[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
U.S. DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST
FOR FISCAL YEAR 2013
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, FEBRUARY 15, 2012
__________
Serial No. 112-43
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
CLIFF STEARNS, Florida BOB FILNER, California, Ranking
DOUG LAMBORN, Colorado CORRINE BROWN, Florida
GUS M. BILIRAKIS, Florida SILVESTRE REYES, Texas
DAVID P. ROE, Tennessee MICHAEL H. MICHAUD, Maine
MARLIN A. STUTZMAN, Indiana LINDA T. SANCHEZ, California
BILL FLORES, Texas BRUCE L. BRALEY, Iowa
BILL JOHNSON, Ohio JERRY McNERNEY, California
JEFF DENHAM, California JOE DONNELLY, Indiana
JON RUNYAN, New Jersey TIMOTHY J. WALZ, Minnesota
DAN BENISHEK, Michigan JOHN BARROW, Georgia
ANN MARIE BUERKLE, New York RUSS CARNAHAN, Missouri
TIM HUELSKAMP, Kansas
MARK E. AMODEI, Nevada
ROBERT L. TURNER, New York
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
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further refined.
C O N T E N T S
__________
February 15, 2012
Page
U.S. Department Of Veterans Affairs Budget Request For Fiscal
Year 2013...................................................... 1
OPENING STATEMENTS
Chairman Jeff Miller............................................. 1
Prepared Statement of Chairman Miller........................ 50
Hon. Bob Filner, Ranking Democratic Member....................... 2
Prepared Statement of Hon. Filner............................ 51
Hon. Silvestre Reyes, prepared statement only.................... 51
Hon. Michael Turner, prepared statement only..................... 52
WITNESSES
Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans
Affairs........................................................ 4
Prepared Statement of Hon. Shinseki.......................... 53
Accompanied by:
Hon. Robert A. Petzel, M.D., Under Secretary for Health,
Veterans Health Administration
Hon. Allison A. Hickey, Under Secretary for Benefits,
Veterans Benefits Administration
Hon. Steve L. Muro, Under Secretary for Memorial Affairs,
National Cemetery Administration
Hon. Roger W. Baker, Assistant Secretary for Information
and Technology, U.S. Department of Veterans Affairs
Mr. W. Todd Grams, Executive in Charge for the Office Of
Management and Chief Financial Officer, U.S. Department
of Veterans Affairs
Mr. Carl Blake, National Legislative Director, Paralyzed Veterans
of America..................................................... 35
Prepared Statement of Mr. Blake.............................. 64
Mr. Raymond C. Kelley, Director, National Legislative Service,
Veterans of Foreign Wars of the United States.................. 37
Prepared Statement of Mr. Kelley............................. 67
Mr. Jeffrey C. Hall, Assistant National Legislative Director,
Disabled American Veterans..................................... 38
Prepared Statement of Joseph A. Violante..................... 71
Ms. Diane Zumatto, National Legislative Director, AMVETS......... 40
Prepared Statement of Ms. Zumatto............................ 78
Mr. Timothy M. Tetz, Director, National Legislative Commission,
The American Legion............................................ 41
Prepared Statement of Mr. Tetz............................... 83
STATEMENTS FOR THE RECORD
Association of the United States Army............................ 91
Modular Building Institute....................................... 94
Warrior Group, Inc............................................... 96
MATERIALS SUBMITTED FOR THE RECORD
Pre-Hearing Questions and Responses from Chairman Jeff Miller to
the Department of Veterans Affairs (VA)........................ 98
Post-Hearing Questions from Chairman Jeff Miller to the
Department of Veterans Affairs (VA)............................ 105
Post-Hearing Responses from the Department of Veterans Affairs
(VA) to Chairman Jeff Miller................................... 110
Post-Hearing Responses from the Department of Veterans Affairs
(VA), submitted by Hon. Bob Filner............................. 136
U.S. DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FISCAL YEAR 2013
Wednesday, February 15, 2012
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, D.C.
The Committee met, pursuant to notice, at 10:31 a.m., in
Room 334, Cannon House Office Building, Hon. Jeff Miller
[Chairman of the Committee] presiding.
Present: Representatives Miller, Bilirakis, Roe, Johnson,
Runyan, Buerkle, Huelskamp, Turner, Filner, Brown, Reyes,
Michaud, Sanchez, McNerney, Donnelly, Walz, Barrow, and
Carnahan.
OPENING STATEMENT OF CHAIRMAN JEFF MILLER
The Chairman. Good morning, everybody. This hearing will
come to order. Welcome to this morning's hearing to review the
administration's fiscal year 2013 budget request for the
Department of Veterans Affairs. Mr. Secretary, we all
appreciate you being here this morning and bringing your entire
team with you as well.
Although we are still combing through the budget, a process
that will likely involve further follow up questions after this
hearing this morning, I think it is safe to say that viewed in
context of an extraordinarily tight fiscal climate a 4.3
percent increase in discretionary spending should be termed
positive. That said, outcomes are what really matter. Mr.
Secretary, I know you and I both agree with that. Veterans do
not really care about the numbers as long as their claims are
being decided quicker, their health care is taken care of in a
timely fashion, and their aging facilities are upgraded.
I have got some questions about how this funding request
relates to the actual resource requirement but I will get to
those later. I want to use the remainder of my time to talk
about the issue of sequester and the Veterans Administration.
Mr. Secretary, let me begin by saying that I agree with you
and the President that sequestration is not desirable whether
it is applied to DoD, VA, or any other Federal agency. Again, I
think we can all agree on that. But I also agree that specific
guidance as to how sequestration will be carried out and its
impact at the operational level is something that will likely
be determined a bit farther down the road, but not too much
further down that road. For example, will there be layoffs?
Will maintenance needs be postponed or deferred? Will facility
activations be delayed? Those are details that I am curious
whether VA has already looked at, and they probably should have
been looked at, but I can understand if we are not quite at
that point yet.
And finally we are in agreement that there is an ambiguity
in the law with respect to VA that requires a clarifying legal
decision that only the Office of Management and Budget can
make. That is where my agreement with the administration and
its series of nonresponses to me and other Committee Members
ends.
For months I have been trying to get clarity about what we,
as a Committee, and veterans, as our constituency, deserve to
have resolved. Namely, because of a conflict in the law is VA
even part of the picture should a sequester order occur? Do we
have cause to be concerned? There is no such ambiguity with
respect to the Department of Defense. There is no ambiguity
with respect to most other non-defense programs. All know that
those agencies are definitely in play. But because the
administration has not clarified the matter, no one can say or
will say if VA is completely exempt or not.
Now I have received legal opinions from lawyers from both
the Congressional Research Service and the Government
Accountability Office saying that in their judgment VA appears
to be completely exempt. They provided these opinions to me in
a matter of days, proving that the legal issue at hand is not
really that complicated. But their judgments, mine, and that of
others in Congress carry no weight presently. Only OMB can
resolve this completely. And after multiple requests from this
Committee, a secretive legal opinion from VA lawyers delivered
to OMB several months ago, and obvious concern expressed by
veteran organizations alike, the question still lingers.
The obvious question is, why does it still linger? Why not
resolve the issue now? The ambiguity will remain in law even if
Congress and the President agree on finding $1.2 trillion in
cuts to avoid a sequester next January. This is an issue that
needs clarifying once and for all. Mr. Secretary, I know that
you are not the hold up. And I do not direct this comment at
you. But I believe that we are seeing here a cynical attempt to
keep veterans twisting in the wind to create more pressure to
act to avoid a sequester.
I say to the President there is enough pressure to act
already without threatening America's veterans. One way or
another, a decision has got to be made. And I am not going to
hold my breath any longer waiting for OMB to make their
decision. I have introduced legislation to clarify the law as
it stands now. I ask my colleagues to join me in support. The
Protect VA Healthcare Act of 2012 would simply amend the law to
conform to what Congress intended when it voted on the Budget
Control Act.
We need to get this issue resolved. If the President will
not lead on this issue then we will. With that said, I yield to
my good friend and Ranking Member Mr. Filner for his opening
statement.
[The prepared statement of Chairman Miller appears in the
Appendix]
OPENING STATEMENT OF BOB FILNER,
RANKING DEMOCRATIC MEMBER
Mr. Filner. Thank you, Mr. Chairman. Thank you, Mr.
Secretary and your staff for being here. I also thank those who
will be on the second panel, the independent budget panel. All
of you have worked so hard on that budget and that gives us
some points of reference. It holds the VA accountable and
allows us to look at this in a comprehensive fashion. So we
thank the independent budget panel for their presentations.
I disagree with you on one thing, Mr. Chairman, when you
said the administration is somehow cynically holding veterans
hostage, or something like that. The proof is in the pudding.
I'm sorry, Mr. Secretary, you are not the pudding. But the
proof is right here. That is at a time when everything is being
cut back, I just cannot imagine the internal bureaucratic
budget struggles that you had to go through to get this budget.
But here we are with everything being threatened, and our
veterans are moving forward. Not only in this budget but in the
advance appropriations budget.
So to say we are leaving veterans twisting in the wind is
just not true. You are here to say, as you have in the budget,
that we are moving forward. Yes, we have problems. I mean, we
know it, you know it, we go back and forth on how best to
resolve them whether it is the backlog, or mental health care,
or homelessness. But there is no twisting in the wind here. We
recognize the problems. We acknowledge them and we are moving
forward on them. And this budget shows that you are moving
forward.
It does not go as far as the independent budget goes. But
in this context of incredible cutbacks, Mr. Secretary, I think
you have done a great job here to keep the veterans of this
country moving forward. Thank you.
[The prepared statement of Hon. Filner appears in the
Appendix]
The Chairman. And now I would like to welcome the first
panel that will be speaking with us today. We have got the
Honorable Eric Shinseki, Secretary of the U.S. Department of
Veterans Affairs. And he is accompanied, and I will just read
their name, and Mr. Secretary, I do not know if you are going
to further introduce them in your opening statement or not. But
Dr. Robert Petzel, Under Secretary for Health; Honorable
Allison Hickey, Under Secretary for Benefits; Honorable Steven
Muro, Under Secretary for Memorial Affairs; Honorable Roger
Baker, Assistant Secretary for IT; and finally W. Todd Grams,
the Executive in Charge for the Office of Management and Chief
Financial Officer. Mr. Secretary, your complete written
statement as usual will be entered in the record and you are
recognized for five minutes.
STATEMENT OF HONORABLE ERIC K. SHINSEKI, SECRETARY, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY ROBERT A.
PETZEL, M.D., UNDER SECRETARY FOR HEALTH, VETERANS HEALTH
ADMINISTRATION; GENERAL ALLISON A. HICKEY, UNDER SECRETARY FOR
BENEFITS, VETERANS BENEFITS ADMINISTRATION; MR. STEVE L. MURO,
UNDER SECRETARY FOR MEMORIAL AFFAIRS, NATIONAL CEMETERY
ADMINISTRATION; HONORABLE ROGER W. BAKER, ASSISTANT SECRETARY
FOR INFORMATION AND TECHNOLOGY, U.S. DEPARTMENT OF VETERANS
AFFAIRS; MR. W. TODD GRAMS, EXECUTIVE IN CHARGE FOR THE OFFICE
OF MANAGEMENT AND CHIEF FINANCIAL OFFICER, U.S. DEPARTMENT OF
VETERANS AFFAIRS
STATEMENT OF HON. ERIC K. SHINSEKI
Secretary Shinseki. Thank you, Chairman Miller, Ranking
Member Filner, distinguished Members of the Committee. Thank
you for this opportunity to present the President's 2013 budget
and 2014 advance appropriations requests for the Department of
Veterans Affairs.
This Committee has a long history of strong support for our
Nation's veterans. I have certainly witnessed that over the
past three budgets which I have been present for. The President
has demonstrated his respect and his sense of obligation for
our 22 million veterans by sending the Congress yet again
another strong budget request for Veterans Affairs. I thank the
Members for your unwavering support, and I seek your support,
continued support, on this budget request.
I would also like to acknowledge the representatives from
our veterans service organizations who are present this
morning. Their insights are always helpful as VA develops
resources and strives to constantly improve our programs. Mr.
Chairman, thank you for introducing the Members of the panel
here. I would just point out that to my left is Roger Baker,
Assistant Secretary for Information Technology. Then Mr. Todd
Grams to my immediate left. Dr. Petzel to my immediate right.
General Hickey to his right, and then the Honorable Steve Muro.
And thank you for allowing my written statement to be submitted
for the record.
This hearing occurs at an important moment in our Nation's
history. I am old enough to have experienced our return from
Vietnam and to have witnessed the end of the Cold War. We are
again in another period of transition. Our troops have returned
home from Iraq. Their numbers in Afghanistan are likely to
decline over time. Our history also suggests that VA's
requirements from these two operations will continue to grow
long after the last combatant leaves Afghanistan, perhaps
another decade or more. We must provide access to quality care,
timely benefits and services, and job opportunities for all
generations of veterans. They have all earned it.
In the next five years it is estimated that more than a
million veterans are expected to leave military service, a
generation that has come to rely on VA at unprecedented levels.
Through September, 2011 of the approximately 1.4 million
veterans who deployed to and returned from Operations Enduring
Freedom and Iraqi Freedom, 67 percent have used some VA benefit
or service, a far higher percentage than those from previous
wars. The 2013 budget request would allow VA to fulfill the
requirements of our mission: health care for 8.8 million
enrolled veterans; compensation and pension benefits for nearly
4.2 million veterans, about 10 percent of whom are 100 percent
disabled; life insurance covering 7.1 million active duty
servicemembers and enrolled veterans at a 95 percent customer
satisfaction rating; educational assistance for over 1 million
veterans and family members on over 6,500 campuses; home
mortgages that guarantee over 1.5 million servicemember and
veteran loans with the Nation's lowest foreclosure rate; burial
honors for nearly 120,000 heroes and eligible family members in
our 131 national cemeteries, befitting their service to our
Nation.
The 2013 budget request continues the momentum of our three
priorities: increasing access to care, benefits, and services;
eliminating the claims backlog; and ending veterans
homelessness, through effective, efficient, and accountable use
of the resources you and the Congress provide.
Access encompasses VA's facilities, programs and
technology. This 2013 budget request allows VA to continue
improving access by opening new or improved facilities closer
to where veterans live and by providing telehealth including in
veterans' homes; by fundamentally transforming veterans' access
to VA benefits through a new electronic tool called the
Veterans Relationship Management System; by collaborating with
the Department of Defense to turn the current Transition
Assistance Program, TAP, into an outcomes-based training and
education program that fully prepares departing servicemembers
for the next phase of their lives; and by establishing a
national cemetery presence in eight rural areas and better
serving rural and women veterans.
We know that more than a million veterans will leave the
military over the next five years. Potentially all will enroll
in VA and over 600,000 of them will likely seek care and
benefits and services from VA in the out years. From what we
know, fiscal year 2013 will be the first year in which our
claims production, that is the number of claims going out the
door, will exceed our incoming claims. For that reason the
paperless initiative we have been building over the past two
years is critical to reversing years of backlog growth and we
must not falter here. We must not hesitate. There is no turning
back. We must protect stability in IT funding. It is critical
to solving this issue we have been wrestling with.
From January, 2010 to January, 2011 alone, the estimated
number of homeless veterans declined by 12 percent, from 76,300
to 67,500 on any given night. This downward trend must
continue. Much remains to be done to end veterans homelessness
in 2015. We are now developing a dynamic homeless veterans
registry which contains over 400,000 names of current and
formerly homeless veterans, allowing us to better see, track,
and understand the causes of veterans homelessness. In the
years ahead, this information will help us to more effectively
prevent it, not just for veterans, but perhaps for other
communities as well. We look to develop more visibility of the
``at-risk'' veteran population in order to prevent veterans
from falling into homelessness, and this budget supports that
plan.
We are committed to the responsible use of the resources
you provide through the 2013 budget and 2014 advance
appropriations request that you will consider.
Again, thank you Mr. Chairman for this opportunity to
appear before this Committee, and to all the Members as well.
Thank you for your continued, unwavering support. We look
forward to your questions.
[The prepared statement of Hon. Shinseki appears in the
Appendix]
The Chairman. Thank you very much, Mr. Secretary, again for
your testimony. And I and the Ranking Member again want to say
thank you for the diligent work that you and your team has done
in a very austere time in bringing additional funds to our
veteran population.
I would like to go back if I could, the budget states that
as a result of reassessments to resource requirements for
health care services, long term care, and other programs, the
estimates for these programs are now substantially lower than
what was included in last year's budget submission, which was
the basis for the Congress providing funds to the VA. In fact
the revised estimate suggests that Congress provided nearly $3
billion more than the administration needed in fiscal year
2012, and roughly $2 billion more than was needed in the 2013
advance appropriation. So my question, I guess I have got two
questions. One is when did VA conduct the reassessment and
communicate its findings to Congress? And number two, it is a
significant amount of funds. I think we would all be interested
in knowing exactly how this money was reinvested.
Secretary Shinseki. A fair question, Mr. Chairman. Let me
just offer that the budgeting process is a series of estimates
that get refined over time until we submit the final budget.
They are based on actuarial projections to create that
estimate. Sometimes the advance appropriation request
incorporates data that gets refined as we get closer to
submitting the actual budget itself, as we are doing here in
2013.
Most current estimates of utilization intensity,
unemployment, inflation, long term care, and CHAMPVA
requirements are things that influence that budget estimate,
that modeling process. How much change occurred? About $1.9
billion to about $2 billion. Those dollars have been reinvested
in homelessness, activations, new models of care, expanded
access, caregivers, and improved mental health. As to the
process, the timing by which we would provide this notification
to the Congress, this would be the appropriate time. It is in
the submission of the budget that we acknowledge we had an
adjustment to the model and we have reinvested the money in
this fashion. And so this would ordinarily be the appropriate
time for that notification.
The Chairman. And your number is more at the $2 billion
range?
Secretary Shinseki. I say $2 billion. I think the number is
like $1.995 billion. So $2 billion, I think, is a fair round
off.
The Chairman. In the current budget submission it has $1
billion for a Veterans Job Corps. We all are keenly aware of
the high number of unemployed veterans in our country today and
not a single Member of this Committee nor this Congress should
be in any way satisfied with that number. And we have tried to
do things in this Committee to help bring those numbers down.
My concern is that there is no detail in the budget submission.
You know, where did the number $1 billion come from? You know,
it was chosen to be provided in your entitlement accounts to be
dispensed I think over a five-year period. And so I think we
would all benefit from a conversation, Mr. Secretary, as to who
it is going to be focused on, what area of the veteran
population? How is it going to work? And what will happen to
these jobs once the funds run out?
Secretary Shinseki. Mr. Chairman, the proposal for the
Veterans Job Corps, the $1 billion piece of that is a program
that we are seeking congressional authorization on. We are
putting together the details of that, which we would provide to
you, and you would have a chance to review.
I would say that the intent here is to put up to 20,000
back to work over the next five years on projects that will
restore and protect our public lands. Projects would be in
national parks, forests, on rivers, trails, wildlife refuges,
national monuments, and other public lands. Veterans could work
on park maintenance projects, patrolling public lands,
rehabilitating natural and recreational areas, and in
administrative, technical, and law enforcement related
activities.
The Veterans Job Corps program is a project that is going
to be coordinated with other departments and we are sort of an
oversight of the distribution of funds. There are others who
will be participating. I am told, and I am confident that VA
resources will not be diverted to fund this $1 billion, that it
will come from elsewhere. I do not know exactly where at the
moment, but Mr. Chairman I will share that with you as soon as
we have final details.
The Chairman. Thank you. Mr. Filner?
Mr. Filner. Thank you, Mr. Secretary. And I just want to
focus on a couple of areas that I have been involved with over
the years. One is the claims backlog. In your budget
presentation you title it eliminate the claims backlog. I do
not see any real estimate, or projection, or anything of when
you think you are going to do that. But I still think that in
the short run at least to get this turned around your notion
of, I think you used the word brute force a few years ago if I
recall that----
Secretary Shinseki. Probably a poor choice of words----
Mr. Filner. Well no, it was okay, it was good. It gives me
something to shoot at, very nice. So. I do not think it is
going to work. I just think all of this stuff you have is good
stuff, but it is too big. And you know, as you point out there
are all kinds of factors making it bigger. I still think you
have to take some radical steps in the short run. Whether it is
to grant all of the Agent Orange claims that have been
submitted or have been there for more than, I do not know, X
number of years. Or as I suggested at other times, all claims
that have the medical information and have been submitted with
the help of a veterans service officer you accept subject to
audit. Unless you take some real radical step to eliminate a
million of them, or 500,000 of them, you are never going to get
there. It is just going to always be there. You do not want
that as your legacy, I do not think. Nor do we.
You are going to have to take some really strong step in
terms of accepting stuff that has been in the pipeline a long
time. Again, that has adequate, by whatever definition,
documentation and professional support. Plus, this incredible
situation of Agent Orange. Where, as you know, not only have
those claims increased but we are talking about, as you well
know, your comrades for 30 or more years that have been
wrestling with this. Let us give the Vietnam vets some peace.
Let us give them a real welcome home. Let us grant those Agent
Orange claims. Get those, whatever it is, if it is 100,000 or
200,000 of our backlog, just get them off the books.
I do not know if you want to comment on that, but I still
think you are never going to get there with, you know, all this
is good stuff. I mean, we have talked about it on many
occasions. But it is not going to fundamentally, or at least in
the short run, change it around so you can get to a base level
of zero, or wherever you want to be, and move forward from
there.
Secretary Shinseki. Mr. Filner, I will call on Secretary
Hickey for the final details. We have pretty much worked
through the increase in Agent Orange claims. I think we are
well down on the number and I will rely on her statistics here.
I would say, you and I have discussed the IRS-like model
several times. We have looked at it and we continue to look at
it. We continue to look for aspects of it that we can use. So
it is not an either, or, as in it is either the IRS model or
not. We have seen goodness in it and we have taken pieces of
it. What concerns us about the IRS model is that it shifts the
burden for submitting a complete, accurate claim to the
veteran. It is shifted entirely to the veteran. Unlike today
where the VA has a duty to assist, and that is what we do.
We have taken pieces of the model. Online claims submission
using a Turbo Tax-like form. We are moving towards a paperless
IT claims technology, which is the foundation for IRS. We are
on the verge of achieving that this summer. We have created
segmented lanes where claims are categorized as easy, moderate,
or difficult and they get processed much more efficiently that
way.
So we have looked at the IRS model and taken what is good
from it. I think we are on the verge of revolutionizing the way
we process claims. We ought to go through with fielding this
automation tool, that we have been building for two years and
get the results from it.
Mr. Filner. Okay. I do not think you will revolutionize it.
I think you may evolutionize it. But it is going to take longer
than you and I are alive.
By the way, to use as a reason that this shifts the burden
to the veterans is a beside the real point. I would drop that
as one of your opposition points. Because we are not saying
that. You are saying, ``Oh, the poor veteran has this stuff and
our bureaucracy wants to help.'' Come on, the problem is the
bureaucracy, not the veteran. And to say, ``Oh, now we are
shifting it more.'' We are not. We are saying we accept the
claim that you have, assuming it was done with, again,
professional help. And our duty to assist is to accept it
subject to audit. I think it is a little bit disingenuous to
say that, ``Oh, the poor veteran now, my plan shifts all the
burden to him.'' It does not. It does nothing of the sort. It
puts all the burden on the bureaucracy to say, ``Yeah, we are
going to accept that,'' rather than go through a year, or two
years, or five years of putting the veteran under such
incredible tension from bureaucratic kinds of demands that it
is, I mean it is probably worse than the original claim.
Just one last point, if I may Mr. Chairman, I will be very
brief. As you know I have, and you have it in your testimony,
about women's veterans that I do not think you had time to do
in your oral testimony. And I applaud you on that. The House
passed a bill that I had put forward a year or two ago called a
Women Veterans' Bill of Rights. It got through the House. It
got stuck in the Senate. I would just ask that you look at that
and you can do stuff administratively. You could post something
in each of our, you know, centers and clinics. We have a long
way to go on this.
But women veterans need to feel that this institution is
evolving to meet their needs. And a statement at the front door
of their rights I think would be very helpful. So I would just
ask you to look at that. We did not do it legislatively, but I
think you could do some stuff administratively.
Secretary Shinseki. Thank you, Mr. Filner. I will look at
that. Just as a point of information, I think in this budget
you will see that between 2012 and 2013 women veterans' issues
were increased in funding by 17 percent. If you go back to
2009, when you and I began discussions like this, between 2009
and this 2013 budget, women's issues funding has gone up 124
percent. If you include 2014, which is the advance
appropriation out there, it would be 158 percent. So I want to
assure you that this is not something that----
Mr. Filner. Right. I don't question the commitment or the
budget situation. You know, the average woman veteran who comes
to a VA center does not know all of those statistics, nor do
the men inside who may be catcalling, nor does the doctor who
will not see the woman because she has brought her kids that
she cannot get babysitting to. So it is a question of what is
going on at that front door, and how they perceive themselves,
and how the male veterans perceive them, and how the VA
perceives them. I do not question your budget stuff. I want a
more public and a cultural almost saying, ``We are going to
change this. And here is what you should expect. And here is
what all of us are going to work toward.'' Thank you, Mr.
Chairman.
The Chairman. Thank you. Colonel Johnson?
Mr. Johnson. Thank you, Mr. Chairman. And Mr. Secretary and
your team, thank you for being here this morning. My questions
are brief and I'll try to get through them quickly. Mr.
Secretary, how can the VA pursue effective procurement when you
still do not have an integrated financial system with which to
control the VA's spending? I mean, if you do not have a system
to track the VA's spending how can you account for what is
being spent?
Secretary Shinseki. Thank you, Congressman Johnson. I am
going to call on a couple of folks here to talk about
acquisition from their perspective. When we arrived three years
ago acquisition was being done in multiple places. We have
moved to centralizing acquisition now. The first step has been
an integrated model with the first step to integrate all of
VHA's activities in one account so there is visibility. Then
the decision will come here, once that is done and we are
running smoothly, about whether we go to the next step to
totally centralize acquisition in VA. That is a decision to be
made at the appropriate time.
Other evidence of what we have done in the area of
centralizing our acquisition efforts relates to the
centralization of IT, which we did quite a significant move in
a very short period of time. It took us a couple of years to
grow through that and because of that lesson we are taking a
more deliberate move in centralization of acquisition. But we
will get there.
Let me ask Dr. Petzel to talk about acquisition
centralization in VHA and then perhaps Mr. Baker to talk about
IT.
Mr. Johnson. Okay, I appreciate that. If you could keep
your answers short I appreciate that too, because I have got
several others and limited time. But that is okay.
Secretary Shinseki. Well we can provide it for the record,
if you wish.
Mr. Johnson. Okay. Go ahead, I will give you just a minute
or so.
Dr. Petzel. VHA, thank you Congressman Johnson, VHA spends
a large proportion of the money that VA has for acquisition. We
have centralized our acquisition activities within VHA, ensured
that everybody is certified and educated about their
responsibilities. I think most importantly we have developed
strategic purchasing groups to ensure that we are getting the
best price and that we have standardized the purchase of all of
the medical equipment that we have got. Artificial hips,
surgical gloves, suture material, all of the supplies, we want
to have a best price and we want to ensure that unless there is
a real good reason why not, that people are purchasing from
them.
Mr. Johnson. And I certainly commend that. My concern is
you are talking process. I am talking about an integrated
financial system with visibility from front to back. That is
what I see that is missing. And I will get to Mr. Baker in just
a second.
In the President's budget request he asks for $1 billion
for Veterans Jobs Corp. We have yet to see specific details
about the Jobs Corp or how these funds would be spent. How can
you expect Congress to support and fund a program with which we
have so little to no information?
Secretary Shinseki. Mr. Johnson, as I indicated earlier,
that plan is being finalized, it is being brought together. It
is a multi-department coordination effort over which VA has
oversight and as soon as we have that we will provide details.
Mr. Johnson. Do you have any idea when that is going to be,
Mr. Secretary?
Secretary Shinseki. I will give you a better answer when I
submit it for the record.
Mr. Johnson. Okay.
Secretary Shinseki. We are still in the process of bringing
that plan together.
Mr. Johnson. Okay. Mr. Baker, as you well know you and I
started our very first dialogue over a year ago talking about
an integrated systems architecture, a roadmap that shows where
you are and where you are going. And we are here a year later,
I still have not seen that. How can you justify a 6.9 percent
increase in IT spending when you do not know what you have got,
and you do not know where you are going?
Mr. Baker. Thank you, Congressman. I think two points on
that one and I will make them relatively quickly. About 80
percent of my budget is spent in the hospitals and in the
benefits offices providing direct support to the people who
serve veterans. And so as we look at that we have had
substantial growth in employees and in the cost of that
infrastructure. That is the main driver of the increase----
Mr. Johnson. All the more reason, absolutely. I agree with
you. But all the more reason why an integrated architecture is
so vitally important. Because in any IT environment, as you and
I well know, 75 percent of the life cycle costs is in O&M,
supporting and managing those systems to do that kind of thing.
The better you do at managing that architecture, integrating
the systems, and finding cost efficiencies the lower that O&M
cost is. That is exactly--you are making my case for why I am
asking for a systems architecture.
Mr. Baker. And as you are aware, Congressman, I think we
have made improvements since the May hearing. Most importantly
to us, we now have a chief architect who gets it. He came up
and met with your staff, we have delivered three CDs, and
actually I understand you may take some time to go through
those.
Mr. Johnson. I just got those last night. So I have not
gone through them yet but I can assure you that I will.
Mr. Baker. We appreciate the input. I think you will find
it is better than it was last May. It is not where either of us
would like it to be. But we are making progress on that. I in
no way disagree with you. As we talked last May, in a swamp
full of alligators we might choose different paths through
that. But we are working on architecture and we appreciate your
input.
Mr. Johnson. Okay. Mr. Chairman, I yield back.
The Chairman. Thank you very much. Ms. Brown?
Ms. Brown. Thank you, Mr. Chairman. Mr. Secretary, first of
all let me thank you for your service. This Committee has
always been very bipartisan and we have always worked very
closely to provide benefits to the veterans. And I probably
have been on this Committee longer than any other Member except
the Ranking Member, and we really came on at the same time. His
name just came before mine. So I have been on this Committee
for over 20 years. I do not know how they did that. Maybe we
was elected minutes apart, or something.
Anyway, the point I am trying to make is I think it is
sometime important to have some institutional memory, and I
have it for this Committee. And I do know that I have
participated in conferences after conferences over the years,
and I want to thank, you know, a lot of times people ask,
``Well, what have we done for the veterans?'' Before 2009 we
did not have forwarding budget. We didn't have, you know,
everybody wants more. But for the first time we had stability
when we had this President, President Barack Obama. And the
budget that we put forth. And I know most people in this room
may not remember that, but I have been in every conference and
I know how all of us talked the talk, but was not prepared to
walk the walk. And so when we have these little fights up here
I am confident that the veterans are not going to participate
with some of the things that have been proposed. So I am very
grateful. And I do know that you have a very difficult job.
Let me, you know, when we sit here and we know that we are
stepping down as far as the military is concerned, and so a lot
more veterans will be coming back to the community, clearly the
Job Corps, working with the communities, working with the
mayors, I met with my Mayor last week. We have an unemployment
rate of close to 30 percent with the veterans. So we need to do
all we can. Because lack of employment leads to suicides, the
mental health services. So you have a very tough job. And I am
happy to be able to work with you in the forwarding budget
process.
I want to know, do you have all of the tools you need
necessary? Because I have been working with the different
hospitals around the country. And I want to make sure that they
can get all of the equipment, that you have all of what you
need. I understand the forwarding budget, we have it. But do we
have it to make sure that the hospitals and the different
facilities get the equipment that they need?
Secretary Shinseki. Thank you, Congresswoman Brown. This
budget is adequate to meet our requirements for veterans in
2013. The 2014 advance appropriations gives us that first
strong step in submitting an even stronger budget for year
2014.
This budget is a 10.5 percent increase over the last budget
at a time when other departments are being tasked mightily. The
President has been very supportive of veterans. That 10.5
percent increase is split between mandatory, mandatory is
actually a 16.2 percent increase and discretionary, about 4.5
percent. Each of those pieces of our budget is strong enough to
support our requirements. This budget helps us meet our
obligations to veterans.
Ms. Brown. On the homeless can you give us a, I mean, that
is, you know, you have done a yeoman's job. We have been
talking about it for a long time. One-third still of the people
that are on the street are veterans that have not been able to
get the assistance that they need. What are you doing, the
department, to, I mean, to increase what you are doing?
Secretary Shinseki. Congresswoman, I am going to call on
Dr. Petzel in just a second, because in the execution of our
homeless programs, I have pinned the rose on VHA because it is
our largest administration. VHA goes to all of the communities:
with 152 hospitals; 800 community-based outpatient clinics; and
300 vet centers. They are out there and they touch our
communities in ways no other administration does. Our success
over the last three years has been to establish a partnership
from our national headquarters level all the way down through
VHA's medical facilities, and out into those communities so
that the organizers in those communities, the Catholic
Charities, the Volunteers of America, the Salvation Army,
Swords to Plowshares, all of those great folks that, as I have
said for years now, are creative geniuses when it comes to
dealing with the homeless because they have done so much with
so little for so many years. We are putting resources out of
VA, through VHA, the health care system, and reaching out to
those community organizers.
Ms. Brown. Are we partnering with them?
Secretary Shinseki. I am sorry?
Ms. Brown. Are we partnering----
Secretary Shinseki. We are absolutely partnering with them.
Every local medical center director and CBOC director is in
dialogue with those individuals. We tried not to take a cookie
cutter approach to this so that we could adjust that
arrangement by community, and fit into what the community
needed.
Ms. Brown. Thank you. And I hope we have another round
because I want to talk some more about Job Corps. Because maybe
some of the Members have some bright ideas about what we can do
to assist with the veterans unemployment. Because that is a
crucial problem throughout the country. Unemployment is
extremely high but veterans unemployment is unacceptable. And
Job Corps is one way that we could partner with the
communities. But you know, I am sure we have some geniuses who
can help work with the VA to help come up with some proposals
as to what we could do to help. Thank you. I yield back the
balance of my time.
The Chairman. Thank you very much, Ms. Brown. With your
fine last statement you got Mr. Filner's, something about
exceptional genius. You got his attention. Dr. Roe?
Mr. Roe. I thank you Mr. Chairman. And to General Shinseki,
again thank you for your service, not only to the military, but
to the Veterans' Affairs Committee and to the Veterans
Administration. I am going to carry on with what Congresswoman
Brown was talking about homelessness. That has become a real
passion of mine. And one of the problems we found out when you
peel the onion back and get down to the weeds, the VA seems to
be a little slow in moving. Not the VA, but the local people
need more vouchers. It is a catch-22 because the VA is so
paternalistic that they will not turf out the case workers so
that we can have maybe a caseworker that is not a VA employee.
This creates a problem because when you hit the maximum number
of people that one caseworker can take care of the vouchers
stop. In my district, we have a need for a number of more
vouchers. We can put a lot more people in homes, and every
night you do not do that somebody is outside. Is there a way
that we can speed up the hiring of the caseworkers, or turf
that out so we can get these veterans off? We've got the
vouchers. We've got the need. We've got the houses. We just are
not able to get the veterans in there because of this little
snafu.
Secretary Shinseki. Congressman, this is a good point. You
know that the vouchers go through HUD----
Mr. Roe. I do know that.
Secretary Shinseki. --they go through the public housing
authorities. What we had not been doing, and I think you are
referring back here to some recent history, HUD decides where
those vouchers go. We recommend, but the final call is made by
HUD. We found that that decision is made, say in May, and then
we are now running to go hire case managers in those locations.
What we have worked out with HUD is when we give our
recommendation it is a pretty educated guess on where the
issues are. We would appreciate it if HUD would give those
locations the strongest consideration. If HUD will do that,
then we can use the six or seven months while they are doing
their final analysis, to go ahead and start hiring case
managers. That is the model that we are now moving to.
Mr. Roe. Okay. Well let me just walk you down to where I am
with it. We have got a great relationship with the regional HUD
office in Knoxville, Tennessee. We have talked to them. We know
the people on a first name basis because we are trying to
shorten that. Also, there is still a bottle neck on the case
workers at the local Mountain Home. So I hope that will work
because it is leaving veterans outside when we could get them
inside.
Secretary Shinseki. Right.
Mr. Roe. We have the shelters.
Secretary Shinseki. I will go look at that specific case.
It had come up elsewhere and we thought this was the fix. We
have been able to hire case managers in advance of the
allocation of the HUD vouchers.
Mr. Roe. And if we do not do that, is there a way that the
VA can be flexible enough to allow other--we will bring you
some ideas because I do not want to----
Secretary Shinseki. We will be happy to work with you on
that.
Mr. Roe. Ms. Brown is right. The second thing I want to
talk about briefly and then we will move on is the mental
health issue. When you have a situation where more veterans are
dying of suicide than combat then we have a huge problem in
this country. And one of the things I hear from local veterans
about at home is, that they were with individual therapy with a
psychiatrist or with a specialist in mental health, and now
they are in larger groups. That does not seem for some of them
to work as well. Is that just a manpower issue? I know Mr.
Michaud has talked about this, I have heard him and Mr. Walz
both talk about this on numerous occasions. It is being brought
up to me a lot of places I go that these needs probably are not
being met as well in a large group setting. Are there resources
in this budget to help alleviate that?
Secretary Shinseki. Just very quickly, Congressman, there
is a 5 percent increase between 2012 and 2013 in the budget.
But if you look at where we started in 2009 to the 2013 budget
the increase is 39 percent. If you look out to 2014, the
increase in resources is 45 percent, and that is the firepower
for us to go out and hire people.
Mr. Roe. Okay. But it is not getting chewed up by the
bureaucracy, though? And it is getting down to the veteran? Are
we just getting bigger up here at the VA, but not actually
getting the resources down to a veteran where he or she can
talk to a person and not in a group setting?
Secretary Shinseki. I am going to call on Dr. Petzel to
give you the numbers here. But it is not being captured in
the----
Mr. Roe. Thank you.
Dr. Petzel. Thank you, Mr. Secretary. Congressman Roe, the
money is being distributed down into the field. As the
Secretary mentioned we have poured a tremendous amount of
resources over the last three years into mental health
professionals and now stand at a point where we have 20,500
clinical professionals, psychiatrists, psychologists,
psychiatric social workers, etcetera.
The question is, I think, is that sufficient? This is what
you are asking. And the sufficiency of that depends on three
things. One, do we have enough people out there? Have we given
enough resources to hire enough people? Two, are those people
being hired? That is, are we filling vacancies as rapidly as we
can? And three, are we getting the kind of appropriate
productivity out of those people?
We have some of the same questions that you have. And to
that end, we are site visiting every single one of our 152
medical centers with a mental health team to evaluate the
staffing, the access that veterans have, and to assess whether
additional resources are needed. If that is not found to be the
case, we will provide them.
Mr. Roe. I thank you, and I thank the Chairman. I yield
back.
Ms. Brown. Mr. Chairman? Before you go to the next person,
can I have a follow up question on that, mental health?
The Chairman. Yes, ma'am.
Ms. Brown. Sir, I have a question. You said that we are,
can we hire? Are we not, are we trying to hire all of those
people? Or are we working with other agencies as far as
subcontracting out? Because if we, we are not going to be able
to hire enough people. He talked about the group setting. Some
people can benefit from the group setting. But everybody do not
need that one on one, but some people do. So we cannot, based
on the resources how can we better utilize the dollars to meet
the needs?
Dr. Petzel. Thank you, Congresswoman Brown. We do contract
in the community. We do provide mental health on a fee basis
non-VA care. And as the Secretary was just pointing out to me,
a new modality that is becoming increasingly important is
telemental health. Where we provide both evaluation and therapy
in a telehealth setting, where the patient may be remotely, 100
miles away. They are on a television screen with an appropriate
supervisor, and the psychiatrist or psychologist is back at a
larger medical center. It has been very successful in treating
PTSD and other mental health disorders. And I think that this
is going to become a more common practice as we move forward.
Ms. Brown. Well, thank you. I sure would like to review
that. Because I am a hands on, touching person, and I cannot do
it over the television. But maybe I can see how it works.
Dr. Petzel. Okay.
Ms. Brown. Thank you.
The Chairman. Mr. Michaud?
Mr. Michaud. Thank you very much, Mr. Chairman. And thank
you, Mr. Secretary, for coming down. Three questions, the first
one is at the time we passed advance appropriation for the VA,
my concern was what was going to happen on the IT side,
particularly where health, they are building buildings and IT
is delayed. Has that caused a problem so far within the system?
Is my first question.
My second question is many states have a prescription
monitor program to help address the growing problems of
prescription drug abuse. And as of now the VA doesn't report
data in those programs in different states, which leaves an
information gap for the people who are trying to address the
problem. In light of the VA's commitment to deal with the
substance abuse in a better integrated way, are you willing to
work with states to provide that data to the states?
And my third question is, it is my understanding that an
RFP for the PC3s will be issued sometime in March or April. I
am concerned that the VA may not be moving, or they are moving
ahead without a well thought out strategy or vision for the
PC3s. Can you explain what your expectations are for the PC3s?
And are you going to work or incorporate some of the ideas,
well we have done pilot programs under the HERO program, are
you going to incorporate some of those particular ideas as
well?
Secretary Shinseki. Mr. Michaud, I will take the first
question, and ask Dr. Petzel to take number two, and Secretary
Baker to take the third one.
As Members of this Committee will recall, IT used to be
distributed throughout VA. With encouragement from this
Committee and by the will of our leadership, we centralized the
IT programs under a single office. That is our Office of
Information and Technology under Secretary Baker.
So we did this and it was the right decision. It took us a
while to get it done, but we collapsed all of IT into a single
office.
Then subsequently we were given this wonderful mechanism
that you all provided us called advance appropriations. When
advance appropriations came on it allowed for our health care
system to have a two-year budget process, really almost a
continuous budget program because of a two-year submission
every year.
In advance appropriations you give us approval for medical
services, medical facilities, and medical compliance and
support programs. When you give us approval on medical
facilities, that is hospitals and community-based outpatient
clinics. And so we have authority to expend dollars and stand
those facilities up except for medical IT which is captured
over here in the IT budget. We are then a bit desynchronized.
It becomes most obvious in a year when we have a continuing
resolution. So from October we are executing our health care
budget but if it is as late as April, as it was last year, it
is not until April that we can release the IT funding to then
catch up with those facilities. We are a little desynchronized
and I am looking for ways to try to solve that.
Another downside is the IT budget perhaps looks bigger than
it needs to be. Therefore when there are decisions being made
about whether or not this budget, IT budget, can be executed,
as happened last year, we lost $300 million of IT funding which
was in the IT account but really belonged over to health care.
We are looking for ways to try to resolve this issue. With
that, Dr. Petzel?
Dr. Petzel. Thank you, Mr. Secretary. Congressman Michaud,
we are very interested in the monitoring program. And by law we
have been unable to participate up to date. My understanding is
there is legislation in the offing to make it possible for us
to do that and we will be a delightful participant in that
program. I think it is very, very important for veterans and
for the community at large.
Mr. Baker. Thank you, Congressman. Two points for you, and
I really appreciate your question related to the tie to health
care. Because as I commented earlier about 80 percent of what
my organization does is directly in those hospitals and helping
support veterans.
I want to make sure we are going to answer your question
right. When you said PC3s, my thinking was you were asking
about our acquisition about desktop computers? With that----
Mr. Michaud. No, sorry. No, the patient centered community
care.
Mr. Baker. We will let Dr. Petzel have that one instead of
me.
Mr. Michaud. Okay.
Dr. Petzel. Thank you, Roger. That is mine. And you are
referring to our PACT program, the patient accountable care
teams. This is the central feature of a cultural transformation
that is occurring within our delivery system. Patient
centeredness, team care, continuous improvement, data driven,
evidence based, providing value and a population component, and
prevention component to what it is doing. And we do want to
incorporate those things into the community projects that we
are involved in, such as ARCH and such as Project HERO.
Absolutely.
Mr. Michaud. So you intent to incorporate what you learned
from those two programs into the----
Dr. Petzel. We absolutely do.
Mr. Michaud. Thank you. Thank you, Mr. Chairman.
The Chairman. Mr. Turner? You are recognized.
Mr. Turner. Thank you, Mr. Chairman. The complexities of
this budget are such, maybe you could just help me shed a
little light on what efforts will be made to help veterans
secure mortgages? And I know the VOW Act is now kicked in. Can
you let me know, or let us know, how any of the efforts to help
veterans get capital for business start ups have taken effect?
Thank you.
Secretary Shinseki. Thank you, Congressman. Let me call on
Secretary Hickey to address the mortgage piece of this.
General Hickey. Thank you, Congressman for your question.
VA's loan program has been very active. In fact, for 14
quarters now we have shown the Nation how to keep from having
seriously delinquent loans. We have in fact, over the last year
alone, kept 73,000 veterans and their family members in their
homes. We see that as a homelessness prevention program. This
is not something we just serve our veterans for. In fact, we
serve our servicemembers quite heavily as well, and we engage
with them in the same respects.
From a home loan perspective, moving forward we see an
increase in the demand for home loans for our veterans and
servicemembers, and we are responding in kind and have some
good results associated with that.
Mr. Turner. Do you have any numbers?
General Hickey. I do, sir. The total number of loans that
we have to date for 2011, is 357,594 VA home loans. I would
also share with you that though we help and assist our veterans
and servicemembers with VA loans, we are also very actively
engaged with those who choose not to use a VA loan and use
another loan. We are happy to work with them when they find
themselves in trouble and help to act on their behalf to keep
them in their home and keep them solvent in their family
environment.
Mr. Turner. Thank you. Any comment on the efficacy of the
VOW Act in regard to business loans?
General Hickey. So sir, I can take that. Specifically for
business loans, what I would offer you, under VOW certainly are
the tax credits that are provided in the provision of the law.
Certainly even better for those businesses that choose to hire
our disabled veterans who have been out of work for a while. So
we encourage that. We do provide resources to help educate and
provide employment opportunities for our veterans.
Specifically, since 1 October last year, we have also added to
the Post 9/11 G.I. Bill education through four-year degree
programs, the opportunities to participate in non-degree
programs, and we have a full 8,000 veterans who are using their
G.I. Bill benefit to do that today. So I would say that is the
active part of that piece of the discussion that we are
involved and engaged in with our veterans.
Mr. Turner. Thank you. I yield back.
Mr. Miller. Sergeant Major? Mr. Walz?
Mr. Walz. Thank you, Mr. Chairman. Thank you, Mr. Secretary
and to your team for the work you have done. As a veteran I can
say I am proud of the work you are doing and the care you are
extending to our veterans. Also, thank you to everyone else who
is here today. This is certainly a team effort, as you well
know. The second panel that will be speaking are unwavering
supporters of our VA but always they can be our harshest
critics, as they should be. And so I am very proud of the work
that we have all done. I often say this is, this seems to me
many times to be the most positive place on Capitol Hill. It is
about coming together, working together across the aisle to
find solutions. So I am very appreciative of that. And I also
think maybe, I see a lot of folks around today with our purple
lanyards on. A lot of your employees that are out there in like
the Minneapolis VA and those things. I go a lot of times to
visit our warriors but there is an awful lot of heroes in the
likes of yourself and your team that have served in uniform
too, so thank you for that.
I would also associate, I know the Chairman started out,
and I too express my concern with sequestration is simply bad.
It is a failure of this Congress. It, the Constitution is very
clear about tasking us to make the hard decisions to cut
programs and eliminate them if they are not working, but to
make sure we are funding those that are working. So I am deeply
concerned with sequestration, too, trying to see how this works
out. The silver lining might be though, and I don't know, I
would ask again, if there, what attempts are being made during
this where DoD is going through trying to understand what
sequestration means or whatever? Is it another opportunity for
us to try and look at collaboration? I know when you do this
budgeting, or are budgeting of DoD and VA the separate silos
again? Or how are we getting that seamless transition? I know
it is a broad question but I am always trying to figure out if
there is a way to merge those two.
Secretary Shinseki. Well Congressman, I assure you that
there is lots of effort between both the Secretary of Defense
and myself to bring our two large departments together. It is a
constant dialogue between us, as it was with Secretary Gates. I
met with Secretary Gates I think four times in the last five
months of his tenure as Secretary, so I can tell you how much
energy and importance he gave to it. I have met with Secretary
Panetta several times now. We will be meeting again on the
27th, working through the issues that are common to both of us
which are about young men and women in uniform, and veterans,
one and the same. So how do we create that seamless transition
we are all looking for?
Much of it has to be electronic and that is why I push so
hard to protect what we have set aside here in the IT budget. I
just want to assure you it is a solid relationship. There are
still warts on it, and things we need to work through, but we
now have an integrated agreement on an integrated electronic
health record.
Mr. Walz. That is great.
Secretary Shinseki. It has taken us about three years
actually two years, to get here with a joint, common, open
architecture platform that we are both now putting our thoughts
together on how to build. Hopefully in the near future this
thing will be fielded.
Mr. Walz. No, I am certainly glad to hear that and I know
the commitments there. But I think all of us know it will end
up being better care for our veterans, and the plus side is it
will save us money. I think that is trying to get the
efficiencies out of government.
I would just end with, I know we have got a lot of folks
who want to ask questions, Mr. Chairman, but I could not agree
more on this issue of synchronizing IT back over to the advance
appropriations. And I would say, Mr. Chairman, and tell my
colleagues, Representative Betty McCollum has been working on
this. She and I have been working together to put something
forward. I think this can be done as a rule change or something
out of this Committee to allow for that to happen. Because the
fact of the matter is we can build a new hospital and put in a
wonderful x-ray machine but we cannot coordinate the transfer
of those files and the infrastructure that, it would be the
equivalent now if the plumbing was not part of the advance
funding on that hospital and you could not put the plumbing in
the building. I mean, that is how integrated IT is. And it is
just simply an antiquated piece of legislation, in my opinion.
I think you guys can do it better. And again, I would make the
argument if we do it on the front end and we plan accordingly,
I think we will save money as well as integrating.
So that piece is out there. We are working on it. Your
folks have been very good about articulating that to us. So
with that, again, thank you. We will continue to go through the
budget. But I too would echo my sentiments that in a very, very
difficult budgeting time we cannot forsake our veterans. We
must make those hard choices and I think this budget is doing
that. So I thank you. Mr. Chairman?
The Chairman. Mr. Runyan?
Mr. Runyan. Thank you, Mr. Chairman. And I want to kind of
roll out with Congressman Walz was saying, about integrating.
Because I applaud you, Secretary Shinseki, because every time
we talk to you we talk about accountability. One of the biggest
issues I think here, and I know we have had conversations,
there are about 300,000 people in the Veterans Administration,
correct? Sometimes I question the ability of how long your
tentacles are to get that down into this administration.
Because at the end of the day, we have the conversations here
in these Committees. We all agree that we want, our purpose is
to take care of veterans. And how we are going to do that
within this Committee is dedicating funds for that. But if
people are not being held accountable in the administration,
and they are there using money that is there to benefit
veterans, I think is one of the biggest oversights, and a big
thing we have to do in oversight here in this Committee is to
do that and to force that down.
And the two points I want to raise on that, and they are
not budget related, but in the end of the day they are budget
related because it does not allow the money to get down, and we
have had several hearings on here about updating regulations to
current practices. Now we had the fiduciary hearing last week
about the same thing, which the regs have not been updated
since the seventies. Current, you know, and we are implementing
more and more procedures on outdated instructions and protocol
on how to do this. Times have changed.
And in that same process, and it goes right back to your
accountability aspect of it, you know, the metrics of how we do
this. I think the one metric that needs to be at the top of the
list every single time is customer satisfaction. And I think
that is what is missing in a lot of this. We all, every under
secretary has their numbers that they come out and talk about,
and we have the benchmarks that a lot of time in Congress we
put on you. But at the end of the day, is the customer
satisfied? Because that is what we hear day in and day out, and
that is what we are in the business to do.
And I think there is a lot when I go back to, you know, the
accountability and you being able to get down to the grassroots
level and actually, whether it is access to care, all that type
of stuff, we need to get there. And going back to what Ms.
Brown was saying, and talking about, and we talk about it
across the board, with veterans hiring preference in the VA. I
applaud you guys for that. But my one question, and I will take
it for the record and I will stop because I am pretty sure you
do not have the number on it, what is the retention, the
longevity of those veterans you actually do hire throughout
this process? Because I think that is a key issue as we move
forward. It is one thing to give them a job for six months.
They get frustrated, possibly, with the way this administration
works. And I think that is one thing we can clear up. Because
obviously in a constrained budget environment we are in, I do
not think there is enough money we can appropriate to take care
of veterans. But I think internally there is plenty of room
there that we have to take a serious look at, to make the
customer satisfaction the number one goal. And I think any
private industry in this country that does that well has a
great, great leader like yourself that can get down and sink
down to the grassroots level. And I would just appreciate a
comment if you do have any retention on veterans hiring
preference.
Secretary Shinseki. Yes, Mr. Runyan, you are right. I do
not have the longevity data here today, so I will be happy to
provide it for the record.
I just want to assure you that we want customer
satisfaction, we are a services organization. Customer
satisfaction in this kind of an organization ranks very high.
We make tremendous efforts to try to ensure that we are getting
a sense for what our veterans and eligible family members think
of our services.
Steve Muro here runs the largest cemetery system in the
country. Seventy-four percent of his workforce are veterans.
For the last ten years he has been the top customer
satisfaction entity in the country. That is not because we say
so, but the University of Michigan ACSI Customer Satisfaction
Index rates them above Lexus, above Google, above all the
others, hands down.
We are not quite up to his standard across the VA. But in
VHA our pharmaceutical effort has received both J.D. Powers as
well as Malcolm Baldrige recognitions. We have evidence where
we know how to do it right in some places, and you are right,
what we need to do is make sure that is uniform across the
board.
Mr. Runyan. Yeah, and I agree. And just to keep the
pressure on you, I mean customer satisfaction for a long time
was very high at Arlington Cemetery also and we see what we
have ended up there. So it is the due diligence of not only
your administration but this Committee to keep that up. And
with that, I yield back, Chairman.
The Chairman. Mr. McNerney?
Mr. McNerney. Thank you, Mr. Chairman. Thank you, Secretary
Shinseki and staff. I just want to say, I want to congratulate
you. Back home I am hearing from the veterans that this is not
the VA that was there ten years ago. The VA is responsive, it
is reaching out, it is getting things done. And I like to think
it has to do with the leadership of the group in front of us,
with the budget that has been increased over the last several
years, and with this Committee. So I want to congratulate
ourselves.
But there is still a tremendous amount to do. For example,
last week, we had a hearing on the fiduciaries. And it was just
breathtakingly stark, the difference in viewpoint between what
the VA administrators were saying and what the beneficiaries
were saying. And both of them had legitimate points of view.
The administrators were trying to follow the regulations to the
best of their ability, and they have to do that. And yet there
was significant fall out. So there is still a lot of
collaboration, there is a lot of language that needs to be
discussed, a lot of hard work to make sure that this end of the
programs are responsive to the veterans, not just to some sort
of framework that is out there. And so we need to pat ourselves
on the back and yet we need to take a deep breath and plow
forward. But I am really proud to be a part of this Committee
and to work with this group.
So I have a few questions. The online veterans benefits
system will be a critical component in the claims process. Can
you give me an update as to where we are, and what hiccups you
have seen in this system?
Secretary Shinseki. Secretary Hickey?
General Hickey. Thank you, Congressman. I believe you are
speaking about our Veterans Benefits Management System?
Mr. McNerney. Yes.
General Hickey. It is our paperless IT system that brings
us from an essentially pencil and paper environment into an
environment where we are working on a claim in an electronic
method.
We have been through phase one. I think you have heard
about it, and many of you I believe have come with us to see
what is going on in Providence, Rhode Island, and also in Salt
Lake City. We have been through phase two where we have done
some more additions to functionality in the system and tested
it. We have run nearly a thousand claims through it now, and we
are completing those claims in about 120 days per claim. We are
moving, and right now, we are in phase three of that process.
We are expanding, scoping, and scaling it so that by the fourth
quarter of this year, we will have 16 regional offices on the
system, and then 40 by the end of the calendar year in 2013.
In terms of issues we are seeing, as in any new system, as
you develop it, you see points that you want to make
adjustments to and shape and change. We have had active
involvement and engagement from super users sitting right next
to coders and developers to make that happen. We are working
closely with OIT on a day-to-day and week-to-week basis to
ensure that we close any gaps that we have, and do.
Critical to that is this fiscal year 2013 budget and every
dollar that is in it that is associated with VBMS.
Mr. McNerney. Well, thank you. The Vocational
Rehabilitation and Employment Program is also very valuable,
and peer to peer and so on. But I hear from back home that
there is an average counseling ratio of one counselor to 145
veterans. What can we do to reduce that ratio to make it more
responsive?
General Hickey. Congressman, thank you for asking that
question. We actually are right, now today. Our target is 125
to one. We believe that is an appropriate workload. We are at
139 today, so we are closing in on that gap, and we will close
it even further. We are taking new steps to meet earlier in the
process with our veterans. You will see this budget reflects a
growth in VetSuccess on Campus vocational and rehabilitation
employment counselors. We get those counselors out where our
student veterans are today, to help them both in the adjustment
and in their graduation rates using their G.I. Bill. Also you
will see this budget reflects a growth of VR&E counselors at
our wounded, ill, and injured sites so that we start the
planning process with them earlier rather than waiting for them
to exit service and come into the veteran community.
Mr. McNerney. Okay, well it sounds good. Mr. Secretary, one
last question. The VA cites management improvement as one of
the areas where it can achieve savings. Can you elaborate on
that a little bit, give me some details?
Secretary Shinseki. I am going to call on Dr. Petzel.
Mr. McNerney. Okay.
Dr. Petzel. Thank you, Mr. Secretary. Congressman, we have
a number of management improvements that have been put in
place, in fact, in the previous year and we are elaborating on
this year. As an example, in non-VA care where we spend about
$4 billion, we now are able to use Medicare prices for
reimbursement for both the facilities and the professional fee.
Previously we were only using Medicare for the professional
fee. This is going to save us over $100 million this coming
year.
Secondly, we are reducing non-VA hospitalization, contract
hospitalization. Third, we have dramatically decreased the cost
of dialysis. We now have a regulation allowing us to charge
Medicare prices. We have renegotiated contracts with all of our
providers and have saved literally hundreds of millions of
dollars over the cost in 2010 of dialysis. And those are just a
few examples of the many things we are doing.
Secretary Shinseki. Mr. McNerney I just want to have Mr.
Muro add one piece to this with the first Notice of Death
office and what we have achieved with it.
Mr. Muro. Thank you, Mr. Secretary. Congressman, our First
Notice of Death office collects information on veterans deaths.
And by doing so we are able to go into our VA system, our
electronic system, and annotate that the veteran has passed
away, which ensures timely discontinuation of payments to the
deceased. And we are working now with VHA to cancel
appointments and to cancel medication shipments that are going
out. By doing this, we are able to save the funding that would
have gone out to the veterans and prevent collections from
veterans families after they pass.
The Chairman. Mr. Bilirakis?
Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it
very much. And thank you, Mr. Secretary, for all of your good
work on behalf of our heroes. I have one question. I have been
closely following the many implications of the many provisions
of the Affordable Health Care Act, particularly the HHS
contraception mandate. General, I know that one of your
priorities is ending veterans homelessness, and of course it is
our priority on this Committee as well. I also know that the VA
partners with many faith-based organizations to reduce veterans
homelessness. Has the VA taken into consideration the
repercussions of the HHS mandate, particularly if these faith-
based entities choose to pay fines rather than violate their
religious tenets by providing contraception? And that such
fines could potentially reduce resources available to meet the
needs of homeless veterans?
Mr. Filner. I thought we would get through a whole hearing
without you mentioning contraception.
Secretary Shinseki. Congressman, I would say there is more
work to be done here. The President has announced a policy that
would ensure employers affiliated with religious organizations
that they will not have to pay or refer for contraceptive
services. The administration has said we will work
collaboratively with organizations that self-fund to address
their concerns. Our local community partners, of which we have
many across the country, thus far, like VA are committed to our
goal of ending veterans homelessness by 2015 and there is no
indication that they will be deterred from their commitment to
that goal of ending veterans homelessness. But as I say, we are
early in the discussions.
Mr. Bilirakis. Okay. I would like to continue to work with
you on this issue. Thank you, Mr. Secretary. I yield back.
The Chairman. Ms. Sanchez?
Ms. Sanchez. Thank you, Mr. Chairman. And I want to thank
all of our panelists for being here today to answer questions.
I think the questions are many and I am going to get through
the most important questions that I have fairly quickly.
Secretary Shinseki, I recently had the opportunity to visit the
patient aligned care center at the Long Beach VA facility. And
I want to applaud the efforts there to provide an integrated
system of care. But one of the things that has been brought to
my attention is the levels of staffing for the new models that
will be put in place. I heard from doctors, nurses, and other
practitioners to discuss how thinly they feel that they are
being stretched in this new system. And it is a system that
they want to see succeed. I mean, they are employed there
because they believe in the mission, they want to provide the
service. But I am wondering if you could maybe go into a little
bit of detail as to how the $433 million that is proposed for
patient centered care, how that will go towards staffing to
make sure that we have the staff available to meet the needs of
those veterans?
Secretary Shinseki. I am going to call on Dr. Petzel for
the details of this.
Ms. Sanchez. Sure.
Dr. Petzel. Thank you, Mr. Secretary. Congressman Sanchez,
when we implemented the PACT program several years ago, the
first thing that we did was a survey of what we called PACT
readiness, one of which was to determine how many support
people that were in place for each one of the providers in a
PACT clinic. The desirable ratio agreed to in the entire health
care community is three people per provider. We found that
there were places that were reaching that goal, and others that
weren't. One of the major things that has been involved in the
PACT new model financing has been to provide the medical
centers with, and the clinics, with the number of people that
they need in order to support the provider.
I will look specifically at Long Beach, and I can in fact
get back to you. But our goal, and we are very close to it as I
understand, is to have three support people per provider in
each one of our clinics.
Ms. Sanchez. Okay. Because I, you know, I hear stories
about staffing being stretched thin and, you know, no new
hires, or people leave and then are not replaced. And so the
concern is to have the appropriate amount of people available
to provide the services that are needed. And I would appreciate
you following up with me about that.
To the Secretary, I know that you and I have previously
discussed some of my concerns, specifically with respect to the
VA employing female specialists to assist specifically female
veterans with VA services. And I know that the administration's
budget contains $403 million to address the needs of women
veterans. I am wondering if you can tease that out a little bit
and provide more specifics on how that money will be used to
address the growing needs of the female veteran population?
Secretary Shinseki. Thank you, Congresswoman. I am going to
call on Dr. Petzel for the details, but this is to confirm that
you and I have had discussions about this.
Dr. Petzel. Thank you, Mr. Secretary. Our goal is to ensure
that every female veteran has a choice of providers, and that
if they wish to, they will be able to be seen by a female
provider. About 75 percent of women choose to have a female
provider and we are able to meet that need in virtually every
setting except perhaps some remote community-based outpatient
clinics, where we just do not have those sorts of facilities
available.
I can for the record, give you the details about how much
staffing, what kind of staffing would be associated with the
$403 million increase that we are seeing in women's health
programs. I do not have that number at the tip of my fingers.
But it is important to us, as I am sure it is to you, that
women have a choice. That if they wish to see a female provider
they are afforded that opportunity.
Ms. Sanchez. Yeah, one of the things on my tour of the Long
Beach facility was they do have a sort of separate women's
clinic area where women can choose, you know, that to be their
point of entry to the system.
Dr. Petzel. About 60 of our largest medical centers have
specific women's centers, women's health centers, where all of
the services are provided in that same environment. The rest of
them are associated with women specific primary care clinics,
when they are not as large. And then in community-based
outpatient clinics, we have trained the primary care providers
in the necessities of women's health.
Ms. Sanchez. Great. I appreciate your time and look forward
to the additional information. I will yield back.
The Chairman. Thank you. Mr. Huelskamp?
Mr. Huelskamp. Thank you, Mr. Chairman. And Mr. Secretary,
good to see you here. I appreciate the conversation with you
and your staff last week. And I have a couple of questions. I
appreciate the recent question about choices and opportunities.
It made reference to rural areas. That would describe much of
my congressional district, and, but I often get asked the
question, ``Mr. Congressman, we served our country, however, we
have difficulty accessing the medical care we have been
promised.'' And actually this past weekend one of the smaller
communities in my district, there was a newspaper article about
them finishing the construction of a new hospital, a $24
million hospital, for a community of 3500 folks. And there are
veterans in Scott City, Kansas. But if you look at, and pull up
the Web site, it indicates if you would like to access health
care through the system your closest opportunity would be 69.5
miles, that is a CBOC. If you want to access a hospital, your
closest hospital is 203 miles. What do I tell my veterans, Mr.
Secretary, when they say, ``You know, we would like to attend
our local hospital, or we would like to receive care in our
local hospital. We would like to receive care from our local
doctor.'' What am I supposed to tell them, other than, ``Get in
the car and drive 69.5 miles or drive 203 miles to the nearest
VA hospital?''
Secretary Shinseki. Congressman, fair question. If there is
one thing we have focused on for the last three years it is how
to serve veterans closer to home. It is not either a VA CBOC or
a VA hospital. We have the option to provide fee basis service.
We also provide contract care. I am not familiar with the
specific instance here, we will go take a look at it. Let me
ask Dr. Petzel to fill in the gaps here.
Dr. Petzel. Thank you, Mr. Secretary. Congressman
Huelskamp, we also have two pilot programs where we are looking
at specifically what you have been talking about. Project HERO,
which is in its last year, and Project ARCH, which is just
beginning. And I know that Kansas is one of the network areas
where we are piloting Project ARCH.
Both of these are multipurpose, but a primary thing is to
look at the feasibility of providing fee care and contract
care. And as importantly if not more importantly, the cost of
providing fee or contract care. We intend to explore once the
results of these pilots are available the feasibility of doing
more of these kinds of efforts. Forty-three percent of our
veterans are rural. A large percentage of that 43 percent are
highly rural, as you find I think in large parts of Kansas.
Mr. Huelskamp. And I appreciate that. And I will follow up
on that, and I appreciate the pilot project in Pratt, which is
about 60 miles from a hospital.
Dr. Petzel. Right.
Mr. Huelskamp. We are talking about folks that are 200
miles away, that if they were to drive to the nearest VA
hospital they would be passing along probably 20 community
hospitals. My veterans are saying, ``Can't we just have a card
like in Medicare that we would not have to have a special pilot
project? We simply would access our local doctor in our local
hospital.'' And they are not talking about a pilot program, and
which is in, and initially it looks like Pratt is not working
very well and we appreciate data as we go along. But what are
we supposed to tell them? That it is coming sometime in the
future. Meanwhile they have probably the best medical care they
are going to get within 250 miles, is at their local hospital,
just down the street.
Dr. Petzel. As I said, there is the fee basis option in
some of these communities if they are eligible for that. And
telehealth and telehome health----
Mr. Huelskamp. But I appreciate that, doctor.
Dr. Petzel. --are becoming a much large part of what we do
rurally.
Mr. Huelskamp. What makes them eligible?
Dr. Petzel. I would like to respond for the record to that.
Mr. Huelskamp. Sure.
Dr. Petzel. But basically it is service-connection and
being treated for a service-connected disability. Otherwise,
they would not be eligible. Unless they are a part of one of
these pilots.
Mr. Huelskamp. Well I presume they were eligible, had
service-connected injuries. But they can go to their hospital?
Who do they call to say, ``I would like to go to the Scott City
Hospital rather than driving to Wichita for care?''
Dr. Petzel. They would talk to the intake people at their
local hospital. And this is done commonly. Again, if they are
service-connected, and they live that distance, more than 60
miles, that would be someone that we would often give a fee
card to, to get care in the community.
Mr. Huelskamp. Yeah, I appreciate that. And one follow up
as well. The question referenced the Affordable Care Act. I am
very troubled by the mandates that have been proposed about
religious organizations. But Mr. Secretary, the religious
organizations have already responded. They think it is a
distinction without a difference, and it is going to be
difficult to expect people of faith to participate in
Affordable Care Act with these particular type of mandates. So
I appreciate it. I would like to be involved in the discussion
as well. Mr. Secretary, it is very troubling when we have a
First Amendment and many Americans feel like these mandates
violate the First Amendment. So I appreciate the time. Thank
you, Mr. Chairman.
The Chairman. Mr. Carnahan?
Mr. Carnahan. Thank you, Mr. Chairman, and also special
thanks for your commitment to come out to St. Louis next week
to follow up an oversight visit at Cochran VA Medical Center.
And Mr. Secretary, really to you and all your team for the work
you have done for our veterans, but also close to home on
behalf of the folks in St. Louis and veterans there for the
work you have done to help turn things around at Cochran. The
targeted investments there, we get good reports back from our
veterans about improvements there. And reiterate my invitation,
I hope you will come out when they open up that new state of
the art sterile processing department there that you and your
team can be a part of that. We think that is an important
success story that we want to be sure and share with the
community, and to our veterans.
And since we last spoke I had another issue, close to home
issue raised, but also I think it has some implications
nationwide. And it has to do with the Veterans Benefits
Administration claims processing centers. One large one, as you
know, in St. Louis employs a number of our veterans there. My
understanding is that the VA is getting into a contract with a
Xerox subsidiary, ACS, to outsource parts of the claims
processing. I am hearing reports from staff in St. Louis they
are being asked to train contractor replacements. And I had
five particular questions I wanted to submit for the record and
hope we can get some detailed answers to, but I would like to
see if we can get a brief answer here at the hearing.
First, did VBA comply with the law requiring there to be a
public/private competition before direction converting this
kind of work? This was a change in the law that was championed
by our former Missouri U.S. Senator Kit Bond to address these
kind of issues.
Secondly, do we know this contract is actually saving money
in terms of supplying those kind of services?
And why is this contract being put in place now when many
millions have been invested in pilot programs all over the
country as part of this transformation? And the national roll
out of these projects was to be completed next year, was my
understanding.
Fourthly, are you aware of this particular contractor we
have heard reports of a not very good track record in providing
services to the Federal government.
And finally, with regard to our veterans and their high
jobless rates now, why is VBA not using its new hiring
authority under the Vow to Hire Heroes Act instead of assigning
this work out to contractors? In St. Louis alone, I know nearly
half of those employees are veterans.
I know that is a mouthful but I wanted to get that on the
record. And I am going to ask if you could address that briefly
within the time we have.
Secretary Shinseki. Congressman, thanks. I am not familiar
with that contract personally and so I will provide you a full
answer for the record.
Mr. Carnahan. Great. Thank you. I appreciate that. Again, I
think that has impact nationally in terms of those services I
think are very important, but also close to home in our region
of St. Louis.
Mr. Filner. Congressman, would the director of VBA know
more about the contract to get a quick answer? I mean, somebody
must know the contract.
General Hickey. So thank you, Congressman. I think you are
referring to the VBMAP (Veterans Benefits Management Assistance
Program) contract with ACS Federal Solutions?
Mr. Carnahan. Right.
General Hickey. Absolutely. We followed all the provisions
for the VBMAP contract. And what it is, and I will explain it
very quickly, it is a short-term ability for us to essentially
do two things: one, push through some claims to get them ready
to rate because we grew our rater workforce last year
significantly, and we need to have work for them to rate in
order to get through that backlog which, as you all well know,
is over 500,000 claims today.
Two, it is not meant to be long-term, but we are looking at
how they do the work, trying to take lessons from that to bring
them into VBA, and finding the ways in which we are
incorporating lessons as we move forward on our transformation
model.
So I understand the initial concern from the workforce. I
have sent a letter out to them this week telling them that
nobody is going to lose their job over this. Nobody is going to
be replaced as a result of this, so I just want you to know
that. We are----
Mr. Carnahan. Excuse, if I, just if I could interrupt? So
no current employees are expected to lose their positions?
General Hickey. No, sir.
Mr. Carnahan. You are strictly using this as a, to
supplement and take care of a backlog?
General Hickey. Yes, sir. For the short-term, yes, sir.
Ms. Brown. Will the gentleman yield?
Mr. Carnahan. Yes, I would yield.
Ms. Brown. Let me just say, that sounds good. But when you
all put the contract out, why is it that you did not have some
criteria, whoever is getting the contract why cannot they use
veterans where possible? I mean, that should have been a part
of the RFP, or whatever, when you sent the proposal out, and it
still can be a part of whoever has the contracts should have
some preference for veterans when they are qualified and they
have a very high unemployment. I am not saying you are going to
do additional work, you have additional money, we should have
an opportunity to hire additional veterans.
General Hickey. Congresswoman Brown, that is a great
question. And I will tell you that ACS has made a concerted
effort to do that. In fact, 15 percent of the folks in this
contract are veterans.
Mr. Filner. Fifteen? Or 50, did you say?
General Hickey. Fifteen percent right now, but they are
continuing to go to----
Mr. Filner. Is that required or is that just their
voluntary thing?
General Hickey. They are voluntarily doing this----
Mr. Filner. But the question was, why do we not insist on
it in their contracts? And why is it not 50 instead of 15? I
mean, why are we complimenting them on doing this, it still
sounds small to me. You are issuing the contract: Put the
mandates on the requirements that we want. Why can we not do
that?
General Hickey. So Congressman, we have had conversations
back and forth with the contractor to encourage them----
Mr. Filner. You are not answering the question. You are
having conversations with the contractor. Why does the contract
not specify and mandate that preference level so you do not
need the conversations that is part of their requirement? And
as, if Mr. Carnahan is correct, that they may not even have a
history of doing this, I mean, put it in the contract. Why are
you going through these voluntary conversations?
General Hickey. Congressman----
Secretary Shinseki. Fair enough, Mr. Filner. We will take a
look at this.
Mr. Filner. Oh, come on. You can give me some general
answer. Are you saying we cannot do it legally? Or we do not--
--
Secretary Shinseki. I do not know the answer to that
question.
Mr. Filner. Yeah, but she must know the answer. Why, I mean
come on. This is not rocket science here. You issue contracts a
hundred times a day. Why can we not have contracts that do
this?
Secretary Shinseki. You can. And I do not know the
circumstances of this contract and I would like----
Mr. Filner. But she apparently does, so why did we not do
it here?
General Hickey. So Congressman, I will go back to our
acquisition folks to ask----
Mr. Filner. Oh come on, you know, you guys know the answer
to this. Why are you so afraid to just tell us?
Secretary Shinseki. I am not sure it was not in the
contract, Mr. Filner. That is what I need to go check.
Mr. Filner. Well but she sure, she did not say it was or
was not.
General Hickey. Congressman----
Mr. Filner. You said, you started off your testimony, ``I
know the contract.'' So did it specify or not?
General Hickey. I will find out and give you for the
record, exactly what the contract----
Mr. Filner. --I mean, I don't understand this. Come on. You
know this better than you are saying here.
Ms. Brown. Reclaiming my time that I probably do not have--
--
Mr. Carnahan. I will yield the time that I do not have.
The Chairman. Three and a half minutes ago you had--we do,
if you would, but we have one more Member who has not asked a
question.
Ms. Brown. Right. He probably will be okay with me
finishing. What we want in this Committee, with the high
unemployment, close to 30 percent, one place that we can start,
and one complaint I constantly get, is that the VA that does
billions of dollars of work do not do it with veterans. I mean,
there are opportunities for, someone asked the question earlier
about helping veterans' businesses, we should have some kind of
a grants program, but part of all, everything we do should have
some opportunity for veterans to participate. We should set the
standards with the VA. I mean, it is a business. Government is
a business, regardless of what some of these people in this
Committee and in this Congress think. It is a big business. And
it employs a lot of people and it has a lot of opportunities. I
think about it as my grandmama's sweet potato pie. We should
all have the opportunity to get a slice of that pie. Thank you.
The Chairman. I'm sorry, Mr. Donnelly is before you. Mr.
Donnelly?
Mr. Donnelly. Thank you, Mr. Chairman. You always show
great wisdom. Mr. Secretary, I just want to thank you and your
team for everything you have done for our veterans. I talk to
our veterans all the time and they say they have never had the
type of care and the type of services that they have received
in recent years. So to everybody, I want to thank you very,
very much. And especially on behalf of the folks in the South
Bend, Indiana region for the center that is going there. And
then also to the vets groups for your dedication, and to the
employees. And from my home state of Indiana who have made it
possible for these people to get the kind of care they have
received, I want to thank you very, very much for that.
And then to Mr. Muro, I mentioned this to you once before
that my mom is in one of the military cemeteries. They do an
extraordinary job there. I try to get there as often as I can
and it has always been a place that we take great, great pride
in. So thank you very much for that.
And then my question is this, on the patient centered care
initiative, when we talk about differences, what are the
differences we can expect as we move forward, as we go more
towards this? What are the improvements we can be looking for?
Dr. Petzel. That is an excellent question. And I would like
to just go through what patient centered care means. It means
two things, first of all. Number one, it means that the
patients are in control of their health care. That they have
access to the information and the advice, the counsel they need
to be an important part of the decision process. And then the
second thing that it means is that the whole care system
revolves around the needs of the patient. That is, they have
access to the care they need in that place, in a
chronologically and geographically reasonable fashion. The
scheduling of patients is around the needs of the patient. So
we have after hours clinics, we have Saturday clinics,
etcetera.
And then it translates into the way we deliver care. The
medical care system has been disease oriented in the past, I
think as Dr. Roe would probably agree. The idea was you were
treating somebody with diabetes, you were treating somebody
with hypertension, or obesity. That is shifting to a much more
holistic view of how you take care of a person. That is, you
are treating the individual and you are providing care for the
things that they need. The blood sugar level may be important
to us in the diabetic patient. But his or her mobility, his or
her lifestyle may be a much more important thing to them than
those blood chemistries. And we need to take into account what
is important.
So it is number one, personalizing the care. Number two, it
is care that is aimed at taking care of the entire person as
opposed to taking care of a specific disease entity. And then
thirdly is, it is integrated, and it is coordinated. So that
you get all of the services that you need under the auspices of
that PAC team. They take responsibility for everything that you
might need in your health care environment.
Mr. Donnelly. And I do not know if this is you again, Dr.
Petzel. But one of my concerns has always been for our soldiers
who are coming home, our servicemen and women, that they be
able to somehow without any stigma receive the mental health
care that might be needed as they make this transition. And I
know, General, you said that you are working closely with DoD
on transition issues and working together. But I am, I just
want to make sure that for these young men and women when they
come home that so many of the things they have seen and dealt
with and may wake up at night thinking about, that there is
some way to, and I know we work hard to do this, but that there
be no stigma, and that there be an opportunity for them to be
able to pick up the phone as we have, with many of the programs
we have to get the care they need.
Dr. Petzel. Thank you again, Mr. Secretary, and
Congressman. There are several things that are happening right
now that are, I think, are going to have a real impact on the
stigma and the destigmatization of mental health. Number one is
we have a campaign out called Make the Connection, where
veterans who have had mental health issues are relating how
important it was to them to be able to talk to somebody at the
VA about their problems. And it is a very effective, we would
be delighted to present the Committee with a copy of the 60-
second spot that is being used across the Nation.
The second thing is that we are trying to integrate mental
health care into our primary care setting so that when you
visit your primary care provider you can also have your mental
health issues dealt with so that you do not have to go to a
separate mental health clinic. Because some people are really
quite reluctant actually to go.
Mr. Donnelly. I think that is a big step.
Dr. Petzel. And for women particularly, we have
incorporated behavioral health and mental health providers into
the women's health centers so that, again, they do not have to
go to a separate mental health clinic in order to have their
mental health needs treated. We think that the integration of
primary care and mental health is a big important wave of the
future.
Mr. Donnelly. Thank you very much. Mr. Chairman, thank you.
The Chairman. Thank you. Mr. Reyes?
Mr. Reyes. Thank you, Mr. Chairman. Thank you, Mr.
Secretary, and all of you for accompanying us. I apologize for
being late, but we had Secretary Panetta in the Armed Services
Committee this morning and one of the main topics was BRAC,
which always gets the attention of every Member of Congress. So
I apologize for being late, but I also want to associate myself
with the comments of the Members here expressing appreciation
for your leadership and the quality of health care that is
being given to our veterans, and the outreach that has
dramatically improved under your leadership. We appreciate
that.
In regard to customer service I was wanting to. I happened
to be at a Veterans Day parade the day after one of the
presidential candidates had proposed privatizing health care by
giving vouchers to veterans. There was unanimous opposition
from the veterans there at that parade against privatizing or
giving vouchers for health care. They are extremely satisfied
with the quality of health care that they get, at least in my
district in El Paso.
I also had an opportunity a few months back to go to the VA
hospital in Houston. In regard to women veterans, Houston
hospital has a separate women's health care facility that is
working tremendously well. So to the extent that we can make
that a strategy throughout the VA system, I would strongly
recommend and urge that we follow it. In talking to some of the
women veterans there, they definitely felt more at ease having
a facility that they could go to themselves. They definitely
felt that they were getting the kind of attention that made a
real difference to them. So I would urge that we do that as
much as possible.
The other thing that I saw there, which was pretty
interesting, was that one of the doctors had developed a system
of tracking the day to day surgical operations by using a
computer software program. And I have mentioned it to the
Committee before. The question I have is, within the system, is
there a way that best practices can be proposed so that they
can be incorporated around the country using those kinds of
improvements?
Secretary Shinseki. Congressman, I am going to call on Mr.
Baker to talk about this program that you have seen. We have
similar interests. Going back to your first comment about women
veterans, we are doing everything we can to stay out ahead of
what we know are going to be growing numbers over the next ten
years. As I indicated earlier, between 2009 and this budget,
2013, we have increased funding for women's programs by 124
percent. Then if you roll this out one more year to 2014, with
the advance appropriations, our investments go up 158 percent.
I expect there will be more growth. What I am trying to assure
you of is we are trying to stay out ahead of the requirements.
Identify the requirements, where they are, and get resources
where they need to be.
Let me turn to Mr. Baker on the second part of your
question.
Mr. Baker. Thank you, Congressman. One of the things that
has made the VA electronic health record system great is
exactly what you described. Doctors looking at the problem and
helping develop the software, or even developing the software
themselves. Most of what we have right now grew up in that
fashion.
The sort of thing you are describing, where an individual
doctor has put together a package tends to move through our
system if you will very democratically. If it is good, other
people pick it up. And if it is not, something else tends to
take its place. We have a long history of doing that. We have a
whole program for doing that, it is called Class 3 software in
our vernacular. There are at last count about 12,000 different
pieces of Class 3 software in the system, some of them used
broadly and some of them used in only one facility. So they
grow up exactly that way. But innovation in Vista is what has
made it great and it is exactly that approach that that doctor
has taken.
Mr. Reyes. Great, thank you. Mr. Chairman, I have a
question for the record from one of our colleagues, Congressman
Hinojosa from the Rio Grande Valley. The VA clinic has been in
operation now for a year and they have nothing but good things
to say, except for a couple of issues on reimbursement. So can
I give it to you for the record?
Secretary Shinseki. Absolutely. I will be happy to provide
an answer for the record.
Mr. Reyes. Thank you. Thank you very much, Mr. Chairman.
The Chairman. Ms. Brown, you are recognized for one final
question.
Ms. Brown. Thank you. First of all, I would like to submit
for the record a story today in the Washington Post about
members of the Reserve component. I understand the VA has no
direct responsibility for active duty medical care but what is
the VA doing to supplement what the Department of Defense to
care for those heroes once they return home? I want to submit
that, I am sure, without objections. And going back to what----
The Chairman. Now wait a minute. I get to say without
objection.
Ms. Brown. Oh, all right. I did not read the script, Mr.
Chairman.
The Chairman. Without objection.
Ms. Brown. Thank you. And going back to the, what we said
about the Corps and high unemployment, it goes back to, and I
guess we could work together if you need additional language or
information as far as the hiring of veterans, of contracting
with veterans and minority businesses. If it is something that
we need to do on our part, I am certain that we will. Because
with this influx of addition of veterans, even the Job Corps,
we need to see what we can do.
I was talking to the Mayor of Jacksonville just a couple of
days ago. And we were talking about the fact that we have this
unemployment, and we are working together, and they have the
big conferences for the veterans. Even though a lot of times
they get hired they do not stay on but about the month. So the
problem is we need more than just the companies willing to hire
them. We need to make sure that they have the skills, the
counseling, the technology they need to stay on the job. And so
that is long term. It is just not helping them to get the job,
but helping them to keep the job.
Lastly, Mr. Secretary, I know the question came up about
women's health care. I want to make sure, I do not care who the
VA is contracting with, women are not second class citizens,
women veterans. Are they able to get the medical, medication or
whatever they need to take care of themselves as they deem
necessary?
Secretary Shinseki. Yes, to that last question. To the
first question you had regarding National Guard and Reserve, 43
percent of our beneficiaries in the benefits we handle are
National Guard and Reserve veterans of the Global War on
Terrorism. I am not sure why the disconnect here. But if you
have particulars we would like to follow up and resolve them.
On the contract, we will look at this. Congresswoman, you
know for three years I have pushed veterans employment, and I
would not let something get in the way of doing a better job at
this. I will go look at this contract because I am not familiar
with it, but if we need help I would be happy to work with you
on it.
Ms. Brown. Yes, sir. And I just was not speaking of that
one contract, I am speaking of the policy pertaining to how we
handle contracts. Are we partnering with veterans businesses,
small businesses, minority businesses? I guess that is what I
am saying.
Secretary Shinseki. Absolutely. As you may know, we run a
National Veteran Small Business Conference every year. We did
one in New Orleans last year. We had a tremendous turn out. We
used this as a training opportunity where veteran owned small
businesses and service-disabled veteran small business owners
can come in and get tutored on what it takes to be successful.
They also have an opportunity to speak directly with VA's
contract manager so they have a good idea of what proposals
ought to look like. We are going to do it again in Detroit the
last week in June of this year.
Ms. Brown. Okay.
Secretary Shinseki. We are going to link to the small
business conference, a jobs fair to hire veterans as well.
There will be two events going on simultaneously. We have
government and for-profit businesses in the area of Detroit who
are going to participate, offering jobs and also mentoring
small business owners.
Ms. Brown. Back to the question of women, I want to be
clear we are talking about birth control. Are they able to get
whatever they need, as they deem necessary?
Secretary Shinseki. Congresswoman, I am not a physician,
but I believe those services are provided when requested.
Ms. Brown. Thank you. This is very important to women
veterans. Lastly, Mr. Secretary, you are really a bright spot
in the administration. And I know it is very difficult dealing
with the multiplicity of what we have here. But I want to thank
you for your service, and I am very impressed that you
committed to come to St. Louis. You have my written request to
come to Orlando. Thank you.
The Chairman. Thank you very much. Members, I appreciate
your questions. Mr. Secretary, thank you very much for your
patience. And you and your team are now excused. Thank you,
sir.
I would like to remind everybody there is a second panel.
The Chairman. If I could get everybody to return to their
seats I would appreciate it. Thank you to the second panel for
making your way to the table, reminding Members that we are
supposed to have our first vote at 1:30.
This second panel includes people who we all know very
well. We appreciate you being here today to testify.
Mr. Carl Blake, the National Legislative Director of the
Paralyzed Veterans of America; Raymond Kelley, Director of
National Legislative Services for the Veterans of Foreign Wars
of the United States; Mr. Jeffrey Hall, the Assistant National
Legislative Director of the Disabled American Veterans; Diane
Zumatto, who is probably the newest person at the table, but
has been before this Committee before, National Legislative
Director for AMVETS; and Tim Tetz, the Director of National
Legislative Commission for The American Legion.
Thank you all for being here today. Each of your written
statements will be included in the hearing record and you will
each be recognized for five minutes.
I don't know who is going to begin first. Mr. Blake, you
are recognized for five minutes.
STATEMENTS OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR,
PARALYZED VETERANS OF AMERICA, RAYMOND C. KELLEY, DIRECTOR,
NATIONAL LEGISLATIVE SERVICES, VETERANS OF FOREIGN WARS OF THE
UNITED STATES; JEFFREY HALL, ASSISTANT NATIONAL LEGISLATIVE
DIRECTOR OF THE DISABLED AMERICAN VETERANS; DIANE ZUMATTO,
NATIONAL LEGISLATIVE DIRECTOR, AMVETS, TIMOTHY M. TETZ,
DIRECTOR, NATIONAL LEGISLATIVE COMMISSION, THE AMERICAN LEGION
STATEMENT OF CARL BLAKE
Mr. Blake. Thank you, Mr. Chairman. Chairman Miller,
Ranking Member Filner, Members of the Committee, on behalf of
the co-authors of the Independent Budget, Paralyzed Veterans of
America is pleased to be here today to discuss the fiscal year
2013 budget request for the Department of Veterans Affairs.
Since you already have my full written statement for the
record that includes most of the analysis of the Independent
Budget recommendations, I am going to limit my comments to some
observations and thoughts on the budget request specifically,
and some of the comments made here this morning.
I will begin by saying the Independent Budget certainly
appreciates the increases provided for by the Administration
for the VA programs for fiscal year 2013. That being said, it
does not eliminate our concerns that you raised and many
Members of the Committee have raised regarding sequestration
and its impact on veterans health care programs specifically.
We find it quite troubling that the Office of Management
and Budget has taken months to come up with a position that we
feel like should be pretty well spoken, and the fact that it
has taken this long certainly is worrisome to us and we
appreciate your introduction of H.R. 3895, that we believe will
correct that problem once and for all.
We also appreciate the fact that the VA has been
particularly in recent years very open to working with the
veteran service organizations more so than in the past, of
course we believe it could be done more, but we certainly
appreciate the fact that they have brought us more into the
fold as they have moved forward, particularly with their
transformation of their VBA claims process.
All that being said I am going to focus on a couple of
concerns that I have specifically.
There was a lot of discussion here this morning about
efficiencies in particular. The Administration continues its
presumption for program improvements and efficiencies to the
tune of more than $1.2 billion I believe in 2013 and in 2014.
What is more troubling to me is the discussion that I
believe you raised, Mr. Chairman, about this excess resources
that apparently they have identified to the tune of
approximately $3 billion in 2012, about $2 billion I think they
say in 2013.
It sort of begs the question, how has the Administration
determined that they have $3 billion too much for 2012 when we
have seven months of this fiscal year still to finish? If they
came back after the fact and said we had all this extra money
that would be one thing, but sort of in midstream, it is
certainly a concern for it. It doesn't mean that it wouldn't
necessarily be realized, but it is certainly a concern.
They identify health care services in particular which was
a big chunk of it, they identify long-term care. I wonder where
are those savings for long-term care? Does that mean that there
are fewer veterans taking advantage of VA's long-term care
programs? This given fact that the veterans population is
actually aging.
So we have some concerns about that. And the fact that they
don't even meet what they are mandated to meet as far as their
capacity requirement for long-term care.
We also have concerns about this roller coaster ride of
medical care collections estimates. I would note that two years
ago the fiscal year 2012 collections estimate was $3.7 billion.
Last year when they submitted the 2012 budget, it was revised
to $3.1 billion. And I would note that this year's budget shows
that their estimate is now $2.7 billion. So that is a $1
billion change over the course of the last two years, and I
understand there are factors that play into those changes, but
the fact is that that difference in resources which they factor
into their ability to provide health care services has to have
some sort of an impact on the delivery of services in a timely
fashion and quality services to veterans. So I think these
things need to be teased out.
I go back to the excess resources they have. As important
as I would consider that issue, I would think that there would
be more than a couple of bulleted points or a paragraph in a
four volume document explaining that. That might be the most
important fact that they outline in their entire budget,
because that certainly has an impact on everything going
forward. So we certainly hope that the Committee will pursue
that and that the VA will come forward with more information
about it.
Lastly I would direct my comments towards the 2014 advance
appropriation. While the Independent Budget does not offer
specific budget recommendations for that for any number of
reasons, a couple of things jump out at me about the 2014
recommendation. Given our concerns about whether 2013 is
actually a sufficient budget put forward, it could arguably be
a fairly small increase for 2014. Additionally they project a
very huge jump in medical support and compliance over previous
years funding. I would point out that I believe that is the
part of the administrative arm of the medical care side of the
VA, so that would certainly give us pause. At the same time
there is an even larger decrease projected for medical
facilities.
While I know they project some transfers of resources and
staffing in medical facilities to medical services, I would
also note that the budget shows a substantial decrease in non-
recurring maintenance in 2014, a very substantial decrease.
So with all those thoughts, Mr. Chairman, I would like to
thank you for the opportunity to be here today and we would be
happy to answer any questions that you might have.
[The prepared statement of Carl Blake appears in the
Appendix]
The Chairman. Thank you.
Mr. Kelley.
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 our auxiliaries thank you for the opportunity to
testify today.
As a partner of the IB the VFW is responsible for the
construction portion of the budget, so I will limit my remarks
to that.
I would like to start by thanking the secretary and his
team. His work has improved the service for and the lives of
veterans. So Mr. Secretary, thank you for that.
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 injured and ill veterans. Every
effort must be made to insure that these facilities are a safe
and sufficient environment to deliver that care.
A VA budget that does not adequately fund facility
maintenance and construction will reduce the timeliness and
quality of care.
Since 2004 utilization in VA has grown from 80 percent to
121 percent, and during that same time facility conditions has
dropped from 81 percent to 71 percent. This is having an impact
on the delivery of health care.
To determine and monitor the condition of its facilities,
VA conducts facility condition assessments, or FCAs. These
assessments include inspections of building systems such as
electrical, mechanical, structural, and architectural safety
and water protection.
The FCA review team can grant a rating between an A and an
F. A through C is a new facility to an average facility, a D
rating is below average, an F rating means the condition is
critical and requires immediate attention. To correct the D's
and F's, VA would need to invest nearly $10 billion.
VA is requesting $400 million for 4 of the 21 partially-
funded VHA major construction projects in fiscal year 2013,
leaving well over $5 billion remaining in partially-funded
projects dating back to fiscal year 20007.
These projects include improving seismic deficiencies,
providing spinal cord injury centers, completing a polytrauma
blind rehab and research facility, as well as expanding mental
health facilities.
This request is too low to support the ever growing need of
veterans, therefore, the IB partners request that Congress
provide funding of $2.3 billion for VHA major construction
accounts and the total of $2.8 billion for all major
construction accounts. This will allow VA to complete all
current partially-funded major construction seismic
corrections, and a mental health center, and fund the four VA
identified projects for 2013.
Although VA's funding request for minor construction
account is lower than the IB request, this level of funding
will allow VA to fund more than 120 minor construction
projects.
Even though nonrecurring maintenance is funded through VA's
medical facilities account and not through the construction
account, it is critical to VA's capital infrastructure.
NRM embodies the many small projects that together provide
the long-term sustainability and usability of VA's facilities.
VA is requesting $774 million in NRM for fiscal year 2013,
but to keep pace with the need and to reduce the backlog of
NRM, $2.1 billion would be needed.
The IB is not requesting this amount of funding for NRM,
only pointing out the actual need to reach VA strategic goals.
An enhanced use lease provides VA the authority to lease
land or buildings as long as that lease is consistent with VA's
mission. Although enhanced use lease can be used for a wide
range of activities, the majority of these leases result in
housing for homeless veterans and assisted living facilities.
In 2013, VA has 19 buildings or parcels of land that are
planned for enhanced use lease; however, that lease authority
has expired and we encourage Congress to reauthorize it so VA
can continue to put empty and underused life space to work for
veterans.
Mr. Chairman, thank you for the opportunity to testify
today and I look forward to any questions you or the Committee
may have.
[The prepared statement of Raymond C. Kelley appears in the
Appendix]
The Chairman. Thank you, Mr. Kelley.
Mr. Hall.
STATEMENT OF JEFFREY HALL
Mr. Hall. Thank you, Mr. Chairman. Good morning to you and
Ranking Member Filner and Members of the Committee. On behalf
of the Disabled American Veterans and our 1.4 million members,
all of whom are wartime disabled veterans, I am please to be
here today to offer our recommendations of the Independent
Budget as it relates to veterans benefits programs, judicial
review, and the veterans benefits administration for fiscal
year 2013.
Mr. Chairman, we are now in the third year of VBA's latest
effort to transform its outdated and inefficient claims
processing system into a modern rules based digital system.
Over the next year we will begin to see whether their
strategies to transform these people, processes, and
technologies will finally result in a cultural shift away from
focusing on speed and production to a business culture of one
of quality and accuracy, which is truly the only way to get the
backlog of claims under control.
Although we have been very pleased with VBA's increasing
partnership with VSO stakeholders, we urge this Committee to
provide constant and aggressive oversight of the many
transformation activities that are going to take place
throughout this year.
Perhaps the most important initiative is the new veterans
benefits management system, or VBMS, which we will begin
rolling out in June with full deployment planned by the end of
2013. As VBA works to complete, perfect, and deploy this vital
new IT system, it is absolutely crucial that sufficient
resources are provided.
We note that the budget for VBMS this year drops down from
$148 million for fiscal year 2012 to $128 million for fiscal
year 1013. We hope that this Committee will thoroughly examine
whether that level of funding is sufficient to complete this
essential program.
In order to sustain VBA's transformation efforts, the
Independent Budget for fiscal year 2013 recommends maintaining
current staffing levels in most business lines. Given the large
increases in claims processors over the past few years, we
believe that VBA's focus should now be on properly training new
and existing employees.
That is why we are concerned about recent reports from the
field indicating that VBA is already short on training dollars
and cutting back on the Challenge training program done at its
centralized training academy. Yet at the same time, we have
heard that the VBA is instituting a new round of mandatory
overtime for compensation service employees which at time and a
half would have significant impact or implications.
We hope that the Committee will look into these questions
to insure that VBA's focus and resources remain on quality and
accuracy and not just production.
The VR&E budget proposal for fiscal year 2013 does request
funding for approximately 150 new counselor designated for the
expansion into the integrated disability evaluation system and
for the VetSuccess on campus program, both of which we support;
however, in order to reach their target of having one counselor
for every 125 veterans served, they will need approximately 195
additional counselors for fiscal year 2013 in order to meet the
projected workload increase.
The IB also recommends a staffing increase at the Board of
Veterans Appeals. Although the board is currently authorized to
have 544 full-time employee equivalents, its adopted budget for
fiscal year 2012 only supported 532, and for fiscal year 2013,
the budget request would further reduce the FTEE to 527.
Looking at historical appeals rates and the rising number
of original compensation claims, the IB recommends that VBA be
given the sufficient funding for the authorized workforce in
2013 of at least 585 FTEE.
Mr. Chairman, the IB also recommends that Congress this
year finally enact legislation to repeal the inequitable
requirement that veterans military longevity retired pay be
offset by an amount equal to their disability compensation if
rated less than 50 percent disabled. Congress has previously
removed this offset for veterans with service-connected
disabilities rated 50 percent or greater and should pass
legislation to treat all veterans equitably.
We also recommend that Congress eliminate the survivor
benefit plan and the dependency and indemnity compensation
offset. Under current law the amount of an annuity under the
survivor benefit plan must be reduced on account of and by an
amount equal to dependency and indemnity compensation for
survivors and dependents. This offset is inequitable because
there is no duplication of benefits since payments under the
SBP and the DIC programs are made for different purposes.
And finally, Mr. Chairman, the IB strongly recommends that
Congress and VA determine the most practical and equitable
manner of providing compensation for non-economic loss and the
loss of quality of life suffered by service-connected disabled
veterans and then move expeditiously to implement this new
component.
The Institute of Medicine and the congressionally mandated
Veterans Disability Benefits Commission and even the Dole
Shalala Commission all recommended that the current disability
benefits system be reformed to include non-economic loss and
the loss of quality of life as factors in compensation.
Both the Canadian and Australian disability compensation
programs already do just that and it is time that we did the
same for the brave men and women who have suffered permanent
disabilities affecting their entire lives in their service to
this great Nation.
Mr. Chairman, this concludes my statement, I would be happy
to answer any questions.
[The prepared statement of Joseph A. Violante appears in
the Appendix]
The Chairman. Thank you very much.
Ms. Zumatto.
STATEMENT OF DIANE ZUMATTO
Ms. Zumatto. Distinguished Members of the House Veterans'
Affairs Committee thank you for this opportunity to you share
the IB's recommendations in what we believe to be the most
financially responsible way while still insuring the quality
and integrity of the care and benefits earned by American
veterans.
In light of this Nation's unresolved fiscal crisis, the
IBVSOs have serious concerns about the potential reductions in
VA spending which will seriously impact our veterans, their
families, and survivors.
That being said, my main focus today will be the NCA.
The single most important obligation of the NCA is to honor
the memory, achievements, and sacrifices of our veterans who so
nobly served in this Nation's armed forces. These acts of self-
sacrifice by our veterans obligate America to preserve,
rehabilitate, and expand our national cemetery system as
necessary.
These venerable and commemorative spaces are part of
America's historic material culture. They are museums of art
and American history. They are fields of honor and hallowed
grounds and they deserve our most respectfully stewardship.
The sacred tradition of our national cemeteries spans
roughly 150 years back to the time when the earliest military
cemeteries were situated at battle sites, at field or general
hospitals, and at former prisoner of war sites.
The NCA currently maintains stewardship of 131 of the
Nation's 147 national cemeteries as well as 33 Soldiers' lots.
Since 1862 when President Lincoln signed the first
legislation establishing the national cemetery concept, more
than three million burials have taken place in national
cemeteries, which are currently located in 39 states and Puerto
Rico.
As of late 2010 there were more than 20,021, 21 acres of
historic landscape, funerary monuments, and other architectural
features included within established NCA cites.
VA estimates that of the roughly 22.4 million veterans
alive today, that approximately 14.4 percent of them will
choose a national or state veteran cemetery as their final
resting place.
With the transition of an additional one million
servicemembers into veteran status over the next 12 months,
this number is expected to continue rising until approximately
2017.
The NCA, which is the Nation's largest cemetery system,
invested an estimated $39 million into the National Shrine
Initiative in fiscal year 2011 in its efforts to improve the
appearance of our national cemeteries.
While an NCA survey conducted in October 2011 indicated
that process continues to be made in reaching its performance
measures, more needs to be done.
In order to adequately meet the demands for interment,
gravesite maintenance, and related essential elements of
cemetery operations, the IBVSOs recommend $280 million for the
NCA's operations and maintenance budget in fiscal year 2013
with an annual increase of $20 million until the operational
standards and measures goals are reached. This request also
includes $20 million for the National Shrine Initiative.
Finally the IBVSOs call on the Administration and Congress
to provide the resources needed to meet the sensitive and
critical nature of the NCA's mission and to fulfill the
Nation's commitment to all veterans who have served their
country so honorably and faithfully.
The state cemetery grants program compliments the NCA's
mission by establishing gravesites for veterans in areas unable
to fulfill veteran burial needs. In fiscal year 2011 the
cemetery grants budget was $46 million, and that funded 16
cemeteries, including the establishment of five new ones. The
IB recommends an increase to $51 million for 2013 in order to
meet rising demands which should peek in 2017.
Since burial benefits were first introduced in 1917 they
have continually evolved, and this process needs to continue in
order for this benefit to meet 21st Century needs and expenses.
Benefits should be split into two categories. Veterans
within the accessibility model and those outside the
accessibility model.
Plot allowances as well as burial benefits for both service
and non-service-connected veterans need to be increased to meet
rising costs.
That is the conclusion of my statement.
[The prepared statement of Diane Zumatto appears in the
Appendix]
The Chairman. Thank you very much.
Mr. Tetz.
STATEMENT OF TIMOTHY M. TETZ
Mr. Tetz. Chairman Miller and Ranking Member Filner, thanks
for the opportunity to join this distinguished panel and
present the American Legion's viewpoint on the 2013 VA budget.
If the VA budget were a house that was up for sale, you
would have a lot of prospective buyers. The curb appeal of this
budget is phenomenal. You have an expansion of existing
programs for homeless, rural, women, and student veterans, you
have activation of new much needed medical facilities
throughout the Nation, and you have an increase in minor
construction funding.
VA proposed increased funding to eliminate the backlog of
claims and homelessness and expand access.
If the VA budget were a house, it would have the granite
counter tops, walk-in closets, a fenced yard, and every modern
amenity a prospective buyer would want. Buy it now because it
is undervalued for the market. Everyone has their eyes on this
one.
One small problem, it is not the gem it is made out to be.
Yes, certainly there are some things to celebrate, but there
are many more things we should be worried about.
One such worry is the funding of the major, minor, and
nonrecurring maintenance and construction accounts. As we
outlined in our testimony through the SCIP process, the VA has
identified more than $50 billion in construction projects that
are necessary in the coming ten years.
We appreciate the additional $792 million in medical
services account that will help the activation of Las Vegas,
Orlando, Denver, and New Orleans health centers. The veterans
of these regions have waited years for these facilities, yet it
strikes me stupid that the VA would only ask for $608 million
in minor construction money and $532 million in major
construction for the remainder of the projects that SCIP has
identified. At this pace, the 10-year plan will go on for 50
years.
Today's 30-year-old sergeant who just returned from
Djibouti will be a nursing home resident if the VA facility was
built.
The VA construction budgets must be increased to meet the
real needs identified by the SCIP plan.
The American Legion also supports the increased funding for
the NCA. Secretary Muro and the thousands that work for NCA are
the heroes in the VA, they exceed every standard from veteran
contracting to employment of veterans to monetary savings
through operational efficiencies, yet they are beginning to
feel the budget pinch and need an increase to meet those
requirements.
The budget proposes a seven percent increase in the medical
care collection funds. VA points to increased collections in a
legislative fix to bill private insurer rates rather than the
Medicare rate. Neither the proposal or increased collections
have been successful in the past.
What happens when VA falls short on MCCF collections? VA
must scrimp and save elsewhere. Maybe they don't hire their
full staff, maybe they put off purchasing upgraded equipment,
perhaps they put off training or other programs. In the end it
is the veteran who suffers. It will be the veteran who has to
wait longer for his claim to be processed. It will be the
veteran who must wait two months for her appointment. It will
be the veteran who won't have the latest technology to diagnose
cancer early.
The MCCF fund is budget gimmickry at its best. It is
unrealistic and a poor excuse for an increase in an increased
budget.
So if the VA budget is our dream home, I am going to
encourage you to invest in buyer's insurance, you are going to
need it.
I am not the most experienced person in this room or even
at this table, yet I can guarantee that some of the selling
features of this VA budget are never going to see the light of
day. If we look at that 10.5 percent increase, we are talking
about $13.3 billion. Take away the $9.6 billion of mandatory
spending for compensation, education, and disability claims.
That was earned with the blood, sweat, and tears of our
military. Now you are left with $3.7 billion. Take away the
$500 million of rollover savings that the VA hasn't spent from
a previous fiscal year and you are left with $3.2 billion.
Some argue Congress will never agree upon the tax cuts and
spending cuts elsewhere in the budget to come up with the $1
billion to fund the Veterans Job Corps, so Veterans Job Corps
becomes just another dream for the 20,000 jobless veterans, and
we are left with only $2.2 billion increase in the VA budget.
Take out the $200 million of MCCF collections and you are left
with a VA budget increase of $2 billion.
Now $2 billion isn't much to scoff at, there are plenty of
agencies that would love to have a $2 billion increase in their
budget, but how are we going to meet the needs of a million
veterans who are returning from Iraq and Afghanistan? How are
we going to keep pace with the escalating costs of care,
construction needs, and badly needed technology improvements?
Two billion dollars is not quite two percent, 1.6 to be exact,
and if the Office of Management and Budget comes in later this
year and asks for two percent from the VA, it is game over.
Our house, our wonderful house with such great curb appeal
is nothing more than a house of cards. We have left our
Nation's heroes with nothing more than broken promises,
meaningless letters, and intolerable wait times.
Our Nation's veterans deserve real increases with real
money that can meet their real needs.
We must not, you cannot put forth a budget based on pipe
dreams of collections, hopes of grand compromises that generate
$1 billion, and putting off purchases of infrastructure
investments for today or tomorrow.
The American Legion implores you to take a thorough review
of this budget, weed out the parts that are unrealistic or may
never happen, make sure you adequately fund both the minor and
major construction accounts, allow VA to remain a leader in
prosthetic and medical research, and assist the VA in breaking
the back of the backlog.
That is going to cost money, real money. Your task is to
make sure your priorities find and protect that money. Protect
it as you were protected by those who served. Find it for it is
your time to serve now, your time to serve our Nation's
veterans and give them a budget they deserve.
Thank you for the opportunity to present the American
Legion views, I look forward to answering your question.
[The prepared statement of Timothy M. Tetz appears in the
Appendix]
The Chairman. Thank you very much for your testimony.
I was going to ask for further explanation of the gimmickry
that you had talked about in your testimony, I think you have
been pretty clear with it.
But Mr. Blake, you too also referenced some of the way the
numbers have been fudged, and I just want to ask, where do you
think the VA is being less than transparent?
Mr. Blake. I don't know that is an easy question to answer,
but if it is a question of transparency, I go back to my point
about this $3 billion in excess funding.
I wouldn't consider just simply saying we have got $2.9
billion in excess funding and that is it, transparent. They
didn't give us any--there are no details to that other than
some mild breakdowns they say approximately $2.6 billion I
think in health care services, a couple hundred million in
long-term care, and another hundred or so million in other
health care programs I think, but that is not very specific.
So I think there needs to be a full accounting of where
that money is, how it--you know, why it is excess?
And I go back to my point that I don't know how we can
decide up front that we have an excess of resources unless we
have just preordained that we are going have an excess of
resources, which means that somehow or the other, perhaps we
are not going to meet the full demand that is going to come to
the VA within the next seven months.
So you know, I am not suggesting--I think there just needs
to be more clarification about some of these savings that their
claim, that they are going to realize and excess money that
they have.
The Chairman. I mean to a layman who is not a CPA, it
appears that they have a very difficult time budgeting. We have
all talked about that, and each of you have brought that up in
your comments. Does it instill confidence in you, number one,
that they could be that far off in their numbers? And number
two, do you agree with their ability to take that money then
and use it as they choose without coming back to Congress to
reprogram the money?
Mr. Tetz. Mr. Chairman, I think from our perspective what
we are seeing on the--out in the field we are seeing you have
got medical center directors who are not given their full
allotment of money who are saying where did the money go? You
gave me these increases and we are not getting them and seeing
it down here, and then magically at the end of the year they
are reprioritized albeit for sometimes very good programs, but
there needs to be a better dialogue.
If we are here on the hill lobbying as a group for
increased funding for program X, Y, or Z and you no longer need
it for program Z, well, shouldn't we be part of the group that
you come to and say where do you want us to use this money now?
Mr. Blake. Not fully understanding this excess money that
they have, it would seem to me, that at least the health care
services portion must be governed by the model, which we have
obviously put a lot of stake in, and it concerns me that they
have apparently, you know, rerun the model and found that they
had that much extra savings, which that is not necessarily out
of the realm of possibility, but that is a four to five percent
difference in its funding needs, that is pretty substantial
when you are talking about a budget this big.
So I would really like to know what--it almost seems that
it would have to be sweeping assumption changes to have that
much of a difference in the change in its resources. So you
know, I think they would almost have to identify, you know,
some of these ideas.
In their budget request last year they projected a need for
certain I think $900 million was their contingency fund, but
they said that they built in there some assumptions about
economic factors without really assigning a good dollar figure
to that. I mean is that part of this? You know, there certainly
needs to be a better accounting of it than we just have this
much extra money.
The Chairman. Any other comments?
Mr. Filner.
Mr. Filner. Thank you. I just want to again thank you for
your incredible work on this that allows us to ask these
questions. I mean you have given us some--I want you as my
realtor too.
There are some real questions here, and to say, we have
extra resources for a VA that would like to do a lot more, it
really weakens the whole argument for the next budget, right? I
mean, if you say you don't have this money, or you have this
extra money.
I just also want to say for the record that I see in the
audience, who stayed from the first panel, Secretary Petzel,
Secretary Hickey, Secretary Muro, Secretary Baker, thank you
for staying. I think it is important that you do hear directly
our questions, so thank you very much for staying for the
second panel.
So we will take this critique seriously and try to do what
we can to make sure that your concerns are met.
Thank you so much.
The Chairman. Mr. Michaud.
Mr. Michaud. Thank you very much, Mr. Chairman.
A question for each of you. It relates to what you talked
about this morning when you look at the maintenance and
construction budget, but it also is actually a separate piece
of legislation that I would like to get your opinion on because
it relates to the construction piece.
Last week in the House of Representative we passed 1734,
the Civilian Property Realignment Act, which sets up a BRAC
process where this group will look at facilities that are
currently out there. DoD is exempted from it. VA, we tried to
get it exempted but it failed. So the VA is part of that BRAC
type process if the Senate passes it.
And I have two major problems with it. Number one is we do
not know, over the next five years, the soldiers that come back
exactly what facilities they are going to be needing, which
could cause a problem with more space.
And number two, under that process that money doesn't stay
within the VA, it goes in to pay down the debt. So we are
talking assets that VA currently has and actually taking that
money for something else.
Have you seen that legislation and if so are you supportive
or do you oppose it?
Mr. Kelley. The VFW hasn't taken a position on the piece of
legislation, but what I will add is that we are satisfied with
the BUR process that VA uses to assess their facilities to see
if it needs to be repurposed, if it can demolished, what to do
with that property.
It is a very usable model, so I would--my knee jerk
reaction without making a stance on this bill would be that
allow BUR to do its job, don't let the larger government
influence what VA needs to do with its property.
Mr. Hall. I just concur with my colleague, Ray, on that.
Mr. Tetz. I think, Mr. Michaud, the American Legion doesn't
have a formal position on that bill, but obviously we have been
through the cares process, the BUR process now, and when we
look at the enhanced use lease agreements and that overall
structure, you bring up a great point, how are we going to
address the veterans' needs in five years from now, and when we
sell something in the northeast that people aren't using today
are we truly doing that?
And keeping that as close to the users, and that being the
veterans and the VA, certainly would be in the best interest of
our Nation's veterans.
Mr. Michaud. Okay. Thank you very much.
Well, I would suggest that you pay attention to the
legislation because it passed the House, it is on its way to
the Senate. I agree with the rest of it except for the VA part
for the reasons that I mentioned.
My next question, if you look at the budget, the VA budget
they are adding $433 million in 2013. The budget requests VA--
well, it states that it has a specific plan to support the
cultural changes necessary to become a more patient-centered
health care system.
Have your organizations been part of this transformation
efforts? Have you seen the plans that the VA offers? To each
Member of the panel.
Mr. Blake. I think that is PACT is what they are calling
it.
Mr. Michaud. Yes.
Mr. Blake. The Independent Budget has some discussion on
PACT, and what I will say is, we don't necessarily believe PACT
is a bad thing, it is a model that is pretty commonly used in
the private sector for health care delivery.
That being said, what we have heard is the way staffing is
being done for these PACT teams and the resources are being
allocated, doesn't seem to fit the way it is supposed to be
done. That is what we have heard.
There is certainly more discussion about it in the IB and I
am not the expert on it, but you know, it is something we
definitely have within our--it is one of the major issues going
on within VHA as far as its transformation that we are
concerned about.
Mr. Tetz. Mr. Michaud, as the only Member on the panel not
part of the IB, we have had similar briefings from the VA.
Obviously patient care is utmost concern. I can get back to
your staff on our individual basic, but many of those models
basically take and throw the entire organization and super
structure on its ear and say instead of paying attention to the
nurses and the doctors, we are now going to pay attention to
the patients, and when they do so, sometimes the nurses and
doctors aren't willing to give up that care.
And so to instrumentally change, that really has to be
believed in from top to bottom all through the program.
Mr. Michaud. I see I only got seven seconds left, so just a
yes or no question. Each one of you, have you seen the plan?
Yes or no?
Mr. Blake. I personally have probably seen the cover of the
plan, but I know my staff has seen the plan that specifically
works on it, yes.
Mr. Kelley. Same as Carl, we have staff that has looked at
this and has talked with VA. I am not personally fully aware of
all aspects of it though.
Mr. Hall. Same for DAV, I have not seen it, but we have
individuals that deal with that issue specifically.
Ms. Zumatto. I actually have not seen the plan yet and I
don't have any staff to look at it, so obviously I need to get
it.
Mr. Tetz. And with the exception of Diane, I agree with the
rest of them, we have staff that review this.
The Chairman. Mr. Walz.
Mr. Walz. Thank you, Mr. Chairman, and thank you all for
being here. There is literally millions of veterans that stand
with you that you represent, them and their families, and I
can't tell you as a member of several organizations how proud I
am to have you here. These are the conversations we have to
have. I know each and every one of you is the staunchest
supporting there is of VA, and because of that you will be the
harshest critics, so I always appreciate the very candid
responses that you give.
And I would have to say, Tim, I loved your analogy. I am
also a big fan though of Extreme Makeover. We can do this.
And the President's budget and the VA budget is a
suggestion. Constitutionally we hold the purse strings, we hold
the final decisions. So this is where democracy works its best
and works its will, and it is very important that we have this,
so I want to thank you for that.
And again, I would also be the first to say Members of
Congress are experts at gross generalizations, so I want to be
very careful of what I do on this, but I do concur and I think
some of you brought up some things that I am hearing
personally, and I go out and talk to people in the field. I
talk to those directors, and I talk to the nurses, and I talk
to the people that are cleaning the rooms to hear what is going
on.
And one of the things that I am hearing, and this came from
one of my areas, we have out in Minnesota, listing one of them,
we have dental equipment and the space needed ready to stand up
three new dental facilities or ability to deliver that care;
however, we haven't hired anybody to do it. So it is boxed up
sitting there and that is going.
Does that surprise any of you? Maybe I am just looking at
where you are at. If that is the case again that our intent was
to fund and put it out there and make that available, how are
we making sure it happens?
And I am wondering, and I think Carl brought up a good
point along with the Chairman, of how do we account--is not
standing those dental clinics accounting for some of the money
that is not spent that is going back to go elsewhere? Because I
wanted the dental clinics, that is what I voted for and that is
what I wanted to see.
So I am just curious to get with you on this. And I say
that being very careful of a gross generalization, being very
careful of the dreaded disease around here, somebody told me
and we did it, it needs to be more accurate than that, but I am
hearing it from you somewhat echoed.
If somebody could give me just your feeling on this. Is
that kind of what is happening here? Are we not given the
ability to follow through on some of the things that we are
doing or intended to do?
Mr. Tetz. Mr. Walz, the system, we are saving, task force
at the American Legion stands up and sends around the
facilities nationwide has made their visits this year and they
continue to do so, and it is not uncommon for us to come across
empty facilities like this or empty rooms where you are, hey,
when we have the right people we can have this telehealth
center.
The problem with telehealth, and it is a great program and
I agree with Dr. Petzel on the future that it has, telehealth
requires somebody to be there to open up to office on the one
end, the rural end, and somebody to be there, the professional
on the other end, to take it. If you don't have those people,
all this infrastructure in the world doesn't do anything for
veterans.
Mr. Walz. Yeah, and I think for me it is about following
through and I think best made plans are best intentions, but I
am pretty certain if those three dental areas were up they
would be full, we could keep them full if we had the dentists,
the dental hygienists, everything else that goes with it, so I
am concerned.
And that leads me to my next question. Again, don't want to
over generalize, but this comes from a claim processor out
there. They are being asked to do 20 hours of overtime each
month, pressure is incredibly high, they lost three mid-range
folks who just simply didn't want to do it anymore, and that
happens in every business.
Again, I don't want to over generalize, but I heard you
mention it, I am hearing it, and kind of if there is smoke
there is fire.
Has this been a problem that you are seeing? I think Mr.
Hall you mentioned this in yours. And I know this directly from
the person who came to me and again said it, but with the
disclaimer on that if you are hearing it too.
Mr. Hall. We are hearing it. We are hearing it as an
organization, I think other members of the IB may be. I have
personally heard it because I have friends that work for the VA
in various places, and it was just basically said as mandatory
overtime. There is no choice. It is not, you know----
Mr. Walz. Yeah, that is the way it is being described to
me.
Mr. Hall. So the mandatory however they get the 20 hours,
two and a half Saturdays or one hour extra every day, whatever
it may be.
The biggest concern to those individuals and shared by us
is not necessarily the mandatory overtime, it is to quote them,
where are they getting the money for this if we are cutting
training? How are they requiring this, you know, for me to come
in on a Saturday to do this, but yet we are cutting the
training? We are already disenchanted by the training that we
don't receive, so----
Mr. Walz. I want to give them the flexibility if they need
to do overtime or whatever, but I just don't think it is a good
model to rely on. It always makes me question----
Mr. Hall. I think it is certainly sending the wrong
message.
Mr. Walz. It is unsustainable too.
Mr. Hall. Right.
Mr. Walz. Okay. Well, very good.
Again, I appreciate what all of you do. I think, and like I
said, I have seen some really bad homes on that show turn out
really nice, and so the 20-year high school lunchroom
supervisor in me remains optimistic, Tim, that we will get
this, a lot of folks working hard. This room and this Committee
is in absolute agreement that our job is to deliver the best
care that can be possibly be given to our veterans and I
appreciate you playing a huge part in that. So thank you all.
I yield back, Mr. Chairman.
The Chairman. Thank you very much.
Mr. Michaud, any more questions?
Mr. Michaud. No, just a comment if I might on Mr. Walz'
last issue about the facility that has dental care.
I know we have a facility in Maine that has just opened up,
a CBOC that actually could provide dental health care, but the
VA is not going to provide it because they are saying the need
is not there, which I disagree with.
But here is a situation, Mr. Chairman, if you look at one
of the biggest issues on trooper readiness for the guard and
reserve is actually dental care, and I think there is an
opportunity for the VA to work collaboratively with the DoD,
particularly the national guard and reserves to provide those
types of services, because there are actually guard and
reservists who are dentists that could actually do the work if
they were able to share the facilities, and I think that will--
and I know Minnesota has a lot of guard and reserves there as
well.
So I think if there was more collaboration in the health
care area with DoD and the VA, I think we could actually get
more bang for the buck.
And I yield back.
The Chairman. Thank you very much, and I concur with your
comments in regards to greater sharing of services between DoD
and VA, and I would like to say thank you to the witnesses on
the second panel.
Again, thank you to the witnesses of the first panel that
are still remaining here.
We have got a long way to go in this process, but I would
ask unanimous consent that all Members would have five
legislative days to revise and extend their remarks and add
extraneous materials, and in the absence of Ms. Brown, I will
go ahead and say without objection, and with, that this hearing
will be adjourned.
[Whereupon, at 1:22 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Chairman Jeff Miller
Good morning, and welcome to this morning's hearing to review the
Administration's Fiscal Year 2013 budget request for the Department of
Veterans Affairs. Mr. Secretary, I thank you and your team for joining
us today.
Although we are still combing through the budget, a process that
will likely involve further follow-up questions after this hearing, I
think it's safe to say that viewed in context of an extraordinarily
tight fiscal climate, a 4.3% increase in discretionary spending is
certainly positive.
That said, outcomes are what really matter . . . veterans don't
care about numbers, they want their claims decided faster, their health
care taken care of, and their aging facilities upgraded.
I do have some questions about how this funding request relates to
the actual resource requirement, but I'll get to those later. I want to
use the remainder of my time to talk about the issue of sequestration
and VA.
Mr. Secretary, let me begin by saying that I agree with you and the
President that sequestration is not desirable, whether it is applied to
DoD, VA, or any agency. I think all of us agree on that.
I also agree that specific guidance as to how sequestration will be
carried out and its impact at the operational level is something that
will likely be determined a bit farther down the road, but not much
farther. For example, will there be layoffs? Will maintenance needs be
postponed? Will facility activations be delayed? Those are details that
I'm curious whether VA has looked at, and they probably should have
already, but I can understand if we aren't quite at that point yet.
Finally, we are in agreement that there is an ambiguity in the law
with respect to VA that requires a clarifying legal decision that only
the Office of Management and Budget can make.
That is where my agreement with the Administration and its series
of non-responses to me, and other Committee Members, ends. For months
I've been trying to get clarity about what we, as a Committee, and
veterans, as our constituency, deserve to have resolved. Namely,
because of a conflict in the law, is VA even part of the picture should
a sequester order occur? Do we have cause to be concerned?
There is no such ambiguity with respect to DoD. There is no
ambiguity with respect to most other non-defense programs. All know
that those agencies are definitively in play.
But because the Administration has not clarified the matter, no one
can say if VA is completely exempt or not. I have legal opinions from
lawyers from both the Congressional Research Service and the Government
Accountability Office saying, in their judgment, VA appears to be
completely exempt. They provided these opinions to me in a matter of
days, proving that the legal issues at hand aren't that complicated.
But their judgments, mine, and that of others in Congress carry no
weight presently. Only OMB can resolve this. After multiple requests
from this Committee, a secretive legal opinion from VA lawyers
delivered to OMB several months ago, and obvious concern expressed by
veterans' organizations, the question still has been left to linger.
The obvious question, is ``why?''. Why not resolve this now? The
ambiguity will remain in law even if Congress and the President agree
on finding $1.2 Trillion in cuts to avoid a sequester next January.
This is an issue that needs clarifying once and for all.
Mr. Secretary, I know you're not the holdup. And I don't direct
this next comment at you. But I believe what we're seeing here is a
cynical attempt to keep veterans twisting in the wind to create more
pressure to act on the immediate sequester threat. I say to the
President, there is enough pressure to act already without threatening
veterans. One way or another, a decision must be made.
I won't hold my breath any longer waiting for an OMB decision. I've
introduced legislation to clarify the law as it stands now. The Protect
VA Healthcare Act of 2012 would simply amend the law to conform to what
Congress intended when it voted on the Budget Control Act. I ask all my
colleagues here for their support. We need to get this resolved. If the
President won't lead, then we must.
With that, I yield to the Ranking Member for his opening statement.
Prepared Statement of Hon. Bob Filner,
Ranking Democratic Member
Thank you, Mr. Chairman.
Secretary Shinseki, I want to welcome you this morning, and I am
looking forward to your testimony addressing the funding needs of the
Department of Veterans Affairs for fiscal year 2013, and the agency's
advance appropriation recommendation for the Medical Care accounts for
fiscal year 2014.
I would also like to thank the representatives of the veterans
service organizations who co-author the Independent Budget, and The
American Legion, for presenting us with their views as to the resource
requirements of the VA. Every year this Committee relies on the
veterans' community to provide an important insight into the needs of
the VA, and the pressing issues facing veterans and their families.
Mr. Secretary, I applaud your budget request this year. In a
constrained fiscal environment your budget recognizes the reality of
increased medical care costs and the importance of delivering the
health care and benefits that our veterans have earned in a timely
fashion. If you tell this Committee that you need these funding levels,
then I will commit to you that I will work with my colleagues to ensure
you get it.
In discretionary funding you request a 4.5 percent increase, and a
16.2 percent increase in mandatory funding, for an overall budget
increase of 10.5 percent in 2013. The majority of these discretionary
funds have already been provided through advance appropriations. I know
this Committee will carefully assess your 2013 request, as well as the
additional $165 million you are seeking to augment the amount already
provided for the Medical Care accounts.
Budgets represent a choice, and provide a window into the
priorities of the VA. I believe many, if not all, of your priorities
are the priorities of this Committee. I remain concerned, however, that
at the end of the day you have the resources you need to fulfill your
mission. In light of this, I believe we must ensure that your
``operational improvements'' and other cost-saving claims are actually
realized. We must ensure that your medical collections estimates are
achievable. And we must ensure that your workload estimates, especially
workload projections for our returning servicemembers are accurate.
CBO recently released a report entitled ``The Veterans Health
Administration's Treatment of PTSD and Traumatic Brain Injury Among
Recent Combat Veterans.'' The report found that of those seeking care
at VA, 28 percent of the OEF/OIF/OND cohort suffers from PTSD, TBI or
both. Treatment in the first year for these conditions can be four to
six times greater than for those who do not have these conditions. So
while we have come a long way in the past 10 years, clearly there is
much left to be done.
Over the years I have looked to the Independent Budget for guidance
as we make the tough decisions necessary to fully fund the VA and to
ensure that our budget priorities meet our national priorities and
aspirations. I look forward to hearing from the IB as to why they
believe we need to add nearly $4 billion to the Administration's
request, including $1.5 billion for medical care for FY2013. I also
look forward to hearing the panel's views as to the sufficiency of the
Administrations advance funding request for FY2014.
Mr. Secretary, we have all worked together over the years to
increase funding levels for the VA to meet the needs of our veterans. I
am sure that we will do the same this year. But as scripture informs
us, ``to who much is given, much is expected.'' I know that I speak for
my colleagues on this Committee that we expect great results from you
that will serve our veterans and their families.
Thank you, Mr. Chairman. I yield back the balance of my time.
Prepared Statement of Hon. Silvestre Reyes
Thank you Chairman Miller and Ranking Member Filner for convening
this important hearing. One of the most critical functions of this
Committee is to ensure that we are providing the men and women who
served our Nation with the health care, compensation, and support they
have earned.
Secretary Shinseki, thank you for your service and tireless
dedication to all veterans and thank you for being here today. The VA
is an incredibly diverse and dispersed agency and this Committee will
spend the next few weeks studying the budget document provided by the
Department.
Today, I am particularly interested in hearing how the Department
will deal with the difficult problem of unemployment among veterans -
both those recently returned from Iraq and Afghanistan and those from
other eras who are coping with long term unemployment. Adequate funding
for VA health care continues to be a concern, and I look forward to
working with you as we expand the VA's footprint in El Paso to meet the
needs of the growing veterans population. Younger veterans dealing with
prosthetics, brain and eye injuries, and post-traumatic stress bring
new challenges to the VA, but these new issues cannot supplant the
needs of older veterans who continue to deal with the effects of their
service.
There are no easy answers, but we owe those who sacrificed
themselves in defense of our Nation nothing less than the health care
and benefits that have earned with their service.
Prepared Statement of Hon. Michael R. Turner
Thank you, Chairman Runyan, for holding this important hearing. I
would also like to recognize your advocacy on this issue within the
House Armed Services Committee. Special thanks, as well, to all the
panelists for their advocacy of victim's rights and determination to
address the military culture and climate. I have worked with Anu and
SWAN for several years now and their contribution to this issue have
been instrumental in achieving many legal and policy changes.
Before I start my remarks, I would like to point out that the great
majority of the Servicemembers are patriotic citizens that serve their
country honorably and selflessly. And while today's hearing may focus
on the criminal behavior of a relative few, their behavior should not
be used to broadly tarnish the reputation of the many Servicemembers
who have honorably sacrificed for their country.
I became involved in this issue in 2008 following the tragic murder
of Lance Corporal Maria Lauterbach. Maria reported being sexually
assaulted and was later murdered by a fellow Marine while she was
stationed at Camp LeJeune, North Carolina. During the course of the
investigation a Marine Corps representative told me that ``we lost two
good Marines today.'' When, in fact, we had only lonst one good Marine,
Maria Lauterbach, and another Marine who was a rapist and murder that
tarnished the reputation of the Corps. Later, during the course of
Congressional hearings on the subject, a Lieutenant General stated that
Maria ``never alleged any violence or threat of violence in either
sexual encounter.''
These and several other incidents demonstrated a fundamental lack
of understanding of the problem and how to deal with it. In addressing
the issue of military sexual assault it is necessary to address some
fundamental areas, namely: Command, Culture and Accountability. I think
the hearing today strikes at the heart of the cultural element. Culture
within the Department of Defense and the Department of Veterans
Affairs.
In working on sexual assault issues on the House Armed Services
Committee and the Military Sexual Assault Prevention Caucus, which I
co-chair with Niki Tsongas, we have sculpted legislation that aims to
facilitate a culture that encourages victims to come forward and
punishes the criminal actors that degrade our military. The personal
nature of sexual assault makes it difficult for victims to come forward
and discuss the details of their experience. This is compouned by
policies that require victims to repeatedly relive the experience and
re-victimize the victims. These additional stresses decrease the
likelihood of victims coming forward and permit the retention of
criminals. As Anu pointed out in her testimony, the DoD Sexual Assault
Prevention and Response Office (SAPRO) report indicated that 86.5% of
sexual assaults go unreported. The end result is that some of these
ciminal later draw DoD and VA benefits, while their victims are left to
fight to substantiate their PTSD claims.
Addressing the issue before the Committee today is a step towards
creating a more victim-centric system that improves our military by
rewarding victims for coming forward and punishing the bad actors. In
addressing this issue, Niki Tsongas and I included a provision in the
Defense STRONG Act last year requiring the DoD to retain records
prepared in connection with sexual assaults involving members of the
Armed Forces or dependents of members. That provision was later
included in the FY12 NDAA. This provision requires the Department of
Defense to permanently retain records of sexual assault in the
military, and ensures that a servicemember who is a victim of sexual
assault has access to these records. Servicemembers find it difficult
to obtain documentation proving their sexual assault once they have
left the services because DoD destroys many of these documents after
only a few years. It is our hope that improving this process will
contribute to removing the negative stigma that surrounds the process
and, thereby, improves military culture and climate.
Questions
Col. Metzler and Mr. Murphy. What is the status of implementation
of this new policy (HR1540 Sec 586)?
Prepared Statement of Hon. Eric K. Shinseki
Chairman Miller, Ranking Member Filner, Distinguished Members of
the House Committee on Veterans' Affairs:
Thank you for the opportunity to present the President's 2013
Budget and 2014 advance appropriations requests for the Department of
Veterans Affairs (VA). For the past three budget requests, the Congress
has supported the very high priority that the President has placed on
funding for programs that provide care and benefits for our Nation's 22
million Veterans and their families. This submission seeks your support
of the President's continued high priority support for Veterans who
have earned this Nation's respect and the benefits and services we
provide.
We meet at an historic moment for our nation's Armed Forces, as
they turn the page on a decade of war. Recently, the President outlined
a major shift in the Nation's strategic military objectives - with a
goal of a more agile, more versatile, more responsive military focused
on the future. The President also outlined another important objective
- keeping faith with those who serve as they depart the military and
return to civilian life. As these newest Veterans return home, we must
anticipate their transitions by readying the care, the benefits, and
the job opportunities they have earned and they will need to smoothly
and successfully make this transition.
The President's 2013 Budget for VA requests $140.3 billion -
comprised of $64 billion in discretionary funds, including medical care
collections, and $76.3 billion in mandatory funds. The discretionary
budget request represents an increase of $2.7 billion, or 4.5 percent,
over the 2012 enacted level. Our 2013 budget will allow the Department
to operate the largest integrated healthcare system in the country,
with more than 8.8 million Veterans enrolled to receive healthcare; the
eighth largest life insurance provider covering both active duty
members as well as enrolled Veterans; a sizeable education assistance
program serving over 1 million participants; a home mortgage service
that guarantees over 1.5 million Veterans' home loans with the lowest
foreclosure rate in the Nation; and the largest national cemetery
system that continues to lead the country as a high-performing
organization - for the fourth time in a 10-year period besting the
Nation's top corporations and other federal agencies in an independent
survey of customer satisfaction. In 2013, VA national cemeteries will
inter about 120,000 Veterans or their family members.
The Department of Veterans Affairs fulfills its obligation to
Veterans, their families, and survivors of the fallen by living a set
of core values that define who we are as an organization: ``I CARE''-
Integrity, Commitment, Advocacy, Respect, and Excellence, - cannot be
converted into dollars in a budget. But Veterans trust that we will
live these values, every day, in our medical facilities, our benefits
offices, and our national cemeteries. And where we find evidence of a
lack of commitment to our values, we will aggressively correct them by
re-training employees or, where required, removal. We provide the very
best in high quality and safe care and compassionate services,
delivered by more than 316,000 employees, who are supported by the
generosity of 140,000 volunteers.
Stewardship of Resources
Safeguarding the resources - people, money, time - entrusted to us
by the Congress, managing them effectively and deploying them
judiciously, is a fundamental duty at VA. Effective stewardship
requires an unflagging commitment to apply budgetary resources
efficiently, using clear accounting rules and procedures, to safeguard,
train, motivate, and hold our workforce accountable; and to assure the
proper use of time in serving Veterans on behalf of the American
people.
During the audit of the Department's fiscal year 2010 financial
statement, VA's independent auditor certified that we had remediated
all three of our remaining material weaknesses in financial management,
which had been carried forward for over a decade. In terms of internal
controls and fiscal integrity, this was a major accomplishment. We have
also dramatically reduced the number of significant financial
deficiencies since 2008, from sixteen to two.
Another example of VA's effective stewardship of resources is the
Project Management Accountability System (PMAS) developed by our Office
of Information Technology. PMAS requires Information Technology (IT)
projects to establish milestones to deliver new functionality to its
customers every six months. Now entering its third year, PMAS continues
to instill accountability and discipline in our IT organization. In
2011, PMAS achieved successful delivery of 89 percent of all IT project
milestones. VA managed 101 IT projects during the year, establishing a
total of 237 milestones and successfully executing 212 of them. Of the
25 IT projects that missed their delivery milestone date, more than
half delivered within the next 14 days. Ensuring IT projects meet
established milestones means that savings and delivery of solutions are
achieved throughout development, and that Veterans reap improvements
sooner. By implementing PMAS, we have achieved at least $200 million in
cost avoidance by stopping or improving the management of 45 projects.
VA's stewardship of resources continues with the expansion of our
ASPIRE dashboard to the Veterans Benefits Administration (VBA).
Originally established in 2010 for the Veterans Health Administration
(VHA), ASPIRE publicly provides quality goals and performance measures
of VA healthcare. The success of this approach was reflected in its
contribution to VHA's receipt of the Annual Leadership Award from the
American College of Medical Quality. On June 30, 2011, VBA established
an ASPIRE website at http://www.vba.va.gov/reports/aspiremap.asp for
aspirational goals and monthly progress for 46 performance metrics
across six business lines. This new effort expands the Department's
commitment to unprecedented public transparency by sharing performance
and productivity data in the delivery of Veterans' benefits, including
compensation, pension, vocational rehabilitation and employment,
education, home loans, and insurance.
Through the effective management of our acquisition resources, VA
achieves positive results for Veteran-owned small businesses. VA leads
the Federal government in contracting with Service-Disabled, Veteran-
Owned Small Businesses (SDVOSB). In 2011, more than 18 percent of all
VA procurements were awarded to SDVOSBs, exceeding our internal goal of
10 percent and far exceeding the government-wide goal of three percent.
Finally, VA's stewardship achieved savings in several other areas
across the Department. The National Cemetery Administration (NCA)
assumed responsibility in 2009 for processing First Notices of Death to
terminate compensation benefits to deceased Veterans. This allows the
timely notification to next-of-kin of potential survivor benefits.
Since that time NCA has avoided possible collection action by
discontinuing $100.3 million in benefit payments. In addition, we
implemented the use of Medicare pricing methodologies at VHA to pay for
certain outpatient services in 2011, resulting in savings of over $160
million without negatively impacting Veteran care and with improved
consistency in billing and payment.
Veterans Job Corps
In his State of the Union address, President Obama called for a new
Veterans Job Corps initiative to help our returning Veterans find
pathways to civilian employment. The budget includes $1 billion to
develop a Veterans Job Corps conservation program that will put up to
20,000 Veterans back to work over the next five years protecting and
rebuilding America. Veterans will restore our great outdoors by
providing visitor programs, restoring habitat, protecting cultural
resources, eradicating invasive species, and operating facilities.
Additionally, Veterans will help make a significant dent in the
deferred maintenance of our Federal, State, local, and tribal lands
including jobs that will repair and rehabilitate trails, roads, levees,
recreation facilities and other assets. The program will serve all
Veterans, but will have a particular focus on post-9/11 Veterans.
Multi-Year Plan for Medical Care Budget
Under the Veterans Health Care Budget Reform and Transparency Act
of 2009, which we are grateful to Congress for passing; VA submits its
medical care budget that includes an advance appropriations request in
each Budget submission. This legislation requires VA to plan its
medical care budget using a multi-year approach. This approach ensures
that VA requirements are reviewed and updated based on the most recent
data available and actual program experience.
The 2013 budget request for VA medical care appropriations is $52.7
billion, an increase of 4.1 percent over the 2012 enacted appropriation
of $50.6 billion. This request is an increase of $165 million above the
2013 advance appropriations enacted by Congress in 2011. Based on
updated 2013 estimates largely derived from the Enrollee Health Care
Projection Model, the requested amount would also allow VA to increase
funding in programs to eliminate Veteran homelessness, fully fund the
implementation of the Caregivers and Veterans Omnibus Health Services
Act, support activation requirements for new or replacement medical
facilities, and invest in strategic initiatives to improve the quality
and accessibility of VA healthcare programs. Our multi-year budget plan
continues to assume $500 million in unobligated balances from 2012 that
will carryover and remain available for obligation in 2013 - consistent
with the 2012 budget submitted to Congress.
The 2014 request for medical care advance appropriations is $54.5
billion, an increase of $1.8 billion, or 3.3 percent, over the 2013
budget request.
Priority Goals
Our Nation is in a period of transition. As the tide of war
recedes, we have the opportunity, and the responsibility, to anticipate
the needs of returning Veterans. History shows that the costs of war
will continue to grow in VA for a decade or more after the operational
missions in Iraq and Afghanistan have ended. In the next 5 years,
another one million Veterans are expected to leave military service.
Our data shows that the newest of our country's Veterans are relying on
VA at unprecedented levels. Through September 30, 2011, of the
approximately 1.4 million living Veterans who were deployed overseas to
support Operation Enduring Freedom and Operation Iraqi Freedom, at
least 67 percent have used some VA benefit or service.
VA's three priorities - to expand access to benefits and services,
eliminate the claims backlog, and end Veteran homelessness - anticipate
these changes and identify the performance levels required to meet
emerging needs. The 2013 Budget builds upon our multi-year effort to
achieve VA's priority goals through effective, efficient, and
accountable program implementation.
Expanding Access to Benefits and Services
Expanding access for Veterans is much more than boosting the number
of Veterans walking in the front door of a VA facility. Access is a
three-pronged effort that encompasses VA's facilities, programs, and
technology. Today, expanding access includes taking the facility to the
Veteran--be it virtually through telehealth, by sending Mobile Vet
Centers to rural areas where services are sparse, or by using social
media sites like Facebook, Twitter, and YouTube to connect Veterans to
VA benefits and facilities. Expanding access also means finding new
ways to break down artificial barriers so that Veterans are aware of
and can gain access to VA services and benefits. Technology is the
great enabler of all VA efforts. IT is not a siloed segment of the
budget, providing just computers and monitors, but rather the vehicle
by which VA is able to extend the reach of its healthcare to rural
America, process benefits more quickly, and provide enhanced service to
Veterans and their families.
The 2013 budget request includes $119.4 million for the Veterans
Relationship Management (VRM) initiative, which is fundamentally
transforming Veterans' access to VA benefits and services by empowering
VA clients with new self-service tools. VA has already made major
strides under this initiative. VRM established a single queue for VBA's
National Call Centers ensuring calls are routed to the next available
agent, regardless of geography. Call-recording functionality was
implemented that allows agents to review calls for technical accuracy
and client contact behaviors. VA recently deployed ``Virtual Hold ASAP
call-back'' technology. During periods of high call volumes, callers
can leave their name and phone number instead of waiting on hold for
the next available operator, and the system automatically calls them
back in turn. The Virtual Hold system has made nearly 600,000 return
calls since November 2011. The acceptance rate for callers is 46
percent, exceeding the industry standard of 30 percent, and our
successful re-connect rate is 92 percent. Since launching Virtual Hold,
the National Call Centers have seen a 15 percent reduction in the
dropped-call rate. In December 2011, VA deployed ``Virtual Hold
Scheduled call-back'' technology, which allows callers to make an
appointment with us to call them at a specific time. Since deployment,
over 185,000 scheduled call-backs have already been processed.
In December, VA deployed a pilot of its new ``Unified Desktop''
technology. This initiative will provide National Call Center agents
with a single, unified view of VA clients' military, demographic, and
contact information and their benefits eligibility and claims status
through one integrated application, versus the current process that
requires VA agents to access up to 13 different applications. This will
help ensure our Veterans receive comprehensive and accurate responses.
Key to expansion of access is the eBenefits portal - one of our
critical VRM initiatives. eBenefits is a VA/DoD initiative that
consolidates information regarding benefits and services and includes a
suite of on-line self-service capabilities for enrollment/application
and utilization of benefits and services. eBenefits enrollment now
exceeds 1.2 million users, and VA expects enrollment to exceed 2.5
million by the end of 2013. VA continues to expand the capabilities
available through the eBenefits portal. Users can check the status of a
claim or appeal, review the history of VA payments, request and
download military personnel records, generate letters to verify their
eligibility for Veterans' hiring preferences, secure a certificate of
eligibility for a VA home loan, and numerous other benefit actions. In
2012, Servicemembers will complete their Servicemembers' Group Life
Insurance applications and transactions through eBenefits. Also, 2012
enhancements will allow Veterans to view their scheduled VA medical
appointments, file benefits claims online in a ``Turbo Claim'' like
approach, and upload supporting claims information that feeds our
paperless claims process. In 2013, funding supports enhanced self-
service tools for the Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA) and VetSuccess programs, as
well as the Veterans Online Application for enrolling in VA healthcare.
VA and the Department of Defense (DoD) have broken new ground in
the development and implementation of the Integrated Disability
Evaluation System (IDES). This system supporting the transition of
wounded, ill, and injured Servicemembers is fully operational and
available to Servicemembers as of October 1, 2011. Because of the
complexity of these cases, the Veterans Benefits Administration devotes
four times the level of staffing resources to processing IDES cases
than claims from other Veterans. VA has reduced its claims processing
time in IDES from 186 days in February 2011 to 104 days in December
2011. The 2013 budget requests an additional $13.2 million and 90 FTE
to support IDES enhancements.
The DoD/VA team is further developing programs to enhance the
transition of all Servicemembers to Veteran status. Together we are
transforming the current Transition Assistance Program (TAP) from a
series of discrete efforts to one that uses an outcome-based approach.
This approach will be more integrated and, once complete will be mapped
to the life cycle of every Servicemember, from recruitment through
separation or retirement. In July 2011, VBA launched on-line TAP
courseware, which provides the capability for Servicemembers to
complete the course without attending the classroom session. VA and DoD
also are collaborating on a policy for implementing mandatory TAP
participation.
VA will improve access to VA services by opening new or improved
facilities closer to where Veterans live. The 2013 medical care budget
request includes $792 million to open new and renovated healthcare
facilities, including resources to support the activation of four new
hospitals in Orlando, Florida; Las Vegas, Nevada; New Orleans,
Louisiana; and Denver, Colorado. These new VA Medical Centers are
projected to serve 1.2 million enrolled Veterans when they are
operational. This budget also includes an initiative to establish a
national cemetery presence in eight rural areas where the Veteran
population is less than 25,000 within a 75-mile service area. In
addition to expanding access at fixed locations, VA is deploying an
additional 20 Mobile Vet Centers in 2012 to increase access to
readjustment counseling services for Veterans and their families in
rural and underserved communities across the country. These new
specialty vehicles will expand the existing fleet of 50 Mobile Vet
Centers already in service by 40 percent. In 2011, Mobile Vet Centers
participated in more than 3,600 Federal, state, and locally sponsored
Veteran-related events. More than 190,000 Veterans and family members
made over 1.3 million visits to VA Vet Centers in 2011.
The Board of Veterans Appeals (BVA) leverages video conference
technology to increase the capability of, and access to, video hearings
to provide Veterans with more options for a hearing regarding their
appeal. The VA is currently upgrading this video conference technology
both at BVA and at VBA regional offices. In 2011, the number of video
hearings increased from 3,979 to 4,355 or 9.4 percent. The Board is
also working with VBA and VHA to allow video hearings to be held from
more locations in the field, which will be more convenient for
Veterans. Initially, the expanded video capability will be used to
reduce the backlog of hearings and the time Veterans have to wait for
them.
We are working harder than ever to reach out to women Veterans.
Women represent about eight percent of the total Veteran population. In
recent years, the number of women Veterans seeking healthcare has grown
rapidly and it will continue to grow as more women enter military
service. Women comprise nearly 15 percent of today's active duty
military forces and 18 percent of National Guard and Reserves. For the
estimated 337,000 women Veterans currently using the VA healthcare
system, VA is improving their access to services and treatment
facilities. The 2013 budget includes $403 million for the gender-
specific healthcare needs of women Veterans, an increase of 17.5
percent over the 2012 level.
VHA regularly updates its standards for improving and measuring
Veterans' access to medical care programs. In 2010, VHA implemented new
wait time measures that assess performance meeting the new standard of
providing medical appointments within 14 days of the desired date,
replacing the previous 30-day desired-date standard. In 2011, 89
percent of medical care appointments for new patients occurred within
14 days of the desired date, an increase of 5 percentage points over
the 2010 level of 84 percent. The President's request for 2013 ensures
we are able to continue to improve our performance in providing this
service.
Access improvements are central to VHAs new Patient-Aligned Care
Teams (PACT) model. VA views appointments as a partnership. We are
implementing a national initiative to reduce costly no-show
appointments. Also, Veterans can manage appointments by visiting
MyHealtheVet website, where they can view all of their pending
appointments. In another effort to help Veterans make and keep
appointments, VA is implementing a pilot program that offers child care
to eligible Veterans seeking medical appointments at three VA medical
centers in 2012 and 2013. The first of these facilities, the Buffalo
VAMC, began providing services in October 2011. Each pilot site will be
operated onsite by licensed childcare providers. Drop-in services will
be offered free of charge to Veterans who are eligible for VA care and
who are visiting a medical facility for an appointment.
VA is taking full advantage of technology to expand access to its
medical centers. In 2008, VA established a presence on Facebook with a
single Veterans Health Administration (VHA) page. In 2009, VA
established the Post-9/11 GI Bill Facebook page to raise awareness
about the implementation of this new benefit program. With over 39,000
subscribers (``or fans''), this page serves as our primary ``real-
time'' tool to communicate GI Bill news and directly interact with our
clients. VA also launched a general VBA benefits page, which describes
all of our services. VBA posts to its followers seven days a week and
is followed in 18 different countries and 15 different languages. In
June 2011, VA outlined a Department-wide social media policy that
provides guidelines for communicating with VA online. By November 2011,
VA had established Facebook pages for all 152 of its medical centers.
This event marks an important milestone in our effort to transform how
the Department communicates with Veterans and provides them access to
healthcare and benefits. By leveraging Facebook, VA continues to
embrace transparency and engage Veterans in a two-way conversation. VA
currently has over 345,000 combined Facebook ``fans.'' As of January
2012, the Department's main Facebook page has over 154,000 fans and its
medical centers have a combined following of over 69,000.
Eliminating the Claims Backlog
To transform VA for the benefit of Veterans, we must streamline the
claims processing system and eliminate the claims backlog. We are
vigorously pursuing a claims transformation plan that will adopt near-
term innovations and break down stubborn obstacles to providing
Veterans the benefits they have earned.
As we pursue a multi-focused approach to eliminate the claims
backlog, workload in our disability compensation and pension programs
continues to rise. VA has experienced a 48 percent increase in claims
receipts since 2008, and we expect that the incoming claims volume will
continue to increase by 4.2 percent in 2013, to 1,250,000 claims from
1,200,000 in 2012. At the same time, Veterans are claiming many more
disabilities, with Iraq and Afghanistan Veterans claiming an average of
8.5 disabilities per claim - more than double the number of
disabilities claimed by Veterans of earlier eras. As more than one
million troops leave service over the next 5 years, we expect our
claims workload to continue to rise for the foreseeable future. In
2013, our goal is to ensure that no more than 40 percent of the
compensation and pension claims in the pending inventory are more than
125 days old. While too many Veterans will still be waiting too long
for the benefits they have earned, it does represent a significant
improvement in performance over the 2012 estimate of 60 percent of
claims more than 125 days old, demonstrating that we are on the right
path.
VA is attacking the claims backlog through an aggressive
transformation plan that includes initiatives focused on the people,
processes, and technology that will eliminate the backlog. We are
implementing a new standardized operating model in all our regional
offices beginning this year that incorporates a case-management
approach to claims processing. It establishes distinct processing lanes
based on the complexity and priority of the claims and assigns
employees to the lanes based on their experience and skill levels.
Integrated, cross-functional teams work claims from start to finish,
facilitating the quick flow of completed claims and allowing for
informal clarification of claims processing issues to minimize rework
and reduce processing time. More easily rated claims move quickly
through the system, and the quality of our decisions improves by
assigning our more experienced and skilled employees to the more
complex claims. The new operating model also establishes an Intake
Processing Center at every regional office, adding a formalized process
for triaging mail and enabling more timely and accurate distribution of
claims to the production staff in their appropriate lanes.
VA is increasing the expertise of our workforce and the quality of
our decisions through national training standards that prepare claims
processors to work faster and at a higher quality level. Our training
and technology skills programs will continue to deliver the knowledge
and expertise our employees need to succeed in a 21st Century
workplace. We are establishing dedicated teams of quality review
specialists at each regional office. These teams will evaluate decision
accuracy at both the regional office and individual employee levels,
and perform in-process reviews to eliminate errors at the earliest
possible stage in the claims process. Personnel trained by our national
quality assurance staff comprise the quality review teams to assure
local reviews are consistently conducted according to national
standards.
Using ``Design Teams,'' VBA is conducting rapid development and
testing of process changes, automated processing tools, and innovative
workplace incentive programs. The first Design Team developed a method
to simplify rating decisions and decision notification letters that was
implemented nationwide in December 2011. This new decision notification
process streamlines and standardizes the development and communication
of claims decisions. This initiative also includes a new employee job-
aid that uses rules-based programming to assist decision makers in
assigning an accurate service-connected evaluation. VBA's
Implementation Center, established at VBA headquarters as a program
management office, streamlines the process of innovation to ensure that
new ideas are approved through a governance process. This allows us to
focus on initiatives that will achieve the greatest gains.
VA continues to promote the Fully Developed Claims (FDC) Program.
We believe utilization of the FDC Program will significantly increase
as a result of the public release last month of 68 more Disability
Benefits Questionnaires (DBQs), bringing the total number of DBQs
publically available to 71. DBQs are templates that solicit the medical
information necessary to evaluate the level of disability for a
particular medical condition. Currently used by Veterans Health
Administration examiners, the release of these DBQs to the public will
allow Veterans to take them to their private physicians, facilitating
submission of a complete claims package for expedited processing. VA
plans an aggressive communications strategy surrounding the release of
these DBQs that will promote the FDC program. We also continue to work
with the VSO community to identify ways to boost FDC program
participation and better inform and serve Veterans and their advocates.
This year VA is also beginning national implementation of our new
paperless processing system, the Veterans Benefits Management System
(VBMS). We are implementing VBMS using a phased approach that will have
all regional offices on the new system by the end of 2013. We will
continue to add and expand VBMS functionality throughout this process.
Establishment of a digital, near-paperless environment will allow for
greater exchange of information and increased transparency to Veterans,
our workforce, and stakeholders. Increased use of state-of-the-art
technology plays a major role in enabling VA to eliminate the claims
backlog and redirect capacity to better serve Veterans and their
families. Our strategy includes active stakeholder participation
(Veterans Service Officers, State Departments of Veterans Affairs,
County Veterans Service Officers, and Department of Defense) to provide
digitally ready electronic files and claims pre-scanned through online
claims submission using the eBenefits web portal. VBA has aggressively
promoted the value of eBenefits and the ease of enrolling into the
system. The 2013 budget invests $128 million in VBMS.
Ending Veteran Homelessness
The Administration is committed to ending homelessness among
Veterans by 2015. Between January 2010 and January 2011 homelessness
declined by 12 percent, keeping VA on track to meet the goal of ending
Veteran homelessness in 2015. The VA's Homeless Veteran Registry is
populated with over 400,000 names of current and formerly homeless
Veterans who have utilized VA's Homeless Programs--allowing us to
better see the scope of the issues so we can more effectively address
them.
In the 2013 Budget, VA is requesting $1.352 billion for programs
that will prevent and treat Veteran homelessness. This represents an
increase of $333 million, or 33 percent over the 2012 level. This
budget will support our long-range plan to eliminate Veteran
homelessness by reducing the number of homeless Veterans to 35,000 in
2013 by emphasizing rescue and prevention.
To get Veterans off the streets and into stable environments, VA's
Grant and Per Diem Program awards grants to community-based
organizations that provide transitional housing and support services.
VA's goal is to serve 32,000 homeless Veterans in this program in 2013.
Transitional housing is also provided through the Healthcare for
Homeless Veterans program. Permanent housing is achieved with Housing
Choice Vouchers in the Department of Housing and Urban Development
(HUD)-VA Supportive Housing (HUD-VASH) Program, and by 2013 VA plans to
provide case management support for the nearly 58,000 HUD Housing
Choice vouchers available to assist our most needy homeless Veterans.
Culminating two years of work to end homelessness among Veterans,
the Building Utilization Review and Repurposing (BURR) initiative
helped identify unused and underused buildings and land at existing VA
property with the potential for repurposing to Veteran housing. The
BURR initiative supports VA's goal of ending Veteran homelessness by
identifying excess VA property that can be repurposed to provide safe
and affordable housing for Veterans and their families. As a result of
BURR, VA began developing housing opportunities at 34 nationwide
locations for homeless or at-risk Veterans and their families using its
Enhanced Use Lease (EUL) authority (now expired). The housing
opportunities developed through BURR will add approximately 4,100 units
of affordable and supportive housing to the projects already in
operation or under construction, for an estimated total of 5,400 units.
Although the Department's Enhanced Use Lease authority has expired,
the Administration will work with Congress to develop future
legislative authorities to enable the Department to further repurpose
the properties identified by the BURR process. Beyond reducing
homelessness among our Veterans, additional opportunities identified
through BURR may include housing for Veterans returning from Iraq and
Afghanistan, assisted living for elderly Veterans, and other possible
uses that will enhance benefits and services to Veterans and their
families.
Of all claimants served by the Veterans Benefits Administration
(VBA), homeless Veterans represent our most vulnerable population and
require specialized care and services. The 2013 budget requests $21
million for the Homeless Veterans Outreach Coordinator (HVOC)
initiative, which would provide an additional 200 coordinators
nationwide to expedite disability claims; acquire housing and prevent
Veterans from losing their homes; expedite access to vocational
training and job opportunities; and resolve legal issues at regional
justice courts. These new case managers would significantly improve
outcomes on behalf of the Nation's homeless Veterans. For example, the
initiative would improve the timeliness of disability claims decisions
for homeless and at-risk Veterans by reducing the claims processing
times by nearly 40 percent between 2011 and 2015.
In 2011, VHA hired 366 (or 90 percent of 407 total positions)
homeless or formerly homeless Veterans as Vocational Rehabilitation
Specialists to provide individualized supported employment services to
unemployed homeless Veterans through the Homeless Veterans Supported
Employment Program. Recent initiatives to increase employment of
Veterans in Federal and other public-sector jobs will help to reduce
homelessness and also ensure their families are supported. On January
18, 2012, VA hosted a career fair for Veterans in Washington, DC. Over
4,000 Veterans attended this event to explore and apply for thousands
of public and private sector job opportunities.
The VA also helps Veterans obtain employment with education and
training assistance. The National Cemetery Administration (NCA) is
helping to provide employment opportunities for homeless Veterans
through a new, paid Apprenticeship Training Program serving Veterans
who are homeless or at risk of homelessness. The program will be based
on current NCA training requirements for positions such as Cemetery
Caretakers and Cemetery Representatives. Veterans who successfully
complete the program at national cemeteries will be guaranteed full-
time permanent employment at a national cemetery or may choose to
pursue employment in the private sector. The Veterans Retraining
Assistance Program is a joint effort with VA and the Department of
Labor to provide 12 months of retraining assistance. The program is
limited to 54,000 participants from October 1, 2012, through March 31,
2014. Education and training assistance are preventive programs.
Other preventive services programs include the Supportive Services
for Veteran Families, which provides rapid case management and
financial assistance, coordinated with community and mainstream
resources, to promote housing stability. In time, VA will transition
its homeless efforts primarily to prevention. Through coordinated
partnerships with other Federal and local partners and providers, VA
will assist at risk Veterans in maintaining housing, accessing
supportive services that promote housing stability, and identifying the
resources to rapidly re-house Veterans and their dependents if they
should fall into homelessness. This shift to increased preventive
efforts will require us to be much more knowledgeable about the causes
of Veterans' homelessness, about the details of our current homeless
and at-risk Veteran populations, and about creating action plans that
serve Veterans at the individual level.
Medical Care Program
The 2013 budget requests $52.7 billion for healthcare services to
treat over 6.33 million unique patients, an increase of 1.1 percent
over the 2012 estimate. Of those unique patients, 4.4 million Veterans
are in Priority Groups 1-6, an increase of more than 64,000 or 1.5
percent. Additionally, VA anticipates treating over 610,000 Veterans
from the conflicts in Iraq and Afghanistan, an increase of over 53,000
patients, or 9.6 percent, over the 2012 level.
Medical Care in Rural Areas
The delivery of healthcare in rural areas faces major challenges,
including a shortage of healthcare resources and specialty providers.
In 2011, we obligated $18.8 billion to provide healthcare to Veterans
who live in rural areas. Some 3.6 million Veterans enrolled in the VA
healthcare system live in rural or highly rural areas of the country;
this represents about 42 percent of all enrolled Veterans. For that
reason, VA will continue to emphasize rural health in our budget
planning, including addressing the needs of Native American Veterans.
The 2013 budget continues to invest in special programs designed to
improve access and the quality of care for Veterans residing in rural
areas. For example, in the remote, sparsely populated areas of Montana,
Utah, Wyoming and Colorado, VA has supported the development and
expansion of a network-wide operational telehealth infrastructure that
supports a virtual intensive care unit, tele-mental health services,
and primary care and specialty care to 67 fixed and mobile sites.
Again, IT investment is the foundation of our work in all of these
areas.
In rural areas with larger populations, funding supports the
opening of new rural clinics, such as the one located in Newport,
Oregon, which serves over 1,200 Veterans. This clinic is a unique
partnership between VA and the local Lincoln County government. The
county government provides clinical space, equipment and supplies,
while VA funds the salaries for the primary care and mental health
providers.
Mental Healthcare
The budget requests $6.2 billion for mental health programs, for an
increase of $312 million over the 2012 level of $5.9 billion. VA is
increasing outreach opportunities to connect with and treat Veterans
and their families in new, innovative ways. In April 2011, VA launched
the first in a series of mobile smartphone applications, the PTSD
Coach. It provides information about PTSD, self-assessment and symptom
management tools, and information on how to get help. VA developed this
technology in collaboration with DoD and with input from Veterans, who
let the development team know what they did and did not want in the
application (app). As of the end of 2011, the app had just over 41,000
downloads in 57 countries. In addition, VA is developing PTSD Family
Coach that will complement the Coaching into Care national call center,
which provides support to family members of Veterans.
In 2011, VA also launched Make the Connection, a national public
awareness campaign for Veterans and their family members to connect
with other Veterans to share common experiences, and ultimately to
connect them with information and resources to help with the challenges
that can occur when transitioning from military service to civilian
society. This is an important effort in breaking down the stigma
associated with mental health issues and treatment. The campaign's
central focus is a website, www.MakeTheConnection.net, featuring
numerous Veterans who have shared their experiences, challenges, and
triumphs. It offers a place where Veterans and their families can view
the candid, personal testimonials of other Veterans who have dealt with
and are working through a variety of common life experiences, day-to-
day symptoms, and mental health conditions. The Web site also connects
Veterans and their family members with services and resources they may
need.
Long-term Medical Care
As the Veteran population ages, VA will expand its provision of
both institutional and non-institutional Long-Term Care services. These
services are designed not just for the elderly, but for Veterans of all
ages who have a serious chronic disease or disability requiring ongoing
care and support, including those returning from Iraq and Afghanistan
suffering from traumatic injuries. Veterans can receive long-term care
services at home, at VA medical centers, or in the community. In 2013,
the Long-Term Care budget request is $7.2 billion. VA will continue to
provide long-term care in the least restrictive and most clinically
appropriate settings by providing more non-institutional care closer to
where Veterans live. This budget supports an increase of 6 percent in
the average daily census in non-institutional long-term care programs
in 2013, resulting in a total average daily census of approximately
120,100.
Medical Research
Medical Research is being supported with $583 million in direct
appropriations in 2013, an increase of nearly $2 million above the 2012
level. In addition, approximately $1.3 billion in funding support for
medical research will be received from VA's medical care program and
through Federal and non-Federal grants. Projects funded in 2013 will
support fundamentally new directions for VA research. Specifically,
research efforts will be focused on supporting development of New
Models of Care, improving social reintegration following traumatic
brain injury, reducing suicide, evaluating the effectiveness of
complementary and alternative medicine, developing blood tests to
assist in the diagnosis of post-traumatic stress disorder and mild
traumatic brain injury, and advancing genomic medicine.
The 2013 budget continues support for the Million Veteran Program
(MVP), an unprecedented research program that advances the promises of
genomic science. The MVP will establish a database, used only by
authorized researchers in a secure manner, to conduct health and
wellness studies to determine which genetic variations are associated
with particular health issues. The pilot phase of MVP was launched in
2011. Surveys were sent to 17,483 Veterans and approximately 20 percent
of those then completed a study visit and provided a small blood
sample. By the end of 2013, the goal is to enroll at least 150,000
participants in the program. Like with so much of VA research, the
impact will be felt not just through improved care for Veterans but for
all Americans, as well.
Veterans Benefits Administration
The 2013 budget request for the general operating expenses of the
Veterans Benefits Administration (VBA) is $2.2 billion, an increase of
$145 million, or 7.2 percent, over the 2012 enacted level. With the
support of Congress, we have made great strides in implementing our
comprehensive plan to transform the disability claims process. This
budget sustains our investments in people, processes, and technology in
order to eliminate the claims backlog by 2015. In addition, this budget
request includes funding to support the administration of other VBA
business lines.
Post 9-11 and other Education Programs
The Post 9-11 GI Bill program provides every returning service
member with the opportunity to obtain a college education. As expected,
the Post-9/11 GI Bill program has become the most used education
benefit that VA offers. Just as with the original GI Bill, today's
program provides Veterans with tools that will help them contribute to
an economically vibrant and strong America. In 2013, VA estimates that
606,300 individuals will participate in this benefit program. The
timeliness and accuracy of processing Post-9/11 GI Bill claims
continues to improve. From 2010 to 2011, VA processing times for
original and supplemental claims improved by 15 days (from 39 to 24
days) and 4 days (from 16 to 12 days), respectively. Over the last two
years, VA has successfully deployed a new IT system to support
processing of Post-9/11 GI bill education claims. With improved
automation tools in place, VA will be able to begin reducing education
benefit processing staff in 2013.
Vocational Rehabilitation and Employment (VR&E)
The VR&E program is designed to assist disabled Service-members in
their transition to civilian life and obtaining employment. The budget
request for 2013 is $233.4 million or a 14.2 percent increase from
2012. The number of participants in the program increased to 107,925 in
2011 and is expected to grow to over 130,000 by 2013.
VA is also expanding VR&E counseling services available at IDES
sites to assist Servicemembers with disabilities in jumpstarting their
transition to civilian employment. In 2012, VA will assign 110
additional counselors to the largest IDES sites, serving an additional
12,000 wounded, ill, and injured Servicemembers. Funds requested in
2013 will support further expansion, adding 90 more counselors to the
program.
In 2009, VA established a pilot program called VetSuccess on Campus
to provide outreach and supportive services to Veterans during their
transition from the military to college, ensuring that their health,
education and benefit needs are met. By the end of 2012, the program
will be operational on 28 campuses. The 2013 budget includes $8.8
million to expand the program to a total of 80 campuses serving
approximately 80,000 Veterans.
National Cemetery Administration
VA honors our fallen soldiers with final resting places that serve
as lasting tributes to commemorate their service and sacrifice to our
Nation. The 2013 budget includes $258 million in operations and
maintenance funding for the National Cemetery Administration (NCA). In
2013, NCA estimates that interments will increase by 1,500 (1.3
percent) over 2012. Cemetery maintenance workload will also continue to
increase in 2013 over the 2012 levels: the number of gravesites
maintained will increase by 82,000 (2.5 percent) and the number of
developed acres maintained will increase by 138 (1.6 percent).
The 2013 Budget will allow VA to provide more than 89.6 percent of
the Veteran population, or 19.1 million Veterans, a burial option
within 75 miles of their residence by keeping existing national
cemeteries open, establishing new State Veterans cemeteries, as well as
increasing access points in both urban and rural areas. VA's first
grant to establish a Veterans cemetery on Tribal trust land, as
authorized in Public Law 109-461, was approved on August 15, 2011. This
cemetery will provide a burial option to approximately 4,036 unserved
Rosebud Sioux Tribe Veterans and their families residing on the Rosebud
Indian Reservation near Mission, South Dakota.
NCA provides an unprecedented level of customer service, which has
been achieved by always striving for new ways to meet the burial needs
of Veterans. In 2011, NCA initiated an independent study of emerging
burial practices including ``green'' burial techniques that may be
appropriate and feasible for planning purposes. The study will also
include a survey of Veterans to ascertain their preferences and
expectations for new burial options. The completed study will provide
comprehensive information and analysis for leadership consideration of
new burial options.
Capital Infrastructure
A total of $1.14 billion is requested in 2013 for VA's major and
minor construction programs, an increase of 6.3 percent over the 2012
enacted level. VA is also proposing legislation in 2013 that would
enhance the ability of the Department to collaborate with other Federal
Departments and Agencies, including the Department of Defense (DoD) on
joint capital projects. This legislative proposal would allow
appropriated funds to be transferred among Federal agencies to
effectively plan and design joint projects when determined to be cost-
effective and improve service delivery to Veterans and Servicemembers.
Major Construction
The major construction request in 2013 is $532 million in new
budget authority. The major construction request includes funding for
the next phase of construction for four medical facility projects in
Seattle, WA; Dallas, TX; Palo Alto, CA; and St. Louis (Jefferson
Barracks), MO. Additionally, funds are provided to remove asbestos from
Department-owned buildings, improve facility security, remediate
hazardous waste, fund land acquisitions for national cemeteries, and
support other construction related activities.
Minor Construction
In 2013, the minor construction request is $608 million. It would
provide for constructing, altering, extending and improving VA
facilities, including planning, assessment of needs, architectural and
engineering services, and site acquisition and disposition. It also
includes $58 million to NCA for land acquisition, gravesite expansions,
and columbaria projects. NCA projects include irrigation and drainage
improvements, renovation and repair of buildings, and roadway repairs.
Information Technology
The 2013 budget requests $3.327 billion for Information Technology
(IT), an increase of $216 million over the 2012 enacted level of $3.111
billion. Veterans and their families are highly dependent upon the
effective and efficient use of IT to deliver benefits and services. In
this day and age, every doctor, nurse, dentist, claims processor,
cemetery interment scheduler, and administrative employee in the VA
cannot do his or her jobs without adequate IT support. Approximately 80
percent of the IT budget supports the direct delivery of healthcare and
benefits to Veterans and their families.
We have made dramatic changes in the way IT projects are planned
and managed at the VA. As described earlier in this testimony, the
Project Management Accountability System (PMAS) has reduced risks by
instituting effective monitoring and oversight capabilities and by
establishing clear lines of accountability. Additionally, we have
strengthened security standards in software development and established
an Identity Access Management program that allows VA to increase on-
line services for Veterans.
The IT infrastructure supports over 300,000 employees and about 10
million Veterans and family members who use VA programs, making it one
of the largest consolidated IT organizations in the world. This budget
request includes nearly $1.8 billion for the operation and maintenance
of the IT infrastructure, the backbone of VA. A sound and reliable
infrastructure is critical to support the VA workforce and all of our
facilities nationwide in the effective and efficient delivery of
healthcare and benefits to Veterans. It is also critical that we
support new facility activations, our major transformational
initiatives, and the increased usage of VA services while maintaining a
secure IT environment to protect Veteran sensitive information.
Improving services for Veterans and their beneficiaries requires
using advanced technologies. For example, VA will continue to utilize
MyHealtheVet to improve access to information on appointments, lab
tests and results, and reduce adverse reactions to medications. The
2013 budget continues an investment strategy of funding the development
of new technologies that will have the greatest benefit for Veterans.
The delivery of high-quality medical care to an increasing number
of Veterans is highly dependent upon adequate IT funding. VA's health
IT investments have, and will continue, to greatly improve the delivery
of medical care with regards to quality, patient safety and cost
effectiveness. This includes transformation of mental health service
delivery through IT enabled self-help, providing data and IT analytical
tools for VA's research community, and creating an open exchange for
collaboration and innovation in the development of clinical software
solutions. Additionally, initiatives focused on ``Care at a Distance''
are heavily reliant on technology and require a robust IT
infrastructure.
The 2013 budget request for integrated Electronic Health Record
(iEHR) is $169 million. The iEHR is a joint initiative with DoD to
modernize and integrate electronic health records for all Veterans to a
single common platform. We must take full advantage of this historic
opportunity to deliver maximum value through joint investments in
health IT. When DoD and VA healthcare providers begin accessing a
common set of health records, iEHR will enhance quality, safety, and
accessibility of healthcare - setting the stage for more efficient,
cost-effective healthcare systems. In 2013, we plan to leverage open
source development to foster innovation and speed delivery for a
pharmacy and immunization solution.
An integral part of iEHR is the Virtual Lifetime Electronic Record
(VLER), which is enabling VA transformation. VLER creates information
interoperability between DoD, VA, and the private sector to promote
better, faster and safer healthcare and benefits delivery for Veterans.
The 2013 budget will ensure continued delivery of enhanced clinical and
benefits information connections and build increased capability to
support women's healthcare. Additionally, we will develop a modern
memorial affairs system for the dynamic mapping of gravesite locations.
The 2013 budget request for VLER is $52.9 million.
In addition, the 2013 budget requests $92 million in the IT
appropriation for VBMS. As noted earlier, the VBMS initiative is the
cornerstone of VA's claims transformation strategy. It is a
comprehensive solution that integrates a business transformation
strategy to address people and processes with a paperless claims
processing system. Achieving paperless claims processing will result in
higher quality, greater consistency and faster claims decisions.
Nationwide deployment of VBMS is on target to begin in 2012 with
completion in 2013.
This budget also includes funding to transform the delivery of
Veterans' benefits. The 2013 IT budget requests $111 million for the
Veterans Relationship Management (VRM) initiative. We will use this
funding to improve communications between Veterans and VA that occur
through multiple channels--phone, web, mail, social media, and mobile
apps. It will also provide new tools and processes that increase the
speed, accuracy and efficiency of information exchange, including the
development of self-service technology-enabled interactions to provide
access to information and the ability to execute transactions at the
place and time convenient to the Veteran. In 2013, Veterans will see
enhanced self-service tools for the Civilian Health and Medical Program
of the Department of Veterans Affairs (CHAMPVA) and VetSuccess
programs, as well as the Veterans Online Application for enrolling in
VA healthcare.
Legislative Program
VA has outlined in this budget a strong legislative program that
will advance our mission to end Veteran homelessness and help Wounded
Warriors by improving our system of grants for home alterations so
Veterans can better manage disabilities and live independently. Our
legislative proposals would also make numerous other common-sense
changes that improve our programs, including provisions that will
reduce payment complexities for both our student Veterans and the
schools using the Post 9/11 GI Bill.
Summary
VA is the second largest Federal department with over 316,000
employees. Our workforce includes physicians, nurses, counselors,
claims processors, cemetery groundskeepers, statisticians, engineers,
IT specialists, police, and educators. They serve Veterans at our
hospitals, community-based outpatient clinics, Vet Centers, mobile Vet
Centers, claims processing centers, and cemeteries. Through the
resources provided in the President's 2013 Budget, VA is enabled to
continue improving the quality of life for our Nation's Veterans and
their families and to completing the transformation of the department
that we began in 2009. Thanks to the President's leadership and the
solid support of all members of the Congress, we have made huge strides
in our journey to provide all generations of Veterans the best possible
care and benefits that they earned through selfless service to the
Nation. We are committed to continue that journey, even as the numbers
of Veterans will increase significantly in the coming years, through
the responsible use of the resources provided in the 2013 budget and
2014 advance appropriations requests.
Prepared Statement of Carl Blake
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 2013.
As the country faces a difficult and uncertain fiscal future, the
Department of Veterans Affairs likewise faces significant challenges
ahead. Following months of rancorous debate about the national debt and
federal deficit during the summer of 2011, Congress agreed upon a
deficit reduction measure, P.L. 112-25, that could lead to cuts in
discretionary and mandatory spending for VA. The coauthors of The
Independent Budget--AMVETS, Disabled American Veterans, Paralyzed
Veterans of America, and the Veterans of Foreign Wars--have serious
concerns about the potential reductions in VA spending. While changes
to benefits programs and cuts to discretionary programs have unique
differences, the impact of these possibilities will be equally
devastating for veterans and their families.
Discretionary spending in VA accounts for approximately $62
billion. Of that amount, nearly 90 percent of that funding is directed
toward VA medical care programs. The VA is the best health-care
provider for veterans. Providing primary care and specialized health
services is an integral component of VA's core mission and
responsibility to veterans. Across the nation, VA is a model health-
care provider that has led the way in various areas of medical
research, specialized services, and health-care technology. The VA's
unique system of care is one of the nation's only health-care systems
that provides developed expertise in a broad continuum of care.
Currently, the Veterans Health Administration serves more than 8
million veterans and provides specialized health-care services that
include program specific centers for care in the areas of spinal cord
injury/disease, blind rehabilitation, traumatic brain injury,
prosthetic services, mental health, and war-related polytraumatic
injuries. Such quality and expertise on veterans' health care cannot be
adequately duplicated in the private sector. Any reduction in spending
on VA health-care programs would only serve to degrade these critical
services.
Moreover, The Independent Budget veterans service organizations
(IBVSOs) are especially concerned about steps VA has taken in recent
years in order to generate resources to meet ever-growing demand on the
VA health-care system. In fact, the FY 2012 and FY 2013 advance
appropriation budget proposal released by the Administration last year
included ``management improvements,'' a popular gimmick used by
previous Administrations to generate savings and offset the growing
costs to deliver care. Unfortunately, these savings were often never
realized leaving VA short of necessary funding to address ever-growing
demand on the health-care system. We believe that continued pressure to
reduce federal spending will only lead to greater reliance on gimmicks
and false assumptions to generate apparent but illusory funding. In
fact, the Government Accountability Office (GAO) outlined its concerns
with this budget accounting technique in a report released to the House
and Senate Committees on Veterans' Affairs in June 2011. In its report,
the GAO states:
If the estimated savings for fiscal years 2012 and 2013 do not
materialize and VA receives appropriations in the amount requested by
the President, VA may have to make difficult tradeoffs to manage within
the resources provided.
This observation reflects the real possibility that exists should
VA health care, as well as other programs funded through the
discretionary process, be subject to spending reductions.
At the same time, Congress once again failed to fulfill its
obligations to complete work on appropriations bills funding all
federal departments and agencies, including VA, by the start of the new
fiscal year on October 1, 2011. Fortunately, as has become the new
normal, last year the enactment of advance appropriations shielded the
VA health-care system from the political wrangling and legislative
deadlock.
In February 2011, the Administration released its budget submission
for VA for FY 2012, recommending an overall discretionary funding
authority of $61.9 billion, approximately $3.6 billion less than The
Independent Budget recommended last year. The Administration's
recommendation included a revised estimate for total Medical Care of
approximately $53.9 billion for FY 2012, including approximately $3.1
billion in medical care collections. The budget also included $509
million in funding for Medical and Prosthetic Research, a substantial
decrease of approximately $72 million below the FY 2011 funding level.
The IBVSOs expressed serious concerns about the downward revision
of the Medical Care estimates for FY 2012. While we certainly
understood that the Administration revised the estimates for Medical
Care down by $713 million due to the proposed federal pay freeze (a
factor not included in the FY 2011 appropriations bill), the revised
budget included ideas of greater concern. Specifically, the IBVSOs had
reservations about the outline of an ill-defined contingency fund that
would provide $953 million more for Medical Services for FY 2012.
Moreover, we were especially troubled that VA presumed ``management
improvements'' of approximately $1.1 billion to be directed toward FY
2012 and FY 2013. The use of management improvements or efficiencies is
a gimmick that has been commonly used in the past to reduce the
requested level of discretionary funding; yet rarely did VA realize any
actual savings from those gimmicks. This is particularly troubling in
light of the fact that we have been told that the VA's efforts to
achieve those efficiencies explicitly outlined in the FY 2012 Budget
Request have failed.
Finally, we were concerned about the revised estimate in Medical
Care Collections from the originally projected $3.7 billion (included
in last year's advance appropriations recommendation and supported by
Congress) to now only $3.1 billion. Given this revision in estimates,
we believed then, as we do now, that the VA budget request, and
ultimately the funding provided through the appropriations process, was
insufficient for VA to meet the demand on the health-care system.
For FY 2012, The Independent Budget recommended that the
Administration and Congress provide $65.5 billion in discretionary
funding to VA, an increase of $4.9 billion above the FY 2011 operating
budget level, to adequately meet veterans' health-care and benefits
needs. Our recommendations included $55 billion for health care and
$620 million for medical and prosthetic research.
The Administration also included an initial estimate for the VA
health-care accounts for FY 2013. Specifically, the budget request
called for $55.8 billion in total budget authority, with $52.5 billion
in discretionary funding and approximately $3.3 billion for medical
care collections. Deeper analysis of the Administration's budget
documents seems to suggest that the VA actually believed then that it
needed approximately $56.6 billion in total funding authority to meet
all of the health care demands placed on the system. Given the
pressures being placed on VA as a result of deficit and debt reduction,
we have serious concerns whether VA will be able to meet new demand
with the resources that it is being provided.
Funding for FY 2013
For FY 2013, The Independent Budget recommends approximately $57.2
billion for total medical care, an increase of $3.3 billion over the FY
2012 operating budget level provided as an advance appropriation by
P.L. 112-10, the ``the Department of Defense and Full-Year Continuing
Appropriations Act for FY 2011.'' Meanwhile, the Administration
recommended an advance appropriation for FY 2013 of approximately $52.5
billion in discretionary funding for VA medical care as a part of its
FY 2012 Budget Request. When combined with the $3.3 billion
Administration projection for medical care collections, the total
available operating budget recommended for FY 2013 is approximately
$55.8 billion.
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 2013, The Independent Budget recommends approximately $46.0 billion
for Medical Services. Our Medical Services recommendation includes the
following recommendations:
Current Services Estimate . . . . . . . . . . . . . . . . . . .
. . $43,855,969,000
Increase in Patient Workload . . . . . . . . . . . . . . . . . .
. $1,510,394,000
Additional Medical Care Program Costs . . . . . . . . . .
$675,000,000
Total FY 2013 Medical Services. . . . . . . . . . . . . . . .
$46,041,363,000
Our growth in patient workload is based on a projected increase of
approximately 110,000 new unique patients--priority groups 1-8 veterans
and covered nonveterans. We estimate the cost of these new unique
patients to be approximately $1 billion. The increase in patient
workload also includes a projected increase of 96,500 new Operation
Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), as well as
Operation New Dawn (OND) veterans at a cost of approximately $349
million. Our recommendations represent an increase in projected
workload in this population of veterans over previous years as a result
of the withdrawal of forces from Iraq, the drawdown of forces in
Afghanistan, and a potential drawdown in the actual number of service
members currently serving in the Armed Forces. And yet, we believe that
growth in demand for this cohort specifically could be far greater
given the changing military policies mentioned above.
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 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 $134
million. When compared to the projections that the Administration had
previously made for increased utilization for this Priority Group, we
believe that our recommendations are on target for those projections.
Lastly, The Independent Budget believes that there are additional
projected funding needs for 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 VA) and to provide additional centralized prosthetics
funding (based on actual expenditures and projections from the VA's
prosthetics service). In order to restore the VA's long-term care
average daily census (ADC) to the level mandated by Public Law 106-117,
the ``Veterans Millennium Health Care and Benefits Act,'' we recommend
$375 million. In order to meet the increase in demand for prosthetics,
the IB recommends an additional $300 million. This increase in
prosthetics funding reflects a significant increase in expenditures
from FY 2011 to FY 2012 (explained in the section on Centralized
Prosthetics Funding) and the expected continued growth in expenditures
for FY 2013. Additionally, it is worth noting that the VA has actively
implemented the new caregiver program mandated by Public Law 111-163,
the ``Caregivers and Veterans Omnibus Health Services Act.'' However,
we believe that still greater funding should be appropriated, above
what the VA has currently allocated for this program, in order to more
effectively and efficiently operate the program.
For Medical Support and Compliance, The Independent Budget
recommends approximately $5.6 billion. Finally, for Medical Facilities,
The Independent Budget recommends approximately $5.6 billion. While our
recommendation does not include an additional increase for nonrecurring
maintenance (NRM), it does reflect a FY 2013 baseline of approximately
$900 million. While we appreciate the significant increases in the NRM
baseline over the last couple of years, total NRM funding still lags
behind the recommended two to four percent of plant replacement value.
In fact, VA should actually be receiving at least $2.1 billion annually
for NRM (Refer to Construction section article ``Increase Spending on
Nonrecurring Maintenance).
For Medical and Prosthetic Research, The Independent Budget
recommends $611 million. This represents a $30 million increase over
the FY 2012 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.
Lastly, Mr. Chairman, I would like to note one late change to our
IB budget recommendations for State Home Construction Grants which
arose after we went to press. Late last week VA finally released the FY
2012 grant priority list for State Home repair, renovation and new
construction projects and there was a significant increase in State
matching funds certified as available. After reviewing the newly
released Priority List for FY 2012, there are now $321 million worth of
Priority 1 State Home projects for which the States have certified
matching funds available. As a result, the federal funding required for
Priority 1 projects will be at least $204 million in FY 2013, and that
number is likely to rise even higher as States approve additional
matching funding this year for a backlog of projects currently
estimated at $400 million. While this recommendation is not reflected
specifically in The Independent Budget, this change reflects what we
believe our recommendation should now be.
Advance Appropriations for FY 2014
As we have noted in the past, P.L. 111-81 required the President's
budget submission to include estimates of appropriations for the
medical care accounts for FY 2013 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 2013) and
provide detailed estimates of the funds necessary for the medical care
accounts for FY 2014. Moreover, the law also requires a thorough
analysis and public report of the Administration's advance
appropriations projections by the Government Accountability Office
(GAO) to determine if that information is sound and accurately reflects
expected demand and costs.
The GAO's responsibility is more important than ever, particularly
in light of their findings concerning the FY 2012 budget submission
last year. The GAO report that analyzed the FY 2012 Administration
budget identified serious deficiencies in the budget formulation of VA.
Yet these concerns were not appropriately addressed by Congress or the
Administration. This analysis and the subsequent lack of action to
correct these deficiencies simply affirm the ongoing need for the GAO
to evaluate the budget recommendations of VA.
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.
Information Required by Rule XI 2(g)(4) of the House of Representatives
Pursuant to Rule XI 2(g)(4) of the House of Representatives, the
following information is provided regarding federal grants and
contracts.
Fiscal Year 2012
No federal grants or contracts received.
Fiscal Year 2011
Court of Appeals for Veterans Claims, administered by the Legal
Services Corporation--National Veterans Legal Services Program--
$262,787.
Fiscal Year 2010
Court of Appeals for Veterans Claims, administered by the Legal
Services Corporation--National Veterans Legal Services Program--
$287,992.
Prepared Statement of Raymond Kelley
MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE:
On behalf of the more than 2 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.
With an infrastructure that is more than 60 years old, the
Department of Veterans Affairs (VA) has a monumental task of
maintaining and improving its vast network of facilities to ensure the
Veterans Health Administration (VHA) can provide accessible, high-
quality health care to our nation's veterans. Currently, VA owns 5,300
buildings and manages more than 800 leases. In 2005, VA began using the
Federal Real Property Council (FRPC) Tier 1 performance measures to
assess its capital portfolio goals. \1\ The two measures that directly
affect patient services are utilization and condition. In 2004, VA's
utilization was at 80 percent, well below capacity. That utilization
grew to 121 percent in 2010, and is projected to grow even more in the
coming years. During the same time period, the condition of VA's
infrastructure decreased from 81 percent to 71 percent. \2\ These
trends show that funding for the next few years will be critical for VA
to fulfill its mission.
---------------------------------------------------------------------------
\1\ FY 2012 Budget Submission, Construction and 10 Year Capital
Plan, February 2011, Vol. 4 of 4, p. 9.3-11, 12
\2\ Ibid, p. 9.3-13, 14
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VA has developed the Strategic Capital Investment Plan (SCIP) to
address the critical deficiencies in its infrastructure. SCIP uses six
criteria to assess deficiencies, or gaps, in its ability to deliver
efficient, high-quality, accessible services and care for veterans. The
six gap criteria are access, utilization, space, condition, energy, and
other (which includes safety, security, privacy, and seismic
corrections). \3\ It was also determined that to close all these gaps
it would cost between $53 billion and $65 billion. \4\
---------------------------------------------------------------------------
\3\ Ibid, p. 8.2-4
\4\ Ibid, p. 81-1
---------------------------------------------------------------------------
To determine and monitor the condition of its facilities, VA
conducted a Facility Condition Assessment (FCA). These assessments
include inspections of building systems, such as electrical,
mechanical, plumbing, elevators, and structural and architectural
safety; and site conditions consisting of roads, parking, sidewalks,
water mains, water protection. The FCA review team can grant ratings of
A, B, C, D, and F. Assessment ratings A through C conclude the assessed
is in new to average condition. D ratings mean the condition is below
average and F means the condition is critical and requires immediate
attention. To correct these deficiencies, VA will need to invest nearly
$10 billion. \5\
---------------------------------------------------------------------------
\5\ Ibid, p. 9.3-14 15
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To close the gaps in access, VA will need to invest between $30
billion and $35 billion dollars in major and minor construction and
leasing. The remaining $20 billion is needed to close the remaining
nonrecurring maintenance deficiencies.
Major Construction Accounts:
By estimation of the Department of Veterans Affairs, the cost to
implement all currently identified gaps in major construction, Congress
will have to authorize and appropriate between $20 billion and $24.5
billion over the next 10 years. Currently, there are 35 major
construction projects that are authorized, dating back as far as 2004.
Only three of these projects are funded through completion. The total
unobligated amount for all currently congressionally budgeted major
construction projects is $2.8 billion. \6\ Yet the total funding
requested for FY 2012 major construction accounts was only $725
million.
---------------------------------------------------------------------------
\6\ FY 2012 Budget Submission, Construction and 10 Year Capital
Plan, February 2011, Vol. 4 of 4, p. 2-85
---------------------------------------------------------------------------
At this level of funding, it will take VA more than 25 years to
complete its current 10-year capital investment plan. The Independent
Budget veterans service organizations (IBVSOs) understand that fiscally
difficult times call for spending restraints, but without quality,
accessible medical centers, VA will not be able to deliver quality,
accessible care. The IBVSOs recommend $2.8 billion to complete all
partially funded and future major construction needs to close all
identified gaps by 2021.
Minor Construction Accounts:
To close the minor construction gaps within its 10-year timeline,
VA will need to invest nearly $8 billion in Veterans Health
Administration minor construction alone. \7\ Minor construction
projects allow VA to address issues of functional space within existing
buildings and improve facility conditions at cost less than $10
million. In past years VA and Congress requested and appropriated
nearly 10 percent of the total need to close the minor construction
gaps. However, the Administration and Congress decreased funding for
minor construction by about $250 million over the past two years. If
this rate of investment is continued, it will take more than 16 years
to complete all current minor construction gaps. Congress and VA must
put minor construction back on track by investing 10 percent of the
total cost to complete the 10-year minor construction plan. With this
in mind, The Independent Budget recommends $969 million in FY 2013 to
achieve this goal.
---------------------------------------------------------------------------
\7\ FY 2012 Budget Submission, Construction and 10 Year Capital
Plan, February 2011, Vol. 4 of 4, p. 1-4
---------------------------------------------------------------------------
Nonrecurring Maintenance Account:
Even though nonrecurring maintenance (NRM), which is funded through
VA's Medical Facilities account and not through the construction
account, it is critical to VA's capital infrastructure. NRM embodies
the many small projects that together provide for the long-term
sustainability and usability of VA facilities. NRM projects are one-
time 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.
Accordingly, to fully maintain its facilities, VA needs an NRM annual
budget of at least $2.1 billion.
Given the low level of funding NRM accounts have historically
received, The Independent Budget veterans service organizations
(IBVSOs) are not surprised that basic facility maintenance remains a
challenge for VA. In addition, the IBVSOs have long-standing concerns
about 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. The IBVSOs
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.
Capital Leasing:
The Department of Veterans Affairs enters into two types of leases.
First, VA leases properties to use for each agency within VA, ranging
from community-based outpatient clinics (CBOC) and medical centers, to
research and warehouse space. These leases do not fall under the larger
construction accounts, but under each administration's and staff office
operating accounts. \8\
---------------------------------------------------------------------------
\8\ FY 2012 Budget Submission, Construction and 10 Year Capital
Plan, February 2011, Vol. 4 of 4, p. 8.2-88.
---------------------------------------------------------------------------
The second type of lease, called enhanced-use lease (EUL), allows
VA to lease property they own to an outside-VA entity. These leases
allow VA to lease properties that are unutilized or underutilized for
projects such as veterans' homelessness and long-term care. Proper use
of leases provides VA with flexibility in providing care as veterans'
needs and demographics changes.
VA has moved to leasing many of its CBOCs and specialty clinics to
increase access of primary and specialty care in local communities as
well as a way to be more modular as veterans' demographics change. The
Independent Budget veterans service organizations (IBVSOs) see the
value in providing quick, accessible health care, but caution a leasing
concept that will rely on contracting inpatient care. Not having
accessible inpatient care can and has left VA looking for ways to treat
veterans in their greatest time of need. As Strategic Capital
Investment Planning continues to move forward and more leases are
entered into, some of which may have in patient alternatives, the
IBVSOs will be continue to be vigilant to ensure that VA has viable
contingency plans for inpatient care.
EUL gives VA the authority to lease land or buildings to public,
nonprofit, or private organizations or companies as long as the lease
is consistent with VA's mission and that the lease ``provides
appropriate space for an activity contributing to the mission of the
Department.'' \9\ Although EUL can be used for a wide range of
activities, the majority of the leases result in housing for homeless
veterans and assisted living facilities. In 2013, VA has 19 buildings
or parcels of land that are planned for EUL. \10\ The IBVSOs encourage
VA to continue to improve their transparency of potential EUL
properties. Improving dialog with veterans in the communities will
reduce the backlash that often occurs when VA property is being
repurposed.
---------------------------------------------------------------------------
\9\ Title 38, U.S.C., paragraph 8162, as amended through Public Law
112-7, enacted March 31, 2011, printed May 2, 2011.
\10\ FY 2012 Budget Submission, Construction and 10 Year Capital
Plan, February 2011, Appendix 10 Year Capital Plan, p. 10-46 -10-49.
---------------------------------------------------------------------------
Empty or Underutilized Space at Medical Centers:
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.
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.
Further, that law required VA to develop short- and long-term plans for
the disposal of these facilities in an annual report to Congress. With
this in mind, VA has begun a review of buildings and properties for
finding possible reuse or repurpose opportunities. Building Utilization
Review and Repurposing or BURR will focus on identifying sites in three
major categories; housing for veterans who are homeless or at risk for
being homeless; senior veterans capable of independent living and
veterans who require assisted-living and supportive services. The three
phases planned include identifying campuses with buildings and land
that are either vacant or underutilized; sites visit to match the
supply of building and land with the demand for services and
availability of financing and lastly identifying campuses using VA's
enhanced-use leasing authority. Under the BURR initiative, if no
repurposing is identified, VA will begin to assess its vacant capital
inventory by demolishing or disposing of buildings that are unsuitable
for reuse or beyond their usefulness.
The IBVSOs have stated that VA must continue to develop these
plans, working in concert with architectural master plans, community
stakeholders and clearly identifying the long-range vision for all such
sites.
Program for Architectural Master Plans:
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 (IBVSOs)
believe that each VA medical center should develop a comprehensive
facility master plan to serve as a blueprint for development,
construction, and future growth of the facility; $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.
Preservation of VA's Historic Structures:
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.
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 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.
Mr. Chairman, this concludes my testimony and I look forward to any
questions you and the Committee may have.
Information Required by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives, VFW has
not received any federal grants in Fiscal Year 2011, nor has it
received any federal grants in the two previous Fiscal Years.
Prepared Statement of Joseph A. Violante
Chairman Miller, Ranking Member Filner and Members of the
Committee:
On behalf of the Disabled American Veterans (DAV) and our 1.2
million members, all of whom are wartime disabled veterans, I am
pleased to be here today to present recommendations of The Independent
Budget (IB) for the fiscal year (FY) 2013 budget related to veterans
benefits, judicial review and the Veterans Benefits Administration
(VBA). The Independent Budget is jointly produced each year by DAV,
AMVETS, Paralyzed Veterans of America and Veterans of Foreign Wars.
While there are dozens of recommendations in this year's Independent
Budget related to VBA's benefit programs and claims processing reform,
I will only highlight some of the most critical ones in my testimony,
and commend the full text of the IB that is now available online.
Mr. Chairman, we are now in the third year of VBA's latest effort
to transform its outdated, inefficient, and inadequate claims-
processing system into a modern, automated, rules-based, and paperless
system. VBA has struggled for decades to provide timely and accurate
decisions on claims for veterans benefits, especially veterans
disability compensation, and there have been numerous prior reform
attempts that began with great promise, only to fall far short of
success. Over the next year we will begin to see whether their
strategies to transform the people, processes and technologies will
finally result in a cultural shift away from focusing on speed and
production to a business culture of quality and accuracy, which is the
only way to truly get the backlog under control.
RESOURCE RECOMMENDATIONS
Adequate Staffing for the Veterans Benefits Administration
In order to sustain the transformation efforts underway at VBA, The
Independent Budget for FY 2013 generally recommends maintaining current
staffing levels in the Veterans Benefits Administration, with only
modest increases for the Vocational Rehabilitation and Employment
Service and the Board of Veterans Appeals. Due to substantial support
from Congress, VBA's Compensation Service experienced significant
staffing increases between fiscal years 2008 and 2010, which supported
an increase in the number of claims processed each of those years.
Unfortunately, however, an even larger increase in new and reopened
claims volume contributed to a rising backlog. Historically, it takes
approximately two years for a new Veterans Service Representative (VSR)
to acquire sufficient knowledge and experience to be able to work
independently with both speed and accuracy. It takes an additional
period of at least two years of training to become a Rating Veterans
Service Representative (RVSR) with the skills to accurately complete
most rating claims. As such, the full productive capacity of the
employees hired in recent years are only now becoming evident.
This year VBA will roll out a new operating model for processing
claims for disability compensation, which will change the roles and
functions of thousands of VSRs and RVSRs at Regional Offices across the
country. VBA is also planning to launch new IT systems, including the
Veterans Benefits Management System (VBMS) and expand the functionality
of their e-Benefits system. Together these transformations are expected
to have a significant effect on the productive capability of VBA's
workforce. While these changes are being fully implemented, and the
effect on workforce requirements analyzed, the Independent Budget
veterans service organizations (IBVSOs) do not recommend an increase in
staffing for VBA's Compensation Service for FY 2013. However, we do
recommend that VBA initiate a scientific study to determine the
workforce necessary to effectively manage its rising workload in a
manner that produces timely and accurate rating decisions.
Moving forward, should there be a decline in personnel dedicated to
producing rating decisions, an increase in claims or the backlog, or
should any of the long-awaited VBA information technology initiatives
fail to produce the projected reductions in processing times for
claims, Congress must be prepared to act swiftly to intervene with the
additional staffing resources.
Staffing Increase for Vocational Rehabilitation and Employment Service
The IBVSOs do recommend that funding for VA's Vocational
Rehabilitation and Employment Service (VR&E) be increased to
accommodate at least 195 additional full-time employees for the VR&E
Service for FY 2013 and at least 9 new full-time employees to manage
its expanding campus program.
The Government Accountability Office (GAO) conducted a study in
2009 to assess VR&E's ability to meet its core mission functions. GAO
found that 54 percent of VBA's 57 regional offices reported they had
fewer counselors than needed, 40 percent said they have fewer
employment coordinators than needed and 90 percent reported that their
caseloads have become more complex since veterans began returning from
Afghanistan and Iraq.
VBA's current caseload target is one counselor for every 125
veterans served; however, feedback received by the IBVSOs from
counselors in the field suggested an actual workload as high as one to
145. Based on comparisons with state vocational rehabilitation programs
and discussions with VR&E personnel, even the 1:125 ratio may be too
high to effectively manage VR&E's workload, particularly in providing
service to seriously disabled veterans. However, to reach the 1:125
standard, VR&E needs approximately 195 new staff counselors.
The VA VetSuccess on Campus program places a full time Vocational
Rehabilitation Counselor and a part time Vet Center Outreach
Coordinator on college campuses to help the transition from military to
civilian and student life. The President's 2012 budget submission
requested funding to support further expansion of the program beyond
the eight existing sites to nine more campuses: the University of South
Florida, Cleveland State University, San Diego State University,
Community College of Rhode Island, Arizona State University, Texas A&M,
Central Texas, Rhode Island College, and Salt Lake Community College.
The Independent Budget recommends that Congress provide funding for at
least nine additional full-time employees in FY 2013 to manage this
expanding campus program.
Staffing Increase for the Board of Veterans Appeals
The Independent Budget also recommends a staffing increase at the
Board of Veterans Appeals of at least 40 full-time employee equivalents
(FTEE) for FY 2013. Based on historical trends, the number of new
appeals to the Board averages approximately five percent of all claims
received, so as the number of claims processed by VBA is expected to
rise significantly, so too will the Board's workload rise
commensurately. With the number of claims processed at VBA having risen
to over one million, and projected to rise even higher, it is virtually
certain that the Board's workload will begin to rise even faster.
The Board is currently authorized to have 544 FTEEs; however, its
budget in FY 2011 could only support 532 FTEEs. Expected workload
projections by the Board indicate that the authorized level for FY 2013
should be closer to 585 FTEEs. The IBVSOs are concerned that unless
additional resources are provided to the Board, its ability to produce
timely and accurate decisions will be constrained by an inadequate
budget, and either the backlog will rise or accuracy will fall. Neither
of these outcomes is acceptable. At a minimum, Congress increase
funding to the Board in order to sustain 585 FTEE in FY 2013.
Dedicated Courthouse for the Court of Appeals for Veterans Claims
Mr. Chairman, I would also like to highlight a recommendation in
this year's Independent Budget concerning the United States Court of
Appeals for Veterans Claims. During the 24 years since the Court was
formed in accordance with legislation enacted in 1988, it has been
housed in commercial office buildings, making it the only Article I
court that does not have its own courthouse. The IBVSOs believe that
the Veterans Court should be accorded at least the same degree of
respect enjoyed by other appellate courts of the United States.
Congress previously acted on this in fiscal year 2008 by allocating $7
million for preliminary work on site acquisition, site evaluation,
preplanning for construction, architectural work, and associated
studies and evaluations for the construction of the courthouse. It is
time for Congress to provide the funding necessary to construct
permanent courthouse in a location of honor and dignity befitting the
Veterans Court and the veterans it serves.
VETERANS BENEFITS REOMMENDATIONS
The Veterans Benefits Administration provides an array of benefits
to our nation's veterans, including disability compensation, dependency
and indemnity compensation, pensions, vocational rehabilitation,
education benefits, home loans, and life insurance. Unfortunately, the
failure to regularly adjust benefit rates or to tie them to realistic
annual cost-of-living adjustments (COLAs), can threaten the
effectiveness of other these benefits. For example, the annual COLAs do
not take into account the rising cost of some basic necessities, such
as food and energy. In addition to prudent increases in a number of
specific benefits programs to meet today's rising costs of living, The
Independent Budget includes a number of recommendations designed to
make several existing benefits more equitable for all veterans,
particularly disabled veterans.
Eliminate Remaining Concurrent Receipt Penalties
Today, 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
can 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. Most nondisabled military retirees
pursue second careers after serving in order to supplement their
income, thereby justly enjoying a full reward for completion of a
military career with the added reward of full civilian employment
income. In contrast, military retirees with service-connected
disabilities do not enjoy the same full earning potential.
In order to place all disabled longevity military retirees on equal
footing with nondisabled military retirees, there should be no offset
between full military retired pay and VA disability compensation.
Congress has previously removed this offset for veterans with service-
connected disabilities rated 50 percent or greater. Congress should
enact legislation to repeal the inequitable requirement that veterans'
military longevity retired pay be offset by an amount equal to their
disability compensation if rated less than 50 percent.
Repeal the DIC - SBP Offset
The current requirement that the amount of an annuity under the
Survivor Benefit Plan (SBP) be reduced on account of and by an amount
equal to dependency and indemnity compensation (DIC) for survivors of
disabled veterans is inequitable and should be repealed.
A veteran disabled in military service is compensated for the
effects of service-connected disability. When a veteran dies of
service-connected causes, or following a substantial period of total
disability from service-connected causes, eligible survivors or
dependents receive DIC from the Department of Veterans Affairs. 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.
Survivors of military retirees have no entitlement to any portion
of the veteran's military retirement pay after his or her death, unlike
many retirement plans in the private sector, however they may
participate in the survivor benefit plan (SBP), which makes deductions
from their spouses military retirement pay to purchase a survivors'
annuity. Upon the military retirees 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 military service or after the requisite period of
total service-connected disability, the SBP annuity is reduced by an
amount equal to the DIC payment. When the monthly DIC rate is equal to
or greater than the monthly SBP annuity, beneficiaries lose all
entitlement to the SBP annuity.
This offset is inequitable because there is no duplication of
benefits since payments under the SBP and DIC programs are made for
different purposes. Under the SBP, coverage is purchased by a veteran
and paid to his or her surviving beneficiary at the time of the
veterans death. On the other hand, DIC is a special indemnity
compensation paid to the survivor of a servicemember who dies while
serving in the military, or a veteran who dies from service-connected
disabilities. In such cases DIC should be added to the SBP, not
substituted for it. Surviving spouses of federal civilian retirees who
are veterans are eligible for DIC without losing any of their purchased
federal civilian survivor benefits. The offset penalizes survivors of
military retirees 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 fully repeal the offset between dependency and indemnity
compensation and the Survivor Benefit Plan.
Adaptive Housing and Automobile Grants
Service-connected disabled veterans who have impairments or loss of
use of at least one of their hands, feet or eyes may be eligible for
several grants to adapt their housing or automobiles, including the
Specially Adapted Housing Grant and the Automobile and Special Adaptive
Equipment Grants. However when veterans who have already received these
grants are forced to move to a new home, or stay temporarily in someone
else's home, or need to replace an outdated automobile, they are
restricted in accessing the full benefits of this program. To remedy
this, Congress should establish a supplementary housing grant that
covers the cost of new home adaptations for eligible veterans who have
used their initial, once in-a-lifetime grant on specially adapted homes
they no longer own and occupy. A separate grant should be provided for
special adaptations to homes owned by family members in which veterans
temporarily reside. VA should also be authorized to provide a
supplementary auto grant to eligible veterans in an amount equaling the
difference between their previously used one-time entitlement and the
increased amount of the grant.
Compensation for Quality of Life and Noneconomic Loss:
Mr. Chairman, our nation's 3.2 million service disabled veterans
rely greatly on VA's disability compensation program as an essential
source of financial support for themselves and their families. However,
a number of recent studies and commissions have all agreed that VA's
disability compensation program does not do enough and should be
revised to compensate for the loss of quality of life and other non-
economic losses that result from permanent disabilities suffered while
serving in the armed forces.
In 2007, the Institute of Medicine (IOM) published a report
entitled, ``A 21st Century System for Evaluating Veterans for
Disability Benefits,'' recommending that the current VA disability
compensation system be expanded to include compensation for noneconomic
loss and loss of quality of 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 (P.L. 108-136), in 2007 also 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.'' That same year, the
President's Commission on Care for America's Returning Wounded
Warriors, chaired by former Senator Bob Dole and former Health and
Human Services Secretary Donna Shalala, also 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 concurs with all these recommendations and
calls on Congress to 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. The Canadian Veterans' Affairs disability compensation program
and the Australian Department of Veterans' Affairs disability
compensation program already do just that. It is now time for our
Congress and VA to 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.
CLAIMS PROCESSING REFORM RECOMMENDATIONS
Over the past decade, the number of veterans filing claims for
disability compensation has more than doubled, rising from nearly
600,000 in 2000 to over 1.4 million in 2011. This workload increase is
the result of a number of factors over the past decade, including the
wars in Iraq and Afghanistan, an increase in the complexity of claims
and a downturn in the economy causing more veterans to seek VA
assistance. Furthermore, new presumptive conditions related to Agent
Orange exposure (ischemic heart disease, B-cell leukemia and
Parkinson's disease) and previously denied claims, resulting from the
Nehmer decision added almost 200,000 new claims this year; leading to a
workload surge that will level off in 2012. During this same decade,
VBA's workforce grew by about 80%, rising from 13,500 FTEE in 2007 to
over 20,000 today, with the vast majority of that increase occurring
during the past four years.
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 February 4, 2012, there were 891,402 pending
claims for disability compensation and pensions awaiting rating
decisions by the VBA, an increase of more than 114,000 from one year
ago, and almost double the 487,501 that were pending two years prior.
The number of claims pending over 125 days, VBA's official target for
completing claims, reached 591,243, which is a 66% increase in one year
and more than twice 185,040 from two years ago.
But more important than the number of claims processed is the
number of claims processed correctly. The VBA quality assurance program
is known as the Systematic Technical Accuracy Review (STAR)and is now
available publicly on VA's ASPIRE Dashboard. The most recent STAR
measure for rating claims accuracy for the one-year period ending
September 2011 is 84 percent, about the same level as one year prior,
and slightly lower than several years earlier. However, the VA Office
of Inspector General (VAOIG) reported in May 2011 that based on
inspections of 45,000 claims at 16 of the VA's 57 regional offices
(VAROs), claims for disability compensation were correctly processed
only 77 percent of the time. This error rate would equate to almost
250,000 incorrect claims decisions in just the past year.
Cultural Change Needed to Fix Claims-Processing System:
Under the weight of an outdated information technology system,
increasing workload and growing backlog, the VBA faces a daunting
challenge of comprehensively transforming the way it processes claims
for benefits in the future, while simultaneously reducing the backlog
of claims pending within its existing infrastructure. While there have
been many positive and hopeful signs that the VBA is on the right path,
there will be critical choices made over the next year that will
determine whether this effort will ultimately succeed. It is essential
that Congress provide careful and continuing oversight of this
transformation to help ensure that the VBA achieves true reform and not
just arithmetic milestones, such as lowered backlogs or decreased cycle
times.
One of the more positive signs has been the open and candid
attitude of VBA leadership over the past several years, particularly
progress towards developing a new partnership between VBA and veterans
service organizations (VSOs) who assist veterans in filing claims. The
IBVSOs have been increasingly consulted on a number of the new
initiatives underway at VBA, including disability benefit
questionnaires (DBQs), Veterans Benefit Management System (VBMS), and
many, but not all business process pilots, including the I-LAB at the
Indianapolis Regional Office. Building upon these efforts, VBA must
continue to the reach out to its VSO partners, not just at central
office, but also at each of the 57 regional offices.
In order to drive and sustain its transformation strategies
throughout such a massive organization, VBA must change how it measures
and rewards performance in a manner designed to achieve the goal of
getting claims decided right the first time. Unfortunately, most of the
measures that VBA employs today are based primarily on production
goals, rather than quality. This bias for speed over accuracy has long
been VBA's cultural norm, and it is not surprising that management and
employees today still feel a tremendous pressure to meet production
goals first and foremost. While accuracy has been and remains one of
the performance standards that must be met by all employees, new
performance standards adopted over the past two years appear to have
done little to create sufficient incentives to elevate quality above
production.
Over the next couple of crucial years, it will be particularly
important for VBA and Congress to remain focused on the principal goal
of enhancing quality and accuracy, rather than focusing on reducing the
backlog. VBA should change the way it measures and reports progress so
that there are more and better indicators of quality and accuracy, at
least equal in weight to measures of speed and production. In addition,
VBA should develop a systematic way to measure average work output for
each category of its employees in order to establish more accurate
performance standards, which will also allow the VBA to better project
future workforce requirements.
Implementing a New Operating Model for Processing Claims:
As the Veterans Benefits Administration begins to implement a new
operating model for processing claims for disability compensation, it
must give priority to ``best practices'' that have been validated to
increase quality and accuracy, not just speed and production. VBA has
conducted more than 40 different pilot programs and initiatives looking
at new ways of establishing, developing, rating, and awarding claims
for benefits. Dozens of other ideas flowed from individual employees
and regional offices, leadership retreats, and an internal ``innovation
competition,'' leading to new initiatives such as quick pay, walk-in
claims, and rules-based calculators.
In order to test how best to integrate these and other pilots and
initiatives conducted over the past two years, VA established the I-LAB
at the Indianapolis Regional Office to develop a new end-to-end
operating model for claims processing. The I-LAB settled on the
segmentation of claims as the cornerstone principle for designing the
new operating model. The traditional triage function was replaced at
the I-LAB with an Intake Processing Center, staffed with experienced
claims processor, whose responsibility was to divide claims along three
separate tracks; Express, Core, and Special Ops. The Express lane is
for simpler claims, such as fully developed claims, claims with one or
two contentions, or other simple claims. The Special Ops lane is for
more difficult claims, such as those with eight or more contentions,
longstanding pending claims, complex conditions, such as traumatic
brain injury and special monthly compensation, and other claims
requiring extensive time and expertise. The Core lane is for the
balance of claims with between three and seven contentions, claims for
individual unemployability (IU), original mental health conditions, and
others.
VBA has seen some early indications that productivity could
increase through the use of the new segmentation strategy at the I-LAB;
however, it may still be too soon to judge whether such results would
be reproduced if applied nationally. While the VBA certainly needs to
reform its claims-processing system, it must first ensure that proper
metrics are in place in order to make sound decisions about the
elements of its new operating model.
By the end of 2011, the VBA stood up an Implementation Team to
develop a strategy and plan for implementing the new operating model
for processing claims. With the Secretary's ambitious goal of
processing all claims in less than 125 days with an accuracy rate of 98
percent by 2015, VBA's strategy calls for 2012 to be a year of
transition; full implementation of the new operating model is planned
for 2013; in 2014, the VBA anticipates stabilization and assessment of
the new system; and 2015 is planned as the year of ``centers of
excellence,'' an apparent reference to a future state that will
centralize some VBA activities or functions.
Critical to the success of this implementation strategy will be the
choices made by VBA this year. It will also be absolutely essential for
Congress to provide strong oversight to ensure that the enormous
pressures on VBA to show progress toward eliminating or reducing the
claims backlog does not result in short term gains at the expense of
long-term reform.
Stronger Training, Testing and Quality Control
Mr. Chairman, training, testing, and quality control must be given
the highest priority within the Veterans Benefits Administration if the
current claims processing reform efforts are to be successful. Training
is essential to the professional development of individuals and tied
directly to the quality of work they produce, as well as the quantity
they can accurately produce. However, the IBVSOs remain concerned that
under the rising pressure of increasing workload and backlogs, VBA
managers and employees often choose to cut corners on training in order
to focus on production at all costs. It is imperative that efforts to
increase productivity not interfere with required training of
employees, particularly new employees who are still learning their job.
Furthermore, after employees have been trained it is important that
they are regularly tested to ensure that they have the knowledge and
competencies to perform their jobs. A GAO report published in September
2011 found that there did not exist a nationwide training curriculum
for VBA's Decision Review Officers (DROs), despite the fact that 93
percent of regional managers interviewed supported such an national
training program, as did virtually every DRO interviewed. We would note
that following a recent DRO examination in which a high percentage
failed to achieve acceptable results, the VBA required all DROs to
undergo a one-week training program to enhance their knowledge and job
skills. This is exactly the type of action that should regularly occur
within an integrated training, testing, and quality control program.
In 2008, Congress enacted Public Law 110-389, the Veterans'
Benefits Improvement Act of 2008, which required VBA to develop and
implement a certification examination for all claims processors and
managers. While tests have been developed and conducted for VSRs,
RVSRs, and DROs, the tests for supervisory personnel and coaches have
yet to be completed. VBA cannot accurately assess its training or
measure an individual's knowledge, understanding, or retention of the
training material without regular testing. The IBVSOs believe it is
essential that all VBA employees, coaches, and managers undergo regular
testing to measure job skills and knowledge, as well as the
effectiveness of the training. At the same time, VBA must ensure that
certification tests are developed that accurately measure the skills
and knowledge needed to perform the work of VSRs, RVSRs, DROs, coaches,
and other managers.
One of the most promising developments over the past year is VBA's
new initiative to stand up Quality Review Teams (QRTs) in every
regional office. Developed from a review of the best practices used at
certain high-performing regional offices, the QRT program will assign
full-time, dedicated employees whose sole function is to seek out and
correct errors in claims processing. QRTs will also work to develop in-
process quality control measures to prevent errors before decisions are
made. The IBVSOs strongly support this program and recommend that VBA
make service in a QRT unit a career path requirement for those seeking
to rise to senior positions in Regional Offices or at VBA's
headquarters in Washington, DC.
Mr. Chairman, the only way the VBA can make and sustain long-term
reductions in the backlog is by producing better quality decisions in
the first instance. The only way to institutionalize such a cultural
shift within the VBA is by developing and giving priority to training,
testing and quality control programs.
New Information Technology Systems
After two years of development, VBA's Veterans Benefits Management
System (VBMS) is planned to be rolled out nationally beginning in June
of this year. The VBMS is designed to provide a comprehensive,
paperless, and rules-based method of processing and awarding claims for
VA benefits, particularly disability compensation and pension. The
IBVSOs have been especially pleased with VBA efforts to incorporate the
experience and perspective of our organizations throughout the VBMS
development process. Understanding the important role that VSO service
officers play in the claims process, VBA proactively sought frequent
and substantive consultation with VSOs, both at the national VBMS
office and at the pilot locations. The IBVSOs are confident that this
promising partnership will strengthen VBMS for VBA, VSOs, and most
importantly, veterans seeking VA benefits.
As VBA turns the corner on VBMS development leading to deployment,
it is imperative that Congress provide full funding to complete this
essential IT initiative. In today's difficult fiscal environment, there
are concerns that efforts to balance the federal budget and reduce the
national debt could result in reductions to VA programs, including IT
programs. Over the next year Congress must ensure that the funding
required and designated for the VBMS is protected from cuts or
reprogramming, and spent as Congress intended.
Another key IT component is e-Benefits, VA's online portal that
allows veterans to apply for, monitor, and manage their benefits over
the Internet. With more than 2 million users registered, e-Benefits
provides a web-based method for veterans to file claims for disability
and other benefits that will ultimately integrate that information
directly into the VBMS to adjudicate those claims. As with VBMS, it is
crucial that Congress and the VBA provide e-Benefits full funding in
order to support the ongoing transformation of the claims processing
system.
Mr. Chairman, the IBVSOs remain concerned about VBA's plans for
transitioning legacy paper claims into the new VBMS work environment.
While VBA is committed to moving forward with a paperless system for
new claims, it has not yet determined how to handle reopened paper
claims; specifically whether, when or how they would be converted to
digital files. Because a majority of claims processed each year are for
reopened or appealed claims and because files can remain active for
decades, until all legacy claims are converted to digital data files,
VBA could be forced to continue paper processing for decades. Requiring
VBA employees to learn and master two different claims processing
systems--one that is paper-based and the other digital--would add
unnecessary complexity and could negatively affect quality, accuracy,
and consistency.
While there are very difficult technical questions to be answered
about the most efficient manner of transitioning to all-digital
processing, particular involving legacy paper files, the IBVSOs believe
the VBA should do all it can to shorten the length of time this
transition takes to complete, and should provide a clear roadmap for
eliminating legacy paper files, one that includes clear timelines and
resource requirements. While this transition may require significant
upfront investment, it will pay dividends for the VBA and veterans in
the future.
Mr. Chairman, that concludes my statement and I would be happy to
answer any questions you or other members of the Committee may have.
Executive Summary
VBA AND GOE RESOURCE RECOMMENDATIONS
In order to sustain the transformation efforts underway at VBA, The
Independent Budget recommends generally maintaining current staffing
levels for FY 2013 in the Veterans Benefits Administration, with modest
increases for the Vocational Rehabilitation and Employment Service
(VR&E) and the Board of Veterans Appeals.
Increase funding for VR&E to allow 195 new counselors to
reach recommended staffing rations and 9 new full-time employees to
manage its expanding campus program
Increase funding to the Board to allow 40 FTEE to keep up
with rising workload.
Provide the funding necessary to construct a permanent
courthouse for the United States Court of Appeals for Veterans Claims.
VETERANS BENEFITS RECOMMENDATIONS
Congress should enact legislation to repeal the
inequitable requirement that veterans' military longevity retired pay
be offset by an amount equal to their disability compensation if rated
less than 50 percent.
Congress should fully repeal the offset between
dependency and indemnity compensation (DIC) and the Survivor Benefit
Plan (SBP).
Congress and VA should determine the most practical and
equitable manner to provide compensation for noneconomic loss and loss
of quality of life for service connected disabled veterans and move
expeditiously to implement this new component.
CLAIMS PROCESSING REFORM RECOMMENDATIONS
Congress must provide close and continuing overslight of
VBA's transformation of their claims processing system in order to
ensure that it is built on the principal of enhancing quality and
accuracy, rather than simply reducing the backlog by any means.
Congress must fully fund VBA's new IT systems,
particularly the Veterans Benefits Management System (VBMS) and e-
Benefits.
All VBA employees, coaches, and managers should undergo
regular training and testing to measure job skills and knowledge, as
well as the effectiveness of the training.
Prepared Statement of Diane M. Zumatto
Chairman Miller, Ranking Member Filner, Congressman Walz and
distinguished members of the committee, as an author of The Independent
Budget (IB), I thank you for this opportunity to share with you the
IB's recommendations in what we believe to be the most fiscally
responsible way of ensuring the quality and integrity of the care and
benefits earned by Americans veterans.
The venerable and honorable history of our national cemeteries
spans roughly 150 years and the earliest military graveyards were, not
surprisingly, situated at battle sites, near field or general hospitals
and at former prisoner-of-war sites. With the passage of the National
Cemeteries Act of 1973 (P.L. 93-43), the Department of Veterans'
Affairs (VA) became responsible for the majority of our national
cemeteries. The single most important obligation of the National
Cemetery Administration (NCA) is to honor the memory of America's brave
men and women who have selflessly served in this nation's armed forces.
Many of the individual cemeteries, monuments, grave stones, grounds and
related memorial tributes within the NCA system are richly steeped in
history and represent the very foundation of these United States.
With the signing of the Veterans Programs Enhancement Act of 1998
(P.L. 105-368) officially re-designated the National Cemetery System
(NCS) to the now familiar National Cemetery Administration (NCA). The
NCA currently maintains stewardship of 131 of the nation's 147 national
cemeteries, as well as 33 soldiers' lots. Since 1862, when President
Abraham Lincoln signed the first legislation establishing the national
cemetery concept, more than 3 million burials have taken place in
national cemeteries currently located in 39 states and Puerto Rico. As
of late 2010, there were more than 20,021 acres of landscape, funerary
monuments, grave markers and other architectural features, much of it
historically significant, included within established installations in
the NCA.
VA estimates that approximately 22.4 million veterans are alive
today and with the transition of an additional 1 million service
members into veteran status over the next 12 months, this number is
expected to continue to rise until approximately 2017. On average, 14.4
percent of veterans choose a national or state veterans' cemetery as
their final resting place. As new national and state cemeteries
continue to open and as our aging veterans' population continues to
grow, we continue to be a nation at war on multiple fronts. The demand
for burial at a veterans' cemetery will continue to increase.
The Independent Budget veterans service organizations (IBVSOs)
would like to acknowledge the dedication and commitment demonstrated by
the NCA leadership and staff in their continued dedication to providing
the highest quality of service to veterans and their families. It is in
the opinion of the IBVSOs that the NCA continues to meet its goals and
the goals set forth by others because of its true dedication and care
for honoring the memories of the men and women who have so selflessly
served our nation. We applaud the NCA for recognizing that it must
continue to be responsive to the preferences and expectations of the
veterans' community by adapting or adopting new interment options and
ensuring access to burial options in the national, state and tribal
government-operated cemeteries. We also believe it is important to
recognize the NCA's efforts in employing both disabled and homeless
veterans.
NCA Accounts
In FY 2011, the National Cemetery Administration operated on an
estimated budget of $298.3 million associated with the operations and
maintenance of its grounds. The NCA had no carryover for FY 2011. The
NCA was also able to award 44 of its 48 minor construction projects and
had four unobligated projects that will be moved to FY 2012.
Unfortunately, due to continuing resolutions and the current budget
situation, the NCA was not able to award the remaining four projects.
The IBVSOs support the operational standards and measures outlined
in the National Shrine Commitment (P.L. 106-117, Sec. 613) which was
enacted in 1999 to ensure that our national cemeteries are the finest
in the world. While the NCA has worked diligently improving the
appearance of our national cemeteries, they are still a long way from
where they should be.
The NCA has worked tirelessly to improve the appearance of our
national cemeteries, investing an estimated $39 million into the
National Shrine Initiative in FY 2011. According to NCA surveys, as of
October 2011 the NCA has continued to make progress in reaching its
performance measures. Since 2006, the NCA has improved headstone and
marker height and alignment in national cemeteries from 67 percent to
70 percent and has improved cleanliness of tombstones, markers and
niches from 77 percent to 91 percent. Although the NCA is nearing its
strategic goal of 90 percent and 95 percent, respectively, for height
and alignment and cleanliness, more funding is needed to continue this
delicate and labor-intensive work. Therefore, the IBVSOs recommend the
NCA's Operations and Maintenance budget to be increased by $20 million
per year until the operational standards and measures goals are
reached.
The IBVSOs recommend an Operational and Maintenance budget of $280
million for the National Cemetery Administration for FY 2013 so it can
meet the demands for interment, gravesite maintenance and related
essential elements of cemetery operations. This request includes $20
million for the National Shrine Initiative.
The IBVSOs call on the Administration and Congress to provide the
resources needed to meet the critical nature of the NCA's mission and
to fulfill the nation's commitment to all veterans who have served
their country so honorably and faithfully.
State Cemetery Grant Programs
The State Cemetery Grants Program (SCGP) complements the National
Cemetery Administration's mission to establish gravesites for veterans
in areas where it cannot fully respond to the burial needs of veterans.
Several incentives are in place to assist states in this effort. For
example, the NCA can provide up to 100 percent of the development cost
for an approved cemetery project, including establishing a new cemetery
and expanding or improving an established state or tribal organization
veterans' cemetery. New equipment, such as mowers and backhoes, can be
provided for new cemeteries. In addition, the Department of Veterans'
Affairs may also provide operating grants to help cemeteries achieve
national shrine standards.
In FY 2011, the SCGP operated on an estimated budget of $46
million, funding 16 state cemeteries. These 16 state cemeteries
included the establishment or ground breaking of five new state
cemeteries, three of which are located on tribal lands, expansions and
improvements at seven state cemeteries, and four projects aimed at
assisting state cemeteries to meet the NCA national shrine standards.
Since 1978, the Department of Veterans' Affairs has more than doubled
the available acreage and accommodated more than a 100 percent increase
in burials through this program.
With the enactment of the ``Veterans Benefits Improvement Act of
1998,'' the NCA has been able to strengthen its partnership with states
and increase burial services to veterans, especially those living in
less densely populated areas without access to a nearby national
cemetery. Through FY 2010, the state grant program has established 75
state veteran's cemeteries in 40 states and U.S. territories.
Furthermore, in FY 2011 VA awarded its first state cemetery grant to a
tribal organization.
The Independent Budget veteran's service organizations recommend
that Congress fund the State Cemetery Grants Program at $51 million for
FY 2013. The IBVSOs believe that this small increase in funding will
help the National Cemetery Administration meet the needs of the State
Cemetery Grant Program, as its expected demand will continue to rise
through 2017. Furthermore, this funding level will allow the NCA to
continue to expand in an effort of reaching its goal of serving 94
percent of the nation's veteran population by 2015.
Veteran's Burial Benefits
Since the original parcel of land was set aside for the sacred
committal of Civil War Veterans by President Abraham Lincoln in 1862,
more than 3 million burials have occurred in national cemeteries under
the National Cemetery Administration.
In 1973, the Department of Veterans' Affairs established a burial
allowance that provided partial reimbursement for eligible funeral and
burial costs. The current payment is $2,000 for burial expenses for
service-connected deaths, $300 for nonservice-connected deaths and a
$700 plot allowance. At its inception, the payout covered 72 percent of
the funeral costs for a service-connected death, 22 percent for a
nonservice-connected death and 54 percent of the cost of a burial plot.
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 until it was
removed in 1936. 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. Although neither the plot allowance nor the burial
allowance was intended to cover the full cost of a civilian burial in a
private cemetery, the recent increase in the benefit's value indicates
the intent to provide a meaningful benefit. The Independent Budget
veterans' service organizations are pleased that the 111th Congress
acted quickly and passed an increase in the plot allowance for certain
veterans from $300 to $700 effective October 1, 2011. However, we
believe that there is still a serious deficit between the original
value of the benefit and its current value.
In order to bring the benefit back up to its original intended
value, the payment for service-connected burial allowance should be
increased to $6,160, the non-service-connected burial allowance should
be increased to $1,918 and the plot allowance should be increased to
$1,150. The IBVSOs believe Congress should divide the burial benefits
into two categories: veterans within the accessibility model and
veterans outside the accessibility model.
Congress should increase the plot allowance from $700 to $1,150 for
all eligible veterans and expand the eligibility for the plot allowance
for all veterans who would be eligible for burial in a national
cemetery, not just those who served during wartime. In addition,
Congress should increase the service-connected burial benefits from
$2,000 to $6,160 for veterans outside the radius threshold and to
$2,793 for veterans inside the radius threshold.
Congress should increase the nonservice-connected burial benefits
from $300 to $1,918 for all veterans outside the radius threshold and
to $854 for all veterans inside the radius threshold. The
Administration and Congress should provide the resources required to
meet the critical nature of the National Cemetery Administration's
mission and to fulfill the nation's commitment to all veterans who have
served their country so honorably and faithfully.
Education, Employment and Training
During this time of persistent unemployment in our country, the
veterans' community as a whole has been hit disproportionately hard,
but for Iraq and Afghanistan veterans and Reserve Component members,
the job prospects are particularly bleak. Estimates as recent as
October 2011 suggest that the unemployment rate among veterans
returning from Iraq and Afghanistan is at least 3 percent greater than
the national average. In consideration of the tremendous sacrifices our
veterans have made for this nation, Congress and the Administration
must make a concerted effort to guarantee that all veterans have access
to education, employment and training opportunities to ensure success
in an unfavorable civilian job market.
Assisting those who have honorably served to secure the proper
skills, certifications and degrees so that they can achieve personal
success is and should always be central to our support of veterans. In
addition, disabled veterans often encounter barriers to entry or
reentry into the workforce. The lack of appropriate accommodations on
the job can make obtaining quality training, education and job skills
especially problematic. These difficulties, in turn, contribute to low
labor force participation rates and leave many disadvantaged veterans
with little choice but to rely on government assistance programs. At
present funding levels, entitlement and benefit programs cannot keep
pace with the current and future demand for such benefits. The vast
majority of working-age veterans want to be productive in the
workplace, and we must provide greater opportunities to help them
achieve their career goals. Thankfully, Congress passed the VOW to Hire
Heroes Act in recognition of these veterans' employment challenges
which an important step in improving veterans' job prospects.
Education
In 2008, Congress enacted the Post-9/11 GI Bill and ensured that
today's veterans have greater opportunities for success after their
years of voluntary service to our nation. The Independent Budget
veterans' service organizations (IBVSOs) were pleased with the quick
passage of this landmark benefit and worked with Congress to quickly
correct unforeseen inequities via the ``Post-9/11 Veterans Education
Assistance Improvement Act of 2010.'' When it was signed into law,
leaders in Congress and in the veterans' advocacy community touted the
prospect that the Post-9/11 GI Bill could create a new ``Greatest
Generation,'' offering critical job skills and training to a new
generation of leaders.
The IBVSOs are concerned that the Post-9/11 GI Bill may be
vulnerable to budgetary attacks as the conflicts in Iraq and
Afghanistan draw to a close. The benefits of the Post-9/11 GI Bill must
continue to remain available to honor the sacrifice of our nation's
veterans. To support this request, the Department of Veterans' Affairs
must develop the metrics to accurately measure the short- and long-term
impacts of these educational benefits. The IBVSOs believe that the
Post-9/11 GI Bill is an investment, not only in the future of our
veterans but also our nation.
Training and Rehabilitation Services: Vocational Rehabilitation and
Employment
Vocational rehabilitation for disabled veterans has been part of
this nation's commitment to veterans since Congress first established a
system of veterans' benefits upon entry of the United States into World
War I in 1917. Today the Vocational Rehabilitation and Employment
(VR&E) Service, through its VetSuccess Program, is charged with
preparing service-disabled veterans for suitable employment or
providing independent living services to those veterans with
disabilities severe enough to render them unemployable. Approximately
48,000 active duty, Reserve and Guard personnel are discharged
annually, with more than 25,000 of those on active duty found ``not fit
for duty'' as a result of medical conditions that may qualify for VA
disability ratings. With a disability rating the veteran would
potentially be eligible for Vocational Rehabilitation and Employment
services. According to the most recent report from the Government
Accountability Office (GAO) on VR&E services, the ability of veterans
to access VR&E services has remained problematic.
The task before Vocational Rehabilitation and Employment's (VR&E)
VetSuccess program is critical, and the need becomes clearer in the
face of the statistics from the current conflicts. Since Sept. 11,
2001, there have been more than 2.2 million service members deployed.
Of that group, more than 941,000 have been deployed at least two or
more times. As a result, many of these service members are eligible for
disability benefits and VR&E services if they are found to have an
employment handicap. Specifically, 43 percent may actually file claims
for disability. Due to the increasing number of service members
returning from Iraq and Afghanistan with serious disabilities, VR&E
must be provided the resources to further strengthen its program. There
is no VA mission more important than that of enabling injured military
personnel to lead productive lives after serving their country. In the
face of these facts, of concern to The Independent Budget veterans
service organizations (IBVSOs) are the current constraints placed on
VR&E as a result of an average client to counselor ratio of 145:1
compared to the VA standard of 125:1. VR&E, working through outside
contractors, continues to refine and refocus this important program so
it can maximize its ability to deliver services within certain
budgetary constraints. Given the anticipated caseload that future
downsizing of the military will produce, a more concise way to
determine staffing requirements and a more rigorous manpower formula
must be developed.
With this in mind, the IBVSOs recommend that VA needs to strengthen
its Vocational Rehabilitation and Employment (VR&E) program to meet the
demands of disabled veterans, particularly those returning from the
conflicts in Afghanistan and Iraq. It must provide a more timely and
effective transition into the workforce and provide placement follow-up
with employers for a minimum of six months. Congress must provide the
resources for VR&E to establish a maximum client to counselor standard
of 125:1 and a new ratio of 100:1 to be the standard. VR&E must place a
higher emphasis on academic training, employment services and
independent living to achieve the goal of rehabilitation of severely
disabled veterans. Congress should provide the resources to support the
expansion of VR&E's quality assurance staff to increase the frequency
of site visits.
Congress must also conduct oversight to ensure that Vocational
Rehabilitation and Employment (VR&E) program services are being
delivered efficiently and effectively. VR&E must develop and implement
metrics that can identify problems and lead to solutions that
effectively remove barriers to veteran completion of VR&E programs.
Transition Assistance Programs
The Transition Assistance Program (TAP) was developed to assist
military families leaving active service. The Department of Labor (DOL)
began providing TAP employment workshops in 1991, pursuant to section
502 of the ``National Defense Authorization Act for Fiscal Year 1991''
(P.L. 101-510). It is an interagency program delivered in partnership
by DOL and the Departments of Veterans Affairs, Defense (DOD) and
Homeland Security (DHS). Returning to civilian life is a complex and
exciting time for service members. TAP and the Disabled Transition
Program (DTAP) will, generally, now be mandatory thanks to the ``VOW to
Hire Heroes Act'' (P.L. 112-56) and will result in the program becoming
an even greater benefit in meeting the needs of separating service
members as they transition into civilian life.
As part of the new TAP, eligible members will be allowed to
participate in an apprenticeship or pre-apprenticeship program that
provides them with education, training, and services necessary to
transition to meaningful employment. These new TAP classes will also
upgrade career counseling options and resume writing skills, as well as
ensuring the program is tailored for the 21st century job market. TAP
is also available for eligible demobilizing service members in the
National Guard and Reserves. The news is that efforts to improve both
TAP and DTAP are under way.
The IBVSOs recommend that all Transition Assistance Program (TAP)
classes should include in-depth VA benefits and health-care education
sessions and time for question and answer sessions. The Departments of
Veterans Affairs, Defense, Labor and Homeland Security should design
and implement a stronger Disabled Transition Assistance Program (DTAP)
for wounded service members who have received serious injuries, and for
their families. Chartered veterans service organizations should be
directly involved in TAP and DTAP or, at the minimum, serve as an
outside resource to TAP and DTAP. The DOD, VA, DOL and DHS must do a
better job educating the families of service members on the
availability of TAP classes, along with other VA and DOL programs
regarding employment, financial stability and health-care resources.
Congress and the Administration must provide adequate funding to
support TAP and DTAP to ensure that active duty as well as National
Guard and Reserve service members receives proper services during their
transition periods.
February 13, 2012
The Honorable Representative Jeff Miller, Chairman
U.S. House of Representatives
Committee on Veterans' Affairs
335 Cannon House Office Building
Washington, D.C. 20510
Dear Chairman Miller:
Neither AMVETS nor I have received any federal grants or contracts,
during this year or in the last two years, from any agency or program
relevant to the February 15, 2012, House Veterans Affairs Committee
hearing on the U.S. Department of Veterans Affairs Budget Request for
Fiscal Year 2013.
Sincerely,
Diane M. Zumatto
AMVETS National Legislative Director
Prepared Statement of Timothy M. Tetz
Chairman Miller and Members of the Committee:
The American Legion welcomes this opportunity to comment on the
President's budget request.
As thousands of troops return from deployments to Iraq and
elsewhere in a shifting of our national security focus, it's
encouraging to see that President Obama's Fiscal Year 2013 budget for
the Department of Veteran Affairs (VA) pivots to meet the needs caused
by this reprioritization. On the surface, a double-digit increase in an
operational budget would be the envy of any agency during these dire
fiscal times. Yet, few agencies would be anxious to be faced by the
bulla of thousands of new clients and their corresponding claims and
care.
While grateful for this increase, The American Legion remains
concerned this increase is not only short of meeting the ultimate need,
but also a byproduct of budget and funding gimmickry that will
ultimately endanger veteran care if unsuccessful. Moreover, we remain
concerned these increases are directed not towards the veteran and his/
her care, but rather to the VA's bureaucratic structure that already is
unable to meet present needs of veterans.
Advanced Appropriations for FY 2014
Due to the successful passage of the Veterans Health Care Budget
Reform and Transparency Act of 2009 (P.L. 111-81) three of the four
accounts that make up the Veterans Health Administration (VHA) are
funded in advance of the regular budget cycle. Those three accounts -
medical services, medical support and compliance, and medical
facilities - are funded one year in advance and supplemented as
necessary during following year.
While The American Legion supported the advance appropriation
model, we remain concerned accurate projections on population and
utilization and other challenges still remain.
For example, one challenge came to our attention this year
regarding the procurement of medical equipment and Information
Technology (IT) products. When IT within the VA was combined together
across the entire agency in 2007, it was intended to improve
efficiency, contracting, management and other challenges inherent with
three disjointed IT management teams. This has proved somewhat
successful.
However we hearing that procurement of medical equipment and IT is
hampered at medical facilities due to budget implementation failures
caused by continuing resolutions. While a VA medical center director
would have operational funding beginning October 1 because of advance
appropriations, much needed purchases of IT or medical equipment might
be delayed due to a budget impasse in Congress. This has a detrimental
impact on the enrolled veteran and his/her care.
Medical Services
Over the past two decades, VA has dramatically transformed its
medical care delivery system. Through The American Legion visits to a
variety of medical facilities throughout the nation during our System
Worth Saving Task Force, we see firsthand this transformation and its
impact on veterans in every corner of the nation.
While the quality of care remains exemplary, veteran health care
will be inadequate if access is hampered. Today there are over 22
million veterans in the United States. While 8.3 million of these
veterans are enrolled in the VA health care system, a population that
has been relatively steady in the past decade, the costs associated
with caring for these enrolled veterans has escalated dramatically.
For example between FY2007 and FY 2009, VA enrollees increased from
7.8 million to 8.1 million. During the same period, inpatient
admissions increased from 589 thousand to 662 thousand. Outpatient
visits also increased from 62 million to 73 million. Correspondingly,
costs to care for these enrolled veterans increased from $29.0 billion
to $39.4 billion. This 36 percent increase during those two years is a
trend that dramatically impacts the ability to care for these veterans.
While FY2010 numbers seemingly leveled off - to only 3 percent
annual growth - will adequate funding exist to meet veteran care needs?
If adequate funding to meet these needs isn't appropriated, VA will be
forced to either not meet patient needs or shift money from other
accounts to meet those needs going forward.
Even with the opportunity for veterans from OIF/OEF to have up to
five years of health care following their active duty period, we have
not seen a dramatic change in overall enrollee population. Yet The
American Legion remains concerned that the population estimates are
dated and not reflective of the costs. If current economic woes and
high unemployment rates for veterans remain, VA medical care will
remain increasingly enticing for a veteran population that might not
have utilized those services in different times.
Finally, ongoing implementation of programs such as the PL 111-163
``Caregiver Act'' will continue to increase demands on the VA health
care system and therefore result in an increased need for a budget that
adequately deals with these challenges.
The final FY 2013 advanced appropriations for Medical Services was
$41.3 billion. In order to meet the increased levels of demand, even
assuming that not all eligible veterans will elect to enroll for care
and keep pace with the cost trend identified above, there must be an
increase to account for both the influx of new patients and increased
costs of care.
The American Legion recommends increasing the FY 2014 budget for VA
Medical Services to $44 billion.
Medical Support and Compliance
The Medical Support and Compliance account consists of expenses
associated with administration, oversight, and support for the
operation of hospitals, clinics, nursing homes, and domiciliaries.
Although few of these activities are directly related to the personal
care of veterans, they are essential for quality, budget management,
and safety. Without adequate funding in these accounts, facilities will
be unable to meet collection goals, patient safety, and quality of care
guidelines.
The American Legion has been critical of programs funded by this
account. We remain concerned whether patient safety is being adequately
addressed at every level. We are skeptical if patient billing is
performed efficiently and accurately. Moreover, we are concerned that
specialty advisors/counselors to implement OIF/OEF outreach,
``Caregiver Act'' implementation, and other programs are properly
allocated. If no need for such individuals exists, should the position
be placed within a facility? Simply throwing more money at this
account, increasing staff and systems won't resolve all these problems.
During the previous budget, this account grew by nearly 8% to $5.31
billion. While some growth is necessary to meet existing cost
increases, The American Legion questions the necessity for that rate to
continue at this time.
The American Legion recommends increasing the FY 2014 budget for VA
Medical Support and Compliance to $5.52 billion.
Medical Facilities
During the FY 2012 budget cycle, VA unveiled the Strategic Capital
Investment Planning (SCIP) program. This ten-year capital construction
plan was designed to address VA's most critical infrastructure needs
within the VA. Through the plan, VA estimated the ten-year costs for
major and minor construction projects and non-recurring maintenance
would total between $53 and $65 billion over ten years. Yet during the
FY 2012 budget, these accounts were underfunded by more than $4
billion.
The American Legion is supportive of the SCIP program which
empowers facility managers and users to evaluate needs based on patient
safety, utilization, and other factors. While it places the onus on
these individuals to justify the need, these needs are more reflective
of the actuality as observed by our members and during our visits. Yet,
VA has taken this process and effectively neutered it through budget
limitations thereby underfunding the accounts and delaying delivery of
critical infrastructure.
So while failing to meet these needs, facility managers will be
forced to make do with existing aging facilities. While seemingly
saving money in construction costs, the VA will be expending money
maintaining deteriorating facilities, paying increased utility and
operational costs, and performing piecemeal renovation of properties to
remain below the threshold of major or minor projects.
This is an inefficient byproduct of budgeting priorities. Yet, as
will be noted later, the reality remains that the SCIP program is
unlikely to be funded at complete levels necessary to deliver on the
ten year plan. Therefore, this account must be increased to meet the
short term needs within the existing facilities.
With a final FY 2013 Advance Appropriations budget of $5.74
billion, The American Legion recommends an FY 2014 budget increase to
$6 billion to ensure facilities are maintained to proper levels,
particularly in an austerity period where much needed improvements by
construction are being neglected and facilities are expected to extend
their normal operating life.
The American Legion recommends increasing the FY 2014 Medical
Facilities budget to $6 billion.
Medical and Prosthetic Research
The American Legion has maintained a position that VA research must
focus on improving treatment for medical conditions unique to veterans.
Because of the unique structure of VA's electronic medical records
(EHR), VA research has access to a great amount of longitudinal data
incomparable to research outside the VA system. Because of the ongoing
wars of the past decade, several areas have emerged as ``signature
wounds'' of the Global War on Terror, specifically Traumatic Brain
Injury (TBI), Posttraumatic Stress Disorder (PTSD) and coping with the
aftereffects of amputated limbs.
Much media attention has focused on TBI from blast injuries common
to Improvised Explosive Devices (IEDs) and PTSD. As a result, VA has
devoted extensive research efforts to improving the understanding and
treatment of these disorders. Amputee medicine has received less
scrutiny, but is no less a critical area of concern. Because of
improvements in body armor and battlefield medicine, catastrophic
injuries that in previous wars would have resulted in loss of life have
led to substantial increases in the numbers of veterans who are coping
with loss of limbs.
As far back as 2004, statistics were emerging which indicated
amputation rates for US troops were as much as twice that from previous
wars. By January of 2007, news reports circulated noting the 500th
amputee of the Iraq War. The Department of Defense response involved
the creation of Traumatic Extremity Injury and Amputation Centers of
Excellence, and sites such as Walter Reed have made landmark strides in
providing the most cutting edge treatment and technology to help
injured service members deal with these catastrophic injuries.
However, The American Legion remains concerned that once these
veterans transition away from active duty status to become veteran
members of the communities, there is a drop off in the level of access
to these cutting edge advancements. Ongoing care for the balance of
their lives is delivered through the VA Health Care system, and not
through these concentrated active duty centers.
Many reports indicate the state of the art technology available at
DOD sites is not available from the average VA Medical Center. With so
much focus on ``seamless transition'' from active duty to civilian life
for veterans, this is one critical area where VA cannot afford to lag
beyond the advancements reaching service members at DOD sites. If a
veteran can receive a state of the art artificial limb at the new
Walter Reed National Military Medical Center (WRNMC) they should be
able to receive the exact same treatment when they return home to the
VA Medical Center in their home community, be it in Gainesville, Battle
Creek, or Fort Harrison.
American Legion contact with senior VA health care officials has
concluded that while DOD concentrates their treatment in a small number
of facilities, the VA is tasked with providing care at 152 major
medical centers and over 1,700 total facilities throughout the 50
states as well as in Puerto Rico, Guam, American Samoa and the
Philippines. Yet, VA officials are adamant their budget figures are
sufficient to ensure a veteran can and will receive the most cutting
edge care wherever they choose to seek treatment in the system.
The American Legion remains concerned about the ability to deliver
this cutting edge care to our amputee veterans, as well as the ability
of VA to fund and drive top research in areas of medicine related to
veteran-centric disorders. There is no reason VA should not be seen at
the world's leading source for medical research into veteran injuries
such as amputee medicine, PTSD and TBI.
Current VA research also is unduly focused on confirming the
effectiveness of treatments for PTSD and TBI already in use within the
VA system. The American Legion remains concerned that little to no
effort is being expended seeking truly experimental and cutting edge
treatment. While there is a wealth of treatments already in use, we
cannot know we are truly providing the best care for these veterans
without pushing the boundaries of science and truly being a world
leader in research.
In FY 2011 VA received a budget of $590 million for medical and
prosthetics research. Only because of the efforts of the House and
Senate, was this budget kept at that level during the FY 2012 budget
due to significant pressure from The American Legion. Even at this
level, The American Legion contends this budget must be increased, and
closely monitored to ensure the money is reaching the veteran at the
local medical facility.
The American Legion recommends FY 2013 budget for Medical and
Prosthetics Research be increased to $600 million.
Medical Care Collections Fund (MCCF)
In addition to the aforementioned accounts which are directly
appropriated, medical care cost recovery collections are included when
formulating the funding for VHA. Over the years, this funding has been
contentious because the VA budget often included proposals for
enrollment fees, increased prescription rates, and other costs billed
directly to veterans. The American Legion has always ardently fought
against these fees and unsubstantiated increases.
Beyond these first party fees, VHA is authorized to bill health
care insurers for nonservice-connected care provided to veterans within
the system. Other income collected into this account includes parking
fees and enhanced use lease revenue. The American Legion remains
concerned that the expiration of authority to continue enhanced use
leases will greatly impact not only potential revenue, but also
delivery of care in these unique circumstances. We urge Congress to
reauthorize the enhanced use lease authority with the greatest amount
of flexibility allowable.
However, the collection of fees and insurance payments comprises
nearly 98% of the revenue gathered within this account. In the previous
budget cycle, this account was budgeted to decrease to $2.77 billion.
The American Legion remained skeptical that the VA was meeting these
deadlines even at a reduced level. We were well aware that failure to
meet these budgeted amounts equated to a reduction in appropriations
and therefore a reduction in services at some level.
In the first quarter of FY 2011, VHA reported a 12.3% decrease
below the budgeted collections - an amount totaling nearly $100
million. They remained below projections for the second quarter of FY
2011 when the Senate Veterans' Affairs Committee shared our concern in
a letter requesting detailed plans on how VA was going to improve on
MCCF collections. To date, our fears have not been assuaged that VA can
actually deliver on projected savings, even when reduced during the
previous budget cycle.
In May 2011, the VA Office of Inspector General (OIG) issued a
report auditing the collections of third party insurance collections
within MCCF. Their audit found that ``VHA missed opportunities to
increase MCCF by . . .46%.'' Because of ineffective processes used to
identify billable fee claims and systematic controls, it was estimated
VHA lost over $110 million annually. In response to this audit, VHA
assured they'd have processes in place to turn around this trend.
Yet even if those reassurances were met, the MCCF collection would
not meet the quarterly loss beneath the budgeted amounts. Without those
collections, savings must be garnered elsewhere to meet these
shortfalls, thereby causing facility administrators and VISN directors
to make difficult choices that ultimately negatively impact veterans
through a lack of hiring, delay of purchasing, or other savings
methods.
It would be unconscionable to increase this account beyond the
previous levels that were not met. To do so without increasing co-
payments or collection methods would be counterproductive and mere
budget gimmickry. While we recognize the need to include this in the
budget, The American Legion cannot support a budget that penalizes the
veteran for administrative failures.
The American Legion recommends budgeting $2.95 billion for Medical Care
Cost Collections.
Appropriations for FY 2013
The remainder of the accounts within VA are being allocated funding
for FY 2013. These include funding for general operation of VA Central
Office (VACO), the National Cemetery Administration (NCA) and Veteran
Benefits Administration.
Veteran Benefits Administration (VBA)
Any discussion of the VBA must include discussion of the
unconscionable backlog of veterans' benefits claims. Despite
improvements to the claims processing system enabling VBA to process
claims more rapidly, the backlog has continued to grow as the influx of
claims each year continues to exceed a million claims a year over the
past three years. Additional claims resulting from additions to
presumptive conditions associated with the aftereffects of the chemical
herbicide Agent Orange have contributed to this backlog. The American
Legion can further foresee significant increases to claims as more
service members return from wars in Afghanistan and Iraq and are
assimilated into the veteran population. Further cuts to military
manpower will drive more veterans into the civilian populace and as
service members transition from active duty to the civilian world, more
claims will continue to pour in. Many of these claims arise because DOD
fails to conduct appropriate physical examinations upon discharge or
retirement of service members.
Despite improvements to claims processing by the beginnings of
implementation of the Veterans Benefits Management System (VBMS), the
VBA's fully electronic claims processing system, the overall VBA will
be strained beyond their already struggling capacity without proper
funding to adequately address the backlog. While there have been
significant improvements in funding to VBA over the past six years,
this trend must continue if there is any hope to stave off disaster.
The system is already strained to its limits and is struggling to even
``tread water.'' Further improvements in this area must be made so that
veterans can finally receive prompt and accurate service addressing
their needs for injuries and conditions sustained during their active
duty service, as well as the residual aftereffects of that selfless
service.
VBA is also deeply involved in a massive overhaul of the ratings
schedule for payment of disability for every major body system.
Potential changes to ratings for mental health disorders and major
musculoskeletal groups will be rolled out over the coming years, and
implementation of these changes will require extensive training of VBA
personnel to ensure they are properly administering the benefits
system. The American Legion has long been critical of training within
VBA, and lack of proper training contributes to high error rates which
further tie up the claims systems with lengthy appeals that would be
unnecessary if the claims had been decided properly, by properly
trained personnel, on the claim review.
In other areas of compensation, pension and fiduciary programs
administered within VBA have been undergoing consolidation. Whether or
not these consolidations contribute to savings and more efficient
operation is a matter of open debate. The American Legion contends
consolidation has often created more problems than it has solved, and
often necessitated additional personnel at the local level to fix
problems created by removing staff to remote areas out of direct
contact with the veterans they purport to serve.
Furthermore, by VBA's own admission, consolidation of fiduciary
programs has resulted in pulling personnel away from claims processing
to be moved to the new fiduciary hubs, thereby creating a vacuum in
claims processing, an area already tasked to the limit. Given the
lengthy training period necessary to bring new claims processing hires
up to speed and effectiveness this only portends more problems in the
already troubled claims processing arena.
Increased funding in this area is necessary to provide for a surge
of new employees to handle the massive caseload, more extensive and
better organized training targeted to address key areas of deficiency
in claims processors, and to ensure personnel adequate for full use of
the VBMS system. Furthermore, as the proliferation of pilot programs to
solve the challenges of the claims systems continues to evolve, more
funding will be needed to ensure the more advanced and effective
business models can be replicated and implemented on a national level
so there is consistency in every Regional Office.
VBA's final FY 2012 appropriation was $2 billion a reduction from
the FY 2011 levels. Given the dire need of enhancements in this area,
The American Legion recommends a 10 percent increase in this budget for
FY 2013 to account for the many areas of need, including increased
staffing and training. As with all areas of VA budgeting, The American
Legion is concerned that any increases in funding actually reach down
to the regional level, rather than be swallowed up by an endlessly
expanding VACO bureaucracy. Congress has shown good faith recognizing
the dire need for funding to ensure veterans receive timely access to
benefits, but oversight must be exercised to ensure this money actually
reaches the veteran on the street.
The American Legion recommends budgeting $2.2 billion for the Veteran
Benefits Administration (VBA).
Information Technology
Like the VBA budget, the Information Technology (IT) budget was
slightly pared back in FY 2012. The American Legion was unable to gauge
the progress gained on the 76 IT projects proposed during that budget
cycle. In addition to the implementation and launch of the VBMS system,
the greatest long awaited project is the launch of the joint VA and
Department of Defense (DOD) lifetime record - Virtual Lifetime
Electronic Record (VLER).
The American Legion remains a strong advocate for the
implementation of such recordkeeping, yet we are pessimistic the VA and
DOD are making sufficient progress towards that end. As of right now,
VA can only point to a hopeful deadline of five years to implement
VLER, and The American Legion does not believe this was the will of
Congress when the proposal of a records system to follow a veteran from
induction through the rest of the life was passed into law.
During the previous budgeting, VA was unable to provide information
on the overall cost of creating such a system, but assured veteran
advocates there was enough flexibility to address any costs associated
with the project. In the meantime, several releases and announcements
have been issued by VA towards the continued evolution of this project,
but there is little to demonstrate we are any closer to producing a
ready model. The American Legion calls upon Congress to continue to
pressure VA and DOD to move towards this system as expeditiously as
possible. With the development and launch of VBMS nearly complete, the
entire IT focus should center on VLER.
The American Legion's System Worth Saving Task Force focus on rural
health care this year also recognizes significant challenges to IT
infrastructure in the field of telehealth benefits. VA is expanding the
use of telehealth as a means to reach rural veterans, yet obstacles
remain, and the IT budget must reflect overcoming these challenges.
Telehealth scheduling is still not fully integrated into VA health care
scheduling solutions. Furthermore, significant questions about
necessary bandwidth for providing telehealth in rural region remain to
be answered.
In order to provide the necessary resources for the nationwide
rollout of VBMS, increase IT infrastructure to meet the needs of rural
veterans through telehealth programs, and still maintain efforts
towards development of VLER, The American Legion believes a small
increase is justified within IT.
The American Legion recommends budgeting $3.3 billion for Information
Technology.
Major and Minor Construction
After two years of study the Department of Veterans Affairs (VA)
developed the Strategic Capital Investment Planning (SCIP) program. It
is a ten-year capital construction plan designed to address VA's most
critical infrastructure needs within the Veterans Health
Administration, Veterans Benefits Administration, National Cemetery
Administration, and Staff Offices.
The SCIP planning process develops data for VA's annual budget
requests. These infrastructure budget requests are divided into several
VA accounts: Major Construction, Minor Construction, Non-Recurring
Maintenance (NRM), Enhanced-Use Leasing, Sharing, and Other Investments
and Disposal. The Fiscal Year (FY) 2012 VA budget identified more than
5,000 capital projects needed to close all the identified
infrastructure gaps over the ten year period. The VA estimated costs
were between $53 and $65 billion.
The American Legion is very concerned about the lack of funding in
the Major and Minor Construction accounts. In FY 2012 The American
Legion recommended to Congress that the Major Construction account be
funded at $1.2 billion and the Minor Construction account be funded at
$800 million. However, Congress only appropriated $589 million and $482
million respectively to those accounts. Based on VA's SCIP plan,
Congress underfunded these accounts by approximately $4 billion in FY
2012. Clearly, if this underfunding continues VA will never fix its
identified deficiencies within its ten-year plan. Indeed, at current
rates, it will take VA almost sixty years to address these current
deficiencies.
The American Legion also understands there is a discussion to refer
to SCIP in the future as a ``planning document'' rather than an actual
capital investment plan. Under this proposal, VA will still address the
deficiencies identified by the SCIP process for future funding requests
but rather than having an annual appropriation, SCIP will be extended
to a five year appropriation, similar to the appropriation process used
by the Department of Defense as its construction model. Such a plan
will have huge implications on VA's ability to prioritize or make
changes as to design or project specifications of its construction
projects. The American Legion is against this five year appropriation
model and recommends Congress continue funding VA's construction needs
on an annual appropriations basis.
The American Legion recommends Congress adopt the 10-year action
plan created by the SCIP process. Congress must appropriate sufficient
funds to pay for needed VA construction projects and stop underfunding
these accounts. In FY 2013 Congress must provide increased funding to
those accounts to ensure the VA-identified construction deficiencies
are properly funded and these needed projects can be completed in a
timely fashion.
The American Legion recommends budgeting $5.3 billion for Major
Construction and $1.2 billion for Minor Construction projects
within VA.
State Veteran Home Construction Grants
Perhaps no program facilitated by the VA has been as impacted by
the decrease in government spending than the State Veteran Home
Construction Grant program. For the past two fiscal years, Congress has
appropriated $85 million towards the construction, upgrade, and
expansion of long term care facilities operated by the states.
This program is essential in providing services to a significant
number of veterans throughout the country at a fraction of the daily
costs of similar care in private or VA facilities. Yet, in order to
qualify for the federal grant, states must put forward a percentage of
the overall planning and construction costs. With a downturn in the
economy, a majority of the states have been unable to leverage state
funding for these projects. That coupled with a significant increase
NCA funding to meet the backlog in 2009 helped eliminate the backlog
that had been building.
As the economy rebounds and states are pivoting towards resuming
essential services, taking advantage of depressed construction costs,
and meeting the needs of an aging veteran population, greater use of
this grant program will continue. The American Legion encourages
Congress to maintain the funding level of this program.
The American Legion recommends budgeting $85 million for State Veteran
Home Construction Grant program.
National Cemetery Administration (NCA)
No aspect of the VA is as critically acclaimed as the National
Cemetery Administration (NCA). In the 2010 American Customer
Satisfaction Index, the NCA achieved the highest ranking of any public
or private organization. This was not a one-time occurrence; it has
been replicated numerous times in the past decade. In addition to
meeting this customer service level, the NCA remains the highest
employer of veterans within the federal government and remains the
model for contracting with veteran owned businesses.
The NCA is comprised of 131 national cemeteries. NCA was
established by Congress and approved by President Abraham Lincoln in
1862 to provide for the proper burial and registration of graves of
Civil War dead. Since 1973, annual interments in NCA have increased
from 36,400 to over 117,426 in 2011.
While NCA met their goal of having 90 percent of veterans served
within 75 miles of their home, their aggressive strategy to improve
upon this in the coming five years will necessitate funding increases
for new construction. Congress must provide sufficient major
construction appropriations to permit NCA to accomplish this goal and
open five new cemeteries in the coming five years. Moreover, funding
must remain to continue to expand existing cemetery facilities as the
need arises.
The average time to complete construction of a national cemetery is
7 years. The report of a study conducted pursuant to the Millennium
Bill concluded that an additional 31 national cemeteries would be
required to meet the burial option demand through 2020. In order to
adequately fund these five new cemeteries, Congress must be prepared to
appropriate the resources now.
The American Legion recommends budgeting $200 million for major and
minor construction projects within NCA in order to expand
existing facilities and begin procurement, planning, and
construction of new cemeteries.
While the costs of fuel, water, and contracts have risen, the NCA
operations budget has remained nearly flat for the past two budgets.
Some of these expenses have been a result of efficiency transformations
within the cemetery. Others have been due to the thriftiness of
cemetery superintendants.
Unfortunately recent audits have shown cracks beginning to appear
because of these savings. Due predominantly to poor contract oversight,
several cemeteries inadvertently misidentified burial locations.
Although only one or two were willful violations of NCA protocols, the
findings demonstrate a system about ready to burst.
To meet the increased costs of fuel, equipment, and other resources
as well as ever-increasing contract costs, The American Legion believes
a small increase is necessary. In addition, we urge Congress to
adequately fund the construction program to meet the burial needs of
our nation's veterans.
The American Legion recommends budgeting $260 million for National
Cemetery Administration Operating Budget.
State Cemetery Grant Program
The NCA administers a program of grants to states to assist them in
establishing or improving state-operated veterans' cemeteries through
VA's State Cemetery Grants Program (SCGP). Established in 1978, this
program funds nearly 100% of the costs to establish a new cemetery, or
expand existing facilities. For the past two budgets this program has
been budgeted at $46 million to accomplish this mission.
In 2007, the Dr. James Allen Veteran Vision Equity Act of 2007
(Public Law 110-157) authorized VA under the SCGP to provide additional
federal assistance to states for the operation and maintenance of state
veterans cemeteries. Prior to passage of this law, VA could only
provide federal funds for the establishment, expansion, and improvement
of state veterans cemeteries. VA could not fund the operation or
maintenance of state veterans cemeteries.
The new authority granted by the Act authorizes VA to fund
Operation and Maintenance Projects at state veterans cemeteries to
assist states in achieving the national shrine standards VA achieves
within national cemeteries. Specifically, the new operation and
maintenance grants have been targeted to help states meet VA's national
shrine standards with respect to cleanliness, height and alignment of
headstones and markers, leveling of gravesites, and turf conditions.
The Act authorizes VA to award up to a total of $5 million for such
purposes each fiscal year to ensure state veterans cemeteries meet the
highest standards of appearance and serve as national shrines to honor
the Nation's military service members with a final resting place.
In addition, this law allowed VA to provide funding for the
delivery of grants to tribal governments for Native American veterans.
Yet after the passage of this act, we have not seen the allocation of
funding increased to not only meet the existing needs under the
construction and expansion level, but also the needs from operation and
maintenance and tribal nation grants. Moreover, as these cemeteries
age, the $5 million limitation must be revoked to allow for better
management of resources within the projects.
State cemetery grants are managed through an intricate list of
priority groups, assigning rank and priority to projects based on
burial need, matching funds from the state or tribal government, and
other factors. The 2012 priority list has over 100 applications for
grants valued at over $250 million. Sixty applications, totaling over
$150 million already have matching funds necessary to leverage the
grant money from NCA. In order to meet this growing need, the grant
funding must be increased.
The American Legion recommends budgeting $60 million for State Cemetery
Grant Program.
Conclusion
In conclusion, The American Legion questions whether the increased
budget will be adequate to meet the needs of the one-million returning
service members from the Global War on Terror in addition to those 22
million veterans from previous eras. We are hopeful savings generated
through downsizing of the military are leveraged against the need of
thousands of servicemembers who will be discharged to create the
savings. Yet, we are more than pessimistic these will be accomplished
without budget gimmickry such as carryover funds, lofty collection
goals, and other schemes.
As we've seen in previous years, when these sleights-of-hand are
used, it almost always negatively impacts the care and benefits
afforded to our nation's veterans. Too often while veteran advocates
celebrate dramatically increased budgets, the veteran patient,
claimant, or widow is left wondering where the money went. We must not
do so again.
Our nation's veterans deserve adequate and responsible funding to
the fullest level possible. After over a decade of service, our newest
era of veterans will join the ranks of generations of their brothers
and sisters who are owed a great debt.
Our debt is incurred by the sweat in the ungodly heat of Iraq. Our
liability was predicated by the young Marine trudging up and down the
rugged mountains of Afghanistan. This obligation was earned in the
darkened cockpit of a medical evacuation flight jetting over the
Atlantic. It is a debt of tears, blood and sacrifice and deserves to be
repaid in honest true money.
Statements For The Record
Prepared Statement of Association of the United States Army
Mr. Chairman and Members of the Committees:
Thank you for the opportunity to present the views of the
Association of the United States Army (AUSA) concerning veterans'
issues. Both in personal testimony and through submissions for the
record there exists a long-standing relationship between AUSA and the
House Committee on Veterans' Affairs. We are honored to express our
views on behalf of our members and America's veterans.
The Association of the United States Army is a diverse organization
of almost 100,000 members - active duty, Army Reserve, Army National
Guard, Department of the Army civilians, retirees and family members.
An overwhelming number of our members are entitled to veterans'
benefits of some type. Additionally, AUSA is unique in that it can
claim to be the only organization whose membership reflects every facet
of the Army family.
Each year, the AUSA statement before the committee stresses that
America's veterans are not ungrateful. Much of the good done for
veterans in the past would have been impossible without the commitment
of those who serve on the committee and the tireless efforts of its
professional and personal staff.
The inherently difficult nature of military service has never been
more self-evident than during the current conflicts. While grateful for
the good things done for veterans, AUSA reminds our elected
representatives that we consider veterans benefits to have been duly
earned by those who have answered the nation's call and placed
themselves at risk.
AUSA is heartened that Congress has expressed a commitment to
support America's veterans. Despite this, many are concerned that the
declining number of veterans in Congress might in some way lessen the
value this institution places on veterans and their service to the
nation. We, at AUSA, do not share this opinion. AUSA is confident that
you - well-intentioned, patriotic men and women - will faithfully
represent the interests of America's veterans during fiscal
deliberations.
As elected representatives, you must be responsible stewards of the
federal purse because each dollar emanates from the American taxpayer.
AUSA emphasizes that the federal government must remain true to the
promises made to her veterans. We understand that veterans' programs
are not above review, but always remember that the nation must be there
for the country's veterans who answered the nation's call.
Veterans seldom vote in a block, despite their numbers. This is one
reason AUSA seeks this forum to speak for its members about veterans'
issues. Our veterans have lived up to their part of the bargain; the
Congress must live up to the government's part.
Those who have volunteered to serve their country in uniform
deserve educational benefits that support their transition to civilian
life. AUSA applauds Congress for enacting the Post-9/11 Veterans
Educational Assistance Act of 2008 and the more recent Post-9/11
Veterans Improvement Act of 2010. These landmark pieces of legislation
are helping educate a new generation of veterans by allowing them to
enroll as a full-time students and to focus solely on education.
With the Committee's support, the Department of Veterans' Affairs
has implemented the largest increase in education benefits for our
fighting men and women since World War II. AUSA has long endorsed a
21st century GI Bill that is built on the principles of simplicity,
equity and adequate reimbursement of the cost of education / training.
As we work to fully realize Congressional intent for the program, AUSA
believes consideration should be given to having hearings regarding a
unified architecture for all GI Bill programs for active duty, Guard
and Reserve under the principle of awarding benefits according to the
length and type of duty performed.
Because of Congress' establishment of the Gunnery Sergeant John D.
Fry Scholarship program, children of an active duty member who died in
the line of duty after September 10, 2001 are eligible for
substantially the same benefits as the Post-9/11 GI Bill when they
reach age 18. However, surviving spouses are eligible only for
Survivors and Dependents Educational Assistance (DEA) (Chapter 35, 38
USC) benefits, which for many means college or vocational training is
unaffordable.
For college attendance, DEA pays even less than the Montgomery GI
Bill stretched out over 45 monthly payments (instead of 36 months for
the MGIB). For full-time college enrollment, a surviving spouse
receives just $936 per month. When Congress established the Post-9/11
GI Bill in 2008, it authorized a one-time 20% rate hike to the MGIB,
but overlooked DEA. Today, the potential total DEA benefit is $42,120
compared to $51,336 under the MGIB. So surviving spouses receive
substantially reduced benefits under DEA and are not eligible for a
housing allowance or book stipend under the program. For many survivors
with children, college or vocational training is beyond their reach.
Therefore, AUSA urges Congress to authorize Post-9/11 GI Bill
benefits for surviving spouses of the current conflict, the same
educational benefit available to their children under the Gunnery Sgt.
John D. Fry Scholarships, in lieu of Dependents and Survivors'
Educational Assistance (DEA) benefits. As an interim measure, if
resources are not available to raise DEA reimbursement to the Post-9/11
GI Bill level, authorizing survivors of the current conflicts the Post-
9/11 GI Bill housing allowance and book stipend under DEA.
Also, AUSA is concerned about the rising unemployment of Army and
other veterans and believes additional full time counseling staff is
needed for the Vocational Rehabilitation and Employment (VRE) program
to support the increasing demand among the rising number of disabled
veterans. VRE helps equip disabled veterans to transition back into the
work force.
AUSA strongly encourages Congress to raise education benefits for
National Guard and Reserve service members under Chapter 1606 of Title
10. For years, these benefits have only been adjusted for inflation.
Currently, Reserve GI Bill benefits have fallen to less than 25 percent
of the active duty benchmark giving them much less value as a
recruiting and retention incentive. This also sends a signal to Reserve
Component personnel that their service is undervalued. Further, a
transfer of the Reserve MGIB-Select Reserve authority from Title 10 to
Title 38 will permit proportional benefit adjustments in the future.
Members of the National Guard called to active duty under Title 32
in support of the current crisis do not receive veteran's status for
their active duty military time. Those called to active duty under
Title 10 do receive veteran's status. Similarly, Army Reserve personnel
who are not called to active duty can complete a full reserve career
and yet not be entitled to be called veterans. This inequity must be
addressed. Your support in allowing Guard and Reserve members to earn
veterans' status on equal footing with their active duty counterparts
will send the message that Reserve Component personnel are part of the
Total Force.
Veterans' medical facilities must remain expert in the specialties
which most benefit our veterans. These specialties relate directly to
the ravages of war and are without peer in the civilian community. We
are grateful for the significant increase in resources and
appropriations, as well as the advanced appropriations process,
provided by the Congress to the veterans' health care. That said, a way
must be found to build on the inclusion of more Category 7 and 8
veterans this year, so that ultimately all Category 7 and 8 veterans
can receive care from the VA.
AUSA applauds the unprecedented and historic legislation which
authorized the unconditional concurrent receipt of retired pay and
veterans' disability compensation for retirees with disabilities of at
least 50 percent and the legislation that removed disabled retirees who
are rated as 100 percent from the 10-year phase-in period. However, we
cannot forget about the thousands of disabled retirees left out by this
legislative compromise. The principle behind eliminating the disability
offset for those with disabilities over 50 percent is just as valid for
those 49 percent and below. AUSA urges that the thousands of disabled
veterans left out of previous legislation be given equal treatment and
that the disability offset be eliminated completely.
Another critical area needs to be addressed. For chapter 61
(disability) retirees who have more than 20 years of service, the
government recognizes that part of that retired pay is earned by
service, and part of it is extra compensation for the service-incurred
disability. The added amount for disability is still subject to offset
by any VA disability compensation, but the service-earned portion (at
2.5 percent of pay times years of service) is protected against such
offset.
AUSA believes that a member who is forced to retire short of 20
years of service because of a combat disability must be ``vested'' in
the service-earned share of retired pay at the same 2.5 percent per
year of service rate as members with 20+ years of service. This would
avoid the ``all or nothing'' inequity of the current 20-year threshold,
while recognizing that retired pay for those with few years of service
is almost all for disability rather than for service and therefore
still subject to the VA offset.
Fortunately, legislation provided in previous defense bills extends
Combat Related Special Compensation (CRSC) to retirees with less than
20 years of service with combat or operations-related disabilities.
Unfortunately, retirees with non-combat disabilities forced to retire
short of 20 years of service still have to fund their VA compensation
dollar-for-dollar from their disability retirement from DoD, and this
year funding of concurrent receipt for these Chapter 61 medical
retirees is not included in the administration's budget.
AUSA supports legislation that establishes a presumption of service
connection for veterans with Hepatitis C (HCV).
The rules for interment in Arlington National Cemetery (ANC) have
never been codified in public law. Twice the House has passed
legislation to codify rules for burial in Arlington National Cemetery.
However, the legislation has not passed in the Senate. AUSA supports a
negotiated settlement of differences between the House and Senate
concerning codification of rules for burial in Arlington National
Cemetery. Further ``gray area'' reservists eligible for military
retirement should be included among those eligible for interment at
Arlington National Cemetery.
AUSA remains opposed to the imposition of an annual deductible on
veterans already enrolled in VA health care and any increase in the co-
payment charged to many veterans for prescription drugs. AUSA urges
Congress to continue to oppose such fees.
AUSA supports continuing congressional efforts to help homeless
veterans find housing and other necessities, which would allow them to
re-enter the workforce and become productive citizens.
Terminally ill veterans who hold National Service Life Insurance
and U.S. Government Life Insurance should, upon application, be able to
receive benefits before death, as can holders of Servicemembers Group
Life Insurance and Veterans Group Life Insurance. AUSA supports
legislation to amend the U.S. Code appropriately.
Much more needs to be done to ensure that returning combat
veterans, as well as all other service men and women who complete their
term of service or retire from service receive timely access to VA
benefits and services. This issue encompasses developing and deploying
an interoperable, bi-directional and standards-based electronic medical
record; a ``one-stop'' separation physical supported by an electronic
separation document (DD-214); benefits determination before discharge;
sharing of information on occupational exposures from military
operations and related initiatives. AUSA strongly recommends
accelerated efforts to realize the goal of ``seamless transition''
plans and programs.
We encourage the positive steps toward mutual cooperation taken
recently by the Department of Defense (DOD) and the VA. The closer we
can come to a seamless flow of a servicemember's personnel and health
files from service entry to burial, the more likely it will be that
former service members receive all the benefits to which they are
entitled. AUSA supports closer DOD-VA collaboration and planning
including billing, accounting, IT systems, patient records, but not
total integration of facilities nor of VA/DOD healthcare systems.
AUSA strongly supports preservation of dual eligibility of
uniformed service retirees for VA and DOD healthcare systems. We
applaud Congress' opposition to ``forced choice'' in the past and
encourage you to hold the line in the future.
AUSA recognizes that significant progress has been made in reducing
the unacceptably high numbers of backlogged disability claims. The key
to sustained improvement in claims processing rests on adequate funding
to attract and retain a high quality workforce supported by investment
in information management and technology.
The committee safeguards the treatment of America's veterans on
behalf of the nation. AUSA knows that you take this responsibility
seriously and treat this privilege with the gratitude and respect it
deserves. Although your tenure is temporary, the impact of your actions
lasts as long as this country survives and affects directly the lives
of a precious American resource - her veterans. As you make your
decisions, please do not forget the commitment made to America's
veterans when they accepted the challenges and answered the nation's
call to serve.
Thank you for the opportunity to submit testimony on behalf of the
members of the Association of the United States Army, their families,
and today's soldiers who are tomorrow's veterans.
MODULAR BUILDING INSTITUTE
February 13, 2012
Hon. Jeff Miller
Chairman, House Veterans' Affairs Committee
335 Cannon House Office Building
Washington, DC 20510
Dear Chairman Miller:
On behalf of the Modular Building Institute, I want to thank you
for holding a Hearing on the Department of Veterans Affairs Fiscal Year
2013 budget request. The Modular Building Institute (MBI) is a not-for-
profit trade association established in 1983 that serves to represent
companies involved in the manufacturing and distribution of commercial
factory-built structures.
Last year, the Modular Building Institute had the opportunity to
testify in front of the House Veterans' Affairs Committee to discuss
construction practices within the Department of Veterans' Affairs. We
believe that the Department of Veterans' Affairs could greatly increase
efficiency and reduce construction cost by adopting changes to their
construction practices.
Throughout the construction industry there has been concern with
the Department of Veterans Affairs as to the solicitation of
construction projects that call for a delivery system referred to as
``Design-Bid-Build.'' This project delivery method is often more costly
and less efficient than other delivery methods and its restrictive
nature prohibits alternate forms of construction such as permanent
modular, tilt-wall and pre-engineered steel construction from being
able to participate in the bidding process.
As is explained in greater detail throughout this letter, the
Department of Veterans' Affairs could greatly improve the way it
procures construction projects if it utilized an alternate project
delivery system known as ``Design-Build.'' Over the past decade, the
use of Design-Build has greatly increased in the United States, making
it one of the most significant changes in the construction industry.
The Design-Build method, which has been embraced by several
government agencies, including the United States Army Corps of
Engineers (USACE), streamlines project delivery through a single
contract between the government agency and the contractor. This simple
but fundamental difference not only saves money and time, improves
communication between stakeholders, and delivers a project more
consistent with the agency's needs, it also allows for all sectors of
the construction industry to participate.
I. The Increased Use of a Design-Build Delivery System - How would it
benefit the Department of Veterans' Affairs?
The Design-Build project delivery system offers the Department of
Veterans Affairs a variety of advantages that other project delivery
systems cannot. Typically, under the Design-Build approach, an agency
will contract with one entity to both design and construct the project.
This is in contrast with Design-Bid-Build, where an agency has to
contract with multiple entities for various design and construction
scopes during the construction project.
By greater utilization of the Design-Build delivery system, the
Department of Veterans Affairs can achieve these goals:
Faster Delivery--collaborative project management means
work is completed faster with fewer problems;
Cost Savings--an integrated team is geared toward
efficiency and innovation. Furthermore, with Design Build, construction
costs are often known far earlier than in other delivery methods.
Because one entity is typically responsible for the entire project,
they are able to predict costs more accurately than when a Design-Bid-
Build system is utilized. The contracting for Design-Build services
allows the agency several decision points during design. The decision
to proceed with the project is made before substantial design
expenditure and with knowledge of final project costs;
Quality--Design-Builders meet performance needs, not
minimum design requirements, often developing innovations to deliver a
better project than initially foreseen;
Single Entity Responsibility--one entity is held
accountable for cost, schedule and performance. With both design and
construction in the hands of a single entity, there is a single point
of responsibility for quality, cost, and schedule adherence. The firm
is motivated to deliver a successful project by fulfilling multiple
objectives, such as with the budget and schedule for completion. With
Design-Build, the owner is able to focus on timely decision making,
rather than on coordination between designer and builder;
Reduction in Administrative Burden--owners can focus on
the project rather than managing separate contracts;
Reduced Risk--the Design-Build team assumes additional
risk. Performance aspects of cost, schedule and quality are clearly
defined and responsibilities balanced. Change orders due to errors are
virtually eliminated, because the design-builder had responsibility for
developing drawings and specifications as well as constructing a fully-
functioning facility.
Just to underscore the benefits of a Design-Build project delivery
system, the Construction Industry Institute, in collaboration with
Pennsylvania State University performed a study examining the various
construction methods and found that:
Unit Cost: Design-Build was typically 6% less costly than
a Design-Bid-Build system;
Delivery Speed: Design-Build was 33% faster than Design-
Bid-Build;
Quality: Design-Build met and exceeded quality
expectations at all levels
Unfortunately, the Department of Veterans' Affairs has been
unwilling to embrace the Design-Build construction method as much as
other Federal Agencies. According to Department of Veterans Affairs
personnel, only 20% of VA solicitations call for a Design-Build
delivery system, while the rest rely on a Design-Bid-Build delivery
method.
As our nation prepares for an influx of returning warriors, it is
imperative that we are able to provide them with the services that will
help them assimilate into civilian life. Medical clinics, dental
facilities, physical rehabilitation facilities, mental health treatment
facilities as well as interim veteran housing will need to be provided
in an efficient and cost effective manner. By adopting the Design-Build
approach, the VA could provide these facilities in a compressed
timeframe while ensuring that the product delivered is top quality.
II. Design-Build Utilized by Other Federal Agencies
Over ten years ago, the Federal Acquisition Regulation (FAR) was
changed to accommodate the Design-Build project delivery method. Since
then, the Design-Build delivery method used by numerous Federal
Agencies, including the United States Army Corps of Engineers has been
utilized to bring thousands of facilities to completion on time and on
budget, thus creating savings for the agencies and the taxpayer.
Most Agencies have adopted the Design-Build method as their primary
means of project delivery. While figures vary slightly, most Agencies
estimate the overwhelming majority of their projects are solicited with
a Design-Build delivery method:
1. United States Army Corps of Engineers (USACE): 83-85% Design-
Build. According to Paul M. Parsoneault, construction management team
leader, U.S. Army Engineers Military Programs Branch, when Congress
approved the 2005 Base Realignment and Closure (BRAC) recommendations,
the agency had to respond faster than ever before. ``There was no way
possible to execute a historically large mission using the traditional
delivery system,'' he said. ``We determined that, in terms of the Army,
the default delivery system is design-build. We can deliver more
quickly, and we can leverage the innovation of industry to provide us
with the most cost-effective solutions to our requirements.''
2. Navy Facilities Engineering Command (NAVFAC): 75% Design-Build.
According to Joseph Gott, Director, NAVFAC, ``The largest reason we
select a project for the design-build delivery vehicle is the single
point of accountability and responsibility. We have an architect-
engineer and a design-build constructor on the same team and have a
contract with one company.''
3. Air Force Center for Engineering & Environment (AFCEE) 70%
Design Build. This number comes from a report done by Mr. Terry G.
Edwards (AFCEE).
4. Federal Bureau of Prisons: The Federal Bureau of Prisons has
relied exclusively on design-build project delivery. ``Design-build
shortens the delivery period because it eliminates the procurement
phase between the design and the construction phase,'' Pete Swift,
deputy chief, Design and Construction Branch.
By greater utilizing the Design-Build delivery system the
Department of Veterans' Affairs would experience several time and cost
benefits. With a Design-Build delivery method there are fewer
unforeseen problems and when problems do arise, they are resolved more
quickly. Projects delivered on or before deadline are the rule rather
than the exception with the Design-Build delivery method.
III. A Design-Build System Opens Opportunities for Alternative Design
Offerings
By utilizing a Design-Build philosophy, the Department of Veterans
Affairs could allow for sectors of the construction industry, such as
modular construction, tilt-wall and pre-engineered steel to offer
products as well as project means and methods that are currently not
exercised due to the restrictive nature of Design-Bid-Build project
delivery methods.
Numerous permanent modular contractors have performed services for
the Department of Veterans Affairs but because of the limited amount of
Design-Build solicitations, the opportunities are severely limited.
Recently, the National Institute of Standards and Technology (NIST)
released a report identifying modular construction as an underutilized
resource and a breakthrough for the U.S. construction industry to
advance its competitiveness and efficiency. One of the findings in the
NIST report was ``Greater use of prefabrication, preassembly,
modularization, and off-site fabrication techniques and processes.
For those who specialize in alternative construction such as
permanent modular, this report simply validated what has been known for
a long time: Construction methods such as permanent modular leads to
improved efficiency and productivity.
By greater utilizing the Design-Build delivery system into the
Department of Veterans' Affairs construction policies, the Department
of Veterans Affairs could greatly increase the amount of projects that
contractors utilizing alternative forms of construction could
participate in and therefore experience the benefits as outlined in the
NIST report.
It should be noted that alternative construction methods such as
permanent modular are not always the solution. There is no one perfect
building system for every application. However, by expanding
opportunities for them to be part of the process the Federal Government
can be assured that it gets the `best value' by seeing all the options
before awarding a contract.
IV. Conclusion
Contractors that rely on a Design-Build delivery system have, and
continue to overcome obstacles when it comes to working with the
Department of Veterans Affairs. Moreover, in an era where the
government is looking to trim costs wherever possible, the Department
of Veterans' Affairs would be able to reduce construction costs,
increase efficiency and provide our veterans with the quality
facilities they deserve.
The construction industry has seen great advances over the past ten
years, and one of those is the Design-Build delivery system. More and
more contractors are beginning to utilize Design-Build because of the
advantages that are offered. However, until agencies such as the
Department of Veterans Affairs decide to solicit more projects using a
Design-Build method, these companies will be unable to participate. The
members of MBI ask that the Veterans' Affairs Committee look into the
issues discussed in the hopes of improving the way the VA procures
facilities.
On behalf of the Modular Building Institute I thank you for your
time and attention to these matters. It is our hope the Committee can
continue to rely on MBI as a valuable resource when it comes to issues
relating to the construction industry.
Respectfully Submitted,
Tom Hardiman
Executive Director
Modular Building Institute
WARRIOR GROUP, INC
February 15, 2012
Hon. Jeff Miller
Chairman, House Committee on Veterans' Affairs
335 Cannon House Office Building
Washington, DC 20515
Dear Chairman Miller:
On behalf of the Warrior Group, Inc. (Warrior), thank you for
holding this Hearing examining the Department of Veterans Affairs
budget request for Fiscal Year 2013. The Department of Veterans Affairs
provides critical services to our nation's warriors and it is very
important that we ensure our veterans receive the best care possible.
To that end, we believe the Department of Veterans Affairs could take
steps to improve the method in which they procure facilities by
adopting a more efficient project delivery method that reduces agency
risk, decreases total project costs and meets and exceeds quality
expectations.
The intent of this testimony is to provide a comprehensive overview
of the advantages of a Design Build project delivery system. Over the
past decade, the use of Design Build has dramatically increased in the
United States. Its incorporation into federal procurement was codified
in 1996 with the passage of the Clinger-Cohen Act, which allowed for a
two-step procurement process. This Act gives agency officials the
discretion to choose whether Design Build is an appropriate delivery
method for a specific project.
The Design-Build method streamlines project delivery through a
single contract between the government agency and the contractor. This
simple but fundamental difference not only saves money and time,
improves communication between stakeholders, and delivers a project
more consistent with an agencies needs.
Currently, the Department of Veterans Affairs publishes the
majority of their solicitations with a Design Bid Build delivery
method. This project delivery method is often more costly and less
efficient than other delivery methods and its restrictive nature
prohibits alternate forms of construction such as permanent modular
construction from being able to participate in the bidding process.
At a time when Congress is looking to reduce spending wherever
possible, the utilization of a Design Build delivery method is a great
opportunity to reduce construction costs while at the same time
ensuring quality facilities that meet or exceed expectations.
The Increased Use of a Design-Build Delivery System
We have heard directly from agency personnel that the Department of
Veterans Affairs solicits only 20% of their construction projects
through a Design Build approach. This is in stark contrast to other
government agencies that procure the majority of facilities using a
Design Build approach.
The Design-Build project delivery system offers the Department of
Veterans Affairs a variety of advantages that other construction
delivery systems cannot. Typically, under the Design-Build approach, an
agency will contract with one entity to both design and construct the
project. By greater utilizing the Design-Build delivery system, the
Department of Veterans Affairs can achieve these goals:
Faster Delivery
Cost Savings
Quality
Single Responsibility
Reduction in Administrative Burden
Improved Budget Management
Numerous federal agencies benefit from the inherent benefits of
Design Build. The United States Army Corps of Engineers (USACE), Navy
Facilities Engineering Command (NAVFAC), Air Force Center for
Engineering and the Environment (AFCEE), Coast Guard and the Federal
Bureau of Prisons issue the vast majority of their solicitations under
the Design Build procurement method, and as a result, have benefited
from increased efficiency, reduced construction schedules and lower
costs.
In contrast, the Department of Veterans Affairs continually resists
efforts to adopt Design Build in a greater capacity. Recently, Agency
officials were asked why the Department continues to rely on the Design
Bid Build method of procurement. The response was ``because that's how
we've always done it.'' We believe this issue mindset prohibits the
consideration of a variety of factors all of which would suggest that a
Design Build approach could benefit the Department in a multitude of
ways. However, we believe that barring agency action, this issue should
be effectively addressed through legislation or other actions that this
Committee could undertake and champion on behalf of the construction
community.
A recent report by the Construction Industry Institute (CII) in
collaboration with Penn State University examined the various
construction methods and found that Design Build was typically 6-8%
less costly than a Design Bid Build system; Design Build was 33% faster
than Design Bid Build; and Design Build met and exceeded quality
expectations at all levels.
In addition to these advantages, a Design Build procurement process
allows all sectors of the construction industry to compete. Alternative
design offerings such as permanent modular construction, tilt-wall and
pre-engineered steel would be able to participate in VA solicitations
if the solicitations were issued using a Design Build delivery system.
However, because of the limited amount of Design Build solicitations,
the opportunities for alternate construction methods to be used on
Department of Veterans Affairs are severely restricted.
Admittedly, alternative construction methods such as permanent
modular construction are not always the solution. Nevertheless, by
expanding opportunities for them to be part of the process the
Department of Veterans Affairs can be assured that it gets the `best
value' by seeing all the options before awarding a contract.
Conclusion
It is Warrior's belief that the Department of Veterans Affairs
needs to make prompt, meaningful changes to their construction policies
in order to enhance participation among all sectors of the construction
industry as well as enjoy significant cost reductions and greater
efficiency provided by embracing the Design Build project delivery
system.
We ask that this Committee look into the issues and recommendations
we have presented in this testimony and act upon them promptly. We
believe our suggestions will help Congress achieve its desire for
greater efficiency and significant cost reductions within the
Department of Veterans Affairs. Our recommendation is practical and can
be readily implemented if there is the commitment from Department of
Veterans Affairs to do so. As the evidence demonstrates, Design Build
is an effective, efficient process that many federal agencies have
successfully implemented. It is time the Department of Veterans Affairs
follows suit.
We thank the Committee for its attention to this important
procurement matter.
Respectfully Submitted,
Gail Warrior
President & CEO
Warrior Group, Inc.
Background on Warrior Group:
Warrior is a general contractor that specializes in a form of
alternate construction known as Permanent Modular Construction (PMC).
Warrior was founded in 1997 and has performed numerous projects
including permanent barracks installations at Ft. Sam Houston and Ft.
Bliss. By incorporating a Design Build project delivery system with
commercial modular design, Warrior Group has been able to increase
efficiency, remove administrative issues, decrease construction costs
and speed up the delivery and completion of its projects.
Materials Submitted For The Record
PRE-HEARING QUESTIONS AND RESPONSES FROM CHAIRMAN JEFF MILLER TO THE
DEPARTMENT OF VETERANS AFFAIRS (VA)
Question 1: The Budget Control Act put in place statutory spending
caps on discretionary spending over the next decade. Although the
details of how annual appropriations to each Federal agency will fare
under those spending caps is yet to be determined, it is probable that
VA spending growth will be much more measured in the coming years.
a. Is this an accurate assessment?
Response: The Administration will continue to ensure that budget
requests will allow VA to deliver on its promise to provide the
services and benefits that Veterans have earned. The 2013 request for
discretionary appropriations is an increase of 4.3 percent over the
2012 enacted level. This rate of increase is higher than the 3.8
percent increase in appropriations VA received in 2012 compared to the
2011 level. This clearly demonstrates that our commitment to meet the
needs of Veterans and their families is unwavering.
Safeguarding the budgetary resources entrusted to us by the
Congress by managing them effectively and spending them judiciously is
part of our management culture and business process at VA. We are
constantly looking at new ways to enhance our operations and programs
to stretch every dollar provided even further and to improve how our
programs and services are delivered to Veterans, their families, and
survivors. VA officials take these responsibilities very seriously and
strive to deliver maximum value for our Nation's Veterans.
b. If so, and assuming that the demands placed on VA's health care
system will only increase as a result of an aging population needing
more expensive care, as well as the needs of returning war veterans,
what strategic policy and administrative changes does VA envision
needing to make in order to ensure quality of care does not
deteriorate?
Response: VA's commitment to providing high quality accessible
health care services will not change. The budget includes an advance
appropriations request for FY 2014 to meet the estimated health care
demands of all enrolled Veterans as determined by VA's Enrollee
Healthcare Projection actuarial model plus requirements for long-term
care, CHAMPVA programs, and select initiatives. In order to ensure the
continued high quality of VA health care, VA has and will continuously
evaluate overall mission requirements through efforts such as: enhanced
collaboration and coordination with the Department of Defense;
continued refresh of the VA Strategic Plan; execution of planning,
programming, budgeting, and evaluation (PPBE) processes through the VA
Office of Corporate Analysis and
Evaluation to support strategic decision-making and align resources
to achieve VA priorities for Veterans; and leveraging robust data
analysis and predictive modeling capabilities through the VA Office of
Data Governance and Analysis to support strategic and programmatic
planning, as well as policy development, with empirical analysis and
appropriately aligning resources to mirror the long term demographic
changes of our Veterans.
c. What about funding for VA's aging infrastructure? Will the
reality of a tight fiscal climate cause a shift in strategic thinking
about meeting construction needs? Is the Strategic Capital Investment
Plan (SCIP) still a realistic blueprint, or will funding restraints
necessarily bring about a new plan?
Response: The Strategic Capital Investment Planning (SCIP) process
is a VA-wide planning tool VA uses to evaluate and prioritize its
capital infrastructure needs for the current Budget cycle and for
future years. SCIP quantifies the infrastructure gaps that must be
addressed for VA to meet its long-term strategic capital targets,
including providing access to Veterans, ensuring the safety and
security of Veterans and our employees, and leveraging current physical
resources to benefit Veterans.
VA infrastructure funding requirements will continue to be balanced
against other Department and National priorities. SCIP continues to be
a critical and viable data- driven process that identifies all current
and future gaps in safety, security, access, utilization and other
related areas that most affect the delivery of benefits and services to
Veterans. SCIP then evaluates the means, including specific projects
(major, minor, non-recurring maintenance, leasing, or non-capital) to
efficiently mitigate these gaps. SCIP continues to be a realistic
blueprint in that it details a comprehensive methodology to mitigate
all currently-identified capital needs. In a tight fiscal climate, this
blueprint is an essential tool both this year and into the future, as
SCIP projects are prioritized each year to ensure that only the highest
priority projects are included in VA's annual budget request.
VA will continue to update this plan in order to capture changes in
the environment, including evolving Veteran demographics, newly-
emerging medical technology, advances in modern health care delivery
and construction technology, and increased use of non-capital means
(when appropriate) in a continuous effort to better serve Veterans,
their families, and their survivors.
Question 2: What is the Administration's view of how the Affordable
Care Act, when and if (pending the Supreme Court's review and/or
Congressional intervention) its requirements go into full effect, will
impact the VA healthcare system? What is the Administration's forecast
on whether heavily subsidized purchases of insurance off of health care
exchanges will result in a potential exodus of veterans from the VA
healthcare system?
Response: On March 21, 2010, Secretary Shinseki stated ``As
Secretary of Veterans Affairs, I accepted the solemn responsibility to
uphold our sacred trust with our nation's Veterans. Fears that Veterans
health care and TRICARE will be undermined by the
health reform legislation are unfounded. I am confident that the
legislation being voted on today will provide the protections afforded
our nation's Veterans and the health care they have earned through
their service. The President and I stand firm in our commitment to
those who serve and have served in our armed forces. We pledge to
continue to provide the men and women in uniform and our Veterans the
high quality health care they have earned.''
The national health care reform law, the Affordable Care Act (ACA),
has strategic implications for VA; many Veterans will have new options
for health care coverage under the new law starting in 2014, although a
Veteran's ability to access health care at VA will not be diminished.
VA has and will continue to review how the health care reform law may
influence VA health care programs. VA will continue to offer the
highest quality of health care to Veterans.
Question 3: Based on VA's Enrollee Healthcare Projection Model,
what is the total resource requirement for VA medical care in Fiscal
Year 2013 and FY2014? Will the appropriation request (when combined
with other sources of funding, e.g., carryover from prior years,
medical collections, account reimbursements) meet what the Model
projected as the resource requirement, or will policy proposals and/or
management initiatives reflected in the budget reduce the appropriation
request?
Response: The total resource requirement for FY 2013 is $56.580
billion and for FY 2014 is $57.929 billion based on the VA's Enrollee
Healthcare Projection Model and requirements for Long-Term Care
programs, Other Health Programs, Initiatives, Operational Improvements,
and Legislative Proposals.
Yes, the appropriation request, when combined with other sources,
will meet the total requirement listed above. The details of the other
sources is as follows: operational improvements of $1.284 billion in FY
2013 and $1.328 billion in FY 2014, collections of $2.966 billion in FY
2013 and $3.051 billion in FY 2014, reimbursements and prior year
recoveries of $408 million in FY 2013 and $416 million in FY 2014, and
a carryover of $500 million in FY 2013. The Administration will review
the initial FY 2014 advance appropriations request during the next
Budget cycle.
Question 4: The Office of Management and Budget's ``Campaign to Cut
Waste'' requires Federal agencies to reduce spending in certain
categories by 20 percent below Fiscal Year 2010 levels. Please detail
how VA is complying with this directive. Please outline what level of
spending VA envisions in each of these categories in response to the
directive and VA's strategy to deal with the funding reductions. What
will happen to the savings realized from this effort?
Response: VA is taking action to reduce spending in each of the
categories covered in the Campaign to Cut Waste, as well as reducing
spending for management support services contracts. On December 23,
2011, VA provided OMB with its proposed plan for reduced spending
levels - VA's total reduction target is $173 million. VA
administrations and staff offices have reduction targets for each of
the categories in 2012 and 2013, in concert with the overall approved
reduction goals. All offices also developed reduction plans detailing
how they will meet reduction goals and where these dollars will be
applied once realized.
Executive Order 13589, ``Promoting Efficient Spending,'' requires
agencies to establish a plan for reducing ``the combined costs
associated with the activities covered by sections 3 through 7 of the
order. Accordingly VA did not set individual reduction targets by
category but aggregates our reductions across target categories
(travel, printing, IT devices, supplies, and management support
services).
VA's Chief Financial Officer CFO monitors monthly financial data
related to the Campaign to Cut Waste to ensure planned actions are
achieved and reports to OMB quarterly. VA will reinvest realized
savings into VA programs.
Question 5: In response to questions for the record submitted prior
to the Committee's hearing on the FY 2012/2013 Budget Submission last
year, the Department wrote that: ``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.'' Please provide the following:
a. The total amount spent in FY 2011 to implement the law.
Response: The cost of Sections 101-104 in 2011 was $30.8 million.
This includes $7.4 million for additional requirements such as the
Caregiver Website, and the implementation of other evidence based
practices and staffing that is not included in the answer to section d
below.
b. The total amount expected to be spent in FY 2012 to implement
the law.
Response: The total amount expected to be spent in FY 2012 is $251
million.
c. The total amount expected to be spent in FY 2013.
Response: The total amount expected to be spent in FY 2013 is $278
million.
d. Provide a cost breakdown for each of the following services
available to primary caregivers under Section 101 of this law, for FY
2011 and FY 2012 to date:
i. instruction and training
ii. travel, lodging, and per diem expenses to attend training
iii. lodging and subsistence for VA appointments
iv. respite care
v. ongoing technical support
vi. counseling
vii. monthly stipend
viii. health coverage under the Civilian Health and Medical Program
of the Department of Veterans Affairs (CHAMPVA) if not already covered
under existing insurance
Response:
----------------------------------------------------------------------------------------------------------------
FY 2011 1st QTR FY 2012
----------------------------------------------------------------------------------------------------------------
Instruction and Training $3,933,563 $81,422
----------------------------------------------------------------------------------------------------------------
Travel, lodging, and per diem expensed to attend $141,832 $24,122
training
----------------------------------------------------------------------------------------------------------------
Lodging and subsistence for VA appointments $60,784 $56,284
----------------------------------------------------------------------------------------------------------------
Respite care $1,308,503 $249,734
----------------------------------------------------------------------------------------------------------------
Ongoing technical support $10,687,172 $3,146,041
----------------------------------------------------------------------------------------------------------------
Mental Health $6,600 $9,108
----------------------------------------------------------------------------------------------------------------
Monthly stipend $11,002,530 $16,568,583
----------------------------------------------------------------------------------------------------------------
CHAMPVA $201,783
----------------------------------------------------------------------------------------------------------------
Question 6: Does VA have sufficient resources in the FY 2012 budget
to implement the provisions of the VOW to Hire Heroes Act of 2011 and
has it adjusted its FY2013 budget to properly implement the Act's
provisions? How will the Memorandum of Understanding between the
Department of Labor and VA required for implementation of the VOW Act
affect resource requirements?
Response: VA has sufficient resources in the FY 2012 budget and FY
2013 budget request to implement the Veterans Retraining Assistance
Program (VRAP) provisions of the VOW to Hire Heroes Act of 2011. To
ensure that VA can effectively implement VRAP, our 2013 budget request
reflects the resources to support hiring 166 Veterans claims examiners
to process claims. This temporary staffing increase equates to 85 full
time equivalent (FTE) in 2012 and 90 FTE in 2013. These resources will
allow us to manage increased workload and avoid disrupting current
claims processing workload. VA will administer payments under VRAP from
amounts appropriated for the payment of readjustment benefits. The
Memorandum of Understanding between the Department of Labor and VA is
not expected to affect resource requirements.
Question 7: Please detail how VA's budget reflects the needed
funding to adjust current IT systems for the Montgomery GI Bill to
account for the re-training program added by the VOW to Hire Heroes Act
of 2011?
Response: The Veterans Retraining Assistance Program (VRAP)
provision was signed into law on November 21, 2011, as part of the VOW
to Hire Heroes Act of 2011. The Act authorizes VA to spend no more than
$2 million in information technology expenses from the readjustment
benefits account for the administration of this program. This is an in-
house development effort and funds from the readjustment benefits
account will be used as needed to cover the project.
Question 8: I understand that the funding for the long-term IT
solution for the Post 9/11 GI Bill was decreased by $50 million. That
reduction prevents development and fielding of the phase that fully
automates the adjudication and payment system. What is VA's plan for
this project? Will this project be a priority within IT funds requested
in FY 2013?
Response: The Consolidated Appropriations Act of 2012 (P.L. 112-74)
provides $52 million for continued development of an automated claims
processing system for the Post 9/11 GI Bill, known as the Long Term
Solution (LTS). The initial end-to-end technology solution for
automation of Post 9/11 GI Bill claims is expected in July 2012. FY
2013 planning will focus on expanding the automated claims processing
capabilities of the LTS system.
Question 9: What is the negative impact, if any, of the expiration
of VA's authority to pool mortgages under section 3720 of title 34
U.S.C.?
Response: Please note that the authority cited above is included
under section 3720 of title 38 U.S.C., not 34 U.S.C. It expired on
December 31, 2011.
VA, in cooperation with OMB, is currently conducting a review of
options relating to managing the Vendee Direct Loan Portfolio,
including the potential of an extension of this authority. The review
will focus on both the direct and indirect costs associated with Vendee
loan sales.
Question 10: Please provide a list of each Medical Center and
Veterans Integrated Service Network (VISN) Director position vacant, by
location, and the total number of days the positions have been vacant.
Response: VA's SES positions are essential to fulfilling the
Department's mission to care for the Nation's Veterans, their families
and survivors. Upon Secretary Shinseki's appointment, President Obama
directed him to transform the Department into a 21st century
organization. Fulfilling this mandate requires that VA keeps executive
positions filled and prioritizes filling them.
When the Secretary arrived, he realized that transforming VA
required him to change the way VA managed senior executives. In the
fall of 2009, he centralized management of the entire executive cadre
and established a corporate office to do so. In early 2010,
VA hired a new director for the corporate office and began laying
the foundation for corporate management. Since then, we have made vast
improvements in the effectiveness of VA's executive cadre.
We have revamped the SES performance management system into an
effective tool for developing our strategic leaders to provide the best
possible care and service to Veterans. Top VA leadership is involved in
this process, and every executive's performance is rated by 2 levels of
management. VA is preparing to implement the new government-wide SES
performance appraisal system in FY 2012 and fully incorporate
performance management into executive life cycle management and
development.
VA has developed a robust executive development program designed to
ensure each executive is prepared for success. VA conducts executive on
boarding to ease an executive's assimilation into VA's leadership
cadre. VA develops an individual, tailored transition plan for each new
executive that identifies specific actions or experiences the executive
needs to fulfill within a specified time period. VA mentors each
executive and assigns a coach to new executives. All VA executives are
attending an executive training program that focuses on strategic
leadership. We accomplish succession planning for executive cadre
positions by moving executives to positions of greater scope and
responsibility and developing replacements through VA's SES Candidate
Development Program. VA also recruits executives from outside VA and
outside the Federal government to ensure VA's executive cadre is
diverse in the broadest sense.
To attract and retain the best leaders, we use all the tools
available to us including recruitment, relocation, and retention
incentives, as well as, performance awards to recognize our highest
performers.
VA is aggressively managing executive recruitment and has
reengineered the process to reduce the time required to fill jobs. For
VA's executive cadre as a whole, the average time to fill jobs has been
reduced from 102 days in FY 2009 to 83 days in first quarter FY 2012.
There are past examples of individuals who were placed in complex
or challenging medical center director positions for which they were
not yet well prepared. The Secretary recognized this and instituted an
enterprise approach to filling these key leadership positions -
focusing on strategic leadership competencies and VA-wide needs. The
selection process now requires greater senior leader engagement.
Interviews are conducted at multiple levels and nominations are
endorsed by 2 or more levels of management. The Secretary approves
every SES selection.
VA is focused on hiring the right person for the right position and
investing in each executive's development. VA leadership has
prioritized filling senior executive positions with the right people in
a timely manner. This is critical to improving delivery of services to
the Nation's Veterans.
Of the 152 Medical Center Director positions, 19 (12 percent) are
vacant as of February 2, 2012 for an average of 156 calendar days.
Breakdown follows:
8 of the 19 (42 percent) were vacated after 11/1/11, and
have been vacant for an average of 33 days.
7 of the 19 (37 percent) vacancies have nominations
awaiting approval from the Office of Personnel Management (required) or
an established start date within the next 30 days.
6 of the 19 (32 percent) vacancies have nominations
pending approval.
6 of the 19 (32 percent) have interviews underway.
5 of the 19 have been announced more than once because of
the difficulty finding acceptable personnel with the right skills and
competencies.
Of the 21 VISN Director positions in VA, 4 (19 percent) are vacant
as of February 2, 2012 for an average of 29 calendar days.
Three of the 4 were vacated on December 31, 2011; one on
January 14, 2012.
Permanent VISN Directors for two of the vacancies will be
placed on March 11, 2012.
Candidates for the other two positions are under review.
VA Medical Center and Veterans Integrated Service Network (VISN) Director positions vacant, by location, and
total number of days vacant (as of 2/2/2012)
----------------------------------------------------------------------------------------------------------------
Medical Centers
-----------------------------------------------------------------------------------------------------------------
Location Vacant Number of Days Vacant Comments
----------------------------------------------------------------------------------------------------------------
Bath, NY 6/5/2011 242 Candidate identified
----------------------------------------------------------------------------------------------------------------
Buffalo, NY 7/29/2011 188 Candidate selected
----------------------------------------------------------------------------------------------------------------
Altoona, PA 9/25/2011 130 Candidate selected
----------------------------------------------------------------------------------------------------------------
Butler, PA 7/31/2011 186 Candidate selected
----------------------------------------------------------------------------------------------------------------
Clarksburg, WV 1/31/2012 2 Candidate identified
----------------------------------------------------------------------------------------------------------------
Augusta, GA 11/20/2011 74 Candidates under review
----------------------------------------------------------------------------------------------------------------
Montgomery, AL 9/2/2011 153 Candidates under review
----------------------------------------------------------------------------------------------------------------
Bay Pines, FL 4/1/2011 307 Candidates under review
----------------------------------------------------------------------------------------------------------------
Miami, FL 1/3/2012 30 Candidates under review
----------------------------------------------------------------------------------------------------------------
Danville, IL 1/2/2012 31 Candidate selected
----------------------------------------------------------------------------------------------------------------
Tomah, WI 6/3/2011 244 Candidate selected
----------------------------------------------------------------------------------------------------------------
Poplar, MO 12/18/2011 46 Candidates under review
----------------------------------------------------------------------------------------------------------------
Jackson, MS 1/29/2011 369 Candidate identified
----------------------------------------------------------------------------------------------------------------
Harlingen, TX 9/25/2011 130 Candidates under review
----------------------------------------------------------------------------------------------------------------
Phoenix, AZ 6/18/2011 229 Candidate selected
----------------------------------------------------------------------------------------------------------------
Boise, ID 7/3/2011 214 Candidate identified
----------------------------------------------------------------------------------------------------------------
Spokane, WA 11/3/2011 91 Candidate selected
----------------------------------------------------------------------------------------------------------------
San Diego, CA 5/22/2011 256 Candidates under review
----------------------------------------------------------------------------------------------------------------
Minneapolis, MN 12/31/2011 33 Candidates under review
----------------------------------------------------------------------------------------------------------------
Vacancy average: 156 days
----------------------------------------------------------------------------------------------------------------
VISN Directors
----------------------------------------------------------------------------------------------------------------
VISN 7, Atlanta, GA 12/31/2011 33 Candidate identified
----------------------------------------------------------------------------------------------------------------
VISN 15, Kansas, MO 1/14/2012 19 Candidates under review
----------------------------------------------------------------------------------------------------------------
VISN 16, Jackson, MS 12/31/2011 33 Candidate selected
----------------------------------------------------------------------------------------------------------------
VISN 19, Denver, CO 12/31/2011 33 Candidate selected
----------------------------------------------------------------------------------------------------------------
Vacancy average: 29 days
----------------------------------------------------------------------------------------------------------------
Question 11: What does the VA Acquisition Academy provide that the
Federal Acquisition Academy doesn't? Please explain why these two
Academies are not duplicative in their purpose.
Response: This response was prepared under the impression that the
reference to the ``Federal Acquisition Academy'' was intended to be the
``Federal Acquisition Institute (FAI).'' VA believes that its VA
Acquisition Academy (VAAA) both compliments and supplements the
trainings offered by FAI.
As described by FAI, this program was established in 1976, under
the Office of Federal Procurement Policy Act, FAI is charged with
fostering and promoting the development of a federal acquisition
workforce. FAI facilitates and promotes career development and
strategic human capital management for the acquisition workforce. In
conjunction with its partners, FAI seeks to ensure availability of
exceptional training, provide compelling research, promote
professionalism, and improve acquisition workforce management.
VAAA was created in 2008 to train and recapitalize VA's acquisition
workforce who are responsible for approximately $16 billion in
acquisitions annually. The VAAA tailors its courses to VA and civilian
agency education requirements while still meeting FAI's Federal
Acquisition Certification standards. To our knowledge, the FAI provides
approximately 1,400 seats for all Federal Contracting Officers (CO) and
Contracting Officer Representatives (COR) annually. In contrast, VAAA
annually provides over 3,300 seats to COs and over 2,000 seats to CORs.
To date, VA's Acquisition Academy has delivered more than 6,700 seats
of training to COs and more than 3,700 seats to COR training. VAAA is a
fully staffed and functional training organization that can also be
leveraged across all Federal agencies. In addition to providing
training to VA employees, the academy has served more than 200 students
from eight other Cabinet- level agencies.
Since February 2010, VAAA has also been delivering Program
Management training supporting Federal Acquisition Certification for
Program/Project Management with over 10,000 seats delivered. VAAA's
current program includes an on-the-job application component; a
comprehensive performance based certification exam; and a robust
effectiveness evaluation and continuous improvement process. The
trainings described above are offered through the VAAA's Acquisition
Internship School, Contracting Professional School, and Program
Management School.
Question 12: Please detail the total number of SES performance
bonuses awarded in the preceding 12 month period and the total dollar
amount of those awards.
Response: For the 12-month period beginning February 1, 2011, and
ending January 31, 2012, VA granted 244 SES performance awards and
spent $2,823,922 on these awards. This includes 1 bonus deferred from
the FY 2010 performance cycle. Performance awards are based on Fiscal
Year performance and are normally awarded at the end of the calendar
year.
POST-HEARING QUESTIONS FROM CHAIRMAN JEFF MILLER TO THE DEPARTMENT OF
VETERANS AFFAIRS (VA)
1. In responses to pre-hearing questions VA stated that the
Affordable Care Act (ACA) has ``strategic implications for VA.'' VA
also stated in response to pre-hearing questions that it ``has and will
continue to review how the health care reform law may influence VA
health care programs.''
a. What are the strategic implications?
b. Please provide the results of any review VA has conducted to
date regarding the influence the ACA may have on VA health care
programs.
2. VA's appropriation request is based, largely, on VA's Enrollee
Health Care Projection Model (Model) estimates. Key components of the
Model include the enrollee population and utilization.
a. Recognizing the difficulty of forecasting utilization behavior,
how were the ``strategic implications'' of the ACA on potential
enrollment and utilization factored into the FY 2014 advance request?
b. Going forward, how will the strategic implications of the ACA
influence resource requests in subsequent budget submissions?
3. What is the current backlog of non-recurring maintenance
projects?
4. The following questions are based on information provided to
Committee staff on February 24, 2012, explaining the overestimation of
resources in FY 2012 and FY 2013:
a. When did VA first learn that it had significantly overestimated
resource requirements for FY 2012 and FY 2013?
b. When was the decision made to reallocate those overestimated
resources in the ``initiative'' areas outlined in the February 24,
2012, briefing materials?
c. Who made that decision?
d. When were the resources actually provided to the field for each
of those initiatives?
e. It appears that VA made significant downward adjustments from
what the Model suggested was necessary for non-recurring maintenance
(NRM). Please explain what the Model's original estimate was based on
and, given the backlog of NRM projects, why VA decided to significantly
reduce money allocated for NRM. Is it that a large number of NRM
projects that comprise the backlog aren't deemed critical, i.e.,
maintenance can be deferred because healthcare to veterans or employee
safety won't be compromised? Please explain VA's decision making
process in this area.
f. One of the initiatives VA reallocated overestimated money for
was ``Improving Mental Health.'' Please describe that initiative.
5. What changes in law are required (e.g., extended or increased
authorizations, etc.) to allow the resources requested in the FY 2013
budget to be spent? Please list the dollar amounts that, if
appropriated, VA will not have authority to spend absent Congressional
authorization.
6. What is the 3-year average expenditure on VA's bonus program
(performance, retention, and relocation)?
7. At a recent Congressional staff briefing on VA's major medical
lease program it was revealed that delays associated with 7 health care
centers authorized in Public Law 111-82 were largely attributable to an
internal debate among senior VA leaders about the wisdom of moving
forward with them at all. Who were the senior VA leaders responsible
for holding these projects back from their original schedule? When was
the decision made to ultimately move forward with them? Please provide
documentation of when the decision was made to ultimately move forward
with these projects.
8. Please provide information on how the FY 2012 budget will/has
changed to fully implement the VOW to Hire Heroes Act and how the
budget request for FY 2013 will satisfy requirements to fully implement
this Act.
a. How much will the FY2013 outreach budget be used to promote the
retraining program of the VOW to Hire Heroes Act?
b. Will VA's outreach plan for the VOW to Hire Heroes Act contain
ways to partner with agencies like DoD, IRS, DOL, and others to provide
information to eligible veterans?
c. Does the outreach plan include funding for a national
advertising program?
9. VA's response to the Committee's pre-hearing questions indicated
that it was planning to hire additional FTE for the Education Service
to process applications for the retraining provision of the VOW to Hire
Heroes Act of 2011. However, the budget request for FY 2013 shows a
reduction in the number of FTE at the education service.
a. Can you please describe this apparent variance?
b. Would keeping these additional FTE on staff reduce processing
times for the Retraining assistance provided under the VOW to Hire
Heroes Act of 2011?
NCA Questions
10. Please provide an update on NCA's efforts to reconcile cemetery
placement maps and headstones at all VA cemeteries.
a. How many cemeteries have completed this review?
b. How many cemeteries are still in need of this review?
c. How many misidentified graves were found?
d. What steps were taken to notify families and correct these
errors?
e. What is the department going to do to ensure these types of
mistakes never happen again?
11. Please describe the reason behind increases in both of NCA's
``personal services'' and ``other accounts''?
12. Please provide more information on how VA will choose the two
new cemeteries or plots of land to be open to new burial under NCA's
new rural commitment and how VA would provide upkeep at these
cemeteries and if this upkeep will be contracted out.
13. The Millennium Study identified a significant number of one-
time repairs required at NCA cemeteries. In response, Congress has
increased NCA's budget for these and other identified repairs over the
last decade.
a. How many projects did VA confirm as needing repairs following
the Millennium Study and what was the cost of addressing those repairs?
b. Which projects have been addressed with funding provided, and
how many remain (and how much will it cost to address them)?
VBA Mandatory Account Questions
14. There has been rapid growth of Compensation and Pension
obligations, going from $53.9 billion in FY2011 to an estimated $64.7
billion FY 2013.
a. What are the symptoms of this growth?
b. Why do you believe we are seeing an increase in the average
payment to veterans by almost $1,000 per payment?
c. Do you believe that VA's current compensation system provides
compensation that is directly related to a servicemember's disability
and quality of life?
15. Please expand on VA's legislative proposal to have Chapter 33
tuition and fee payments paid directly to students instead of schools?
a. What impact will this have on overpayments by VA to students
when they change their rate of pursuit of study or drop out entirely?
b. Will VA provide the tuition and fee payments in a lump sum or in
monthly installments as is done under the Chapter 30 program?
c. What fraud prevention measures would be instituted if this
provision were to become law?
16. One of VA's legislative proposals is to increase the funding
for the contracting of educational and vocational rehabilitation
counseling under chapter 36. What has been the utilization of the
current funding and what improvements do you believe need to be made to
improve participation in this program?
17. In VA's response to the Committee's pre-hearing questions VA
stated that OMB was currently reviewing what the impact will be on VA's
home loan program if Congress does not re-authorizing the pooling
authority for VA mortgages. This authority expired on December 31,
2011. When do you expect this review to be completed?
VBA GOE Questions
18. On page 2A-8 of Volume 3 of the budget submission, VA announced
that its obligations for contract medical examinations will increase by
11.8 million, or approximately 55,000 additional contract examinations.
In what circumstances is VA relying on contract examinations rather
than examinations provided by VHA?
(a) At 4B-18, VA states that it is using three companies for
contract examinations. What are the three companies?
(b) What training mechanisms are in place to ensure that contract
examinations meet the required adequacy standards?
19. At 2A-13, VA states that the number of veterans in receipt of a
total disability rating based on individual unemployability (TDIU) is
gradually increasing. What portion of this increase is OIF/OEF
Veterans?
(a) Similarly, with regard to the increase in special monthly
compensation (SMC) funding, are these numbers also going up because of
the types of injuries seen in OIF/OEF Veterans or other factors?
(b) Although VA's total number of claims increased by about 3
million (at 2A-22), its overall benefits obligations increased by
approximately $10 billion. What portion of this is due to:
1. New claims from OIF/OEF Veterans?
2. TDIU/SMC for OIF/OEF Veterans?
3. Number/types of injuries seen in OIF/OEF Veterans?
20. Throughout the budget, mention is repeatedly made that VA will
track metrics for the number of claims that remain pending after VA's
target processing time of 125 days. What is VA's planned response if
these numbers are not being met?
(a) Other than tracking through VBMS, is VA planning on utilizing
any new strategies to reach this target goal?
(b) What type of improved metrics/methodology is VA using to keep
track of these statistics?
21. At 4A-3, VA reiterates that ``our employees are the key to our
success.'' Please elaborate on this assertion, as it appears that
hiring many new employees since 2007 has not greatly contributed to
reducing the backlog.
(a) What actions are you taking to decrease training time? What is
the basis for the frequently cited assertion that it takes 2 years to
fully train an examiner?
(b) Has VA made any recent updates to its training procedures?
22. At 4A-4, how did you arrive at the case-management approach/
processing lanes?
(a) Where is this system being tested?
(b) Do you have initial results you can share?
23. At 4A-4, what initial feedback have you received from the use
of Disability Benefit Questionnaires?
(a) Do you have any procedures in place to follow up with private
physicians in compliance with the CAVC's decision in Savage v.
Shinseki?
(b) Does the use of DBQ's have the potential to save VA money on
using contract examinations?
24. At 4A-14; 4F-5 - you note that you are already using an
entirely paperless process for insurance claims. Is this the same
platform as VBMS?
a. How is the scanning for insurance claim documents handled?
b. Are there any data showing that this paperless system increases
processing times or quality?
c. Have there been any unforeseen costs associated with using this
paperless processing or the insurance self-service website?
25. At 4B-8 you mention a study by George Washington University on
earnings loss and Musculoskeletal system. Please elaborate on the
specifics of this study, including its intended completion date and its
intended effect on the ongoing modernization of VA's rating schedule.
26. At 5C-2, with regard to the newly authorized FTEs, how many
will be attorneys and how many will be support staff?
a. What training procedures does the Board have in place to handle
so many new FTEs?
b. What else is the Board looking at to address its backlog besides
additional FTEs?
27. Please describe what the budgetary impact will be on the recent
expansion of T-SGLI for loss of reproductive organs? How will this
decision impact future budget requests and what other injuries is VA
considering adding for coverage under the TSGLI program?
28. The budget documents stated that there are nearly 3,800 appeals
still being processed for payments from the Filipino Veterans
Compensation Fund and that over half of the 42,800 claims filed for
compensation have been denied.
a. When do you expect the remaining appeals to be resolved?
b. Is there any idea of how much of the remaining appropriation
will be left at the conclusion of the decisions on these appeals?
c. What is your opinion on the potential for fraud in this program
and what steps has the Department taken to ensure the correct
adjudication of these claims?
d. What is the status of the two ongoing law suits involving this
account?
29. Please provide more information about the rules-based process
job aide that will be included in the first ``design team'' and if this
system will be integrated with VBMS?
a. What other type of rules-based systems will be part of the final
VBMS system?
b. What is VA's plan for scanning documents for the VBMS system?
Will this be done with private contractors?
c. Where will the scanning take place and what is the long-term
scanning plan?
d. Are you partnering with Veteran Service Organizations and other
interested stakeholders as you develop the VBMS system?
e. When do you expect all regional offices to use VBMS and not rely
on other legacy systems?
f. How will VBMS be integrated with the eBenefits and other VBA
systems?
g. VA's budget states that the nationwide deployment of VBMS will
begin in FY2012 and be completed by the end of FY2013. Please provide a
detailed schedule of this rollout.
h. How has the functional requirements for VBMS evolved since the
program was originally developed and funded? Has there been a reduction
in the system requirements or functions from when VBMS was originally
developed?
30. The contracted Fast Track system is used to expedite the
processing of presumptive Agent Orange claims. This system is being
funded by VA Innovations Initiatives. Can you give some figures that
reflect the cost of this system and its estimated long term usability?
a. Using this system, how much oversight do you have on the medical
evidence used in these claims and will this system provide
communication between the medical evaluator and the person processing
the claims?
b. Could this result in an assembly line of Agent Orange claims
approvals with little to no oversight of the origin and condition of
the actual presumptive diagnosis?
31. The budget states that VA's disability claims production has
increased. That should be expected after such a large staffing increase
over the last decade. What I'm interested in is the level of individual
productivity of VA employees.
a. What is the productivity level of each claims examiner?
b. How many claims should each examiner be responsible for
accurately deciding in a given year?
c. Are you concerned about the continued reports by the Office of
Inspector General that show major quality issues at the Regional
Offices that they have visited?
d. What steps will VBA take with this budget to improve overall
quality production?
32. VBA and AFGE recently modified article 67 of their master
contract on skills certification. While I appreciate VA and AFGE's
apparent move to meet the requirements of H.R. 2349, as amended, a bill
passed by House last fall, I do have to question why an employee would
not be held accountable under this modification for failure to pass
this skills certification test as required by P.L. 110-389.
a. While I understand this test is in place so a claims processor
can move up a GS level, why does VA not administer testing to test
current knowledge and competence?
b. Will all employees and managers be required to take the skills
certification test as required under both P.L. 110-389 and the modified
article 67 of the master contract?
c. Are you at all concerned that current certification testing
shows only a 57% pass rate? What steps has VA taken to address issues
surrounding this test and involve union partners in developing this
test as required by P.L. 110-389?
33. What statistical analysis was completed on the effectiveness of
the 6.0 release of the Long Term Solution for Post 9/11 GI Bill Claims
to justify the shifting of close to 200 FTE from the Education Service
to the Compensation Service? How was the impact of the re-training
provisions of the VOW to Hire Heroes Act taken into account and what is
the target for the average days to process these type of claims?
34. One of the largest complaints that we receive from veterans is
the lack of customer satisfaction and consistent answers to questions
provided by the GI Bill call center. What efforts have you undertaken
to improve the dropped call rate and improve customer satisfaction at
the call center?
35. Please explain why there is a planned FTE reduction in the Loan
Guaranty Service while the personal services line has a request for a
$2.4 million increase?
36. How much will the appraisal management services and the
automated valuation management services cost and how will it add value
to training and other benefits?
37. What measures are in place to review the performance of the Vet
Success on Campus program?
38. Please provide more information about the Voc Rehab Service's
plan to improve employment-based rehab by 15%.
39. Please provide the justification for reducing the FTE for the
Insurance Service by 21.
GOE, General Administration Questions
40. What is the justification for the additional funding of 20 FTE
for the Enterprise Program Management Office of the Office of Policy
and Planning?
41. What portion of the Office of Public and Intergovernmental
Affairs budget is used on providing national advertising campaigns to
inform veterans and the public about services and benefits provided by
VA?
42. The budget documents state that the National Veterans Outreach
Office of the Office of Public and Intergovernmental Affairs is working
to develop a system to track the performance of VA's outreach programs.
When do you expect this tracking system to be complete and what type of
data will it collect?
43. Please provide more information about the Homeless Veteran
Supportive Employment Program and what type of jobs and wages/salary
the 360 homeless or formally homeless veterans are doing as part of
this program.
44. How does the Office of Public Affairs and Intergovernmental
Affairs measure what percent of news coverage is positive or neutral in
tone as listed in the office's performance measures?
45. The performance measures for the Office of Congressional and
Legislative Affairs tracks the percentage of testimony submitted to
Congress within the required timeframe, percentage of responses to pre-
and post-hearing questions that are submitted to Congress within the
required timeframe, and the percentage of title 38 reports that are
submitted to Congress within the required timeframe. What is the
definition of the ``required timeframe'' for each of these measures and
who sets this definition?
POST-HEARING RESPONSES FROM THE DEPARTMENT OF VETERANS AFFAIRS (VA) TO
CHAIRMAN JEFF MILLER
Question 1: In responses to pre-hearing questions VA stated that
the Affordable Care Act (ACA) has ``strategic implications for VA.'' VA
also stated in response to pre- hearing questions that it ``has and
will continue to review how the health care reform law may influence VA
health care programs.''
a. What are the strategic implications?
b. Please provide the results of any review VA has conducted to
date regarding the influence the ACA may have on VA health care
programs.
Response: VA's assessment of ACA examined a number of different
areas including:
New health care coverage options for Veterans via
Medicaid expansion;
Premium tax credits and exchange eligibility;
Reliance on VA by Veterans who are enrolled in or use
multiple systems of care;
Maintaining affiliations with academic medical centers;
Ability to attract and maintain a highly skilled health
care workforce; and
Impact of Accountable Care Organizations (ACOs) and other
payment reforms on VA costs, care coordination, and information
sharing.
VA has been proactive in understanding the potential impacts of ACA
and in ensuring that VA health care programs remain responsive to
Veterans' needs.
Question 2: VA's appropriation request is based, largely, on VA's
Enrollee Health Care Projection Model (Model) estimates. Key components
of the Model include the enrollee population and utilization.
a. Recognizing the difficulty of forecasting utilization behavior,
how were the ``strategic implications'' of the ACA on potential
enrollment and utilization factored into the FY 2014 advance request?
b. Going forward, how will the strategic implications of the ACA
influence resource requests in subsequent budget submissions?
Response: In 2010, VA worked with its consulting health actuary,
Milliman, to assess Veteran health care enrollment and reliance in the
Commonwealth of Massachusetts before and after the implementation of
universal health care mandate there. This analysis demonstrated no
measurable impacts on either enrollment or reliance in the short term.
Although the experience in Massachusetts may not mirror that of the
country as a whole, there is insufficient evidence at this time to
warrant any material change in the Model assumptions for the 2014
advance appropriations request related specifically to ACA.
VA is collaborating with other federal agencies to understand their
activities regarding health reform to ensure a coordinated approach to
implementing the law as currently enacted. This collaboration includes
efforts to clarify Veteran eligibility related to the premium tax
credit provided in the legislation as this will also impact VA's
analysis.
Based on updated analysis, VA will reassess potential changes to
the 2014 advance appropriations request as a result of the ACA in the
2014 Budget.
Question 3: What is the current backlog of non-recurring
maintenance projects?
Response: The VA 2013 Long Range Capital Plan identifies 2,789 NRM
projects with an estimated cost of $9.2 billion. The 2013 request
includes $710 million to address the design needs for 180 of these
projects.
Question 4: The following questions are based on information
provided to Committee staff on February 24, 2012, explaining the
overestimation of resources in FY 2012 and FY 2013:
a. When did VA first learn that it had significantly overestimated
resource requirements for FY 2012 and FY 2013?
Response: VA's FY 2012 President's Budget estimates for FY 2012 and
the FY 2013 advance appropriation assumed that Federal employees would
receive pay raises in those years. Prior to submission of the FY 2013
President's Budget, the President imposed a freeze on Federal employee
pay for Calendar Years 2011 and 2012. The FY 2013 President's Budget
adjusted the FY 2012 and FY 2013 estimates to reflect that action,
accounting for the majority of the revised estimate. Other adjustments
in the FY 2013 President's Budget included updates to Long-Term Care
and other utilization factors, as well as updates to morbidity and
aging assumptions about the enrolled Veteran population.
b. When was the decision made to reallocate those overestimated
resources in the ``initiative'' areas outlined in the February 24,
2012, briefing materials?
Response: During the summer of 2011, VA officials reviewed and
validated the revised estimates and their impact on the 2012 budget
estimates and 2013 request. During the fall of 2011, VA worked with OMB
to review budget requirements, the updated model projections, and VA's
request to reinvest available funding from the updated estimates to
programs that have been a priority to Veterans, VA, and the Congress,
including activations of new or replacement medical facilities,
implementation of the Caregivers and Veterans Omnibus Health Services
Act of 2010, and eliminating Veteran homelessness. The results of those
deliberations were released with the annual budget request in February
2012.
c. Who made that decision?
Response: The decision occurred as part of the Administration's
process that produced the President's 2013 Budget.
d. When were the resources actually provided to the field for each
of those initiatives?
Response: For the FY 2012 appropriation, resources were provided to
the field for these initiatives in October and November 2011. Resources
for the FY 2013 advance appropriation have not yet been distributed to
the field these funds will be distributed at the start of the fiscal
year this October.
e. It appears that VA made significant downward adjustments from
what the Model suggested was necessary for non-recurring maintenance
(NRM). Please explain what the Model's original estimate was based on
and, given the backlog of NRM projects, why VA decided to significantly
reduce money allocated for NRM. Is it that a large number of NRM
projects that comprise the backlog aren't deemed critical, i.e.,
maintenance can be deferred because healthcare to veterans or employee
safety won't be compromised? Please explain VA's decision making
process in this area.
Response: The model projects NRM based on what was obligated in the
base year (in this case 2010) and adjusts the future years based upon
cost trends and the changes in patient workload. Beginning with the FY
2012 Budget, VA does not use the model estimate to develop its NRM
request, but bases its estimate in part upon the Strategic Capital
Investment Planning (SCIP) process. VA does an engineering-based review
of the condition of all of its buildings on a rotating basis every
three years. This process results in the development of VISN-level
projects that are annually reviewed and ranked for the overall capital
investment process. VA sets the funding level of the NRM program as
part of its determination of the overall budget during the final
deliberation process.
The NRM decision-making process needs to be viewed within the
Department's overall efforts to plan for infrastructure needs.
Developed first in the FY 2012 budget process, SCIP is a VA-wide
planning tool used to evaluate and prioritize capital infrastructure
needs for the current Budget cycle and for future years. SCIP
quantifies the infrastructure gaps that must be addressed for VA to
meet its long-term strategic capital targets, including providing
access to Veterans, ensuring the safety and security of Veterans and
our employees, and leveraging current physical resources to benefit
Veterans.
VA has dedicated approximately 30 percent of its 2013 Capital
Budget Request for NRM projects. The 2013 NRM request is $710 million.
Of the $710 million requested, $632 million (89 percent) will fund
projects already partially funded by Congress and projects determined
by local needs. Within the spending targets established in the
President's 2013 Budget request, VA's allocation for capital projects,
including NRM projects, is one that:
Emphasizes completing prior appropriated projects that
provide healthcare, memorial, and benefits delivery services to
Veterans;
Impacts more VA medical centers (VAMC) and corrects more
seismic, safety, and security issues in less time through a focus on
minor construction projects;
Completes a large number of grandfathered projects,
attacking and reducing the capital backlog; and
Recognizes the importance of alternative strategies to
traditional capital approaches to meet overall needs, such
telemedicine, extended hours, mobile clinics, and fee basis contract
care.
f. One of the initiatives VA reallocated overestimated money for
was ``Improving Mental Health.'' Please describe that initiative.
Response: The initiative to Improve Veterans Mental Health (IVMH)
is one of VA's 16 major transformational initiatives. It began in FY
2010 and is operationally aligned under the Office of Healthcare
Transformation within the Veterans Health Administration (VHA). The
overall goals of IVMH are to:
Develop the infrastructure necessary to maintain full
implementation of the VHA Handbook on Uniform Mental Health Services in
VA Medical Centers and Clinics, including the needed IT resources,
workforce development, and on-going monitoring and technical
assistance;
Initiate public health outreach and education to support
Veterans' mental health in the communities in which they live, work, go
to school, raise families, and otherwise contribute to society,
including through the use of all available technologies; and
Complete the 28 strategic actions in the Department of
Veterans Affairs (VA)/ Department of Defense (DoD) Integrated Mental
Health Strategy and strengthen the partnership between VA and DoD in
support of the mental health of Servicemembers and Veterans
Question 5: What changes in law are required (e.g., extended or
increased authorizations, etc.) to allow the resources requested in the
FY 2013 budget to be spent?Please list the dollar amounts that, if
appropriated, VA will not have authority to spend absent Congressional
authorization.
Response: VA's complete list of expiring authority appears in
Volume I of the fiscal year (FY) 2013 President's Budget: Legislative
Authorization of Programs, page 3C-1. New authorities are requested and
described on pages 3A-1 - 3A-14 and page 3B-1 of the same volume. The
following are authorities which expire over the next year and would
affect the VA budget with respect to either the spending of funds or
collection of revenue:
----------------------------------------------------------------------------------------------------------------
P.L.-Citation
Title Section of U.S.C.- Public Law (P.L.) (Most Recent Expiration Date Amount
Citation Citation Extension)
----------------------------------------------------------------------------------------------------------------
Programs for Homeless Veterans
----------------------------------------------------------------------------------------------------------------
Homeless Veterans 38 U.S.C. 2021(e) P.L. 107-95 P.L. 112-37 9/30/12 N/A
Reintegration section 5(a)(1) section 10(b)
Programs
----------------------------------------------------------------------------------------------------------------
Housing 38 U.S.C. 2041 P.L. 109-461 P.L. 112-37 12/31/12 N/A
Assistance for section 705 section 10(e)
Homeless
Veterans
----------------------------------------------------------------------------------------------------------------
Grant Program for 38 U.S.C. 2061(c) P.L. 107-95 P.L. 112After FY 2012 $235 million -
Homeless section 5(a)(1) section 13 (for funding) reverts to $150
Veterans with million
Special Needs
----------------------------------------------------------------------------------------------------------------
Financial 38 U.S.C. 2044(e) P.L. 110-387 P.L. 112After FY 2012 $300 million
Assistance for section 606 section 12(a)
Supportive
Services for
Very Low-Income
Veterans
Families in
Permanent
Housing
----------------------------------------------------------------------------------------------------------------
Medical Care Programs
----------------------------------------------------------------------------------------------------------------
Treatment and 38 U.S.C. 2031(b) P.L. 105-114 P.L. 112-37 12/31/12 $196 million
Rehabilitation section 202(a) section 10(c)
for Seriously
Mentally Ill and
Homeless
Veterans -
General
treatment
----------------------------------------------------------------------------------------------------------------
Treatment and 38 U.S.C. 2033(d) P.L. 105-114 P.L. 112-37 12/31/12 in above
Rehabilitation section 202(a) section 10(d)
for Seriously
Mentally Ill and
Homeless
Veterans -
Additional
services at
certain
locations
----------------------------------------------------------------------------------------------------------------
Co-Payments and Medical Care Cost Recovery
----------------------------------------------------------------------------------------------------------------
Co-Payments for 38 U.S.C. P.L. 111-163, P.L. 111-163, 9/30/12 $3 million
Hospital Care 1710(f)(2)(B) section 517 section 517
and Nursing Home
Care
----------------------------------------------------------------------------------------------------------------
Medical Care Cost 38 U.S.C. P.L. 111-163, 10/1/12 $980 million
Recovery 1729(a)(2)(E) section 518
Authority (Third-
party Billing)
----------------------------------------------------------------------------------------------------------------
General Operating Expenses, Veterans Benefits Administration
----------------------------------------------------------------------------------------------------------------
Philippines 38 U.S.C. 315(b) P.L. 102-83 P.L. 112-74 12/31/12 N/A
Regional Office section 2(a) section 234
----------------------------------------------------------------------------------------------------------------
Contract Medical 38 U.S.C. 5101 P.L. 108-183 P.L. 111-275 12/31/12 $251 million
Disability Exams note section 704 section 809
- (Temporary
Authority for
Performance of
Medical
Disability
Examinations by
Contract
Physicians)
----------------------------------------------------------------------------------------------------------------
Benefits Programs
----------------------------------------------------------------------------------------------------------------
Annual Disability 38 U.S.C. 1114 P.L.85-857 P.L. 112-53 Annually $772 million
Compensation note section 302 section 2
Cost of living
Adjustment
----------------------------------------------------------------------------------------------------------------
Question 6: What is the 3-year average expenditure on VA's bonus
program (performance, retention, and relocation)?
Response: The table, below, provides data on all VA monetary awards
with effective dates between FY 2009 - 2012. Data are current as of
March 31, 2012. SES performance awards are paid in the fiscal year that
follows the fiscal year in which the actual performance occurs. For
example, SES performance awards reported in FY 2012 were for FY 2011
performance.
----------------------------------------------------------------------------------------------------------------
FY 2009 NO. OF AWARDS TOTAL AWARDS
----------------------------------------------------------------------------------------------------------------
841 GROUP CASH AWARD 43,316 $ 22,183,613
----------------------------------------------------------------------------------------------------------------
845 TRAVEL SAVINGS INCENTIVE 90 $ 56,224
----------------------------------------------------------------------------------------------------------------
849 INDIVIDUAL CASH AWARD (NRB) 81,105 $ 49,421,708
----------------------------------------------------------------------------------------------------------------
878 PRESIDENTIAL RANK AWARD 15 $ 616,196
----------------------------------------------------------------------------------------------------------------
879 SES PERFORMANCE AWARD 166 $ 2,833,629
----------------------------------------------------------------------------------------------------------------
840 INDIVIDUAL CASH AWARD (RB) 100,820 $ 140,573,419
----------------------------------------------------------------------------------------------------------------
817 STUDENT LOAN REPAYMENT 103 $ 695,052
----------------------------------------------------------------------------------------------------------------
825 SEPARATION INCENTIVE 0 $ -
----------------------------------------------------------------------------------------------------------------
842 INDIVIDUAL SUGGESTION/INVENTION AW222 $ 51,492
----------------------------------------------------------------------------------------------------------------
843 GROUP SUGGESTION/INVENTION AWARD 19 $ 7,350
----------------------------------------------------------------------------------------------------------------
844 FOREIGN LANGUAGE AWARD 0 $ -
----------------------------------------------------------------------------------------------------------------
848 REFERRAL BONUS 1,425 $ 712,178
----------------------------------------------------------------------------------------------------------------
889 GROUP AWARD - OTHER 1,412 $ 672,846
----------------------------------------------------------------------------------------------------------------
948 SPECIALTY CERTIFICATION AWARD 690 $ 856,517
----------------------------------------------------------------------------------------------------------------
950 EXEMPLARY JOB PERF/ACHIEV AW1,167 $ 3,511,148
----------------------------------------------------------------------------------------------------------------
885 LUMP SUM PERF PAYMENT (RB-I8PA) $ 9,800
----------------------------------------------------------------------------------------------------------------
886 LUMP SUM PERF PAYMENT(RBNI15A) $ 14,028
----------------------------------------------------------------------------------------------------------------
887 LUMP SUM PERF PAYMENT (NR241 $ 351,896
----------------------------------------------------------------------------------------------------------------
RECRUITMENT 5,569 $ 48,554,956
----------------------------------------------------------------------------------------------------------------
RELOCATION 755 $ 9,698,672
----------------------------------------------------------------------------------------------------------------
RETENTION 14,532 $ 105,995,029
----------------------------------------------------------------------------------------------------------------
TOTAL 251,670 $ 386,815,753
----------------------------------------------------------------------------------------------------------------
AVERAGE EXPENDITURE PER AWARD $ 1,537
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
FY 2010 NO. OF AWARDS TOTAL AWARDS
----------------------------------------------------------------------------------------------------------------
841 GROUP CASH AWARD 33,087 $ 16,219,211
----------------------------------------------------------------------------------------------------------------
845 TRAVEL SAVINGS INCENTIVE 149 $ 91,717
----------------------------------------------------------------------------------------------------------------
849 INDIVIDUAL CASH AWARD (NRB) 69,734 $ 45,837,752
----------------------------------------------------------------------------------------------------------------
878 PRESIDENTIAL RANK AWARD 10 $ 400,510
----------------------------------------------------------------------------------------------------------------
879 SES PERFORMANCE AWARD 197 $ 2,856,968
----------------------------------------------------------------------------------------------------------------
840 INDIVIDUAL CASH AWARD (RB) 125,029 $ 175,450,691
----------------------------------------------------------------------------------------------------------------
817 STUDENT LOAN REPAYMENT 271 $ 1,962,845
----------------------------------------------------------------------------------------------------------------
825 SEPARATION INCENTIVE 0 $ -
----------------------------------------------------------------------------------------------------------------
842 INDIVIDUAL SUGGESTION/INVENTION AW182 $ 43,394
----------------------------------------------------------------------------------------------------------------
843 GROUP SUGGESTION/INVENTION AWARD 43 $ 5,385
----------------------------------------------------------------------------------------------------------------
844 FOREIGN LANGUAGE AWARD 0 $ -
----------------------------------------------------------------------------------------------------------------
848 REFERRAL BONUS 860 $ 506,987
----------------------------------------------------------------------------------------------------------------
889 GROUP AWARD - OTHER 2,948 $ 1,177,164
----------------------------------------------------------------------------------------------------------------
948 SPECIALTY CERTIFICATION AWARD 998 $ 1,268,761
----------------------------------------------------------------------------------------------------------------
950 EXEMPLARY JOB PERF/ACHIEV AW1,585 $ 2,308,593
----------------------------------------------------------------------------------------------------------------
885 LUMP SUM PERF PAYMENT (RB-13LPA) $ 25,647
----------------------------------------------------------------------------------------------------------------
886 LUMP SUM PERF PAYMENT(RBNI51A) $ 57,036
----------------------------------------------------------------------------------------------------------------
887 LUMP SUM PERF PAYMENT (NR327 $ 323,085
----------------------------------------------------------------------------------------------------------------
RECRUITMENT 3,456 $ 34,215,756
----------------------------------------------------------------------------------------------------------------
RELOCATION 762 $ 9,107,085
----------------------------------------------------------------------------------------------------------------
RETENTION 15,430 $ 110,919,319
----------------------------------------------------------------------------------------------------------------
TOTAL 255,132 $ 402,777,907
----------------------------------------------------------------------------------------------------------------
AVERAGE EXPENDITURE PER AWARD $ 1,579
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
FY 2011 NO. OF AWARDS TOTAL AWARDS
----------------------------------------------------------------------------------------------------------------
841 GROUP CASH AWARD 33,307 $ 15,417,012
----------------------------------------------------------------------------------------------------------------
845 TRAVEL SAVINGS INCENTIVE 118 $ 78,733
----------------------------------------------------------------------------------------------------------------
849 INDIVIDUAL CASH AWARD (NRB) 78,976 $ 51,546,813
----------------------------------------------------------------------------------------------------------------
878 PRESIDENTIAL RANK AWARD 12 $ 460,861
----------------------------------------------------------------------------------------------------------------
879 SES PERFORMANCE AWARD 238 $ 3,457,762
----------------------------------------------------------------------------------------------------------------
840 INDIVIDUAL CASH AWARD (RB) 140,486 $ 182,847,647
----------------------------------------------------------------------------------------------------------------
817 STUDENT LOAN REPAYMENT 471 $ 3,351,101
----------------------------------------------------------------------------------------------------------------
825 SEPARATION INCENTIVE 7 $ 175,000
----------------------------------------------------------------------------------------------------------------
842 INDIVIDUAL SUGGESTION/INVENTION AW165 $ 47,880
----------------------------------------------------------------------------------------------------------------
843 GROUP SUGGESTION/INVENTION AWARD 83 $ 42,030
----------------------------------------------------------------------------------------------------------------
844 FOREIGN LANGUAGE AWARD 0 $ -
----------------------------------------------------------------------------------------------------------------
848 REFERRAL BONUS 641 $ 355,678
----------------------------------------------------------------------------------------------------------------
889 GROUP AWARD - OTHER 4,119 $ 1,457,712
----------------------------------------------------------------------------------------------------------------
948 SPECIALTY CERTIFICATION AWARD1,034 $ 1,311,418
----------------------------------------------------------------------------------------------------------------
950 EXEMPLARY JOB PERF/ACHIEV AW1,949 $ 2,557,099
----------------------------------------------------------------------------------------------------------------
885 LUMP SUM PERF PAYMENT (RB-I5PA) $ 7,648
----------------------------------------------------------------------------------------------------------------
886 LUMP SUM PERF PAYMENT(RBN921A) $ 1,800,686
----------------------------------------------------------------------------------------------------------------
887 LUMP SUM PERF PAYMENT (NR824 $ 858,781
----------------------------------------------------------------------------------------------------------------
RECRUITMENT 2,477 $ 28,858,378
----------------------------------------------------------------------------------------------------------------
RELOCATION 789 $ 10,294,345
----------------------------------------------------------------------------------------------------------------
RETENTION 14,376 $ 104,801,988
----------------------------------------------------------------------------------------------------------------
TOTAL 280,998 $ 409,728,572
----------------------------------------------------------------------------------------------------------------
AVERAGE EXPENDITURE PER AWARD $ 1,458
----------------------------------------------------------------------------------------------------------------
3 YEAR AVERAGE (2009 - 2011) $ 1,525
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
FY 2012 YTD NO. OF AWARDS TOTAL AWARDS
----------------------------------------------------------------------------------------------------------------
841 GROUP CASH AWARD 4,125 $ 2,055,677
----------------------------------------------------------------------------------------------------------------
845 TRAVEL SAVINGS INCENTIVE 60 $ 33,136
----------------------------------------------------------------------------------------------------------------
849 INDIVIDUAL CASH AWARD (NRB) 15,335 $ 9,627,059
----------------------------------------------------------------------------------------------------------------
878 PRESIDENTIAL RANK AWARD * 0 $ -
----------------------------------------------------------------------------------------------------------------
879 SES PERFORMANCE AWARD 245 $ 2,778,856
----------------------------------------------------------------------------------------------------------------
840 INDIVIDUAL CASH AWARD (RB) 140,251 $ 124,640,960
----------------------------------------------------------------------------------------------------------------
817 STUDENT LOAN REPAYMENT 48 $ 348,080
----------------------------------------------------------------------------------------------------------------
825 SEPARATION INCENTIVE 33 $ 809,185
----------------------------------------------------------------------------------------------------------------
842 INDIVIDUAL SUGGESTION/INVENTION AWA47 $ 13,814
----------------------------------------------------------------------------------------------------------------
843 GROUP SUGGESTION/INVENTION AWARD 15 $ 9,733
----------------------------------------------------------------------------------------------------------------
844 FOREIGN LANGUAGE AWARD 0 $ -
----------------------------------------------------------------------------------------------------------------
848 REFERRAL BONUS 177 $ 85,665
----------------------------------------------------------------------------------------------------------------
889 GROUP AWARD - OTHER 370 $ 191,309
----------------------------------------------------------------------------------------------------------------
948 SPECIALTY CERTIFICATION AWARD 449 $ 569,834
----------------------------------------------------------------------------------------------------------------
950 EXEMPLARY JOB PERF/ACHIEV AW1,112 $ 1,171,759
----------------------------------------------------------------------------------------------------------------
885 LUMP SUM PERF PAYMENT (RB-I0PA) $ -
----------------------------------------------------------------------------------------------------------------
886 LUMP SUM PERF PAYMENT(R1,432A) $ 856,001
----------------------------------------------------------------------------------------------------------------
887 LUMP SUM PERF PAYMENT (NR114 $ 75,082
----------------------------------------------------------------------------------------------------------------
RECRUITMENT 1,171 $ 10,380,721
----------------------------------------------------------------------------------------------------------------
RELOCATION 418 $ 4,237,774
----------------------------------------------------------------------------------------------------------------
RETENTION 11,058 $ 47,649,479
----------------------------------------------------------------------------------------------------------------
TOTAL YTD 176,460 $ 205,534,123
----------------------------------------------------------------------------------------------------------------
AVERAGE EXPENDITURE PER AWARD YTD $1,165
----------------------------------------------------------------------------------------------------------------
Question 7: At a recent Congressional staff briefing on VA's major
medical lease program it was revealed that delays associated with 7
health care centers authorized in Public Law 111-82 were largely
attributable to an internal debate among senior VA leaders about the
wisdom of moving forward with them at all. Who were the senior VA
leaders responsible for holding these projects back from their original
schedule? When was the decision made to ultimately move forward with
them? Please provide documentation of when the decision was made to
ultimately move forward with these projects.
Response: In a briefing to the HVAC Committee staff on March 22,
2012 on construction topics, Department staff extensively discussed
several reasons for the delay in the leasing of Health Care Centers
(HCCs) authorized in fiscal year 2010. These included difficulties in
securing sites; making final determinations on the space and functional
composition of the clinics; retaining support from private sector
design teams; and a revalidation of VA HCC projects, among other
reasons. In that discussion, on the topic of revalidation, Department
staff advised the Committee staff that a Departmental revalidation of
the concept of large HCCs was one of the factors that contributed to
the delay but that the Department concluded that all seven clinics
should continue moving forward. This decision was made in January of
2011.
Question 8: Please provide information on how the FY 2012 budget
will/has changed to fully implement the VOW to Hire Heroes Act and how
the budget request for FY 2013 will satisfy requirements to fully
implement this Act.
a. How much will the FY2013 outreach budget be used to promote the
retraining program of the VOW to Hire Heroes Act?
Response: VA has sufficient resources in the FY 2012 budget and FY
2013 budget request to implement the Veterans Retraining Assistance
Program (VRAP) provisions of the VOW to Hire Heroes Act of 2011. To
ensure that VA can effectively implement VRAP, our 2013 budget request
reflects the resources to support hiring 166 Veterans claims examiners
to process claims. This temporary staffing increase equates to 85 full-
time equivalents (FTE) in 2012 and 90 FTE in 2013. These resources will
allow us to manage increased workload and avoid disrupting current
claims processing workload. VA will administer payments under VRAP from
amounts appropriated for the payment of readjustment benefits. Although
the outreach communication plan is currently under review by VA and
DOL, we anticipate that the final plan will include a national
advertising program. VA is still evaluating how much of the FY 2013
outreach budget will support outreach efforts associated with VOW to
Hire Heroes Act for FY 2013.
b. Will VA's outreach plan for the VOW to Hire Heroes Act contain
ways to partner with agencies like DoD, IRS, DOL, and others to provide
information to eligible veterans?
Response: Yes, VA's plan will focus on communications required to
support the governance, adoption, and success of the VOW to Hire Heroes
Act. VA and Department of Labor (DOL) are working jointly in developing
an effective communication plan. The strategies within the plan are
designed to guide VA, DOL, Department of Defense (DoD), and other
stakeholders (i.e., Veterans service organizations and public/private
sector organizations) in delivering key messages to Servicemembers,
Veterans, family members, and caregivers about the value of VOW to Hire
Heroes Act programs. The plan also includes the development of the VOW
to Hire Heroes Act web site that will be a one-stop shop for Veterans
and stakeholders to obtain information related to VOW to Hire Heroes
Act. The utilization of social media is another critical component
within the outreach plan. Ultimately, VA's outreach strategies are
designed to increase awareness of and enrollment in the VOW to Hire
Heroes Act programs.
c. Does the outreach plan include funding for a national
advertising program?
Response: Although the communication plan is currently under review
by VA and DOL, we anticipate that the final plan will include a
national advertising program. VA is still evaluating how much of the FY
2013 outreach budget will support outreach efforts associated with VOW
to Hire Heroes Act for FY 2013.
Question 9: VA's response to the Committee's pre-hearing questions
indicated that it was planning to hire additional FTE for the Education
Service to process applications for the retraining provision of the VOW
to Hire Heroes Act of 2011. However, the budget request for FY 2013
shows a reduction in the number of FTE at the education service.
a. Can you please describe this apparent variance?
Response: While VA's FY 2013 budget request shows a net reduction
of FTE due to the attrition of temporary claims examiners hired to
support the Post-9/11 GI Bill, our request includes additional FTE
required to implement the Veterans Retraining Assistance Program (VRAP)
of the VOW to Hire Heroes Act of 2011.
b. Would keeping these additional FTE on staff reduce processing
times for the Retraining assistance provided under the VOW to Hire
Heroes Act of 2011?
Response: VA's 2013 budget request reflects the resources to
support hiring 166 Veterans claims examiners to process VRAP claims in
FYs 2012 and 2013. This temporary staffing increase equates to 90 FTE
in 2013. These resources will allow us to manage the increased workload
and maintain current claims processing.
NCA Questions
Question 10: Please provide an update on NCA's efforts to reconcile
cemetery placement maps and headstones at all VA cemeteries.
a. How many cemeteries have completed this review?
Response: NCA is conducting the gravesite review in two phases.
Phase I was initiated to review all gravesites involved in a raise and
realign project. A second phase has been initiated to review all
remaining gravesites. During Phase 1, NCA fully audited 22 national
cemeteries and 1 soldiers' lot.
b. How many cemeteries are still in need of this review?
Response: Phase II involves review of all remaining burial sections
in 109 national cemeteries as well as all soldiers lots administered by
the Department of Veterans Affairs.
c. How many misidentified graves were found?
Response: During Phase 1, 1,588,372 gravesites were audited. NCA
identified a total of 251 corrective actions for Phase 1 which included
243 headstones or markers that needed to be reset or ordered, and 8
caskets or urns that needed to be relocated.
d. What steps were taken to notify families and correct these
errors?
Response: All NCA employees are the custodians of a sacred trust
and strive to be the model of excellence in the delivery of burial
benefits. We have created a culture of accountability in which errors
are addressed immediately and openly. NCA regrets the grief and
emotional hardship our errors cause and seeks to correct errors in
consultation with family members. Where an error occurred, NCA
corrected the error and contacted the affected families, wherever
possible, to extend our sincerest apologies. NCA also ensured VA's
congressional committees and the local congressional offices were
notified of the issues.
e. What is the department going to do to ensure these types of
mistakes never happen again?
Response: In April 2011, NCA implemented new procedures to
strengthen internal controls and further enhance the accountability of
remains interred in VA national cemeteries. These procedures require
cemetery personnel to verify each gravesite location for second
interments by checking the numbers and inscriptions of the gravesites
in front of, behind, and to the left and right of the second interment.
This step will alert the site crew to the potential for misaligned
markers, either at the interment site or in an adjacent row.
Additional procedures are being implemented to prevent these types
of errors from occurring in the future. Contracts to raise and realign
headstones and markers will require contractors to keep headstones or
markers at the gravesite during the renovations. Such control measures
will reduce the likelihood of inaccurate replacement of headstones and
markers upon project completion. Also, NCA will hire certified
contracting officer representatives at each of its Memorial Service
Network offices to oversee future gravesite renovation projects. If
employees or contractors need to move a headstone or marker for any
reason, NCA will use its new process to track temporary movement or
replacement of any headstone or marker within a national cemetery. NCA
can accomplish these actions within the 2013 budget request.
Question 11: Please describe the reason behind increases in both of
NCA's ``personal services'' and ``other accounts''?
Response: The increase in personal services is a result of the
addition of 4 FTE for interment workload increases, increased benefits
costs, and pay and staff composition changes. The increase in ``other
services'' reflects higher maintenance cost due to more gravesites and
developed acres.
Question 12: Please provide more information on how VA will choose
the two new cemeteries or plots of land to be open to new burial under
NCA's new rural commitment and how VA would provide upkeep at these
cemeteries and if this upkeep will be contracted out.
Response: The location of the two new National Veterans Burial
Grounds is dependent on the availability of land for these rural
facilities. NCA will be looking for small tracts of land (2-5 acres) in
already established public or private cemeteries in which to establish
the new national cemetery presence. NCA plans to contract the grounds
maintenance of these cemeteries under the oversight of the nearest
national cemetery to ensure adherence to our National Shrine Standards.
Burial operations will be conducted and supervised by NCA personnel.
Question 13: The Millennium Study identified a significant number
of one-time repairs required at NCA cemeteries. In response, Congress
has increased NCA's budget for these and other identified repairs over
the last decade.
a. How many projects did VA confirm as needing repairs following
the Millennium Study and what was the cost of addressing those repairs?
Response: At the completion of the Millennium Study in 2002, a
total of 929 projects at an estimated repair cost of $280 million were
identified.
b. Which projects have been addressed with funding provided, and
how many remain (and how much will it cost to address them)?
Response: To date, 401 projects with an estimated cost of $99
million were completed at an actual cost of $135 million. NCA is
evaluating the remaining 528 identified projects estimated at $180
million to determine how they will be best addressed. Since the
Millennium Study was conducted, new projects that require immediate
attention have been identified. These emerging requirements will be
addressed along with previously identified projects within the annual
budget process.
VBA Mandatory Account Questions
Question 14: There has been rapid growth of Compensation and
Pension obligations, going from $53.9 billion in FY2011 to an estimated
$64.7 billion FY 2013.
a. What are the symptoms of this growth?
Response: The growth in compensation and pension obligations is
primarily attributable to estimated increases in compensation benefit
payments to Veterans and survivors. Compensation benefit payments to
Veterans account for approximately 82 percent of total compensation and
pension program costs.
Driving the growth in total compensation and pension obligations is
the estimated increase in the number of Veterans and survivors added to
the compensation rolls and their average payments. The average growth
in the number of Veteran beneficiaries is 120,000 per year and average
payment increases 6 percent each year. We expect these trends to
continue. Another factor contributing to the increase in obligations is
retroactive payments to Veterans and survivors with pending claims.
b. Why do you believe we are seeing an increase in the average
payment to veterans by almost $1,000 per payment?
Response: The following factors contribute to the increase in
annual average payments to Veterans: the average degree of disability
continues to increase yearly as Veterans claim more disabilities and
their disabilities progress; the average number of dependents included
on Veterans' awards has increased 7 percent over the last four years
the impact of enacted legislation or regulations, including new
presumptive disabilities; the number of Veterans receiving special
monthly compensation continues to increase; the increased number of
Veterans receiving Individual Unemployability (IU); the number of
retroactive payments released; and the fluctuation in the numbers of
accessions and terminations resulting in net increases. Deviations in
these factors alter average payments and historically increase
compensation and pension obligations.
c. Do you believe that VA's current compensation system provides
compensation that is directly related to a servicemember's disability
and quality of life?
Response: VA disability compensation is a monthly benefit paid to a
Veteran who is disabled by injuries or illnesses incurred or aggravated
in military service. The intent of disability compensation in 38 U.S.C.
Sec. 1155 is to compensate individuals for the ``average impairments
of earning capacity'' resulting from the disability.
There have been various commissions and studies that have examined
the effectiveness and fairness of the disability compensation program.
The 2007 Veterans' Disability Benefits Commission (VDBC) report,
Honoring the Call to Duty: Veterans' Disability Benefits in the 21st
Century, included survey results by the Center for Naval Analyses (CNA)
on disability compensation as a replacement for the average impairment
in earning capacity. This study found that compensation is generally
adequate in replacing earned income losses due to service-connected
disabilities.
Although the statute requires that VA compensate for earnings loss,
VA does address quality of life for certain disability patterns (e.g.,
amputations) by paying special monthly compensation above and beyond
the schedular evaluation.
In October 2009, VA began a comprehensive revision and update of
all 15 body systems contained in the rating schedule. This
modernization effort includes a more detailed analysis to determine if
conditions are adequately compensated based on current associated
evaluation levels.
Question 15: Please expand on VA's legislative proposal to have
Chapter 33 tuition and fee payments paid directly to students instead
of schools?
Response: Under the Post-9/11 GI Bill, VA issues payments for
tuition and fees directly to schools on behalf of the student. Although
the student does not directly receive the amount paid, the payment is
made on the student's behalf, and the student is therefore considered
to have received such payment. Sending payments directly to students
would allow them to personally manage their financial obligations with
the school and minimize some of the confusion created by having a third
party (school) involved.
a. What impact will this have on overpayments by VA to students
when they change their rate of pursuit of study or drop out entirely?
Response: Currently, when students change their rate of pursuit or
withdraw from courses, VA reduces the amount of tuition and fees
previously paid to the school and the student is held liable for any
debt created. The schools have been directed by VA to follow their own
refund policies. Frequently, the school refund policies will not
coincide with the amount the student owes to VA, which causes confusion
for the student when working with VA's Debt Management Center to settle
outstanding debts. This legislative proposal would simplify the payment
process, which will in turn aid the student in identifying the debt
owed to VA. Additionally, it will eliminate the school's role in
returning funds to either VA or the student, thereby streamlining the
payment and debt collection processes.
b. Will VA provide the tuition and fee payments in a lump sum or in
monthly installments as is done under the Chapter 30 program?
Response: The intent of this legislative proposal is to direct the
tuition and fee payments from the schools to the students. As a result,
the lump sum tuition and fee payments would go directly to the
students.
c. What fraud prevention measures would be instituted if this
provision were to become law?
Response: VA does not anticipate an increase of fraud if the
tuition and fee payments are issued to the students as opposed to the
school. Payment amounts will still be determined based on information
received from the schools regarding net charges for tuition and fees.
Additionally, VA will continue to require schools to report any changes
to enrollments and will create any debts accordingly. VA will then be
able to collect on debts established under the Post-9/11 GI Bill in the
same manner as all other VA education benefits.
Question 16: One of VA's legislative proposals is to increase the
funding for the contracting of educational and vocational
rehabilitation counseling under chapter 36. What has been the
utilization of the current funding and what improvements do you believe
need to be made to improve participation in this program?
Response: In accordance with 38 United States Code (USC) Sec.
3697, chapter 36 contract counseling is paid out of funds appropriated
to VA. Payments may not exceed $6 million in any fiscal year. Please
see the chart below for historical utilization.
----------------------------------------------------------------------------------------------------------------
Fiscal Year Obligations New Ch. 36 Applicants
----------------------------------------------------------------------------------------------------------------
2009 $5,473,711 20,034
----------------------------------------------------------------------------------------------------------------
2010 $3,609,488 14,533
----------------------------------------------------------------------------------------------------------------
2011 $3,474,418 17,113
----------------------------------------------------------------------------------------------------------------
FY 2010 and FY 2011 expenditures were lower following the
termination of the National Acquisition Strategy contracts late in FY
2009, leaving no contract vehicle available for Chapter 36 counseling
except where regional offices were able to implement interim local
contracts. The VetSuccess national contracts were awarded in late FY
2011. VR&E continues to perform early outreach to Veterans to encourage
participation in Chapter 36 services through job fairs as well as VR&E
Coming Home to Work and Yellow Ribbon Reintegration Program events. The
Coming Home to Work Program is VR&E's primary early intervention and
outreach program where Servicemembers and Veterans work with a
Vocational Rehabilitation Counselor to determine eligibility and
entitlement to VR&E services. The Yellow Ribbon Reintegration Program
is a DoD- wide effort to promote the well-being of National Guard and
Reserve members, their families, and communities, by connecting them
with resources, including VR&E benefits, throughout the deployment
cycle. Recently, VR&E Service enhanced marketing strategies to reach
more Veterans through the VetSuccess.gov site, which can be used by all
Veterans, not only Veterans with disabilities. VBA is also modernizing
the Transition Assistance Program and Disabled Transition Assistance
Program, placing greater emphasis Chapter 36 services for transitioning
Servicemembers.
Question 17: In VA's response to the Committee's pre-hearing
questions VA stated that OMB was currently reviewing what the impact
will be on VA's home loan program if Congress does not re-authorizing
the pooling authority for VA mortgages. This authority expired on
December 31, 2011. When do you expect this review to be completed?
Response: In cooperation with OMB, VA's review of options relating
to managing the Vendee Direct Loan Portfolio is ongoing. The review
focuses on both direct and indirect costs associated with vendee
mortgage trusts and it will be completed in time to inform the Mid-
Session Review report to Congress. Vendee loans continue to accumulate
in the existing portfolio. However, volume suggests that another
securities offering would not be viable until sometime in early FY
2013.
VBA GOE Questions
Question 18: On page 2A-8 of Volume 3 of the budget submission, VA
announced that its obligations for contract medical examinations will
increase by 11.8 million, or approximately 55,000 additional contract
examinations. In what circumstances is VA relying on contract
examinations rather than examinations provided by VHA?
Response: VBA contracts with private vendors in areas across the
country where VHA is unable to support the volume of examination
requests being submitted, and in rural areas where Veterans have to
travel greater distances to attend VA examinations. Specifically, VBA
has a contract in place to provide Integrated Disability Evaluation
System (IDES) examinations at multiple facilities nationwide.
a. At 4B-18, VA states that it is using three companies for
contract examinations. What are the three companies?
Response: VBA has contracted with QTC Medical Services, VetFed, and
Veterans Evaluation Services to conduct medical disability
examinations.
b. What training mechanisms are in place to ensure that contract
examinations meet the required adequacy standards?
Response: All contracted physicians are required to complete the
same level of training that VA physicians complete prior to conducting
medical disability examinations. Each contract specifically requires
each physician to complete training on the VA disability examination
protocol. Additionally, they are required to complete VA-specific
training courses directly related to the type of disability
examinations that are being conducted. Completed examinations undergo
quality review by both the contractor and VA.
Question 19: At 2A-13, VA states that the number of veterans in
receipt of a total disability rating based on individual
unemployability (TDIU) is gradually increasing. What portion of this
increase is OIF/OEF Veterans?
Response: At the end of FY 2011, there were 18,749 Veterans with
service after September 11, 2001, receiving TDIU. However, they are not
all OIF/OEF Veterans. Budget forecasts are based on combined degrees of
disability, not by period of service; therefore, VBA does not project
total compensation funding associated with OIF/OEF Veterans.
The 18,749 Post 9/11 Veterans represent 6.5 percent of the total
Veteran population (287,133) in receipt of TDIU. Additionally,
approximately 2.5 percent of all Post 9/11 Veterans in receipt of
disability compensation are receiving TDIU.
a. Similarly, with regard to the increase in special monthly
compensation (SMC) funding, are these numbers also going up because of
the types of injuries seen in OIF/OEF Veterans or other factors?
Response: Since the end of FY 2009, the number of Post 9/11
veterans in receipt of SMC has grown by one percent, while the overall
percentage of veterans receiving SMC has grown 1.6 percent. The amount
of SMC funding may be in part due to the types of injuries seen in OIF/
OEF/OND Veterans and the increased survival rate after serious injury.
Another reason driving SMC rates in Veterans of prior conflicts is
likely attributable to presumptive Agent Orange disabilities.
b. Although VA's total number of claims increased by about 3
million (at 2A-22), its overall benefits obligations increased by
approximately $10 billion. What portion of this is due to:
1. New claims from OIF/OEF Veterans?
2. TDIU/SMC for OIF/OEF Veterans?
3. Number/types of injuries seen in OIF/OEF Veterans?
Response: The chart on page 2A-22 is the total number of Veterans
and survivors on the rolls who are receiving compensation benefit
payments and the total dollars associated with the benefit payments.
Compensation payments are based on combined degree of disability and
Veterans often receive compensation for multiple injuries or diseases.
Budget forecasts are based on combined degrees of disability not by
period of service; therefore, VBA does not project total compensation
funding associated with OIF/OEF Veterans.
Question 20: Throughout the budget, mention is repeatedly made that
VA will track metrics for the number of claims that remain pending
after VA's target processing time of 125 days. What is VA's planned
response if these numbers are not being met?
Response: Based on current projections, VBA is currently on track
to reach this goal in 2015. However, as our environment over the next
few years changes, we may face new challenges that impact our ability
to reach our goal. Historically, unexpected events have created a surge
in VBA workload. New presumptive conditions, court decisions, and
legislative requirements add unexpected volume. We will continue to
monitor these issues.
a. Other than tracking through VBMS, is VA planning on utilizing
any new strategies to reach this target goal?
Response: VBA's Transformation Plan is based on more than 40
initiatives in the areas of People, Processes, and Technology, selected
from ideas submitted from employees and stakeholders. Transformation is
not a ``one and done,'' flip-of-the-switch proposition - it is a
dynamic process of intaking, researching, testing, and launching new
ideas and initiatives. This process requires that VBA initiatives
become more structured projects with a Program Manager/Team Lead and a
standardized way of measuring the initiative's impact, schedule, and
costs.
VBA is using a Transformation Governance Framework to evaluate
projects that directly impact our transformation goals. Existing and
future transformation initiatives will progress through the
Transformation Governance Framework, providing a formal review process
for evaluating and implementing systemic improvements to VBA
operations. Under this process, designated VBA teams, or ``Design
Teams,'' are designing and testing initiatives through pilots and
documenting results through a standard set of analytical reports and
project management documents.
b. What type of improved metrics/methodology is VA using to keep
track of these statistics?
Response: VBA established the Implementation Center Program
Management Office at headquarters in September 2011 to plan and carry
out the implementation of its Transformation Plan using program
management principles, incorporating an integrated work-breakdown
schedule that captures all dependencies, resourcing the implementation
with field and corporate headquarters representatives, managing the
rollout of the Veterans Benefits Management System (VBMS) and Veterans
Relationship Management (VRM) technologies, preparing the regional
offices with change management personnel and training, and effectively
communicating the entire plan with a well-structured communications
strategy to inform our workforce and our stakeholders of the
implementation details. The Implementation Center is in the process of
developing performance measures that will track the impact of the
Transformation Plan initiatives.
Question 21: At 4A-3, VA reiterates that ``our employees are the
key to our success.'' Please elaborate on this assertion, as it appears
that hiring many new employees since 2007 has not greatly contributed
to reducing the backlog.
Response: VBA's employees are integral in the successful
implementation of our new operating model and achieving our 2015
strategic goals. VBA's transformation plan is based on 40+ initiatives
that are a product of more than 600 stakeholder and employee ideas.
VBA's transformation plan requires highly skilled, motivated, and
inspired employees who are Veteran-centric and work each day to provide
Veterans, Servicemembers, their family members, and survivors the full
range of benefits, support, and services. VBA is organizing its
workforce into ``case management'' teams, managing work in the most
efficient, effective ways possible, leveraging proven automated
workflow tools. VBA is also increasing the expertise of its workforce
through the use of national training standards and the Challenge
training program that prepares employees to work faster at a higher
quality level. VBA's training and technology skills programs will
continue to deliver the knowledge and expertise VBA employees need to
succeed in a 21st-Century workplace.
a. What actions are you taking to decrease training time? What is
the basis for the frequently cited assertion that it takes 2 years to
fully train an examiner?
Response: Training for new claims processors previously consisted
of six months of combined centralized and ``home-station'' training.
VBA has compressed this training into four weeks for Veterans Service
Representatives and eight weeks for Rating Veterans Service
Representatives. The centralized program utilizes practical application
by working live claims under the supervision of subject matter experts.
Upon returning to their home stations, employees work simple
claims, have their work reviewed by mentors, and continue to receive
training based upon their experience level.
The two-year period of training includes on-the-job training that
allows employees to acquire the many legal and medical skills required
by the position, to include a working knowledge of Court decisions,
learning the complexity of Parts 3 and 4 of the Regulations, and
familiarizing themselves with the multitude of Rating Job Aids. As
their knowledge and skills increase, employees receive training at the
intermediate-level and progress to processing more complex claims such
as diabetes, traumatic brain injury and their complications/secondary
conditions, as well as SMC.
b. Has VA made any recent updates to its training procedures?
Response: Yes, the training for new claims processors has been
completely revamped in the past year. VBA developed and delivered
national training on the Quality Review Teams (QRT) and Simplified
Notification Letters (SNL) transformation initiatives. VBA and VHA
jointly developed mandatory training for all employees who process
Military Sexual Trauma (MST) claims.
This updated training includes several new virtual learning
products that will be available for field use by the end of fiscal year
2012 such as a ``Traumatic Brain Injury Training and Performance
Support System (TPSS)'' module and Medical TPSS modules focusing on the
body systems.
Question 22: At 4A-4, how did you arrive at the case-management
approach/processing lanes?
Response: VBA's Transformation Plan is based on more than 600 ideas
solicited from its employees, Veterans Service Organization partners,
and other stakeholders, including this Subcommittee and your staffs.
After evaluating a multitude of innovative ideas, VBA focused on the 40
most promising, tested, and measured initiatives for inclusion in its
Transformation Plan. The case management and processing lanes
approaches have been incorporated into VBA's new transformation process
model, which includes the intake processing center, segmented lanes,
and cross-functional teams initiatives. The new model allows VBA
employees to manage work in the most efficient and effective way
possible, leveraging proven automated workflow tools. The intake
processing center enables quick, accurate claims triage. Segmented
lanes will improve the speed, accuracy, and consistency of claims
decisions by organizing claims work into distinct categories, or lanes
(Express, Core, and Special Operations), based on the amount of time
required to process the claim. The cross-functional teams initiative
consists of teams of cross-trained decision makers co-located to reduce
rework time, increase staffing flexibility, and better balance workload
by facilitating a case- management approach to completing claims.
a. Where is this system being tested?
Response: VBA initially implemented the new process model at the
Indianapolis Regional Office (RO). The Wichita, Kansas; Fort Harrison,
Montana; and Milwaukee, Wisconsin, ROs were selected as the three sites
to pilot the new process model being implemented as part of the VBA
Transformation Plan. The intake processing center, segmented lanes, and
cross-functional teams initiatives were rolled out to Wichita on
February 21, Fort Harrison on February 27, and Milwaukee on March 5.
National deployment is expected by the end of fiscal year 2013.
b. Do you have initial results you can share?
Response: It is too early to report actual results of the
performance of these initiatives. However, we project that the new
operating model (including cross-functional teams, intake processing
centers, and segmented lanes) has the potential to save 40 days in the
processing of a claim, which currently stands at 246.1 days as of April
30, 2012. The VBA Implementation Center will use dedicated resources to
oversee the implementation of the Transformation Plan using a
governance process that achieves standardization and sustainability.
The Implementation Center is identifying and developing performance
measures to track the impact of these initiatives.
Question 23: At 4A-4, what initial feedback have you received from
the use of Disability Benefit Questionnaires?
Response: Generally, we have received favorable feedback on
Disability Benefits Questionnaires (DBQs). The question and answer
format of DBQs eliminates the need for examiners to prepare lengthy
narratives and efficiently focuses on the specific evaluation criteria
needed for a given disability. We have received much feedback on ways
to improve content and format of the DBQs so that they more readily
elicit information from examiners and better apply findings for
accurate and consistent rating decisions. VBA continues to work closely
with the Veterans Health Administration to make these improvements and
updates.
a. Do you have any procedures in place to follow up with private
physicians in compliance with the CAVC's decision in Savage v.
Shinseki?
Response: The Court of Appeals for Veterans Claims (Court), in
Savage v. Shinseki, held that if a private examination report
reasonably appears to contain information necessary to properly decide
a claim but it is ``unclear'' or ``not suitable for rating purposes,''
and the information reasonably contained in the report otherwise cannot
be obtained, VA must either (1) ask the private examiner to clarify the
report, (2) ask the claimant to obtain the necessary information to
clarify the report, or (3) explain why such clarification is not
needed.
VA provided the field offices with an analysis of the decision,
informing them of the Court's holding and impact of the decision. VA is
amending its regulations and adjudication procedures to comply with the
Court's holding.
b. Does the use of DBQ's have the potential to save VA money on
using contract examinations?
Response: DBQs change the way medical evidence is collected, giving
Veterans the option of having their private physician provide the
medical information necessary to process their claim. VHA and VA-
contract physicians will be completing DBQs as well as private
physicians.
The medical disability examination contracts pay for each
examination contractors complete. The potential for savings is based on
exam avoidance, which means getting fully completed DBQs from VA
primary care and private providers. Because the DBQs have just been
released to the public, we do not have data on exam avoidance yet.
However, we will monitor exam avoidance as part of our oversight
efforts.
Question 24: At 4A-14; 4F-5 - you note that you are already using
an entirely paperless process for insurance claims. Is this the same
platform as VBMS?
Response: No, the Insurance Center is using a paperless platform
that was uniquely designed for it in 1996. This platform is not
compatible with other VBA benefit programs.
a. How is the scanning for insurance claim documents handled?
Response: The US Postal Service delivers mail to the Insurance
Center four times a day. All mail and Veteran-related documents are
immediately taken to the imaging unit where they are classified,
scanned, and automatically routed to an Insurance Specialist to process
them. The scanned items are immediately available for viewing on every
Insurance desktop. The document imaging and routing processes are
completed within two hours of each mail delivery.
The insurance document imaging system currently contains over 16
million documents.
b. Are there any data showing that this paperless system increases
processing times or quality?
Response: The paperless system has significantly improved the
timeliness and quality of disbursements. Payments of death claims,
policy loans, and cash surrenders are the most important services the
Insurance program provides to Veterans and beneficiaries.
Before the paperless initiative, the average processing time for
Insurance disbursements exceeded four days. Paperless processing has
helped Insurance consistently reduce that time to less than two days
while maintaining a 99 percent accuracy rate. The current 12-month
average processing time for disbursements is 1.5 days.
Paperless processing has also significantly improved Insurance's
ability to provide information to policyholders. Before imaging,
Insurance could only answer questions about beneficiary designations by
retrieving the insurance folder, which could take two to three
workdays. Since all beneficiary designations are now imaged,
policyholders calling the Insurance Center now receive current
beneficiary information in minutes, contributing to the 85 percent
first-call-resolution rate.
c. Have there been any unforeseen costs associated with using this
paperless processing or the insurance self-service website?
Response: There have been no unforeseen costs associated with these
initiatives. The comprehensive use of imaging and automated procedures
allowed the Insurance Center to retire its 2.5 million folders to the
Federal Records Center in January 2002, saving $1 million annually in
clerical and other charges.
Question 25: At 4B-8 you mention a study by George Washington
University on earnings loss and Musculoskeletal system. Please
elaborate on the specifics of this study, including its intended
completion date and its intended effect on the ongoing modernization of
VA's rating schedule.
Response: The study will evaluate the effectiveness of VA's rating
schedule in compensating Veterans for average earnings impairment
resulting from musculoskeletal service-connected disabilities. The
findings of this study will provide the data necessary to determine
whether current compensation rating levels reflect the average
impairment in earning capacity for specific conditions in the current
rating schedule. The expected completion date for the musculoskeletal
body system earnings loss study is December 2012.
Question 26: At 5C-2, with regard to the newly authorized FTEs, how
many will be attorneys and how many will be support staff?
a. What training procedures does the Board have in place to handle
so many new FTEs?
b. What else is the Board looking at to address its backlog besides
additional FTEs?
Response: The increase in BVA funding in Fiscal Year (FY) 2012 was
to enable BVA to sustain its FY 2011 level of FTE with base funding,
rather than through carryover funding. Therefore, while the increase
was critical to maintain BVA's level of operations, the organization
saw no increase in FTE for FY 2012. In this fiscal year, BVA has
limited hiring to attrition hiring in both its attorney and
administrative staffs.
BVA has a robust training program in place for all newly hired
attorneys, led by its Office of Learning and Knowledge Management
(OLKM). Each new attorney is paired with an attorney mentor for a
period of six months, during which time the mentor provides one- on-one
training and reviews and provides feedback on draft decisions. OKLM has
established a standardized methodology for mentors to follow in
providing this direction. Additionally, OLKM organizes approximately 24
hours of classroom training for new attorneys over the course of their
first month to convey the basic substantive requirements of the law.
Substantive trainings are provided for the entire Veterans Law
Judge (VLJ) and attorney staff on an on-going basis. OLKM has created
targeted training based, in part, on trends gleaned from BVA's quality
review process, as well as based on outcomes in cases heard before the
Court of Appeals for Veterans Claims and the Court of Appeals for the
Federal Circuit. In addition, BVA has expanded medical training for its
staff to address the increasing complexity of disability compensation
appeals.
Specifically, in FY 2011, BVA's VLJs and attorneys attended courses
on topics such as Evaluating Lay Evidence & Making Credibility
Determinations; Recent Significant CAVC and Federal Circuit Decisions;
Speculation & Medical Opinions; Recent Trends in the Duty to Assist;
Supervisory Training; Medical Training on the Back, Heart Disease,
Knee, and Psychiatric Disorders; VA's Core Values & Characteristics;
Women Veterans Issues; Disability Benefit Questionnaires; and ongoing
Medical Advisor and Quality Review small group chat sessions.
Newly hired employees within the Management, Planning, and Analysis
Directorate (MPA) receive one-on-one coaching and training from an
experienced mentor during their first 90 days on the job. Each employee
also completes a new employee orientation, MPA-wide training, and VA/
BVA database systems training. Employees continue to receive task-
specific training conducted by the Branch Team Leads and Coach
throughout the first year on the job.
MPA conducts annual functional refresher training which allows for
expansion or enhancement of an employee's current job duties and
abilities. In addition, MPA-wide cross training enables an employee to
perform additional duties outside of his or her current job function at
the same level of responsibility, allowing MPA to meet organizational
needs in response to human resource needs, re-engineering,
restructuring, and/or program changes.
For a cohesive approach to personal training goals, MPA's Training
and Development Plan offers a series of ``training tracks'' that
incorporate existing resources, both internal and external. Courses are
built around job-specific tracks to provide a clear training plan for
employees and managers. Training tracks are available in the following
areas: Administrative Service Division, Decision Team Support Division,
Financial Management Division, Supervisory and Management Development,
and General Career Development. For off-site training the following
resources are used for developing new and existing employees: Graduate
School, Human Resources Institute, Office of personnel Management, VA
Learning University, Talent Management System and VA Central Office
Human Resource Service.
To meet the challenge of the growing appeals workload, BVA has
implemented efficiencies in two key areas: hearings and remands. The
Department also submitted several legislative proposals to improve the
appeals process. These initiatives are discussed more fully below.
With respect to hearings, approximately 25 percent of appellants
before BVA request a hearing before a VLJ. The majority of appellants
request an in-person hearing (e.g., 66 percent in FY 2011). An average
of 75 percent of scheduled in-person hearings in FY 2011 took place,
meaning that 25 percent of those Veterans scheduled for hearings did
not appear for the hearing. Data confirms that over the past five
years, the national average show rate for field hearings is 73 percent.
This leaves the VLJ who traveled to the field station with substantial
blocks of time without scheduled activity, and thus, a loss of
productive time to decide appeals.
The annual hearing schedule depends on demand, and slots are
allocated to field stations well in advance of the beginning of each
fiscal year. In planning for the FY 2012 hearing schedule, BVA
decreased the number of available field hearings offered by 25 percent
in favor of increasing video teleconference (VTC) hearings, which take
place between the VLJ in Washington, DC and the Veteran at his or her
local Regional Office (RO). This results in both monetary and time
savings for VA. VLJs will gain time in the office, with an anticipated
increase in decisional output (ranging from 2 percent to 5 percent)
over the next few years. Additionally, VA will save an estimated
$864,000 in travel costs through 2015.
Remands generate a substantial amount of rework for both VBA and
BVA, which increases workload, while also greatly increasing the delay
for Veterans. In FY 2011, BVA remanded 44 percent of appeals before the
Board (21,464) to the Agency of Original Jurisdiction (AOJ), generally
VBA. Historically, approximately 75 percent of all remands return to
the Board. VLJs determined that 40 percent of FY 2011's remands (8,585)
could have been avoided if the RO properly processed and reviewed the
case in accordance with existing laws and regulations.
BVA has analyzed the data from its Remand Reasons Database
(collecting reasons for remands since 2004) and determined that the top
reason for remand is inadequate medical examinations and opinions. To
reduce the number of remands that are returned to the Board, BVA has
partnered with the Veterans Health Administration (VHA) to develop
training tools and provide direct training to VA clinicians to improve
VA compensation and pension examinations. Additionally, BVA and VBA
have agreed to a mandatory joint training program to aid in
standardizing adjudication across the system, driven by the most common
reasons for remand. BVA has established an interactive training
relationship with VBA's key organizations involved in the appellate
process, i.e., the Systemic Technical Accuracy Review (STAR) staff,
Decision Review Officers, and the Appeals Management Center staff. The
goal of these efforts is to reduce the number of avoidable remands in
the system.
VA has submitted legislative proposals to Congress that would
streamline the appellate process. Specifically, VA has proposed a
provision that would allow BVA to determine the most expeditious type
of hearing for those appellants who request a hearing before a VLJ. The
proposal includes a ``good cause'' exception for those appellants who
do not desire a video conference hearing. VA has also proposed an
automatic waiver provision, establishing a presumption that an
appellant, or his or her representative, has waived RO consideration of
any evidence he or she files after filing the Substantive Appeal to the
Board. This would eliminate readjudication of the appeal by the RO in
some cases, in favor of the Board directly addressing the evidence.
Additionally, VA has proposed reducing the time period to file a Notice
of Disagreement (NOD) from 365 days to 180 days, to ensure timely
processing of appeals and less rework due to stale evidence.
Question 27: Please describe what the budgetary impact will be on
the recent expansion of T-SGLI for loss of reproductive organs? How
will this decision impact future budget requests and what other
injuries is VA considering adding for coverage under the TSGLI program?
Response: The Insurance Center estimates a cost of $11.7 million
for 260 retroactive claims resulting from the expansion of TSGLI for
genitourinary (GU) losses.
After completing an outreach mailing in February 2012 to Veterans
identified as having sustained GU injuries, we expect to see most of
the retroactive GU claims filed and paid during the second half of FY
2012. We are projecting that about 65 claims (one-fourth of the
projected total retroactive claims) will be filed in FY 2013 for an
estimated cost of
$2.9 million. For FY 2014 and future years, we expect 35 claims per
year attributable to GU losses for an annual cost of $1.6 million.
These payments will have no impact on VA's future budget requests.
The branches of service cover the cost of TSGLI claims in excess of
premiums received for the TSGLI program, this includes funding for the
GU claims.
At the present time, VA is not considering adding additional
payable losses to the TSGLI program.
Question 28: The budget documents stated that there are nearly
3,800 appeals still being processed for payments from the Filipino
Veterans Compensation Fund and that over half of the 42,800 claims
filed for compensation have been denied.
a. When do you expect the remaining appeals to be resolved?
Response: As of April 11, 2012, 963 appeals were pending at the
Manila VA Regional Office (VARO). Of those, 217 were Notices of
Disagreement and 746 have filed a formal appeal. Of the 746 formal
appeals, 70 are currently pending at the Board of Veterans' Appeals.
We are unable to provide a completion date at this time as these
cases are in various stages of the appeals process. While there are
many variables involved in resolving the 963 appeals, the Manila VARO
considers these appeals one of their highest priorities.
b. Is there any idea of how much of the remaining appropriation
will be left at the conclusion of the decisions on these appeals?
Response: We estimate an unobligated balance of $39.5 million at
the end of FY 2013.
c. What is your opinion on the potential for fraud in this program
and what steps has the Department taken to ensure the correct
adjudication of these claims?
Response: While the possibility for fraud in this program is high
due to the problem of fraudulent or improper documentation from the
1940s, the Manila VARO has mitigated this risk by:
Training employees to identify potentially fraudulent
claims;
Utilizing its fiduciary unit to personally deliver
payments if any type of fraud is suspected; and
Using an ID Verification System that allows VARO
employees to identify Veterans by photograph when they visit the VARO.
Upon receipt of a claim for benefits based on service with the
Philippine Commonwealth Army, a recognized guerrilla organization, or
the Special Philippine Scouts, Manila VARO personnel conduct a search
to determine if the claimant previously forfeited entitlement or should
be considered for forfeiture of benefits by reason of fraudulent action
on another claim.
d. What is the status of the two ongoing law suits involving this
account?
Response: The two lawsuits are De Fernandez v. U.S. Department of
Veterans Affairs and Recinto v. U.S. Department of Veterans Affairs.
Both were filed in the U.S. District Court for the Northern District of
California. Although in April 2011 the district court granted VA's
motion to dismiss Recinto, the plaintiffs appealed the district court's
decision to the U.S. Court of Appeals for the Ninth Circuit. That
appeal has been fully briefed, but is still pending. The Government's
motion to dismiss De Fernandez has been fully briefed in the district
court, but not yet argued. It remains pending in the district court.
Question 29: Please provide more information about the rules-based
process job aide that will be included in the first ``design team'' and
if this system will be integrated with VBMS?
Response: As part of the first Design Team, VBA created a
standardized and simplified rating notification letter that goes to
Veterans using more clear language. The simplified notification letter
(SNL) standardizes and streamlines the decision-notification process
and helps integrate essential information into one simplified
notification, while reducing complexity and time. SNL reduced
complexity and time by 10-20 percent in testing. This initiative was
fully implemented nationally on March 12, 2012. This process has also
begun to incorporate rater decision support tools that establish more
consistent rater performance. These rules-based tools are currently
being integrated into the Veterans Benefits Management System (VBMS).
a. What other type of rules-based systems will be part of the final
VBMS system?
Response: Once more structured data is in place, VBMS will use
rules to recommend decisions and create Veterans Claims Assistance Act
(VCAA) letters. Additional rules- based functionality may be identified
as feedback from end users is captured.
b. What is VA's plan for scanning documents for the VBMS system?
Will this be done with private contractors?
Response: VBMS is taking a ``point forward approach'' to
transitioning offices to fully functional paperless centers. All paper
claims currently pending will continue to be processed in paper. Once
VBMS is launched at an office, all new claims received will be
processed in VBMS as paperless claims. However, end users will use VBMS
to make decisions on both paper and paperless claims.
VA is currently evaluating several scanning options, including the
use of private contractors to conduct scanning operations.
c. Where will the scanning take place and what is the long-term
scanning plan?
VBA Response: VBA's Transformation Plan includes a strategy for
conversion to a paperless system that provides a combination of
scanning and electronic or web-based submission of documents. The
transition to a paperless system may take an extended period of time as
we continue to encourage Veterans, Servicemembers, their families, and
their representatives to take advantage of our web-based and electronic
systems. As VBA pursues these advances and expands its strategy for
converting to a paperless system, it will still continue to process
paper claims.
d. Are you partnering with Veteran Service Organizations and other
interested stakeholders as you develop the VBMS system?
Response: Throughout VBA's development and implementation of our
Transformation plan, we have partnered with Veterans Service
Organizations (VSOs) and other stakeholders. For example, in April
2011, a subject matter expert from Disabled American Veterans
participated in requirements-gathering sessions during a 30-day detail
with VA. VA continues to involve VSOs and interested stakeholders on a
regular basis to ensure that their interests are considered in VBMS
development.
e. When do you expect all regional offices to use VBMS and not rely
on other legacy systems?
Response: VBMS is expected to be deployed to all regional offices
by the end of calendar year 2013. Once VBMS demonstrates the capability
to process all claims end- to-end in an electronic environment without
reverting to legacy systems, VA will evaluate retiring its legacy
systems.
f. How will VBMS be integrated with the eBenefits and other VBA
systems?
Response: Currently, VA is exploring Veterans On-Line Application
(VONAPP) Direct Connect (VDC) as one of the integration points between
VBMS and eBenefits. Claims filed through eBenefits will use VDC, and
the information and data received will be loaded into VBMS.
Requirements to integrate with other VBA systems are being identified
and prioritized.
g. VA's budget states that the nationwide deployment of VBMS will
begin in FY2012 and be completed by the end of FY2013. Please provide a
detailed schedule of this rollout.
Response: VBMS began national deployment in March 2012, and is
expected to be completed by the end of calendar year 2013. VBMS's
rollout schedule follows:
VBMS Rollout Schedule
Regional Offices - FY 2012
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
1 Wichita 3/26/2012
----------------------------------------------------------------------------------------------------------------
2 Ft. Harrison 3/26/2012
----------------------------------------------------------------------------------------------------------------
3 Hartford 7/16/2012
----------------------------------------------------------------------------------------------------------------
4 Huntington 7/23/2012
----------------------------------------------------------------------------------------------------------------
5 Houston 7/30/2012
----------------------------------------------------------------------------------------------------------------
6 Cleveland 8/6/2012
----------------------------------------------------------------------------------------------------------------
7 New Orleans 8/13/2012
----------------------------------------------------------------------------------------------------------------
8 Milwaukee 8/20/2012
----------------------------------------------------------------------------------------------------------------
9 Boise 8/20/2012
----------------------------------------------------------------------------------------------------------------
10 Portland 8/27/2012
----------------------------------------------------------------------------------------------------------------
11 Phoenix 8/27/2012
----------------------------------------------------------------------------------------------------------------
12 San Juan 9/3/2012
----------------------------------------------------------------------------------------------------------------
13 Des Moines 9/10/2012
----------------------------------------------------------------------------------------------------------------
14 Atlanta 9/17/2012
----------------------------------------------------------------------------------------------------------------
15 Newark 9/24/2012
----------------------------------------------------------------------------------------------------------------
Please note that the schedule for FY 2013 is still pending.
h. How have the functional requirements for VBMS evolved since the
program was originally developed and funded? Has there been a reduction
in the system requirements or functions from when VBMS was originally
developed?
Response: VBMS requirements development and delivery have evolved
from the VBMS proof-of-concept, referred to as the Virtual Regional
Office. The current process elicits business requirements information
from regional office SMEs every three weeks and systematically captures
information in ``use cases'' utilizing narratives, process models,
information models, decision models, and business acceptance criteria.
Once complete, each use case is delivered to system developers, where
it is broken down into user stories and corresponding story points,
ready to be consumed by development teams in accordance with an agile-
like methodology.
Not only has the VBMS program not experienced a reduction in the
system requirements or functions, the number of requirements developed
and delivered have increased over the past five months.
Question 30: The contracted Fast Track system is used to expedite
the processing of presumptive Agent Orange claims. This system is being
funded by VA Innovations Initiatives. Can you give some figures that
reflect the cost of this system and its estimated long term usability?
Response: The Fast Track claims processing system is jointly funded
by VA Innovation Initiatives (VAI2) and the Office of Information and
Technology (OI&T). Fast Track was developed, certified, accredited, and
deployed within 120 days for under $4 million and released Veterans Day
2010. Subsequent enhancements were made totaling $3.5 million. The
annual sustainment/operation and maintenance investment was under $2
million. The year-to-date investment in Fast Track as of April 2012 is
$11 million. On March 30, 2012, VA exercised option year 1, which
begins July 1, 2012.
a. Using this system, how much oversight do you have on the medical
evidence used in these claims and will this system provide
communication between the medical evaluator and the person processing
the claims?
Response: All documents submitted as part of Fast Track are
reviewed by a Veterans Service Representative (VSR) and a Rating
Veterans Service Representative (RVSR) for completeness and evidence of
fraud or tampering. A sample of claims are also reviewed by the Quality
Review Team. There is no direct communication between the VA person(s)
processing the claim and the medical evaluator. If clarification is
needed, a request is sent to the medical evaluator in writing.
b. Could this result in an assembly line of Agent Orange claims
approvals with little to no oversight of the origin and condition of
the actual presumptive diagnosis?
Response: There are currently very few diagnoses being received
through the public- facing automated system. All incoming digital
documents can be traced back to the originating IP address. The claims
received through the Fast Track system receive the same level of
development and oversight as claims received through any other means.
All evidence received with the claim is reviewed, all evidence
identified by the Veteran is developed, and the claims file is reviewed
prior to making a disability determination. In addition, VBA conducts a
monthly validation review of a random sample of disability benefits
questionnaires received with claims both in paper and through the Fast
Track system.
Question 31: The budget states that VA's disability claims
production has increased. That should be expected after such a large
staffing increase over the last decade. What I'm interested in is the
level of individual productivity of VA employees.
a. What is the productivity level of each claims examiner?
Response: VBA claims examiners are classified into two categories:
Veterans Service Representatives (VSRs) and Rating Veterans Service
Representative (RVSRs). VSRs and RVSRs must consistently and
conscientiously exercise sound, equitable judgment in applying laws,
regulations, policies, and procedures to ensure accurate information is
disseminated to Veterans and accurate decisions are provided on all
benefit claims administered by VA. Claims examiners are evaluated on
two major criteria: production and quality. Production is captured by a
points-based system, rather than a case-based system. The goal of the
points-based system is to allow consistency in measuring an employee's
production, as cases can often vary in complexity and require different
lengths of time to complete. The national daily productivity goals for
VSRs in association with their grade levels are as follows: GS-7 (4.5),
GS-9 (5), GS-10 (5.5), and GS-11 (6).
Due to the complexity of the position, RVSRs are not considered to
be fully productive (i.e., journeyman) until they have reached 24
months of experience. The associated weighted actions per day are 3.5
for a journeyman RVSR. The national daily productivity goal for RVSRs
in association with their experience levels are as follows: 7- 12
months (1), 13-18 months (2), and 19-24 months (3).
b. How many claims should each examiner be responsible for
accurately deciding in a given year?
Response: The national daily productivity goals for VSRs in
association with their grade levels are as follows: GS-7 (4.5), GS-9
(5), GS-10 (5.5), and GS-11 (6). The quality goals for VSRs are: GS-7
(80 percent), GS-9 (85 percent), GS-10 (90 percent), and GS-11 (91
percent). The national daily productivity goal for RVSRs in association
with their experience levels are as follows: 7-12 months (1), 13-18
months (2), and 19- 24 months (3). The rating decision accuracy goal
for RVSRs with 0 to 24 months of experience is 80 percent. The
associated quality goal for a journeyman RVSR (over 24 months
experience) is 85 percent.
At the end of February, the national rating accuracy was 85.5
percent for compensation claims. This is an increase from the fiscal
year 2010 rating quality of 83.8 percent.
c. Are you concerned about the continued reports by the Office of
Inspector General that show major quality issues at the Regional
Offices that they have visited?
Response: VBA continues to focus on improving the quality of claims
decisions. However, a major component of the cases reviewed by the OIG
during their recent regional office audits were claims that had been
decided over a period of many years (going back at least as far as
1999). In these cases, VA had awarded temporary 100 percent disability
evaluations for Veterans whose conditions had not stabilized, and these
Veterans should have been scheduled for follow-up disability
examinations. However, in many cases the follow-up examinations were
not scheduled, due in significant part to a national computer problem
that caused correctly established future diaries to drop out of our
claims processing system. This issue was identified in a separate and
focused nationwide OIG audit of temporary 100 percent disability
evaluations, the report of which was released in January 2011. OIG
accepted VA's corrective action plan in response to this report and
recommendations, which included fixes to our information technology
system and reviews of all of these cases by our regional offices.
Inclusion of these temporary 100 percent cases with known deficiencies
in the overall quality findings for the regional offices does not give
a true picture of the quality of the work being performed by VBA
employees.
Nevertheless, VBA recognizes that there is room for improvement in
the service provided to Veterans, their families, and survivors. VBA's
Transformation Plan will improve and standardize processes to improve
quality, eliminate the claims backlog, achieve efficiencies, and
reallocate capacity. VBA's Transformation initiatives such as Quality
Review Teams (QRTs), Simplified Notification Letter (SNL), and
Challenge training will help VA achieve its goal of 98 percent accuracy
for benefits delivery. QRTs have been established at each regional
office to bridge the gap between local and national quality metrics and
foster consistency. The SNL initiative standardizes and streamlines the
decision-notification process and helps integrate essential information
into one simplified notification, while reducing complexity and time.
The national-level Challenge training provides a standardized
curriculum to new claims processers to help ensure high quality and
productivity.
VBA continually reviews all quality error trends and works closely
with numerous VA entities, such as the Office of General Counsel, the
Board of Veterans' Appeals, and the VHA's Disability Examination
Office, to provide additional training and quickly identify, clarify,
or correct policies, procedures, and processes that impact quality.
d. What steps will VBA take with this budget to improve overall
quality production?
Response: The funding requested for FY 2013 budget, both for VBA
and the Office of Information and Technology, which supports all of
VBA's crucial IT investments, will support the ongoing phased
implementation of VBA's Transformation Plan, which will improve the
quality and timeliness of claims processing. VBA's initiatives are
being implemented through a deliberate process and rolled out to
regional offices (ROs) in a multi-year, phased approach that will
ensure success and minimize risk. The successful execution of the plan
is expected to result in a 14-point increase in quality in 2015 from FY
2011.
VBA has requested a total of $18 million in GOE funds to support
the development, oversight, and implementation of transformation
initiatives. While the $18 million requested includes implementation
and oversight activities, the direct labor FTE and associated training
funds for initiatives such as Quality Review Teams (QRTs), Simplified
Notification Letter (SNL), and Challenge training are within the funds
requested to support payroll and training for the 14,520 FTE requested
in the Compensation and Pension programs.
Question 32: VBA and AFGE recently modified article 67 of their
master contract on skills certification. While I appreciate VA and
AFGE's apparent move to meet the requirements of H.R. 2349, as amended,
a bill passed by House last fall, I do have to question why an employee
would not be held accountable under this modification for failure to
pass this skills certification test as required by P.L. 110-389.
a. While I understand this test is in place so a claims processor
can move up a GS level, why does VA not administer testing to test
current knowledge and competence?
Response: P.L. 110-389, section 225 requires that an employee take,
rather than pass, the skill certification test. Claims processor
positions are complex in nature, and requiring time and training in
order to become proficient. By the time an employee is eligible to take
the test, the expectation is that they will have obtained a certain
level of job competence. This knowledge is tested through the skills
certification process. According to Article 67, employees will now be
required to sit for periodic recertification as long as they remain in
the position.
b. Will all employees and managers be required to take the skills
certification test as required under both P.L. 110-389 and the modified
article 67 of the master contract?
VBA Response: VBA is developing skills certification tests for all
positions that are involved in the claims process, to include certain
supervisory positions. Currently, there is a test for VSRs, RVSRs,
Decision Review Officers (DROs), and Coaches. Other tests are currently
being designed, such as for Senior VSRs. According to Article 67,
eligible employees are required to take the skills certification test
within a year from the article implementation.
c. Are you at all concerned that current certification testing
shows only a 57 percent pass rate? What steps has VA taken to address
issues surrounding this test and involve union partners in developing
this test as required by P.L. 110-389?
Response: VBA is dedicated to improving the skills certification
process. Work groups for each position were established that includes
subject matter experts, union representatives, and other pertinent
members. The work groups perform such tasks as, reviewing previous test
results, working with contractors to re-design certain aspects of the
test (i.e., improve test questions that may not be clear), and
performing job assessments to ensure the right questions are being
asked to best measure a participant's job skills.
Question 33: What statistical analysis was completed on the
effectiveness of the 6.0 release of the Long Term Solution for Post 9/
11 GI Bill Claims to justify the shifting of close to 200 FTE from the
Education Service to the Compensation Service? How was the impact of
the re-training provisions of the VOW to Hire Heroes Act taken into
account and what is the target for the average days to process these
type of claims?
Response: VA does not plan to shift FTE from Education Service to
Compensation Service. In FY 2009, VA used funds made available by the
American Recovery and Reinvestment Act to hire temporary claims
processors to address the Post-9/11 GI Bill workload surge. VA retained
the temporary surge claims processors, and in 2012, VA will hire
additional temporary claims processors to address additional workload
resulting from Public Law 112-56, the Vow to Hire Heroes Act of 2011,
and Public Law 111-377, the Post-9/11 Veterans Educational Assistance
Improvements Act of 2010. The deployment of release 6.0 of the Long
Term Solution for the Post -9/11 GI Bill will automate several segments
of claims processing that are currently manual or only semi- automated.
We are evaluating both the impact of LTS and emerging initiatives, such
as VRAP, potential legislative changes, and workload increases on
future FTE requirements.
VA does not expect that the VRAP provisions of the VOW to Hire
Heroes Act will have an impact on the Post-9/11 GI Bill Long Term
Solution. VA plans to utilize the Benefits Delivery Network, a payment
processing system used to process Montgomery GI Bill and other
education benefits, to process all VRAP claims. VA estimates the
average days to process these claims will be 23 days for original
claims and 12 days for supplemental claims in FY 2012.
Question 34: One of the largest complaints that we receive from
veterans is the lack of customer satisfaction and consistent answers to
questions provided by the GI Bill call center. What efforts have you
undertaken to improve the dropped call rate and improve customer
satisfaction at the call center?
Response: Providing clear, courteous, and accurate information to
Veterans, their families and survivors is a priority for VA. VA has
implemented a Virtual Hold call back system to improve the dropped call
rate during periods of peak call volumes, such as the beginning of
school terms. When wait times exceed three minutes, VA offers callers
the ability to hold their place in line and receive a call back, rather
than holding on the phone. In addition, the Virtual Hold system allows
callers to schedule a return call by providing their name and telephone
number. All appointments are scheduled on average within 48 hours.
Additionally, during enrollment periods, the Education Call Center
deploys senior agents and case managers to assist with high call
volume.
VA records all incoming and outgoing calls at the call centers.
Each month call recordings for each agent are evaluated to assess
overall call quality. All calls are reviewed for technical proficiency,
security identification protocol, client contact behaviors, and first-
call resolution. Through the second quarter of FY 2012, the overall
monthly quality score for Education Call Center agents was 98 percent.
We have a survey measurement system, known as the ``Voice of the
Veteran'', that a caller completes after speaking with an agent. This
survey assesses attributes such as knowledge of the agent, agent's
concern for caller needs, and usefulness of information provided by VA
employees to the Veteran. The surveys allow VA to monitor customer
satisfaction and establish improvement plans as needed. The ``Voice of
the Veteran'' satisfaction score for FYTD 2012 is 755 for Education.
The service industry benchmark satisfaction score is 765.
VA is piloting a new Client Relationship Management Unified Desktop
that will provide contact history and a consolidated view of the
Veteran's information in one location to enhance the service experience
provided by VA employees. In addition, VA is developing an enhanced
knowledge management system for call center agents that will ensure
accurate and consistent information is provided to the caller and
increase client satisfaction.
Question 35: Please explain why there is a planned FTE reduction in
the Loan Guaranty Service while the personal services line has a
request for a $2.4 million increase?
Response: While the number of FTE for the Loan Guaranty Program
declines by 28, increases to salary and benefits from 2012 to 2013
result in a net increase of $2.4 million in personal services. Salary
and benefit increases are a result of the cost of living adjustment,
changes in staff composition including grade and step, as well as
increases to employee benefits such as health care, the government's
share of employee retirement, and thrift savings contributions.
Question 36: How much will the appraisal management services and
the automated valuation management services cost and how will it add
value to training and other benefits?
Response: The Appraisal Management Service/Automated Valuation
Model (AMS/AVM) initiative is being pursued as a contract for services.
As of April 12, 2012, the Request for Proposals has not been published;
therefore, the contract has not been awarded. Actual lifecycle costs
are not yet available, but the FY 2013 budget estimates $4.2 million
will be obligated for AVM/AMS.
The combined project goals anticipate the refined analysis of VA
fee appraiser and lender staff appraisal reviewer performance
(scoring), which will allow VA to target both appraisers and lender
personnel for training based on their actual performance. This risk-
based approach will allow VA to concentrate on those individuals
placing VA at the highest risk while minimizing expenditures in
training. As this risk-based performance measurement matures over time,
VA expects the actual quality of the appraisal products to increase,
benefiting both Veterans and taxpayers.
Additional benefits of AVM/AMS include a standardized appraiser
scorecard that provides data and reporting on deficiencies and improves
the quality of the appraisal product being delivered; a streamlined,
standardized, and improved appraisal review process that allows more
timely, higher quality review completion; capacity for more detailed
oversight; a reduction in risk of fraudulent/invalid valuations; and
industry comparison metrics which allow VA to benchmark its program and
performance against the conventional market.
Question 37: What measures are in place to review the performance
of the Vet Success on Campus program?
Response: Performance measures for VetSuccess on Campus (VSOC)
include retention rates, graduation rates, and Veteran-students'
satisfaction. These measures will be used to determine effectiveness of
the VSOC program at specific sites. In addition, VBA is considering the
development of a Veteran-student survey to determine Veteran
satisfaction with VSOC services. The survey results would provide
information on ways to better meet the changing needs of Veterans in an
effort to continue to increase graduation rates and employment of
Veterans.
Currently, VSOC counselors are required to complete and submit to
VBA Central Office a recurring monthly report identifying and tracking
the number of Veteran-students seeking VSOC services, the number of
Veterans enrolled in VA education benefits, statistics on student
activities, and details on networking and outreach activities. These
reports are designed to gather pertinent information about services
provided to Veterans on campus.
Question 38: Please provide more information about the Voc Rehab
Service's plan to improve employment-based rehab by 15 percent.
Response: To address the need to assist more Veterans in obtaining
employment and decrease unemployment rates among Veterans, VR&E Service
developed a plan to increase employment-based rehabilitations 15
percent by FY 2014. This plan includes strategies to increase
employment at the national level with actions to be implemented at the
local level. The plan includes:
An eight-member workgroup to brainstorm ideas and
implement best practices of employment coordinators;
Quarterly training webinars to focus on stations with
high unemployment rates;
Participation in virtual career fairs to reach Veterans
across the Nation, including rural areas;
Sponsored employer forums to provide annual training to
human resource personnel and hiring managers on special hiring
authorities, tax credits, and special employer incentive programs;
Enhanced annual employment coordinator training
conference with a new curriculum and certificates for completion;
National memberships with Chamber of Commerce, the
Society of Human Resource Managers, the National Federation Executive
Board, the National Association for Colleges and Universities, and the
Governors' Board; and
Continued enhancements to VetSuccess.gov, in coordination
with VA for VETS, to increase employer registrations and connect
Veterans to employers.
Question 39: Please provide the justification for reducing the FTE
for the Insurance Service by 21.
Response: The reduction in FTE from FY 2012 to FY 2013 for the
Insurance Center consists of 17 direct and four management support
personnel. The direct FTE reduction is attributed to a projected
decline in the workload associated with the Agent Orange presumptive
conditions that were recently added, which we assumed to mostly impact
FY 2012. In addition, Insurance expects a decline in the general
workload for all other administered programs that are closed to new
issues. The management support FTE reduction is based on the decline in
direct Insurance personnel.
GOE, General Administration Questions
Question 40: What is the justification for the additional funding
of 20 FTE for the Enterprise Program Management Office of the Office of
Policy and Planning?
Response: The Office of Policy and Planning (OPP) is not requesting
an additional 20 FTE or additional funding, simply a different source
of funding. In FY 2012 OPP had funded the enterprise Program Management
Office (ePMO) through reimbursements from the Administrations and
Office of Information and Technology. In FY 2013, the budget requests a
direct appropriation for that office. OPP's actual funding level
remains the same as in fiscal 2012.
The VA established the ePMO in late FY 2010 to ensure successful
transition of the Department's major initiatives into operational
status and foster the implementation of program management discipline,
standards, and doctrine throughout the Department. Since its inception,
the ePMO has executed a number of important actions including:
Set the conditions for and implemented a world class
program management organization, transforming Department-wide business
processes, and fostering accountability throughout the Department;
Mandated and executed detailed reviews and lockdowns of
major initiatives to provide independent assessment of progress,
identify barriers to success, and define solutions to ensure collective
execution;
Led cross-cutting teams to develop and complete overdue
acquisition packages in support of the 16 major programs; and
Provided program management support and operational
planning direction to the 16 major initiatives deemed critical by the
Secretary to transform VA into a 21st century organization.
Question 41: What portion of the Office of Public and
Intergovernmental Affairs budget is used on providing national
advertising campaigns to inform veterans and the public about services
and benefits provided by VA?
Response: The 2013 budget for OPIA does not include funding for
national advertising campaigns to inform veterans and the public about
services and benefits provided by VA. OPIA leads Departmental efforts
to develop advertising campaigns. For example, OPIA worked with VHA in
the production and placement of public service announcements for the
National Veterans Awareness Campaign.
Question 42: The budget documents state that the National Veterans
Outreach Office of the Office of Public and Intergovernmental Affairs
is working to develop a system to track the performance of VA's
outreach programs. When do you expect this tracking system to be
complete and what type of data will it collect?
Response: VA created the National Veterans Outreach Office (NVO)
within the Office of Public and Intergovernmental Affairs (OPIA) in FY
2010 to coordinate outreach throughout VA, and to standardize outreach-
related activities. We are working diligently towards being able to
track the costs of outreach VA-wide. Among other approaches, this
requires a proposal to build a universal system to track outreach
across VA. This could potentially require IT funding and other
resources and support. The NVO has made considerable progress in
researching and analyzing VA's outreach programs and activities in
2011, and has already developed a framework for an effective approach
to tracking outreach in support of VA's major initiatives. The final
plan includes building a process for VA's administrations (VHA, VBA and
NCA) and staff offices to:
provide Veterans with high-quality products and
information on activities that are consistent;
provide trained outreach coordinators to assist Veterans;
evaluate and develop metrics to measure the effectiveness
of outreach programs; and
track costs associated with outreach programs.
Recognizing the need for centralized outreach management, NVO has
developed the first resources that provide critical and consistent
information to VA's Outreach community:
An intranet site that houses important information to
enhance how VA Outreach coordinators execute outreach including
policies and procedures, the National Veterans Outreach Guide, links to
the Congressionally mandated 2010 Biennial Report to Congress on the
VA's outreach activities, and other links. An online National Veterans
Outreach Guide that provides best business practices, expert
recommendations, proven examples of successful VA outreach activities
in serving Veterans, and lessons learned. This guide outlines processes
for how to conduct outreach events, track expenditures, measure the
success of activities and tap into key VA resources and contacts, plus
so much more.
Next steps include finalizing a proposal, mentioned
above, for a robust National Veterans Outreach System (NVOS) which will
allow VA Outreach leaders to populate a series of fields with
information about planned outreach activities. The NVOS will be an
interactive tool that allows users to systematically and uniformly
enter, store, organize, view, retrieve and report outreach-related data
easily. The goal of the database is to provide a more advanced, easy-
to-use tool that may either be used in concert with existing data
collection methods or replace less efficient and effective approaches.
It would also provide the data necessary to extract any number of data
pulls including the costs associated with outreach in a fiscal year and
the number of events executed.
Question 43: Please provide more information about the Homeless
Veteran Supportive Employment Program and what type of jobs and wages/
salary the 360 homeless or formally homeless veterans are doing as part
of this program.
Response: The Homeless Veteran Supported Employment Program (HVSEP)
is a collaborative effort between the Compensated Work Therapy (CWT)
and the Veterans Health Administration (VHA) Homeless Programs.
Homeless, formerly homeless, or at- risk of homelessness Veterans were
hired as Vocational Rehabilitation Specialists (VRSs) at the GS-1715-5,
7, or 9 levels; the exact amount of these salaries are dependent on the
geographic location of the position. The VRSs are administratively
assigned to and supervised by the CWT Program Manager and functionally
assigned to work within the various homeless teams. These VRSs provide
vocational assistance, customized job development, competitive
community placement, and ongoing employment supports designed to
improve employment outcomes among the homeless Veterans that they
serve. As of March 30, 2012, 366 (91 percent) of the 402 approved full-
time equivalents (FTE) VRS positions were filled by homeless or
formerly homeless Veterans in HVSEP.
Question 44: How does the Office of Public Affairs and
Intergovernmental Affairs measure what percent of news coverage is
positive or neutral in tone as listed in the office's performance
measures?
Response: VA contracts with a private sector company to provide the
Department's daily news clippings for senior leadership. That contract
includes characterizations by the contractor of the tone of each news
story. Tone is expressed as one of three categories: positive, neutral,
or negative.
Question 45: The performance measures for the Office of
Congressional and Legislative Affairs tracks the percentage of
testimony submitted to Congress within the required timeframe,
percentage of responses to pre- and post-hearing questions that are
submitted to Congress within the required timeframe, and the percentage
of title 38 reports that are submitted to Congress within the required
timeframe. What is the definition of the ``required timeframe'' for
each of these measures and who sets this definition?
Response: The definitions of ``required timeframe'' for testimony
and questions for the record are set by the Committee. As per the
Committee rules, written testimony is due 48 hours in advance of the
hearing. The specific due date for questions for the record is set in
the Committee letter transmitting the questions for the record to the
Department. There are times when a due date is amended based on mutual
agreement between committee and VA staff. If the due date is amended,
the new date is used to compute the performance metric. The ``required
timeframe'' for Title 38 reports is set by the applicable statue
requiring the submission of the report.
POST-HEARING RESPONSES FROM THE DEPARTMENT OF VETERANS AFFAIRS (VA),
SUBMITTED BY THE HON. BOB FILNER, RANKING DEMOCRATIC MEMBER
Question 1: The budget request contains ``operational
improvements'' that total $1.3 billion dollars.
a. How is VA tracking the success of those operational
improvements?
Response: VA is tracking progress of each of the six operational
improvements on a monthly basis with status reports from the field and
the responsible program office.
b. Who at VA is responsible for tracking the savings?
Response: Each of the six operational improvements is assigned to a
specific program office to track and report the monthly progress of
each initiative as listed below. The VHA Office of Finance is
responsible for consolidating the tracking of these savings.
1.) Fee Care Payments Consistent with Medicare (VHA Business
Office)
2.) Fee Care (VHA Business Office)
3.) Clinical Staff & Resource Realignment (VHA Office of Finance &
VHA Office of Health Operations & Management)
4.) Medical & Administrative Support (VHA Office of Finance & VHA
Office of Health Operations & Management)
5.) Acquisition Improvements (VHA Office of Health Operations &
Management)
6.) VA Real Property Cost Savings & Innovation Plan (VA Office of
Management)
c. The Committee would like mid-year fiscal year 2012, and 2013
reports that delineate in detail, these savings.
Response: VA will provide the mid-year data for FY 2012 when it is
available. There is a time lag in reporting for some of the initiatives
and we do not currently have the first full six months of data
available for all six initiatives. Also, as identified in a recent GAO
report (GAO-12-305, February 2012) and VA's response to that report,
initiatives 3, 4, and 5 (listed in answer # 1b above) are being revised
and are not anticipated to be completed until the end of May. The
following is the current status for FY 2012:
Operational Improvements
Dollars in Millions
--------------------------------------------------------------------------------------------------------------------------------------------------------
Description FY 2012 as of:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Fee Care Payments Consistent with Medicare ($230) March 2012
Fee Care Savings ($109) February 2012
Clinical Staff and Resource Realignment (1) $0 January 2012
Medical & Administrative Support Savings (2) ($69) December 2011
Acquisition Improvements (3) $45 March 2012
VA Real Property Cost Savings & Innovation Plan (4) ($66) March 2012
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total Operational Improvements ($519)
--------------------------------------------------------------------------------------------------------------------------------------------------------
(1),(2),(3) Methodology under revision
(4) Updated quarterly
Question 2: The Caregivers and Veterans Omnibus Health Services Act
of 2010 significantly expanded benefits for caregivers and increased
services for women and rural veterans. Your request for 2013 and 2014
is $278 million, respectively.
a. Have all of the sections of this law been fully implemented? If
not, why not?
b. Please provide to the Committee a full accounting of
expenditures and a time line for the full implementation of the
Caregivers Act to date.
Response: Response: Many of the provisions of the Caregivers and
Veterans Omnibus Health Services Act of 2010 have been implemented. The
table below provides a status of each of these sections as of April 26,
2012 and the narrative that follows provides an explanation of terms
and an update on those provisions that are still in development. The
``Amount Spent'' column refers to funds used to comply with Public Law
111-163, not for the broader program referenced.
----------------------------------------------------------------------------------------------------------------
Amount Spent
Title or Date Completed or Target (if Date Amount
Section Summary Status* Completion applicable) Spent was
(000s)** Pulled
----------------------------------------------------------------------------------------------------------------
Title I Family Caregiver Program IO May 5, 2011 (Interim $36,219 2/29/12
Final Rule Published)
----------------------------------------------------------------------------------------------------------------
201 Study on Women Veterans IO Awarded contract $52 4/4/12
February 1, 2012
----------------------------------------------------------------------------------------------------------------
202 Training for MST/PTSD IO MST Coordinators and VISN- $765 Data was
level Points of Contact pulled for
completed training by from the
June 30, 2011; Directive beginning of
establishing the training FY2011
as mandatory for all through
mental health and primary FY2012. Some
care providers approved of the listed
January 23, 2012. First $765, 000 has
annual report submitted been
January 4, 2012 obligated but
not spent -
but it will
be spent by
the end of
this year.
----------------------------------------------------------------------------------------------------------------
203 Women Veterans Retreats IO First retreat held June $265 4/9/2012
6, 2011
----------------------------------------------------------------------------------------------------------------
204 Women and Minority FI May 5, 2010 (already in $0
Advisory Committees compliance)
----------------------------------------------------------------------------------------------------------------
205 Child Care Pilot IO First site began offering $966 2/10/2012
services October 2, 2011
----------------------------------------------------------------------------------------------------------------
206 Newborn Care IO Initial Guidance provided $4,334 5/10/2012
August 18, 2010
Final Rule published
December 19, 2011
----------------------------------------------------------------------------------------------------------------
301 Education Debt Reduction ID Estimated publication of $0
Program updated policy by
September 2012
----------------------------------------------------------------------------------------------------------------
302 Visual Impairment ID Regulations in $0
Scholarship development; estimated
publication of final rule
by January 1, 2014
----------------------------------------------------------------------------------------------------------------
303 Rural Health Pilot NI This is a permissive $0
Programs authority and not a
statutory mandate. VA
believes numerous
interagency pursuits with
IHS and HHS make use of
this authority
unnecessary. Notified
Committee on May 17,
2012.
----------------------------------------------------------------------------------------------------------------
304 Peer Outreach for IO Will begin hiring support $0
Veterans specialists in fourth
quarter FY 2012; continue
hiring through FY 2013
(target completion: end
of FY 2013)
----------------------------------------------------------------------------------------------------------------
305 Travel/Reimbursement ID Beneficiary Travel $0
Benefits Handbook re-published
July 23, 2010; estimated
publication of final rule
by December 1, 2013
----------------------------------------------------------------------------------------------------------------
306 Physician Incentive Pilot NI Notified Committee of $0
inadequate physician
interest to proceed with
the pilot on ZJanuary 4,
2012
----------------------------------------------------------------------------------------------------------------
307 VSO Transportation Grants IO Proposed rule published $0
December 30, 2011;
estimated publication of
final rule by February 1,
2013
----------------------------------------------------------------------------------------------------------------
308 Amendment to P.L. 110- FI Federal Register notice $0
387, Section 403 (Project published August 15, 2011
ARCH)
----------------------------------------------------------------------------------------------------------------
401 Servicemember Eligibility ID Proposed rule published $0
for Readjustment March 12, 2012; estimated
Counseling publication of final rule
by February 1, 2013
----------------------------------------------------------------------------------------------------------------
402 Vet Center Referrals IO Proposed rule published $0
March 12, 2012; estimated
publication of final rule
by February 1, 2013
----------------------------------------------------------------------------------------------------------------
403 Veteran Suicide Study IO Data on suicide/mortality $0
received or committed to
by 49 states; Advisory
Board meeting targeted
third quarter FY 2012
----------------------------------------------------------------------------------------------------------------
501 Elimination of Annual N/A Not applicable $0
Reports
----------------------------------------------------------------------------------------------------------------
502 Gulf War Research Report N/A Not applicable $0
----------------------------------------------------------------------------------------------------------------
503 CHAMPVA Payments IO Estimated publication $0
date of final rule by
December 31, 2014
----------------------------------------------------------------------------------------------------------------
504 Patient Information FI Final rule published $0
Disclosure February 8, 2011
Published revised VA Form
10-0137 in September 2011
----------------------------------------------------------------------------------------------------------------
505 Quality Management IO Quality management $0
officers in place; report
provided to Congress on
December 21, 2010
----------------------------------------------------------------------------------------------------------------
506 Outreach Pilot ID Developing regulations; $75 4/8/2012
estimated publication of
final rule in First
Quarter FY 2013
----------------------------------------------------------------------------------------------------------------
507 Residential TBI Care IO VA began pilot program on $39 4/9/2012
assisted living October
6, 2009; VA is continuing
this pilot program and
will use the results to
determine best use of
section 507 authority
----------------------------------------------------------------------------------------------------------------
508 IOM Project SHAD Study IO Study began June 1, 2011 $2,215 5/18/2012
----------------------------------------------------------------------------------------------------------------
509 Non-VA TBI Care IO Written guidance $335 05/17/2012
distributed to field on
October 1, 2010
----------------------------------------------------------------------------------------------------------------
510 Dental Insurance Pilot ID Proposed rule published $0
March 1, 2012; estimated
publication of final rule
by January 1, 2013
----------------------------------------------------------------------------------------------------------------
511 Prohibition of Copayments IO Information Technology $0
changes partially
implemented September 19,
2011; additional changes
to be made in May, 2012.
Final rule published
August 22, 2011
----------------------------------------------------------------------------------------------------------------
512 Medal of Honor FI Final rule published $0
Eligibility August 22, 2011
----------------------------------------------------------------------------------------------------------------
513 Herbicide and Gulf War FI Final rule published $0
Veteran Eligibility August 22, 2011
----------------------------------------------------------------------------------------------------------------
514 Physician Assistant FI Position filled on $0
Director February 27, 2011
----------------------------------------------------------------------------------------------------------------
515 Special Committee on TBI FI First committee meeting $0
held June 2011
----------------------------------------------------------------------------------------------------------------
516 HISA Grant Increase IO Payments being made; $32 4th Quarter
estimated publication of FY 2010 - 2nd
final rule by September Quarter FY
1, 2014 2012
----------------------------------------------------------------------------------------------------------------
517 Extension of Nursing Home N/A Not applicable $0
and Hospital Copayments
Authority
----------------------------------------------------------------------------------------------------------------
518 Health Plan Repayment N/A Not applicable $0
----------------------------------------------------------------------------------------------------------------
601 Health Care Retention ID VA Handbook 5007 $0
revisions completed on
March 12, 2012.
Retroactive premium
payment for registered
nurses pending;
disbursement is pending
modification of DFAS
(estimated completion
second quarter FY 2013)
----------------------------------------------------------------------------------------------------------------
602 Nurse Working Hours ID Developing policies for $0
Handbook 5011; estimated
publication on October
31, 2012
----------------------------------------------------------------------------------------------------------------
603 Health Professional ID Regulations in $0
Scholarship development; estimated
publication by January 1,
2014
Anticipate awarding
scholarships beginning
summer 2014 semester
----------------------------------------------------------------------------------------------------------------
604 Clinical Research ID Regulations in $0
Scholarship development; estimated
publication by fourth
quarter FY 2014
----------------------------------------------------------------------------------------------------------------
701 GPD for Non-Conforming NI This is a permissive $0
Entities authority and not a
statutory mandate. VA
believes it will not be
of practical use and
would be inefficient to
pursue. Notified
Committee on May 17,
2012.
----------------------------------------------------------------------------------------------------------------
Title VIII Non-Profit Research FI Published updated $0
Corporations Handbook 1200.17 on
December 8, 2010
----------------------------------------------------------------------------------------------------------------
Title IX Construction/Facility FI Last facility$0eld
Naming renaming ceremony on
September 11, 2010
----------------------------------------------------------------------------------------------------------------
1001 Expanded Authority for VA ID Pending Department of $0
Police Justice (DoJ) approval;
VA defers to DoJ on the
timing of this approval
----------------------------------------------------------------------------------------------------------------
1002 VA Police Officer ID Payments to begin Third $0
Allowance Quarter FY 2012
----------------------------------------------------------------------------------------------------------------
* Status refers to fully implemented (FI), implemented and ongoing (IO), not implementing (NI), in development
(ID), or not applicable (N/A). Fully implemented provisions are those where VA has completed all elements of
the law and no further action is required. Implemented and ongoing are those are those provisions where VA is
continuing to administer programs, benefits, or services as required by law. Provisions VA is ``not
implementing'' refer to those where authority is permissive or where VA has notified the Committees that,
after taking steps to implement the program, further implementation became unfeasible or inadvisable.
Provisions that are ``in development'' are still undergoing necessary preparations (usually developing
regulations) before the Department can begin administering benefits or services. ``Not applicable'' (NA)
provisions refer to those sections where no Departmental action was required.
** Some entries in the ``Amount Spent'' column reflect $0. This may be for several reasons. First, the
Department may have already been in compliance with the requirements of the law, and therefore no additional
funds were needed. Second, there may have been no action called for by the Department (such as an extension of
authority or an elimination of a report), or the law may have only modified VA's internal organization
resulting in negligible costs (such as Title VIII's provisions regarding non-profit research corporations or
the renaming of a facility). Third, the Department may be opting to not exercise a permissive authority in the
law, in which case no additional funds were needed. Fourth, the Department may be working to execute a program
but it has not yet begun to deliver the benefits (for example, if regulations are required and a final rule
has not yet been published). Finally, the Department may not have a mechanism to reliably separate out the
costs from a change required by the law and identify the additional resources allocated for a specific
provision (for example, VA cannot calculate the actual increase in costs resulting from enrolling Medal of
Honor recipients in a higher priority group).
Status of Provisions ``In Development'':
Section 301 (Education Debt Reduction Program): On June 13, 2011,
the Under Secretary for Health authorized implementation of the changes
permitted in P.L. 111-163 while the revisions of VHA Directive 1021 and
VHA Handbook 1021.01 were undergoing revision. VA anticipates the
revised Directive and Handbook to be published by September 2012.
Section 302 (Visual Impairment Scholarship Program): VA is drafting
regulations and anticipates publication of a final rule by January 1,
2014. VA is aiming to provide the first 30 Visual Impairment
Scholarships for the summer semester of 2014.
Section 305 (Travel/Reimbursement Benefits): VA is currently
developing regulations to implement a broad update to VA's beneficiary
travel program and is including the statutory revisions from section
305 as part of that package. Beneficiary Travel benefits for family
caregivers were implemented under current, existing authority. VA
expects the remaining changes will be published by December 1, 2013.
Section 401 (Servicemember Eligibility for Readjustment
Counseling): VA published a proposed rule on March 12, 2012, and the
period for public comment closed on May 12, 2012. At that time, we will
draft a final rule to address any public comments and submit a proposed
final rule to the Office of Management and Budget for a 90-day review
period. We anticipate publication of a final rule by February 1, 2013.
Section 506 (Outreach Pilot): VA is developing regulations to
establish a pilot program and anticipates publication by the first
quarter of FY 2013. The pilot program would be conducted through
grantees during fiscal years 2013 and 2014 before ending in 2015, when
VA will submit a report to Congress on the results of the program.
Section 510 (Dental Insurance Pilot): The proposed rule was
published March 1, 2012. The public comment period closed April 30,
2012. At that time, we will draft a final rule to address any public
comments and submit a proposed final rule to the Office of Management
and Budget for a 90-day review period. We anticipate publication of a
final rule by February 1, 2013. The Request for Proposal for the dental
contracts will be issued to coincide with the publication of the final
rule.
Section 601 (Health Care Retention): VA has implemented all
provisions of section 601 except subsection (k), which changes the rate
of premium pay for registered nurses retroactive to May 5, 2010. VA is
calculating the hours that are creditable as premium pay and will make
these payments to eligible nurses when modifications to Defense
Financing and Accounting Services (DFAS) are completed. VA expects this
to be complete by the second quarter of FY 2013.
Section 602 (Nurse Working Hours): VA has disseminated information
about the statutory changes to its facilities; VA has proposed policy
revisions regarding the restrictions on overtime duty for nurses and
other occupations. Currently, a review is ongoing to compare proposed
language with union contracts. VA would prefer to provide situational
guidance as advisory supervisory guidance, rather than publishing a
formal policy. This guidance would identify specific situations and
provide advice on how to handle these scenarios, including when
overtime remains appropriate. VA anticipates this guidance will be
completed by October 31, 2012.
Section 603 (Health Professional Scholarship): VA is developing
regulations with a projected publication date by November 2013. VA
anticipates providing the first 100 scholarship awards for the summer
semester of 2014.
Section 604 (Clinical Research Scholarship): VHA's Healthcare
Retention and Recruitment Office is working with VHA's Office of
Regulatory Affairs and Office of Research and Development to prepare
draft regulations. VA estimates publication of these regulations by
fourth quarter FY 2014.
Section 1001 (Expanded Authority for VA Police): VA has developed a
proposed policy defining the use of this expanded authority and has
submitted it to the Department of Justice (DoJ) for review. When DoJ
approves the policy, VA will begin implementing it.
Section 1002 (VA Police Office Allowance): VA has updated specific
uniform requirements in VA Handbook 0730 and completed a survey of
costs. VA has also obtained policy approval from the VA administrations
and its labor partners. VA will implement the new allowance beginning
third quarter of fiscal year 2012.
a. Please provide to the Committee a full accounting of
expenditures and a time line for the full implementation of the
Caregivers Act to date.
Response: The table in the previous response includes an account of
when each provision of the bill was fully implemented or when we
anticipate it will be.
Question 3: Please provide the Committee with a detailed timeline
of the steps that led to the formulation of the FY 2013 budget request
and FY 2014 advance appropriation recommendation.
Response: The following is a timeline for formulation of the FY
2013 budget request and FY 2014 advance appropriation request:
Department of Veterans Affairs
Timeline of Formulation of 2013 Budget
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April 2011 VA issues internal call letter for 2013/2014 budget proposals
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May 2011 VA Administrations develop 2013 budget, program, and legislative proposals;
and the 2014 Advance Appropriation (AA) request for medical care
----------------------------------------------------------------------------------------------------------------
June 2011 VA construction budget proposals for 2013 prioritized through Strategic
Capital Investment Planing (SCIP) process
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July 2011 VA leadership considers the 2013/2014 budget proposals
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August 2011 VA prepares OMB budget submission
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September 2011 VA submits 2013 budget to OMB with the 2014 AA request
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November 2011 VA receives OMB Passback of 2013/2014 budget decisions
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December 2011 VA and OMB reach agreement on budget levels
----------------------------------------------------------------------------------------------------------------
January 2012 VA prepares 2013 Congressional Budget Justifications
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February 2012 President's 2013 Budget transmitted to Congress, including the President's
2014 AA request for medical care
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Question 4: You have asked for $119.4 million for the Veterans
Relationship Management (VRM) initiative. Please provide more detail on
what VRM is and how this initiative will fundamentally transform
veterans' access to VA benefits and services. In addition to providing
more detail please answer the following questions:
Response: The Veterans Relationship Management (VRM) initiative
provides Veterans and VA clients with secure, on-demand access to
comprehensive VA services and benefits. These enhancements ensure that
VA clients have a direct path to consistently accurate information and
can perform multiple, self-service transactions. VRM also provides VA
employees with up-to-date tools to better serve Veterans and their
families. VRM's accomplishments to date include:
41 Self-Service Features Accessible via eBenefits:
Examples of these features include: access to the Post-9/11 GI Bill
application; the ability to generate letters such as service
verification letters and preference letters for hiring; access to 10-
10EZ form to apply for VHA services; and the ability to apply for a
Veteran's Group Life Insurance policy or view and update information
for an existing policy.
Improvements to Veterans On-Line Application (VONAPP)
Direct Connect (VDC): VDC moves VBA closer to a paperless model by
allowing users to securely submit and track claims for benefits
electronically through the eBenefits portal. VDC presents pre-
populated, interview-style questions to users and navigates them
through the entire online claim submission process. Currently, VA is
exploring VDC as one of the integration points between the Veterans
Benefits Management System (VBMS) and eBenefits. Claims filed through
eBenefits will use VDC, and the information and data received will be
loaded into VBMS.
Enhanced Telephone Features: Callers to VBA's line are
now routed to the best skilled agent through a national queue. Callers
can also choose to be called back automatically rather than wait on
hold, or pick a date and time to be called back. All calls are recorded
for quality assurance to identify training needs, and select calls are
included in a best quality call library.
Customer Relationship Management/Unified Desktop (CRM/
UD): Pilots have been conducted to provide VA call center employees a
view of VA clients' information through one integrated application
rather than up to 13 applications during a single phone call. CRM/UD
improves call center business processes, provides the capability to
capture and track caller history, improves information presentation to
facilitate first-contact resolution, and aids in personalizing call
service to Veterans.
In FY 2013, the VRM initiative will accomplish the following
strategic business objectives:
Expand access to information and services available
online that promote Veteran self-service, including the capability to
apply for benefits (electronic interview process) via the eBenefits
portal;
Expand CRM and telephone capabilities to provide clients
with a higher quality of customer service and enhanced self-service
options via interactive voice response;
Identify and grant access to VA's external stakeholders,
including VSOs, business partners, and service providers, through a
stakeholder enterprise portal;
Implement a personal identity management framework,
allowing Veterans and their authorized representatives a standard and
consistent way to verify their identity across VA, whether interacting
by phone, e-mail, internet, or other access channels; and
Expand upon information available to VA staff and
communicated to clients.
a. How are you tracking the accuracy of the answers provided once
the veteran is either called back from the virtual hold or has a
scheduled call back?
Response: All calls are recorded. Each month, call recordings are
evaluated locally for each agent and nationally by a quality assurance
group. All calls are reviewed for technical proficiency, security
identification protocol, client contact behaviors, and first-call
resolution. We also use a Voice of the Veteran customer satisfaction
survey in which callers assess attributes such as the agent's concern
for caller needs and usefulness of information provided. This customer
satisfaction survey system allows VA to monitor customer satisfaction
and make improvements as needed.
b. How are you tracking the accuracy of what the veteran is told?
Response: Calls are tracked by technical proficiency, security
identification protocol, customer service-client contact behaviors, and
first-call resolution. Quality evaluations are consistently performed
on a monthly basis, to include reviews of system data available at the
time of the call, to ensure completeness of answers.
Question 5: In the 2013 budget you request $433 million for the
Patient-Centered Care initiative, a new model of patient-centered care,
that is organized under the Enhancing the Veteran Experience and Access
to Healthcare (EVEAH) initiative.
a. What are the three major differences in this initiative that
will help VA support the culture change necessary to become a more
patient-centered health care system? Please be specific.
b. How do you propose to establish a partnership among the primary
care team, veteran patients, and their families or caregivers? What
elements are in the plan and do you have a proposed timeline?
c. You also state in your budget request that every one of our
transformation efforts embody some component of patient- centered care.
Please explain that statement and how it relates to the EVEAH.
d. How many transformation efforts are currently underway and what
are they?
Response: The $433 million requested in the President's budget was
for New Models of Care. These efforts to change the way we deliver
health care for Veterans, as you note, all embody patient-centered
concepts. We have a specific initiative in the Major Initiative called
``Enhancing the Veteran Experience and Access to Health care'' (EVEAH)
which contains a specific Patient Centered Care (PCC) sub-initiative
focused on a more systematic change in VHA business and clinical
practices. We have requested $120 million for EVEAH in FY 2013 and
budgeted $55 million to support PCC.
a. What are the three major differences in this initiative that
will help VA support the culture change necessary to become a more
patient-centered health care system? Please be specific.
Response: The Office of Patient Centered Care (PCC) has
responsibility 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. The office will work directly with
Network and medical center leadership to bring about these changes. To
accomplish this goal they have created a virtual office with field-
based experts capable of assisting medical center leadership with this
transformation.
A literature review suggested that some private sector
organizations that have adopted similar patient care principles have
realized economic returns on that investment. For example, some studies
have found that patients tend to have shorter hospital stays. After
reviewing the evidence, we felt that there was not enough specific data
to do a formal return on investment analysis. That said, 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 has undertaken this initiative to craft standards and
programs that are best aligned with our very unique mission and patient
population. We do expect many of the necessary changes at the patient
care level can easily be accomplished within existing resources and
will improve patient satisfaction and quality outcomes.
Much of the resources for the New Models of Care initiative have
been used to fund pilot projects at medical centers. These projects are
designed to help facilities with local innovations. We have also
established 5 (and plan 4 more) Centers of Excellence to adapt, test,
evaluate, and refine patient centered care concepts. The new PCC office
will also 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.
b. How do you propose to establish a partnership among the primary
care team, veteran patients, and their families or caregivers? What
elements are in the plan and do you have a proposed timeline?
Response: Over the last three years, our efforts to transform
primary care into a patient centered medical home model (our Patient
Aligned Care Teams or PACT) have focused on staffing and building the
necessary infrastructure. A major training effort has been underway for
the last two years to train all PACT teams across the country and to
assist teams to change their clinical practices to meet the goals of
this transformation. This training has included information on
relationship-based care.
One of the underlying principles of the medical home model is
active patient engagement. We intend that patients will be able to
develop a personal plan for their health and health care. As part of
this initiative, we are acquiring and adapting for the Veteran
population a web-based Health Risk Assessment tool that patients will
complete. Teams will be able to use those results to help patients
develop a personalized health plan. We have hired Health Promotion and
Disease Prevention Coordinators and Behavioral Health Coaches at every
medical center. A significant part of their job is to provide training
and support to PACT teams to help them gain the skills to be able to
actively partner with patients, families or caregivers to improve
health outcomes. Enhancements to MyHealtheVet, the deployment of secure
messaging, and through our mobile application development will allow
patients greater access to health information and to their caregivers.
c. You also state in your budget request that every one of our
transformation efforts embody some component of patient- centered care.
Please explain that statement and how it relates to the EVEAH.
Response: All of our Major Initiative efforts are aimed at
improving the experience patients have when accessing VHA health care
services. If we improve the access to care, coordination of services,
and find meaningful and effective ways of personalizing health services
to better engage patients and their families in their health and health
care, we expect to be able to improve health outcomes. Our EVEAH Major
Initiative contains our plans to develop a broad patient centered
culture - redesigning all our clinical and business activities around
specific patient centered principles. For example, we have worked over
the last several years to revise facility design guides to incorporate
patient centered design elements that will be used to remodel or build
new space. EVEAH also contains our System Redesign sub-initiative that
is working with both outpatient and inpatient teams to reengineer
clinical and business processes.
d. How many transformation efforts are currently underway and what
are they?
Response: There are 16 Major Initiatives in VA's Strategic Plan
Refresh for FY 2011-2015. These cross-cutting and high-impact priority
efforts were designed to address the most visible and urgent issues in
VA. These initiatives are on track for completion by 2015; many of them
are now transitioning toward sustainment. They will strengthen VA's
ability to meet the evolving needs of Veterans and their families.
VHA's efforts are focused on transforming our care to be more Veteran
centered, more coordinated, more accessible, and more efficient.
For each of the six transformation initiative related to health
care, VHA has created operating plans, which outline the goals, means,
milestones, and resources required to achieve the initiatives outlined
in the VA Strategic Plan. These are the VHA FY 2011-2013 Operating
Plans. Collectively, these efforts transform VA healthcare to be the
patient-centered, integrated system that this plan envisions.
Leadership, creativity, prudent risk taking, and a disciplined effort
to learn from our effort will be required to successfully make this
journey. When we do this well, we not only will transform our system of
care, but the lives of those who nobly served this Nation.
----------------------------------------------------------------------------------------------------------------
Major Initiative Brief Description
----------------------------------------------------------------------------------------------------------------
New Models of Health Care (NMOC) Design a Veteran-centric health care model to help Veterans navigate
the health care delivery system and receive coordinated care.
NMOC is a portfolio of initiatives created to fundamentally improve
the experience for America's Veterans when accessing VA healthcare services.
This initiative is aimed at transforming our Primary Care services into a
medical home model (our Patient Aligned Care Teams or PACT), aligning our
specialty care services to better support PACT teams and their patients, and
improving access by adopting various eHealth technologies.
Enhancing the Veteran Experience The EVEAH Initiative includes:
and Access to Health Care
(EVEAH)
Eliminate Veteran Homelessness VA has developed a Plan to End Homelessness that will assist every
eligible homeless Veteran willing to accept services. VA will help Veterans
acquire safe housing; needed treatment services; opportunities to return to
employment; and benefits assistance.
Improve Veterans' Mental Health VHA must provide Veterans with meaningful choices among effective
treatments, balancing biological and biomedical approaches to care with
psychological and psychosocial strategies. Knowing that mental health is not
only a function of medical care, VHA must work to connect Veterans with
support services through technology and in their communities. VHA must also
partner with the Department of Defense (DoD) to identify and develop the most
effective practices for addressing mental health issues associated with
military service, and provide the appropriate mental health services
throughout the full continuum of service delivery.
Perform research and development Two long-term transformative programs that the Office of Research
to enhance the long-term health and Development is undertaking are genomic medicine and point of care
and well-being of Veterans research. 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. Point of care (POC) research is an intermediate strategy
between randomized clinical trial (RCT) and observational studies.
Health Care Efficiency: Improve Through this initiative VHA will begin to reduce operational costs
the quality of health care while and create more streamlined deployment of targeted program areas to enhance
reducing cost program efficiency across VHA.
Transform health care delivery These new initiatives will shape the future of VHA clinical
through health informatics information systems through deliberate application of health IT and
informatics to deliver solutions that transform health care delivery to
Veterans, and directly improve quality and accessibility, while optimizing
value.
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Question 6: Is the Patient Centered Community Care (PC3) part of
the Patient-Centered Care (PCC) initiative mentioned in the budget
request?
a. If it is not part of the PCC, please explain the difference
between the two initiatives.
Response: The Patient-Centered Care initiative is how VA intends to
change the care VA delivers. Patient-Centered Community Care (PC3) is a
new vehicle that will be used to purchase care if/when required. The
Patient-Centered Care initiative is working to evaluate and redesign
its primary care delivery system to a patient-centered model of care
focused on shared decision-making processes, patient-guided treatment,
and population management.
PC3 is an effort to improve the management and oversight of the
health care purchased for Veterans when VA facilities are not
geographically accessible, services are not available at a particular
facility, or when care cannot be provided in a timely manner. PC3 is
intended to standardize the overall processes, performance metrics and
outcomes for these services. It is not intended to replace VA health
care (managed within our Patient-Centered Care initiative). VA is in
the process of leveraging lessons learned from Project HERO and other
Purchased Care pilot programs to develop contracts that will ensure
Veterans receive coordinated, evidence-based care from non-VA
providers. We intend to apply the patient-centered focus of the
initiative to the care we purchase through the PC3 contract.
Question 7: Please explain the intent and rationale for the Non-VA
Care Coordination (NVCC) pilot program. Is VA coordinating the
implementation of NVCC with PC3? For example, has NVCC influenced the
development of the PC3 program?
Response: Non-VA Care Coordination (NVCC) is now in the
implementation phase. As identified during program improvement reviews
of the NVCC Program, VA determined that a more streamlined and
standardized process would assure better patient outcomes for Veterans.
NVCC was developed to meet that need. VA considers the NVCC standard
operating procedures (SOPs) integral to purchasing any community health
care services and will utilize these standardized processes in any
effort, including PC3. PC3 will not develop new procedures, but will
utilize the NVCC SOPs to assure that purchased care is appropriately
utilized, that VA care is considered prior to use of non-VA care and
that appropriate controls are in place to continually monitor and
oversee these services.
Question 8: When VA authorizes Fee care for veterans, it is
critical that VA does not lose track of these veterans and is able to
monitor them continuously as they receive care from both VA and non-VA
providers.
a. How will this be accomplished with the seemingly stove-piped
NVCC and PC3 initiatives?
Response: The NVCC program and PC3, both sponsored by VHA's Chief
Business Office (CBO), are efforts focused on ensuring Veterans receive
high quality and well-coordinated care from non-VA providers.
NVCC is intended to improve the efficiency and standardize the
processes for purchasing Fee care whether provided through a formal
contract or through traditional methods of utilizing an authorization
as the contract/negotiated agreement. PC3 is one vehicle we intend to
utilize to provide that care, approved, managed and monitored via the
processes implemented under the NVCC initiative. PC3 is an effort to
bring centrally supported contracts throughout VHA so that when the
decision is made to purchase care from the community, purchasing
vehicles are in place that include the quality, timeliness, and
services we need to support our Veterans. The two programs will work
hand in hand. NVCC front end processes will be in place for care
coordination, fee program standardization and improved efficiency
within VHA, and when it is determined the care must be purchased, PC3
contracts will be in place for obtaining the services. Both include
elements to ensure Veterans' care is well-coordinated and patient
centered.
To ensure proper care coordination, NVCC and PC3 utilize processes
that include a referral from a VA provider documenting the specific
care requested. The appointment process includes NVCC team coordination
with the Veteran and non VA provider, whether that is with a contracted
network (such as PC3) or directly with a community provider. The
appointment is tracked, monitored and managed by VA staff with
appropriate follow up procedures. Once the care is provided, the non-VA
provider will return supporting medical documentation to VA, so that it
can be scanned into the patient's electronic medical record (EMR) and
reviewed by the ordering VA provider. Any additional treatment requests
will be approved and coordinated by VA before the treatment is
provided.
a. What is VA's overall vision and intended outcome for NVCC and
PC3?
Response: NVCC and PC3 are efforts focused on ensuring Veterans
receive high-quality, well coordinated care from non-VA providers, when
VA cannot otherwise provide that care. The intended goals are:
- NVCC - to optimize and standardize non-VA care coordination
processes and tools across VHA's service networks, supporting program
consistency and equitable delivery of non VA care services.
- PC3 - to provide enterprise-wide contracts to purchase community-
based care that meets VA standards.
b. What assurance can you provide that this vision and strategy
will help VA achieve the intended outcomes?
Response: NVCC was piloted at four VAMCs, ensuring the model was
tested and obtains the intended results. Lessons learned and feedback
from the pilot sites, metric data, and patient satisfaction serve as
the foundation for development of the enterprise deployment plan. Based
on the success of the pilot, it is currently being rolled out
nationwide.
The PC3 contracts are being developed based on lessons learned from
the Congressionally-mandated Project HERO and other purchased care
pilot programs. VA has purchased care through the Project HERO
contracts since 2008, providing years of data and experience to
understand what works well and what does not work well in contracting
for care.
Question 9: Your operational improvements are vague and it is
unclear how these changes will generate savings. For example, Fee Care
savings are expected to be $200 million dollars by using an electronic
re-pricing tool, using contract and blanket ordering agreements,
decreasing contract hospital average daily census, decreasing duplicate
payments, decreasing interest penalty payments, and increasing revenue
generation through the use of automated tools.
a. Please explain the re-pricing tool that you are going to use. Is
it currently in place or is this a tool that is still being developed
or deployed and therefore not in use system wide?
Response: Claims repricing provides the VA Non-VA Care (Fee)
Program with access to economical community-based vendor contracts that
complement the VHA system of care. Since the program's inception, the
claims repricing program has reduced VA Fee Program expenditures by
millions of dollars, allowing VAMCs to achieve greater value from their
health care dollars. In FY 2011, this process was automated and is
currently in use system-wide. The automation resulted in an increased
number of claims submitted for repricing. From FY 2010 to FY 2011, the
number of submitted claims tripled.
b. How do you plan on decreasing contract hospital average daily
census? Do you have a timeline to do that? Is there guidance out in the
field to reduce the ADC in the contract hospitals? How will you track
these savings?
Response: VA identified the contract hospital ``bed days of care''
as an initiative intended to assess opportunities to reduce, when
appropriate, non-VA hospital stays. This initiative is not intended to
apply to all VA locations as some utilization of non-VA inpatient
services is required to provide timely and accessible care to Veterans.
This includes urgent services not readily available at a VA (such as a
CBOC referral to a local community hospital). VISNs are given broad
authority to determine when it is clinically appropriate to reduce bed
days of care, assuring that Veterans health care is not negatively
impacted. VA tracks these data by reviewing prior-year bed days of care
and comparing with current-year bed days of care. There is not a
reduction target but an effort to assuring stringent monitoring and
oversight of these services.
c. Please explain what automated tools you will be using to
increase revenue generation. Revenue from where and how will you be
tracking this?
Response: The VHA's CBO utilizes a number of automated tools to
improve revenue generation. These tools include insurance card scanners
for enhancing the accuracy of Insurance Capture; a workflow management
tool used to optimize revenue cycle activities conducted by VA's
Consolidated Patient Account Centers in areas such as billings,
accounts management follow-up, and cash posting; an Enterprise Wide
Denials Management system used to minimize Third Party Payer denials; a
coding software system that supports billing activity; and Fee Basis
Claims System Software used to identify 3rd party collection
opportunities when patients are referred to the private sector for
health care.
VHA's CBO also operates several business intelligence tools to
track, analyze and improve revenue cycle performance. These tools allow
VHA to develop automated data queries and analytical reports that
present performance metrics in a context that enables meaningful
analysis and performance-driven decision making. Increases in revenue
generation occur when problems and issues are discovered, analyzed and
resolved through the business intelligence process.
Question 10: I understand that the provision of dialysis services
is one of the biggest costs to the VA system. According to estimates
provided by the VA, over 27,000 veterans have End Stage Renal Disease
and approximately 16,500 of those veterans receive dialysis from the VA
either on contract with a provider or on an outpatient basis from a VA
facility. Many studies demonstrate that home-based dialysis therapies,
including peritoneal dialysis and home hemodialysis, are less costly
than in center hemodialysis, while providing equal, if not better,
patient outcomes. One analysis looking at the cost of dialysis to the
Medicare program found that a 5 percent increase in peritoneal dialysis
would generate savings to the Medicare program of up to $295 million a
year. It is my understanding that the utilization of home dialysis in
the VA is fairly low, even lower than the national average. What is the
VA doing to increase the use of home dialysis by veterans in the VA
system?
Response: Since 2001, VA has engaged in the following activities
related to home dialysis:
Completed a VA home dialysis capacity and needs
assessment of nephrology field;
VA home dialysis benefits guidance issued to field and
executive leadership;
Clarified VA home dialysis program to ensure compliance
with Joint Commission review standards;
Developing novel VAi2 sponsored chronic kidney disease
patient education tool, enriched for home dialysis as the preferred
modality of dialysis;
Assembled home dialysis task force and drafted charter;
Developing a Make-Buy model for VA home dialysis
programs;
Policy reviews planned for: Caregiver support, Logistics,
Telehealth Guidance; and
Veteran and care partner Focus Groups to be conducted to
identify patient perceived barriers and mitigation strategies.
a. How many VA facilities offer home dialysis as a outpatient
service?
Response: Currently, 37 VA medical centers directly offer home
dialysis services. All VAMCs can offer home dialysis indirectly though
fee basis.
b. Please provide a financial impact analysis to the committee of
every 1% increase in the utilization of home dialysis in the VA.
Response: VHA has tasked a working group to conduct a financial
impact analysis of every 1 percent increase in the utilization of home
dialysis in VA. At this time, the estimated completion date is early FY
2013.
Question 11: Do you have a plan in place and implemented to realign
clinical staff and resources that you say will save you $151 million?
Response: The objective is to have clinical staff working at the
``top of their license''. That is, duties that require a registered
nurse or a license practical nurse should not be performed by a
physician and duties that require a license practical nurse should not
be performed by either a physician or a registered nurse. To achieve
this long term objective will require an assessment of clinical staff
positions as they become vacant to ensure that they are filled with the
appropriate clinical personnel. At the current time VA does not have a
process for tracking the actual savings and this was addressed by the
GAO in their report (GAO-12-305, February 2012). In response to the GAO
report, a method for tracking these savings should be completed by the
end of May 2012.
a. Is this part of the patient centered care initiative?
Response: Yes. Proper alignment of clinical staff to perform at the
``top of their license'' is one of the desire components of this
initiative.
b. If you do have a plan, what is the timeline to realign these
resources and how are you tracking the effectiveness and efficiency of
this realignment?
Response: At the current time, VA does not have a process for
tracking the actual savings in the area of realigning clinical staff
and resources; this was addressed by the GAO in their report (GAO-12-
305, February 2012). In response to the GAO report, a method for
tracking these savings should be completed by the end of May 2012.
Question 12: Please explain how you will provide oversight and
account for the medical and administrative support savings in your
budget of $150 million by ``employing the resources in various medical
care, administrative, and support activities at each medical center and
in VISN and central office operations.''
Response: The objective of this initiative is to reduce the
controllable indirect cost for all VHA operations. Initially it was
designed to measure the difference between the actual and expected
percent of controllable indirect cost to total cost nationally and at
each facility. The recent GAO report (GAO-12-305, February 2012)
indicated that this approach may overstate such savings. VA is
currently revising the methodology used for this initiative and that
work is expected to be complete by the end of May 2012.
a. Do you have a plan in place?
Response: In response to the GAO report (GAO-12-305, February 2012)
a method for tracking these savings is being developed and should be
completed by the end of May 2012.
b. How are you tracking the savings?
Response: On a monthly basis using the method described in # 12
above, which is currently being revised.
Question 13: Acquisition improvements are projected to save $355
million dollars in 2013 and 2014. The eight bulleted statements in the
budget justification are vague regarding how you are implementing and
tracking these changes that should have associated savings attached to
them. In light of the recent Full Committee Hearing on the Pharmacy
Prime Vendor program and the subsequent numerous violations of the
Federal Acquisition Regulation (FAR) and the Veterans Affairs
Acquisition Regulation (VAAR) that were admitted to in the hearing:
a. What is the status of the 8 initiatives that you cite in the
budget justification and how are you tracking them? Who is responsible
for ensuring that these get done? The eight are:
i. Consolidated Contracting
ii. Increasing Competition
iii. Bring Back Contracting In House
iv. Reverse Auction Utilities
v. MED PDB/EZ Save
vi. Reduce Contracts
vii. Property Re-utilization
viii. Prime Vendor
Response: In its FY12 budget submission, VA identified $1.2B in
operational improvements, of which $355M was identified as savings
resulting from acquisition improvements. Initial FY12 roll-out included
initiatives carried over from the OMB-mandated FY10-11 Acquisition
Savings program (OMB Memorandum M-09-25, Improving Government
Acquisition, July 29, 2009). These included:
i. Consolidated Contracting
ii. Increasing Competition
iii. Bring Back Contracting In House
iv. Reverse Auction Utilities
v. MED PDB/EZ Save
vi. Reduce Contracts
vii. Property Re-utilization
viii. Prime Vendor
VHA convened an interdisciplinary Tiger Team in late Q1 of FY12 to
review and revise the VHA-specific acquisition savings initiatives
based, in part, on input received from GAO and OIG. That group was
chartered with providing recommendations to improve the program.
Specifically, the group was charged with proactively addressing
anticipated issues from the OIG report; providing more rigorous
definitions, methodology, documentation, review/internal auditing for
the program; identifying new initiatives; identifying other savings/
avoidance areas not previously captured; removing any carry-over
initiatives that risk double counting with other operation improvement
initiatives; and consolidating initiatives as necessary to ensure more
rigorous methodology. The revised and new initiatives recommended by
the team are identified below along with their definitions and
methodologies.
----------------------------------------------------------------------------------------------------------------
Initiative Definition Calculation(s)
----------------------------------------------------------------------------------------------------------------
FedBid* Dollar Value of savings realized through IGCE-award price
utilization of FedBid
NAC CoDollar value of savings realized through Calc 1: (Benchmark Quote from Facility -
the consolidation of high-tech equipment Award Price) - NAC surcharge
at the National Acquisition Center (NAC) Calc 2 (additional savings): Orig Quote -
Benchmark Quote
Medical Sharing Office Dollar value of savings related to the Proposal Price - Final Award Amount (for
negotiation with affiliated institutions current FY only)
Strategic Sourcing/FSSI Savings realized through the use of FSSI OEM less Remand price multiplied by
Vendors for toner cartridges utilization
ConSavings resulting from the use of VISN and (Previous Price - Price of Contractual
Regional contractual vehicles (including Vehicle) x # Units
vehicles such as contracts, BPAs, and
basic ordering agreements). Do not include
facility only contracts.
Increased CompetDollar value that can be attributed to (Previous Price - Current Price)
increased competition from contracts that X units if applicable
had been previously awarded sole source.
Ex: Construction or service contracts
previously sole sourced
Reverse Auction Dollar savings attributable to the reverse (Price of Utility unit before auction -
(Utilities) auction of utility contracts by GSA. Price of Utility unit after auction) x
usage
ContraDollar Value of savings related to the In-sourced contract cost - A-76 Total
cancellation of contracts. Includes
contracts that are no longer required due
to some administrative action such as in
sourcing.
Includes clinical contacts (Scarce
Medical; Nursing); Must offset savings by
any increased in-house costs.
Property Reutilization Dollar value of cost savings that results Depreciated Value - Shipping Costs
from the need to no longer procure new
supplies or equipment due to the
reutilization of property.
Negotiation Dollar value of savings realized through (Previous Price - New Price) x
negotiation with vendors. utilization
ContracDollar Value of reimbursement of fees Value of Fees Reimbursed by contractors
Check associated with contractor background less any administrative costs associated
checks. with obtaining those fees.
----------------------------------------------------------------------------------------------------------------
* Reverse Auctions Other than Utilities (current vendor is FedBid)
The team's recommendations were then provided to senior leadership
in March 2012, and subsequently communicated and rolled out to front-
line staff for execution in FY12 and into FY13-FY14. Six (6) training
sessions were provided to frontline staff on the new methodologies
between March 26 and April 9, 2012 with over 300 employees attending.
As of April 10, 2012, VHA has reported preliminary savings of $47M.
Frontline staff has been directed to review previous savings reports to
ensure that previous reports comply with the revised methodologies and
to identify any previously unreported savings from new initiatives.
Responsibility for capturing data, calculating savings, and
reporting are shared between Network Contracting Organizations,
Networks, and VHA Procurement & Logistics Office (P&LO). Monthly
savings reports are consolidated by P&LO and provided to the Office of
Acquisition and Logistics (OAL) for high level review and to the Office
of the VHA Chief Financial Officer for consolidation in the Monthly
Performance Report.
Question 14: The military has opened up and expanded some ``combat
roles'' to women. While VA has made great strides in their efforts to
embrace women veterans of all eras into the system, it took several
years to actually make that change - some of it due to lack of
recognition and failure to strategically plan for such a shift.
a. To what extent is VA preparing to anticipate and then address
the possible different health effects and exposures that may come with
this change?
Response: Women serving in Iraq and Afghanistan face combat
activity similar to their male counterparts. Therefore, women will
incur manyof the same service-related physical and mental disabilities.
VA is prepared to address the increase in combat related service-
connected disabilities for women Veterans through increased nationwide
outreach efforts. For example, VA has a Women Veterans Coordinator
(WVC) at each VBA regional office. WVCs advocates on behalf of women
Veterans concerning gender-specific issues. Additionally, WVCs
collaborate with Women Veterans Program Managers (WVPM) at local
Veterans Health Administration facilities to assist women Veterans
access VA benefits and healthcare services. VBA further maintains a
public website devoted to the unique issues associated with women
Veterans. As the role of women in the military continues to change, VBA
remains dedicated to keeping pace with the changing needs of women
Veterans and is prepared to ensure women Veterans' needs are met.
In recognition of the needs of the growing numbers of women
Veterans, Secretary Shinseki called for a Women Veterans Task Force to
develop a comprehensive VA plan that will focus on key issues facing
women Veterans and the specific actions needed to resolve them. In
developing this action plan, the Task Force examined a broad set of
issues affecting women Veterans and VA's current efforts to close these
gaps.
In 2009, VA started The Long Term Health Outcomes of Women's
Service During the Vietnam Era study. This comprehensive study of the
mental and physical health of women Vietnam Veterans was initiated to
shape future research to plan for appropriate services for women
Veterans. VA has recognized the potential for increased exposures and
has added specific questions to several scientific studies of Veterans.
For example, The National Health Study for a New Generation of U.S.
Veterans has oversampled female Veterans and has posed specific
questions concerning female health and reproductive issues. These
questions include any history of sexual trauma, birth and miscarriage
information, and changes in gynecological health such as cessation of
menstruation. Other studies of traumatic brain injuries specifically
investigate any additional adverse health outcomes in female Veterans.
These and other studies will allow VA to fully understand the impact of
combat deployments, to include the potential for adverse health effects
related to environmental exposures, on female Veterans.
The number of women Veterans using VA health care services has
doubled since 2000, from almost 160,000 to more than 337,000 in FY
2011. While the overall Veteran population is declining, the number of
women Veterans is on the rise. Among women Veterans of Operation Iraqi
Freedom, Operation Enduring Freedom and Operation New Dawn, 55.5
percent have enrolled for VA care; of this group, 89.2 percent have
used VA regularly.
Since FY 2010, VA has trained over 1,200 providers in women's
health, and now has designated women's health providers at every
medical center and at 60 percent of community based outpatient clinics
(CBOCs). In addition, VA has staffed 144 full-time WVPMs at VA
facilities nationwide.
Finally, VA has made significant strides in strategically planning
for health care delivery for women Veterans of all eras. The Women
Veterans Health Strategic Health Group (WVHSHG) has strategically
addressed health care improvements by focusing on policy, education and
training, outreach to women Veterans and internal culture change.
Question 15: This budget proposal requests an additional $312
million for mental health care, bringing the total to $6.2 billion. The
Secretary said during questioning that if the VA's budget for mental
health care from 2009 to 2013 was examined, there was actually a 39
percent increase in funding, which provided the ``firepower to go out
and hire'' mental health professionals.
a. For the period of 2009-2013 please provide the Committee with
amount, per year, spent specifically for hiring mental health
professionals.
b. Of the monies not spent for hiring mental health professionals,
please provide, for the period 2009-2013, a detailed breakdown of
expenditures by activities.
Response: For questions 15a and b please see below table.
Mental Health Obligations by Categories ($000s)
----------------------------------------------------------------------------------------------------------------
FY09 Actual FY10 Actual FY11 Actual FY12 Estimated FY13 Estimated
----------------------------------------------------------------------------------------------------------------
FTEE 35,197 36,756 38,282 39,886 41,460
Salary Cost $3,226,914 $3,525,036 $3,721,335 $3,954,822 $4,191,429
----------------------------------------------------------------------------------------------------------------
Other
----------------------------------------------------------------------------------------------------------------
Travel (BOC 21) $106,529 $152,165 $163,595 $188,506 $195,676
Utilities et. al. (BOC 22- $146,841 $187,154 $196,471 $222,119 $227,475
BOC 24)
Contracts (BOC 25) $349,613 $428,509 $464,495 $538,641 $561,605
Supplies (BOC 26) $180,071 $228,116 $235,011 $261,577 $264,846
Grants (BOC 41) $92,122 $132,677 $151,218 $183,764 $200,672
Capital and Equipment (BOC $344,120 $507,022 $502,217 $522,306 $542,394
31 and 32)
----------------------------------------------------------------------------------------------------------------
Total $4,446,211 $5,160,678 $5,434,343 $5,871,735 $6,184,097
----------------------------------------------------------------------------------------------------------------
Question 16: During the hearing, Dr. Robert A. Petzel, the Under
Secretary for Health, stated that the VA had hired ``20,500 clinical
professionals'' to meet the needs of veterans' mental health.
a. Please provide a complete and detailed break-down of that
population of 20,500 individuals, by specialty and by years of
experience.
b. How many are psychiatrists?
c. How many are psychologists?
d. How many are licensed professional counselors?
e. How many are marriage and family therapists?
f. Of those 20,500, how many of these hires have more than 3 years
of clinical experience as a licensed mental health professional?
Response: Please see below for a detailed table which provides the
number of mental health staff by discipline as of December 31, 2011.
Please note that the table does not denote individuals; it reflects the
total of full time equivalent (FTE) employees that is dedicated to
providing direct clinical care. The current staff is only able to be
broken down into the following categories: nurses, physician extenders,
physicians, psychologists, social workers, and therapists. There are
not categories for licensed professional counselors and marriage and
family therapists in our current datasets, these positions are
reflected under Therapist. We are not able to provide years of
experience as that information is stored in local personnel files.
------------------------------------------------------------------------
Mental Health Discipline FY2012, Quarter 1 FTEE
------------------------------------------------------------------------
Nurse 8,122.53
------------------------------------------------------------------------
Physician Extender 1,375.43
------------------------------------------------------------------------
Physician 2,516.74
------------------------------------------------------------------------
Psychologist 3,009.62
------------------------------------------------------------------------
Social Worker 3,723.97
------------------------------------------------------------------------
Therapist 1,842.18
------------------------------------------------------------------------
Grand Total 20,590.47
------------------------------------------------------------------------
* Physician Extender is a term used to describe a health care provider
that is not a physician but performs medical activities that is
typically performed by a physician; including, Clinical Nurse
Specialist, Nurse Practitioner Psychiatric and Physician Assistant.
Question 17: With the VA expending more resources on publicizing
the importance of accessing mental health services to veterans through
your ``Make the Connection'' campaign and the ``PTSD Family coach,''
what is the VA doing to ensure that it has enough staff to take care of
the influx of veterans who are seeking mental health treatment?
Response: VA has increased its mental health staff that provides
direct clinical care by 52 percent since 2005 from 13,567 to 20,590.
During this same period, Veterans using mental health services have
increased by 49 percent (from 897,643 to 1,338,482). VA has provided
$12M in funding to facilities and VISNs in fiscal year 2012 to hire
staff to expand the use of telemental health for the treatment of Post
Traumatic Stress Disorder (PTSD).
On April 19, 2012, VA announced the department would add
approximately 1,600 mental health clinicians - to include nurses,
psychiatrists, psychologists, and social workers as well as nearly 300
support staff to its existing workforce of 20,590 mental health staff
as part of an ongoing review of mental health operations. VA's ongoing
comprehensive review of mental health operations has indicated that
some VA facilities require more mental health staff to serve the
growing needs of Veterans. VA is moving quickly to address this top
priority. Based on this model for team delivery of outpatient mental
health services, plus growth needs for the Veterans Crisis Line and
anticipated increase in Compensation and Pension/Integrated Disability
Evaluation System exams, VA projected the additional need for 1,900
clinical and clerical mental health staff at this time. As these
increases are implemented, VA will continue to assess staffing levels.
On April 24, 2012, VA announced that it has expanded its mental
health services to include professionals from two additional health
care fields: marriage and family therapists (MFT) and licensed
professional mental health counselors (LPMHC).
The two fields will be included in the hiring of an additional
1,900 mental health staff nationwide mentioned above. Recruitment and
hiring will be done at the local level. The new professionals will
provide mental health diagnostic and psychosocial treatment services
for Veterans and their families in coordination with existing mental
health professionals at VA's medical centers, community-based
outpatient clinics, and Vet Centers.
VA has developed qualification standards for employment as LPMHCs
and MFTs and has announced the appointments of mental health and health
science professionals to serve on professional standards boards. The
boards will review applicants for LPMHC and MFT positions in the
Veterans Health Administration (VHA) to determine eligibility for
employment and the government grade level appropriate for the
individual in the selected position. The boards will also review
promotions in these positions.
Question 18. The Independent Budget recommends that VA add 40 FTEs
to the Board of Veterans Appeals. As you know, the BVA has its own
backlog, with appeals averaging 883 days (over two years). Yet, VA's
budget flat funds the General Administration account under which BVA
receives its funding.
a. In light of the CAVC's recent Freeman v. Shinseki decision,
which allows a beneficiary to appeal to the BVA the appointment of the
fiduciary selected by VA (resulting in even more potential appeals),
what is VA doing to address the backlog of appeals at the Board of
Veterans' Appeals in its budget.
Response: VA acknowledges the fiscal constraints facing all
agencies in 2013 and appreciates Congress' approval of an increase in
2012 funds to address the appeals claims workload. BVA historically
receives an average of 5 percent of all compensation claims that VBA
receives. In FY 2011, BVA issued approximately 90 decisions per FTE,
which includes Veterans Law Judges (VLJ), attorneys, and administrative
support staff, for a total of 48,588 decisions. In FY 2012, BVA
projects issuing 47,600 decisions based on the current level of FTE
supported. While additional FTE would result in additional decisions,
VA must allocate its resources with consideration of needs across the
entire Department.
To meet the challenge of the growing appeals workload, BVA has
implemented efficiencies in two key areas: hearings and remands. The
Department also submitted several legislative proposals to improve the
appeals process. These initiatives are discussed more fully below.
With respect to hearings, approximately 25 percent of appellants
before BVA request a hearing before a VLJ. The majority of appellants
request an in-person hearing (e.g., 66 percent in FY 2011). An average
of 75 percent of scheduled in-person hearings in FY 2011 took place,
meaning that 25 percent of those Veterans scheduled for hearings did
not appear for the hearing. Data confirms that over the past five
years, the national average show rate for field hearings is 73 percent.
This leaves the VLJ who traveled to the field station with substantial
blocks of time without scheduled activity, and thus, a loss of
productive time to decide appeals.
The annual hearing schedule depends on demand, and slots are
allocated to field stations well in advance of the beginning of each
fiscal year. In planning for the FY 2012 hearing schedule, BVA
decreased the number of available field hearings offered by 25 percent
in favor of increasing video teleconference (VTC) hearings, which take
place between the VLJ in Washington, DC and the Veteran at his or her
local Regional Office (RO). This results in both monetary and time
savings for VA. VLJs will gain time in the office, with an anticipated
increase in decisional output (ranging from 2 percent to 5 percent)
over the next few years. Additionally, VA will save an estimated
$864,000 in travel costs through 2015.
Remands generate a substantial amount of rework for both VBA and
BVA, which increases workload, while also greatly increasing the delay
for Veterans. In FY 2011, BVA remanded 44 percent of appeals before the
Board (21,464) to the Agency of Original Jurisdiction (AOJ), generally
VBA. Historically, approximately 75 percent of all remands return to
the Board. VLJs determined that 40 percent of FY 2011's remands (8,585)
could have been avoided if the RO properly processed and reviewed the
case in accordance with existing laws and regulations.
BVA has analyzed the data from its Remand Reasons Database
(collecting reasons for remands since 2004) and determined that the top
reason for remand is inadequate medical examinations and opinions. To
reduce the number of remands that are returned to the Board, BVA has
partnered with the VHA to develop training tools and provide direct
training to VA clinicians to improve VA compensation and pension
examinations. Additionally, BVA and VBA have agreed to a mandatory
joint training program to aid in standardizing adjudication across the
system, driven by the most common reasons for remand. BVA has
established an interactive training relationship with VBA's key
organizations involved in the appellate process, i.e., the Systemic
Technical Accuracy Review (STAR) staff, Decision Review Officers, and
the Appeals Management Center staff. The goal of these efforts is to
reduce the number of avoidable remands in the system.
VA has submitted legislative proposals to Congress that would
streamline the appellate process. Specifically, VA has proposed a
provision that would allow BVA to determine the most expeditious type
of hearing for those appellants who request a hearing before a VLJ. The
proposal includes a ``good cause'' exception for those appellants who
do not desire a video conference hearing. VA has also proposed an
automatic waiver provision, establishing a presumption that an
appellant, or his or her representative, has waived RO consideration of
any evidence he or she files after filing the Substantive Appeal to the
Board. This would eliminate readjudication of the appeal by the RO in
some cases, in favor of the Board directly addressing the evidence.
Additionally, VA has proposed reducing the time period to file a Notice
of Disagreement (NOD) from 365 days to 180 days, to ensure timely
processing of appeals and less rework due to stale evidence.
Question 19. A recent NCA audit concluded in January 2012, revealed
numerous misplaced headstones and several inaccurate burials.
a. What is being done to correct these errors and does this budget
allow sufficient increases to prevent these types of errors from
occurring in the future?
Response: All employees at the National Cemetery Administration
(NCA) are the custodians of a sacred trust and strive to be the model
of excellence in the delivery of burial benefits. NCA has created a
culture of accountability in which errors are addressed immediately and
openly. NCA regrets the grief and emotional hardship errors cause and
seeks to correct errors in consultation with family members. Where an
error occurred, NCA has corrected the error and contacted the affected
families, where possible, to extend our sincerest apologies. NCA has
also ensured VA's congressional committees and the local congressional
offices were notified of the issues.
To prevent these types of errors from occurring in the future,
contracts to raise and realign headstones and markers will require
contractors to keep headstones or markers at the gravesite during the
renovations. Such control measures will reduce the likelihood of
inaccurate replacement of headstones and markers upon project
completion. Also, NCA will hire certified contracting officer
representatives at each of its Memorial Service Network offices to
oversee future gravesite renovation projects. If employees or
contractors need to move a headstone or marker for any reason, NCA will
adopt a new process to track temporary movement or replacement of any
headstone or marker within a national cemetery. NCA can accomplish
these actions within the 2013 budget request.
Question 20: Even with the NCA's efforts in this budget to try to
ensure that rural and urban veterans are better served with burial
options the uptick in those served by a government national cemetery
falls short of the target goal of 94 percent of veterans served with a
VA cemetery option.
b. When will this long-standing target be achieved? (note, no part
``a'' to the question was provided)
Response: NCA's Strategic Target is to ensure that 94 percent of
Veterans have reasonable access to a burial option in a national or
state cemetery. (Reasonable access defined as a first interment option
within 75 miles of their residence.) The addition of five new national
cemeteries, the establishment of new state cemeteries through the
cemetery grant program, and the implementation of the Rural Veterans
Burial Initiative will result in reasonable access to 95 percent of our
Nation's Veterans. Under the Rural Veterans Burial Initiative, NCA will
seek to serve rural Veterans by establishing relatively small (3-5
acres) NCA-managed Veterans sections (i.e., National Veterans Burial
Grounds) within existing public or private cemeteries in rural areas
where Veterans have no national or state Veterans cemetery option
within 75-miles of their residence. Construction funding in future
budget requests will allow achievement of this target.
Question 21: Will VA continue to use the Fast Track system for
Agent Orange claims?
a. If so, how much will it cost during this budget cycle?
Response: Yes, VBA will continue to use the Fast Track system for
Agent Orange claims. The budget request is $1.8 million annually for
operations and maintenance.
Question 22: Please elaborate on the claims processing initiatives
involving the use of private contractors.
a. What are the costs associated with these initiatives,
particularly the contract with ACS for claims development?
Response: The Veterans Benefits Management Assistance Program
(VBMAP) contract is for $18.6 million for claims development, eBenefits
enrollment, and training to VBA employees on change management and Lean
Six Sigma. $16.4 million is focused on the claims development task.
VBMAP is a one-year professional services contract to perform
disability claims development. This effort was developed and awarded on
a firm-fixed price basis that pays the contractor only for claims
returned at a 100 percent accuracy rate. The contractor is not paid for
claims not meeting acceptance criteria, and the work is returned to
normal VBA channels for correction or additional follow-up as
necessary. The VBMAP contract also focuses on process automation,
expedition, and transition/maintenance in the electronic (vice paper)
environment.
The VBMAP contract was issued as a means to address the current
backlog in VBA claims development workload. Secondary purposes included
increasing enrollment in eBenefits, and providing training to VBA
employees on change management and Lean Six Sigma.
b. How many claims will ACS develop or process?
Response: The maximum volume of claims will be 357,600.
c. What will happen to current FTEs under the applicable C&P
accounts?
Response: There will be no changes to FTE as a result of the VBMAP
contract.
Question 23: What is the status of the Expedited Claims processing
initiative mandated in P.L. 110-389?
Response: The Fully Developed Claim (FDC) program was piloted in
2009 at ten regional offices. Because of the pilot's favorable results,
the FDC program was implemented nationwide beginning in May 2010. VA
received 2,883 and 19,241 claims in the FDC program in FY 2010 and FY
2011, respectively. VA estimates that we will receive 29,400 and 48,529
claims in the FDC program in FY 2012 and FY 2013, respectively. Please
note that a claim submitted under the FDC program may be removed from
the program for various reasons during subsequent processing. Examples
of reasons for removal from the FDC program include receipt of evidence
from the claimant that requires further development and a claimant's
failure to report for a VA examination. VA is increasing awareness of
the FDC program requirements to better educate claimants. Information
and fact sheets on the FDC program can be found online at http://
benefits.va.gov/transformation/fastclaims.
a. Will it require any additional funding?
Response: VA does not anticipate the need for additional funding to
continue the FDC program.
Question 24: How much funding is VBMS expected to receive this
budget cycle?
Response: VBMS' funding request is $128 million for FY 2013.
a. When is national roll-out slated and completed roll-out expected
to conclude?
Response: National deployment is scheduled to begin in July 2012
and will be completed by the end of calendar year 2013.
b. Have all of VA's claims processing legacy systems been properly
interfaced?
Response: VBMS currently interfaces with the Corporate Database and
VA's legacy claims processing system, the VETSNET suite of
applications. VA will evaluate interfaces with systems for other VBA
benefits as systems development and requirements-gathering continue.
c. How will VBMS interface with the Fiduciary Program's case
management system?
Response: VBMS is initially focused on the establishment,
development, and rating sections of the claims process. We will
evaluate interfaces with Fiduciary and other programs as systems
development and requirements gathering continue.
d. Why would the VA reduce the funding by $59 million?
Response: Funding for most of the IT systems development for VBMS
was requested in FY 2011 and FY 2012. The development is being
accomplished through an inter-agency agreement (IAA) with the Space and
Naval Warfare Systems Command through March 2013. Although a majority
of systems development work will be performed through the IAA and
completed prior to FY 2013, VA will continue to develop additional
features throughout FY 2013. The reduced funding request reflects this
reduction in IT systems development.
Question 25: If the purpose of the VBMS Phase 2 is to validate and
refine the technology solution from Phase 1 will a decrease in funding
affect the deployment of Phase 2? What about Phase 3?
Response: Phase 2 was completed in November 2011. Phase 3 is
scheduled for completion prior to national deployment in July 2012. Any
decrease in the FY 2013 funding request will affect national deployment
and the ability to deploy VBMS to all regional offices.
a. What happens if the deployment of VBMS is unsuccessful? Will a
decrease in funding affect any needed fix?
Response: VBMS is following a prescribed deployment schedule, which
aligns with VA's transformation efforts. To ensure successful
deployment, lessons learned and best practices have been captured from
VBMS stations and will be implemented prior to deploying VBMS at
subsequent stations. In addition, VA continues to engage its Veteran
Service Organizations' partners through requirement gathering sessions.
VBA continues to evaluate people, process, and technology solutions to
improve timeliness and quality for claims processing. A decrease in the
FY 2013 funding request for VBMS ($128 million) would have significant
impact on our ability to deploy VBMS to regional offices on schedule,
scan claims for electronic processing, enhance the system, and repair
defects.
Question 26: At a recent hearing, many stakeholders complained
about the inadequacies of VA's Fiduciary Program, including questioning
the effectiveness of Western Hub centralization effort and the efficacy
of VA's audit process.
a. What is the funding level for VA's Fiduciary Program?
Response: The fiduciary program is part of the compensation and
pension programs. In 2013, approximately $76 million will support 693
fiduciary program FTE.
b. Is this figure broken out like compensation and pension, and if
not should it be?
Response: The fiduciary program is part of the compensation and
pension programs; however, pension and fiduciary policy and oversight
functions were separated from the compensation service in April 2011,
as part of a VBA reorganization, to address the critical need for
greater oversight of pension and fiduciary program administration. This
headquarters operational realignment also allows VBA to give greater
focus to the complex and challenging workload and policy issues in our
compensation program while giving greater attention to our most
vulnerable Veterans in our fiduciary program. Fiduciary
responsibilities and workload distributions encompass both compensation
and pension beneficiaries.
c. What are the performance measures for the VA Fiduciary Program?
Response: Key performance indicators and outcomes for FY 2011 for
the fiduciary program are listed in the following table along with
targets for FY 2012 and FY 2013.
----------------------------------------------------------------------------------------------------------------
Measure FY 2011 Target FY 2011 Actual FY 2012 Target FY 2013 Target
----------------------------------------------------------------------------------------------------------------
Accuracy 90% 88% 92% 94%
----------------------------------------------------------------------------------------------------------------
Follow-up appointments pending <= 120 90% 62% 90% 90%
days
----------------------------------------------------------------------------------------------------------------
Follow-up appointments processed <= 120 92% 83% 92% 92%
days
----------------------------------------------------------------------------------------------------------------
Initial appointments pending <= 45 days 90% 64% 90% 90%
----------------------------------------------------------------------------------------------------------------
Initial appointments processed <= 45 92% 78% 92% 92%
days
----------------------------------------------------------------------------------------------------------------
% accountings reviewed within 14 days 94% 93% 94% 94%
----------------------------------------------------------------------------------------------------------------
% accountings not seriously delinquent 95% 96% 95% 95%
----------------------------------------------------------------------------------------------------------------
Question 27: VA requested funding for additional IDES employees for
FY 2013.
a. Is this request level adequate given the amount of resources you
disclose this process requires?
Response: VA is staffed to support the current level of
separations, which is now estimated to be over 27,000 claims per year.
VA and DoD continue to assess the impact of troop movement and drawdown
of forces to the IDES program. We will monitor resource needs as part
of our overall evaluation of the program, and address shortfalls as
appropriate.
b. Is it adequate given the expected influx of new veterans
returning from war and expected to file claims?
Response: VA's estimate of claims receipts is based on available
information. VA and the DoD will continue to assess the impact of the
drawdown of forces, as well as the impact of the recent VOW to Hire
Heroes Act of 2011.
Question 28: What is the status of the Virtual Lifetime Electronic
Record Initiative?
Response: VLER enables VA and its partners to proactively provide
the full continuum of services and benefits to Veterans through
Veteran-centric processes made possible by effective, efficient, and
secure standards-based information sharing. VLER is neither an IT
program nor an information service provider. VLER is a multi-faceted
business and technology initiative that includes a portfolio of health,
benefits, and personnel information sharing capabilities, with four
over-arching goals that align to VA Strategic Plans. They are:
Empower Veterans to securely access and control the use
and dissemination of their health, benefits, and personnel information;
Eliminate material and non-material barriers to
information sharing across the VA enterprise and with external
partners;
Exploit information sharing innovations to ensure that
the VA proactively delivers services and benefits; and
Ensure that Veterans, their families, and other
stakeholders are engaged to better understand their needs and increase
participation in the development and use of VLER-enabled services.
To achieve its goals, VLER efforts are managed in four VLER
Capability Areas (VCAs):
VCA 1 - Exchange health information required to support
clinical healthcare between VA, DoD and private providers;
VCA 2 - Expand the exchange of health, benefits, military
personnel and administrative data in order to support disability claims
adjudication;
VCA 3 - Exchange additional health, benefits, military
personnel and administrative information required to proactively
deliver the full spectrum of benefits and services including, but not
limited to, compensation, housing, education, pension, insurance and
memorials; and
VCA 4 - Provide Service members and Veterans the ability
to securely access and control the use and dissemination of their
health, benefits, and personnel information via the eBenefits portal.
a. What is the funding level requested?
Response: VA's FY 2013 budget request for VLER is for $52.939
million.
b. When is roll-out and implementation expected?
Response: Each VLER capability area includes multiple projects in
different stages of development. Some projects are in the early stages
of development and will be implemented in FY 2013 and FY 2014. However,
other VLER projects are already delivering valuable benefits. The
following is a sample of VLER projects which have already made major
impacts for millions of Servicemembers and Veterans in numerous ways:
More than 800,000 Servicemembers and Veterans use the
VLER eBenefits portal (VCA-4) to manage their Servicemembers Group Life
Insurance, obtain GI Bill Certificates of Eligibility and access more
than 40 capabilities made available via eBenefits; new capabilities are
being added to eBenefits on a quarterly basis.
``Blue Button'' has been implemented, providing online
self-service downloads for on-demand access to personal health
information to 750,000 active users.
More than 1.6 million Veteran and Servicemember medical
records have been shared via the VLER Bidirectional Health Information
Exchange (BHIE) and Clinical Data Repository/Health Data Repository
(CHDR) projects.
The VLER Health program has met its milestone goal of
obtaining 50,000 Veteran authorizations to exchange their Veteran
Health Data with a private provider thru the Nationwide Health
Information Network.
VLER has impacted thousands of disabled Servicemembers,
including our most severely wounded, ill, and injured by automating
information management and sharing between DoD and VA in support of the
Federal Recovery Coordinator and Integrated Disability Evaluation
System.
Planned VLER Deliverables:
Making Blue Button self-service downloads of on-demand
personal health information available via eBenefits.
Expanding NwHIN nationwide starting in July 2012, making
health information exchange between VA, DoD, and private sector
available to all Veterans.
Providing VA Compensation and Pension examiners direct
access to existing/legacy DoD health record systems (AHLTA & TMDS).
Incorporating career transition assistance behind
eBenefits portal (resume building, job search, entrepreneurship and
voc/tech training).
Completing automation of the transfer of all required
claims adjudication information between DoD and the VA.
Helping reduce the backlog of disability claims, VLER is
planning to deliver the following in the latter half of FY 2012 and FY
2013:
--A ``TurboTax like'' web-based forms which facilitate the
collection of specific disability rating schedule information from DoD,
VA and private clinicians performing compensation and pension (C&P)
examinations;
--Enabling and automating the electronic sharing of rating schedule
information so that systems used by VA to determine a Servicemember's
or Veteran's eligibility for benefits; and
--Providing VA C&P clinicians access to the information they need
(from DoD systems) to make it easier and less time consuming to perform
C&P exams for initial applications from active duty and recently
discharged Servicemembers (including mobilized national Guard and
Reservists).
Question 29: What is the status of the Long Term Solution for the
Education division?
Response: VA is currently working to deploy initial end-to-end
automation functionality into the Long Term Solution (LTS) that will
process some supplemental claims without human intervention. Deployment
for LTS release 6.0 is scheduled for July 30, 2012. In addition to the
planned release in July, LTS has been updated in FY 2012 with the
following releases:
1. LTS release 5.1 was deployed October 17, 2011. This installed
the third of three releases of requirements associated with PL 111-377,
including those necessary to address the October 1, 2011 legislative
mandates.
2. LTS release 5.1.1 was deployed December 31, 2011. This provided
student debt management functionality.
3. LTS release 5.2 was deployed February 21, 2012 and provided
architectural foundation that will support end-to-end automation of
supplemental claims.
4. LTS release 5.2.1 was deployed March 24, 2012. This installed
two additional automated letters into the system and fixed minor
errors.
Question 30: How much money will VA spend on IT for the Education
division in 2013 and 2014?
Response: VA did not initially request funding for Post-9/11 GI
Bill system development in the FY 2013 budget. As a result of
legislation enacted after the FY 2013 budget request was developed, VA
had to redirect IT development funding in FY 2012 to make system
changes to support the new legislation and defer development of some
previously planned functionality. VA is reviewing Post-9/11 GI Bill
development requirements that may require funding in FY 2013. Estimates
are not yet available for FY 2014. The budget request for Education
Operation and Maintenance funding in FY 2013 is $11,189,000.
Question 31: What is the current ratio of veterans to counselors in
the Vocational Rehabilitation and Employment division?
Response: As of February 2012, the ratio of Veterans to counselors
was 140:1.
Question 32: When will the regulations for the Post 9-11 GI Bill be
finalized?
Response: VA anticipates publishing the final regulations governing
the, Post-9/11 Improvements, Fry Scholarship, and Work-Study by the end
of the summer, 2012.
Question 33: According to the universities the VA's education
system went down in January. No university was able to submit
information to VA.
a. What caused the problem and does it need an IT fix?
Response: VA's Online Certification of Enrollment (VAONCE), is the
system used by education institutions to submit enrollment
certifications on behalf of Veterans. Beginning around January 11,
2012, some VAONCE users began to experience significantly slow response
times due to high volume. The high volume caused some institutions' web
browsers to ``time out'' when trying to connect to the system; at no
time was the system actually down. VA does not have information to
indicate how many users were affected; however, we continued to receive
an above average number of enrollment certifications during the period
in question.
On January 13, 2012, coding was completed to ``load balance''
VAONCE to multiple web servers; testing of this new code was completed
the morning of January 17, 2012, and installed in production. The web
server load balancing corrected the problem.
b. Is the VA working on any system enhancement for TMS?
Response: VA believes the reference to TMS is a reference to The
Image Management System (TIMS), which is the repository for education
electronic claims folders. Future TIMS enhancements include:
April 2012: Addition of a drop down tool to select
``benefit type,'' accommodating the addition of benefits available
under the Veterans Retraining Assistance Program
June 2012: Mass Folder Transfer capability to allow
automation for a large number of folders to be transferred between
stations
August 2012: Microsoft Windows 7/Office 2010
compatibility, which is not currently compatible with TIMS
December 2013: Reconfiguration to a web/server format to
increase the speed and efficiency of the TIMS software and minimize
down-time for end-users during upgrades
c. Is VA working on any enhancement for TMS?
Response: Please see the response to question 33b.
Question 34: Some students are complaining about mistakes that the
VA or school makes.
a. What is the VA doing to minimize all overpayments?
Response: In FY 2011, VA maintained a payment accuracy rate of 98
percent for Post-9/11 GI Bill benefit payments. As a result of the
statutory requirement that VA pay all applicable tuition and fees at
the beginning of a student's term, there is a risk of overpayments to
any student who changes his/her enrollment after VA has issued
payments. These overpayments differ from ``improper payments''
resulting from an error by VA or by a school, which are often
identified through VA's compliance review process. Education Service
issues ``Training Reminders'' to VA staff when a pattern of errors are
identified. For School Certifying Officials (SCO), we provide
information on the SCO resources page when patterns of errors are
identified. We continue to try to identify the human errors that can be
fixed through IT solutions, such as system validations and automation.
Increased automation of entitlement and payment calculations within the
LTS reduces the potential for human error by VA processors.
Additionally, the FY 2013 President's Budget includes a legislative
proposal that would allow VA to send Post-9/11 GI Bill tuition and fee
payments to the student, rather than the school. While this proposal
does not minimize all overpayments, it simplifies the payment process
that will in turn aid in a student's ability to identify debts owed to
VA. The proposal is described on page 3A-11of VA's 2013 Congressional
Budget Justification and can be viewed at: http://www.va.gov/budget/
docs/summary/Fy2013--Volume--I-Summary--Volume.pdf.
Question 35: Why is there a decrease of $117 million for the 16
major transformational initiatives?
Response: The 2013 Budget requests $488 million for IT resources in
support of the VA's 16 Major Initiatives, a reduction of $117 million
from the 2012 enacted level of $605 million. Of the total request, $377
million is for development and $111 million is for sustainment. Annual
funding requirements for IT systems change as the initiatives mature,
and their status shifts from development to sustainment. For example,
the 2013 budget includes a reduction of $60 million below the 2012
enacted level for the VBA system that is being deployed to support the
new paperless claims processing system, known as VBMS. Development and
sustainment of these systems has a significant impact on the 2013
request for the Major Initiatives.
Question 36: VLER funding was decreased by $13 million this pilot
program is in its infancy stage.
a. With continuing Information Technology (IT) systems developments
why would the funding decrease?
Response: The FY 2013 budget request is adequate to meet the
planned needs for the VLER initiative.