[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
ASSESSING INADEQUACIES IN VA DATA USAGE FOR AND SERVICES PROVIDED TO
VISUALLY-IMPAIRED VETERANS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATION
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
THURSDAY, MAY 29, 2014
__________
Serial No. 113-70
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.fdsys.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
88-981 WASHINGTON : 2015
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking
GUS M. BILIRAKIS, Florida, Vice- Minority Member
Chairman CORRINE BROWN, Florida
DAVID P. ROE, Tennessee MARK TAKANO, California
BILL FLORES, Texas JULIA BROWNLEY, California
JEFF DENHAM, California DINA TITUS, Nevada
JON RUNYAN, New Jersey ANN KIRKPATRICK, Arizona
DAN BENISHEK, Michigan RAUL RUIZ, California
TIM HUELSKAMP, Kansas GLORIA NEGRETE McLEOD, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
PAUL COOK, California TIMOTHY J. WALZ, Minnesota
JACKIE WALORSKI, Indiana
DAVID JOLLY, Florida
Jon Towers, Staff Director
Nancy Dolan, Democratic Staff Director
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATION
MIKE COFFMAN, Colorado, Chairman
DOUG LAMBORN, Colorado ANN KIRKPATRICK, Arizona, Ranking
DAVID P. ROE, Tennessee Member
TIM HUELSKAMP, Kansas MARK TAKANO, California
DAN BENISHEK, Michigan ANN M. KUSTER, New Hampshire
JACKIE WALORSKI, Indiana BETO O'ROURKE, Texas
TIMOTHY J. WALZ, Minnesota
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
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Thursday, May 29, 2014
Page
Assessing Inadequacies in VA Data Usage for and Services Provided
to Visually-Impaired Veterans.................................. 1
OPENING STATEMENTS
Hon. Mike Coffman, Chairman...................................... 1
Prepared Statement........................................... 34
Hon. Ann Kirkpatrick, Ranking Member............................. 2
WITNESSES
Mr. Travis Fugate, Veteran....................................... 4
Prepared Statement........................................... 35
Mr. Terry Kebbel, Veteran........................................ 5
Prepared Statement........................................... 38
Mr. Gleen Minney, Veteran........................................ 6
Prepared Statement........................................... 42
Dr. Maureen McCarthy, MD, Deputy Chief Patient Care Services,
Veterans Health Administration, Department of Veterans' Affairs 22
Ms. Lorraine Landfried, DCIO for Product Development, Office of
Information Technology, Department of Veterans' Affairs........ 23
Combined Statement of Dr. McCarthy and Ms. Landfried......... 46
Accompanied by:
Dr. Mary Lawrence, MD, Deputy Director, Vision Center of
Excellence
And
Mr. Pat Sheehan, Director, 508 Compliance Office,
Department of Veteran' Affairs
FOR THE RECORD
Attachment of VCE................................................ 54
Questions for the Record From: Subcommittee Chairman Mike Coffman 55
ASSESSING INADEQUACIES IN VA DATA USAGE FOR AND SERVICES PROVIDED TO
VISUALLY-IMPAIRED VETERANS
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Thursday, May 29, 2014
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Oversight and Investigation,
Washington, D.C.
The subcommittee met, pursuant to notice, at 10:15 a.m., in
Room 334, Cannon House Office Building, Hon. Mike Coffman
[chairman of the subcommittee] presiding.
Present: Representatives Lamborn, Roe, Huelskamp,
Benishek, Walorski, Kirkpatrick, Takano, Kuster, O'Rourke,
Walz.
OPENING STATEMENT OF CHAIRMAN MIKE COFFMAN
Mr. Coffman. Good morning. This hearing will come to order.
I want to welcome everybody to today's hearing titled Assessing
Inadequacies in VA Data Usage for and Services Provided to
Visually Impaired Veterans.
My name is Mike Coffman and prior to hearing testimony and
asking questions to our witnesses, I ask that each member state
his or her name to assist our witnesses in identifying who is
speaking. Thank you for your cooperation. Now let us begin.
This hearing focuses on continued problems within VA that
have caused its contribution to the Vision Center of Excellence
to stagnate, allowed VA systems to continue to operate in non-
compliance with Section 508 of the Americans With Disabilities
Act, and compromised other services provided to veterans with
visual impairments.
The creation of the Vision Center of Excellence, or ``VCE''
as we will refer to it today, was mandated by the National
Defense Authorization Act of FY 2008. It stated that the
Department of Defense was required to create the facility and
to collaborate with the Department of Veterans Affairs in doing
so.
One of the main responsibilities required in the 2008 NDAA
for the operation of the VCE was to ``enable the Secretary of
Veterans Affairs to assess the registry and add information
pertaining to additional treatments or surgical procedures and
eventual visual outcomes for veterans who were entered into the
registry and subsequently received treatment through the
Veterans Health Administration.''
The reference to the Registry is that the Department of
Veterans Eye Injury and Vision Registry, which we will also
refer to as the ``Registry'' today for convenience. The DoD has
done a commendable job of populating the Registry with over
20,000 unique patient entries. However, the most recent number
VA has provided the Committee regarding the contribution of the
Vision Registry is one entry. One, compared to 20,000.
Notably, in an October, 2013 briefing, VA staff stated that
the one entry was just a test case to ensure that the transfer
of information would work. So, essentially, VA had not entered
in any veterans information into the Registry, which precludes
VA from meaningfully contributing to the very purpose the
Registry was created--``to collect the diagnosis, surgical
intervention, operative procedures, and related treatments, and
follow-up on each significant eye injury incurred by members of
the Armed Forces while serving on active duty.''
We will hear from a veteran today who will articulate the
importance of VA fulfilling its obligation to contribute to the
Registry. Another major issue we will address today is VA's
continued failure to bring its information systems into full
compliance with Section 508 of the Americans with Disabilities
Act.
The two separate of the Section 508 addresses access for
people with physical, sensory, or cognitive disabilities in
various types of technologies. Two separate memoranda, dated
July 26, 2012, issued by then Assistant Secretary for
Information and Technology, Roger Baker, illustrated the
ongoing problems with VA regarding Section 508 compliance. Both
memoranda reference how recent audits conducted by VA show that
most of the content and information on VA web sites was not
Section 508 compliant.
Further, in a 2012 VA dashboard summary analysis, every
site review showed a status of less than 50 percent compliance
with Section 508. Some notable examples include VA jobs, e-
benefits, and VA forms. VA jobs at 80 percent critical, e-
benefits at 95 percent critical, and VA forms at 100 percent
critical.
The rating of critical in the analysis states that the
listed percentage is the amount of that web site that is
completely inoperable.
We will hear today in VA's testimony that they are making
great strides in bringing VA systems into compliance with
Section 508. However, we will also hear from a blinded veteran,
who must actually navigate these pages himself. He may be
inclined to disagree.
With that, I now recognize Ranking Member Kirkpatrick for
her opening statement.
[The prepared statement of Chairman, Mike Coffman appears
in the Appendix]
OPENING STATEMENT OF ANN KIRKPATRICK, RANKING MEMBER
Ms. Kirkpatrick. Thank you, Mr. Chairman. I am Ranking
Member Ann Kirkpatrick from Congressional District 1 in
Arizona.
The hearing topic today is an important one and I look
forward to an in-depth discussion with our witnesses. Today we
are examining the Department of Veterans Affairs role in the
operation of the Vision Centers of Excellence and Section 508
of the Rehabilitation Act of 1973 compliance as they relate to
proper access and services for blinded veterans.
We will also hear the testimony of Mr. Glenn Minney, from
the Blinded Veterans Association on HR 1284, a bill introduced
by my colleague and Ms. Brownley, a member of the House
Committee on Veterans Affairs, and Ranking Member of the
Subcommittee on Health.
This bill will expand the VA's Beneficiary Travel Coverage
Program for some veterans who are not currently eligible for
beneficiary travel, but who are in need of treatment at one of
the VA's Blind Rehabilitation Centers or Spinal Cord Injury
locations.
Mr. Minney, I look forward to hearing your testimony and as
a result of being a cosponsor of HR 1284, I believe this bill
will help remove another access to care obstacle within the VA
medical system for our veterans.
Many of our visually disabled veterans would greatly
benefit and become capable of living independently in their own
homes if able to receive rehabilitation. However, some of these
veterans are not able to receive these treatments because of
high travel costs and ineligibility for beneficiary travel
under the VA programs, and this is a special problem in my
district, which is a very large rural district in Arizona, and
my veterans have to go to three different veterans hospitals
depending on where they live, and travel hundreds of miles.
This bill will expand eligibility for beneficiary travel so
that more veterans are able to receive rehabilitative
treatments.
I understand that in the current conflicts, eye injuries
have accounted for approximately 15 percent of all battlefield
traumas. We also know that as many as 75 percent of traumatic
brain injures, those patients also suffer visual dysfunctions
that can affect their quality of life.
When the Vision Center of Excellence was envisioned and
established through the 2008 National Defense Authorization
Act, the Department of Defense, in collaboration with
Department of Veterans Affairs, was tasked with prevention,
diagnosis, mitigation, treatment, and rehabilitation of eye
injuries. While it took some time, I understand that the Center
is now functioning, although problems such as staffing,
funding, and clear policy remain challenging.
In addition to the Center, the 2008 National Defense
Authorization Act also required the establishment of a Vision
Registry. I look forward to hearing from our witnesses today on
the progress of that collaboration, especially enrollment and
seamless transfer of VA vision care data to the Vision
Registry.
Mr. Chairman, while the wars may be winding down, we know
that the need for research, treatment, and rehabilitation will
remain for eye injury veterans for decades to come. Today we
are also looking at the Department of Veterans Affairs
compliance with Section 508 of the 1973 Rehabilitation Act.
Section 508 addresses access for the disabled to different
types of technology. According to VA testimony, VA systems are
still not compliant with the law. One of our witnesses today
described the difficulty of navigating through the VA web sites
because they are not 508 compliant, causing him frustration and
a lot of extra time to get the information he is looking for.
Eye injured veterans are already challenged and we should
be working as fast as we can to ensure that their next
encounter on the VA web sites will not be so difficult.
I would like to hear from our VA panel what they are doing
to become compliant, why is it taking so long, and what
resources are needed, if any, to aid in becoming compliant. We
need to get this right sooner rather than later.
Thank you, Mr. Chairman. I yield back.
Mr. Coffman. Thank you, Ranking Member Kirkpatrick. I ask
that all members waive their opening remarks as per this
Committee's custom.
With that, I welcome the first panel at the witness table.
On this panel, we will hear from Mr. Travis Fugate, Kentucky
National Guard, Retired; Mr. Terry Kebbel--did I say that
right--United States Army, Retired; and Mr. Glenn Minney,
Director of Government Relations for the Blinded Veterans
Association. All of your complete written statements will be
made part of the hearing record.
Mr. Fugate, you are now recognized for five minutes.
STATEMENT OF MR. TRAVIS FUGATE
Mr. Fugate. Thanks, Chairman, and Ranking Member, for
inviting me here to speak again.
It was over five years ago that I came here to speak about
the VCE. It had been--the creation had been mandated the year
prior to the time that I spoke before, which was March, 2009.
Only a week before the day that I spoke, I had been told that
my vision was totally gone and I wouldn't see again.
Most people who reviewed the case agreed that the vision
that I had lost--let me explain something further. When I was
injured, I had some remaining vision and I had it for three
years, and then I got an infection within the VA and the
doctors did not have access to the proper medical data. So they
failed to do preventative surgeries, and when I had an
emergency situation, they did not have access to the medical
documentation, which may have lead to the vision loss that
resulted after the surgery.
Since I was here before, I have went on. I have went to
school. I have worked to improve myself and my life. I have
been active in the VA and the Blinded Veterans Association,
trying to help other blinded veterans. I meet new young blind
men coming from the wars every year.
I am interested in hearing you ask questions about how
things have changed since the testimony in March, 2009, in
which I participated. If some young man went into the VA
tomorrow, as I did, would his doctors be able to have access to
electronic data that would allow them to perform preventative
surgeries and see all of the surgeries he had in the past, or
she?
I am open for questions.
[The prepared statement of Travis Fugate appears in the
Appendix]
Mr. Coffman. Thank you so much for your testimony, Mr.
Fugate. Mr. Kebbel, you are now recognized for five minutes.
STATEMENT OF TERRY KEBBEL
Mr. Kebbel. As a blinded veteran, I have had an opportunity
to assist other blinded veterans on how to use websites. We
have done a good job of describing what 508 is, compliance. We
have done a good job of stating that we need to do something
about it. I want to talk about what we have not done yet, okay?
As I was asked to investigate ten websites or ten web pages
for this testimonial. I had the opportunity to design, with
some help from some other blind veterans, a form that helped us
to evaluate each of those web pages. In my opinion, each of
those web pages failed. Each of those web pages failed in
different areas--some very major and some very minor.
When I get the opportunity to read a web page, I would like
to be able to navigate properly, and I can do that with
headings. And headings is a way for a non-visual person like
myself to navigate a web page.
One of the pages I evaluated had no heading level--heading
on the page, which means that I have to navigate the whole web
page to find out what the purpose of that web page is. A
sighted person can visualize it and see what that purpose is
right away.
Another page that I had the opportunity to evaluate was one
with link problems and I was kind of interested when you said
the forms page failed 100 percent, well I am in total agreement
with that one. I had the--you know, when I went to the web page
I listed the links on the page and there was 217 of them, and
these are links to forms. Every one of those links were named
by a numerical number. It had no description on what that form
was.
Another one was--another form I evaluated is where I went
to the web page. The first one I downloaded it was a form to
fill in, okay? The first thing I noticed was that it was an
image file. Well, for those of us who use a screen reader and
who are blind, we know that we can not look at pictures, and
that is an image file. So I can not read that image file.
The second thing is that it was a form I was supposed to be
able to fill out. Well, if it is an image file and there are no
form of edit boxes on that page, I can not fill in the
information needed to fill out that form.
So when I hear that we are making progress on it, it is
difficult for me to believe. You know, I would like the same
opportunity to read a web page as a sighted person, and I can
do that on web pages. I can go to Open Culture, which is a
website from Stanford University and access all their
information. I can take courses there. I can, you know, do a
lot of things on that particular web page.
I can go to the Library of Congress and do the same thing.
I can go to the National Federation of the Blind, which is
probably one of the best websites that I know of, and read as
if I was a sighted person.
What concerns me the most is that we are sitting here
arguing about are we compliant or not. When I went to Viet Nam,
I went to Viet Nam as a volunteer. I did not go because it was
the law, you know, I went because I thought it was the right
thing to do. And as we sit here now, I think the right thing is
to do is to make it compliant, whether it is not the law or
not. I just think it is an issue of that you have the right to
do it.
As I look back, you know, in the 20th century, the law
became in fact, okay? We are now 13 percent into the 21st
century, and as far as I am concerned, we have not made any
progress. And I am not going to be around for the 22nd century,
so I do not think I am really going to see anything happen.
Thank you.
[The prepared statement of Terry Kebbel appears in the
Appendix]
Mr. Coffman. Thank you so much. And an inability to access
care is really no different than a denial of care.
Mr. Minney, you have five minutes for your remarks.
STATEMENT OF GLENN MINNEY
Mr. Minney. Chairman Coffman, Ranking Member Kirkpatrick,
and other distinguished members of the House Veterans Affairs
Subcommittee on Oversight Investigation, thank you for allowing
the Blind Veterans Association and its members to appear before
you today. The Blind Veterans Association is here to express
our views and concerns regarding specific VBA issues. The issue
I am going to discuss is HR 1284, the Beneficial Travel.
As a Director of the government relations for VBA, I have
already spent many hours and days with members of the House
Committee on Veterans Affairs regarding this bill. For veterans
who are currently ineligible, which are non-service connected
veterans for beneficiary travel, Title 38, U.S.C. Section 111
does not cover the costs of travel for those non-service
connected veterans to one of the 13 blind rehab centers or to
any of the 28 spinal cord injury locations.
If the law continues to stay as written, the non-service
connected veteran must bear the financial hardship of
purchasing their own mode of travel to one of these rehab
centers. The cost will certainly continue to discourage the
non-service connected veteran from traveling to a blind rehab
center or spinal cord injury center.
At this time, most of the ER non-service connected veterans
are of the age of 67 years old and their blindness or vision
impairment is due to age-related conditions. They often live on
Social Security, which is approximately $1,450 a month. And
with having that limited income and requiring them to pay for
their own mode of travel to a rehab center, that is really
going to pay dividends and be detrimental to their monthly
income.
The Chief Business Office has scored this bill, HR 1284, as
$3 million which, to be honest, I do not think that is true.
Because as the language states in Title 38, what we want
changed is for it to say that it covers non-service connected
veterans. We are not wanting $3 million. We are just wanting
the wording, the language to state that 1284 covered non-
service connected veterans as well as service connected
veterans so they can have the access to the rehab centers that
the VA has out there--the 13 blind rehab centers and the 29
spinal cord injury facilities.
In a letter dated May 21, 2013, Under Secretary of Health,
Dr. Robert Jessie clearly stated, ``VA supports the intent of
broadly travel eligibility for those who can most benefit from
the program.'' And also he states the VA welcomes the
opportunity to work with this Committee to craft the
appropriate language so that those who are not service
connected can have access to those rehab treatment facilities.
One thing I have ran into with several other members,
speaking with them, is the word, the ``pay for'' or the ``pay
go.'' Well, VA travel budget continues to increase every year
and they ask where are we going to get this $3 million? Well,
in 2013 the VA collected $2.913 billion through the Medical
Care Collection Fund. Well, there is money that they have
collected and I sat up last night listening to last night's
hearing: $1.1 billion returned two years ago, $1 billion
returned last night, and a half billion returned just this
year. If there is that much money that can be turned back in
from the VA to Congress, well, there is our $3 million to send
these non-service connected veterans to the rehab that they so
dearly deserve.
So there is no pay for or pay go. The money is there. It
was clearly stated last night in the hearing that the VA is
giving the money back. So if you want to pay for it, there is
your pay go.
Also, the VA right now is currently--there are 147 state
veterans homes. I have been collecting data, and right now I
have got 14 of those state veterans homes, which is ten
percent. And of those--that 10 percent, those state veterans
homes house 268 veterans who are there for blindness or visual
impairment.
Each one of those veterans the VA pays a per diem of
$100.37 a day per vet per day. You add that up--266 vets, 365
days a year--that is just ten percent. Now let us make it 100
percent, and to be honest, that total is $97.5 million annually
we are paying to house veterans in state veterans homes just
because of blindness. If we can send them to a blind rehab
center, get them the rehab that they so dearly deserve, how
many of them could we offer the opportunity to live
independently? Not house in a state veterans home, but live
independently--live on their own.
The one thing I did want to mention here is, just remember
this: there is no cure for blindness. There is not, no matter
how much research we do. But what there is is rehab for those
who are blind or visually impaired, and getting that rehab will
allow them to enrich their lives, become independent, and be
active members of their community. So let us not say, well, you
are not service connected so we will not send you to a rehab.
You know, blindness does not discriminate between service
connected and non-serviced connected, and it does not know.
Blindness is blindness. Let us eliminate service connected and
non-service connected. Let us send the blind veteran to the
rehab that the VA is providing.
And lastly, I want to make this quote. George Washington
once stated, ``The willingness to which our young people are
likely to serve in any war shall be directly perpetual to how
they perceive the veteran of earlier wars were treated and
appreciated by their Nation.'' This quote clearly begs the
following question: As generations pass, will this great Nation
continue to see young people volunteer to join the Armed
Forces, knowing that their future healthcare issues will not be
covered by the VA? Are we willing--are we all aware of the
issues surrounding what is going on right now? Are we willing
to enrich the lives of hundreds of non-service connected
veterans by allowing them to go to a blind rehab center? Are
you willing to sponsor 1284, push it up and see to it that it
is voted on so that the non-service connected veteran can get
the same rehab that the service connected veteran gets?
Thank you, ladies and gentlemen.
[The prepared statement of Glenn Minney appears in the
Appendix]
Mr. Coffman. This is Mike Coffman, Mr. Minney. Thank you
for your testimony. I have got a few questions. Again, this is
Mike Coffman.
Mr. Fugate, unfortunately your story is not likely a unique
one. Have you found that other blind veterans have gone through
similar experiences with VA's failure to populate the Vision
Registry?
Mr. Fugate. It is really hard for me to say that I know
individuals who have had situations that match to my own, but I
am sure that they exist.
Mr. Coffman. Okay. Mr. Fugate, again, Mike Coffman. In your
opinion, what would have been the benefits during your past
surgeries had the VA contributed to the Vision Registry?
Mr. Fugate. If my information was accessible to the VA
doctors when I first met them, rather than asking me about the
surgeries I had and thumbing through a two-inch stack of
documents, they would have had access to--better access to the
information. They would have seen that the DoD doctors wanted
me to have a preventative surgery within the year. I told the
doctor that. The doctor--my word is not as strong as the
military doctors that had made the suggestion to me at Walter
Reed.
Mr. Coffman. Okay.
Mr. Fugute. Also, I am a number. I am a statistic, and it
is meaningless. There is no research being done on the numbers.
If my information and all of the other blinded veterans'
information were in this data set, much more information could
be discovered and we could direct ourselves forward to help
us--help us all much better.
Mr. Coffman. Thank you. Again, this is Mike Coffman. Mr.
Kebbel, thank you for providing a number of findings and
observations for improving the VA's compliance with Section
508. Have you had an opportunity to share your findings with
the VA?
Mr. Kebbel. This is my first opportunity to do that, but I
do share my findings with other veterans. I belong to a lot of
virtual supports groups in which us veterans talk about
problems with veterans web sites. You know, how to deal with
the inconsistencies, how to deal with the inaccuracies and how
to deal with the problems of filling out forms. So, I do that
virtually.
Mr. Coffman. Okay. Mike Coffman, again. You stated earlier,
Mr. Kebbel, you stated earlier that there are many good
examples of 508 compliant web pages. Do you and your team keep
repository of best practices and lessons learned associated
with that? And do you have a list of performance metrics that
agencies such as VA can strive to achieve?
Mr. Kebbel. Yes, we do. It is in various forms. It is not
in one form that I would consider accessible yet and we're in
the process of developing that.
Mr. Coffman. Thank you very much. Ranking Member
Kirkpatrick.
Ms. Kirkpatrick. Thank you, Mr. Chairman. Mr. Fugate, one
of the things that our committee has been focused on is
creating and making sure there is a seamless transfer of
records from DoD to VA so that there is no gap at all in the
records that a doctor might see, the day that you transition
our of the Department of Defense. So, I am curious, did Walter
Reed have the Department of Defense records but just not look
through them? Can you just explain that to me?
Mr. Fugate. Walter Reed had my medical records and it was
at the VA that I had the complications. It was the transfer
between Walter Reed and the VA.
Ms. Kirkpatrick. So, did the VA have your Department of
Defense records?
Mr. Fugate. My first meeting with my doctor at the VA was
surprising. My father drove me three hours to get to the
facility. I lived at the time in back glacier mountains of
Eastern Kentucky. Once we got to the meeting the doctor came
and sat with me and the nurse brought in my records, which was
a big, heavy stack of records. I could not see them, but I
heard the thump and he said there was--something along the
lines of he could not do anything with that, he would have to
review it later and find the information and I was sent back
home, sent along my way.
Ms. Kirkpatrick. Even though you told him that the doctors
recommended that you have preventative surgery within a year?
Mr. Fugate. Absolutely. I told him that numerous times and
after probably the third time he said that it was better for us
to wait until an issue occurred and address it then and I am
pretty sure he must have been aware that I was commuting two
and a half, three hours.
Ms. Kirkpatrick. Well, I am so sorry that treatment was not
given to you in a timely manner and I just want to say your
positive attitude is really an inspiration and I thank you for
coming again. And I just wanted to take you up on what you said
in your testimony and ask you what changes you have seen since
your testimony before the committee in 2009.
Mr. Fugate. I have been deeply involved in my education.
But, yearly I catch up with my blind veteran friends at the BVA
and it is--every year it gets more discouraging, so for the
last year or so I have stopped asking about it because it was
just depressing to me. And this year when I got with them they
told me that for the past years the staffing was inadequate and
that the records were not being put into the registry and the
collaboration was not taking place as it was supposed to. I
never got any positive information about the progress of the
VCE.
Ms. Kirkpatrick. If there were one thing that our committee
could do to make a difference in that area, what would that be,
in your estimation?
Mr. Fugate. To ask to--to see what--to ask the people
responsible what they were asked to do and which of those tasks
they've completed and how long it took them to complete that
task. Just to hold the people responsible for creating this
wonderful tool for us.
Ms. Kirkpatrick. Mr. Chairman, I think that is what our
committee should do. And, Mr. Fugate, I understand that you are
friends with our colleague, Tim Walz, and I am not going to
hold that against you, but actually I want to tell you that he
is a ardent supporter, a passionate advocate for our veterans,
you could not have a better friend.
So, thank you very much for your courage and your testimony
here today. I yield back.
Mr. Fugate. Thank you.
Mr. Coffman. Thank you, Ranking Member Kirkpatrick. Dr.
Huelskamp, you have five minutes.
Dr. Huelskamp. Thank you, Mr. Chairman. It seems like I was
just here a few minutes ago and I do appreciate having more
time to discuss these, but I appreciate the testimony. My name
Tim Huelskamp and here from the State of Kansas.
Mr. Fugate, I hope I pronounced your name correctly, mine
is often mispronounced as well. But a little follow up on your
particular situation and one thing I have seen lacking in just
my years in Congress is accountability.
Systems do fail. People do fail. I am curious with your
particular situation and you described it in your testimony--in
written and oral testimony. Has the VA followed up with you
after this fact and determined yes, this is where we failed in
this system? I mean, I see a number of things that, obviously,
the electronic medical records did not happen and I'll have a
follow up question for Mr. Minney about other items in that
vein.
Did the VA ever contact you after this or after your
testimony and say, hey this is where we failed? This is the
doctor, this is where the system failed for you?
Mr. Fugate. No. No one ever phoned that I can recall,
explained to me where the failure occurred or held themselves
accountable or provided an apology. I have stuck with the VA
and I have had great medical care and met and became friends
with a lot of medical professionals within the VA, but the
system clearly, clearly failed in my case and no one ever has
explained to me what happened.
Dr. Huelskamp. Do you still travel two and a half hours to
a VA center for your current care with the VA or have you found
one closer to you that would let you--or did you move? Can you
describe that a little bit more? I come from a very rural
district, plenty of veterans as well have to drive 100, 200,
300 miles one way for care often times they could get next door
almost, literally, and the VA says no, you have to drive. And I
am just curious of your particular situation.
Mr. Fugate. I moved out to California to go to school, to
California State Monterey Bay. Luckily there is a VA in Palo
Alto, a branch of the Pal Alto system right next to my campus.
So, that was very helpful for me.
I have came back home to Eastern Kentucky to spend some
time with my family and we now have a branch of sorts. It is an
office and a medical facility. They do not--I can't get my
medications there. I still have to travel or get them by mail.
So, I have seen improvements in trying to get centers or
branches into rural areas.
Dr. Huelskamp. Yeah, appreciate that and I appreciate your
testimony today. Mr. Minney, a follow up question. This
electronic medical records issue which has been plaguing the VA
and the DoD attempting to communicate. It is my understanding
that it often--actually happens in the private world, they
actually do communicate. It is a fairly regular process, but
the VA and DoD cannot do that, it is my understanding. Can you
describe the situation that occurred with Travis? Given the
current scenario, would that likely occur again when a veteran
walks in and says, here is my medical records where they show
it is just paper; is that still the situation in many cases?
Mr. Minney. Yes, it is. Travis was one of the unique
individuals because he actually did have a copy of his health
records. But I spent 21 years in the Navy as a corpsman in the
medical field and then once I retired from there, then I
actually went to work for the VA. So, I can tell you right now,
DoD health records, they're not being transferred into the VA
healthcare system.
If you take a young 0311 Marine that gets injured and he
gets surgery and lunch stool, when he gets back home and he
goes into a VA healthcare system and a doctor will ask him,
what surgeries did you have? He is not going to know the names
of these surgeries. So right there the VA has to start from
scratch and build a health profile on him.
If there was a transfer of those health records or a joint
health record, the VA could access his DoD health records and
see exactly what surgeries he has had, what medications he's on
and what therapies he is needed. That is where the benefit
would come into play, but no, not everybody was as fortunate as
Travis to actually have a copy. Some of the injured show up at
the VA with nothing, no documentation at all.
Dr. Huelskamp. Thank you, Mr. Minney, Mr. Fugate. I yield
back, Mr. Chairman. Thank you.
Mr. Coffman. Mr. Takano.
Mr. Takano. Thank you, Mr. Chairman. Mr. Huelskamp, that
last question brought up some very, very bitter memories. I
mean, one of my first committee hearings was about this issue
of the medical records not being able to be transferred from
DoD into Vista and I can barely contain the anger I feel about
this situation and the millions and millions of dollars that
have been spent trying to solve this situation, and then to
hear in the interim months between my first hearing and now,
that there seems to be no way to bridge this gulf between the
two departments.
It is bad enough to see a casualty of war, but it is even
worse to see that casualty of war made even more tragic by this
systemic failure between these two departments. I do not know
what to do about this. I mean, it is frustrating to be a member
of Congress and not be able to say, fix this thing and have it
fixed.
That being said, I do want to say to Mr. Fugate and--is it
Mr. Kebbel or Kibbel? Mr. Kebbel, that I am proud to have
started the first deaf caucus in the Congress, I'm one of the
co-chairs and it has put me in touch with the disabilities
community. One of the useful things that has come out of that
is that we've made a commitment to have an intern from the deaf
community from Guidant University. It is my belief that some of
the disabilities communities are not well represented by
advocates here on the hill compared to all the other very
strongly represented interests here.
And I want to ask Mr. Fugate, you're a young man and you're
getting an education at Cal State. I am proud to call you a
Californian now. Have you given much thought to what direction
your life might take at this point?
Mr. Fugate. I was really excited after having the
opportunity to speak here back in 2009. It felt great to be
heard, but as the year went on and a couple more years passed
and things did not happen, it was very discouraging. So, I was
really happy that I had picked a career in computer science
where I could talk to computers instead of asking people for
help.
Computers are much easier to talk to. They give you the
answers out one end, so my path is in technology.
Mr. Takano. Well, I am wondering if there might be some
individuals in your capacity--the same situation that might be
willing to intern on the hill to be able to kind of be a
constant reminder to members about just what are the
challenges.
Mr. Minney, if there might be a way for us to have a
pipeline of veterans in this situation, that might facilitate
that. This is going to take a long--I mean, it has been
several--I don't know how much time it's taken to get attention
focused on DoD and the Veterans Affairs Department--the VA on
its records issue--the health records issue and it seems like
it is going to take us several more months, if not years of
focus.
Might it not be helpful to have a way to get some of these
service members to intern or to even to have staff positions
here on the hill?
Mr. Minney. I think it would be an absolute wonderful thing
to have a few blind veterans here up on the hill for the simple
fact as members of Congress are walking the halls, their staff,
or even individuals from the outside coming in, if they see the
blind veteran maneuvering the halls, getting around, and seeing
that their disability is not hindering them from being an
active member of society or the community, then I am all for
having some blind veterans doing internship here on the hill
and I would advocate for that.
Mr. Takano. Mr. Kebbel, do you think that we could
understand--members might understand your struggles with the
websites if we had to upgrade our systems to be able to
accommodate blind interns--blind veteran interns here on the
hill if our systems had to have the kind of software that would
make it possible for them to work here and to advocate on
behalf of their brothers and sisters in arms?
Mr. Kebbel. There is no question about it that it would
help. There are some serious issues that have to be overcome
first. There is that some of the Legacy software that the VA
uses, no matter how much work you do on it will be accessible
for Screen Reader.
It would be valuable for someone to sit down and evaluate
the process of using a website or even just documents to do
that. As we look at it a little bit though, is right now I
think the VA doesn't even have--I think they are self audited
as far as if a web page is usable. Okay.
The automation systems are fine. Okay. And that may give
you an indication that it is ``accessible.'' But until you have
someone who sits down and uses a Screen Reader with it I don't
think you are going to have very good results.
Mr. Takano. Thank you. Mr. Chairman.
Mr. Coffman. Dr. Roe, Tennessee.
Dr. Roe. Thank you, Chairman. I would like to introduce
someone before I start. Timothy Dennis is 19 years of age is
here with us today. This is Foster Youth Shadow Day on the--and
Timothy, if you would stand up. He has spent six years in
foster care in Tennessee and he is here, as many of his other
friends are, with the hill today. So, let us give him a warm
round----
Phil Roe speaking. Travis, I remember your testimony very
well and I remember you being here and it was powerful then, it
is powerful now and thank you for coming back. And I am your
neighbor just south of you in East Tennessee, so I am just
down--where in Kentucky are you from?
Mr. Fugate. I'm from a small town in Knott County,
Kentucky. We border Virginia. The closest city to me that
people recognize is Hazard, Kentucky.
Dr. Roe. So, you are Hazard. Okay, I know exactly where you
live then. First of all, I appreciate your testimony and one of
the things that you brought up is extremely important. Five
years ago--last year we had the VA and DoD come in and they
just burned a billion dollars, a billion. We are worried about
three million. We burned a billions dollars trying to make the
DoD and the VA health care records speak to each other and they
can't, they quit. So, three million dollars is nothing.
And I have been to Great Lakes, Illinois twice to look at
the system where they tried to get it to interact. It has not
worked and I do not know, Travis, whether you are finding that
information out, but it would certainly have been nice if they
had that information out--whether it would have prevented what
happened to you, no one--only God knows that, but it certainly
would have been nice if a doctor would have had all the
information available to be able to make those decisions and,
by the way, just a commentary, when you go to California do not
let them mess you up. You are just fine in eastern Kentucky,
okay? Out there in California.
And also, I think, Mr. Kebbel, what you said--tomorrow I go
back. I am a veteran as you are, as all of you are and I am
going back to Vietnam tomorrow, on a kodel, and what you just
said when you made your testimony is the right thing to do is
absolutely correct. Not because you have to do these things,
because it is the right thing to do.
And one of the things I do every year, we have--about
January or February we have our sight impaired folks come to
the hill and I go to my condo and I put a blindfold on for an
hour and I try to walk around my condo, which is very small,
and get around. Let me tell you, it is not easy.
And we need to do everything we can for our veterans who
have been--who are sight impaired and I agree with you, whether
it's service connected or not. If there are veterans--and I
completely agree with that--I have a question that may be
better for the next panel but I'm going to have to miss it, is
that Glaucoma and Diabatic Retinopathy and Macular Degeneration
are potentially blinding diseases that are highly prevalent in
the aging veteran populations, as you mentioned. What
procedures or processes are in place as far as you know to
insure that veterans with advanced sight threatening eye
diseases have been seen by an Ophthalmologist?
Mr. Fugate. I had trouble hearing you, sir.
Dr. Roe. I said, what procedures or processes are in place
to insure that veterans with advanced sight threatening eye
diseases have been seen by an ophthalmologist? Do you know that
in the VA hospital system?
Mr. Fugate. I do know that once they are first diagnosed
with the first stages, that they are put on like a screening
program where they monitor it three months, six months, but
then that's really all that they can do is monitor it, because
Macular Degeneration, there is medication to slow the progress
but there is no cure. Glaucoma, medications, no cure. So the
only thing they can do is monitor it.
Dr. Roe. Travis, just one other thing before I have to
leave is that your comment here on your testimony, I am
disappointed that after the passed three years while on DoD
side they already have 23,450 eye injured records in the vision
registry, but today VA has one veteran's record. The VA has not
set this up because instead of having the clinical electronic
data records contract--the contractors at DoD already doing the
work. The VA, from we have been told now, is waiting for
contract bids to be settled before getting started.
It is now four years ago you were here. I recently had a
chance to talk to my Congressman Harold Rogers to insure this
is not delayed any longer. Thank you for that information right
there. We will find out from the next panel. And the three of
you, all of you, sincerely, thank you for your service to our
country.
Mr. Coffman. Thank you, Dr. Roe. And now Command Sergeant
Walz.
Mr Walz. Thank you very much, Mr. Chairman and thank you
for holding this hearing. Great to have you all here again.
Travis, I know my colleague gave a kind introduction and
associated you and I together as friends, but I think Harry
Truman was right. I know you've got a companion at your side a
lot, if you need a friend in Washington, get a dog. You have
got that one, so--but, I am honored, there's no one I'd rather
stand with.
And I say that because--and we are going to hear the panel,
but it is not often you get the opportunity, we're going to
discuss the intent of Congress, the spirit and the letter of
the law. Today you got the folks in the room that wrote the
law. We have got the person in the room that advocated for the
funding and we work together. I am reminded and I had it here,
I pulled it up. You would probably appreciate this, Travis.
Here was a USA Today story that said, a military center devoted
to finding new treatment for combat eye injuries has been
delayed for a year by an ongoing squabble between Congress and
the Pentagon over who will pay the five million needed to get
it started, according to interviews. That was January 28th,
2009 and so we hear this--Mr. Takano asked the question, how
long this issue of electronic records is going on and seamless
transition. I can just say from my perspective, my entire adult
life, we have advocated for this, both when I was in the
military and then after. It is an important point.
I also think it is important to note though because it was
mentioned here, a February 2013 New England Journal of Medicine
story though, made this clear, in the private sector 12.2
percent of physicians use electronic record meaningfully. Do
not try and pretend that there is some type of magic bullet on
the other side that it is working. That is nonsense, too. The
issue on this is not trying to set up some pyridine here that
the private sector is doing this and we are not, we are failing
in getting this done here. Our purpose is to get this right and
I would ask, Travis, on this, is your goal to have the Vision
Center of Excellence up and running and doing what it is
supposed to do and getting this care, or is your goal to go to
the private sector to get your eye care?
Mr. Fugate. My goal is to have the--I care deeply about the
VA and all the care they provided, recreational care, therapy,
mental health counseling. I recently came back to Kentucky to
help my parents who are getting up there in the years address
some of their medical issues and they were unable to manage
their care in the private sector. It was too complicated. I
could not imagine trying to go into the private sector, to be
honest with you.
And one of the selling points when I am telling young men
and women about my military experience is that you can avoid
the private sector when it comes to medical care. It is so
freeing to know that I can just take the bus to the VA and be
around people who know me and care about me and understand my
issues.
Mr Walz. This is an important point, because we need to
really be careful because these service issues are absolutely
fair issues. There is a role for that and there is a goal for
that, but these core mission issues, especially on the issues
of vision impairment and different things, you are not going to
get off the hook by not fixing what is here. And I am angry too
that this communication is not working. I said in this
interview back in 2009 demanding that we get this right. But I
think, collectively, together, when there is a role and a
mission and a purpose and one that is working for people like
Travis or our other veterans, we need to get that right.
So, I agree with Dr. Roe's on this, this is not a funding
issue on that. They have got to get this figured out. I
represent the Mayo Clinic and they tell me, the Vista system in
the VA is the best medical record in the world, okay. So, we
have that.
DoD has a different one. Now, keep in mind, I understand
DoD's role is to fight wars, but until this Nation understands
when we have our two biggest bureaucracies in government siloed
up in DoD and VA not communicating with one another, you cannot
separate Travis and these warriors and their injuries from the
war that we fought. And now we have got the problem of a turf
battle fighting over who is going to institute, who is going to
put it in.
Tom Gagliano, who is an absolute expert in this and
everyone testified to that, in this article was talking about,
yeah, I have an Eye Care Center of Excellence, but I do not
have any computer and I cannot get going.
So, we have got a responsibility here to avoid the easy
flippant answers of what it's going to do. Dig down and hold
the accountability, which we heard, get the accountability on
this, get this thing up and running. Because as Travis came to
me and told me, his goal is to get back and do the things you
enjoy doing, get back into technology. Get that little place
sometime and you did say Tennessee, I got to give Dr. Roe that,
that at some point in time, going there.
But we can do that. So I would appeal to my colleagues, let
us let the data, let us let the oversight, let us drive this
and get this going. We chose to do the Vision Center of
Excellence, fully knowing that it was the best chance to do all
the things that Mr. Minney, Mr. Kebbel, Mr. Fugate asked us to
do. Now let us just make it work. I yield back.
Mr. Coffman. Thank you. Dr. Benishek.
Dr. Benishek. Thank you, Mr. Chairman.
Gentlemen, thank you very much for being here. I am Dan
Benishek from Michigan, I am a physician as well as Mr. Roe,
and I worked within the VA system for about 20 years as a
consultant, and I have a couple questions for you all.
Mr. Fugate, let me ask you this question. It sounds from
your testimony that you are not quite happy with the care you
are getting from the VA right now; is that correct? I mean what
could the VA be doing? It seems to me that you are checking in
with them periodically and that is about all you are doing; is
that correct?
Mr. Fugate. It is tough for me because I am very satisfied
and happy with the medical professionals and the community that
I deal with and that I work with when I go to the VA. It is
failures in the system that are causing the--you know, that
bother me.
Dr. Benishek. What could the VA be doing for you now that
they are not doing? What would you like them to--is there
something you would like them to do? I mean to me seems like
you are not having that close a communication with the VA over
this, you know, tragedy of your loss of sight. It seems to me
that there should be some ongoing help to you to get your life
in order as best as can be. Are you getting anything like that
from the VA now?
Mr. Fugate. Yes, absolutely. They are serving--I go to
mental health meetings regularly, I have been involved, as I
said before, with the recreational departments.
Dr. Benishek. What could they be doing that you would like
them to do that they are not doing?
Mr. Fugate. Well currently everything they are doing fine
by me, it is that they failed. And I could see a little bit, I
had some vision, some very useful vision, and it was their
failure in handling me when I transferred from the DoD to the
VA that led to me losing that remaining vision. And what--my
care is fine now.
What I hope to do is prevent other soldiers, veterans from
being hurt further by a failed transition between the DoD and
the VA.
Dr. Benishek. Right.
Mr. Minney, do you have any comments on that question? I
mean who could the VA be doing to, you know, besides avoiding
the issues like Mr. Fugate talks about and the whole reason
this testimony here is----
Mr. Minney. The biggest challenge I see that can be fixed
once again is communication across the board. The two agencies
need to communicate better. It needs to be a more seamless
transition so that no one gets lost in the system.
When I was injured my injuries required me to get surgery
from a German hospital, Landstuhl wouldn't touch me, so I had
five eye surgeries from a German hospital. While Landstuhl had
no idea--Landstuhl sent me there, but then when my unit was
looking for me Landstuhl couldn't tell them where I was at.
Once they discovered where I was at I had already left Homburg.
After Landstuhl my unit and my family were looking at Homburg.
Homburg finally got around to telling them I was at Landstuhl.
By the time they made it to Landstuhl I was back at Bethesda
Naval Hospital.
The same thing went on as far as my purple heart. My purple
heart was delivered to me by the UPS man because it went from
Homburg to Landstuhl to Bethesda. Everything was a month behind
because no one was communicating.
It is the tracking. They need better tracking. That is
where I would see improvements being made.
Dr. Benishek. Mr. Kebbel, I was intrigued by your statement
here about the lack of--or the difficulty for a blind person to
get through the VA website, and I guess I am really not
familiar with the technology that involves the blind to deal
with a computer, and I guess there is a big lack in the ability
of the VA to communicate with the blind veteran. Could you just
elaborate on that a little bit more than your testimony before?
Mr. Kebbel. Yeah, I will be glad to do that.
Let me just go back in history a little bit and down scale
the situation a little bit instead of being at a government
level I will be at the city level in the City of Las Cruces.
Okay, they were in the process of redesigning their website
so I had an opportunity to sit there with their IT department
and discuss what that means to us. And the next thing is once
the IT department had the concept of what to do I sat down and
performed training for the city employees to give them a basic
understanding on why we need accessibility and why we need
properly tagged elements. Okay. Once I was able to do that,
okay, the city employees were 100 percent in.
So I think right now what I see the problem is, is that we
understand what needs to be done but nobody really understands
why it should be done.
Dr. Benishek. All right. Well, I know why it should be
done, Mr. Kebbel, and I appreciate you being here to tell us.
Thank you all for your testimony, I am out of time.
Mr. Coffman. Thank you, Dr. Benishek.
Mr. O'Rourke from the State of Texas.
Mr. O'Rourke. Thank you, Mr. Chairman.
And I want to thank the witnesses for being here. And I
wanted to begin my comments and then ask a question to Mr.
Fugate.
You know, in the beginning of your comments you talked
about being here five years ago in 2009 and implied in that
was, you know, what difference did your testimony then make,
what progress have we made since then, what is the value of
your appearance here today?
And I want to just tell you from my perspective as a member
of this committee you have focused my attention on this
problem, I have learned many things today that I did not know
before today's hearing. I am a new member of Congress, this is
my first session in Congress, my first session as a member of
this committee, and I am now resolved, as I know the rest of
this committee is, in insuring that we correct the mistakes
that were made in your individual case and the larger systemic
problems that today's hearing has uncovered in these Vision
Centers of Excellence and other problems for those who are
sight impaired and are working with the VA.
So I first want to begin my thanking you and telling you
that what you are doing today is very powerful, very impactful,
and it has set up I think some excellent questions that this
committee will then ask the VA. You are helping us to hold the
VA accountable, so I wanted to tell you that.
And I also wanted to make you aware of a bill that we
authored this session of Congress, H.R. 3045, which would
require the DoD to provide every transitioning service member
with a portable electronic record so that they have that, they
own it, and they can bring it to their visit with a VA doctor,
they can bring it to their visit with a private medical doctor,
they can just have it and refer to it as they need it, and you
have given us a poignant example of why that is so badly
needed.
I will say that we have cosponsors that include the
chairman of this committee, the ranking member of this
committee, Mr. Walz, Mr. Takano, members from both parties, we
would welcome additional support, but as you continue to
advocate on that issue, and Mr. Minney and Mr. Kebbel as well,
we would certainly encourage you to make sure that members are
aware that we have a bill that would provide part of the
solution to some of these problems.
You, Mr. Fugate, offered some good advice when asked what
you would ask other veterans to do who might be in your
situation. You know, you said that working within the VA you
found to be helpful versus working within the private sector.
And let me also just say I really appreciate your even-
handed description of VA services. You talked about providers
both on the physical and mental health side who were there to
help you, the great quality care that you got once you got in,
despite the unfortunate decision that was made initially, so I
really appreciate that.
What else? Because besides influencing this committee and
the VA I think there is a wider public that is listening to
your remarks today.
The veteran who is returning from Afghanistan today who has
sight impairment, what is your advice to that veteran, what
would you like them to keep in mind?
Mr. Fugate. I would hope that they would understand that
the VA is there for them, it is a veteran community. I have
enjoyed sitting in the waiting rooms and meeting veterans from
the pastors and their wives and their families and having
coffee with them from down the hall while they are waiting.
It is a community and the system is slow and you have to
reach really deep to find the patience sometimes to allow the
system to turn. The system is not turning fast enough. The
people in the VA aren't out to get you, they are not against
you, the system just is turning too slowly. People care deeply
about their returning veterans.
Mr. O'Rourke. Thank you for saying that. And again, thank
you for finding the good within the system that we can build
upon while also recognizing the frustrations that you and
others have with parts of that system that do not work.
Mr. Kebbel, I am about out of time and I may ask you some
questions following the hearing, but I did want to follow up on
a point that you are making about inaccessibility on the VA's
website, and really make sure that this committee is also doing
everything it can. Mr. Walz leaned over earlier during your
testimony and asked is this committee's website fully compliant
and accessible to you and others who are sight impaired? And I
think the answer we received from staff initially is that it is
not.
So I think we need to do our part to make sure that we are
not just blaming the VA and not just holding them accountable,
which we should do, but also holding ourselves accountable.
You mentioned the Library of Congress as an example of a
federal agency that is doing it right. I am going to have to
give my time back to the chairman, but I would like to follow
up with you after the hearing to find other agencies and
federal departments who are doing the job the right way and see
what we can learn from them.
So I wanted to thank you and Mr. Minney also for being
here. And with that, Mr. Chair, I will yield back.
Mr. Coffman. Thank you.
Ms. Kuster, State of New Hampshire.
Ms. Kuster. Thank you, Mr. Chair, and thank you to your
witnesses here today both for your courage and articulating the
problem, but also I want to join my colleague, Mr. O'Rourke, in
his comments because I want you to understand we are--I am also
a new member of Congress, a new member of this committee, and
Mr. Fugate, when you said people cared deeply within the VA but
the system is slow this has been our experience within the
United States Congress. People care deeply but the system is
very slow.
And I want to revisit a letter that I led with my
colleagues, a bipartisan letter that we wrote last summer, July
22, 2013, to Secretary of Defense, Chuck Hagel, and Secretary
of Veterans Affairs, Eric Shinseki, where we raised our
concerns about the Vision Centers of Excellence and asked for
information to get a sense. Sometimes around here it is
difficult to even get the information about where things stand,
because obviously we have colleagues on both sides of the aisle
that came before us that cared deeply about creating this
Vision Center of Excellence.
And one of the parts of the response that I find troubling,
this is dated January 4, 2014 from Secretary Shinseki, is that
there seem to be a number of positions that are open. The VA
contributed 6.6 full-time equivalent employees for the vision
center. Now that doesn't sound like very many to me given the
scope of this project. 2.6 are currently filled, 4 are in the
hiring process, and then this is also the case with the Hearing
Center of Excellence, 4 FTEEs of which one position was filled
and 3 were in the hiring process. And I don't know if anyone of
this panel can help us with this, but I do want to convey to
you, as Mr. O'Rourke has, that you have focused our attention
on this issue and that we intend to press this case forward,
because the very purpose of setting up the Vision Center of
Excellence is to address these concerns. We have so many new
veterans are Iraq and Afghanistan with sight impairment from
the war and then aging veterans with sight issues.
So could you comment on, if you know, any member of the
panel, what is the current progress and do you think there are
sufficient resources, including people power, to address these
concerns about registering the people into the system and the
computer issue that you have raised? Mr. Minney.
Mr. Minney. Well, I know the last word that we got was on
the VA side there is a blind rehab specialist position that
is--they are interviewing for, and then the VA side will have
all their FTEs filled, but now they are looking--they are
putting bids out for contractors.
My question is, the inception was in 2009. There was $6.9
million that was budgeted for the VA side for 2.6 employees
between 2010 and 2014. I would like to have that salary. 6.9
million split between 2.6 employees over 4 years? So my
question is I don't know where that funding went.
Ms. Kuster. Right.
Mr. Minney. So that is what I would like to know.
Ms. Kuster. And I also think the comment was well taken
about the funds that are returned to the treasury.
It is a fine thing in this world to be frugal, we don't see
a lot of that around here, but the point is how can funds be
returned to the treasury if there are issues like this that
remain up resolved and not addressed.
So I am going close my time and I just want to thank you
for coming, and I also want to join Dr. Roe in addressing, I
have a constituent here, Dakota Umbro from Berlin High School
who is joining us in the back of the room and fostered--not
child, young person here to learn more about our congress.
And Mr. Fugate, I think you have a bright future and I can
just hope and pray that you might choose to address it to
resolving the computer issues at the VA.
So thank you for joining us.
Mr. Coffman. Thank you, Ms. Kuster.
Before the panel leaves I would like to have Mr. Hannel
discuss an issue that Mr. O'Rourke raised relative to the
compliance of this committee's website.
Mr. Hannel. Thank you, chairman.
To your question, sir, the committee's web site does use a
reader and it is called BrowseAloud, which is an element of a
five-way compliance. So have you folks at the panel been able
to access that?
Mr. Fugate. Could you say the name again, please.
Mr. Hannel. BrowseAloud.
Mr. Fugate. I never heard that term in my life.
Mr. Kebbel. I have not used it.
Mr. Hannel. Okay. Then we will get with you after this and
you can walk us through to make sure that it does address your
needs.
Mr. Fugate. Can I make a comment on that?
Mr. Coffman. Yes, sir.
Mr. Hannel. Yes, please.
Mr. Fugate. There is standard screen reading software that
blind folks use, and when you introduce a screen reader that a
blind person isn't accustomed to using it is hard to expect
that they will be able to interact with your--the information
the way that they are accustomed to interacting with
information on other web pages. So in my opinion a custom
screen reading solution for a web page is inadequate.
Mr. Kebbel. Can I address that too?
Mr. Coffman. Yes.
Mr. Kebbel. Yeah, this is Terry Kebbel.
The problem with an automated system is it is designed by
someone who looks at a script and says this is what it is
supposed to do. Okay. So I would say most of the time it is
probably accurate, okay? But there is a lot of times where it
will look at a tag and there will be a description of the tag
of the label and the label will say button, well it passes the
test, but the button--I don't know what the button does. Okay?
Is it a button for searching something, is it the blue button
that we are talking about, is it a button that sends me
nowhere? Okay? So yes, it all passed test, but is it
effectively labeled, is it effectively described?
You can probably go to the form fields web site on the VA
web site and look at the link, because I bet you every one of
those links will pass inspection, but every one of those links
are numerically described. There is no description of what that
form is.
So yes, yeah, you can use that, but as I spoke later, that
you really need someone to sit down and evaluate it who uses a
screen reader. Either Jaws or voice over or whatever screen
reader you are using. If it is designed correctly any other
screen readers will be able to address that.
Mr. Coffman. Let me have Mr. Takano and then we need to
move to the second panel. Mr. Takano.
Mr. Takano. Very briefly, Mr. Chairman.
I appreciate that you and your staff are going to work with
Mr. Kebbel after the hearing, but could we not share this
information with the House Administration Committee and our
counterparts in the Senate? I think it is important that the
entire institution of the Congress, every members' web site
should be able to accommodate blind veterans and the blind
community in general.
Mr. Coffman. We will certainly do that, and this is the
same system I think that is on the House VA committee that the
Library of Congress uses, as I understand it, but I think there
is always room for improvement and we will certainly look at
that.
I want to thank you all so much for coming and testifying
here today. Really appreciate your service to our country.
Mr. Kebbel.
Mr. Kebbel. Yeah. As a Vietnam veteran what I hear concerns
me, okay, because we are talking about all the young veterans
coming back. Okay? What concerns me about us Vietnam veterans
is Agent Orange, okay? I had a catastrophic heart failure that
led to a heart transplant, okay? I feel that is because of
Agent Orange. That led to my blindness. There are a lot of us
Vietnam veterans out there who are dying without any health
care right now. Okay? And I have a concern about that and I
don't think we addressed that.
Thank you.
Mr. Coffman. Thank you very much, I appreciate it.
Appreciate your service to our country, all three of you. Thank
you very much.
And now we will move to the next panel, the second panel. I
now invite the second panel to the witness table.
On our second panel we will hear from Dr. Maureen McCarthy,
Deputy Chief of Patient Care Services for the Veterans Health
Administration, and Ms. Lorraine Landfried, Deputy Chief
Information Officer for Product Development for VA's Office of
Information Technology. They are accompanied by Dr. Mary
Lawrence, Deputy Director of the Vision Center of Excellence,
and Mr. Pat Sheehan, Director of VA's 508 Compliance Office.
I think we will continue the--for committee members we will
continue the process of stating your name so those that are
vision impaired in the audience can know who is speaking, and I
would ask the panel to do the same.
Dr. McCarthy, your complete written statement will be made
part of the hearing record and you are now recognized for five
minutes.
STATEMENTS OF DR. MAUREEN McCARTHY, MD, DEPUTY CHIEF PATIENT
CARE SERVICES, VETERANS HEALTH ADMINISTRATION, DEPARTMENT OF
VETERANS AFFAIRS; MS. LORRAINE LANDFRIED, DEPUTY CHIEF
INFORMATION OFFICER FOR PRODUCT DEVELOPMENT, OFFICE OF
INFORMATION TECHNOLOGY, DEPARTMENT OF VETERANS AFFAIRS;
ACCOMPANIED BY DR. MARY LAWRENCE, MD, DEPUTY DIRECTOR, VISION
CENTER OF EXCELLENCE, AND MR. PAT SHEEHAN, DIRECTOR, 508
COMPLIANCE OFFICE, DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF DR. MAUREEN McCARTHY
Dr. McCarthy. Thank you.
Good morning Chairman Coffman, Ranking Member Kirkpatrick,
and members of the committee. I appreciate the opportunity to
discuss the Department of Veterans Affairs contributions to the
Vision Center of Excellence and the care and services provided
to veterans with visual impairments.
I am accompanied today by Dr. Mary Lawrence, Deputy
Director of the Vision Center of Excellence.
The Vision Center of Excellence, or VCE, was established by
the National Defense Authorization Act in January of 2008. In
October of 2009 a DoD and VA memorandum of understanding
defined the roles and responsibilities of the departments and
the establishment and operation of the VCE.
VCE's efforts are directed at improved vision health,
optimized readiness, and enhanced quality of life.
The National Defense Authorization Act also required the
implementation of the defense and veterans eye injury and
vision registry. The vision registry collects longitudinal data
on eye injuries, guides research and clinical education,
promotes best practices, and informs policy for the treatment
of eye and vision-related injuries for service members and
veterans. I am pleased to share that the vision registry is on
schedule and on budget.
VCE has achieved many significant accomplishments since its
inception. VCE has identified and addressed 33 process
improvement opportunities through the monthly VCE hosted World-
wide Ocular Trauma Video Teleconferences which connect
providers across the continuum from combat support hospitals
and coalition providers to VA Poly-Trauma Centers. It has also
led the way to initial inclusion of Fox protective eye shields
in joint first aid kits and is attempting to expand them into
individual first aid kits.
In addition VCE, in collaboration with VA Blind Rehab
Services, has designed an educational pamphlet geared toward
in-patient care teams in hospitalized settings to assist with
transitions.
Mr. Chairman, the consequences of vision injuries to our
service members and veterans will be with us for decades to
come, therefore VA will continue to partner with DoD to provide
eye care providers, clinical care practitioners, and
researchers to have access to the information needed to develop
strategies that will enhance and improve patient care outcomes.
Mr. Chairman, this concludes my testimony, I am prepared to
answer any questions you may have.
Mr. Coffman. Next I would like to introduce Lorraine
Landfried, Deputy Chief Information Officer for Product
development, Office of Information and Technology, to address
issues related to 508 compliance.
[The prepared statement of Dr. Maureen McCarthy appears in
the Appendix]
STATEMENT OF LORRAINE LANDFRIED
Ms. Landfried. Thank you, Dr. McCarthy, and good morning
Chairman Coffman, Ranking Member Kirkpatrick, and members of
the committee.
We appreciate the opportunity to discuss veterans affairs
work to improve access to information technology resources for
visually impaired veterans, stakeholders, and employees.
Accompanying me today is Mr. Pat Sheehan, Director of our 508
program office.
Since 2001 this office has provided validation testing on
VA web sites and applications using a combination of automated
tools and manual auditing, the latter of which is performed by
users who have a disability, including those with a visual
impairment.
When VA identifies non-conformant applications or web sites
Section 508 staff work with relevant parties to correct or
remedy accessibility issues.
As critical as it is for us to audit and improve our
existing web sites it is just as important to insure that all
future applications and web sites are in conformance with 508
standards as well.
To do this we have implemented formal policies requiring
all information technology developed by VA to complete a four-
step milestone process. This helps us insure that accessibility
is planned for and built in up front rather than trying to
inspect it in the future.
We also provide training to VA's system content creators
providing them with the tools and the know how to make VA
information 508 conformant.
We have made tremendous progress over the past year. For
example, we improved the conformance of the my healthy vet web
site from 16 percent in November to 95 percent today, and we
will continue to pursue an aggressive strategy to insure access
to all covered systems and electronic information.
We are also committed to working with our veteran
stakeholder groups. VA will attend the Blinded Veterans
Association's upcoming national conference to review recent
updates to frequently used applications and web sites with BVA
stakeholders and work with them to identify ways that usability
can be improved, even in areas where we are technically already
Section 508 conformant.
Mr. Chairman, this concludes my prepared remarks, and Mr.
Sheehan and I look forward to answering any questions you may
have. Thank you.
[The prepared statement of Lorraine Landfried appears in
the Appendix]
Mr. Coffman. Thank you. Are there further remarks?
Okay. Dr. McCarthy, again this is Mike Coffman. According
to your testimony there were 23,664 unique patients enrolled in
the vision registry. How many of those patients were enrolled
by the Department of Defense and how many from the Veterans
Administration?
Dr. McCarthy. Mr. Coffman, that is an important question.
The actual entry of the data was primarily done by the
Department of Defense. You heard mention that there was one
person entered by VA and that was to test the systems.
I want to explain the registry just for a minute if I
could. The registry is seated at the Department of Defense and
so it is set up to take information more directly from the
Department of Defense for servicemembers who do receive eye
injuries.
Okay. VA set up the architecture for the registry and over
50 percent of it was used by the Department of Defense in order
to enter service members' data into it.
VA has to go through a two-step process to enter the data
into the registry. It is typical with cancer registries and all
kinds of registries of that sort that information is harvested
from a particular medical record, placed in a repository, and
then entered into the registry.
VA's contract you may have heard is currently out for bid
that we--the bids close June 9th, for the completion of the
data entry into the registry--well first into the repository to
go into the registry. So the two-step process for VA is under
way.
We did look at how many veterans--let me rephrase that--how
many people who are--have treated in the VA because some active
duty servicemembers have been through our blind rehab program.
How many people have actually been treated at the VA that
already have data in the registry, and currently there are at
least 2,400 veterans who have data in the registry, but you are
accurate that that data was entered by----
Mr. Coffman. If we could just go back to the question, and
that is that I get the Department of Defense, because they are
going to have the service connection ones as folks are out
processing in active duty so they are going to enter that in,
but this registry is also for non-service connected veteran eye
issues is it not?
Dr. McCarthy. It is about eye injuries.
Mr. Coffman. So whether it is service connected or not
service connected it is about veteran eye injuries. And so, but
the fact remains you haven't entered into a single person, so
what it tells me is you are not participating.
Dr. McCarthy. I understand why you say that, and it is
regrettable that none have been entered, but the framework is
in place, the target date for the registry to be functional is
by the end of fiscal year 2015, and so the fact that the
contract is out for bid at this point is progress and we are
looking forward to data being entered by the end of the fiscal
year.
Mr. Coffman. Well we had a lot of those definitions in
progress last night before the full committee and it is
disconcerting.
Ms. Landfried, in VA's February 2014 response to a letter I
wrote in October 2013 I was told that VA had not awarded a data
abstraction contract due to contracting delays. What were those
delays and have the problems that caused them been corrected?
Ms. Landfried. That is actually probably better answered by
Dr. McCarthy.
Dr. McCarthy. And, Mr. Coffman, I am not aware of the exact
delays. I would be happy to take that for the record and get
back to you. Before the hearing I did ask if we could find a
timeline for the process of the contract awards and what the
delays were. I don't have that at this point but we will get
back with you.
Mr. Coffman. Okay. Mike Coffman again.
Ms. Landfried, according to a July 26th, 2012 memo from the
assistant secretary for information and technology all VA IT
software was required to be compliant with Section 508 by
January 2013. Is all VA software compliant at this point in
time?
Ms. Landfried. At this point in time it is not. We have not
achieved 100 percent conformance with the 508 standard. We have
made significant progress since that time.
Mr. Coffman. What percentage are you at right now? This is
Mike Coffman again, and I want to remind people to identify
themselves for this hearing before they speak. What percentage
are you at right now?
Ms. Landfried. Mr. Sheehan, would you like to take that?
Mr. Sheehan. Yes. This is Pat Sheehan. Thank you.
The percentage is difficult for me to address right now,
because the software that we are looking at particularly on the
web and particularly the software that we look at as far as
applications are concerned are pretty much in development.
I think the important point that I want to make here is
that the process that what we are doing with the software is
working through the processes that we have established so that
we can build software in at the beginning of the software life
cycle and through the test process.
Mr. Coffman. So I think the simple answer would be you are
not compliant at this point in time. Thank you very much.
Ms. Kirkpatrick.
Ms. Kirkpatrick. This is Ann Kirkpatrick.
And, Dr. McCarthy, I would like to go back to your
description about the VCE. So it is housed at the DoD, but does
the VA have access to the records that are at DoD?
Dr. McCarthy. Yes, there would be the opportunity for a VA
provider to access that record. That would be the opportunity.
Ms. Kirkpatrick. And does that happen?
Dr. McCarthy. At this point I am going to defer to Dr.
Lawrence on that question.
Ms. Kirkpatrick. Okay.
Dr. Lawrence. Yes, Ranking Member Kirkpatrick, the registry
is designed so that eventually individual providers from DoD or
VA will be able to access the information in the registry on
their individual patients and de-identify data on other
patients. So they could, for example, put in some criteria that
may be characteristic of a patient they are seeing and look at
de-identified data and look at the outcomes of that de-
identified data to help inform the provider and the patient as
a----
Ms. Kirkpatrick. I appreciate that. My concern is suppose
that a military member transitions out today, goes to a doctor
tomorrow, technically in the VA system, will that doctor be
able to see that person's records regarding the eye injury that
was service connected?
Dr. McCarthy. This is Dr. McCarthy speaking.
There are multiple opportunities for VA doctors to be able
to access records from the Department of Defense. In our CPRS
record system screen there is an opportunity to use a web-based
interface in order to have access to those records.
Ms. Kirkpatrick. So I am still not clear what your answer
is. Would that doctor be able to see that patient's military
medical records the day after they transition out?
Dr. McCarthy. It is my understanding that if those records
are electronic those records can be accessed, and most of the
records are electronic at this point.
Ms. Kirkpatrick. Do you know what percentage?
Dr. McCarthy. I do not have that number but we could check
with DoD and get back with you.
Ms. Kirkpatrick. Okay. So then the VA's portion of this is
just eye injuries, not necessarily military connected, and that
is where your contracting out to have somebody enter that
information?
Dr. McCarthy. What we are contracting for is for someone to
go through our CPRS records and pull out information such as
eye exams, data from those exams, visual acuity, treatment
interventions that were made so that over time progress can be
tracked by the individual but looked at collaboratively. That
is the point of the registry.
Ms. Kirkpatrick. I have a question about the funding, Dr.
McCarthy. Again, this is Ann Kirkpatrick.
Your testimony notes a total of 6.9 million that the VA has
budgeted for the center from fiscal year 2010 to fiscal year
2014. Has the funding been consistent each year, and can you
provide a year by year breakdown of the funding over the past
five years?
Dr. McCarthy. Thank you, Ranking Member Kirkpatrick. This
is Dr. McCarthy speaking.
The $6.9 million was allocated in an accumulative amount
for that period of initially from fiscal year 2009 to 2013,
extended to 2014. So really over a five to six-year period.
What happened was an initial kind of ramping up of salary
dollars, but in addition a kind of fencing of the money for
contracting to enter the data that we are talking about from
that VA medical record into the repository. So that money has
kind of been kept separate, but the money that has been used
over time, and I will be happy to provide those dollars for you
for the record if you like, that is a gradual increase over
time as salaries have increased and functions have increased.
Ms. Kirkpatrick. Thank you, Dr. McCarthy. I would like to
see the breakdown, the year by year breakdown since the funding
started.
Dr. McCarthy. Yes.
Ms. Kirkpatrick. And then how much is set aside for the
contractor.
And thank you, ranking member, I yield back.
Mr. Coffman. Thank you, Ranking Member Kirkpatrick.
Dr. Benishek.
Dr. Benishek. Thank you, Mr. Chairman.
I can't believe it takes five years to get this thing
going. What is the story with that? I mean apparently it is not
even all staffed up yet, this Center of Excellence. Why has it
taken five years? I mean the entire Second World War was four
years for us.
Dr. McCarthy. Sir, this is Dr. McCarthy speaking. I would
like to respond.
There have been processes involved in getting this set up.
The joint executive committee, VA, DoD set----
Dr. Benishek. Five years?
Dr. McCarthy. They set a target for the registry to be
functional.
Dr. Benishek. I know, but five years seems like a really
long time.
Dr. McCarthy. I appreciate that.
Dr. Benishek. Well let me get to something a little bit
more pertinent.
Dr. McCarthy, it has come to my attention that there is
many issues with our veterans with their eye diseases,
glaucoma, and Dr. Roe brought it up earlier, this diabetic
retinopathy, macular degeneration, blinding eye conditions that
if left untreated will lead to blindness and we are very
prevalent in our ageing veterans population. So what procedures
are in place to insure that veterans with these eye diseases
are seen by an ophthalmologist?
Dr. McCarthy. Sir, this is Dr. McCarthy speaking again.
What I would be happy to tell you about is some of the
processes we have in place. For instance a patient who has
diabetes is at risk for diabetic retinopathy. They are
screening processes in place in which we use telemedicine and
photographs of the retina of every patient with diabetes are
taken and read by an optometrist or an ophthalmologist, and if
needed then that patient is referred to an ophthalmologist for
care, but it is part of the routine screening for diabetics.
In addition patients with glaucoma are followed regularly
in our eye clinics.
And you mentioned one other disease, I am sorry.
Dr. Benishek. Macular degeneration.
Dr. McCarthy. And macular degeneration is a tragedy. We do
have ophthalmologists carefully following people with macular
degeneration. I can't speak to the exact screening procedures
that are developed for those patients, but I----
Dr. Benishek. Well, I have a concern because, you know, I
worked at a VA hospital, and you know, it is tough to staff
many of these clinics with ophthalmologists, I mean they have a
hard time keeping people.
Are you aware of any of the procedures for hiring local
ophthalmologists for staffing VA centers on a part-time basis?
Are you familiar with any of that?
Dr. McCarthy. Well, I am a former chief of staff from a VA
facility in Salem, Virginia, and it was our experience there
that we did try to hire full-time ophthalmologists or we would
ask for people to come in on a contract basis. Because we were
an academic facility we had a strong partnership with the
University of Virginia and we were able to recruit people
effectively there. But I am aware that other institutions do
have contracts for folks to be hired.
Dr. Benishek. Well, I am somewhat concerned because, you
know, some of my friends are ophthalmologists that work at the
VA----
Dr. McCarthy. Yes.
Dr. Benishek [continuing]. And they are concerned of the
fact that the VA limits their ability to work at the VA because
once they reach a certain dollar amount then they can't work
anymore for the year, and so--because they think well maybe it
is more cost effective to be a full-time ophthalmologist within
the VA, but of course they don't have any full-time
ophthalmologist so the patient then travels 250 miles to
Milwaukee to get to see the ophthalmologist.
So they say well you can't pay them more because it would
be more efficient to hire a full-time ophthalmologists but yet
they don't hire a full-time ophthalmologist so the patient just
goes without. Whereas if they just would allow him to work
there a little longer he could continue to provide the care and
not have the patient go to Milwaukee. And I don't understand
the reasoning for that rule. If you say that it is more
efficient to hire a full-time ophthalmologist then hire a part-
time ophthalmologist. So it seems like it is sort of a catch-22
problem.
Dr. McCarthy. But it doesn't--I can respond.
Dr. Benishek. Let me ask another question.
Apparently I have also heard that in order to improve the
access to eye care that they are having like eye technicians do
some of the work rather than physicians, some of the screening
work. I mean you mentioned, you know, the screening the retinal
pictures. You know, it concerns me when, you know, people other
than physicians are providing care. I mean how do we know those
people are trained properly? Do you know what the status of
that situation is?
Dr. McCarthy. Yes, sir. This is Dr. McCarthy speaking
again.
I can talk about the training for teleretinal imagers or I
could talk about a typical eye doctor appointment in which
there are other non-physician people that are involved, you
know, that might check visual acuity or might be involved in
checking----
Dr. Benishek. I know, but I am talking about like things
that physicians typically do. I mean I am always concerned
about the quality of care when physicians aren't doing the
things that they are supposed to do.
I am sorry, I guess I am out of time, but maybe we with
further that later.
Dr. McCarthy. Discuss later. Thank you, sir.
Mr. Coffman. Mr. Takano, State of California.
Mr. Takano. Thank you, Mr. Chairman.
Dr. McCarthy, just help me, where is this central--where is
your center located physically?
Dr. McCarthy. The Vision Center of Excellence?
Mr. Takano. The Vision Centers for Excellence.
Dr. McCarthy. I am going to defer to Dr. Lawrence.
Dr. Lawrence. Yes, Dr. Mary Lawrence.
The Vision Center of Excellence has two locations in the
national capital region. One, our headquarters is at Walter
Reed National Military Medical Center in Bethesda, and we also
have an office in Crystal City, Arlington, Virginia, and we
also have a small office at Madigan Army Medical Center in
Tacoma, Washington.
Mr. Takano. Okay. And Walter Reed is under the agents of
the DoD, right, but nevertheless this veteran Center for Vision
of Excellence is located at--one of them is located at Walter
Reed; is that right?
Dr. McCarthy. Yes, sir. This is Dr. McCarthy again.
The Vision Center of Excellence is a joint effort between
DoD and----
Mr. Takano. Okay.
Ms. McQueen [continuing]. And VA, and of the Centers of
Excellence DoD authorized navy to be involved with this, and so
it is a partnership between the navy on behalf of DoD with VA.
Mr. Takano. That clears up something. I have actually been
to Walter Reed and actually saw the center and so I said is
that the same center? But nevertheless we are still having
problems with the registry being populated.
Now help me understand this registry. The registry has not
been populated, we are waiting for the contracts to be filled
and you are saying by the end of fiscal 2015 is when we expect
this registry work to be done or begin?
Dr. McCarthy. No, sir. Dr. McCarthy again.
The registry contract is out for bid at this point, it is
on the streets and we will have the bids in mid June and we
expect it to be awarded and the data entry to start by the end
of fiscal year.
Mr. Takano. Okay. All right. And you are saying--and I want
to clear up a question that--the answer to Ms. Kirkpatrick's
question about a provider being able to access a
servicemember's records once they leave service and go to the
VA.
So even without the registry being populated you are saying
that the entire record is still theoretically accessible if it
is electronic, if it exists in electronic form at DoD the
medical provider on the VA side still can access it--should be
able to access it overnight or you know the next day?
Dr. McCarthy. It is actually realtime, it is not exactly
instantaneous. I have to say it does take some time.
Mr. Takano. Okay.
Dr. McCarthy. But I would like to yield to Lorraine to see
if she could say more about that.
Ms. Landfried. On how interoperability works?
Dr. McCarthy. Yes.
Mr. Takano. Yeah, I just wanted--I think she asked the
question--Ms. Kirkpatrick asked the question, a servicemember
leaves defense, next day sees a VA doctor, can that VA doctor
access the record?
Ms. Landfried. As long as it is an electronic record then
yes, and as was stated earlier most of the records in DoD are
now in electronic form in their health record system.
I guess the daylight there or the gap there is between
interoperability and seamless interoperability. So if it is DoD
data then essentially you have to, you know, push a button to
say go fetch it and bring it to me. It is not stored locally as
part of the VA system, and that is what a lot of the work
recently has been about is to go from interoperability to
seamless interoperability. So as you are conducting a clinical
work flow that the information that you need is there hand in
hand with the step that you are doing.
Mr. Takano. I have a couple more questions, I will try to
ask them really quickly. It has to do with accounting for
diversity.
I know that in certain ethnic groups, Asians in particular,
that glaucoma can show up much earlier in a patient. Do you
have procedures in place to be able to accommodate the
different health needs among servicemembers according to
ethnicity?
Dr. McCarthy. You know, VA has set up an office of
healthcare equity and diversity and I would want to yield to
them, so if it is possible I would like to take that one for
the record and get back to you.
Mr. Takano. Thank you, I appreciate that.
And related to Mr. Kebbel's--he raised the point about
Agent Orange and its connection to his blindness. Is there
anything being done to sort of deal with this huge Agent Orange
population that we are going to have to address from the point
of view of any kind of preventative work we can do?
Dr. McCarthy. This is one, sir, I would have to take for
the record. I don't have an answer for that.
Mr. Takano. Okay.
Dr. McCarthy. I mean I could talk about Agent Orange in
general but not specifically related to blindness.
Mr. Takano. Yeah, I would like to sort of address that
issue if you--and we can deal with that later in written form.
Dr. McCarthy. Thank you. Okay.
Mr. Coffman. Mr. O'Rourke, State of Texas.
Mr. O'Rourke. Thank you, Mr. Chairman. This is Beto
O'Rourke, El Paso, Texas.
So for Dr. McCarthy, some of these questions you may have
already answered and they may be repetitive, but I am new to
this and I want to make sure that I fully understand it. You
mentioned that January '08 was the start date for this
initiative for the eye injury and vision registry.
Dr. McCarthy. I mentioned--I am sorry, this is Dr.
McCarthy. I mentioned that the act that established it was
January 2008.
Mr. O'Rourke. That is when it became law?
Dr. McCarthy. Yes, sir.
Mr. O'Rourke. Okay. And then the funding was appropriated
the next year?
Dr. McCarthy. I don't have the date of the funding, I can
tell you the date that the MOU was signed----
Mr. O'Rourke. Okay.
Dr. McCarthy [continuing]. Between DoD and VA, and that was
October 2009.
Mr. O'Rourke. And the back up I received shows that at
least $5 million of that funding has been spent, and I hope I
am speaking about the same pot of money, there was a total of
$6.9 million appropriated, $5 million has been spent. What has
that $5 million been spent on?
Dr. McCarthy. Okay, let me just back up.
Mr. O'Rourke. And in the plainest terms possible just
because we are limited on time.
Dr. McCarthy. Okay, I am sorry, and again this is Dr.
McCarthy.
We have $2.8 of that $6.9 million set aside for the
contract, so that brings us to $4.1. The $4.1 million has been
used for salaries for individuals as we have ramped up the
employment over the past five years, and in addition to
education and training events, and I would yield to Dr.
Lawrence for more details about that if you like.
Mr. O'Rourke. Not just yet.
Dr. McCarthy. Yes.
Mr. O'Rourke. Thank you though.
You in responding to an earlier question about how long it
has taken you said it is regrettable but that you also
mentioned that we are on schedule and on budget. So when this
became law in January of '08 and when the funding was
appropriated in the year thereafter was it always understood
that June 9 of 2014 was when we would go out to bid or make a
decision on closing those bids?
Dr. McCarthy. This is Dr. McCarthy again.
Actually it was always understood that by the end of fiscal
year 2015 the registry would be operational.
Mr. O'Rourke. Okay. Thank you. And it does just from a
layman's perspective seem like a very long time. Dr. Benishek
compared it to the amount of time that we spent in World War II
and the number of people who are affected by these issues who
do not have access to this care.
And I would like to take one that we had as an example
today from Mr. Fugate. Based on his testimony from '09, to the
extent you are familiar with it and his testimony today, do you
have anything to offer in response to concerns that he raised
or the specific case study that he has offered and how we are
or have not yet learned from it and are or not yet able to
provide the kind of care that might have provided for a better
outcome in Mr. Fugate's case?
Dr. McCarthy. This is Dr. McCarthy again. And I am happy to
be in touch with Mr. Fugate after the hearing and I would be
interested in offering support in that way.
I do want to mention the 33 process improvement activities
that were identified as part of the Vision Center of Excellence
calls in which the people in the field and the people at Vision
Center of Excellence and the people at the polytrauma centers
have worked together to try and solve those kind of
communication issues.
Mr. O'Rourke. Okay, and that might be good for myself and
the entire committee to understand from your perspective Mr.
Fugate's specific case and how that case in 2014 might be
handled differently and how the interoperability between DoD
records and medical recommendations and decisions and those in
the VA might provide for a better outcome or might not where we
still have some ground to make up. And so I think it is very
important for us if nothing else to learn from his specific
case and ensure that it is not repeated, and I think you could
probably agree with me on that.
Dr. McCarthy. Yes.
Mr. O'Rourke. And then for Ms. Landfried and the Section
508 issues. I think this discussion today is happening within
the larger context of the American publics' and Congress'
frustration with lack of accountability within the VA. And so
again, just looking at the backup and all of the chances that
the VA had to come into compliance, the waivers that were
issued to allow the VA to remain out of compliance, the fact
that on some of the most critical issues like the ability to
fill out a VA form that Mr. Kebbel brought to our attention, it
seems like not only would that be a benefit to the sight-
impaired veteran, it would be a benefit to the VA to be able to
have that information entered there by the veteran himself or
herself instead of have been to go to a VBA office.
How do you answer in the plainest terms possible what I
feel is very justified frustration at the amount of time that
the VA has had to get it right? And you and Mr. Sheehan spoke
earlier of the processes involved, all the things you have got
to do, which are really lost on me. I think we just really want
to know what is taking so long, where is the accountability,
when will you be able to assure this committee and the veterans
who depend on these services through the web that you will be
100 percent compliant?
Ms. Landfried. Sure, I would be happy to address that.
We are absolutely committed to making sure that all of the
information that veterans need about benefits, about healthcare
available to them, and everything else that we have to offer is
available to them as electronic products through our web sites
and forms. And the memo that was mentioned earlier by the
chairman, that was I think a wake-up call and accountability
for us to say there are these waivers out there, what are we
doing with them?
Mr. O'Rourke. With the chairman's indulgence could I just
ask you a really quick pointed question? Give us a date by when
every single page on every single VA web site will be 508
compliant.
Ms. Landfried. And the reason that we keep talking about
the process is, is that if I was 100 percent compliant tomorrow
new systems are going to come online, additional forms are
going to be added, additional web pages are going to be added,
additional documents are going to be added, so----
Mr. O'Rourke. This does not build confidence in you and
what you are doing and what our veterans can expect, and I
would hope that you could come back to this committee with a
set date and from that date we are 100 percent compliant and
every day there forward we will be 100 percent compliant.
Ms. Landfried. Okay.
Mr. O'Rourke. I think that is what we are asking, I don't
think it is too much to expect, and I think that is what the
veterans that we serve deserve.
So with that I yield back to the chair.
Mr. Coffman. Thank you, Mr. O'Rourke.
Ms. Kirkpatrick.
Ms. Kirkpatrick. Dr. McCarthy, I appreciate your
willingness to provide the committee with a year by year
breakdown of how the money has been spent. You know, that is
part of our responsibility on this committee is, Mr. Chairman,
to oversee how taxpayer dollars are being spent. So I am going
to ask that within that year by year breakdown you also
categorize that and work with the committee staff on what
categories seem to be appropriate and we will get that to you
and just like to have some dialogue with our staff on that. In
other words I would like to know how much is spent on salaries,
how much is spent on space, how much is spent in other areas
just so we have got an idea of how that is being spent.
And I thank the panel for being here today, and thank you,
Mr. Chairman, for having this meeting.
Mr. Coffman. Thank you. Our thanks to the panel. Second
panel you are now excused. Again this is Mike Coffman.
All right, today we have had a chance to hear about
problems that have led to many years passing while virtually--I
am sorry--visually-impaired veterans continue to be denied
equivalent access to VA services due to VA failures. As such
this hearing was necessary to accomplish a number of items.
First to identify the reasoning for VA's lack of progress
in implementing the vision registry, despite years having past
since authorization.
Second to receive an explanation on why VA has not brought
its system into compliance with Section 508, of the Americans
with Disabilities Act.
And third to determine what steps are being taken to
correct these issues and improve the care provided to veterans
and their ability to access crucial information.
I ask unanimous consent that all members have five
legislative days to revise and extend their remarks and include
extraneous material. Without objection so ordered.
I would like to once again thank all of the witnesses and
the audience members for joining us in today's conversation.
With that this hearing is adjourned.
[Whereupon, at 12:06 p.m., the subcommittee was adjourned.]
APPENDIX
Prepared Statement of Chairman Mike Coffman
Good morning. This hearing will come to order.
I want to welcome everyone to today's hearing titled, ``Assessing
Inadequacies in VA Data Usage for and Services Provided to Visually-
Impaired Veterans.'' My name is Mike Coffman, and prior to hearing
testimony and asking questions to our witnesses, I ask that each Member
state his or her name to assist our witnesses in identifying who is
speaking. Thank you for your cooperation. Now let us begin.
This hearing focuses on continued problems within VA that have
caused its contribution to the Vision Center of Excellence to stagnate,
allowed VA systems to continue to operate in noncompliance with Section
508 of the Americans with Disabilities Act, and compromised other
services provided to veterans with visual impairments.
The creation of the Vision Center of Excellence, or VCE as we will
refer to it today, was mandated by the National Defense and
Authorization Act of FY 2008. It stated that the Department of Defense
was required to create the facility and to collaborate with the
Department of Veterans Affairs in doing so. One of the main
responsibilities required in the 2008 NDAA for the operation of the VCE
was to ``enable the Secretary of Veterans Affairs to access the
registry and add information pertaining to additional treatments or
surgical procedures and eventual visual outcomes for veterans who were
entered into the registry and subsequently received treatment through
the Veterans Health Administration.''
The reference to the registry is that of the Defense and Veterans
Eye Injury and Vision Registry, which we will also refer to as the
Registry today for convenience. The DoD has done a commendable job of
populating the Registry, with over 20,000 unique patient entries.
However, the most recent number VA has provided the Committee regarding
its contribution to the Vision Registry is one entry. One, compared to
20,000. Notably, in an October 2013 briefing, VA staff stated that the
one entry was just a test case to ensure that their transfer of
information would work. So, essentially, VA had not entered any
veterans information into the Registry, which precludes VA from
meaningfully contributing to the very purpose the Registry was created,
``to collect the diagnosis, surgical intervention, operative procedures
and related treatments, and follow up of each significant eye injury
incurred by members of the Armed Forces while serving on active duty.''
We will hear from a veteran today who will articulate the importance of
VA fulfilling its obligation to contribute to the Registry.
Another major issue we will address today is VA's continued failure
to bring its information systems into full compliance with Section 508
of the Americans with Disabilities Act. Section 508 addresses access
for people with physical, sensory, or cognitive disabilities to various
types of technologies. Two separate memoranda, dated July 26, 2012,
issued by then-Assistant Secretary for Information and Technology Roger
Baker, illustrated the ongoing problems within VA regarding Section 508
compliance. Both memoranda reference how recent audits conducted by the
VA showed that most of the content and information on VA web sites was
not Section 508 compliant.
Further, in a 2012 VA Dashboard Summary analysis, every site
reviewed showed a status of less than 50% compliance with Section 508.
Some notable examples include: VA Jobs (86% critical), eBenefits (95%
critical), and VA Forms (100% critical). The rating of ``critical'' in
the analysis states that the listed percentage is the amount of that
web site that is ``completely inoperable.'' We will hear today in VA's
testimony that they are making great strides in bringing VA systems
into compliance with Section 508. However, we will also hear from a
blinded veteran who must actually navigate these pages himself. He may
be inclined to disagree.
With that, I now recognize Ranking Member Kirkpatrick for her
opening statement.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Attachment Vision Center of Excellence (VCE) Data Abstraction Contract
Summary
September 13, 2013
1. June 12, 2012: VCE contacts General Services Administration
(GSA) Contracting Officer (CO) regarding involvement of VA for funding
of the Data Abstraction contract.
2. July 3, 2012: Office of Specialty Care Transformation
contacted by Department of Defense (DoD) representative supporting VCE,
requesting assistance with VCE Data Abstraction Contract.
3. July 3, 2012: Office of Specialty Care Transformation contacted
the Office of Specialty Care Services (SCS) to assist VCE.
4. Patient Care Services (PCS) Budget Office was contacted by SCS
on July 3, 2012, to review funding for VCE in support of the Data
Abstraction Contract.
5. July 16, 2012:
a. VCE sends initial paperwork for Data Abstraction Contract to
SCS.
b. VCE staff provides virtual introduction for VA Contracting, GSA
Contracting, and VHA SCS staff.
c. VA Office of Acquisition Services (OAS) assigns Contract
Specialist advisor.
6. July 17, 2012: SCS notified by PCS Budget Office that funding
would have to go through VA OAS.
7. July 22, 2012: VA OAS notifies SCS that funds transfer
documents must be loaded into the VOA portal.
8. July 26, 2012: Attempt made to set up funds transfer to OAS.
9. August 22, 2012:
a.Contracting documents forwarded to SCS Executive Assistant for
entry into the Veterans Online Application (VOA) portal for
acquisition.
b.Contracting specialist notifies SCS that award is now high risk
for not being awarded by October 1, 2012.
10. September 4, 2012: All requirements documents loaded into VOA
portal.
11. September 11, 2012: Contracting Specialist notifies SCS that
contracting requirement is not within the scope of the Interagency
Agreement (IAA). Contracting Specialist recommends initiating contract
in Quarter 1, Fiscal Year 2013.
12. September 30, 2012, Fiscal Year 2012 closed out. Contract not
awarded.
13. October 1, 2012, contracting process reinitiated.
14. November 16, 2012: Rolling discussions between Contracting
Specialist and General Services Administration (GSA) regarding use of
the DoD/GSA IAA.
15. November 27, 2012: Contracting Specialist starts research to
find another contracting vehicle to use.
16. November 28, 2012: Contracting Specialist request copy of DoD/
GSA IAA award for review.
17. November 30, 2012: Attempts to load requirements documents
into VOA portal unsuccessful due to technical issue with the portal.
18. December 3, 2012: Requirements successfully loaded into VOA
portal and Contracting Officer and Contracting Specialist assigned.
19. December 13, 2012: Conference call held with GSA, Contracting
Specialist, VCE, and SCS representative to discuss issues with security
clause.
20. December 18, 2012: Contracting Specialist requests new
Determination and Findings (D&F) and part B be completed.
21. December 20, 2012: New 2237 issued for funding.
22. January 8, 2013: Contracting Specialist request submission of
completely new requirements package to include D&F, Independent
Government Cost Estimate, Part A and B.
23. February 12. 2013: New documents submitted to Contracting
Specialist for review.
24. February 21, 2013: Contracting Specialist returns documents
with comments. Proposes to GSA to push contracting date to May/June
2013.
25. March 5, 2013: Contracting Specialist returns IGCE to modify
period of performance
26. March 6, 2013: Contracting Specialist notifies SCS that market
research must be signed by an SES as the acquisition would be awarded
to a large business vice a small business.
27. March 14, 2013: 2237 funding document submitted to OAS
Contracting for base year IAA between GSA and VA. Contracting
Specialist returns PWS with comments for revision.
28. March 15, 2013: Contracting Specialist returns D&F with
comments for revision.
29. March 21, 2013: Contracting Specialist sends Memorandum for
the Record to SCS, ``the VHA Program Office is not making a serious
effort to take ownership of this requirement and to take action to
refine this requirement so that it can be determined actionable and can
be reviewed and recommended for award.
30. April 1, 2013: Contracting Specialist informs SCS/VCE that
contracting action is being cancelled due to shifting resources at OAS
contracting.
31. April 12, 2013: Contract reinitiated with TAC.
32. April 19, 2013: New Contracting Specialist assigned.
33. June 12, 2013: GSA working on new IAA.
34. June 21, 2013: New documents loaded to VOA.
35. June 25, 2013: Previous Contracting Specialist notifies SCS/
VCE that contract will stay in Frederick OAS with new Contracting
Specialist assigned.
36. June 26, 2013: OAS VOA notification received that all
documents have been received for processing and new Contracting Officer
and new Contracting Specialist have been assigned.
37. July 30, 2013: Informed by the Contracting Specialist that due
to new VA policy this contracting action is cancelled and will be
transferred to VHA for procurement.
38. July 31, 2013: SCS POC sends copies of procurement package to
VHA Service Area Office (SAO) East contracting Officer as VA OAS had
not transferred package.
39. August 8, 2013: VHA SAO East Contracting Officer requests copy
of current DoD/GSA IAA for review.
40. August 16. 2013: Procurement package has to be loaded into VHA
contracting portal eCMS. Requires establishment of account. Technical
problems prevent establishment of account.
41. August 19, 2013: Electronic Contract Management System (eCMS)
account established and procurement package loaded.
42. August 20, 2013: Informed by GSA that they are no longer
accepting Fiscal Year 2013 fund transfers.
43. October 1, 2013: Non-essential Government employees
furloughed.
44. October 16, 2013: New procurement package uploaded into eCMS
portal.
45. November 14, 2013: New funding received for procurement.
46. November 15, 2013: Contracting Officer load's procurement
package into actions folder.
47. December 12, 2014: New Contracting Officer assigned to the
procurement.
48. January 2, 2014: Contracting Officer notifies SCS/VCE that he
can proceed with processing IAAs at this time.
49. February 3, 2014: Contracting Officer notifies SCS/VCE that
new procurement package required and that only VHA employees may have
input into the package. This is crippling to VCE as DoD staff have been
working original IAA since its inception.
50. February 6, 2014: Contracting Officer sends PWS back to SCS/
VCE for revision.
51. March 3, 2014: General Counsel makes statement that DoD
personnel are excluded from working on this contract.
52. March 4, 2014: Contracting Officer decides competitive
contracting is appropriate vehicle vice IAA.
53. March 26, 2014: Drafting of new Performance Work Statement
starts.
54. March 27-June 16, 2014: Processing of contract continues.
QUESTIONS FOR THE RECORD
Questions for the Record from Subcommittee Chairman Mike Coffman
Question 1: During the hearing, I asked the VA witnesses about the
February 2014 response to my October 2013 letter; particularly
regarding the statement that a data abstraction contract had not been
awarded due to contracting delays. Dr. McCarthy asked if she could take
that question for the record. Please provide me an answer on what
specific contract delays led to a data abstraction contract not being
awarded.
VA Response: The specific delays include changes in the two
contracting agencies (VA to the Veterans Health Administration (VHA));
multiple changes in contracting specialists; VA and VHA not clearly
understanding how Interagency Agreements work; and multiple requests to
redo the procurement package.
Question 2: Similarly, I was told that I would be provided with a
timeline for the process of the contract awards and what the delays
were. Please provide that response as well.
VA Response: A timeline summary is attached.
Question 3: Once the contract is awarded, how long will it be
before VA begins populating the Vision Registry?
VA Response: Due to the contract going out for bid, an exact date
cannot be established at this time. VA is targeting an award by mid-
July 2014. The VA expects to begin populating the registry in fiscal
year 2015.
Question 4: According to a July 26, 2012, memorandum from the
Assistant Secretary for Information and Technology (ASIT), no new IT
software could be deployed unless it was Section 508 complaint. Was any
such software created after the date of that memorandum that was or is
not currently 508 compliant?
VA Response: The 2012 memo effectively rescinded hundreds of
waivers, some in effect for years. Waivers were granted to the July 26,
2012, memorandum for various software products that VA considered
critical to serving the needs of Veterans, including software products
that contain information about how Veterans can access health and
benefits information. However, these products were only allowed to be
deployed after their respective development teams provided remediation
plans that would move their applications towards full compliance with
the requirements of Section 508, and the 508 Team approved their
remediation plans as sufficient. Of the mission-critical products that
were granted waivers to the memo, 25 remain non-compliant. Sixteen of
these products are internal facing, meaning that they are used
exclusively by members of the VA workforce. The other nine are external
facing, meaning that they are used by members of the public. VA
leadership and staff are actively engaged in implementing the approved
remediation plans for each of these products.
Question 5: The same memorandum also states that the Section 508
Program Office would audit VA's 508 compliance and provide reports on a
monthly basis. Please provide the Subcommittee with digital copies of
these reports from July 2012 to present.
VA Response: Requested information is enclosed.
Question 6: In a separate memorandum from the ASIT from the same
date, he stated that a recent audit of VA's internet framework, HTML
code, and site framework showed that most of VA's internet sites were
not 508 compliant. Please provide the Subcommittee with a digital copy
of that audit and any subsequent audits.
VA Response: Requested information is enclosed.
Question 7: Of the top 12 busiest VA-related sites listed in the
July 2012 memo, are there any listed that remain noncompliant with
Section 508? If so, which ones and why are they still noncompliant?
VA Response: The top 12 busiest VA Web sites are listed below. VA's
Web sites are constantly being changed and modified, which creates
challenges in maintaining compliance with Section 508 standards.
However, over the last 2 years, VA's enterprise-wide use of Section 508
compliant Web design templates has greatly improved the level of
compliance with Section 508.
------------------------------------------------------------------------
Current 508
compliance rate
Web sites from July 2012 memo (as of June
2014)
------------------------------------------------------------------------
www.va.gov............................................. 59%
www.vba.va.gov......................................... 57%
www.gibill.va.gov...................................... 89%
www.va.gov/opa......................................... 52%
www.va.gov/directory................................... 80%
www.va.gov/forms....................................... 92%
www.vacareers.va.gov................................... 87%
www.va.gov/health...................................... 78%
www.insurance.va.gov................................... 92%
www.va.gov/jobs........................................ 50%
www.ebenefits.va.gov/ebenefits-portal/ebenefits.portal. 15%
www.myhealth.va.gov.................................... 95%
------------------------------------------------------------------------
[all]