needed increases in certain funding for
the VA provided by the legislation and we hope the Congress
will act on this legislation quickly.
Additionally, we appreciate the fact that the
Appropriations Committee has outlined the advanced
appropriations for fiscal year 2012. As you know, last year,
the Administration recommended an advanced appropriation for
fiscal year 2012 of approximately $50.6 billion in
discretionary funding for VA medical care. The House Committee
on Appropriations supported this recommendation in H.R. 1 as
well.
When combined with the $3.7 billion for medical care
collections previously projected, the total available operating
budget recommended for 2012 is approximately $54.3 billion.
However, included in the President's budget request for
fiscal year 2012, the Administration revised the estimates for
medical care down by $713 million due to the proposed Federal
pay freeze. That is something that we recognized in The
Independent Budget and we chose to do so as well as part of our
recommendations.
I would like to say that I believe that the Administration
has offered a reasonable starting point, particularly for
medical care, for the overall medical care budget. However, we
do have some concerns about some of the proposals that are
included in the fiscal year 2012 health care budget.
Of particular concern to The Independent Budget is the ill-
defined contingency fund that would provide $953 million more
for medical services for fiscal year 2012. Moreover, we are
especially concerned that the VA presumes management
improvements, something that harkens back to the gimmicks known
as management efficiencies of the past, of approximately $1.1
billion to be directed towards fiscal year 2012 and fiscal year
2013.
The VA has explained that these management improvements
provide $1.1 billion that the VA would like to carry over and,
yet, if the VA is not authorized to carry over this additional
money, its fiscal year 2012 budget request and 2013 advanced
appropriations request will be insufficient to meet the health
care demand of veterans it serves.
Finally, we have real concerns about the revised estimates
and medical care collections from what was originally
projected. In last year's advanced appropriations, as I
mentioned, it was projected that they would collect $3.7
billion and now it appears that they are projecting only $3.1
billion.
Given the emphasis on medical care collections and ramping
up through Consolidated Patient Account Center (CPAC) in recent
years, we are just as curious, as I hope the Committee is, as
to how these things have occurred like this.
Given this revision in estimates, the VA's budget may
arguably be short $600 million additionally in budget authority
for next year based on the consideration of those collections.
The Administration recommended, as I mentioned, $53.9
billion for total medical care funding for fiscal year 2012.
The Independent Budget recommends approximately $55 billion for
total medical care. This includes approximately $43.8 billion
for medical services. Our medical services recommendation
includes $41.3 billion for current services, $1.1 billion for
the increase in projected workload, and $1 billion for
additional medical care program costs. Each of these areas is
explained in more detail in my full written statement and in
The Independent Budget for fiscal year 2012.
For medical support and compliance, The Independent Budget
recommends approximately $5.4 billion and finally for medical
facilities, The Independent Budget recommends approximately
$5.9 billion.
While our recommendation does not include additional
increases over and above the baseline for nonrecurring
maintenance (NRM), it does reflect the fiscal year 2012
baseline of approximately $1.1 billion for NRM.
We are also concerned about the steep reduction in spending
for medical and prosthetic research. The Independent Budget
recommends $620 million, approximately $111 million more than
the Administration's request. As you know, research is a vital
part of veterans' health care and an essential mission for our
national health care system.
Finally, Mr. Chairman, The Independent Budget is pleased to
see that the Administration has proposed an increase in the
medical care accounts for fiscal year 2013. However, we cannot
emphasize enough that Congress must remain vigilant to ensure
that the proposed funding levels for fiscal year 2013 are, in
fact, sufficient to meet the continued growth and demand on the
health care system.
Mr. Chairman, that concludes my statement. I will be happy
to answer any questions that you might have.
[The prepared statement of Mr. Blake appears on p. 64.]
STATEMENT OF RAYMOND C. KELLEY
Mr. Kelley. Mr. Chairman, Members of the Committee, on
behalf of the 2.1 million members of the Veterans of Foreign
Wars and its auxiliary, I would like to thank you for the
opportunity to testify today.
As a partner of The Independent Budget, the VFW is
responsible for the construction accounts, so I will limit my
remarks to that portion of the budget.
A vast growing and aging infrastructure continues to create
a burden on VA's overall construction and maintenance
requirements. These facilities are the instruments that are
used to deliver the care to our ill and injured veterans. Every
effort must be made to ensure these facilities are safe and
sufficient environments to deliver that care.
A VA budget that does not adequately fund facility
maintenance and construction will reduce the timeliness and
quality of care to our veterans. This is why The Independent
Budget partners are recommending an overall construction budget
of $2.8 billion, $2.2 billion for the major construction
accounts, $585 million for the four minor construction
accounts.
Last fall, VA provided the IB partners with an overview of
the strategic capital investment plan or SCIP. After this
briefing and upon reviewing the VA's fiscal year 2012 budget
submission, The Independent Budget partners were pleased with
the improved transparency of the capital planning.
The VA has advised The Independent Budget partners that
SCIP is intended to identify capital acquisition needs ranging
from nonrecurring maintenance and leasing to major and minor
construction projects to close the currently identified
performance gaps. All tolled, these gaps will require between
$53 billion and $65 billion in funding over the next 10 years.
However, at the Administration's requested funding level,
it will take between 18 and 22 years to complete the current
10-year plan. Under-funding VA's capital plan in its infancy
will only exacerbate their ongoing construction and maintenance
needs.
We are happy to see the VA's fiscal year 2012 budget
request for the medical facilities in New Orleans and Denver
along with three other major construction projects will be
fully funded. However, only 7 of the 23 partially funded major
construction projects will continue to be funded in 2012,
leaving over $4 billion remaining in partially funded projects
dating back to fiscal year 2007.
These projects include improving seismic deficiencies,
providing spinal cord injury centers, completing a polytrauma,
blind and rehab research facility, as well as expanding mental
health facilities. These projects have a purpose and should be
funded as quickly as possible to fulfill the promise of care to
our wounded and ill veterans.
VA is requesting approximately $545 million to continue
construction on the seven existing projects and to begin work
on four new projects. At this pace, VA will not reach its
strategic capital investment 10-year plan. Therefore, the IB
partners request that Congress provide funding of $1.85 billion
for VHA major construction accounts. This will allow VA to
complete all current partially funded major construction
projects within 5 years, begin providing funding for 15 new
projects, and fund the four currently partially funded seismic
correction projects at a level that will have them completed
within 3 years.
The IB partners are pleased with VA's funding request for
VHA minor construction accounts. This level of funding will
allow VA to fully fund more than 75 projects.
The Administration's request for managerial cost accounting
(MCA) construction projects is nearly $80 million. The IB is
requesting $161 million. This will allow MCA to complete nearly
all of its minor construction projects and begin three major
projects, expanding veterans' access to cemeteries in Hawaii,
Florida, and Colorado.
The IB partners are also requesting an increase in funding
for research facilities. Funding at a level of $150 million
will allow work to begin on the five highest priority research
facilities. Again, it is critical to the care of our veterans
that we fully fund VA construction.
Mr. Chairman, thank you for the opportunity to testify
today and I look forward to any questions you may have.
[The prepared statement of Mr. Kelley appears on p. 67.]
STATEMENT OF JOSEPH A. VIOLANTE
Mr. Violante. Mr. Chairman, Ranking Member Filner, Members
of the Committee, on behalf of the Disabled American Veterans,
I am here today to present the recommendations of The
Independent Budget for fiscal year 2012 in the area of
veterans' benefits.
Mr. Chairman, for fiscal year 2012, the IB recommends only
modest increases in personnel levels for Veterans Benefits
Administration. And those increases are targeted primarily at
the Vocational Rehabilitation and Employment Service and the
Board of Veterans' Appeals.
The Voc Rehab Program is one of the most important benefits
provided to many disabled veterans. However, a 2009 study by
GAO found that 54 percent of the VA regional offices reported
they had fewer vocational rehab counselors than needed.
The current caseload target is one counselor for every 125
veterans, but the ratio is reported to be as high as one to
160. Therefore, the IB supports an increase of 100 new
counselors and an additional FTEE dedicated to management and
oversight of the growing number of contract counselors and
service providers.
The Board of Veterans' Appeals' workload has consistently
averaged about 5 percent of the total number of claims before
VBA. So as claims rise, so, too, do the number of appeals. To
meet the new demand and avoid creating an ever-larger backlog
of appeals, the IB recommends funding increases for the board
that are commensurate with increasing workload.
Mr. Chairman, the IB once again calls on Congress to
completely end the ban on concurrent receipt for all disabled
veterans and eliminate the SBP and DIC offsets for veterans'
widows and dependents. Under current law, most service-
connected disabled veterans who retire after a full career in
the Armed Forces must forfeit a portion of their retirement pay
before they can receive VA disability compensation rightfully
due to them. This inequity unfairly penalizes a servicemember
who pursues a career in the military.
A disabled veteran who elects to pursue a civilian career
will be able to receive full VA disability compensation and
full civilian retirement pay. Although Congress has addressed
this inequity for veterans with disability ratings of 50
percent or greater, it is time to extend fairness to all
veterans.
Similarly, when a disabled veteran dies of service-
connected causes, their eligible survivors or dependents
receive dependency and indemnity compensation or DIC. The
benefit provides a modest support to compensate for the
veteran's earnings loss due to disability. However, if the
survivors are also eligible under the Survivor Benefit Program
or SBP, they will have their SBP benefits reduced by the amount
of DIC payments.
This fails to recognize that SBP is a separate and
purchased program paid for by deductions from servicemembers'
military pay. Surviving spouses of Federal civilian retirees
who are disabled veterans can receive a DIC payment without any
offset for their purchased Federal civilian survivor benefits.
Congress should treat military widows equally by repealing the
offset between DIC and SBP.
Mr. Chairman, VA is at a critical junction in its efforts
to reform the outdated, inefficient, and overwhelmed claims
processing system. Secretary Shinseki has made clear his
intention to break the back of the backlog as a top priority.
And while we welcome this goal, we would caution that
eliminating the backlog is not necessarily the same goal as
reforming the claims process system. To achieve real and
lasting success, the VA must focus on creating a veterans
benefits claims processing system designed to decide each case
right the first time.
Undoubtedly, the most important new initiative underway is
the Veterans Benefits Management System, VBMS, their new IT
program being designed to provide a paperless and rules-based
method of processing and awarding claims. We would urge
Congress to carefully monitor and oversee this work and
recommend considering an independent outside expert review of
the VBMS. However, regardless of the IT solutions, VBA must
ensure that they have a properly trained workforce and a
comprehensive quality control system.
That concludes my statement and I would be happy to answer
any questions from the Committee.
[The prepared statement of Mr. Violante appears on p. 79.]
STATEMENT OF CHRISTINA M. ROOF
Ms. Roof. Chairman Miller, Ranking Member Filner, and
distinguished Members of the Committee, on behalf of AMVETS, I
would like to thank you for inviting me and the representatives
of the other member organizations that authored The Independent
Budget to share with you our recommendations on the Department
of Veterans Affairs' fiscal year 2012 budget.
We believe our recommendations to be the most fiscally
responsible way of ensuring quality and protecting the
integrity of the care and benefits our veterans' community
receives.
As a partner of The Independent Budget, AMVETS devotes a
majority of our time to the concerns and matters of VA's
National Cemetery Administration as well as veteran
entrepreneurship and Federal procurement. Today I will briefly
speak to both issues.
The most important obligation of the NCA is to honor the
memory of America's brave men and women who served in the Armed
Forces. As of late 2010, NCA maintained more than three million
graves at 131 national cemeteries in 39 States and Puerto Rico.
With the anticipated opening of several new national
cemeteries, annual interments are projected to increase to
approximately 116,000 in 2013 and are projected to remain at
this level through 2015.
The IB recommends a total operating budget of $275 million
for NCA for fiscal year 2012. This is so that they may meet the
increasing demands for interments, grave site maintenance and
related essential elements of cemetery operations. This
recommendation is based upon the immediate and increasing need
for NCA services as well as the upkeep of these sacred grounds.
The State Cemeteries Program is currently facing the
challenge of meeting the growing needs from States to provide
burial services in areas not currently served by NCA. The
Independent Budget thus recommends Congress appropriate $51
million for the State Cemetery Grant Program (SCGP) for fiscal
year 2012. This funding level will allow SCGP to establish new
State cemeteries at the current rate of need and will provide
burial options for veterans that otherwise would have no
reasonable access to State or national cemeteries.
We call on the Administration and to you, the Congress, to
provide the resources required to meet the critical nature of
NCA's mission and to fulfill this Nation's commitment to all
veterans who have served their country so honorably and
faithfully.
AMVETS' second focus of the fiscal year 2012 IB is on
veteran entrepreneurship and Federal procurement as it relates
to service-disabled veteran-owned small businesses and veteran-
owned small businesses. And while I will note that a majority
of the preceding information is focused on policy rather than
hard fiscal numbers, we believe that broken policies,
duplication of efforts, and lack of oversight are key factors
in determining a fiscally responsible budget and eliminating
any unnecessary waste.
Supporting service-disabled veteran-owned small businesses
and veteran-owned small businesses contributes significantly in
sustaining a veteran's quality of life while also contributing
to the success and ease of transitioning from active duty to
civilian life.
Given the current state of the economy, now more than ever
Federal agencies must be held accountable in meeting the 3-
percent Federal procurement goal as outlined by Executive Order
13-360 and Section 36 of the Small Business Act. All Federal
agencies must assist in the development and implementation of
strong strategies and be held accountable to meeting the 3-
percent goal.
Furthermore, Congress must ensure adequate resources are
available to effectively monitor and recognize those agencies
that are not meeting the 3-percent goal and hold them
accountable for their failure.
Another critical part of protecting veterans in a
successful Federal procurement system is to centralize the
vendor verification system. Thus far, VA has been awarded $1.4
billion in Recovery Act funds to aid in the employment and
contracting opportunities available to veteran-owned
businesses. And according to VA, of the Recovery Act funds they
have received, $538 million, of the $1.4 billion, have been
used on awards to service-disabled-owned small businesses and
veteran-owned small businesses.
However, we have serious concerns on how much of the
awarded funds were actually awarded to legitimate veteran-owned
businesses due to the lack of a solid verification process in
place at VA.
In closing, I encourage each of the Members to review my
full written testimony, which will outline all of our concerns
and recommendations on veteran entrepreneurship, contracting,
and the NCA.
Again, Chairman Miller and Members of the Committee, thank
you for your time.
[The prepared statement of Ms. Roof appears on p. 86.]
STATEMENT OF TIMOTHY M. TETZ
Mr. Tetz. Good afternoon, Mr. Chairman and Ranking Member
Filner and Members of the Committee. On behalf of the American
Legion, I would like to thank you for the opportunity to
present our thoughts on the VA's 2012 budget.
You only have to open the newspapers to know we are all as
a Nation deeply concerned with financial responsibility, making
smart choices about how to spend money. The American Legion
believes in making those smart choices, the right choices.
When I started to buy my first car, I remember my father
speaking to me about how to make the right choices, being wise
about spending. I was, of course, not really interested in
hearing what he had to say. I was a young man and thinking more
about what I wanted out of my car. Did I want the truck to feel
with my attitude or did I want the sporty coupe to attract the
ladies? Yet, the reality was I only had a limited amount of
money, only so much to spend to meet all my needs, all of my
desires. And I was too naive to understand factoring the cost
of insurance, tires, maintenance, and other unforeseen hazards.
The Department of Veterans Affairs' approach to the 2012
budget is not much different than the car buying experience of
a 21-year-old. They have tried to manage the reality today
against the possibilities of tomorrow while listening to the
veterans service organizations. And they have done a fairly
admirable job.
The American Legion is grateful the President's budget
represents a 10-percent increase over the last budget. This
demonstrates a mind set that places a priority on the debt owed
to the men and women who have sacrificed so much and, yet, ask
so little.
We understand these are hard times and hard choices must be
made. What are the smart decisions in the current budget? Smart
is funding $6 billion to enhance VA's ability to provide the
best possible specialized care for post-traumatic stress,
traumatic brain injury, and other mental health needs. Smart is
funding $939 million towards programs to help eradicate veteran
homelessness. Yet, we are left with the question, are these
decisions based on the reality of today overlooking the
probability of tomorrow?
Some of the $6 billion will help meet this research need,
but is that enough? This money seems to be directed at the
immediate medical needs of these veterans, but perhaps not the
long-term needs of those very same veterans. Does it address
the chasm between the advances in treatment of PTSD and TBI in
DoD and is available once they leave the service and separate
to return to their homes in upstate New York or rural Indiana?
We face many new and evolving medical concerns for which
the VA is uniquely placed to a be a trailblazer in research.
Perhaps one of the greatest investments to consider is to give
VA funding to lead this research. Given the intellectual and
technological might of this Nation, there is no reason the VA
should not be the world expert and leading authority on TBI,
PTSD, amputation and prosthetic medicine.
Fully fund VA research for prosthetics, vision, medical,
and TBI and PTSD. Give this aspect the needed money and let it
be what we all imagine it can be. VA must lead from the front,
not play catch-up for the rest of the world.
Despite these positives, VA seems short-sighted in their
allocation of resources for tomorrow. A reduction of
construction funds of $800 million certainly points to this.
Infrastructure is vital. Infrastructure is one of those things
you can pay for now or later and if you choose to pay for it
later, you always pay more.
How can we complete the new projects in Las Vegas, Denver,
New Orleans and the upgrades needed nationwide without adequate
funding? This is one area the American Legion strongly
disagrees with the proposed budget and asks Congress to
consider the importance of funding nearly twice that amount.
Cutting money from construction creates an illusionary savings.
You can choose to pay now or pay later, but the price of
failure to invest in infrastructure will eventually come due.
Smart money invests in infrastructure now.
We realize there is only so much money. We realize the
American Legion as well as every other veterans' organizations
here comes with expanded visions of what we need, what our
veterans need, and what the VA must deliver. We remain
committed to help you find savings within the existing budget,
identifying chances to shift resources to serve the needs of
the veterans sitting in the clinic in Florida and the future
veteran sitting in the forward observation base in Afghanistan.
We find ourselves in that very same situation my father was
in all those years ago, pointing out considerations that quite
honestly you do not take account for as a 21-year-old. You can
learn a lot by making bad choices and you also learn the older
you get, the wiser your dad seems to be. It is the little
things. It is the details you do not think about that make the
sense in the long run.
I thank you again for the opportunity to present this
testimony and will gladly answer any questions you might have.
[The prepared statement of Mr. Tetz appears on p. 92.]
The Chairman. We thank each and every one of you for your
testimony.
The President's Commission on Fiscal Responsibility and
Reform released its report back in December. And, basically, it
said that everything needed to be on the table to include
finding waste, fraud, and abuse that may exist in Federal
agencies.
I know each of your organizations works very closely with
VA as do your members in utilizing their services. And I would
like to just ask, do you have any particular areas that you can
bring to our attention so that we can help find these extra
dollars?
Mr. Blake. Right now I do not know that I can answer that
question, Mr. Chairman, but it is probably something where we
could mine the information from the bulk of our organization
and provide you with a better answer after having had a chance
to sort of spread that word and that question around.
Mr. Kelley. My office has taken some time to go ahead and
look into some of that. And I will be happy to work with the
Committee to identify more than a handful of areas where there
are some savings.
Mr. Violante. Mr. Chairman, I think when you opened up this
hearing, you pointed to a number of issues that we think need
to be looked at, including the growth in the administrative
side versus the hands-on services. So we certainly would be
willing to work with staff to look into that to see if all
those increases are as necessary as VA seems to think.
Ms. Roof. As AMVETS has been saying for the past year and a
half, I would love the opportunity to sit down with each and
every one of you and identify some areas where we definitely
believe there is duplication of efforts and so on.
Mr. Tetz. Mr. Chairman, we obviously join our fellow
veterans organizations in that. Like all of us, we go out there
and hear it and we will be happy to share that.
I think earlier Mr. Michaud brought up some of the
duplicative contracting, some of the oversight. And if we can
start looking at those little pieces, tens of millions of
dollars here suddenly start adding up to big savings that we
get out to the right people in the right places.
The Chairman. That they do. And I appreciate your
willingness to work with the Committee and staff. This is
something again that we pledge to work with you and hope that
you will work with us and VA as well as we try to navigate
through these very perilous financial waters that we find
ourselves in here in the United States.
Mr. Blake, you talked about concerns regarding VA's
proposed contingency fund. I have concerns as well. The Ranking
Member and I have been discussing it. I would like you to
expand a little bit, if you would, on your concerns.
Mr. Blake. Well, first let me say that when we had the
briefing from the VA, it was a little unclear as to what
exactly the contingency fund is. So maybe this is my
interpretation of the way they explained it.
But as I understood it, the cost associated with that
contingency fund is based on some assumptions they made for
their model that is impacted by changes in the economic
conditions, unemployment and things like that, as best as I can
understand, which sounds a little bit like they have
manipulated their health care projection model to serve a
singular purpose beyond the broader scope of the model itself.
I guess the concern I have is do you need $953 million or
do you not. I believe they do because I think our projections
go along that line of thinking for workload and things like
that and, yet, by identifying it as sort of a contingency fund,
you say, well, maybe we need it or maybe we do not and, yet,
their budget is built on the assumption that they need that
money because it is included in their overall recommendation.
So I would sit here and say you need the money from The
Independent Budget's perspective. We believe that money can be
used and is needed. I think the VA should do the same.
The Chairman. Mr. Filner.
Mr. Filner. Thank you, Mr. Chairman. Just three quick
points.
First, in the past, some administrations have, after the
Secretary's presentation, not stayed around to hear your
testimony. I want to thank all of you for staying and listening
to these stakeholders who worked so hard on this budget. So
thank you.
Again, all of you who worked so hard on this, you give us
material that we have to absorb and chew over for a long period
of time. But we have a lot of confidence in it because of the
work you put into it. We are going to use this again and again
and again and there is a lot to absorb. I just want to thank
you once more for each year that you put such hard work in it.
Lastly, I want to just point out the success that you all
had. Most of your organizations had as your top priority last
year the forward or advanced funding. You showed how important
that was.
We are going around and around on the Continuing
Resolution. Various agencies do not know what the budget will
be. They cannot plan. They cannot move forward while the health
care budget of the VA is solid and they are working from it.
Veterans are being positively impacted by that.
So that was your work, all of you, and it shows how
necessary it was because this year, the first year that it was
in effect, it is absolutely necessary that we had it. So I want
to just thank you for all the work you did on that and all this
stuff on The Independent Budget. We will be using it for the
coming year.
Thank you, Mr. Chairman.
The Chairman. Mr. Bilirakis.
Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it.
Mr. Blake, in your testimony, you make reference to medical
and prosthetic research. Many breakthroughs have been made with
medical technology and products.
Do you believe that the VA has the necessary tools to
partner with companies that develop and produce such cutting-
edge products to ensure that we are providing veterans with the
highest quality of life possible? And anyone who wants to
comment on that as well, I would appreciate it.
Thank you.
Mr. Blake. If by necessary tools you mean the funding, I
think my statement speaks for itself. The concern I have is for
years, we felt like medical and prosthetic research was under-
funded. And in the last 2, 3 years, the Congress as a whole,
has committed to funding medical and prosthetic research at a
more appropriate level.
And I think it is absolutely necessary because of the
demand for advanced prosthetics and the things across the
spectrum that particularly this newest generation of veterans
have placed on the VA for their needs and because, you know,
this is a young generation that is going to rely on these
things for a very long time. And so we need to make sure that
the VA is prepared to address those needs for a long time.
So we are certainly disappointed to see that the
Administration is coming with a significantly reduced
recommendation for medical and prosthetic research. In fact, it
is $72 million below what may or may not end up being the
appropriated level when H.R. 1 or whatever the final version of
the funding is. So that would suggest a pretty significant
curbing in the availability of grants and such like that which
are the way that the VA sort of farms out its research
programs. So I would certainly have real concerns about that.
The Chairman. Anyone else on this particular subject
matter?
Mr. Tetz. Mr. Bilirakis, our concern and what we are
hearing out in the field is the discrepancy once they leave the
service. They sit there and they go through the DoD and they
get the quality of care and the tools and the prosthetics that
they need and all of a sudden, they come back out and they get
into their local community and they cannot service that.
And there should be that seamless help to say, hey, we had
you covered when you were wearing the uniform and now that you
are wearing a suit, we still have you covered. And that is a
bigger piece. So it goes beyond merely just keeping on top of
that advances but making sure that it is hand in hand and
seamless.
Mr. Bilirakis. Good point. Anyone else?
Ms. Roof. Just a real quick point I would like to add in. I
think a lot of times when people think prosthetics, they think
a leg or an arm. I think it is really, really important for
everyone to remember anything that goes on a veteran, in a
veteran, or a veteran uses is a prosthetic device from a heart
stent to a prosthetic leg to a service dog. So I agree with
Carl, 100 percent on the funding aspect. So I would want
everyone to keep that in mind when talking about cutting that
kind of funding.
Mr. Bilirakis. Okay. Mr. Kelley and anyone who wants to
comment on this, I would appreciate it. In general, is the VA
adequately transforming to meet the different needs of the men
and women who serve in Iraq and Afghanistan and what are the
top concerns associated with ensuring that changes are meeting
veterans' needs? We will start with Mr. Kelley if that is okay.
Mr. Kelley. Mr. Bilirakis, I had a hard time hearing the
question.
Mr. Bilirakis. I will repeat it if that is okay. Is the VA
adequately transforming to meet the different needs of the men
and women who have served in Iraq and Afghanistan? And,
secondly, what are the top concerns associated with ensuring
that the changes are meeting veterans' needs?
Mr. Kelley. Sure. I think they are making strides. I do not
know how you predicate adequate if we still have a suicide rate
that is 18 veterans a day. And so they are making strides. They
are going in the right direction, but there are areas that need
to continue to be improved, mental health, suicide prevention,
making sure that the needs of women veterans are being met.
There was a GAO report back in December that showed that
women veterans who applied for a disability rating for PTSD
related to combat service were denied at a very high rate and
men were accepted at a very high rate.
But in reversing that, if they applied for some other type
of mental health issue, whether it was military sexual trauma
or some other sort of trauma that affected them
psychologically, women were rated at a very high rate and men
were rated at a very low rate.
So there is still some training that needs to be done
within VA to make sure that they have a full understanding of
the needs of gender--I guess gender specific needs.
Mr. Bilirakis. Thank you.
Anyone else wish to comment?
Mr. Violante. I would just like to add to that. I agree. I
think there is a lot more work that needs to be done with
regards to women veterans. There are more of them. There are
now women serving in combat coming back with combat
disabilities. And VA needs to be mindful of that and work
towards improving access.
I think one area that they have greatly improved is what
they are doing jointly with DoD at a lot of the separation
centers with regards to getting claims done before men and
women leave the military. And that seems to be working rather
well. So we are happy to see that.
And I think better collaboration between DoD and VA with
regards to electronic records would be very helpful.
Mr. Blake. I want to go back to something that I think Mr.
Michaud or a number of the Members on the panel mentioned
earlier. It is not just about health care. They talked about
the evolution of the virtual lifetime record. That is not just
their medical record, but it could be their DoD service record
and all that. I do not think that is something that can happen
fast enough. I think that is something that should have
happened long ago.
I mean, we talk about the overwhelming problems with the
claims backlog and a lot of times, you hear about just the
sheer volume and weight of paper and things like that. So I
know that the Administration and Secretary Shinseki has made
one of their top priorities being this conversion into a
virtual lifetime record. And we hope that that is something
that will be expedited, not just we are still working on seeing
how close we are and all that. That needs to happen. It needs
to be done.
And now, in defense of the VA, it is not just a VA problem.
I mean, DoD has some blame in not getting this going faster as
well. And we have talked to some of the folks on the Armed
Services side about our concern with their involvement in this
as well. But that is something that needs to be done yesterday.
Mr. Bilirakis. Thank you.
The Chairman. Dr. Benishek.
Mr. Benishek. My concern about the electronic record, do
you get a copy of all your records that you have had from DoD
when you are in the service? You know, I have a little bit of
concern about the fact that sometimes the electronic record can
be lost easier than the paper record. I have concerns about
that. Does anybody have any insight as to what that is about or
is that going to be a problem?
The problem that I see for veterans is they are delayed in
their benefits because they cannot find their records. I mean,
that is what I hear all the time. We cannot prove that you are
saying what you said. And I just do not see how that is really
possible. I mean, the guy was in the service. I mean, how can
you not, you know what I mean?
Mr. Kelley. If a servicemember has the foresight to make
copies of their medical record, they will leave the military
with their medical record. But they have to have the foresight
to say I am going to take my medical record down to the copy
machine, make a copy of everything that is in there so I can
have my own personal record. That is not something that they
tell them to do. They have to do that on their own.
The idea of having a database that loses accessibility,
whatever happens, that system goes down, and you cannot
retrieve it, it is no better or no worse than having paper
copies. St. Louis is an example. We lost hundreds of thousands,
if not millions of documents from Vietnam era veterans who are
without medical records because they did not make their own.
The military kept them in St. Louis and the building burned.
So there will always be a fear of lost records. Is it a
good idea to hand a veteran his or her medical records the day
they leave? Absolutely. Is it a good idea to have them
electronically so it is easily accessible by the VA?
Absolutely.
Mr. Benishek. Thank you.
I yield the remainder of my time.
The Chairman. Mr. Flores.
Mr. Flores. I want to thank you for joining us today and
also for The Independent Budget that you have prepared for our
use. I think that will be a helpful tool.
Have you looked at the section of the VA budget about
greening the VA? In the grand scheme of things, it is minor
dollars, but I just wondered if it might be better deployed. We
are talking about $124 million.
Mr. Blake. We do not typically dig down that deep, but if
there is something you have an issue of concern about, I will
be glad to look at it.
Mr. Flores. I am just thinking about the allocation in
terms of we have talked about raising administrative costs, we
have talked about not enough resources going to help the vets
directly, but on the other hand, we have $124 million to green
the VA. I was wondering what your----
Mr. Blake. I have a hard enough time understanding regular
budgeting without understanding how you quantify greening to be
perfectly honest with you. But, again, it is something we would
certainly take a look at.
Mr. Flores. Okay. If you have any feedback, you can provide
it back to us. Thank you.
I yield back.
The Chairman. Mr. Johnson.
Mr. Johnson. Thank you, Mr. Chairman.
And thank you all for coming and speaking with us today.
Just a real quick question. The claims backlog, everybody
is talking about it. That is what we are focused on. You know,
certainly it is addressed in the budget.
In your view, and no particular order to answer here, what
is your top three things that you think we can do or should be
done to reduce that backlog?
Mr. Violante. Mr. Johnson, it is interesting because right
now we are not focused so much on legislative fixes. We are
still looking at that to see what is working. VA has roughly
about 48, 50 pilot programs out there that they are running and
we would like to see what the results are of those pilot
programs.
The big key to all of this is their VBMS and how that
system is going to operate their IT system and whether or not
it is a good searchable database, whether or not it is rules
based. And that is why we have asked Congress to monitor that
closely, maybe even bring in some third-party experts.
I mean, I do not know that any of us here are IT experts.
But we know what we would like to see the end result be and
that is a searchable electronic database rules based system. So
that is a key element and if you can keep an eye on that.
I mean, the other part of this is training. We do not
believe that VA personnel are adequately trained to do the job
that they are supposed to do to get the case right the first
time. So training is an important element.
And another element is accountability. No one is held
accountable for the fact that the decisions are wrong. The only
thing they are held accountable for is did they do a decision,
right or wrong. So we would like to see some accountability in
there.
And I think if we can get those elements and get VA focused
on that, I think we can tackle this claims backlog and get
things under control.
Mr. Tetz. I would really echo many of the things that my
counterpart said. You know, too often we want to throw more
things at them. Too often we want to say, hey, let's get
another project in there, let's do another, what do you think.
And with these pilot programs that are out there and the
opportunities out there, we really need to take a step back and
look at those and say what works, what does not, what is
realistic. And until you can sit there and work through that,
you cannot say what those successes are.
Currently, the VBMS when it is implemented, when it is
actually there could have a tremendous, tremendous help. It
also could be a disaster and we could be upside down there. But
I think that, you know, training all those folks who are
brought on board and creating a way for us to know, the VA
leadership and for the public to know that those folks are
using every hour they can dedicate to those and the work they
are doing is quality work and not just getting shoved around to
level to level. Make certain that all that staff we brought on
board and all that time is going to actually help the veteran
at the end and decrease and break the backlog.
Mr. Johnson. Sorry. I want to take just a couple of seconds
and give you some encouragement. I came to Congress from the
role of Chief Information Officer for a global manufacturing
company and spent 27 years in the Air Force as an IT geek.
So in our Subcommittee on Oversight and Investigations, we
have already begun a very open dialogue with Mr. Baker and the
team from the VA and we are going to be looking at these
things. I certainly am concerned because this is not rocket
science. These are technologies that are available, have been
available, and, you know, why we are not putting them to good
use for our veterans, we are going to be digging into that and
where we can help push those along.
So with that, Mr. Chairman, I yield back.
The Chairman. Thank you very much
Anything else for the good of the order?
[No response.]
The Chairman. I thank you very much again for your
indulgence, also in waiting through the delays with the votes.
We thank you for your testimony.
And also thank you to the VSOs and to VA for your timely
submission of your statements. It is very important that we and
the staff are able to get them in a timely fashion so that we
can go through them to develop questions prior to this hearing.
So, again, without objection, each Member will have 5
legislative days to submit further testimony, revise and extend
extraneous materials. Any objection?
[No response.]
The Chairman. Without objection, so ordered.
And with that, this hearing is adjourned.
[Whereupon, at 1:42 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Jeff Miller, Chairman,
Full Committee on Veterans' Affairs
Welcome, Secretary Shinseki, to you and your team. Thank you for
being here today to present the President's fiscal year 2012 budget
request for the Department of Veterans Affairs (VA). Welcome also to
the veterans' organizations that are with us today.
Let me say at the outset that I look forward to a close working
relationship with all of you as we work to improve the delivery of
benefits and services to America's veterans.
As everyone knows, this is a tougher budget to measure because we
do not have a full-year appropriation for every VA account for the
current fiscal year. That said, if the numbers in the House CR bill are
carried forward I see the President's fiscal year 2012 budget as,
roughly, a 3.5 percent increase in VA discretionary spending. Relative
to prior years, this is a much more measured request.
What is important, however, is not the percentage increase it is
whether the resources requested meet our obligations to America's
veterans and America's taxpayers. Toward that end, I have several
initial observations.
First, I'm interested to learn how this budget will chart a path
forward to address the broken disability claims system. Staffing for
compensation claims has tripled since the late 1990's, numerous
Information Technology tools have been utilized, and there have been
different organizational models attempted. Nothing has worked. I want
to know how this budget takes a new approach to this challenge.
Second, I'm interested in learning how this budget is prioritized
to meet the needs of family caregivers of severely wounded Iraq and
Afghanistan veterans.
The reaction to VA's initial plan to implement the new Family
Caregiver law has been negative. I will explore ways we might be able
to refocus resources for this important initiative.
Third, I'd like to know what energy went into eliminating wasteful,
redundant spending. The President's bipartisan Deficit Reduction
Commission suggested that every agency, VA included, step up to the
plate.
I have to say, when I look at this budget and I see that it
proposes a funding level for the Office of the Secretary that is 41
percent higher than 2009 levels; 50 percent higher for the Office of
Congressional and Legislative Affairs; 96 percent higher for the Office
of Policy and Planning; and 140 percent higher for the Office of Public
and Intergovernmental Affairs . . . it raises all kinds of red flags.
Finally, there are some curious new accounting mechanisms proposed
in this budget. VA proposes that a portion of its 2012 medical care
budget be classified as a `contingency fund.'
It also proposes that Congress appropriate money VA says it can
save through management efficiencies so that it can then carry that
money over into another fiscal year. These are new concepts that I'd
like to get more detail on.
Mr. Secretary, we are all acutely aware of the fiscal and economic
crisis our Nation is in . . . debt of $14 Trillion, a deficit this year
of $1.55 Trillion, unemployment hovering at just under 10 percent.
We also are aware of the obligation we have to those who defend our
freedoms every day. That is the privilege we all have in serving on
this Committee. One measure of that obligation is how well we are
addressing veterans' needs through the programs and services
administered by VA.
So, there is a balance that must be struck a balance that
recognizes both the moral duty we have to care for those who served in
uniform and the reality that funding for that care doesn't exist in a
vacuum.
Let me borrow a quote from recent history that touches on the
challenge we face in finding that balance
`[T]he Committee's Members have kept in mind the fiscal
limitations within which we must operate if we are to get
Federal spending under control and thereby reduce the Federal
deficit and debt. We believe that the Government can be
fiscally responsible while still fulfilling its commitments to
the most deserving among us--including our Nation's veterans.
We also are mindful that uncontrolled Federal spending
threatens the long-term health of the Nation's economy and, in
turn, could adversely affect the provision of veterans'
benefits. Thus, we recognize that those who have worn the
uniform in defense of the Nation seek, as we do, to protect the
health of Nation's economy.'
Now, I know some listening might think I'm quoting from a Tea Party
Committee.
No, these were views expressed in a letter signed by every Member,
Democrat and Republican, of the Senate Committee on Veterans' Affairs
back in 1997, including the current Chairman of that Committee.
I recognize that times are different now than they were then. We
are now fighting a war on terrorism that has placed demands on VA's
medical and benefits system, so our priorities must obviously reflect
that basic fact.
But here is another difference, the deficit then was only $128
billion, today it's over 10 times larger.
Moving forward, I sincerely hope every Member of this Committee can
work together to find common ground on the difficult choices ahead.
Together, I truly believe we can meet our commitments to veterans while
also being mindful of our fiscal stewardship of taxpayer dollars.
Prepared Statement of Hon. Bob Filner, Ranking Democratic
Member, Full Committee on Veterans' Affairs
Thank you, Mr. Chairman.
I want to thank Secretary Shinseki for appearing before us this
morning to testify as to the resource requirements of the Department of
Veterans Affairs for the upcoming fiscal year, and the VA's
recommendation for an advance appropriation for medical care for fiscal
year 2013.
I would also like to thank the representatives of the veterans
service organizations who annually co-author The Independent Budget,
and The American Legion, for presenting us with their views as to the
needed funding levels for veterans' programs.
Although I have a number of concerns regarding the funding levels
you propose, and questions regarding some of the assumptions and
estimates that underlie your request, if you, Secretary Shinseki, tell
me that this is what you need to get the job done in the coming fiscal
year, then I will offer you my support and I will fight to get you the
funding levels you say you need.
I do, however, have concerns about your request for a ``contingency
fund'' and questions as to whether your ``operational improvements''
will actually generate the cost savings you estimate, but I will work
with my colleagues to ensure that you have the bottom-line dollars that
you need to care for our veterans in the coming fiscal year.
I look forward to hearing from our veterans' groups as to how they
generated their recommendations, and to hear from them their
experiences, and the experiences of their fellow veterans, who are on
the receiving end of the programs we fund. What is the need out there
and is the need being met?
Every year I refer to The Independent Budget as ``my bible'' when
it comes to helping us decide what funding levels to recommend to the
Budget Committee-- this year is no different. Budgets speak louder than
words as to what our priorities are as a country. Caring for our
veterans is a national priority.
I am hopeful that all of us, working together, will be able to
provide the VA with the funding it needs, and that the VA will be a
faithful steward of the taxpayer dollars it receives. I firmly believe
that you should request what you need, and that you need every dollar
that you request.
Thank you, Mr. Chairman. I yield back the balance of my time.
Prepared Statement of Hon. Ann Marie Buerkle
Thank you, Mr. Chairman.
As a Freshman Member of this Committee and Chair of the
Subcommittee on Health, I take very seriously my responsibility to
ensure that the Department of Veterans Affairs is adequately funded to
provide our veterans with the benefits their service afforded them.
We are all aware of our country's current economic crisis. We have
a $14 trillion debt. We have an unemployment rate that is close to 10
percent. There is no doubt we have to take a critical look at how we
spend our tax dollars and make tough choices.
However, laws providing for the care of our Nation's veterans were
some of the very first laws enacted by Congress because our Founding
Fathers had the foresight to know that America's veterans deserve the
gratitude of a grateful Nation and providing care and benefits for
those who had proved so worthy would make our country stronger.
I hope that our hearing this morning will point the way toward
close cooperation among all of us as advocates of our Nation's veterans
to respond to their evolving needs and those of their families. That
does not mean that there aren't many areas where we can improve. We
can, we should, and we will conduct rigorous oversight to ensure the VA
is being a responsible steward of taxpayer dollars.
I want to thank the Secretary for his appearance before the
Committee today and I thank you for your leadership.
I also appreciate the Veterans Service Organization representatives
for participating in our hearing today. Your outlook on funding
recommendations for veterans programs and input into the budget is of
great value to me in this process.
I look forward to today's discussion and yield back my time.
Prepared Statement of Hon. Silvestre Reyes
Thank you Mr. Chairman,
Secretary Shinseki, I want to thank you for coming today to address
our concerns with the care of our Nation's Veterans. I also want to
thank you for your outstanding service to this Nation. As a Veteran,
the issues we address in this Committee are very personal to me. They
are also very personal to the more than 80,000 veterans that live in my
district.
Many Veterans issues have come to the forefront in the recent
weeks. They include violations of the Servicemember's Civil Relief Act,
high rates of homeless veterans, failure of the administration to honor
the Caregivers and Veterans Omnibus Health Services Act, and the recent
lawsuit by victims of sexual assault, although against the U.S.
Department of Defense (DoD), it is brought by veterans. These are just
a few issues that are affecting the brave men and women who have fought
for this country.
Even with all these high profile issues, the most important thing
we can give our Veterans is comprehensive health care for the injuries
they sustained in service of their Nation. As a Member of this
Committee, and the Armed Services Committee, I feel very strongly that
one of the most effective ways the Veterans Administration can provide
these services to our Soldiers, Sailors, Airmen, and Marines is to
ensure a seamless hand-off between the Department of Defense and the
VA. Too often wounded servicemembers must wait for months while their
records are transferred between the two agencies, and what's worse, is
that the information that is transferred is not comprehensive in
regards to what our soldiers were exposed to on the battlefield. The
Vietnam War ended almost 40 years ago, and to this day there are
Veterans that have still not received medical care for their exposure
to Agent Orange.
It is my goal that we address all of the challenges facing our
Veterans. Although we cannot erase the mistakes of the past, it is
imperative that we move forward with the programs that will efficiently
and effectively provide care to those who have given so much defending
this country.
Thank you Mr. Chairman, and I yield back the balance of my time.
Prepared Statement of Hon. Eric K. Shinseki, Secretary,
U.S. Department of Veterans Affairs
Chairman Miller, Ranking Member Filner, Distinguished Members of
the House Committee on Veterans' Affairs:
Thank you for the opportunity to present the President's 2012
Budget and 2013 Advance Appropriations Requests for the Department of
Veterans Affairs (VA). Budget requests for this Department deliver the
promises of Presidents and fulfill the obligations of the American
People to those who have safeguarded us in times of war and peace.
Today, the Nation's military remains deployed overseas as it has
during the last 9 years of major conflict. Our requirements have grown
over the past 2 years as we addressed longstanding issues from past
wars and watched the requirements for those fighting the current
conflicts grow significantly. These needs will continue long after the
last American combatant departs Iraq and Afghanistan. It is our intent
to continue to uphold our obligations to our Veterans when these
conflicts have subsided, something that we have not always done in the
past. Not upholding these obligations in the past has left at least one
generation of Veterans struggling in anonymity for decades. We, who
sent them, owe them better.
VA has an obligation to track, communicate to stakeholders, and
take decisive action to consistently meet the requirements of our
Nation's Veterans for care and services. We pay great attention to
detail but there are many factors in the health care market that we
cannot control. We must mitigate the risk inherent when requirements
for Veterans' care and services, and costs in the health care market,
exceed our estimates. This request is the Department's plan for
managing that risk and meeting our obligations to all Veterans
effectively, accountably, and efficiently.
The President's budget for 2012 requests $132 billion--$62 billion
in discretionary funds and $70 billion in mandatory funding. Our
discretionary budget request represents an increase of $5.9 billion, or
10.6 percent, over the 2010 enacted level.
Our plans for 2012 and 2013 pursue strategic goals we established 2
years ago to transform VA into an innovative, 21st century organization
that is people-centric, results-driven, and forward-looking. These
strategic goals seek to reverse in-effective decision-making,
systematic inefficiency, and poor business practices in order to
improve quality and accessibility to VA health care, benefits, and
services; increase Veteran satisfaction; raise readiness to serve and
protect in a time of crisis; and improve VA internal management systems
to successfully perform our mission. We seek to serve as a model of
governance, and this budget is shaped to provide VA both the tools and
the management structure to achieve that distinction.
For almost 146 years now, VA and its predecessor institutions have
had the singular mission of caring for those who have ``borne the
battle'' and their survivors. This is our only mission, and to do that
well, we operate the largest integrated health care system in the
country; the eighth largest life insurance entity covering both active
duty members as well as enrolled Veterans; a sizable education
assistance program; a home mortgage enterprise which guarantees over
1.4 million Veterans' home loans with the lowest foreclosure rate in
the Nation; and the largest national cemetery system, which continues
to lead the country as a high performing institution.
For 2 years now, we have disciplined ourselves to understand that
successful execution of any strategic plan, especially one for a
Department as large as ours, requires good stewardship of resources
entrusted to us by the Congress. Every dollar counts, both in the
current constrained fiscal environment and during less stressful times.
Accountability and efficiency are behaviors consistent with our
philosophy of leadership and management. The responsibility of caring
for America's Veterans on behalf of the American people demands
unwavering commitment to effectiveness, accountability, and in the
process, efficiency. In the past 2 years, we have established and
created management systems, disciplines, processes, and initiatives
that help us eliminate waste.
Stewardship of Resources
VA has made great progress instilling accountability and
disciplined processes by establishing our Project Management
Accountability System (PMAS). This approach has created an information
technology (IT) organization that can rapidly deliver technology to
transform VA. PMAS is a disciplined approach to IT project development
whereby we hold ourselves and our private-sector partners accountable
for cost, schedule and performance. In just 1 year, PMAS exceeded an 80
percent success rate of meeting customers' milestones.
In addition to PMAS, we adopted a new acquisition strategy to make
more effective use of our IT resources. This new strategy,
Transformation Twenty-One Total Technology (T4--for short), will
consolidate our IT requirements into 15 prime contracts, leveraging
economies of scale to save both time and money and enable greater
oversight and accountability. T4 also includes significant goals for
subcontractors and other protections to make sure Veteran-owned small
businesses get a substantial share of the work. Seven of the 15 prime
contracts are reserved for Veteran-owned small businesses, and four of
the seven are reserved for service-disabled small businesses.
In developing the 2012 budget, VA used an innovative, Department-
wide process to define and assess VA's capital portfolio. This process
for Strategic Capital Investment Planning (SCIP) is a transformative
tool enabling VA to deliver the highest quality of services by
investing in the future and improving efficiency of operations. SCIP
has captured the full extent of VA infrastructure and service gaps and
developed both capital and non-capital solutions to address these gaps
through 2021. SCIP also produced VA's first-ever Department-wide
integrated and prioritized list of capital projects, which is being
used to ensure that the most critical infrastructure needs are met,
particularly in correcting safety, security, and seismic deficiencies,
and creating consistent standards across the system.
The use of metrics to monitor and assess performance is another key
strategy we employ to ensure the effective use of resources and
accountability. For example, in November 2010, VA launched two online
dashboards to offer transparency of the clinical performance of our
health care system to the general public. First, VA's Linking
Information Knowledge and Systems (LinKS) provides outcome measurement
data in areas such as acute, intensive, and outpatient care. This
allows management to assess a specific medical facility's performance
against other facilities while, at the same time, serving as a
motivational tool to improve performance. The dashboard, Aspire,
compiles data from VA's individual hospitals and hospital systems to
measure performance against national private-sector benchmarks.
Financial and performance metrics also provide the foundation for
monthly performance reviews that are chaired by the Deputy Secretary.
These monthly meetings play a vital role in monitoring performance
throughout the Department, and are designed to ensure both operational
efficiency and the achievement of key performance targets.
We also demonstrated our ongoing commitment to effective
stewardship of our financial resources by obtaining our 12th
consecutive unqualified (clean) audit opinion on VA's consolidated
financial statements. In 2010, we were successful in remediating 3 of 4
longstanding material weaknesses, a 75 percent reduction in just 1
year. We also began implementation of a number of key management
initiatives that will allow us to better serve Veterans by getting the
most out of our available resources:
Reducing improper payments and improving operational
efficiencies in our medical fee care program will result in estimated
savings of $150 million in 2011. This includes continued expansion of
the Consolidated Patient Account Centers to standardize VA's billing
and collection activities.
Implementing Medicare's standard payment rates will allow
VA to better plan and redirect more funding into the provision of
health care services. The estimated savings of this change in business
practices in 2011 is $275 million.
Consolidating contracting requirements, adopting
strategic sourcing and other initiatives will reduce acquisition costs
by an estimated $177 million in 2011.
The effective use of information technology is critical to
achieving efficient health care and benefits delivery systems for
Veterans. To accelerate the process for adjudicating disability claims
for new service-connected presumptive conditions associated with
exposure to Agent Orange, we implemented a new on-line claims
application and processing system.
A recent independent study, which covered a 10-year period between
1997 and 2007, found that VA's health IT investment during the period
was $4 billion, while savings were more than $7 billion. \1\ More than
86 percent of the savings were due to the elimination of duplicated
tests and reduced medical errors. The rest of the savings came from
lower operating expenses and reduced workload. VA is continuing to
modernize its electronic medical records to optimally support health
care delivery and management in a variety of settings. This effort
includes migrating the current computerized patient record system into
a modern, Web-based electronic health record.
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\1\ The Value From Investments In Health Information Technology At
The U.S. Department Of Veterans Affairs, Colene M. Byrne, Lauren M.
Mercincavage, Eric C. Pan, Adam G. Vincent, Douglas S. Johnston, and
Blackford Middleton, Health Aff April 2010 29:4629-638.
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Advance appropriations for VA medical care require a multi-year
approach to budget planning whereby 1 year builds off the previous
year. This provides opportunities to more effectively use resources in
a constrained fiscal environment as well as to update requirements.
Multi-Year Plan for Medical Care Budget
The 2012 budget request for VA medical care of $50.9 billion is a
net increase of $240 million over the 2012 advance appropriations
request of $50.6 billion in the 2011 budget. This is the result of an
increase of $953 million associated with potential increased reliance
on the VA health care system due to economic employment conditions,
partially offset by a rescission of $713 million which reflects the
cumulative impact of the statutory freeze on pay raises for Federal
employees in 2011 and 2012. The 2013 request of advance appropriations
is $52.5 billion, an increase of $1.7 billion over the 2012 budget
request.
The establishment of a Contingency Fund of $953 million for medical
care is requested in 2012. These contingency funds would become
available for obligation if the Administration determines that
additional costs, due to changes in economic conditions as estimated by
VA's Enrollee Health Care Projection Model, materialize in 2012. This
economic impact variable was incorporated into the Model for the first
time this year. Based on experience from 2010, the need for this fund
will be carefully monitored in 2011 and 2012. This cautious approach
recognizes the potential impact of economic conditions as estimated by
the Model to ensure funds are available to care for Veterans, while
acknowledging the uncertainty associated with the new methodology
incorporated into the Model estimates.
Another key building block in developing the 2012 and 2013 budget
request for medical care is the use of unobligated balances, or
carryover, from 2011 to meet projected patient demand. This carryover
of more than $1 billion, which includes savings from operational
improvements, supports anticipated costs for providing medical care to
Veterans in 2012 and 2013 and is factored into VA's request for
appropriations. This is a vital component of our multi-year budget and
any reductions in the amount of 2011 projected carryover funding would
require increased appropriations in 2012 and 2013.
Transforming VA
The Department faces an increasingly challenging operating
environment as a result of the changing population of Veterans and
their families and the new and more complex needs and expectations for
their care and services. Transforming VA into a 21st-century
organization involves a commitment to many broad challenges: to stay on
the cutting edge of health care delivery; to lay the foundation for
safe, secure, and authentic health record interoperability; to deliver
excellent service for Veterans who apply for disability and education
benefits; and to create a modern, efficient, and customer-friendly
interface that better serves Veterans. In this journey, we are focusing
on opportunities to improve our efficiency and effectiveness and the
individual performance of our employees.
Our health informatics initiative is a foundational component for
VA's transition from a medical model to a patient-centered model of
care. The delivery of health care will be better tailored to the
individual Veteran, yet utilize treatment regimens validated through
population studies. Veterans will receive fewer unnecessary tests and
procedures and more standardized care based on best practices and
empirical data.
The purpose of the VA Innovation Initiative (VAi2) is to identify,
fund, and test new ideas from VA employees, academia, and the private
sector. The focus is on improving access, quality, performance, and
cost. VA remains committed to the best system of delivering quality
care and benefits to Veterans. VAi2 plays an important role by enabling
the use of promising technologies in the design of cost-effective
solutions. For example, TBI Toolbox pilot, located at McGuire VA
Medical Center in Richmond, Virginia, will test a software tool to
standardize data gathered from brain injury treatments. The strategy
will allow sharing of rapidly evolving treatment guidelines at VA
polytrauma centers and Department of Defense medical facilities, as
well as patient progress and outcomes.
The 2012 budget continues our focus on three key transformational
priorities I established when I became Secretary: Expanding access to
benefits and services; reducing the claims backlog; and eliminating
Veteran homelessness by 2015. These priorities address the most visible
and urgent issues in VA.
Expanding Access to Benefits and Services
Expanding access to health care and benefits for underserved
Veterans is vital to VA's success in best serving Veterans of all eras.
The Veterans Relationship Management (VRM) initiative will provide
Veterans, their families, and survivors with direct, easy, and secure
access to the full range of VA programs through an efficient and
responsive multi-channel program, including phone and Web services. VRM
will provide VA employees with up-to-date tools to better serve VA
clients, and empower clients through enhanced self-service
capabilities. Expanding the self-service capabilities of the eBenefits
on-line portal is one of the early successes of the VRM program in
2010, and expansion of eBenefits functionality continues through
quarterly releases and programs to engage new users.
VA also saw significant progress in expanding access to Veterans.
In July 2010, the Center for Women Veterans sponsored a forum to
highlight enhancements in VA services and benefits for women Veterans
which resulted in an information toolkit for advocates such as Veteran
Service Organizations to share with their constituencies.
Outreach was extended directly to women when, for the first time in
25 years, VA surveyed women Veterans across the country to (1) identify
in a national sample the current status, demographics, health care
needs, and VA experiences of women Veterans; (2) determine how health
care needs and barriers to VA health care differ among women Veterans
of different generations; and (3) assess women Veterans' health care
preferences in order to address VA barriers and health care needs. The
interim report, released in summer 2010, informs policy and planning
and provides a new baseline for program evaluation with regard to
Veterans' perceptions of VA health services. The final report will be
released in spring 2011.
The Enhancing the Veteran Experience and Access to Health care
(EVEAH) initiative will expand health care for Veterans, including
women and rural populations. Care alternatives will be created to meet
these special population access needs, including the use of new
technology. Where technology solutions safely permit, VA has already
transitioned from inpatient to outpatient settings through the use of
telemedicine, in-home care, and other delivery innovations.
One area of success is our expansion of telehome health-based
clinical services in rural areas, which increases access, and reduces
avoidable travel for patients and clinicians. In 2010, the total
average daily census in telehome health was 31,155. This program will
continue to expand to an estimated average daily census of 50,147 in
2012, an increase of 60 percent over 2010.
Through the Improve Veteran Mental Health (IVMH) initiative more
Veterans will have access to the appropriate mental health services for
which they are eligible, regardless of their geographic location. VA is
leveraging the virtual environment with services such as the Veterans'
Suicide Prevention Chat Line and real-time clinical video conferences.
Reducing the Claims Backlog
One of VA's highest priority goals is to eliminate the disability
claims backlog by 2015 and ensure all Veterans receive a quality
decision (98 percent accuracy rate) in no more than 125 days. VBA is
attacking the claims backlog through a focused and multi-pronged
approach. At its core, our transformational approach relies on three
pillars: a culture change inside VA to one that is centered on advocacy
for Veterans; collaborating with stakeholders to constantly improve our
claims process using best practices and ideas; and deploying powerful
21st century IT solutions to simplify and improve claims processing for
timely and accurate decisions the first time.
The Veterans Benefits Management System (VBMS) initiative is the
cornerstone of VA's claims transformation strategy. It integrates a
business transformation strategy to address process and people with a
paperless claims processing system. Combining a paperless claims
processing system with improved business processes is the key to
eliminating the backlog and providing Veterans with timely and quality
decisions. The Virtual Regional Office, completed in May 2010, engaged
employees and subject-matter experts to determine system specifications
and business requirements for VBMS. The first VBMS pilot began in
Providence in November 2010. Nationwide deployment of VBMS is expected
to begin in 2012.
VA is encouraging Veterans to file their Agent Orange-related
claims through a new on-line claims application and processing system.
Vietnam Veterans are the first users of this convenient automated
claims processing system, which guides them through Web-based menus to
capture information and medical evidence for faster claims decisions.
While the new system is currently limited to claims related to the new
Agent Orange presumptive conditions of Parkinson's Disease, Ischemic
Heart Disease, and Hairy Cell Leukemias, we will expand it to include
claims for other conditions.
VA also published the first set of streamlined forms capturing
medical information essential to prompt evaluation of disability
compensation and pension claims, and dozens more of these forms are in
development for various disabilities. The content of these disability
benefit questionnaires is being built into VA's own medical information
system to guide in-house examinations. Veterans can provide them to
private doctors as an evidence guide that will speed their claims
decisions.
Another initiative to reduce the time needed to obtain private
medical records utilizes a private contractor to retrieve the records
from the provider, scan them into a digital format, and send them to VA
through a secure transmission. This contract frees VA staff to focus on
processing claims more quickly.
Additional claims transformation efforts deployed nationwide in
2010 include the Fully Developed Claims initiative to promptly rate
claims submitted with all required evidence and an initiative to
proactively reach out to Veterans via telephone to quickly resolve
claims issues.
VA needs these innovative systems and initiatives to expedite
claims processing as the number of claims continue to climb. The
disability claims workload from returning war Veterans, as well as from
Veterans of earlier periods, is increasing each year. Annual claims
receipts increased 51percent when comparing receipts from 2005 to 2010
(788,298 to 1,192,346). We anticipate claims receipts of nearly 1.5
million in 2011 (including new Agent Orange presumptive) and more than
1.3 million claims in 2012. The funding request in the President's
budget for VBA is essential to meet the increasing workload and put VA
on a path to achieve our ultimate goal of no claims over 125 days by
2015.
Eliminating Veteran Homelessness
VA has an exceptionally strong track record in decreasing the
number of homeless Veterans. Six years ago, there were approximately
195,000 homeless Veterans on any given night; today, there are about
75,600. VA uses a multi-faceted approach by providing safe housing;
outreach; educational opportunities; mental health care and treatment;
support services; homeless prevention services, and opportunities to
return to employment. The National Call Center for Homeless has
received 13,000 calls since March 2010, and 18,000 Veterans and
families of Veterans have been provided permanent housing through VA
and Housing and Urban Development Department programs. These Veterans
were also provided with dedicated case managers and access to high-
quality VA health care.
The Building Utilization Review and Repurpose (BURR) study is using
VA's inventory of vacant/underutilized buildings to house homeless and
at-risk Veterans and their families, where practical. Congress
allocated $50 million to renovate unused VA buildings and VA has
identified 94 sites with the potential to add approximately 6,300 units
of housing through public/private ventures using VA's enhanced-use
lease authority. This legislative authority is scheduled to lapse at
the end of calendar year 2011. The Administration remains committed to
this important program, and a proposal to address the expiration will
accompany the Department's legislative package submitted through the
President's Program. In addition to helping reduce homelessness, vacant
building reuse is being considered for housing for Operation Enduring
Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND)
Veterans, polytrauma patients, assisted living, and seniors.
Homelessness is both a housing and health care issue, heavily
burdened by depression and substance abuse. Our 2012 budget plan also
supports a comprehensive approach to eliminating Veteran homelessness
by making key investments in mental health programs.
The 2012 budget includes $939 million for specific programs to
prevent and reduce homelessness among Veterans. This is an increase of
17.5 percent, or $140 million over the 2011 level of $799 million. This
increase includes an additional $50.4 million to enhance case
management for permanent housing solutions offered through the Housing
Urban Development-VA Supported Housing (HUD-VASH) program. These funds
are required to maintain the services that keep Veterans rescued from
homelessness sheltered; get the remaining men and women off the streets
whom we have not reached in the past; and, prevent additional Veterans
from becoming homeless during a time of war and difficult economic
conditions.
Mental Health
The mental health of Veterans is a more important issue now than
ever before, as increasing numbers of Veterans are diagnosed with
mental health conditions, often coexisting with other medical problems.
More than 1.2 million of the 5.2 million Veterans seen in 2009 in VA
had a mental health diagnosis. This represents about a 40 percent
increase since 2004.
Veterans of Iraq and Afghanistan rely on mental health care from VA
to a greater degree than earlier groups of Veterans. Diagnosis of PTSD
is on the rise as the contemporary nature of warfare increases both the
chance for injuries that affect mental health and the difficulties
facing Veterans upon their return home. In addition, mental health
issues are often contributing factors to Veterans' homelessness.
In order to address this challenge, VA has significantly invested
in our mental health care workforce, hiring more than 6,000 new mental
health care workers since 2005. In 2010, VA hired more than 1,500
clinicians to conduct screenings and provide treatment as well as
trained over 1,000 clinicians in evidenced-based practices. The
Department has also established high standards for the provision of
mental health care services through the recent publication of our
Handbook on Uniform Mental Health Services in VA medical centers and
clinics, and we have developed an integrated mental health plan with
DoD to ensure better continuity of care--especially for Veterans of
Iraq and Afghanistan. The 2012 budget includes $6.2 billion for mental
health care programs, an increase of $450 million, or 8 percent over
the 2011 level of $5.7 billion.
Medical Care Program
We expect to provide medical care to over 6.2 million unique
patients in 2012, a 1.4 percent increase over 2011. Among this
community are nearly 536,000 Veterans of Iraq and Afghanistan, an
increase of over 59,000 (or 12.6 percent) above 2011.
The 2012 budget will support several new initiatives in addition to
our efforts to eliminate Veteran homelessness. For example, $344
million is provided for the activation of newly constructed medical
facilities. In addition, we provide $208 million to implement
provisions of the Caregivers and Veterans Omnibus Health Services Act
and improve the quality of life for Veterans and their families.
The 2012 budget also includes operational improvements that will
make VA more effective and efficient in this challenging fiscal and
economic environment. VA is proposing $1.2 billion of operational
improvements which include aligning fees that VA pays with Medicare
rates, reducing and improving the administration of our fee-based care
program, clinical staff realignments, reducing indirect medical and
administrative support costs, and achieving significant acquisition
improvements to increase our purchasing power.
Beginning in 2010, VHA embarked on a multi-year journey to enhance
significantly the experience of Veterans and their families in their
interactions with VA while continuing to focus on quality and safety.
This journey required the VHA to develop new models of health care that
educated and empowered patients and their families, focused not only on
the technical aspects of health care but also designed for a more
holistic, Veteran-centered system, with improved access and
coordination of care. New Models of Health Care is a portfolio of
initiatives created to achieve these objectives. We are re-designing
our systems around the needs of our patients and improving care
coordination and virtual access through enhanced secure messaging,
social networking, telehealth, and telephone access.
An essential component of this approach is transforming our primary
care programs to increase our focus on health promotion, disease
prevention, and chronic disease management through multidisciplinary
teams. The new model of care will improve health outcomes and the care
experience for our 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.
This important 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. VA Telehealth and the Home Care Model will
develop a new generation of communication tools (i.e. social
networking, micro-blogging, text messaging, and self management groups)
that VA will use to disseminate and collect critical information
related to health, benefits and other VA services.
VA is taking this historic step in redefining medical care for
Veterans with the adoption of a modern health care approach called
PACT, which stands for Patient Aligned Care Team. PACT is VA's
adaptation of the popular contemporary team-based model of health care
known as Patient Centered Medical Home designed to provide continuous
and coordinated care throughout a patient's lifetime.
Medical Research
VA's many trailblazing research accomplishments are a source of
great pride to our department and the Nation. Today's committed VA
researchers are focusing on traumatic brain injury, post-traumatic
stress disorder, post-deployment health, women's health and a host of
other issues key to the well-being of our Veterans. As one of the
world's largest integrated health care systems, VA is uniquely
positioned to not only conduct and fund research, but to develop
solutions and implement them more quickly than other health care
systems--turning hope into reality for Veterans and all Americans.
VA's budget request for 2012 includes $509 million for research, a
decrease of $72 million below the 2010 level. In addition, VA's
research program will receive approximately $1.2 billion from medical
care funding and Federal and non-Federal grants. These research funds
will continue support for genomic medicine, point of care research, and
medical informatics and information technology. Genomic medicine, also
referred to as personalized medicine, uses information on a patient's
genetic make-up to tailor prevention and treatment for that individual.
The Million Veteran Program invites users of the VA health care system
nationwide to participate in a longitudinal study with the aim of
better understanding the relationship between genetic characteristics,
behaviors and environmental factors, and Veteran health.
To leverage data in the electronic health record, VA Informatics
and Computing Infrastructure (VINCI) is creating a powerful and secure
environment within the Austin Information Technology Center. This
environment will allow VA researchers to access more easily a wide
array of VHA databases using custom and off-the-shelf analytical tools.
The Consortium for Health care Informatics Research (CHIR) will provide
research access to patient information in VA's Computerized Patient
Record System (CPRS) narrative text and laboratory reports. Together,
VINCI and CHIR will allow data mining to accelerate findings and
identify emerging trends. Ultimately, this critical work will lead to
greater effectiveness of our medical system--improving value by
assisting in the prevention and cure of disease.
Veteran Benefits
The 2012 budget request for the Veterans Benefits Administration is
$2.0 billion, an increase of $330 million, or 19.5 percent, over the
2010 enacted level of $1.7 billion. This budget supports ongoing and
new initiatives to reduce disability claims processing time, including
development and implementation of further redesigned business
processes. It funds an increase in FTE of 716 over 2010 to 20,321 to
assist in reducing the benefits claims backlog. It also supports the
administration of expanded education benefits eligibility under the
Post-9/11 GI Bill, which now includes benefits for non-college degree
programs, such as on-the-job training, flight training, and
correspondence courses. In addition, the 2012 budget request supports
the following initiatives:
Integrated Disability Evaluation System (IDES) Program
IDES simplifies the process for disabled servicemembers
transitioning to Veteran status, improves the consistency of disability
ratings, and improves customer satisfaction. An IDES claim is completed
in an average of 309 days; 43 percent faster than in the legacy system.
VA and DoD worked together to increase the number of sites for the IDES
program from 21 to 27 in 2010. The six new sites are Fort Riley, Fort
Benning, Fort Lewis, Fort Hood, Fort Bragg and Portsmouth Naval
Hospital, and VA and DoD will continue to expand the IDES program.
IDES is being expanded to provide Vocational Rehabilitation and
Employment (VR&E) services to active duty Servicemembers transitioning
through the IDES. These services range from a comprehensive
rehabilitation evaluation to determine abilities, skills, and interests
for employment purposes as well as support services to identify and
maintain employment. The budget request includes $16.2 million for 110
FTE for the VR&E program to support IDES.
Veterans Benefits Management System (VBMS)
In 2011, we will conduct two of three planned pilot programs to
test VBMS, the new paperless claims processing system. Each pilot will
expand on the success of the first pilot by adding additional software
components. In the 2012 budget request for information technology, we
will invest $148 million to complete pilot testing and initiate a
national rollout.
VetSuccess on Campus
In July 2009, VA established a pilot program at the University of
South Florida called VetSuccess on Campus to improve graduation rates
by providing outreach and supportive services to Veterans entering
colleges and universities and ensuring that their health, education and
benefit needs are met. The program has since expanded to include an
additional seven campuses, serving approximately 8,000 Veterans. The
campus Vocational Rehabilitation Counselor (VRC) and the Vet Center
Outreach Coordinator liaise with school certifying officials, perform
outreach, and communicate with Veteran-students to ensure their health,
education, and benefit needs are met. This will enable Veterans to stay
in college to complete their degrees and enter career employment. In
addition, it provides Veterans the skills necessary to gain employment
after graduation, which can help prevent Veteran homelessness. The 2012
budget includes $1.1 million to expand the program to serve an
additional 9,000 Veteran students on nine campuses, more than doubling
the size of the current program.
National Cemetery Administration
The budget plan includes $250.9 million in operations and
maintenance funding for the National Cemetery Administration (NCA). The
funding will allow us to provide more than 89.8 percent of the Veteran
population a burial option within 75 miles of their residences by
keeping existing national cemeteries open and establishing new State
Veterans cemeteries, as well as increasing outreach efforts.
VA expects to perform 115,500 interments in 2012, a 1.0 percent
increase over 2011. In 2012, NCA will provide maintenance of 8,759
developed acres, 3.0 percent over the 2011 estimate, while 3,228,000 or
2.6 percent more gravesites will be given perpetual care.
The budget request will allow NCA to maintain unprecedented levels
of customer satisfaction. NCA achieved the top rating in the Nation
four consecutive times on the prestigious American Customer
Satisfaction Index (ACSI) established by the University of Michigan.
ACSI is the only national, cross-industry measure of satisfaction in
the United States. On the most recent 2010 survey and over the past
decade, NCA's scores bested over 100 Federal agencies and the Nation's
top corporations including Ford, FedEx and Coca Cola, to name a few.
Our own internal surveys confirm this exceptional level of performance.
For 2010, 98 percent of the survey respondents rated the appearance of
national cemeteries as excellent; 95 percent rated the quality of
service as excellent.
NCA has implemented innovative approaches to cemetery operations:
the use of pre-placed crypts, that preserve land and reduce operating
costs; application of ``water-wise'' landscaping that conserves water
and other resources; and installation of alternative energy products
such as windmills and solar panels that supply power for facilities.
NCA has also utilized biobased fuels that are homegrown and less
damaging to the environment. NCA is developing an independent study of
emerging burial practices throughout the world to inform its planning
for the future.
Support for the Veterans Cemetery Grants Program continues in 2012
with $46 million to fund the highest priority Veterans cemetery grant
requests ready for award. In addition to State cemetery grants, NCA is
engaged in discussions with tribal governments regarding the
construction of Veterans' cemeteries on their land and is awarding six
such grants in 2011. The inclusion of tribal governments as grant
recipients recognizes and empowers the authority of these groups to
represent a unique group of Veterans and respond to their needs.
Capital Infrastructure
Congressional support of VA has resulted in 63 major construction
projects funded in whole, or in part, since 2004. When combined with
investments in our minor construction and major lease programs, this
has contributed to a plant inventory which includes 5,541 owned
facilities, 1,629 leased facilities, 155 million square feet of
occupied space (owned and leased) and 33,718 acres of owned real
property.
To best utilize resources, VA has reduced its inventory of owned
vacant space by 34 percent, from 8.6 million square feet in 2001 to 5.7
million square feet in 2010. As discussed previously, we are using the
Building Utilization Review and Repurpose (BURR) effort to reuse vacant
space for homeless Veterans and their families. BURR also identifies
other potential reuses of vacant and underutilized space and land
within VA's inventory such as assisted living, senior housing, and
housing for Veterans of Iraq and Afghanistan and their families. VA
also houses homeless Veterans in public/private ventures through
enhanced-use leasing.
Major Construction
The major construction request in 2012 is $589.6 million in new
budget authority. In addition, VA has been the beneficiary of a
favorable construction market and, as a result, is able to reallocate
$135.6 million from previously authorized and appropriated projects to
accomplish additional project work--resulting in a total of $725.2
million for the major construction program. This reflects the
Department's continued commitment to provide quality health care and
benefits through improving its infrastructure to provide for modern,
safe, and secure facilities for Veterans. It includes seven ongoing
medical facility projects (New Orleans, Denver, San Juan, St. Louis,
Palo Alto, Bay Pines, and Seattle) and design for three new projects
(Reno, West Los Angeles and San Francisco) primarily focused on safety
and security corrections. One cemetery expansion will be completed to
maintain and improve burial service in Honolulu, HI.
Minor Construction
In 2012, the minor construction request is $550.1 million. 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 and
patient privacy, increase capacity for dental care, improve treatment
of special emphasis programs, and, expand our research capability. We
also use minor construction funds to improve the appearance of our
national cemeteries. Further, minor construction resources will be used
to comply with energy efficiency and sustainability design
requirements.
Greening VA
The ``greening VA'' effort continues to be strong. There are 21
facilities Green Globe-certified and four LEED-certified. We have
completed energy efficiency benchmarking for 99 percent of VA-owned
facilities and obtained the Energy Star label for 30 VA sites since
2003. Electric meter installations were completed for 60 percent of
targeted buildings and we are installing solar energy systems at 35
sites for a total capacity of 30 megawatts. VA has installed wind
turbines at two sites, awarded two ground source heat pump projects,
awarded five renewably fueled cogeneration projects, and completed one
fuel cell project.
In 2012, we plan to invest $27 million for solar photovoltaic
projects, $51 million in energy infrastructure improvements, $21
million in renewably fueled cogeneration using biomass (wood waste) or
biogas (waste methane), $1 million in sustainable building, $14 million
for wind projects, and $10 million for alternative fueling projects and
expansion of environmental management systems.
Information Technology
Information Technology (IT) is integral to the delivery of
efficient and effective service to Veterans. IT is not a supplementary
function--it is key to the delivery of efficient, modern health care.
The 2012 budget includes $3.161 billion to support Information
Technology (IT) development, operations and maintenance expenses. The
2012 budget will fund the Department's highest IT priorities as well as
information security programs, which protect privacy and provide secure
IT operations across VA. Under our disciplined development program,
PMAS, the delivery of customer software milestones exceeds 80 percent
which is up from just 20 percent before the implementation of PMAS. The
budget request will also fund systems that VA will develop and
implement under the Caregivers and Veterans Omnibus Health Services Act
of 2010.
In 2010, VA made the sound business decision to discontinue the
Integrated Financial Accounting System (IFAS) and the data warehouse
component of the Financial and Logistics Integrated Technology
Enterprise (FLITE), but will continue to provide funding for the
Strategic Asset Management (SAM) system in 2011 and 2012. OI&T will
fund other continuing projects such as Compensation and Pension Records
Interchange (CAPRI) which offers VBA Rating Veteran Service
Representatives and Decision Review Officers help in building the
rating decision. CAPRI does this by creating a more efficient means of
requesting compensation and pension examinations and navigating
existing patient records.
Veterans Relationship Management (VRM)
The 2012 IT budget for VRM is $108 million, and will support
continued development of the on-line portal as well as the development
of Customer Relationship Management capabilities.
Virtual Lifetime Electronic Record (VLER)
The Virtual Lifetime Electronic Record (VLER) is a Federal, inter-
agency initiative to provide portability, accessibility and complete
health, benefits, and administrative data for every servicemember,
Veteran, and their beneficiaries. The goal of this major initiative is
to establish the interoperability and communication environment
necessary to facilitate the rapid exchange of patient and beneficiary
information that will yield consolidated, coherent and consistent
access to electronic records between DoD, VA, and the private sector.
VLER will not create a new data record, but it will ensure
availability of reliable data from the best possible source. The VLER
health component of this initiative is in operation at two pilot sites
with a plan to add nine more pilots this fiscal year. VLER will work
closely with other major initiatives including the Veterans Benefits
Management System (VBMS) and the Veterans Relationship Management
(VRM). A total of $70 million in IT funds in 2012 is required to
complete the effort and move to national production and deployment of
initial VLER capabilities. The VLER partnership between VA and the
Department of Defense will serve as a positive model for electronic
health record interoperability in the country, which has been an
Administration priority.
Summary
VA is the second largest Federal department and has over 300,000
employees. Among the many professions represented in the vast VA
workforce are physicians, nurses, counselors, claims processers,
cemetery groundskeepers, statisticians, engineers, architects, computer
specialists, budget analysts, police, and educators--all working with
the greatest determination to best serve all generations of Veterans.
In addition, VA has approximately 140,000 volunteers serving Veterans
at our hospitals, Vet Centers and cemeteries. There are things that
they do that cannot be converted into dollar values--patience, dignity
and respect for Veterans, some of whom are heavily challenged by the
memories of their wars.
As advocates for Veterans and their families, VA is committed to
providing the very best services. I will do everything possible to
ensure that we wisely use the funds Congress appropriates for VA to
improve the quality of life for Veterans and the efficiency of our
operations--innovatively and transparently--as we deliver on the
enduring promises of Presidents and the obligations of the American
people to our Veterans.
I am honored to present the President's 2012 budget request for VA,
and to represent all VA employees and the interests of those outside of
VA, who share our commitment to Veterans.
Prepared Statement of Carl Blake, National Legislative
Director, Paralyzed Veterans of America
Chairman Miller, Ranking Member Filner, and Members of the
Committee, as one of the four co-authors of The Independent Budget
(IB), Paralyzed Veterans of America (PVA) is pleased to present the
views of The Independent Budget regarding the funding requirements for
the Department of Veterans Affairs (VA) health care system for FY 2012.
With the newly elected 112th Congress just beginning to conduct
business, it is important to once again review and assess the efforts
of the 111th Congress to provide sufficient, timely, and predictable
funding for the Department of Veterans Affairs (VA), particularly the
VA health-care system. The first session of the 111th Congress laid the
groundwork for a historic year in 2010. In 2009 the President signed
Public Law 111-81, the ``Veterans Health Care Budget Reform and
Transparency Act,'' which required the President's budget submission to
include estimates of appropriations for the Medical Care accounts for
fiscal year (FY) 2012 and thereafter (advance appropriations) and the
VA Secretary to provide detailed estimates of the funds necessary for
these accounts in budget documents submitted to Congress. Consistent
with advocacy by The Independent Budget, the law also required a
thorough analysis and public report by the Government Accountability
Office (GAO) of the Administration's advance appropriations projections
to determine whether that information is sound and accurately reflects
expected demand and costs to be incurred in FY 2012 and subsequent
years.
The Independent Budget veterans service organizations (IBVSOs) were
pleased to see that in February 2010 the Administration released a
detailed estimation of its FY 2011 funding needs as well as a blueprint
for the advance funding needed for the Medical Care accounts of VA for
FY 2012. It is important to note that last year was the first year that
the budget documents included advance appropriations estimates.
Unfortunately, due to differences in interpretation of the language of
Public Law 111-81, the GAO did not provide an examination of the budget
submission to analyze its consistency with VA's Enrollee Health Care
Projection Model. The Independent Budget was informed that the GAO was
not obligated to report on the advance appropriations projections of VA
until at least 2011. The IBVSOs look forward to working with Congress
to ensure that the GAO fulfills its responsibility this year.
For FY 2011, Congress provided historic funding levels for VA in
the House and Senate versions of the Military Construction and Veterans
Affairs appropriations bill that matched, and in some cases exceeded,
the recommendations of The Independent Budget. Unfortunately, as has
become the disappointing and recurring process, the Military
Construction and Veterans Affairs appropriations bill was not completed
even as the new fiscal year began October 1, 2010. Although the House
passed the bill in the summer, the Senate failed to enact the bill in a
timely manner. This fact serves as a continuing reminder that, despite
excellent funding levels provided over the past few years, the larger
appropriations process continues to break down over matters unrelated
to VA's budget due to partisan political gridlock.
Fortunately, this year, the enactment of advance appropriations has
temporarily shielded the VA health-care system from this political
wrangling and legislative deadlock. However, the larger VA system is
still negatively affected by the incomplete appropriations work. VA
still faces the daunting task of meeting ever-increasing health-care
demand as well as demand for benefits and other services.
In February 2010, the President released a preliminary budget
submission for VA for FY 2011. The Administration recommended an
overall funding authority of $60.3 billion for VA, approximately $4.3
billion above the FY 2010 appropriated level but approximately $1.2
billion less than The Independent Budget recommended. The
Administration's recommendation included approximately $51.5 billion in
total medical care funding for FY 2011. This amount included $48.1
billion in appropriated funding and nearly $3.4 billion in medical care
collections. The budget also included $590 million in funding for
Medical and Prosthetic Research, an increase of $9 million over the FY
2010 appropriated level.
For FY 2011, The Independent Budget recommended that the
Administration and Congress provide $61.5 billion to VA, an increase of
$5.5 billion above the FY 2010 operating budget level, to adequately
meet veterans' health-care and benefits needs. Our recommendations
included $52 billion for health care and $700 million for medical and
prosthetic research.
The Administration also included an initial estimate for the VA
health-care accounts for FY 2012. Specifically, the budget request
calls for $54.3 billion in total budget authority, with $50.6 billion
in discretionary funding and approximately $3.7 billion for medical
care collections. Unfortunately, because work on the FY 2011
appropriations bill was not completed, advance appropriations funding
for FY 2012 remains in limbo.
Moreover, recent actions by VA suggest that the FY 2011 advance
appropriations funding levels (which were affirmed in the President's
budget request) may not be sufficient to support the health-care
programs managed by VA. In a letter sent to Congress on July 30, 2010,
VA Secretary Eric Shinseki explained that he believes the advance
appropriations levels provided for FY 2011--that virtually match the
Administration's request for FY 2011--will be insufficient to meet the
health-care demand that VA will face this year. He also emphasized that
the passage of Public Law 111-163, the ``Caregivers and Veterans
Omnibus Health Services Act,'' and Public Law 111-148, the ``Patient
Protection and Affordable Care Act,'' will increase workloads for VA.
Unfortunately, the House version of the FY 2011 Military Construction
and Veterans Affairs appropriations bill did not fully address this
projected current year demand. Likewise, the Senate version of the
appropriations bill is apparently insufficient to meet the new demand
the Secretary projects.
While we appreciate the funding levels that are provided by the
appropriations bills, we believe that the Secretary's letter sends a
clear message that, absent some unclear ``management action'' by VA,
more funding will be needed for FY 2011 for VA Medical Care accounts.
We hope that as the House and Senate finally complete work on the FY
2011 Military Construction and Veterans' Affairs appropriations bill,
proper consideration must be given to this concern.
Funding for FY 2012
Last year the Administration recommended an advance appropriation
for FY 2012 of approximately $50.6 billion in discretionary funding for
VA medical care. The House Committee on Appropriations supported this
recommendation in H.R. 1 as well. When combined with the $3.7 billion
Administration projection for medical care collections, the total
available operating budget recommended for FY 2012 is approximately
$54.3 billion. However, included in the President's Budget Request for
FY 2012, the Administration revised the estimates for Medical Care down
by $713 million due to the proposed Federal pay freeze (a factor not
included in H.R. 1).
Of particular concern to The Independent Budget is an ill-defined
contingency fund that would provide $953 million more for Medical
Services for FY 2012. Moreover, we are especially concerned that the VA
presumes ``management improvements'' of approximately $1.1 billion to
be directed towards FY 2012 and FY 2013; and yet, the VA does not
define the relationship between the contingency fund and the
``management improvements'' that it proposes. Additionally, we are
concerned about the revised estimate in Medical Care Collections from
the originally projected $3.7 billion to now only $3.1 billion.
Ultimately, the VA seems to recommend a revised decrease to
approximately $53.9 billion for Medical Care for FY 2012.
For FY 2012, The Independent Budget recommends approximately $55.0
billion for total medical care, an increase of $3.4 billion over the FY
2011 operating budget level currently proposed in H.R. 1, the
``Continuing Resolution for FY 2011.'' The medical care appropriation
includes three separate accounts--Medical Services, Medical Support and
Compliance, and Medical Facilities--that comprise the total VA health
care funding level. For FY 2012, The Independent Budget recommends
approximately $43.8 billion for Medical Services. Our Medical Services
recommendation includes the following recommendations:
Current Services Estimate........................... $41,274,505,000
Increase in Patient Workload........................ $1,495,631,000
Additional Medical Care Program Costs............... $1,010,000,000
Total FY 2012 Medical Services...................... $43,780,136,000
Our growth in patient workload is based on a projected increase of
approximately 126,000 new unique patients--Priority Group 1-8 veterans
and covered non-veterans. We estimate the cost of these new unique
patients to be approximately $1.0 billion. The increase in patient
workload also includes a projected increase of 87,500 new Operation
Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans at a
cost of approximately $306 million.
Finally, our increase in workload includes the projected enrollment
of new Priority Group 8 veterans who will use the VA health care system
as a result of the Administration's continued efforts to incrementally
increase the enrollment of Priority Group 8 veterans by 500,000
enrollments by FY 2013. We estimate that as a result of this policy
decision, the number of new Priority Group 8 veterans who will enroll
in the VA should increase by 125,000 between FY 2010 and FY 2013. Based
on the Priority Group 8 empirical utilization rate of 25 percent, we
estimate that approximately 31,250 of these new enrollees will become
users of the system. This translates to a cost of approximately $148
million.
Lastly, The Independent Budget believes that there are additional
projected funding needs for the VA. Specifically, we believe there is
real funding needed to restore the VA's long-term care capacity (for
which a reasonable cost estimate can be determined based on the actual
capacity shortfall of the VA), to provide additional centralized
prosthetics funding (based on actual expenditures and projections from
the VA's prosthetics service), and to meet the new projected demand
associated with the provisions of P.L. 111-163, the ``Caregivers and
Veterans Omnibus Health Services Act.'' In order to restore the VA's
long-term care average daily census (ADC) to the level mandated by P.L.
106-117, the ``Veterans Millennium Health Care Act,'' we recommend $375
million. In order to meet the increase in demand for prosthetics, the
IB recommends an additional $250 million. This increase in prosthetics
funding reflects the significant increase in expenditures from FY 2010
to FY 2011 (explained in the section on Centralized Prosthetics
Funding) and the expected continued growth in expenditures for FY 2012.
Finally, we believe that there will be a significant funding need
in order for the VA to address the provisions of P.L. 111-163,
specifically as it relates to the caregiver provisions of the law.
During consideration of the legislation, the costs were estimated to be
approximately $1.6 billion between FY 2010 and FY 2015. This included
approximately $60 million identified for FY 2010 and approximately
$1.54 billion between FY 2011 and FY 2015. However, no funding was
provided in FY 2011 to address this need. As a result, the VA will have
an even greater need for funding to support P.L. 111-163 between FY
2012 and FY 2015 in order to fully implement these provisions. While
the Administration claims to have provided an additional $208 million
for implementation of P.L. 111-163, we remain concerned about the lack
of action by the VA thus far to actually implement the law. Moreover,
it is not clear where that additional funding is included in the FY
2012 Medical Care budget request. With this in mind, The Independent
Budget recommends approximately $385 million to fund the provisions of
P.L. 111-163 in FY 2012.
For Medical Support and Compliance, The Independent Budget
recommends approximately $5.4 billion, approximately $50 million above
the FY 2011 appropriated level. Finally, for Medical Facilities, The
Independent Budget recommends approximately $5.9 billion, approximately
$160 million above the FY 2011 appropriated level. While our
recommendation does not include an additional increase for non-
recurring maintenance (NRM), it does reflect a FY 2012 baseline of
approximately $1.1 billion. While we appreciate the significant
increases in the NRM baseline over the last couple of years, total NRM
funding still lags behind the recommended 2 to 4 percent of plant
replacement value. In fact, the VA should actually be receiving at
least $1.7 billion annually for NRM (Refer to Construction section
article ``Increase Spending on Nonrecurring Maintenance'').
For Medical and Prosthetic Research, The Independent Budget
recommends $620 million. This represents a $39 million increase over
the FY 2011 appropriated level. We are particularly pleased that
Congress has recognized the critical need for funding in the Medical
and Prosthetic Research account in the last couple of years. Research
is a vital part of veterans' health care, and an essential mission for
our national health care system.
Advance Appropriations for FY 2013
As explained previously, P.L. 111-81 required the President's
budget submission to include estimates of appropriations for the
medical care accounts for FY 2012 and subsequent fiscal years. With
this in mind, the VA Secretary is required to update the advance
appropriations projections for the upcoming fiscal year (FY 2012) and
provide detailed estimates of the funds necessary for the medical care
accounts for FY 2013. Moreover, the law also requires a thorough
analysis and public report of the Administration's advance
appropriations projections by the GAO to determine if that information
is sound and accurately reflects expected demand and costs.
The Independent Budget is pleased to see that the Administration
has proposed an increase in the Medical Care accounts for FY 2013. We
simply urge Congress to remain vigilant to ensure that the proposed
funding levels for FY 2013 are in fact sufficient to meet the continued
growth in demand on the health care system. Moreover, it is important
to note that this is the first year that the GAO will examine the
budget submission to analyze its consistency with VA's Enrollee Health
Care Projection Model. The Independent Budget looks forward to
examining all of this new information and incorporating it into future
budget estimates.
In the end, it is easy to forget, that the people who are
ultimately affected by wrangling over the budget are the men and women
who have served and sacrificed so much for this Nation. We hope that
you will consider these men and women when you develop your budget
views and estimates, and we ask that you join us in adopting the
recommendations of The Independent Budget.
This concludes my testimony. I will be happy to answer any
questions you may have.
Prepared Statement of Raymond C. Kelley, Director,
National Legislative Service, Veterans of Foreign Wars of the United
States
MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE:
On behalf of the 2.1 million men and women of the Veterans of
Foreign Wars of the U.S. (VFW) and our Auxiliaries, I would like to
thank you for the opportunity to testify today. The VFW works alongside
the other members of The Independent Budget (IB)--AMVETS, Disabled
American Veterans and Paralyzed Veterans of America--to produce a set
of policy and budget recommendations that reflect what we believe would
meet the needs of America's veterans. The VFW is responsible for the
construction portion of the IB, so I will limit my remarks to that
portion of the budget.
The Department of Veterans Affairs (VA) manages a wide portfolio of
capital assets throughout the nationwide system of health-care
facilities. According to the latest VA Capital Asset Plan, VA owns
5,405 buildings and almost 33,000 acres of land. It is a vast network
of facilities that requires much time and attention from VA's capital
asset managers. Unfortunately, VA's infrastructure is aging rapidly.
Although Congress has funded a significant number of new facilities in
recent years, the vast majority of existing VA medical centers and
other associated buildings are on average more than 60 years old.
Aging facilities create an increased burden on VA's overall
maintenance requirements. They must be maintained aggressively so that
their building systems--electrical, plumbing, capital equipment, etc.--
are up to date and that these facilities are able to continue to
deliver health care in a clean and safe environment. Older, out-of-date
facilities do not just present patient safety issues: from VA's
perspective, older buildings often have inefficient layouts and
inefficient use of space and energy. This means that even with
modification or renovation, VA's operational costs can be higher than
they would be in a more modern structure.
VA has begun a patient-centered reformation and transformation of
the way it delivers care and new ways of managing its infrastructure
plan based on the needs of sick and disabled veterans in the 21st
century. Regardless of what the VA health-care system of the future may
look like, our focus must remain on ensuring a lasting, accessible,
modernized system that is dedicated to the unique needs of veterans
while also providing unparalleled and timely care when and where
veterans need it.
The Capital Asset Realignment for Enhanced Services (CARES)
process, VA's data-driven assessment of current and future construction
needs, gave VA a long-term roadmap and has helped guide its capital
planning process over the past 10 years. The CARES process developed a
large number of significant construction objectives that would be
necessary for VA to fulfill its obligation to sick and disabled
veterans. Over the past several years, the Administration and Congress
have made significant inroads in funding these priorities. Since fiscal
year (FY) 2004, $5.9 billion has been allocated for these projects.
The Independent Budget veterans service organizations believe that
CARES was a necessary undertaking and that VA has made slow but steady
progress on many of these critical projects. In the post-CARES era,
many essential construction projects are still awaiting authorization
and funding, and the IBVSOs firmly believe that Congress cannot allow
the construction needs that led to the CARES blueprint to be
disregarded. Both strong oversight and sufficient funding are critical
in this ongoing task of maintaining the best care for veterans.
Given the challenges presented by the CARES blueprint, including a
backlog of partially funded construction projects, high costs of
individual projects, and our concern about the timeliness of these
projects--noting that it can take the better part of a decade from the
time VA initially proposes a project until the doors actually open for
veterans' care--VA has proposed a new program, named ``Strategic
Capital Investment Planning'' (SCIP). This initiative will address some
of the infrastructure issues that have been noted in The Independent
Budget.
SCIP is VA's newest approach to reevaluating its aging and
underutilized infrastructure, as well as examining the lack of
infrastructure in various locations around the country. The intent of
SCIP, according to VA, is to scrutinize all property so that VA can
best address gaps in delivery of care and services to veterans. Unlike
CARES, SCIP will cover all of VA, not only Veterans Health
Administration facilities; however, similar to CARES, SCIP is designed
to evaluate the condition of VA infrastructure, in order to build a 10-
year integrated capital plan. The goal is to improve quality of and
access to VA services by modernizing facilities based on current and
future needs. If SCIP is approved as VA's capital planning method, the
Department plans to begin this process with the FY 2012 budget cycle.
VA has also advised the IBVSOs that SCIP is intended to address the
funding shortfall of $24.3 billion to deal with major construction and
facility condition assessment backlogs, inefficient use of resources,
and high maintenance costs, as well as an existing commitment of about
$4.4 billion to complete ongoing major construction projects. If
approved, the goal of this new initiative must be a comprehensive plan
that will improve quality by providing equitable access to services for
all veterans across the VA system of care and services. As the age of
VA structures increase, costs go up, often dramatically so.
Accordingly, more funding is spent on older projects, leaving less for
other maintenance and construction needs and increasing the overall
budget for both major and minor construction. VA must adopt a plan for
the future that will review and assess all current and future needs
while providing priorities and transparency at the forefront.
A draft of the SCIP proposal was most recently provided to the
IBVSOs in October 2010. The overview included a future-oriented view of
VA capital needs beginning with the 2012 budget. According to VA, SCIP
would adapt to changes in environment, provide a comprehensive planning
process for all projects, and result in one prioritized listing of
capital projects VA wide. The list intends to ensure equitable access
to services for veterans across the country and includes major and
minor construction, nonrecurring maintenance, and leasing.
Because SCIP is a new initiative, The Independent Budget veterans
service organizations encourage VA to be transparent during the process
and would advise that challenges must be met when reviewing all current
and future needs of its aging infrastructure. The goal must be a
comprehensive plan that will improve quality by maintaining equitable
access to services across the VA system. The changing health-care
delivery needs of veterans, including reduced demand for inpatient beds
and increasing demand for outpatient care and medical specialty
services, along with limited funding available for construction of new
facilities, has created a growing backlog of projects that are becoming
more expensive to complete. VA has advised that SCIP is intended to
address the funding shortfalls of its current capital backlog needs.
Major and Minor Construction Accounts
The Department of Veterans Affairs continues to be faced with
challenges with respect to the maintenance backlog. VA regularly
surveys each facility as part of the Facilities Condition Assessment
(FCA) process. VA estimates the cost of repair and uses this cost
estimate as a component of its Federal Real Property Report
requirements. According to its latest 5-Year Capital Plan, VA has
estimated the total cost of repairing all ``D-rated'' and ``F-rated''
FCA deficiencies at a cost of $8 billion, even as it and Congress have
greatly increased the amount of funding and resources devoted to this
critical aspect of capital asset management. Although Congress has
increased recent funding for nonrecurring maintenance (NRM), these
funding levels only touch the surface of the backlog.
For years, NRM and other maintenance needs were significantly
underfunded, and massive backlogs ensued (see ``Increased Spending on
Nonrecurring Maintenance'' in this Independent Budget). Maintenance is
only a small fraction of the major infrastructure issues confronting
the system. The Independent Budget veterans service organizations
(IBVSOs) are also concerned about the huge backlog of major medical
construction projects and the political and economic reality that fully
funding each of these projects and constructing them in a timely manner
may not be feasible.
One of the reasons for such a large backlog of construction
projects is because Congress allocated so little funding during the
Capital Asset Realignment for Enhanced Services (CARES) process. The
Appropriations Committees provided few resources during the initial
review phase, and against our advice, preferred to wait for the result
of CARES. Because of our convictions that a number of these projects
needed to go forward and that they would be fully justified through any
plans developed by CARES, the IBVSOs argued that a de facto moratorium
on construction was unnecessary and would be harmful. The House agreed
with our views as evidenced by its passage of the Veterans Hospital
Emergency Repair Act, March 27, 2001; however, Congress never
appropriated funding to carry out the purposes of that act, and the
construction and maintenance backlogs continued to grow.
Upon completion of the CARES decision document in 2004, former VA
Secretary Anthony Principi testified before the Health Subcommittee of
the House Committee on Veterans' Affairs. He noted that CARES
``reflects a need for additional investment of approximately $1 billion
per year for the next 5 years to modernize VA's medical infrastructure
and enhance veterans' access to care.'' In a November 17, 2008, letter
to the Senate Committee on Veterans' Affairs, then-Secretary James
Peake reported that VA would need at least $6.5 billion over the
following 5 years to meet its funding requirements for major medical
facility construction projects.
As noted previously, VA has proposed a new program, Strategic
Capital Investment Planning (SCIP), to address some of the construction
and infrastructure issues presented in The Independent Budget. Given
the President's pledge to create a VA for the 21st century, the IBVSOs
expect the Department to proceed with its SCIP plan in a transparent
way, coordinate the plan through our community and other interested
parties, and provide its plan to Congress for review and approval if
required. However, until SCIP is fully implemented, we fear that VA's
capital programs and the significant effects on the system as a whole
and veterans individually will go unchanged; ultimately risking a
diminution of care and services provided by VA to sick and disabled
veterans in substandard facilities.
Until the SCIP plan is approved and in place across the VA network
of care, the IBVSOs will continue to argue for sufficient funding needs
to maintain VA's capital infrastructure and to ensure a safe and useful
system for all veterans who need VA health care. With this in mind, the
IBVSOs would like to outline the components of our Major and Minor
Construction account requests of this Independent Budget.
MAJOR CONSTRUCTION
Recommendation ($ in
Category Thousands)
Major Medical Facility Construction $1,850,000
NCA Construction $61,000
Advance Planning $45,000
Master Planning $15,000
Historic Preservation $20,000
Medical Research Infrastructure $150,000
Miscellaneous Accounts $60,000
------------------------------------------------------------------------
MINOR CONSTRUCTION
Category Funding ($ in Thousands)
Veterans Health Administration $450,000
National Cemetery Adminsitration $100,000
Veterans Benefits Administration $20,000
Staff Offices $15,000
------------------------------------------------------------------------
Major Medical Facility Construction--This amount would allow VA to
continue to address the backlog of partially funded construction
projects which includes any ongoing major construction projects already
approved. Depending on the stage in the process and VA's ability to
complete portions of the projects within the fiscal year, remaining
funds could be used for projects identified by VA as part of SCIP.
National Cemetery Administration--This amount would fund a number
of national cemeteries from VA's priority list as well as potential
projects identified by SCIP.
Advanced Planning--This amount helps develop the scope of the Major
Medical Facility construction project as well as to identify proper
requirements for their construction. It allows VA to conduct necessary
studies and research similar to the planning process in the private
sector.
Master Planning--A description of The Independent Budget request
follows later in the text.
Historic Preservation--A description of The Independent Budget
request follows later in the text.
Miscellaneous Accounts--These included the individual line items
for such accounts as asbestos abatement, the judgment fund, and
hazardous waste disposal.
Minor Construction Account--SCIP has already identified minor
construction projects that update and modernize VA's aging physical
plant, ensuring the health and safety of veterans and VA employees.
Medical Research Infrastructure--Funding needs to be allocated by
Congress to allow for needed renovations to VA research facilities.
Medical Research Infrastructure--A description of The Independent
Budget request follows later in the text.
National Cemetery Administration--This includes minor construction
projects identified by SCIP to include the construction of several
columbaria, installation of crypts, and landscaping and maintenance
improvements.
Veterans Benefits Administration--This includes several minor
construction projects identified by SCIP in addition to the leasing
requirements the Veterans Benefits Administration needs. It also
includes $2 million transferred yearly for the security requirements of
its Manila office.
Staff Offices--This includes minor construction projects related to
staff offices, including increased space and numerous renovations for
the VA Office of Inspector General.
We view these issues as the critical areas that must be addressed
when developing our funding recommendations. We would also like to note
that within many of these categories lies ongoing and unfunded projects
as well as backlogged facility repairs and maintenance.
INADEQUATE FUNDING AND DECLINING CAPITAL ASSET VALUE:
The Department of Veterans Affairs must protect against
deterioration of its infrastructure and a declining capital asset
value.
Good stewardship demands that VA facility assets be protected
against deterioration and that an appropriate level of building
services be maintained. Given VA's construction needs, such as seismic
correction, compliance with the Americans with Disabilities Act (ADA)
and Joint Commission on Accreditation of Health care Organization
(JCAHO) standards, replacing aging physical plant equipment, and
projects that were identified by the Capital Asset Realignment for
Enhanced Services (CARES) initiative, the VA construction budget
continues to be inadequate. During the past decade of underfunded
construction budgets, VA has not adequately recapitalized its
facilities.
Recapitalization is necessary to protect the value of VA's capital
assets through the renewal of the physical infrastructure. This ensures
safe and fully functional facilities long into the future.
VA facilities have an average age of more than 60 years, and it is
essential that funding be increased to renovate, repair, and replace
these aging structures and physical systems. In the past, The
Independent Budget veterans service organizations (IBVSOs) have cited
the recommendations of the final Report of the President's Task Force
to Improve Health Care Delivery for Our Nations Veterans (PTF). To
underscore the importance of this issue, we again cite the
recommendations of the PTF. It was noted that VA health-care facility
major and minor construction over the 1996 to 2001 period averaged only
$246 million annually, a recapitalization rate of 0.64 percent of the
$38.3 billion total plant replacement value. At this rate of
investment, VA would be recapitalizing its infrastructure every 155
years.
If maintenance and restoration were considered along with major
construction, VA invests less than 2 percent of plant replacement value
for its entire facility infrastructure nationwide. A minimum of 5
percent to 8 percent investment of plant replacement value is necessary
to maintain health-care infrastructure. If this rate is not improved,
veterans could be receiving care in potentially more unsafe and
dysfunctional settings as time goes along. Improvements in the delivery
of health care to veterans require that VA adequately create, sustain,
and renew physical infrastructure to ensure safe and functional
facilities. The FY 2008 VA Asset Management Plan provided the most
recent estimate of plant replacement value (PRV).Using the guidance of
the Federal Government's Federal Real Property Council, VA's PRV is
more than $85 billion. The IBVSOs appreciate the Administration's
efforts to increase the total capital budget, and we hope future
requests will be more in line with the system's needs.
Recommendations:
Congress and the Administration must ensure that adequate funds are
appropriated for VA's capital needs so that it can properly invest in
its physical assets to protect their value and to ensure that it can
continue to provide health care in safe and functional facilities long
into the future.
INCREASED SPENDING ON NONRECURRING MAINTENANCE:
The deterioration of many VA properties requires increased spending
on nonrecurring maintenance.
For years The Independent Budget veterans service organizations
(IBVSOs) have stressed the importance of providing necessary funding
for nonrecurring maintenance (NRM) accounts to ensure that longstanding
and continual upkeep requirements at VA facilities are met. NRM
embodies the many small projects that together provide for the long-
term sustainability and usability of VA facilities. NRM projects are
onetime repairs, such as modernizing mechanical or electrical systems,
replacing windows and equipment, and preserving roofs and floors, among
other routine maintenance needs. Nonrecurring maintenance is a
necessary component of the care and stewardship of a facility. When
managed responsibly, these relatively small, periodic investments
ensure that the more substantial investments of major and minor
construction provide real value to taxpayers and to veterans as well.
When NRM projects are ignored, the results can be detrimental to
the value of a VA property and the quality of care they facilitate for
veterans. Nonrecurring maintenance projects that are left undone
inevitably require more costly and time-consuming repairs when they are
eventually addressed. Furthermore, this lack of attention to basic
structural maintenance issues jeopardizes the safety of staff and
patients. Because delayed maintenance projects always require a more
invasive response as opposed to situations in which NRM is responsibly
managed, the IBVSOs believe neglecting such projects is tantamount to
denying veterans timely and professional care and even placing them in
danger.
Accordingly, to fully maintain its facilities, VA needs an NRM
annual budget of at least $1.7 billion. Teams of professional engineers
and cost estimators survey each medical facility at least once every 3
years as part of VA's Facilities Condition Assessment (FCA) process.
These surveys assess all components of a given facility to include
internal issues, such as plumbing, and external issues, such as parking
and mobility barriers. Each component of a facility is given a letter
grade, A through F. Areas given a grade of F no longer function or are
in danger of imminent structural or system failure. VA estimates the
cost of repair for each item that is rated D or F and then uses this
cost estimate as a component of its Federal Real Property Report
requirements. VA's latest 5-Year Capital Plan estimated the total cost
of repairing all D-rated and F-rated FCA deficiencies at a staggering
$8 billion, even as VA and Congress have greatly increased the amount
of funding and resources devoted to this critical aspect of capital
asset management. Since that time, NRM received a one-time allocation
of $1 billion through Public Law 111-5, the ``American Recovery and
Reinvestment Act.''
VA uses the FCA reports as part of its Federal Real Property
Council metrics. The department calculates a Facility Condition Index
(FCI), which is the ratio of the cost of FCA repairs compared to the
cost of replacement. According to the FY 2008 Asset Management Plan,
this metric has declined from 82 percent in 2006 to 68 percent in 2008.
VA's strategic goal is 87 percent, and for the Department to meet that
goal, it would require a sizeable investment in NRM and minor
construction. Given the low level of funding NRM accounts have
historically received, the IBVSOs are not surprised that basic facility
maintenance remains a challenge for VA.
In addition, the IBVSOs have long-standing concerns with how this
funding is apportioned once received by VA. Because NRM accounts are
organized under the Medical Facilities appropriation, it has
traditionally been apportioned using the Veterans Equitable Resource
Allocation (VERA) formula. This formula was intended to allocate
health-care dollars to those areas with the greatest demand for health
care, and is not an ideal method to allocate NRM funds. When dealing
with maintenance needs, this formula may prove counterproductive by
moving funds away from older medical centers and reallocating the funds
to newer facilities where patient demand is greater, even if the
maintenance needs are not as intense. We are encouraged by actions the
House and Senate Veterans' Affairs Committees have taken in recent
years requiring NRM funding to be allocated outside the VERA formula,
and we hope this practice will continue.
Another issue related to apportionment of funding and the budget
cycle has been well documented. Prior to the passage of advance
appropriations, the GAO had found that the bulk of NRM funding was not
apportioned until September, the final month of the fiscal year. For
example, the GAO reported that 60 percent of total NRM funding for FY
2006 was allocated in September of that year.
In other words, during the first 11 month of FY 2006, only 40
percent of NRM funding had been allocated even as VA knew any
unobligated funds would be remitted to the Department of the Treasury
by statute. This is a shortsighted policy that impairs VA's ability to
properly address its maintenance needs, and with NRM funding year to
year, those conditions, which lead to a functional mishandling of
essential funds, have been changed by advance appropriations. Medical
accounts are now appropriated by Congress a year in advance to allow VA
the ability to plan farther in advance and reduce the impact of delayed
appropriations.
Not receiving timely appropriations from Congress has curtailed the
positive impacts of medical spending over the years, and Congress must
now provide oversight of this process to ensure that these upfront
dollars for NRM and all medical spending realize their potential
benefits. Congress and VA should provide oversight to ensure this
change will not result in medical center managers continuing to sit on
unspent funds for longer periods of time, but that it will produce more
efficient spending and better planning, thereby eliminating the
previous situation in which these managers sometimes spent a large
portion of their maintenance funding very late in the fiscal year.
Recommendations:
VA must dramatically increase funding for nonrecurring maintenance
(NRM) in line with the industry standard of 2 percent to 4 percent of
plant replacement value in order to maintain modern, safe, and
efficient facilities. Congress should provide VA with additional
maintenance funding in the Medical Facilities appropriation to enable
the Department to begin addressing the substantial maintenance backlog
of Facilities Condition Assessment--identified projects.
Congress should provide NRM funding to support maintenance and
upgrades to VA's research infrastructure. Portions of the NRM account
should continue to be funded outside of the Veterans Equitable Resource
Allocation formula so that funding is allocated to the facilities that
have the greatest maintenance needs, rather than based on other
criteria unrelated to the condition of facilities. Congress must
provide oversight of the NRM funding allocated through the advance
appropriations process to ensure NRM funds are being spent in such a
way to meet their full potential.
MAINTAIN CRITICAL VA HEALTH INFRASTRUCTURE:
The Department of Veterans Affairs must execute a comprehensive,
strategic health infrastructure plan that is focused on the unique
needs of its veteran population. In order to reduce the growing backlog
and maintenance needs of its medical facilities, Congress and the
Administration must work together to secure the Department's future by
designing the ``VA of the 21st century.''
Today we find ourselves at a critical juncture with respect to how
VA health care will be delivered and what the VA of the future will be
like in terms of its health care facility infrastructure. One fact is
certain--our Nation's sick and disabled veterans deserve and have
earned a stable, accessible VA health-care system that is dedicated to
their unique needs and can provide high-quality, timely care where and
when they need it. Given these significant challenges and the shift in
care in many areas, in 2008 VA developed a new approach to dealing with
infrastructure, the Health Care Center Facility (HCCF) leasing program.
Under the HCCF leasing program, in lieu of the traditional approach to
major medical facility construction, VA would obtain by long term lease
a number of large outpatient clinics built privately to VA
specifications. These large clinics could provide a broad range of
outpatient services, including primary and specialty care as well as
outpatient mental health services and ambulatory surgery.
According to VA, inpatient needs at such sites would be managed
through contracts with affiliates or local private medical centers. The
Independent Budget veterans service organizations (IBVSOs) believe that
the adoption of Strategic Capital Investment Planning (SCIP) and more
HCCF leasing proposals illustrate a shift toward reliance on health
care leasing or a build-to-suit strategy with reliance on community
providers or academic affiliates for inpatient services, rather than VA
constructing its own comprehensive medical centers. We remain watchful
as to how such arrangements will be managed and what unintended
consequences may await sick and disabled veterans and those who
represent them.
Further, SCIP must be clearly explained and integrated with all
stakeholders involved in the process--specifically, how will it be
developed and prioritized, and will the implementation of the HCCF
model impact VA's specialized medical care programs, continuity of
high-quality care, delivery of comprehensive services, protection of VA
biomedical research and development programs, and particularly the
sustainment of VA's renowned graduate medical education and health
profession training programs? VA noted that, in addition to any new
HCCF facilities, it would maintain its VA medical centers, larger
independent outpatient clinics, community-based outpatient clinics
(CBOCs), and rural outreach clinics.
VA has argued that adopting the HCCF model would allow it to
quickly establish new facilities that would provide 95 percent of the
care and services veterans need in their catchment areas, specifically
primary care, a variety of specialty care services, mental health,
diagnostic testing, and same-day ambulatory surgery. Initially, the
IBVSOs have been supportive of the goals of this program. The HCCF
model seems to offer a number of benefits in addressing VA capital
infrastructure problems, including more modern facilities that meet
current life-safety codes, better geographic placements, increased
patient safety, reductions in veterans' travel costs, and increased
personal convenience.
This process could also offer the advantage of quick completion as
compared to the existing major construction design-authorization-
appropriation process, thus allowing more flexibility to respond to
changes in patient loads and technologies and making possible net
savings in operating costs and in facility maintenance.
While it offers these obvious advantages, the HCCF model raises
concerns about VA's plan for providing inpatient services. VA suggests
it will contract for these essential services with affiliates or
community hospitals. The IBVSOs believe this program would privatize
many services that we believe VA should continue to provide directly to
veterans. We are also deeply concerned about the overall impact of this
new model on the future of VA's system of care, including the potential
unintended consequences on continuity of high quality care; maintenance
of VA's specialized medical programs for spinal cord injury, blindness,
amputation care, and other health challenges of seriously disabled
veterans; delivery of comprehensive services; its recognized biomedical
research and development programs; and, in particular, the impact on
its renowned graduate medical education and health profession training
programs, in conjunction with long-standing affiliations with nearly
every health professions university in the Nation.
Moreover, we believe the HCCF model could well challenge VA's
ability to provide alternatives to maintaining directly its existing
130 nursing home care units now called ``community living centers''),
homelessness programs, domiciliary facilities, compensated work therapy
programs, hospice and respite, adult day health-care units, the Health
Services Research and Development Program, and a number of other highly
specialized services, including 24 spinal cord injury/dysfunction
centers, 10 blind rehabilitation centers, a variety of unique ``centers
of excellence'' (in geriatrics, gerontology, mental illness,
Parkinson's, and multiple sclerosis), and various critical care
programs for veterans with serious and chronic mental illnesses.
In general, the IBVSOs believe the HCCF proposal could be a
positive development, with good potential. But the process must be
transparent to all those involved--veterans, stakeholders, community
leaders, VA employees--and there must be a well-thought-out and well-
communicated plan to carry out the HCCF policy. It has been proven that
leasing can help to diminish long and costly in-house construction
delays and can be adaptable, especially when compared to costs for
renovating existing VA major medical facilities. Leasing options have
been particularly valuable for VA as evidenced by the success of the
leased-space arrangements for many VA community-based outpatient
clinics, Vet Centers, and leased VA regional office staff expansions.
However, the IBVSOs remain concerned with VA's plan for obtaining
inpatient services under the HCCF model, and have many unanswered
questions. There are major concerns with the pervasive contracting that
would be mandated by this type of proposal.
Acknowledging all the changes taking place in health care, VA needs
to look very closely at all its infrastructure plans, and needs to do a
better job explaining to veterans, their representatives, and Congress
what its plans are for every location, with a full exposition based on
facts.
Responding to a Congressional request, VA addressed a number of
specific questions related to its plan for the HCCF leasing initiative,
including whether studies had been carried out to determine the
effectiveness of the current approach; the full extent of the current
construction backlog of projects; its projected cost over the next 5
years to complete; the extent to which national veterans organizations
were involved in the development of the HCCF proposal; the engagement
of community health-care providers related to capacity and willingness
to meet veterans' needs; the ramifications on the delivery of long-term
care and specialized services; and whether it would be able to ensure
that needed inpatient capacity would remain available indefinitely.
Based on its response, the IBVSOs believe VA has a reasonable
foundation for assessing capital needs and has been forthright with the
estimated total costs for ongoing major medical facility projects, and
that the HCCF model can be a basis for meeting some of these needs at
lower cost. We agree with VA's assertion that it needs a balanced
capital assets program, of both owned and leased buildings, to ensure
that demands are met under current projections. Likewise, we agree with
VA that the HCCF concept could provide modern health-care facilities
relatively quickly that might not otherwise be available because of the
predictable constraints of VA's major construction program.
However, what is not clear to us is the extent to which VA plans to
deploy the HCCF model. In areas where existing CBOCs need to be
replaced or expanded with additional services due to the need to
increase capacity, the HCCF model would seem appropriate and
beneficial.
On the other hand, if VA plans to replace the majority or even a
large fraction of all VA medical centers with Health Care Center
Facilities, such a radical shift would pose a number of concerns for
us. Nevertheless, the IBVSOs see this challenge as only a small part of
the overall picture related to VA health infrastructure needs. The
emerging HCCF plan does not address the fate of VA's 153 medical
centers located throughout the Nation that are on average 60 years of
age or older. It does not address long-term-care needs of the aging
veteran population, inpatient treatment of the chronically and
seriously mentally ill, the unresolved rural health access issues, the
lingering questions on improving VA's research infrastructure, or the
fate of VA's academic training programs. Fully addressing these and
related questions is extremely important and will have an impact on
generations of sick and disabled veterans far into the future.
We would like to reiterate: Creating a VA of the 21st century must
include all stakeholders' interests. The IBVSOs expect VA to establish
any new infrastructure plan in a transparent way; vet that plan through
our community and other interested parties; and provide its plan to
Congress for review, oversight, and approval if required by law.
Congress and the Administration must work together to secure VA's
future to design a VA of the 21st century. It will take the joint
cooperation of Congress, veterans' advocates, and the Administration to
support this reform, while setting aside resistance to change, even
dramatic change, when change is demanded and supported by valid data.
Finally, one of our community's frustrations with respect to VA's
infrastructure plans is lack of consistent and periodic updates,
specific information about project plans, and even elementary
communications. The IBVSOs ask that VA improve the quality and quantity
of communications with us, our larger community, enrolled veterans,
concerned labor organizations, and VA's own employees, affiliates, and
other stakeholders as the VA capital planning process moves forward. We
believe that all of these groups must be made to understand VA's
strategic plan and how it may affect them, positively and negatively.
Talking openly and discussing potential changes will help resolve the
understandable angst about these complex and important questions of VA
health-care infrastructure. While we agree that VA is not the sum of
its buildings, and that a veteran patient's welfare must remain at the
center of the Department's concern, VA must be able to maintain an
adequate infrastructure around which to build and sustain ``the best
care anywhere.''
If VA keeps faith with these principles, the IBVSOs are prepared to
aid and support VA in accomplishing this important goal.
Recommendations:
VA must develop a well-thought-out health-care infrastructure and
strategic plan that becomes the means for it to establish a veterans
health-care system for the 21st century. Congress, the Administration,
and internal and external stakeholders must work together to secure
VA's future, while maintaining the integrity of the VA health-care
system and all the benefits VA brings to its unique patient population.
VA's new proposal, the Strategic Capital Investment Planning (SCIP)
and VA's health Care Center facility leasing proposal must be clearly
explained and integrated with all stakeholders involved in the process,
including how will it be developed, prioritized, and implemented, and
how it will impact VA's specialized medical care programs, continuity
of high-quality care, delivery of comprehensive services, protection of
VA biomedical research and development programs, and particularly the
sustainment of VA's renowned graduate medical education and health
profession training programs.
VA must improve the quality and quantity of communications with
internal and external communities of interests, including the authors
of this Independent Budget, concerning its plans for future
infrastructure improvements through the HCCF leasing and other
approaches.
VA must improve the quality and quantity of communications with
internal and external communities of interests, including the authors
of this Independent Budget, concerning its plans for future
infrastructure improvements through the HCCF leasing and other
approaches.
EMPTY OR UNDERUTILIZED SPACE AT MEDICAL CENTERS:
The Department of Veterans Affairs must use empty and underutilized
space appropriately.
The Department of Veterans Affairs maintains approximately 1,100
buildings that are either vacant or underutilized. An underutilized
building is defined as one where less than 25 percent of space is used.
It costs VA from $1 to $3 per square foot per year to maintain a vacant
building. Studies have shown that the VA medical system has extensive
amounts of empty space that can be reused for medical services. It has
also been shown that unused space at one medical center may help
address a deficiency that exists at another location. Although the
space inventories are accurate, the assumption regarding the
feasibility of using this space is not. Medical facility planning is
complex. It requires intricate design relationships for function, as
well as the demanding requirements of certain types of medical
equipment. Because of this, medical facility space is rarely
interchangeable, and if it is, it is usually at a prohibitive cost.
Unoccupied rooms on the eighth floor used as a medical surgical unit,
for example, cannot be used to offset a deficiency of space in the
second floor surgery ward. Medical space has a very critical need for
inter- and intra-departmental adjacencies that must be maintained for
efficient and hygienic patient care.
When a department expands or moves, these demands create a domino
effect on everything around it. These secondary impacts greatly
increase construction expense and can disrupt patient care. Some
features of a medical facility are permanent. Floor-to-floor heights,
column spacing, light, and structural floor loading cannot necessarily
be altered. Different aspects of medical care have various requirements
based upon these permanent characteristics. Laboratory or clinical
spacing cannot be interchanged with ward space because of the different
column spacing and perimeter configuration. Patient wards require
access to natural light and column grids that are compatible with room-
style layouts. Laboratories should have long structural bays and
function best without windows. When renovating empty space, if an area
is not suited to its planned purpose, it will create unnecessary
expenses and be much less efficient if simply renovated. Renovating old
space, rather than constructing new space, often provides only marginal
cost savings. Renovations of a specific space typically cost 85 percent
of what a similar, new space would cost. Factoring in domino or
secondary costs, the renovation can end up costing more while producing
a less satisfactory result.
Renovations are sometimes appropriate to achieve those critical
functional adjacencies, but are rarely economical. As stated earlier in
this analysis, the average age of VA facilities is 60 years. Many older
VA medical centers that were rapidly built in the 1940s and 1950s to
treat a growing war veteran population are simply unable to be
renovated for modern needs. Most of these so called ``Bradley-style''
buildings were designed before the widespread use of air conditioning
and the floor-to floor heights are very low. Accordingly, it is
impossible to retrofit them for modern mechanical systems. Many of them
also have long, narrow wings radiating from small central cores, an
inefficient way of laying out rooms for modern use. This central core,
too, has only a few small elevator shafts, complicating the vertical
distribution of modern services. Another important problem with this
existing unused space is its location. Much of it is not in a prime
location; otherwise, it would have been previously renovated or
demolished for new construction. This space is typically located in
outlying buildings or on upper floor levels and is unsuitable for
modern use.
Public Law 108-422 incentivized VA's efforts to properly dispose of
excess space by allowing VA to retain the proceeds from the sale,
transfer, or exchange of certain properties in a Capital Asset Fund
(CAF). Further, that law required VA to develop short- and long-term
plans for the disposal of these facilities in an annual report to
Congress. VA must continue to develop these plans, working in concert
with architectural master plans and the long-range vision for all such
sites.
Recommendations:
VA must develop a plan for addressing its excess space in non
historic properties that is not suitable for medical or support
functions because of its permanent characteristics or locations
PROGRAM FOR ARCHITECTURAL MASTER PLANS:
Each VA medical facility must develop a detailed master plan and
delivery models for quality health care that are in a constant state of
change as a result of factors that include advances in research,
changing patient demographics, and new technology.
The Department of Veterans Affairs must design facilities with a
high level of flexibility in order to accommodate new methods of
patient care and new standards of care. VA must be able to plan for
change to accommodate new patient care strategies in a logical manner
with as little effect as possible on other existing patient care
programs. VA must also provide for growth in existing programs based on
projected needs through capital planning strategy.
A facility master plan is a comprehensive tool to examine and
project potential new patient care programs And how they might affect
the existing health-care facility design. It also provides insight with
respect to growth needs, current space deficiencies, and other facility
needs for existing programs and how they might be accommodated in the
future with redesign, expansion, or contraction.
In many past cases VA has planned construction in a reactive
manner. Projects are first funded and then placed in the facility in
the most expedient manner, often not considering other future projects
and facility needs. This often results in short-sighted construction
that restricts rather than expands options for the future. The
Independent Budget veterans service organizations believe that each VA
medical center should develop a comprehensive facility master plan to
serve as a blueprint for development, construction, and future growth
of the facility; $15 million should be budgeted for this purpose.
We believe that each VA medical center should develop a
comprehensive facility master plan to serve as a blueprint for
development, construction, and future growth of the facility. VA has
undertaken master planning for several VA facilities, and we applaud
this effort. But VA must ensure that all VA facilities develop master
plan strategies to validate strategic planning decisions, prepare
accurate budgets, and implement efficient construction that minimizes
wasted expenses and disruption to patient care.
Recommendations:
Congress must appropriate $15 million to provide funding for each
medical facility to develop a 10-year comprehensive facility master
plan. The master plan should include all services currently offered at
the facility and should also include any projected future programs and
services as they might relate to the particular facility. Each facility
master plan is to be reviewed every 5 years and modified accordingly
based on changing needs, technologies, new programs, and new patient
care delivery models.
ARCHITECT-LED DESIGN-BUILD PROJECT DELIVERY:
The Department of Veterans Affairs must evaluate use of architect-
led design-build project delivery.
VA currently employs two project delivery methods: design-bid-build
and design-build. Design-bid build project delivery is appropriate for
all project types. Design-build is generally more effective when the
project is of a low complexity level. It is critical to evaluate the
complexity of the project prior to selection of a method of project
delivery.
Design-bid-build is the most common method of project design and
construction. In this method, an architect is engaged to design the
project. At the end of the design phase, that same architect prepares a
complete set of construction documents. Based on these documents,
contractors are invited to submit a bid for construction of the
project. A contractor is selected based on this bid and the project is
constructed. With the design-bid-build process, the architect is
involved in all phases of the project to insure that the design intent
and quality of the project is reflected in the delivered facility. In
this project delivery model, the architect is an advocate for the
owner.
The design-build project delivery method attempts to combine the
design and construction schedules in order to streamline the
traditional design-bid-build method of project delivery. The goal is to
minimize the risk to VA and reduce the project delivery schedule.
Design build, as used by VA, is broken into two phases. During the
first phase, an architect is contracted by VA to provide the initial
design phases of the project, usually through the schematic design
phase. After the schematic design is completed, VA contracts with a
contractor to complete the remaining phases of the project.
This places the contractor as the design builder. One particular
method of project delivery under the design-build model is called
contractor-led design build. Under the contractor-led design-build
process, the contractor is given a great deal of control over how the
project is designed and completed. In this method, as used by VA, a
second architect and design professionals are hired by the contractor
to complete the remaining design phases and the construction documents
for the project. With the architect as a subordinate to the contractor
rather than an advocate for VA, the contractor may sacrifice the
quality of material and systems in order to add to his own profits at
the expense of VA. In addition, much of the research and user interface
may be omitted, resulting in a facility that does not best suit the
needs of the patients and staff.
Use of contractor-led design-build has several inherent problems. A
short-cut design process reduces the time available to provide a
complete design. This provides those responsible for project oversight
inadequate time to review completed plans and specifications. In
addition, the construction documents often do not provide adequate
scope for the project, leaving out important details regarding the
workmanship and/or other desired attributes of the project. This makes
it difficult to hold the builder accountable for the desired level of
quality. As a result, a project is often designed as it is being built,
compromising VA's design standards.
Contractor-led design-build forces VA to rely on the contractor to
properly design a facility that meets its needs. In the event that the
finished project is not satisfactory, VA may have no means to insist on
correction of work done improperly unless the contractor agrees with
VA's assessment.
This may force VA to go to some form of formal dispute resolution,
such as litigation or arbitration. An alternative method of design-
build project delivery is architect-led design-build. This model places
the architect as the project lead rather than the builder. This has
many benefits to VA. These include ensuring the quality of the project,
since the architect reports directly to VA.
A second benefit to VA is the ability to provide tight control over
the project budget throughout all stages of the project by a single
entity. As a result, the architect is able to access pricing options
during the design process and develop the design accordingly. Another
advantage of architect-led design-build is in the procurement process.
Since the design and construction team is determined before the design
of the project commences, the request-for-proposal process is
streamlined. As a result, the project can be delivered faster than the
traditional design-bid-build process. Finally, the architect-led
design-build model reduces the number of project claims and disputes.
It prevents the contractor from ``low-balling,'' a process in which a
contractor submits a very low bid in order to win a project and then
attempts to make up the deficit by negotiating VA change orders along
the way.
In addition to selecting the proper method of project delivery,
there is much to learn from the design and construction process for
each individual project. It is important for VA to apply these
``lessons learned'' to future projects.
Recommendations:
VA must establish a category system Ranking design/construction
project types by complexity. This system should be used to determine if
the project is a candidate for the design-build method of project
management. The design-build method of project delivery should only be
used on projects that have a low complexity, such as parking structures
and warehouses. For health-care projects,
VA must evaluate the use of architect-led design build as the
preferred method of project delivery in place of contractor-led design-
build project delivery. VA must institute a program of ``lessons
learned.'' This would involve revisiting past projects and determining
what worked, what could be improved, and what did not work. This
information should be compiled and used as a guide to future projects.
This document should be updated regularly to include projects as they
are completed.
INCREASE NEED FOR VA RESEARCH SPACE AND INFRASTRUCTURE MPROVEMENTS:
The Department of Veterans Affairs needs research space renovations
and improved infrastructure.
A state-of-the-art physical environment for VA research promotes
excellence in science as well as teaching and patient care. Research
opportunities help VA recruit and retain the best and brightest
clinician scientists to care for veterans. However, many VA facilities
effectively have run out of usable research space. Also, research
``wet'' laboratory ventilation, electrical supply, plumbing, and other
projects appear frequently on internal VA lists of needed upgrades
along with research space renovations and new construction, but these
projects languish due to the weight VA places on direct medical care
projects as opposed to research space and facility needs.
Five years ago, the House Appropriations Committee expressed
concern (House Report 109-95) that ``equipment and facilities to
support the research program may be lacking and that some mechanism is
necessary to ensure the Department's research facilities remain
competitive.'' The Committee directed VA to conduct a comprehensive
review of its research facilities and report to the Congress on the
deficiencies found and suggestions for correction of the identified
deficiencies.
To comply, VA initiated a comprehensive assessment of VA research
infrastructure. To prompt VA to complete its long overdue assessment,
House Report 111-564 accompanying the FY 2011 VA appropriations bill
directed the Department to provide its final report to Congress by
September 1, 2010, with details of any recent renovations or new
construction.
As of publication of this Independent Budget, VA had not released
the results of its review. According to an October 26, 2009, VA report
to the VA National Research Advisory Committee, however, preliminary
results of the review indicated, ``there is a clear need for research
infrastructure improvements throughout the system, including many that
impact on life safety.''
The Independent Budget veterans service organizations (IBVSOs) are
concerned that a significant cause of VA's research infrastructure
neglect is that neither VA nor Congress provides direct funding for
research facilities. The VA Medical and Prosthetic Research
appropriation excludes funding for construction, renovation, or
maintenance of VA research facilities. VA researchers must rely on
their local facility management to repair, upgrade, and replace
research facilities and capital equipment associated with VA's research
laboratories. As a result, VA research competes with other medical
facility direct patient care needs (such as medical services
infrastructure, capital equipment upgrades and replacements, and other
medical maintenance needs) for funds provided under either the Major
Medical Facility, Minor Construction, or Medical Facilities
appropriations accounts.
The IBVSOs believe that correction of VA's known infrastructure
deficiencies should become a higher VA and Congressional priority.
Therefore, we recommend VA promptly submit to Congress the report it
requested in 2006, provide construction funding sufficient to address
VA's five highest priority research facility construction needs as
identified in its facilities assessment report, and approve a pool of
funding targeted at renovating existing research facilities to address
the current and well-documented shortcomings in research
infrastructure. For these funding needs we recommend $150 million and
$50 million, respectively. Additionally, an emerging problem is that VA
research facilities often are not an integral component of planning for
new VA medical centers (including new medical centers in Las Vegas,
Denver, and Orlando).
Modern-day biomedical research needs customized power, safety,
privacy, and configuration requirements that should be fundamental to
the new construction planning processes, not an expensive afterthought.
The IBVSOs urge the Administration to require that research space be
made an integral component of planning for every new medical center and
that such space be designed by architects and engineers experienced in
contemporary research facility requirements.
Recommendations:
Congress should require VA to report its findings from its research
infrastructure review, now pending more than 5 years. Congress should
authorize construction of, and appropriate $150 million in FY 2012 to
advance, the five highest priority research construction projects
identified by VA in its research infrastructure review, and provide VA
an additional $50 million in maintenance funding (in the Non Recurring
Maintenance account) in FY 2012 to address current shortfalls in VA's
research laboratories and other research space.
PRESERVATION OF VA'S HISTORIC STRUCTURES:
The Department of Veterans Affairs must further develop a
comprehensive program to preserve and protect its inventory of historic
properties.
The Department of Veterans Affairs has an extensive inventory of
historic structures that highlight America's long tradition of
providing care to veterans. These buildings and facilities enhance our
understanding of the lives of those who have worn the uniform, of those
who cared for their wounds, and of those who helped to build this great
Nation. Of the approximately 2,000 historic structures in the VA
historic building inventory, many are neglected and deteriorate year
after year because of a lack of any funding for their upkeep. These
structures should be stabilized, protected, and preserved because they
are an integral part our Nation's history.
Most of these historic facilities are not suitable for modern
patient care but may be used for other purposes. For the past 7 years,
The Independent Budget veterans service organizations (IBVSOs) have
recommended that VA conduct an inventory of these properties to
classify their physical condition and study their potential for
adaptive reuse. VA has moved in that direction; historic properties
have been identified. Many of these buildings have been placed in an
``Oldest and Most Historic'' list and require immediate attention.
The cost for saving some of these buildings is not very high
considering that they represent a part of American history. Once gone,
they cannot be recaptured. For example, the Greek Revival Mansion at
the VA Medical Center in Perry Point, Maryland, built in the 1750s can
be restored and used as a facility or network training space for about
$1.2 million. The Milwaukee Ward Memorial Theater, built in 1881, could
be restored as a multipurpose facility at a cost of $6 million. These
expenditures would be much less than the cost of new facilities and
would preserve history simultaneously. The preservation of VA's
historic buildings also fits into the VA's commitment to ``green''
architecture. Materials would be reused, reducing the amount of
resources needed to manufacture and transport new materials to building
sites.
As part of its adaptive reuse program, VA must ensure that
facilities that are leased or sold are maintained properly. VA's legal
responsibilities could, for example, be addressed through easements on
property elements, such as building exteriors or grounds. The IBVSOs
encourage VA to use the tenants of Public Law 108-422, the ``Veterans
Health Programs Improvement Act,'' in improving the plight of VA's
historic properties. This act authorizes historic preservation as one
of the uses of the proceeds of the capital assets fund resulting from
the sale or leases of other unneeded VA properties.
Recommendations:
VA must continue to develop a comprehensive program to preserve and
protect its inventory of historic properties. VA must allocate funding
for adaptive reuse of historic structures and empty or underutilized
space at medical centers.
Mr. Chairman, this concludes my statement. I would be happy to
answer any questions that you or the Members of the Committee may have.
Prepared Statement of Joseph A. Violante, National
Legislative Director, Disabled American Veterans
Chairman Miller, Ranking Member Filner and Members of the
Committee:
On behalf of the Disabled American Veterans and our 1.2 million
members, all of whom are wartime disabled veterans, I am pleased to be
here today to present the recommendations of The Independent Budget for
the fiscal year 2012 budget in the area of veterans' benefits. As you
know, The Independent Budget is a collaboration amongst the DAV,
AMVETS, Paralyzed Veterans of America and Veterans of Foreign Wars.
First, however, I want to congratulate you, Chairman Miller, on
your selection to lead this great Committee. I also want to welcome
back the Committee's Ranking Minority Member and past Chairman, Bob
Filner. The DAV looks forward to working together with both of you, as
well as all of the returning and new Members of the Committee, to
improve the lives of our Nation's veterans, particularly disabled
veterans, their families and survivors.
For the past 25 years, The Independent Budget has provided Congress
and the Administration with budget and policy recommendations to
strengthen programs serving America's veterans. I note with
appreciation that Public Law 111-275, the Veterans Benefits Act of
2010, which was enacted in the last Congress, contained a number of
provisions addressing recommendations made to this Committee by The
Independent Budget. In particular, the new law includes an increase in
the automobile grant from $11,000 to $18,900; an expansion of
eligibility for Aid and Attendance benefits for veterans suffering from
traumatic brain injury; an increase in Supplemental Service-Disabled
Veterans' Insurance (SDVI or ``RH'') from $20,000 to $30,000; and an
increase in Veterans Mortgage Life Insurance (VMLI) for disabled
veterans from $90,000 to $150,000 effective October 1, 2011, with a
2012 increase to $200,000. Each of these and many other provisions in
this new law will make a real difference in the lives of thousands of
disabled veterans and their families and we thank this Committee for
helping to enact this legislation.
SUFFICIENT STAFFING FOR THE VETERANS BENEFITS ADMINISTRATION
Mr. Chairman, for fiscal year 2012, The Independent Budget
recommends only modest increases in personnel levels for the Veterans
Benefits Administration (VBA), and those increases are targeted at
Vocational Rehabilitation and Employment (VR&E) and the Board of
Veterans' Appeals (BVA). Over the past couple of years, with strong
support from Congress, VBA's Compensation and Pension Service has seen
a significant increase in personnel to address the rapidly rising
workload they face. It is important to note that this large increase in
claims processors could actually result in a short-term net decrease in
productivity, due to experienced personnel being taken out of
production to conduct training, and the length of time it takes for new
employees to become fully productive. While we do not recommend
additional staffing increases at this time, we do recommend that VBA
conduct a study on how to determine the proper number of full-time
employees necessary to manage its growing claims inventory so that
claims are decided accurately and in a timely manner.
The Independent Budget does, however, recommend that Congress
authorize at least 160 additional full-time employees for the VR&E
Service for fiscal year (FY) 2012, primarily to reduce current case
manager workload. A 2009 study by the GAO found that 54 percent of
Department of Veterans Affairs Regional Offices (VAROs) reported they
had fewer counselors than they needed and 40 percent said they had too
few employment coordinators. VR&E officials indicated that the current
caseload target is 1 counselor for every 125 veterans, but that ratio
is reported to be as high as 1 to 160 in the field. An increase of 100
new counselors would address that gap. Given its increased reliance on
contract services, VR&E also needs an additional 50 full-time employee
equivalents (FTEE) dedicated to management and oversight of contract
counselors and rehabilitation and employment service providers. In
addition, VR&E has requested at least 10 FTEE in FY 2012 to expand its
college program--`Veteran Success on Campus,'' and we support that
request.
With the number of claims for benefits increasing over the past
several years, so too is the number of appeals to the BVA. On average,
BVA receives appeals on 5 percent of all claims, a rate that has been
consistent over the past decade. With the number of claims projected to
rise significantly in the coming years, so too will the workload at
BVA, and thus the need for additional personnel. Funding for the BVA
must rise at a rate commensurate with its increasing workload so it is
properly staffed to decide veterans' appeals in an accurate and timely
manner.
CLAIMS PROCESSING REFORM: GET IT RIGHT THE FIRST TIME
The VBA is at a critical juncture in its efforts to reform an
outdated, inefficient, and overwhelmed claims-processing system. After
struggling for decades to provide timely and accurate decisions on
claims for veterans' benefits, the VBA over the past year has started
down a path that may finally lead to essential transformation and
modernization, but only if it has the leadership necessary to undergo a
cultural shift in how it approaches the work of adjudicating claims for
veterans benefits.
The number of new claims for disability compensation has risen to
more than 1 million per year and the complexity of claims have also
increased as complicated new medical conditions, such as traumatic
brain injury, have become more prevalent. To meet rising workload
demands, The Independent Budget has recommended, and Congress has
provided, significant new resources to the VBA over the past several
years in order to increase their personnel levels. Yet despite the
hiring of thousands of new employees, the number of pending claims for
benefits, often referred to as the backlog, continues to grow.
As of January 31, 2011, there were 775,552 pending claims for
disability compensation and pensions awaiting rating decisions by the
VBA, an increase of 289,081 from 1 year ago. About 41 percent of that
increase is the result of the Secretary's decision to add three new
presumptive conditions for Agent Orange (AO) exposure: ischemic heart
disease, B-cell leukemia, and Parkinson's disease. Even discounting
those new AO-related claims, the number of claims pending rose by
171,522, a 37 percent increase of pending claims over just the past
year. Overall, there are 331,299 claims that have been pending greater
than VA's target of 125 days, which is an increase of 147,930, up more
than 80 percent in the past year. Not counting the new AO-related, over
50 percent of all pending claims for compensation or pension are now
past the 125-day target set by the VBA.
Worse, by the VBA's own measurement, the accuracy of disability
compensation rating decisions continues to trend downward, with their
quality assurance program, known as the Systematic Technical Accuracy
Review (STAR) reporting only an 83 percent accuracy rate for the 12-
month period ending May 31, 2010. Moreover, VA's Office of Inspector
General found additional undetected or unreported errors that increased
the error rate to 22 percent. Complicating the Department's problems is
its reliance on an outdated, paper-centric processing system, which now
includes more than 4.2 million claims folders.
Faced with all of these problems, VA Secretary Shinseki last year
set an extremely ambitious long-term goal of zero claims pending more
than 125 days and all claims completed to a 98 percent accuracy
standard. Throughout the year he repeatedly made clear his intention to
``break the back of the backlog'' as his top priority. While we welcome
his intention and applaud his ambition, we would caution that
eliminating the backlog is not necessarily the same goal as reforming
the claims-processing system, nor does it guarantee that veterans are
better served.
The backlog is not the problem, nor even the cause of the problem;
rather, it is only one symptom, albeit a very severe one, of a much
larger problem: too many veterans waiting too long to get decisions on
claims for benefits that are too often wrong. If the VBA focuses simply
on getting the backlog number down, it can certainly achieve numeric
success in the near term, but it will not necessarily have addressed
the underlying problems nor taken steps to prevent the backlog from
eventually returning. To achieve real success, the VBA must focus on
creating a veterans' benefits claims-processing system designed to
``get each claim done right the first time.'' Such a system would be
based upon a modern, paperless information technology and workflow
system focused on quality, accuracy, efficiency, and accountability.
Recognizing all of the problems and challenges discussed above, we
have seen some positive and hopeful signs of change. VBA leadership has
been refreshingly open and candid in recent statements on the problems
and need for reform. Over the past year, dozens of new pilots and
initiatives have been launched, including a major new IT system that is
now being field-tested. The VBA has shared information with the
veterans service organizations (VSOs) about its ongoing initiatives and
sought feedback on these initiatives. These are all positive
developments.
Yet despite the new openness and outreach to the VSO community, we
remain concerned about VBA's failure to fully integrate service
organizations in reforming the claims process. VSOs not only bring vast
experience and expertise about claims processing, but our local and
national service officers hold power of attorney for hundreds of
thousands of veterans and their families. In this capacity, VSOs are an
integral component of the claims process. We make the VBA's job easier
by helping veterans prepare and submit better claims, thereby requiring
less time and resources to develop and adjudicate them. VBA leadership
must commit to a true partnership with service organizations, and
infuse this new attitude throughout the VBA from central office down to
each of the 57 regional offices.
Mr. Chairman, the VBA must also change how it measures success and
rewards performance in a manner designed to achieve the goal of
``getting it right the first time.'' Unfortunately, most of the
measures that the VBA employs today, whether for the organization as a
whole, or for regional offices or employees, are based primarily on
measures of production, which reinforces the goal of ending the
backlog. VBA must change how it measures and reports progress and
success so that there are more and better indicators of quality and
accuracy. VBA must also continue to review employee performance
standards to ensure that it creates incentives and accountability to
achieve quality and accuracy, not just increased speed or production.
PILOT PROGRAMS
As the VBA moves forward with dozens of pilots and initiatives
designed to modernize and streamline the claims-processing system, it
is imperative that the VBA have a systematic method for analyzing and
integrating ``best practices'' that improve quality and accuracy,
rather than just those that may increase production. One of the most
important new initiatives is the use of templates for medical evidence,
which VBA calls Disability Benefits Questionnaires (DBQs). There are
currently three DBQs that have been approved for use in claims for the
three new presumptive conditions associated with Agent Orange exposure:
ischemic heart disease, Parkinson's disease, and B-cell leukemia. An
additional 76 DBQs are in various stages of the development and
approval process. We support the use of DBQs as a method to streamline
and improve the quality and timeliness of decisions; however, it is
crucial that DBQs are properly completed, either by VA or private
medical examiners. VBA employees must be properly trained so they
understand that DBQs are but one piece of evidence that must be
considered in the development and decision-making process. VBA's rating
specialists must properly consider the evidentiary weight and value of
all evidence related to the claim and address it adequately in the
reason and bases of the subsequent decision.
One of the major new claims process reform initiatives is the Fully
Developed Claims (FDC) program, which began as a pilot program mandated
by Public Law 110-389, and was rolled out to all VAROs last year. We
were pleased that VBA modified the FDC application process at our
request so that a veteran could make an informal notification to the
VBA of his or her intention to file a FDC claim, thereby protecting the
earliest effective date for receipt of benefits. However, we have been
hearing numerous reports from the field that local ROs are not allowing
such informal claims to be made. We have also been told that that the
participation level of veterans in the FDC program remains low. We
continue to believe in the FDC program and urge this Committee to work
with us and VBA to address the obstacles to its success.
In order to synthesize the ``best practices'' from all of the
ongoing pilots, VBA recently started a new Integration Laboratory at
their Indianapolis Regional Office. Given all of the pressure to
``break the backlog'' by increasing production, we have concerns about
whether the VBA will successfully extract and then integrate the best
practices from so many ongoing initiatives. Given the enormous pressure
to reduce the backlog, we are concerned that there could be a tendency
to focus on process improvements that result in greater production
rather than those that lead to greater quality and accuracy.
Congress must continue to provide aggressive oversight of the VBA's
myriad ongoing pilots and initiatives to ensure that practices adopted
and integrated into a cohesive new claims process are judged first and
foremost on their ability to help VA get claims ``done right the first
time.''
TRAINING AND QUALITY CONTROL
Mr. Chairman, two longstanding weaknesses of VBA's claims
adjudication process are training and quality control, which should be
linked to create a single continuous improvement program, both for
employees and for the claims process itself. Quality control programs
can identify areas and subjects that require new or additional training
for VBA employees and better training programs for employees and
managers should improve the overall quality of the VBA's work.
VBA's primary quality assurance program is the STAR program. The
STAR program was last evaluated by the VA Office of Inspector General
(OIG) in March 2009, with the OIG finding that STAR does not provide a
complete assessment of rating accuracy. Although the STAR reviewers
found that the national accuracy rate was about 87 percent, the OIG
found additional errors and projected an overall accuracy rate of only
78 percent. In addition to rectifying errors found by the OIG, we
recommend that the VBA establish a true quality control program that
looks at claims ``in-process'' in order to determine not just whether a
proper decision was made, but how it was arrived at in order to
identify ways to improve the system. The data from all such reviews
should be incorporated into the VBA's new information technology
systems being developed so that analysis can provide management and
employees important insights into processes and decisions. This in turn
would lead to quicker and more accurate decisions on benefits claims,
and most important, the delivery of all earned benefits to veterans,
particularly disabled veterans, in a timely manner.
Training is essential to the professional development of an
individual and tied directly to the quality of work they produce, as
well as the quantity they can accurately produce. Veterans service
organization officers have been told by many VBA employees that meeting
production goals is the primary focus of management, whereas fulfilling
training requirements and increasing quality is perceived as being
secondary. An overemphasis on productivity must not interfere with the
training of new employees who are still learning their job.
The GAO recently conducted a study to determine the appropriateness
of training for experienced claims processors and the adequacy of VBA's
monitoring and assessment of such training. Of particular interest are
GAO findings that experienced claims processors' had concerns with the
training received--specifically the hours, amount, helpfulness,
methods, and timing of training. Likewise, as the GAO report pointed
out, there is very little done by the VBA to ensure the required
training is completed or to assess the adequacy and consistency of the
training, nor to properly ascertain the total number of employees who
have met the annual training requirement. In fact, only one VARO met
the annual training requirement and nine VAROs had less than half their
employees meet the annual training requirement. It is simply
unacceptable to have only one VARO meeting the most basic requirement
of ensuring that all its employees complete 80 hours of training. VBA
must place greater emphasis on training by implementing stricter
monitoring mechanisms for all VAROs and ensuring that they are held
accountable for failure to meet this minimal standard.
Mr. Chairman, Public Law 110-389, the ``Veterans' Benefits
Improvement Act of 2008,'' required the VBA to develop and implement a
certification examination for claims processors and managers; however,
today there are still gaps in the implementation of these provisions.
While tests have been developed and piloted for Veterans Service
Representatives (VSRs) and Rating Veterans Service Representatives
(RVSRs), additional tests need to be developed and deployed for
Decision Review Officers and supervisory personnel. None of these
certification tests are mandatory for all employees, nor are they done
on a continuing basis.
The VBA cannot accurately assess its training or measure an
individual's knowledge, understanding, or retention of the training
material without regular testing. It is important, however, that all
testing and certification be applied equally to employees and to the
people who supervise and manage them. All VBA employees, coaches, and
managers should undergo regular testing to measure job skills and
knowledge, as well as the effectiveness of the training.
Equally important, testing must properly assess the skills and
knowledge required to perform the work of processing claims. Many
employees report that the testing does not accurately measure how well
they perform their jobs, and there have been reports that significant
numbers of otherwise qualified employees are not able to pass the
tests. VBA must ensure that certification tests are developed that
accurately measure the skills and knowledge needed to perform the work
of VSRs, RVSRs, decision review officers, coaches and other managers.
Successful completion of training by all employees and managers
must be an absolute requirement for every VARO and must be a shared
responsibility of both employees and management. Managers must be held
responsible for ensuring that training is offered and completed by all
of their employees. However it is also the responsibility, as well as
part of the performance standard, for employees to complete their
training requirements. Managers must provide employees with the time to
take training and employees must fully and faithfully complete their
training as offered. Neither should be able or pressured to just
``check the box'' when it comes to training.
NEW VBA INFORMATION TECHNOLOGY SYSTEMS
Mr. Chairman, undoubtedly the most important new initiative
underway at the VBA is the Veterans Benefits Management System (VBMS),
which is designed to provide the VBA with a comprehensive, paperless,
and ultimately rules-based method of processing and awarding claims for
VA benefits, particularly disability compensation and pension.
Following initial design work, the VBMS had its first phase of
development in Baltimore last year where a prototype system was tested
in a virtual regional office environment. The first actual pilot of the
VBMS system was begun in November 2010 at the Providence, Rhode Island
Regional Office. The 6-month pilot program began with simulated claims
and was scheduled to begin working on actual ``live'' claims early this
year. A second 6-month pilot is expected to begin in May 2011 at the
Salt Lake City Regional Office, which will build on the work begun at
Providence. A third pilot is scheduled to begin in November 2011 at an
undesignated location, and the final national rollout of the VBMS is
schedule to take place in 2012.
Although the development and deployment of a modern information
technology (IT) system to process claims in a paperless environment is
long overdue, we have concerns about whether the VBMS is being rushed
to meet self-imposed deadlines in order to show progress toward
``breaking the back of the backlog.'' While we have long believed that
the VBA's IT infrastructure was insufficient, outdated, and constantly
falling further behind modern software, Web, and cloud-based technology
standards, we would be equally concerned about a rushed solution that
ultimately produces an insufficiently robust IT system.
Given the highly technical nature of modern IT development, we
would urge Congress to fully explore these issues with the VBA and
suggest that it could be helpful to have an independent, outside,
expert review of the VBMS system while it is still early enough in the
development phase to make course corrections, should they be necessary.
To be successful, the VBMS must include the maximum level of rules-
based decision support feasible at the earliest stages of development
in order to build a system capable of providing accurate and timely
decisions, as well as include real-time, quality control as a core
component of the system. VBA must also commit to incorporating all
veterans' legacy paper files into the paperless environment of the VBMS
within the minimum amount of time technically and practically feasible.
DISABILITY COMPENSATION AND QUALITY OF LIFE
The Institute of Medicine (IOM) Committee on Medical Evaluation of
Veterans for Disability Compensation published a report in 2007, ``A
21st Century System for Evaluating Veterans for Disability Benefits,''
recommending that the current VA disability compensation system be
expanded to include compensation for nonwork disability (also referred
to as ``noneconomic loss) and loss of quality of life. Nonwork
disability refers to limitations on the ability to engage in usual life
activities other than work. This includes ability to engage in
activities of daily living, such as bending, kneeling, or stooping,
resulting from the impairment, and to participate in usual life
activities, such as reading, learning, socializing, engaging in
recreation, and maintaining family relationships. Loss of quality of
life refers to the loss of physical, psychological, social, and
economic well-being in one's life.
The IOM report stated that, ``. . . Congress and VA have implicitly
recognized consequences in addition to work disability of impairments
suffered by veterans in the Rating Schedule and other ways. Modern
concepts of disability include work disability, nonwork disability, and
quality of life (QOL) . . . '' The congressionally-mandated Veterans
Disability Benefits Commission (VDBC), established by the National
Defense Authorization Act of 2004 (Public Law 108-136), spent more than
2 years examining how the rating schedule might be modernized and
updated. Reflecting the recommendations of the IOM study, the VDBC in
its final report issued in 2007 recommended that the ``. . . veterans
disability compensation program should compensate for three
consequences of service-connected injuries and diseases: work
disability, loss of ability to engage in usual life activities other
than work, and loss of quality of life.''
The IOM Report, the VDBC (and an associated Center for Naval
Analysis study) and the Dole-Shalala Commission (President's Commission
on Care for America's Returning Wounded Warriors) all agreed that the
current benefits system should be reformed to include noneconomic loss
and quality of life as a factor in compensation.
The Independent Budget recommends that Congress finally address
this deficiency by amending title 38, United States Code, to clarify
that disability compensation, in addition to providing compensation to
service-connected disabled veterans for their average loss of earnings
capacity, must also include compensation for their noneconomic loss and
for loss of their quality of life. Congress and VA should then
determine the most practical and equitable manner in which to provide
compensation for noneconomic loss and loss of quality of life and then
move expeditiously to implement this updated disability compensation
program.
ELIMINATION OF CONCURRENT RECEIPT FOR ALL DISABLED VETERANS
Mr. Chairman, many veterans retired from the armed forces based on
longevity of service must forfeit a portion of their retired pay,
earned through faithful performance of military service, before they
receive VA compensation for service-connected disabilities. This is
inequitable--military retired pay is earned by virtue of a veteran's
career of service on behalf of the Nation, careers of usually more than
20 years. Entitlement to compensation, on the other hand, is paid
solely because of disability resulting from military service,
regardless of the length of service.
A disabled veteran who does not retire from military service but
elects instead to pursue a civilian career after completing a service
obligation can receive full VA compensation and full civilian retired
pay--including retirement from any Federal civil service. A veteran who
honorably served and retired for 20 or more years and suffers from
service-connected disabilities due to disability should have that same
right.
Congress should enact legislation to repeal the inequitable
requirement that veterans' military longevity retired pay be offset by
an amount equal to their rightfully earned VA disability compensation
if rated less than 50 percent.
REPEAL OF OFFSET AGAINST SURVIVOR BENEFIT PLAN
When a disabled veteran dies of service-connected causes, or
following a substantial period of total disability from service-
connected causes, eligible survivors or dependents receive Dependency
and Indemnity Compensation (DIC) from VA. This benefit indemnifies
survivors, in part, for the losses associated with the veteran's death
from service-connected causes or after a period of time when the
veteran was unable, because of total disability, to accumulate an
estate for inheritance by survivors.
Career members of the armed forces earn entitlement to retired pay
after 20 or more years' service. Unlike many retirement plans in the
private sector, survivors have no entitlement to any portion of the
member's retired pay after his or her death. Under the Survivor Benefit
Program (SBP), deductions are made from the member's retired pay to
purchase a survivors' annuity. Upon the veteran's death, the annuity is
paid monthly to eligible beneficiaries under the plan. If the veteran
died of other than service-connected causes or was not totally disabled
by service-connected disability for the required time preceding death,
beneficiaries receive full SBP payments. However, if the veteran's
death was a result of his or her military service or followed from the
requisite period of total service-connected disability, the SBP annuity
is reduced by an amount equal to the DIC payment. Where the monthly DIC
rate is equal to or greater than the monthly SBP annuity, beneficiaries
lose all entitlement to the SBP annuity.
We strongly believe this offset is inequitable because no
duplication of benefits is involved. Payments under the SBP and DIC
programs are made for different purposes. Under the SBP, a dependent
purchases coverage that would be paid in the event of the death of the
servicemember. On the other hand, DIC is a special indemnity
compensation paid to the survivor of a servicemember who dies while
serving or a veteran who dies from service-connected disabilities. In
such cases, VA indemnity compensation should be added to the SBP, not
substituted for it.
We note that surviving spouses of Federal civilian retirees who are
veterans are eligible for dependency and indemnity compensation without
losing any of their purchased Federal civilian survivor benefits. The
offset penalizes survivors of military retired veterans whose deaths
are under circumstances warranting indemnification from the government
separate from the annuity funded by premiums paid by the veteran from
his or her retired pay. Congress should repeal the offset between DIC
and the SBP.
In addition, Congress should lower the age required for survivors
of veterans who died from service-connected disabilities who remarry to
be eligible for restoration of dependency and indemnity compensation to
conform with the requirements of other Federal programs. Current law
permits the VA to reinstate DIC benefits to remarried survivors of
veterans if the remarriage occurs at age 57 or older or if survivors
who have already remarried apply for reinstatement of DIC at age 57.
Although we appreciate the action Congress took to allow this
restoration of rightful benefits, the current age threshold of 57 years
is arbitrary. Remarried survivors of retirees of the Civil Service
Retirement System, for example, obtain a similar benefit at age 55. We
believe the survivors of veterans who died from service-connected
disabilities should not be further penalized for remarriage and that
equity with beneficiaries of other Federal programs should govern
Congressional action for this deserving group.
VA SCHEDULE FOR RATING DISABILITIES
The amount of disability compensation paid to a service-connected
disabled veteran is determined according to the VA Schedule for Rating
Disabilities (VASRD), which is divided into 15 body systems with more
than 700 diagnostic codes. In 2007, both the VDBC, as well as the IOM
Committee on Medical Evaluation of Veterans for Disability Compensation
in its report ``A 21st Century System for Evaluating Veterans for
Disability Benefits,'' recommended that VA regularly update the VASRD
to reflect the most up-to-date understanding of disabilities and how
disabilities affect veterans' earnings capacity.
In line with these recommendations, the VBA is currently engaged in
the process of updating the 15 body systems, beginning with mental
disorders and the musculoskeletal system. Additionally, it has
committed to regularly updating the entire VA Schedule for Rating
Disabilities every 5 years.
In January 2010, the VBA held a Mental Health Forum jointly with
the Veterans Health Administration (VHA), which included a VSO panel.
In August 2010, the VBA and VHA held a Musculoskeletal Forum, which
also included a VSO panel. Just a few weeks ago, a series of four
public forums were held in Scottsdale, Arizona over the course of 2
weeks on four additional body systems. The Arizona sessions in
particular, were far removed from the public and offered little
opportunity for most VSOs to observe, much less offer any input.
While we are appreciative of such efforts, we are concerned that
except for these initial public forums, VBA is not making any
substantial efforts to include VSO input during the actual development
of draft regulations for the updated rating schedule. Since the initial
public meetings, the VBA has not indicated it has any plans to involve
VSOs at any other stage of the rating schedule update process other
than what is required once a draft rule is published, at which time
they are required by law to open the proposed rule to all public
comment. We strongly believe that the VBA would benefit from the
collective and individual experience and expertise of VSOs and our
service officers throughout the process of revising the rating
schedule. In addition, since the VBA is committed to a continuing
review and revision of the rating schedule, we believe it would be
beneficial to conduct reviews of the revision process so that future
body system rating schedule updates can benefit from ``lessons
learned'' during prior body system updates.
Mr. Chairman and Members of the Committee, this concludes my
statement and I would be happy to answer any questions you may have.
Prepared Statement of Christina M. Roof, National
Acting Legislative Director, American Veterans (AMVETS)
Chairman Miller, Ranking Member Filner and distinguished Members of
the Committee, on behalf of AMVETS I would like to thank you for
allowing myself and representatives of the other member organization
authors of The Independent Budget to share with you our recommendations
on the Department of Veterans Affairs Fiscal Year 2012 budget, in what
we believe to be the most fiscally responsible way of ensuring the
quality and integrity of the care and benefits our veterans community
receive.
AMVETS is honored to join our fellow Veterans' Service
Organizations in presenting The Independent Budget's recommendations on
the Fiscal Year 2012 Department of Veterans Affairs Budget Request.
AMVETS testifies before you as a co-author of The FY 2012 Independent
Budget. This is the 25th year AMVETS, the Disabled American Veterans,
the Paralyzed Veterans of America and the Veterans of Foreign Wars have
combined our expertise, experiences and resources to produce this
unique and in-depth document; one that has stood the test of time.
In developing The Independent Budget we are always guided by the
same set of principles. These principles include, first, our belief
that veterans should not have to wait for the benefits to which they
are entitled through their service to our country. Second, every
veteran must be ensured access to the highest quality medical care
available. Third, specialized care must remain a top priority and focus
of the Department of Veterans Affairs (VA). Furthermore, we believe
veterans must be guaranteed timely access to the full continuum of
health care services, including, but not limited to, long-term care.
Finally, veterans must be assured accessible burial in a State or
national cemetery regardless of their location.
As a partner of The Independent Budget, AMVETS devotes a majority
of our time to the concerns and matters of the Department of Veterans
Affairs National Cemetery Administration (NCA) and to all of the
aspects of veteran entrepreneurship and Federal procurement. Today I
will be speaking directly to these two issues.
By way of background, the stated mission of The National Cemetery
Administration (NCA) is to honor veterans with final resting places in
national shrines and with lasting tributes that commemorate their
service to our Nation. Their vision is to serve all veterans and their
families with the utmost dignity, respect, and compassion and ensure
that every national cemetery will be a place that inspires visitors to
understand and appreciate the service and sacrifice of our Nation's
veterans. Furthermore, many States have established State veterans
cemeteries. Eligibility is similar to that of the Department of
Veterans Affairs (VA) national cemeteries, but may include residency
requirements. Even though they may have been established or improved
with government funds through VA's State Cemetery Grants Program, State
veterans cemeteries are run solely by the States.
As of late 2010 the Department of Veterans Affairs National
Cemetery Administration (NCA) maintained more than 3 million graves at
131 national cemeteries in 39 States and Puerto Rico. Of these
cemeteries, 71 are open to all interment; 19 will accept only cremated
remains and family members of those already interred; and 41 will only
perform interments of family members in the same gravesite as a
previously deceased family member.i
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\i\ http://www.cem.va.gov/cem/cems/listcem.asp
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VA estimates nearly 23 million veterans are living today. They
include veterans from World Wars I and II, the Korean War, the Vietnam
War, the Gulf War, the conflicts in Afghanistan and Iraq, the Global
War on Terrorism, as well as peacetime veterans. With the anticipated
opening of the newly planned national cemeteries, annual interments are
projected to increase to approximately 116,000 in 2013, and are
projected to maintain that level through 2015. Historically, only 12
percent of veterans opt for burial in a State or national cemetery,
although these numbers are rising.
The most important obligation of the NCA is to honor the memory of
America's brave men and women who served in the armed forces.
Therefore, the purpose of these cemeteries as national shrines is one
of NCA's top priorities. Many of the individual cemeteries within the
system are steeped in history and the monuments, markers, grounds and
related memorial tributes represent the very foundation of the United
States. With this understanding, the grounds, including monuments and
individual sites of interment, represent a national treasure that must
be protected, respected and cherished.
The Independent Budget Veterans Service Organizations (IBVSOs)
would like to acknowledge the dedication and commitment of the NCA
staff who continue to provide the highest quality of service to
veterans and their families. We call on the Administration and Congress
to provide the resources needed to meet the changing and critical
nature of NCA's mission and fulfill the Nation's commitment to all
veterans who have served their country honorably and faithfully.
In FY 2010, $250 million was appropriated for the operations and
maintenance of NCA, with approximately $2 million in carryover. NCA
awarded 47 of its 50 minor construction projects that were in the
operating plan. Additionally, the State Cemetery Grants Service (SCGS)
awarded $48.5 million in grants for 12 projects.
NCA has done an exceptional job of providing burial options for the
nearly 91 percent, about 170,000, of veterans who fall within a 75-mile
radius threshold model. However, the NCA realized that, without
adjusting this model, only one area, St. Louis, would qualify for a
cemetery within the next 5 years and that the five highest veteran
population concentrated areas of the country would never qualify if the
threshold remained unchanged.
In 2010, the IBVSOs recommended several new threshold models for
NCA to consider in an effort to best serve a veterans population
declining in number. The IBVSOs are pleased to see that NCA has
adjusted its model and will begin factoring in 80,000 veterans within a
75-mile radius for future cemetery placement. This modification will
allow NCA to continue to provide burial options for veterans who would
otherwise be limited geographically for this benefit.
National Cemetery Administration (NCA) Accounts
The Independent Budget recommends an operations budget of $275
million for NCA for fiscal year 2012 so it can meet the increasing
demands of interments, gravesite maintenance and related essential
elements of cemetery operations.
NCA is responsible for five primary missions: (1) to inter, upon
request, the remains of eligible veterans and family members and to
permanently maintain gravesites; (2) to mark graves of eligible persons
in national, State, or private cemeteries upon appropriate application;
(3) to administer the State grant program in the establishment,
expansion, or improvement of State veterans cemeteries; (4) to award a
presidential certificate and furnish a United States flag to deceased
veterans; and (5) to maintain national cemeteries as national shrines
sacred to the honor and memory of those interred or memorialized.
However, the national cemetery system continues to face serious
challenges. Though there has been significant progress made over recent
years, NCA is still struggling to remove decades of blemishes and scars
from military burial grounds across the country. Visitors to national
cemeteries are still likely to encounter sunken graves, misaligned and
dirty grave markers, deteriorating roads, spotty turf and other patches
of decay that have been accumulating for decades. If NCA is to continue
its commitment to ensure national cemeteries remain dignified and
respectful settings that honor deceased veterans and give evidence of
the Nation's gratitude for their military service, there must be a
comprehensive effort to greatly improve the condition, function, and
appearance of all our national cemeteries.
NCA has worked tirelessly to improve the appearance of our national
cemeteries, investing $45 million in the National Shrine Initiative in
FY 2010 and approximately $25 million per year for the three previous
years. NCA has done an outstanding job thus far in improving the
appearance of our national cemeteries, but we have a long way to go to
get us where we need to be. In 2006 only 67 percent of headstones and
markers in national cemeteries were at the proper height and alignment.
By 2009 proper height and alignment increased to 76 percent. NCA is on
target to reach 82 percent this fiscal year. To ensure that NCA has the
resources to reach its strategic goal of 90 percent, the IBVSOs
recommend that NCA's operations and maintenance budget be increased by
$20 million per year until the operational standards and measures goals
are reached.
In addition to the management of national cemeteries, NCA is
responsible for the Memorial Program Service. The Memorial Program
Service provides lasting memorials for the graves of eligible veterans
and honors their service through Presidential Memorial Certificates.
Public Laws 107-103 and 107-330 allow for a headstone or marker for the
graves of veterans buried in private cemeteries who died on or after
September 11, 2001. Prior to this change, NCA could provide this
service only to those buried in national or State cemeteries or to
unmarked graves in private cemeteries. Public Law 110-157 gives VA
authority to provide a medallion to be attached to the headstone or
marker of veterans who are buried in a private cemetery. This benefit
is available to veterans in lieu of a government-furnished headstone or
marker.
The State Cemetery Grants Program
The State Cemeteries Grant Program (SCGP) faces the challenge of
meeting a growing interest from States to provide burial services in
areas that are not currently served. The intent of the SCGP is to
develop a true complement to, not a replacement for, our Federal system
of national cemeteries. With the enactment of the Veterans Benefits
Improvements Act of 1998, the NCA has been able to strengthen its
partnership with States and increase burial service to veterans,
especially those living in less densely populated areas not currently
served by a national cemetery. Currently there are 48 State and tribal
government matching grants for cemetery projects.
The Independent Budget recommends Congress appropriate $51 million
for SCGP for FY 2012. This funding level would allow SCGP to establish
new State cemeteries at their current rate that will provide burial
options for veterans who live in regions that currently have no
reasonably accessible State or national cemeteries.
Burial Benefits
Burial allowance was first introduced in 1917 to prevent veterans
from being buried in potter's fields. In 1923 the allowance was
modified. The benefit was determined by a means test, and then in 1936
the means test was removed. In its early history the burial allowance
was paid to all veterans, regardless of their service-connectivity of
death. In 1973 the allowance was modified to reflect the status of
service-connection. The plot allowance was introduced in 1973 as an
attempt to provide a plot benefit for veterans who did not have
reasonable access to a national cemetery.
In 1973, NCA established a burial allowance that provided partial
reimbursements for eligible funeral and burial costs. The current
payment is $2,000 for burial expenses for service-connected (SC) death,
$300 for non-service-connected (NSC) deaths, and $300 for plot
allowance. At its inception, the payout covered 72 percent of the
funeral cost for a service-connected death, 22 percent for a non-
service-connected death, and 54 percent of the burial plot cost. In
2007 these benefits eroded to 23 percent, 4 percent, and 14 percent
respectively. It is time to restore the original value of the benefit.
The IBVSOs are pleased that the last Congress acted to improve the
benefits, raising the plot allowance to $700 as of October 1, 2011.
However, there is still a serious deficit in original value of the
benefit when compared to the current value.
While the cost of a funeral has increased by nearly 700 percent,
the burial benefit has only increased by 250 percent. To restore both
the burial allowance and plot allowance back to their 1973 values, the
SC benefit payment should be $6,160, the NSC benefit value payment
should be $1,918, and the plot allowance should increase to $1,150.
Based on accessibility and the need to provide quality burial
benefits, The Independent Budget recommends that VA separate burial
benefits into two categories: veterans who live inside the VA
accessibility threshold model, and those who live outside the
threshold. For those veterans who live outside the threshold, the SC
burial benefit should be increased to $6,160, NSC veteran's burial
benefit should be increased to $1,918, and plot allowance should
increase to $1,150 to match the original value of the benefit. For
veterans who live within reasonable accessibility to a State or
national cemetery that is able to accommodate burial needs, but the
veteran would rather be buried in a private cemetery, the burial
benefit should be adjusted. These veterans' burial benefits will be
based on the average cost for VA to conduct a funeral. The benefit for
an SC burial should be $2,793, the amount provided for an NSC burial
should be $854, and the plot allowance should be $1,150. This will
provide a burial benefit at equal percentages, but based on the average
cost for a VA funeral and not on the private funeral cost that will be
provided for those veterans who do not have access to a State or
national cemetery.
In addition to the recommendations we have mentioned, the IBVSOs
also believe that Congress should enact legislation to adjust these
burial benefits for inflation annually.
The IBVSOs call on the Administration and Congress to provide the
resources required to meet the critical nature of the NCA mission and
fulfill the Nation's commitment to all veterans who have served their
country so honorably and faithfully.
NCA honors veterans with a final resting place that commemorates
their service to this Nation. More than 3 million servicemembers who
died in every war and conflict are honored through interment in a VA
national cemetery. Each Memorial Day and Veterans Day we honor the last
full measure of devotion they gave for this country. Our national
cemeteries are more than the final resting place of honor for our
veterans; they are hallowed ground to those who died in our defense,
and a memorial to those who survived.
AMVETS' second focus in the FY 2012 IB is on veteran
entrepreneurship and Federal procurement as it relates to Service
Disabled Veteran Owned Small Businesses (SDVOSB) and Veterans Owned
Small Businesses (VOSB). We believe that both of these issues play a
vital role in the success of transitioning servicemembers and the
quality of life for veterans. And while I do note that a majority of
the proceeding information is focused on policy rather than hard fiscal
numbers, we believe that broken policy, duplication of efforts and lack
of oversight are key factors in determining fiscally responsible
budgets.
Veteran Preference in Federal Hiring and Procurement
Supporting Service-disabled Veteran-owned Small Businesses
(SDVOSBs) and Veteran-owned Small Businesses (VOSB) contributes
significantly in sustaining a veteran's quality of life, while also
contributing to the success and ease of transitioning from active duty
to civilian life. Often in these tough economic times, self employment
and entrepreneurship are the only ways many veterans are able to earn a
living wage. Given the circumstances, now more than ever, Federal
agencies must be held accountable to meet the Federal procurement goals
outlined by Executive Order 13360, Sections 15 (g) and 36 of the Small
Business Act and the numerous other published Federal regulations
outlining veterans' preference and SDVOSB set-aside laws.
The GAO's most recent review of interagency agreements found that
VA is still lacking an effective process to ensure that interagency
agreements include the required language instructing all Federal
agencies comply with VA's contracting goals and preferences for SDVOSBs
and VOSBs. While it is noted that VA issued guidance to all contracting
officers on managing interagency acquisitions in March 2009, the
numerous interagency agreements still did not even include the required
language addressing VA's contracting goals and preferences until it was
amended on March 19, 2010. This serves as an example of how VA is
clearly lacking an established hierarchy or clear delegation of duties
in oversight activities. This lack of oversight is continuing to
contribute to VA having no assurance or metrics in place to conduct
proper oversight that agencies have made maximum feasible efforts to
contract with SDVOSBs or VOSBs. This lack of oversight only stands to
hurt those in which the laws were established to protect, the veterans.
We recommend stronger oversight, outreach and enforcement by all
Federal agencies tasked with ensuring the success of our veteran
entrepreneur community. This includes, but is not limited to, the U.S.
Department of Labor (DOL), Office of Small Business Programs (OSBP),
Small Business Administration (SBA), Office of Federal Contract
Compliance and Procurement (OFCCP) and all other Federal agencies
committing to reaching their 3 percent goal. All Federal agencies must
make a high priority of assisting in the development and implementation
of stronger strategies and accountability in reaching the 3-percent
goal of veteran employment and contracting.
Congress must ensure adequate resources are available to
effectively monitor and recognize those agencies that are not meeting
the 3-percent goal and hold them accountable for failure. The annual
reports filed by all Federal agencies, reporting the prior fiscal
years' actual percentage of goal achieved, should serve as guidance as
to which agencies need the most assistance in the development and
implementation of stronger contracting plans and oversight.
Center for Veteran Enterprise
Another critical aspect in ensuring the success of our veteran
entrepreneur community is promoting and assisting veterans in their
entrepreneurial endeavors through programs such as the Center for
Veteran Enterprise (CVE). CVE was established to assist all veterans
with the numerous aspects of establishing and maintaining a small
business. CVE is a subdivision of the Office of Small and Disadvantaged
Business Utilization that extends entrepreneur services to veterans who
own or who want to start a small business. CVE is also tasked with
aiding other Federal contracting offices in identifying VOSBs in
response to Executive Order 133600. In the past, VA has faced many
obstacles, from lack of leadership to best practices with their
entrepreneurship programs, which have directly resulted in and
prevented the success of veteran owned businesses. For this reason, VA
established the program entitled the Center for Veterans Enterprise
(CVE) with the passage of the Veterans Entrepreneurship and Small
Business Development Act of 1999. Furthermore, on Dec. 22, 2006,
President Bush signed Public Law 109-461, the Veterans Benefits, Health
Care, and Information Technology Act of 2006 in an effort to
successfully identify and grant status to SDVOSBs. Effective June 20,
2007, this legislation authorized a unique ``Veterans First'' approach,
specific to VA contracting.
As we move through the 21st century, during a time of war on
multiple fronts, the VOSB and SDVOSB population continues to rise at a
rate not seen since the end of World War II. As America's war-fighters
transition back into civilian life, many are choosing to pursue lives
as entrepreneurs. Given the almost 35 percent influx of VOSB and
SDVOSB, it is vital that the Center for Veterans Enterprise be ready
and able to meet the growing demand for their services. However, the
IBVSOs do not believe that CVE is serving the needs of those veterans
it was originally designed to help. Due to a lack of leadership over
the past year, we have seen CVE slowly move from the role of assisting
VOSB and SDVOSBs to that of an information and referral agency for
other Federal and State agencies. We believe the Center for Veteran
Enterprise must be brought back up to par with what it was originally
tasked to do: assisting our veteran population in all aspects for their
entrepreneurship endeavors. In order to effectively accomplish this
Congress must provide dedicated funding and strong oversight in
ensuring CVE is properly staffed, trained and funded.
Vendor Verification Systems
Another key part of protecting our veterans in a successful Federal
procurement system is through a centralized vendor verification system.
We believe it to be vital for all Federal agencies to utilize a
continually updated, single centralized source database in the
verification of all businesses claiming preferred status as a VOSB or
SDVOSB.
At present, vendors desiring to do business with the Federal
Government must register in the Central Contractor Registration (CCR)
database, and those who indicate they are veterans or service-disabled
veterans, self-certify their status without verification. P.L. 109-461
required VA to establish a Vendor Information Page (VIP) database to
accurately identify businesses that are 51 percent or more owned by
veterans or service-disabled veterans. This database was originally
designed to act as a reliable, centralized database enabling all
Federal agencies a single source in the identification of possible
SDVOSB and VOSB for consideration during their procurement processes.
Furthermore, both contractors and subcontractors involved in the
procurement process of any government award is then required to provide
the Secretary of Labor a specific breakdown of all information required
by the VETS 100 and VETS 100-A filed on an annual basis, demonstrating
their continued compliance with the contracts terms regarding veterans
preference and status. As of April 15, 2009, approximately 18,000
SDVOSBs were registered in the Central Contractor Registration,
however, due to lack of oversight and an inconsistent, self-reported
status verification processes, many non-veteran-owned businesses are
not receiving the protections they are entitled to under the law.
On February 8, 2010, the final CFR rules regarding ``VA Veteran-
Owned Small Business Verification Guidelines'' were published. The
document affirms as final, with changes, an interim final rule that
implements portions of the Veterans Benefits, Health Care, and
Information Technology Act of 2006. This law requires the Department of
Veterans Affairs (VA) to verify ownership and control of veteran-owned
small businesses, including service-disabled veteran-owned small
businesses. This final rule declares to define the eligibility
requirements for businesses to obtain verified status, explains
examination procedures and establishes records retention and review
processes. However, the newly published rule fails to outline any solid
changes or improvements to the SDVOSB verification process. We further
believe the newly published rules on the verification process focused
on control and ownership definitions, yet provided no clarification on
the specifics of the verification process. The IBVSOs believe these
updates to 38 CFR, Part 74 regarding P.L. 109-461 still leave the
integrity of the SDVOSB and VOSB verification system open to fraud.
This continued lack of clarity and non-uniformed inconsistent status
verification processes will cause the same unwanted results of many
veteran owned businesses not receiving the protections they are
entitled to under the law.
VA has thus far been awarded $1.4 billion in recovery act funds to
aide in the employment and contracting opportunities available to
SDVOSB and VOSB. To date $538 million has been used on awards to SDVOSB
and VOSB, according to VA. However, we have very serious concerns on
how much of these appropriated funds were actually awarded to
legitimate SDVOSB and VOSBs, due to the lack of verification processes
in place at VA.
In an effort to resolve this issue we recommend that all Federal
agencies should be required to certify veteran status and ownership
through the VA's VIP program before awarding contracts to companies
claiming veteran status. We also recommend the database be maintained
and updated on a regular basis to avoid backlogs of vendors waiting to
be certified or re-certified.
Furthermore, Congress must take the necessary actions in requiring
all Federal agencies to use a single source database in all
verifications of veteran ownership statuses before unknowingly awarding
contracts to companies on the basis of claiming SDVOSB or VOSB
preference. Finally, internal promotion and education on proper usage
of the database should coincide with implementation of databases use.
Veteran Set-Asides
Protecting veteran set-asides within the Federal procurement system
is a matter that must be addressed more rigorously within VA's training
and personnel programs. Public Law 109-461, the ``Veterans Benefits,
Health Care and Information Technology Act of 2006,'' was signed Dec.
22, 2006, and went into effect on June 20, 2007. The law allows VA
special authority to provide set-aside and sole-source contracts to
small businesses owned and operated by veterans and service-disabled
veterans. This legislation is codified in Title 38, United States Code,
sections 8127 and 8128. After more than 3 years since its enactment, no
significant change has been implemented with regard to how Federal
contracting officers are trained. VA personnel involved in the
acquisition process need to be trained and familiarized with all
current and new authorizations and responsibilities under P.L. 109-461,
as well as all other procurement directives regarding VOSBs and
SDVOSBs. Our service disabled veterans who own small businesses cannot
afford to wait any longer for VA to enforce compliance with the law.
Under current policy, no proof of compliance is required, nor do
random labor audits occur. OIG has issued more than 10 reports
illustrating these deficiencies in recent years. Most recently, in
October of 2009 the GAO issued their report on ``Service-Disabled
Veteran-Owned Small Business Program: Case Studies Show Fraud and Abuse
Allowed Ineligible Firms to Obtain Millions of Dollars in Contracts''
to the Committee on Small Business. This report outlines how millions
of dollars in set-aside contracts were awarded to non-SDVOSB businesses
due to the gross lack of program controls in place to detect and
prevent fraud. The report identified 10 case-study examples of firms
that did not meet the basic SDVOSB program eligibility requirements,
but yet received over $100 million in SDVOSB set-aside contracts. VA,
DOL, SBA and the OFCCP must exercise better oversight and stronger
enforcement with consequences for any government agency or
nongovernment business claiming to be awarding set-asides to veteran-
owned businesses when, indeed, they are not. There needs to be an
immediate focus on proactive measures to eliminate untruths, such as
``rent a vet,'' and cease only exercising ``reactive'' strategies. VA,
the DOL, SBA, and OFCCP should pool all their resources and successful
strategies to ensure swift action and to avoid duplication of efforts.
Furthermore, we believe VA must develop and implement uniformed
training processes for all staff involved with the Federal procurement
process, especially contracting officers. VA must also provide systems
and metrics to identify the strengths and weaknesses in its procurement
processes, as well as continued training and evaluations of contracting
staff in efforts of successfully identifying weaknesses and strengths
within the program as a whole.
Lastly, VA, DOL, SBA, OFCCP and the Employment and Training
Administration must collaborate in developing and implementing a
single-source database for employer outreach programs for the promotion
of veterans' entrepreneurship at local and national levels. This system
must allow all employers to locate veterans for employment as well as
provide an updated listing of employment opportunities.
Again, Chairman Miller and Members of the Committee, we thank you
for inviting us to share with you our recommendations and stand ready
to answer any questions you may have.
Prepared Statement of Timothy M. Tetz, Director,
National Legislative Commission, American Legion
Mr. Chairman and Members of the Committee:
The American Legion welcomes this opportunity to comment on the
President's budget request.
President Obama has issued the challenge to invest in the future of
America. The American Legion believes strongly in this ideal.
Investment in the future means taking care of the needs of veterans
today. Investing in the future means solving problems at their onset
rather than reaping heavy debts down the road as the problems grow to
unmanageable levels. Investing in the future means having the foresight
to see tomorrow's problems today, and avoiding the errors of the past.
Imagine how the lives of veterans today would be changed had this
Nation had the foresight to invest in preparation to deal with the full
consequences of Agent Orange, the ever-growing claims backlog, and
substandard medical facilities as in days past.
Challenging tasks require aggressive solutions. The American Legion
supports the value of fiscal responsibility and recognizes the economic
stability of this Nation is vital to its overall security. Even in
difficult times, however, there is always the duty to ensure that vital
needs are not neglected. The budget, at a proposed 10.6 percent
increase over fiscal year (FY) 2010 levels, recognizes meeting the
needs of veterans continues to be an area where we must ensure proper
funding.
Furthermore, with advance appropriations for the Department of
Veterans Affairs (VA) now the law of the land, The American Legion is
encouraged to see the proposed advance appropriations as the fruition
of many years of hard work by our organization and others to ensure the
stability and ability for long term health care planning in this
sector.
The veterans' community is paradoxically vulnerable in many ways.
Our Nation's defenders are visualized justly as brave and true
sentinels, yet as they transition from warrior to citizen they face
challenges not commensurate with the rest of the population. The twin
scourges of joblessness and homelessness are growing and remain
challenges. Veterans make up less than 10 percent of the population,
yet face unemployment at rates two thirds higher than the overall
average of America and while the numbers are being reduced, still the
staggering figure of over 75,000 of our Nation's homeless are believed
to be veterans. Clearly these are areas where we are not meeting the
duty to care for our Nation's heroes.
These numbers of veterans in need are only going to grow. Already
Defense Secretary Gates speaks of force reduction for those on Active
Duty, and this will contribute more to the growing rolls of veterans as
those servicemembers step down from active service. While it may not
make the glamorous front page news, The American Legion has not
forgotten that every single day the brave men and women of our armed
forces overseas ``leave the wire'' to face roadside bombs, ambushes,
combat and other hazards which continue to send service-disabled
servicemembers back home to cope with the aftereffects of war. This is
the true and on-going cost of war, and even in tough times this country
cannot shirk the duty of paying that cost.
Therefore, it is absolutely critical the entire military and
veterans' community (active duty, Reserve Component, and veterans)
continue to remain supportive of honorable military service. No
servicemember should ever doubt:
the quality of health care he or she will receive if
injured;
the availability of earned benefits for honorable
military service upon discharge; or
the quality of survivors' benefits should he or she pay
the ultimate sacrifice.
When National Commander Jimmie Foster testified on September 22,
2010 before a Joint Session of the Committees on Veterans' Affairs, he
clearly outlined the funding recommendations of The American Legion for
FY 2012. Our testimony today re-emphasizes those recommendations for
certain specific areas.
MEDICAL SERVICES
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The American Legion strongly supports the overall funding level for
total medical services proposed by the administration.
------------------------------------------------------------------------
The American Legion fully supports funding ``the best health care
anywhere''. VA reports that 6.1 million veterans will need to receive
timely access to quality health care in this upcoming year alone. This
represents an anticipated increase of 168,904 new patients who will
``vote with their feet'' in making VA their health care provider of
choice. VA medical care is still America's best investment in quality
health care delivery--the right care, at the right time, in the right
facility. The Legion would further urge Congress to act now and ensure
the passage of the full budget for FY 2011 so that a continuity of
funding, to include all advanced appropriations, is available for full
use and planning purposes.
Medical and Prosthetic Research
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The American Legion recommends $600 million for Medical and
Prosthetics Research in FY 2011.
------------------------------------------------------------------------
The American Legion believes VA's focus in research must remain an
understanding and improving treatment for medical conditions that are
unique to veterans and their military service. Servicemembers are
surviving catastrophically disabling blast injuries due to the superior
armor they are wearing in the combat theater and timely access to
quality combat medical care. The unique injuries sustained by the new
generation of veterans clearly demand particular attention. It has been
reported that VA does not have state-of-the-art prostheses like DoD and
that the fitting of prostheses for women has presented problems due to
their smaller stature. Clearly, adequate funding is needed to ensure
that VA does not continue to lag behind DoD in this capacity, and both
agencies should be pushing forward in the field of innovations in
prosthetic technology.
There is a need for adequate funding of other VA research
activities, including basic biomedical research and bench-to-bedside
projects. Congress should continue to encourage acceleration in the
development and initiation of needed research on conditions that
significantly affect veterans, such as prostate cancer, addictive
disorders, trauma and wound healing, post-traumatic stress disorder
(PTSD), rehabilitation; in addition, VA must have direction and funding
to support supplementary research conducted jointly with DoD, the
National Institutes of Health (NIH), other Federal agencies, and
academic institutions.
As challenging health concerns such as the long term effects of
Traumatic Brain Injury (TBI), exposures to environmental hazards in
domestic and overseas deployment, and the mental health impact of
exposure to combat conditions as well as military sexual trauma and
assault develop, it is essential that VA lead the way in research and
development to combat and treat these conditions. Servicemembers
afflicted by these conditions will have a deep and lasting effect on
the economy through their reduced ability to contribute if these
conditions are not treated and mitigated. Quite simply, the more that
can be learned about diagnosing and treating these conditions, the more
likely this Nation can avert catastrophic impact in the future.
Truly, investing in research at the onset is investing in the
future. While The American Legion applauds the budget's stated research
priorities of Mental Health, Gulf War Illness and Environmental
Exposures, Prosthetics, and TBI and Spinal Cord Injuries, the allocated
$509 million should be made more robust. As the lesson learned from
Agent Orange exposure in Vietnam should have taught us, research
delayed can have devastating economic impact down the road. Money
invested now in this research has the potential to not only save this
Nation money in the long run, but also ameliorate and alleviate the
suffering of veterans at a time when the long term impact can be
minimized.
DEPARTMENTAL ADMINISTRATION
Construction--Major and Minor
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The American Legion recommends that the President's budget request for
$590 million for Major Construction and $550 million for Minor
Construction in FY 2012 be increased to $1.2 billion for Major
Construction projects and $800 million for Minor Construction projects
to provide for additional facilities particularly the aforementioned
improvements to infrastructure, as well as Community-Based Outpatient
Clinics in rural and highly rural areas and additional Vet Centers.
------------------------------------------------------------------------
The American Legion has seen firsthand the structural deficiencies
and challenges facing the infrastructure of the VA Health Care system
as a part of the preparation for the annual System Worth Saving
reports. During those site visits, many VA Medical Center staff have
informed Legion personnel they are unable to dedicate needed funds
towards construction projects due to the funding needs of actual
medical care. Furthermore, many VA construction projects were only made
possible through the use of funding from the America Reinvestment and
Recovery Act. Such money is no longer available to meet the
construction needs to shore up VA infrastructure in areas such as
seismic criteria, aging electrical systems, insufficient parking and
space utilization, and other needed areas. Therefore, the need to fully
fund this area of the budget is even more apparent.
Recent reports of the VA Regional Office in Roanoke, VA noted the
floors of the building were in danger of collapsing due to the
aggregate weight of the claims files. While this highlights yet another
major implication of the claims backlog, it also underlines this is not
an area where VA can afford to scrimp and save. Substandard facilities
do not serve the veterans of this country, and are a hazard to VA
employees as well.
If we are to truly invest in the future of this country, there are
few more sound decisions to be made than investing in infrastructure.
Just as the roads and bridges of America must be upgraded to support
the crumbling infrastructure and prevent even greater costs down the
road, so too must the infrastructure of VA solidify to meet the needs
of the growing veterans' community.
Whether it is much needed medical facilities in the rural regions
of the country, repairs to aging urban hospitals, proper laboratory
facilities, adequate parking or other needs, it is short-sighted to see
opportunities to cut and save on immediate construction, for cuts to
this area now will only bring far greater construction costs down the
road. The wise fiscal decision is to invest carefully now to head off
ballooning costs in the future.
Information Technology Systems
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The American Legion urges Congress to ensure this key component
receives full funding as VA transitions towards paperless processing,
but also that this budget continues to fund the efforts towards a truly
seamless electronic health records from induction in service through the
rest of a veteran's life.
------------------------------------------------------------------------
Since the data theft occurrence in May 2006, VA has implemented a
complete overhaul of its Information Technology (IT) division
nationwide. The American Legion is hopeful VA continues to take the
appropriate steps to strengthen its IT security to regain the
confidence and trust of veterans who depend on VA for the benefits they
have earned. The American Legion urges Congress to maintain close
oversight of VA's IT restructuring efforts and fund VA's IT to ensure
the most rapid implementation of all proposed security measures.
As acknowledged by the GAO Report 11-265 ``Electronic Health
Records--DoD and VA Should Remove Barriers and Improve Efforts to Meet
Their Common System Needs'' there are still major hurdles to be
overcome to achieve the goals set forth of a Virtual Lifetime
Electronic Record for servicemembers from induction through the rest of
their lives as active duty and veteran. The President's budget sets
aside monies for this purpose, but it is vitally important to ensure
that this component is not left behind, nor allowed to falter.
Achieving this goal should remain a major priority of both DoD and VA
in cooperation with one another.
Obviously, with VA's transformation of the VBA to a ``paperless''
processing system through the Veterans Benefits Management System
(VBMS) this can be an area of great savings overall for VA as VBA moves
out of the research and piloting stage of this system and into regular
operations. Start up costs can now be eliminated and hopefully VA will
be vigilant in ensuring that this new system offers the speed and
accuracy promised.
Homelessness
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The American Legion supports sustaining funding levels addressing
homelessness in the veterans' community and urges complete support
through other Departments such as Housing and Urban Development to help
eliminate homelessness among veterans.
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The American Legion notes that by the VA Secretary's own recent
estimates there are approximately 75,600 homeless veterans on the
street each night as of 2009. This number represents a significant
improvement over previous years. As far back as 2007 the estimates were
over 150,000 and each year of concerted effort has brought further
improvement and reduction of these numbers. Clearly the good work in
this area must retain the funding to continue so that the levels will
never again reach those seen in the past.
With 300,000 servicemembers entering the civilian sector each year
since 2001 with at least a third of them potentially suffering from
mental illness, such as the effects of Combat Stress, PTSD and TBI,
nothing could more clearly indicate programs to prevent and assist
homeless veterans are vitally needed. The American Legion applauds VA's
continued emphasis as one of its priority items the elimination of
homelessness among America's veterans.
FISCAL RESPONSIBILITY
Fiscal responsibility is of course a vital concern in the difficult
times we are facing as a Nation. The American Legion strongly believes
money spent must be spent wisely. To this end, all aspects of operation
must be scrutinized, and where waste and mismanagement contribute to an
inflated budget, these must be eliminated. Rather than wholesale
cutting of necessary infrastructure, areas of redundancy must be
sought, and targeted cuts to those areas serve a far better purpose in
managing the budget of VA.
Better coordination with outside evaluations can help reduce
internal costs of evaluation. For example, State Veterans' Homes are
evaluated not only by VA internal evaluation, but also by outside
Centers for Medicare and Medicaid Services (CMS) evaluation. Better
coordination and standardization of evaluation could result in reduced
costs of VA evaluations by millions of dollars by reducing this level
of redundancy. The American Legion has also called for some time for VA
to accept outside, third party evaluation of accuracy and quality rates
in the benefits management and claims system. Such outside evaluation
could further reduce costs where areas of redundancy with VA's own
evaluative process can be found. Surely, though savings of this type
may only rank individually in the tens of millions, these are funds
that could be directed towards better use addressing shortfalls
elsewhere.
Better Central Office oversight is further needed at the local
level to ensure that money directed to the VISNs and Regional Offices
are being spent in accordance with the direction of the administration.
All too often in The American Legion visits to local areas as a part of
the System Worth Saving (SWS) Reports and Regional Office Action
Reviews (ROAR), discover wide variances in execution of basic policies
and directives from region to region. To truly manage the budget of VA
most effectively, developing uniform consistency is vital across the
country.
CONCLUSION
In conclusion, The American Legion believes a true investment in
the future means investing in key areas of infrastructure now and not
making short-sighted cuts to vital areas that will only bring greater
costs in the future.
Full funding of essential projects such as research in emerging
health risks and disabilities, as well as the physical infrastructure
of VA facilities, will be the prudent choice now to stave off even
greater financial burdens down the road. VA must meet these challenges
with an adequate budget to fund these necessary aims.
The American Legion welcomes the opportunity to work with this
Committee on the enactment of a timely, predictable and sufficient
budget for the Department of Veterans Affairs.
VA MEDICAL DISCRETIONARY PROGRAMS
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FY 2013
P.L. 111-117 FY P.L. 111-322 FY President's FY Proposed American Legion's
2010 VA Final 2011 VA Funding 2012 VA Budget Advance FY 2013 Request
Funding Proposal Appropriations
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Medical Supplies $34.7 billion $37.1 billion $39.5 billion $41.3 billion $38.1 billion
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Medical Support & $4.9 billion $5.3 billion $5.4 billion $5.7 nillion $5.3 billion
Compliance
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Medical Facilities $4.8 billion $5.7 billion $5.4 billion $5.4 billion $6.2 billion
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Medical/Prosthetic $581 billion $581 million $509 million ------ $600 million
Research
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Medical Care Collections Fund [$2.9 billion] [$2.9 billion] [$3.1 billion] ------ ------
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Total Medical Care $47.9 billion $51.6 billion $53.9 billion $52.4 billion $50.2 billion
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VA NON-MEDICAL DISCRETIONARY PROGRAMS
----------------------------------------------------------------------------------------------------------------
P.L. 111-117 FY President's FY American
2010 VA Final P.L. 111-322 FY 2012 VA Budget Legion's FY
Funding 2011 VA Funding Proposal 2012 Request
----------------------------------------------------------------------------------------------------------------
Major Construction $1.2 billion $1.2 billion $590 million $1.2 billion
----------------------------------------------------------------------------------------------------------------
Minor Construction $703 million $703 million $550 million $800 million
----------------------------------------------------------------------------------------------------------------
State Veterans' Homes Construction $100 million $100 million $85 million $100 million
Grants
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State Veterans' Cemeteries Construction $46 million $46 million $46 million $60 million
Grants
----------------------------------------------------------------------------------------------------------------
General Operating $2.1 billion $2.5 billion $2.5 billion $2.6 billion
Expenses
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Information $3.3 billion $3.3 billion $3.2 billion $3.5 billion
Technology
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National Cemetery System $250 million $250 million $251 million $260 million
----------------------------------------------------------------------------------------------------------------
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
FISCAL YEAR 2012
BUDGET ESTIMATE
TABLE OF CONTENTS
INTRODUCTION
SALARIES AND EXPENSES
Appropriation Language
Program Justification
Fiscal Year 2010 Program
Fiscal Year 2011 Program
Fiscal Year 2012 Program
Summary of Fiscal Year 2012 Budget Request
Program Funding Changes
Program and Financing Schedule
Object Classification Schedule
U.S. COURT OF APPEALS FOR VETERANS CLAIMS RETIREMENT SYSTEM
Introduction
Status of Funds Schedule
PRO BONO REPRESENTATION PROGRAM
Fiscal Year 2012 Budget Request--Appendix A
__________
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
INTRODUCTION
The United States Court of Appeals for Veterans Claims (Court) is a
national court of record established by the Veterans Judicial Review
Act, Pub. L. No. 100-687, Division A (1988) (The Act). The Act, as
amended, is codified in part at 38 U.S.C. Sec. Sec. 7251-7299. The
Court is part of the Federal judicial system and has a permanent
authorization for seven judges, one of whom serves as chief judge. The
judges are appointed by the President, by and with the advice and
consent of the Senate, for 15-year terms, except that two have been
appointed for 13-year terms pursuant to Pub. L. No. 106-117, Nov. 30,
1999. Two additional positions have been authorized but not yet filled,
and one judge recently entered senior status, such that the Court
currently has three vacancies. Our senior judges, now numbering 6, are
available for service, and have been recalled the past several years.
One judge is retired due to permanent disability. Certain decisions by
the Court are reviewable by the United States Court of Appeals for the
Federal Circuit and, if certiorari is granted, by the United States
Supreme Court. Further, for management, administration, and expenditure
of funds, the Court exercises the authorities provided for such
purposes applicable to other courts under Title 28, U.S. Code.
The Court has exclusive jurisdiction to review decisions made by
the Department of Veterans Affairs' Board of Veterans' Appeals (Board)
that adversely affect a person's entitlement to VA benefits. This
judicial review, although specialized in scope, is the same as that
performed by all other United States Courts of Appeal. In cases before
it, the Court has the authority to decide all relevant questions of
law; to interpret constitutional, statutory, and regulatory provisions;
and to determine the meaning or applicability of actions/decisions by
the Secretary of Veterans Affairs. The Court may affirm, set aside,
reverse, or remand those decisions as appropriate. Additionally, the
Court has authority under 28 U.S.C. Sec. 1651, to issue all writs
necessary or appropriate in aid of its jurisdiction, and to act on
applications under 28 U.S.C. Sec. 2412(d), the Equal Access to Justice
Act (EAJA).
The Court is empowered to compel actions of the Secretary that are
unlawfully withheld or unreasonably delayed, and can set aside
decisions, findings, conclusions, rules, and regulations issued or
adopted by the Secretary, the Board, or the Board Chairman that are
arbitrary or capricious, an abuse of discretion or otherwise not in
accordance with law, contrary to constitutional right, in excess of
statutory jurisdiction or authority; or without observance of the
procedures required by law. The Court also may hold unlawful and set
aside or reverse findings of material fact that are adverse to the
appellant if the findings are clearly erroneous.
The Court is located in Washington, D.C., see 38 U.S.C. Sec. 7255
(requiring the principal offices of the Court to be located in the D.C.
metropolitan area), but as a national court, the Court may conduct
hearings anywhere in the United States.
APPROPRIATION LANGUAGE
GENERAL AND SPECIAL FUND
SALARIES AND EXPENSES
For necessary expenses for the operation of the United States Court
of Appeals for Veterans Claims as authorized by 38 U.S.C.
Sec. Sec. 7251-7299, [$90,146,729] $55,796,690: Provided that, of the
foregoing amount, $25,000,000 shall be transferred to the General
Services Administration (GSA) for the design engineering and site
acquisition of a courthouse to house the United States Court of Appeals
for Veterans Claims: Provided further, that [$2,515,229] $2,726,363
shall be available for the purpose of providing financial assistance as
described, and in accordance with the process and reporting procedures
set forth, under this heading in Public Law No. 102-229.
PROGRAM JUSTIFICATION
Court Caseload Trends and Variations:
The United States Court of Appeals for Veterans Claims is one of
the busiest Federal appellate courts, when considering numbers of
appeals per judge. Approximately 200 cases were filed monthly from FY
1999 through FY 2004. Thereafter the caseload began a steady increase,
with the Court averaging 350 cases filed per month for the past several
years. The chart below shows the figures by fiscal year since FY 1999.
In addition, in FY 2010 the Court acted on over 2,600 applications for
fees and expenses authorized by the Equal Access to Justice Act (EAJA).
28 U.S.C. Sec. 2412(d).
Appeals to the Court come from the pool of cases in which the Board
has denied some or all benefits sought by claimants. Also, under its
All Writs Act authority, the Court has jurisdiction to consider
petitions for extraordinary relief or writs of mandamus filed by
claimants who believe that unlawful action is being taken by the
Secretary of Veterans Affairs on their claims. As the number of claims
processed by the Board has increased over the years, and as the number
of issues raised in each claim has grown, the number of appeals filed
with the Court has increased, although not on a linear path. Every
indication is that the number of cases handled by the Board will
continue to increase, and we anticipate that this will result in
continued growth in the number of appeals to the Court over time.
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 99 FY 00 FY 01 FY 02 FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10
------------------------------------------------------------------------------------------------------------------------------------------------------ ----
BVA TOTAL DENIALS 14881 14080 8514 8606 10228 9299 13033 18107 16531 17005 17601 13788
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CASE FILINGS TO USDAVC 2397 2442 2296 2150 2532 2234 3466 3729 4644 4128 4725 4341
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CASE FILINGS AS % OF 16.1% 17.3% 27.0% 25.0% 24.0% 24.2% 26.6% 20.6% 28.1% 24.3% 26.8% 31.5%
DENIALS
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Unrepresented Appellants:
The Pro Bono Representation Program (the Pro Bono Program or
Program) began in FY 1992 when Congress authorized the Court to fund a
pilot Pro Bono Representation Program in the amount of $950,000 from
that fiscal year's appropriation. Under this program, the Legal
Services Corporation (LSC) administers pro bono representation and
legal assistance to veterans and their survivors who have appeals at
the Court and who are unable to afford legal representation. The Court
and the parties benefit from this Program because when an attorney is
retained, the issues and arguments presented in the brief are generally
more detailed and thorough than would be if the claimant had remained
unrepresented.
The now well-established Pro Bono Program continues to receive
funding through the Court's annual appropriation. Before FY 1997,
Congress gave the Court limited discretion over the Pro Bono Program's
funding level. Since FY 1997, the Appropriations Subcommittees have
considered the Program's budget request separately from the Court's
budget request, although both are submitted together. The Program
budgeted $2,515,229 in FY 2011. Distribution of the grant and oversight
for the Program continues to be performed by the LSC, which provides
monitoring, evaluation, and technical support, as it does for all of
its grantees. The Pro Bono Program's FY 2012 request for $2,726,363 is
attached at Appendix A.
Staffing Requirements:
The Court requests funding for 127 full-time equivalent (FTE)
positions. This request represents no increase from the FY 2011 level.
It includes, as did the 2011 budget, staffing for two additional
chambers, as authorized by 38 U.S.C. Sec. 7253(i). It also includes one
Secretary for support to our senior judges in service, one additional
staff attorney, and a senior attorney position (for possible service as
an Appellate Commissioner), originally requested for FY 2011; these
positions have not been filled as of this writing because we are
operating on a continuing resolution for FY 2011.
Veterans Courthouse:
The United State Court of Appeals for Veterans Claims is the newest
Federal court and the only Article I court without a dedicated
courthouse. Since at least 2003, several of our Nation's largest
Veterans Service Organizations (VSOs) have supported a dedicated
courthouse for veterans seeking judicial review. In 2004, the House of
Representatives expressed its sense that the Court ``should be housed
in a dedicated courthouse'' that would be ``symbolically significant of
the high esteem the Nation holds for its veterans'' and would ``express
the gratitude and respect of the Nation for the sacrifices of those
serving and those who have served in the Armed Forces, and their
families'' (H.R. 3936). That sentiment was echoed in 2007 with the
sense of Congress that the Court be provided appropriate office space
``to provide the image, security, and stature befitting a court that
provides justice to the veterans of the United States'' (S. 1315). The
Board of Judges fully supports the convictions expressed by Congress
and the VSOs.
In 2004, pursuant to Congressional support and funding, an initial
and a follow-on study were undertaken by GSA to determine the
feasibility of acquiring a dedicated courthouse. In 2009, eight
National VSOs collaboratively sent a letter to Congress expressing
their strong support of legislation that would authorize the funding
and construction of a veterans courthouse. In FY 2009, Congress
responded by appropriating $7 million (M) for advance planning and
architectural design, and those funds were transferred to GSA for
completion of a pre-development planning study (planning study). The
Court made no specific funding request for the courthouse project in
its FY 2010 budget request because the planning study had not yet been
concluded and plans were too uncertain at that time to make such a
request prudent.
Following receipt of a GSA estimate that $62M was needed for
construction funding, this amount was requested in the Court's FY 2011
budget. In response, the House proposed full funding at $62M, and the
Senate proposed $25M--sufficient funding, per GSA, to perform more
detailed design and planning, and to purchase necessary land adjacent
to GSA property being considered for the courthouse, the next steps in
the process. The FY 2011 budget request has not yet been acted on
because we are operating on a continuing resolution, and therefore no
funding has been appropriated for construction of the courthouse in FY
2011. Subsequent to submitting the Court's FY 2011 request, GSA
presented a more specific courthouse cost estimate based on the
particular location and general design developed in the planning study.
This estimate reflects a substantial cost increase for project
completion over the FY 2011 budget request. We understand that GSA has
either briefed or offered to brief the appropriate congressional
Committees as to the basis for the cost increase.
Given the increased cost estimate from GSA and need for close study
thereof, and mindful of the Court's responsibility to ensure fiscal
prudence, our FY 2012 request includes $25M, necessary for funding the
next steps toward construction, i.e., more detailed planning, design
and land acquisition. (This $25M is not needed in FY 2012 if the $25M
for the veterans courthouse is appropriated in FY 2011.) We are
sensitive to budget constraints and understand that priorities must be
set by Congress; however, if any Federal courthouses are to be funded
for construction, we support the veterans who contend that their
courthouse should be one of them.
FISCAL YEAR 2010 PROGRAM
The Court's FY 2010 program accomplished the following:
Opened 4,341 new cases, including appeals from decisions of the
Board of Veterans' Appeals and petitions for extraordinary relief
directed to the Court. During the same period, the Court disposed of
5,141 cases through a combination of court orders, single judge
decisions, and panel opinions. In addition, the Court ruled on
thousands of motions and took action on 2,653 applications for attorney
fees filed under the Equal Access to Justice Act.
Paid all obligations and staffed all positions necessary for the
continued, proper functioning of the Court.
Received a clean audit with no exceptions for FY 2010.
Continued to develop and execute plans for construction of a
veterans courthouse for the United States Court of Appeals for Veterans
Claims, including coordinating with GSA.
Continued to work with GSA to locate additional leased space for
existing staff and two new judicial chambers.
Continued the agreements with the U.S. Marshals Service (U.S.MS)
for Court security, with the Department of Agriculture's National
Finance Center (NFC) for payroll/personnel services, and with the
Bureau of the Public Debt (BPD) for administrative payments, credit-
card, travel, and financial accounting and reporting services. Also,
continued existing agreement with the Administrative Office of U.S.
Courts (AO) for electronic-case filing (e-filing) system support.
Transferred appropriations made available for the Pro Bono
Representation Program.
FISCAL YEAR 2011 PROGRAM
To maintain and enhance the FY 2010 initiatives, the Court's FY
2011 budget request reflected the following:
Funding to pay for projected expenses to staff and support the
operations of the Court to ensure its continued, proper functioning
throughout the fiscal year, including two new chambers and three FTE
positions not previously required--a secretary for the senior judges, a
staff attorney, and a senior attorney (for possible service as an
appellate commissioner).
Funding to have the Court's financial statements audited.
Funding to build a veterans courthouse at GSA cost estimate.
Funding to acquire additional leased space to meet space needs for
existing staff and two new judicial chambers.
Funding to continue agreements with the USMS for Court security,
with the Department of Agriculture's NFC for payroll/personnel
services, and with BPD for administrative payments, credit-card,
travel, and financial accounting and reporting services. Also, to
continue existing agreement with the AO for e-filing system support.
Funding to be made available for the Pro Bono Representation
Program.
FISCAL YEAR 2012 PROGRAM
To maintain and enhance the FY 2011 initiatives, the Court's FY
2012 budget request reflects the following:
Funding to pay for projected expenses to staff and support the
operations of the Court to ensure its continued, proper functioning
throughout the fiscal year, including two new chambers to accommodate
the two judges authorized by Congress (judges authorized but not yet
appointed), and three FTE positions first requested for funding in FY
2011 (budget not yet approved)--a secretary for the senior judges, a
staff attorney, and a senior attorney (for possible service as an
appellate commissioner).
Funding to have the Court's financial statements audited.
Funding for design and site acquisition toward ultimate
construction of a veterans courthouse. The FY 2012 request includes
funding for the next major step in the construction, planning, and
design process, as opposed to full construction cost funding, and is
subject to continued congressional and veteran support for a veterans
courthouse at this time.
Funding to acquire additional leased space to meet space needs for
existing staff and two new judicial chambers.
Funding to continue agreements with the USMS for Court security,
with the Department of Agriculture's NFC for payroll/personnel
services, and with BPD for administrative payments, credit-card,
travel, and financial accounting and reporting services. Also, to
continue existing agreement with the AO for e-filing system support.
Funding to be made available for the Pro Bono Representation
Program.
SUMMARY OF FISCAL YEAR 2012 BUDGET REQUEST
(in thousands of dollars--$000)
A summary of the FY 2012 funding requirements for conducting the Court's activities follows:
----------------------------------------------------------------------------------------------------------------
FY 2011
Appropriation FY 2012 Estimate Change
----------------------------------------------------------------------------------------------------------------
FTE Positions 127 127 0
----------------------------------------------------------------------------------------------------------------
Personnel Compensation and Benefits $17,458 $17,863 +$405
----------------------------------------------------------------------------------------------------------------
Other Objects (Operating Expenses) $8,174 $10,208 +$2,034
----------------------------------------------------------------------------------------------------------------
Courthouse $62,000 $25,000 -$37,000
----------------------------------------------------------------------------------------------------------------
Grants $2,515 $2,726 +$211
----------------------------------------------------------------------------------------------------------------
Budget Authority/ $90,147 $55,797 -$34,350
Appropriation
----------------------------------------------------------------------------------------------------------------
The FY 2012 budget request of $55,796,690 reflects a decrease of
$34,350,039 from the Court's budget request for FY 2011. This
significant decrease results primarily from the fact that $62,000,000
was requested in FY 2011 for construction of a veterans courthouse.
That request has not been approved, and indications from congressional
staff are that the project will be funded, if at all, in a piecemeal
fashion tied to major steps in the construction process. GSA advises
that $25,000,000 will fund the next major step, which is design
engineering and site acquisition, and this is the amount reflected in
our FY 2012 budget request.
The Court's operating expenses reflect an overall increase of
$2,033,827, primarily due to the fact that two new chambers for which
funding was requested and appropriated in 2010 were not built out and
equipped because the judges were not appointed, and funding for this
purpose was not requested in our FY 2011 budget request. The FY 2012
request for personnel compensation and benefits reflects an increase of
$405,000 over our FY 2011 budget request to accommodate scheduled step
increases and time-in-grade promotions for current FTE positions. There
is also a $211,000 increase requested by the Pro Bono Representation
Program.
FISCAL YEAR 2012 PROGRAM FUNDING CHANGES
(in thousands of dollars--$000)
Personnel Compensation and Benefits:
+$405
The overall increase in personnel compensation and benefits
includes maintaining FTE positions at the FY 2011 level, as well as
accommodating scheduled step increases and time-in-grade promotions.
All Other Objects (Operating Expenses):
+$2,034
The increase in operating expenses is due largely to anticipated
one-time expenses to build out and equip two new chambers for two
additional judges authorized and anticipated to be appointed.
Courthouse:
(-$37,000)
This significant decrease results primarily from the fact that
$62,000,000 was requested in FY 2011 for construction of a veterans
courthouse that has not been approved, with indications from
congressional staff that the project will be funded, if at all, in a
piecemeal fashion tied to major steps in the construction process. GSA
advises that $25,000,000 will fund the next major step, which is design
engineering and site acquisition.
Grants:
+$211
The grantee, Pro Bono Representation Program, explains its request
in Appendix A.
Total Changes:
-$34,350
DETAILS OF FISCAL YEAR 2012 FUNDING CHANGES
(in dollars--$0)
The following information provides details for the funding changes
from the FY 2011 budget request:
PERSONNEL COMPENSATION & BENEFITS:
+$405,000
The overall increase in personnel compensation and benefits
includes maintaining existing FTE positions as well as accommodating
possible promotional allowances.
OTHER OBJECTS (OPERATING EXPENSES):
+$2,033,827
TRAVEL:
+$55,000
Budget requests in FY 2010 and FY 2009 have proven to be
inadequate, but this trend was identified after submission of the FY
2011 budget. This increase will accommodate ongoing Court travel for
oral arguments outside of the Washington, D.C. Metropolitan Area.
TRANSPORTATION OF EQUIPMENT:
+$1,000
Budget requests in FY 2010 and FY 2009 have proven to be
inadequate, but this trend was identified after submission of the FY
2011 budget. This increase will accommodate ongoing Court activities,
to include transportation of things associated with Court travel as
well as continue to fund for anticipated additional staff.
RENTAL PAYMENTS TO GSA:
+$105,000
This increase is attributed to the estimated rental costs for the
current space (42,541 sq ft) plus future space (13,000 sq ft). The
amount is calculated based on information provided by GSA.
RENTAL PAYMENTS TO OTHERS:
+$3,600
This increase is attributed to the estimated rental cost for garage
and storage space.
COMMUNICATIONS, UTILITIES, AND MISCELLANEOUS
CHARGES:
+$25,000
This increase is based on increased communications and utilities
costs experienced over the past 2 years and projected additional costs
to provide communications and utilities associated with the appointment
of two additional judges, additional staff, and an increase in future
leased space of approximately 13,000 sq ft.
PRINTING & REPRODUCTION:
+$7,000
Increased to accommodate additional printing costs for a Bench and
Bar Conference.
ALL OTHER SERVICES:
+$100,000
This increase is due to increased cost associated with the USMS
contract for Court security officers, finance and accounting services,
guards in the building and garage pursuant to the FPS contract,
security-system maintenance, and projected cost associated with the
appointment of two additional judges, additional staff, and an increase
in future leased space of approximately 13,000 sq ft.
SUPPLIES & MATERIALS:
+$60,000
This increase is for the initial set up and supply for two new
chambers to accommodate two additional judges and the required
supporting staff.
EQUIPMENT:
+$625,000
This increase reflects our scheduled industry standard (3-year)
replacement program for IT equipment and continued enhancement of
electronic filing and case management.
CONTRIBUTION TO JUDGES RETIREMENT TRUST FUND:
+$1,052,227
This increase reflects the amount required to maintain the
statutorily required estimate for full funding as of September 30,
2011, for the retirement fund, as estimated by Actuary's report.
COURTHOUSE:
(-$37,000,000)
This significant decrease results primarily from the fact that
$62,000,000 was requested in FY 2011 for construction of a veterans
courthouse that has not been approved, with indications from
congressional staff that the project will be funded, if at all, in a
piecemeal fashion tied to major steps in the construction process. GSA
advises that $25,000,000 will fund the next major step, which is design
engineering and site acquisition.
GRANTS:
+$211,134
The grantee, Pro Bono Representation Program, explains its request
in Appendix A.
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
PROGRAM AND FINANCING
(in thousands of dollars)
------------------------------------------------------------------------
2011 Budget 2012
2010 Actual Request Estimate
------------------------------------------------------------------------
OBLIGATIONS BY PROGRAM ACTIVITY
------------------------------------------------------------------------
10.00 Total obligations $25,436.0 $90,147.0 $55,797.0
------------------------------------------------------------------------
BUDGETARY RESOURCES AVAILABLE FOR OBLIGATION
------------------------------------------------------------------------
21.40 Unobligated balance $ --
available, start of year
------------------------------------------------------------------------
22.0 New budget authority $27,115.0 $90,147.0 $55,797.0
(gross)
------------------------------------------------------------------------
22.30 Unobligated balance $1,679.0 $ -- $ --
expiring
------------------------------------------------------------------------
23.95 New Obligations $25,436.0 $90,147.0 $55,797.0
------------------------------------------------------------------------
24.40 Unobligated balance $ -- $ -- $ --
available, end of year
------------------------------------------------------------------------
NEW BUDGET AUTHORITY (GROSS) DETAIL
------------------------------------------------------------------------
40.00 Appropriation $27,115.0 $90,147.0 $55,797.0
------------------------------------------------------------------------
40.35 Appropriation rescinded $ -- $ -- $ --
------------------------------------------------------------------------
43.00 Appropriation (total) $27,115.0 $90,147.0 $55,797.0
------------------------------------------------------------------------
CHANGE IN UNPAID OBLIGATIONS:
------------------------------------------------------------------------
72.40 Obligated balance, start $10,796.0 $10,987.1 $11,077.2
of year
------------------------------------------------------------------------
73.10 New obligations $25,914.2 $90,147.0 $55,797.0
------------------------------------------------------------------------
73.20 Total outlays (gross) -$25,712.5 -$90,056.9 -$50,217.3
------------------------------------------------------------------------
74.40 Obligated balance, end $10,987.1 $11,077.2 $16,656.9
of year
------------------------------------------------------------------------
OUTLAYS (GROSS), DETAIL
------------------------------------------------------------------------
86.90 Outlays from new current $23,313.8 $79,069.8 $39,140.1
authority
------------------------------------------------------------------------
86.93 Outlays from current $2,398.8 $10,987.1 $11,077.2
balances
------------------------------------------------------------------------
87.00 Total Outlays $25,712.5 $90,056.9 $50,217.3
------------------------------------------------------------------------
NET BUDGET AUTHORITY AND OUTLAYS
------------------------------------------------------------------------
89.00 Budget authority $27,115.0 $90,147.0 $55,797.0
------------------------------------------------------------------------
90.00 Outlays $25,712.5 $90,056.9 $50,217.3
------------------------------------------------------------------------
SALARIES AND EXPENSES
Object Classification (in thousands of dollars)
------------------------------------------------------------------------
2011 Budget 2012
Direct Obligation 2010 Actual Request Estimate
------------------------------------------------------------------------
11.1 Full-time permanent $10,386.25 $13,225.00 $13,625.00
------------------------------------------------------------------------
11.5 Other personnel $284.47 $150.00 $150.00
compensation
------------------------------------------------------------------------
11.9 Total personnel $10,670.72 $13,375.00 $13,775.00
compensation
------------------------------------------------------------------------
12.1 Civilian personnel $2,853.77 $4,083.00 $4,087.50
benefits
------------------------------------------------------------------------
13.1 Unemployment compensation
------------------------------------------------------------------------
21.0 Travel and transportation $99.63 $70.00 $125.00
of
persons
------------------------------------------------------------------------
22.0 Transportation of things $3.40 $3.00 $4.00
------------------------------------------------------------------------
23.1 Rental payments to GSA $2,100.00 $3,500.00 $3,605.00
------------------------------------------------------------------------
23.2 Rental payments to others $104.10 $120.00 $123.60
------------------------------------------------------------------------
23.3 Communications, $149.97 $145.00 $170.00
utilities, and miscellaneous
charges
------------------------------------------------------------------------
24.0 Printing and reproduction $23.35 $13.00 $20.00
------------------------------------------------------------------------
25.2 Other services $1,577.28 $1,793.00 $1,843.00
------------------------------------------------------------------------
25.3 Purchases of goods and $757.53 $590.00 $620.00
services from government
sources
------------------------------------------------------------------------
25.4 Operation and maintenance $41.00 $37.00 $45.00
of facilities
------------------------------------------------------------------------
25.7 Operation and maintenance $89.50 $80.00 $92.00
of equipment
------------------------------------------------------------------------
26.0 Supplies and materials $164.97 $193.00 $253.00
------------------------------------------------------------------------
31.0 Equipment $691.99 $325.00 $950.00
------------------------------------------------------------------------
32.0 Land and Structures $0.00 $62,000.00 $25,000.00
------------------------------------------------------------------------
41.0 Grants, subsidies, and $1,820.00 $2,515.00 $2,726.36
contributions
------------------------------------------------------------------------
43.0 Interest -- -- --
------------------------------------------------------------------------
94.0 Contributions to Trust $4,715.37 $1,305.00 $2.357.23
Fund
------------------------------------------------------------------------
99.0 Total obligations $25,862.58 $90,147.00 $55,796.69
------------------------------------------------------------------------
JUDGES RETIREMENT FUND
The Judges Retirement Fund, established under 38 U.S.C. Sec. 7298,
is used for judges' retired pay and for annuities, refunds, and
allowances provided to surviving spouses and dependent children.
Participating judges pay 1 percent of their salaries to cover
creditable service for retired-pay purposes and 2.2 percent of their
salaries for survivor-annuity purposes. Additional funds needed to
cover the unfunded liability may be transferred to this fund from the
Court's annual appropriation. The Court's contribution to the fund is
estimated annually by an actuarial firm retained by the Court. The fund
is invested solely in government securities. The Court paid from fund
assets one survivor annuitant and six retired judges in FY 2010. In FY
2011 and FY 2012, the Court anticipates these payments to retired
judges to increase to seven retirees.
JUDGES RETIREMENT FUND
(in thousands of dollars)
------------------------------------------------------------------------
Unavailable Collections 2011 Budget 2012
Schedule: 2010 Actual Request Estimate
------------------------------------------------------------------------
Balance, Start of year:
------------------------------------------------------------------------
01.99 Balance, start of year $19,039.00 $22,727.00 $23,657.00
------------------------------------------------------------------------
Receipts:
------------------------------------------------------------------------
02.01 Earnings on investment $52.22 $650.00 $80.00
------------------------------------------------------------------------
02.02 Employer contributions $4,715.37 $1,530.00 $2,357.00
------------------------------------------------------------------------
02.03 Employee contributions $47.60 $50.00 $55.00
------------------------------------------------------------------------
02.99 Subtotal, receipts $4,815.19 $2,230.00 $2,492.00
------------------------------------------------------------------------
04.00 Ofsetting Collectons $1,124.17 $-1,300.00 $-1,474.00
(Outlays)
------------------------------------------------------------------------
88.03 Total: Balances and $22,727.00 $23,657.00 $24,675.00
collections
------------------------------------------------------------------------
Appropriations:
------------------------------------------------------------------------
65.99 Judges Retirement and $1,124.17 $-1,300.00 $-1,474.00
Survivor Annuity Fund
------------------------------------------------------------------------
88.99 Balance, end of year $22,727.00 $23,657.00 $24,675.00
------------------------------------------------------------------------
APPENDIX A
THE VETERANS CONSORTIUM PRO BONO PROGRAM
FY 2012 FUNDING REQUEST, BUDGET AND NARRATIVE
Overview
The Pro Bono Program is requesting an appropriation of new grant
funds in the amount of $2,726,363 for FY 2012. This request represents
an increase of $216,133 or 8 percent from the $2,515,229 pending
authorization for the Program for the current FY 11. The Pro Bono
Program has recently brought on a new Executive Director and taken
steps to become a ``stand-alone'' entity. The 8 percent increase is due
to the need to cover the additional costs associated with this goal.
The Program's proposed budget for FY 2012 is attached.
SIGNIFICANT PRO BONO PROGRAM, COURT, and BVA STATISTICS:
The Program sent program information to 2,320 pro se appellants in
calendar year (CY) 2010, a slight decline over prior years. The Program
received 671 requests for assistance in 2010. This continues to mirror
the change in the Court's caseload; historically, the Court has
received 2,200-2,400 new filings per fiscal year, until FY 2005, when
the Court's caseload began to rise rather dramatically.
The Court's Annual Reports (available at www.uscourts.cavc.gov/
documents/
Annual_Report_FY_2009_October_1_2008_to_September_30_2009.pdf) indicate
that the Court had 4,725 new pro se and represented cases filed in
2009; 4,128 new cases filed in FY 2008; 4,644 new cases filed in FY
2007; and 3,729 new cases filed in 2006. Preliminary Court statistics
for FY 2010 indicate that the number of new cases filed with the Court
in FY 2010 declined slightly from FY 2009, to 4,340.
The Program evaluated 669 cases in 2010, a decline over the 849
cases evaluated in 2009, the 818 cases evaluated in CY 2008 and the 737
cases evaluated in CY 2007. Of those 669 evaluated cases, 205 cases
were accepted into the Program, the remainder being rejected for a
variety of reasons (e.g., financial ineligibility, jurisdictional
defects, lack of merit, retained own counsel, etc.).
We note, as we did in our FY 11 budget request, that the Court's
statistics (reported on a fiscal year basis) show that the percentage
of appellants unrepresented at the time of filing the appeal remained
steady at 58-59 percent from FY 2002 through FY 2005. While the
percentage decreased to 53 percent in FY 2007, it rebounded to 64
percent in FY 2008 and increased further to 68 percent in FY 2009 (a
level not seen since FY 2000). However, the pro se percentage declined
in FY 2010 to 57 percent.
The Program continues to provide free legal service to a
significant number of unrepresented veterans with active appeals at the
Court, as more and more veterans seek judicial review. The number of
appeals decided by the Board of Veterans' Appeals increases annually,
with the BVA issuing over 48,800 decisions in 2009 and 43,700 decisions
in 2008 (see http://www.bva.va.gov/docs/Chairmans_Annual_Rpts/
BVA2009AR.pdf). Preliminary reports from the BVA indicate that the
Board decided some 49,100 cases in FY 2010, although the percentage of
denials declined from 36.1 percent in 2009 to 28.1 percent in 2010,
which necessarily impacts the number of appeals to the Court, and the
number of appellants seeking Program services.
However, the number of claims filed by a rapidly growing number of
returning Iraq and Afghanistan veterans can be expected to continue to
increase. We believe that the BVA will continue to decide an even
greater number of appeals and that, in turn, more cases will be filed
with the Court, and that there will be a resultant increased demand for
Program services in 2012 and beyond.
To meet that anticipated demand, we added a full-time
administrative support person in January, 2009. We are requesting
continued funding for this administrative support person in FY 2012,
and continuation of funding for the remainder of the Program staff. In
addition, the Legal Services Corporation, in a recent review of the
Program, concurred in the decision of the Board of Directors to hire a
full-time Executive Director. We are pleased to report that the new
Executive Director, with an extensive background in nonprofit
management, joined the program on January 10, 2011.
DETAIL
Personnel costs--salary and benefits of those individuals
performing services for the Program that are reimbursed from grant
funds--account for 57 percent of the proposed FY 12 budget. These costs
include the time for part-time personnel who staff the Outreach and
Education Components and the time of the full-time paid personnel who
staff the Case Evaluation and
Table A
PRO BONO PROGRAM PERSONNEL AND FTE DISTRIBUTION
----------------------------------------------------------------------------------------------------------------
Total Number Total Number
of Personnel of Personnel Total FTE to
Providing Total FTE Providing be
Component Services to Authorized Services to Authorized
the Program by the Grant the Program by the Grant
FY 11 FY 11 FY 12 FY 12
----------------------------------------------------------------------------------------------------------------
Outreach 6 0.25 6 0.25
----------------------------------------------------------------------------------------------------------------
Education 13 0.92 13 0.92
----------------------------------------------------------------------------------------------------------------
Case Evaluation and Placement 11 11 11 11
----------------------------------------------------------------------------------------------------------------
Direct Representation 1 1 1 1
----------------------------------------------------------------------------------------------------------------
Administration 3 3 3 3
----------------------------------------------------------------------------------------------------------------
Total 34 16.17 34 16.17
----------------------------------------------------------------------------------------------------------------
Placement Component along with the three new additional personnel
required to move the Pro Bono Program to a stand-alone entity. Staff
who are reimbursed from grant funds for all or a portion of their
salary and benefits are currently employees of either the National
Veterans Legal Services Program (NVLSP) or the Paralyzed Veterans of
America (PVA). It is anticipated that by the end of 2011, all of these
personnel will be employees of the stand-alone entity.
Table A above shows in summary form the number of persons providing
services for each component, and the number of Full Time Equivalent
(FTE) positions to be paid out of grant funds in FY 11 and FY 12.
A detailed breakdown by Component follows.
I. Case Evaluation and Placement Component
$1,698,330
The FY 12 funding request reflects a $168,132 (10.99 percent)
increase over the FY 11 budget for the Case Evaluation and Placement.
Personnel cost increased by $56,361 and non-personnel cost increased by
$111,771 for this Component.
A. Personnel
There are three categories of personnel staffing this component--
attorneys, non-attorney veterans law specialists, and other.
Three attorneys--the Director, the Deputy Director for Case
Evaluation and the Deputy Director for Placement--function full time.
Their personnel costs are currently fully reimbursed by the Program--
one position to PVA and two positions to NVLSP. The attorneys are
reimbursed from grant funds, in both FY 11 and FY 12. It is anticipated
that all of these individuals will become full time employees by FY 12.
Veterans law specialists review the VA claims file and BVA decision
in each case to determine whether the case presents an issue that
justifies referral to a lawyer. Veterans law specialists are among the
most experienced non-lawyer personnel in the veterans-law field. The
Program requests funding for four full time veterans law specialists in
FY 12, the same number as in FY 11. It is anticipated that all of these
individuals will also become full time employees by FY 12.
We request funding for four full time administrative support staff.
All are currently employees of NVLSP, and are all reimbursed out of
Program funds. The other components in this increase represent the
combination of a modest cost of living and merit raises.
The level of salaries and benefits paid by the Program for
personnel provided on a reimbursable basis is governed by the personnel
policies of the constituent organizations of which they are employees--
i.e., NVLSP and PVA--and to which they may return in the event of
termination of the Program or rotation of personnel by the
organizations involved. Typically, the Program budgets a 5 percent
increase in salary and benefits--3 percent for cost-of-living
increases, and 2 percent for merit increases. The budget for FY 12
follows this formula. Such increases are reflected in the personnel
costs of all four Components of the Program in the FY 12 budget.
B. Space-Rent
The largest single increase in the requested budget for FY 12 is
associated with space-rental costs. The Program's current space lease
will expire in November, 2012. Consequently, during FY 12, the Program
will be entering into a new lease. It is expected that the Program will
incur higher rental costs and moving costs related to the anticipated
move. The FY 12 funding request reflects an $82,208 (33.39 percent)
increase over the FY 11 budget for this line item.
C. Equipment Rental and Maintenance
The increase of $903 from FY 11 provides for a 5 percent rate
adjustment for the maintenance contracts/service agreements on office
equipment and telephone system.
D. Office Supplies & Expense
The increase of $12,122 over the amount budgeted for FY 11 reflects
the increased cost for office supplies and the use of Priority Mail to
expedite delivery of Program materials to an increased number of pro se
appellants. Furthermore, due to the Court's change in the manner in
which the cases are referred to the Pro Bono Program, i.e., from hard
copy to electronically, the copying costs have risen significantly.
This increase represents a 17.32 percent rise over the prior year.
E. Telephone
The increase of $540 over the amount budgeted for FY 11 provides
for a 5 percent rate increase.
F. Travel/Continuing Legal Education
The increase of $1,060 provides for a 5 percent increase over FY
11.
G. Library
The increase of $381 over the amount budgeted for FY 11 provides
for a 5 percent rate increase.
H. Insurance
The increase of $5,344 over the amount budgeted for FY 11
represents a 77.67 percent increase that is due to the Pro Bono Program
having to acquire its own insurance. In prior years, the Pro Bono
Program was able to rely on the NVLSP for insurance coverage. By moving
to a stand alone entity, the Pro Bono Program's insurance costs have
significantly increased.
I. Dues and Fees
There is a significant increase in expected costs associated with
Dues and Fees over the prior year. The increase of $3,090 represents a
166.51 percent rise over FY 11 due, in large part, to costs related to
becoming a stand alone entity.
J. Audit
The increase of $1,050 over the amount budgeted for FY 11 provides
for a 5 percent rate increase.
K. Property Acquisition
The increase of $525 over the amount budgeted for FY 11 provides
for a 5 percent rate increase.
L. Contract Services
The increase of $20,277 over the amount budgeted for FY 11 provides
for a 5 percent rate increase in expected Contract Services.
M. Expense for Administration
The increase of $2,100 allows for a 5 percent rate increase for the
cost of grant administration, which now must be procured from a third
party, since NVLSP will no longer supply it at a reduced fee.
II. Direct Representation Component
$131,250
Some cases require immediate attention by a lawyer experienced in
veterans law. Previously, PVA committed to accepting 20 such cases and
charging the Pro Bono Program just 75 percent of PVA's out-of-pocket
costs, the remaining 25 percent being donated by PVA. It is unclear
whether, when the Pro Bono Program becomes a stand-alone entity, these
services will remain available at a discounted rate. Consequently, the
FY 12 budget provides for the hiring of a full-time attorney to handle
these cases and other items that may arise during the course of the
year.
III. Outreach Component
$74,579
The Outreach Component is provided on a fixed price contract by the
NVLSP. Overall, the FY 12 budget calls for a $3,551 increase from the
FY 11, a 5 percent increase. In addition to the prior outreach
services, this budget component also provides for Web site maintenance
and an annual report and brochure.
IV. Education Component
$300,828
The proposed FY 12 budget for the Education Component reflects an
increase of $14,325 (5 percent) over the budget for FY 11. Like the
Outreach Component, for FY 12, these services are being provided by the
NVLSP at a fixed price. Included in this budget component are the costs
of volunteer reference materials of approximately $105,000.
V. Executive Administration
$501,375
In accordance with certain suggestions made by the Legal Services
Corporation in its 2009 Program Quality Report assessing the Pro Bono
Program, the Program is in the process of becoming a ``stand-alone''
entity such that it will no longer be able to rely upon component
veterans service organizations (The American Legion, Disabled American
Veterans, National Veterans Legal Services Program and Paralyzed
Veterans of America) for certain administrative and other assistance.
The amount budgeted for FY 12 represents a 5 percent increase over FY
11, specifically $23,875.
VI. TOTAL BUDGET REQUESTED
Case Evaluation and Placement Component $1,698,330
Direct Representation Component $131,250
Outreach Component $74,579
Education Component $300,828
Executive Administration $501,375
LSC Oversight $20,000
LESS: ANTICIPATED FY 11 CARRYOVER ($0)
Pre-Hearing Budget Questions
The Honorable Jeff Miller, Chairman
U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2012
February 17, 2011
General Questions
Question 1: The President's National Commission on Fiscal
Responsibility and Reform issued its report in December 2010. In
discussing possible solutions to our country's fiscal crisis the report
highlighted that ``everything must be on the table,'' to include the
elimination of redundant, wasteful, and ineffective spending that may
exist within every Federal agency.
Question 1(a): To what extent has VA undertaken a comprehensive
effort to identify and eliminate redundant, wasteful, and ineffective
spending consistent with the Commission report's mandate? If VA has not
yet done so, will it?
Response: VA has conducted a review of the efficiencies to be
gained, and the savings to be achieved within the agency. These
improvements are estimated to total $745 million in FY 2011. Similar
improvements are included in VA's budget request for 2012 at estimated
savings of $1.2 billion.
The VA is firmly committed to increasing the value of every dollar
entrusted by the Congress and the American taxpayer to this Department
for the delivery of benefits and services to Veterans, their families
and survivors. For example, in 2011, we are implementing several
operational improvements in our medical care programs that will save
money while improving the quality of health care. These include:
Reducing indirect costs by adopting uniform standards for
administrative and support services;
Reducing the costs of non-VA provided dialysis by
implementing Medicare's standard payment rates;
Reducing acquisition costs by consolidating contracting
requirements, adopting strategic sourcing and other initiatives;
Reducing improper payments and improving operational
efficiencies in the administration of the medical fee program; and
Reducing payroll costs by increasing capabilities and
productivity of health care professionals through more appropriate
alignment of the mix of physician and nursing staff, and other non-
physician providers, to meet patient demand.
In developing the 2012 budget, we also carefully reviewed
requirements in our non-medical programs. As a result, we will reduce
spending by $1.1 billion below current 2011 estimates in several
program areas. For example, by prioritizing our most critical safety
and security capital infrastructure needs, funding for major and minor
construction will be reduced. Investments in information technology
will begin to pay dividends as deployment of the Veterans Benefits
Management System (VBMS) begins in 2012, allowing for increased
productivity and reduced operating costs in processing disability
compensation claims in the Veterans Benefits Administration. In
addition, we are adopting new acquisition strategies to make more
effective use of our information technology resources, including
consolidating requirements into 15 prime contracts that will allow VA
to leverage economies of scale and reduce IT spending.
VA has also instituted a number of innovative practices to improve
our energy efficiency and make more effective use of our resources. For
example, the National Cemetery Administration (NCA) has implemented
creative approaches to cemetery operations: the use of pre-placed
crypts, that preserve land and reduce operating costs; application of
``water-wise'' landscaping that conserves water and other resources;
and installation of alternative energy products such as windmills and
solar panels that supply power for facilities. NCA has also utilized
biobased fuels that are homegrown and less damaging to the environment.
NCA is developing an independent study of emerging burial practices
throughout the world to inform its planning for the future.
In the past 2 years, we have established and created management
systems, disciplines, processes, and initiatives that help us eliminate
waste. Financial and performance metrics provide the foundation for
monthly performance reviews that are chaired by the Deputy Secretary.
These monthly meetings play a vital role in monitoring performance
throughout the Department, and are designed to ensure both operational
efficiency and the achievement of key performance targets. In addition,
a new budget review cycle was established to further strengthen
stewardship of our financial resources. This cycle has three
components: pre-year review; mid-year review; and post-year review. The
Secretary chairs meetings in each review cycle to assess budget and
operational efficiency and effectiveness.
We also demonstrated our ongoing commitment to effective
stewardship of our financial resources by obtaining our 12th
consecutive unqualified (clean) audit opinion on VA's consolidated
financial statements. In 2010, we were successful in remediating 3 of 4
longstanding material weaknesses, a 75 percent reduction in just 1
year.
Question 1(b): What barriers exist, legal or otherwise, to
eliminate any such wasteful spending?
Response: We have not identified any legal barriers to date.
However, VA's authority to enter into private/public ventures to make
better use of underutilized space and land through enhanced use leasing
is scheduled to lapse at the end of calendar year 2011. The
Administration remains committed to this important program, and a
proposal to address the expiration will accompany the Department's
legislative package through the President's program.
Question 2: The President's Commission highlighted the fact that
Federal travel, printing, and vehicle budgets have ballooned in recent
years and recommended these areas for fiscal restraint.
Question 2(a): Please outline for me VA-wide spending in each of
these categories for each of fiscal years 2009, 2010, the current
estimate for FY 2011, and what is proposed for FY 2012.
Response: VA medical personnel require frequent training to
maintain clinical skills and medical knowledge. Similarly benefits
raters require training to implement programs. Please see the table
below:
Department of Veterans Affairs
Employee, Travel, Printing, and Fleet Services
($ in millions)
----------------------------------------------------------------------------------------------------------------
Appropriated 2009 2010 2011 2012
----------------------------------------------------------------------------------------------------------------
Employee Travel 193 228 259 252
----------------------------------------------------------------------------------------------------------------
Printing 27 40 46 56
----------------------------------------------------------------------------------------------------------------
Fleet Vehicles 69 73 80 86
----------------------------------------------------------------------------------------------------------------
Total $289 $341 $385 $394
----------------------------------------------------------------------------------------------------------------
Question 2(b): What is your assessment regarding the Commission's
recommendation in this area and its potential applicability to VA?
Response: The Commission made the following observations:
``1.10.5 Reduce Federal travel, printing, and vehicle budgets.
Despite advances in technology, Federal travel costs have ballooned in
recent years, growing 56 percent between 2001 and 2006 alone.
Government fleets, meanwhile, have grown by 20,000 over the last 4
years. Printing costs are still higher than necessary despite
technological advancement. We propose prohibiting each agency from
spending more than 80 percent of its FY 2010 travel budget and
requiring them to do more through teleconferencing and telecommuting.
We also recommend a 20 percent reduction in the nearly $4 billion
annual Federal vehicle budget, excluding the Department of Defense and
the Postal Service. Additionally, we recommend allowing certain
documents to be released in electronic-only form, and capping total
government printing expenditures. This proposal will save $1.1 billion
in 2015.''
For VA, the key driver to savings in this area lies in government
travel, which dwarfs the costs of government printing and fleet
vehicles. In this important area, VA's 2012 budget proposes a reduction
of $6M from the current estimate for 2011, which is a reduction of 2.3
percent. VA believes that these costs should be taken in context with
the growth in complexity of the Department's mission and our
initiatives to increase access to health care to Veterans residing in
rural areas. In addition, travel costs have increased with the hiring
and training of new staff, including additional disability claims
processors.
Question 3: VA's budget request for fiscal year 2011 did not assume
any unobligated balance, i.e., carryover, would be available from funds
appropriated for fiscal year 2010. However, VA's Quarterly Status
Report for the fourth quarter of fiscal year 2010 suggests an end-of-
year unobligated balance for VA medical care accounts in excess of $1.5
B and additional unobligated balances in other accounts.
Question 3(a): What is VA's plan for this unanticipated carryover
of funds?
Response: VA will use all of the carryover funds, from FY 2010 in
FY 2011, to meet Veterans' health care needs.
Veterans Health Administration Unobligated Balances as of September 30, 2010
That Are Available for Obligation in FY 2011
----------------------------------------------------------------------------------------------------------------
Unobligated
Fund Account Number Fund Description Balance
----------------------------------------------------------------------------------------------------------------
0152 Medical Support & Compliance $132 million
----------------------------------------------------------------------------------------------------------------
$48 million will be used to pay for supplies, equipment and contracts to provide health care services
to veterans at VA medical centers.
$39 million will fund initiatives to expand access to and enhance health care services for rural
veterans
$32 million will be used to fund initiatives including enhanced teleradiology capabilities, recruiting
initiatives for scarce clinical specialists, training for clinical staff, and enhancements to the disability
rating process for veterans.
$7 million was specifically designated by Congress for prosthetics for veterans that will be used for
that purpose in FY 2011.
$6 million was specifically designated by Congress for pandemic influenza.
----------------------------------------------------------------------------------------------------------------
0160 Medical Services $1,208 million
----------------------------------------------------------------------------------------------------------------
$700 million will be used to pay for supplies, equipment and contracts to provide health care to
Veterans at VA medical centers.
$289 million will be used to fund activation costs of 55 major construction and lease projects
providing new or enhanced VA health care facilities, including the cost of initial outfitting of each facility
with equipment and supplies, as well as the cost of new workload associated with those new facilities that will
begin to provide health care to Veterans during FY 2011.
$105 million will be used to implement provisions of Public Law 111-163, the Caregivers and Veterans
Omnibus Health Services Act of 2010.
$30 million will fund the Homeless Veterans Supported Employment Program.
$24 million will fund pilot projects to provide dialysis care for Veterans and to enhance the process
by which Veterans receive disability ratings.
$24 million will fund initiatives for recruitment and training of scarce clinical specialties.
$13 million will be used in FY 2011 for polytrauma centers to treat severely wounded and injured
Veterans, as specifically designated by Congress.
$10 million will fund enhanced operations at the National Center for Post-Traumatic Stress Disorder.
$7 million was specifically designated by Congress for pandemic influenza prevention, treatment and
staff protection at VA medical centers and will be used for that purpose in FY 2011.
$6 million will fund the DoD-VA Eye Center of Excellence.
----------------------------------------------------------------------------------------------------------------
0161 Medical & Prosthetic Research $106 million
----------------------------------------------------------------------------------------------------------------
These funds will be used for ongoing and new resesarch projects.
----------------------------------------------------------------------------------------------------------------
0162 Medical Facilities $109 million
----------------------------------------------------------------------------------------------------------------
$103 million will be used to fund activation costs of 55 major construction and lease projects
providing new or enhanced VA health care facilities, including the cost of initial outfitting of each facility
with equipment and supplies.
$3 million was specifically designated by Congress for polytrauma centers to treat severely wounded and
injured Veterans and will be used for that purpose in FY 2011.
$2 million is energy rebate collections that will be used to fund FY 2011 energy costs.
$1 million was specifically designated by Congress for pandemic influenza prevention, treatment and
staff protection at VA medical centers and will be used for that purpose in FY 2011.
----------------------------------------------------------------------------------------------------------------
Total $1,555 million
----------------------------------------------------------------------------------------------------------------
Obligated as of January 31, 2011 $660 million
----------------------------------------------------------------------------------------------------------------
Question 3(b): In fiscal year 2010 VA used carryover funds from FY
2009 to begin new Information Technology initiatives and create new
staff positions within the Office of the Secretary, initiatives and
positions that were never justified in the FY 2010 budget submission.
Has VA used any carryover funds from FY 2010 to begin initiatives,
increase staff, or establish new offices that were never justified in
the FY 2011 budget request? Does it plan to do so?
Response: The Department has used Information Technology carryover
in implementing a new approach to managing the Department's IT
investments in FY 2011 within the authorities previously provided. That
new approach, the Project Management Accountability System (PMAS) is
documented in detail in the Volume 2 of the FY 2012 President's Budget
submission for the Department. The limited carryover available in the
General Administration account has not been used to begin new
initiatives, increase staff or establish new offices that were not
included in the FY 2011 budget and there are no current plans to do so.
Question 4: In a July 30, 2011, letter to Congress, Secretary
Shinseki stated that there currently is no authority to carry over
unobligated balances made available in the FY 2011 advance
appropriation and ``[a]s a result, VA will be unable to use carryover
funds in this manner in future years unless Congress extends carryover
authority.''
Question 4(a): Will the Department seek such carry over authority
and, if so, how does this reconcile with VA's FY 2011 budget submission
which assumed no unobligated carryover balances from fiscal year 2011?
Response: The legislative language to authorize this carryover was
included in the 2011 President's budget that was submitted in February
2010, in sections 226, 227 and 228 of the Administrative Provisions. VA
strongly recommends that Congress provide this authority in final
appropriations action for FY 2011. The ability to carryover funding
from 2011 into 2012 is a key building block of VA's 2012 budget.
Without the authority for carryover funding at the end of 2011,
increased appropriations would be required in the carryover amount over
the 2012 budget request to meet the health care needs of Veterans.
Question 5: Public Law 111-322 included a 2-year freeze on Federal
employee pay through December 31, 2012.
Question 5(a): What impact, if any, does this Federal pay freeze
have on the Department of Veterans Affairs employees? Specifically,
does this prohibit VA from implementing regularly scheduled step
increases, bonuses, pay authorities for Veterans Health Administration
physicians and dentists as provided for under Public Law 108-445 or
other title 38 hybrid occupations?
Response: The Federal pay freeze has an impact on all Department of
Veterans Affairs (VA) employees, including Veterans Health
Administration (VHA) physicians and dentists and other employees in
health care occupations who are normally entitled to statutory and
administrative adjustments.
In accordance with the Office of Personnel Management's guidance
regarding the pay freeze, VA will forgo general increases to all pay
systems and pay schedules covered by title 38 whenever possible.
However, we will authorize such administrative increases if
extraordinary circumstances exist that compromise patient care.
Consistent with the spirit of the President's memorandum regarding the
pay freeze, management officials will make any such adjustments in a
prudent and strategic manner.
During the pay freeze, VHA physicians and dentists will continue to
receive regular step increases based on longevity. Additionally,
adjustments to market pay for individual physicians and dentists are
not prohibited by the pay freeze, and may be used in a strategic effort
to meet the recruitment and retention needs for a specialty or
assignment of a physician or dentist at a VA facility. Physicians and
dentists will also remain eligible to receive performance pay and
special contribution awards during the pay freeze.
The pay freeze does not prohibit employees from receiving regularly
scheduled step increases or bonuses. In regard to the VHA Physician and
Dentist pay system, authorized by Public Law 108-445, the pay freeze
did not affect employees from receiving scheduled increases on the Base
and Longevity Pay Scale nor the receipt of Performance Pay, which is
paid in a lump sum payment after the end of the fiscal year through the
attainment of established goals.
Overall, the pay freeze may have an impact on retention for
critical health care occupations or information technology positions
that are in high demand in the private sector; however, having the
ability to provide incentive pay and awards during the pay freeze will
help in our efforts to retain high quality employees.
Question 5(b): What is the financial impact of the pay freeze and
what is VA's plan for the excess appropriation?
Response: The 2011 advance appropriation for VA medical care
included $213 million for the employee pay raise. VA plans to carry
over this funding into 2012 to meet increased patient demand in our
health care system. All other programs are operating under the funding
provided by the current continuing resolution.
Question 6: VA frequently conducts national training and
educational conferences for its employees at various locations
throughout the country.
Question 6(a): For both the current fiscal year and fiscal year
2012, how much money is budgeted for such national conferences?
Response: $20,018,644 for FY 2011 and $22,020,508 for FY 2012.
Question 6(b): Does VA have a policy on the maximum per night cost
for lodging and daily per diem payments when choosing conference
locations?
Response: VA ensures that when selecting venues we are in
compliance with the published FY 2011 GSA per diem rates that define
the maximum for lodging and per diem.
Question 6(c): If so, what are those maximums and if not, why has
VA not adopted such a policy in light of the current fiscal and
economic climate?
Response: Maximum rates vary by locality and must comply with GSA
schedule. Venues are selected based on compliance with GSA published
per diem rates; we often rule some cities/venues out of contention
based on ``price unreasonableness'' IAW FAR 14.408-2 and 15-404-1(b).
In doing so, the contracting officer performs a price analysis before
evaluating the venues. If a venue is not ``price reasonable'', it is
automatically eliminated and is no longer considered for evaluation. If
a venue is determined price reasonable, then it is evaluated based on
``best value.''
Question 7: Both VA and DoD operate overlapping programs and
systems of benefits and care that have as their goal improving the
lives of Servicemembers, veterans, and their families. Although much
improvement has been made in this area, more can be done.
Question 7(a): How can both entities better partner on issues of
relevance to both organizations in a manner that reflects better
accountability and fiscal responsibility?
Response: The VA/DoD Joint Executive Council (JEC) was established
by Congress in 2003 and provides opportunities for improved
collaboration and coordination between the two Departments. The JEC has
served as a mechanism for identifying policies, procedures, and
practices that would promote the sharing or exchange of services and
resources between VA and DoD. The JEC consists of separate Health and
Benefits Councils with nineteen working groups focusing on finding
better ways to partner on a wide range of health and benefits related
issues. Two specific examples of JEC initiatives in FY 2010 designed to
increase fiscal responsibility were:
VA and DoD expanded the capabilities of the Medical
Surgical Product Data Bank (MEDPDB) which provides VA and DoD the
unique ability to analyze spending, resource and standardize products,
and determine best prices from a single system, resulting in a cost
avoidance of over $13.2 million dollars in FY 2010.
There were 98 VA and DoD pharmaceutical contracts and
agreements that resulted in more than a $500 million in cost avoidance.
Additionally, the VA and DoD Deputy Secretaries chair monthly
meetings of the Wounded, Ill, and Injured (WII) Senior Oversight
Committee (SOC). The SOC was created to coordinate policies to improve
the medical care, disability processing, and transition activities to
the Department of Veterans Affairs for all military personnel, but
particularly to improve the support of injured Servicemember's
recovery, rehabilitation, and reintegration.
Health Care
Question 8: The Department recently announced the establishment of
two new offices: The Office of Patient Centered Care and Cultural
Transformation; and the Office of Tribal Government Relations.
Question 8(a): Given the state of the U.S. economy, what, if any,
cost analysis did VA employ to determine the cost of operating these
separate and distinct offices and the reason the stated
responsibilities could not be assumed under current Veterans Health
Administration business lines which have received substantial budget
increases to improve outreach and coordination and quality of care? If
such an analysis was done, please provide it.
Response: The Patient Centered Care effort is one of many
transformation initiatives in the Department's Strategic Plan. These
major initiatives are designed to improve the value of VA health care--
safety, quality, efficiency, and the experience patients and their
families have when they obtain VA health care services. The new Office
of Patient Centered Care (PCC) consists of 10 employees, including its
Director, and has an operating budget of $1.676 million for its first
year. The Office is responsible for VA's effort to transform our
clinical and business processes to be more Veteran-centric. This
fundamental change in our systems will allow VA to engage patients and
their families in mutually beneficial and respectful health care
partnerships that improve health outcomes and patient satisfaction.
They will be working directly with Network and Medical Center
leadership to bring about these changes.
VA attempted a cost benefit analysis before undertaking the PCC
initiative. A literature review indicated many private sector
organizations with similar patient care principles have realized
economic returns on that investment. Patient-centered care approaches
are rapidly becoming the norm in private health care. The Joint
Commission has recently published proposed standards that will be
incorporated into their accreditation requirements. Recognizing the
evolving industry standards and the needs of Veterans, VA took this
initiative to craft standards and programs that are best aligned with
our very unique mission and patient population. We expect that many of
the necessary changes can easily be accomplished within existing
resources and will improve patient satisfaction and quality outcomes.
The new PCC office will be responsible for developing, evaluating,
and implementing broad strategies to change current practices and
organizational culture consistent with our patient centered care goals.
They will have a major role in ensuring that all these efforts are
integrated and aligned with operational plans. Consequently, this new
Office was created under the Deputy Under Secretary for Health for
Operations and Management. This placement is consistent with the
philosophy and intent of the Under Secretary for Health's plans for the
realignment of VHA Central Office to create a more effective and
efficient organizational structure.
American Indians and Alaska Natives are one of the highest per
capita populations of Veterans in any ethnic group but are among the
least likely to access VA services and benefits. The Federal Government
has a unique relationship with Indian tribes derived from the
Constitution of the United States, treaties, Supreme Court doctrine,
and Federal statutes. It is deeply rooted in American history, dating
back to the earliest contact in which colonial governments addressed
Indian tribes as sovereign Nations. The Department of Veterans Affairs,
as a Federal agency, recognizes the government-to-government
relationship between the United States and Federally recognized Indian
tribes and acknowledges Indian tribes as sovereign Nations with
inherent powers of self-governance. This relationship has been defined
and clarified over time in legislation, Executive Orders, Presidential
directives, and by the Supreme Court. The determination was made that
as the Office of Public and Intergovernmental Affairs, within VA, is
responsible for VA's partnerships with State, county, municipal
governments that it should also be home to the office responsible for
partnerships with Federally recognized tribal governments (OTGR). These
partnerships address not only issues related to health care, but the
full spectrum of services and resources offered by VA including
Veterans Benefits Administration and the National Cemetery
Administration.
Question 6(b): Who do the new Directors of these offices report to
and how many new offices, such as these, does VA plan to establish this
year?
Response: The new Director of PCC reports to the Deputy Under
Secretary for Health for Operations and Management. Presently, under
the Veterans Health Administration's (VHA) new T21 Major Initiatives,
there are no plans to open any new offices such as PCC.
The new Director of the Office of Tribal Government Relations
reports to the Assistant Secretary for Public and Intergovernmental
Affairs.
Question 6(c): Please provide the Committee with a detailed
description of all Department of Veterans Affairs, and in particular,
Veterans Health Administration, office operations that are leased or
shared in and around the Washington, D.C. area.
Response: Below is a list of office operations that are leased or
shared in and around the Washington, DC area:
VACO--810 Vermont Ave., NW
NWLAF Bldg.--811 Vermont Ave., NW
TechWorld--801 I Street, NW
1800 G Street, NW
Indiana Plaza--625 Indiana Ave., NW
Landover Warehouse--7100 Old Landover Rd.
1575 I Street, NW
1722 I Street, NW
1717 H Street, NW
1990 K Street, NW
7th and D Sts., SW
131 M St., NE
Question 9: In a July 30, 2011, letter to Congress, Secretary
Shinseki stated that VA expected new funding requirements as a result
of passage of Public Law 111-148, the Patient Protection and Affordable
Care Act (PPACA).
Question 9(a): What additional costs does VA expect for fiscal year
2012 as a result of the PPACA?
Response: The Indian Health Service (IHS) is initiating
implementation of sections 2901(b) and 10221 of the Patient Protection
and Affordable Care Act (Public Law 111-148). Section 2901(b)
establishes IHS, Indian tribes, tribal organizations, and Urban Indian
organizations as the payer of last resort for services provided by such
entities to eligible individuals (25 U.S.C. 1623(b)). Section 10221
includes two provisions relating to Veterans and VA; the first relating
to sharing arrangements between IHS, Indian tribes and tribal
organizations and VA and the Department of Defense (DoD) (25 U.S. C.
1645) and the second pertaining to ``eligible Indian Veterans'' (25
U.S.C. 1647). The estimated cost in 2012 is $52 million.
Question 10: The statutory deadline for full implementation of the
family caregiver program mandated by the Caregivers and Veterans
Omnibus Health Services Act of 2010 (Public Law 111-163) was January
30, 2011. However, not only is the program not implemented yet, no
initial plan for the new program was submitted on November 1, 2010,
also a statutory mandate.
Question 10(a): What is the delay attributable to?
Response: Drafting and policy discussions related to this
unprecedented legislation, which directs the payment of a stipend
directly to caregivers, has caused the VA to miss the mandated
submission date. VA's planning and work on regulations has been ongoing
since before the Caregivers and Veterans Omnibus Health Services Act of
2010 was signed into law. This work has continued throughout the time
the implementation plan was under development.
The Implementation Plan was provided to Congress on February 9,
2011 and can be accessed at http://www.caregiver.va.gov/docs/
Caregivers_part1.pdf.
The requirements of this legislation will take time to implement.
Important requirements include determining eligibility, designating and
approving primary and additional family caregivers, and providing
stipends and health care coverage to primary family caregivers. VA must
draft regulations defining specified benefits, and this process will
provide Veterans and their caregivers an opportunity to provide
comments before those regulations are finalized. VA advised Committee
staff during the consideration of the bill of its concerns with the
proposed effective date, based on the mandatory periods involved in
drafting regulations and submitting them for public comment. VA is
working as quickly and responsibly as possible to deliver these
enhanced benefits to eligible Veterans and their caregivers and will
keep the Committee closely apprised of its progress.
Not all of the benefits in the law are complex. New benefits will
be phased in with many enhanced support, training and counseling
services already available. The new Caregiver Support Line (1-855-260-
3274) and other support, training, and counseling services are
available to all caregivers of Veterans. As of February 11, 2011, the
Caregiver Support Line has already received well over 1,000 calls since
it launched on February 1, 2011. Each VA medical center has designated
caregiver support coordinators who will assist eligible Veterans and
caregivers in understanding and applying for the new benefits, as well
as accessing other existing support services. VA also has a Caregiver
Support Web site, www.caregiver.va.gov, which will provide general
information once final regulations are published.
Question 10(b): What funding in fiscal year 2011 has VA set aside
for the caregiver program and what funding proposed for fiscal year
2012 will be devoted to it?
Response: VA has set aside $132 million in 2011 and $208 million in
2012 for implementation of all sections of the Caregivers and Veterans
Omnibus Health Services Act of 2010 (Public Law 111-163); of these
amounts, $30 million in 2011 and $66 million in 2012 are for
implementation of the enhanced programs for caregivers found in
Sections 101-104 of that law.
Question 11: As you know VA has a substantial backlog of pending
projects designed to ensure that health care delivery is rendered in a
modern setting. Among the options VA has to consider to achieve its
goal of providing 21st century health care in modern, state-of-the-art
facilities is to (1) renovate existing facilities; (2) build new
facilities; (3) lease new facilities; (4) contract for care or (5) some
combination of some or all of the above.
Question 11(a): What cost-benefit analysis does VA conduct before
making decisions on how best to deliver modern health care to veterans.
Response: All capital (major, minor, non-recurring maintenance and
leases) business case applications are reviewed and prioritized by a
Department-wide Strategic Capital Investment Planning (SCIP) Board and
approved through the VA governance process. VA Policy, the Capital
Programming Guide in OMB Circular A-11, and OMB Circular A-94 all
require a cost benefit or cost effectiveness analysis be completed. The
VA SCIP process utilizes a cost-effectiveness analysis (CEA) that
provides a life cycle cost comparison of alternatives including: Build,
renovate, lease, and contract out for services. A detailed cost
effectiveness analysis must be completed for each capital solution
included in the OMB exhibit 300 business case. For SCIP projects, the
benefits of each are provided in the business case justification and by
the project's impact on closing specific gaps in access, space,
utilization, safety and security.VA capital projects are required to
complete business cases for capital projects which include alternatives
analysis and a comparison of the net present value (NPV) of up to four
options: status quo; construct new/renovate; lease space; and contract
out services where appropriate.
Please outline the methodology VA uses to determine whether one
approach should be advanced over another.
Response: The first step in deciding which capital solution should
be chosen is to establish the type and level of the health care
services needed and their appropriate location(s). VA's Health Care
Planning Model provides data on the projected Veteran population,
demographics, utilization, and access that assist in this
determination.
The second step is to determine the best solution to meet the need
(including SCIP identified infrastructure gaps) to provide that care--
with a new facility, leased facility, renovated facility, or contract
care where appropriate. All capital (major, minor, non-recurring
maintenance and leases) business case applications are reviewed and
prioritized by a Department-wide SCIP Board and approved through the VA
governance process.
Other factors, such as the need for additional space, the ability
to build on medical center campuses or renovate existing buildings, the
requirement for quick implementation or flexibility to terminate a
contract, and budget constraints, all go into determining the best
solution for providing the best quality health care. For example, a
medical center campus that is landlocked, with no excess space would
need to pursue leasing or contracting out because building on campus or
renovating existing space to provide additional care is not feasible. A
campus with excess building space or acreage could more easily renovate
space or build new space on the campus.
Each Administration reviews their need to fill gaps in
service, space, or condition and which capital project is the best
solution.
All business case applications are reviewed by a
Department-wide SCIP Board, with assistance of the SCIP Panel. For a
complete business case, capital projects (Construction and Lease) are
required to conduct an alternatives analysis, including a comparison of
the net present value (NVP) of four options: status quo; construct new/
renovate; lease space; and contract out services.
Project business case applications are scored and ranked
on several SCIP criteria, one of which is called the ``Best Value
Solution,'' which provides an analysis of which option has the best
NPV. If the chosen option does not have the best NPV, an explanation of
why it is the chosen option is required.
Question 11(b): How is buy vs. lease determined?
Many factors, such as the need for additional space, the
capacity to build on medical center campuses or renovate existing
buildings, the requirement for quick implementation or flexibility to
terminate a contract, the most cost effective alternative, all go into
the buy vs. lease determination. Each acquisition decision is
considered and reviewed on an individual basis.
Question 11(c): Is a Cost Benefit Analysis (CBA) completed and by
whom for every new construction project or lease agreement?
VA utilizes the cost-effectiveness analysis for each
construction and/or lease business case application to help ensure an
accurate analysis the status quo and viable options. These cost-
effectiveness analyses (CEA) are completed by the business case
preparers and reviewed by the Department as part of the SCIP process.
Benefits and Memorial Affairs
Question 12: According to VBA's most recent Monday Morning Workload
Report, the backlog of pending compensation and pension claims is
currently at 775,552. This is an increase of 289,081 claims, or about
59 percent, from this time last year and is an increase of 390,410, or
a 101 percent increase since President Obama took office. Congress has
invested heavily in improving the claims process over the years, nearly
tripling the number of claims processing staff since 1997 and making
hundreds of millions in IT investments, yet the same problems persist.
Question 12(a): Can you please reflect on the goal of ``breaking
the back of the backlog'' by reducing the average days to complete to
125 days with a 98 percent accuracy rate as listed as integrated
objective 1 for the Compensation and Pension Service in the FY 2011
budget request?
Response: VA's commitment to ``breaking the back of the backlog''
relies on a three-tiered approach that addresses people and culture,
re-engineered business practices, and technology improvements. Our
backlog today is a symptom of fundamental problems in our capabilities
and processes--problems we are now aggressively solving. We remain
dedicated to providing timely service with the highest quality to our
Nation's Veterans. By 2015, we intend to have no Veteran wait longer
than 125 days for a quality decision (98 percent accuracy).
To date, we have passed clear milestones on the path to success. VA
has developed two rules-based calculators to streamline and improve
decision quality, and together with VHA, developed the Agent Orange
(AO) Miner Tool that links AO-related databases together and
facilitates data search in developing Veterans' AO claims.
Additionally, VA completed the Virtual Regional Office (VRO), which was
the first major milestone in the Veterans Benefits Management System
(VBMS) initiative. VBMS integrates technological advances to streamline
the disability claims process and establish a paperless processing
environment. It is being developed in three 6-month phases that
continue to build on the previous phase and expand functionality.
Information gained from the VRO helped create the specifications and
requirements for the VBMS Phase 1 software solution now being developed
and tested at the Providence Regional Office. Phases 2 and 3 of VBMS
development will be undertaken at two additional regional offices.
Deployment of the system to all regional offices begins in 2012.
In addition to the VBMS initiative, the Veterans Relationship
Management (VRM) initiative is building a multi-channel gateway for
Veterans to securely access VA health care and benefits information and
provide self-service capabilities that will put Veterans in control of
their relationship with VA. VRM will provide Veterans with rapid access
to high quality benefits and services when and how they choose, whether
through telephone, web, email, social media, or in person.
Question 12(b): Do you still believe this goal is attainable and
how does the President's budget approach the problem in a way that
doesn't repeat past failures?
Response: We believe this goal is attainable. The President's FY
2012 budget proposal sustains our FY 2011 growth in personnel devoted
to claims processing at a time that earlier hires are becoming fully
trained and more productive. Additionally, the budget bolsters an
investment in strategic planning, IT development and execution,
continued acquisitions support, and project management. For both IT and
acquisitions, past weaknesses have stemmed from overly decentralized
control, lack of enterprise-wide information and, in some cases,
improvised policies.
One of the most important steps VA has taken to ensure
accountability was the establishment of the Project Management
Accountability System (PMAS). PMAS is a disciplined approach to
information technology (IT) project development whereby we hold
ourselves and our private-sector partners accountable for cost,
schedule and performance. In just 1 year, PMAS tripled the success of
meeting project milestones.
Our holistic approach to transformation changes our culture,
improves our processes, and integrates innovative technologies. This
approach as outlined in the 2012 budget ensures different results from
our past efforts. VA's transformation strategy for the claims process
integrates the power of 21st Century technologies applied to redesigned
business processes so that the overall service we provide is more
efficient, timely and accurate. Additionally, we continue to partner
with Veteran Service Organizations and business partners from the
private sector to deliver services faster. As we transform VA, we will
closely monitor our progress in achieving our strategic goals and
integrated objectives. We will continue developing an annual
performance plan, which we submit with the President's budget each
year. We will report to Congress and other stakeholders each year in
our VA Performance and Accountability Report. We will monitor each of
our major initiatives through a quarterly Operational Management Review
team, chaired by the Deputy Secretary, to ensure that cost, schedule,
and performance targets are being met, and that corrective action is
taken where necessary, and with Monthly Performance Review meetings to
monitor progress in meeting our annual performance plan.
Question 13: Please provide the Committee with an update on VBA's
efforts to improve training and require skills certification for claims
examiners and managers as required by section 225 of P.L. 110-389.
Response: To ensure VA has highly proficient claims examiners, we
have developed a National Training Curriculum with input from the
Compensation and Pension (C&P) Quality Assurance Staff and managers and
subject matter experts working in the field. As the Quality Assurance
Staff identify national error trends through quality reviews, we create
or revise training products to address knowledge gaps. This National
Training Curriculum establishes a consistent and uniform standard for
training quality across VA, and is updated based on feedback each year.
For example, analysis of national error trends in FY 2010 led to the
inclusion of mandatory training topics in the curriculum for FY 2011.
The C&P Service Training Staff uses the results from these studies and
analyses of error patterns to generate interactive training lessons.
All training material is reviewed and updated on a continuing basis as
changes are made to policy and procedures and knowledge gaps from the
field are identified.
VBA's managers are responsible for ensuring that claims processors
accomplish the minimum annual training requirement of 85 hours.
Training requirements were recently written into Veterans Service
Representative (VSR) performance plans, and VBA plans to incorporate
training requirements into other claims-processor performance plans.
VBA improved its capability to monitor the quantity and type of
training by establishing the lessons in a VA LMS (Learning Management
System) curriculum. Managers at all levels are held accountable for
their subordinates' completion of training requirements. If employees
do not meet the requirement of 85 hours per year, it is reflected in
both the managers' and employees' performance evaluations.
In 2008, VBA created the position of Training Manager for each
regional office. The Training Manager uses LMS to track training and
ensure each regional office is compliant with requirements. VBA fielded
an on-line evaluation tool in February 2010 to collect employees'
evaluations of the usefulness, relevance, and quality of national
training. As of February 11, 2011, 8,560 evaluations have been
submitted for FY 2011. Every regional office has access to the
evaluations so that feedback can be used to improve the training. On a
national level, the evaluations are reviewed to enhance the content of
the training and identify additional topics for the National Training
Curriculum.
Prior to FY 2010, four skill certification tests were implemented--
Veterans Service Representative (VSR), Pension Maintenance Center (PMC)
VSR, Basic Rating VSR (RVSR) and Journey-Level RVSR. In FY 2010, the
skills certification operational tests for supervisory VSRs (coach
level) and decision review officers (DROs) were completed. Testing was
held on January 13, 2010 for coaches and June 16, 2010 for DROs. VBA
plans to offer each test twice a year.
The VSR skill certification test began in 2003. Since that time,
2,084 VSRs have been certified. In 2008, the PMC VSR test and the Basic
RVSR test were introduced. The numbers of employees certified for these
two tests are 84 and 1,212 respectively. The Journey-Level RVSR test
was first given in 2009 and there have been 413 employees certified
under this test. The 2010 test for coaches certified 70 employees, and
the DRO test certified 88 employees.
A Skills Certification Readiness Guide is available on the training
Web site that includes references and job aids to assist in test
preparation. Under a recently awarded contract, an on-line preparatory
tool is being developed to provide additional training materials.
Question 14: In a tough economy it is imperative that VA provide
the highest level of support to veterans seeking employment, especially
veterans with service-related disabilities.
Question 14(a): How many professional level Vocational
Rehabilitation and Employment staff will the proposed FY 2012 budget
support?
Response: The Vocational Rehabilitation and Employment budget
request for FY 2012 supports 1,286 direct FTE, an increase of 132 over
the FY 2010 FTE level.
Question 14(b): What will be the resulting average caseload, and
what performance improvements will the budget detail, to include
successful job placement services?
Response: VR&E expects an average caseload per rehabilitation
counselor of 135 in FY 2012. VR&E projects a 77 percent national
rehabilitation rate and a 77 percent employment rehabilitation rate in
FY 2012, up from the 76 percent national rehabilitation rate and 73
percent employment rehabilitation rate achieved in FY 2010. The
employment rehabilitation rate refers to the number of disabled
Veterans who successfully complete VA's vocational rehabilitation
program and acquire and maintain suitable employment. The national
rehabilitation rate also includes Veterans with disabilities for which
employment is infeasible but who obtain independence in their daily
living with assistance from the program.
Increased staffing will also support 9 additional VetSuccess on
Campus locations and expansion of VR&E services to include early
intervention through integration with the Integrated Disability
Evaluation System (IDES) program.
Question 14(c): As a point of comparison, what did VA accomplish in
FY 2010 in these areas and what is expected in the current fiscal year?
Response: In FY 2010, VR&E rehabilitated 10,041 Veterans, of which
8,161 were placed in employment and 1,880 successfully completed
Independent Living services. VR&E achieved a national rehabilitation
rate of 76 percent and an employment rehabilitation rate of 73 percent
in FY 2010. In FY 2011, VR&E projects a national rehabilitation rate of
77 percent and an employment rehabilitation rate of 75 percent.
Question 15: VA hired nearly 1,000 temporary and full time
education claims processors as a result of passage of the Post 9/11 GI
Bill.
Question 15(a): With the fielding of the new Post 9/11 IT system,
how does the proposed budget reflect those employees?
Response: The Post-9/11 GI Bill required VA to significantly
increase staffing in the short term until a new, robust IT environment
is developed, deployed, and proved successful. To support the
implementation of the Post-9/11 GI Bill, VA hired 530 temporary claims
examiners with funds from the Supplemental Appropriations Act of 2008,
and 428 temporary claims examiners with American Recovery and
Reinvestment Act (ARRA) funding. While the ARRA employees were retained
through FY 2010, VA anticipated the remaining temporary claims
examiners would be retained through the end of FY 2011.
Public Law 111-377, the Post-9/11 Veterans Educational Assistance
Improvement Act of 2010, modifies aspects of the Post-9/11 GI Bill. In
order to implement the new law, changes need to be made to the Long
Term Solution (LTS) for processing Post-9/11 GI Bill claims. As a
result, automation of end-to-end processing for some reenrollments,
functionality planned for release in June 2011, will not be available
until the third quarter of FY 2012. This delay increases the number of
FTE needed to process education claims. Our budget request of 1,429 FTE
reflects the need for 324 of the 530 temporary claims examiners to
remain through FY 2012 to maintain current claims processing
efficiencies.
Question 16: Foreclosures continue across the country at record
levels, making VA efforts to assist veterans with VA-guaranteed loans
to avoid foreclosure extremely important.
Question 16(a): Please detail VA's progress in fiscal year 2010 in
helping veterans avoid foreclosures.
Response: When a VA-guaranteed home loan becomes delinquent, VA
provides supplemental servicing to help cure the default. VA's focus is
working with borrowers and mortgage servicers to ensure every effort is
made to help Veterans avoid foreclosure.
Assistance that VA and servicers can offer Veterans/Servicemembers
includes:
Repayment Plan--The borrower makes the regular
installment each month plus part of the missed installments.
Special Forbearance--The servicer agrees not to initiate
foreclosure to allow time for borrowers to repay the missed
installments. An example of when this would be likely is when a
borrower is waiting for a tax refund.
Loan Modification--The servicer agrees to reamortize the
loan to include delinquent payments and establish a new payment
schedule.
Additional Time to Arrange a Private Sale--The servicer
agrees to delay foreclosure to allow a sale to close if the loan will
be paid off.
Short Sale--A borrower sells his/her home for a lesser
amount than owed. VA recently instituted a ``Relocation Assistance''
program where servicers may pay $1,500 to borrowers upon successful
sale to help them obtain alternate housing.
Deed-in-Lieu of Foreclosure--The borrower agrees to deed
the property to the servicer instead of foreclosure. VA recently
instituted a ``Relocation Assistance'' program where servicers may pay
$1,500 to borrowers.
Refunding--When VA believes a borrower may be able to
retain his/her home through an aggressive loan modification, but the
servicer has decided to proceed with foreclosure, VA may purchase the
VA-guaranteed loan from the servicer.
Servicemembers Civil Relief Act (SCRA)--VA discusses SCRA
eligibility and protections with defaulted borrowers, and advises them
of their rights and responsibilities to request relief.
Financial Guidance--VA has a toll-free number Veterans
can call for financial guidance, whether or not they have a VA-
guaranteed loan (1-877-827-3702).
Relocation Assistance--For properties conveyed to VA
after loan termination, VA offers the occupants relocation assistance
(cash-for-keys) to vacate the property and to assist in their
transition.
Homelessness Assistance--Veterans potentially at risk for
homelessness are directed to VA's Call Center for Homeless Vets 1-877-
4AID VET (877-424-3838).
In FY 2010:
VA helped 76 percent (66,030) of all borrowers who
defaulted on their VA mortgage loan retain their home or avoid
foreclosure.
Of that 66,030, 60,816 were able to remain in their
homes. 5,214 voluntarily completed a deed-in-lieu of foreclosure, or a
short sale.
VA made 137,982 contacts with Veterans on delinquent VA
loans, and 199,749 contacts with their servicers.
Question 16(b): What is the funding devoted to reducing the number
of foreclosures in the current fiscal year and what is proposed for FY
2012?
Response: The Loan Guaranty funding level is $137.1 million in FY
2011 and 2012. This funding level includes all Loan Guaranty staff to
support our mission to help Veterans obtain, retain, and adapt homes.
Included are loan administration staff members who help Veterans in
default avoid foreclosure.
The VA Loan Electronic Reporting Interface (VALERI) is the Web-
based system that supports VA employees and loan servicers in assisting
veteran borrowers in default on their VA home loans. For FY 2011 and
2012, the funding allocated for the VALERI contract is $4.8 million.
Question 17: Please detail for me National Cemetery
Administration's capability to train not only its own employees at the
NCA Training Academy in St. Louis, but also personnel from Arlington
National Cemetery and the National Parks Service. Will that capability
remain intact in the current fiscal year and the next?
Response: NCA's Training Academy was established in 2004 to ensure
training for cemetery directors and assistant directors. The curriculum
has expanded over the years to provide training for a wide range of NCA
employees including cemetery directors, equipment operators, foremen,
caretakers and cemetery representatives. Training is focused on all
aspects of national cemetery operations and management. Subjects
include supervisory skills, use of NCA's electronic databases for
recordkeeping, grounds maintenance, burial operations and resource
allocation. Experienced and successful national cemetery employees are
called upon to share their expertise as classroom instructors. The
training academy is located in 3,000 square feet of leased space in St.
Louis, MO. The location was selected because it is near Jefferson
Barracks National Cemetery, where employees can receive practical
experience. A training session is usually comprised of 20-25 employees.
Since 2006, NCA has conducted 95 courses in 24 training areas.
A Memorandum of Agreement (MOA) is in place between the Department
of the Army and the Department of Veterans Affairs to support the Army
through NCA training programs. The MOA is in effect through September
30, 2013. As of December 2010, four Arlington National Cemetery (ANC)
employees participated in NCA training: two employees in cemetery
representative training and two employees in supervisory training. Two
ANC employees are scheduled for supervisory training in the spring
2011. The Department of Army pays for each ANC employee's travel and
accommodations while at the training center.
The National Park Service (NPS) has sent one employee to NCA's
training center who attended cemetery representative training and a
course on using NCA's electronic databases for recordkeeping. Another
NPS employee plans to enroll in the same courses.
NCA can accommodate ANC and NPS employees who enroll in NCA
training programs. NCA will sustain its current level of support
without compromising the Training Academy's operations.
Committee on Veterans' Affairs
Washington, DC.
March 16, 2011
The Honorable Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. Secretary:
In reference to our full Committee hearing entitled, ``U.S.
Department of Veterans Affairs Budget Request for Fiscal Year 2012,''
that took place on February 17, 2011, I would appreciate it if you
could answer the enclosed hearing questions by the close of business on
April 20, 2011.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Diane Kirkland at [email protected]. If you have any
questions, please call 202-225-3527.
Sincerely,
JEFF MILLER
Chairman
JT/dk
__________
Questions for the Record
The Honorable Jeff Miller, Chairman
House Committee on Veterans' Affairs
U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2012
February 17, 2011
Question 1: According to VA's response to question 2, VA's 3-year
increase for employee travel will exceed 30 percent.
Question 1(a): If the President's Fiscal Commission recommendation
was adopted and VA had to manage an employee travel budget that was 80
percent of FY 2010 levels, how could that be accomplished without
degrading services to veterans?
Response: If VA were held to the travel limitation of 80 percent of
the FY 2010 level, this would have an adverse impact upon VA's ability
to deliver health care services to veterans and deliver training to VBA
claims examiners. This would amount to a $69 million (27 percent)
reduction in the overall employee travel costs across VA for FY 2012.
This magnitude reduction would impact VA's ability to relocate health
care staff, to properly train benefits claims examiners, and delay
continuing education of our health care and service providers. This
reduction would also limit the number of times staffs can meet face-to-
face to share best practices, a technique which allows VA to improve
service delivery to veterans.
Question 1(b): Has this question been examined in full by VA?
Response: Yes, VA's travel requirements were fully evaluated as VA
considered its resource needs to meet its commitments to deliver
services to veterans. These requirements are reflected in the estimates
included in the President's budget request.
Question 2: According to VA's response to question 2, VA's 3-year
increase in its printing costs will be 100 percent.
Question 2(a): If the President's Fiscal Commission recommendation
was adopted and VA had to manage a printing costs budget that was 80
percent of FY 2010 levels, how could that be accomplished without
degrading services to veterans?
Response: If VA were held to the printing limitation of 80 percent
of the FY 2010 level, this would amount to a $24 million reduction
across VA. This would mean that fewer documents would be available to
inform veterans of their benefits and how to access them.
Question 2(b): Has this question been examined in full by VA?
Response: VA printing requirements were evaluated and are reflected
in the estimates included in the President's budget request.
Question 3: According to VA's response to question 2, VA's 3-year
increase in its vehicle fleet costs will be approximately 25 percent.
Question 3(a): If the President's Fiscal Commission recommendation
was adopted and VA had to manage a vehicle fleet budget that was 80
percent of FY 2010 levels, how could that be accomplished without
degrading services to veterans?
Response: A 20 percent reduction on the vehicle fleet budget is
expected to impact on the services to veterans. The vast majority of
the VA fleet is used for direct services to veterans. These services
primarily include transportation services to bring veterans and staff
to medical care facilities, transportation to bring care to veterans in
the home-based health care and rural outreach programs, transitional
programs for veterans such as the Compensated Work Therapy program,
home visits to veterans by benefits counselors and field examiners,
facility/campus maintenance, security and emergency services
(ambulances and fire trucks), and interments at cemeteries. A 20
percent reduction of the vehicle fleet budget will also limit VA's
ability to fully implement the outreach initiatives to underserved
veterans.
Some VA medical centers also rely on donations of vehicles from
veterans service organizations, but these vehicles are normally not as
fuel-efficient as the vehicles that we buy or lease. A reduction in our
fleet budget would require both greater reliance on donated vehicles,
and retain VA-owned vehicles beyond their economical life span. Greater
use of older vehicles would further hamper our ability to meet
petroleum reduction mandates and increase the cost of maintaining the
fleet.
Question 3(b): Has this question been examined in full by VA?
Response: VA reviews its vehicle utilization annually, and is
closely monitoring growth in our fleet. Vehicle utilization reviews
have improved usage rates of fleet vehicles to the point of reaching
optimum levels. New initiatives have been put in place by VHA to review
and approve all fleet acquisitions, and additional measures are being
considered across VA to identify additional ways to meet the fleet
petroleum reduction mandates without compromising services to our
veterans.
Question 4: In response to question 3, VA suggested that $105
million of money carried over from FY 2010 into FY 2011 will be used to
implement provisions of the new Caregiver Law (P.L. 111-163).
Question 4(a): Please detail those provisions and how the $105
million will be (or has been) allocated among the provisions of P.L.
111-163.
Response: VA will be updating the cost estimates for the
implementation of the Caregiver Act. These costs cannot be finalized
while the Interim Final Rule is pending. VA will continue to keep the
Committee informed, including providing our final estimate, once the
process is completed.
Question 4(b): Please detail how the request for FY 2012 and FY
2013 is allocated among the provisions of P.L. 111-163.
Response: The specific eligibility criteria that will be adopted in
the final publication of the Interim Final Rule are still under review.
A change in these criteria that resulted in a different population of
eligible veterans would also change VA's cost estimates. VA will
continue to keep the Committee informed, including providing our final
estimate, once the process is completed.
Question 5: In response to question 3b VA states that carryover
funding from FY 2010 into FY 2011 in the General Administration account
was not used to begin new initiatives, increase staff or establish new
offices.
Question 5(a): What, then, was the carryover used for?
Response: In our original response we stated, ``The limited
carryover available in the General Administration account has not been
used to begin new initiatives, increase staff or establish new offices
that were not included in the FY 2011 budget and there are no current
plans to do so.''
The carryover is being used to support initiatives to transform the
Department by improving accountability, efficiency and veteran safety
throughout the system. Initiatives that will help transform the way we
provide services include: VA's Human Capital Investment Plan (HCIP),
which will re-engineer VA's human capital framework and provide a
corporate strategy to improve training throughout the system; VA/DoD
collaboration efforts and Corporate Analysis and Evaluation, which will
produce better data that drive corporate level decisions; Facilities-
wide transformation to maximize life cycle performance, increase on-
site project management, and reduce project costs; and implementation
of VA's Emergency Preparedness and Homeland Security Presidential
Directive 12, which will lead to improvements in veterans' safety as
well as security of VA employees and all of our facilities.
Question 6: In response to question 5 VA stated that VA will only
authorize administrative pay increases under ``extraordinary
circumstances'' and that management officials will make any such
adjustments in a ``prudent and strategic manner.''
Question 6(a): Have any adjustments been made thus far? If so,
when, where, and under what circumstances?
Response: We have not processed any schedules for which we applied
the ``exceptional circumstances'' authority. We have processed several
new nurse Locality Pay Schedules effective on/after Jan 2, 2011 based
on new assignments that have been created; these actions are considered
to be an exception and are not covered by the pay freeze. There have
been no adjustments to pay scales since the pay freeze has been
implemented. VHA medical centers and other human resource offices have
been apprised that discretionary pay adjustments are not permitted
until guidance is received through the Human Resource Management Letter
(HRML), which is pending concurrence.
Question 6(b): Please provide any guidance as to what qualifies as
an ``extraordinary circumstance'' for purposes of providing a pay
increase.
Response: When higher non-Federal rates of pay in a local labor
market are causing extraordinary recruitment or retention problems a
facility may establish or increase a special rate schedule or nurse
Locality Pay schedule. Examples of some factors that may be relevant in
determining the existence of extraordinary circumstances include a
turnover rate of more than 40 percent, a ``quit for pay'' rate of more
than 30 percent, a job acceptance or staffing success rate of less than
50 percent, a vacancy rate of more than 30 percent, a large number of
declinations for positions, unsuccessful recruitment activity, a large
number of employees having received bona fide job offers, etc.
Nurse Locality Pay Schedules (LPS):
Some factors that may demonstrate an extraordinary
circumstance or critical staffing or retention problem include
increases in turnover rates, ``quits for pay'', decreased job
acceptance or staffing success due to pay. Facilities authorizing an
increase to an existing LPS schedule must provide detailed staffing
data that supports the percentages provided above as well as detailed
information regarding recruitment efforts, to include information on
vacancy announcements (i.e. number of advertisements placed or job
fairs attended during a specific period of time) how long a position(s)
has remained vacant despite recruitment efforts, and the use of
appropriate incentives. Increases to existing rates may also be
authorized in instances where a facility anticipates extraordinary
recruitment or retention problem. An adjustment made under this
assumption must be fully documented; for example, the facility must
provide information on the number of employees that have received bona
fide job offers; information on how the facility has used all available
incentives and other flexibilities to alleviate the likelihood of
losses; what external factors contribute to the belief that a critical
retention problem exists, etc.
Physician and Dentist Market Pay Adjustments:
All market pay adjustments that result in an increase,
excluding those that result from a change in assignment, must include
information that addresses the following criteria/justification in
addition to the seven market pay criteria as prescribed in VA Handbook,
Part IX, paragraph 9e:
(a) The individual possesses unique skills and competencies for
a particular specialty or assignment that are essential to recruit or
retain. This may include information regarding the extent to which the
employee's departure would affect VA's ability to provide quality
patient care or information on how the employee's skills and
competencies uniquely contribute to the organization; or
(b) The individual is in a scarce specialty or assignment, or
possess skills and competencies that are hard-to-find, or in high
demand within the local labor market area. This may include information
that the local labor market is in a less than desirable location (i.e.
in a rural area, a high cost of living area, etc.); or
(c) The availability and quality of candidates. This may include
information on past recruitment activity, the length of time a
position(s) have remained vacant and the affect on patient care, or the
likelihood of being able to recruit should the individual decide to
leave the VA; or
(d) Information on salaries typically paid for similar
specialties within the local labor market. This may include information
regarding unique opportunities or benefits that exist in the private
sector that affect VA's ability to recruit and/or retain high quality
physicians and dentists; or
(e) Other situations or unique circumstances, as deemed
appropriate, that indicate an increase to market pay is necessary.
Question 6(c): Please provide the guidance released to the field on
this matter.
Response: A Human Resources Management Guidance Letter was
developed by the Office of Personnel Management and the Office of
Management and Budget and has been determined to fully comply with law
and the President's Memorandum. We expect it to be released soon and
will provide it to you at that time.
Question 7: In response to question 6 VA stated that it complies
with GSA per diem rates defining the maximum for lodging and per diem,
and that maximum rates vary by locality.
Question 7(a): Does VA have a policy concerning which locality to
choose after it determines that the localities among those available
for selection all comply with the GSA strictures, i.e., is there a
policy steering VA to localities or venues that are the lowest cost
option allowing VA to accomplish the purpose of the conference (even
though other options may be permissible under GSA's strictures)?
Response: Yes, VA has drafted policy to govern the financial
policies and procedures relating to conference planning. Currently
under internal review, the policy is intended to implement and
supplement those portions of the Federal Travel Regulation (FTR)
pertaining to Temporary Duty Travel (TDY) and provides specific
guidance on cost control procedures, such as conference planning and
technical evaluation factors pertaining to location and price, among
others.
Question 7(b): Should there be such a policy?
Response: As previously stated, VA is currently reviewing draft
policy relating to conference planning and financial controls.
Question 7(c): If authorizations for national conferences were
capped at 80 percent of fiscal year 2010 levels, would that encourage
such a policy being adopted? What efforts have there been to reduce
costs in this area through the use of lower-cost venues or technology?
Response: VA has implemented efforts to reduce cost (venues and
technology) while maintaining quality service for our customers. For
example, VALU's training (i.e. Supervisory and Management, Leadership
Development, Transformation Leadership, etc) is facilitated by the
trainers that deploy to the location where the VA employees are located
as opposed to the employees traveling to a venue. Secondly, VA is
currently working on recording/videotaping training sessions to reduce
the overall costs required of the vendors. As previously stated, VA is
currently reviewing draft policy pertaining to conference planning and
financial controls.
Medical Care
Question 1: Secretary Shinseki's February 17, 2011, testimony
suggests that certain operational improvements will result in savings
of over $1 billion. However, VA proposes that Congress still provide
money in the amount VA says it will save so that it may then carry
those funds over into a subsequent fiscal year. This seems to be a
``pay us now, we'll account for the savings later'' approach to
budgeting.
Question 1(a): Why does that make sense? Why, if VA asserts it can
save money through a variety of management efficiencies, should
Congress provide that money anyway?
Response: Estimated savings from management improvements to be
achieved in 2011 and 2012 will be carried forward into the following
years to reduce the new appropriations needed in 2012 and 2013.
Question 1(b): Wouldn't accounting for the management efficiencies
up front actually create the pressure and incentive necessary to
realize them?
Response: VA accounted for the savings up front. VA has conducted a
review ofthe efficiencies to be gained, and the savings to be achieved
within the agency through improved management actions. VA is
implementing several operational improvements in our medical care
programs that will save money while improving the quality of health
care. These savings are in six separate areas listed in the budget
submission. These savings are estimated to total $746 million in FY
2011 and $1.2 billion in FY 2012 and FY 2013. We are confident that
these are achievable savings.
Question 1(c): Which of the management improvements resulting in
savings would otherwise be reflected in data captured by the Enrollee
Health Care Projection model estimates?
Response: None of the management improvements resulting in savings
would be reflected in data captured by the Enrollee Health Care
Projection model estimates. Enrollee Health Care Projection model for
the 2012 President's submission is based on FY 2009 (base year). The
effects of the operational improvements are anticipated beginning in FY
2011.
Question 2: It would appear that a cursory look at budget requests
spanning multiple administrations that carryover of unobligated
balances for medical care was a normal element of the request. Only in
the past several years has VA not assumed such a carryover, although
with the President's FY 2012 request there is, again, a carryover
assumption.
Question 2(a): Please clarify why carryover of funds is a necessary
management tool that should be available to VA.
Response: The Medical Services, Medical Support and Compliance, and
Medical Facilities appropriations have historically had a small portion
of their total appropriation available for obligation for two fiscal
years. The purpose of this authority is to provide the flexibility to
make the most appropriate procurement decisions as the end of the
fiscal year approaches without being forced to simply obligate any
available funds on less critical requirements. Forced year-end spending
incentivizes organizations to spend funds in order to protect the
following year's budget request. Congress has historically granted this
carryover authority and we believe that it has enabled good stewardship
of the Nation's resources and ensured that our veterans receive the
best possible health care.
Question 2(b): Is carryover necessary because VA, at times, can't
prudently spend all the money it is given in a fiscal year? Or, is
carryover evidence that VA doesn't need all of the money appropriated
to it? Or, is carryover evidence of some combination of the above?
Response: In addition to the response to Question 2a, it is also a
reflection of the complexities associated with acquisition in the
health care industry. In the Medical Facilities appropriation, protests
of contract awards also frequently delay final obligation of funds, and
long lead times associated with executing major leases sometimes cause
award dates to slip across fiscal years. This authority also provides
additional assurance that unforeseen delays in implementing new
authorities may be addressed without requiring supplemental
appropriation requests.
Question 3: One of the new accounting features of this budget is a
proposed $953 million ``contingency fund'' for medical care. Secretary
Shinseki's testimony suggests this money is based on an economic
variable that was incorporated into VA's actuarial model, and that the
money may or may not actually be needed.
Question 3(a): In the heart of the economic recession when VA
submitted its resource requests for medical care for fiscal years 2010
and 2011, was there an economic variable used to inform VA's budget
request?
Response: The 2008 VA Enrollee Health Care Projection Model
(Model), which supported VA's 2010 Budget Submission, did not include
an economic variable because it was developed early in the economic
downturn cycle. In response to indicators that the economic downturn
could deepen into a recession, VA initiated a study to assess the
potential impact of a recession on enrollee reliance on VA health care.
This study was complex and time consuming since economic conditions
were relatively stable during the last decade. As the recession
deepened, and with an understanding that the impact would continue
throughout the recovery, an economic variable was included in the 2010
Model, which supports VA's 2012/2013 Budget Submission.
Question 3(b): Even though no carryover of funds was expected in
VA's budget submissions for 2009 through 2011, VA carried over
substantial sums of money in each of those years, and it expects to
carry over a substantial sum of money from 2011 into 2012. This would
suggest that VA's actuarial model worked as designed, even without
incorporating an economic variable, and even though the model used data
on utilization that predated the recession. Is this correct?
Response: The Model is updated annually to reflect the most current
data, updated analyses, new policies and regulations, and evolving
experience, such as the economic downturn. As a result, the Model is
successfully accounting for the changing dynamics of veteran demand for
VA health care.
Question 3(c): If that's the case, why did VA decide to incorporate
an economic variable into the FY 2012 submission, especially for a year
when the President is expecting job recovery?
Response: Historically, unemployment rates have not returned to
prerecession levels for 5 years following the recession. While both the
Administration and the Congressional Budget Office are projecting that
the unemployment rate will improve this year, both are projecting that
unemployment rates will remain above prerecession levels through 2015.
Question 3(d): What assumptions regarding unemployment in 2012 were
used for the economic variable, and do the assumptions track the
President's own forecasts for unemployment in 2012?
Response: VA's FY 2012/2013 Budget Submission is based on the
Office of Management and Budget's July 2010 Mid-Session Review
unemployment rate projections.
Question 4: Page 1A-3 of the VA FY 2012 Budget Submission reads
``Based upon experience in 2010, the need for this [contingency fund]
funding will be carefully initiated in 2012. This cautious approach
recognizes the impact of economic conditions as estimated by the model
while acknowledging the uncertainty associated with estimates.''
Question 4(a): Please describe what 2010 experience contributed to
the development of the Contingency Fund and a description of how the
Department addressed that experience.
Response: VA saw a 4.4 percent increase in unique patients and a
3.7 percent increase in unique enrollees from FY 2009 to FY 2010. VA
was able to meet all of its commitments to treat veterans and
Servicemembers in 2010. The $953 million contingency fund, estimated in
the VA's Enrollee Health Care Projection Model, was created to address
the potential demand increase for medical care services due to changes
in economic conditions. The fund will only become available for
obligation if the Administration determines the anticipated changes in
economic conditions, as estimated by the Model, materialize in 2012.
Question 4(b): What methodology was used to determine that $953
million was the appropriate amount to account for changes due to
economic change?
Response: The actuarial estimates that were used to develop the
budget request included estimates of unemployment rates and how they
are expected to influence veterans reliance on VA for care. This
methodology resulted in the estimated $953 million amount.
Question 5: Is the Contingency Fund a one-time request or does the
Department expect to continually require a bank of reserve funds to
respond to economic fluctuations?
Response: This economic impact was incorporated into the Model for
the first time this year. Based upon experience from 2010, the need for
this funding will be carefully monitored in 2012. This cautious
approach recognizes the potential impact of economic conditions as
estimated by the Model while acknowledging the uncertainty associated
with the estimates. VA's experience with the relative reliability of
the model forecast for economic conditions will help determine the need
for a contingency fund in future years.
Question 6: If the Contingency Fund funds are not utilized in FY
2012, will they be returned to the Treasury, re-allocated to patient
care, carried over as an offset in FY 2013, or used for some other
purpose?
Response: These funds will be returned to the Treasury.
Question 7: How confident is VA in the accuracy of its FY 2013
advance appropriations request? Are economic conditions or other
factors expected to impact that estimate? If so, how?
Response: The FY 2013 advanced appropriations request is based
largely on our actuarial estimates using FY 2009 data as the base year.
The request does not include additional resources for any new
initiatives that would begin in FY 2013, Strategic Planning Major
Initiatives other than Homeless or Rural Health Initiatives.
Obligations for these categories will be addressed in the FY 2013
budget submission.
Question 8: It is my understanding that VA retains ``virtual''
central office employees at the VISN level.
Question 8(a): Provide a detailed list for all virtual employees
that includes: the number of employees at each VISN; title and job
description for each position; and GS pay associated with each
position.
Response: VHA does have Central Office employees that perform their
duties at locations other than Washington, DC. The attached spreadsheet
provides a listing of individuals that have a duty station outside VHA
Central Office. [The attached spreadsheet will be retained in the
Committee files.]
Question 9: The budget submission estimates savings of $275M in FY
2011 and $315 million in FY 2012 by moving the fee care program
payments to be consistent with that of Medicare payments.
Question 9(a):What are the underlying assumptions for these savings
estimates?
Response: The underlying assumptions for these savings were based
on use of the multiple pricing schedules covered under the regulation.
VA has had authority to pay inpatient hospital claims and physician
services utilizing the Centers for Medicare & Medicaid (CMS) payment
methodologies for many years. Effective for non-VA treatment on or
after February 15, 2011, VHA adopted CMS payment methodologies for
outpatient services. This aligns VHA with standard Federal payment
schedules and assures these payments from VA utilize the same
structure. Prior to adopting CMS payment methodologies VHA processed
payment for outpatient services for facility charges using a ``VA Fee
Schedule'' which is based on billed charges and reimbursement was based
on the 75th Percentile of those charges, significantly higher than
standard CMS pricing. The estimated savings were developed using the
difference between the 75 Percentile from the VA Fee Schedule and the
CMS rates extrapolated from actual payment data from the first 6 months
of calendar year 2008. VHA contracted with an outside vendor to
complete a comparison to identify cost savings under this regulation.
The analysis compared CMS rates with VA Fee Schedule rates to make this
estimate. A sampling of lab, ESRD, and other Medicare methodologies was
used to estimate an average savings based on these rates.
Question 9(b): What is the status of upgrading the IT
infrastructure to process the new fee payments at the Medicare rate?
Please provide a timeline for this process.
Response: The current claims processing system, Fee Basis Claims
System, is scheduled to be updated with CMS rates by mid-year FY 2012.
To assure accurate pricing, VA developed an interim solution utilizing
a contract service to price claims submitted to VHA for authorized
services by non-VA providers. This service will initially be manual,
with a move to a web-based solution by the end of April. VA will
continue to utilize this service until such time as the appropriate
technology is in place to accurately price these claims.
Question 9(c): How can VA realize savings in 2011 if there is not a
system currently and fully in place to handle electronic processing of
payments?
Response: VHA contracted with an outside vendor to price claims at
Medicare rates for all claims submitted for treatment dates on or after
February 15, 2011. VA facilities were instructed to hold those claims
until the contractor was ready to accept those claims for pricing. It
is anticipated the contractor will be ready to receive those claims
effective March 28, 2011. Claims will be printed and mailed to the
contractor for pricing. A web based portal will be available for
pricing by sites in late April. VA is working towards an electronic
mechanism to transmit the claims via Electronic Data Interchange (EDI)
later this year once the IT solution is developed.
Question 9(d): Are the savings estimates in the budget submission
the same as what VA projected when developing the regulations to move
the fee program to Medicare rates? Please explain any changes in
assumptions that resulted in an adjustment to the savings estimate.
Response: No, the savings are less due to delay in publication of
the regulations. The savings were adjusted because the implementation
date was delayed to February 15, 2011. The estimated savings are
included below. The FY 2012 budget request utilizes the same cost
savings estimates documented in the Final Rule.
------------------------------------------------------------------------
Year Estimated Projected Savings
------------------------------------------------------------------------
FY 2011 $274,700,000
------------------------------------------------------------------------
FY 2012 $314,700,000
------------------------------------------------------------------------
FY 2013 $361,800,000
------------------------------------------------------------------------
FY 2014 $405,800,000
------------------------------------------------------------------------
FY 2015 $452,700,000
------------------------------------------------------------------------
5-year total $1,809,700,000
------------------------------------------------------------------------
Question 10: Describe the mission of the Chief Business Office
(CBO) and if and how this mission has changed since the office was
established.
Response: The VHA Chief Business Office provides national
leadership for advancing business practices that support patient care
and the efficient delivery of health benefits.
Question 10(a): Do the current activities of the CBO directly align
with the original mission?
Response: Yes. Established in 2002, the CBO's original mission was
to develop and implement policy, processes, information and business
solutions to support high quality service delivery to veterans, enhance
employee development and demonstrate effective stewardship. The CBO
Mission Statement supported the Vision which was to provide quality
veteran focused services with smart business solutions. In 2006, the
CBO reorganized functionally to more effectively carry out the mission.
The reorganization resulted in realigning the existing executive
positions subordinate to the Chief Business Officer to lead each of the
three functional areas--Revenue Operations, Member Services and
Purchased Care.
Question 10(b): What are the three primary areas of responsibility
for each of the three deputy directors?
Response:
The Deputy Chief Business Officer for Revenue Operations
is accountable for the development of administrative processes,
policies, regulations, and directives associated with revenue
activities. The incumbent serves as primary advisor to the field on
revenue collections and is responsible for developing quality products
whose business processes and outcomes are measurable and effectively
managed.
The Deputy Chief Business Officer for Purchased Care
supports and augments the delivery of health care benefits through
enterprise program management and oversight of Purchased Care services,
including programs such as Fee Basis, CHAMPVA, State Home Per Diem and
others.
The Deputy Chief Business Officer for Member Services
provides veterans and their families with respectful, timely, accurate
and efficient service. Member Services supports ``front-end'' elements
of interaction with VA's Health Care System such as enrollment, contact
management, beneficiary travel and transportation.
Question 10(c): Please provide a comprehensive list that includes
the following related to the CBO: total number of employees; title and
job description for each position; and GS pay associated with each
position.
Response: See attachment. [The attachment is being retained in the
Committee files.]
Question 11: What is the status of the establishment of seven
consolidated patient account Centers (CPACs)?
Response: An integral part of VHA's strategy for increasing
collections is deployment of industry best practice Consolidated
Patient Account Centers (CPACs). VHA is deploying CPACs by FY 2012, 1
year earlier than required by Public Law 110-387. Four CPACs have been
completed to date: North Central (VISNs 10/11/12); Mid South (VISNs 9/
16/17); Mid Atlantic (VISNs 5/6/7); and Florida/Caribbean (VISN 8).
Three CPACs are in progress for completion in FY12: West (VISNs 18/20/
21/22); North East (VISNs 1/2/3/4); and Central Plains (VISNs 15/19/
23). CPACs have demonstrated success in improving collections through
process standardization and internal controls to mitigate risks.
Question 12: How will the CPACs be funded? If funded through the
use of VISN resources, what is the formula for determining individual
VISN contributions?
Response: Each CPAC's annual operational cost is funded by the
VISNs to which it provides services based on each VISN's percentage of
the Medical Care Collection Fund (MCCF) goal assigned to that CPAC.
Initial start up costs for each CPAC are paid by the VHA Central
Office. This funding approach will continue through FY 2012. Once all
CPACs are operational in FY 2013, both the operational cost and any
recurring lease costs will be paid by the VHA Central Office, with no
charges to the VISNs. The rationale for this funding approach during
the start up of the CPACs is to not place those VISNs not yet supported
by a CPAC at a financial disadvantage because they currently pay all
costs of collection activities within their VISN.
Question 13: What is the total number of VA and total number of
contracted employees expected to staff each CPAC?
Response: The number of staff authorized for each CPAC is
determined by the estimated workload from the serviced VISNs assigned
to that CPAC. Contractors are only used to handle small balance claims
once the CPAC is fully operational. The number of VA employees expected
to staff each CPAC are as follows:
Mid-Atlantic CPAC: 539
Mid-South CPAC: 583
North Central CPAC: 461
Florida Caribbean CPAC: 324
Central Plains CPAC: 515
West CPAC: 483
Question 14: How will the staffing and functional responsibilities
that are currently in place at the Veterans Integrated Service Network
be transferred to the CPACs? Will any functions be duplicated at the
VISNs? What will happen to VISN employees whose current
responsibilities will be assumed by the CPACs?
Response: Prior to the start of the national CPAC deployment, VHA
developed a detailed implementation plan grounded in industry best
practices and lessons learned from previous transitions. The plan for
each CPAC is organized around four main phases of transition:
Readiness Planning: A team of evaluators assess VAMC
operations to determine overall readiness for transition and develop
site specific implementation plans based on assessment results.
Transition of Host VISN/Expansion VISNs: Ownership for
designated revenue cycle function is officially transferred from VA
medical centers to CPAC. Typically, the host VISN of each consolidated
center is transitioned first following the implementation of the new
business model and deployment of CPAC business tools. Expansion VISNs
are scheduled for transition following sustainment of the host network.
Stabilization: CPAC business analysts and industry
experts conduct further assessments of transitioned sites, resolve
identified issues with field leadership, and further stabilize
operations following the transition period.
Sustainability: Based on observed operational performance
and the results of internal controls and quality assurance monitoring
activities, CPAC business processes are continually enhanced, and staff
is provided with targeted professional development to optimize business
performance.
Each element of the implementation plan contains thousands of
activities, which are carefully managed and reported on by our
implementation coordinator and team of project management
professionals.
The CPAC business model was carefully crafted by industry experts
to ensure that CPAC-owned business processes complement supporting
functions that remain at the medical centers (registration, charge
capture, coding, etc.) There is no duplication of effort expected as a
result of the national CPAC deployment.
VHA is working diligently to minimize the impact of this
reorganization on employees and will provide as smooth a transition as
possible. Impacted employees are strongly encouraged to apply for CPAC
positions and are notified as soon as the positions are announced.
Additionally, these employees are in the first area of consideration
for facility-based and CPAC-based positions. Impacted staff remaining
after CPAC positions are filled will be placed in comparable positions
at their current duty station based upon their requisite knowledge,
skills, and abilities. Local facility management is responsible for the
placement of remaining impacted employees at each medical center. The
placement process is unique for each facility given their individual
circumstances and staff. VHA has also received concurrence for both
Voluntary Early Retirement Authority (VERA) and Voluntary Separation
Incentive Payment (VSIP) from the U.S. Office of Personnel Management
(OPM) to assist with the transition of impacted staff.
Question 15: Medical collections goals have been adjusted downward
for FY 2011 and FY 2012.
Question 15(a): What is the reason?
Response: The reduction is a result of VA revising assumptions from
the collections forecasting model to incorporate the following factors:
Poor economic conditions--Growth in national unemployment
(from 7.7 percent in the First Quarter of FY 2009 to 9.8 percent at the
end of the First Quarter of FY 2011) continues to impact both first
party collections (veteran out-of-pocket costs) and third party
collections (unemployment and resultant loss of health insurance
coverage).
Hardship waivers and exemptions from copayments are
increasing--veteran first party copayment economic hardship waivers and
exemptions were at their highest levels in FY 2010 (the most recent
completed year) and this is expected to continue with the current poor
economic conditions.
Third party ``Collections to Billings'' (CtB) ratios are
down nationally--CtB ratios are expected to continue a downward trend,
reducing third party collections. CtB decreased from 43.1 percent in
January 2009 to 39.1 percent in January 2011, influenced by the
continued shift by insurance companies of payment responsibility to the
patient (i.e., higher deductibles, increased copayments, etc.). Section
1729 of title 38 prevents VA from billing veterans if insurance
companies do not pay. Each 1 percent decrease in CtB represents a $55
million revenue loss.
Veterans aging to 65 years and older--FY 2012 begins to
reflect the shift in workload for Vietnam Era veterans aging to 65
years and older. Once a veteran is Medicare-eligible, Medicare becomes
the primary insurance coverage and VA can bill insurance companies only
for the portions Medicare does not cover (typically their deductibles).
This significantly reduces the amount VA can collect.
Priority Group migration from lower to higher status--
National Priority Group migration over the past 2 years has shown a
sharp decrease in collections for veterans in Priority Group 8 which is
the primary driver of both first and third party collections.
Shift in Service Connected Workload vs. Non-Service
Connected Workload--As veterans migrate from lower to higher status,
there is also a shift in workload from Non-Service Connected (Non-SC)
care (which could be billable if the veteran has insurance) to Service
Connected (SC) care (regardless of insurance coverage VA does not bill
for SC care). From FY 2009 to FY 2011 the total number of outpatient
encounters has seen an increase of 2 percent nationally in SC care,
with an equal decrease of 2 percent in Non-SC care, which has impacted
Third Party collections.
Question 15(b): Have you identified specific obstacles that impede
meeting the collections goals? If so, what is being done to address
these problems?
Response: Specific obstacles that impede meeting the collection
goals, as noted in the response to (15a) are primarily tied to economic
market conditions. However, VA also recognizes that focused efforts
must be implemented to optimize available revenue opportunities and
several initiatives are underway to improve results aside from the
deployment of Consolidated Patient Account Centers described in
question 11 including:
Improving Recoveries from Non-VA (FEE) Care: VA can bill
third party payers for veterans receiving non-service-connected Fee
care with insurance. In an effort to enhance charge capture for these
services, a workgroup has been formed to develop monitoring metrics to
assist in identifying best-practice performers and opportunities for
improvement. As part of this effort, a pilot is currently underway at
two medical centers in VISN 9 (Mountain Home and Huntington) to
reengineer business processes.
Revenue Cycle Enhancement Teams (RCET): RCET visits
identify opportunities to improve revenue cycle performance at lower
performing facilities by developing action plans to increase
collections. During FY 2011, RCET will conduct 32 sites reviews.
Payer Relations and Business Practices: VHA is conducting
an in depth analysis of managed care contracts, billing practices and
rates/charges in an effort to optimize revenues. The outcome of this
work will be a 5 year strategic roadmap with short, medium and long-
term project deliverables.
Regulatory and Policy Changes: Currently, third party
payers unilaterally offset payments on claims without notification to
VHA. A Final Rule barring offsets by third party payers and
establishing a process by which they will submit a request for a refund
on claims for which there is an alleged overpayment is in review within
VA. Eliminating these offsets will positively impact VA by ensuring
accounting records accurately reflect any necessary adjustments to
accounts and speeds processing of claims. VA also recently (March 18,
2011) implemented a new methodology for billing third parties for
outpatient prescriptions. VA's actual costs for each drug dispensed,
plus an administrative fee are now being billed instead of using a
national average drug cost.
Enhanced Business Systems: VA continues to develop
electronic business transaction capabilities including insurance
verification, billing, and payments. Benefits from electronic
transmissions include faster payments.
Question 15(c): What is the total potential medical collections
number (as opposed to what VA actually collects)?
Response: CBO utilizes the Integrated Collections Forecasting Model
(ICFM) to produce a 20-year collection forecast at the MCCF fund and
Station levels. ICFM incorporates the VHA Office of Policy & Planning
Enrollee Health Care Projection Model (EHCPM) workload projections as a
starting point of the model. ICFM accounts for several factors in
determining a collections forecast including: service volume, Priority
Group status, demographics, economic market conditions, insurance
coverage, and historical billings and collections performance.
Additional considerations are made for any legislative or regulatory
policy changes that may impact collections.
The goal of establishing Expected Results (ER) is to set reasonable
and achievable medical collections targets. The current published
President's Budget for FY 2011, FY 2012 and FY 2013 represent
collection targets that challenge each Medical Center to achieve their
revenue potential.
------------------------------------------------------------------------
Published President's Budget FY 2011 FY 2012 FY 2013
------------------------------------------------------------------------
MCCF Collections (in millions) $2,817 $2,925 $3,134
------------------------------------------------------------------------
Question 16: The Secretary stated that the cost of caring for a
homeless veteran is three and a half times the cost of caring for a
non-homeless veteran in the VA health care system. Please provide a
detailed cost comparison of what and how the care and services differ
for a homeless veteran and non-homeless veteran.
Response: See table below.
------------------------------------------------------------------------
Dollars in Thousands
---------------------------------------
Description Non-Homeless
Veteran Homeless Veteran
------------------------------------------------------------------------
Inpatient Medical/Surgical $10,084,130 $410,372
------------------------------------------------------------------------
Inpatient Pyschiatric $1,068,085 $459,553
------------------------------------------------------------------------
Residential Rehabilitation $190,496 $488,478
------------------------------------------------------------------------
PTSD Residential Rehabilitation $73,902 $29,056
------------------------------------------------------------------------
Nursing Home $3,861,526 $93,106
------------------------------------------------------------------------
Primary Care Clinic $3,230,059 $111,807
------------------------------------------------------------------------
Medical/Surgical Cliics $6,577,896 $296,831
------------------------------------------------------------------------
Mental Health Clinics $1,845,179 $586,882
------------------------------------------------------------------------
PTSD Clinics $249,706 $21,826
------------------------------------------------------------------------
Other Clinics $7,653,696 $276,571
------------------------------------------------------------------------
Diagnostics $2,719,443 $113,336
------------------------------------------------------------------------
Pharmacy $5,150,716 $140,782
------------------------------------------------------------------------
Readjustment Counseling $147,211 --
------------------------------------------------------------------------
State Home $701,936 --
------------------------------------------------------------------------
Miscellaneous Contracts $131,683 --
------------------------------------------------------------------------
Total $43,685,664 $3,028,600
------------------------------------------------------------------------
Number of Veterans $5,332,093 $108,966
------------------------------------------------------------------------
Cost Per Veteran $8,193 $27,794
= 3.4 times
greater
------------------------------------------------------------------------
Question 17: What changes, if any, have been made this year to
improve the analysis capabilities of VA's Enrollee Health Care
Projection Model? How much confidence does VA have in the model's
estimates?
Response: VA is confident in the Model's estimates of veteran
demand for VA health care. The Model is supported by an extensive array
of in-depth analyses of the factors that drive demand for VA health
care, including those listed below. These analyses and the study
methodology are updated annually or as new data become available.
Impact of income, unemployment rates, distance from VA
facilities on enrollment rates
Impact of unemployment rates on enrollee reliance on VA
health care
Impact of enrollee age, gender, morbidity, and geographic
migration patterns
Enrollee transition between enrollment priorities, i.e.,
movement into service-connected priorities and transitions due to
changes in income
Reliance on VA versus other health care providers
Unique utilization patterns of Operating Enduring
Freedom/Operation Iraqi Freedom/Operation New Dawn
Enrollee attitudes towards VA health care.
As a result of these analyses, the Model supporting VA's 2012/2013
Budget Submission included an assumption to reflect the unique
utilization pattern of enrollees in the first year of enrollment. This
will improve the Model's capability to model for enrollee cohorts with
significant new enrollment.
Question 18: What is the total number of new Priority 8 veterans
enrolled in the VA health care system whose income exceeds the
geographic HUD index threshold, but were able to enroll as a result of
the relaxed income restrictions?
Response: As of February, 2011 the total count is 19,810.
Question 18(a): Please provide a breakdown of the number of new
priority 8's who have come into the system since Secretary Shinseki
relaxed the income restrictions.
Response: There is a total of 65,760new Priority Group 8
enrollments since 6/15/2009. A breakout by Fiscal Year (FY) is as
follows: FY09--18,858, FY 2010 -- 33,231, FY 2011 through February--
13,671.
Question 18(b): What is the assumption for new priority 8's in FY
2011? What is the assumption for FY 2012 and 2013?
Response: The projected number of new Priority 8 enrollees is
approximately 40,000 in FY 2011. The projected number of new Priority 8
enrollees is approximately 26,000 and 86,000 for FY 2012 and FY 2013,
respectively, according to the 2010 Enrollee Health Care Projection
Model (Base Year 2009).
Question 18(c): How do the assumptions VA used for the number of
new priority 8's compare with the actual number enrolled in FY 2009, FY
2010, and thus far in FY 2011?
Response: Previously, we projected a surge in enrollment when the
suspension on Priority 8's was lifted and veterans who had not been
able to enroll took advantage of the new opportunity. In light of
recent experience, this assumption has been significantly scaled back
in the 2010 Model. The projected number of new Priority 8 enrollees
coming into the system was approximately 21,000 for FY 2010 per the
2010 Model (Base Year 2009), where the actual number of new Priority 8
enrollees closely mirrored that at approximately 17,000 for FY 2010.
Question 18(d): What resources were budgeted for FY 2009, FY 2010,
and FY 2011 for health care services for new priority 8's and how do
the actual amounts obligated compare? What is budgeted for new priority
8's in FY 2012 and FY 2013?
Response: See table below.
----------------------------------------------------------------------------------------------------------------
FY 2009 FY 2010 FY 20111 FY 2012 FY 2013
----------------------------------------------------------------------------------------------------------------
Budget $74 $66 $161 $203 $432
----------------------------------------------------------------------------------------------------------------
Actual $61 $92 $58
----------------------------------------------------------------------------------------------------------------
1 Actuals as of end of January 2011.
FY 2009 Budget Estimates: 2008 Base, 2011 President's Submission.
FY 2010-FY 2013 Estimates: 2009 Base, 2012 President's Submission.
Question 19: GAO Report 11-205 regarding the model used to develop
the VA health care budget indicated that OMB provided VA with estimates
of the savings associated with a Presidential initiative for a
government wide emphasis on reducing operating costs associated with
maintaining surplus property for fiscal year 2011.
Question 19(a): What was the OMB estimate of the savings associated
with reducing these operating costs and did VA achieve those savings?
Response: The estimated real property operating costs reduction in
FY 2011 was $7 million. VA is in the process of implementing this
initiative and intends to fully achieve the projected savings.
Question 20: Has VA conducted a long-term analysis of the impact
the Patient Protection and Affordable Care Act (Public Law 111-148)
will have on the VA health care system? Please share that analysis, if
any.
Response: VA has not conducted a long-term analysis of the impact
of the Patient Protection and Affordable Care Act (Public Law 111-148)
will have on the VA health care system. A task force was assembled to
conduct a preliminary assessment. The task force has recommended that
VA conduct an in depth analysis to quantify the law's effect on
veterans and the VA health system.
Inspector General
Question 1: What was the rationale for flat lining the budget
request for the IG given the government-wide emphasis on reducing
wasteful and fraudulent spending?
Response: The VA Inspector General (IG) has received a $20.6
million (23 percent) increase in 2012 compared to 2009. This is an
average increase of 7.7 percent per year, which is comparable to the
General Administration staff office 3-year average increase of 8.8
percent when excluding the President's government-wide acquisitions
initiative. In addition, employment for the VA OIG has increased by 103
FTE over the 2009 level (20.2 percent).
Benefits & Memorial Affairs
Question 1: Have any of the National Cemeteries ever undergone an
energy audit to review the energy usage and look for more efficient
ways to conduct operations?
Response: Energy audits were conducted at national cemeteries
between 2007 and 2009. Energy audits will be conducted at the national
cemeteries every 4 years, and new audits began in July 2010. Cemeteries
will be reviewed to identify additional energy reduction measures.
Question 2: What steps is NCA taking to reduce energy costs at
national cemeteries?
Response: Energy improvements at the national cemeteries include
the following actions:
Programmable thermostats.
Replacing incandescent bulbs with compact florescent
bulbs.
Replacing older 4-foot florescent tubes with newer, more
efficient ones.
Replacing older electronic devices with more efficient
ones (Energy Star rated), such as computers, printers, fax machines,
copiers, and hot water heaters.
Tuning up furnaces and air conditioning.
Replacing older furnaces and air conditioning systems
with more efficient systems (Energy Star rated).
Installing programmable irrigation controllers to reduce
irrigation water use, which lowers water pumping costs.
NCA has implemented the use of pre-placed crypts, that preserve
land and reduce operating costs, and water-wise landscaping that
conserves water and other resources. Photovoltaic solar systems have
been installed at Calverton (Long Island) and San Joaquin Valley
National Cemeteries. Two additional photovoltaic solar systems are
under contract for Riverside and Sacramento Valley National Cemeteries,
and a system is planned for Fort Rosecrans (San Diego) National
Cemetery. A wind turbine has been installed at Massachusetts National
Cemetery.
Geothermal heat pumps, using heat stored in the ground instead of
air, are being evaluated for new and existing cemetery buildings.
Geothermal heat pumps save approximately 40 percent of energy
consumption compared to regular heat pumps.
Question 3: Please explain Integrated Objective 1(A)(1),
``Percentage of applications for headstones and markers that are in
processed within 20 days for veterans who are not buried in a national
cemetery,'' which suggests a reduction in performance from 93 percent
in FY 2009 to 74 percent in FY 2010.
Question 3(a): What accounts for the deterioration in performance?
Question 3(b): How will requested funds for FY 2012 improve
performance to that achieved in FY 2009?
Response: FY 2010 performance was impacted by staff vacancies and
intermittent system network issues which contributed to reduced
performance. NCA has hired staff to fill the vacant positions and used
overtime to reduce the number of days to process applications. We have
worked to minimize system disruptions. Additionally, there were some
weather-related events that shut down operations temporarily at several
satellite offices. An alternative worksite initiative has now begun to
ensure a continuity of operations when future weather related closures
occur. Current FY 2011 performance is slightly above the target of 90
percent. NCA expects to maintain current performance in FY 2011 and
expects to meet the target in FY 2012 of 90 percent.
Question 4: With a near flat line funding for the NCA Operations
and Maintenance accounts in FY 2011 and in the FY 2012 request, how
will NCA meet its Integrated Objective 1(A)(4) ``Percent of headstones,
markers, and niche covers that are clean and free of debris or
objectionable accumulations'' by increasing performance from 85 percent
in FY 2010 to the planned 90 percent in FY 2011 and FY 2012?
Response: In addition to the funding included in the FY 2010 budget
and funding provided by the American Recovery and Reinvestment Act, the
FY 2011 budget includes $36.9 million and the FY 2012 budget request
includes $32.9 million for gravesite renovation projects that include
cleaning headstones/markers. The impact of these funds on performance
will be realized within 2 years of contract award as projects are
completed. With this funding, NCA expects to increase performance to
the planned 90 percent in FY 2011 and FY 2012.
Question 5: Please explain the reasoning for the increase in Senior
Executive Service Level employees at NCA from four in FY 2010 to 11 in
the FY 2012 request.
Response: The new SES positions reflect the growing scope and
complexity of NCA operations. We are not requesting any additional
funding or FTE for the positions.
Five of the seven positions are for our regional office directors.
Workload has increased considerably in the field. For example, in the
last decade NCA has opened 15 new national cemeteries, a national
training center, and a national scheduling center.
Another of the new positions is for the Memorial Programs Service
(MPS) director. In FY 2010, this office processed nearly 400,000
headstone/marker applications and over 800,000 Presidential Memorial
Certificates. MPS responsibilities have expanded to include the First
Notice of Death function and the new medallion benefit.
The final position restores an SES management slot that was
available to NCA prior to FY 2010.
These new positions are necessary to reflect current management
requirements and will ensure the recruitment and retention of top
managers.
Question 6: What is the reasoning of increasing the appropriation
for Headquarters staff and operations by $327,000 from FY 2010 level to
the FY 2012 request?
Response: The increase represents estimated payroll changes
associated with grade and step increases for existing employees. The
comparison is less than a 1-percent increase and does not reflect an
increase in Headquarters FTE.
Question 7: What is the reasoning for increasing the employee
travel budget by $191,000 from FY 2010 level to the FY 2012 request?
Response: The increase of $191,000 (7.5 percent) is due to
projected cost increases associated with all modes of transportation.
NCA is a national organization with 131 cemeteries in 39 states and
Puerto Rico; State cemeteries in 38 states, Guam and Saipan; a national
training center; and a national scheduling center. Travel funding is
critical to ensure appropriate operational oversight, training, and
organizational communication. Employee travel is approved based on
program and training requirements. Approximately 480 NCA employees
travel in a year.
Question 8: How will NCA define the ``urban core'' in regards to
planning for the new urban initiative?
Response: NCA developed a set of criteria for establishing urban
initiative facilities in densely populated areas. These ``urban core''
areas were identified by using the top 50 metropolitan areas by
population as defined by the U.S. Census Bureau. NCA used this list to
identify high population, urban areas currently served by a national
cemetery. We identified existing national cemeteries that were 50 miles
or more from the urban core of the top 50 cities by population.
Additional urban initiative requirements included travel time of 1 hour
or more from the urban core, documented veteran utilization rates of
less than 20 percent for at least two of the last 3 years, and
documentation that clients cite travel time and/or distance as an
access barrier at least 5 percent above the national average on the
Survey of Satisfaction with National Cemeteries for at least two of the
last three surveys.
Question 9: The FY 2012 budget request listed four cemeteries that
would be eligible for expansion at an urban core under a new urban
initiative yet the minor construction budget only contains funds for
the Chicago cemetery in FY 2012.
Question 9(a): How was Chicago selected over the other sites?
Question 9(b): What is the timeline for construction of the other
sites?
Response: Two of the urban initiative sites will be funded from the
major construction budget. The FY 2011 budget includes funding to
construct a columbarium expansion project at Los Angeles National
Cemetery, which is currently a closed cemetery. This project will serve
the Los Angeles area. The FY 2011 budget also includes design funding
for a columbarium at Alameda Point, California, which will serve
veterans in the San Francisco/Oakland/San Jose area. Construction
funding for the Alameda project will be requested in a future budget
request.
Minor construction funding for the Chicago area is included in the
FY 2012 budget request, and minor construction funding for the New York
City area will be requested in a future budget request. Chicago was
selected for FY 2012 funding because it is believed that property will
be easier to acquire in that area than in New York City. VA is
currently advertising for land in New York City. VA will consider
adjusting its plan if circumstances warrant.
Question 10: How has NCA used the appropriation for the land
acquisition account since its inception? Please describe if and when
there has ever been a carryover in this account in the last three
fiscal years.
Response: Funding for the land acquisitionline item was first
requested in 2009 to provide the flexibility to acquire land when an
opportunity arises. Carryover funds are available in this account;
however, they have been allocated for land purchases.
VA is currently pursuing land for two existing cemeteries: an
expansion of Willamette National Cemetery in Oregon and a replacement
cemetery for Puerto Rico. Specific parcels have been identified and the
acquisition process is underway.
Land acquisition for five new national cemeteries is also in
progress: Southern Colorado; Tallahassee, Florida; Central East
Florida; Omaha, Nebraska; and Western New York. Funds have been
obligated for due diligence. Using funds in the land acquisitionline
item, NCA plans to purchase land for these new cemeteries in 2011 and
2012.
Question 11: What is your view of expanding the State Cemetery
Grant Program to eligible local and municipal governments who have
shown that they have the financial resources to maintain to NCA
standards of upkeep at these cemeteries after construction?
Response: Any expansion of eligibility for the State Cemetery
Grants Program would require legislation. If such legislation is
introduced, VA will respond to the Committee's request to provide
views.
Question 12: Please explain the reason that the FY 2012 request
anticipates a drop of $2.5 billion in survivor benefits.
Response: This decrease in survivor benefits is primarily due to
the expectation of paying the Agent Orange retroactive veteran and
survivor claims in 2011 in addition to the veterans currently receiving
compensation and potential veteran and survivor accessions. Discounting
the effects of Agent Orange claims in 2011, caseload and average
payment for both veterans and survivors resume the normal annual trend
in 2012.
Question 13: Please explain the projection of a $3.2 million
increase in clothing allowances.
Response: Based on historical data, VA assumes that 2.85 percent of
veterans on the rolls will receive a clothing allowance. Applying this
percentage to the estimated FY 2012 veteran caseload results in an
increase of 3,589 clothing allowance recipients over the FY 2011 level.
This increase in caseload results in an additional cost of $2.6 million
in FY 2012. A cost of living adjustment of 0.9 percent in 2012
increases the expected clothing allowance cost by an additional $0.6
million.
Question 14: What factors contribute to the 12 percent rise in
veterans who received an increased disability rating in FY 2010
compared to FY 2009?
Response: In 2009, of the total veterans on the rolls for
compensation benefits, approximately 5.6 percent, received an increase
in their disability rating. In 2010, this percentage increased to 6
percent of the total veterans receiving compensation. Contributing
factors are increasing average age of veterans from earlier war
periods, additional regulations, legislation, and the increasing
numbers of issues per claim.
Question 14(a): Does this budget predict a similar outcome for FY
2011 and FY 2012.
Response: Based on historical data, the average degree of
disability is forecasted to increase through 2012 and the outyears. The
budget request considers the increasing average degree of disability in
conjunction with estimated VA workload projections.
Question 15: Please elaborate on how P.L. 111-377 will affect the
budget account estimates for programs under:
Question 15(a): Chapter 30 of title 38, United States Code.
Question 15(b): Chapter 33 of title 38, United States Code.
Question 15(c): Chapter 35 of title 38, United States Code.
Response: The impact of Public Law 111-377 to the Readjustment
Benefits account is currently being assessed by VA staff and will be
fully incorporated into the release of the 2012 Mid Session Review
Budget.
Question 16: Since the President has taken office the backlog of
disability claims has grown by 103 percent, and this budget projects
that the average days to complete a claim will rise from 165 days in FY
2010 to 230 days in FY 2012. With the knowledge that it takes new
claims examiners close to 2 years to become fully productive, and the
Veterans Benefits Management System is years away from being completed,
what is the short term plan to address this increasing backlog?
Response: VA is not waiting for the implementation of the Veterans
Benefits Management System (VBMS) to take aggressive action toward the
goal of completing all claims within 125 days at 98 percent accuracy.
VA's multi-tiered approach for addressing the dramatically increasing
volume of incoming claims includes a number of innovations. VA deployed
two rules-based calculators to streamline and improve decision quality,
with more tools in the pipeline. Providing veterans with improved
online access to claims status information and other self-service
options (such as ordering copies of discharge records) increases client
satisfaction while freeing VA staff to work on claims. The Agent Orange
(AO) Miner Tool links AO-related databases together and facilitates
data search in developing veterans' AO claims. New evidence-gathering
tools such as the Disability Benefits Questionnaires sharpen the focus
in medical examinations to ensure all information needed to rate the
claim is gathered the first time in the medical examination process and
is presented succinctly. The Fully Developed Claims (FDC) program puts
veterans in the driver's seat for submitting claims that are ready to
rate when received by allowing them to certify that their claim
includes all available evidence in exchange for expedited processing by
VA.
It is estimated that in late 2012, production will begin to outpace
receipts. At that same time, we plan to begin the deployment phase of
VBMS. VBMS will provide powerful new tools to claims examiners to boost
efficiency and productivity. Gains in accuracy through rules-based
processing will reduce re-work and appeals. Rules-based processing and
calculator tools also speed the rating process, which will increase
employee productivity and provide more staff hours to rate other
claims.
Question 17: Can you please address reports that in several
regional offices that all pending disability benefits claims have been
put aside to work Agent Orange claims?
Response: In response to VA Secretary Shinseki's announcement of
October 13, 2009, which added three new presumptive conditions to
disabilities currently presumed service-connected based on exposure to
herbicides in the Republic of Vietnam (ischemic heart disease,
Parkinson's disease and Hairy Cell (B-Cell) leukemia), VBA shifted the
mission of the 13 Resource Centers (RC) in addition to a few employees
at the St. Paul Regional Office. The mission of these nationwide
processing centers, originally established to review, develop, and
promulgate pending claims for service-connected benefits, shifted to
focus on processing decisions on the 94,000 cases that fall under the
Nehmer Readjudication Project.
This work is necessary to comply with VA's obligations under the
Nehmer Stipulation and Order, and judicial decisions issued in this
class action lawsuit.
Over the last several years, these Resource Centers have been
allocated additional staff to allow them to work the national missions
separate and apart from the local regional offices' workload. These
resource centers were designed to improve the timeliness, consistency,
and accuracy of national workload while allowing regional offices to
focus more resources on processing local disability compensation
claims. VA currently has over 1,300 employees at these resource centers
around the country devoted to the readjudication of Nehmer claims. The
current workload and mission (Nehmer Readjudication) of the Resource
Centers will be national and temporary in scope, but will also service
local veterans with pending Nehmer claims.
In addition, approximately 1,800 VA employees across VA's 57
regional offices that have been adjudicating the numerous new Nehmer
Agent Orange claims received between October 13, 2009 and August 31,
2010. These regional office employees continue to process local pending
disability claims, in addition to the new Nehmer claims.
Question 18: We have also heard reports that medical appointments
are being rescheduled so Agent Orange related disability rating exams
can take place. Is this true and if so could you please explain the
rationale for this decision?
Response: VHA has not issued any guidance giving Nehmer claimants
priority for compensation and pension appointments. Veterans' scheduled
compensation and pension appointments are not being cancelled. To cut
down the backlog of pending compensation and pension disability
examination requests, one VISN is reassigning clinicians in VHA primary
care clinics to perform disability examinations 1 week per month. This
exercise is taking place from March 2011 to May 2011. They will perform
all C&P disability examinations, not just those related to Nehmer
claims. However, primary care is still being provided. The decision to
reassign clinicians is within the individual authority of the VISN.
Question 19: Please discuss VA's current efforts to standardize the
private medical questionnaires for disability benefits claims and how
these forms will have an impact on the backlog of disability benefits
claims.
Response: VA is developing Disability Benefits Questionnaires
(DBQs) to streamline the process by which veterans submit relevant
medical evidence to VA. The targeted questions in the DBQs will improve
the quality and timeliness of medical evidence necessary to support a
veteran's claim for disability benefits, which will enable VA to
adjudicate claims faster. Use of the streamlined medical questionnaires
by private physicians, at the request of veterans, as well as by VA
contractors and VHA physicians, will create an aggregate timeliness
advantage for claims processing and thus help alleviate the claims
backlog. It also offers the long-term potential for VBA to
electronically pull the data directly into its systems to aid in the
claims process.
Question 19(a): How many of these questionnaires have been approved
for use?
Response: VA developed the first three DBQs related to the new
Agent Orange presumptive service-connected conditions of ischemic heart
disease, Parkinson's disease, and hairy cell and B-cell leukemias. They
were released to the public on October 6, 2010.
Question 19(b): How many of these questionnaires are under review?
Response: VA is working on an additional 81 DBQs, in four stages of
development. Fourteen DBQs were published in the Federal Register on
February 15, 2011, for the initial 60-day public comment period. We
estimate that they will be available for public use in September 2011.
The remaining DBQs are in the process of development, review by
Veterans Service Organization representatives and physicians,
amendment, and formal public comment, with the plan for final
publication of all DBQs by June 2012.
Question 19(c): What is the cost or savings associated with using
these questionnaires?
Response: The savings related to this initiative will be impacted
by how many VHA initial exams are no longer needed due to exams being
completed by private physicians. To date, VBA has received 2,441 DBQs
from outside of the traditional VA disability examination process.
Savings will be further impacted by how many follow-up VA exams can be
avoided by increasing the adequacy of initial VA examinations. VA is
assessing potential savings in a field study based on the DBQs
currently in use. The long-term savings will potentially increase as VA
is able to pull exam information electronically directly into its
systems to assist in the eligibility determination process.
Question 19(d): What is the timeline for the rollout of these
questionnaires?
Response: The remaining DBQs are in the process of development,
review by Veterans Service Organization representatives and physicians,
amendment, and formal public comment, with the plan for final
publication of all DBQs by June of 2012.
Question 19(e): Has there been any external feedback from the
private medical community on the effectiveness of the questionnaires?
Response: There has been no external feedback to date from the
private medical community. VA currently is working on an electronic
portal for the private medical community to submit DBQs and provide
feedback. This iterative process will assist veterans and physicians in
providing evidence that meets the requirements of the VA Schedule for
Rating Disabilities, helping VBA to increase consistency and timeliness
of disability decisions.
Question 19(f): How will you measure success in this program?
Response: VBA is conducting a field study to quantify the time
differential between utilizing DBQs compared to traditional medical
examination templates by both VHA examiners and VBA rating veterans
service representatives. It is also evaluating the adequacy of the
examinations and consistency of disability determinations.
Question 20: What steps is VBA taking to provide better customer
service for veterans who live overseas and have a claim pending for
disability benefits?
Response: VA provides benefits information and assistance to
veterans and their families residing overseas through the American
embassies and consulates under the Foreign Services Program (FSP).
The Pittsburgh Regional Office has jurisdiction of claims from
veterans residing in Europe, Asia, Australia, and Africa. The
Pittsburgh RO has a designated telephone line that veterans residing in
foreign countries may use to contact the RO about their claims. A
second shift was established at the beginning of fiscal year 2010, with
the goal of providing better service and greater access for veterans
residing in foreign countries.
Additionally, the Pittsburgh RO is assisting the Veterans Health
Administration (VHA) in the coordination of a pilot program in which
VHA clinicians will travel to foreign countries to conduct VA medical
examinations in order to expedite the examination process.
Question 21: When will all of the Nehmer-related cases be completed
and what are the mandatory and discretionary costs associated with re-
adjudicating these claims?
Response: For mandatory benefits, VA estimates that the majority of
the approximately 94,000 Vietnam beneficiaries, whose claims require
readjudication under Nehmer, and the many claimants who have filed new
Nehmer claims (approximately 50,000), will have their claims
readjudicated or adjudicated in 2011. This amounts to an estimated
$12.3 billion in Nehmer retroactive payments.
VA has devoted extensive resources to the task of adjudicating and
readjudicating the approximately 144,000 Nehmer claims involving
ischemic heart disease, Parkinson's disease, and hairy cell and other
chronic B-cell leukemias. VA is continuously reevaluating this process
to ensure that we adjudicate claims as quickly and accurately as
possible.
Secretary Shinseki established a goal of adjudicating the
approximately 144,000 Nehmer claims by September 30, 2011; however,
there are many factors affecting VA's ability to meet that goal. The
complexity of the workload and the resources required to be devoted to
completion of the project may impact VA's ability to fully adjudicate
every Nehmer claim by that date.
VA currently has over 1,300 employees at 13 resource centers around
the country devoted to the readjudication of Nehmer claims. In
addition, approximately, 1,800 VA employees at the 57 VA regional
offices have been adjudicating the new presumptive claims that VA
received between October 13, 2009 and August 31, 2010 that are also
subject to the Nehmer provisions. As of March 22, 2011, VA has
processed over 68,000 Nehmer claims. VBA does not separately track the
discretionary costs related to Nehmer claims processing.
Question 22: What funds will VBA need to implement the provisions
of P.L. 111-377? How much of that need is part of the FY 2012 request?
Response: In FY 2012, VBA has requested $17.5 million to fund the
discretionary costs associated with implementing the provisions of P.L.
111-377. The Post-9/11 GI Bill required VA to significantly increase
staffing in the short term until a new, robust IT environment is
developed, deployed, and proved successful. To support the
implementation of the Post-9/11 GI Bill, VA hired 530 temporary claims
processors. Public Law 111-377 modifies aspects of the Post-9/11 GI
Bill. In order to implement the new law, changes need to be made to the
Long Term Solution (LTS) for processing Post-9/11 GI Bill claims. As a
result, automation of end-to-end processing for some reenrollments,
functionality planned for release in June 2011, will not be available
until the third quarter of FY 2012. This delay increases the number of
FTE needed to process education claims. Our budget request reflects the
need to retain 274 of the claims examiners to remain through FY 2012 to
maintain current claims processing efficiencies.
Question 23: What automation enhancements for education claims
processing have been delayed because of the enactment of P.L. 111-377
and what is the new timeline for deploying these enhancements?
Response: Public Law 111-377, the Post-9/11 Veterans Educational
Assistance Improvements Act of 2010, modifies certain aspects of the
Post-9/11 GI Bill. The enactment of this law impacts the development of
the Long Term Solution (LTS) for processing Post-9/11 GI Bill claims
and our ability to fully automate the delivery of benefits. The
capability to conduct automated end-to-end processing on some
reenrollments was tentatively planned for June 2011. This capability
would create a subset of claims that do not require manual
intervention. Because all efforts will now be directed to implementing
the changes in the new law, we anticipate this functionality will not
be available until the third quarter of fiscal year (FY) 2012.
Question 24: How will the Vet Success on Campus program differ or
interact with the centers of excellence for veteran education pilot
program that is being run by the Department of Education?
Response: The VetSuccess on Campus program places a full-time VA
Vocational Rehabilitation Counselor (VRC) on campus. The counselor is
trained and proficient in all aspects of VA benefits, and provides
adjustment counseling, career counseling, assistance with benefits, or
referrals for other services to the student veteran population. The
VetSuccess on Campus program also includes a part-time Vet Center
Coordinator, who provides peer-to-peer counseling services and
referrals. The Centers for Excellence for Veteran Education pilot
program, run by the Department of Education, is a grant program that
provides funding to colleges interested in setting up a Center of
Excellence on campus to provide comprehensive services to veteran
students. The primary difference between the two programs is that,
while there are standard criteria for a college to receive funding for
a Center for Excellence, the universities receiving the funding do not
have a standardized setup or staffing model for the centers, nor are
the centers staffed by VA employees. The VetSuccess on Campus program
provides a standardized program across each college campus that is
staffed with VA employees who can provide direct VA benefits assistance
and support to the veteran students. VR&E is interacting with the
Department of Education to determine how best to collaborate with the
Centers for Excellence program.
Question 25: What type of faith-based organizations is the VR&E
service planning to partner with under the budget request?
Response: The VR&E Faith-based and Neighborhood Partnerships (FBNP)
Program is working diligently with the Center for FBNP. Four veterans
roundtable events are facilitated each year at different VA regional
offices. VR&E collaborates with FBNP organizations such as non-profit
social service, charitable, and religious organizations in the
community. These organizations complement VR&E services by providing
ancillary support services to veterans. FBNP organizations also work
with VR&E counselors and employment coordinators to recruit and hire
veterans into their program vacancies.
Question 26: What is the explanation for the apparent promotion of
the following VBA employees from certain GS ratings?
A loss of 131 GS-5 level employees with an increase of
131 GS-7 level employees
A loss of 991 GS-9 level employees with an increase of
934 GS-10 level employees
A loss of 100 GS-11 level employees with an increase of
103 GS-12 level employees
Question 26(a): Was this step made to provide these employees with
an increase in salary before the President but a freeze on civil
service raises?
Response: No, these promotions reflect the normal career
progression of claims assistants (career path of GS 5 to 7), veterans
service representatives (career path of GS 7-9-10, test for GS 11), and
rating veterans service representatives (career path of GS 9-10-11,
test for GS 12).
Question 26(b): Are promotion rates of what is outlined above
typical?
Response:Yes, these are the normal career paths for the majority of
VBA's claims processors.
Question 27: How many regional office directors are not SES level
employees?
Question 27(a): Which offices do not have a SES level employee as a
director?
Response: The following ROs have a GS-15 director:
Hartford, CT
Manchester, NH
Newark, NJ
Providence, RI
Togus, ME
Huntington, WV
Des Moines, IA
Fargo, ND/Sioux Falls, SD (combined as the Dakotas RO)
Wichita, KS
Boise, ID
Honolulu, HI
Reno, NV
Albuquerque, NM
Question 27(b): How are the regional offices chosen to have SES
level director vs. a GS-14 or GS-15 level director?
Response: In determining whether an SES director is needed to lead
a regional office, the factors that are considered include workload,
programs administered, number of employees, complexity and scope of
operations, and special national missions, such as the resource centers
previously mentioned, the consolidated processing of specific
categories of claims (e.g., Camp Lejeune water contamination claims and
radiation claims), the National Call Centers, and the Tiger Team for
claims from veterans over 70 years old or pending over 1 year.
Question 27(c): Is there a different level of training for an SES
level director vs. a GS-14 or GS-15 level director?
Response: There are no GS-14 directorships. The first assignment
for our newest directors is frequently a GS-15 directorship. This
allows newly appointed directors to gain experience in managing a less
complex office before taking on the challenge of managing one of our
larger and more complex regional offices at the SES-level. Most of our
newly appointed directors, whether appointed to a GS-15 or SES
position, have participated in VA's SES Candidate Development Program,
through which they receive extensive training, mentoring, and
development opportunities that include temporary assignments to SES-
level positions. Many of them have also completed VBA's Assistant
Director Development Program and have served as Assistant Regional
Office Directors.
Question 28: Please provide the average GS level for the following
positions at a VBA regional office:
Question 28(a): Director
Response: On average, Directors are at the SES level.
Question 28(b): Assistant Director
Response: On average, Assistant Directors are at the GS-15 level.
Question 28(c): Service-Center Manager
Response: On average, Service-Center Managers are at the GS-15
level.
Question 28(d): Vocational Rehabilitation Counselor
Response: On average, Vocational Rehabilitation Counselors are at
the GS-12 level.
Question 28(e): Unit Chiefs
Response: On average, Unit Chiefs are at the GS-13 level.
Question 29: With the renewed efforts to remove VBA from paper-
based systems and VA's constant overestimation of this account for the
past three fiscal years, why is the budget line for VBA printing costs
under General Operating Expenses for VBA going up by $608,000?
Response: Printing costs increase primarily for Education Service
to develop a Post-9/11 pamphlet/booklet for national distribution.
Also, in continued efforts to standardize training information provided
to School Certifying Officials (SCOs), Education Service is developing
a comprehensive School Certifying Official Guide to be the official
handbook for all SCOs. Distribution will be to all institutions of
higher learning (IHLs) and non-college degree institutions (NCDs), as
well as State Approving Agencies and Education Liaison Representatives.
Question 30: What is included in the ``other services'' line item
under VBA's General Operating Expenses and what is the justification
for increasing this amount by $95 million?
Response: The other services budget category funds service and
maintenance contracts, Homeland Security and GSA services, and other
miscellaneous contracts and agreements. The $95 million increase funds
a $60.8 million increase for contract exams, $27.8 million for the
Claims Transformation Plan, $5 million for the Integrated Disability
Evaluation System (IDES) initiative, $2 million for a business process
reengineering contract for the VR&E program, and $600,000 in
miscellaneous reductions.
Question 31: Please explain the $300,000 drop in rent,
communications, and utilities for the Insurance Service.
Response: Insurance Services is co-located with the VA Regional
Office in Philadelphia; therefore, Insurance's rent, communications,
and utilities consist of Insurance's share of the building-wide amenity
spaces in addition to the cost per square foot for the space that it
occupies.
Rent, communications, and utilities decrease by $300K from FY 2010
to FY 2012 due to lower standard level user charges (SLUC) associated
with the projected decline in the ratio of Insurance to building-wide
FTE.
Question 32: For FY 2011 the budget shows that Compensation and
Pension Service was given (or is expected to be given under a full-year
CR) an additional appropriation for total administrative obligations
over the FY 2011 request. Please explain why the FY 2012 request shows
a re-estimate of Direct FTE for the Compensation and Pension Service of
1,109 FTE under the ``CR'' when compared with the FY 2011 request. If
C&P plans to spend more money than budgeted, but on fewer staff, what
is that money going towards?
Response: In FY 2011, VBA will realign approximately $57 million
from personal services to other services and apply $19 million in
carryover funding for the exploration of alternatives to FTE to assist
in eliminating the claims backlog.
Question 33: Please provide a detailed summary of the type of work
and GS level that the new 109 Management Direction and Support FTE's
from the FY 2010 level for the Compensation and Pension Service will be
providing under the request.
Response: The additional FTE, ranging in grades from GS-5 to SES,
will perform mission-essential functions, primarily in support of VBMS,
VRM, the Claims Transformation Plan, and outreach. Duties range from
senior oversight, supervision, program management and analysis, project
development and oversight, change management and implementation,
process analysis and refinement, and administrative support.
Question 34: What changes does this budget request support to
account for the estimated reduction in the average days to complete
pension entitlement claims from 125 days under the ``CR'' to 90 days in
FY 2012?
Response: Contractor support is being acquired to assist in
reengineering business processes at the Pension Management Centers
(PMCs). This project, known as the Pension Transformation Plan, will
document the distinct workflows in place at the PMCs. The contractor
will analyze these workflows, along with other inputs (stakeholder
interests, policies, procedures, regulations) and produce a common,
optimized ``to be'' process that will be implemented at all three PMCs.
In addition to the Pension Transformation Plan, the ``average days
to complete'' for pension entitlement claims in 2012 will be influenced
by the rollout of the Rules-Based Processing initiative. Under this
initiative, new tools will process some claims actions end-to-end,
outside of the current people-centric system. These rules-based tools
will deliver results by streamlining pension claims processing.
Additionally, the pension program policy and oversight functions
are being separated from the compensation program functions in the VBA
Headquarters organization. A separate Pension and Fiduciary Service is
being created to give greater oversight and management attention to the
pension and fiduciary programs.
Question 35: Why do you believe that the number of cases claiming
eight issues or more has expanded from 22,776 in 2001 to 70,620 during
2010?
Response: Several factors likely contribute to the growth of the
number of issues claimed by veterans and Servicemembers. We believe
that the increase stems from a general increased awareness of the
availability and importance of disability compensation.
Improved and Expanded Outreach: The Department of Veterans Affairs
(VA), Department of Defense (DoD), Department of Labor (DoL), and other
Federal agencies have combined outreach efforts to Servicemembers
recently released from active duty, or those not yet released. Benefit
programs for those injured during service are discussed in such
programs as:
Federal Recovery Coordinator Program
Wounded Warrior Program
The Army Reserve Family Program
DoD's Transition Assistance Program (TURBOTAP) Web site,
which contains links, application forms, information, phone numbers,
etc.
Yellow Ribbon Reintegration Program
VA teams that attend demobilization briefings
Increase in VA Programs Focused on Transition: VA and DoD have
joint initiatives to help Servicemembers apply for VA disability
benefits early in their transition process. Pre-discharge programs like
Benefits Delivery at Discharge (BDD), Quick Start, Very Seriously
Injured/Seriously Injured (VSI/SI) case management, and the Integrated
Disability Evaluation System (IDES) begin the claims process before
discharge, so that the benefits can be paid promptly after release from
active duty. Examinations and exchange of medical evidence between the
agencies also promote quicker service and encourage the filing of
disability claims prior to release from active duty.
Media: The Internet provides Servicemembers with access to benefits
information through VA and DoD Web sites. News programs discuss the
current wars, their effect on the health of Servicemembers and
veterans, and benefit programs available. Military installations
distribute brochures and other outreach materials to explain VA
benefits. veterans service organizations, as well as other
transitioning Servicemembers and veterans, also discuss and share
disability benefit information.
Question 35(a): Do you have any data on how many of these eight
issue cases have been granted or denied?
Response: In FY 2010, 91 percent of all claims with eight or more
issues were granted service-connection for one or more disabilities.
For the same group of claims, 54 percent of all claimed issues were
granted.
Question 36: What steps have been taken to finalize the skills
certification testing requirements for all claims adjudicators and
managers under P.L. 110-389?
Response: VBA leadership is scheduled to meet with AFGE
representatives for mid-term bargaining the week of April 11, 2011. The
purpose of these negotiations is skills certification issues, to
include the statutory requirement for VBA to provide for examinations
of appropriate employees and managers who are responsible for
processing claims for compensation and pension benefits. After
conducting pre-decisional involvement with our labor partners, VBA will
finalize a policy to require all claims adjudicators and managers to
participate in skills certification.
Question 36(a): What steps have been taken to provide remediation
to approximately 3,432 employees who have not passed the skills
certification?
Response: In addition to the standard training curriculum for new
claims processing employees, Veterans Service Representatives (VSRs)
are provided an additional 20 hours of training conducted within 60
days prior to the test date that includes a review of the VSR Skills
Certification Training Guide and the Boot Camp Training test. The
expectation is that VSRs at the GS-10 level will sit for certification.
However, it has been determined that there is a sufficient amount of
work at the VSR GS-10 level for those employees who are not successful
in the skills certification testing since they continue to add value to
the organization. Rating Veterans Service Representatives (RVSRs) are
now required to pass the Basic RVSR skills certification as a condition
of employment in the position. RVSRs who have completed the RVSR
training curriculum, are meeting the local trainee performance
standard, and have been in the position for a minimum of 6 months and a
maximum of 24 months are eligible to take this test. More recent skills
certification testing for experienced RVSRs, Decision Review Officers,
and managers are currently utilized to identify training concerns and
increase proficiency. Feedback is provided to all employees on the
areas where questions were answered incorrectly. The intent of skills
certification is to require that employees demonstrate a certain level
of proficiency. However, in requiring that a certain level of
proficiency be demonstrated, VBA has to consider and provide for the
possibility that some employees will be unable to demonstrate
proficiency on a test even though they may be performing successfully
on the job. Thus, skills certification feedback is given and used for
training purposes.
Question 36(b): If a person does pass the skills certification test
do they receive a GS rating promotion?
Response: If an employee was hired into a position that requires
passing the skills certification to reach full promotion potential,
they are promoted upon passing the skills certification test along with
meeting time in grade requirements.
Question 36(c): What types of skills certification tests are
required for new employees who have completed the basic standardized
training before they can begin working live cases?
Response: VBA has developed and implemented a standardized training
curriculum for new claims processing employees, referred to as the
Challenge training program. The Challenge program is a national
technical training curriculum that provides new Veterans Service Center
employees the skills they need to function effectively in their
positions as Veterans Service Representatives (VSRs) or Rating Veterans
Service Representatives (RVSRs). The Challenge program is delivered in
a blended learning fashion in three phases. These phases require
completion of knowledge-based prerequisite training at home stations
using lectures, demonstrations of computer applications, and team-
learning through VBA's Training and Performance Support Systems (TPSS),
along with centralized classroom training. Centralized training
provides hands-on training with computer applications and advances the
new employees through progressively more challenging practice claims.
Every new employee handles sample claims just as they will when they
return to their home stations. Additionally, post-tests are built into
TPSS to confirm learning achievement. As part of the continued
training, new employees working live cases do so under the constant
guidance of experienced employees.
Question 36(d): Does VBA provide the skills certification to all
direct FTE or just ones that want to move up a GS rating?
Response: Employees recently hired as Rating Veterans Service
Representatives (RVSRs) are required to pass the Basic RVSR skills
certification test as a condition of their retention in the position.
Veterans Service Representatives (VSRs) must pass the VSR skills
certification test to be promoted to the GS-11 level. The results of
recently established testing for experienced RVSRs, Decision Review
Officers, and Managers is used for feedback and training.
Question 37: The Committee has received many complaints about the
level of service and performance of many of VA's assigned fiduciaries.
What non-workload performance metrics are in place for this budget for
fiduciaries and how can this system be improved?
Response: VA has established three key components for FY 2012 to
address fiduciary performance.
Training: Centralized training for fiduciary personnel is
anticipated to begin in FY 2012. The centralized training will provide
field examiners and legal instruments examiners with the knowledge and
skills to better select and instruct fiduciaries. Additionally, this
standardized training will provide fiduciary personnel with the tools
necessary to identify and address any performance issues with
fiduciaries earlier in the process.
Technical Support: VA will undertake activities to
support the replacement for the Fiduciary Beneficiary System (FBS) in
FY 2012. FBS is the computer program used by the fiduciary program to
manage workload and track fiduciary performance. The new version of FBS
is being designed to significantly enhance workload management and
provide a historical record of fiduciary performance. This tool will
allow for greater oversight of fiduciaries and better selection based
on valid data.
Communications: In FY 2011, VA launched a fiduciary
Internet site. This site provides fiduciaries with information
regarding their duties and responsibilities, references, forms, and
frequently asked questions. Plans for FY 2012 include enhanced
communications to veterans and beneficiaries who have been determined
unable to manage their financial affairs. These communications will
include written information regarding their rights and responsibilities
and increased sharing of information regarding estate balances. Future
plans for the Internet site include incorporating online training and
eventually a certification process for professional fiduciaries.
Question 38: Please provide a detailed account of how the
$29,929,000 in requested funding for the Claims Transformation Plan
will provide accountability and oversight over the 40 pilots that are
underway to test policies and procedures to increase timeliness and
accuracy for disability benefit claims.
Response: The $29,929,000 is requested to support non-IT
requirements associated with the Claims Transformation Plan. It
includes funding for 10 FTE for the Office of Strategic Planning to
oversee initiative development, testing, assessments, and deployment;
travel associated with deployment and oversight of all 40+ initiatives;
contract support of the initiatives (private medical records vendor,
project management support, strategic and communications support
services); and supplies, materials, and equipment.
Question 39: How will the enactment of P.L. 111-377 and delaying of
certain automation for processing Chapter 33 claims affect the
performance measures for adjudicating original and supplemental
education claims?
Response: We expect to have most of the automation to support P.L.
111-377 in place prior to the fall semester of school year 2011-2012
and therefore expect minimal impact on performance measures. As with
any change, training and experience are required to administer
benefits. We anticipate a slight increase in timeliness for processing
Chapter 33 claims due to the enactment of P.L. 111-377, but expect
timeliness rates to return to current levels by the end of the fall
semester. While delaying previously scheduled automation enhancements
to support implementation of P.L. 111-377 will not impact current
processing timeliness, it will delay realization of the efficiency and
processing timeliness gains we expect to achieve through the fully
automated functionality to be developed in the LTS.
Question 40: P.L. 110-389 required VA to conduct two studies, a
study on the completion of VR&E training programs and a 20-year
longitudinal study of three cohorts of veterans.
Question 40(a): Was funding allocated for either of these studies
in FY 2011?
Response: Due to the fact that P.L. 110-389 was passed after the FY
2011 budget request was submitted, both studies were identified as
unfunded requirements.
Question 40(b): What is the status of those studies?
Response: Section 333 (Study on Measures to Assist and Encourage
Veterans in Completing Vocational Rehabilitation) was completed and
submitted to Congress on June 18, 2010. In response to Section 334
(Longitudinal Study), VR&E Service is currently preparing the July 2011
Longitudinal Study report using limited VA data from the FY 2010
cohort.
Question 40(c): Has funding been allocated in the FY 2012 budget
and, if so, what will that funding provide?
Response: VA has included $1.2 million in the FY 2012 budget
request for implementation of P.L. 110-389. These funds will allow VR&E
Service to begin the longitudinal study. The study will enable VR&E to
analyze trends among veterans receiving services and respond with
forward-looking initiatives that adapt services to the changing needs
of veterans.
Question 41: Counting the time to receive a disability rating and
to be evaluated for Vocational Rehabilitation, it takes nearly a year
for a veteran to begin receiving VR&E benefits. Page 4E-6 of the
President's budget mentions Business Process Reengineering (BPR) as a
means to shorten that time and to simplify administration. Please
provide some examples of changes that have been made under BPR and the
results of those changes?
Response: The Business Process Reengineering (BPR) project is
designed to identify process improvements and reduce cycle time; review
and revising staffing roles and performance metrics; and enhance case
management with new technologies. All efforts of the BPR are focused on
improving veterans' experiences and increasing successful outcomes
through the VR&E program.
As of mid-February, the following accomplishments have been
achieved:
Knowledge Management Portal (KMP)--An inventory and
mapping of program reference materials that include a VR&E Central
Office workflow component. It is scheduled to be released for VR&E
field and Central Office use on March 31, 2011. The KMP will allow VR&E
counselors to more quickly research the answers to regulatory and
procedural questions, thus streamlining the delivery of benefits to
veterans.
Remote Counseling--VR&E Service identified and tested
equipment to conduct remote counseling services via a secure video
connection. The equipment was successfully pilot-tested in 3 regional
offices. VR&E Service is developing an expansion plan to roll out
remote counseling nationally. Remote counseling will allow veterans in
rural and remote areas to receive more timely counseling and case
management services by eliminating the travel requirement.
Integrated Disability Evaluation System (IDES) ratings--
VR&E Service revised policy to allow IDES Proposed Ratings to be
utilized in lieu of memorandum ratings, allowing transitioning
Servicemembers to receive VR&E services in an expedited fashion.
Question 42: The 2004 VR&E Task Force made about 120
recommendations to improve the VR&E program. How many of the
recommendations have been implemented, how many remain, and what are
VA's intentions on the remaining recommendations?
Response: The 2004 VR&E Taskforce made 110 recommendations. The
VR&E Service implemented 100 of the 110 VR&E Task Force
recommendations. Three additional recommendations are being further
developed for implementation. VR&E Service determined that 7 of the
recommendations were not feasible for implementation.
Question 43: Since 2005, the number of veterans completing the
Independent Living program has dropped from 2,693 to 1,880, a 30
percent drop. That seems counter-intuitive with aging of Vietnam-era
veterans and the current wars in Iraq and Afghanistan (and resulting
injuries). Has there been a decrease in applications for the
Independent Living Program? If not, to what do you attribute the
decrease?
Response: VR&E Service anticipates that as new veterans continue to
return from combat with complex injuries and Vietnam veterans suffer
additional disabilities determined related to Agent Orange exposure or
exacerbations of existing disabilities, we will continue to focus on
providing IL services to veterans who are unable to work due to the
most significant service-connected disabilities.
Over the past 3 years, VR&E Service has given significant attention
to ensuring the IL program is being appropriately administered to
provide the best services possible to the most deserving veterans. Last
year 2,456 IL plans were initiated.
In addition, as assistive technologies continue to progress,
enabling veterans with more significant disabilities to enter the world
of work; we are developing more employment plans that include
independent living services as part of our holistic approach to
rehabilitation. Employment plans, even when independent living services
are included, are not counted separately under the independent living
track.
Question 44: Please provide the following data:
Question 44(a): Number of veterans who were receiving VR&E benefits
and/or services on October 1, 2010.
Response: As of October 1, 2010, 105,253 veterans were receiving
VR&E benefits and services across all statuses, including applicant
status.
Question 44(b): Number of veterans you estimate who will be
determined to be eligible for VR&E benefits and/or services from 1 Oct
2010 to Sep 30, 2011.
Response: VBA estimates that 70,053 veterans will be found eligible
in FY 2011. Approximately 43,157 of these eligible veterans will
complete their evaluations and be found entitled, and approximately
29,299 of the entitled veterans will begin participation in a
rehabilitation plan during the same time frame
Question 45: The Department of Education funds a grant program
called Veterans Centers of Excellence which competitively funds
programs on college campuses that are similar to the Vet Success on
Campus program. Is VA coordinating the Vet Success on Campus program
with the Department of Education?
Response: Where Veterans Centers of Excellence exist, VR&E
counselors coordinate with these programs to provide Veteran-students
with referrals for tutors, remedial classes, and the development of
computer skills. As VetSuccess on Campus sites are established,
coordination occurs with the college veterans services centers,
including Veterans Centers of Excellence. Coordination ensures that
services are complementary as opposed to duplicative.
Question 46: How many professional level VR&E staff will the
proposed budget support, what will be the resulting average caseload,
and what performance improvements will the budget provide? Will those
performance improvements include job placement services?
Response: The FY 2012 budget request supports a professional
counseling staff of 893 FTE. The projected average caseload for each
counselor in FY 2012 is 136 cases. VR&E Service estimates the increase
in FTE will lead to improvements in the national rehabilitation and
national employment rates and the speed of entitlement decisions, as
well as support the implementation of the Integrated Disability
Evaluation System (IDES) and VetSuccess on Campus (VSOC) initiatives.
Question 47: VA hired nearly 1,000 temporary and full-time
education claims processors as a result of passage of the Post-9/11 GI
Bill. With the fielding of the new Post-9/11 IT system, how does the
proposed budget reflect those employees?
Response: The Post-9/11 GI Bill required VA to significantly
increase staffing in the short term until a new, robust IT environment
is developed, deployed, and proven successful. To support the
implementation of this bill, VA hired 530 temporary claims examiners
with funds from the Supplemental Appropriations Act of 2008, and 428
temporary claims examiners with American Recovery and Reinvestment Act
(ARRA) funding. While the ARRA employees were retained through FY 2010,
VA anticipated the remaining temporary claims examiners would be
retained through the end of FY 2011.
Public Law 111-377, the Post-9/11 Veterans Educational Assistance
Improvement Act of 2010, modifies aspects of the Post-9/11 GI Bill. In
order to implement the new law, changes need to be made to the Long
Term Solution (LTS) for processing Post-9/11 GI Bill claims. As a
result, automation of end-to-end processing for some reenrollments,
functionality planned for release in June 2011, will not be available
until the third quarter of FY 2012. This delay increases the number of
FTE needed to process education claims. Our budget request of 1,429 FTE
reflects the need for 324 of the 530 temporary claims examiners to
remain through FY 2012 to maintain current claims processing
efficiencies.
Question 48: What is the funding devoted to reducing the number of
foreclosures of homes purchased with a VA-guaranteed loan and does that
funding support any new initiatives?
Response: Total funding of $28.56 million will be devoted to
reducing the number of foreclosures in 2012. This includes $23.63
million for FTE with responsibilities related to loan servicing
activities and $4.93 million for VA Loan Electronic Reporting
Interface. This funding does not support any new initiatives.
General Administration
Question 1: At the Committee's February 17, 2011, budget hearing
Secretary Shinseki testified that the budget for the Office of the
Secretary had increased significantly since 2009 due, in large part, to
the fact that staff formerly detailed to the Secretary's Office (and
accounted for elsewhere within VA) were now being accurately reflected
as employees working within that Office.
Question 1(a): How many detailed employees now work within the
Office of the Secretary full time? Please provide the number of
detailed employees who have worked within that Office for each of the
last 5 years.
Response: As of March 30, 2011, two persons are currently on short-
term detail to the Office of the Secretary. Over the past 5 years, 12
persons were on detail to the Office of the Secretary in 9 distinct
positions. Duration of these details varied. Three of these detail
positions were converted to full time positions in the Office of the
Secretary, and six of the detail positions were eliminated. The 4-
person Center for Faith-Based and Neighborhood Partnerships was also
transferred from the Office of Public and Intergovernmental Affairs to
the Office of the Secretary during this 5-year period. This transfer
also involved temporary detailing of Center employees until funding
adjustments were coordinated. All Center employees now work in, and are
funded by, the Office of the Secretary.
Question 1(b) Please provide a breakdown of the salaries of the
formerly detailed employees now converted to full-time employees
working within the Office of the Secretary.
Response: Two detail positions were transferred and reassigned to
the OSVA in FY 2010 and one in FY 2011. These positions were included
in the OSVA FTE total for that fiscal year. The respective salaries for
each of the employees reassigned in FY 2010 were approximately $124,000
and $85,000 and $141,000 for FY2011.
Question 1(c) When detailed employees are transferred back to their
primary office, how are they reflected in the budget? Or, have they
always been reflected and, therefore, there is no net effect of FTE
increase or decrease?
Response: Employees on detail are and continue to be reflected in
the FTE numbers of their original office.
Question 2: Please explain the justification for the following
proposed 3-year budget increases (FY 2009 to FY 2012), then detail the
performance measures used to justify these increases:
Question 2(a): 23.1 percent for the Office of Management
Response: The balance of the increases during this period went (or
will go) to VA-wide financial management initiatives in the areas of
financial systems, audit readiness and enterprise-wide cost
accountability; a VA-wide Integrated Operating Model; OMB A-123 audits;
VA's enhanced use lease program; and greening and renewable energy
projects. Included in the 2012 request is $1.6 million for audits for
the non-VA care (fee) program.
VA has made significant progress in financial management
performance. Most notable is the elimination of three longstanding
material weaknesses.
Question 2(b): 20.1 percent for the Office of Human Resources
Response: The $12.4 million increase in the budget for the Office
of Human Resources (HR&A) from FY 2009 to FY 2012 is primarily due to
payroll ($3.1 million), other services ($1.5 million), rent,
communication and utilities ($4.4 million), and the change in
unobligated balances ($2.9 million).
The payroll increase reflects costs associated with the pay raise
in FY 2010 and the salary requirements for 302 FTE funded through
General Operating Expenses. This FTE level includes 16 FTE hired in FY
2010 for the Office of Resolution Management for several initiatives
aimed at increasing the effective use of Alternative Dispute Resolution
(ADR) throughout VA. Additional full-time employees to serve as
conflict coaches, facilitators, mediators and trainers were deployed to
VISNs 4, 8, 12, 15, 16, and 23 to provide more ADR access at the
facility level, meet the increased utilization of ADR to address
workplace disputes, and maintain satisfaction with the process. These
dedicated resources have improved the efficiency and effectiveness of
the ADR program by reducing average processing time for ADR requests in
three of the six VISNs and increasing the ADR participation rate in
four of the six VISNs. Due to these efforts, VA employees had increased
opportunities for early resolution of complaints and grievances. Also,
ORM staff stood up a full-service hotline, designed to provide
employees and managers a forum to ask general questions or questions
related to Transformation-21 initiatives, and learn about avenues to
address workplace conflict and disputes. In 2010, the call center
answered over 1,000 calls and 200 emails. This new service is a
separate and distinct service from the EEO complaint processing toll-
free line. It is not designed to replace the complaint hotline or
bypass other dispute resolution avenues (local union, facility program
manager, workplace ADR). Benefits of the call center include increased
use of ADR, decreased EEO complaint activity, increased opportunities
to market and distribute accurate information about T-21 initiatives,
and improved ability to educate employees and managers on a variety of
issues that often result in workplace disputes.
The increase in other services is for increased funding of
contracts, including establishing contracts to maintain the ADR Call
Center and for an EEO/ADR dashboard. The EEO/ADR Dashboard was
developed to provide VA leadership an access panel to EEO data that can
serve as a barometer of the work environment. The dashboard leverages
technology by pulling from various data systems to display key
indicators that provide valuable, real time information for managers to
determine if there are opportunities for intervention that will improve
the work climate. A 90-day dashboard pilot was implemented on September
30, 2010, at VISNs 8, 9 and 16. It will be evaluated and measured using
customer surveys, customer feedback from dashboard links and monthly
usage reports. The intended goal of the dashboard is to provide a
management tool that identifies trends and affords managers the
opportunity to align strategies and organizational goals that
ultimately impact the quality of services VA provides to veterans. In
2011, an Executive Dashboard will be developed to provide executive
level staff a snapshot of the aforementioned information, while
providing restricted access for highly sensitive information.
ADR participation in the EEO complaint process in the last fiscal
year has increased from 48 percent in 2009 to 52 percent at the end of
2010, significantly avoiding costs to the Department. The cost of
handling a discrimination case through the formal complaint process
ranges from $18,000 per complaint to $60,000, excluding the cost of
damages that may be payable in the event of a finding of
discrimination. In 2010, participation in the ADR process resulted in
the resolution of 1,094 disputes outside of the traditional EEO
complaint process, resulting in 86 percent of these workplace disputes
being resolved using ADR. The overall resolution rate for ADR to
include its use before, during, and in lieu of the EEO complaint
process increased from 54 percent in 2009 to 60 percent in 2010. VA
estimates cost avoidance of $82 million as a result of increased use of
ADR to resolve workplace disputes.
The rent, communication and utilities increase is primarily related
with ongoing rents and other services required to operate VA
headquarters. Rent includes payment to GSA for buildings occupied by VA
and its employees. Office space rental estimates are based on the
amount prescribed by GSA in accordance with established fair annual
rental appraisals and are in accordance with GSA's current projections.
The obligation increase is for estimated rental costs beyond the normal
non-payroll inflation increase.
Question 2(c): 96.2 percent for the Office of Policy and Planning
Response: Since 2009, staffing increases and funding have allowed
the Office of Policy and Planning (OPP) to establish the Office of
Corporate Analysis and Evaluation (CA&E) and the Transformation and
Innovation Service (TIS). We have also dedicated additional resources
to the National Center for Veterans Analysis and Statistics (NCVAS) and
the VA/DoD Collaboration Service.
As a result of these additional resources, OPP has been able to
improve outcomes to veterans during fiscal year (FY) 2010 and FY 2011
in support of the four key integrated strategies articulated in the VA
Strategic Plan.
a. Enhance our understanding of veterans' and their families'
expectations by collecting and analyzing client satisfaction data and
other key inputs.
Completed the National Survey of Veterans, a
comprehensive nationwide survey of veterans, active duty
Servicemembers, activated National Guard and Reserve members and family
members and survivors. Data collected through the National Survey
enables VA to compare characteristics of veterans who use VA benefits
and services with those of veterans who do not; and study VA's role in
the delivery of all benefits and services veterans receive.
Established VA data governance policy and processes to
ensure VA enterprise data and information are available, current,
reliable, readily accessible, and useful. Developed and implemented
business intelligence capabilities and tools to transform data into
information to support data-driven planning, analysis, and decision-
making activities.
b. Anticipate and proactively prepare for the needs of veterans,
their families, and our employees.
Improved VA policy toward Gulf War veterans by
advocating for the implementation of recommendations made by the
Advisory Committee on Gulf War veterans. Produced a comprehensive
annual report on the use of selected VA benefits and services by pre-9/
11 Gulf War Era veterans. The recommendations included presumptive
criteria for a number of serious illnesses for which veterans will now
be eligible to receive treatment from VA.
Completed the Program Evaluation of VA's Mental Health
Program. This study provided VA with information about the services it
provides, the impact on veterans, how VA compares to the private
sector, patient outcomes, and costs. Study findings and recommendations
are used to refine and improve VA services by suggesting policy and
operating changes.
c. Create and maintain an effective, integrated Department-wide
management capability to make data-driven decisions, allocate
resources, and manage results.
Began the implementation of planning, programming,
budgeting, and evaluation (PPBE) capabilities to implement multi-year
strategic resource allocation system across the Department and
independent analysis to inform senior level decision-making on resource
options. CA&E is an independent body dedicated to aligning VA resource
allocations with investments that best serve our veterans, their
families, dependents, and survivors.
Implemented the new strategic management process for
VA. This process uses strategy to drive the budget and performance
plans, and aligns the execution of VA strategy with performance
management and organizational and individual accountability in an
iterative way. This process centers on implementing the strategic
goals, integrated objectives, and integrated strategies throughout VA.
Ensured the success of Departmental transformation
initiatives via collaboration, oversight, and monitoring of the $2.5
billion portfolio of 16 major transformation initiatives (list of
initiatives at end of this response) and 20 supporting initiatives.
This included assisting in the development of operating plans,
intensive mid-year reviews, and problem solving sessions with the 16
major initiatives that provided independent assessment of progress,
identified barriers to success, helped define solutions, and elevated
issues to senior leadership, as required.
d. Create a collaborative, knowledge-sharing culture across VA and
with DoD and other partners to support our ability to be people-
centric, results-driven, and forward-looking at all times.
Contributed to transforming VA/DoD Collaboration by
coordinating the development and implementation of joint programs such
as the expansion of the virtual lifetime electronic record (VLER)
pilots; the expansion of the integrated disability evaluation system
(IDES) pilot to worldwide deployment; the development of the integrated
mental health strategy (IMHS) and its 28 joint strategic actions; the
increased access of Servicemembers to VA benefits and service
information through e-Benefits; the development of joint policy for the
implementation of separation health assessments for all Servicemembers;
and significant improvements to the transition assistance program
(TAP).
Additionally, OPP continued to provide ongoing services and
capabilities to the VA and to veterans that included the following
outcomes:
Provided statistical and geospatial analysis to support
recurring and ad-hoc reporting. Examples of these statistical products
include the Geographical Distribution of VA Expenditures Report, the
Unemployment Rate of veterans Report: 2000 to 2009, the Labor Force
Participation Rates of veterans Report: 2000 to 2009, The VA
Information Pocket Guide; the Gulf War Era veterans: pre-9/11 Report,
and the VA-DoD Disability Evaluation System Trend Analysis.
Provided actuarial services to the Department on an
ongoing basis. FY 2010 efforts included development of the VA
compensation and pension liability model.
Updated VA's official estimates and projections of the
veteran population by State, county and congressional district from
2009 to 2039. Veteran population estimates are projected with
characteristics such as: age, gender, period of service, race,
ethnicity, rank (officer/enlisted), and branch of service.
Conducted a nationwide management analysis/business
process reengineering study of sanitation operations (8,831 FTE) and
biomedical engineering (990 FTE) services across VHA and monitored the
implementation of the recently reengineered plant operations and
grounds maintenance (7,269 FTE) functions.
The nine FTE within CA&E in FY 2011 are not sufficient to implement
a Department-wide programmatic efforts, conduct independent assessments
of resource requirements needed to meet planned veteran outcomes, and
fully integrate PPBE across a 300,000 person organization with three
distinct administrations (VBA, VHA, and NCA).
The additional 12 FTE to bring the budget authority FTE to 105 in
FY 2012 are requested to meet the emerging requirements identified
above. First, to fully integrate and establish the PPBE methodology in
the Department, it is necessary to expand the CA&E office from nine to
13 personnel. CA&E is still an exceptionally lean and efficient,
operation in relation to comparable governmental agencies. For example,
CA&E staffing of 13 provides strategic resource management and
independent analysis and oversight of a program budget in excess of
$132 billion and a workforce in excess of 300,000. By comparison, the
Office of Program Analysis and Evaluation (PA&E) at the Department of
the Army is staffed with approximately 100 personnel and supports a
similar sized program/budget of $149 billion in FY 2012. Second, the
VA/DoD Collaboration Service is expanding from 13 to 16 personnel to
address the growing number of issues associated with VA/DoD
collaboration including IDES, VLER, electronic health records, IMHS,
TAP, etc. Finally, we are establishing a new capability within the
Office of Policy to conduct long-term policy analysis and alternative
futures development in coordination with DoD and other Federal
agencies.
The additional 12 FTE requested for 2012 will enhance capabilities
primarily in three areas:
The Office of Corporate Analysis and Evaluation will
continue implementation of a Department-wide strategic resource
management system to help inform VA leadership with analysis and
options for future funding of veterans' needs. CA&E provides the
Secretary, and VA senior leadership with independent and objective
analysis of resource requirements and options for funding veterans'
needs across the spectrum of health care, benefits, and memorial
services. Through independent analysis and evaluation, CA&E provides an
added level management insight on the effectiveness and efficiency of
VA programs and budgets and measurable impact to the veteran.
The Office of VA/DoD Collaboration will expand its
development and monitoring of joint policies and programs such as the
expansion of the VLER pilots; the expansion of the IDES pilot to
worldwide deployment; the development of the IMHS and its 28 joint
strategic actions; the increased access of servicemembers to VA
benefits and service information through e-Benefits; the development of
joint policy for the implementation of separation health assessments
for all servicemembers; and significant improvements to TAP. These
activities will protect the equity of veterans as they transition from
servicemembers; producing better outcomes in health care delivery and
benefit service for veterans, servicemembers, military retirees, and
eligible dependents.
Finally, we are establishing a new capability within the
Office of Policy to conduct long-term policy analysis and alternative
futures development in coordination with DoD and other Federal
agencies. It will develop policy analysis capability to evaluate range
of future policy issues and requirements over next 10 years, i.e.
policy challenges due to population trends, changing demographics and
implications to VA infrastructure and capabilities such as the impact
of health care reform on veterans, and implementation of Caregivers
Legislation.
16 Major Initiatives
1. Eliminate veteran homelessness.
2. Enable 21st century benefits delivery and services.
3. Automate GI Bill benefits.
4. Create Virtual Lifetime Electronic Records.
5. Improve veterans' mental health.
6. Build VRM capability to enable convenient, seamless
interactions.
7. Design a veteran-centric health care model to help veterans
navigate the health care delivery system and receive coordinated care.
8. Enhance the veteran experience and access to health care.
9. Ensure preparedness to meet emergent national needs.
10. Develop capabilities and enabling systems to drive performance
and outcomes.
11. Establish strong VA management infrastructure and integrated
operating model.
12. Transform human capital management.
13. Perform research and development to enhance the long-term
health and well-being of veterans.
14. Optimize the utilization of VA's Capital Portfolio by
implementing and executing the Strategic Capital Investment Planning
(SCIP) process.
15. Health Care Efficiency: Improve the quality of health care
while reducing cost.
16. Transform health care delivery through health informatics.
Question 2(d): 50.4 percent for the Office of Congressional and
Legislative Affairs
Response: The Office of Congressional and Legislative Affairs
(OCLA) has a critical role in keeping Congress informed of VA's work on
behalf of veterans. OCLA is the lead VA office responsible for
maintaining open communications with Congress through briefings,
meetings, calls, hearings, site visits, written communications,
reports, and responses to member and Committee requests for
information. OCLA also maintains constituent casework offices on
Capitol Hill to support Congressional offices' veterans, dependents,
and survivors casework. Additionally, OCLA is responsible for liaison
with the U.S. Government Accountability Office (GAO) and coordinates
all meetings and correspondence with the agency. For a number of years
OCLA was not staffed sufficiently to keep pace with Congress'
increasing requests for information. OCLA's budget requests over the
last 3 years were focused at placing additional personnel towards
accomplishing the office's mission and meeting the needs of Congress.
During FY 2010, OCLA supported 105 hearings, 322 information
briefings, coordinated the responses to over 1,240 questions for the
record, responded to over 7,100 written and over 15,000 telephonic
requests for information, and countless e-mails, and supported
approximately 100 oversight visits. In FY 2010, OCLA also coordinated
the VA response to 50 GAO reports that focused on VA issues.
In October 2010, OCLA produced its Operating Plan which implemented
performance measures and metrics for the office for FY 2011-2013. These
measures and metrics were created to improve OCLA's responsiveness to
Congressional requests for information and set goals for the office to
achieve in the out years that support VA's Strategic Plan. These
measures and metrics will be the standard to measure OCLA's progress
and are reviewed on a monthly, quarterly, and annual basis. OCLA also
published a new Standard Operating Procedures (SOP) Manual that
followed a comprehensive review of all of the office's internal
processes. Since the implementation of the Operating Plan, and
publication of the SOP, OCLA has improved its responsiveness to
Congressional requests for information. As an example, OCLA has
revitalized the questions for the record process. OCLA assigned new
program analysts to assist with implementing the new collaborative
processes outlined in the SOP that streamlined the overall QFR process
and turned an underachieving performance throughout FY 2010 into a
process that is exceeding its targeted goal in FY 2011. In FY 2010,
OCLA submitted 16 percent of the QFRs on time. Through the first 5
months of FY 2011 OCLA has submitted a 100 percent of the QFRs on time.
OCLA supported 322 congressional briefings in FY 2010. These briefings
are predominantly in response to Committee or member office requests.
Through the first 5 months of FY 2011, OCLA coordinated 173 briefings,
which is a 60 percent increase over the same period last FY. The added
briefings were a result of the greater depth and breadth on issues
staffed by the additional congressional relations officers and
congressional liaison officers. These new personnel have also
contributed to ensuring OCLA improved its performance submitting VA
witness written testimony on time. In FY 2010, OCLA submitted only 60
percent of testimony on time. Through the first 5 months of FY 2011,
OCLA has submitted 100 percent of testimony on time. VA is committed to
providing Congress accurate and timely information and the increase in
personnel are necessary to achieve that goal.
There are two main indicators that suggest increased staffing is
required. OCLA monitors the feedback members of Congress and
Congressional staffs provide on the timeliness and completeness of the
information VA delivers to Congress. While OCLA has made significant
improvement, there are still additional improvements to be made to
decrease the time it takes to respond to requests for information. The
other main indicator is OCLA's All Employee Survey results. These
results indicate additional personnel are needed to balance workload
within the office. The results of the survey indicated employees
realize the importance of their jobs, but are impacted by the high
volume of work and the very dynamic environment they operate in. These
factors were considered in reorganizing OCLA's structure to provide
greater depth and breadth on issues, adding positions to support the
most over-worked areas, and rebalancing existing duties and
responsibilities. OCLA requested additional funding and staff to
accomplish these actions. However, in FY 2009 and FY 2010, OLCA was
unable to achieve its authorized number of employees due to high
employee turnover. In FY 2009, OCLA was authorized 38 FTEs, only 34
were in fact filled. In FY 2010, OCLA was authorized 42 FTEs, and only
filled 36. As of March 2011, OCLA has increased the number of personnel
to 43 and should be able to achieve our authorized strength of 46
employees before the end of the fiscal year. In FY 2012, OCLA requests
additional funding to support three additional personnel, which
includes the Office of Advisory Committee Management. In the FY 2012
budget request, OCLA will assume the funding for the Office of Advisory
Committee Management, which is responsible for supporting the VA's
advisory committees. The Office of Advisory Committee Management
supported 23 advisories committees and 54 advisory committee meetings
during FY 2010. As a result of the office's grade structure, FY 2012's
requested funding would increase the office's overall FTE to 49 vice
52.
In FY 2010, OCLA added four positions to its organizational
structure.
Congressional Relations Officer--GS-14
Congressional Relations Officer--GS-14
Congressional Liaison Officer--GS-13
Congressional Liaison Officer--GS-13
In FY 2011, OCLA will add four positions to its organizational
structure.
Director, Benefits Legislative Affairs--GS-15
Program Analyst--GS-9
Program Analyst--GS-9
Congressional Liaison Assistant--GS-8
In FY 2012, OCLA is requesting to add three positions to its
organizational structure.
Director, Health Legislative Affairs--GS-15
VA Advisory Committee Management Officer--GS-14
VA Advisory Committee Program Analyst--GS-11
Questions for the Record
The Honorable Jeff Denham
Question 1: In your budget request, you requested $10 million for
the National Cemetery Administration Acquisition Fund. Can you
elaborate on where these additional cemeteries will be constructed and
the timeline in which you expect to see the completed?
Response: VA is currently pursuing land for two existing
cemeteries: an expansion of Willamette National Cemetery in Oregon and
a replacement cemetery for Puerto Rico. Land acquisition for five new
national cemeteries is also in progress: Southern Colorado;
Tallahassee, Florida; Central East Florida; Omaha, Nebraska; and
Western New York. Using funds in the land acquisition line item, NCA
plans to purchase land for these cemeteries in 2011 and 2012. Funding
is available for advance planning, and construction funds for the
cemeteries will be requested in future budget requests.
Question 2: According to the Veterans Affairs budget request, the
VA has asked for an increase in operating expenses over the 2010
budget. What is the Department of Veterans Affairs doing to increase
efficiency in the administrative offices as a means to reduce the
General Operations budget? Additionally, what is being done to reduce
the Secretary's office operating costs?
Response: VA is committed to increasing the value of every dollar
to which we are entrusted by Congress and the American taxpayer. In
developing the 2012 budget, we have carefully reviewed requirements in
our non-medical programs. VA has implemented a systematic process to
evaluate and prioritize our most critical safety and security needs in
our capital program. In addition, we are working to implement the best
long-term IT solutions and are adopting new acquisition strategies for
goods and services, including consolidation and economies of scale.
In the staff offices area, all initiatives included in the budget
were developed to provide direct support to veterans or VA's core
mission. All initiatives in the General Administration budget will
improve efficiency, accountability, veteran and employee safety, and
security of VA facilities. A list of the staff office initiatives are
identified on page 5A-6 in Volume 3 of VA's 2012 Budget Submission.
We have also closely examined appropriated funding for travel and
other supplies. The 2012 General Administration travel estimate of $8.4
million is less than the 2008 travel level of $10 million. In addition,
the 2012 General Administration estimate for supplies and equipment are
both less than the levels in 2010 ($556K and $107K respectively).
For the Office of the Secretary, the 2012 request reflects a
reduction from the 2011 estimate in all non pay categories, including
travel, contractual services and supplies. The only increase is in
payroll--to support the existing on-board staff of 89. In addition, the
89 FTE in the Secretary's 2012 President's budget is 5 FTE less than
the original 2011 request.
Question 3: The amount of $953 Million has been requested for the
medical contingency fund so that this money can be used when needed.
Why has the VA adopted this new process for additional funds instead of
using the appropriations process? Additionally, what process would the
VA utilize to obtain additional funding if all the money in the
contingency fund is spent within the fiscal year?
Response: The $953 million contingency fund, estimated in the VA's
Enrollee Health Care Projection Model, was created to address the
potential demand increase for medical care services due to changes in
economic conditions. The fund will only become available for obligation
if the Administration determines the anticipated changes in economic
conditions, as estimated by the Model, materialize in 2012. This
economic impact was incorporated into the Model for the first time this
year. Based upon experience from 2010, the need for this funding will
be carefully monitored in 2012. This cautious approach recognizes the
potential impact of economic conditions as estimated by the Model while
acknowledging the uncertainty associated with the estimates.
Question 4: Given the current economic conditions of our country,
how is the VA prepared to handle the potential increase in veterans
seeking care and usage of VA benefits while reducing the VA's operating
costs?
Response: Claims for disability compensation and pension benefits
continue to dramatically increase, and economic conditions are only one
of numerous factors contributing to the increase. Annual claims
receipts increased 51 percent from 2005 to 2010. VA's transformational
initiatives now in progress will enable VA to meet that growing demand.
Production will begin to outpace receipts beginning in late 2012.
Through its Claims Transformation initiatives, VBA is laying
technological and business transformation groundwork to streamline
claims processing and eliminate the claims backlog. VA's end goal is a
smart, paperless, electronic claims processing system.
Our approach to transformation is a holistic approach that changes
our culture, improves our processes, and integrates innovative
technologies. While we work to develop the paperless system, we are
making immediate changes to improve the efficiency of our business
activities. New calculators guide claims decision makers with
intelligent algorithms similar to tax preparation software or through
simple spreadsheet buttons and drop-down menus. A growing body of
evidence-gathering tools, called Disability Benefits Questionnaires,
brings new efficiencies to collection of medical information needed to
rate each claim. The Fully Developed Claims program speeds the decision
process by empowering veterans and helping them submit claims that are
ready for a VA decision as soon as they are received.
See response to Question 3. VA's FY 2012 Medical Care appropriation
request of $50.851 billion includes a contingency fund of $953 million.
The $953 million contingency fund, estimated in the VA's Enrollee
Health Care Projection Model, was created to address the potential
demand increase for medical care services due to changes in economic
conditions. The fund will only become available for obligation if the
Administration determines the anticipated demand materializes in 2012.
The FY 2012 total appropriation request will provide services for over
6 million veterans and assumes over $1.2 billion in operational
improvements. In FY 2013, VA's Medical Care appropriation request is
$52.541 billion to provide services for over 6.3 million veterans.
Question 5: How will the Veterans Affairs Administration work to
better reach military personnel who have returned home from service to
notify them of the services the VA can provide them?
Response: The Department of Veterans Affairs created the National
Outreach Office within the Office of Public and Intergovernmental
Affairs (OPIA) in FY 2010 to standardize how outreach is being
conducted throughout the department and have made considerable progress
in researching and analyzing VA's outreach programs and activities. The
National Outreach Office has developed a framework to guide us through
creating a more efficient and effective approach to boost our reach to
veterans and returning military personnel, in support of VA's major
initiatives.
The Department's outreach activities purpose is to increase access
to VA health care and benefits by optimizing linkages to VA services
for all new veterans through targeted programs. VA reaches out to
veterans at 7 different venues throughout the deployment cycle from
pre-deployment, immediately at demobilization, and post-deployment.
Each of these initiatives is described below. The initiatives provide
the opportunity to engage veterans and families with a face to face
encounter at 7 different points to deliver the One-VA message within
the first 6 months of returning home and as they separate from service.
Using in-person outreach events as well as the Web and phone-based
resources, VA works to enroll and register veterans for their health
care services as soon as they separate from active duty. Getting
enrolled quickly is critical to accessing important benefits. For
instance, National Guard and Reserve members returning from combat are
entitled to 5 years of free VA health care for any condition related to
their service in the Iraq/Afghanistan theater and have 180 days to
obtain an appointment for a one-time dental evaluation and treatment.
Combat veterans are always eligible to access services at VA Vet
Centers located in communities and through mobile vans.
1. Reserve Component Demobilization Initiative at 63
Demobilization Sites
In May 2008, VA created an initiative to inform demobilizing
reserve component (RC) combat veterans of their enhanced VA health care
and dental benefits during their mandatory demobilization separation
briefings. The purpose is to provide and offer Servicemembers
assistance with the completion of their enrollment forms for VA health
care. Servicemembers returning from the combat zone are introduced to
VA during the out processing period at the demobilization sites. They
receive a standardized 46-minute briefing on VA services and benefits
and are encouraged to enroll into the VA health care system. All
members leave the demobilization site for home with the names of their
local OEF/OIF Program Managers to contact or who will contact them to
set up their initial health and dental appointments at the VA Medical
Center (VAMC) nearest to their homes. As of October 2009, this
initiative has been implemented at 15 Army, 4 Navy, 5 Marine Corps, 36
Air Force and 3 Coast Guard Reserve demobilization sites. In
collaboration with the Veterans Benefits Administration, VHA developed
a standardized slide presentation, and staff provides educational
materials to all new veterans. VA staff has reached out to 152,204
returning Servicemembers and enrolled 143,448 (94 percent) into the VA
health care system since May 2008.
2. Individual Ready Reserve Muster (IRR) Initiative for U.S.
Marine Corps and U.S. Army Reserve Veterans
In May 2009, VA created an initiative to inform Individual Ready
Reserve (IRR) Army Reserve soldiers and Marines of their enhanced VA
health care and dental benefits during their mandatory IRR Muster.
Prior active duty members who are in the IRR are introduced to VA
during this event. VA staff has 20 minutes to brief on VA services and
benefits and provide assistance with the completion of enrollment forms
for the VA health care system. VA encourages 100 percent enrollment of
all those attending the IRR Muster. All members leave the IRR muster
with the names of their local OEF/OIF Program Managers to contact or
who will contact them to set up their initial health and dental
appointments at the VAMC closest to their homes. VA has reached out to
22,596 members and enrolled 6,712 (30 percent) since May 2009.
3. Post-Deployment Health Reassessment (PDHRA) Initiative for the
National Guard and Reserve Components
In early 2005, DoD mandated the Post Deployment Health Reassessment
(PDHRA), a health care screening (DD-2900), for all National Guard &
Reserve Servicemembers returning from deployment. The PDHRA is a global
health assessment, with an emphasis on behavioral health and service-
related conditions that is designed to be conducted between 90 and 180
days post-deployment. The intent of the PDHRA is to identify
deployment-related physical health, mental health and readjustment
concerns, and to identify the need for follow-up evaluation and
treatment.
VA has been an active partner in this outreach initiative. RC Units
conduct the PDHRA through three primary modes: on-site events conducted
by DoD contract health care providers; on-site call center events; and
from a 24/7 Call Center operation. VAMC and Vet Center staff conduct
briefings, staff table-top information displays, enroll veterans in the
VA health care system and arrange follow-up appointments at VAMCs and
Vet Centers. VA has supported over 2,200 PDHRA events and the DoD PDHRA
24/7 Call Center since November 2005, resulting in over 70,000
referrals to VAMCs and over 27,000 referrals to Vet Centers.
4. Combat Veterans Call Center Initiative
On May 1, 2008, VHA began the Combat Veteran Call Center initiative
help OEF/OIF combat veterans become aware of the available VA services
and benefits. Veterans are provided information about VA benefits,
services, and employment opportunities. They are also offered the
opportunity to be assigned a care manager. In FY 2010, 91,833 calls
were placed and VA staff spoke with 9,679 veterans. Of that, 2,294
requested and were sent information packets.
5. Department of Defense Yellow Ribbon Reintegration Program
Support Initiative for National Guard and Reserve Components
The DoD Yellow Ribbon Reintegration Program (YRRP) is a DoD-wide
effort to support National Guard and Reserve Servicemembers and their
families with information on benefits and referrals throughout the
entire deployment cycle, before, during and after deployments. YRRP
events are hosted by military units and held throughout the year in
every State.
VA is a major support partner of the YRRP. VA staff attends YRRP
events to provide support and information on benefits, services, and
programs available to Guard and Reserve members; enroll veterans in the
VA health care system; and coordinate referrals to other VA services
and/or programs. VA staff may also provide specialized briefings on
issues like PTSD and TBI upon request. Additionally, VA has placed a
dedicated, full-time liaison in the YRRP Office at the Pentagon.
6. VA, National Guard, and the Transition Assistance Advisors
(TAAs) Initiative
VHA assists the National Guard (NG) in the training of their 62
National Guard Transition Assistance Advisors (TAAs) that serve as
liaisons in the field at the State level to assist NG Servicemembers,
veterans, and their families with questions; and provide assistance to
access VA benefits and services, VA Medical Centers, and VBA Regional
Offices.
7. OEF/OIF Internet Web Page Initiative
To support VA programs and services, VA developed a new internet
webpage for OEF/OIF veterans. In addition to providing information
about VA benefits and services, the site contains blogs and other
social media tools to engage this new generation of veterans. There is
also a section on the Web site for family members. There have been over
1 million visits to this site. The Web site is: www.oefoif.va.gov.
Question 6: What legislative or regulatory limitations are
preventing the VA from being able to successfully reach out to
returning servicemembers? How is the VA limited in conducting its
outreach due to the budget?
Response: None at present. VA is currently conducting and the
Budget request allows for the following ongoing efforts to be able to
be sustained:
Since FY 2010, OPIA has awarded several marketing/public relations
contracts to assist the Department of Veterans Affairs in developing
outreach plans and campaigns. The campaigns cover topics from
Paralympic sport to veteran homelessness, and suicide prevention and
target various generations of veterans. For example, VA launched a
national advertising campaign in the fall of 2010 with two commercials,
``What Lies Ahead'' and ``Care Package,'' which targeted returning OEF/
OIF/OND veterans and their families and highlighted VA services such as
health care, education, job assistance, and home loans. Through the
continuance of these campaigns and other outreach initiatives, OPIA
plans to increase veteran awareness, improve education, and increase
client confidence using specific and targeted outreach activities and
communication materials and products.
Questions for the Record
The Honorable Jon Runyan
Question 1: Mr. Secretary, since the President has taken office the
backlog of disability claims has grown by 103 percent, and this budget
projects that the average days to complete a claim will rise from 165
days in FY 2010 to 230 days in FY 2012. With the knowledge that it
takes new claims examiners close to 2 years to become fully productive,
and the Veterans Benefits Management System is years away from being
completed, what is the short term plan to address this increasing
backlog?
Response: VA is not waiting for the implementation of the Veterans
Benefits Management System (VBMS) to take aggressive action toward the
goal of completing all claims within 125 days at 98 percent accuracy.
VA's multi-tiered approach for addressing the dramatically increasing
volume of incoming claims includes a number of innovations. VA deployed
two rules-based calculators to streamline and improve decision quality,
with more tools in the pipeline. Providing veterans with improved
online access to claims status information and other self-service
options (such as ordering copies of discharge records) increases client
satisfaction while freeing VA staff to work on claims. The Agent Orange
(AO) Miner Tool links AO-related databases together and facilitates
data search in developing veterans' AO claims. New evidence-gathering
tools such as the Disability Benefits Questionnaires sharpen the focus
in medical examinations to ensure all information needed to rate the
claim is gathered the first time in the medical examination process and
is presented succinctly. The Fully Developed Claims program puts
veterans in the driver's seat for submitting claims that are ready to
rate when received.
It is estimated that in late 2012, production will begin to outpace
receipts. At that same time, we plan to begin the deployment phase of
VBMS. VBMS will provide powerful new tools to claims examiners to boost
efficiency and productivity. Gains in accuracy through rules-based
processing will reduce re-work and appeals. Rules-based processing and
calculator tools also speed the rating process, which will increase
employee productivity and provide more staff hours to rate other
claims.
Question 2: Mr. Secretary, given the historic budget increases in
the past 5 years and the important oversight and accountability role of
the Inspector General (IG), what was the rationale for flat lining the
budget request for the IG?
Response: The VA Inspector General (IG) has received a $20.6
million (23 percent) increase in 2012 compared to 2009. This is an
average increase of 7.7 percent per year, which is comparable to the
General Administration staff office 3-year average increase of 8.8
percent when excluding the President's government-wide acquisitions
initiative. In addition, employment for the VA OIG has increased by 103
FTE over the 2009 level (20.2 percent).
Question 3: Mr. Secretary, can you please address reports that in
several regional offices that all pending disability benefits claims
have been put aside to work Agent Orange claims? We have also heard
reports that medical appointments are being rescheduled so Agent Orange
related disability rating exams can take place. Is this true and if so
could you please explain the rationale considering that you have
highlighted in your testimony the new on-line application and
processing system for these claims?
Response: There are three categories of disability claims related
to VA Secretary Shinseki's announcement of October 13, 2009, which
added three new presumptive conditions to disabilities currently
presumed service-connected based on exposure to herbicides in the
Republic of Vietnam (ischemic heart disease, Parkinson's disease and
Hairy Cell (B-Cell) leukemia), Nehmer readjudication claims, Nehmer
adjudication claims, and new or non-Nehmer classified claims. Nehmer
readjudication claims are under the court orders and final stipulation
and order of the U.S. District Court for the Northern District of
California (the ``Court'') in Nehmer v. U.S. Department of Veterans
Affairs, 712 F. Supp. 1404, 1409 (N.D. Cal. 1989). As a result of the
Nehmer litigation, VA must readjudicate previously denied claims for
IHD, PD, or HCL filed by Nehmer class members (Vietnam Veterans and
their survivors) and provide retroactive benefits pursuant to 38 C.F.R.
Sec. 3.816. This requirement involves claims filed or denied from
September 25, 1985, to the date of Secretary Shinseki's announcement of
October 13, 2009. Approximately 94,000 cases were identified as fitting
this criteria, and approximately 50,000 new Nehmer claims have been
received between the Secretary's announcement of his decision to add
these three new presumptive diseases and the issuance of VA's final
regulation adding those diseases to its list of conditions which
qualify for presumptive service-connection based on exposure to
herbicides used in Vietnam. Due to the complexity of readjudicating
claims in this category, all Nehmer readjudication claims are currently
being reviewed and readjudicated by VBA's 13 nationwide Resource
Centers along with some employees at the St. Paul Regional Office.
Nehmer adjudication claims are those claims for the three new Agent
Orange presumptive conditions that were received after Secretary
Shinseki's announcement on October 13, 2009, and the date VA published
the final regulation establishing a presumption of service-connection
for the foregoing diseases on August 31, 2010. While these cases were
not previously denied by VBA, because they were received prior to the
publication of the final regulation, they qualify for adjudication
under Nehmer provisions, as they were pending before VA issued the
final rule adding the three new conditions. Approximately 50,000 cases
were received during this time period. These Nehmer claims are being
processed by the local regional office of jurisdiction. Special teams
were established to process these claims expeditiously and as of March
22, 2011, less than 7,000 Nehmer adjudication claims remain pending.
Non-Nehmer or new claims are those claims for the three new Agent
Orange presumptive conditions that have been received after the
publication of the final regulation on August 31, 2010. All ``Non-
Nehmer'' claims for the three new Agent Orange presumptive conditions
are being processed by the local regional office of jurisdiction with a
portion of those claims processed through the new Fast Track Claims
Processing System. The Fast Track Claims Processing System has been
operational since October 29, 2010, and accepts claims for the three
Agent Orange presumptive conditions. Veterans may file claims for these
conditions electronically into the system through the web-based portal,
or traditionally by mail or fax to the Regional Office or the intake
facility in Rocket Center, WV. Through the use of Disability Benefits
Questionnaires, the system automatically generates recommended rating
decisions to assist VA decision makers.
Although disability Benefits Questionnaires have been utilized in
the Fast Track program for new claims for benefits, they were neither
available nor prudent to use for the Nehmer readjudication and Nehmer
adjudication claims. Therefore, many of those claims required VA
medical examinations which were requested through the traditional
examination process.
Question 4: Mr. Secretary, please discuss VA's current efforts to
standardize the private medical questionnaires for disability benefits
claims and how these forms will have an impact on the backlog? What is
the timeline for the rollout of these questionnaires?
Response: VA is developing Disability Benefits Questionnaires
(DBQs) to streamline the process by which veterans submit relevant
medical evidence to VA. The targeted questions in the DBQs will improve
the quality and timeliness of medical evidence necessary to support a
veteran's claim for disability benefits, which will enable VA to
adjudicate claims faster. Use of the streamlined medical questionnaires
by private physicians, at the request of veterans, as well as by VA
contractors and VHA physicians, will create an aggregate timeliness
advantage for claims processing and thus help alleviate the claims
backlog. It also offers the long-term potential for VBA to
electronically pull the data directly into its systems to aid in the
claims process.
VA developed the first three DBQs related to the new Agent Orange
presumptive service-connected conditions of ischemic heart disease,
Parkinson's disease, and hairy cell and B-cell leukemias. They were
released to the public on October 6, 2010. VA is working on an
additional 81 DBQs, in four stages of development. Fourteen DBQs were
published in the Federal Register on February 15, 2011, for the initial
60-day public comment period. We estimate that they will be available
for public use in September 2011. The remaining DBQs are in the process
of development, review by Veterans Service Organization representatives
and physicians, amendment, and formal public comment, with the plan for
final publication of all DBQs by June 2012.
VA is putting feedback mechanisms in place to make future
improvements to the DBQs. This iterative process will assist veterans
and physicians in providing evidence that meets the requirements of the
VA Schedule for Rating Disabilities, helping VA to increase consistency
and timeliness of disability decisions.
Questions for the Record
The Honorable Bill Flores
Mr. Secretary, in the recent budget that you submitted for fiscal
year 2012 I noticed that you are spending $124 million on ``Greening
the VA''.
$27 million for solar photovoltaic projects
$51 million in energy infrastructure projects
$21 million in renewably fueled cogeneration using biomass
$1 million in sustainable building
$14 million for wind projects
$10 million for alternative fueling projects and expansion of
environmental management system
TOTAL = $124 million
Question 1: Has the Veterans Administration done a cost-benefit
analysis of ``Greening the VA''? If the VA has not I would request one
should be done immediately.
Response: VA performs cost-benefit and other analyses on all
proposed projects. When assessing any energy or environmental project,
VA's primary concern is whether the project will enhance the
Department's ability to care for veterans. Criteria evaluated when
assessing the feasibility of a project include the amount of savings to
be realized from reduced maintenance and repair, utility bill savings,
and simplified operations and maintenance. Other factors include the
degree to which a project contributes to energy security and how it
affects VA's ability to continue operations under a variety of adverse
scenarios via on-site generation of electricity. In addition, VA also
considers factors that are very important to veterans, but that are not
easily quantified. These factors include indoor air quality, infection
control, and improvements to patient comfort. Prospective projects are
compared to other proposed projects and then ranked in order of how
well they score in terms of getting the most benefit with the least
investment.
The process of identifying, evaluating and selecting projects
involves pre-screening, energy audits, feasibility studies,
environmental assessments, and the calculation of return on investment
and the use of other key statistics. This process enables VA to meet
multiple goals, such as security and cost-control as well as to meet
Congressional mandates.
Question 2: Also, I would like to know how long this initiative has
been going on within your Department and how much funding it has
received to date.
Response: VA has been striving to achieve compliance with
environmental, energy, and transportation laws, regulations, and
executive orders (EO) since 1970, when Congress enacted the National
Environmental Policy Act. Additional environmental statutes, including
the Resource Conservation and Recovery Act of 1976, the Comprehensive
Environmental Response, Compensation, and Liability Act of 1980, and
the Superfund Amendments and Reauthorization Act of 1986, have added to
the base level of resources necessary for VA to operate our hospitals,
cemeteries and other facilities in an environmentally responsible
manner.
In recent years, VA has worked diligently to comply with energy
legislation including the Energy Policy Acts of 1992 and 2005, and the
Energy Independence and Security Act (EISA) of 2007. Revisions to EISA
codified President George W. Bush's Executive Order 13423,
Strengthening Federal Environmental, Energy, and Transportation
Management (signed January 2007).
The following table summarizes VA's Green Management Program budget
requests for FY 2006 through FY 2012.
------------------------------------------------------------------------
Fiscal Year Budget Request
------------------------------------------------------------------------
2006 $25,000,000
------------------------------------------------------------------------
2007 $25,000,000
------------------------------------------------------------------------
2008 $24,587,000
------------------------------------------------------------------------
2009 $27,600,000
------------------------------------------------------------------------
2010 $151,683,000
------------------------------------------------------------------------
2011 $272,396,000
------------------------------------------------------------------------
2012 $144,564,000
------------------------------------------------------------------------
The steep increase in FY 2010 resulted from integrating the
previously separate budget for energy infrastructure improvement
projects into the Greening VA program budget request for enhanced
tracking of VA investment in energy efficiency and renewable energy.
Energy infrastructure improvements represent 35 percent of the FY
2012 Greening VA budget request, 40 percent of the FY 2011 budget, and
48 percent of the FY 2010 budget. Examples of projects thus funded
include HVAC system upgrades at the Waco VA Medical Center (VAMC);
steam and chilled water distribution system improvements at Big Spring
VAMC; HVAC system upgrades at the Houston and San Antonio VAMCs; and
boiler system improvements at the Kerrville VAMC.
As part of the Green Management Program, VA invested $115 million
in fiscal years 2009 and 2010 for advanced metering and utility bill
auditing, covering facilities nationwide. These systems help VA
identify both problems (e.g., water leaks) and opportunities (e.g.,
qualifying for more favorable utility rates), resulting in better
management of energy and water systems and utility cost savings. With
metering and billing data and analysis at their fingertips, managers
are able to target investments more precisely and gain maximum control
of consumption and costs.
Question 3: At its current $124 million funding level, where does
``Greening the VA'' rank in the Department of Veterans Affairs funding
priorities? Specifically, in respect to reducing the backlog of claims
and providing more care for veterans.
Response: When developing its budget request, VA assesses all of
its programs and allocates funds to a multiplicity of programs to
address veterans' needs fully. While ``Greening the VA'' is important
to the Department, the requested level of funding in FY 2011 is far
below what VA has dedicated to improving compensation and pensions
claims processing or increasing access to health care for veterans.
To reduce the claims backlog, VA requested an increase to its
investment in the administration of Compensation and Pensions benefits
by $369 million, or nearly 23 percent compared to FY 2010, to just
under $2 billion in obligations. This increase, sustained in each
Continuing Resolution enacted for FY 2011 to date, provides a 5 percent
increase in the Compensation and Pensions workforce. Part of the
increase supports an approximately $75 million contract for external
claims processing support. $43 million for Veterans Benefits Management
System (VBMS) business process re-engineering and training will also
contribute to the near term reduction of the backlog. These VBA
investments are matched with Information Technology account allocations
of $148 million to be invested in the Veterans Benefits Management
System and another $70 million to be invested in the Virtual Lifetime
Electronic Record initiative.
VA is also making improvements to health care access through an
investment of $939 million to reduce veteran homelessness, up 15
percent from FY 2010. Inpatient, outpatient, and residential mental
health programs are receiving an investment of $6.2 billion, up $459
million, over 7 percent over FY 2010. Another $6.9 billion will be
invested in long term care improvements, up $597 million or nearly 9
percent from FY 2010, of which $146 million will be invested in
telehome health care to facilitate near instant access to care. Women
veterans programs will receive $270 million, an increase of 10 percent.
Conversely the $144 million for Greening VA projects is less than
0.1 percent of the Department's total FY 2012 budget request. Greening
VA is a ``supporting initiative'' cited in the Department's FY 2011-
2015 Strategic Plan. It supports Integrated Initiative 3--``Build our
internal capacity to serve veterans, their families, and other
stakeholders efficiently and effectively.''
Funding Greening VA directly impacts the quality of care provided
to veterans by improving the infrastructure of facilities where
services are provided. Providing veterans with optimum services
requires regular maintenance and periodic upgrades of our
infrastructure to ensure efficient and effective operations of basic
amenities such as the provision of hot water and air-conditioning.
Ensuring sterile environments where needed and preventing infection
requires reliable, secure electricity, clean water, and indoor air
quality that meets or exceeds health care standards.
Investments designed to improve energy and water efficiency have an
impact on operating costs immediately upon project completion. These
investments make a long-term, ongoing, and compounding contribution
toward reducing and managing utility services costs. These efforts make
VA a more sustainable Department, thereby helping us to reduce and
better manage operating costs and protect the resources that enable VA
to better serve veterans.
Question 4: Could the $124 million dollars for ``Greening the VA''
help with the current back log problem the VA currently faces or help
veterans gain more access to care?
The job of the Veterans Administration is to serve veterans who
have sacrificed their lives for our freedom.
I believe the proposed budget is growing bureaucracy and picking
and choosing initiatives that do not may not have giving veterans more
access to their health care as their primary purpose as well as solving
problems that the VA currently faces.
``Greening'' initiatives and growing the bureaucracy at the
Veterans Administration should not come at the cost of those who were
called upon to serve in the interest of protecting the country we love
and the freedom we cherish.
Response: While additional resources for either reducing the claims
back log or improving access to health care could always be applied
with some benefit, our currently proposed investments in FY 2012
already optimize the return on investment in both those areas. The
marginal improvement we might see in either area is more than offset by
the valued added by the ``Greening the VA'' investment of $124
million--less than one tenth of 1 percent of total proposed VA
obligations in 2012.
Committee on Veterans' Affairs
Washington, DC.
March 7, 2011
The Honorable Eric K. Shinseki
The Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. Secretary:
In reference to our Full Committee hearing entitled ``U.S.
Department of Veterans Affairs Budget Request for Fiscal Year 2012,''
that took place on February 17, 2011, I would appreciate it if you
could answer the enclosed hearing questions by the close of business on
April 11, 2011.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax your responses at 202-225-2034. If you have any
questions, please call 202-225-9756.
Sincerely,
BOB FILNER
Ranking Democratic Member
DMT:ds
__________
Questions for the Record
The Honorable Bob Filner
House Committee on Veterans' Affairs
``U.S. Department of Veterans Affairs Budget Request for Fiscal Year
2012''
February 17, 2011
Contingency Fund
Your Enrollee Health Care Projection estimated the need for an
additional $953 million to address potential demand increases due to
economic conditions. The VA budget submission states that the ``fund
will only become available for obligation if the Administration
determines the anticipated changes in economic conditions, as estimated
by the Model, materialize in 2012.''
Question 1: Specifically, what economic changes would have to occur
to trigger a determination to obligate these funds?
Response: Section 226 of the Administrative Provisions state that
``. . . such funds shall only be available upon a determination by the
Secretary of Veterans Affairs, with the concurrence of the Director of
the Office of Management and Budget, that:
a. The most recent data available for:
1. National unemployment rates,
2. Enrollees' utilization rates, and
3. Obligations for Medical Services,
validates the economic conditions projected in the Enrollee
Health Care Projection Model, and
b. Additional funding is required to offset the impact of such
factors.''
Question 2: What economic data was placed in the Model and how
exactly does the Model come to a decision?
Response: Estimates of unemployment rates and how they are expected
to influence Veterans reliance on VA for care were included in the
Model.
Question 3: How confident are you that your Model can accurately
engage in economic forecasting?
Response: The Model does not engage in economic forecasting. The
Model uses Government estimated unemployment rates to estimate the
impact they will have on Veterans reliance on VA for health care.
Question 4: If the Administration determines that the ``economic
conditions'' do not take place what will the VA do with this funding?
Response: In this case, the funds would expire and be returned to
the Treasury.
Your budget estimates a FY 2012 current services level for medical
care of $54.5 billion. This current services level is funded by total
budget authority of $53.9 billion, and the addition of $570 million in
savings. The contingency fund is included as part of the total
budgetary resources available for 2012.
Question 5: It looks like the ``contingency fund'' is already
required to meet your current services estimate for 2012. Why didn't
you just add this amount to your bottom line request for the Medical
Services account?
Response: The contingency fund is included in the bottom line
request for the Medical Services account. The $953 million contingency
fund, estimated in VA's Enrollee Health Care Projection Model, was
created to address the potential demand increase for medical care
services due to changes in economic conditions. The fund will only
become available for obligation if the Administration determines the
anticipated changes in economic conditions, as estimated by the Model,
materialize in 2012. The current services level for medical care of
$54.5 billion includes the contingency fund of $953 million.
Carryover Funding
Prior to the advent of advance appropriations for VA medical care,
appropriations bills routinely provided authority for a small amount of
the appropriation provided in one fiscal year to be expended in during
the course of the next fiscal year. This authority was provided as a
budgeting tool enabling the VA to better weather disruptions that might
be caused by the necessity to rely upon temporary funding bills. The
last time this authority was provided was for amounts appropriated for
FY 2010, with the expectation that these amounts would be expended in
FY 2010 and FY 2011. You state in your testimony that you require
carry-over authority from FY 2011 in order to provide a sufficient
budget for FY 2012 and FY 2013 and that the failure to provide this
authority will necessitate an increase in appropriations for 2012 and
2013.
Question 1: Can you provide us with the specifics as to the amounts
and the rationale behind projecting unobligated balances at the end of
this fiscal year?
Response: At the end of FY 2010, we had an unobligated balance of
$1.449B ($1.208B in Medical Services, $132M in Medical Support and
Compliance, and $109M in Medical Facilities). These amounts were
related to numerous factors such as: equipment purchases planned for FY
2010 but were executed in FY 2011, non-recurring maintenance projects
planned for FY 2010 that had to be moved to FY 2011, contracts that
were not awarded in FY 2010 as planned but were awarded in FY 2011, and
full year hiring actions planned for FY 2010 that did not occur as
planned. The estimated unobligated balances at the end of FY 2011 are
$1.1B ($1.0B in Medical Services, and $100M in Medical Facilities).
These estimated amounts reflect anticipation of similar factors
described for FY 2010 and are consistent with the actual carry-over
balances from prior years.
Question 2: Of the $1 billion in carryover authority provided in
the Medical Services account in the FY 2010 appropriations act, how
much has been obligated as of February 1, 2011?
Response: As of January 31, 2011, $719.6M had been obligated. As of
February 28, 2011, $731.5M had been obligated.
Question 3: [If there is any remaining] Of the amount remaining do
you anticipate obligating this amount by September 30, 2011?
Response: Yes.
Question 4: Do you still plan on having unobligated balances that
could be carried over in FY 2013 in light of the reduction in your
estimates as to collections of $473 million?
Response: The President's Budget estimates that $500M will be
carried over at the end of FY 2012 into FY 2013 and that zero would be
carried over at the end of FY 2013.
Collections
Your estimates as to collections have been substantially reduced,
leaving a shortfall in expected revenues for 2011 and 2012. For FY 2011
you had estimated $3.4 billion but your current estimate is for $2.9
billion. For 2012, you had estimated $3.7 billion but now expect $3
billion.
Question 1: Can you explain to us what has caused this decrease in
your collection levels and estimates and how are you going to fill the
budgetary holes these lower amounts have created?
Response: There are a number of factors that have caused the
decrease in collection levels for FY 2011 and estimates for FY 2012.
These factors include, but are not limited to, the following:
Poor economic conditions--Growth in national unemployment (from 7.7
percent in the First Quarter of FY 2009 to 9.8 percent at the end of
the First Quarter of FY 2011) will continue to impact both first party
collections (Veteran out-of-pocket costs) and third party collections
(unemployment and resultant loss of health insurance coverage).
Hardship waivers and exemptions from copayments are increasing--
Veteran first party copayment economic hardship waivers and exemptions
were at their highest levels in FY 2010 (the most recent completed
year) than in any prior year, and this is expected to continue with the
current economic conditions.
Third party ``Collections to Billings'' (CtB) ratios are down
nationally--CtB ratios are expected to continue a downward trend,
reducing third party collections. CtB decreased from 43.1 percent in
January 2009 to 39.1 percent in January 2011, and was influenced by the
continued shift by insurers of payment responsibility to the patient
(i.e., higher deductibles, increased copayments, etc.). Section 1729 of
title 38 prevents VA from billing the Veteran if the insurance company
does not pay. Each 1 percent decrease in CtB represents a $55 million
loss in revenue.
Priority Group migration from lower to higher status--National
Priority Group migration over the past 2 years has shown a sharp
decrease in collections for Veterans in Priority Group 8, which are the
primary drivers of both first and third party collections.
Veterans aging to 65 years and older--FY 2012 begins to reflect the
shift in workload for Vietnam Era Veterans aging to 65 years and older.
Once a Veteran is Medicare-eligible, Medicare becomes the primary
insurance coverage and VA can bill insurance companies only for the
portions Medicare does not cover (typically their deductibles). This
significantly reduces the amount VA can collect.
The decrease in the collections estimate for FY 2011 of $473
million is offset by a lower overall requirement (-$140 million) and
increased utilization of carryover funds for FY 2010 (+$349 million).
The lower overall requirement takes into consideration operational
improvements in FY 2011. The decrease in the collections estimate for
FY 2012 of $601 million is offset by increases in the Reimbursement and
Prior Year Recoveries estimate (+$1 million) and utilization of
carryover funds (+$600 million). The revised FY 2012 estimate includes
an offset of $713 million for the pay freeze rescission.
Dollars in Thousands
----------------------------------------------------------------------------------------------------------------
2011 Estimate 2012 Estimate *
-----------------------------------------------------------------------------------
Description 2011 Pres. 2012 Pres. Increase/ 2011 Pres. 2012 Pres. Increase/
Subm. Subm. Decrease Subm. Subm. Decrease
----------------------------------------------------------------------------------------------------------------
Total Obligations $51,865,000 $51,724,974 ($140,026) $54,631,985 $54,871,985 $240,000
----------------------------------------------------------------------------------------------------------------
Funding Sources:
----------------------------------------------------------------------------------------------------------------
Appropriation $48,183,000 $48,168,000 ($15,000) $50,610,985 $50,850,985 $240,000
(Including Transfers)
----------------------------------------------------------------------------------------------------------------
Collections $3,355,000 $2,882,000 ($473,000) $3,679,000 $3,078,000 ($601,000)
----------------------------------------------------------------------------------------------------------------
Reimbursements & PY $327,000 $326,000 ($1,000) $342,000 $343,000 $1,000
Recoveries
----------------------------------------------------------------------------------------------------------------
Use of Carryover Funds $0 $348,974 $348,974 $0 $600,000 $600,000
----------------------------------------------------------------------------------------------------------------
Total $51,865,000 $51,724,974 ($140,026) $54,631,985 $54,871,985 $240,000
----------------------------------------------------------------------------------------------------------------
*In 2012, $953 million will be obligated if the Administration determines the requirements for the contingency
fund are met.
Operational Improvements
Question 1: VA is proposing $1.5 billion in new initiatives for FY
2012 that will be partly paid for by $1.2 billion in operational
improvements started in 2011. Some of these initiatives are very vague
such as, ``expanding health care access to veterans which aims at
creating care alternatives, including implementation of Systems
Redesign and using new technologies.'' Can you explain to the Committee
what that means?
Response: Access to health care is vital to the Department's
overall mission of providing exceptional health care to Veterans. VA is
the largest integrated provider of health care in the country, with
over 5.4 million Veterans each year receiving care at over 1,100
locations, including inpatient hospitals, health care centers,
residential facilities, community based outpatient clinics (CBOCs), and
in their homes. It is VA's commitment to provide clinically-
appropriate, quality care for eligible Veterans when they want and need
it. This will be accomplished through Systems Redesign which involves
multiple strategies addressing transportation, use of advancements in
medical technology, workforce challenges, and partnerships in rural
communities. It is the intent to develop a culture nationally within VA
which pursues continuous improvement so that staff is empowered to
solve problems at the front line or at whatever point the Veteran
accesses the health care system.
A few years ago, it was felt that the VA was using ever-increasing
estimates of savings resulting from ``management efficiencies'' in
order to, on paper, cover the increasing gulf between appropriated
dollars and the actual fiscal requirements of providing health care to
veterans.
Question 2: Can you provide real details regarding these
``operational improvements''?
Response: To improve VA health care operations and improve the
value of services provided to the Veterans and their families as well
as recognizing the Federal deficit challenge this Nation faces, VA has
proposed a number of management actions. Many of these proposals will
improve VA's medical services delivery over the long-term.
Fee Care Payments Consistent with Medicare
(-$315 million in 2012)
(-$362 million in 2013)
Dialysis Regulation Savings and other care services are the
estimated cost savings from purchasing dialysis treatments and other
care from civilian providers at the Centers for Medicare and Medicaid
Services rates instead of current community rates.
Fee Care Savings
(-$200 million in 2012)
(-$200 million in 2013)
Fee care savings will be generated through application of the
following initiatives: use of electronic repricing tools, use of
contract and blanket ordering agreements, decrease contract hospital
average daily census, decrease duplicate payments, decrease interest
penalty payments, and increase revenue generation through the use of
automated tools.
Clinical Staff and Resource Realignment
(-$151 million in 2012)
(-$151 million in 2013)
Conversion of selected physicians to non-physician providers;
conversion of selected registered nurses to licensed practical nurses;
and to more appropriately align the required clinical skills with
patient care needs.
Medical & Administrative Support Savings
(-$150 million in 2012)
(-$150 million in 2013)
These savings will be achieved by more efficiently employing
resources to reduce administrative and support costs across VA's
medical facilities. The intent is to invest these savings in direct
patient care and thereby enable VA to provide health care services to
Veterans more effectively and efficiently.
Acquisition Improvements
(-$355 million in 2012)
(-$355 million in 2013)
VA has eight ongoing initiatives. A brief description of each is as
follows:
Consolidated Contracting--This initiative consists of
multi-facility, VISN, and Regional Contracts. It also involves
contracts being administered at the VHA Health Administration Center
(HAC). Contract savings result from combining requirements and
obtaining lower unit pricing.
Increasing Competition--This initiative relates to
competing contracts that were formerly awarded on a sole source basis.
The majority of the savings in this category come from competing
requirements among Service-Disabled Veteran-Owned Small Business firms.
Bring Back Contracting In House--Under this initiative,
VHA is bringing contracting workload back into VHA contracting offices
from the Army Corps of Engineers. By bringing the workload back, VHA
avoids paying the Corps of Engineers administrative charges.
Reverse Auction Utilities--Several VHA facilities are
participating in a program administered by GSA, whereby utilities are
procured using reverse auctions. This has produced savings in utility
pricing.
MED PDB/EZ Save--Through a consolidated effort with DoD,
VHA has been able to obtain visibility of the most favorable government
pricing overall. This has allowed VHA to procure needed supplies at the
identified lower price.
Reduce Contracts--This effort involves canceling/avoiding
contracts by performing the required services in house.
Property Re-utilization--This initiative brings back the
practice of considering ``excess as the first source of supply.'' VHA
has been able to avoid procurement of new equipment by reutilizing
excess equipment.
Prime Vendor--VHA has been able to use the med/surg prime
vendor to achieve additional price concessions. Additionally, the prime
vendor provides improved inventory management thereby eliminating the
procurement of unneeded supplies.
VA Real Property Cost Savings and Innovation Plan
(-$66 million in 2012)
(-$66 million in 2013)
VA Real Property Cost Savings and Innovation Plan includes the
following initiatives for VHA: Repurpose Vacant and Underutilized
Assets--VA has identified 17 vacant or underutilized buildings to
repurpose for homeless housing and other enhanced-use lease (EUL)
initiatives. Demolition and Mothballing--VA has identified 116 vacant
or underutilized buildings to demolish or mothball which will reduce
operating costs after the cost of demolition. Energy and
Sustainability--VA will achieve these savings by regionally pooling
energy commodity purchasing contracts, aggressively pursuing energy and
water conservation, and investing in the co-generation of electric and
thermal energy on-site. Procurement Savings--VA will achieve savings by
engaging in the direct purchase of building supplies and equipment, and
regionalizing certain building service contracts.
In your budget proposal, for example, you portray the operational
improvement amounts as the same for both 2012 and 2013, for acquisition
improvements. This is projected to save VA $355 million in 2012 and
$355 million in 2013.
Question 3: Does this mean that over the course of 2 years that VA
will save over $700 million in real dollars by implementing those
improvements?
Response: Yes, as reflected in the budget, VA estimates acquisition
improvements to save $355 million in FY 2012 and $355 million in FY
2013.
Question 4: Can you provide us with the estimated overall savings
that each improvement is expected to save regardless of fiscal year?
Response: As reflected in the budget, VA estimates the operational
improvements to provide overall savings of $746 million in FY 2011,
$1.237 million in FY 2012, and $1.284 million in 2013.
Dollars in Millions
------------------------------------------------------------------------
2011 Current
Description Estimate 2012 2013
Estimate Estimate
------------------------------------------------------------------------
Fee Care Payments Consistent ($275) ($315) ($362)
with Medicare
------------------------------------------------------------------------
Fee Care Savings ($150) ($200) ($200)
------------------------------------------------------------------------
Clinical Staffing and ($44) ($151) ($151)
Resources Alignment
------------------------------------------------------------------------
Medical & Administrative ($100) ($150) ($150)
Support
------------------------------------------------------------------------
Acquisition Improvements ($177) ($355) ($355)
------------------------------------------------------------------------
VA Real Property Cost Savings $0 ($66) ($66)
& Innovation Plan
------------------------------------------------------------------------
Total ($746) ($1,237) ($1,284)
------------------------------------------------------------------------
Health Informatics
In transforming the VA into a 21st Century organization, your
testimony states the ``Our health informatics initiative is a
foundational component for VA's transition from a medical model to a
patient-centered model of care. The delivery of health care will be
better tailored to the individual veteran.''
Question 1: Can you explain in detail what health informatics
initiatives you reference here?
Response: VA Major Initiative: Transforming Health Care Delivery
through Health Informatics.
Transforming Health Care Delivery through Health Informatics
(Health Informatics) is a new VA Major Initiative (Initiative) that was
formally launched on October 1, 2010. The purpose of the Initiative is
two-fold: To assist with VHA's transition from a medical model of care
to a patient-centered model of care; and, to build a sustainable and
effective collaboration between the Veterans Health Administration
(VHA) and the VA Office of Information and Technology (OIT).
The Initiative is the vehicle for promoting and fostering open,
transparent communication between health care providers and software
development teams through shared responsibility and accountability. The
Health Informatics Initiative is composed of three major projects:
A. Adopt a Health/IT Collaborative supporting rapid product
development and delivery. This effort restructures the working
relationship between VHA and OIT and provides an organizational
foundation for reengineering existing processes and piloting VHA
clinical software prototypes in a rapid, agile and iterative fashion.
B. Build a Health Management Platform to transform patient care.
This effort integrates informatics and health information technology
(IT) in the delivery of health care. It provides a succession plan to
transition the Computerized Patient Record System (CPRS) to the next
generation of browser-based Electronic Health Record (EHR).
C. Create Health Informatics Capacities. This effort develops the
Health Informatics workforce and enhances organizational informatics
literacy through competency, career and community development.
Capital Infrastructure
The VA has recently rolled out the Strategic Capital Investment
Planning (SCIP) process to help strategically plan their infrastructure
needs for the next 10 years. I understand that this process is one that
encompasses all three administration's needs.
Question 1: Can you please explain the difference between SCIP and
the Capital Asset Realignment for Enhanced Services (CARES) process?
Response:
The CARES process was focused chiefly on the realignment
of clinical services to provide for the delivery of health care.
SCIP is not a replacement for CARES, rather it is an
enhancement which builds off of the important lessons learned through
the CARES process.
CARES and SCIP both identify performance gaps
(utilization, access, space, facility condition) and lead to the
development of long term capital plans to meet the gaps.
SCIP is more flexible in its approach as it places
emphasis on looking at non-capital solutions (longer hours of
operation) as well as infrastructure improvements to meet identified
gaps.
SCIP looked at disposing or repurposing of individual
underutilized buildings (not entire campuses as in CARES).
CARES did not produce a comprehensive, integrated list of
capital investments that identified the highest priority medical and
non-medical capital needs within VA.
SCIP ultimately resulted in a 10-year capital plan for all programs
(Major, Minor, NRM, and leases) which includes specific investments
necessary to close all ``gaps'' currently identified by VA
Administrations, Regions and facilities.
Veterans Benefits
Question 1: With the very recent reorganization implementation of
the Veterans Benefits Administration is there adequate allocation of
Full Time Equivalent (FTEs) or are additional FTEs going to be needed?
Please elaborate on what you believe the numbers might be.
Response: The reorganization is being accomplished within existing
resource levels. The change in VBA Headquarters structure does not
result in any change to the VBA field structure, nor is there any
direct impact on VBA's FY 2012 budget request.
The Veterans Benefits Management System (VBMS) is the cornerstone
of VA's plans to address disability claims processing in a paperless
manner.
Question 2: Would you briefly tell us about this system and how has
it impacted the claims process to date?
Response: The VBMS is a business transformation initiative designed
to assist VA in eliminating the claims backlog. The centerpiece of VBMS
is a paperless system, which will be complemented by improved business
processes and workflows.
VBMS will dramatically reduce the amount of paper in the current
claims process, and will employ rules-based claims development and
decision recommendations where possible. Additionally, by using a
services-oriented architecture (SOA) and commercial off-the-shelf
(COTS) products, VA will be positioned to take advantage of future
advances in technology developed in the marketplace to respond to the
changing needs of Veterans over time.
The first iteration of the software is currently being tested at
the Providence Regional Office (RO). Claims processors at the
Providence RO are using the new software to validate and harden the
business requirements, as well as to generate new business requirements
for future software releases. They are utilizing a new graphical user
interface, electronic claims repository, and scanning solution, which
are integrated with existing core business applications (VETSNET) that
support claims processing.
Additional development and testing will continue throughout
calendar year 2011 and into 2012 at additional sites. Full national
deployment is scheduled to begin in calendar year 2012.
In their written statement, the Disabled American Veterans (DAV)
admits that a modern information technology system to process claims in
a paperless environment is long overdue, but they have reservations
about whether the Veterans Benefits Management System (VBMS), VA's
answer to paperless claims processing, is being rushed to meet ``self-
imposed'' deadlines in order to show progress toward the backlog.
Question 3: Can you address these reservations?
Response: The project schedule for the VBMS initiative, while
aggressive, ensures a strategic approach to enhancing claims
processing. The initiative has a deliberate schedule with specific
goals along the timeline. For instance, the software is being
developed, deployed, and tested in a phased approach that began with
the Virtual Regional Office and continues today with testing of the
first iteration of production software at the Providence Regional
Office.
VA ensures an appropriate level of transparency and accountability
for the VBMS initiative through the Operational Management Review (OMR)
process. The OMR is a collaborative process where VA senior leaders
come together on a regular basis in a structured forum to problem
solve, achieve closure on any major initiative issues, and provide
insights and transparency for all of the Department's major
initiatives.
As part of the OMR process, the VBMS initiative leader and
executive sponsor meet with the VA Deputy Secretary on a monthly basis
to discuss performance, schedule, and cost. Key challenges and
mitigations are discussed, as well as lessons learned and best
practices that may be useful to other initiatives. Any challenges or
refinements needed to the schedule are discussed and resolved through
the OMR.
As you know, stakeholders are a very important part of a change
process. DAV mentions in their testimony their frustration with the
VBA's failure to fully integrate service organizations in reforming the
claims process and the development of the draft regulations for the
updated rating schedule.
Question 4: How do you respond to that?
Response: VA held four medical and scientific forums on updating
the rating schedule in January and February of this year. The Veterans
Service Organizations (VSOs) were given the opportunity to provide
formal presentations in 2-hour sessions at each of the forums. In
addition, the VSOs participated in the working group panel sessions and
offered numerous and significant contributions during each body system
review. Our plan is to follow this process in all future forums.
The Independent Budget veterans service organizations have
expressed concern with the oversight by the Veterans Benefits
Administration to ensure the required training is completed or to
assess the adequacy and consistency of the training.
Question 5: Would you address the annual training requirement that
has only been met by one VA Regional office and an additional nine VA
regional offices that had less than half of their employees meet the 80
hours of training requirement?
Response: Improved monitoring procedures and emphasis on training
by leadership increased the number of claims processors that completed
the annual training requirement from 68 percent in FY 2009 to 81
percent in FY 2010. This 13 percent improvement is on top of absorbing
nearly 1,900 new Compensation and Pensions employees in FY 2010, many
of whom were not available for training for a full year.
Question 6: How many veterans have used the Fully Developed Claims
initiative?
Response: Since the pilot started in June 2010, 5,193 claims have
been completed through the Fully Developed Claims program as of March
9, 2011.
The expansion to the Integrated Disability Evaluation System (IDES)
Program that will include a component on Vocational Rehabilitation and
Employment (VR&E) services for those active duty Servicemembers
transitioning through the IDES will require an additional 110 FTE to
support. The budget has requested $16.2 million to cover this increase.
Question 7: Given the big plan to expand IDES to all Military
Treatment Facilities (MTFs) by the end of FY 2011, do you believe the
additional 110 FTE is enough to meet the demand?
Response: In collaboration with DoD, VA will assign the 110
Rehabilitation Counselors at some, but not all, of the IDES locations.
During this expansion of the VR&E IDES initiative, VA will collect data
regarding workload, services provided, and outcomes to be considered in
future expansion efforts.
Office of Inspector General
The President's 2011 and 2012 Budget Requests reflected significant
increases for VA offices in the General Administration (GOE) account.
The increases ranged from 3 to 57 percent and averaged 17 and 13
percent, respectively. Additionally, all of these offices received
substantial increases going from 2009 to 2010. The Administration
places great emphasis on the need for increased accountability,
transparency, internal controls, and minimizing improper payments.
Question 1: In view of the expansion of benefit programs and the
expanded budget authority for most VA offices, could you tell us why
the VA Office of Inspector General funding has not also increased in a
similar fashion since 2010?
Response: The VA OIG has received a $20.6 million, or 23 percent,
increase in 2012 compared to 2009. This is an average increase of 7.7
percent per year, which is comparable to the General Administration
staff office 3-year average of 8.8 percent when excluding funding for
the President's government-wide acquisitions initiative. In addition,
the VA OIG FTE has increased by 103 over the 2009 level (20.2 percent).
Committee on Veterans' Affairs
Washington, DC.
March 7, 2011
Carl Blake
National Legislative Director
Paralyzed Veterans of America
801 18th Street, NW
Washington, DC 20006
Raymond C. Kelley
Director, National Legislative Service
Veterans of Foreign Wars of the United States
200 Maryland Avenue, NE
Washington, DC 20002-5799
Joseph A. Violante
National Legislative Director
Disabled American Veterans
807 Maine Avenue, SW
Washington, DC 20024
Christina M. Roof
National Acting Legislative Director
AMVETS
4647 Forbes Boulevard
Lanham, MD 20706
Dear Members of the Independent Budget:
In reference to our Full Committee hearing entitled ``U.S.
Department of Veterans Affairs Budget Request for Fiscal Year 2012,''
that took place on February 17, 2011, I would appreciate it if you
could answer the enclosed hearing questions by the close of business on
April 11, 2011.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response by
fax at 202-225-2034. If you have any questions, please call 202-225-
9756.
Sincerely,
BOB FILNER
Ranking Democratic Member
DMT:ds
__________
Independent Budget
Washington, DC.
April 7, 2011
Honorable Bob Filner
Ranking Minority Members
House Committee on Veterans' Affairs
338 Cannon House Office Building
Washington, D.C. 20515
Dear Ranking Member Filner:
On behalf of The Independent Budget, we would like to thank you for
the opportunity to present our views on the FY 2012 budget for the
Department of Veterans' Affairs (VA). We are pleased to see that the
Committee has chosen to provide Views and Estimates in a bipartisan
manner this year; however, we believe that much work remains to ensure
that the VA receives a sufficient budget for FY 2012 and FY 2013. Only
through cooperation between the veterans' service organizations and the
Members of the Committee can we hope to attain a sufficient, timely,
and predictable budget for the VA.
We have included with our letter a response to each of the
questions that you presented following the hearing on February 17,
2011. Thank you very much.
Sincerely,
Christina M. Roof
National Deputy Legislative Director
AMVETS
Joseph A. Violante
National Legislative Director
Disabled American Veterans
Carl Blake
National Legislative Director
Paralyzed Veterans of America
Raymond C. Kelley
National Legislative Director
Veterans of Foreign Wars of the United States
__________
VA is proposing $1.5 billion in new initiatives for FY 2012 that
will be partly paid for by $1.2 billion in operational improvements
started in 2011. Some of these initiatives are very vague and the
``operational improvements'' are not actual realized savings, yet. An
example of very vague language in the operational improvements category
is contained in the Medical and Administrative Support savings
narrative, ``indirect cost savings will be produced by more efficiently
employing the resources in various medical care, administrative, and
support activities at each medical center and in VISN and central
office operations.'' VA says they will save $150 million dollars by
implementing this. In light of the fact that many of VA's budgets in
the past were based on failed ``management efficiencies'' savings:
Question 1: In your experience, what is the impact of ``operational
improvements'' to the veteran trying to gain access or get an
appointment at a local VA medical center?
Answer: Gauging the real impact of ``operational improvements'' can
be particularly difficult. In theory, steps taken to make the delivery
of health care more efficient would seemingly benefit veterans seeking
care. However, the impact upon veterans is usually a secondary
consequence of the inability of the VA to actually properly and
effectively implement operational improvements.
Generally, the Administration recommends ``operational
improvements'' in order to realize some savings in real dollars.
Unfortunately, as has been the case with previous Administrations that
have proposed similar gimmicks, the VA typically does not actually
achieve those savings. As a result, the proposed VA budget would then
be short of the funding needed to effectively deliver timely, quality
health care. The immediate impact on veterans is then a rationing of
care. Veterans will find it harder to make appointments in a timely
manner and in some cases the VA will be forced to reduce the services
it delivers. In a worst case scenario, the VA could be forced to take
steps similar to those taken in 2003 when the VA chose to close
enrollment into the health care system for Priority Group 8 veterans--
steps that have still not been fully overturned.
Question 2: Would you care to comment on the feasibility of VA
actually realizing $1.2 billion dollars in ``operational
improvements?''
Answer: In order to appropriately address the question, each of the
individual ``operational improvements'' proposed by the VA must be
looked at separately. These proposals include Fee Care Payments
Consistent with Medicare ($315 million in 2012); Fee Care Savings ($200
million in 2012); Clinical Staff and Resource Realignment ($151 million
in 2012); Medical and Administrative Support Savings ($150 million in
2012); and Acquisition Improvements ($355 million in 2012).
First, the VA proposes to realize cost savings by reimbursing
contract providers of dialysis and other care services at the Medicare
reimbursement rate. This proposal intends to replace current
unpredictable and financially vulnerable fee-basis reimbursement rates
with Medicare reimbursement rates for ambulatory surgical center care,
anesthesia, clinical laboratory, hospital outpatient perspective
payment systems, and end stage renal disease. While this may be a fair
assumption on the surface, the VA ignores the likelihood that this will
not actually happen. The fact is that contract providers who would be
affected by this change are adamantly opposed to this proposal, which
could undermine the VA's ability to actually make this change. As a
result, veterans will almost certainly be negatively impacted by this
proposal as some providers will likely refuse to accept new veteran
patients because they will not accept the Medicare reimbursement rate.
Additionally, while existing contracts will not be affected now,
they will be up for review in the future and VA may opt out of renewing
existing contracts and use Medicare reimbursement rates. Our concern
with this proposal is that it will reduce veteran patients access to
care in the community where providers are not accepting Medicare
patients in greater numbers. Specifically, current non-VA providers may
be subjected to significant rate reductions. To remain viable, these
providers may need to make changes to their patient case mix which
could be detrimental to veteran patients if the applicable
reimbursement rates are non-competitive.
Questions have also been raised over VA's ability to
administratively implement and adjust to Medicare's soon to be released
``bundled payment system,'' which in and of itself is complex in
application by the Centers for Medicare and Medicaid as well as to
multiple providers across many settings. It is noteworthy however, that
there are significant savings to CMS under this new payment system and
there is incentive for community providers to coordinate care in a more
cost-effective manner would serve to address the veteran communities
long-standing concern over quality standards, care coordination and
health information sharing in VA's fee-based care.
We also understand that VA has submitted requests through the
Office of Information and Technology procurement process for a complete
systems modernization to provide automation support for this critical
business process. The Veterans Health Administration (VHA) is also in
the process of deploying the Fee Basis Claims Systems as an interim
technical support solution. Likewise, VHA is also developing a pilot
program for one Veterans Integrated Service Network (VISN) to partner
with the Financial Services Center (FSC) for processing of all non-VA
Fee claims. Finally, VHA will continue to assess alternatives for
improving administration of the Fee program to include opportunities
for consolidation of the claims processing function.
The Independent Budget is aware that some temporary stand-alone
information technology systems have been put in place, but they lack
the functionality for centralized reporting, recording, and decision
support systems. Clearly, what VA leadership expects of IT today to
manage this program for decision-making, policy change, etc., is not
being provided by the interim solution. In light of the need for
significant changes to be made to the overall infrastructure, the
short-term ``band-aid'' approach may be adequate, but it is not in the
best interest of veteran patients or VA to provide timely access to
quality health-care services.
VA currently has three pilot projects to select one automated
claims system for its Fee Program. We are pleased that the VHA has
initiated these efforts in moving toward fee claims automation but are
concerned about the process being used to establish these pilots and
how VA will determine the approach and software that will be
implemented nationwide. There appears to be no coordinated effort with
a single point of accountability or an approved plan for how to
evaluate these pilots' performance in order to ensure VA makes the best
decision on how to automate the fee claims. There is not a publicly
available plan defining specific VHA objectives and the metrics that
will be used to evaluate each pilot.
The IBVSOs would have preferred that before any pilot program or
other project was initiated, a project plan with defined milestones and
desired results, performance metrics, and evaluation methodology would
have been established, analyzed, and approved--as is now required under
VA's Performance Management and Accountability System (PMAS) to
strengthen our IT oversight and performance. It appears that each pilot
program is being implemented separately, without a single point of
Office of Information Technology and program oversight or management of
the objectives, costs, schedule, and performance, and without a
consistent evaluation framework that holds each pilot accountable for
achieving comparable results.
We also believe that savings from Clinical Staff and Resource
Realignment could be problematic. As explained by the American
Federation of Government Employees in testimony before the Senate
Committee on Veterans' Affairs on March 2, 2011, it remains unclear
``whether these proposed conversions to lower skilled positions will
result in a more efficient use of scarce VA medical dollars, or a
harmful de-skilling of the care provided to veterans.'' Unfortunately,
similar efforts to achieve these types of savings in the past have
merely led to reduced access and quality of care. Likewise, as the VA
transitions to the Patient Aligned Care Team (PACT) delivery model, we
are concerned that this effort has already been hindered by short
staffing and poor coordination, which leads us to question how the VA
will realize cost savings from a proposed staff realignment in light of
these difficulties.
Additionally, The Independent Budget believes that estimated
savings from the Medical and Administrative Support Savings are dubious
at best. In the FY 2012 Budget Request, the Administration proposes to
save money by ``more efficiently employing the resources in various
administrative, medical, and support activities'' at all levels. And
yet, the VA outlines no real plan as to how it will ``efficiently
employ'' these resources. Previous Administrations also proposed
``management efficiencies'' that would presumably save the VA money in
much the same manner. However, the VA never seemed to achieve those so-
called efficiencies, arguably leaving the VA budget short each year.
Question 3: VA's budget request contains a $1.1 billion carryover
from the previous Fiscal Year. I would like to ask this panel if they
have heard from the field, anecdotally, concerns with hiring freezes,
programs that were not adequately funded, or any other type of services
shortages that were attributed to a ``funding shortfall'' by the VA
medical centers or VISNs.
Answer: First, we would like to express our serious concern with
the fact that the VA has identified such a significant amount of money
that it apparently has not spent from the previous fiscal year. Given
the growing pressure of demand from new veterans entering the VA health
care system as well as the continued emphasis by Congress and other
stakeholders to improve mental health services, women veterans'
services, and rural health care delivery, it is incomprehensible to The
Independent Budget co-authors that the VA would have appropriated
dollars still available.
We have in fact been hearing from staff in the field who report
that VA medical facilities have placed freezes on hiring new staff.
Similarly, we have received reports that facilities are instituting
staffing caps when there is an obvious need for professional staff. For
example, there continues to be a shortage of nurse staffing across the
VA system, particularly in specialized services such as the spinal cord
injury service. By establishing staffing caps, VA facilities are not
filling staff positions that become open as a result of retirements and
staff departures. We even received information from a particular
facility where the medical center director outlined a plan that would
replace two similar open positions with one full-time equivalent
employee. For example, if two registered nurses (RN) working in a
particular hospital unit leave the VA, that facility will only hire one
new RN to handle the responsibilities of those two positions.
We have also been told by nurses in various medical centers that
the VA is not fulfilling promises made during their recruitment and
retention negotiations. Specifically, we have heard complaints about
the VA offering education program reimbursements through the Education
Debt Reduction Program (EDRP) and then not providing these recruitment
and retention incentives to nurses once they have been locked into
their positions.
Committee on Veterans' Affairs
Washington, DC.
March 7, 2011
Tim Tetz
Director, National Legislative Commission
The American Legion
1608 K Street, NW
Washington, DC 20006
Dear Tim:
In reference to our Full Committee hearing entitled ``U.S.
Department of Veterans Affairs Budget Request for Fiscal Year 2012,''
that took place on February 17, 2011, I would appreciate it if you
could answer the enclosed hearing questions by the close of business on
April 11, 2011.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Ranking Democratic Member
DMT:ds
__________
American Legion
Washington, DC.
April 11, 2011
Honorable Bob Filner, Ranking Member
U.S. House of Representatives
Veterans' Affairs Committee
333 Cannon Office Building
Washington, DC 20515
Ranking Member Filner:
This letter is in response to your post-hearing questions from the
February 17th hearing that The American Legion testified at regarding
U.S. Department of Veterans Affairs Budget Request for Fiscal Year
2012.
In your experience, what is the impact of ``operational
improvements'' to the veteran trying to gain access or get an
appointment at a local VA medical center?
Operational improvements can be difficult to properly
define, so it is difficult to state definitively if such ``operational
improvements'' bring direct benefit to the veteran, although often it
would seem that this is contrary to the case. VA, to their credit, has
made strides over the past few years in reducing wait times for
appointments; however, greater problems have potentially appeared on
the horizon. As discussed later, reports have surfaced noting that
perhaps VA facilities are not able to fill their allotted number of
beds, which could mean that veterans are not receiving full access to
care as intended.
It is important to recognize, however, that there is not a
direct correlation between spending and service to the veteran. Despite
record budget increases for veterans, massive hiring increases, and the
throwing of every available Congressional resource at VBA for the
purposes of reducing the backlog of veterans' claims, the backlog is
paradoxically increasing. Secretary Shinseki has stated an ambitious
goal of ensuring that no claim is pending over 125 days, while
increasing VA's accuracy rate to 98 percent. Over the past year, VA
failed in both of those categories, seeing even their own generous,
internal accuracy numbers drop from 86 percent accuracy to below 84
percent while the number of claims pending over 125 days rose from
under 180,00 to over 290,000.
While VA maintains they are maneuvering into position to deal
with the backlog via IT solutions and business model solutions, there
is little hard evidence thus far to indicate that operational
improvements have been made, and with over 40 pilot programs in
operation last year, there has yet to be any kind of indication what
lessons were learned towards improvement of operations through those
pilot programs. For now, it would seem wise to adopt a ``wait and see''
mindset in determining whether or not VA is capable of providing
operational improvements, be they towards the operation of medical
centers or the claims offices of the VBA.
Would you care to comment on the feasibility of VA
actually realizing $1.2 billion dollars [sic] in ``operational
improvements''?
As indicated by the skepticism expressed above, the
ability of VA to make substantive operational improvements, much less
improvements capable of delivering more than $1.2 billion in savings,
is in question. The American Legion has concerns that ``operational
improvements'' may consist more of consolidation of activity within the
realm of VA Central Office, and not of actual improvements distributed
out to the individual regions of operation and the veterans therein.
Further question must be raised when VA claims $1.2 billion in
``operational savings'' yet requests to hold just under $1 billion in
reserve as a ``contingency fund'' which would seem to indicate that
VA's own planners doubt the ability to achieve real savings and must
hold onto a reserve fund to compensate for overambitious estimates of
achievable savings.
While The American Legion supports the bottom line of the
budget, VA could better serve veterans by targeting that contingency
money to real projects, such as fully funding a Major and Minor
Construction budget slashed by over half from the previous 2010 levels.
VA's budget request contains a $1.1 billion dollar [sic]
carryover from the previous Fiscal Year. I would like to ask this panel
if they have heard from the field, anecdotally, concerns with hiring
freezes, programs that were not adequately funded, or any other type of
services shortages that were attributed to a ``funding shortfall'' by
the VA medical centers or VISNs.
The American Legion has also heard concerning stories
anecdotally of letters from VISN and Medical Center Directors
expressing hiring freezes due to inadequate funding. While Indianapolis
and Cleveland are certainly areas of concern, recent testimony
delivered by American Federation of Government Employees (AFGE)
representative Maryann D. Hooker, MD to the Senate Committee on
Veterans' Affairs explicitly highlighted this exact problem, stating in
part in her written testimony:
As mentioned above, emergency care has suffered
tremendously because of inadequate staffing. The goal is no longer to
provide care to the veteran in the emergency department, but to refer
the patient outside the VA system for care. At Wilmington, VA, we
recently learned that the emergency department is slated to increase
its maximum capacity from six to 14 patients, yet administration wants
to provide zero increase in nursing or physician staff. Recently, five
patients each spent over 48 hours in the emergency department,
including one who received two blood transfusions while he lay on a
stretcher for 2 days. Meanwhile a 25-bed ward has sat idle for the past
3 years because of too few floor nurses.
Such conditions raise serious concerns about the ability to
provide quality care to veterans. When questioned about these
shortfalls, Dr. Robert A. Petzel, the Undersecretary for Health,
responded that ``there may be gaps between what these Directors want
and what they are getting, but not between what they need and what they
are getting. There are no shortfalls in any of the VISN budgets.''
Clearly the reality as indicated by the testimony above would indicate
otherwise. The American Legion urges Congress to initiate more
oversight into this area.
By no means, however, are the stories of shortfalls limited to
those necessary for hiring positions to adequately staff existing
facilities to fully implement their allotted bed spaces. The American
Legion has received other reports of new facilities falling short of
needed ``activation monies'' required to bring these new facilities
online. The failure to fund needed startup costs of a facility is
tantamount to the failure to build the facility to begin with, as this
prevents veterans from accessing the resources that have been built to
service their needs. The American Legion urges Congress to use their
oversight powers to investigate how widespread this situation is and to
encourage VA to rectify this situation. If these cuts in costs are a
portion of VA's proposed slashing of construction costs by over half in
the proposed FY 2012 budget, then The American Legion urges Congress to
ensure that those funding numbers are increased to proper levels so
that veterans aren't denied the long sought access to care provided by
these new facilities.
As this Committee is well aware, The American Legion regularly
performs inspection visits of VA Medical Facilities for field research
compiling our annual ``System Worth Saving'' reports on the state of VA
Health Care delivery. The American Legion reminds the Committee we will
gladly partner with any member of Congress or any staff of the
Committee who wish to delve further into this area and determine
whether or not the funding designated by Congress is truly reaching the
veteran at ground level. Dedicated field research is essential to
finding ``ground truth'' in matters such as this.
The American Legion thanks the Committee for the opportunity to
provide answers to these questions and remains ready and willing to
work with the Committee to determine further answers to these or any
other questions.
For God and Country,
Tim Tetz
Director
National Legislative Commission