[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON H.R. 1460, H.R. 3016,
H.R. 3245, H.R. 3279, H.R. 3337, H.R. 3723, AND
H.R. 4079
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
MONDAY, APRIL 16, 2012
__________
Serial No. 112-56
__________
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
______
SUBCOMMITTEE ON HEALTH
ANN MARIE BUERKLE, New York, Chairman
CLIFF STEARNS, Florida MICHAEL H. MICHAUD, Maine, Ranking
GUS M. BILIRAKIS, Florida CORRINE BROWN, Florida
DAVID P. ROE, Tennessee SILVESTRE REYES, Texas
DAN BENISHEK, Michigan RUSS CARNAHAN, Missouri
JEFF DENHAM, California JOE DONNELLY, Indiana
JON RUNYAN, New Jersey
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
April 16, 2012
Page
Legislative Hearing on H.R. 1460, H.R. 3016, H.R. 3245, H.R.
3279, H.R. 3337, H.R. 3723, and H.R. 4079...................... 1
OPENING STATEMENTS
Chairwoman Ann Marie Buerkle..................................... 1
Prepared Statement of Chairwoman Buerkle..................... 33
Hon. Michael H. Michaud, Ranking Democratic Member............... 2
Prepared Statement of Hon. Michael M. Michaud................ 33
Hon. Russ Carnahan, prepared statement only...................... 34
WITNESSES
Hon. William Owens, U.S. House of Representatives, (NY-23)....... 3
Prepared Statement of Hon. Owens............................. 35
Hon. John Barrow, Member, Committee on Veterans' Affairs, U.S.
House of Representatives, (GA-12).............................. 4
Prepared Statement of Hon. Barrow............................ 35
Hon. Jeff Denham, U.S. House of Representatives, (CA-19)......... 5
Prepared Statement of Hon. Denham............................ 36
Hon. Silvestre Reyes, Member, prepared statement only............ 37
Hon. W. Todd Akin, U.S. House of Representatives, (MO-2)......... 6
Prepared Statement of Hon. Akin.............................. 37
Hon. Robert T. Schilling, U.S. House of Representatives, (IL-17). 7
Prepared Statement of Hon. Schilling......................... 38
Hon. David B. McKinley, U.S. House of Representatives, (WV-1).... 9
Prepared Statement of Hon. McKinley.......................... 39
Shane Barker, Senior Legislative Associate, Veterans of Foreign
Wars........................................................... 13
Prepared Statement of Mr. Barker............................. 40
Adrian Atizado, Assistant National Legislative Director, Disabled
American Veterans.............................................. 15
Prepared Statement of Mr. Atizado............................ 43
Rene A. Campos, Commander, U.S. Navy (Ret.), Deputy Director,
Government Relations, Military Officers Association of America. 16
Prepared Statement of Mrs. Campos............................ 48
Ramsey Sulayman, Legislative Associate, Iraq and Afghanistan
Veterans of America............................................ 18
Prepared Statement of Mr. Sulayman........................... 51
Ralph Ibson, National Policy Director, Wounded Warrior Project... 19
Prepared Statement of Mr. Ibson.............................. 53
Robert L. Jesse, M.D., Ph.D., Principal Deputy Under Secretary
for Health, Veterans Health Administration, U.S. Department of
Veterans Affairs............................................... 25
Prepared Statement of Dr. Jesse.............................. 57
Accompanied by:
Susan Blauert, Deputy Assistant General Counsel, Office of
General Counsel, U.S. Department of Veterans Affairs
STATEMENTS FOR THE RECORD
Institute of Medicine............................................ 63
Burn Pits 360.................................................... 64
Humana Government................................................ 65
National Coalition of Homeless Veterans.......................... 68
Paralyzed Veterans of America.................................... 69
LEGISLATIVE HEARING ON H.R. 1460, H.R. 3016, H.R. 3245, H.R. 3279, H.R.
3337, H.R. 3723, AND H.R. 4079
----------
MONDAY, APRIL 16, 2012
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health,
Washington, D.C.
The Subcommittee met, pursuant to notice, at 4:00 p.m., in
Room 334, Cannon House Office Building, Hon. Ann Marie Buerkle
[Chairwoman of the Subcommittee] presiding.
Present: Representatives Buerkle, Roe, Denham, Michaud,
Reyes, and Barrow.
OPENING STATEMENT OF HON. ANN MARIE BUERKLE,
CHAIRWOMAN
Ms. Buerkle. Good afternoon. This hearing will now come to
order.
Thank you all for being here today as we begin to discuss
seven legislative proposals concerning the care and services
provided to our Nation's veterans and their families through
the Department of Veterans Affairs.
The seven bills on our agenda this afternoon are: H.R.
1460, to provide for the automatic enrollment of veterans
returning from combat zones into the VA medical system; H.R.
3016, to direct the Secretary of Defense and the Secretary of
Veterans Affairs to jointly operate the Federal Recovery
Coordination Program; H.R. 3245, the Efficient Services for
Veterans Act; H.R. 3279, to clarify that caregivers for
veterans with serious illnesses are eligible for assistance and
support services provided by the VA; H.R. 3337, the Open Burn
Pit Registry Act; H.R. 3723, the Enhanced Veteran Healthcare
Experience Act of 2011; and H.R. 4079, the Safe Housing for
Homeless Veterans Act.
Together, these bills touch on a full range of issues
affecting our veterans as well as their families.
The proposals we will discuss include measures to address
fire and building safety code enforcement for homeless veterans
participating in VA grant and per diem programs; streamline the
eligibility determination for veterans seeking readjustment
counseling services at Vet Centers; establish a registry for
OEF/OIF veterans who may have been exposed to toxic chemicals
caused by open burn pits; and allow veterans greater access to
the health care they earned and deserve by reforming the VA's
fee-basis care program and by providing for the automatic
enrollment of returning combat veterans into the VA health care
system.
Additionally, we will discuss two bills, H.R. 3016 and H.R.
3279, that seek to improve programs that support some of our
most seriously Wounded Warriors, the Federal Recovery
Coordination Program and the Comprehensive Assistance for
Family Caregivers Program, respectively. These programs in
particular are very familiar to this Subcommittee, which has
held a total of four oversight hearings last year to examine
them in depth.
Our discussion today will provide us with the opportunity
to thoroughly examine each of these proposals with their
sponsors and the Department, as well as our partners in the
veteran service organizations to find out what works, what
doesn't, and what needs to be improved.
I thank my colleagues this afternoon for sponsoring the
bills on our agenda and for their leadership in this very
important endeavor. I also appreciate our witnesses from the
veterans' service organizations as well as the VA for taking
the time to join us today and for working so hard, day in and
day out, in support of our Nation's heroes. I am very much
looking forward to our discussion; and, at this time, I now
yield to the Ranking Member, Mr. Michaud.
[The prepared statement of Chairwoman Buerkle appears in
the Appendix]
OPENING STATEMENT OF HON. MICHAEL H. MICHAUD,
RANKING DEMOCRATIC MEMBER
Mr. Michaud. Thank you very much, Madam Chair.
I, too, want to thank all three groups of panelists for
coming before us today. I look forward to hearing your
testimony.
As you heard, the purpose of today's hearing will be to
explore the policy implications of seven bills before us that
cover a wide range of topics to help expand and enhance VA's
health care programs and services.
Madam Chair, to allow for the maximum amount of time for
our three panelists, since we are in session this afternoon, I
would ask unanimous consent that the rest of my opening remarks
be submitted for the record.
[The prepared statement of Hon. Michaud, appears in the
Appendix]
Ms. Buerkle. Without objection, thank you.
We will now turn to our first panel where I am very proud
and pleased to welcome such a distinguished group of my
colleagues and friends.
Joining us this afternoon to discuss the legislation they
have introduced is: Air Force veteran and fellow New Yorker,
Mr. Bill Owens; Georgian and fellow Committee Member, John
Barrow.
Californian and Subcommittee Member, Jeff Denham; (Jeff
Denham isn't here yet but will be here.)
Vietnam-era combat veteran, Subcommittee Member, and proud
Texan, Silvestre Reyes; Show-Me State Representative Todd Akin;
a small business owner all the way from the Land of Lincoln,
Mr. Bobby Shilling; and David McKinley, a civil engineer from
West Virginia.
Gentlemen, thank you very much for being here with us this
afternoon and for your advocacy on behalf of our Nation's
veterans.
Mr. Owens, we will start with you. Thank you.
STATEMENT OF THE HON. WILLIAM OWENS
Mr. Owens. Thank you very much, Madam Chair, Ranking Member
Michaud, and Members of the Committee. I appreciate the
opportunity to come before you today and testify on H.R. 1460,
which is legislation I have introduced to provide for the
automatic enrollment of military servicemembers in the VA
health care system. As a veteran of the Air Force, I am honored
to have the opportunity to help improve access to the benefits
that men and women in uniform have earned in the service to
their country.
The soldiers, sailors, airmen, and marines of the Armed
Forces have served with great honor and distinction over a
decade at war in the Middle East. PCS orders, increased op-
tempo, repeat deployments, and shortened dwell times have only
added to the pressures facing the military and their families
to Operations Enduring Freedom, Iraqi Freedom, and New Dawn.
There is no question that we as a country have made great
strides over the past 10 years to strengthen systems of care
for American veterans, but obstacles remain for the men and
women transitioning from service to civilian life.
Representatives from various veterans' service organizations
have testified on their concerns for military families being
overwhelmed by the bureaucracies of both the Veterans
Administration and the Department of Defense, and it should
come as no surprise that VA paperwork is only one in a number
of challenges facing servicemembers in their transition to
civilian life.
Under my legislation, combat veterans discharging from
service within 45 days must be provided enrollment in the VA, a
veterans identification card demonstrating enrollment and
allowing access to hospital and medical services at VA
facilities, a list of VA facilities located within 100 miles of
the vet's home, or the closest veterans home if there is none
located near the veteran, a description of available Federal
benefits, job training, placement programs, educational
benefits, et cetera.
Any veteran considered under this bill will be given an
option to decline enrollment beforehand and proactively given
an option to disenroll from the program no more than 6 months
later. The bill goes into effect 90 days after enactment.
To be clear, this legislation does not change the benefits
for which a veteran is eligible or the care they are entitled
to within the VA. The men and women enrolled under this
legislation are already eligible for VA care. All we are doing
is shifting the burden of enrollment away from those who have
just returned from a theater of war to those who are deployed
to serve American veterans.
In addition to reducing the government paperwork required
of them, we can help ensure that overburdened servicemembers do
not slip through the cracks and miss an opportunity to enjoy
the benefits they have earned.
I remain particularly concerned for servicemembers
afflicted with traumatic brain injury or post-traumatic stress
disorder who face unique pressures in transitioning from
service. This legislation will ensure that they have early
access to screening for TBI and PTSD from experts at the VA who
can improve the long-term prognosis for those affected and
ensure proper treatment in the years ahead.
I thank you again for the opportunity to speak to you on
behalf of H.R. 1460 and respectfully request that you consider
lending your support to the bill. I look forward to your
questions.
Thank you and I yield back.
[The prepared statement of Hon. Owens appears in the
Appendix]
Ms. Buerkle. Thank you very much.
Mr. Barrow.
STATEMENT OF THE HON. JOHN BARROW
Mr. Barrow. Thank you, Chairwoman Burke, Ranking Member
Michaud, and Members of the Subcommittee. Thanks for giving me
the opportunity to speak to you about H.R. 3016, my bill to
improve the Federal Recovery Coordination Program.
Today's returning armed servicemembers face a unique
combination of challenges as they reintegrate into the
community. One important means for helping these folks is the
Federal Recovery Coordination Program, which was originally
envisioned by the Dole-Shalala Commission to help Wounded
Warriors navigate the bureaucracy of the VA and the DoD health
systems.
A Federal Recovery Coordinator is a nurse or a social
worker with graduate-level training who helps guide Wounded
Warriors to the proper treatment and benefits options.
Unfortunately, administrative roadblocks have prevented the
program from achieving its full potential. That is why I
introduced H.R. 3016, which would correct the administrative
problems that prevent the Federal Recovery Coordination Program
from succeeding.
H.R. 3016 establishes joint administration of this program
by placing it under the supervision of both the Secretaries of
Defense and Veterans Affairs. It ensures severely injured armed
servicemembers and veterans receive a Federal Recovery
Coordinator, and it gives coordinators the authority to act
earlier in the recovery process, and it makes certain that each
branch of DoD will refer Wounded Warriors to the program.
Jim Lorraine, the Executive Director of the Augusta Wounded
Warrior Project--an outstanding organization that builds
collaborative relationships with local, State, and national
organizations that support Wounded Warriors and their families
in the Augusta area--explains how this legislation will benefit
veterans:
The Federal Recovery Coordinator Program is essential to
helping our most severely wounded, ill, and injured who have
given so much for our Nation, help them figure out how to
navigate these complex bureaucracies and improve their access
to existing services. This legislation not only formally
establishes the program but directs its management from the
highest levels of the Department of Defense and Veterans
Affairs to ensure unimpeded access to care.
I hope this Committee will join me in strengthening the
Federal Recovery Coordination Program through this legislation.
It is time we fulfilled the promises we made to our
servicemembers by improving their care throughout the recovery
process.
Madam Chair, thank you again for the opportunity to speak
to this Committee. I yield back the balance of my time.
[The prepared statement of Hon. Barrow appears in the
Appendix]
Ms. Buerkle. Thank you very much.
Mr. Denham, you may proceed.
STATEMENT OF THE HON. JEFF DENHAM
Mr. Denham. Thank you, Madam Chair, Ranking Member Michaud,
and Members of the Subcommittee, for holding this legislation
hearing today; and thank you to the Chairwoman for co-
sponsoring this legislation as well as Mr. Roe and Mr. Benishek
for their support. Let me also thank Mr. McNerney, who joined
me in a Subcommittee hearing last week on this very topic.
Vet Centers offer a wide range of readjustment counseling
services to eligible veterans and their families. At our field
hearing, we were able to hear firsthand how effective these
centers are at delivering the care our veterans need
confidentially and without any delay. This bill would provide
Vet Centers with one additional tool to serve our veterans: the
ability to search in the electronic database base of DD-214
records.
A DD-214 is the swiftest way to determine eligibility for
the services provided by Vet Centers. A DD-214 is the capstone
military service document, as it represents the complete,
verified record of a servicemember's time in the military,
awards, medals, and other pertinent service information such as
promotions, combat, or overseas service, military occupational
specialty identifiers, and the record of training and schools
completed.
In the event that a veteran has lost his access to a DD-
214, it can take up to 6 weeks to receive a copy; and there is
no single prevailing method used by Vet Centers to request a
copy of the DD-214. While during the delay, a veteran will
still have access to the facility, instant verification will
allow the Vet Center to immediately provide veterans the
highest possible level of service and eliminate the
bureaucratic hurdle for the servicemember.
There are two electronic records systems that allow users
to view a DD-214 form. These systems are the Defense Personnel
Records Image Retrieval System and the VA/DoD identity
repository.
The latter receives nightly and near realtime transmissions
from the Defense Enrollment and Eligibility Reporting System/
Defense Manpower Data Center of military service information
for servicemembers leaving the military.
The former provides authorized U.S. Government agencies
controlled access to military personnel record images that no
other sources contain. This system was initially implemented in
the late 1990s, so not all personnel records are available and
implementation was staggered across all branches of service.
DPRIS contains narrative information in the DD-214 that no
other sources contain.
The bill simply directs the Secretary of Veterans Affairs
and the Secretary of Defense to jointly ensure that the Vet
Centers of the Department of Veterans Affairs have access to a
veteran's DD-214. As we speak, there are 7,500 current users of
the system within the VBA alone and many others across the VA
system. I strongly believe that the professional staff and
counselors at Vet Centers should be given the same tools to
serve our veterans and believe that it can be done in a way
that preserves the integrity of the Vet Center system. I thank
the American Legion and the VFW, Veterans of Foreign Wars, for
their support of this legislation.
As a veteran myself, I know the difficulties experienced by
those transitioning to civilian life and how common it is for
veterans to be missing records that are important to keep. I am
sure you can all agree that whenever we have the opportunity to
streamline service for our veterans we should seize that
chance.
Again, I thank the chairwoman, the Ranking Member, and
Members of the Committee for allowing me to speak here today. I
look forward to working with all of you to get this bill moving
swiftly.
[The prepared statement of Hon. Denham appears in the
Appendix]
Ms. Buerkle. Thank you very much.
Mr. Akin.
STATEMENT OF THE HON. TODD AKIN
Mr. Akin. Thank you, Chairwoman Buerkle and also Ranking
Member Michaud. Thank you for the opportunity to testify before
you today regarding my bill, H.R. 3337, the Open Burn Pit
Registry Act.
And I am going to go on with the testimony in just a
minute, but the short version is that people are exposed to the
fumes that come off of burn pits, and it sometimes had delayed
medical effects on people. And because it is not very easy to
diagnose, it is hard for people to get connected.
And the whole point of this thing, it is not giving any
money away. It is just simply saying that we are going to
create a registry so that people have a chance to coordinate
together, get the medical information and the symptoms and put
that together. I think it is a $2 million bill total over, I
don't know how many years. So that is the quick version.
It has over 50 bipartisan co-sponsors, has been endorsed by
a wide range of veterans' organizations.
The issue of burn pit exposure first came to my attention
through veterans in my district who served honorably in Iraq
and Afghanistan and are now suffering serious health effects
apparently linked to exposure to burn pits. I will share one
short story.
Tim Wymore is a Missouri Guardsman suffering from the
effects of working around burn pits while deployed to Iraq in
2004 and 2005. His wife, Shanna--if his wife Shanna were here
today she would tell you of the dramatic impact burn pits have
had on the life of her husband and hundreds of others she has
gotten to know as a result of fighting for Tim's treatment.
For nearly a year before contacting my office, as Tim's
health continued to deteriorate, Shanna Wymore fought an often
indifferent and sometimes hostile VA medical system trying to
get care of her husband's unexplained illnesses. Tim, once a
strong, athletic machinist, was suffering debilitating bouts of
abdominal pain, weight loss, and fatigue. Despite the
adversity, Shanna persisted in her fight to get the help her
husband was both entitled to and deserved. Along the way, she
became an expert on burn pits and the growing number of Iraq
war veterans suffering the effects of their exposure.
After more than 2 years of indecision and broken promises,
with assistance from my district staff, the VA finally agreed
to send Tim to the Mayo Clinic. The doctors there confirmed
what the VA had long denied. Tim was suffering from the effects
of what could only be attributed to the work he performed
around the burn pits in Iraq.
I have had at least one other constituent, Aubrey Tapley,
who has suffered the burn pit exposure and who has strongly
advocated for taking proactive steps to help others who may be
suffering from burn pit exposure.
Unfortunately, the health consequences of burn pit exposure
are hard to understand and difficult to prove. Last fall, the
Institute of Medicine released a report which concluded in part
that there is insufficient data available to determine the
long-term health effects of exposure to burn pits and that more
study is warranted.
The intent of my bill is to establish a registry at the
Department of Veterans Affairs for those individuals who have
been exposed to open burn pits during their military service.
This would help the Department study the issue more effectively
and enable them to communicate to interested veterans as
medical research on this issue develops. This registry would
not affect the benefits any veteran is already entitled to
receive but would help the Department take better care of our
veterans.
The experience I have had with veterans in my district is
enough to convince me that we need to be proactive about
studying and analyzing the potential health effects of open
burn pits. We have sent our best and brightest young men and
women into harm's way, and it is our responsibility as a Nation
to take care of them when they return. And although there is a
small cost for this bill, I think it is an affordable and
reasonable approach to dealing with the issue of open burn pits
and ask your Subcommittee to support this bill and consider
moving it forward.
Again, thank you for the opportunity to testify today. I
look forward to answering any questions you may have. Thank
you.
[The prepared statement of Hon. Akin appears in the
Appendix]
Ms. Buerkle. Thank you very much.
Mr. Schilling, you may proceed.
STATEMENT OF THE HON. ROBERT T. SCHILLING
Mr. Schilling. Chairwoman Buerkle, Ranking Member Michaud,
and my colleagues, thank you for this opportunity to come
before the House Veterans Affairs Subcommittee on Health to
speak about my bill, H.R. 3723, the Enhanced Veteran Healthcare
Experience Act of 2011. I truly believe that you can tell a lot
about the country by the way they treat their veterans.
I am pursuing this legislation in part because of the many
constituents who constantly share their stories of having to
drive long distances while experiencing substantial wait times
in an effort to make sure they get the health care they need.
But I also have a personal experience from my father who passed
away in 2005. He served in Korea. And as we were driving many
hours to and from the veteran hospital, you know, one day I
thought to myself, why is it that the veteran has to travel so
far to get the care that is needed and deserved? And, hence,
the reason why I came up with this bill.
We also must keep in mind the fact that we will have a new
group of veterans entering into the VA system with needs that
are different from the past veterans group--groups, actually.
There have been many instances where the current VA fee-based
system has been unable to accurately pay private providers the
correct amounts, which has resulted in multiple overpayments
and costs to taxpayers and their hard-earned tax dollars.
My legislation, the Enhanced Veteran Healthcare Experience
Act, would merge the best parts of Project HERO with the best
parts of Project ARCH and provide an alternative to the current
VA-run fee-based program as the primary source of fee-based
care for veterans. It would ensure that the VA contracts with
qualified outside entities that meet key competency
requirements such as network credentialed providers and
accredited facilities, care coordination, patient advocacy, and
electronic claims processing capabilities. The bill would
standardize referral and authorization processes at all VA
medical centers, require continuity of care for the veteran,
and require key performance metrics and incentive payments.
The bill would not force veterans to stop using VA care.
Veterans who prefer their current VA provider would still be
able to continuing receiving care from that provider. Veterans
that do go outside of the system are also not prevented from
returning to the VA for care in the future.
With a proven system that can properly keep track of
payouts in place, the VA could save money it may have otherwise
misspent, and very little additional fund would therefore be
required for this more efficient program. The Congressional
Budget Office has not yet officially scored this bill, but an
unofficial CBO staff estimate indicated that this bill would
require $3 million total for fiscal years 2012 to 2016.
However, studies and statements by the GAO, the OIG, and the
VSO indicated that implementing the changes in this bill will
promote savings for the VA and address medical care concerns
that veterans have when working with the VA fee-based system.
The congressional process is in place, but we can perfect
legislation. That is why I am working to do that on this bill.
Since H.R. 3723's inception and also from its introduction, I
have continued to work with the Veterans Service Organization,
the VSO, to address their concerns. I hope to continue to do so
with the VSO and the Committee. To that end, I have a draft
legislation on the Committee that you can use to improve H.R.
3723.
Again, I would like to thank you for the opportunity to
speak about ways that we can remain fiscally responsible while
ensuring we keep better our promises to our veterans.
With that, I yield back.
[The prepared statement of Hon. Schilling appears in the
Appendix]
Ms. Buerkle. Thank you very much.
Mr. McKinley, you may proceed.
STATEMENT OF THE HON. DAVID B. MCKINLEY
Mr. McKinley. Thank you.
Chairwoman Buerkle, Ranking Member Michaud, Members of the
Subcommittee. Thank you for holding this legislative hearing
today on these important issues that affect our Nation's
veterans. I appreciate this opportunity to give remarks about
H.R. 4079, the Safe Housing for Homeless Veterans Act.
Currently, there are over 2,100 community-based homeless
veteran service providers across the country and many other
homeless assistance programs that have demonstrated success
reaching homeless veterans. I visited some of these shelters in
my home district in West Virginia but have been struck by how
many are not in compliance with State, local, and fire safety
and building codes.
Consequently, we began to investigate whether this is
something that is isolated or other instances are occurring. It
was unsettling to learn in our research about shelter fires
where lives were lost. For instance, in 2009, an East Texas
homeless shelter fire where five occupants were killed was
found not to have a required sprinkler system. And an instance
in New York City just this past year where two dozen people
were injured because a sprinkler system was not working
properly and the exits were blocked.
I would like to enter news articles about these fires and
an additional three articles regarding other instances of code
violations into the record.
[The attachment appears in the Appendix]
Mr. McKinley. Unfortunately, there is no law mandating VA
homeless shelters meet code. There is only a policy in place.
As a licensed professional engineer who practices both
architecture and engineering, I found this to be an egregious
omission in the law governing homeless program funds. H.R. 4079
would require an organization that seeks funding from VA for
services to homeless veterans to provide documentation that
their building meets or exceeds all Life Safety Codes.
This legislation also requires VA to give priority to
shelters that need financial assistance from the VA for
improvements to ensure that the facility is in compliance with
all safety codes.
I am disappointed that the VA did not initially embrace
H.R. 4079 in their written testimony. However, I do appreciate
their willingness to work with us on this legislation so that
the goal of maintaining a safe environment for homeless
veterans can be achieved.
This bill simply codifies what they already have as a
policy. This is common-sense legislation that would ensure the
well-being of our veterans who have fallen on hard times and
are in most need of assistance; and, in extension, these same
veterans are turning to society to assure them of safe,
reliable housing.
As a Nation, it should be unacceptable for us to allow
homeless veterans be housed in potentially unsafe conditions.
In defense of our country, these men and women were put in
harm's way. They should not be in doubt about their own safety
now that they are home again. These homeless veterans are
experiencing a difficult phase of their lives and should be
able to trust that they will be safe each night as they
continue their rehabilitation as members of society.
I appreciate the testimony in support of H.R. 4079 from
other witnesses testifying here today, and I thank you for your
concern for the safety and living environment of our veterans.
I yield back my time. Thank you.
[The prepared statement of Hon. McKinley appears in the
Appendix]
Ms. Buerkle. Thank you very much, and thank all of you for
your testimony.
I am going to yield myself 5 minutes now for questions.
Mr. Owens, with regards to H.R. 1460, it has been a
priority of this Committee to ensure a seamless transition for
our veterans coming home--and so I want to thank you for your
efforts on this behalf and also thank you for your service to
our country.
Mr. Owens. Thank you.
Ms. Buerkle. We heard from the Disabled American Veterans
in written testimony, that one of their concerns is if we
automatically enroll this large influx of young veterans, will
it squeeze out some of the older veterans from previous wars
and engagements? And if they are not in the system but then try
to enter the system at a later date, is that a problem? Would
you like the opportunity to address that issue?
Mr. Owens. I would say that, from my perspective, if you
think about the process that a veteran is going through when
they are being--in the terms of my experience--mustered out--
maybe something of an ancient phrase now--they simply are
making choices at that point in time. And you walk out of the
CPBO with a pack of papers about this thick. And one of the top
priorities for people who are eligible for VA benefits should
be they are getting those. And so, even if it does create a
little bit more of an initial influx, most of those people are
going to come into the system down the line anyway; and I think
it is most appropriate that they have the opportunity to go in
immediately.
Ms. Buerkle. One other concern that was raised by the
Paralyzed Veterans of America, was the need to ensure that
veterans who decide not to enroll in the VA through that
automatic enrollment process, if at a later date they needed to
or chose to reenter the system, is that a problem?
Mr. Owens. They would not be precluded. The disenrollment
provisions that are in the bill simply allow people to make
that choice but do not prohibit, as long as they are
statutorily eligible, to reenter the system down the road.
Ms. Buerkle. Thank you very much.
Mr. Barrow, if I could.
Mr. Barrow. Yes, ma'am.
Ms. Buerkle. With regards to H.R. 3016, this Subcommittee
has had two hearings on the Federal Recovery Coordination
Program. We have grave concerns, so I am absolutely delighted
that you are bringing this up and we are addressing this issue.
There seems to be such an overlap between what the VA is doing
and what DoD is doing, and we are really concerned about making
this happen for veterans and their families.
Your testimony references administrative roadblocks that
have prevented the Federal Recovery Coordination Program from
achieving its full potential. Can you elaborate on that for the
Committee?
Mr. Barrow. Yes, ma'am.
There is a need to get referrals from the DoD side of
things, and the DoD is not as responsive in the chain of
command. The recovery program has direct access to the
Secretary of the VA but not the DoD, and we think it is
important that that be remedied, that they have access to the
highest levels of authority in both, the two main silos in
which our concerns for Wounded Warriors originate, those where
they began and those where they transition to.
Also, I think it is important that they be codified and
established in law so that we have an ongoing commitment to the
program.
Those are just a couple of ways in which I think we can
overcome some of the obstacles that folks have encountered.
Ms. Buerkle. Very good, thank you.
Mr. McKinley, if you could just elaborate a little bit
further on --
Mr. McKinley. I am sorry. I can't hear.
Ms. Buerkle. If you could just elaborate a little bit
further on what were the conditions that you saw and,
specifically, how your bill would address those conditions.
Mr. McKinley. I still didn't hear.
Mr. Akin. What were the conditions that you saw and how
would your bill affect it?
Ms. Buerkle. I can repeat it.
Mr. McKinley. What we saw were lack of sprinkler systems,
fire doors that were not rated fire doors. Wall assemblies that
did not meet code. Fire exit ways that did not meet code. ADA
requirements of accommodations on upper floors.
These would not be acceptable in almost any other
circumstance, and it is unfortunate. I think it has fallen
through the cracks, that these could be addressed over a period
of time and corrected, and our veterans would be housed in an
equal, comparable to many other situations.
Thank you.
Ms. Buerkle. Thank you very much.
I now yield to the Ranking Member for questions.
Mr. Michaud. Thank you, Madam Chair.
Once again, I would like to thank all of the panelists for
coming here today and look forward to working with you as we
move forward dealing with your individual pieces of
legislation. So I have no questions for any of the panelists. I
yield back.
Ms. Buerkle. Thank you.
I yield to the gentleman from Tennessee, Dr. Roe.
Mr. Roe. First of all, I want to thank the panelists. Every
one of you stayed within your 5 minutes. Thank you. That is
amazing. I have never been to one where everybody did. So this
is the first time since I have been here.
Just a couple of quick questions, one to Congressman Akin.
I want to strongly encourage us to support this piece of
legislation, and I will tell you why. I served in Korea, 11
miles south of the DMZ almost 40 years ago. And sometime before
that, Agent Orange was used there but there is no record of
that. And now it is just a disaster trying to figure out who
was there, who was not there and can you get their benefits.
You are right on by doing this. Let's just put a record
down. You don't know 40 years from now what is going to come up
and who is going to need that. So let's document who was there
so that a congressman, much after we are all gone, can deal
with this years later. I think it is a very good piece of
legislation.
And just for my clarification, from Congressman Owens, if
you would tell me why was the date picked in 1998 for a soldier
that would be signed up, as opposed to a troop before that that
may have been in a combat zone?
Mr. Owens. I think it was simply for administrative
convenience. We needed to pick a date, and we picked that. It
also coincides with Gulf War 1, and we thought that those folks
would be most likely in the position, whereas people who served
in Vietnam were most likely, if they were going to be in the
system, already in the system.
Mr. Roe. I just didn't know why that was picked. That is
fine. So it is arbitrary.
And the other question I guess I had to Congressman
McKinley is that, being a former mayor before I got here, how
can you get a facility permitted past the building codes folks
and the local fire marshal? That wouldn't happen where I live.
Mr. McKinley. Some things, Congressman, occur over time. We
determined up in New York, where they actually blocked fire
exit ways, they may have been approved at one time. But then
the way it operated, they were closed, locked. Sprinkler
systems were turned off because they were not being repaired
properly. So they were dripping, leaking. Instead of fixing
them, they just turned them off. So you have got it initially.
But there has to be and should be a follow-up. For something as
serious as this, there should be ongoing investigation to see
that our men and women are safe.
Mr. Roe. I guess I am more pointing at the local officials
than I am the VA. Because that is a local issue at home. I
don't think that could happen. They are here all the time.
Mr. McKinley. I am not going to finger point as to whether
it was the VA or the local fire marshal, but I think someone
needs to be doing an ongoing operation. Once they get
permission to do it, someone needs to follow up to make sure
that both groups are complying with the requirements that were
passed.
Mr. Roe. Thank you. I yield back.
Ms. Buerkle. Thank you very much.
If there are no further questions from the Committee, I
would just like to say thank you to all of you again. Thank you
for your commitment to our veterans. As a Nation, we owe them a
debt of gratitude, and I appreciate your efforts on their
behalf. Thank you all very much.
If our second panel would come to the table. Good
afternoon, everyone.
With us on our second panel are representatives from our
veteran service organizations:
We have Mr. Shane Barker, Senior Legislative Associate for
the Veterans of Foreign Wars; Mr. Adrian Atizado, Assistant
National Legislative Director for the Disabled American
Veterans; Commander Rene Campos, the Deputy Director of
Government Relations for the Military Officers Association of
America; Ramsey Sulayman, Legislative Associate for the Iraq
and Afghanistan Veterans of America; and Mr. Ralph Ibson,
National Policy Director for the Wounded Warrior Project.
Thank you all very much for joining us this afternoon, and
our sincere thanks to all of you for the good work you do for
and on behalf of our veterans and their families. Thank you.
With that, Mr. Barker, if you would like to begin with your
testimony.
STATEMENTS OF SHANE BARKER, SENIOR LEGISLATIVE ASSOCIATE,
VETERANS OF FOREIGN WARS; ADRIAN ATIZADO, ASSISTANT NATIONAL
LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; RENE A.
CAMPOS, COMMANDER, U.S. NAVY (RET.), DEPUTY DIRECTOR,
GOVERNMENT RELATIONS, MILITARY OFFICERS ASSOCIATION OF AMERICA;
RAMSEY SULAYMAN, LEGISLATIVE ASSOCIATE, IRAQ AND AFGHANISTAN
VETERANS OF AMERICA; AND RALPH IBSON, NATIONAL POLICY DIRECTOR,
WOUNDED WARRIOR PROJECT
STATEMENT OF SHANE BARKER
Mr. Barker. Thank you.
Chairwoman Buerkle, Ranking Member Michaud, and Members of
the Committee, on behalf of the 2 million members of the
Veterans of Foreign Wars and our auxiliaries, it is my pleasure
to be here today to share our views with you on these important
pieces of legislation.
In the interest of time, I will limit my remarks to a
selection of bills before the Committee.
VFW does support the intent of H.R. 1460, which would
direct VA to automatically enroll servicemembers returning from
Iraq and Afghanistan into the Veterans Health Administration.
However, as written, we are concerned that this bill would not
enroll military personnel who are medically retired as a result
of a stateside injury or other extenuating circumstances.
The VFW does hope that this Committee will consider
amending this legislation to provide a similar service as what
you are trying to provide to people returning from Iraq and
Afghanistan to all separating servicemembers and would give the
VA the resources that it needs to be successful in that
mission.
VFW also supports H.R. 3016, a bill that could ensure those
responsible for administering the Federal Recovery Coordination
Program are located in the offices of the Secretaries of DoD
and VA and not down the chain somewhere that would make them
less visible to the respective Secretaries.
This program was created to ensure properly coordinated
care for our Wounded Warriors without placing the
administrative burden on the servicemember or their family. We
have fallen short on this promise for many of our returning
warriors, and we feel that we must do more to alleviate the
burden caused by simply being in the program.
This legislation contains other helpful provisions, but
problems within the FRC program will not be solved without
taking this obvious step, and so we fully support this bill.
We also strongly support H.R. 3279, legislation that would
clarify the veterans eligible for caregiver support under
Public Law 111-163 as a result of serious illness are just as
eligible as those veterans who qualify as a result of a combat
injury. Congressional intent is clear that those who are
catastrophically harmed through a debilitating disease should
have equal access to the full range of benefits under the
caregiver law. This is the case in the Department of Defense
Caregiver Program, and we cannot accept a program that would
curtail essential caregiver benefits when a military member
exits DoD care and enters VA care. This is the right thing to
do for our servicemembers and their families, and we offer our
full support.
VFW supports H.R. 3337, the Open Burn Pit Registry Act of
2011, and thanks Congressman Akin for his introduction of this
bill. It is a recognition that we have not yet reached the
level of scientific knowledge to properly care for the men and
women who had no choice but to inhale the toxic fumes of a burn
pit in Iraq or Afghanistan.
This bill is also a recognition that our Nation wants to
provide enhanced care for those exposed as new treatment
options are discovered. It is important to show that those who
are suffering from the effects of toxic inhalations that we
care for them and want to provide the best possible treatment.
The VFW does not support H.R. 3723, the Enhanced Veteran
Healthcare Experience Act of 2011. We believe this bill is well
intentioned and that it seeks to address a clear and
significant problem within VA. Those problems are inherent in
the current fee-based system. They are manifest. As an example,
while the VA paid out more than $4 billion in fee-basis health
care claims in 2010 alone, they have few tools at their
disposal to ensure they are getting the most for their money.
Among the serious problems that currently exist, VA has no
way to ensure proper credentialing of those who bill VA for
services rendered; no way to ensure bill procedures actually
occurred; and no way to integrate the documentation into a
veteran's electronic health record.
Nevertheless, the remedy this bill offers is, at the same
time, broad in its implication and overly proscriptive in its
mandates. Essentially, it would wipe away the current system of
fee-basis care and would replace it with a network of providers
to be administered by one or more private companies on behalf
of VA.
In order for such a network to be affordable, we believe VA
would have to direct a consistent number of veterans into the
network to keep doctors participating and to drive down unit
cost. In our view, such a calculation could make the health
care needs of veterans a second priority as VA seeks to manage
their network.
We believe this paradigm also presupposes a robust and
successful implementation of the Patient Aligned Care Teams
across VHA to coordinate with the network provider to eliminate
duplicative services and promote overall cost containment. The
PACT model of care is not yet fully implemented, and we
approach the concept of a bidirectional care coordination
across VA with the private sector with a healthy amount of
skepticism.
We are appreciative of the introduction of this bill, and
we are pleased to be a part of this discussion. We would hope
to work with the Committee in the future to continue refining
this legislation.
And with that, Madam Chairwoman, this concludes my
statement. I am happy to take any questions that you or Members
of the Committee may have.
[The prepared statement of Shane Barker appears in the
Appendix]
Ms. Buerkle. Thank you very much.
Mr. Atizado, you may proceed.
STATEMENT OF ADRIAN ATIZADO
Mr. Atizado. Madam Chairman, Ranking Member Michaud, and
Members of the Subcommittee, the Disabled Americans Veterans is
honored to testify at this legislation hearing before the
Subcommittee on Health.
Our organization has 1.2 million members, and we devote our
energies to rebuilding the lives of disabled veterans and their
families. For the sake of brevity, I will only speak on those
bills for which DAV supports favorable consideration by this
Subcommittee.
The intent of H.R. 3279 is to clarify Congress' intent in
passing Public Law 111-163. That is to make family caregivers
of certain veterans with serious illnesses eligible for VA's
comprehensive caregiver assistance and support services. Under
current law, only family caregivers of certain veterans with
serious physical injuries are eligible; and we thank the
sponsor for introducing this bill and strongly urge its
favorable consideration.
Our national resolution passed at our most recent national
convention supporting this important legislation also calls on
Congress to expand the eligibility for comprehensive caregivers
support services to caregivers of veterans of all eras. Those
caregivers have carried a long and heavy burden for their loved
ones and deserve the level of attention and support now being
provided generously by VA to caregivers of the newest
generation of veterans.
DAV also supports H.R. 3337, the Open Burn Pit Registry Act
of 2011, because it partially fulfills propositions in our
national resolution on military exposure to toxic and
environmental hazards. If enacted, this bill would direct VA to
establish an open burn pit registry, advise veterans in how to
participate, and periodically notify registrants about
significant developments in the study and treatment of
conditions associated with exposure to open burn pits.
Madam Chairwoman, we note that participation in the
registry is voluntary. That is the nature of the beast. And
because such participants are self-selected, they do not
constitute a representative sample of all U.S. soldiers who are
exposed to open burn pits.
While the limitation of a registry precludes it from being
used to determine whether a particular condition is caused by a
particular exposure, it does provide useful information to
describe the health status of participants. That is to say, the
burn pit registry could be used to determine whether to pursue
research on a possible link between condition and exposure. For
this importance, we support that provision of this bill.
Now, in October, 2011, the IOM, the Institute of Medicine,
did issue its report on long-term consequences of burn pits in
Iraq and Afghanistan. They found numerous data gaps and
uncertainties in monitoring the airborne pollutants that point
to the need for additional study and analysis. The IOM
recommended conducting a longitudinal study to evaluate the
health status of servicemembers from their time of deployment
to determine their incidence of chronic disease, including
cancers, some which may not appear until many months after.
Madam Chairwoman, although VA is sponsoring large-scale
scientific studies that cover a wide spectrum of health
effects, these studies may not meet IOM's call for a well-
designed study for this particular environmental exposure. We
urge your Subcommittee to considered adding to this bill a
prospective research component with the identification of
specified cohort groups. Cohort studies over an extended period
of time have the potential to provide more meaningful insight
into the long-term health consequences from combined exposures,
including exposures to open burn pits.
Madam Chairwoman, this completes my testimony. I would be
happy to answer any questions you or the Members of the
Subcommittee may have.
[The prepared statement of Adrian Atizado appears in the
Appendix]
Ms. Buerkle. Thank you very much.
Commander Campos.
STATEMENT OF RENE A. CAMPOS
Commander Campos. Madam Chair Buerkle, Ranking Member
Michaud, and distinguished Members of the Subcommittee, on
behalf of the 375,000 members of the Military Officers
Association of America, I am grateful for the opportunity to
present MOAA's views on the legislative provisions before the
Subcommittee. MOAA greatly appreciates the Subcommittee's
leadership in addressing the very important business of taking
care of our veterans by your diligent oversight of their
medical care and benefits.
We would also like to acknowledge and thank the VA for its
hard work and persistence in transforming the agency's culture
and systems of care.
Today, I will focus my remarks on three specific bills.
MOAA thanks Congressman Owens for his commitment to
seamless transition of veterans from the military to the VA
health care system with H.R. 1460. MOAA supports the concept of
automatic enrollment in VA health care and recommends that H.R.
1460 be amended to authorize all Iraq and Afghanistan veterans.
We believe that there should be no distinction between veterans
who have served in combat theater and those who have served in
other types of assignments. Automatic enrollment of only combat
theater veterans will likely be perceived negatively by non-
combat veterans, causing them to view it as a form of health
care rationing that devalues their contributions of service to
their country.
Automatic enrollment is consistent with MOAA's long-
standing support for seamless transition into the VA and
civilian medical systems. Ongoing work on the DoD and VA
electronic medical record could be advanced by automatic VA
health care enrollment, but the provision does not eliminate
the requirement for the veteran to physically enroll in a VA
medical center. Perhaps VA's outreach system could be
strengthened by having advance information on separating
servicemembers put into the VA's enrollment system.
Secondly, MOAA supports the concept of H.R. 3016,
Congressman Barrow's bill, to direct the VA and DoD Secretaries
to operate the joint Federal Recovery Care Coordination
Program. We support, again, in concept, but we would recommend
that Congress continue to provide oversight by conducting
hearings and requiring reports from senior VA and DoD officials
in lieu of additional legislation in order to determine the
efficacy of these programs and increase accountability of the
systems. The two departments have stepped up their
collaborative efforts in recent months, but MOAA believes that
congressional and VA-DoD leadership oversight continues to be
needed until care coordination programs, policies, and systems
mature and are operating efficiently and effectively.
Finally, our association supports Congressman Reyes' bill,
H.R. 3279. MOAA and others here today have already recommended
that there should be a change in--or have recommended in the
past formal changes to the VA's interim final rules concerning
the new caregiver benefits program.
Currently, VA rules define serious injury as any injury,
including psychological trauma or other mental disorder
incurred or aggravated in the line of duty in the active
military, naval, or air service on or after September 11, 2001,
that renders the veteran or servicemember in need of personal
care services.
It is not clear from that definition how VA will address
individuals whose serious illnesses incurred during service
worsened or changed to the point of needing a caregiver once
they are in a veteran status.
MOAA would like to make sure that the definition is not
open to interpretation. We believe the intent of Congress was
to allow both active duty and veteran caregivers to qualify for
the benefit for both serious illness and injury.
MOAA thanks the Subcommittee for being champions of our
veterans and their families. We look forward to working with
the Subcommittee and VA on ways to improve health care so that
we can further enhance the quality of lives of these
individuals in our veterans' community.
I look forward to answering your questions and thank you
again.
[The prepared statement of Rene A. Campus appears in the
Appendix]
Ms. Buerkle. Thank you very much, Commander.
Mr. Sulayman.
STATEMENT OF RAMSEY SULAYMAN
Mr. Sulayman. Madam Chairwoman, Ranking Member,
distinguished Members of the Subcommittee, on behalf of more
than 200,000 members and supporters of Iraq and Afghanistan
Veterans of America I thank you for the opportunity to share
the views of our members on these very important pieces of
legislation.
My name is Ramsey Sulayman, and I am a Legislative
Associate with IAVA. I am a veteran of Iraq, where I was an
infantry platoon commander and company executive officer. I
have spent 14 years in the Marine Corps trying to execute the
Marine Corps' two missions: winning battles and making Marines.
As an IAVA staff member, I don't make soldiers, sailors,
airmen, or Marines, but I do try to make their lives better.
The views expressed here are not the viewpoints of the Marine
Corps. They are solely mine and IAVA's analysis. Thank you for
your attention to the pressing issues facing our Nation's
veterans.
IAVA strongly supports H.R. 1460, ensuring that veterans
are automatically enrolled in the VA health care system and
required to opt out if they do not wish to be enrolled.
Actually getting veterans into the VA system is the most
important part of a smooth and seamless transition from the
Department of Defense health care system to the Veterans
Administration health care system.
Currently, only 54 percent of Iraq and Afghanistan veterans
are enrolled in the VA health care system. The steep cost of
quality health care to the private sector and a high rate of
veteran unemployment, almost 17 percent among our membership,
means many veterans do not have access to any other health care
system, often for their service-related injuries. IAVA believes
that H.R. 1460's solution of changing enrollment is easy and
effective, both in terms of cost and efficacy. Combat veterans
should not have to opt in to receive a benefit they have earned
through their service.
We also support H.R. 3337, the Open Burn Pit Registry Act
of 2011. Burn pits have the potential to be the insidious and
long-term health issue for our generation of veterans that
Agent Orange has been for our Vietnam era veterans. H.R. 3337
gets ahead of the curve in responding to potential future
health concerns by establishing facts. Who is exposed, where
were they exposed, and for how long? These small but crucial
pieces of information will be helpful in the future in
ascertaining the health impacts, facilitating subject
identification for epidemiological studies, and adjudicating
claims.
Burn pits were ubiquitous in Iraq and still are in
Afghanistan. They are located in the midst of large numbers of
troops. The twin facts that burn pits are the way waste is
disposed and must be co-located with troops for logistical
purposes guarantees exposure for most veterans.
While IAVA supports H.R. 3337, we do so with a caveat.
Because of the ubiquity of burn pits in these conflicts, we
believe that the definition of burn pit must extend beyond
solely those authorized by the Secretary of Defense to include
those that were established by small unit commanders to
facilitate mission accomplishment. In other words, there is no
garbage service for our troops to rely on in Iraq and
Afghanistan; and, by necessity, we burn all of the waste that
we have.
This is a necessary addition to this important piece of
legislation, and IAVA encourages inclusion of such language in
the bill before passage.
We also support the goals of H.R. 3723. We believe they are
laudable, and we support many of them. However, we cannot
support H.R. 3723, because we believe that this legislation
makes several changes that are untested and do not necessarily
provide hope of significantly improved patient outcomes or
access to care.
There are significant issues in the VA health care system,
and my colleagues in the other VSOs have addressed them at
length. I would just say that we reiterate most of those, and
we think that there are many questions that need to be answered
before such a drastic step is taken.
We would also point out that there are many medical options
that are not cost effective in the private sector, such as
prosthetics, and real questions exist regarding the fiscal
benefits and patient outcomes when outsourcing these types of
care.
The bill begs the question of whether another system that
makes the VA a third-party payer, essentially replicating the
scenario we have with fee-care, or should the VA system be
strengthened, funded, and fixed if the use of third-party non-
VA providers is minimized and truly used out of necessity. IAVA
prefers the latter option, and therefore we cannot endorse
3723.
In the interest of time, I have submitted all of my other
comments for the record, and I look forward to answering any
questions that the Committee has.
Thank you very much.
[The prepared statement of Ramsey Sulayman appears in the
Appendix]
Ms. Buerkle. Thank you very much.
Mr. Ibson, you may proceed.
STATEMENT OF RALPH IBSON
Mr. Ibson. Thank you, Madam Chair, Ranking Member Michaud,
Members of the Subcommittee. Thank you for inviting Wounded
Warrior Project to offer our views on the legislation pending
before the Subcommittee.
We are particularly pleased that you are considering two
bills that would close gaps in programs of real importance to
Wounded Warriors. Let me first highlight our strong support for
those two measures.
First, H.R. 3016 would remedy fundamental problems in the
governance and operation of the Federal Recovery Coordination
Program, problems that were ably documented in this Committee's
hearings on the program. The bill would require the two
departments both to develop a memo of understanding for joint
program governance and a specific plan for program operations.
Importantly, in our view, a key provision would require the
service Secretaries to refer eligible servicemembers to the
program at the earliest possible time to gain the benefit of
having an FRC assist all aspects of the transition process. It
is clear from the experiences of our warriors and their
families that having the FRC early in the process can make all
of the difference. But as your hearings have documented, the
service departments too often elect not to refer severely
injured servicemembers for an FRC until after that member has
retired, often far too late in the process to be helpful.
We applaud your patient efforts to resolve these issues
through hearings and discussion, but, at this point, with the
risk of Wounded Warriors falling through the cracks, we believe
a legislative solution is needed and strongly support the
approach set out in H.R. 3016.
A second bill under review, H.R. 3279, would, as others
have testified, clarify that a veteran who has a serious
illness incurred in service after 9/11 can be helped through
VA's Comprehensive Caregiver Assistance Program. Although VA's
interim rule draws a hard line, the statute itself is not that
clear. Yet there may be little distinction between the
caregiving needs of a young warrior profoundly disabled by a
service-connected illness and one who is injured. In each
instance, a parent or spouse may have permanently left the
workforce to care at home for that veteran's daily needs,
leaving that veteran vulnerable to the risk of VA
institutionalization if the stresses of caregiving overwhelm
that family member. Surely, Congress sought to address through
the caregiver law the impact of caregiving, not the underlying
etiology of the veteran's condition. Clarifying the law as
proposed would provide needed support. We strongly support
that.
Mr. Ibson. In contrast, H.R. 3723 would change the
statutory underpinnings of the VA's fee-based authority in a
very fundamental but potentially problematic way, as others
have suggested. Current law simply authorizes VA to provide
fee-based treatment to certain veterans when it can't provide
timely, geographically accessible care in its facilities. But
H.R. 3723 would require contracting for care under those
circumstances and require it for all enrolled veterans.
It is not clear what the impact that mandate would
ultimately have. It is possible that facilities might simply be
instructed to provide contract care in accordance with the law.
But we question whether the change would assure the intended
outcome. And by way of illustration, we note that VA policy
currently says that mental health care, for example, must be
made available to eligible veterans either in VA facilities or
under contract arrangements. Notwithstanding that very clear
policy, fee-based care is seldom an option for OEF/OIF veterans
with service-connected mental health conditions, despite the
fact that VA facilities frequently cannot provide that care in
a timely way.
It is possible that the mandate in that bill would not have
great practical effect. And yet on the other hand if the
provisions were implemented literally, it could have sweeping
operational and fiscal implications. In either case, we cannot
support the measure.
H.R. 1640, as discussed, would require VA to enroll any
veteran who served in the combat zone, subject to an option not
to enroll. While the bill appears aimed at facilitating access
to care, in our view enrollment itself has not been a barrier.
The bigger problem that warriors have encountered, particularly
with the prevalence of PTSD, is getting timely, effective
mental health care. We see high percentages of OEF/OIF veterans
enrolling and being ``seen for care,'' but surveys indicate
that VA facilities are often not adequately staffed to provide
the timely care or even the right kind of care that veterans
need.
So our concern is that VA has put much more emphasis on
enrolling as many veterans as possible, and less emphasis on
assuring that veterans are receiving the specialty care that
they may need. In short, we have no objection to this bill, but
we don't believe that it solves the underlying fundamental
access to treatment problems that many are facing.
Seeing that I am running out of time, Madam Chair, I will
close and be available for any questions you might have.
[The prepared statement of Ralph Ibson appears in the
Appendix]
Ms. Buerkle. Thank you very much, and I thank all of the
panelists for your testimony this afternoon.
I yield myself 5 minutes for questions.
Mr. Barker, regarding H.R. 1460, your concern is that it
may send a message to nondeployed veterans that they may not be
eligible for VA care. Is there a way that you could address
that?
Mr. Barker. Let me give it a shot. As I understand the
bill, it basically facilitates enrollment but it has no bearing
on whether or not a person is eligible for services. When I
crafted my testimony, I wanted to try to describe the
importance of allowing all veterans to have access to whatever
services and benefits that they have earned. That is the
important piece, and I would agree with what Mr. Ibson said. We
haven't heard anyone complain about the enrollment process, it
is what happens after the enrollment process in terms of
delays, et cetera.
And so in crafting an alternative to this bill, I think it
would be preferable to see something that applies to everyone
who is separating equally, as opposed to someone who is
deployed versus nondeployed. That is the basic message I think
we are trying to achieve here.
Ms. Buerkle. Thank you.
Mr. Atizado, regarding H.R. 1460--and I asked this question
of our first panel--your concern with regard to when you are
enrolling and you have this influx of young enrollees that
might squeeze out and preclude older veterans from enrolling.
How would you address that concern?
Mr. Atizado. Thank you for that question, Madam Chairwoman.
The main principle behind our position is that the
Secretary of Veterans Affairs' ability to manage patient
enrollment is one of a very few number of tools he or she has
to control the health care system.
This authority was exercised back in 2003 when VA decided
to stop enrollment for Priority Group 8 veterans, and that was
at a time when resources were not keeping up with demand. So in
this era, I should say in this--in the recent past, we were
looking at a fiscal environment where VA will once again be
subjected to fiscal constraints. So what will happen is if the
VA is unable to manage its patient enrollment because they are
automatically enrolling one specific category of veteran, it
will undoubtedly push out others. VA, after all, it operates in
a resource-constrained environment. So that is the main thrust
of our position.
I want to reiterate what my colleagues here have mentioned
about enrolling. I understand, and it is in my testimony, that
the services are looking at or have been mandating transition
assistance for all veterans, not just those that are seriously
injured, not just those who are moderately injured. Even those
who are not injured. Even Guard and Reserves are now being
mandated to go through TAP, and I think done so in a much more
responsible manner. That is, they are given appropriate time to
determine what it is that they need. Because if a
servicemember, in transitioning out of service, doesn't know
that they really should enroll in VA because it is such a good
value, I think there is something wrong with that transition
program if that is not properly conveyed.
Ms. Buerkle. Thank you very much.
I have a few seconds left, and so I will ask Commander
Campos, in your testimony you mentioned that DoD and the VA
have stepped up with regards to H.R. 3016. As I mentioned in my
comments to Mr. Barrow, we have had a couple of hearings on
this issue. We have been really concerned with the inability to
coordinate and the overlap. They have had 4 years to implement
this. Do you think VA and DoD have made significant progress?
Can you shed a little bit of light from your perspective?
Commander Campos. I appreciate the Subcommittee really
keeping the eye on this issue because I think it is very
critical to the long-term care of these wounded and disabled
veterans.
We have watched this very closely. There seems to be a
great deal of indication, especially after attending in early
March, maybe it was late February, the recovering warrior task
force where both DoD and VA recovery care coordination and the
FRCP folks briefed the Committee or task force. And so it is
clear that they are working together. But in our view, adding
more legislation to something that is already in our minds
mandated by Congress doesn't seem to be the answer. I think the
only way that VA and DoD are going to continue to work close
together and make this really seamless is to continue the
oversight by your Subcommittee and Congress as a whole, both on
the Armed Services Committee as well as the Veterans'
Committee.
Ms. Buerkle. Thank you very much.
I yield 5 minutes to the Ranking Member, Mr. Michaud.
Mr. Michaud. Thank you, Madam Chair. This question is for
each of the panelists, and I will start with Mr. Barker first.
Mr. Barker, under H.R. 3279, the VA estimates that 870
additional veterans and servicemembers would qualify for
service and benefits, and that in fiscal year 2013 it would
cost the VA $45 million, and $263.5 million over a 5-year
period under the caregivers bill. Do you believe this number is
accurate given that, to the best of my knowledge, the VA hasn't
even defined under the legislation the term of serious illness?
Mr. Barker. If I may, I would like to take that for the
record to give you an accurate statement from our organization,
although I would just observe there are often things that are
supposed when making these estimates that we often find fault
with, and I would like to engage more in that process of
articulating our view. So that would be something I would like
to take for the record, if I may.
[The attachment appears in the Appendix]
Mr. Atizado. Ranking Member Michaud, thank you for that
question. I do not have inside knowledge on VA's estimates; but
what I do know, there are a significant number of applicants,
caregivers and veterans who have applied and been denied
because of the lack of illness in the eligibility criteria. So
I think VA knows at least those that have applied but were
denied.
What they don't know and what I think they are trying to
get a handle on as best they can are those caregivers and
veterans who may not have applied because they realize, from
hearing from the Subcommittee awhile back, that illness isn't
included. So they just don't apply altogether. So I think that
is the squishy part of the details.
Commander Campos. I believe--I couldn't comment, our
Association couldn't comment on the specific numbers. But I
know that our work with the caregiver program and the folks
there have been very receptive to answering questions and
responding to our questions and even engaging in individual
cases. So I would have no reason to question that. However, as
part of the interim rules for the caregiver, we did comment on
our concerns about how those who were denied would be able to
appeal as well as getting some information as to why their
request was denied.
Mr. Sulayman. Ranking Member Michaud, thank you for the
question.
I would concur with Mr. Barker, that I would like to see a
little bit more analysis on what that number is. It seems a
little bit high to me, especially given the rather small
proportion, or the rather small population that they have cited
would take advantage of it. And I would agree with both Ms.
Campos and Mr. Atizado, that the real question is what other
numbers are they looking at. Are they trying to access those
who have been turned away in the past, or is there some other
metric that they are using? That would be my sense of it.
Like Ms. Campos, we have had good relationships with those
who manage the caregivers assistance program, and they have
always been forthcoming, so I wouldn't doubt their answer. I
would just wonder what the figure encompasses.
Mr. Ibson. At the risk of being the skeptic in the group,
Mr. Michaud, I would only suggest that the history of
attempting to estimate costs on legislation involving caregiver
assistance has been very uneven, in my view, at the VA. And at
least from the perspective of an organization working with a
largely very young population, it strikes me as difficult to
imagine figures that high in terms of illnesses that would
require a need for caregiver assistance.
So while I certainly would be open to looking at that data
and appreciate how hard the VA has worked on implementing the
program, I remain skeptical of those numbers.
Mr. Michaud. Mr. Ibson, how would your organization define
serious illness?
Mr. Ibson. Well, I think it goes to a need for caregiving,
ultimately. Just as the phrase ``serious injury'' in the
Caregiver Law itself ultimately gains meaning from the
circumstances that require a need for caregiving, which is
either on the basis of a need for supervision and protection,
or a need for assistance based on inability to perform one or
more activities of daily living. Loss of function or activities
of daily living.
Mr. Michaud. Thank you.
Ms. Buerkle. I yield to the gentleman from Tennessee, Dr.
Roe.
Mr. Roe. I am just an old public school guy. I didn't go to
private schools. But when you do the math, it is $50 million a
year and you have 800-something people; that is over $50,000
apiece per person. I don't know how they came up with the
number, but the math isn't very hard. I don't know whether that
is accurate or inaccurate, but those are the numbers. It is not
hard to do the math on that. I don't think anybody knows. And I
agree with you, Mr. Ibson, they historically have been pretty
inaccurate. That may have been how they came up with the
number: How much are you spending on a caregiver today? It
would be easy enough to find out. How many you have, that is
not hard to find out. So we should be able to get that
information pretty easily.
Just a couple of comments very quickly because I have
another meeting to go to.
I think in H.R. 1460, and I share your concerns, being a
Vietnam-era veteran. I served in Korea. I am a category 8
veteran, and so I can't go to the VA because of my income. I
have never had a problem with that because I felt like veterans
who did not have the resources I had, they should be in the
front of the line and I should be in the back of the line. I
think a lot of veterans feel that way. I know if the resources
are limited, as you all have pointed out, we need to get those
resources to the most needy veterans. To me, those are the
veterans who have served in a combat zone. That may be why this
is the way it is. I don't know that for a fact, but I just
share that as a veteran sitting here, having gone through when
the resources for veterans were very limited after the end of
the Vietnam War. So perhaps in a perfect world, I agree with
you, everybody should be in there.
The other thing I need a little clarification on, and help
me with this because we need to make some decisions, is in H.R.
3723. I treated patients. I am an OB-GYN doctor. They didn't
have a gynecologist at the local VA, and so I would see a lot
of them, our group would, because they didn't provide that
service. As you pointed out, that is already in the law. How
would that change?
In the real world, how do you all see a change in that
relationship the VA would have with me as a provider? And I
agree, a veteran who has been there and has done that probably
sees things a little differently than a physician who has been
trained but has not been in the military. I am trying to figure
out your concern because I want to make sure that I get the
right vote on that proposal. Anybody who can help me.
Mr. Ibson. As I understand the bill, it aims at fostering
contractual relationships with large providers. I think it
would likely close the door on the individual authorization to
an individual practitioner, notwithstanding a finding in the
bill that suggests the importance of giving veterans that kind
of opportunity.
Mr. Roe. I think I need to go back and really look at that
to see if--because I didn't fully understand what your all's
objection was.
Lastly, I just want to thank you all for representing our
veterans. Each and every one of you do a great job, and thank
you for the job you do in representing the interests of
veterans in this country.
I yield back.
Ms. Buerkle. We have just been joined by Mr. Reyes, and we
would like to give you the opportunity to speak about your bill
if you would like to.
Mr. Reyes. Thank you, Madam Chair. I apologize for being
late. It is not all my fault; American Airlines has a role in
that.
In the interest of time, I ask unanimous consent to include
my statement for the record. I thank you and all who were here
that supported my legislation, and I yield back.
[The prepared statement of Mr. Reyes appears in the
Appendix]
Ms. Buerkle. Thank you, and without objection.
Unless there are any other questions for this panel, again,
let me express my gratitude to you. As was mentioned by all of
the Members of the Subcommittee, thank you for what you do for
our veterans and their families as well. Thanks for being here
today and for your testimony. We appreciate it very much. You
are excused.
Ms. Buerkle. Representing the Department this afternoon is
Dr. Robert Jesse, the Principal Deputy Under Secretary for
Health. Dr. Jesse is accompanied by Ms. Susan Blauert, Deputy
Assistant General Counsel for the U.S. Department of Veterans
Affairs. Thank you both very much for being with us this
afternoon.
Dr. Jesse, you may proceed.
STATEMENT OF ROBERT L. JESSE, M.D., PH.D., PRINCIPAL DEPUTY
UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION,
U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY SUSAN
BLAUERT, DEPUTY ASSISTANT GENERAL COUNSEL, OFFICE OF GENERAL
COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS
Dr. Jesse. Thank you. Good afternoon, Madam Chairwoman
Buerkle and Ranking Member Michaud and Members of the
Subcommittee. I would like to start off by thanking you for
having us here to present the administration views on several
of these bills and how they might affect VA programs.
I would also like to extend my thanks to all of the
veterans organizations who were here and speaking on behalf of
their opinions. I think their input is very important as we
make these decisions.
Five of the bills that are under consideration address
aspects of the transition process from servicemembers to
veterans. First, H.R. 1460 would require VA, in cooperation
with DoD, to automatically enroll combat theater veterans. An
important part of VA's mission is outreach on multiple fronts
to let returning veterans know about the services that they
have earned. We are working together in a number of areas to
support this transition with information technology, an
integrated disability benefits evaluation system and better
information-sharing with veterans and servicemembers.
While this bill is offered in the spirit, the proposal
could have complex and unintended consequences, as explained in
my written statement. Thus, we have requested additional time
to evaluate the proposal before submitting a position and a
cost estimate for the record.
Another bill is H.R. 3016 which would require VA and DoD to
jointly operate the Federal recovery coordination program. We
do not believe this is necessary because a program already has
the active support and engagement of the Secretaries of
Veterans Affairs and of Defense, and we believe that the bill
would result in duplication between the programs.
Third, H.R. 3245 would require that VA's vet centers have
access to certain DoD information databases. We do not object
to the bill, but vet centers are already able to verify
eligibility through a number of systems. We emphasize that
access granted by this bill must ensure confidentiality of
veterans' records. Vet centers currently maintain a separate
system of records that effectively walls off any client
information which reassures veterans that their readjustment
counseling remains confidential.
Fourth, H.R. 3279 would amend the eligibility criteria for
the family caregiver program to include veterans with a serious
illness. We agree with the intent of the legislation which
would make the program more equitable in its application. It is
often difficult for clinicians to distinguish between needs
based on an injury rather than an illness. However, the bill
would create significant additional obligations, and we caution
that without additional resources, veterans' access to medical
services may be negatively impacted.
Fifth, H.R. 3337 would require VA to establish and maintain
a registry for veterans who may have been exposed to toxin
chemicals and fumes produced by open burn bits. While we share
the concerns raised by this bill and its advocates, we believe
a health registry is not the appropriate tool to monitor
potential adverse effects. In our written statement, we
highlight the work we are doing now as well as other approaches
that would yield more comprehensive and complete data. We
strongly encourage any veteran who served in a combat theater
to enroll with the VA to assess health care and services for
conditions possibly related to their combat service for 5 years
after their discharge.
For the remaining bills, H.R. 3723, the Enhanced Veteran
Health Care Experience Act of 2011, would significantly alter
VA's existing authority to contract for certain types of health
care. Requests for non-VA care are currently evaluated based on
the capacity to deliver needed services and the clinical need.
We read the new bill as allowing veterans to elect to receive
care from another provider separate from these limits. We
believe existing authority allows VA to contract for health-
care services; and under that authority, the VA continues to
develop broad-based national and regional contracts. The VA has
proposed legislation this year that would provide helpful
clarification to VA's contracting authority.
Finally, in our written testimony, we do not support H.R.
4079, the Safe Housing for Homeless Veterans Act, which amends
safety standards for housing for homeless veterans. We express
concerns about a number of issues presented, including changes
that could reduce the pool of capital grantees. However, we
understand that some of these consequences may have been
created simply by the way the bill was drafted, and we would be
glad to meet with your staff to offer technical assistance that
could address those issues.
Thank you for the opportunity to testify before the
Subcommittee. I would be pleased to respond to your questions.
[The prepared statement of Dr. Jesse appears in the
Appendix]
Ms. Buerkle. Thank you very much. I yield myself 5 minutes
for questions.
I want to get right to the caregivers assistance program
because that is something--as I mentioned earlier, this
Committee has been very concerned about the very slow
implementation of that plan. It has been 4 years now, and we
still don't feel like we are where we are at. There is
duplication and there are gaps. It is very frustrating.
And in your comments just now, you mentioned that wouldn't
be necessary because you are afraid of duplication of
processes. Can you just tell us a little bit today what
specific efforts are underway to address the concerns that we
had in the last couple of meetings?
Dr. Jesse. So the implementation of caregivers has been
complex and has required capabilities that were not accessible
out of things we had done. It is also relatively complex in the
fact of training caregivers, ensuring capabilities of
caregivers, and a lot of the other social service underpinnings
that are required. It did take a long time to get it up and
running. I am actually a little surprised at veterans'
comments, because I think right now it is moving along at a
pace that is reasonable. It probably could have been moving
that way a little bit sooner. But again, it has been a
complicated and new-to-us system.
I don't think the issue on the table here for extending it
to illness has to--it is not going to be compounded in the same
way. What we have learned from doing this with the injured
veterans is very informing. And, in fact, as I understand it,
it has been the wisdom of Congress that we had a 2-year point
where we would evaluate the program, and, from that
understanding, would be able to then talk about extending it to
injured, is the language in the bill, of other--of the pre-9/11
veteran population. Extending it out to illness is a different
issue, and it raises not a different set of processes, but I
think a different set of definitions.
Ms. Buerkle. Can you just, if you can, and if you can't we
will ask you to submit it to the Committee, can you talk to us
about substantive improvements and changes that have occurred
since the October hearing that we had?
Dr. Jesse. I think it is probably best if I bring that back
for the record.
Ms. Buerkle. Thank you. I would appreciate that.
[The attachment appears in the Appendix]
Ms. Buerkle. Dr. Roe, before he left, the question came
up--I'm sure you were listening--what is the cost for a
caregiver. Do you have any idea what the number is?
Dr. Jesse. Our cost estimates are at this point based on a
lot of suppositions. When we talk about illness, really the
cost is going to be dependent on what are the brackets around
the population that is included and the needs of those specific
populations. So we are learning from the current injured
veterans what those costs are. They will be informing as we
begin to expand this out. We don't know the answer for certain,
but our best guess is what we have presented.
Ms. Buerkle. Thank you. I have a few seconds left.
In our second panel, Mr. Atizado testified that late last
year, both the VA and the DoD had been coordinating a decision
memorandum regarding the future direction of the FRCP. Is that
true; and if so, can you tell us about the memorandum and any
decisions it contains?
Dr. Jesse. There exists actually a memorandum that goes
back to 2007 or 2008, back with the original legislation. What
I think he is referring to is the secretaries themselves have
taken a renewed interest in making this program work.
For the past, close to a year, it started about a year ago
in January, February, in the very strong effort to get the
integrated electronic medical record program moving forward,
the secretaries have been meeting on a relatively frequent
basis every couple of months and dealing with these substantive
issues, and that program is squarely in their sights.
Ms. Buerkle. Thank you. If I can ask you to provide those
decisions of memorandum for the Committee, however many there
might be, with regards to this issue. Thank you very much.
[The attachment appears in the Appendix]
Ms. Buerkle. At this time I yield the Ranking Member 5
minutes.
Mr. Michaud. Thank you, Madam Chair. Thank you, Doctor, for
coming today as well. My questions are also regarding the
caregivers legislation.
How did you come up with the number of 870 additional
servicemembers when you also state that you haven't come up
with a definition of serious illness? How did you come up with
that number?
Dr. Jesse. I will take that for the record to give you the
precise answer because I don't want to misstate it at this
time.
[The attachment appears in the Appendix]
Dr. Jesse. But I think what you said is exactly correct. We
can't come up with an exact number until we define what serious
illness is. That would require regulation and would have to go
through a due process in order to do that. So we can only make
best-guess estimates.
Mr. Michaud. So do you have a definition in mind of serious
illness?
Dr. Jesse. Again, let me get back to you for the record.
[The attachment appears in the Appendix]
Mr. Michaud. You know, it is just amazing that you are
saying it is going to cost X amount when you don't even know
what the definition is going to be. But you said it is going to
be 870 additional servicemembers. I look forward to seeing what
you come up with because I think it is very important because
it gets right back to some of the issues we have had in the
past about the credibility of the VA system. If you can't come
up with a cost estimate, you should say you can't come up with
a cost estimate. But to say that it is going to be 870
additional servicemembers and it is going to cost X amount when
you don't even know what the definition is going to be, that
leads the Committee, and I know myself, to question the
credibility of the VA. So I will be looking forward to that
answer.
And for the future, I wish the VA, whoever is drafting your
testimony, would be up front and honest about it versus trying
to determine whether our legislation is going to pass or fail
because of a cost estimate. So I look forward to that answer.
Dr. Jesse. Yes, sir.
Mr. Michaud. Getting back to the burn pit issue, how does
the VA train its health-care providers to address unexplained
illnesses and symptoms that may be linked to open burn pits?
How do you train?
Dr. Jesse. The burn pit issue is relatively new in the
sense of other issues that we have dealt with in terms of
servicemembers' exposures in the course of deployment or even
in the course of their military careers.
The problem with training on burn pits specifically is
understanding what are exactly those exposures. And one of the
concerns about burn pits in particular is that everyone is
different. So we know that exposure to burning things creates
particulate matter, and we probably have a relatively
reasonable understanding about what that can mean from other
areas. But what happens to--what are the effects of the toxic,
other toxic chemicals in burn pits, we don't know. I think what
we train our providers is to pay attention to patients'
complaints and symptoms and to bring them to resolution as
absolutely best we can.
We have struggled with this in several other areas. The
Gulf War illness. As you know, we have dedicated significant
resources in an ongoing fashion to try and understand what are
the symptoms, what are the causes and the treatment of
symptoms, and in many cases unexplained symptoms, that veterans
of that conflict are coming forward with. It is no simple
matter.
Mr. Michaud. Getting accurate, up-to-date information on
pre-deployment and post-deployment health records, where
servicemembers were located and other pertinent information
from the Department of Defense, has in the past been
characterized as very difficult. What makes you believe that
the exchange of information between the VA and the DoD has
improved with the current deployment of Afghan and Iraqi
soldiers?
Dr. Jesse. I am going to answer that cautiously because we
don't know that it has improved. We are only working very
diligently with them to try and improve that. We have some
isolated instances, Karmanah Li, for instance, where we think
that we have a very solid lockdown on who was exposed. And that
is relatively straightforward. Burn pits become another--you
know, it is a whole different challenge.
The radiation exposures, potential radiation exposures from
the tragedy in Japan after the tsunami, we have a very solid
lockdown on who those folks were.
In the end, the VLER, the Virtual Lifetime Electronic
Record, which is intended to be a consolidation of one's
military service and one's health care record really should
feed forward into that. And that is the intent of beginning to
build that kind of a program.
But I think going back to Agent Orange was a great example
of how we had very little insight into who was exposed. I know
that Secretary Shinseki is passionate about trying to get a
handle on this because we cannot afford to have another example
like that.
Ms. Buerkle. I now yield 5 minutes to the gentleman from
Texas, Mr. Reyes.
Mr. Reyes. Thank you, Madam Chair.
Thank you for being here. I am a little bit puzzled because
as I understand it, the only objection to H.R. 3279 is the
cost. And yet I am not sure you are prepared to give us a
formula on how you arrived at the cost; is that correct,
Doctor?
Dr. Jesse. I personally am not. I don't want to give you a
wrong answer, which is why I best take it for the record.
Mr. Reyes. But that is correct? The objection from the
administration is the cost, because the cost is too high?
Dr. Jesse. No, no, no. I don't think that is the case at
all. In fact, it is not an objection as much as a concern that
we don't understand the true cost, and our comment on the bill
is tempered by that. But in fact--
Mr. Reyes. So how much time will you need to get back to us
with your analysis on the cost on who is affected, on the
definition of a serious illness, and all of these things that
we have been talking about? How much time will it take?
Dr. Jesse. It should not take long because that should
already be there. It should be done. I just don't know the
precision. I don't know the answer with the level of precision
that I am comfortable giving it to you today.
How long should it take us to get an answer? The data
exists. We will get it to you. A couple of weeks. Is that okay?
Mr. Reyes. As soon as possible, I would think. I tell you,
when we take these to the floor, Members need to know exactly
what the concerns are.
Dr. Jesse. I agree. We will get it to you absolutely as
soon as possible.
Mr. Reyes. Can you give me an example of someone who would
be denied caregiver assistance for an injury but approved if
illness were included? Is there a way to give me an example of
that? Can you give me an example with the cost analysis?
Dr. Jesse. Someone with a serious injury should be covered
under the existing caregivers. So what this is opening up to is
to people who have serious illnesses as well.
Let's take an example, ALS. It is a serious illness that is
service-connected, and while those people have access now to a
number of services, including aide and attendants and the like,
this would markedly expand what we can provide to them. And I
don't know--I am not sure that I understand, somebody who has--
Mr. Reyes. Can an individual, who was denied caregiver
assistance as a result of an injury, be subsequently approved
because an illness was included?
Dr. Jesse. I am not sure I can answer.
Mr. Reyes. Can you take that for the record and I will be
happy to provide some clarification if you need it?
[The attachment appears in the Appendix]
Mr. Reyes. My last comment, I have had a number of
opportunities to discuss the difficulty that exists between
giving the benefits to veterans from our perspective as a
Congress to the reality at the VA hospitals and clinics around
the country. And I have shared with General Shinseki, who was
in Vietnam about the same time I was, the issue of Agent
Orange. I think it is one of the best examples because those of
us that had that experience flew in because we had to provide
cover for the C-123s that were spraying the Agent Orange
largely around these high artillery bases in Vietnam. And so
they sprayed around the mountain where these bases were in
order to get rid of the foliage because the VC and the NVA at
night would come up through there. As they were spraying, they
would get fired upon, so it was our job in the helicopters to
go in and provide the protection. As we were providing that
protection, we were flying through the mist of the Agent
Orange. And I can tell you, it didn't taste anything like
oranges. Many asked the question rhetorically: Is this stuff
safe? Is it okay?
I grew up on a farm where we used pesticides and crop
dusters and all of that, and we took great pains to not be in
the way of the crop duster. But we were repeatedly reassured
that the government wouldn't use that if it weren't safe. Well,
now generations later, and today I am concerned about my oldest
daughter because of recent research that has been done, that
now apparently you can pass on the effects of Agent Orange
genetically. That is what makes it so frustrating for those of
us who have had those experiences, to try to get legislation
through and not be taken seriously by the way definitions are
made, by the way people implement the law.
I will tell you, we funded the alternative budget, the 4
years we were in charge of the House, for that reason. Let's
look and see if fully funding the VA would make things get
better. Well, it wasn't money. I don't know what we need to do.
But something has to change to be able to get the message that
these guys that are coming back from Iraq and Afghanistan and
other places with TBI, PTSD and all of these other things are
hurting, and we are obligated to take care of them. We do the
things we do because of their willingness to be out there. And
this is generation after generation.
I just get so exasperated when you can't answer our
questions. I mean, if I were in charge, I would say here is
what they are going to talk about. This is likely what they are
going to ask. Here is the answer. It doesn't seem to be a
problem to come up here and say well, ``we think,'' ``we
might.'' And ``we can get back.'' Madam Chair, I just get so
frustrated. I know it is not--and I don't mean it at the
messenger--it is just the whole damn system that frustrates me.
Thank you.
Ms. Buerkle. Thank you, Mr. Reyes.
I guess I will just echo my colleague's sentiments.
Dr. Jesse, with all due respect, as Mr. Reyes mentioned,
you are the messenger, but when you tell me it is complex and
it is complicated and it takes a long time to figure these
things out, we send men and women overseas. They go over and
serve our Nation. The very least we can do as a country is to
make sure that they get what they need. That is all the
Veterans' Affairs Committee wants, is to make sure that the men
and women who serve this Nation get what they need and deserve.
What we are asking for today, and just to repeat, the cost
analysis, the decision memorandums that we talked about
earlier, and the definition of serious illness so we can get
some clarification on those topics. Time is of the essence, as
just expressed by my colleague's frustration. This isn't
something arbitrary. This is something on which we have the
luxury of time. The men and women care. They need access to
services. Again, that is a message that needs to go back to the
Department of Veterans Affairs. Time is of the essence.
I thank you both for being here today. With that, panel 3
is dismissed. Thank you so much.
If there are no further questions, I move that Members have
5 legislative days to revise and extend their remarks and
include extraneous material. Without objection, so ordered.
[The attachment appears in the Appendix]
Ms. Buerkle. Once again, I just want to extend my gratitude
to all of the witnesses, the Subcommittee Members and the
audience for your participation and attendance this afternoon.
We are a grateful Nation, and we must together work to make
sure that the veterans, the men and women who serve, who are
serving, and who have served, get what they need and what they
deserve.
With that, the hearing is now adjourned. Thank you.
[Whereupon, at 5:48 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Ann Marie Buerkle, Chairwoman
Good afternoon. This hearing will come to order.
Thank you all for being with us today as we meet to discuss seven
legislative proposals concerning the care and services provided to our
Nation's veterans and their families through the Department of Veterans
Affairs (VA).
The seven bills on our agenda this afternoon are: H.R. 1460, to
provide for the automatic enrollment of veterans returning from combat
zones into the VA medical system; H.R. 3016, to direct the Secretary of
Defense and the Secretary of Veterans Affairs to jointly operate the
Federal Recovery Coordination Program; H.R. 3245, the Efficient
Services for Veterans Act; H.R. 3279, to clarify that caregivers for
veterans with serious illnesses are eligible for assistance and support
services provided by VA; H.R. 3337, the Open Burn Pit Registry Act;
H.R. 3723, the Enhanced Veteran Healthcare Experience Act of 2011; and
H.R. 4079, the Safe Housing for Homeless Veterans Act.
Together, these bills touch on a full range of issues affecting our
veterans and their families. The proposals we will discuss include
measures to address fire and building safety code enforcement for
homeless veterans participating in VA grant and per diem programs;
streamline the eligibility determination for veterans seeking
readjustment counseling services at Vet Centers; establish a registry
for OEF/OIF veterans who may been exposed to toxic chemicals caused by
open burn pits; and allow veterans greater access to the health care
they earned and deserve by reforming VA's fee-basis care program and
providing for the automatic enrollment of returning combat veterans
into the VA health care system.
Additionally, we will discuss two bills--H.R. 3016 and H.R. 3279--
that seek to improve programs that support to some of our most severely
wounded warriors, the Federal Recovery Coordination Program and the
Comprehensive Assistance for Family Caregivers Program respectively.
These programs in particular are very familiar to this Subcommittee,
which has held a total of four oversight hearings last year to examine
them in depth.
Our discussion today will provide us the opportunity to thoroughly
examine each of these proposals with their sponsors, the Department,
and our partners in the veteran service organizations to find out what
works, what doesn't, and what needs to be improved.
I thank my colleagues for sponsoring the bills on our agenda this
morning and for their leadership. I also appreciate our witnesses from
the veterans' service organizations and VA for taking the time to join
us today and for working so hard day in and day out in support of our
Nation's heroes. I am looking forward to a very frank and productive
discussion.
Prepared Statement of Hon. Michael H. Michaud,
Ranking Democratic Member
Thank you, Madam Chairwoman.
The purpose of today's hearing will be to explore the policy
implications of seven bills before us today which cover a wide range of
topics that would expand and enhance VA's health care programs and
services. To allow maximum time for discussion, I will limit my opening
remarks primarily to H.R. 1460, H.R. 3016, and H.R. 3279.
H.R. 1460, offered by Mr. Owens of New York, instructs the
Department of Defense, in conjunction with the VA, to automatically
enroll veterans returning from combat zones into the VA medical system,
while providing a chance to opt-out of the system both at the time of
separation from the Armed Services and 6 months following.
In 2008, Public Law 110-181 was enacted, which extended the
eligibility period for free VA medical care from 2 to 5 years for
veterans who served in a combat theater of operations after November
11, 1998. This applies to active duty, National Guard, and Reserve
servicemembers returning from recent conflicts for conditions that may
be related to their combat service. Following this initial 5-year
period, these veterans may continue their enrollment in the VA health
care system, but they may be subject to applicable copayments for
nonservice-connected conditions.
H.R. 1460 does not create new classes of veterans eligible for free
VA health care, but simply changes the process by which these veterans
would become part of the system upon separation from the DoD. This
legislation would ensure that combat veterans are able to seamlessly
receive VA health care services upon their separation from the
military.
Next, H.R. 3016, introduced by Mr. Barrow of Georgia, a Member of
the Full Committee, would improve reintegration efforts and require
that the Federal Recovery Coordination Program (FRCP) operate jointly
under both DoD and VA. This legislation follows up on two Subcommittee
hearings held on this issue last year, where we discussed the
continuing problems between the VA and DoD in working collaboratively.
I still do not feel confident that VA and DoD can overcome existing
barriers and the tangle of bureaucracy that seems to surround the
implementation of this program. H.R. 3016 is intended to ensure that
the FRCP moves forward in a more efficient and effective manner.
Finally, H.R. 3279, sponsored by Mr. Reyes of Texas, a Member of
the Subcommittee, would clarify that caregivers for veterans with
serious illnesses are eligible for assistance and support services
provided by the VA. This legislation also follows up on two
Subcommittee hearings held on this issue last year, where we examined
the delays in the rollout of the implementation plan, next steps, and
the narrowing of criteria for eligibility of these benefits.
When Public Law 111-163, the Caregivers and Veterans Omnibus Health
Services Act of 2010, was enacted on May 5, 2010, the legislation
required the VA to evaluate the program at 2 years. With this benchmark
quickly approaching, I am interested in hearing more about the
potential to expand this program to caregivers for veterans with
serious illnesses-- not just those who are seriously injured-- as
certain mental health conditions do require the full supervision of a
family caregiver. I believe this change will expand the criteria for
eligibility of these benefits to be more in line with the original
intent of Congress.
I look forward to hearing the views of our witnesses on the bills
before us today.
Madam Chair, I yield back.
Prepared Statement of Hon. Russ Carnahan
I would like to thank the Chair and Ranking Member for holding this
hearing. We must ensure that the sacrifices of our current troops,
veterans, and their families do not go unnoticed and that they are
given the support and resources they deserve. Our troops are committed
to protecting our freedom, and our commitment to them does not end when
they return home.
As veterans try to reintegrate into civilian life, many of our
heroes struggle with the physical and mental effects of conflict. PTSD
rates have been steadily growing since the overseas conflicts in
Afghanistan and Iraq began. Diagnoses for depression are up
particularly among younger active duty veterans who usually have higher
combat exposure. Employment, effective health facilities, and
psychological services are crucial to ensuring our veterans and their
families are properly supported. Particularly in these times of tight
Federal budgets and deficit reduction efforts, we must remain steadfast
in our support of our veterans.
This Subcommittee has held two hearings on the Caregivers and
Veterans Omnibus Health Services Act of 2010. The intent of this law is
to provide comprehensive assistance and support services to family
caregivers of veterans with a serious illness or injury. Unfortunately,
the current interpretation of the law excludes the caregivers of
seriously ill veterans. The sacrifices made by our military families
begin before deployment and continue after their loved one returns
home. H.R. 3279 will ensure that we fulfill our commitment to the
families of seriously ill veterans, families who continue to serve our
country by caring for our Nation's heroes when they are most in need of
care.
I look forward to hearing from our witnesses today on ways that we
can work together to guarantee our service men and women have the
support they need and deserve when they return home.
Prepared Statement of Hon. William Owens
Prepared Statement of Honorable William Owens
Chairwoman Buerkle, Ranking Member Michaud and Members of the
Committee, I appreciate the opportunity to come before you today and
testify on H.R. 1460, legislation I have introduced to provide for the
automatic enrollment of military servicemembers in the VA health care
system. As a veteran of the Air Force, I am honored to have the
opportunity to help improve access to the benefits that the men and
women in uniform have earned in their service to the country.
The soldiers, sailors, airmen and marines of the armed forces have
served with great honor and distinction over a decade at war in the
Middle East. PCS orders, increased op-tempo, repeat deployments, and
shortened dwell times have only added to the pressures facing the
military and their families through Operations Enduring Freedom, Iraqi
Freedom, and New Dawn.
There is no question that we as a country have made great strides
over the past ten years to strengthen systems of care for America's
veterans, but obstacles remain for the men and women transitioning from
service to civilian life. Representatives from various Veterans Service
Organizations have testified on their concerns for military families
being overwhelmed by the bureaucracies of both the Veterans
Administration and the Department of Defense, and it should come as no
surprise that VA paperwork is only one a number of challenges facing
servicemembers in their transition to civilian life.
My legislation would automatically enroll veterans who are eligible
for VA health care into the system, while also taking steps to better
inform them of other benefits for which they are eligible. The bill
also offers two proactive opportunities for veterans to opt-out of the
system, both before they enter and six months after. This legislation
has been endorsed by the American Legion, and I believe is a step in
the right direction towards the ``seamless transition'' from service
that has long been the goal of many in Congress and veterans advocates
across the country.
To be clear, this legislation does not change the benefits for
which a veteran is eligible or the care they are entitled to within the
VA. The men and women enrolled under this legislation are already
eligible for VA care. All we are doing is shifting the burden of
enrollment away from those who have just returned from a theater of war
to those who are employed to serve America's veterans.
In addition to reducing the government paperwork required of them,
we can help ensure that overburdened servicemembers do no slip through
the cracks and miss an opportunity to enjoy the benefits they have
earned. I remain particularly concerned for servicemembers afflicted
with Traumatic Brain Injury or Post-Traumatic Stress Disorder, who face
unique pressures in transitioning from service. This legislation will
help ensure they have early access to screening for TBI and PTSD from
experts at the VA who can improve the long-term prognosis for those
affected and ensure proper treatment in the years ahead.
I thank you again for the opportunity to speak before you on H.R.
1460, and respectfully ask that you consider lending your support to
the bill. I look forward to your questions.
Prepared Statement of Hon. John Barrow
Chairman Buerkle, Ranking Member Michaud, and Members of the Sub-
Committee:
Thank you for the opportunity to speak with you about H.R. 3016, my
bill to improve the Federal Recovery Coordination Program.
Today's returning Armed Service Members face a unique combination
of challenges as they reintegrate into the community. One important
means for helping these folks is the Federal Recovery Coordination
Program, which was originally envisioned by the Dole/Shalala Commission
to help wounded warriors navigate the bureaucracy of the VA and DoD
health systems. A Federal Recovery Coordinator is a nurse or a social
worker with graduate level training, who helps guide wounded warriors
to the proper treatment and benefits options.
Unfortunately, administrative roadblocks have prevented the Program
from achieving its full potential. That's why I introduced H.R. 3016,
which would correct the administrative problems that prevent the
Federal Recovery Coordination Program from succeeding.
H.R. 3016 establishes joint administration of this program by
placing it under the supervision of both the Secretaries of Defense and
Veterans Affairs. It ensures that severely injured Armed Service
members and veterans receive a Federal Recovery Coordinator. It gives
Coordinators the authority to act earlier in the recovery process, and
it makes certain that each branch of DoD will refer wounded warriors to
the Program.
Jim Lorraine, the Executive Director of the Augusta Warrior Project
- a fantastic organization that builds collaborative relationships with
local, state, and national organizations to support wounded warriors
and their families in the Augusta area - explains how this legislation
will benefit veterans:
The Federal Recovery Coordinator Program is essential to helping
our most severely wounded, ill, and injured, who have given so much for
our Nation figure out how to navigate these complex bureaucracies and
improve their access to existing services. This legislation not only
formally establishes the program, but directs its management from the
highest levels of the departments of defense and veterans affairs to
ensure unimpeded access to care.
I hope this Committee will join me in strengthening the Federal
Recovery Coordination Program through this legislation. It's time we
fulfill the promises we've made to our servicemembers by improving
their care throughout the recovery process.
Thank you for the opportunity to speak before this Subcommittee,
and I yield the balance of my time.
Prepared Statement of Hon. Jeff Denham
Chairwoman Buerkle, Ranking Member Michaud and Members of the
Subcommittee, thank you for holding this legislative hearing today.
Thank you to the Chairwoman for cosponsoring this legislation as well
as Mr. Roe and Mr. Benishek for their support. Let me also thank Mr.
McNerney, who joined me two weeks ago for an important field hearing of
this Subcommittee examining the role of Vet Centers within the VA
system. Vet Centers offer a wide range of readjustment counseling
services to eligible Veterans and their families. At our field hearing
we were able to hear firsthand how effective these centers are at
delivering the care our veterans need confidentially and without any
delay. This bill would provide Vet Centers with one additional tool to
serve our veterans: the ability to search an electronic database of DD-
214 records.
A veteran's DD-214 is the swiftest way to determine eligibility for
the services provided by Vet Centers. A DD-214 is the capstone military
service document, as it represents the complete, verified record of a
servicemember's time in the military, awards, medals and other
pertinent service information such as promotions, combat or overseas
service, Military Occupational Specialty (MOS) identifiers and their
record of training and schools completed. In the event that a veteran
has lost his access to a DD-214 it can take up to six weeks to receive
a copy and there is no single prevailing method used by Vet Centers to
request a copy of a DD-214. While during the delay a veteran will still
have access to the facility, instant verification will allow the Vet
Center to immediately provide veterans the highest possible level of
service and eliminate the bureaucratic hurdle for the servicemember.
There are two electronic records systems that allow users to view a
DD-214 form. These systems are the Defense Personnel Records Image
Retrieval System and the VA/DoD Identity Repository (VADIR).
The latter receives nightly and near realtime transmissions from
the Defense Enrollment and Eligibility Reporting System/Defense
Manpower Data Center (DEERS/DMDC) of military service information for
servicemembers leaving the military.
The former provides authorized U.S. government agencies controlled
access to military personnel record images maintained by the Military
Services for members of the U.S. Armed Forces. This system was
initially implemented in the late 1990's, so not all personnel records
are available and implementation was staggered across all branches of
service. DPRIS contains narrative information in DD-214 that no other
sources contain.
The bill simply directs the Secretary of Veterans Affairs and the
Secretary of Defense to jointly ensure that the Vet Centers of the
Department of Veterans Affairs have access to a veteran's DD-214. As we
speak there are 7500 current users of the DPRIS system within the VBA
alone and many others across the VA system. I strongly believe that the
professional staff and counselors at Vet Centers should be given the
same tools to serve our veterans and believe that it can be done in a
way that preserves the integrity of the Vet Center System. I thank the
American Legion and Veterans of Foreign Wars for their support of this
legislation.
As a veteran myself I know the difficulties experienced by those
transitioning to civilian life and how common it is for veterans to be
missing records that are important to keep. I am sure you can all agree
that whenever we have the opportunity to streamline service for our
veterans we should seize that chance.
Again I thank the Chairman, the Ranking Member and Members of this
Committee for allowing me to speak here today. I look forward to
working with you all on this bill as I look for its swift passage by
the Committee and this house.
Prepared Statement of Hon. Silvestre Reyes
Chairwoman Buerkle, Ranking Member Michaud, and my fellow Members
of the Health Subcommittee thank you for hosting this hearing. I
appreciate having the opportunity to provide additional information on
a subject that is very important for our Nation's veterans.
As you know, this Committee worked to draft and pass legislation to
provide needed support to caregivers for seriously injured Iraq and
Afghanistan veterans. Under this initiative, the VA provides a monthly
stipend, health insurance, and other support for family members who
provide round the clock care for those who suffered major injuries in
the line of duty.
Last year, the VA expanded the program, which helped bring the
initiative closer to the intent of Congress, and I have introduced
legislation, HR 3279, which would make a further needed improvement to
the program.
The original caregiver legislation covered those servicemembers who
incurred or aggravated a serious injury as a result of their service.
The intent was a provide a much-needed benefit for those families who
had suffered the most, but, by limiting the program to injuries, a
category of veterans facing the same issues have been excluded by a
technicality.
My legislation would expand the caregiver program to include not
just serious injuries, but would also cover those who incurred or
aggravated serious illnesses as well. Not every condition which would
require caregiver support is related to an injury, and making this
change also aligns the caregiver program with other VA programs which
do not distinguish between injuries and illnesses.
I want to thank the VSO's both for expressing their support of my
legislation and for their efforts on behalf of our Nation's veterans
and their families. HR 3279 has garnered the endorsement of the
National Military Family Association, the Retired Enlisted Association,
the Association of the United States Navy, the Veterans of Foreign Wars
(VFW), the Disabled American Veterans (DAV), the Military Officers
Association of America (MOAA), the American Legion, the Iraq and
Afghanistan Veterans Association, and the Wounded Warrior Project.
The VA has also expressed support for the intent of this
legislation which will help them provide the care and support our
veterans require. Expanding coverage to those veterans suffering from
serious illnesses related to their service will help additional
families and ensure that veterans are treated fairly, but this
expansion is not without cost. Working together as a Committee, I am
sure that we can find a way ensure that the caregiver program meets
both the intent of Congress and the needs of veterans and their
families.
The men and women who volunteer to serve our Nation put themselves
at great risk, and we owe them a great debt of gratitude and honor. We
also owe them and their families care and support as they deal with
injuries and illnesses that resulted from their service. Making this
needed change in the caregiver program is one way we to honor their
sacrifice.
Prepared Statement of Hon. W. Todd Akin
Chairwoman Buerkle, Ranking Member Michaud, thank you for the
opportunity to testify before you today regarding my bill, H.R. 3337,
the Open Burn Pit Registry Act. As of today, this bill has over fifty
bipartisan cosponsors and has been endorsed by a wide range of
veterans' organizations.
The issue of burn pit exposure first came to my attention through
veterans in my district who served honorably in Iraq and Afghanistan
and are now suffering serious health effects apparently linked to
exposure to burn pits. Let me share one short story.
Tim Wymore is a Missouri Guardsman suffering from the effects of
working around burn pits while deployed to Iraq in 2004 and 2005. If
his wife Shanna were here today, she would tell you of the dramatic
impact burn pits have had on the life of her husband and hundreds of
others she has gotten to know as a result of fighting for Tim's
treatment.
For nearly a year before contacting my office, as Tim's health
continued to deteriorate, Shanna Wymore fought an often indifferent and
sometimes hostile V.A. medical system trying to get care for her
husband's unexplained illnesses. Tim, once a strong, athletic
machinist, was suffering debilitating bouts of abdominal pain, weight
loss and fatigue. Despite the adversity, Shanna persisted in her fight
to get the help her husband was both entitled too and deserved. Along
the way, she became an expert on burn pits and the growing number of
Iraq war veterans suffering the effects of their exposure.
After more than two years of indecision and broken promises, with
assistance from my District staff, the VA finally agreed to send Tim to
the Mayo Clinic. The doctors there confirmed, what the VA had long
denied, Tim was suffering the effects of what could only be attributed
to the work he performed around the burn pits in Iraq.
I have had at least one other constituent, Aubrey Tapley, who has
suffered the consequences of burn pit exposure and who has strongly
advocated for taking proactive steps to help others who may be
suffering from burn pit exposure.
Unfortunately, the health consequences of burn pit exposure are
hard to understand and difficult to prove. Last fall the Institute of
Medicine released a report which concluded in part that there is
insufficient data available to determine the long-term health effects
of exposure to burn pits and that more study is warranted.
The intent of my bill is to establish a registry at the Department
of Veterans Affairs for those individuals who may have been exposed to
open burn pits during their military service. This would help the
Department study the issue more effectively and enable them to
communicate to interested veterans as medical research on this issue
develops. This registry would not affect the benefits any veteran is
already entitled to receive, but would help the Department take better
care of our veterans.
The experience I have had with veterans in my district is enough to
convince me that we need to be proactive about studying and analyzing
the potential health effects of open burn pits. We have sent our best
and brightest young men and women into harm's way, and it is our
responsibility as a Nation to take care of them when they return.
Although there is a small cost for this bill, I think it is an
affordable and reasonable approach to dealing with the issue of open
burn pits, and I ask your Subcommittee to support this bill and
consider moving it forward.
Again, thank you for the opportunity to testify today and I look
forward to answering any questions you may have.
Prepared Statement of Hon. Robert T. Schilling
Chairwoman Buerkle, Ranking Member Michaud, and my colleagues,
thank you for this opportunity to come before the House Veterans'
Affairs Subcommittee on Health to speak about my bill, H.R. 3723, the
Enhanced Veteran Healthcare Experience Act of 2011.
I truly believe you can tell a lot about a country by the way it
treats its veterans. I'm pursuing this legislation in large part
because of the many constituents who constantly share their stories of
having to drive long distances while experiencing substantial wait
times in an effort to make sure they can get the health care they need.
But I also experienced this in my own family when helping to take care
of my father near the end of his life. We had to drive several hours to
and from Iowa City for him to get the care he needed. While we
appreciated the service and the care provided by the Department of
Veterans Affairs (VA), I also believe that we must continue to make
improvements for our veterans.
Under the current veterans' health care system, our veterans are
shuttled back and forth between the VA and their local doctors'
offices, bound by the red tape that exists in the fee-based care system
administered by the VA. This red tape only exacerbates working with
their local doctors' offices to receive the health care they need.
We also must keep in mind the fact that we will have a new group of
veterans entering the VA system with needs that differ from past
veteran groups. These include not only different injuries, but also
women and the children of veterans. These groups of folks may require
care that cannot always be addressed by the VA and allowing them a more
convenient way to get their health care needs addressed is vital.
On top of that, there have been instances where the current VA fee-
based system has been unable to accurately pay private providers the
correct amounts, which, has resulted in multiple overpayments and has
cost taxpayers their hard earned dollars \1\. It has been under close
scrutiny by the Government Accountability Office and the Office of the
Inspector General. \2\ Veterans Services Organizations have also raised
concerns about ensuring equal or better quality care when veterans are
referred outside of the VA \3\. This system has also been unable to aid
veterans in making and keeping their appointments.
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\1\ http://www.napawash.org/publications/veterans-health-
administration-fee-care-program/
\2\ http://www.va.gov/oig/pubs/VAOIG-statement-20111115-finn.pdf
\3\ www.independentbudget.org/2012/5--medical--care.pdf
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This is unacceptable. Therefore, I am proposing we look at current
systems that do work and have received a very positive response from
veterans. The VA has two pilot programs, Project HERO (Health Care
Effectiveness through Resource Optimization) and Project ARCH (Access
Received Closer to Home), which allow veterans to use fee-based care in
their hometowns with their own doctors. In addition to helping veterans
cut down on commute time, these programs provide timely care to all
veterans who have been placed on a long wait list. Instituting their
models would revamp the VA's current fee-based care program and provide
a fiscally responsible solution that results in more efficient and
higher quality care for veterans seeking services outside of the VA.
While these programs have not been used on a Nation-wide scale, their
utility cannot be ignored.
My legislation, the Enhanced Veteran Healthcare Experience Act,
would merge the best parts of Project HERO with the best parts of
Project ARCH, and provide an alternative to the current VA-run fee-
based care program as the primary source of fee-based care for
veterans. It would ensure that the VA contracts with qualified outside
entities that meet key competency requirements such as network
credentialed providers and accredited facilities; care coordination;
patient advocacy; and electronic claims processing capabilities. The
bill would standardize referral and authorization processes at all VA
medical centers, require continuity of care for veterans, and require
key performance metrics and incentive payments.
The bill would not force veterans to stop using VA care; veterans
who prefer their current VA provider would still be able to continue
receiving care from that provider. Veterans who do go outside of the
system are also not prevented from returning to the VA for care in the
future.
However, the bill would supplement the current VA fee-based program
and utilize the funds saved within the VA's regular operating budget
expenses. With a proven system in place that can properly keep track of
payouts, the VA could save money it may have otherwise misspent, and
very little additional funding would therefore be required for this
more efficient program. The Congressional Budget Office (CBO) has not
yet officially scored this bill, but because the regular VA fee-based
care program is much more costly than Project HERO, the proposed
blended program would likely cut overall VA costs and therefore create
savings. An unofficial CBO staff estimate indicated that this bill
would require $3 million total for fiscal years 2012-2016. However,
studies and statements by the GAO, OIG, and VSO's suggest that
implementing the changes in this bill will create savings for the VA
and address medical care concerns that veterans have when working with
the VA fee-based care system.
This idea is near and dear to me, and has received a positive
response from veterans I have spoken with in my district. The
Congressional process is in place so that we can perfect legislation.
That is what I am working to do on this bill. Since H.R. 3723's
inception and also from its introduction, I have continued to work with
Veteran Service Organizations (VSOs) to address their concerns. I hope
to continue to do this with the VSOs and the Committee. To that end I
have draft legislation that the Committee can use to improve H.R. 3723
in accordance with further input from Members of this Committee,
veterans, and the VSOs.
Again, thank you for this opportunity to speak about ways that we
can remain fiscally responsible, improve care, and keep our promises to
our veterans.
Prepared Statement of Hon. David B. McKinley
Chairwoman Buerkle, Ranking Member Michaud and Members of the
Subcommittee, thank you for holding this legislative hearing today on
important issues that affect our nation's veterans. I appreciate the
opportunity to give remarks on my bill, H.R. 4079, the Safe Housing for
Homeless Veterans Act.
Currently, there are over 2,100 community-based homeless veteran
service providers across the country and many other homeless assistance
programs that have demonstrated impressive success reaching homeless
veterans. I have visited some of the shelters in my home district in
West Virginia and was struck by how many seemed to not be in compliance
with state, local or federal safety codes.
After seeing these conditions with my own eyes, we began to
investigate whether this is something that is isolated or more
instances are occurring. It was unsettling to learn in our research
about shelter fires where lives were lost. For instance, in 2009, an
East Texas homeless shelter fire where five occupants were killed was
found to not have a required sprinkler system and an instance in New
York City just this past year where two dozen people were injured
because the sprinkler system was not working properly and the exits
were blocked. I would like to enter news articles about these fires and
an additional three articles regarding other instances of code
violations into the record.
Unfortunately there is no law mandating VA homeless shelters meet
code; there is only a policy in place. As a licensed professional
engineer, I found this to be an egregious omission in the law governing
VA homeless program funds. H.R. 4079 would require any organization
that seeks funding from VA for services to homeless veterans to have
documentation that their building meets or exceeds all Life Safety
Codes. This legislation also requires VA to give priority to shelters
that need financial assistance from VA for improvements to ensure that
the facility is in compliance with all the safety codes.
I am disappointed that VA has chosen to not support H.R. 4079, a
bill that would codify what they already have as a policy. This is
common sense legislation that would ensure the wellbeing of veterans
who have fallen on hard times and are in the most need of assistance;
and in extension these same veterans are turning to society to assure
them of safe, reliable housing.
As a nation, it should be unacceptable for us to allow homeless
veterans be housed in potentially unsafe conditions. In defense of our
country, these men and women were put in harm's; they should not be in
doubt about their own safety now that they are home again. These
homeless veterans are experiencing a difficult phase of their lives and
should be able to trust that they will be safe each night as they
continue their return to being productive members of society.
I appreciate the testimony in support of H.R. 4079 from other
witnesses testifying here today and I thank you for your concern for
the safety and living environment of our veterans.
Prepared Statement of Shane Barker
Madam Chairwoman and Members of this committee, on behalf of the
more than 2 million members of the Veterans of Foreign Wars of the
United States (VFW) and our Auxiliaries, the VFW would like to thank
this committee for the opportunity to present its views on the
following bills:
H.R. 1460, to provide for automatic enrollment of veterans returning
from combat zones into the VA medical system:
The VFW supports the concept of H.R. 1460, legislation that would
automatically enroll service members who have deployed to Iraq or
Afghanistan for health services in the Department of Veterans Affairs
(VA). For years now, our nation has provided 5 years of no-cost health
care for separating service members through VA, but they must first go
through the enrollment process. This generous provision has been
critically important to many veterans, and the enrollment numbers are
high. However, for a variety of reasons, many veterans have not
enrolled for VA care. We believe that this automatic enrollment could
positively affect those individuals, and tip the scale in favor of them
receiving the VA health care they have earned.
H.R. 1460 will take the assistance we provide one step further by
having VA initiate enrollment into the system on behalf of the combat
veterans of our current conflicts, and taking the cumbersome work of
enrolling off their shoulders while preserving their choice through a
process to opt-out. Returning warriors have serious and pressing
concerns they must address without delay when they return from combat -
employment endeavors, rekindling relationships with family and friends,
and coping with the emotional burden of their war experiences. The
least we can do is remove burdens to begin receiving care from the VA
so they can more quickly begin to address those important needs.
However, the VFW is concerned that it would create a paradigm in
which the injuries and illnesses veterans who do not deploy incur are
not given similar priority as those who deploy but do not experience
any adverse health effects immediately attributable to their military
service. While it does not incentivize current conflict veterans who
have deployed to hostile regions to avail themselves to VA care, it
could prove to be polarizing, and send the message to non-deployed
veterans that they do not qualify for VA health care.
The VFW would support this legislation if it were amended to
include enrolling all separating service members into VHA. This would
allow service members who were injured or became ill during service,
but who did not deploy, the same accessibility as those who have
deployed. Also, Congress would need to ensure VA has the resources to
properly facilitate enrollment.
H.R. 3016, to direct the Secretary of Defense and the Secretary of
Veterans Affairs to jointly operate the Federal Recovery
Coordination Program:
The VFW supports H.R. 3016. In our view, the most important aspect
of this legislation is the length it goes to keep the Federal Recovery
Coordination program (FRC) a top priority of the Secretaries of Defense
and Veterans' Affairs. By mandating the administration of this program
must stay in the respective offices of each secretary, we can have more
peace of mind that the wounded, ill and injured warriors the program
was created to serve will receive the high-level attention they
deserve. Administration of the FRC program has been shuffled around
more than once since it was created in 2007, and we believe this
legislation will end that by mandating in law that it be housed where
it belongs - at the very top. This committee must also conduct
continued oversight over this program as practicable to ensure that the
letter and spirit of this law - and the critical importance of the FRC
program - are embraced within DOD and VA. The men and women who go to
war and come back with life-threatening injuries deserve no less, and
we give our full support to this legislation.
H.R. 3245, the Efficient Service for Veterans Act:
The VFW supports H.R. 3245. This legislation requires collaboration
between the DOD and VA to ensure that VA's Vet Centers have access to
the two data repositories that house a service member's DD-214.
Granting Vet Centers access to these databases means that they can
independently verify a veteran's eligibility for services without the
veteran needing to provide a paper copy of the DD-214. This instant
access to service records will remove an unnecessary and often time-
consuming hurdle to care for veterans needing peer support or mental
health counseling from other veterans. At a time when so many of our
veterans are in need of these kinds of counseling options, we should
make this change without delay and continue to look for ways we can
expedite and streamline services.
H.R. 3279, to amend title 38, United States Code, to clarify that
caregivers for veterans with serious illnesses are eligible for
assistance and support services provided by the Secretary of
Veterans Affairs:
The VFW strongly supports H.R. 3279. The Caregivers and Veterans
Omnibus Health Services Act of 2010, commonly known as the Caregiver
Bill or P.L. 111-163, provided long-overdue financial and medical
support for family members or other designated individuals who are
willing to be trained to provide high-quality in-home health care for
severely injured veterans of the conflicts in Iraq and Afghanistan. The
Department of Defense provides similar support to family members of
members of the armed forces who are catastrophically disabled, and
includes disability caused by illnesses in their eligibility
requirements. Because the law does not currently provide VA caregiver
support to those who are seriously disabled because of an illness, the
potential exists for military members and their families to lose a
critical benefit as they transition out of the military into VA care.
The caregiver benefit must be seamless. It is simply too important
for the physical health and general well-being of the men and women who
are catastrophically disabled in service to preclude those who have
suffered from a debilitating illness from receiving this benefit.
H.R. 3337, the Open Burn Pit Registry Act of 2011:
The VFW supports H.R. 3337. Open-air burn pits were used
extensively in Iraq and Afghanistan to incinerate everything from
medical supplies to automobiles, with possible hidden and grave health
reactions on the military personnel exposed to them. VA, DOD, and other
partners in the civilian sector are working to give us the tools
necessary to properly diagnose and treat the conditions associated with
open-air burn pits and other environmental exposures. However, much
work remains to be done, and any delay means less than optimal
treatment options now.
Both DOD and VA have areas where they could improve their support
to those suffering from an environmental exposure. In addition to
working to treat these conditions, the Veteran Benefits Administration
must continue to improve their ability to account for their effects
when evaluating claims, and DOD could make a greater effort.
Unfortunately, their lack of responsiveness to repeated requests for
information from Congressman Akin in relation to this bill has made it
difficult to ascertain what, if any, measures they have taken. We
lament DOD's unwillingness to provide the requested information, and
hope they will soon respond to that request. We would also very much
like to see DOD reach out to veterans and military service
organizations to forge a more productive working relationship on this
important issue.
The VFW believes that this registry is essential to allow service
members the peace of mind of going on record with VA at the earliest
possible time to say they were exposed, and to assist VA in knowing how
to best deploy advances in medicine and technology as they become
available to treat the serious conditions associated with burn pit
exposure. We know that the physical effects of environmental exposures
can go unnoticed for decades, and it can be extraordinarily difficult
to establish causation to military service that has long since passed.
This legislation is a positive step forward, and we ask the committee
to pass this measure without delay.
H.R. 3723, the Enhanced Veteran Healthcare Experience Act of 2011:
The VFW does not support H.R. 3723. While we do not support the
legislation, we understand the impetus for it and agree that
improvements to the current Fee-Basis system of referring veterans to a
private-sector provider are long overdue. The program has many areas
where improvements would provide more return on investment for the
government and would improve the quality of care for veterans.
Currently, coordination of care between VA and the private provider is
virtually non-existent. As a result of limited controls and processes,
VA does not have the ability to evaluate the quality of care provided,
or integrate the associated private-sector medical records into
existing medical history records the VA maintains for that veteran. VA
also has little reach into the offices of doctors caring for veterans
through the Fee-Basis paradigm to ensure the services being billed were
actually performed. VA has no ability to guarantee or measure distance
or timeliness standards, and veterans get no assistance from VA in
finding doctors or assistance making appointments once a doctor is
found. Clearly, there is much to be desired, especially when taking
into account that the VA paid out more than $4 billion in health care
claims in FY 2010 alone.
Nevertheless, the VFW cannot support this legislation at the
present time. The bill would mandate the Secretary to enter into
contracts with network providers in order to provide a nationwide
network of service providers to improve the non-VA care, thereby
addressing many of the issues identified above. However, the VFW is
concerned that the legislation would result in VA moving veterans
outside of the VA system precipitously. Instead of working to improve
processes and make the VA system more efficient and increase
throughput, VA would have the obligation to move veterans into the non-
VA care program when timeliness or distance standards are not met.
Complicating matters is the reality that the only way to make such
a program cost-effective is to actively manage the volume of referrals
into the program. Network providers would find it necessary to give
care providers reasonable expectations of patient access and volume to
negotiate a favorable rate for services being contracted.
The VFW would also call into question the ability for contracts
entered into under this paradigm to be successful without first seeing
how VA executes the implementation of the Patient Aligned Care Team
(PACT) model of patient-centric care within the VA. The proponents of
this legislation pre-suppose that the PACT care coordinator would act
as a conduit to a care coordinator employed by the network provider.
However, we see no evidence to suggest that the PACT model will
routinely and successfully coordinate the care provided internally at
VA without this layer of complexity added to the equation. The VFW
believes that the PACT model must be a success. Therefore, we should
ensure that it is refined to smooth out the rough edges before taking
this step.
At the same time, VA is moving forward, if slowly, with their own
efforts to implement the Patient Centered Community Care (PCCC) program
that would establish contracts to provide a limited portfolio of
services that would be more fully coordinated with VA. Publicly
available data suggests that this portfolio is limited to medical and
surgical services, but excludes dialysis, mental health, and primary
care. While it is certainly true that we believe any successful program
to coordinate non-VA care would include these services, we firmly
believe VA must get this right. It is imperative that these issues be
resolved, and we believe that VA's initiative must be given a chance to
be executed and evaluated before fundamental and controversial changes,
such that this bill would precipitate, are allowed to move forward.
Our veterans deserve access to timely and high quality health care
that is fully integrated and responsive to their needs. To achieve
this, we strongly encourage the committee to expeditiously conduct due
diligence on the Fee-Basis program to have a better understanding of
this and other potential options before initiating further legislative
changes to this program.
H.R. 4079, the Safe Housing for Homeless Veterans Act:
The VFW supports H.R. 4079. We believe this legislation will ensure
that homeless veterans are living in housing that is deemed safe and in
compliance with codes required by county and state laws. Currently, VA
is required to check housing certificates before awarding grants for
housing services provided to homeless veterans. However, a thorough
check of fire and safety requirements, as well as structural conditions
of the building, are often overlooked.
H.R. 4079 would require certification that the building has met all
necessary code specifications before a grant would be awarded. It also
gives priority in awarding grants to those seeking assistance for any
project that would make improvements to a building in cases where plans
exist to provide housing and services for homeless veterans.
The VFW believes that there is no greater need than providing a
safe and secure environment for our homeless veterans and their
families. This legislation will protect the most vulnerable by making
certain that the housing provided fills that need until they can return
to independent community living.
Madam Chairwoman, this concludes my statement. I would be happy to
answer any questions that you or the members of the Committee may have.
Prepared Statement of Adrian Atizado
Madam Chairwoman, Ranking Member Michaud, and Members of the
Subcommittee:
Thank you for inviting me to testify on behalf of the Disabled
American Veterans (DAV) at this legislative hearing of the Subcommittee
on Health. DAV is an organization of 1.2 million service-disabled
veterans. We devote our energies to rebuilding the lives of disabled
veterans and their families.
Madam Chairwoman, the DAV appreciates your leadership in enhancing
Department of Veterans Affairs (VA) health care programs on which many
service-connected disabled veterans must rely. At the Subcommittee's
request, the DAV is pleased to present our views on seven bills before
the Subcommittee today.
H.R. 1460
This measure would require VA to automatically enroll in VA health
care certain veterans who served on active duty in combat operations
during a period of war after the Persian Gulf War, or veterans who
served in combat against a hostile force during a period of hostilities
after November 11, 1998. These veterans would also have the option to
decline enrollment. If automatically enrolled, the right to be dis-
enrolled as currently provided to all enrolled veterans under title 38,
Code of Federal Regulations Sec. 17.36(d)(5) would be unaffected.
While well intended, the policy this measure proposes would be
inconsistent with DAV's longstanding view that all veterans who need VA
health care should have equal access to enroll, irrespective of age,
geographic barriers or of the particular health needs concerned. In the
event such automatic enrollment increases utilization of VA medical
care, our concern then turns to impacts on VA's resources.
A large-scale ``automatic'' enrollment of the youngest population
cohort could serve to squeeze out older generations of veterans who
have not yet enrolled but will inevitably need health care in the
future. VA would not be an option for them. Moreover, once enrolled,
these veterans would be subjected to existing delays in access to care
that other veterans are experiencing now. While we are not aware of any
service-disabled veteran experiencing difficulty enrolling (and in
fact, most of them are not required to enroll to gain treatment of
service-connected disabilities), we are keenly aware of delays in
timely access once enrolled, generally because of insufficient VA
resources, capacity, or geographic barriers.
We believe outreach and education are far more likely to improve
the use of VA benefits and services, including health care services,
and we believe this Subcommittee is already well aware of VA's outreach
efforts to the newest generation of veterans.
The Transition Assistance Program (TAP) is one of the formal pre-
discharge outreach programs in which VA is an active participant. TAP
is conducted under the auspices of a Memorandum of Understanding
between the Departments of Labor, Defense, Homeland Security, and VA.
TAP programs are conducted nationwide and in Europe at US military
installations, to prepare separating or retiring military personnel for
their return to civilian life. As a partner agency, VA provides VA
benefits and services briefings. At these briefings, service members
are informed of the array of VA benefits and services available and
instructed in completing VA applications forms. Following the general
instruction segments, TAP counselors provide personal interviews for
service members who desire assistance in preparing and submitting
applications for VA health care, disability compensation and/or
vocational rehabilitation and employment benefits.
DAV has previously testified in support of Section 202 of H.R.
2433, the Veterans Opportunity to Work Act of 2011, which would make
mandatory the participation in TAP by members of the armed forces. The
intent of this section was incorporated into Public Law 112-56, Title
II of which is entitled ``Vow to Hire Heroes.'' Also, we note the US
Navy and Marine Corps TAP and Disabled Transition Assistance Program
are already mandatory for all separating members. The US Army recently
announced it is requiring transition processing to begin at least 12
months before a soldier departs active duty. According to the Army's
plan, TAP participation is mandatory for all soldiers discharging from
active duty, including Guard members and Reservists demobilizing after
six months or more on active duty. \1\
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\1\ Jim Tice, ``Transition services now mandatory for soldiers,''
Army Times (APR 3, 2012). Accessed April 04, 2012 10:52 PM
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H.R. 3016
This measure would codify the Federal Recovery Coordination Program
(FRCP) and would direct DOD and VA to jointly operate it. The FRCP's
mission is to assist members of the armed forces who exhibit severe or
catastrophic injuries or illnesses and who are unlikely to return to
active duty but will most likely be medically separated. FRCP would
also aid service members and veterans whose individual circumstances
related to illness, injury, mental health are likely to cause
difficulties in their transitions to civilian life.
This measure requires both agencies to develop a joint plan to
carry out the FRCP and submit this completed plan to committees of
jurisdiction, then submit a subsequent report describing and evaluating
plan implementation.
The 2011 DOD Recovering Warrior Task Force report highlights a
number of issues and provides recommendations pertinent to this bill,
such as standardizing and clearly defining the roles, responsibilities
and criteria for assigning federal recovery coordinators (FRC),
recovery care coordinators (RCC) and other case managers. \2\
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\2\ http://dtf.defense.gov/rwtf/finalreport2011.pdf
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The continuing challenges of the overall recovery coordination
effort can be best portrayed by differences in the definition of the
FRCP between VA and DOD despite the FRCP being a joint program. Another
troubling characteristic is the conflicting policies governing the
referral of injured service members to the FRCP. \3\ The impact of
these differing policies was made painfully clear during this
Subcommittee's hearing on the FRCP on October 6, 2011.
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\3\ VA Directive 0802; DOD Instruction 1300.24
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Partly as a consequence of strong Congressional oversight and by
this Subcommittee, VA and DOD have formulated options \4\ for improving
coordination between the two agencies for a relatively small population
of catastrophically injured service members. By late 2011, DOD and VA
had been coordinating a decision memorandum presumably based on an
options matrix regarding future direction of the FRCP and RCP. The most
recent information available to DAV is that the memorandum was to have
been delivered to the joint Senior Oversight Committee (SOC) for
consideration and a joint decision in December 2011.
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\4\ Beginning in December 2010, the Senior Oversight Committee
directed its care management work group, which includes officials from
the FRCP and DOD's Recovery Coordination Program (RCP) to conduct an
inventory of DOD and VA case managers and perform a feasibility study
of recommendations on the governance, roles, and mission of DOD and VA
care coordination.
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Madame Chairwoman, the DAV is deeply frustrated with the slow
progress for VA and DOD to implement a joint, seamless program for
these severely disabled veterans - a commitment VA and DOD made over
four years ago. Further, we appreciate the sponsor's desire to codify
the FRCP through this bill; however, the bill would still require VA
and DOD to collaborate and implement the provisions of this bill if
passed into law.
We believe the proposal before the SOC has the potential to address
the DOD Recovering Warrior Task Force recommendations and other known
challenges, and improve the recovery coordination effort across VA and
DOD programs. Therefore, we ask that the Subcommittee hold this measure
in abeyance until such time as the fate of the joint decision
memorandum under consideration by the SOC can be ascertained and if
issued, the contents carefully examined.
H.R. 3245, the Efficient Service for Veterans Act
This measure seeks to address any delay in determining eligibility
of veterans to receive Vet Center services by providing a streamlined
electronic process to access military service and eligibility
information. Specifically, this bill would require DOD and VA to ensure
VA's Vet Centers gain access to the extant Defense Personnel Record
Image Retrieval System (DPRIS) and VA/DOD Information Repository
(VADIR).
The DPRIS is a secure electronic gateway that enables veterans to
access to their Official Military Personnel File (OMPF) information.
OMPF is primarily an administrative record, containing information
about the subject's service history, such as date and type of
enlistment/appointment; duty stations and assignments; decorations and
awards; date and type of separation/discharge/retirement (including DD
Form 214, Report of Separation, or equivalent); and, other personnel
actions. The Personnel and Readiness Information Management (P&RIM)
office, in the office of the Under Secretary of Defense (Personnel and
Readiness) is the office of primary responsibility for DPRIS.
VADIR is intended by VA as its ``golden source'' for military
service information. It is a database populated daily and
electronically with military service data provided from DOD's Defense
Manpower Data Center (DMDC). DMDC receives information from Defense
Enrollment Eligibility Reporting System (DEERS) and the military
service branches. Once received, DMDC synchronizes its data with VADIR.
Information from VADIR is disseminated in three ways: 1) approved
VA systems electronically request and receive data from VADIR over the
internal VA network, 2) data are provided over the dedicated circuit
between VADIR and DMDC for reconciliation of records or to identify
military retirees and dependents with entitlement to DOD benefits but
who are not identified in DEERS, and 3) periodic electronic data
extracts of subsets of information contained in VADIR are provided to
approved VA offices over the internal VA network.
Madam Chairwoman, DAV has a special connection to the VA Vet Center
program and the counseling services it provides. In 1976, the DAV
funded the groundbreaking Forgotten Warrior Project, which first
defined the issue of post-traumatic stress disorder (PTSD) among
Vietnam war veterans. Vietnam veterans were experiencing serious post-
war problems at that time, and DAV hoped our new study would make it
impossible for Congress, the VA, and the American public to continue
ignoring the lingering dilemma that prevented many of these veterans
from returning to normal lives after serving in a very unpopular and
difficult war.
Congress and the VA failed to act on the findings from our project;
therefore, DAV initiated our own Vietnam Veterans Outreach Program in
1978. This DAV-sponsored study and the DAV's clinical outreach work
spurred new, broad realization and additional research by others that
forced the federal government to confront the psychological impact of
war on veterans of Vietnam, and subsequently of all wars. When that
movement finally occurred, the DAV Vietnam Veterans Outreach Program
was already there to serve as an effective treatment model to be
adopted by the VA's Vet Center program as we know it today.
Since the Readjustment Counseling Service program was established
by Congress in 1979, eligibility for Vet Center readjustment counseling
services has expanded from Vietnam-era veterans to include all combat
veterans, to veterans who experienced military sexual trauma, to
certain family members, and to survivors of veterans who die in combat
or on active duty. \5\ Vet Centers also offer a list of vital services,
including counseling for post-traumatic stress disorder (PTSD) and
other readjustment challenges; marriage and family counseling; and,
bereavement counseling. One key policy of Vet Centers is to ensure
veterans seeking help are not required to wait to receive it.
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\5\ P.L. 111-163, the Caregivers and Veterans Omnibus Health
Services Act of 2010, and P.L. 110-387, the Veterans' Mental Health and
Other Care Improvements Act of 2008.
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Vet Centers are known for minimal barriers and almost no
bureaucracy. The Vet Center is a non-medical setting in a safe
environment with high confidentially and a strong emphasis on informed
consent. \6\
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\6\ http://www.nytimes.com/2007/04/01/nyregion/
01veterans.html?pagewanted=all. Accessed March 28, 2012.
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Although providing the 300-plus Vet Centers direct access to DPRIS
may improve speed in eligibility determinations, it may also compromise
the confidential nature of services Vet Centers provide. We contacted
the DOD office with primary responsibility for DPRIS. This office
indicated that identifying who accesses DPRIS information and what
DPRIS information is being retrieved is easily accomplished and is
reportable information. Further, any personnel in DOD and in each
military service branch that has designated ``manager'' status for the
system has the capability to discover who is using that system for data
retrieval. We urge the Subcommittee to consider removing the provision
allowing Vet Center access to DPRIS.
In light of VA's recent proposed rule to implement an important
provision in section 401 of Public Law 111-163, to expand eligibility
for Vet Center services to current members of the armed forces,
including members of the National Guard and Reserve who serve on active
duty in Operations Enduring Freedom, Iraqi Freedom and New Dawn (OEF/
OIF/OND), \7\ DAV believes protecting Vet Center confidentiality is
critical to its effectiveness, outreach and success. Therefore, DAV
opposes this measure as currently written.
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\7\ 77 Fed. Reg. 14707-14712
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H.R. 3279
The intent of this bill is to make family caregivers of certain
veterans with serious illnesses eligible for a VA program of
comprehensive assistance and support services. Under current law, only
family caregivers of certain veterans with serious physical injuries
are eligible.
DAV testified before this subcommittee on July 11, 2011,
recommending VA's adding the term ``seriously ill'' as we believe was
intended by Congress under title 38 United States Code, section 1720G
(a)(2)(B), and accordingly that VA revise its proposed eligibility
criteria. To date, the final rule implementing Title I of the
Caregivers and Veterans Omnibus Health Services Act of 2010, Public Law
111-163, has yet to be published.
DAV supports this measure based on our national Resolution No. 195,
to support legislation that would expand eligibility for comprehensive
caregiver support services. We thank the sponsor for introducing this
bill and strongly urge the subcommittee to give it favorable
consideration.
We also note the same resolution supporting this important
legislation also calls on Congress to expand the eligibility for
comprehensive caregiver support services to caregivers of veterans from
all eras of military service. Those caregivers have carried a long and
heavy burden for their loved ones, and deserve the level of attention
and support services now being provided generously by VA to caregivers
of wounded and ill OEF/OIF/OND veterans.
H.R. 3337, the Open Burn Pit Registry Act of 2011
If enacted, this bill would direct VA to establish an open burn pit
registry and ensure military personnel deployed to Afghanistan or Iraq
who are exposed to toxic chemicals and fumes from open burn pits are
advised about the existence of the registry and how to participate.
Under the bill, eligible individuals would be periodically notified
about significant developments in the study and treatment of conditions
associated with exposure to toxic chemicals.
This legislation would direct VA to enter into an agreement with an
independent scientific organization to develop a report that evaluates
the effectiveness of the VA in collecting and maintaining such
information on the health effects of exposure to toxic chemicals from
open burn pits. In addition, the selected independent consultant would
evaluate other published epidemiological studies, and recommendations
regarding the most effective means of addressing medical needs of
individuals that are likely to be occasioned by exposure to open burn
pits.
DAV supports this bill because it partially fulfills the premises
of DAV National Resolution No. 183, by providing improved surveillance
of environmental hazards from military toxic and environmental hazards
exposure. Hundreds of current and former service members have reported
to DAV that they were exposed to heavy fumes from numerous burn pits
throughout Iraq and Afghanistan, often becoming ill during such
exposures, and that their illnesses from such exposures have continued
to worsen thereafter.
The October 2011 Institute of Medicine (IOM) report, ``Long-Term
Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan,''
found numerous data gaps and uncertainties in the monitoring of
airborne pollutants that point to the need for additional studies and
analysis. The IOM recommended a longitudinal study be conducted that
would evaluate the health status of service members from their time of
deployment to Joint Base Balad, Iraq to determine their incidence of
chronic diseases, including cancers, some of which may not manifest for
decades following exposure.
Although VA is sponsoring scientific studies that cover a wide
spectrum of health effects, these studies may not meet the IOM's call
for a well-designed epidemiologic study of this particular
environmental exposure in Iraq and Afghanistan. We urge this
Subcommittee to consider adding to this bill a research component with
the identification of cohort groups, one of which was deployed to the
countries in question and one that was not. This comparative data would
provide VA the opportunity to contrast the two cohorts' health concerns
over an extended period, with the potential to provide more meaningful
insight into the long-term health consequences of toxic exposures.
H.R. 3723, the Enhanced Veteran Healthcare Experience Act of 2011
This bill would require VA to provide all enrolled veterans with
health services to be provided by a contracted non-VA provider, if the
Secretary determined that VA facilities were incapable of furnishing
such services because of geographical inaccessibility or a lack of
required personnel, resources, or ability at VA facilities.
Under the bill, in entering such contracts with non-VA providers,
VA may consider only those contractors that demonstrate the ability to
meet certain quality and safety standards and business processes on par
with VA's. The measure also sets forth requirements concerning VA's
eligibility determinations, coordination with non-VA providers, health
information exchanges, and performance metrics for the purpose of
incentives or bonus payments to the contractor(s). VA would also be
required to submit a report to Congress based on implementation of the
new authority.
DAV National Resolution 182 calls for a non-VA purchased care
coordination program that complements the capabilities and capacities
of each VA medical facility and includes care and case management, non-
VA quality of care and patient safety standards equal to or better than
VA's, timely claims processing, adequate reimbursement rates, health
records management and centralized appointment scheduling. We are
therefore pleased with some provisions in this bill that promote the
coordination of cost effective non-VA health care; however, DAV is
unable to support this measure since it proposes to significantly
change current law that would adversely affect veteran patients and the
VA system quite dramatically.
Title 38, United States Code, section 1703 authorizes VA to
contract for inpatient care and limited outpatient care for specified
categories of veterans, when VA facilities are unable to provide the
care, or when these VA facilities are geographically inaccessible. This
contracting authority is not limited to contracts which contain
negotiated prices. Title 38, Code of Federal Regulations, section
17.52, which implements the statutory authority granted by section
1703, allows for individual authorizations when demand is only for
infrequent use. This is the foundational authority for VA fee-basis
care, where individual authorizations are essentially a price offer to
the non-VA provider, who then accepts that offer by performing services
for the authorized veteran patient.
This measure proposes to change VA's authority under title 38,
United States Code, section 1703 from discretionary to mandatory such
that if a VA facility is not capable of furnishing care to an eligible
veteran, the Department must purchase the care by contract. We are
concerned the mandatory language operates without exception, including
clinical determinations or when the care needed is not available under
existing negotiated contracts. Further, since the bill is intended to
replace VA fee-basis care up to and including its entirety, this
mandatory requirement may serve to obstruct a VA facility or a VA
provider from acquiring non-VA medical care for eligible veterans. We
therefore urge the Subcommittee to consider substituting a
discretionary authority for the mandatory form in the current proposal.
This measure would also expand currently specified categories of
eligible veterans to all enrolled veterans. We note under current law,
VA already possesses three major approaches to provide non-VA care -
through contracts to purchase care; fee-for-service arrangements; and
via sharing agreements with DOD and academic affiliates. Under title
38, United States Code, section 8153, the VA possesses discretionary
authority to use contracts with non-VA providers as a vehicle to
provide hospital care and medical services (as those terms are defined
in title 38, United States Code, section 1701) to all enrolled
veterans.
This authority will be employed in the near future to create
centrally supported health care contracts available throughout the VA
health care system. This effort is a soft approach toward applying
lessons learned from a demonstration project, \8\ now in its fifth and
final year, toward a new contract care initiative called Patient
Centered Community Care (PCCC). According to VA, the goal of PCCC is to
provide eligible veterans coordinated, timely access to high quality
care from a comprehensive network of VA and non-VA providers.
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\8\ Project on Healthcare Effectiveness through Resource
Optimization (See H. Rept. 109-305 for the Military Quality of Life and
Veterans Affairs Appropriations Act of 2006 (P.L. 109-114).
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Unlike H.R. 3723, the stated purpose of VA's contracting authority
under title 38, United States Code, section 8153 is, ``[t]o strengthen
the medical programs at Department facilities and improve the quality
of health care provided veterans under this title by authorizing the
Secretary to enter into agreements with health-care providers in order
to share health care resources with, and receive health-care resources
from, such providers while ensuring no diminution of services to
veterans.'' On the other hand, exercising Sec. Sec. 8151-8154 only
partially meets DAV Resolution 182 lacking certain quality of care and
care coordination provisions that are contained in H.R. 3723.
Finally, DAV is unable at this time to delineate what impact the
enactment of this bill would have on title 38, United States Code,
sections 8151-8154 and on numerous VA health services that are
dependent on non-VA purchased care. We believe a more detailed and
comprehensive discussion is needed with VA on these matters.
With all these thoughts in mind, DAV is unable to support H.R. 3723
in its current form.
H.R. 4079, the Safe Housing for Homeless Veterans Act
This bill would require those organizations receiving VA grants
that provide assistance to homeless veterans through the Homeless
Providers Grant and Per Diem Program (GPD) to certify their facilities
meet current Life Safety Codes as well as state and local housing
codes, licensing and safety requirements. This legislation would also
require VA to give priority to those organizations that include making
improvements to their housing or service facilities to meet these
requirements. Those providers that do not currently meet the
certification requirements would have up to two years to bring their
facilities into compliance.
While DAV has not received a National Resolution from our
membership on this particular matter, we would not be opposed to
favorable consideration of this legislation.
Madam Chairwoman, this completes my testimony. Thank you again for
inviting Disabled American Veterans to present this testimony today. I
would be pleased to address questions from you or other Members of the
Subcommittee.
Prepared Statement of Rene A. Campos
MADAM CHAIR BUERKLE, RANKING MEMBER MICHAUD AND DISTINGUISHED
MEMBERS OF THE SUBCOMMITTEE, on behalf of the 375,000 members of the
Military Officers Association of America (MOAA), I am grateful for the
opportunity to present MOAA's views on several legislative provisions
impacting veterans' health care.
MOAA does not receive any grants or contracts from the federal
government.
MOAA greatly appreciates the Subcommittee's leadership in
addressing the very important business of taking care of our veterans
by your diligent oversight of their medical care and benefits which
tangibly honors their service and sacrifice.
Our Association wants to acknowledge and thank the Department of
Veterans Affairs (VA) for its hard work and persistence in transforming
the agency. Clearly, VA has made significant strides in changing the
culture, policies and programs and is moving towards a more veteran-
centric organization.
MOAA's perspectives on the seven bills being considered by the
Subcommittee today are outlined below.
H.R. 1460, Congressman William Owens (R-NY)--allows
veterans returning from combats zones to automatically be enrolled in
the VA medical system.
MOAA thanks Representative Owens for his commitment to ensuring
veterans seamlessly transfer from the Department of Defense (DoD)
military health care system into VA's medical system.
While MOAA agrees with the need for seamless transition from the
military to VA medical and benefits systems, we believe there should be
no distinction between veterans who have served in combat areas and
those who have served in other types of assignments.
Automatic enrollment of only combat theatre veterans will likely
be perceived as a negative decision by non-combat veterans, causing
them to view it as a form of health care rationing and the government's
attempt to diminish their contributions of service to their country.
The concept of automatic enrollment is consistent with MOAA's
longstanding support for actions that lead to the `seamless transition'
of service women and men into the VA system and civilian life. Ongoing
work on the bi-directional DoD - VA medical record could be advanced by
automatic VA health care enrollment. But, the provision does not
eliminate the requirement for the veteran to physically enroll at a VA
medical center. Perhaps VA's outreach system could be strengthened by
having advance information on separating service members put into VA's
enrollment system.
An automatic process will, of course, simplify enrollment data
tracking and would likely drive the demand and cost of VA care. For
example, when Congress authorized open enrollment in the VA health
system from 1999-2003 for all honorably discharged American veterans,
enrollment climbed but not to unmanageable levels. With the enormous
increases in health care costs since then, more separating service
members might seek VA care if they were automatically enrolled and
informed of the action.
MOAA supports the concept of H.R. 1460, automatic enrollment in
VA health care and recommends H.R. 1460 be amended to authorize
enrollment of all OIF - OEF veterans to advance seamless transition
outcomes from military service to the VA.
H.R. 3016, Congressman John Barrow (D-GA)--directs the
Secretaries of VA and Defense to jointly operate the Federal Recovery
Coordination Program (FRCP).
MOAA testified in September 2011 before this Subcommittee at a
hearing on the FRCP, promoting a joint VA-DoD care coordination program
oversight office and policy modeled after the FRCP.
We again testified in early March 2012, during a hearing before
the House and Senate Veterans' Committees on MOAA's legislative
priorities for veterans health care and benefits, stating the need for
a single, joint VA-DoD office that consolidates the two agency
programs. We did not recommend the program be modeled after the FRCP
program because of the agencies' emphasis and desire to work more
closely together to improve seamless transition of this extremely
vulnerable population.
The two Departments have stepped up their collaborative efforts
significantly since the DoD Recovering Warrior efforts Task Force
published its 2010-2011 Annual Report last September. Both agencies
acknowledge more work needs to be done in improving care coordination.
We believe VA and DoD are doing their best to meet the intent of Sec.
1611 of Public Law 110-181 in the coordination of care require in the
law.
MOAA does, however, believe that congressional and VA-DoD
leadership oversight continues to be needed until care coordination
programs, policies and systems mature and are operating efficiently and
effectively. We look to Congress to determine if ``a single, joint VA-
DoD program and office for managing, coordinating, and assisting
wounded, ill, and disabled members through recovery, rehabilitation,
and retention,'' is still needed as required in the law.
MOAA supports the provision in concept but recommends Congress
continue to provide oversight by conducting hearings and reports from
senior officials in the Departments in lieu of additional legislation
in order to determine the efficacy of programs and increase
accountability of the systems for care coordination.
H.R. 3245, Congressman Jeff Denham (R-CA)--the
``Efficient Service for Veterans Act,'' directs the Secretaries of the
VA and Defense to jointly ensure that the Vet Centers of the VA have
access to the Defense Personnel Record Image Retrieval system and the
VA/DoD Defense Identity Repository system.
MOAA does not have enough information on these issues to take a
position on H.R. 3245.
H.R. 3279, Congressman Silvestre Reyes (D-TX)--amends and
clarifies title 38, United States Code so that caregivers of veterans
with serious illnesses (in addition to injuries) would be eligible for
assistance and support services provided by VA.
On June 30, 2011, MOAA submitted to VA our response to the
Caregiver Program's interim final regulations concerning the new
benefits program directed in title 1 of the Caregivers and Veterans
Omnibus Health Services Act of 2010 (P.L. 111-163), signed May 5 of
that year.
The letter highlighted our concerns about the ``Definition of
Serious Injury'' in Section 71.15. In the letter we stated the VA:
defines `serious injury' as ``any injury, including psychological
trauma, or other mental disorder, incurred or aggravated in the line of
duty in the active military, naval, or air service on or after
September 11, 2001, that renders the veteran or servicemember in need
of personal care services.''
It was not clear from the statement as to how VA will address
those individuals whose conditions incurred during service worsen or
change to the point of needing caregiver assistance once they are in a
veteran status. We believe the intent of Congress was to allow both
active duty and veteran caregivers to qualify for the benefit.
Additionally, VA's definition of serious injury does not specifically
address illness, though it could allow for such conditions but is left
open to interpretation.
In March, MOAA checked with the VA Caregiver Support Office
about the status of the regulations and response to public comments. VA
was quick to respond to our request for information letting us know
that they were still coordinating the rules. VA's Caregiver Support
Office has also been active in its efforts to educate and inform
stakeholders on the program as well as responding to wounded, injured,
ill, and disabled members and families when issues surface.
MOAA supports H.R. 3279.
H.R. 3337, Congressman Todd Akin (R-MO)--``Open Burn Pit
Registry Act of 2011,'' directs the Secretary of Veterans Affairs to
establish an open-air burn pit registry to ensure that members of the
Armed Forces who may have been exposed to toxic chemicals and fumes
caused by open-air burn pits while deployed to Afghanistan or Iraq.
MOAA appreciates Congressman Atkins' concern over the health and
welfare of those men and women who have served and are currently
serving in uniform near burn pit operations in Iraq and Afghanistan.
For years, the Air Force provided warnings in their pre-
deployment briefings and fact sheets stating that use of open burn pits
``can be harmful to human health and environment and should only be
used until more suitable disposal capabilities are established.'' Yet
open-air burn pits continued operations in Iraq and Afghanistan.
Over the past decade, many servicemembers have complained of
headaches, nausea, and irritation of the eyes after immediate exposure
while several servicemembers and veterans have contracted various
symptoms and life-threatening medical conditions after being exposed to
burn pits used to dispose of waste in Iraq and Afghanistan.
MOAA fully supports H.R. 3337. Establishing a registry of
servicemembers and veterans exposed to burn pit operations will provide
a potential long-term link between exposure to harmful open-air burn
pits and significant, long-term health problems.
H.R. 3723, Congressman Robert Schilling (R-IL)--
``Enhanced Veteran Healthcare Experience Act of 2011,'' amends title
38, United States Code, requiring VA to enter into contracts with
health care providers to improve access to health care for veterans who
have difficulty receiving treatment at a health care facility of the
VA.
Our Association, like Congressman Schilling, is very much
concerned about the access, adequacy, and the quality of health care
for our veterans. VA acknowledges a number of challenges to the
existing fee-based care program and has committed significant resources
and funds to look at alternative ways to deliver care while maintaining
the integrity and quality of the medical system. They are also taking
lessons learned from the contract pilots that have been launch in
recent years, continuing to look at better and more efficient ways to
deliver care and services.
MOAA agrees with the Veterans' Independent Budget (IB)
conclusion that current purchased care initiatives need time to mature.
Imposing a mandate on VA could be counter-productive, disruptive,
costly, and ultimately limit progress on ongoing purchased care
efforts.
In addition, VA currently has no mechanism to ensure medical
data from fee-based care providers are transmitted back to VA and
integrated in veterans' electronic medical records. MOAA strongly
agrees with our Veterans Service Organization partners that any non-VA
care must be fully integrated into the VA health care systems to
protect not only the system, but also the safety of veterans.
MOAA does not support H.R. 3723 as written. Rather, we urge the
Subcommittee to consider the recommendations in the FY2013 IB that
address the issues in VA's purchased care system. Specifically, we
strongly recommend that:
VA should provide Congress and the veteran community a
final analysis and evaluation of Project HERO.
VA should develop an effective integrated care
coordination model for all non-VA purchased care to ensure eligible
veterans gain timely access to care, in a manner that is cost-effective
to the VA, preserves agency interests, and most important, preserves
the level of service veterans have come to rely on inside the VA.
VA should develop identifiable measures to assess its
integrated care coordination model for all non-VA purchased care. The
evaluation should be shared with Congress and the veteran community.
H.R. 4079, Congressman David McKinley (R-WV)--``Safe
Housing for Homeless Veterans Act,'' requires homeless veteran
recipients of housing grants and other assistance from the Secretary of
VA to comply with codes relevant to operations and level of care
provided.
MOAA does not have sufficient information on the issues to take
a position on H.R. 4079.
Conclusion
MOAA thanks the Subcommittee for being champions of our veterans
and their families. We appreciate the opportunity to share our views on
these important provisions and we look forward to working with the
Subcommittee on ways to improve VA health care so we can further
enhance the quality of lives of those individuals in our veterans'
community.
Prepared Statement of Ramsey Sulayman
Madam Chairwoman, Ranking Member, distinguished members of the
subcommittee, on behalf of more than 200,000 members and supporters of
Iraq and Afghanistan Veterans of America (IAVA), I thank you for the
opportunity to share the views of our members on these very important
pieces of legislation.
My name is Ramsey Sulayman and I am a Legislative Associate with
IAVA. I am a veteran of Iraq where I was an infantry platoon commander
and company executive officer. I have spent 14 years in the Marine
Corps trying to execute the Marine Corps' two missions: winning battles
and making Marines. As an IAVA staff member, I don't make soldiers,
sailors, airmen or Marines but I do try to make their lives better. The
views expressed in this testimony reflect the views and analysis of
IAVA and not the United States Marine Corps. Thank you for your
attention to the pressing issues facing our nation's veterans.
H.R. 1460 - IAVA strongly supports H.R. 1460, ensuring that combat
veterans smoothly and seamlessly transition their care from the
Department of Defense (DoD) healthcare system to the Veterans
Administration (VA) healthcare system by automatically enrolling
service members in the VA healthcare system and requiring them to opt-
out if they do not wish to be enrolled. The creation of an integrated
health record and the electronic transfer of medical records are steps
in the right direction but the most important step is actually getting
veterans into the system. Currently, veterans must independently seek
out care in the VA system. That is why only 54 percent of Iraq and
Afghanistan veterans are enrolled in the VA healthcare system. The
steep cost of quality healthcare through the private sector and a high
rate of veteran unemployment (almost 17% among our membership) means
many veterans do not have access to any other healthcare system, in
many cases for service-related injuries. IAVA believes that H.R. 1460's
solution, changing enrollment for VA healthcare to an opt-out system,
is easy and effective, both in terms of cost and efficacy. Combat
veterans should not have to opt-in to receive a benefit they have
earned through their service.
H.R. 3016 - IAVA supports H.R. 3016 which addresses the slow
implementation of the Federal Recovery Coordination Program (FRCP) by
mandating cooperation, setting deadlines and requiring oversight
through reports to Congress. H.R. 3016 gets to the heart of the
criticisms of the FRCP leveled by the General Accounting Office (GAO),
specifically the lack of coordination between the DoD and VA. The
remarkable advances in medical technology and treatment of traumatic
injuries we have witnessed over the past decade have resulted in an
increased survival rate for service members with formerly unrecoverable
injuries. While great strides have been made in the treatment of these
injuries, the fragmentation of care across multiple systems has
resulted in difficulty and frustration for many injured service members
and their families. The FRCP was a common-sense response that placed an
experienced health care professional at the center of the process to
help guide service members and their families through the intricate,
confusing and stressful process of navigating the healthcare system.
IAVA believes that those who fought for their country and were injured
deserve every possible bit of help to restore their lives to order.
H.R. 3279 - IAVA endorses H.R. 3279 which seeks to rectify an
oversight in eligibility for family members of service members to
participate in the caregivers' assistance program. Currently, service
members who suffer a serious, life-altering illness as a result of
service to their country are not afforded the option to participate.
Only service members with physical injuries, loss of limbs for example,
are eligible to apply for caregivers' assistance. A service member who
contracts a debilitating disease, for example malaria, is not eligible.
Many programs are hailed as ``important'' or ``vital'' but fail to live
up to their billing. The VA caregivers' assistance program is vital and
important, both to injured service members and their families. By
promising what amounts to a very minimal safety net, caregivers'
assistance allows families to make huge sacrifices in their own lives
to care for severely injured service members. Families are able to make
the choice to care for their loved one at home, rather than in a
medical facility. Families are given the choice to stay together. The
process for receiving caregivers' assistance is already robust and
oversight is stringent. A relatively small number of veterans and their
families receive assistance and explicitly stating that serious illness
is covered as well as injury will not add significantly to the cost or
numbers of veterans using caregivers' assistance but will make a
significant difference in their lives.
H.R. 3337 - IAVA supports H.R. 3337, the Open Burn Pit Registry Act
of 2011. Burn pits have the potential to be the insidious and long-
lasting health issue for our generation of veterans that Agent Orange
has been for Vietnam-era veterans. H.R. 3337 seeks to be ahead of the
curve in responding to potential future health concerns by establishing
facts: who was exposed, where they were exposed, and for how long.
These small but crucial pieces of information will be helpful in the
future in ascertaining health impacts of burn pits, facilitating
subject identification for epidemiological studies, and adjudicating
claims. Burn pits were ubiquitous in Iraq and still are in Afghanistan.
They are located in the midst of large numbers of troops. The twin
facts that burn pits are the way waste is disposed and must be co-
located with troops for logistical reasons guarantees exposure for most
service members. While IAVA supports H.R. 3337, we do so with a caveat.
Because of the ubiquity of burn pits in these conflicts, we believe
that the definition of burn pit must extend beyond solely those
authorized by the Secretary of Defense. That proviso must be
interpreted as broadly as possible and language should be inserted into
H.R. 3337 that recognizes burn pits established by small-unit leaders
to facilitate mission accomplishment. There is no garbage service for
our troops to rely on in Iraq and Afghanistan and small units, by
necessity, burn all the waste they have. This is a necessary addition
to this important piece of legislation and IAVA urges inclusion of such
language in the bill before passage.
H.R. 3723 - The goals of H.R. 3723, the Enhanced Veteran Healthcare
Experience Act of 2011, are laudable and IAVA supports many of them.
However, IAVA cannot support H.R. 3723 because we believe that this
legislation makes several changes that are untested and do not
necessarily provide hope of significantly improved patient outcomes or
access to care. Increased access to healthcare for rural and
underserved veterans, comprehensive care coordination, and a focus on
metrics of quality care and patient satisfaction are reforms which IAVA
has supported and campaigned for in the past. In addition, there are
significant issues present in the VA's fee-care program that need to be
addressed for the sake of patient outcomes and providing the highest
quality healthcare services possible.
The VA system has the capability to provide non-VA care to veterans
who are either geographically constrained or who cannot be treated in a
timely manner through VA providers. By removing the discretion of the
VA to offer such options and mandating that services be provided on a
contract basis, H.R. 3723 would effectively cripple VA healthcare.
Entering into a contract for each veteran who would have previously
fallen under the fee-care system would be unwieldy and cumbersome:
would VA have to solicit several bids and pick the lowest bidder? Would
the patient have to wait for care while the contracting process was
being executed? Or would VA simply pay the fee charged by the
healthcare provider without negotiation or comparison, a scenario under
which upwardly spiraling healthcare costs and diminished access to
services is easily envisioned? In addition, many medical options are
not cost-effective in the private sector (i.e. prosthetics) and real
questions exist regarding fiscal benefits and patient outcomes when
outsourcing those types of care.
As mentioned previously, there are many issues with the current
fee-care system that have been raised. The National Association of
Public Administrators (NAPA) issued a report which recommended that the
VA cease the fee-care program because VA lacks the infrastructure and
expertise to implement fee-care in the best manner possible. This begs
the question: should the fee-care system be replaced by another system
that makes the VA a third-party payer (essentially replicating the
scenario encountered with fee-care) or should the VA system be
strengthened, funded and fixed so that the use of third-party non-VA
providers is minimized and truly used out of necessity? IAVA prefers
the latter option. Therefore, we do not endorse H.R. 3723.
H.R. 4079 - IAVA supports H.R. 4079, the Safe Housing for Homeless
Veterans Act. This bill makes explicit what we would already assume to
be the case: recipients of VA funds to house homeless veterans must be
in compliance with all relevant building and safety codes. This is not
an onerous burden. Rather, H.R. 4079 requires meeting minimum standards
of safety and construction before an entity is eligible to receive or
continue to receive federal funds. ``Minimum standards'' are explicitly
``the least we can do.'' Homeless veterans are those who have fallen on
hard times after honorably serving their country. Their service and
sacrifice for this country should at least earn them a safe place to
get back on their feet and the Safe Housing for Homeless Veterans Act
accomplishes this goal.
Prepared Statement of Ralph Ibson
Chairman Buerkle, Ranking Member Michaud, and Members of the
Subcommittee: Thank you for inviting Wounded Warrior Project (WWP) to
offer our views on legislation pending before the Subcommittee.
WWP works to honor and empower this generation of wounded warriors
- physically, psychologically and economically. Our policy objectives
are targeted to filling gaps in programs or policies--and eliminating
barriers--that impede warriors from thriving. Importantly, two of the
bills before you this morning, H.R. 3016 and H.R. 3279, would close
critical gaps facing warriors and their families and we strongly
support their enactment.
H.R. 3016
Among the recommendations in WWP's policy agenda is that Congress
review the operation and effectiveness of the many programs created to
improve warriors' transition from military service to civilian status.
The Federal Recovery Coordination Program (FRCP) may be among the most
important of those initiatives to our warriors and their families, and
we appreciate the inclusion of H.R. 3016 on your subcommittee's agenda.
H.R. 3016 would require the Secretaries of Defense and Veterans Affairs
to develop a memo of understanding setting out a plan for joint
Department of Defense (DoD) and Department of Veterans Affairs (VA)
operation of the FRCP in accordance with the bill. As discussed below,
a key provision of the bill would require the service secretaries to
refer eligible servicemembers to the program at the earliest possible
time, but not later than six months before expected retirement or
separation from service.
By way of background, the FRCP has its roots in the President's
Commission on the Care of America's Returning Wounded Warriors (the
Dole-Shalala Commission), which found that the system of care,
services, and benefits created to assist those who had been injured was
too complex to navigate alone. The Commission recommended the creation
of ``recovery coordinators'' or, in the words of the father of a
severely wounded Marine, ``a case manager to manage the case
managers.'' Ultimately, the National Defense Authorization Act of 2008
(NDAA 2008) directed DoD and VA to develop and implement a
comprehensive policy to improve care, management and transition of
recovering servicemembers and their families, to include the
development of comprehensive recovery plans, and the assignment of a
recovery care coordinator for each recovering servicemember. \1\ Early
on, DoD and VA entered into a memorandum of understanding establishing
a joint VA-DoD Federal Recovery Coordination Program to assist those
with category 3 injuries - individuals with a severe or catastrophic
injury or illness who are highly unlikely to return to active duty and
will most likely be medically separated. A separate DoD Recovery
Coordinator Program was designed for those with category 2 injuries who
might or might not return to duty.
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\1\ Public Law 110-181, sec. 1611.
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In WWP's view, the services provided warriors and their families
through the FRCP represent a too-rare instance of a holistic,
integrated effort to help injured veterans successfully transition and
adjust to their new normal. Federal Recovery Coordinators (FRCs) make
unique contributions - both medical and non-medical--in facilitating
wounded warriors' care-coordination and reintegration. Their invaluable
work underscores the importance of ensuring that this program reaches
all who need that help, and that it operate as effectively as possible.
But while FRCs provide extraordinary assistance to warriors and their
families, overarching systemic problems must be addressed to ensure
that the program fully meets its objectives. We believe H.R. 3016
effectively addresses those systemic problems and we strongly support
its enactment.
VA and DoD each share an obligation to severely wounded warriors
and their families, but the reality is that they do not now share full
responsibility for the FRC program. As this Subcommittee's hearings
have ably documented, the FRC program suffers from acknowledged
interdepartmental gaps.
As both your hearings and the General Accountability Office have
documented, individual Service departments are not uniformly referring
severely and catastrophically wounded warriors to the FRCP for
assignment, or are doing so at much too late a point in the transition
process. It is difficult to reconcile service-department practices that
defer referral of a severely wounded warrior until that individual has
retired with DoD policy or with the DoD-VA understanding under which
the FRC program was established. The DoD policy makes it clear that
``all category 3 service members shall be enrolled in the FRCP [Federal
Recovery Coordination Program] and shall be assigned an FRC [Federal
Recovery Coordinator] and an RT [recovery team].'' \2\ The policy
instructs further that the FRC is to coordinate with the recovery care
coordinator and recovery team to ensure the needs of the service member
and his or her family are identified and addressed.
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\2\ Department of Defense Instruction (DODI) Number 1300.24,
``Recovery Coordination Program (RCP),'' Enclosure 4, sec. 2.d.
(December 1, 2009).
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But rather than advancing seamless transition, individual Service
department practices that defer referral for a possible FRC assignment
until a severely wounded warrior has retired tend to frustrate
realization of the goals the program was developed to achieve. By way
of illustration, many severely and catastrophically wounded warriors
may be eligible for assistance not only from military treatment
facilities and the TRICARE program, but from the Veterans Health
Administration, the Veterans Benefits Administration, the Social
Security Administration, and Medicare. (As GAO recognized, ``FRCs are
intended to be care coordinators whose planning, coordination,
monitoring and problem-resolution activities encompass both health
services and benefits provided through DoD, VA, other federal agencies,
states, and the private sector.'' \3\) It is critical that a Federal
coordinator have the depth of experience, training, and authority to
navigate these multiple care/benefits systems. In contrast to those
demanding requirements for an FRC, neither warrior transition unit
staff nor recovery care coordinators (RCCs) - who are to assist
servicemembers whose injuries are not deemed likely to result in a need
for medical separation \4\--have the training, let alone the authority,
to help coordinate care and other needs outside the military system.
Resolving this referral problem is vitally important-- failing to make
a referral for an FRC until severely wounded servicemembers retire can
mean delay in their recovery, rehabilitation and re-integration. These
are the very kinds of problems that sparked the call for a seamless
transition.
---------------------------------------------------------------------------
\3\ General Accountability Office, ``DoD and VA Health Care:
Federal Recovery Coordination Program Continues to Expand but Faces
Significant Challenges,'' GAO-11-250, (Mar 23, 2011) 2. accessed at
http://www.gao.gov/products/GAO-11-250
\4\ DoDI 1300.24, Enclosure 4, sec. 2.a.
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The referral issue seems a manifestation of the fact that instead
of being operated as a joint, integrated VA-DoD effort, the FRC program
tends to be seen--and marginalized--as a ``VA program.'' Given the
program's importance to severely wounded warriors, it is critical that
both departments fully support it. Experience under the program
strongly suggests that that goal will remain elusive until there is
truly shared responsibility for the program. In our view, enactment of
H.R. 3016 would achieve that important objective by providing a sound
framework for joint operation of the program under principles to ensure
early referrals and efficient, effective recovery, transition and
reintegration of severely wounded warriors. We strongly support
enactment of this bill.
H.R. 3279
WWP is also pleased to lend our strong support to H.R. 3279. This
bill would clarify that a veteran who has a serious illness incurred or
aggravated in service on or after 9/11, and who is deemed to need
personal care services, is an ``eligible veteran'' for purposes of the
comprehensive caregiver-assistance program established under Public Law
111-163. The rationale for providing support services to caregivers of
our wounded apply equally to family members caring for a young veteran
suffering from a serious illness incurred in service. Current law
governing caregiver-assistance certainly makes it clear that there is
not a hard ``eligibility-line'' between a traumatic injury and other
medical conditions. That is clear since the law states that the
defining term, ``serious injury,'' includes a mental disorder. Yet
while it would cover some veterans with mental health conditions, VA's
interim final rule otherwise reads the statute as covering only
``injury'' not illness. But there may be little distinction between the
caregiving needs of a young warrior who is profoundly disabled as a
result of serious illness in service and one who is injured. In each
instance, a parent or spouse may have permanently left the workforce to
care at home for the veteran's daily needs, leaving that veteran
vulnerable to the risk of VA institutionalization if the stresses of
caregiving overwhelm that family member. Surely the needs Congress
sought to address through the caregiver-assistance law relate to the
emotional, psychological, physical, and financial impact of caregiving,
not to the underlying etiology of a veteran's condition. Clarifying the
law, as proposed in H.R. 3279, would provide needed support for
deserving caregivers while averting risks of unwanted
institutionalization.
H.R. 3723
H.R. 3723 would change current law - which authorizes VA to provide
fee-basis treatment to certain veterans for whom it cannot provide
timely, geographically-accessible care in its facilities - to require
it to contract for care under those circumstances for all enrolled
veterans pursuant to a specified framework. It is helpful to review
this measure in light of section 1, namely its proposed findings that
(1) VA's health care system fails to provide veterans easily accessible
treatment; (2) veterans can be provided care more efficiently closer to
where they live and with more flexibility in choosing their own
doctors; and (3) replacing VA's fee-basis care system with the model
proposed under the bill can yield better care at little to no increased
cost.
We concur that the VA health care system does not consistently
provide veterans easily accessible treatment. Of course there are many
factors associated with access to care, to include funding and
staffing, as well as eligibility-limits on fee-basis care set in
current law. Under section 1703 of title 38, U.S. Code, VA's authority
to provide care or treatment under contract is limited to specified
circumstances (such as to provide ongoing needed care in follow-up to
an episode of hospitalization \5\) and to specified categories of
veterans (such as veterans needing treatment for a service-connected
condition or veterans with service-connected disabilities rated 50% or
more \6\). In short, existing law generally limits VA's use of this
tool to ensuring continuity of care and to accommodate veterans that
Congress has identified as having high priority for access to care.
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\5\ 38 U.S.C. sec. 1703(a)(2)(B)
\6\ 38 U.S.C. secs. 1703(a)(1)(A); (2)(A)
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In this connection, our most recent experience, particularly as it
relates to mental health care, is that fee-basis care is seldom an
option for warriors with service-incurred mental health conditions
despite VA facilities' too-frequent inability to provide timely care or
even the kind of care some need. This troubling situation exists
despite very clear direction to VA facility directors regarding mental
health services:
``[These services] must be made accessible when clinically
needed to patients receiving health care from VHA. They may be provided
by appropriate facility staff, by telemental health, by referral to
other VA facilities, or by sharing agreements, contracts or non-VA fee-
basis care to the extent the veteran is eligible.'' \7\ (Emphasis
added.)
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\7\ Department of Veterans Affairs, VHA Handbook 1160.01 (September
11, 2008), sec. 3.a.(1)
At a time that VA facilities are ignoring or circumventing a
directive that calls for utilizing fee-basis care under the limited
circumstances authorized in law, it is difficult to embrace the notion
implicit in H.R. 3723 that it would be timely to expand eligibility for
fee-care to all enrolled veterans. But, in our view, there also is a
real question as to how best to craft a legislative response to a
situation where--VA's own directive that action ``must'' be taken--is
construed by some as simply a guideline. Under these circumstances, one
cannot necessarily assume that amending a statutory provision governing
fee-basis care to read ``shall'' rather than ``may,'' as the bill
proposes, would ensure the desired change. On the other hand, the
establishment of such a broad mandate could certainly create serious
fiscal-management challenges for VA with unintended results. We submit
that these uncertainties alone raise real concerns, and suggest that
the Subcommittee consider the unintended consequences of such a far-
reaching bill.
Finally, we would acknowledge that H.R. 3723 raises a fair question
as to whether VA's fee-basis model can be improved or even redesigned.
In that regard, there is certainly merit to establishing requirements
that any health care provider would have to meet in contracting with VA
to treat veterans. But it is not clear that the requirements proposed
in H.R. 3723 represent an optimal contracting framework. For example,
the measure calls for a contractor to have ``care coordinators to help
veterans make, confirm and keep medical appointments.'' But it does not
specifically require the contractor to coordinate care with VA
clinicians, and as such would not necessarily assure real care-
coordination or continuity of care for the veteran. In addition, the
bill's requirement that a contractor have the ability to process claims
from others in the provider's network suggests that such a contract
would likely not, as a practical matter, be open to most individual
providers or small group practices. As such, it is not clear that the
bill would, in fact, ``allow veterans more flexibility in choosing
their own doctors'', as section 1(b)(3) suggests. In sum, while H.R.
3723 raises questions that merit discussion, we cannot support its
enactment.
H.R. 1460
H.R. 1460 would, in essence, direct VA to enroll any veteran who
served in a combat zone in the VA health care system, subject to an
option not to enroll. The bill appears aimed at facilitating a combat
veteran's access to care. As discussed above, however, it has not been
our experience that warriors have encountered difficulty in enrolling
or are unaware of their eligibility for VA health care. Rather, we hear
of warriors encountering problems after enrollment, particularly in
getting timely, effective mental health care. VA has reported
historically high percentages of OEF/OIF veterans' enrolling and being
``seen'' at VA health care facilities. But surveys of both warriors and
VA mental health staff strongly suggest that at least some of those
facilities may not be adequately staffed to provide timely care or even
the right kind of care, and that in meeting VA's goal of enrolling as
many veterans as possible have been less successful in providing the
timely, effective care they should expect. In short, while we have no
objection to H.R. 1460, we do not see this bill as solving the more
serious access-to-treatment problems some returning warriors are
facing.
H.R. 3337
H.R. 3337 would require VA to establish a registry for individuals
who may have been exposed to toxic chemicals and fumes from ``open burn
pits'' in Iraq or Afghanistan, and require an independent scientific
organization to assess that effort, and make recommendations on (1)
collection and maintenance of such information, and (2) on how best to
meet the medical needs of those exposed with respect to the likely
result of such exposure.
WWP shares the concern underlying this bill regarding unexplained
respiratory and other illnesses among OEF/OIF veterans, and the
possible role of environmental exposures in Iraq and Afghanistan. H.R.
3337 focuses specifically on the potential vulnerability of those who
were based or stationed at a location where an open burn pit was used.
We note, however, the recent Institute of Medicine suggestions that
``service in Iraq or Afghanistan - that is, a broader consideration of
air pollution than exposure only to burn pit emissions--might be
associated with long-term health effects . . . .'' \8\ While we have no
objection to this legislation, IOM's findings and recent research \9\
suggesting other environmental factors in southwest Asia may also be
implicated in increased risk of illness raise a question whether the
proposed registry would ultimately be a sufficiently helpful tracking
mechanism.
---------------------------------------------------------------------------
\8\ Long-Term Health Consequences of Exposure to Burn Pits in Iraq
and Afghanistan, Institute of Medicine (Oct. 2011), 114. http://
www.iom.edu/Reports/2011/Long-Term-Health-Consequences-of-Exposure-to-
Burn-Pits-in-Iraq-and-Afghanistan.aspx
\9\ See ``Harsh Environment in Southwest Asia, Not Just Burn Pits,
Cause Health Problems in Troops,'' U.S. Medicine, vol. 48, no. 3 (March
2012), 33.
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Finally, WWP has no position on the two remaining bills under
consideration, H.R. 4079 (addressing requirements for VA's grant
program to assist homeless veterans) and H.R. 3245 (to direct VA and
DoD to provide Vet Centers with access to DoD electronic records
systems in order to obtain service-discharge records (DD-214 forms). We
would note, however, that warriors with whom we work have not reported
any problems obtaining DD-214s or establishing eligibility for Vet
Center services.
We would be pleased to answer any questions.
Prepared Statement of Robert L. Jesse
Good afternoon, Madam Chairwoman and Members of the Subcommittee:
Thank you for inviting me here today to present the
Administration's views on several bills that would affect Department of
Veterans Affairs (VA) benefits programs and services. Joining me today
is Susan Blauert, Deputy Assistant General Counsel.
H.R. 1460: ``Automatic Enrollment of Veterans''
H.R. 1460 would require the Secretary of VA, in cooperation with
the Secretary of the Department of Defense (DoD), to automatically
enroll combat-theater Veterans described in 38 U.S.C. Sec.
1710(e)(1)(D) in VA's health care system not later than 45 days after
their discharge or separation from active military, air, or naval
service. The Secretary of VA would be required to provide these
Veterans with a ``Veteran identification'' card that: 1) shows they are
enrolled in VA's health care system, and 2) allows them access to VA
health care facilities. The Secretary would also be required to furnish
these Veterans with a list of VA medical facilities (including
hospitals, outpatient centers, and mental health clinics) that are
located within 100 miles of the Veterans' homes, or the closest VA
facilities if none falls within that distance. It would also require
that these Veterans receive at the same time a description of Federal
benefits and programs, including educational benefits and job training
and placement programs, for which they may be eligible.
H.R. 1460 would also permit Veterans to opt out of automatic
enrollment by requiring, as part of the enrollment process described
above, that they also receive the option to decline enrollment. In
cases where automatic enrollment is declined, the Secretary of VA would
be prohibited from automatically enrolling those individuals. A Veteran
automatically enrolled in VA's health care system would have up to 6
months (from the date of enrollment) to disenroll by providing notice
to the Secretary. The Secretary would be required under the bill to
disenroll the Veteran within 60 days of receipt of the notice.
Finally, the provisions of H.R. 1460 would become effective 90 days
after the date of enactment.
H.R. 1460 would dramatically change the process for transitioning
Servicemembers, and VA is still evaluating the impact this change would
have on its enrollment model, budget projections, utilization rates,
and overall access to our health care system.
VA is working on many fronts to reach out to all separating
Servicemembers and to ensure they know about the benefits they have
earned, while making it as easy as possible to avail themselves of
these benefits. Encouraging enrollment is certainly one piece of that
effort.
VA and DoD are working in close partnership to ensure that every
Servicemember's transition from DoD to VA is as smooth as possible.
Together, the two Departments continue to progress in providing a
comprehensive continuum of care to optimize the health and wellbeing of
Servicemembers, Veterans, and their eligible beneficiaries. Our joint
efforts to provide a ``single system'' experience of lifetime services
encompass efficiencies in three common areas: operations; health care;
and benefits. Joint planning and resource sharing have reduced
duplication and increased cost savings for both Departments. Our health
care goal is a patient-centered health care system that consistently
delivers excellent quality, access, and value across the Departments.
We also strive to anticipate and address Servicemember, Veteran, and
family needs through an integrated approach to delivering comprehensive
benefits and services.
VA and DoD are cooperating to improve the transition and
coordination of care and benefits for Servicemembers and Veterans in
four specific areas. First, in information technology, DoD and VA share
a significant amount of health and benefits information today, and the
Departments continue to spearhead numerous interagency data sharing
activities and are delivering information technology solutions that
significantly improve the secure sharing of appropriate electronic
health and benefits information for those who have served our country.
Second, in benefits determinations, VA and DoD's joint efforts have
created an integrated disability evaluation process for Servicemembers
who are being medically retired or separated. This new, joint process
was designed to eliminate the duplicative, time consuming, and often
confusing elements of the separate disability processes within VA and
DoD. Third, in informing Veterans and Servicemembers of the benefits
they have earned, the National Resource Directory (NRD) is a
comprehensive, Web-based portal that provides Servicemembers, Veterans,
and their families with access to thousands of resources to support
recovery, rehabilitation, and reintegration. NRD is a collaborative
effort between DoD, Labor, and VA and has more than 13,000 Federal,
state and local resources which are searchable by topic or location.
Finally, in mental health, one of our cooperative efforts is the
Integrated Mental Health Strategy (IMHS), which was developed to
address the growing population of Servicemembers and Veterans with
mental health needs. The IMHS centers on a coordinated public health
model to improve the access, quality, effectiveness, and efficiency of
mental health services. Recipients of these services include Active
Duty Servicemembers, National Guard and Reserve Component members,
Veterans, and their families.
Because of the complex issues this legislation raises and its wide-
ranging impact on VA, we are still developing a position and a cost
estimate for this bill. We will provide these in a letter after the
hearing.
H.R. 3016 Joint Operation of Federal Recovery Coordination Program
H.R. 3016 would direct the Secretary of DoD and the Secretary of VA
to jointly operate the Federal Recovery Coordination Program (FRCP). It
would require the Departments to ensure that the FRCP assists members
of the Armed Forces with severe or catastrophic injuries or illnesses
who are unlikely to return to active duty and will most likely be
medically separated, as well as Servicemembers and Veterans whose
individual circumstances are determined by the Secretary concerned to
cause difficulties to the Servicemember or Veteran in transitioning to
civilian life. It would require the military services and the VA to
make referrals to the FRCP at the earliest time feasible, including no
later than 180 days prior to the last day of the month in which the
Servicemember is expected to be retired or separated.
The bill would also require that the Secretaries of VA and DoD
ensure that each Federal Government agency and department provides
Federal Recovery Coordinators (FRC) with information, coordination, and
cooperation necessary to allow FRCs to: (1) ensure the efficient
recovery, transition and reintegration of eligible Servicemembers and
Veterans; (2) act as liaisons between such Servicemembers and Veterans
and the team of care providers and other personnel involved with a
Servicemember or Veteran's recovery, transition and reintegration; and
(3) work closely with case and care-management programs that assist
such Servicemembers and Veterans. H.R. 3016 would require the
Secretaries of VA and DoD, no later than 180 days after enactment, to
develop a plan to carry out the requirements of the bill, enter into a
Memorandum of Understanding (MOU) to jointly carry out the plan, and
jointly submit both the plan and the MOU to designated congressional
committees. No later than 180 days after the MOU becomes effective, the
bill would require the Secretaries to jointly submit to designated
congressional committees, a report describing and evaluating the
implementation of the plan and MOU.
While VA appreciates the efforts of Congress to recognize and
improve FRCP operations and provide high quality care coordination to
wounded, ill, and injured Servicemembers and Veterans, VA does not
support H.R. 3016. The Secretaries of VA and DoD are actively engaged
on this issue and have directed that the Departments resolve the issue
of coordinating efforts between and recognizing the value of each case
management and care coordination program within the Departments- to
include, but not limited to, the VA-administered FRCP and the Service-
administered Recovery Coordination Programs (RCP). Much of H.R. 3016
represents a duplication of existing requirements for VA and DoD for
providing care coordination, and the requirements in the bill are
already included in an existing VA-DoD MOU and in VA and DoD policy.
Because of the nature of the bill's requirements, VA cannot provide
a reliable cost estimate of H.R. 3016. To provide a reliable estimate
VA would need to work with DoD to develop estimates of potential
clients who would be referred to FRCP under the eligibility criteria in
the bill, which are significantly broader than under current policy.
We note that section 1(a)(5) of the bill would direct the
Secretaries of VA and DoD to ensure that information, coordination, and
cooperation are provided by each Federal Government agency and
department. We believe this provision was designed, rather, to ensure
that VA and DoD appropriately coordinate with other Federal agencies
and departments in supporting the responsibilities of FRCs - as VA and
DoD cannot direct the actions and responsibilities of other Federal
agencies and departments.
H.R. 3245 Efficient Service for Veterans Act
H.R. 3245 would require the Secretaries of VA and DoD to ensure
that Vet Centers, established under 38 U.S.C. 1712A, have access to
``the Defense Personnel Records Information Retrieval System'' and
``the Veterans Affairs/Department of Defense Identity Repository
system.''
VA is authorized, under 38 U.S.C. 1712A, to establish Vet Centers
that provide readjustment counseling to eligible Veterans and certain
family members, upon their request. To be eligible for readjustment
counseling, an individual must: have a Form DD-214 (Certificate of
Release or Discharge from Active Duty); have received at least one
qualifying medal; have received combat pay or combat tax exemption
after November 11, 1998; or allow VA to independently verify his or her
eligibility with DoD. See Vet Centers, 77 Fed. Reg. 14707-14712 (March
13, 2012) (adding 38 C.F.R. Sec. 17.2000). H.R. 3245 would allow Vet
Centers direct access to DoD's Defense Personnel Records Information
Retrieval System and the VA/DoD Identity Repository system. While the
bill does not discuss the rationale for providing Vet Centers with
access to these databases, we believe that the bill is designed to
allow Vet Centers to utilize the databases to verify eligibility for
readjustment counseling services if a Veteran does not have his or her
DD-214.
VA has no objection to this bill, as it would enable Vet Centers to
verify eligibility information in a timely fashion even if the Veteran
or Servicemember does not have his or her DD-214. We would, however,
recommend that the bill clarify the purpose for Vet Center access to
the databases and the extent to which access is required. We also
recommend that the bill list the information, within these databases,
that should be disclosed to Vet Centers--for instance, ``information
relevant to Vet Center eligibility determinations.'' Without these
clarifications, the bill would simply ensure that Vet Centers have
access to the databases, but would not specify what level of access
would be granted, or the purpose for that access.
VA prides itself on maintaining Veteran and Servicemember
confidentiality. To that end, Vet Centers currently maintain a separate
system of records within VA, which effectively ``walls off'' any
client's personal identifying information from individuals who do not
need access to that information. The only time that Vet Centers
disclose a client's personal identifying information is when VA has the
client's authorization or there is an immediate crisis that requires
the disclosure. To protect the confidentiality of active duty
Servicemembers and Veterans who request readjustment counseling, we
recommend that this bill include a provision to restrict the monitoring
or ``logging'' of Vet Center activity within the databases, other than
for lawful purposes, such as law enforcement.
We would be happy to work with the Subcommittee to ensure the bill
achieves its goals. Because Vet Centers already have the required
technology to access these databases, we estimate that the costs for
implementing this bill would be minimal. We also recommend a technical
amendment to the language in H.R. 3245 to reference the ``Defense
Personnel Records Information Retrieval System'' instead of
the''Defense Personnel Record Image Retrieval System''.
H.R. 3279 Amending the Eligibility Criteria Under 38 U.S.C. Sec.
1720G(a)(2)(B) to Include Eligible Veterans who have a Serious
``Illness''
H.R. 3279 would amend the eligibility criteria for VA's Program of
Comprehensive Assistance for Family Caregivers under 38 U.S.C. Sec.
1720G(a)(2)(B) to include Veterans or Servicemembers who have incurred
or aggravated ``a serious illness in the line of duty in the active
military, naval, or air service on or after September 11, 2001.'' Under
current law, eligibility for VA's Program of Comprehensive Assistance
for Family Caregivers is limited to Veterans or Servicemembers who have
incurred or aggravated ``a serious injury (including traumatic brain
injury, psychological trauma, or other mental disorder) . . . in the
line of duty in the active military, naval, or air service on or after
September 11, 2001.'' See 38 U.S.C. Sec. 1720G(a)(2)(B).
VA supports the intent of this bill. Expanding eligibility for VA's
Program of Comprehensive Assistance for Family Caregivers to include
Veterans and Servicemembers with a serious illness would eliminate the
need to distinguish illness from injury and establish a more equitable
program. Distinguishing between a Veteran or Servicemember who incurred
or aggravated a serious injury in the line of duty from one who
incurred or aggravated a serious illness is often a complex process
since either individual may require the assistance of a caregiver. The
amendment proposed by this bill is supported by public comments
received by VA in response to its interim final rule. See Caregivers
Program, 76 Fed. Reg. 26148 (May 5, 2011) (adding 38 C.F.R. Part 71).
These comments requested that VA consider ``illness'' as one of the
eligibility factors for VA's Program of Comprehensive Assistance for
Family Caregivers. VA's Office of General Counsel, however, concluded
that the statutory language did not permit the addition of illness as
criteria in regulations, and instead would require a statutory change.
The amendment would also align VA and the DoD Special Compensation
for Assistance with Activities of Daily Living (SCAADL) program,
authorized by section 603 of Public Law 111-84 (Oct. 28, 2010). Both
SCAADL and VA's Program of Comprehensive Assistance for Family
Caregivers provide monetary benefits; SCAADL provides monetary
compensation to eligible Servicemembers, whereas VA provides a stipend
to primary Family Caregivers. SCAADL does not distinguish between
illness and injury when determining eligibility compared to VA's
Program of Comprehensive Assistance for Family Caregivers, which limits
eligibility to Veterans and Servicemembers who incurred or aggravated a
``serious injury.'' 38 U.S.C. Sec. 1720G(a)(2)(B). This amendment
would help align the two programs' eligibility requirements, since they
both aim to serve Veterans and Servicemembers who require ongoing
assistance with activities of daily living or need supervision or
protection.
To implement this amendment, VA would need to define the term
``serious illness'' and solicit public feedback on this definition. VA
would also need to amend its interim final rule to include the new
eligibility criteria. The amendment would expand the population
eligible for benefits and services under VA's Program of Comprehensive
Assistance for Family Caregivers. An increase in the eligible
population and the services and benefits that are provided to them
would result in increased costs. At present, VA has approximately 3,500
Veterans and Servicemembers who have family caregivers enrolled in VA's
Program of Comprehensive Assistance for Family Caregivers. Based on
this amendment, VA estimates that 870 additional Veterans and
Servicemembers would qualify for services and benefits. These benefits
and services include: a stipend available to primary family caregivers;
VA health insurance available to eligible primary family caregivers;
and respite care, mental health services, educational services, and
beneficiary travel benefits available to family caregivers.
VA estimates the total cost for this bill would be $45 million
during Fiscal Year (FY) 2013, $263.5 million over 5 years, and $649.5
million over 10 years. VA does support the intent of this bill, because
caregiver benefits indirectly support Veterans by providing assistance
to their designated caregivers. However, because of the cost of the
expansion proposed under this bill, there could be a negative impact on
access to medical care services for Veterans unless additional funding
is provided.
H.R. 3337: ``Open Burn Pit Registry Act of 2011''
H.R. 3337 would require the Secretary of Veterans Affairs, not
later than 180 days after enactment, to establish and maintain a
registry for eligible individuals who may have been exposed to toxic
chemicals and fumes caused by open burn pits. The bill would define an
``open burn pit'' as an area of land located in Afghanistan or Iraq
that the Secretary of Defense designates for use for the disposal of
solid waste by means of burning in the outdoor air without the use of a
commercially manufactured incinerator or other equipment specially
designed and manufactured for the burning of solid waste. It would
define ``eligible individual'' as anyone who, on or after September 11,
2001, was deployed in support of a contingency operation while serving
in the Armed Forces and who during such deployment was based or
stationed at a location where an open burn pit was used.
H.R. 3337 would also require the Secretary of VA to include in the
registry any information that the Secretary deems necessary to
ascertain and monitor the health effects of such exposure. It also
would require the Secretary to develop a public information campaign to
inform eligible individuals about the registry and to periodically
notify them of significant developments in the study and treatment of
conditions associated with exposure to toxic chemicals and fumes from
open burn pits. Additionally, the Secretary would have to enter into an
agreement with an independent scientific organization to report on the
effectiveness of the Department's actions to collect and maintain
information on the health effects associated with this particular type
of environmental exposure. Specifically, the organization would be
required to make recommendations on how the Department may improve its
efforts (in collecting and maintaining registry information) and on the
most effective and prudent means of addressing the medical needs of
this cohort for conditions likely to result from their exposure to
toxic chemicals and fumes from open burn pits.
Finally, H.R. 3337 would require the Secretary of VA to submit the
scientific organization's report to Congress not later than 18 months
after establishment of the registry.
VA does not support H.R. 3337. Special authority for such a
registry is not required. In carrying out the Department's medical and
research missions, the Secretary may already establish under existing
authority any needed health registry. Pursuant to section 703(b)(2) of
Public Law 102-585 (1992), the Secretary may also provide, upon
request, an examination, consultation, and counseling to any Veteran
who is eligible for inclusion in any Department health registry. H.R.
3337, therefore, duplicates existing authorities.
We do not believe that a health registry is the appropriate
epidemiological tool to use in identifying possible adverse health
effects associated with certain environmental exposures. Health
registries by their nature can only produce very limited and possibly
skewed results. The major purpose of a registry is to enable medical
follow-up and outreach efforts of those potentially exposed to an
environmental hazard. Studies of self-selected individuals, such as
those in a registry, are not representative of an entire population of
potentially exposed individuals; they may therefore lead to false
associations as to cause of perceived or actual illnesses. Indeed, for
years, VA has maintained an Agent Orange health registry and a Gulf War
health registry. While useful for outreach purposes, neither of these
registries has been useful in terms of researching the types of health
concerns raised by these Veterans. In addition to the issue of self-
selection, there are other reasons why studies of registry populations
are not useful, including exposure misclassification (self-reported but
with no availability of data to support amount and time of exposure)
and an inability to link to medical records to substantiate concerns
about illnesses (not all registrants receive care from VA). We also
note the particular timeframes under the bill are far too short to
produce scientifically valid evidence.
Instead, it would be more appropriate to conduct a comprehensive
prospective study of the long-term adverse health effects associated
with specified environmental exposures, including exposure to toxic
chemicals and fumes from open burn pits that were experienced by the
OEF/OIF/OND cohort. Such a study would produce the most complete and
representative information on possible adverse health effects
associated with specified exposures. We are currently developing cost
estimates and data requirements for a large-scale study and defining
the outcomes it would provide. More importantly, VA and DoD are already
engaged in several focused studies on health effects related to this
cohort, including DoD's Millennium Cohort Study and VA's New Generation
Study. Both Departments are also working on establishing clinical
protocols for evaluating Veterans with respiratory complaints after
deployment.
Finally, we note that combat-theater Veterans are eligible to
enroll in VA health care up to 5 years after discharge or separation
from service and receive free hospital care and medical services for
conditions possibly related to their combat service. Eligible Veterans
may take advantage of their VA health care benefits to obtain any
desired medical advice on this topic as well as any needed medical
services.
VA estimates the total cost for H.R. 3337 would be $2.3 million
during FY 2013, $6.2 million over 5 years, and $11.5 million over 10
years.
H.R. 3723 Enhanced Veteran Health Care Experience Act of 2011
H.R. 3723 would make various revisions to 38 U.S.C. 1703, which
currently provides authority for VA to contract for certain types of
health care for select Veterans when Department facilities are not
capable of furnishing economical hospital care or medical services
because of geographic inaccessibility or are not capable of furnishing
the care or services required. Specifically, this bill would require
the Secretary to provide health care through contract providers if the
Secretary determines that Department facilities are not capable of
economically furnishing covered health services to a Veteran because of
geographic inaccessibility or because such facilities lack the required
personnel, resources, or ability. This contract care would be available
to all enrolled Veterans who elect to receive care under this
authority.
With respect to standard acquisition practices, VA's existing
authority, 38 U.S.C. 8153, to contract for health care resources from
any health care provider or other entity or individual is sufficient.
In fact, VA has an acquisition initiative under way to develop broad-
based nationwide and regional contracts with health care providers to
enhance and expand VA's ability to refer Veterans to qualified health
care providers when VA is unable to furnish the required health care
while helping to contain overall costs. With regard to subsection
(a)(2) of section 2 of the bill, addressing qualified providers and
quality of care, VA currently includes these requirements in health
care contracts.
For the reasons described above, VA does not support this
legislation. In addition, VA does not support H.R. 3723 because it
would allow Veterans to elect to receive non-VA care under section 1703
as amended. As outlined above, section 1703 currently allows VA to
purchase non-VA health care for certain eligible Veterans when
facilities are not capable of furnishing economical health care
services because of geographical inaccessibility or such services are
reasonably unavailable within VA. Requests for non-VA care from a VA
provider must document that the local VA does not provide the requested
service and that the services requested are medically necessary within
generally accepted standards of medical practice. When such referral
for non-VA services is received, local fee basis offices are required
to verify geographic inaccessibility, availability of VA services (to
include those of other VA medical centers), and eligibility for fee
basis care. VA is concerned that H.R. 3723 as written would eliminate
this step and marginalize the definition of what is considered
geographically inaccessible as a result of the Veterans ability to
elect to receive care. VA is still preparing cost estimates on this
bill as written. We will provide it as soon as it is available.
VA regulations implementing the current authority in section 1703
have long provided that ``individual authorizations'' may be used as a
method of making infrequent purchases of necessary non-VA health care
for eligible Veterans. Individual authorizations provide the
flexibility to purchase services necessary to a full continuum of care
based on the patient's condition, frequency of need, and quality of
care issues which would otherwise be unavailable from VA without
negotiating the purchase under formal contracting provisions. VA, in
its budget transmittal, summarized a proposal that will soon be
transmitted to Congress to amend section 1703 to clarify that VA is not
limited to formal contracting when purchasing health care services
under this authority. We note that price reasonableness would be
ensured by continuing to utilize Medicare payment rates as the payment
methodology for these purchases.
VA would welcome the opportunity to work with the Subcommittee to
enhance 38 U.S.C. 1703 and thereby improve VA's ability to deliver high
quality health care and provide Veterans with a full continuum of
health care, where standard acquisition practices are inadequate.
H.R. 4079 Safe Housing for Homeless Veterans Act
H.R.4079 would modify the Secretary's current requirements for
entities seeking grants or other assistance to provide housing or
services to homeless Veterans using the Life Safety Code of the
National Fire Protection Agency, applicable state and local housing
codes, licensing requirements, fire and safety requirements, and any
other jurisdictional requirements.
The proposed amendment requires that entities providing housing or
services for homeless Veterans certify compliance with ``the most
current Life Safety Code and all applicable State and local housing
codes, licensing requirements [and], fire and safety requirements'' for
the buildings where services or housing is being provided. The proposed
law would require that community partners are fire and safety code
compliant before they are otherwise eligible to receive a grant, as
well as require compliance with standards that may be above and beyond
what is required by local law. This new requirement could dramatically
reduce the pool of eligible capital grantees and could even preclude
entities seeking capital grants intended to fix fire and safety issues.
This would effectively mean severely limiting eligibility to existing
providers with existing approved structures and could defeat the
purpose of capital granting for new and existing community partners to
make the necessary changes to provide services to Veterans.
The legislation appears to require meeting not only life safety
requirements but it also outlines ``any other requirements in the
jurisdiction in which the project is located regarding the condition of
the structure and the operation of the supportive housing or service
center.'' This could be construed as requiring an applicant to have
existing permits or licenses to provide services prior to being an
eligible applicant for a capital grant.
Furthermore, by amending subchapter I of chapter 20 of title 38,
this legislation would apply to every specialized homeless program
operated under chapter 20 of title 38, including the Supportive
Services for Homeless Vets program found in 38 U.S.C. 2044, and could
require mandatory housing code upgrades in existing structures even
when Veterans are not cared for in these structures. For example, under
38 U.S.C. 2044, VA provides grants to community partners to provide
prevention and rapid re-housing services to homeless Veterans. In
general, community partners operating under these types of grants would
use existing structures for the administration of services; Veterans
are not ``cared for'' in these structures, but services are
administered and provided out of these structures. Certainly, these
community partners would be expected to meet the necessary state and
local housing codes, but in many cases, the Life Safety Code imposes
much more rigorous requirements. This legislation would likely require
costly upgrades to meet the Life Safety Code. In short, this
legislation could impose onerous remodeling and upgrade costs on
community partners' administrative buildings even though the services
they are providing are wholly unrelated to the conditions of the
building the entity occupies.
For the reasons stated above, we do not support this bill. It has
the potential to be unduly burdensome and therefore would undermine the
original congressional intent to encourage new partners to provide
services to Veterans. The proposed law could also have a chilling
effect upon the entry of new providers into the market. There are no
Federal- level costs associated with this bill.
This concludes my prepared statement. Thank you for the opportunity
to testify before the Subcommittee. I would be pleased to respond to
any questions you or Members of the Subcommittee may have.
Statements For The Record
PREPARED STATEMENT OF INSTITUTE OF MEDICINE
Mr. Chairwoman and members of the Subcommittee on Health, my name
is Harvey V. Fineberg. I am the President of the Institute of Medicine
of the National Academies. The Institute of Medicine (IOM) is an
independent, nonprofit organization that works outside of government to
provide unbiased and authoritative advice to decision makers and the
public.
Established in 1970, the IOM is the health arm of the National
Academy of Sciences, which was chartered under President Abraham
Lincoln in 1863. Today, the National Academy of Sciences has expanded
into what is collectively known as the National Academies, which
comprises the National Academy of Sciences, the National Academy of
Engineering, the National Research Council, and the IOM.
I have been asked by your subcommittee to submit a statement for
this hearing on the topic of H.R. 3337, the Open Burn Pit Registry Act
of 2011. Our service men and women have long indicated concern that
their health may have been adversely impacted by the burning of solid
waste in open pits at US bases overseas where they were or are
stationed. This concern has been echoed by Congress and the Department
of Veterans Affairs. In 2009 the IOM was asked by the Department of
Veterans Affairs to assess the long-term health risks from open pit
burning at bases in Iraq and Afghanistan, using Joint Base Balad (JBB)
near Baghdad, one of the largest military bases in Iraq, as an example.
IOM convened an expert committee to study this matter and the
committee completed their report in 2011. A PDF download of this report
is available to the public at no charge from the National Academy Press
at the following web address: [ http://www.nap.edu/catalog.php?record--
id=13209].
I am submitting a copy of the summary of this IOM report for the
record here. Briefly, the IOM collected data on environmental releases
and concentrations of combustion products at JBB, considered
information on possible human exposures at the base and elsewhere, and
assessed the potential for long-term health effects of those exposures.
The Department of Defense provided raw air-sampling data from JBB taken
when the burn pit was in operation (it has since been replaced by
incinerators), which were used to determine which chemicals were
present at JBB. Based on these data, the committee found that levels of
most pollutants at the base were not higher than levels measured at
other polluted sites worldwide.
However, insufficient evidence prevented the IOM committee from
developing firm conclusions about what long-term health effects might
be seen in service members exposed to burn pits. Along with more
efficient data-gathering methods, the report recommends that a study be
conducted that would evaluate the health status of service members from
their time of deployment to JBB over many years to determine the
incidence of chronic diseases, including cancers, that tend to show up
decades after exposure. Given the many hazards to which military
personnel are exposed in the field, service in Iraq and Afghanistan in
general, rather than exposure to burn pits only, might be associated
with long-term adverse health effects.
In addition to instructing the Department of Veterans Affairs to
establish a health registry, the proposed H.R. 3337 instructs the
Secretary, Department of Veterans Affairs to enter into an agreement
with an independent scientific organization to accomplish tasks
outlined in Section 3 of the legislation. I will offer brief comments
about those tasks. The three tasks are appropriate and feasible for an
independent scientific organization to accomplish. For example, the
first task is to assess of the effectiveness of actions taken by the
Secretaries (Defense and Veterans Affairs) to collect and maintain
information on the health effects of exposure to toxic chemicals and
fumes caused by open burn pits. The independent organization could
invite the Secretaries to review with the external independent
organization in a public venue, their plans and programs for carrying
out the legislation's requirements. That review would include assessing
the completeness of a toxic agents inventory that the Secretary,
Department of Veterans Affairs, believes is associated with the open
burn pits, how and where the information is being derived and
maintained, and how accessible it is to veterans included in the
registry. This assessment would naturally lead to a set of
recommendations (the second task) to improve the collection and
maintenance of such information. Finally, the third task requires an
independent organization to review epidemiological studies, established
and previously published, and to offer recommendations regarding the
most effective and prudent means of addressing the medical needs of
eligible individuals with respect to conditions that are likely to
result from exposure to open burn pits. An independent scientific
organization would be able to scour the world literature for relevant
articles relating to this topic.
Depending on the nature of the information discovered, the
independent organization could ascertain which exposures might present
the most significant potential long-term health risks. That, in turn,
would lead to recommendations about how best to prevent or clinically
manage these potential effects. If little or no information could be
obtained from a comprehensive literature review, the independent
organization could suggest new research, epidemiological and otherwise,
to inform the health risks.
In sum, the tasks outlined in section 3 of H.R. 3337 can be
accomplished by a credible independent organization. Thank you for the
opportunity to submit a statement for the record.
PREPARED STATEMENT OF BURN PITS 360
Honorable Chairman Jeff Miller and Honorable Members Of The
Committee On Veterans' Affairs
It is an honor to have the opportunity to submit a statement for
the record regarding Bill H.R. 3337. I am the wife of Captain Leroy
Torres and founder/Executive Director of Burn Pits 360. ``The War That
Followed Us Home'' is the slogan on t-shirts worn by many service
members, veterans, and families affected. They are also the 6 words
that describe the health and lives stolen from thousands of soldiers
who served in the OEF/OIF war campaign where they were exposed to
environmental toxins.
My husband, Captain Leroy Torres served a dual role to his
community as a State Trooper in the State Of Texas and a Captain in the
U.S. Army Reserves. He served a one-year tour at Camp Anaconda, a
forward operating base that contained the largest burn pit. As he
walked down the airport terminal with both arms and both legs, I sighed
with relief thinking that we had accomplished a mission and our life
would resume back to normal. It was his bulletproof vest in his
civilian job that confirmed our biggest fear, returning from a war zone
with life threatening injuries, everytime he put on the vest it
restricted his breathing leaving him gasping for air. Since then he has
been diagnosed with an irreversible lung disease, pulmonary
hypertension, memory loss, parasitic infections, etc. . . . He has lost
both of his careers at the age of 39 due to toxic inhalation and the
effects this has had on him and on our family has been devastating. The
once healthy father of 3 and husband that served on the SWAT police
tactical squad and ran circles around his children is now a patient to
over a dozen specialty doctors including: cardiology, neurology,
pulmonary, GI, etc. . . .
Gasping for air and searching for answers we felt alone and
confused. What was causing the coughing spasms, fatigue, memory loss,
headaches, Gastric pains and were we the only ones out there
experiencing these unexplained symptoms. Our prayers were answered the
night that I googled the words, `` soldiers returning sick from Iraq''.
It was at that moment that we discovered a community of soldiers and
their families that had lost the battle to toxic exposure and many that
were still fighting the battle to toxic exposure.
Like the names listed on the Vietnam Memorial Wall, we discovered
name after name of individuals that were suffering from brain tumors,
cancer, lung diseases, etc. . . . One of those names is SSG. Steven
Ochs, 32 yrs. old, who's story of battling cancer after 3 tours in Iraq
was told at the October 8, 2009 testimony before the United States
Senate Committee On Veterans' Affairs. The lists of Fallen Soldiers
that have lost the battle to toxic exposure include: Amanda Downing 24
yrs. old, Sgt. William Mc Kenna, Major Kevin Wilkins 51 yrs. old, SSG.
Matthew Bumpus 31 yrs. old, Christopher Sachs 36 yrs. Old, Andy Rounds
22 yrs. Old, Jessica Sweet, SSGT Danielle Nienajadlo, and many more.
Since organizing Burn Pits 360, we are currently the only
organization that manages a registry for those affected by toxic
exposures from the Burn Pits In Iraq and Afghanistan. Our registry
consists of over 600 self-reported entries. Over 90 % of the registries
represent those suffering from pulmonary symptoms and others from
Parkinson's, low testosterone levels, skin rashes, fatigue, joint pain,
memory loss, crohn's disease, parasites, h-pylori, colon cancer, t-cell
lymphoma, AML-acute myeloid leukemia, lung cancer, throat cancer, brain
tumors, CML-chronic myelogenous leukemia, renal cell carcinoma, and
several other illnesses.
Burn Pits 360 was developed as a pathway of advocacy by
constituents and military families affected by toxic exposure. It was
the only answer to avoid from becoming the next Agent Orange. This
became a passion and a mission for my husband, my family, and for
myself. The service members, veterans, families of the fallen,
children, spouses, mothers, fathers, husbands, wives to those affected
ask each and every one of you to support H.R. 3337. We have traveled to
Washington at our own expense, walked the halls of Capitol Hill,
visited the gravesites of those that have lost the battle, and built
life long friendships with one thing in common, Burn Pits. As a
military family our patriotism is shown by the American Flag that hangs
over our front porch, as a caregiver to a wounded warrior, a twenty one
year employee of the Department Of Veteran Affairs, and executive
director to Burn Pits 360, it is my hope that each and everyone of you
will show your patriotism by supporting a bill that will serve as a
platform to those affected by toxic exposure.
Respectfully,
Rosie Torres
PREPARED STATEMENT OF HUMANA GOVERNMENT
Chairwoman Buerkle, Ranking Member Michaud, and members of the
Subcommittee:
Introduction
Thank you for the opportunity to present Humana Veterans' views on
H.R. 3723, the Enhanced Veteran Healthcare Experience Act of 2011,
which would provide much needed improvements to the Department of
Veterans Affairs' (VA) Fee program for Veterans who are authorized to
receive medical care from non-VA providers.
Through the congressionally-directed pilot Project HERO (Healthcare
Effectiveness through Resource Optimization), Humana Veterans
Healthcare Services, Inc. (Humana Veterans), a Humana Government
subsidiary, provides Veterans with access to non-VA healthcare when the
Department determines that specific medical resources are not available
within the VA healthcare system in VISNs 8, 16, 20, and 23. In these
VISNs, we provide access to a competitively priced network of
physicians, institutions and ancillary providers to supplement the VA
healthcare system while adhering to high quality and access to care
standards. With the HERO pilot scheduled to end on September 30, 2012,
we would like to provide the Subcommittee our perspective on what key
pilot program elements should be adopted and incorporated into a
follow-on national program to replace the current VA Fee process.
Humana strongly supports H.R. 3723 because the bill addresses the
fundamental flaws of the VA's non-HERO Fee program where Veterans
receive fragmented care with little or no coordination between VA and
non-VA healthcare systems. The bill ensures that VA would adopt the
successful elements of the HERO pilot program, along with additional
improvements to create a fully integrated healthcare delivery system
where Veterans receive well-coordinated, patient-centric care. This
bill enables VA to track and monitor all Veterans with Fee care
authorizations, requires proper care coordination to positively impact
Veterans' health outcomes, and will lead to cost savings by minimizing
duplicative healthcare services and tests. Because of the care
coordination elements in this bill, its adoption will also result in
greater empowerment for VA to recapture as much of the Fee workload
into the VA healthcare delivery system as they can absorb.
Challenges in VA's Fee Process
As currently implemented, the Fee process is not integrated with
VA's healthcare delivery system and there is no coordination or care
management of Veterans with Fee care authorizations, except in certain
congressionally-directed pilot programs such as Project HERO and
Project ARCH (Access Received Closer to Home). VA's Fee process fails
to ensure that Veterans are seen by credentialed and qualified non-VA
providers and does not guarantee the return of pertinent clinical
information to the VA primary care provider in a timely manner. With
the exception of Veterans participating in Project HERO and Project
ARCH, VA has no way of tracking and monitoring if and when Veterans
schedule and receive care in the community. This means that VA loses
track of Veterans and the care they receive once they leave the VA
system for Fee care. Veterans are also left with the daunting task of
navigating the very confusing VA and non-VA healthcare systems on their
own without a single point of contact who will be the integrator of all
care. This process is not Veteran-centered nor structured to allow VA
to determine if and how a Veteran can be brought back to the VA for
follow- up care and treatment, if appropriate.
In addition, the problem of erroneous Fee payments is well
documented. Despite VA's best efforts to automate the Fee claims
process through various pilot programs over the past 10 years, claims
are still not automated today and the current manual claims process
places VA at high risk for improper payments. For example, a March 2012
report by the VA Office of Inspector General identified the Fee
program's improper payment rate at 12.4 percent \1\, and the Government
Accountability Office's February 2012 report placed the Fee program
among the top 10 Federal programs with the highest reported improper
payment rates \2\. These findings are consistent in the September 2011
report by the National Academy of Public Administration (NAPA). The
NAPA study also discusses the Fee program's use of ``antiquated systems
and technology'' and points to private sector payors who provide ``much
more efficient and accurate claims processing'' \3\.
---------------------------------------------------------------------------
\1\ VA Office of Inspector General. Department of Veterans Affairs:
Review of VA's Compliance with the Improper Payments Elimination and
Recovery Act. Mar. 14, 2012. Web. 6 Apr. 2012,
\2\ U.S. Government Accountability Office. Improper Payments:
Moving Forward with Government-Wide Reduction Strategies. Feb. 7, 2012.
Web. 6 Apr. 2012
\3\ National Academy of Public Administration. Veterans Health
Administration Fee Care Program. Sept. 2011. Web. 6 Apr. 2012
---------------------------------------------------------------------------
To address these problems, VA and Humana Veterans worked in a close
partnership to implement the HERO pilot program. The result of this
experience has allowed us to capture the positive outcomes and lessons
learned, and we can identify the ideal core elements that should be
incorporated into the Fee program. However, instead of leveraging the
lessons learned from this pilot program, VA's plan for the follow-on
HERO program that they are calling Patient Centered Community Care
(PCCC), would only result in the creation of a sub-specialty provider
network. Care coordination is not possible under PCCC, because it
excludes a number of health care services that will end up being
provided in the community separately from PCCC. This will not yield
meaningful improvements in the existing Fee program. Instead, PCCC will
maintain the status quo of the current Fee program and the re-pricing
contract that only gives VA a discount in price, but does not include
Veteran-facing services.
In addition, under PCCC the contractor would not be able to provide
the administrative services that exist in the HERO pilot and which were
instrumental to the contractor's care coordination role. In its current
design, PCCC would significantly limit the contractor's role to one of
establishing and managing a provider network. Concurrently, VA is also
creating and building new in-house capacity to handle administrative
functions associated with the Fee care authorizations, visits and
treatment through the Non-VA Care Coordination (NVCC) program. Instead
of tapping the capacity that already exists in industry, NVCC will
require significant resource investments, both in staff and the
necessary tools (including IT) to properly handle the ``back-office''
administrative functions. It is not clear why VA would want to build
internal capacity to become an insurance payor, when their expertise
and experience is in delivering excellent healthcare as a provider. An
unintended consequence of removing contractor-provided administrative
services under the PCCC proposed model is the threat to the
contractor's ability to maintain a provider network responsive to VA's
changing needs. It also means that VA will not be able to get the best
price, since the contractor cannot negotiate a better price with their
network providers in the absence of a predictable minimum workload and
without the ability to guarantee a low no-show rate, and timely,
predictable payments.
The current flawed Fee program operates much like a fee-for-service
program, which has perpetuated and magnified the risk for poor health
outcomes, improper payments, and has resulted in unnecessary
duplicative healthcare services and tests. These problems will persist
if VA moves forward with PCCC in its current design, and NVCC that will
excise the back-office functions that contributed to the success of
HERO. In today's challenging budget environment, VA cannot afford to
support and expand ineffective and efficient programs. VA must make
fundamental changes to the traditional Fee program to address the
current program challenges. This is possible with the enactment of H.R.
3723, since this bill provides a sound foundation of core Fee program
elements that can be used to guide VA as they develop the requirements
for PCCC. The purpose of the congressionally directed HERO pilot
program was to test ways to improve the broken Fee process. As
discussed below, the HERO pilot program data point to key positive
outcomes. H.R. 3723 builds on the integrity and basic successful
elements of HERO to create meaningful improvements to the traditional
Fee program.
H.R. 3723
H.R. 3723 ensures that Veterans with Fee authorizations receive the
same high-quality care and protections that the VA healthcare system
provides through the following HERO elements:
Fully credentialed and certified network of specialty
providers: Humana Veterans provided a network of 39,443 providers in
the four HERO pilot VISNs. This network made it possible for Veterans
to travel a median appointment distance of only 13 miles, even though
45 percent of the HERO appointments were in rural or highly rural
areas.
Clinical information exchange: Under Project HERO, Humana
Veterans returned 94 percent of clinical information to the VA within
30 days with a median return of 9 days. This helped to improve clinical
decision-making, and minimized duplicate care and services.
Care coordination: Humana Veterans' care coordinators
helped each Veteran in Project HERO navigate the care that they receive
in the community. For example, Humana Veterans assisted Veterans in
identifying a network community provider, scheduling the appointment,
and following up to ensure that the Veteran made the doctor's visit. As
a result, Humana Veterans achieved a no-show rate of 5 percent, which
is significantly below the industry average that ranges between 14
percent and 24 percent. Humana Veterans also provided VA direct access
to the Authorization and Consult Tracking (ACT) system, which is our
proprietary IT tool for care coordination that allowed VA to track and
monitor Veterans with Fee authorizations for the very first time.
Clinical quality management to respond to patient safety
events: Under Project HERO, Humana Veterans operated a clinical quality
management program, which provided a structured way for identifying and
addressing possible patient safety events. The clinical quality
management program has reviewed all identified potential quality
indicators and investigated 100 percent of confirmed quality issues, as
well as discussed outcomes with the VA through the jointly operated
Patient Safety Peer Review Committee.
Accurate and timely claims payment: Project HERO required
Humana Veterans to handle Fee related administrative services,
including claims processing for our network providers. Using our
automated claims process and contracted rates that minimize the risk
for improper payments, we made 99 percent of claim payments to our
providers within 30 days and maintained an extremely low payment error
rate in FY 2011.
In addition, H.R. 3723 provides for stronger care coordination by
requiring a VA-provided and a contractor-provided care coordinator to
work together in managing the care that Veterans receive. The bill also
attempts to eliminate variation by requiring VA to make consistent
determination of Fee authorizations for Veterans, while leaving the
Department with the flexibility to define the standards for referrals
and authorizations. This means that VA retains the decision-making
control of if and when they use Fee care as a tool to supplement the
care that Veterans receive in the VA. In summary, H.R. 3723 provides
necessary changes to the Fee program and incorporates the successful
elements from HERO that will enable the VA to work in partnership with
community providers to provide Veterans with not only patient-centric
and coordinated care, but also ensures continuity of care across VA and
non-VA provided healthcare systems.
Conclusion
In order to enhance the Veteran's healthcare experience, VA should
do what they do very well (i.e., delivery of excellent healthcare) and
partner with an administrative services contractor to provide services
they do very well in the marketplace (e.g., care coordination,
maintaining credentialed provider networks, payments, etc.). For the
reasons outlined above, Humana Veterans strongly supports H.R. 3723 and
encourages its enactment. Eligible Veterans for whom VA provides Fee
authorizations will benefit greatly from a fully integrated care
coordinated Fee program that will also ensure VA's ability to bring
these Veterans back into the VA if and when follow-up care is needed.
We look forward to working with the Committee to make the necessary
transformational changes to the Fee program so that Veterans receive
more effective and efficient care when they must go outside of the VA
system for care.
PREPARED STATEMENT OF NATIONAL COALITION OF HOMELESS VETERANS
Chairwoman Ann Marie Buerkle, Ranking Member Michael Michaud, and
distinguished members of the House Committee on Veterans' Affairs,
Subcommittee on Health:
The National Coalition for Homeless Veterans (NCHV) is honored to
present this Statement for the Record for the legislative hearing on
April 16, 2012. On behalf of the 2,100 community- and faith-based
organizations NCHV represents, we thank you for your commitment to
serving our nation's most vulnerable heroes.
For the purposes of this statement, NCHV would like to formally
indicate its support for the following three bills:
H.R. 4079, Rep. David McKinley's ``Safe Housing for
Homeless Veterans Act.''
H.R. 3723, Rep. Bobby Schilling's ``Enhanced Veteran
Healthcare Experience Act of 2011.''
H.R. 1460, Rep. Bill Owens' bill to provide for automatic
enrollment of veterans returning from combat zones into the VA medical
system.
H.R. 4079, ``Safe Housing for Homeless Veterans Act''
Among the homeless veteran programs that would be affected by this
legislation is the Homeless Providers Grant and Per Diem Program (GPD)
- which provides transitional housing with supportive services, and is
a staple of the Department of Veterans Affairs' Five-Year Plan to End
Veteran Homelessness.
A vast majority of homeless veterans must address mental illnesses,
substance abuse disorders, physical disabilities, or co-occurring
disorders. The road to recovery for GPD participants often results in
triumph, but it is not without tribulation. A safe environment is
critical to ensure this rehabilitation can happen.
Existing GPD capital grant regulations require compliance with the
Life Safety Code of the National Fire Protection Association, as well
as local and state codes and licensing requirements. The ``Safe Housing
for Homeless Veterans Act'' would establish these policies as federal
law.
Numerous homeless shelters across the country have witnessed fatal
fires. We have the technology, however, to prevent these tragedies from
happening. H.R. 4079 would signal to VA's community-based service
provider partners the importance of meeting these safety measures.
As Congress works to protect homeless veterans and their families,
it must not create undue obstacles for those who wish to serve them.
The ``Safe Housing for Homeless Veterans Act'' offers a short-term
safeguard for homeless veteran programs currently receiving federal
funds - those that do not already meet the required certification would
have up to two years to come into compliance.
We believe the essential components of the Five-Year Plan to End
Veteran Homelessness are in place and advancing - these include access
to safe housing, health services, income stability and prevention
strategies. Without ensuring the safety of veterans in rehabilitative
housing programs, however, our efforts to end their homelessness will
be incomplete. This bill takes a sensible approach to help protect
America's former service members.
H.R. 3723, ``Enhanced Veteran Healthcare Experience Act of 2011''
Homeless veteran service providers have long recognized the need
for an ``open door'' policy that ensures veterans have access to
immediate primary and mental health services. This legislation would
promote this policy by replacing VA's fee-based care system with the
contract-based ``veterans enhanced care program.''
At present, it is incumbent upon the veteran - no matter his or her
disability level - to travel potentially hundreds of miles to the
nearest VA medical facility to apply for fee-basis care. H.R. 3723
would remove this unnecessary burden by allowing qualified service
providers to enter into contracts with VA to serve eligible veterans in
areas that are underserved by VA facilities.
The provisions in this bill cover primary medical care, mental
health services, and long-term rehabilitative care - all of which are
critical to the overall health and well-being of veterans, particularly
those who have served in combat and combat support operations.
For vulnerable veterans in highly rural and underserved areas, the
``Enhanced Veteran Healthcare Experience Act of 2011'' will provide
much-needed relief, and enhance the responsiveness of the VA. NCHV
supports this bill's patient-centered approach to providing medical
care.
H.R. 1460, to provide for automatic enrollment of veterans returning
from combat zones into the VA medical system
Although combat exposure is not definitively linked to
homelessness, it is a high predictor of later difficulties in life. The
full scope of this relationship remains unclear, however. By
automatically enrolling veterans returning from combat zones into the
VA medical system, H.R. 1460 would enable our nation to build a
comprehensive record of the health care services required by these
veterans. This is critical to the VA's full understanding of the health
issues related to combat exposure, and the agency's ability to
effectively plan for the services it will have to provide to combat
veterans in the long term.
This bill protects service members' autonomy by including an option
not to enroll during their discharge or separation process.
Additionally, all veterans would have the option to ``disenroll'' for a
period of up to six months after their initial enrollment.
In Summation
Thank you for the opportunity to submit this Statement for the
Record. We look forward to working with this subcommittee to help
advance H.R. 4079, H.R. 3723, and H.R. 1460 to the full committee and
House of Representatives.
John Driscoll
President and CEO
National Coalition for Homeless Veterans
333 \1/2\ Pennsylvania Avenue SE
Washington, DC 20003
202-546-1969
PREPARED STATEMENT OF PARALYZED VETERANS OF AMERICA
Chairwoman Buerkle, Ranking Member Michaud, and members of the
Subcommittee, Paralyzed Veterans of America (PVA) thanks you for the
opportunity to submit a statement for the record regarding the proposed
legislation being considered today. PVA appreciates the fact that you
are addressing these important issues that affect the health and well-
being of our nation's veterans. We support your effort to improve the
health care and benefit services that these men and women have so
honorably earned and deserve.
H.R. 1460
PVA generally supports the intent of H.R.1460, a bill that would
require the Department of Veterans Affairs (VA) to automatically enroll
veterans returning from combat zones into the VA health care system.
This bill would also provide veterans with information on job training
and educational programs that may benefit veterans as they transition
back into their civilian lives. PVA believes that automatic enrollment
in the VA health care system immediately after veterans are discharged
or separated from service will help make veterans more aware of the
health care services, benefits, and veterans programs available to them
through the VA. However, we recognize that as a result of automatic
enrollment there will be a significant increase in utilization, which
will require additional resources and funding for VA facilities.
Therefore, PVA's full support for this bill is contingent upon
providing the VA with the additional resources and funding that will be
necessary to meet the growth in health care demand.
PVA also has concerns that if this legislation is enacted the
current generation of veterans who are discharged or separated from
military service will be granted enrollment in the VA health care
system when they may not otherwise be eligible. As written, this bill
is unclear if the targeted population of veterans will be enrolled in
the VA health care system in accordance with current enrollment
policies; or if veterans discharged or separated from military service
after the bill is enacted will be eligible to enroll regardless of
restrictions that may be in place for other veterans. PVA believes that
veterans entering the VA health care system must meet the VA
eligibility requirements that are in place during the time of automatic
enrollment.
PVA would also like to ensure that a veteran's decision not to
enroll does not preclude him or her from enrolling in the future. The
VA must also be certain to continue its outreach to inform veterans of
the many services and benefits that the VA has to offer. Educating
returning service members on the many benefits of enrollment in VA's
health care system is an essential element of veterans consistently
seeking VA services.
Lastly, PVA believes that it is imperative that this legislation
recognizes and includes our mobilized National Guard and Reservists as
they are demobilized from wartime service. The period when a member of
the Reserves demobilizes is an extremely hectic time and the focus of
the service member is to get back home to their family. They are no
less deserving of automatic enrollment and it may be even more
important as they do not have the long period of preparation often
afforded to those being discharged from active service.
H.R. 3016
PVA supports H.R. 3016, legislation that would mandate both the VA
and the Department of Defense (DoD) to jointly operate the Federal
Recovery Coordination Program (FRCP). PVA believes that the FRCP is an
excellent program and has the potential to help severely injured, ill,
or wounded service members and veterans navigate through the various
benefits and services for which they are eligible through the VA or
DoD. However, in order for the FRCP to succeed, both VA and DoD must
take joint responsibility for its administration.
As identified by past hearings held by the Subcommittee,
communication between the VA and DoD, as well as duplication of
efforts, continues to be a problem in the administration of the
program. It is for this reason that PVA believes H.R. 3016, if enacted,
would not only improve communication between VA and DoD, but also
encourage coordination between the two departments as veterans enter
the program.
Since the VA and DoD both have responsibility for individuals
enrolled in the FRCP, PVA believes that both departments should equally
share responsibility for the program. If this bill is enacted, VA and
DoD must work to ensure that the changes that will occur as a result of
joint responsibility do not thwart the progress that has been mad thus
far. Administration of the program must continue to move forward in
order to provide veterans with the necessary guidance and stability
that is needed for them to make informed decisions in support of their
full recovery and rehabilitation.
H.R. 3245, the ``Efficient Service for Veterans Act''
PVA does not have a position on H.R. 3245, legislation that ensures
that VA Vet Centers have access to the Defense Personnel Record Image
Retrieval System and the VA/DoD Identity Repository system.
H.R. 3279
PVA strongly supports H.R. 3279, a bill that would amend title 38,
United States Code, to clarify that caregivers for veterans with either
a serious illness or injury are eligible for assistance and support
services provided by the VA. PVA has over 60 years of experience
understanding the complex needs of spouses, family members, friends,
and personal care attendants that love and care for veterans with life-
long medical conditions. PVA believes the original legislation was
clearly intended to support populations of veterans that have
experienced a catastrophic injury or illness.
Additionally, the Secretary of Veterans Affairs, Eric Shinseki,
emphasized during the roll-out of the new caregiver program that
``caregivers are critical partners with VA in the recovery and comfort
of ill and injured veterans.'' Unfortunately, the law is being
interpreted very narrowly and thus excluding caregivers who care for
veterans dealing with catastrophic illnesses. PVA believes that this is
simply unacceptable and urges the Committee to pass this legislation.
H.R. 3337, the ``Open Burn Pit Registry Act of 2011''
PVA supports H.R. 3337, which would require the VA to create an
open burn pit registry for members of the Armed Forces who may have
been exposed to toxic chemicals and fumes caused by open burn pits
while deployed to Afghanistan or Iraq. This legislation would provide
this population of veterans with information regarding burn pit
exposures, and potentially assist VA with future research and health
care initiatives. PVA believes that the burn pit registry is a first
step towards ensuring that veterans returning from Afghanistan and Iraq
receive the proper medical attention regarding exposure to toxic
elements.
H.R. 3723, the ``Enhanced Veteran Healthcare Experience Act of 2011''
PVA does not support H.R. 3723, the ``Enhanced Veteran Healthcare
Experience Act of 2011.'' This bill would amend title 38, United States
Code to authorize the VA to enter into contracts with health care
providers in an effort to increase access to health care for veterans
who have difficulty receiving treatment at a health care facility of
the VA. While access is indeed a serious concern for PVA, we believe VA
is the best health care provider for veterans.
The veterans enhanced care program as proposed in H.R. 3723 would
change the veteran eligibility requirements for VA contracted care, as
well as eliminate VA's current Fee-basis care program and replace the
federal statute governing contract care within the VA. Currently,
contracted care services provided through the VA are at the discretion
of VA leadership; reserved for veterans who have sustained a service
connected disability, or a disability for which a veteran was
discharged or released from active duty; and provided when the VA is
not capable of providing the needed care, or such services are
geographically inaccessible. Under H.R. 3723 VA leadership will no
longer have the discretion to choose when to contract with private
providers for veterans' health care, and all veterans enrolled in the
VA health care system would become eligible to receive contracted care
outside of the VA. This policy change has the potential to drastically
increase the number of veterans seeking care outside of the VA, and PVA
believes that providing quality care to meet the unique needs of
veterans is an integral component of the VA fulfilling its mission.
Additionally, this legislation would also expand the criteria under
which the VA must provide contracted health care to include personnel
and resource shortages within VA medical facilities. PVA believes that
this will only lead to the diminution of VA health care services and
resources. It is PVA's position that the quality of VA's health care
and ``veteran specific'' expertise cannot be adequately duplicated in
the private sector. When VA is not capable of providing timely, quality
services to veterans, it is the responsibility of VA leadership and
Congress to work together to ensure that VA is able to meet veterans'
health care needs. PVA does not believe that contracting health care
services to private facilities is an appropriate enforcement mechanism
for ensuring access to care.
H.R. 4079, the ``Safe Housing for Homeless Veterans Act''
PVA supports H.R. 4079, legislation to amend title 38, United
States Code, to require recipients of VA grants and other assistance
for the provision of housing and other services for homeless veterans
to comply with codes relevant to operations. This bill will help insure
the safety of facilities that offer services to homeless veterans, as
well as prevent delays in construction of such facilities by requiring
that all recipients of VA grants be in compliance with safety housing
codes or licensing requirements. PVA believes that H.R. 4079 is in
direct alignment with Secretary Shinseki's goal of eradicating
homelessness among America's veterans.
Chairwoman Buerkle, Paralyzed Veterans of America appreciates this
opportunity to express our views on these pieces of important
legislation. We look forward to working with the Subcommittee on these
and other issues in the future.