[Senate Hearing 113-403]
[From the U.S. Government Publishing Office]






                                                        S. Hrg. 113-403

                    THE FISCAL YEAR 2014 BUDGET FOR 
                            VETERANS AFFAIRS

=======================================================================

                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED THIRTEENTH CONGRESS

                             FIRST SESSION

                               __________

                             APRIL 15, 2013

                               __________

       Printed for the use of the Committee on Veterans' Affairs





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                     COMMITTEE ON VETERANS' AFFAIRS

                 Bernard Sanders, (I) Vermont, Chairman
John D. Rockefeller IV, West         Richard Burr, North Carolina, 
    Virginia                             Ranking Member
Patty Murray, Washington             Johnny Isakson, Georgia
Sherrod Brown, Ohio                  Mike Johanns, Nebraska
Jon Tester, Montana                  Jerry Moran, Kansas
Mark Begich, Alaska                  John Boozman, Arkansas
Richard Blumenthal, Connecticut      Dean Heller, Nevada
Mazie Hirono, Hawaii
                    Steve Robertson, Staff Director
                 Lupe Wissel, Republican Staff Director

















                            C O N T E N T S

                              ----------                              

                             April 15, 2013
                                SENATORS

                                                                   Page
Sanders, Hon. Bernard, Chairman, U.S. Senator from Vermont.......     1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North 
  Carolina.......................................................     4
Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia...     7
Johanns, Hon. Mike, U.S. Senator from Nebraska...................     8
Tester, Hon. Jon, U.S. Senator from Montana......................     9
Isakson, Hon. Johnny, U.S. Senator from Georgia..................    10
Boozman, Hon. John, U.S. Senator from Arkansas...................    10
Begich, Hon. Mark, U.S. Senator from Alaska......................    11
Blumenthal, Hon. Richard, U.S. Senator from Connecticut..........   243
Moran, Hon. Jerry, U.S. Senator from Kansas......................   245
Hirono, Hon. Mazie, U.S. Senator from Hawaii.....................   248

                               WITNESSES

Shinseki, Hon. Eric K., Secretary, U.S. Department of Veterans 
  Affairs; accompanied by Hon. Robert A. Petzel, M.D., Under 
  Secretary for Health; Hon. Allison A. Hickey, Under Secretary 
  for Benefits; Hon. Steve L. Muro, Under Secretary for Memorial 
  Affairs; Stephen W. Warren, Acting Assistant Secretary for the 
  Office of Information and Technology; and W. Todd Grams, 
  Executive in Charge for the Office of Management and Chief 
  Financial Officer..............................................    12
    Prepared statement...........................................    13
    Response to posthearing questions submitted by:
      Hon. Bernard Sanders.......................................    25
      Hon. Richard Burr..........................................    76
    Response to request arising during the hearing by:
      Hon. Richard Burr..........................................6, 252
      Hon. Jerry Moran.........................................246, 247

                                APPENDIX

Hall, Jeffrey C., Assistant National Legislative Director, 
  Disabled American Veterans (DAV); prepared statement...........   255
Tarantino, Tom, Chief Policy Officer, Iraq and Afghanistan 
  Veterans of America (IAVA); prepared statement.................   261
Paralyzed Veterans of America (PVA); prepared statement..........   262
Wounded Warrior Project (WWP); prepared statement................   266

 
                    THE FISCAL YEAR 2014 BUDGET FOR 
                            VETERANS AFFAIRS

                              ----------                              


                         MONDAY, APRIL 15, 2013

                                       U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 2:30 p.m., in 
room 418, Russell Senate Office Building, Hon. Bernard Sanders 
presiding.
    Present: Senators Sanders, Rockefeller, Tester, Begich, 
Blumenthal, Hirono, Burr, Isakson, Johanns, Moran and Boozman.

          OPENING STATEMENT OF HON. BERNARD SANDERS, 
              CHAIRMAN, U.S. SENATOR FROM VERMONT

    Chairman Sanders. OK. We have got a lot of work, so let's 
get the hearing underway.
    And I want to welcome everyone to this afternoon's hearing 
on the fiscal year 2014 budget and the fiscal year 2015 
advanced appropriations request for the Department of Veterans 
Affairs.
    Earlier this year, as I think we will all recall, we heard 
from nearly all of the veterans service organizations. These 
groups shared with us their priorities which reflect the needs 
of the men and women who have served our country. I want to 
thank all of the service organizations not only for the 
important testimony but for the great work they do every single 
day, protecting the interests of America's veterans.
    If there is anything that many of us have learned in recent 
years, it is that the real cost of war is far, far greater than 
simply paying for the tanks and guns and planes and the 
manpower to fight those wars. I believe that we now understand 
more fully than we have in the past that soldiers who come home 
from war are often very different people than when they went.
    We now understand that the cost of war includes significant 
care not only for those who lost their legs and their arms and 
their eyesight but for those who came home with what we now 
call the invisible wounds of war. Most recently, this includes 
the hundreds of thousands of brave soldiers who returned from 
Iraq and Afghanistan with Traumatic Brain Injury and Post 
Traumatic Stress Disorder.
    So, while this $152 billion budget we discuss today is a 
complicated document with a whole lot of numbers, it all comes 
down to how the people of our country, through their 
government, honor their commitments to those who have 
sacrificed so much and to the spouses and children who have 
often also sacrificed.
    In their testimonies, the VSOs discussed many of the 
important and positive things that the VA does, which sometimes 
we overlook, but let me talk a little bit about what the VSOs 
discussed.
    In terms of health care, in a nation with over 45 million 
people lacking any health insurance and at a time when the cost 
of health care in this country is far higher than any other 
country on earth, the VA is recognized by many as providing 
excellent quality health care in a cost-effective way to those 
who have served our Nation. Like every other health care 
organization, the VA can do better--and it must do better--but 
most will agree that the VA has come a very long way in the 
last 20 to 30 years in terms of health care.
    In terms of another important issue--homelessness. At a 
time when too many Americans and people in my own State of 
Vermont are sleeping out in the streets or in their cars, the 
VA has undertaken an aggressive and successful effort to 
significantly reduce the number of homeless veterans in our 
country. Since 2009, there has been a 17 percent decline in 
veterans homelessness despite the tough economy. That is the 
good news. The bad news is that there were still more than 
62,000 homeless veterans in January 2012.
    The VA must sustain its positive efforts in combating 
veterans homelessness. Progress is being made; more must be 
done.
    Through its world-class research program, the VA is making 
significant advances in health care not only for veterans but 
for the entire country. That progress must continue.
    The VSOs, while praising the VA in many areas, also 
highlighted the significant challenges and problems that 
continue to confront veterans of all generations, and I agree 
with many of their concerns. Among many other issues, they 
spoke of the obligation to address the tragic number of 
servicemember and veteran suicides. This is a horrendous 
tragedy. It is a tough issue. We have got to address it.
    Further, the need to accelerate the transformation of the 
compensation claims system in order to deal with the 
unacceptably long delays that we are now seeing and the huge 
backlog in cases--if there is any issue that I think veterans 
and the veterans community are concerned about, it is that 
issue, and I share that concern.
    While the VA is now processing far more claims than ever 
before, the movement to a paperless and efficient system must 
be completed on schedule. I know we will be discussing that 
issue during this hearing.
    Further, the responsibility to make smart investments in 
infrastructure and information technology systems to ensure 
that the VA can continue to provide the care and benefits 
veterans have earned is a major issue. This means--and this, 
again, is a huge issue which this Committee will delve into--a 
significant improvement in the relationship between the VA and 
the Department of Defense. We may be dealing with two separate 
agencies, but we are dealing with one human being who goes 
through the DOD into the VA.
    I believe that this year's budget request, especially 
within the overall budget restraints facing Congress, again 
reflects a strong commitment by this Administration to provide 
veterans and their families with the care and benefits they 
deserve.
    This year's total budget request is $152.7 billion--$86.1 
billion for mandatory entitlements and $66.5 billion for the 
discretionary account. This is a 10.2 percent increase over 
last year's enacted amount.
    While the VA budget presented by the Administration is a 
strong one, and I applaud the President for that, I remain 
deeply disappointed that the White House included in their 
budget request the so-called chained CPI. Switching to a 
chained CPI would mean major cuts in Social Security and the 
benefits that disabled veterans receive. Veterans who started 
receiving VA disability benefits at age 30 would have their 
benefits reduced by $1,425 at age 45, $2,341 at age 55 and over 
$3,000 a year at age 65--tens of thousands of dollars within 
their lifetime. This, to my mind, is unconscionable, and I will 
do all that I can to prevent these cuts from taking place.
    When it comes to the issue of funding for suicide 
prevention, the budget is literally a matter of life or death. 
Ensuring timely access to high quality mental health care is 
critical for our veterans and their loved ones. To that end, I 
am pleased to see the President's budget recommendation calls 
for a 7.2 percent increase in funding for mental health.
    At our last hearing, when we discussed the issue of mental 
health and suicide, Dr. Petzel testified that the VA is on 
track to hire the 1,600 mental health clinicians called for in 
the President's Executive Order by the deadline of June 30. As 
I noted at that hearing, I remain concerned that the VA has 
hired just 47 clinicians in the 2 months prior to that hearing. 
I understand VA must ensure that they are hiring high-quality 
clinicians, but VA must pick up the pace of hiring if it 
intends to meet its goal of 1,600 new clinicians by the end of 
June of this year.
    When hiring these clinicians, the VA must recognize that 
individual veterans respond differently to different treatments 
and not all veterans respond well to traditional therapies. I 
appreciated Senator Boozman at our last hearing raising the 
important issue of over-medicating veterans seeking mental 
health treatment. I share that concern, as I believe do many 
Americans.
    I also know that many veterans respond positively to 
complementary and alternative medicine. As the name indicates, 
such treatments--which include therapies such as acupuncture, 
guided imagery, meditation, chiropractic care and yoga--can be 
provided in conjunction with traditional care or as stand-alone 
care. I commend the VA's top leadership for embracing these 
therapies but worry that that interest has not penetrated all 
levels of the VA health care system. VA must do a better job to 
make sure that these therapies are available to all interested 
veterans.
    In terms of the claims backlog, the fact that nearly 70 
percent of claims are pending longer than 125 days is 
completely unacceptable as is the fact that it took, on 
average, 287 days to complete a compensation rating claim in 
2012.
    The inability to provide compensation benefits in a timely 
manner tarnishes VA's reputation among the very population it 
serves. I never want a veteran's negative experience with the 
claims system to prevent him or her from seeking mental health 
care or help in battling homelessness.
    Mr. Secretary, I see your testimony reiterates VA's goal of 
eliminating the claims backlog by 2015. VA has set ambitious 
goals, put forward a plan and has been working hard to 
transform the system.
    I think we can all agree that the VA took too long to start 
transforming itself from a paper-based to electronic system. 
Clearly, that effort should have begun a decade ago, or longer, 
and not just 4 years ago. Yet, despite these facts, one must 
certainly understand how it is difficult for the average person 
to believe VA is making progress when we continue to see the 
unacceptably long wait times faced by veterans and their 
survivors in obtaining benefits.
    VA must do a better job of showing not only the Congress 
but also veterans and their survivors about how VA plans to 
accomplish their ambitious goals. And I look forward to working 
with you to establish benchmarks which will allow us to see the 
progress, or lack of progress, that VA is making in this 
vitally important area.
    VA must be able to construct, repair, or lease the physical 
infrastructure necessary to provide the high-quality care that 
veterans deserve. Yet, for the fourth year in a row the 
President's request has been out of touch with the realities on 
the ground. Adequate funding to maintain VA's aging 
infrastructure must be a critical part of the discussion on 
providing quality health care.
    Further, the fiscal year 2014 budget request includes 
another 13 major medical facility leases but does not include 
funding for the full cost of authorizing these leases despite 
the challenges Congress is still working to surmount. This is 
an issue I would like to address later today.
    Last, let me repeat; the importance of information 
technology cannot be understated as VA seeks to deliver the 
care and benefits that our veterans deserve in a more efficient 
and effective way. I think the bottom line is there must, must, 
must be much better cooperation between the DOD and the VA.
    So let me conclude my remarks by thanking the Secretary and 
his staff for being with us today. The issues that we are going 
over are of enormous importance to millions of veterans and the 
American people. I look forward to a very productive hearing.
    Senator Burr.

        STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 
                U.S. SENATOR FROM NORTH CAROLINA

    Senator Burr. Good afternoon, Mr. Chairman, and Secretary 
Shinseki, welcome. And to your team, welcome.
    Mr. Chairman, thank you for that very thorough opening 
statement.
    As the Chairman indicated, we will be discussing the 
President's budget request for the Department of Veterans 
Affairs for fiscal year 2014.
    As I have said at past budget hearings, it's important that 
we provide adequate funding for the VA so that all veterans 
receive the benefits and care that they have earned and 
deserve. Yet, along with that funding we must conduct vigorous 
oversight to make sure programs which benefit veterans are 
working properly and lead to better outcomes for veterans, 
their families, and their survivors.
    Yet, in looking over the budget request, the lack of 
consistent predictions and a lack of transparency lead me to 
question if VA's stewardship of the taxpayers' money is leading 
to better outcomes.
    First, VA has been consistently inconsistent with its 
workload projections. These changing projections mask whether 
they have the backlog situation under control.
    Second, the unclear accounting practices in the IT budget 
make it difficult for us to conduct the necessary oversight 
into these programs.
    Regarding claims processing, we all know that the backlog 
and delays have gotten worse over the past 4 years even though 
VA has hired more staff, spent millions on IT solutions, and 
rolled out dozens of initiatives. Today, we will again hear VA 
assure that despite these trends this situation will be 
completely under control by 2015; but in my view, this budget 
provides one more reason to seriously question those 
assurances.
    For starters, the budget reflects that in 2013 and 2014 VA 
will receive 2.6 million claims and decide 2.5 million. But in 
the VA's strategic plan for eliminating the backlog, which was 
sent to Congress less than 3 months ago, VA projected output of 
2.8 million claims during those years. That means VA has 
already lowered its productivity expectations by 12 percent.
    As for receipts, the backlog plan estimated that VA would 
take in 2.7 million claims this year and next year combined, 
but VA acknowledged it could receive as many as 774,000 
additional claims as a result of recent laws. Despite that 
caution, the budget shows that VA will have even lower receipts 
in those years than the backlog plan estimated.
    The budget also reflects that incoming claims will continue 
to exceed output during this year and next year, which means 
that the number of pending claims will continue to grow. In 
fact, VA now projects that it will have an inventory of roughly 
960,000 claims at the end of 2014--about 100,000 more than are 
pending today.
    Compare that with VA's backlog plan, which predicted that 
the decisions would outpace claims receipts next year, and, as 
a result, the level of claims would drop to less than 800,000.
    Finally, the budget projects that no more than 40 percent 
of claims will be pending long enough this year and in 2014 to 
be considered backlogged even though 70 percent of claims are 
currently backlogged. On the other hand, VA's strategic plan 
showed a backlog of 68 percent this year and 57 percent next 
year, just 3 months ago.
    Even if VA has updated these estimates based on more recent 
data, it is difficult to understand how all of these projects 
could change so dramatically in less than 12 weeks. These 
fluctuating predictions, together with a history of missed 
milestones and deteriorating performance, make it extremely 
difficult to believe that VA has the backlog situation under 
control.
    As I said earlier, another area of concern for me is the 
ambiguity of the IT projects that are becoming the backbone of 
operations at VA medical centers and VA regional offices.
    Currently, VA has several IT projects that are vital to 
providing benefits and services to our Nation's veterans. In 
the President's request, the Office of Information Technology, 
or OIT, requested roughly $3.7 billion, a $360 million increase 
over last year.
    There are three areas of concern within the IT budget I 
believe are worth highlighting.
    First, OIT requested $252 million for the IPO for 
development activities of the iEHR and VLER. How much of this 
money will be spent on a new strategy of quick wins versus the 
two initial operating capabilities at two sites in 2014 is a 
question.
    Second, according to the budget justifications, the 2014 
allocation for VBMS development is roughly $33 million, which 
would be a $71 million decrease from fiscal year 2012. However, 
we are being told that there is another $155 million for VBMS 
in this budget. Is this additional funding coming from VBA's 
budget?
    Finally, in my questions from last year's budget hearing, I 
asked about the cost of the new patient scheduling system. VA's 
response stated that they planned to have a Life Cycle Cost 
Estimate completed by January 2013.
    As of today, this life cycle cost analysis has yet to be 
received by my office. Since the 2014 budget request has a $30 
million allocation for the development of a new scheduling 
package, I wonder if the life cycle cost analysis has now been 
completed. [See below for answer.]
    This unclear nature of the IT budget stands in the way of 
Congress's ability to conduct effective oversight into these 
programs to make sure they are working properly and, more 
importantly, meeting their milestones. Unfortunately, these 
inconsistent projections and lack of transparency are becoming 
the standard operating procedure at VA, which is even more 
troubling when it is our Nation's veterans that stand to lose 
the most.
    Mr. Chairman, I thank you, and I look forward to spending 
some time with our panel today.
  Response to Request Arising During the Hearing by Hon. Richard Burr 
from Office of Information and Technology, U.S. Department of Veterans 
                                Affairs
    Response: As a follow up to our prior correspondence to Senators 
Burr and Murray on September 12, 2102, VA provides the following update 
to its scheduling procurement efforts:

    VA will procure a scheduling solution in two phases. In the first 
phase, currently ongoing, VA is running a risk-reduction contest under 
the America Competes Act calling for scheduling application 
submissions. The purpose of this contest will be to reduce procurement 
and deployment risk. VA will offer up to three prizes for scheduling 
packages that demonstrate their compatibility with the Open Source 
version of VA's electronic health record, VistA. Contest submissions 
are due in June, and VA is scheduled to announce winners in September.
    The second phase will include the actual procurement of a 
scheduling solution. As this risk-reduction activity proceeds, VA will 
continue working with the Department of Defense and the Interagency 
Program Office to determine joint requirements and a master development 
and acquisition plan. The master development and acquisition plan will 
be based upon an evaluation of contestant responses for proposed 
functionality and compliance with iEHR architecture.

                                May 2013

    Chairman Sanders. Senator Burr, thank you very much.
    Senator Rockefeller.

           STATEMENT OF HON. JOHN D. ROCKEFELLER IV, 
                U.S. SENATOR FROM WEST VIRGINIA

    Senator Rockefeller. Thank you, Mr. Chairman; and I welcome 
General Shinseki and his staff, as we all do.
    I just want to recount to my colleagues that I spent a 
very, very long time last week talking with General Shinseki 
about how one takes a 220,000-person agency and gets it to be 
responsive on all kinds of different issues, many of which have 
been mentioned today and some more of which I will mention.
    The General actually has done a lot of work on management 
over the course of his life, and training, and he described how 
he broke the 220,000 down into blocks and then blocks within 
blocks, all of them to be held accountable, all evaluating 
themselves, and being evaluated.
    The reason I say this is because I really do not know of 
any job which has such a human poignancy in its work and yet 
has complexity and bulk at the level that the VA has.
    I think you are a superb General of that VA, and I just 
want to say that. We talked about claims and all the rest of 
it. I mean, you are really working at it, and I believe that.
    Does that give veterans enough comfort? No. But everything 
in life is a process and the process is either pushed from 
above or it is not.
    As you and I discussed, General, a number of years ago, all 
of a sudden the VA, medically, went from sort of a not really 
very, very good place to a really good place. And we both, at 
the same time, said Ken Kizer.
    Ken Kizer had been sitting here on that row for years. I 
knew his position. I had no idea until he left the effect that 
he had, which lasts today.
    I don't want Johnny Isakson, who is my dear friend, to be 
mad at me if I say something nice about the President, but I am 
really struck, Mr. Chairman, by the specificity and directness 
of the budget increases which the President--with the entire 
rest of the world claiming every nickel that he doesn't have in 
this government--what he has done to make your mission more 
amenable to your leadership, though not in all fields and not 
with all problems. But he has given a vote of confidence, and 
more importantly than that, he has spoken very strongly to the 
veterans.
    I do not usually say things like that at hearings, but I 
just wanted to in this case.
    A 10.2 increase percent is huge, you know. We throw those 
numbers around and soon forget them, but this will not be 
forgotten.
    Nevertheless, I am also very concerned about the persistent 
problems that have been addressed by the two speakers prior to 
me--the needs of the rapidly growing veterans community to the 
backlog in veterans' claims. I am actually not sure whether it 
is 600,000, or at one point, I heard it was 800,000. In one 
sense, it does not make any difference. It is too many.
    And, yes, you are attacking that crisis. You are bringing 
in more mental health clinicians. You are meant to have 1,600; 
I think you have over 1,200. People all over the country--
hospitals--are screaming and yelling because you are taking 
some of their best people. I say, well done. But the importance 
of that, as Chairman Sanders indicated, is so incredibly 
important.
    Mental health care is so needed and so recently, 
powerfully, on the minds of all of us. I think Americans in 
general, American families, and even Senators as policymakers 
are capable of seeing those kinds of things.
    There is no quick fix for health care, mental health care, 
claims, or anything else. There is the need for a persistent 
driving agenda--when the Secretary and his team come to work 
every day, determined as you are, sir, to make a difference as 
best you can.
    I am disturbed by the fact that this very promising DOD/VA 
joint effort on IT and other things, which was quite vibrant 7 
or 8 years ago, has now kind of been called off. So I want to 
ask why and what price do we pay, and what can be done?
    I would just say to my friends on this Committee that we 
are very, very lucky to serve here. I've been on here every 
year that I've been in the Senate, which some may think is 1 or 
2 but actually is 28 years. And it is a proud, proud service.
    You know, in West Virginia we have so many veterans; every 
State does. The work is powerful in its poignancy.
    I commend you for the work to be done, and I have more 
questions I want to ask.
    Thank you, Mr. Chairman.
    Chairman Sanders. Thank you, Senator Rockefeller.
    Senator Johanns.

                STATEMENT OF HON. MIKE JOHANNS, 
                    U.S. SENATOR FROM NEVADA

    Senator Johanns. Mr. Chairman, thank you and thank you for 
calling this hearing on this budget request.
    Mr. Secretary, it is good to see you again. One of the 
things that I appreciate, and I know the other Members 
certainly do also, is your willingness to stop by our offices 
and talk to us about the issues that are of concern to us.
    I also want to indicate, as a former department head, I 
understand the complexities of putting together a budget that 
meets the priorities of the President of the United States. I 
also understand the challenges in trying to touch all of the 
bases.
    There are many challenges facing the VA. The Chairman and 
the Ranking Member went through those. I will not take up time 
this afternoon and go through them item-by-item myself.
    There are a couple of things that I did want to mention. 
The first one is one that I appreciate a great deal. As you 
know, for some period of time, a number of us have been working 
on a VA cemetery in the Omaha area. I do want to thank you for 
including that in the fiscal year 2014 budget request.
    There are about 112,000 veterans and their families who 
currently do not have a VA cemetery within 75 miles that will 
be very positively impacted. I did not want the start of this 
hearing to go by without me saying how much I appreciate that.
    In addition, I also wanted to mention on a more concerning 
note, though, is the issue of facilities. As I mentioned, I 
have gone through these budget efforts, where you are trying to 
put together the necessary funds and get it passed through OMB, 
et cetera, and one of the things that always tends to slip is 
the capital improvements. It is just the reality of what we 
deal with. You have real human beings with real human needs 
that you need to find funding for.
    I think about the facility in Omaha, but I do not want this 
to be just about that facility because I know there are 
problems all over the country where we are dealing with 1950s-
era buildings. Recently, in the Omaha VA they closed the 
operating suite for much needed repairs. I am sure there are 
stories that could be told about that kind of thing all across 
the country.
    So, as we go through the hearing this afternoon, I would 
like to spend a little bit of time on facility needs around the 
country and how you think we are doing in addressing that 
because I do believe it is an important issue and, again, I 
recognize it is an issue that I would suspect slips as the 
budget gets put together.
    With that, I do want to thank you for being here and look 
forward to your testimony.
    Thank you, Mr. Chairman.
    Chairman Sanders. Well, thank you, Senator Johanns.
    Senator Tester.

                 STATEMENT OF HON. JON TESTER, 
                   U.S. SENATOR FROM MONTANA

    Senator Tester. Yes, thank you, Mr. Chairman.
    I want to thank each and every one of you for being here 
today. I have had a chance to work with, I think, every one of 
you pretty closely, and I appreciate that.
    A special thanks to the Secretary--thank you, General. 
Thank you for being here and thank you for the work you do.
    You have been saddled with a tough job, and you have 
received some criticism. I just want to say some of it has been 
pretty unfair criticism, and I think you have done a great job 
considering the conditions that you are faced with in this 
position. I appreciate your leadership, and I appreciate your 
service to the country very much.
    Now I will be the first to tell you--and you know this--I 
do not agree with everything you have done, and there is plenty 
to improve upon. Yet, I think we have made great strides under 
your leadership, working with some incredibly complex issues--
the cost of war, the men and women coming back from Iraq and 
now Afghanistan, and the injuries, both seen and unseen, that 
you have to deal with and your staff has to deal with and 
everybody on the ground has to deal with.
    I can tell you that I have been on this Committee for 6 
years and in this Senate for 6 years. I have had numerous 
meetings around the State of Montana, and I have found one--
one--person that does not like VA health care. The rest of them 
love it. So I just want to say thank you for your work.
    This is a $152.7 billion budget. It is a fair chunk of 
change that invests significantly in our veterans, and we need 
to make sure that we spend it as effectively as possible. That 
is our job, and it is your job. We need to proceed in a way 
that honors our military folks' service, and one that also 
makes the most sense for the taxpayers as we go forward.
    This is an important discussion, whether we are talking 
mental health or local partnerships or vet vans or Vet Centers 
or vet cemeteries or homelessness or education. There are 
plenty of issues to talk about. How we make this budget work 
for our veterans is going to be critically important.
    I want to thank you for being here, and I look forward to 
the discussion today, Mr. Chairman.
    Chairman Sanders. Thank you very much, Senator Tester.
    Now, Senator Isakson.

               STATEMENT OF HON. JOHNNY ISAKSON, 
                   U.S. SENATOR FROM GEORGIA

    Senator Isakson. Thank you, Mr. Chairman.
    So, as to not disappoint the distinguished Senator from 
West Virginia, not only do I acknowledge that the President's 
budget is a 10 percent increase, but it is $7 billion more than 
this Senate approved in its budget just a month ago. So he has 
topped us as well, as to what needs to be done.
    I will also point out the fact that unlike a lot of 
appropriations units that we do--whether it is the Department 
of Energy, the Department of Labor--we are talking about 
mandatory spending when we talk about veterans. When one of our 
soldiers comes back from serving overseas, we have a commitment 
to them that is going to drive how much we spend.
    We should never shortchange those benefits, or look at it 
as an efficiency or a savings. Instead, what we have got to do 
is make sure we run the Department as efficiently as it can be 
and find our savings there.
    So I commend the President and the Senate, and most of all, 
I am grateful and thankful to those soldiers who sacrificed and 
fought for us overseas.
    My interest is really in two things: suicide; and the 
benefit claims backlog. Those two things are terrible, 
protracted problems that I know you are facing. I acknowledge 
the compliments that everybody has given you, General Shinseki, 
because they are well deserved, but those are the two 
priorities that we have got to focus on if we are ever going to 
get the VA responding as it should respond to those who have 
come back from overseas and who have served this country.
    So, with that said, I will yield back the balance of my 
time so we can get to our questions.
    Chairman Sanders. Senator Isakson, thank you very much.
    Senator Boozman.

                STATEMENT OF HON. JOHN BOOZMAN, 
                   U.S. SENATOR FROM ARKANSAS

    Senator Boozman. Thank you, Mr. Chairman.
    Likewise, again, I do not have a lengthy statement at all.
    It is good to have you here. We appreciate you and 
appreciate your service, not only to the VA but in so many ways 
throughout your career, and the team that you have assembled to 
try to help us get this done.
    I think as you hear the mood of the comments so far I think 
it is important that the public understands that this is not a 
partisan issue. This is something that I think both sides are 
very much committed to helping you here in the Senate and then 
also spending a lot of time in the House with Congressmen 
Michaud and Miller. I know that they also are totally dedicated 
to seeing if we can figure out how to solve some of these very, 
very difficult problems, as Senator Isakson said--the suicide 
issue, the benefits, and also just the ongoing.
    As was said by our Senator from West Virginia, we can be 
very proud of the VA system that we have. We are doing a lot of 
things really, really right.
    We have got two VA hospitals in Arkansas that are 
excellent. That has taken a lot of hard work to get to that 
outcome. So, again, we appreciate the efforts there.
    Clearly, we have to address these other things, but we do 
have some things that we can celebrate.
    Thank you.
    Chairman Sanders. Senator Boozman, thank you very much.
    Senator Begich.

                STATEMENT OF HON. MARK BEGICH, 
                    U.S. SENATOR FROM ALASKA

    Senator Begich. Mr. Chairman, I really do not have an 
opening statement. I just want to first thank you for having 
this hearing.
    Thank you, General Shinseki--Secretary Shinseki--for all 
the work you have done.
    First, with Alaska and our rural vets that are moving 
forward in a relationship with the tribal community on delivery 
of health care, we really appreciate VA's efforts there. We 
hope to see, as it moves forward, some good progress.
    Second, I know you have put some resources in this budget, 
which I will be anxious to hear about, regarding disability 
claims and how we move those forward. We had a hearing, and 
your staff was--they survived that last hearing, and we 
appreciate that--but a lot of effort is needed to make sure we 
move that forward. I know that is one of your priorities.
    Last, is the effort that you all are making regarding 
homeless vets. I know this is one of your top three priorities, 
within the top three. In Alaska, as you can imagine, homeless 
veteran issues are even more severe because of climatic 
conditions and other things that we have to deal with.
    So thank you for being here. I look forward to your budget, 
and I am anxious to hear the testimony.
    Thank you, Mr. Chairman.
    Chairman Sanders. OK. It is now my pleasure to welcome VA 
Secretary Eric Shinseki.
    Thank you, General, for joining us today to give your 
perspective on the President's fiscal year 2014 budget and the 
fiscal year 2015 advanced appropriations request for the 
Department of Veterans Affairs. We look forward to hearing your 
testimony.
    Secretary Shinseki is accompanied by Steve Muro, Under 
Secretary for Memorial Affairs; Allison Hickey, Under Secretary 
for Benefits; and Dr. Robert Petzel, Under Secretary for 
Health. We also have Todd Grams, Executive in Charge for the 
Office of Management and Chief Financial Officer, and Stephen 
Warren, Acting Assistant Secretary for the Office of 
Information and Technology.
    Your prepared remarks will be submitted for the record.
    Secretary Shinseki, please begin and thanks again for being 
with us today.

STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT 
  OF VETERANS AFFAIRS, ACCOMPANIED BY: HON. ROBERT A. PETZEL, 
M.D., UNDER SECRETARY FOR HEALTH; HON. ALLISON A. HICKEY, UNDER 
SECRETARY FOR BENEFITS; HON. STEVE L. MURO, UNDER SECRETARY FOR 
MEMORIAL AFFAIRS; STEPHEN W. WARREN, ACTING ASSISTANT SECRETARY 
   FOR THE OFFICE OF INFORMATION AND TECHNOLOGY; AND W. TODD 
  GRAMS, EXECUTIVE IN CHARGE FOR THE OFFICE OF MANAGEMENT AND 
                    CHIEF FINANCIAL OFFICER

    Secretary Shinseki. Chairman Sanders, Ranking Member Burr, 
distinguished Members of the Committee, thank you for this 
opportunity to present the President's 2014 budget and 2015 
advanced appropriations requests for VA. We deeply value your 
partnership and support in providing the resources needed to 
assure quality care and services for veterans.
    Let me also join you, Mr. Chairman, in acknowledging other 
partners here today--our veteran service organizations, whose 
insights and support make us much better at our mission of 
caring for veterans, their families and our survivors.
    Mr. Chairman, thank you for accepting my written statement 
for the record.
    The 2014 budget and 2015 advanced appropriations requests 
demonstrate the President's steadfast commitment to our 
Nation's veterans. And I thank the members for your resolute 
commitment as well to veterans and seek your support on these 
requests.
    The latest generation of veterans is enrolling at VA at a 
higher rate than previous generations. Sixty-two percent of 
those who deployed in support of operations in Afghanistan and 
Iraq have used at least one VA benefit or service. VA's 
requirements are expected to continue growing for years to 
come. Our plans and resources must be robust enough to care for 
them all.
    The President's 2014 budget for VA, as the Chairman 
outlined: $152.7 billion--$66.5 billion in discretionary 
funding and $86.1 billion in mandatory funding, an increase of 
$2.7 billion in discretionary funding, 4.3 percent above the 
2013 level.
    This is a strong budget which enables us to continue 
building momentum for delivering three long-term goals we set 
for ourselves roughly 4 years ago--increase veterans' access to 
VA benefits and services, eliminate the disability claims 
backlog in 2015, and end veterans' homelessness in 2015. These 
were bold and ambitious goals then. They remain bold and 
ambitious today because veterans deserve a VA that advocates 
for them and then finds a way to put resources against its 
words, against those promises.
    Access. Of the roughly 22 million living veterans in the 
country today, more than 11 million now receive at least 1 
benefit or service from VA--an increase of over a million 
veterans in the last 4 years. We have achieved this by opening 
new facilities, renovating others, increasing investments in 
telehealth and telemedicine, sending mobile clinics and Vet 
Centers to remote areas where veterans live, and using every 
means available, including the social media, to connect more 
veterans to VA. Increasing access is a success story at VA.
    The backlog. No question, too many veterans wait too long 
to receive benefits they deserve. We know this is unacceptable 
and no one wants to turn this situation around more than this 
Secretary, Under Secretary Hickey or the folks who come to work 
at VBA every day, 52 percent of whom are veterans themselves.
    We are resolved to eliminate the claims backlog in 2015 
when claims will be processed in 125 days or less at a 98 
percent accuracy level. Our efforts mandate investments in 
VBA's people, processes and technology. Not just technology--
people, processes and technology.
    In terms of people, more than 2,100 claims processors have 
completed training to improve the quality and productivity of 
claims decisions. More are being trained, and VBA's new 
employees now complete more claims per day than their 
predecessors.
    Processes. Use of disability benefits questionnaires, DBQs, 
online forms for submitting medical evidence, have dropped 
average processing times of medical exams and improved 
accuracy.
    There are now three lanes for processing claims--an express 
lane for those that will, predictably, take less time; a 
special operations lane for unusual cases or those requiring 
special handling; and a core lane where roughly 60 percent of 
the claims will go, and that is the remainder.
    Technology is critical in ending the backlog. Our paperless 
processing system, VBMS--Veterans Benefits Management System--
will be faster, improve access, drive automation and reduce 
variance. Thirty regional offices now use VBMS. All 56 will 
have it by the end of this year.
    Homelessness. The last of our three priority goals is to 
end veterans' homelessness in 2015. Since 2009 we have reduced 
the estimated number of homeless veterans by more than 17 
percent. The latest available estimate from January 2012 is 
62,600.
    There is more work to be done here, but we have mobilized a 
national program that reaches into communities all across this 
country. Prevention of veterans' homelessness is our follow-on 
main effort. The first phase to be completed by 2015 is the 
rescue of veterans currently on the street, and at the same 
time we are building a prevention program to keep others from 
ending up there.
    Mr. Chairman, we are committed to the responsible use of 
the resources Congress provides.
    Again, thank you for this opportunity to appear here today, 
and we look forward to your questions.
    [The prepared statement of Secretary Shinseki follows:]
Prepared Statement of Hon. Eric K. Shinseki, Secretary, U.S. Department 
                          of Veterans Affairs
    Chairman Sanders, Ranking Member Burr, Distinguished Members of the 
Senate Committee on Veterans' Affairs: Thank you for the opportunity to 
present the President's 2014 Budget and 2015 advance appropriations 
requests for the Department of Veterans Affairs (VA). This budget 
continues the President's historic initiatives and strong budgetary 
support and will have a positive impact on the lives of Veterans, their 
families, and survivors. We value the unwavering support of the 
Congress in providing the resources and legislative authorities needed 
to care for our Veterans and recognize the sacrifices they have made 
for our Nation.
    The current generation of Veterans will help to grow our middle 
class and provide a return on the country's investments in them. The 
President believes in Veterans and their families, believes in 
providing them the care and benefits they've earned, and knows that by 
their service, they and their families add strength to our Nation.
    Twenty-two million living Americans today have distinguished 
themselves by their service in uniform. After a decade of war, many 
Servicemembers are returning and making the transition to Veterans 
status. The President's 2014 Budget for VA requests $152.7 billion--
comprised of $66.5 billion in discretionary funds, including medical 
care collections, and $86.1 billion in mandatory funds. The 
discretionary request reflects an increase of $2.7 billion, 4.3 percent 
above the 2013 level. Our 2014 budget will allow VA to operate the 
largest integrated healthcare system in the country, with more than 9.0 
million Veterans enrolled to receive healthcare; the ninth largest life 
insurance provider, covering both active duty members as well as 
enrolled Veterans; an education assistance program serving over 1 
million students; a home mortgage service that guarantees over 1.5 
million Veterans' home loans with the lowest foreclosure rate in the 
Nation; and the largest national cemetery system that leads the Nation 
as a high-performing organization, with projections to inter about 
121,000 Veterans and family members in 2014.
                             priority goals
    Over the next few years, more than one million Veterans will leave 
military service and transition to civilian life. VA must be ready to 
care for them and their families. Our data shows that the newest of our 
country's Veterans are relying on VA at unprecedented levels. Through 
January 31, 2012, of the approximately 1.58 million Veterans who 
returned from Operations Enduring Freedom, Iraqi Freedom, and New Dawn, 
at least 62 percent have used some VA benefit or service.
    VA's top three priorities--increase access to VA benefits and 
services; eliminate the disability compensation claims backlog in in 
2015; and end Veterans homelessness, also in 2015--anticipate these 
changes and identify the performance levels required to meet emerging 
needs. These ambitious goals will take steady focus and determination 
to see them through. As we enter the critical funding year for VA's 
priority goals, this 2014 budget builds upon our multi-year effort to 
position the Department through effective, efficient, and accountable 
programming and budget execution for delivering claims and homeless 
priority goals.
                        stewardship of resources
    Safeguarding the resources--people, money, time--entrusted to us by 
the Congress, managing them effectively, and deploying them 
judiciously, is a fundamental duty. Effective stewardship requires an 
unflagging commitment to use resources efficiently with clear 
accounting rules and procedures, to safeguard, train, motivate, and 
hold our workforce accountable, and to assure the effective use of time 
in serving Veterans on behalf of the American people. Striving for 
excellence in stewardship of resources is a daily priority. At VA, we 
are ever attentive to areas in which we need to improve our operations, 
and are committed to taking swift corrective action to eliminate any 
financial management practice that does not deliver value for Veterans.
    VA's stewardship of resources begins at headquarters. Recognizing 
the very difficult fiscal constraints facing our country, the 2014 
request includes a 5.0 percent reduction in the Departmental 
Administration budget from the 2013 enacted level. This reduction 
follows a headquarters freeze in the 2013 President's Budget--a two-
year commitment.
    Recent audits of the Department's financial statements have 
certified VA's success in remediating all three of our remaining 
material weaknesses in financial management, which had been carried 
forward for over a decade. In terms of internal controls and fiscal 
integrity, this was a major accomplishment. In the past four years, we 
have also dramatically reduced the number of significant financial 
deficiencies from 16 to 1.
    At VA, we believe that part of being responsible stewards is 
shutting down information technology (IT) projects that are no longer 
performing. Developed by our Office of Information and Technology, the 
Project Management Accountability System (PMAS) requires IT projects to 
establish milestones to deliver new functionality to its customers 
every 6 months. Now entering its third year, PMAS continues to instill 
accountability and discipline in our IT organization. Through PMAS, the 
cumulative, on-time delivery of IT functionality since its inception is 
82 percent, a rate unheard of in the industry where, by contrast, the 
average is 42 percent. By implementing PMAS, we have achieved at least 
$200 million in cost avoidance by shutting down or improving the 
management of 15 projects.
    Through the effective management of our acquisition resources, VA 
has achieved savings of over $200 million by participating in Federal 
strategic sourcing programs and establishing innovative IT acquisition 
contracts. In 2012, VA led the civilian agencies in contracting with 
Service-Disabled Veteran-Owned Small Businesses, which, at $3.4 
billion, accounted for 19.3 percent of all VA procurement awards. In 
addition, we have reduced interest penalties for late payments by 19 
percent (from $47 to $38 per million) over the past four years.
    Finally, VA's stewardship achieved savings in several other areas 
across the Department. The National Cemetery Administration (NCA) 
assumed responsibility in 2009 for processing First Notices of Death to 
terminate compensation benefits to deceased Veterans. Since taking on 
this responsibility, NCA has advised families of the burial benefits 
available to them, assisted in averting overpayments of some $142 
million in benefit payments and, thereby, helped survivors avoid 
possible collections. In addition, we implemented the use of Medicare 
pricing methodologies at the Veterans Health Administration (VHA) to 
pay for fee-basis services, resulting in savings of over $528 million 
since 2012 without negatively impacting Veteran care and with improved 
consistency in billing and payment.
                               technology
    To serve Veterans as well as they have served us, we are working on 
delivering a 21st century VA that provides medical care, benefits, and 
services through a digital infrastructure. Technology is integrated 
with everything we do for Veterans. Our hospitals use information 
technology to properly and accurately distribute and deliver 
prescriptions/medications to patients, track lab tests, process MRI and 
X-ray imaging, coordinate consults, and store medical records. VA IT 
systems supported over 1,300 VA points of healthcare in 2012: 152 
medical centers, 107 domiciliary rehabilitation treatment programs, 821 
community-based outpatient clinics, 300 Vet Centers, 6 independent 
outpatient clinics, 11 mobile outpatient clinics, and 70 mobile Vet 
Centers. Technology supports Veterans' education and disability claims 
processing, claims payments, home loans, insurance, and memorial 
services. Our IT infrastructure consists of telephone lines, data 
networks, servers, workstations, printers, cell phones, and mobile 
applications.
    No Veteran should have to wait months or years for the benefits 
that they have earned. We will eliminate the disability claims backlog 
in 2015; technology is the critical component for achieving our goal. 
VA is deploying technology solutions to improve access, drive 
automation, reduce variance, and enable faster and more efficient 
operations. Building on the resources Congress has provided in recent 
years to expand our claims processing capacity, the 2014 budget 
requests $291 million for technology to eliminate the claims backlog? 
$155 million in Veterans Benefits management System (VBMS) for our new 
paperless processing system, and $136 million in the Veterans Benefits 
Administration (VBA) to support a Veterans Claims Intake Program, our 
new online application system that will allow for the conversion of 
paper to digital images for our new paperless processing system, the 
Veterans Benefits Management System (VBMS). Without these resources, VA 
will be unable to meet its goal to eliminate the disability claims 
backlog in 2015.
Information Technology
    At VA, advances in technology--and the adoption of and reliance on 
IT in our daily commercial life--have been dramatic. Technology is 
integral to providing high quality healthcare and benefits. The 2014 
budget requests $3.683 billion for IT, an increase of $359 million from 
the President's 2013 Budget, reflecting the critical role technology 
plays in VA's daily work in serving and caring for Veterans and their 
families. Of the total request, $2.2 billion will support the operation 
and maintenance of our digital infrastructure and $495 million is for 
IT development modernization and enhancement projects.
    The 2014 budget includes $32.8 million for development of VBMS, our 
new paperless processing system that enables VA to move from its 
current paper-based process to a digital operating environment that 
improves access, drives automation, reduces variance, and enables 
faster, more efficient operations. As we increase claims examiners' use 
of VBMS version 4.2 to process rating disability claims, our major 
focus is on system performance, as we tune the system to be responsive 
and effective. VA will complete the rollout of VBMS in June 2013.
    In addition, the 2014 budget includes $120 million for development 
of the Veterans Relationship Management (VRM) initiative, which 
enhances Veterans' access to comprehensive VA services and benefits, 
especially in the delivery of compensation and pension claims 
processing. The program gives Veterans secure, personalized access to 
benefits and information and allows a timely response to their 
inquiries. Recently, VRM released Veterans Online Application Direct 
Connect (VDC), which enables Veterans to apply for VBA benefits by 
answering guided interview questions through the security of the 
eBenefits portal. Claims filed through eBenefits use VDC to load 
information and data directly into VBMS.
    The Virtual Lifetime Electronic Record (VLER) is an overarching 
program which aims to share health, benefits, and administrative 
information, including personnel records and military history records, 
among DOD, VA, SSA, private healthcare providers, and other Federal, 
State and local government partners. eBenefits is already reaching 2 
million Veterans and Servicemembers and 1 million active users with 
BlueButton. The 2014 budget requests $15.4 million for VLER to develop 
and support these functions as well as the Warrior Support Veterans 
Tracking Application; the Disability Benefits Questionnaires; a VA/DOD 
joint health information sharing project known as Bidirectional Health 
Information Exchange; and a storage interface known as Clinical Data 
Repository/Health Data Repository. All of these efforts are designed to 
enable the sharing of health, military personnel and personal 
information among VA, other Federal agencies, Veteran Service 
Organizations and private health care providers to expedite the award 
and processing of disability claims and other services such as 
education, training and job placement.
                     eliminating the claims backlog
    Too many Veterans wait too long to receive benefits they have 
earned. This is unacceptable. Today's claims backlog is the result of 
several factors, including: increased demand; over a decade of war with 
many Veterans returning with more severe, complex injuries; decisions 
on Agent Orange, Gulf War, and combat PTSD presumptions; and, 
successful outreach to Veterans informing them of their benefits. These 
facts, in no way, diminish the urgency that we all feel at VA to fix 
this problem which has been decades in the making. VA remains focused 
on eliminating the disability claims backlog in 2015 and processing all 
claims within 125 days at a 98-percent accuracy level.
    To deliver this goal, the Veterans Benefits Administration (VBA) is 
implementing a comprehensive transformation plan based on more than 40 
targeted initiatives to boost productivity by over the next several 
years However, as VBA transforms its people, processes, and 
technologies, its claims demand is expected to exceed on million 
annually. From 2010 through 2012, for the first time in its history, 
VBA processed more than one million claims in three consecutive years. 
In 2013, VBA expects to receive another million claims and similar 
levels of demand are anticipated in 2014. This is driven by successful 
outreach, claims growth not previously captured in VBA's baseline, and 
new requirements. Included are mandatory Servicemember participation in 
VOW/VEI benefits briefings and an expected increase upon successful 
completion of a transition assistance program, revamped by the 
President as Transition: Goals, Plan, Success (GPS). As more than one 
million troops leave service over the next 5 years, we expect our 
claims workload to continue to rise. In addition, VBA is experiencing 
an unprecedented workload growth arising from the number and complexity 
of medical conditions in Veterans' compensation claims. The average 
number of claimed conditions for our recently separated Servicemembers 
is now in the 12 to 16 range--roughly 5 times the number of 
disabilities claimed by Veterans of earlier eras. While the increase in 
compensation applications presents challenges, it is also an indication 
that we are being successful in our efforts to expand access to VA 
benefits.
    Investments in transformation of our people, processes, and 
technologies are already paying off in terms of improved performance. 
For example:

     People: More than 2,100 claims processors have completed 
Challenge Training, which improves the quality and productivity of VBA 
compensation claims decisionmakers. As a result of Challenge Training, 
VBA's new employees complete more claims per day than their 
predecessors--with a 30 percent increase in accuracy.
    VBA's new standardized organizational model incorporates a case-
management approach to claims processing that organizes its workforce 
into cross-functional teams that work together on one of three 
segmented lanes: express, special operations, or core. Claims that 
predictably can take less time will flow through an express lane (30 
percent); those taking more time or requiring special handling will 
flow through a special operations lane (10 percent); and the rest of 
the claims flow through the core lane (60 percent). Initially planned 
for deployment throughout 2013, VBA accelerated the implementation of 
the new organizational model by nine months due to early indications of 
its positive impact on performance.
    VBA instituted Quality Review Teams (QRTs) in 2012 to improve 
employee training and accuracy while decreasing rework time. QRTs focus 
on improving performance on the most common sources of error in the 
claims processing cycle. Today, for example, QRTs are focused on the 
process by which proper physical examinations are ordered; incorrect or 
insufficient exams previously accounted for 30 percent of VBA's error 
rate. As a result of this focus, VBA has seen a 23 percent improvement 
in this area.
     Process: Disability Benefits Questionnaires (DBQs) are 
online forms used by non-VA physicians to submit medical evidence. Use 
of DBQs has improved timeliness and accuracy of VHA-provided exams--
average processing time improved by 6 days from June 2011 to 
October 2012 (from 32 to 26 days).
    Fully developed claims (FDCs) are critical to reducing ``wait 
time'' and ``rework.'' FDCs include all DOD service medical and 
personnel records, including entrance and exit exams, applicable DBQs, 
any private medical records, and a fully completed claim form. Today, 
VBA receives 4.5 percent of claims in fully developed form and 
completes them in 117 days, while a regular claim takes 262 days to 
process. Fulfilling the Veterans Claims Assistance Act, to search for 
potential evidence, is the greatest portion of the current 262-day 
process. The Veterans Benefit Act of 2003 allows Veterans up to 365 
days, from the date of VA notice for additional information or 
evidence, to provide documentation. Of the 262 days to complete a 
regular claim, approximately145 days are spent waiting for potential 
evidence to qualify the application as a fully developed claim.
    VBA built new decision-support tools to make our employees more 
efficient and their decisions more consistent and accurate. Rules-based 
calculators provide suggested evaluations for certain conditions using 
objective data and rules-based functionality. The Evaluation Builder 
uses a series of check boxes that are associated with the Veteran's 
symptoms to help determine the proper diagnostic code of over 800 
codes, as well as the appropriate level of compensation based on the 
Veteran's symptoms.
     Technology: The centerpiece of VBA's transformation plan 
is VBMS--a new paperless electronic claims processing system that 
employs rules-based technology to improve decision speed and accuracy. 
For our Veterans, VBMS will mean faster, higher-quality, and more 
consistent decisions on claims. Our strategy includes active 
stakeholder participation (Veterans Service Officers, State Departments 
of Veterans Affairs, County Veterans Service Officers, and Department 
of Defense) to provide digital electronic files and claims pre-scanned 
through online claims submission via the eBenefits Web portal.
     VBA recently established the Veterans Claims Intake 
Program (VCIP). This program will streamline processes for receiving 
records and data into VBMS and other VBA systems. Scanning operations 
and the transfer of Veteran data into VBMS are primary intake 
capabilities that are managed by VCIP. As VBMS is deployed to 
additional regional offices, document scanning becomes increasingly 
important as the main mechanism for transitioning from paper-based 
claim folders to the new electronic environment.

    There are other ways that VA is working to eliminate the claims 
backlog. VHA has implemented multiple initiatives to expedite timely 
and efficient delivery of medical evidence needed to process a 
disability claim by VBA. As a result, timeliness improved by nearly 
one-third, from an average of 38 days in January 2011 to 26 days in 
October 2012. Recently, VA launched Acceptable Clinical Evidence (ACE), 
an initiative that allows clinicians to review existing medical 
evidence and determine whether they can use that evidence to complete a 
DBQ without requiring the Veteran to report for an in-person 
examination. This initiative was developed by both VHA and VBA in a 
joint effort to provide a Veteran-centric approach for disability 
examinations. Use of the ACE process opens the possibility of doing 
assessments without an in-person examination when there is sufficient 
information in the record.
    Another way to eliminate the claims backlog is by working closely 
with the DOD. The Integrated Disability Evaluation System (IDES) is a 
collaborative system to make disability evaluations seamless, simple, 
fast and fair. If the Servicemember is found medically unfit for duty, 
the IDES gives them a proposed VA disability rating before they leave 
the service. These ratings are normally based on VA examinations that 
are conducted using required IDES examination templates. In FY 2012, 
IDES participants were notified of VA benefit entitlement in an average 
of 54 days after discharge. This reflects an improvement from 67 days 
in May 2012 to 49 days in September 2012.
    The Benefits Delivery at Discharge (BDD) and Quick Start programs 
are two other collaborations for Servicemembers to file claims for 
service-connected disabilities. This can be done from 180 to 60 days 
prior to separation or retirement. BDD claims are accepted at every VA 
Regional Office and at intake sites on military installations in the 
U.S., and at two intake site locations overseas. In 2012, BDD received 
more than 30,300 claims and completed 24,944--a 14% increase over 
2011's productivity (21,657). During this same period of time Quick 
Start decreased their rating inventory by over 44 percent.
               expanding access to benefits and services
    VA remains committed to ensuring that Veterans are not only aware 
of the benefits and services that they are entitled to, but that they 
are able to access them. We are improving access to VA services by 
opening new or improved facilities closer to where Veterans live. Since 
2009, we have added 57 community-based outpatient clinics (CBOCs), for 
a total of 840 CBOCs through 2013, and increased the number of mobile 
outpatient clinics and mobile Vet Centers, serving rural Veterans, to 
81. Last August, we opened a state-of-the-art medical center in Las 
Vegas, the first new VAMC in 17 years. The 2014 medical care budget 
request includes $799 million to open new and renovated healthcare 
facilities and includes the authorization request for 28 new and 
replacement medical leases to increase Veteran access to services.
    Today, access is much more than the ability to walk into a VA 
medical facility; it also includes technology, and programs, as well 
as, facilities. Expanding access includes taking the facility to the 
Veteran--be it virtually through telehealth, by sending Mobile Vet 
Centers to rural areas where services are scarce, or by using social 
media sites like Facebook, Twitter, and YouTube to connect Veterans to 
VA benefits and facilities. Telehealth is a major breakthrough in 
healthcare delivery in 21st century medicine, and is particularly 
important for Veterans who live in rural and remote areas. The 2014 
budget requests $460 million for telehealth, an increase of $388 
million, or 542 percent, since 2009.
    As more Veterans access our healthcare services, we recognize their 
unique needs and the needs of their families--many have been affected 
by multiple, lengthy deployments. VA provides a comprehensive system of 
high-quality mental health treatment and services to Veterans. We are 
using many tools to recruit and retain our large mental healthcare 
workforce to better serve Veterans by providing enhanced services, 
expanded access, longer clinic hours, and increased telemental health 
capabilities. In response to increased demand over the last four years, 
VA has enhanced its capacity to deliver needed mental health services 
and to improve the system of care so that Veterans can more readily 
access them. Since 2006, the number of Veterans receiving specialized 
mental health treatment has risen each year, from over 927,000 to more 
than 1.3 million in 2012, partly due to proactive screening. Outpatient 
visits have increased from 14 million in 2009 to over 17 million in 
2012. VA believes that mental healthcare must constantly evolve and 
improve as new knowledge becomes available through research.
    The 2014 budget includes $168.5 million for the Veterans 
Relationship Management (VRM) initiative, which is fundamentally 
transforming Veterans' access to VA benefits and services by empowering 
VA clients with new self-service tools. VA has already made major 
strides under this initiative. Most recently, in November 2012, VRM 
added new features to eBenefits, a Web application that allows Veterans 
to access their VA benefits and submit some claims online. Veterans can 
now enroll in and manage their insurance policies, select reserve 
retirement benefits, and browse the Veterans Benefits Handbook from the 
eBenefits Website. With the help of Google mapping services, the update 
also enables Veterans to find VA representatives in their area and 
where they are located. Since its inception in 2009, eBenefits has 
added more than 45 features allowing Veterans easier, quicker, and more 
convenient access to their VA benefits and personal information.
    VBA has aggressively promoted eBenefits and the ease of enrolling 
into the system. We currently have over 2.5 million registered 
eBenefits users. Users can check the status of claims or appeals, 
review VA payment history, obtain military documents, and perform 
numerous other benefit actions through eBenefits. The Stakeholder 
Enterprise Portal (SEP) is a secure Web-based access point for VA's 
business partners. This electronic portal provides the ability for VSOs 
and other external VA business partners to represent Veterans quickly 
and efficiently.
    VA also continues to increase access to burial services for 
Veterans and their families through the largest expansion of its 
national cemetery system since the Civil War. At present, approximately 
90 percent of the Veteran population--about 20 million Veterans--has 
access to a burial option in a national, state, or tribal Veterans 
cemetery within 75 miles of their homes. In 2004, only 75 percent of 
Veterans had such access. This dramatic increase is the result of a 
comprehensive strategic planning process that results in the most 
efficient use of resources to reach the greatest number of Veterans.
                      ending veteran homelessness
    The last of our three priority goals is to end homelessness among 
Veterans in 2015. Since 2009, we have reduced the estimated number of 
homeless Veterans by more than 17 percent. The January 2012 Point-In-
Time estimate, the latest available, is 62,619. We have also created a 
National Homeless Veterans Registry to track our known homeless and at-
risk populations closely to ensure resources end up where they are 
needed. In 2012, over 240,000 homeless or at-risk Veterans accessed 
benefits or services through VA and 96,681 homeless or at-risk Veterans 
were assessed by VHA's homeless programs. Over 31,000 homeless and at-
risk Veterans and their families obtained permanent housing through VA 
specialized homeless programs.
    In the 2014 budget, VA is requesting $1.393 billion for programs to 
assist homeless Veterans, through programs such as Department of 
Housing and Urban Development-VA Supportive Housing (HUD-VASH), Grant 
and Per Diem, Homeless Registry, and Health Care for Homeless Veterans. 
This represents an increase of $41 million, or 3 percent over the 2013 
enacted level. This budget will support our long-range plan to end 
Veteran homelessness by emphasizing rescue and prevention--rescue for 
those who are homeless today, and prevention for those at risk of 
homelessness.
    Our prevention strategy includes close partnerships with some 150 
community non-profits through the Supportive Services for Veteran 
Families (SSVF) program; SSVF grants promote housing stability among 
homeless and at-risk Veterans and their families. The grants can have 
an immediate impact, helping lift Veterans out of homelessness or 
providing aid in emergency situations that put Veterans and their 
families at risk of homelessness. In 2012, we awarded $100 million in 
Supportive Service grants to help Veterans and families avoid life on 
the streets. We are currently reviewing proposals for the $300 million 
in grants we will distribute later this year. In 2012, SSVF resources 
directly helped approximately 21,000 Veterans and over 35,000 household 
members, including nearly 9,000 children. This year's grants will help 
up to 70,000 Veterans and family members avoid homelessness. The 2014 
budget includes $300 million for SSVF.
    To increase homeless Veterans' access to benefits, care, and 
services, VA established the National Call Center for Homeless Veterans 
(NCCHV). The NCCHV provides homeless Veterans and Veterans at-risk for 
homelessness free, 24/7 access to trained counselors. The call center 
is intended to assist homeless Veterans and their families, VA medical 
centers, Federal, state and local partners, community agencies, service 
providers, and others in the community. Family members and non-VA 
providers who call on behalf of homeless Veterans are provided with 
information on VA homeless programs and services. In 2012, the National 
Call Center for Homeless Veterans received 80,558 calls (123 percent 
increase) and the center made 50,608 referrals to VA medical centers 
(133 percent increase).
    VA's Homeless Patient Aligned Care Teams (H-PACTs) program provides 
a coordinated ``medical home'' specifically tailored to the needs of 
homeless Veterans. The program integrates clinical care with delivery 
of social services and enhanced access and community coordination. 
Implementation of this model is expected to address health disparity 
and equity issues facing the homeless population. Expected program 
outcomes include reduced emergency department use and hospitalizations, 
improved chronic disease management, and improved ``housing readiness'' 
with fewer Veterans returning to homelessness once housed.
    During 2012, 119,878 unique homeless Veterans were served by the 
Health Care for Homeless Veterans Program (HCHV), an increase of more 
than 21 percent from 2011. At more than 135 sites, HCHV offers 
outreach, exams, treatment, referrals, and case management to Veterans 
who are homeless and dealing with mental health issues, including 
substance use. Initially serving as a mechanism to contract with 
providers for community-based residential treatment for homeless 
Veterans, many HCHV programs now serve as the hub for myriad housing 
and other services that provide VA with a way to outreach and assist 
homeless Veterans by offering them entry to VA medical care.
    VA's Homeless Veterans Apprenticeship Program was established in 
2012--a 1-year paid employment training program for Veterans who are 
homeless or at risk of homelessness. This program created paid 
employment positions as Cemetery Caretakers at five of our 131 national 
cemeteries. The initial class of 21 homeless Veterans is simultaneously 
enrolled in VHA's Homeless Veterans Supported Employment program. 
Apprentices who successfully complete 12 months of competency-based 
training will be offered permanent full-time employment at a national 
cemetery. Successful participants will receive a Certificate of 
Competency which can also be used to support employment applications in 
the private sector.
    Another avenue of assistance is through Veterans Treatment Courts, 
which were developed to avoid unnecessary incarceration of Veterans who 
have developed mental health problems. The goal of Veterans Treatment 
Courts is to divert those with mental health issues and homelessness 
from the traditional justice system and to give them treatment and 
tools for rehabilitation and readjustment. While each Veterans 
Treatment Court is part of the local community's justice system, they 
form close working partnerships with VA and Veterans' organizations. As 
of early 2012 there are 88 Courts.
    The Veterans Justice Outreach (VJO) program exists to connect these 
justice-involved Veterans with the treatment and other services that 
can help prevent homelessness and facilitate recovery, whether or not 
they live in a community that has a Veterans Treatment Court. Each VA 
Medical Center has at least one designated justice outreach specialist 
who functions as a link between VA, Veterans, and the local justice 
system. Although VA cannot treat Veterans while they are incarcerated, 
these specialists provide outreach, assessment and linkage to VA and 
community treatment, and other services to both incarcerated Veterans 
and justice-involved Veterans who have not been incarcerated.
                multi-year plan for medical care budget
    Under the Veterans Health Care Budget Reform and Transparency Act 
of 2009, which we are grateful to Congress for passing; VA submits its 
medical care budget that includes an advance appropriations request in 
each budget submission. The legislation requires VA to plan its medical 
care budget using a multi-year approach. This policy ensures that VA 
requirements are reviewed and updated based on the most recent data 
available and actual program experience.
    The 2014 budget request for VA medical care appropriations is $54.6 
billion, an increase of 3.7 percent over the 2013 enacted level of 
$52.7 billion. The request is an increase of $157.5 million above the 
enacted 2014 advance appropriations level. Based on updated 2014 
estimates largely derived from the Enrollee Health Care Projection 
Model, the requested amount would allow VA to increase funding in 
programs to eliminate Veteran homelessness; continue implementation of 
the Caregivers and Veterans Omnibus Health Services Act; fulfill 
multiple responsibilities under the Affordable Care Act; provide for 
activation requirements for new or replacement medical facilities; and 
invest in strategic initiatives to improve the quality and 
accessibility of VA healthcare programs. Our multi-year budget plan 
assumes that VHA will carry over negligible unobligated balances from 
2013 into 2014--consistent with the 2013 budget submitted to Congress.
    The 2015 request for medical care advance appropriations is $55.6 
billion, an increase of $1.1 billion, or 1.9 percent, over the 2014 
budget request. Medical care funding levels for 2015, including funding 
for activations, non-recurring maintenance, and initiatives, will be 
revisited during the 2015 budget process, and could be revised to 
reflect updated information on known funding requirements and 
unobligated balances.
                          medical care program
    The 2014 budget of $57.7 billion, including collections, provides 
for healthcare services to treat over 6.5 million unique patients, an 
increase of 1.3 percent over the 2013 estimate. Of those unique 
patients, 4.5 million Veterans are in Priority Groups 1-6, an increase 
of more than 71,000 or 1.6 percent. Additionally, VA anticipates 
treating over 674,000 Veterans from the conflicts in Iraq and 
Afghanistan, an increase of over 67,000 patients, or 11.1 percent, over 
the 2013 level. VA also provides medical care to non-Veterans through 
programs such the Civilian Health and Medical Program of the Department 
of Veterans Affairs (CHAMPVA) and the Spina Bifida Health Care Program; 
this population is expected to increase by over 17,000 patients, 2.6 
percent, during the same time period.
    The 2014 budget proposes to extend the Administration's current 
policy to freeze Veterans' pharmacy co-payments at the 2012 rates, 
until January 2015. Under this policy, which will be implemented in a 
future rulemaking, co-payments will continue at $8 for Veterans in 
Priority Groups 2 through 6 and at $9 for Priority Groups 7 through 8.
    The 2014 budget requests $47 million to provide healthcare for 
Veterans who were potentially exposed to contaminated drinking water at 
Camp Lejeune as required by the Honoring America's Veterans and Caring 
for Camp Lejeune Families Act of 2012, enacted last August. Since VA 
began implementation of the law and in January 2013, 1,400 Veterans 
have contacted us concerning Camp Lejeune. Of these, roughly 1,100 were 
already enrolled in VA healthcare. Veterans who are eligible for care 
under the Camp Lejeune authority, regardless of current enrollment 
status with VA, will not be charged a co-payment for healthcare related 
to the 15 illnesses or conditions recognized, nor will a third-party 
insurance company be billed for these services. In 2015, VA expects to 
start treating family members as authorized under the law and has 
included $25 million for this purpose within the 2015 advance 
appropriations request. VA continues a robust outreach campaign to 
these Veterans and family members while we press forward with 
implementing this complex new law.
Mental Healthcare and Suicide Prevention
    At VA, we have the opportunity and the responsibility to anticipate 
the needs of returning Veterans. Mental healthcare at VA is a system of 
comprehensive treatments and services to meet the individual mental 
health needs of Veterans. VA is expanding mental health programs and is 
integrating mental health services with primary and specialty care to 
provide better coordinated care for our Veteran patients. Our 2014 
budget provides nearly $7.0 billion for mental healthcare, an increase 
of $469 million, or 7.2 percent, over 2013. Since 2009, VA has 
increased funding for mental health services by 56.9 percent. VA 
provided mental health services to 1,391,523 patients in 2012, 58,000 
more than in 2011.
    To serve the growing number of Veterans seeking mental healthcare, 
VA has deployed significant resources and is increasing the number of 
staff in support of mental health services. Consistent with the 
President's August 31, 2012 Executive Order, VHA is on target to 
complete the goal of hiring 1,600 additional mental health clinical 
providers and 300 administrative support staff by June 30, 2013 to meet 
the growing demand for mental health services. In addition, as part of 
VA's efforts to implement the Caregivers and Veterans Omnibus Health 
Services Act of 2010, VA has hired over 100 Peer Specialists in recent 
months, and is hiring and training nearly 700 more. Additionally, VA 
has awarded a contract to the Depression and Bipolar Support Alliance 
to provide certification training for Peer Specialists. This peer staff 
is expected to be hired by December 31, 2013, and will work as members 
of mental health teams.
    In addition to hiring more mental health workers, VA is developing 
electronic tools to help VA clinicians manage the mental health needs 
of their patients. Clinical Reminders give clinicians timely 
information about patient health maintenance schedules, and the High-
Risk Mental Health National Reminder and Flag system allows VA 
clinicians to flag patients who are at-risk for suicide. When an at-
risk patient does not keep an appointment, Clinical Reminders prompt 
the clinician to follow-up with the Veteran.
    Since its inception in 2007, the Veterans Crisis Line in 
Canandaigua, New York, has answered over 725,000 calls and responded to 
more than 80,000 chats and 5,000 texts from Veterans in need. In the 
most serious calls, approximately 26,000 men and women have been 
rescued from a suicide in progress because of our intervention--the 
equivalent of two Army divisions.
    We recently completed a 2012 VA suicide data report, a result of 
the most comprehensive review of Veteran suicide rates ever undertaken 
by VA. We are working hard to understand this issue--and VA and DOD 
have jointly funded a $100 million suicide research project. We will be 
better informed about suicides, but while research is ongoing, we are 
taking immediate action and are not waiting 10 years for final study 
outcomes. These actions include Veterans Chat on the Veterans Crisis 
Line, local Suicide Prevention Coordinators' for counseling and 
services, and availability of VA/DOD Suicide Outreach resources.
The Affordable Care Act
    The Affordable Care Act (ACA) expands access to coverage, reins in 
health care costs, and improves the Nation's health care delivery 
system. The Act has important implications for VA. Beginning in 2014, 
many uninsured Americans, including Veterans, will have access to 
quality, affordable health insurance choices through Health Insurance 
Marketplaces, also known as Exchanges, and may be eligible for premium 
tax credits and cost-sharing reductions to make coverage more 
affordable. The 2014 budget requests $85 million within the Medical 
Care request and $3.4 million within the Information Technology request 
to fulfill multiple responsibilities as a provider of Minimum Essential 
Coverage under the Affordable Care Act, including: (1) providing 
outreach and communication on ACA to Veterans related to VA health 
care; (2) reporting to Treasury on individuals who are enrolled in the 
VA healthcare system; and (3) providing a written statement to each 
enrolled Veteran about their coverage by January 2015.
Medical Care in Rural Areas
    VA remains committed to the delivery of medical care in rural areas 
of our country. For that reason, in 2012, we obligated $248 million to 
support the efforts of the Office of Rural Health to improve access and 
quality of care for enrolled Veterans who live in rural areas. Some 3.4 
million Veterans enrolled in the VA healthcare system live in rural or 
highly rural areas of the country; this represents about 41 percent of 
all enrolled Veterans. For that reason, VA will continue to emphasize 
rural health in our budget planning, including addressing the needs of 
American Indian and Alaska Native (AI/AN) Veterans.
    VA is committed to expanding access to the full range of VA 
programs to eligible AI/AN Veterans. Last year, VA signed a Memorandum 
of Agreement with the Indian Health Service (IHS), through which VA 
will reimburse IHS for direct care services provided to eligible 
American Indian and Alaska Native Veterans. While the national 
agreement applies only to VA and IHS, it will inform agreements 
negotiated between the VA and tribal health programs.
    This follows the agreement already in place between VA and IHS 
whereby nearly 250,000 patients served by IHS have utilized a 
prescription program that allows IHS pharmacies to use VA's 
Consolidated Mail Outpatient Pharmacy (CMOP) to process and mail 
prescription refills for IHS patients. By accessing the service, IHS 
patients can now have their prescriptions mailed to them, in many cases 
eliminating the need to pick them up at an IHS pharmacy.
Women Veterans Medical Care
    Changing demographics are also driving change at VA. Today, we have 
over 2.2 million women Veterans in our country; they are the fastest 
growing segment of our Veterans' population. Since 2009, the number of 
women Veterans enrolled in VA healthcare increased by almost 22 
percent, to 591,500. However, by 2022--less than a decade from now--
their number is projected to spike to almost 2.5 million, and an 
estimated 900,000 will be enrolled in VA healthcare.
    The 2014 budget requests $422 million, an increase of 134 percent 
since 2009, for gender-specific medical care for women Veterans. Since 
2009, we have invested $25.5 million in improvements to women Veterans' 
clinics and opened 19 new ones. Today, nearly 50 percent of our 
facilities have comprehensive women's clinics, and every VA healthcare 
system has designated women's health primary care providers, and has a 
women Veteran's program manager on staff.
    In 2012, VA awarded 32 grants totaling $2 million to VA facilities 
for projects that will improve emergency healthcare services for women 
Veterans, expand women's health education programs for VA staff, and 
offer telehealth programs to female Veterans in rural areas. These new 
projects will improve access and quality of critical healthcare 
services for women. This is the largest number of one-year grants VA 
has ever awarded for enhancing women's health services.
                            medical research
    Medical Research is being supported with $586 million in direct 
appropriations in 2014, with an additional $1.3 billion in funding 
support from VA's medical care program and through Federal and non-
Federal grants. VA Research and Development will support 2,224 projects 
during 2014.
    Projects funded in 2014 will be focused on supporting development 
of New Models of Care, identifying or developing new treatments for 
Gulf War Veterans, improving social reintegration following Traumatic 
Brain Injury, reducing suicide, evaluating the effectiveness of 
complementary and alternative medicine, developing blood tests to 
assist in the diagnosis of Post Traumatic Stress Disorder and mild 
Traumatic Brain Injury, and advancing genomic medicine.
    The 2014 budget continues support for the Million Veteran Program 
(MVP), an unprecedented research program that advances the promises of 
genomic science. The MVP will establish a database, used only by 
authorized researchers in a secure manner, to conduct health and 
wellness studies to determine which genetic variations are associated 
with particular health issues--potentially helping the health of 
America's Veterans and the general public. MVP recently enrolled its 
100,000th volunteer research participant, and by the end of 2013, the 
goal is to enroll at least 150,000 participants in the program.
                    veterans benefits administration
    The 2014 budget request of $2.455 billion for VBA, an increase of 
$294 million in discretionary funds from the 2013 enacted level, is 
vital to the transformation strategy that drives our performance 
improvements focused most squarely on the backlog.
    Virtually all 860,000 claims in the VBA inventory, including the 
600,000 claims that have been at VA for over 125 days and are 
considered backlogged, exist only in paper. Our transition to VBMS and 
electronic claims processing is a massive and crucial phase in VBA 
transformation. VA awarded two VCIP contracts in 2012 to provide 
document conversion services that will populate the electronic claims 
folder, or eFolder, in VBMS with images and data extracted from paper 
and other source material. Without VCIP, we cannot populate the eFolder 
on which the VBMS system relies. The 2014 request for $136 million for 
our scanning services contracts will ensure that we remain on track to 
reach this key goal. In addition, the budget request includes $4.9 
million for help desk support for Veterans using the Veterans On-Line 
Application/eBenefits system.
    VBA projects a beneficiary caseload of 4.6 million in 2014, with 
more than $70 billion in compensation and pension benefits obligations. 
We expect to process 1.2 million compensation claims in 2014, and we 
are pursuing improvements that will enable us to meet the emerging 
needs of Veterans and their families.
Veterans Employment
    Under the leadership of President Obama, VA, DOD, the Department of 
Labor, and the entire Federal Government have made Veterans employment 
one of their highest priorities. In August 2011, the President 
announced his comprehensive plan to address this issue and to ensure 
that all of America's Veterans have the support they need and deserve 
when they leave the military, look for a job, and enter the civilian 
workforce. He created a new DOD/VA Employment Initiative Task Force 
that would develop a new training and services delivery model to help 
strengthen the transition of our Veteran Servicemembers from military 
to civilian life. VA has worked closely with other partners in the Task 
Force to identify its responsibilities and ensure delivery of the 
President's vision. On November 21, 2012, the effective date of the VOW 
Act, VA began deployment of the enhanced VA benefits briefings under 
the revised Transition Assistance Program (TAP), called Transition GPS 
(Goals, Plans, Success). VA will also provide training for the optional 
Technical Training Track Curriculum and participate in the Capstone 
event, which will ensure that separating Servicemembers have the 
opportunity to verify that they have met Career Readiness Standards and 
are steered to the resources and benefits available to them as 
Veterans. Accordingly, the 2014 budget requests $104 million to support 
the implementation of Transition GPS and meet VA's responsibilities 
under the VOW Act and the President's Veterans Employment Initiative.
Veterans Job Corps
    In his State of the Union address in 2012, President Obama called 
for a new Veterans Job Corps initiative to help our returning Veterans 
find pathways to civilian employment. The 2014 budget includes $1 
billion in mandatory funding to develop a Veterans Job Corps 
conservation program that will put up to 20,000 Veterans back to work 
over the next five years protecting and rebuilding America. Jobs will 
include park maintenance projects, patrolling public lands, 
rehabilitating natural and recreational areas, and administrative, 
technical, and law enforcement-related activities. Additionally, 
Veterans will help make a significant dent in the deferred maintenance 
of our Federal, State, local, and tribal lands including jobs that will 
repair and rehabilitate trails, roads, levees, recreation facilities 
and other assets. The program will serve all Veterans, but will have a 
particular focus on post-9/11 Veterans.
Post-9/11 and other Education Programs
    Since 2009, VA has provided over $25 billion in Post-9/11 GI Bill 
benefits to cover the education and training of more than 893,000 
Servicemembers, Veterans, family members, and survivors. We are now 
working with Student Veterans of America to track graduation and 
training completion rates.
    The Post-9/11 GI Bill continues to be a focus of VBA transformation 
as it implements the Long-Term Solution (LTS). At the end of February 
we had approximately 60,000 education claims pending, 70 percent lower 
than the total claims pending the same time last year. The average days 
to process Post-9/11 GI Bill supplemental claims has decreased by 17 
days, from 23 days in September 2012 to 6 days in February 2013. The 
average time to process initial Post-9/11 GI Bill original education 
benefit claims in February was 24 days.
                    national cemetery administration
    The 2014 budget includes $250 million in operations and maintenance 
funding for the National Cemetery Administration (NCA). As we move 
forward into the next fiscal year, NCA projects our workload numbers 
will continue to increase. For 2014, we anticipate conducting 
approximately 121,000 interments of Veterans or their family members, 
maintaining and providing perpetual care for approximately 3.4 million 
gravesites. NCA will also maintain 9,000 developed acres and process 
approximately 345,000 headstone and marker applications.
Review of National Cemeteries
    For the first time in the 150-year history of national cemeteries, 
NCA has completed a self-initiated, comprehensive review of the entire 
inventory of 3.2 million headstones and markers within the 131 national 
cemeteries and 33 Soldiers' Lots it maintains. The information gained 
was invaluable in validating current operations and ensuring a 
sustainment plan is in place to enhance our management practices. The 
review was part of NCA's ongoing effort to ensure the full and accurate 
accounting of remains interred in VA national cemeteries. Families of 
those buried in our national shrines can be assured their loved ones 
will continue to be cared for into perpetuity.
Veterans Employment
    NCA continues to maintain its commitment to hiring Veterans. 
Currently, Veterans comprise over 74 percent of its workforce. Since 
2009, NCA has hired over 400 returning Iraq and Afghanistan Veterans. 
In addition, 82 percent of contracts in 2012 were awarded to Veteran-
owned and service-disabled Veteran-owned small businesses. NCA's 
committed, Veteran-centric workforce is the main reason it is able to 
provide a world-class level of customer service. NCA received the 
highest score--94 out of 100 possible--in the 2010 American Customer 
Satisfaction Index (ACSI) sponsored by the University of Michigan. This 
was the fourth time NCA participated and the fourth time it received 
the top rating in the Nation.
Partnerships
    NCA continues to leverage its partnerships to increase service for 
Veterans and their families. As a complement to the national cemetery 
system, NCA administers the Veterans Cemetery Grant Service (VCGS). 
There are currently 88 operational state and tribal cemeteries in 43 
states, Guam, and Saipan, with 6 more under construction. Since 1978, 
VCGS has awarded grants totaling more than $500 million to establish, 
expand, or improve Veterans' cemeteries. In 2012, these cemeteries 
conducted over 31,000 burials for Veterans and family members.
    NCA works closely with funeral directors and private cemeteries, 
two significant stakeholder groups, who assist with the coordination of 
committal services and interments. Funeral directors may also help 
families in applying for headstones, markers, and other memorial 
benefits. NCA partners with private cemeteries by furnishing headstones 
and markers for Veterans' gravesites in these private cemeteries. In 
January of this year, NCA announced the availability of a new online 
funeral directors resource kit that may be used by funeral directors 
nationwide when helping Veterans and their families make burial 
arrangements in VA national cemeteries.
                         capital infrastructure
    A total of $1.1 billion is requested in 2014 for VA's major and 
minor construction programs. The capital asset budget reflects VA's 
commitment to provide safe, secure, sustainable, and accessible 
facilities for Veterans. The request also reflects the current fiscal 
climate and the great challenges VA faces in order to close the gap 
between our current status and the needs identified in our Strategic 
Capital Investment Planning (SCIP) process.
Major Construction
    The major construction request in 2014 is $342 million for one 
medical facility project and three National Cemeteries. The request 
will fund the completion of a mental health building in Seattle, 
Washington, to replace the existing, seismically deficient building. It 
will also increase access to Veteran burial services by providing a 
National Cemetery in Central East Florida; Omaha, Nebraska; and 
Tallahassee, Florida.
    The 2014 budget includes $5 million for NCA for advance planning 
activities. VA is in the process of establishing two additional 
national cemeteries in Western New York and Southern Colorado, 
according to the burial access policies included in the 2011 budget. 
These two new cemeteries, along with the three requested in 2014, will 
increase access to 550,000 Veterans. NCA has obligated approximately 
$16 million to acquire land in 2012 and 2013 for the planned new 
national cemeteries in Central East Florida; Tallahassee, Florida; and 
Omaha, Nebraska.
Minor Construction
    In 2014, the minor construction request is $715 million, an 
increase of 17.8 percent from the 2013 enacted level. It would provide 
for constructing, renovating, expanding and improving VA facilities, 
including planning, assessment of needs, gravesite expansions, site 
acquisition, and disposition. VA is placing a funding priority on minor 
construction projects in 2014 for two reasons. First, our aging 
infrastructure requires a focus on maintenance and repair of existing 
facilities. Second, the minor construction program can be implemented 
more quickly than the long-term major construction program to enhance 
Veterans' services.
    In light of the difficult fiscal outlook for our Nation, it's time 
to carefully consider VA's footprint and our real property portfolio. 
In 2012, VA spent approximately $23 million to maintain unneeded 
buildings. Achieving significant reduction in unneeded space is a 
priority for the Administration and VA. To support this priority, the 
President has proposed a Civilian Property Realignment Act (CPRA), 
which would allow agencies like VA to address the competing stakeholder 
interests, funding issues, and red tape that slows down or prevents the 
Federal Government from disposing of real estate. If enacted by 
Congress, this process would give VA more flexibility to dispose of 
property and improve the management of its inventory.
                              legislation
    Besides presenting VA's resource requirements to meet our 
commitment to the Nation's Veterans, the President's Budget also 
requests legislative action that we believe will benefit Veterans. 
There are many worthwhile proposals for your consideration, but let me 
highlight a few. For improvements to Veterans healthcare, our budget 
includes a measure to allow VA to provide Veterans with alternatives to 
long-stay nursing homes, and enhance VA's ability to provide 
transportation services to assist Veterans with accessing VA healthcare 
services. Our legislative proposasl also request that Congress make 
numerous improvements to VA's critical homelessness programs, including 
allowing an increased focus on homeless Veterans with special needs, 
including women, those with minor dependents, the chronically mentally 
ill, and the terminally ill.
    We also are putting forward proposals aimed squarely at the 
disability claims backlog--such as establishing standard claims 
application forms--that are reasonable and thoughtful changes that go 
hand-in-hand with the ongoing transformation and modernization of our 
disability claims system. We are offering reforms to our Specially 
Adaptive Housing program that will remove rules that in some 
circumstances can arbitrarily limit the benefit. The budget's 
legislative proposals also include ideas for expanding and improving 
services in our national cemeteries.
    Finally, this budget includes provisions that will benefit Veterans 
and taxpayers by allowing for efficiencies and cost savings in VA's 
operations--for example, we are forwarding a proposal that would 
require that private health plans treat VA as a `participating 
provider'--preventing those plans from limiting payments or excluding 
coverage for Veterans' non-service-connected conditions. VA merits 
having this status, and the additional revenue will fund medical care 
for Veterans. We are also requesting spending flexibility so that we 
can more effectively partner with other Federal agencies, including 
DOD, in pursuit of collaborations that will benefit Veterans and 
Servicemembers and deliver healthcare more efficiently.
                                summary
    Veterans stand ready to help rebuild the American middle class and 
return every dollar invested in them by strengthening our Nation. And 
we, at VA, will continue to implement the President's vision of a 21st 
century VA, worthy of those who, by their service and sacrifice, have 
kept our Nation free. Thanks to the President's leadership and the 
solid support of Congress, we have made huge strides in our journey to 
provide all generations of Veterans the best possible care and benefits 
through improved technology that they earned through their selfless 
service. We are committed to continue that journey, even as the numbers 
of Veterans using VA services increase in the coming years, through the 
responsible use of the resources provided in the 2014 budget and 2015 
advance appropriations requests. Again, thank you for the opportunity 
to appear before you today and for your steadfast support of our 
Nation's Veterans.
                                 ______
                                 
Response to Posthearing Questions Submitted by Hon. Bernard Sanders to 
 Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs
                      benefits and burial programs
    Question 1. Provide the current performance standards for employees 
involved with the processing of claims.
    Response. Please see attached documents, ``Q1--PMC RVSR Performance 
Plan,'' ``Q1--PMC VSR Performance Plan,'' ``Q1--RVSR Standard,'' and 
``Q1--VSR Standard.''

    [The referenced files, due to their volume, are not being 
reproduced here.]

    The current performance standards for Veterans Service 
Representatives (VSR) and Rating Veterans Service Representatives 
(RVSR) are attached. The performance standards are based on the 
employee's General Schedule grade level. VSRs and RVSRs are evaluated 
based on quality of work, productivity, customer service, workload 
management, cooperation, and organizational support. Claims processors 
are awarded credit for actions taken to process a claim.

    Question 2. Provide the job titles, grade level and number of FTE 
assigned to each of the services and organizations within the Veterans 
Benefits Administration as of April 1, 2011 and April 1, 2013.
    Response. Please see attachment entitled ``VBA-SVAC-PHQ2FTElist''

    [The referenced file, due to its volume, is not being reproduced 
here.]

    For the purposes of this response, the spreadsheet reflects Full-
time Equivalent (FTE) rather than individual employees. One FTE is the 
equivalent of one employee working full time. For example, an employee 
who is scheduled for 80 hours per pay period is considered 1 FTE, an 
employee scheduled for 40 hours per pay period is considered .5 FTE, an 
employee scheduled for 20 hours is considered .25 FTE, and so on. It is 
also important to note that if an office has and is authorized 10 FTE, 
there could theoretically be 20 half time employees to meet the 10 FTE 
limit. In this example, when examining performance output or budget 
authorizations, it would be misleading to note the office has 20 
employees since it may be assumed the office has 20 full time 
employees. This accounts for why whole numbers are not shown in the 
spreadsheet.

    Question 3. Provide the number of FTE at each VA regional office, 
separated by job tittle and grade as of April 1, 2011 and April 1, 
2013.
    Response. Please see attachment entitled ``VBA-SVAC-PHQ3FTElist''

    [The referenced file, due to its volume, is not being reproduced 
here.]

    For the purposes of this response, the spreadsheet reflects Full-
time Equivalent (FTE) rather than individual employees. One FTE is the 
equivalent of one employee working full time. For example, an employee 
who is scheduled for 80 hours per pay period is considered 1 FTE, an 
employee scheduled for 40 hours per pay period is considered .5 FTE, an 
employee scheduled for 20 hours per pay period is considered .25 FTE, 
and so on. It is also important to note that if an office has and is 
authorized 10 FTE, there could theoretically be 20 half time employees 
to meet the 10 FTE limit. In this example, when examining performance 
output or budget authorizations, it would be misleading to note the 
office has 20 employees since it may be assumed the office has 20 full 
time employees. This accounts for why whole numbers are not shown in 
the spreadsheet.

    Question 4. Provide the methodology utilized to allocate personnel 
and resources to the regional offices.
    Response. Veterans Benefits Administration's (VBA) Resource 
Allocation Model (RAM) is a systematic approach to distributing field 
resources each fiscal year. The RAM uses a weighted model to assign 
compensation and pension FTE resources based on regional office (RO) 
workload in rating receipts, rating inventory, non-rating receipts, and 
appeals receipts. VBA leaders use the model as a guide, making some 
adjustments for special circumstances or missions performed by 
individual ROs. Special missions include the Appeals Management Center, 
the Records Management Center, Day-One Brokering Centers, IDES 
processing sites, Benefits Delivery at Discharge sites, Quick Start 
processing locations, national call centers, fiduciary hubs, pension 
management centers, etc. Similar workload-based models are used for 
each VBA business line.
    Non-payroll and travel resources are allocated to each RO based on 
business need. RO need is driven by the number of FTE, benefits 
programs administered by the RO, and other factors that are unique to 
each RO, such as geographic location and jurisdiction, facility 
characteristics, security needs, and workload.
    VBA's Office of Field Operations works with the Area Offices and 
ROs to determine resource needs.

    Question 5. As of 2009, VA started updating the VA Schedule for 
Rating Disabilities yet this budget request includes little information 
about the status or resources necessary to complete this effort.
    a. Provide an itemized list of funding expended in FY 2012 on the 
rating schedule modernization.
    Response. The Department of Veterans Affairs (VA) is in the process 
of updating the VA Schedule for Rating Disabilities (VASRD). As part of 
this process, members of Compensation Service, Regulations Staff hosted 
multiple public forums to gather scientific evidence regarding 
disabling conditions and their impact on the average impairment of 
earnings capacity. These public forums have also been used as a 
platform to solicit public input regarding these deliberations. In 
addition, during these forums, working groups were formed to support 
the ongoing review process. For fiscal year (FY) 2012, the non-payroll 
expenditures for the VASRD modernization project totaled $366,139. The 
table below shows a breakdown:


----------------------------------------------------------------------------------------------------------------
                                    Event                                               Date           Expenses
----------------------------------------------------------------------------------------------------------------
VASRD FORUM--NYC.............................................................         October 11-20      $84,626
VASRD Forum--NYC.............................................................         January 17-26      $52,688
Travel.......................................................................               FY 2012      $27,467
Medical consultation contract................................................               FY 2012     $201,358
                                                                                                     -----------
    TOTAL....................................................................                           $366,139
----------------------------------------------------------------------------------------------------------------

    The medical consultation contract provided subject matter expertise 
to assist with medical content relevant to rating disabilities, consult 
on policy issues and revisions to the disability benefits 
questionnaires, and various other responsibilities.
    b. Provide an itemized list of funding expended in FY 2013 on the 
rating schedule modernization?
    Response. So far in FY 2013, an event focused on mental health 
disorders was held on May 1 and 2, with expenses totaling $4,300, and a 
meeting focused on skin diseases was held from March 28 through 
April 5, with expenses totaling $2,000.
    VA plans to fund additional VASRD modernization project conferences 
this year. These conferences are needed for the body systems still 
pending final review and revision, which include the musculoskeletal 
system and mental disorders. The purpose of these work group 
conferences is to intensify the review process and to expedite 
research, development, and deliberations within these sections of the 
VASRD. The diverse work group includes medical doctors, psychologists, 
attorneys, Veterans Service Organization representatives, and VA 
adjudicators. The benefit of these conferences is the generation of 
more ideas and energizing of the collaborative process which is at the 
heart of the VASRD review. Each conference will require participants to 
travel, with estimated costs of $12,000 to $15,000.
    VBA medical officers responsible for drafting the VASRD regulations 
will also meet with subject matter experts (SME) to obtain clinical 
expertise and opinions useful in revising the VASRD regulations. The 
estimated cost for FY 2013 is $15,000.
    c. Provide an itemized list of the requested funding in FY 2014 for 
the rating schedule modernization? Also, include the number of FTE 
assigned to or supporting this modernization effort.
    VBA Response: It is anticipated that conferences, travel, and 
outside consultation will be completed in FY 2013. In FY 2014, it is 
expected that the remaining work will be accomplished by VA without 
travel or outside consultation. VA has $15,000 in funding in FY 2014 to 
support any unforeseen travel or conferences. There are currently 5 FTE 
assigned to the VASRD modernization project.
    d. Provide the Project Management Plan, the VASRD Update Operating 
Plan and project schedule for the rating schedule modernization.
    Response. VA is currently expanding the Project Management Plan 
(PMP) to include a specific addendum that will include milestones, 
deliverables, and the designation of a sub-program manager who is 
dedicated to managing any earnings loss and validation studies VA 
undertakes. VA is currently exploring the option of engaging in 
research partnerships to conduct more than one earnings loss study at a 
time to increase our research capacity. A copy of the updated PMP and 
operating plan as well as the project schedule will be provided when 
completed.
    e. Provide an itemized list of any funding requested to support IT 
solutions to modernize the rating schedule.
    Response. The VASRD modernization project did not require any IT 
solutions.
    f. Does the FY 2014 request include any funding to support updates 
that will need to be made to IT solutions, including VBMS, disability 
benefit questionnaires, rules based calculators, or other initiatives 
based on current VASRD? How much funding does VA anticipate these 
updates will require upon publication of final rules for the various 
body systems?
    Response. The FY 2014 request does not include funding changes to 
IT systems related to the VASRD modernization project, as Veterans 
Benefits Management System (VBMS) enhancements will incorporate any 
VASRD changes. VBMS will continue to be enhanced and additional system 
capabilities will be released in 3 future generations of VBMS that will 
be deployed over the next 2 years.
                          va/dod collaboration
    Question 6. According to the FY 2014 budget request, IDES now 
operates at 139 military treatment facilities worldwide and is 
available to all servicemembers who are referred to Medical Evaluation 
Boards. The FY 2014 budget request also noted over 30,000 new referrals 
in 2012.
    a. Provide the amount of funding spent in FY 2012 (both mandatory 
and discretionary) and how many VA employees were dedicated to the IDES 
process.
    Response. During FY 2012, VA's Office of Planning and Policy (OPP) 
spent approximately $1,074,539, consisting of $467,081 for a program 
management support contract, $577,458 in salary for 5 full-time 
equivalent employees (FTE), and $30,000 in travel costs.
    During FY 2012, the Veterans Benefits Administration (VBA) spent 
approximately $54.8 million for salaries and general operating expenses 
for 490 FTE dedicated to disability claims processing in the Integrated 
Disability Evaluation System (IDES) process. Compensation staff and 
Vocational Rehabilitation and Employment Counselors are included in 
this count. Veterans filing claims through the IDES sites are captured 
in the nationwide Veteran caseload count and total compensation benefit 
obligations; therefore, mandatory funding cannot be separated for this 
program.
    The FY 2012 IDES Supplemental Budget distributed to the operational 
field sites supporting IDES was $24.4 million. Staffs located at the VA 
medical centers (VAMC) are not solely dedicated to the IDES process.
    b. Provide the amount of funding spent in FY 2013 (both mandatory 
and discretionary) and how many VA employees were dedicated to the IDES 
process.
    Response. During FY 2013, OPP spent approximately $1,336,630 which 
is comprised of $570,630 for a program management support contract, 
$741,000 in salary for 5 FTE, and $25,000 in travel costs.
    During FY 2013, VBA estimates it will spend approximately $63 
million for salaries and general operating expenses to support 580 FTE 
dedicated to disability claims processing in the IDES process.
    The FY 2013 IDES Supplemental budget was $21.6 million. These funds 
were distributed to the VAMCs in support of IDES. Staffs located at the 
VAMCs are not solely dedicated to the IDES process.
    c. Provide the amount of funding requested in FY 2014 (both 
mandatory and discretionary) and how many VA employees will be 
dedicated to the IDES process.
    Response. During FY 2014, OPP estimates it will spend $1,057,458, 
which is comprised of $450,000 for a program management support 
contract, $577,458 in salary for 5 FTE, and $30,000 in travel costs.
    During FY 2014, VBA estimates it will spend approximately $63.6 
million for salaries and general operating expenses to support 580 FTE 
dedicated to disability claims processing in the IDES process.
    For FY 2014, the IDES Supplemental budget request is $18.6 million. 
Staff located at the VAMCs are not solely dedicated to the IDES 
process.
    d. What is the methodology used to predict workload for this joint 
program? Has DOD provided information on the anticipated number of 
referrals that VA can expect the program to receive in FY 2013 and 
FY14?
    Response. The IDES workload is based solely on the number of 
referrals made by the Military Services; therefore, IDES workload 
projections are made by DOD. We defer to DOD to explain the methodology 
used in workload predication. VA has requested a 5 year projection from 
DOD, and DOD is working on that request. The anticipated number of 
referrals for FY 2013 is 32,000 and for FY 2014 is 32,000.
    e. How many referrals has the program received in FY 2013 and how 
many are anticipated for FY14.
    Response. For FY 2013, 19,841 referrals have been received as of 
May 12, 2013, and the anticipated number of referrals for FY 2014 is 
32,000.
    f. For each of the 139 military treatment facilities operating 
IDES, provide performance metrics to include enrollment, outcomes, VA 
exam utilization rate, timeliness, referred and total conditions, and 
timeliness for case processing by stage.
    Response. VA is at 116 sites throughout the United States and 
Puerto Rico. The remaining 23 sites are overseas locations. The 
attached spreadsheet shows the performance metrics for enrollment, 
referred and total conditions, and timeliness for case processing by 
stage. IDES outcomes are determined by the Military Services Physical 
Evaluation Boards. VBA defers to DOD to provide definitive IDES outcome 
metrics and the exam utilization rate, which is based on the outcome 
metrics.
    g. How many contract disability examinations were used to support 
IDES in FY 2012 and FY 2013 and at which IDES locations?
    Response. In FY 2012, 11,616 VBA contract examinations were 
completed in support of IDES. In FY 2013 (through May 15, 2013), 7,426 
VBA contract examinations have been completed in support of IDES. The 
attached spreadsheet provides a breakdown by location of the contract 
disability examinations completed so far in FY13.
    The Veterans Health Administration (VHA), similar to VBA, has a 
contract--the Disability Examination Management (DEM) Contract, which 
is used by the VAMCs to supplement Compensation & Pension (C&P) 
examination services. No IDES exams were conducted using the DEM 
Contract in FY 2012. However, 1,116 IDES exams were conducted using 
this contract in FY 2013 through March 2013. Of these, 661 exams were 
conducted to directly support IDES locations as described below. The 
remaining examinations were conducted by VAMCs Nation-wide in support 
of the IDES Reserve Component Exams Closest to Home initiative.


------------------------------------------------------------------------
                     IDES Location                       Number of Exams
------------------------------------------------------------------------
West Point............................................               44
Ft. Bragg/Pope AFB/Camp Lejeune.......................                4
Ft. Riley/Ft. Leavenworth/McConnell AFB/Whiteman......               32
Ft. Hood..............................................              571
Ft. Bliss.............................................                1
Mountain Home AFB.....................................                9
                                                       -----------------
    Total.............................................              661
------------------------------------------------------------------------


    Question 7. VA's Office of VA/DOD Collaboration is responsible for 
``coordinating the implementation of the integrated disability 
evaluation system (IDES) and streamlining the disability evaluation 
process through continual process improvements.''
    a. What process improvements were made in FY 2013 to streamline the 
process?
    Response. VA has made the following process improvements in 
streamlining the disability evaluation process:

     Entry of Physical Evaluation Board (PEB) Decisions in the 
Veterans Tracking Application (VTA)--IDES cases that have completed 
Secretarial Review are missing Disposition and Combat Condition data in 
VTA. Consistent entry of timely PEB decision information into VTA will 
improve Benefits Notification process timeliness (Implemented).
     Ensure cases are ``Ready to Rate'' before reaching the 
Disability Rating Activity Site (DRAS)--Current IDES case processing 
requires certain military information and/or documentation which ensure 
cases are ready to rate before forwarding them to the DRAS. At times, 
some of the required information and/or documentation were missing. DOD 
has provided 15 DOD personnel to perform DOD administrative procedures 
in development teams to assist in increasing the ready to rate 
inventory (Implemented).
     Disability Benefits Questionnaire (DBQs)--Currently DBQ's 
are used in processing regular disability claims. VA's move to DBQ's 
will increase the efficiency of the DRAS operations, assist in reducing 
the current IDES backlog, reduce the percentage of insufficient medical 
exams, and provide raters with needed clinical information to 
effectively complete disability ratings.

    Other identified initiatives in development are as follows:

    One Rating--Current IDES case processing procedures require the 
DRAS to prepare a rating decision for a case at two separate points in 
time--Proposed Rating and Benefits Notification. Resources expended to 
complete final rating could be devoted to proposed ratings which will 
enable timely Benefit Notification and additional resources 
(information technology changes will have to be made in the claims 
processing system, potential implementation in FY 2014).

    b. What is the status of electronic case file transfer capabilities 
within IDES?
    Response. Partial IDES case files, minus Service Treatment Records 
(STRs), are already being shared electronically between DOD and VA 
using DOD's Safe Access File Exchange (SAFE) system. Moreover, DOD and 
VA have successfully tested a new system for electronically sharing 
IDES case files-to include portions of STRs and other non-medical case 
forms-using the Electronic Case File Transfer (eCFT) system, exchanging 
more than 3,000 case files since the pilot began in September 2012. The 
eCFT pilot was designed to demonstrate the ability of the Departments 
to jointly develop and electronically share files that execute various 
portions of the IDES process.
    In January 2013, VA identified additional requirements to establish 
interoperability between eCFT and VA IT via a data-exchange service. 
These will satisfy VA's needs to (1) retain electronic copies of case 
files for legal purposes, and (2) maintain the ability to track 
documents entered into case files on a per member, per document basis. 
Once these requirements are met, eCFT will replace SAFE.
    To this end, VA and DOD are working together to provide an 
automated file transfer capability that physically moves the files from 
eCFT to VA systems (i.e., the Veterans' Benefits Management System or 
VBMS) by way of VA's Virtual Lifetime Electronic Record Data Access 
Service (VLER DAS).
                            medical programs
Budget Request Assumptions
    Question 8. The President's budget request includes an increase of 
15.4 percent for mental health care since 2012, which is a 7.2 percent 
increase since last year's enacted level. Please explain how VA arrived 
at this number. Specifically, did VA take into account an anticipated 
increase in enrollment and use of behavioral health services that may 
result from the return of troops from Afghanistan and the downsizing of 
the force?
    Response. The Veterans Health Administration (VHA) places a high 
priority on ensuring that all enrolled Veterans have access to needed 
mental health services. The VA Enrollee Health Care Projection Model 
(Model), with input from VHA's Office of Mental Health Services, 
projected an increase in the utilization of mental health services by 
taking into account several techniques to forecast Veteran enrollee 
needs for VA mental health services. These techniques include 
incorporating the latest scientific evidence about effective mental 
health interventions, data analysis of Veteran demographics, access to 
care data, and trends in service utilization projections. The Model 
projects future demand for mental health services and accounts for the 
impact of enrollee age, gender, morbidity, the unique utilization 
patterns of specific cohorts such as Operation Enduring Freedom/
Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND), events such 
as the return of troops from Afghanistan, and the downsizing of the 
force.

    Question 9. Given that VA saw an increase of nearly 150,000 
patients between 2010 and 2011, when the impact of the health insurance 
coverage requirement in the Affordable Care Act coupled with the 
drawdown of troops in Afghanistan was less of a factor, what led VA to 
estimate that only 100,000 new patients will come into VA between 2014 
and 2015?
    Response. The year-to-year enrollment and patient projections 
presented in the President's budget submission represent the net change 
in projected enrollment and patients over the prior fiscal year. VA 
recognizes that the additional options available under the Affordable 
Care Act (ACA) may lead some Veterans to choose non-VA providers while 
other Veterans may enroll with VA for the first time in order to 
satisfy the requirement to have minimum essential coverage. The VA 
Enrollee Health Care Projection Model (EHCPM) accounts for many factors 
affecting enrollment, such as the drawdown of troops in Afghanistan, 
mortality, change in demographic mix, morbidity, reliance on the VA 
health care system, and economic conditions. These factors will affect 
the net enrollment and patient growth differently each fiscal year. The 
extent to which ACA will impact VA will be closely monitored on an 
ongoing basis.

    Question 10. How did VA determine that an increase of 5.4 percent 
over the FY 2013 level for medical services was sufficient? To what 
extent does this increase allow for an expansion of health care 
treatment options beyond what VA is currently providing?
    Response. VA's medical care budget is based on an actuarial model 
(the Enrollee Health Care Projection Model) that reflects health care 
trends within VA and also considers health care trends in the broader 
health care industry. The estimate is informed by understanding the 
demographic changes in the enrolled Veteran population, which is a key 
factor for projecting future demand for health care services. VA's 
budget also includes several initiatives for expanding services to 
Veterans such as addressing Veteran homelessness and new models of 
care, which include Patient Aligned Care Teams (PACT), Women's Health, 
Special Care Team Based Models, and Connected Health. VA's program 
offices are actively engaged to ensure that the actuarial model 
reflects continued evolution of VA's health care delivery system and 
reflects VA's vision for personalized, proactive, Veteran-centric 
health care.
Complementary and Alternative Medicine
    Question 11. How has VA included complementary and alternative 
medicine (CAM) specialists into its health care delivery model? Are 
clinicians who provide these services integrated into VA's Patient 
Aligned Care Teams?
    Response. As VHA does not have occupational codes that would allow 
the hiring of CAM providers, almost all CAM delivered within VHA is 
done by providers with allopathic training who have an interest in CAM. 
Eighty-nine percent of VA facilities offer at least one form of CAM, 
and these therapies are integrated into traditional VA care. CAM is 
primarily used for the management of chronic pain and mental health 
disorders and for the promotion of general health and well-being. The 
principles of patient activation and self-management embodied by many 
CAM activities are very consistent with VA's health care delivery model 
which advocates for proactive, personalized, and patient-driven care. 
The issue of chronic disease management, including management of mental 
health disorders and chronic pain, as well as the promotion of healthy 
lifestyle and behavior modification are a key part of the management of 
Veterans in PACTs. While the clinicians who deliver CAM services within 
VA are not physically part of the PACTs, many of the services they 
provide are ones that would be accessed through PACTs. The providers 
who deliver CAM would be considered part of the PACTs' resources.

    Question 12. What are individual medical centers doing to promote 
CAM therapies among their patients, including those seeking treatment 
for behavioral health and pain management?
    Response. The main reason cited by individual medical centers for 
offering CAM therapies was to promote wellness, as an adjunct to 
chronic disease management, and because they believed it was consistent 
with patient preferences. The strategies of facilities regarding CAM 
are variable. Some facilities offer CAM services such as Yoga and Tai 
Chi, which may be accessed directly by Veterans, as well as other 
services which may be accessed via referral from a primary care 
provider or offered by a treating specialist as part of a comprehensive 
plan of care. According to a 2011 VHA Survey of Complementary and 
Alternative Medicine conducted by VHA's Healthcare Analysis and 
Information Group, the conditions most commonly treated with CAM in VA 
are mental health disorders and chronic pain. Within mental health, CAM 
therapies such as meditation, biofeedback, and guided imagery, while 
not a substitute for conventional therapies, are seen as potentially 
useful adjuncts to care. The potential benefits of CAM therapies as 
adjuncts to allopathic care are a consistent theme within VA.
    For the past 13 months, VHA Primary Care Services and the Office of 
Patient Centered Care and Cultural Transformation have hosted a monthly 
Integrative Medicine Community of Practice conference call. This call 
has served as a forum to spread information and education on 
Integrative Health and CAM and on the ways CAM is being used within VA 
as well as to create dialog on issues of policy and implementation.

    Question 13. Would CAM therapies be more readily available to 
veterans if clinicians could be hired solely to practice these 
therapies?
    Response. The lack of allopathic providers with training and 
expertise in CAM does pose a barrier to being able to offer CAM 
services, as does the lack of CAM providers. Further education of our 
allopathic providers regarding the evidence and integration of these 
practices, as well as the ability to hire CAM providers, would likely 
enhance VA's ability to provide CAM services. In 2005, the Institute of 
Medicine published its national report on CAM, and one of the key 
recommendations was that ``health profession schools should incorporate 
sufficient information about CAM into the standard curriculum at the 
undergraduate, graduate, and postgraduate levels to enable licensed 
professionals to competently advise their patients about CAM.'' The 
scope of Integrative Health and CAM is vast, including whole systems of 
medicine and a diverse group of practices and products. As with 
conventional approaches, those that are best trained and most qualified 
should be the ones providing the services, which would also make these 
services more readily available.
Medical Care Collections
    Question 14. How does VA plan to ensure it meets its budget 
projection of collecting nearly $3.1 billion for Fiscal Year 2014?
    Response. The Medical Care Collections budget can be broken out 
into three segments: Medical Care Collection Fund (MCCF) collections, 
other collections (including parking fees, enhanced-use revenue, 
compensation work therapy, compensation and living expenses and makes 
up $65 million of the FY 2014 budget), and collections tied to 
legislative proposals. The MCCF collections portion accounts for $2.870 
billion of the $3.064 billion budget. VA's plans to ensure that FY 2014 
MCCF budget projections are met through the following:

     Consolidated Patient Accounting Centers (CPAC): In FY 
2012, VA completed the transition of revenue collection activities from 
individual VA medical centers to seven industry-best-practice CPACs. 
This transition was done one year earlier than required under Public 
Law 110-387. Most critically, CPACs have demonstrated success based on 
standardized business practices, enhanced employee training and greater 
accountability for results. In order to ensure MCCF collection targets 
are met in FY 2014, VA will continue to focus on improving efficiencies 
using the CPAC model in areas related to people, process and 
technology.
     Payer Relations Activities: VHA continues to aggressively 
pursue strategies to effectively manage relationships with third-party 
payers. In order to ensure that MCCF collection targets are met in FY 
2014, VA plans to provide comprehensive training to payer relations 
staff located in each CPAC, implement enhanced denials management 
capabilities and deploy tools to monitor payments versus agreement 
terms and conditions.
     Electronic Business Initiatives: In an effort to leverage 
the health care industry's migration to national standard electronic 
data exchanges under the Health Insurance Portability and 
Accountability Act and to comply with other legal requirements, VHA has 
put in place electronic business initiatives to add efficiencies to the 
billing and collections processes. In order to meet FY 2014 MCCF 
collection targets, VHA will continue to enhance this capability 
through expanded utilization of Electronic Data Interchange tools 
related to insurance verification, electronic billing and electronic 
payments.

    Question 15. To what extent would VA be unable to meet its 
projected collections level if the legislation the Department proposed 
on this topic does not become law?
    Response. VA has submitted two legislative proposals in the FY 2014 
President's Budget that 1) allow for VA to release of patient 
information to bill health plans for non-service-connected care 
relating to drug abuse, alcoholism, or alcohol abuse and 2) require 
health plans to treat VA as a participating provider, whether or not an 
agreement is in place with the health plan. These two proposals account 
for $129 million of the $3.064 billion FY 2014 budget (4%). VA does not 
anticipate being able to achieve this target without these proposals 
becoming law.
Affordable Care Act
    Question 16. Veterans enrolled in VA health care are not eligible 
for tax credits established by the Affordable Care Act to assist 
individuals in paying for health care coverage through the Exchange. 
What is VA doing to inform veterans of this and how is VA working with 
the IRS to determine which veterans will be ineligible for the tax 
credit?
    Response. VA has developed a plan to inform, educate, and engage 
Veterans, eligible beneficiaries, and other stakeholders about ACA. 
This plan includes a set of key messages that have been incorporated 
into communications materials addressed to Veterans and other 
beneficiaries. One of these key messages is that enrollment in VA 
health care programs meets the ACA minimum essential coverage (MEC) 
requirement. VA and the Internal Revenue Service (IRS) collaborated to 
draft a special provision for Veterans. Under an IRS final rule, 
individuals who are enrolled in specified VA health care programs 
identified as MEC will not be eligible to receive premium tax credits 
(with respect to that individual) to purchase coverage through the 
Health Insurance Marketplace.
    VA will inform enrollees that individuals enrolled in specified VA 
health care programs (i.e., Veterans health care program, VA Civilian 
Health and Medical Program (CHAMPVA), and Spina Bifida health care 
benefits program) are not eligible for a tax credit to purchase 
additional health insurance coverage. Family members of enrolled 
Veterans who are not enrolled in specified VA health care programs may 
still be eligible for a tax credit (if they otherwise meet the 
applicable eligibility criteria) to purchase health insurance coverage 
through the Health Insurance Marketplace (formerly known as Health 
Insurance Exchanges). Similar information will also appear in documents 
such as fact sheets, frequently asked questions, and language for VA 
social media sites accessible to both enrolled and non-enrolled 
Veterans and other beneficiaries.

    Question 17. Please provide a justification for the amount the 
President requested for compliance with the Affordable Care Act.
    Response. VA has prepared for health reform by examining the key 
provisions of the law, identifying the implications for Veterans and 
VA, and conducting analyses to estimate the potential impact of the law 
on VA. The Fiscal Year 2014 President's Budget submission reflects the 
estimated cost impacts due to the current assumption that VA will 
experience a modest net enrollment increase as a result of ACA. VA's 
Fiscal Year 2014 budget request included $85 million for the care of 
the estimated 66,000 new Veterans that VA estimates may choose VA for 
their health care under ACA. VA believes that some Veterans may enroll 
with VA to satisfy the requirement to have MEC, and other Veterans may 
disenroll in order to take advantage of the premium tax credit. VA 
believes that those most likely to enroll or disenroll are those 
Veterans who will have low reliance on VA health care. In addition, the 
Fiscal Year 2014 VA Information Technology budget includes $3.4 million 
to build functionality needed to deliver statements to enrolled 
Veterans and beneficiaries enrolled in CHAMPVA and Spina Bifida who 
maintain MEC through VA. This funding will also go toward building the 
tool to identify and report on individuals who are enrolled in VA 
health programs identified as MEC.

    Question 18. What is VA doing to address the expected increase in 
demand for primary care services that will be the result of expanded 
insurance coverage under the Affordable Care Act?
    Response. Since the Affordable Care Act's enactment, VA has been 
proactive in working to understand the law's impact on Veterans, other 
beneficiaries, and VA's health care system, and in preparing for 
implementation of the law. VA will continue to provide eligible 
Veterans with high quality, comprehensive health care they have earned 
through their service. VA is preparing for ACA implementation with a 
focus on providing personalized, Veteran-centric health care. Ongoing 
efforts include, for example, developing data tools and coordinating 
directly with other Federal agencies, including the Department of 
Health and Human Services.

    Question 19. The President's Budget requests an additional $19 
million for the HHS Inspector General for new oversight efforts, 
including efforts related to the ACA. Do you anticipate VA's Office of 
Inspector General will require any additional funds specific to ACA-
related activities?
    Response. Until VA more clearly understands the impact of ACA on 
its programs and operations, it is not possible to determine what OIG 
efforts will be required. Additional funds may be needed when VA is 
able to provide the OIG with detailed plans on ACA's impact.
Homeless Veterans
    Question 20. As we pass the halfway point in the Secretary's five-
year plan to end homelessness among veterans, is any program 
realignment necessary to ensure that there are no unsheltered homeless 
veterans by the end of 2015?
    Response. VA's successes thus far in reducing Veteran homelessness 
is in part due to ongoing program evaluation and realignment in two 
areas: services and resource investments. Finishing the job of ending 
Veteran homelessness and ensuring there are no unsheltered homeless 
Veterans on our streets will require continued realignment of program 
resources and continued investment in Veteran-centric permanent housing 
and health programs, including the widespread adoption of evidence-
based best practices, such as Housing First and critical time 
intervention case management services.
    Already, VA has realigned its programs and instituted a number of 
Veteran-centric program innovations and transformations based on a 
guiding principle: the solution to homelessness is permanent housing 
with wrap-around supportive services. This commitment to permanent 
supportive housing is best captured by VA's adherence to a Housing 
First model. Housing First is an evidence-based approach that focuses 
on helping individuals and families access and sustain permanent 
housing as quickly as possible while providing the necessary health 
care and other supports to help sustain permanent housing and improving 
the Veteran's quality of life. VA's service delivery system has become 
more accessible, community-based, and Veteran-centric, with a focus on 
meeting Veterans where they are and helping them to move forward to 
improve their health and housing stability. Resources focused on rapid 
engagement and placement in permanent housing need to continue to grow 
to ensure there are no unsheltered Veterans on the street. VA has 
demonstrated its commitment to properly realigning program services and 
program investments through the Department of Housing and Urban 
Development-VA Supportive Housing (HUD-VASH) Program, Supportive 
Services for Veteran Families (SSVF) Program, and the ongoing 
transformation of the Grant and Per Diem (GPD) Program.
    The HUD-VASH Program is concrete evidence of VA's efforts to 
realign program services to successfully end Veteran homelessness. The 
HUD-VASH Program is jointly administered by HUD and VA to provide 
permanent supportive housing for eligible homeless Veterans. Veterans 
in the HUD-VASH Program receive a HUD-provided Section 8 Housing Choice 
voucher and VA-provided case management services. Since 2008, a total 
of 48,385 vouchers have been awarded, and 42,557 formerly homeless 
Veterans are currently in homes because of HUD-VASH. VA's ongoing 
commitment to the HUD-VASH Program is in keeping with its efforts to 
realign program services under a Housing First permanent supportive 
housing model.
    The SSVF Program is further evidence of VA's ongoing efforts to 
realign program services and investments to end Veteran homelessness. 
Although still a relatively new program, it is already clear that the 
SSVF Program has been an enormous success. The SSVF Program provides 
grants to private non-profit organizations and consumer cooperatives to 
help Veteran families rapidly exit homelessness or to assist Veterans 
at-risk of homelessness. The SSVF Program is unique in that it can 
serve both the Veteran and his or her family member(s) and continues 
VA's efforts to realign services under a Housing First permanent 
supportive housing model. In fiscal year (FY) 2012, during the SSVF 
Program's first full year of operations, SSVF surpassed expectations, 
serving approximately 21,500 Veterans and a total of over 35,000 
persons. Of those served, 40 percent were at-risk for homelessness and 
seeking prevention services while the remaining 60 percent were 
provided rapid re-housing services to transition from homelessness into 
permanent housing. At the end of FY 2012, VA awarded 151 SSVF grants in 
49 states and the District of Columbia for operations in FY 2013. In 
recognition that this community-based resource needed to be more 
geographically available to all communities assisting Veterans and 
their families, VA recently announced an FY 2013 SSVF Notice of Funding 
Availability (NOFA) for an additional $300 million to further grow this 
program.
    Additionally, VA's recent efforts to transform the GPD Program 
provides further evidence of VA's commitment to the realignment of 
program services and investments. As VA advances its realignment 
efforts focused on a community-based, Veteran-centric permanent 
supportive housing, VA expects that the demand for transitional housing 
will be less intense. In recognition of the decreased demand for 
transitional housing, the GPD Program is already working with a new 
model utilizing the principles of Housing First and focused on 
facilitating permanent supportive housing, GPD Transition in Place 
(TIP). In FY 2012, VA awarded approximately $28.4 million in grants to 
provide capital funding for transitional housing projects. Thirty-one 
of the funded projects were GPD TIP, which will provide time-limited 
wrap-around supportive services to homeless Veterans housed in 
apartment style housing, in which the services transition but the 
Veteran remains in the housing. GPD TIP provides an opportunity to 
realign traditional transitional housing services with VA's preferred 
permanent supportive housing model.
    To increase and enhance efforts at housing unsheltered homeless, VA 
is working with community-based agencies to realign efforts at 
targeting vulnerable unsheltered homeless Veterans. For example, some 
local VA medical centers have started partnering with local homeless 
Continuums of Care (CoC) to conduct local ``Registry Weeks.'' A 
Registry Week is a concept used to develop an accurate registry of the 
needs of individuals/Veterans who are permanently, or frequently, 
living on the street. Volunteers are recruited and trained to reach out 
to unsheltered homeless individuals and survey them in an effort to 
collect valuable information that will help connect them to the 
appropriate housing and services. Those identified as the most 
vulnerable (physical and behavioral health conditions that are serious) 
are prioritized for available permanent housing and support. Local VA 
medical centers have also teamed with local homeless CoCs and other 
local community-based organizations to evaluate and realign system 
processes through Rapid Results Boot Camps. A Rapid Results Boot Camp 
is a full-day event designed to train service providers who are already 
helping homeless Veterans in their communities to learn new and more 
efficient ways to house Veterans and provide them with the services 
they need. Teams of representatives from VA, public housing 
authorities, local governments, and other agencies who work with 
homeless Veterans attend and participate in the Boot Camps. Boot Camps 
help communities to improve their processes in order to decrease the 
amount of time it takes a homeless Veteran to leave the streets and 
enter into permanent housing.
    VA has had significant and measurable success in VA's Plan to End 
Veteran Homelessness. Based on HUD's Point in Time (PIT) Count, from 
2009 to 2012, the number of Veterans experiencing homelessness on a 
single night in January has decreased 17.2 percent (from 75,609 to 
62,619). Furthermore, these reductions in Veteran homelessness took 
place in a challenging economic period.
    In conclusion, VA has made significant and measurable success in 
ending Veteran homelessness. VA must continue to focus its efforts on 
housing unsheltered homeless Veterans. The key to success is a 
continued and increased investment in the HUD-VASH and SSVF Programs, 
continued focus on the principles of Housing First, and effective and 
ongoing realignment of program services and resources nationally and at 
the local level.

    Question 21. While homelessness is generally an urban phenomenon, 
it is important to recognize that homelessness also occurs in rural 
areas, albeit generally in the form of overcrowding or substandard 
housing. What specific actions is VA taking to ensure that the housing 
needs of rural veterans are also being met?
    Response. VA has taken decisive action to eliminate Veteran 
homelessness in both urban and rural areas. VA's ongoing prevention, 
transitional housing, and permanent supportive housing programs provide 
wide-ranging services in rural areas. VA realizes the importance of 
reaching the rural homeless Veteran population. Rural homeless persons 
are often referred to as the ``hidden homeless'' as many of these 
individuals reside in the woods, campgrounds, abandoned farm buildings, 
and buildings not intended for human habitation. Much of the rural at-
risk homeless population reside in substandard housing or are doubled 
up in temporary housing arrangements. Additionally, rural community-
based homeless service providers often lack adequate capacity and 
infrastructure to address rural homelessness.
    The SSVF Program provides grant funding for private non-profit 
organizations and consumer cooperatives to assist Veterans and their 
families with preventive supportive services. Of those grants awarded 
in FY 2011 for operations conducted in FY 2012, approximately 5 percent 
of the SSVF grants serve Veteran families in rural areas exclusively 
while an additional 32 percent of grants serve a mix of rural and urban 
areas. In FY 2012, VA awarded funding for operations in FY 2013. 
Approximately 10 percent of the community agency grantees provide 
services exclusively in rural areas. Additionally, over 45 percent of 
these grantees included a rural component in their services. VA is 
expanding access to services both by increasing available resources and 
by specifically targeting rural areas. In the past year, VA has 
increased funding available through its SSVF grant program from $100 
million to $300 million. Additionally, the FY 2013 SSVF NOFA lists 
``Veteran families located in a rural area'' as one of the target 
populations for SSVF funding.
    Community agencies funded under VA's Homeless Providers GPD Program 
provide transitional housing for Veterans who are homeless. In FY 2012, 
16.8 percent of those GPD Programs were in rural areas. As of 
April 2013, 26.6 percent of those GPD Programs indicated that they 
provided transitional housing for Veterans in rural areas.
    VA's HUD-VASH Program offers homeless Veterans permanent housing 
opportunities through Section 8 vouchers, linked with wrap-around VA 
case management services. Vouchers are distributed through Public 
Housing Authorities in both urban and rural areas. From FY 2008 to FY 
2012, HUD allocated approximately 11 percent of the approximately 
48,000 HUD-VASH vouchers to rural areas, awarding a total of 5,260 
vouchers to rural areas. VA expects HUD to announce the allocation of 
an additional 10,000 vouchers for FY 2013 and expects a similar 
proportion of these additional vouchers to serve rural areas.
    Finally, VA understands that the rural homeless Veteran population 
has pressing and unique needs. To that end, VA continues to explore the 
potential use of video-teleconferencing and related technologies in the 
care of rural homeless Veterans. Connecting people through technology 
can reduce costly and inconvenient travel and prevent isolation for 
remote staff and Veterans.

    Question 22. The FY 2014 budget request notes that over 3,000 
veterans were enrolled in H-PACTS in 2012 and that enrollment was 
associated with greater health outcomes. Please provide more specific 
data on what type of outcomes improved and how care improved.
    Response. The Homeless Patient Aligned Care Team (H-PACT) 
initiative is a pilot program that provides integrated homeless program 
support and primary care to homeless Veterans. Teams integrate a 
housing agenda with providing care for the ongoing and evolving 
medical, mental health, and substance abuse needs of homeless Veterans 
coming into the system. The goal is to create a ``medical home'' 
tailored to the needs of homeless Veterans that reduces unnecessary 
trips to the emergency department for care; assists in addressing 
chronic medical, mental health, and substance abuse treatment needs; 
and integrates homeless program staff to expedite housing placement and 
reduce recidivism. Enrollment in the H-PACT program has consistently 
been associated with high volume use of primary care, mental health, 
and specialty care outpatient services. Homeless Veterans enrolled in 
H-PACT have shown reductions in inpatient hospitalizations and 
emergency department visits. While national data is not available on H-
PACT program clinical performance, published site-specific data 
(Providence VA Medical Center (VAMC): American Journal of Public Health 
2010, American Journal of Public Heath 2013 (publication forthcoming)) 
has demonstrated improvements in chronic disease (diabetes, 
hypertension, hyperlipidemia) monitoring and management, as well as 
accelerated placement in permanent housing among Veterans enrolled in 
the H-PACT program.
    Through September 2012, approximately 3,549 Veterans were enrolled 
in an H-PACT program. Of those enrolled, approximately 40.6 percent 
have shown a reduction in emergency department use and a 32.3 percent 
reduction in inpatient hospitalizations. Data from the Providence VAMC 
has shown 80.7 percent of homeless Veterans enrolled in an H-PACT 
program moved into transitional or permanent supportive housing within 
6 months and demonstrated significant improvements in blood pressure 
and cholesterol management.
    The H-PACT model has already shown considerable promise with 
preliminary data from early May 2013 showing 5,691 enrolled H-PACT 
patients nationwide. H-PACT sites average approximately 350 new 
patients each month with an 86 percent retention rate. Based on the 
positive patient outcomes and the excellent performance of H-PACTs, VA 
is considering further resource realignment to fund additional H-PACT 
sites in FY 2014.

    Question 23. CRRCs are critical to ending homelessness among 
veterans. The FY 2014 budget request states that ``based on 
demonstrated positive contribution to the community, additional CRRC 
investment is anticipated in FY 2013 and FY 2014.'' Please describe the 
level of additional investment anticipated in each fiscal year, and the 
locations that may be considered for placement of additional CRRCs.
    Response. Community Resource and Referral Centers (CRRC) are 
collaborative, multi-agency, multi-disciplinary programs that provide 
``one-stop shopping'' access to housing, health care, job development 
programs, and other VA and non-VA benefits. In FY 2013, an additional 
13 medical centers across the country were awarded funding to establish 
CRRCs. Two of these sites will become operational in FY 2014. The total 
funding for 28 of 30 CRRCs in FY 2013 will amount to approximately $23 
million. All 28 sites will continue operations in FY 2014 along with 
two new sites that will activate in FY 2014. At an estimated annual 
cost of $1 million per site, the total estimated FY 2014 cost is $30 
million. CRRC costs include lease, staffing costs, and supply costs.
    Although specific locations for future CRRCs have not been 
determined, additional sites for CRRCs may be selected as the budget 
allows in FY 2014. VA medical centers will be encouraged to apply for 
the placement of a CRRC upon announcement of a Request for Proposals. 
In the event funding is available, potential future sites will be 
chosen through selection criteria including: documentation of need, 
homeless Veteran population, services offered, support from the local 
VA medical center, and community support.
Veterans Canteen Service
    Question 24. What is VA doing to ensure that everyone who is 
eligible to make purchases in person at Veterans Canteen Service (VCS) 
retail locations can do so via the VCS online exchange store?
    Response. Working with internal/external stakeholders, Veterans 
Canteen Service (VCS) has placed special emphasis on outreach 
initiatives to eligible patrons communicating the benefits of VCS 
services. VCS' Online Exchange Catalog validates eligible patrons 
through VA's enrolled Veterans and active employee database.
    Additional initiatives include:

     VA's Health Benefits Office Veterans Benefit Handbook 
includes VCS Online Exchange Catalog Program and 1-800 Special Order 
Program information. Since February 2013, approximately 1.5 million 
copies have been mailed to Veterans. The Veteran Identification Card 
(VIC) will include information about VCS shopping benefits, and 
Veterans will be able to directly access the VCS Web site from the 
Health Benefits Web site.
     eBenefits will host a promotional graphic with the VCS 
Online Exchange Catalog Program on its homepage carousel. This will 
take place in September 2013.
     Veterans Integrated Service Network (VISN) Newsletters and 
booklets include the VCS Online Shopping program. VISN newsletters are 
electronically sent to Veterans and VA employees. As an incentive, VCS 
provides coupons placed in newsletters and in some Community Living 
Centers' (CLC) booklets to be used at the retail stores.
     VCS conducts sale events at community-based outpatient 
clinics (CBOC) on a scheduled basis. These operations do not have 
traditional retail/food operations. VCS flyers and Exchange Catalogs 
are offered to patrons informing them of online shopping benefits and 
opportunities with VCS.
     VCS uses ``eBlasts'' (e-mail) to send information 
periodically to patrons about new VCS programs and online shopping 
benefits. The list includes 97,000 VA employees and 2,000 Veterans. VCS 
ran a promotion through July 2013 to sign up Veterans to the eBlast 
program. VCS accumulated 6,870 new e-mail addresses to include in our 
national eBlast promotions schedule. Veterans that signed up for the 
promotion were also registered into a drawing to win prizes for their 
participation. Winners were notified and visited the VCS Patriot Store 
to claim their prize. In addition, VCS has increased the e-mail list 
for VA employees from 97,000 to 101,368 since June 2013.

    Question 25. The FY 2014 budget details an anticipated increase of 
50 FTE for the Veterans Canteen Service (VCS). Please describe how VCS 
plans to use these FTE, and where VA anticipates that they will be 
located.
    Response. Veterans Canteen service (VCS) will open 30 PatriotBrew 
Coffee Shops as well as eight food/retail combo operations located in 
CBOCs and VBA sites. Additional full-time employees (FTE) will be 
secured to operate and maintain services at these locations.

    Question 26. How is VCS working to improve the profitability of 
underperforming locations?
    Response. VCS has initiated a ``deep-dive'' assessment of the 
underperforming operations. This will include analysis of current 
business models for small, class 4/5 operations; business metrics 
assessment (gross margins, retail turns, personnel cost increase, FTE/
productivity goals, supply chain, retail turns, retail/food/vending 
promotions, overhead costs, leadership skill sets and core 
competencies, etc.) to ascertain cause/effect correlations involving 
successful/unsuccessful operating canteens; and the development of 
aspirational goals and/or new business models to facilitate improved 
sales and earnings for these operations. This assessment and supporting 
action plans were completed in July 2013. Financial reports for 
August 2013 indicate that 70 percent of the targeted canteens showed 
improvement in operating income and other metrics. Monthly financial 
results are addressed directly with targeted operations to ascertain 
progress toward defined aspirational goals.

    Question 27. Is VA considering any expansion of the healthy vending 
initiative?
    Response. VCS currently provides healthy vending machines at 10 
percent of VA medical centers. These units offer a variety of organic, 
gluten free, and healthy food/beverage options. VCS expects to increase 
the presence of healthy vending machines by 60 percent by the end of 
fiscal year 2013. This will include VA medical centers, CBOCs, and 
Veterans Benefits Administration locations.
    In 2012, VCS increased the assortment of healthy vending snack 
options across the country. The assortment includes low fat and low 
calorie selections. These additions produced a 25-percent sales 
increase over the previous selections and have been well received by 
customers. This fiscal year, VCS will double its healthy choice options 
available from existing food and snack machines to include freshly 
prepared salads, sandwiches, fruits, and vegetables as well as organic 
and gluten free products.
Miscellaneous
    Question 28. Given that VA generally pays for non-VA care at the 
Medicare rate, does VA have plans to reduce reimbursement rates, since 
Medicare is subject to a 2 percent cut and has reduced repayment rates 
by that percentage?
    Response. If the services are under contract, VA will continue to 
honor the contractual reimbursement rate. Likewise, for services that 
VA reimburses under the applicable Medicare Fee Schedule when there is 
no contract, VA payments would continue to reflect Medicare Fee 
Schedule rates, as only Medicare final payment amounts--not Medicare 
Fee Schedule rates--are affected by the sequester.

    Question 29. Please provide documentation to illustrate the mental 
health staffing model that VA uses to determine the target number of 
mental health staff at each facility.
    Response. VA has developed and is implementing staffing guidance 
for general outpatient mental health programs per 1,000 Veterans using 
mental health services. VA does not yet have a staffing model that 
determines the target number of mental health staff for the whole 
facility. VA has previously developed a staffing model for the 
Residential Rehabilitation Programs that is based on the number of beds 
in the program. The general outpatient mental health model's clinical 
staffing ratio is as follows:


------------------------------------------------------------------------
                                            FTEE for Mental Health (MH)
            Employee Category                 Team Panel Size of 1,000
------------------------------------------------------------------------
Total MH Clinician: Licensed Independent                        5.1-5.5
 Providers (LIP).........................
Admin. Clerical Support..................                         0.5-1
Non-LIPs.................................                             1
                                          ------------------------------
    Total FTEE...........................                       6.6-7.5
------------------------------------------------------------------------


    The ``Total MH Clinician'' full-time equivalent employee (FTEE) 
refers primarily to LIPs (e.g., psychiatrists, psychologists, social 
workers, nurse practitioners, physician assistants, clinical nurse 
specialists, licensed marriage and family therapists, and licensed 
professional mental health counselors) and certain Doctors of Pharmacy 
(Pharm.D.) with residency and board certification in psychiatric 
pharmacy while the non-LIPs refer to providers such as Registered 
Nurses (RN), addiction therapists, and peer support staff. The ``Admin. 
Clerical Support'' is the administrative and/or clerical FTEE needed to 
support the mental health providers on the team. In sum, at the 
Residential Rehabilitation Program, each team of approximately 6.6-7.5 
FTEE will be responsible for the mental health care of 1,000 Veterans.
    Under Section 729 of the National Defense Authorization Act for 
Fiscal Year 2013, VA is currently developing guidance to determine the 
staffing level required for specialty mental health outpatient programs 
per 1,000 Veterans. Finally, VA will develop guidance for acute 
inpatient programs. Actual staffing at facilities will be based on the 
types of programs available at the facilities and adjusted for local 
factors such as use of telemental health programs and non-VA contracts.

    Question 30. To the extent that there has been a study completed 
within the last few years on the nutritional content of food available 
at VA medical centers, please provide a brief summary of the study's 
findings as well as a copy of the report.
    Response. The automated version of the nutrient analysis data of VA 
medical center diets began in FY 2002 for Veteran patients. The total 
calories, fat, cholesterol, and sodium are decreasing. The sodium 
content of meals has decreased by 1500 milligrams since FY 2002 with 
the average FY 2012 content at approximately 3100 milligrams of sodium 
per day. VA medical centers offer modified diets to meet the needs of 
inpatient Veterans, including Diabetic/Carbohydrate Controlled, Renal, 
and others that are specific to our patient population. In 2010, VHA's 
Nutrition and Food Services published VHA Directive 2010-007, Healthy 
Diet Guidelines, to improve the Regular Diet offered in all VA medical 
centers: www.va.gov/vhapublications/ViewPublication.asp?pub--ID=2167.
    Subsequent to the release of VHA Directive 2010-007, Healthy Diet 
Guidelines, the sodium, fat, and cholesterol contents of our meals 
reached their lowest average since 2002. A copy of the data report is 
provided as an attachment below.

                                 Nutritional Analysis of Patient Hospital Menus
----------------------------------------------------------------------------------------------------------------
                                   FY 2005   FY 2006   FY 2007   FY 2008   FY 2009   FY 2010   FY 2011   FY 2012
----------------------------------------------------------------------------------------------------------------
Average Calories................     2442      2444      2427      2383      2433      2387      2304      2271
Average Percentage Protein......     16.9        17      17.2      17.3        17      17.1        18      18.8
Average Percentage Carbohydrate.     49.9      50.3      50.3      49.9      49.8     52.57        51      51.1
Average Percentage Fat..........     33.3      33.5      32.5      32.7      32.3      32.3        31        30
Average Milligrams Sodium.......     4293      4167      3911      4068      4003      3688      3250      3165
Average Milligrams Cholesterol..      377       369       358       364       386       378       308       361
----------------------------------------------------------------------------------------------------------------


    Question 31. Please provide the amount VA spent on outreach during 
fiscal year 2012 and the estimate for how much will be spent during 
fiscal year 2013.
    Response. The Office of Public and Intergovernmental Affairs' 
(OPIA) National Veterans Outreach Office (NVO) spent approximately 
$600,000.00 on outreach during Fiscal Year 2012. This amount was 
expended for message development and production of creative material 
for an integrated advertising campaign. The goal of this campaign was 
to inform and educate Veterans, their families, and other stakeholders 
about the health care, benefits and services VA provides and 
eligibility based on their service.
    During FY 2013, OPIA will spend approximately $1,600,000.00 on 
costs related to a national advertising campaign led by the Ad Council. 
Ad Council is collaborating with DDB, an award winning advertising 
agency, to produce the campaign. DDB is providing pro bono advertising 
services. By working with the Ad Council and DDB, VA is receiving 
advertising support from a world class advertising agency, which 
represents approximately $35,000,000.00 worth of savings for the 
government. These professional services will continue national VA 
outreach efforts to increase awareness among Veterans and family 
members regarding the breadth of VA benefits and services available to 
them and how to access them.
                construction and long range capital plan
    Question 32. Please provide a list of priority weights for the 
major criteria and sub criteria used to inform the FY 2014 Strategic 
Capital Investment Plan decision plan.
    Response. The diagram below shows the major criteria and sub 
criteria priority weights that were used to inform the FY 2014 
Strategic Capital Investment Plan.


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    The decision criteria are Improve Safety and Security, Fixing What 
We Have; Increasing Access; Right-Sizing Inventory; Ensure Value of 
Investment; and Departmental Initiatives.
    The details of each major criterion are listed below:

     Improve Safety and Security: VA is dedicated to ensuring 
its Clients (Veterans) and Customers (VA Staff) are being served and/or 
work in a safe and secure environment. Mitigating the destruction and 
injury caused by natural or manmade disasters (including seismic, 
hurricane, flooding, blast, etc.); improving compliance with safety and 
security laws, building codes, and regulations; mitigating threats to 
persons on a VA facility (physical security), and ensuring VA mission 
critical buildings are able to provide service in the wake of a 
catastrophic event, are of paramount importance.
     Fixing What We Have (making the most of current 
infrastructure/extending useful life): VA is committed to managing its 
buildings in order minimize the extent to which deficiencies in 
infrastructure (including IT infrastructure) and other areas impact the 
delivery of benefits and services to Veterans. For infrastructure 
deficiencies, facility condition assessments (FCA) evaluate the 
condition of VA buildings. Mitigating other deficiencies (such as 
functional deficiencies and privacy deficiencies) also has a positive 
impact on the delivery of benefits and services.
     Increasing Access: Serving Veterans is at the core of VA's 
mission. VA strives to increase access for Veterans by reducing the 
time and distance a Veteran must travel to receive the best quality 
services and benefits; providing adequate supporting structures at VA 
facilities, such as gravesite locators; by increasing our ability to 
handle workload; and by enabling VA staff to work efficiently.
     Right-Sizing Inventory: In order to provide the highest 
quality service to Veterans at the right time and in the right place, 
VA is managing its space inventory by reducing excess space, building 
new space, collocating (VHA, VBA, NCA, and Staff Offices using the 
vacant or underutilized space of another office), leasing new space, 
and converting underutilized space of one type to another type, to 
better suit its mission.
     Ensure Value of Investment: As a steward of the public's 
trust, VA is responsible for making capital investments in the most 
cost-effective way possible by ensuring new capital investments 
optimize operating and maintenance costs, in order to create the best 
value.
     Departmental Initiatives: For improved management and 
performance across the Department, capital projects should contribute 
to key major (such as eliminating Veterans homelessness; improving 
Veterans mental health; enable 21st century benefits, etc.) and 
supporting initiatives (such as educating and empowering minority and 
women Veterans; enabling 21st century vocational rehabilitation and 
employment; expanding Veterans access to burial options in National or 
State Veterans cemeteries) from the Department's strategic plan, 
including DOD collaboration and complying with energy standards 
established in law and Executive Orders.

    Question 33. VA has identified over $9 billion in facility 
condition deficiencies to remediate, and a total of $54-66 billion in 
facility improvements that have been requested over the next ten years. 
In light of several successful partnerships to share space with 
community providers, what type of considerations are being made 
regarding the use of these means to close this gap with fewer 
appropriated dollars?
    Response. Generally speaking, assets that have significant 
conditions to remediate are often poor candidates for sharing of space. 
The risk associated with significant deficiencies must be mitigated 
prior to engaging with community partners or other Federal agencies to 
share such space. This mitigation falls on VA and would require 
appropriated funding.
    For assets that have some deficiencies, but are otherwise in usable 
condition, VA has had success using public-private partnerships. In 
these cases, VA is able to leverage non-appropriated funds to address 
the condition deficiencies of certain assets. VA has used its enhanced-
use lease (EUL) authority to repurpose and restore un-needed assets, 
using private funding, in support of housing homeless Veterans and 
delivering complementary services at local VA medical centers. Since 
the EUL program was authorized in 1991, VA has awarded 100 projects. 
These projects include housing (57), special services for Veterans (3), 
consolidation/improved VA operations (14), energy (4), and mixed-use/
community benefit (14). Eight of the 100 projects have been terminated.
    VA's current EUL authority, a narrow version to that which existed 
before expiration on December 31, 2011, only allows re-purposing assets 
for supportive housing, which limits the type of partnerships and 
assets that can be pursued. A restoration of VA's full EUL authority, 
as requested in the FY 2014 President's Budget, would allow additional 
assets to be considered for re-purposing.
    Other VA authorities, such as sharing agreements or joint ventures 
with DOD have also assisted in meeting some of its condition or space 
needs. These arrangements, however, generally still require 
appropriated funding, although they may be shared across agencies. One 
example of this is the Captain James A. Lovell Federal Health Care 
Center in North Chicago, Illinois, where VA and DOD operate the center 
jointly.

    Question 34. The budget requests authorization to proceed with 27 
major medical facility leases in 18 states. For each, please detail the 
following:

    a. When the existing facility will close, if the request is for a 
replacement, consolidation, or expansion lease.
    b. The number of unique veterans that will not be able to access 
care, if the request is for a replacement, consolidation, or expansion 
lease.
    c. The effect that pursuing each alternative to lease would have on 
the patient population or the ability to provide care.
    Response. The attached document contains information responsive to 
questions 34 a-c for each of the 27 major medical facilities requiring 
Congressional authorization. The attached information was previously 
transmitted to the Committee on June 4, 2013, and was current at the 
time of submission.



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    d. Tables analyzing the costs of alternatives to leasing that were 
considered.
    Response. In response to question 34.d, the Department provides 
tables [below] analyzing the total life cycle cost of the alternatives 
to the 2013 and 2014 major medical facility leases.



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    Question 35. Please provide national quantity and cost data for 
purchased utilities at VHA facilities, to include water, electricity, 
gas, and sewage for FY 2010 through FY12.
    Response. The below tables detail the cost and consumption data for 
purchased utilities at VHA facilities for FY 2010 through FY 2012.



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    Question 36. Please provide national quantity and cost data for 
waste disposal, divided by category to include general, regulated 
medical, hazardous chemical, etc. for FY 2010 through FY12.
    Response. The following attachment is the Waste Management and 
Compliance data that provides the national quality and cost data for 
waste disposal, divided by category to include general, regulated 
medical, hazardous chemical, etc. for FY 2010 and FY 2011. VHA is 
finalizing FY 2012 as part of our roll out and implementation of the 
new VHA real time waste management and cost avoidance web based 
tracking system developed by Practice GreenHealth (PGH).



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    Question 37. The FY 2014 budget request commits to improving the 
functionality of VA's national utility metering data collection and 
analysis system. What type of improvements is the Department planning 
to make?
    Response. In FY 2014, VA will continue to build on its successful 
metering program by improving the functionality of its data reporting 
and analysis capability. Both electric and non-electric (water, natural 
gas, etc.) information will be more visible and useful across VA from 
facility managers to policymakers. System enhancements will help ensure 
the capture and display of key data from meters around the country, 
allowing better evaluation of facility performance to reduce energy 
use. VA's capability to respond quickly and accurately to information 
requests and perform annual reporting will be improved. Additionally, 
VA will pursue avenues to more cost-effectively add, maintain, and 
modify meter installations across the Department.
    Specific areas of improvement include:

     VA will add meters to fill gaps that have been identified 
or created since past meter installations
     VA will begin linking meter data into local facility 
management systems
     VA will create additional capacity to use historical 
information to guide current operations--currently VA has limited ways 
to use historical information
     VA will develop new analysis capability on existing data 
to improve local, regional, and national decisionmaking
                    information technology programs
    Question 38. The President's Budget requests $344 million for the 
Interagency Program Office (IPO) to support the integrated electronic 
health record project. Please describe the assumptions used to arrive 
at this estimate, and how the IPO plans to use this funding, given that 
the Department of Defense is still making a decision regarding the core 
technology they will use for this initiative.
    Response. The budget request for FY 2014 is based on the Lifecycle 
Cost Estimate and will support the following major iEHR efforts:

     Identify Management
     Access Control Services
     Immunization
     Laboratory
     Pharmacy
     Presentation Services
     Service-Oriented Architecture (SOA) Suite Enterprise 
Service Bus (ESB)

    Question 39. Please provide documentation to detail estimated 
savings through ideas generated by the Ruthless Reduction Task Force.
    OIT Response: The Ruthless Reduction Task Force (RRTF) was 
established to identify opportunities for cost avoidance and to help VA 
focus resources on access, benefits and homelessness. Over 60 projects 
have been identified under RRTF that would result in an estimated total 
cost avoidance of $2.5 billion. Below is a more in depth breakdown of 
the cost avoidance, inclusive of approximate cost avoidance for pending 
and active projects.

     Total Estimated Cost Avoidance: $2.5 billion
     Total Estimated Cost Avoidance for Pending Projects: 
$2.166 billion
         - Total Estimated Cost Avoidance to harmonize identity 
        management and access control across VA: $1.7 billion
         - Note: A ``pending project'' is defined as a project for 
        which a plan of action and milestones (PoAM) idea scope is 
        still being defined, or one that is awaiting development of the 
        PoAM slide deck or else assignment of a project manager (PM.)
     Total Estimated Cost Avoidance for Active Projects: $340 
million
         - Note: An ``active project'' is defined as a project for 
        which a PoAM has been developed and to which a PM has been 
        assigned

    Question 40. In FY 2014, how much does VA anticipate spending to 
improve the Department's Section 508 compliance?
    Response. Making VA accessible for all Veterans, beneficiaries, and 
employees is important not only because it is the law, but because it 
is the right thing to do. Previously, VA's Section 508 IT compliance 
efforts were divided between OIT's ``Section 508 Program Office'' and 
VHA's ``Health 508 Office.''
    In FY 2014, all Section 508 efforts will be centralized within OIT. 
The combined Federal IT staff on this endeavor will amount to 11 FTE.
    The President's FY 2014 budget request includes $11.9 million for 
VA's Section 508 program. This funding will cover:

     Contracted resources to support the development and 
execution of Section 508-related training for developers, testers, and 
non-technical staff
     Testing support services to (1) bring new software into 
compliance with Section 508 requirements, and (2) audit existing 
Section 508-compliant software to ensure that it remains compliant
     Maintenance of hardware and software that is used to test 
IT systems for Section 508 compliance
     Development of an enterprise-wide approach to bringing all 
VA SharePoint repositories into compliance with Section 508 
requirements
                                 ______
                                 
  Response to Posthearing Questions Submitted by Hon. Richard Burr to 
 Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs
                                general
    Question 41. In the Department of Veterans Affairs (VA) 2012 
Performance and Accountability Report (PAR), VA indicated that it has 
``developed and executed a plan to reduce the cost associated with 
activities covered in [Executive Order 13589, Promoting Efficient 
Spending].'' VA also indicated that, for 2012, it ``exceeded its 
spending reduction target of $173.4 million by an additional $69 
million.''
    A. Please provide the Committee with a copy of the plan that was 
developed in response to the Executive Order.

    [The referenced files, due to their volume, are not being 
reproduced here.]

    B. Please outline where those spending reductions were realized and 
what was done with the funds that were saved through those reductions.
    Response. Spending reductions were realized in the categories of 
travel, supplies and materials, printing, employee information 
technology (IT) devices, and management support contracts. Realized 
savings were used for:

     Over-time hours for compensation claims processing staff 
to support the reduction of the benefits claim backlog;
     Non-recurring maintenance projects to improve the health 
care environment;
     Critical infrastructure and life cycle refresh for 
existing IT equipment to support current and new VA staff; and
     Additional health care-related equipment purchases.

    Question 42. In response to questions about VA's fiscal year 2013 
budget request, VA indicated that, at the end of fiscal year 2011, 
there was $1.2 billion in outstanding delinquent debt owed to VA, of 
which $732 million was created in connection with VA benefit payments. 
VA also indicated that, during fiscal year 2011, VA wrote off or waived 
$247 million of debts to VA.
    A. What was the total amount of outstanding delinquent debt at the 
end of fiscal year 2012?
    Response. At the end of FY 2012, VA reported $3.7 billion in 
outstanding debt.
    B. What portion of that amount was debt created in connection with 
VA benefit payments?
    Response. At the end of FY 2012, VA reported $1.6 billion in 
outstanding benefit debt.
    C. What is the total value of debts for which VA waived recoupment 
during fiscal year 2012 and what is the total value of debts that were 
written off during fiscal year 2012?
    Response. In FY 2012, VA waived debts totaling $116,167,896 and 
wrote-off debts totaling $85,194,153.
    D. During fiscal year 2013, how much new debt does VA project will 
be established?
    Response. For FY 2013, VA estimates new benefit debts of $1.2 
billion.
    E. During fiscal year 2014, how much new debt does VA project will 
be established?
    Response. For FY 2014, VA estimates new benefit debts of $1.3 
billion

    Question 43. In response to questions regarding VA's fiscal year 
2013 budget request, VA indicated that approximately $305 million in 
mandatory funding would be used to pay for non-direct benefits.
    A. Does that figure include any amounts spent on contract 
vocational and educational counseling?
    Response. The $6 million from the Readjustments Benefits account 
authorized for contract vocational and educational counseling is a 
benefit to Veterans and is therefore not included in the $305 million 
total for non-direct benefits. The $305 million in mandatory funding 
used to pay for non-direct benefits includes funding for: equal access 
to Justice Act payments, medical examination payments, and income 
verification matching (38 United States Code (U.S.C.) Sec. 5317) from 
the Compensation and Pensions (C&P) account. This also includes: 
reporting fees, State Approving Agencies, reimbursements to the General 
Operating Expense account as authorized under Public Laws (P.L.) 101-
237 and 105-368, and reimbursements to the Office of Information 
Technology account as authorized under P.L.s 106-419, 108-454, and 112-
56 from the Readjustments Benefits account.
    B. For fiscal year 2014, please identify how much in mandatory 
funding will be spent on non-direct benefits and how those funds would 
be spent.
    Response. For FY 2014, VA expects to spend $285.3 million in 
mandatory funding on non-direct benefits. Below is a detailed breakdown 
of the requested funding:


----------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------
                                        Compensation and Pension ($000s)

Medical Exams......................................................................................    $231,376
Equal Access to Justice Act........................................................................     $11,768
Income Verification Matching.......................................................................      $9,232
                                                                                                    ------------
  C&P Total........................................................................................    $252,376
                                                                                                    ------------
                                          Readjustment Benefits ($000s)

State Approving Agencies...........................................................................     $19,000
Reporting Fees.....................................................................................     $13,308
Reimbursement to GOE...............................................................................        $568
                                                                                                    ------------
RB Total...........................................................................................     $32,876
                                                                                                    ------------
  TOTAL............................................................................................    $285,252
----------------------------------------------------------------------------------------------------------------

    C. Are any mandatory funds expected to be spent to hire 
contractors? If so, please specify the amount(s) and purpose(s).
    Response. In accordance with Section 504 of the Veterans' Benefits 
Improvement Act of 1996, Public Law 104-275, VA is authorized to pay 
for contracting of disability evaluation examinations from the C&P 
account. In FY 2014, VA estimates this amount to be $231.4 million.
    Also, section 3697 of title 38 U.S.C, authorizes VA to use $6 
million from the Readjustment Benefits account to pay for educational 
or vocational counseling services obtained by VA by contract for 
Veterans applying for or receiving Education or Vocational 
Rehabilitation and Employment benefits.
    Additionally, under section 3674 of title 38 U.S.C., VA is 
authorized to reimburse State Approving Agencies up to $19 million from 
the Readjustment Benefits account. This funding is for the reasonable 
and necessary salary, travel, and administrative expenses incurred by 
employees of the State Approving Agencies in carrying out contracts or 
agreements entered into with VA for the purpose of ascertaining the 
qualifications of educational institutions for furnishing courses of 
education to eligible persons or Veterans.
    D. Are mandatory funds expected to be used to pay the salary of any 
VA employees? If so, please specify the amount(s) and purpose(s).
    Response. Section 5317 of title 38 U.S.C., directs VA to pay the 
expenses of carrying out certain income verification matching 
activities with the mandatory C&P appropriation. Accordingly, the C&P 
appropriation reimburses the General Operating Expenses (GOE) account 
and the Office of Information Technology account for administrative 
costs associated with verification of eligibility for the pension 
program through income verification matching. The FY 2014 reimbursement 
to the GOE account is estimated to be $8.4 million, which will be used 
to support 97 FTE. Reimbursement to the Office of Information 
Technology in FY 2014 is estimated to be $110,000, which will be used 
to support one FTE.
    P.L. 104-275 directs VA to make payments for contracts for the 
pilot program for disability examinations from the C&P appropriation. 
Historically, VA appropriations acts have provided that the mandatory 
C&P appropriation is the source of funding for the pilot program for 
disability examinations. Accordingly, the C&P appropriation has 
reimbursed the the GOE account for the purposes of conducting a pilot 
program to contract disability evaluation examinations of claimants for 
benefits administered through VBA. The FY 2014 reimbursement amount is 
estimated to be $2.1 million, which will support 25 FTE.

    Question 44. This budget would cut VA central office (VACO) funding 
by 5 percent; however, the offices that comprise VACO would realize an 
increase of 106 full-time equivalents (FTE) if this budget were 
adopted. During the budget rollout on April 10, 2013, VA responded to a 
question inquiring about the contradiction of an increase in FTE and a 
funding decrease that the additional staff is paid for out of the 
Supply Fund and Franchise Fund. Additionally, throughout the budget 
request for the General Administration account, many offices within 
VACO indicate budget allocations and staffing under the heading 
``reimbursement.''
    A. Of the 3,334 staff requested in the fiscal year 2014 request, 
how many are funded through the Supply Fund and Franchise Fund? Please 
breakout this number by individual VACO offices (for example, Office of 
the Secretary, Office of General Counsel, Office of Policy and 
Planning, etc.).
    Response. The 3,334 staff represent the FTE level funded within the 
General Administration (GenAd) account in the President's FY 2014 
budget request. A total of 76 GenAd FTE are reimbursed by the Supply 
Fund for services provided (62 FTE in the Office of General Counsel, 7 
in the Office of Business Oversight, and 7 in the Office of 
Acquisitions, Logistics and Construction). None of the 3,334 FTE are 
direct Supply Fund or Franchise Fund employees. The 106 FTE increase 
reflected in GenAd represent staff being hired during the later stages 
of FY 2013 which will be fully annualized in FY 2014. The on-board FTE 
at the beginning of the fiscal year is not expected to change 
significantly over the course of the year.
    The 106 FTE consists of 31 FTE from budget authority (BA) and 75 
FTE from reimbursable authority (RA). They are primarily funded through 
VA's Human Capital Investment Plan (RA), VA's Identify Credentials 
Management Program (RA), and VA's enterprise-wide facilities 
transformation efforts (BA and RA).
    B. Please provide the Committee with a detailed description of the 
heading ``reimbursement.'' Please include the office, department, or 
agency that is being reimbursed, a description of the program or 
service for which they are being reimbursed, and the number of staff 
associated with the reimbursement. Please break this out by individual 
VACO offices (for example, Office of the Secretary, Office of General 
Counsel, Office of Policy and Planning, etc.).
    Response. The reimbursement process for VA's GenAd account occurs 
when one office provides a service that benefits another office, and 
the office receiving the service reimburses the providing office for 
the cost of that service. Authority to provide reimbursements is 
allowed under the Economy Act (31 United States Code (U.S.C.) 
Sec. 1535), Account Adjustment Statute (31 U.S.C. Sec. 1534), or other 
specific authority, including appropriations language. In many 
instances, these authorities are utilized to ``pool'' funds to pay for 
products or services that benefit more than one appropriation. VA 
charges the benefiting appropriations amounts that are commensurate 
with the value received by their staff office(s) and/or 
Administrations.
    Authorized reimbursements are requested through the Office of 
Management and Budget apportionment process. Of the 3,334 FTE requested 
in FY 2014, 1,067 are reimbursable FTE in the GenAd account. Of this 
total, 76 GenAd FTE are reimbursed by the Supply Fund for services 
provided directly to the Fund (62 FTE in the Office of General Counsel 
for legal services provided to the Fund; 7 FTE in the Office of 
Business Oversight for logistics reviews for the Fund; and 7 FTE in the 
Office of Acquisition, Logistics, and Construction for management 
oversight of the Fund). Below is a description of the reimbursable 
programs and FTE (if applicable) performed within the GenAd account.
                        office of the secretary
Office of Employment Discrimination Complaint Adjudication (OEDCA)--
        FTE: 24
    OEDCA has statutory authority to collect reimbursements for costs 
incurred to carry out its operations. Historically, an administrative 
provision in the annual appropriations act has provided that VA 
customers may reimburse OEDCA for services provided, see, e.g., section 
210 of title II of division E of section 2 of the Consolidated and 
Further Continuing Appropriations Act, 2013 (Public Law 113-6). OEDCA 
is an independent office responsible for issuing final agency decisions 
and orders on the merits of employment discrimination complaints filed 
by employees. OEDCA is also responsible for determining equitable 
relief and issuing final agency decisions on a complainant's 
entitlement for compensatory damages and attorney's fees if the 
complainant is the prevailing party. OEDCA collects funding from the 
customers it services.
Leading Executives Driving Government Excellence (EDGE)--FTE: 3
    The President's Management Council initiated Leading EDGE to: 1) 
inspire a seamless and powerful senior executive corps with shared 
governmentwide identity and vision; 2) craft solutions that have impact 
across agencies; and 3) reignite the highest ideals of public service. 
To achieve these objectives, Leading EDGE employs five integrated 
learning components: workshops, leadership assessments, government 
performance projects, executive coaching, and a Web portal for 
increased cross-agency networking and problem-solving. In FY 2012, the 
program's first year, 15 Federal Government departments (totaling over 
150 individual bureaus) reimbursed VA to participate in Leading EDGE.
                    office of general counsel (ogc)
    OGC receives reimbursement for legal services it provides where 
authorized by statute.
MSCA Medical Support and Compliance Account--FTE: 63
            Public Law 101-508 MSCA (formally Medical Care Collection 
                    Fund (MCCF))
    The Budget Reconciliation Act of 1990, Public Law 101-508, 
established the Medical Care Cost Recovery Revolving Fund (MCCF). VA 
medical centers receive the funds collected through the MCCF program 
and may use those funds for direct patient care. The reimbursement OGC 
receives for its collection efforts, as authorized by 38 U.S.C. 
Sec. 1729A(c)(1)(B), enables it to provide legal services related to 
the recovery of reasonable charges from third parties (health insurance 
companies, workers compensation plans, no-fault automobile insurance 
carriers, and third-party tortfeasors) that are legally responsible for 
paying for medical care and services provided to Veterans. In addition, 
the Medical Support and Compliance Appropriations Account has 
traditionally contained specific language that provides that the 
account is available to fund ``legal expenses of the Department for 
collecting and recovering amounts owed the Department as authorized 
under chapter 17 of title 38, United States Code, and the Federal 
Medical Care Recovery Act.'' See Public Law 113-6, the Consolidated and 
Further Continuing Appropriations Act, 2013. Through OGC's services in 
this program, VA has collected over $260 million which it returned to 
VA medical centers for providing care to Veterans.
Credit Reform--FTE: 41
    The Federal Credit Reform Act (FCRA) states that ``[a]ll funding 
for an agency's administration of a direct loan or loan guarantee 
program shall be displayed as distinct and separately identified 
subaccounts within the same budget account as the program's cost'' 
(emphasis added). Generally, the FCRA requires a fund established for a 
credit program to have two types of accounts. One is a program account 
that records administrative expenses and disburses the subsidy cost to 
the financing cost, and the other is a financing account that records 
all of the cash-flows resulting from direct loans or loan guarantees 
(It disburses loans, collects repayments and fees, makes claim 
payments, holds balances, borrows from Treasury, and earns or pays 
interest.).
    OGC provides legal services under the FCRA and receives 
reimbursement from the following two programs' accounts as authorized 
by law:

    Veterans Housing Program: OGC provides legal services related to 
the origination and liquidation of guaranteed loans and to the 
acquisition and sale of properties acquired as a result of guaranteed 
loans that are foreclosed.
    Native American Housing Program: OGC provides legal services 
regarding the negotiation of memoranda of understanding with tribal 
governments, the origination and liquidation of Native American Direct 
Loans (NADL), and the acquisition and sale of properties acquired as a 
result of NADL loans that are foreclosed.
Supply Fund Contract Attorneys and Staff--FTE: 62
    OGC personnel provide direct contract support regarding all legal 
aspects of Supply Fund procurements, including defending the Department 
against protests, and are reimbursed by the Revolving Supply Fund. 
Section 8121 of title 38, U.S.C., authorizes VA to use the Supply Fund 
to cover ``all expenses necessary'' for the operation and maintenance 
of a supply system.
Veterans Canteen Service (VCS)--FTE: 1
    The employee is under the supervision of the OGC Regional Counsel 
and the Assistant Regional Counsel in St. Louis, Missouri, where the 
VCS has its headquarters. The attorney provides advice and 
representation in administrative hearings and court proceedings as it 
pertains to employee/labor relations and Equal Employment Opportunity 
matters and acts as a liaison with personnel from other OGC regions who 
perform representational tasks involving VCS personnel and operations. 
Section 7804 of title 38, U.S.C., authorizes VA to use the Veterans 
Canteen Service Revolving Fund to cover administrative and operating 
expenses of the VCS.
Veterans Administration Law Enforcement Training Center (LETC)--FTE: <1
    OGC provides reimbursable legal services from an attorney, part-
time, to LETC to plan, coordinate, develop, and teach courses in legal 
aspects related to the field of law enforcement. LETC is a Franchise 
Fund entity that is authorized to collect fees for services provided 
and to use such fees to cover the total costs of providing such 
services.
Enhanced-Use Lease (EUL)--FTE: <1
    OGC provides legal support to VA's Office of Asset Enterprise 
Management (OAEM), which administers VA's EUL program. VA's EUL 
program, codified at 38 U.S.C. Sec. Sec. 8161-8169, authorizes VA to 
out-lease underutilized and vacant real property to lessees for terms 
of up to 75 years. In return, the lessees develop and operate the out-
leased real property consistent with the EUL statute (which is 
currently limited to providing eligible Veterans and non-Veterans with 
``supportive housing,'' as defined in 38 U.S.C. Sec. 8161(3)) and 
provide VA with negotiated consideration (i.e., in-kind consideration 
and/or cash, depending upon when the underlying EUL was executed). VA's 
EUL policy is contained in VA Directive and Handbook 7415. Section 8165 
of title 38 U.S.C. authorizes the Secretary to use the proceeds from 
any EUL to reimburse applicable appropriations of the Department for 
any expenses incurred in the development of additional EULs. Notably, 
per Chapter 8, paragraph 3 of the Handbook (copied below), OAEM may 
charge a ``reimbursement fee'' for EUL projects that involve VA 
receiving cash lease consideration. This fee is charged to reimburse 
OAEM and OGC for their direct and indirect project-related expenses 
associated with negotiating and administering the underlying EUL.
    EU Reimbursement Policy and Procedures. Each executed EU lease 
project managed by OAEM may be subject to a reimbursement fee to be 
charged against the proceeds from the project. This charge is designed 
to reimburse OGC and OAEM for direct and indirect project-related 
expenses associated with planning, developing, executing, managing and 
providing legal advice and services for the respective EU project, 
transactions and lease. This fee is not to exceed reasonable VA 
expenses.
Construction Facility Management (CFM)--FTE: 6
    OGC attorneys review and comment on legal issues associated with 
the Office of Acquisition, Logistics, and Construction (OALC) and CFM 
major construction and real property projects located throughout the 
country. The attorneys are solely dedicated to OALC/CFM work and are 
supported through funding reprogrammed from CFM within the GenAd 
account. At least one will support OALC/CFM major leasing projects. The 
attorneys who will support the OALC/CFM major construction program will 
be assigned to the major projects in Denver, Colorado; Orlando, 
Florida; New Orleans, Louisiana; and Palo Alto, California. 
Additionally, the attorneys will assist with the remaining projects in 
the Western, Central, and Eastern Regions, as well as the National 
Region, which supports the National Cemetery Administration (NCA). 
OALC/CFM initiated this arrangement of direct legal support to assist 
in the expedient resolution of legal issues associated with major 
construction and leasing projects.
                          office of management
Defense Finance and Accounting Service (DFAS)--FTE: 0
    The Office of Finance within the Office of Management has an Inter-
Agency Agreement with DFAS to process VA's payroll and leave and 
earnings statements. Obligations are incurred and managed centrally, 
and VA offices reimburse the Office of Management for their share of 
the costs. No FTE are reimbursed.
Office of Business Oversight (OBO)--Veterans Health Administration 
        (VHA)--FTE: 20
    OBO receives reimbursements from VHA to support OBO personnel in 
conducting expense and revenue reviews that ensure VHA field facilities 
comply with existing financial rules, regulations, and policies and 
assure the quality of VHA fiscal information.
OBO--Supply Fund--FTE: 7
    OBO collects funding from the Supply Fund to cover expenses for OBO 
logistics reviews of the Supply Fund to ensure VHA field stations and 
VA Central Office organizations comply with existing rules, 
regulations, and policies.
OBO--A-123--FTE: 4
    OBO personnel conduct and test reviews of internal controls of 
financial reporting as required by Office of Management and Budget 
Circular A-123 at VA facilities. The VA organizations that contribute 
funding toward these reviews are VHA, the Veterans Benefits 
Administration (VBA), NCA, and Office of Information and Technology.
OAEM--Green Management--FTE: 5
    OAEM receives reimbursement from VHA for support of the VA Green 
Management Program at VHA field facilities. The portfolio managers 
support the Department's initiative, Establish Enterprise Energy Cost 
Reduction and Implement VA-wide Greenhouse Gas Initiative to Address 
VA's Carbon Footprint--Greening VA. These professionals assist OAEM in 
managing the Green Management Program and meeting its performance and 
reporting mandates.
OAEM--Building Utilization Review and Repurposing (BURR)--FTE: 3
    OAEM receives reimbursement from VHA for support it provides to 
eliminate Veteran homelessness through VA's EUL program. Another 
initiative, BURR, uses VA's EUL program through public/private 
partnerships to leverage VA's vacant and underutilized buildings and 
land nationwide to provide housing for Veterans and their families who 
are homeless or at-risk of homelessness.
Office of Management--VA Center of Innovation (VACI)--FTE: 0
    The VACI program taps the talent and expertise of individuals 
inside and outside of government to innovate and improve Veterans 
access to services, lower costs, improve quality, and enhance the 
performance of VA operations. The offices receiving the benefits and 
services provide reimbursement to support any contractual costs and 
operating expenses.
           office of human resources and administration (hra)
Human Capital Investment Plan (HCIP)--FTE: 298
    The HCIP includes VA's Learning University and focuses on the 
development of VA's workforce through enterprise-wide training. This is 
accomplished by leadership training, workforce competency training, 
Veteran hiring efforts, employee wellness, and the Corporate Senior 
Executive Management Office. HCIP program costs are funded by each 
program office through reimbursements to HRA on a pro-rata FTE basis.
Office of Resolution Management (ORM)--FTE: 267
    Historically, an administrative provision in the annual 
appropriations act has provided that VA customers may reimburse ORM for 
services provided, see, e.g., section 210 of title II of division E of 
section 2 of the Consolidated and Further Continuing Appropriations 
Act, 2013 (Public Law 113-6). ORM promotes a discrimination-free work 
environment focused on serving Veterans by preventing, resolving, and 
processing Equal Employment Opportunity discrimination complaints and 
providing Alternative Dispute Resolution services as required by law. 
Each office's costs are proportionate to the number of employees that 
use the services across the entire VA system.
VA Child Care Subsidy Program (CCSP)--FTE: 0
    VA CCSP is a nationwide program that assists lower income VA 
employees (household income of less than $59,999 per year) with the 
cost of child care. There are over 2,000 VA employee participants who 
receive child care services and receive a subsidy. Reimbursement is 
strictly for the costs of the program.
VA Central Office Services--FTE: 20
    The Office of Administration (O/A) provides numerous services for 
the VA Central Office campus. O/A houses the simplified acquisitions 
staff which processes all procurement and acquisition requests for 
purchases under a threshold of $150,000 for VA organizations in 11 
buildings throughout the National Capital Region. Funding supports 
acquisitions, labor support, and warehouse staff. O/A manages the 
National Transit Benefits Program Office which administers the transit 
benefits program for VA nationwide. Funds cover the salaries and 
benefits of the National Transit Benefits Program Office. O/A oversees 
the contract of the health units which provides health care services to 
VA Central Office employees in designated buildings and maintains the 
VA Central Office fitness center. The costs support the contract and 
personnel who manage the contract. O/A has a contract to transport VA 
Central Office employees across campus during duty hours.
                  office of policy and planning (opp)
Enterprise Data Contracts--FTE: 0
    OPP requires three types of contract support to be the 
authoritative organization for data governance, Veterans' statistics, 
statistical analysis, and modeling to manage the Department's business 
intelligence tools and processes and to manage VA resources for 
developing interactive mapping tools and products. The three contracts 
will enhance data collection reporting and analysis capabilities while 
providing standards and guidelines for corporate-level business 
intelligence program management. A major contract for OPP is data-
mining, which acquires Veteran demographics to supplement existing VA 
data sources. The integrated data will be used by VA to conduct 
statistical research and analysis, develop predictive models, and 
conduct outreach to Veterans. The offices that receive the data and 
analysis and benefit from these services reimburse OPP for these 
contracts.
Secretary's Carey Awards Program--FTE: 0
    The Secretary of Veterans Affairs' Robert W. Carey Performance 
Excellence Award is an annual award that recognizes organizations 
within the Department that have implemented management approaches that 
result in sustained high levels of performance and service to the 
Veterans we serve. OPP's Enterprise Program Management Office, executor 
of the Carey Awards Program, uses award criteria aligned with the 
Malcolm Baldrige Criteria for Performance Excellence. These criteria 
are nationally recognized as a framework and standard for 
organizational excellence. VHA, VBA, and NCA provide funding for 
contractor support to train personnel to understand the Baldrige 
criteria in order to develop application packages, provide support to 
Carey examiners during consensus week, provide technical editing 
support, and provide feedback to applicants for continuous improvement 
purposes.
         office of operations, security, and preparedness (osp)
Identity, Credential and Access Management Program (ICAM)--FTE: 30
    A new program in FY 2014, ICAM, along with the ongoing 
transformation initiative of Continuous Readiness in Information 
Security (CRISP), will strengthen VA's security by sharing information 
on the character and conduct of VA employees during the on-boarding, 
station code or inter-Department transfer, or off-boarding processes, 
consistent with Privacy Act requirements, VA Privacy Policy, and 
collective bargaining agreements where applicable. Each program office 
reimburses OSP for its share of the costs of this program.
Personal Identity Verification (PIV) Card--FTE: 0
    Costs reflect procurement, distribution, and management support 
related to Homeland Security Presidential Directive--12 PIV cards and 
consumables for the Department. Each VA office reimburses OSP for its 
share of the PIV cards and consumables.
         office of public and intergovernmental affairs (opia)
Homeless Veterans Initiative Office (HVIO)--FTE: 15
    OPIA's HVIO provides policy development, interagency coordination, 
and public/community engagement in collaboration with VHA, which is 
responsible for the operation and clinical implementation of 
eliminating homelessness among Veterans. VHA provides reimbursement to 
fund this initiative.
       office of acquisition, logistics, and construction (oalc)
    Consistent with appropriation language (see, e.g., Public Law 113-
6, the Consolidated and Further Continuing Appropriations Act, 2013), 
OALC receives funding from the Major Construction and VHA Medical 
Facilities appropriations to cover costs for resident engineers who 
provide on-site supervision of VA's Major Construction projects and for 
VHA lease projects located throughout the country.
    OALC also receives reimbursement for FTE from NCA and the Supply 
Fund to cover the costs of the work and services related to those 
programs. In all circumstances, funding will cover employee costs 
including salary and benefits, training, travel, permanent change of 
station expenses, contracts, and other associated costs of these 
programs. Additional detail is below:

     Reimbursement for on-site resident engineers--187 FTE from 
Major Construction, as authorized in appropriation language;
     Reimbursement for proportionate share of OALC management 
support provided from the Supply Fund--7 FTE; and
     Reimbursement for NCA Real Property Land Acquisitions/
Actions support--2 FTE.
                         readjustment benefits
    Question 45. One item that VA pays for using mandatory funding is 
reporting fees provided to educational institutions. In response to 
questions about the fiscal year 2013 budget request, VA indicated that 
information was not available for 2011 regarding the number of 
institutions that received reporting fees from VA or the size of those 
payments.
    A. Is that information now available regarding 2011 reporting fees? 
If so, please provide the number of institutions that received 
reporting fees, the 10 largest payments made to an institution, and the 
10 smallest payments made to an institution.
    Response. VA paid 9,557 educational institutions a total of 
$9,370,303 in reporting fees in calendar year 2011. The tables below 
show the institutions with the 10 largest and 10 smallest total payment 
amounts.


------------------------------------------------------------------------
                                                 Largest Reporting Fee
                 SCHOOL NAME                     Amounts  for Calendar
                                                  Year 2011  (in $'s)
------------------------------------------------------------------------
University of Phoenix (Online)...............          230,317.00
American Public University System (American            109,697.00
 Military University)........................
University of Maryland University College....           65,313.00
Grantham University..........................           60,696.00
Kaplan University............................           58,707.00
Central Texas College........................           45,947.00
Columbia Southern University.................           41,257.00
University of Phoenix (San Diego)............           39,424.00
Florida State College at Jacksonville........           39,085.00
DeVry University Online......................           38,530.00
------------------------------------------------------------------------




------------------------------------------------------------------------
                                                Smallest Reporting Fee
                SCHOOL NAME                   Amounts  for Calendar Year
                                                    2011  (in $'s)
------------------------------------------------------------------------
A and B Training Academy...................                        7.00
A Head of Time Design Academy..............                        7.00
A Step Ahead Academy and Salon.............                        7.00
A T E of Texas Inc., DBA American Fly......                        7.00
A.B. Training Center, LLC..................                        7.00
Abrams College (CHAPTER 31)................                        7.00
Academy of Acadiana--New Iberia............                        7.00
Academy of Cosmetology.....................                        7.00
Academy of Equine Dentistry(CHAPTER 31)....                        7.00
Academy of Hair Design.....................                        7.00
1,046 other institutions...................                        7.00
------------------------------------------------------------------------

    B. Is that information available regarding reporting fees paid in 
2012? If so, please provide that information.
    Response. VA paid 10,578 educational institutions a total of 
$10,442,799 in reporting fees in calendar year 2012. The tables below 
show the institutions with the 10 largest and 10 smallest total payment 
amounts.


------------------------------------------------------------------------
                                                        Largest Gross
                                                        Payments  in
                    SCHOOL NAME                      Calendar Year 2012
                                                          (in $'s)
------------------------------------------------------------------------
University of Phoenix (Online)....................        339,132.00
American Public University System (American               169,596.00
 Military University).............................
Ashford University (Online).......................        143,835.00
University of Maryland University College.........         91,740.00
Liberty University................................         79,119.00
Grantham University...............................         75,600.00
Kaplan University.................................         72,060.00
Columbia Southern University......................         59,076.00
Central Texas College.............................         55,752.00
University of Phoenix (San Diego).................         51,372.00
------------------------------------------------------------------------




------------------------------------------------------------------------
                                                       Smallest Gross
                   SCHOOL NAME                     Payments  in Calendar
                                                    Year 2012  (in $'s)
------------------------------------------------------------------------
Louisiana Technical College--Shreveport..........                 12.00
YogaMotion--Center for Holistic Education........                 12.00
Yoga Yoga Teacher Training.......................                 12.00
Yoga Connection, The.............................                 12.00
Yale University School of Medicine--School of                     12.00
 Public Health...................................
Yale University School of Drama..................                 12.00
Xtra-mile Driver Training, Inc. (CHAPTER 31 ONLY)                 12.00
Xenon International Academy--Grand Island........                 12.00
Xenon International Academy......................                 12.00
Wyzsza Szkola Komunikacji I Zarzadania...........                 12.00
------------------------------------------------------------------------


    Question 46. The fiscal year 2014 budget request reflects that VA 
now expects to spend $4,764,000 from readjustment benefits in fiscal 
year 2013 for ``[r]eimbursement to [General Operating Expenses] and 
[Information and Technology],'' which is $4,226,000 more than VA had 
originally projected would be spent in fiscal year 2013 for that 
purpose. The budget submission also reflects that, in fiscal year 2014, 
VA expects to spend $568,000 for that purpose.
    A. Please provide an itemized list of how that $4.8 million is now 
expected to be spent during fiscal year 2013.
    Response. Please see the following chart:


------------------------------------------------------------------------
                                           FY 2013
          Readjustment Benefits            ($000s)        Authority
------------------------------------------------------------------------
Reimbursements to GOE
  Information Pamphlets on Education          $234  PL 101-237: sec 421
   Benefits.
  Education Outreach Letters............      $304  PL 105-368: sec 206
Reimbursements to IT
  Licensing and Certification System          $158  PL 106-419: sec 121
   Start-Up Funds.
  Computer System Modifications for         $2,189  PL 108-454: sec 104
   Apprenticeship and OJT.
  Veterans Retraining Assistance Program    $1,880  PL 112-56: sec 211
   (VRAP) IT Expenses.
                                         ----------
    Total Reimbursements................    $4,764
------------------------------------------------------------------------

    B. Please explain the specific changes that led to this expected 
increase during fiscal year 2013.
    Response. The increases in the FY 2013 current estimate are a 
result of available funds carried over from FY 2012 to FY 2013 for 
reimbursements to the Office of Information and Technology. At the time 
the following laws were passed, $3 million was made available for 
Licensing and Certification systems under Pub. L. 106-419; $3 million 
was made available for Apprenticeship and on-job training (OJT) systems 
under Pub. L. 108-454; and $2 million was made available for VRAP 
systems under Pub. L. 112-56. Each fiscal year, the remaining unused 
funds are still available for the intended purpose identified in law. 
The increase for FY 2013 reflects the remaining funds being carried 
over for obligation during FY 2013.
    C. Please provide an itemized list of how these funds are expected 
to be spent during fiscal year 2014.
    Response. Please see the following chart:


------------------------------------------------------------------------
                                          FY 2014
          Readjustment Benefits           ($000s)        Authority
------------------------------------------------------------------------
Reimbursements to GOE
  Information Pamphlets on Education        $248   PL 101-237: sec 421
   Benefits.
  Education Outreach Letters............    $320   PL 105-368: sec 206
Reimbursements to IT
  Licensing and Certification System          $0   PL 106-419: sec 121
   Start-Up Funds.
  Computer System Modifications for           $0   PL 108-454: sec 104
   Apprenticeship and OJT.
  Veterans Retraining Assistance Program      $0   PL 112-56: sec 211
   (VRAP) IT Expenses.
                                         ---------
    Total Reimbursements................    $568*
------------------------------------------------------------------------
* Assuming funds associated with PL 106-419, PL 108-454, and PL 112-56
  are obligated in FY 2013, the remaining $568 thousand is budgeted to
  carry out the authority provided by PL 101-237 and PL 105-368.


    Question 47. In the fiscal year 2014 budget request, VA proposes 
legislation to increase funding for ``contract vocational and 
educational counseling'' for certain veterans or members of the Armed 
Forces.
    A. In fiscal year 2012, how many individuals requested this type of 
counseling, how many individuals were provided with this type of 
counseling, and how much in total was spent to provide counseling to 
those individuals?
    Response. Please see table below showing FY 2012 data:


------------------------------------------------------------------------
                              Completed by
   Total       Completed       Vocational                      Ed Voc
  Veteran         with       Rehabilitation   Completed by   Funding for
  Requests     Counseling    and  Employment    Contractor   Contractor
 for Ch. 36                   (VR&E) Staff                    Services
------------------------------------------------------------------------
15,513       5,341          271               5,070         $1,853,640.9
                                                             5
------------------------------------------------------------------------
* Requests which are not completed with counseling include those that
  are pending completion, as well as those that did not attend their
  required counseling appointments despite follow-up outreach attempts.

    B. In fiscal year 2013, how many individuals are expected to seek 
this type of counseling, how many individuals are expected to be 
provided with this counseling, and how much in total is expected to be 
spent on these counseling services?
    Response. Please see table below showing FY 2013 data:


------------------------------------------------------------------------
   Total                                                        Ed Voc
  Veteran     Still     Completed    Completed   Completed   Funding for
 Requests    Pending       with       by VR&E        by       Contractor
for Ch. 36              Counseling     Staff     Contractor    Services
------------------------------------------------------------------------
14,322      1,193      5,585        279         5,306        $2,089,792.
                                                              93
------------------------------------------------------------------------


    FY 2013 estimates are based on the assumption that 60 percent of 
the year is complete, which equates to 60 percent of annual demand. 
Part of the decrease in Veteran requests is caused by the National 
Defense Authorization Act (NDAA) and VR&E counselors at Integrated 
Disability Evaluation System (IDES) installations accelerating 
Servicemembers into the Chapter 31 program. Veterans with service-
connected disabilities who received Chapter 36 counseling often also 
became eligible for and enrolled in the Chapter 31 program. As a result 
of NDAA accelerating eligibility and entitlement to Chapter 31 
services, transitioning Servicemembers going through the IDES are 
receiving counseling under Chapter 31 instead of under Chapter 36.
    C. In fiscal year 2014, how many individuals are expected to seek 
this type of counseling?
    Response. In FY 2014, VA estimates there will be a total of 15,754 
Veterans requesting Chapter 36 counseling. FY 2014 estimates are 10 
percent above FY 2013 projections due to anticipated increases in 
Veteran requests through mandatory TAP, increased outreach to eligible 
Veterans using Post-9/11 GI Bill, and VOW/VEI efforts.

    Question 48. In the fiscal year 2014 budget request, VA proposes 
legislation to permanently authorize work-study activities for which 
authorization is currently set to expire in June 2013. Those work-study 
activities include outreach programs with State approving agencies, 
working in State homes, and administration of a national cemetery or 
state veterans' cemetery.
    A. During fiscal year 2012, how many individuals participated in 
each of those work-study activities.
    Response. The following table shows how many individuals 
participated in each of those work-study activities:


------------------------------------------------------------------------
                                                           Work-Study
                       Category                          Students for FY
                                                              2012
------------------------------------------------------------------------
SAA Outreach..........................................          11
National Veteran Cemetery.............................         106
State Veteran Cemetery................................          19
VA State Homes........................................         166
                                                       -----------------
    Total.............................................         302
------------------------------------------------------------------------


    B. To date, during fiscal year 2013, how many individuals have 
participated in each of those work-study activities?
    Response. Since VA collects work-study statistics at the end of 
each fiscal year, data for FY 2013 is not yet available.
    C. Please describe the resources required to administer this 
portion of the work-study program.
    Response. VA does not anticipate any additional administrative 
costs associated with permanent authorization of this program.

    Question 49. The Honoring America's Veterans and Caring for Camp 
Lejeune Families Act of 2012 provided a temporary expansion of 
eligibility for specially adapted housing for certain veterans with 
disabilities causing difficulty with ambulating.
    A. How many veterans have qualified for this expansion?
    Response. VA claims examiners are processing claims for benefits 
under Section 202 of P.L. 112-154. VA does not track the status and 
disposition of claims for benefits under Section 202 of P.L. 112-154 
separately from other claims. Also, due to the recent implementation of 
this law, VA has not yet compiled data related to this temporary 
expansion.
    VA notes that the law specifies that assistance under certain 
provisions of Section 202 of P.L. 112-154 may only be furnished for 
applications approved on or before the sunset date (September 30, 
2013). Because approval of a Specially Adapted Housing (SAH) grant is a 
two-step process, in order for a Veteran or Servicemember to be 
qualified for benefits under those provisions of Section 202, the 
individual must receive a medical rating from VA of eligibility for SAH 
grant benefits, as well as a determination of site feasibility and 
suitability by VA to ensure the home can be adapted to meet the 
individual's needs. For a Veteran or Servicemember to receive benefits 
authorized by those provisions, both the medical rating and the site 
feasibility and suitability determination would need to be completed on 
or prior to the expiration date of the provisions (September 30, 2013).
    In the fourth quarter of FY 2013, VA will be conducting a manual 
count of Veterans and Servicemembers who have been medically rated 
eligible for Section 202 benefits and who have begun the process of 
site feasibility and suitability to obtain actual data. VA will be 
happy to provide this information to SVAC upon conclusion of the count. 
VA is also researching options for a system enhancement to the 
Specially Adapted Housing/Special Housing Adaptation (SAHSHA) system, 
which would allow SAH staff to flag and report on in-process grants 
associated with Section 202 eligibility.
    B. How many houses have been adapted using this authority?
    Response. VA is unable to provide the requested figures at this 
time. Upon conclusion of the fourth quarter of FY 2013 manual count, VA 
will provide more information to the Committee.
    C. What is the average cost and the total cost per veteran of those 
who qualified and used the expansion?
    Response. VA is unable to provide the requested figures at this 
time; however, please note that each eligible Veteran may receive a 
grant of up to $63,780.00. Upon conclusion of the fourth quarter of FY 
2013 manual count, VA will provide additional information to the 
Committee.
                    veterans benefits administration
Disability Compensation
    Question 50. In January 2013, VA sent to Congress a strategic plan 
for eliminating the backlog that projected VA would decide 1.6 million 
claims in fiscal year 2014. Less than three months later, VA submitted 
its budget request, which projects that VA will decide 1.3 million 
claims in fiscal year 2014.
    A. What specific performance metrics did VA assess in lowering this 
projection and what did they show?
    Response. The projections of received and completed claims in VA's 
Strategic Plan to Eliminate the Compensation Claims Backlog, submitted 
to Congress on January 25, 2013, were based on assumptions made earlier 
in the budget cycle that included a higher level of claims receipts and 
FTE than is reflected in the 2014 VA Budget Submission. VA revised its 
projections prior to submission of the FY 2014 budget to Congress based 
on FY 2013 actual experience to date that reflected a lower volume of 
claims receipts than previously projected. Projections are periodically 
updated based on recent experience, the impact of the transformation 
initiatives, and enhanced forecasting capabilities.
    B. Are there any on-going initiatives that are not having the 
impact on production that VA expected? If so, please explain.
    Response. VBA closely monitors the impact of initiatives on 
performance. All currently on-going initiatives have provided 
improvements to the disability claims process. A previous initiative 
called the Veterans Benefits Management Assistance Program (VBMAP) did 
not have an impact as expected and was not pursued further.
    VBMAP was a professional services contract for rapid development of 
claims for increased benefits, initial compensation claims, pension 
claims, and dependency verification claims. The VBMAP contract was 
awarded September 2011, requiring 100% quality and 300,000 developed 
claims. The VBMAP vendor did not meet the quality or volume 
requirements of the contract. In June 2012, VA halted shipment of 
claims to allow the vendor to improve performance. The contract ended 
after the base period, September 12, 2012.

    Question 51. According to VA's January 2013 backlog plan, VA 
expected that, in the first quarter of 2014, the number of claims VA 
decides would start to outpace the number of claims being received and 
that the total number of pending claims would be reduced in 2014. The 
fiscal year 2014 budget submission reflects that claims receipts will 
exceed production in 2014 and the number of pending claims will 
continue to grow.
    A. What specific information and metrics initially led VA to 
project that the first quarter of 2014 would be the point when output 
would start to exceed input?
    Response. The January 2013 strategic plan presented a worst case 
scenario in terms of a large number of incoming claims due primarily to 
the implementation of the Veterans Opportunity to Work (VOW) program 
for separating servicemembers. We anticipated that 200K+ additional 
claims might come in. Our belief was that if they did come in, they, 
and many other supplemental claims, would be submitted electronically, 
be fully-developed, and be simpler to process overall. Those 
assumptions led us to believe that if the large volume of new VOW-
related claims occurred, we had a reasonable chance of turning them 
around very quickly; thus, we showed very large production increases in 
FY 2014 and especially FY 2015. In this worst case scenario, we 
believed that by not later than first quarter FY 2014 we would see 
significant production improvements from Transformation. We understood 
the high risk that we would be assuming in production and that possible 
risk generated significant discussion about resource requirements.
    B. In revising this projection, what metrics did VA assess and what 
did they show?
    Response. In revising the January 2013 projections for the FY 2014 
budget submission, we had trend data showing that traditional receipts 
were moving downward but we were not yet ready to ignore the potential 
impact of additional VOW-related claims. In reviewing the risk 
associated with the dramatic increase in production we postulated in 
the January plan, we concluded that with the resources requested we 
needed to adjust our production plan to reflect a less risky output 
projection. The combination of less projected production with the still 
very real possibility of a large influx of VOW-related claims turned FY 
2014 into a year where we might see no significant reduction in the 
inventory.
    Since the FY 2014 budget was submitted, we have not seen any 
significant effect from VOW on total receipts in FY 2013 or the 
beginning of FY 2014. In addition, we achieved a significant increase 
in FY 2013 production. The net result was that we actually reached the 
point where production exceeded receipts on a consistent basis in the 
third quarter of FY 2013.

    Question 52. In the January 2013 backlog plan, VA noted that it did 
not take into account 774,000 claims that may be filed as a result of 
the VOW to Hire Heroes Act and the Honoring America's Veterans and 
Caring for Camp Lejeune Families Act.
    A. Does VA still expect those laws to generate an additional 
774,000 claims?
    Response. VA still expects that the VOW to Hire Heroes Act will 
result in an increase in claims between FY 2013 and FY 2015. VA will 
provide comprehensive benefits briefings at 250 sites worldwide. 
Together with the Veterans Employment Initiative, this could result in 
many additional claims as Servicemembers transition to civilian life.
    Estimates show that the population assigned to Camp Lejeune between 
1957 and 1987 was 630,000. Although the law provides health care to 
certain eligible Veterans and their eligible family members, it does 
not change the eligibility requirements for granting disability 
compensation. However, as a result of increased media exposure to the 
issue of contaminated water at Camp Lejeune, VA still expects that this 
law could generate additional claims between FY 2013 and FY 2015.
    B. What specific assumptions led VA to project in the fiscal year 
2014 budget submission that less claims will be filed in 2013 and 2014 
than VA projected in the backlog plan?
    Response. As previously mentioned, the projections of received 
claims VA's Strategic Plan to Eliminate the Compensation Claims 
Backlog, submitted to Congress on January 25, 2013, were based on 
assumptions made earlier in the budget cycle that included a higher 
level of claims receipts and FTE than is reflected in the 2014 VA 
Budget Submission. VA revised its projections prior to submission of 
the 2014 budget to Congress based on FY 2013 actual experience to date 
that reflected a lower volume of claims receipts than previously 
projected. Projections are periodically updated based on recent 
experience, the impact of the transformation initiatives, and enhanced 
forecasting capabilities.

    Question 53. The Winston-Salem regional office helps with national 
missions, such as the Benefits Delivery at Discharge program and the 
Quick Start program, in addition to handling claims from North 
Carolinians. That office currently has about 50,000 pending claims.
    A. For that workload, how many employees would be appropriate and 
how many are there currently?
    Response. Based on the RAM for FY 2012, the Winston-Salem RO 
compensation rating claims processing FTE ceiling was 605. Due to 
workload challenges, 25 additional FTE were approved in August 2012. As 
of April 30, 2013, the actual on board FTE was 621.
    B. What specific factors are considered in determining how claims 
processing staff are allocated among the regional offices?
    Response. The RAM is a systematic approach to distributing field 
resources each fiscal year. The RAM uses a weighted model to assign 
compensation and pension FTE resources based on RO workload in rating 
receipts, rating inventory, non-rating receipts, and appeals receipts. 
VBA leaders use the model as a guide, making some adjustments for 
special circumstances or missions performed by individual ROs. Special 
missions include the Appeals Management Center, the Records Management 
Center, Day-One Brokering Centers, IDES processing sites, Benefits 
Delivery at Discharge sites, Quick Start processing locations, national 
call centers, fiduciary hubs, pension management centers, etc. Similar, 
workload-based models are used for each VBA business line.
    C. When did VA last assess the staffing needs of each regional 
office and what did that assessment show?
    Response. VBA assesses staffing needs in each RO at the beginning 
of each fiscal year based on the RAM. In FY 2013, VBA shifted to a RAM 
weighted more heavily on receipts and current workload, rather than the 
previous model which was weighted more on performance. As a result, 
some resources have been shifted to those ROs processing a greater 
portion of claims receipts and those currently carrying a greater 
portion of the claims inventory. The FY 2013 RAM has yet to be fully 
implemented, since rebalancing FTE resources is dependent upon 
attrition, and VBA must operate within its overall funding level. VBA 
anticipates continued use of this workload-driven RAM going forward.
    D. When is the next assessment scheduled to occur? Please share the 
results of that review with the Committee.
    Response. The RAM will be reviewed to ensure consistency with 
achieving VBA's national mission and updated with current workload and 
performance metrics for each RO at the beginning of FY 2014. VA can 
share the results of the review with the Committee once it has been 
finalized.

    Question 54. VA has a number of initiatives underway to reach its 
goal of a 98 percent accuracy rate.
    A. In total, how much did VA spend in fiscal year 2012 to carry out 
all of those quality initiatives?
    Response. VBA's transformation plan is based on over 40 high-impact 
initiatives across people, process, and technology through a systematic 
and repeatable gap analysis process. It is difficult to separate each 
initiative's precise impact on quality and productivity; however, the 
FY 2012 funding for three of the initiatives with the greatest impact 
on quality is provided below:

     VBMS: $23.9 million (VBA GOE funding)
     Challenge training: $9.5 million
     Quality Review Teams: $51 million

    B. In total, how much is VA expecting to spend in fiscal year 2013 
to carry out all of those quality initiatives, including the quality 
review teams at each regional office?
    Response. As previously noted, several initiatives will impact 
quality. A summary of FY 2013 funding for the primary initiative 
focused on improving quality is provided below:

     VBMS: $20.8 million (VBA GOE funding)
     Challenge training: $10.1 million
     Quality Review Teams: $52 million
     Station Enhancement Training: $925,000

    C. In total, how much is VA requesting for fiscal year 2014 to 
carry out all of those quality initiatives, including the quality 
review teams at each regional office?
    Response. For FY 2014, VBA has requested the following funding for 
these initiatives:

     VBMS: $35.7 million
     Challenge training: $9.9 million
     Quality Review Teams: $53 million

    D. Nationwide, how many full-time equivalents are currently 
assigned to these quality review teams?
    Response. Currently, there are 583 Quality Review Specialists 
nationwide.
    E. If the fiscal year 2014 budget request is adopted, how many 
individuals Nation-wide would be assigned to these teams?
    Response. During the development and piloting of the Quality Review 
Team (QRT) positions, analysis showed an appropriate staffing ratio of 
one Quality Review Specialist to 15 claims processors. VBA anticipates 
continuing to utilize this staffing ratio for QRT positions during FY 
2014. Since RO staffing will remain consistent from FY 2013 to FY 2014, 
there will be no change to the number of Quality Review Specialists in 
FY 2014.

    Question 55. In the 2012 PAR, VA indicated that the use of 
Disability Benefits Questionnaires has ``resulted in more timely rating 
decisions, fewer duplicated examinations, a reduced need for VA 
examinations, and a potential to improve rating accuracy.''
    A. Please provide any statistics on the timeliness of rating 
decisions in cases involving Disability Benefits Questionnaires 
compared to cases that do not.
    Response. All Veterans benefit from the efficiencies built into the 
Disability Benefits Questionnaires (DBQ) tools. Submitting a claim with 
a DBQ completed fully and accurately by a treating clinician can 
obviate the need to request a C&P examination, thus reducing the time 
required to obtain all the evidence necessary to decide the claim. 
Additionally, since DBQs are streamlined, condition-focused, and 
capture the specific rating criteria needed to evaluate a medical 
condition, they elicit from the examiner responses to very specific 
questions that yield all necessary facts to evaluate a disability 
claim. Since the initiation of the DBQ process in 2012, VA has received 
just over 15,000 DBQs from treating clinicians and more than 2.54 
million DBQs completed through the C&P exam process.
    At this time, there is insufficient data to compare the differences 
in timeliness of rating decisions in cases involving DBQs with those 
that do not as there are a limited number of cases in which DBQs are 
not used. Additionally, other factors may affect timeliness which are 
not related to DBQ use, such as requesting military and other Federal 
records.
    B. Please provide any statistics on the number of duplicated 
examinations that have been avoided as a result of the use of 
Disability Benefits Questionnaires and the cost savings associated with 
that reduction.
    Response. Because DBQs are streamlined, condition-focused, and 
capture the specific rating criteria needed to evaluate a medical 
condition, they elicit from the examiner responses to very specific 
questions that yield all necessary facts to evaluate a disability 
claim. Therefore, the DBQ examination report is less frequently found 
insufficient for rating purposes, reducing the number of additional 
exams on any given Veteran's claim. However, there is insufficient data 
related to a measurable difference in the number of duplicate 
examinations requested. This is not because the value and efficiency of 
DBQs is not being seen, but because of other factors that held the 
national insufficiency rate steady since the implementation of DBQs.
    C. Please provide any statistics on the reduction of VA 
examinations attributable to the use of Disability Benefits 
Questionnaires and the cost savings associated with that reduction.
    Response. The data set of DBQs completed by treating clinicians is 
too small to allow for accurate measure of overall examination 
avoidance. However, conservatively assuming that half of the DBQs 
completed by a treating clinician avoided the need for a C&P 
examination, it is possible that 7,500 fewer examinations were ordered. 
With the average cost of an examination at $500, this equates to $3.75 
million in cost savings. Again, these are estimates based on a non-
statistically significant sample of DBQs. VBA anticipates that the 
examination avoidance figure will actually be higher once DBQs are 
fully automated and become the norm for use by treating clinicians.

    Question 56. In the fiscal year 2014 budget request, VA projects 
that VA will complete 1.1 million claims in fiscal year 2013 and 1.3 
million claims in fiscal year 2014.
    A. If those projections are accurate, how many claims does VA 
expect would need to be completed in fiscal year 2015 in order to meet 
VA's goal of eliminating the backlog by 2015?
    Response. Over the last 6 months, VBA has received a lower volume 
of claims than previously projected. From October 1, 2012, through 
June 3, 2013, VBA received 5.7 percent fewer receipts than last year at 
the same time. As a result, VA will revise its estimates of the number 
of completed claims needed through FY 2015 in connection with 
developing the FY 2015 budget submission. Projections are periodically 
updated based on recent experience, the impact of the transformation 
initiatives, and enhanced forecasting capabilities. Eliminating the 
claims backlog in 2015 remains VA's goal.
    B. What specific performance outcomes suggest to VA that that level 
of output during 2015 is possible?
    Response. These increased levels of output are possible due to the 
implementation of VA's comprehensive Transformation Plan, which is 
designed to eliminate the claims backlog and achieve our goal of 
processing all claims within 125 days at a 98-percent accuracy level in 
2015. This major transformation in claims processing includes a series 
of tightly integrated people, process, and technology initiatives that 
are being implemented according to a carefully developed multi-year 
timeline. The transformational initiatives are being rolled out in a 
progressive, intentional sequence that enables efficiency gains while 
minimizing risks to performance. We are confident that we will meet 
this goal as we continue to implement the Transformation Plan. It is 
important to note that the timeline for eliminating the claims backlog 
could be affected if policymakers establish new presumptive conditions, 
courts make new precedential decisions, or legislators make laws that 
establish new entitlements. VA continues to monitor the performance 
impact of transformation as well as other external factors that could 
potentially have an impact.
    VBA has increased its rating output in each of the past 3 months, 
and in May 2013, VBA set production history by processing more claims 
(109,097) than any previous month. Additionally, VA is eliminating the 
backlog by prioritizing claims for those Veterans who have been waiting 
the longest for a decision, including claims over 2 years old, followed 
by claims over 1 year old. From April 19, 2013, through June 19, 2013, 
VBA successfully processed 65,507 2-year-old claims, and 67,050 1-year-
old claims. Over this same period, VBA reduced its backlog, defined as 
those claims pending for over 125 days, by over 58,000 claims, from 
588,868 to 530,104.

    Question 57. VA's ``appeals resolution time'' in fiscal year 2012 
was 866 days, an increase of 210 days since fiscal year 2010.
    A. How much in total is expected to be expended by the Veterans 
Benefits Administration (VBA) to process appeals during fiscal year 
2013?
    Response. In FY 2013, VBA estimates that funding to process appeals 
will total $84.5 million, including $63 million for Decision Review 
Officers assigned at ROs and $21.5 million on Appeals Management Center 
staffing and operations. There are also VSRs and RVSRs assigned to 
Appeals Teams at ROs. However, VBA is unable to specifically identify 
the payroll costs associated with those employees.
    B. What level of funding is requested in total for fiscal year 2014 
for purposes of processing appeals by VBA?
    Response. The FY 2014 budget includes $85.9 million for processing 
appeals, including $64 million for Decision Review Officers assigned at 
ROs and $21.9 million on Appeals Management Center staffing and 
operations. There are also VSRs and RVSRs assigned to Appeals Teams at 
ROs. However, VBA is unable to specifically identify the payroll costs 
associated with those employees.

    Question 58. In the fiscal year 2014 budget request, the 
discretionary request for the disability compensation program includes 
$526 million for Other Services. Please provide a detailed itemized 
list of how that funding would be utilized during fiscal year 2014. To 
the extent any of the funds will be spent on contracts, please explain 
the nature of the contract and the expected outcomes.
    Response. The discretionary request for $526 million contains 
funding of $420.6 million for contracts that directly impact or support 
the delivery of disability compensation claims:

     Contract Medical Examinations ($239.1 million)
     Veterans Claims Intake Program (scanning) ($132.1 million)
     Program management and systems engineering support 
services for the Veterans Benefits Management System ($32.3 million)
     Development of instructional methodologies and systems 
that support the training and skills development of the disability 
compensation workforce ($8.2 million)
     Program management, scientific, technical, and engineering 
support for Compensation Service and the VBA Operations Center ($6.2 
million)

    The request also includes $31.9 million for studies and analyses 
that support strategic planning ($16.4 million) and innovation ($15.5 
million).
    The remaining $73.5 million is for administrative and management 
support costs associated with VBA-internal support agreements, such as 
Franchise Fund fees for Debt Management Center, Financial Services 
Center, Computer Data Center Operations services, and for support 
attained via interagency agreements with the Department of Homeland 
Security, the Department of the Treasury, and the National Archives and 
Records Administration.

    Question 59. In response to questions about VA's fiscal year 2012 
budget request, VA provided this prediction: ``Investments in 
information technology will begin to pay dividends as deployment of the 
Veterans Benefits Management System (VBMS) begins in 2012, allowing for 
increased productivity and reduced operating costs in processing 
disability compensation claims.'' Then, in response to questions about 
the fiscal year 2013 budget request, VA indicated that ``VA will be 
able to better examine increases in productivity and reduction in costs 
once additional software releases are deployed in November 2012 and 
May 2013.''
    A. Please quantify any increased productivity or reduced costs 
realized during fiscal year 2012 and to date in fiscal year 2013 as a 
result of VBMS, in terms such as individual productivity of claims 
processing staff, cost per case, or overall operating costs.
    Response. VBA began deployment of VBMS Generation 1 in 
September 2012, concluding the calendar year with 18 stations on the 
system. It is important to note that early adopters of first generation 
technology participated heavily in the development and refinement of 
efficiencies and functionality of the system, which had a direct impact 
on productivity as a result of the live test environment. These 
stations paved the way for the accelerated deployment of VBMS, which 
will enable VBA to track and measure productivity outcomes in a 
consistent and accurate manner once all ROs are operating with the new 
technology and after a period of stabilization. The first 18 stations 
enabled VBA to also test business processes and functionality for the 
establishment of eFolders in VBMS and the model for tracking and 
shipping of paper-based claims with two scanning vendors. Under VBA's 
accelerated VBMS deployment schedule, all ROs have implemented VBMS as 
of June 10, 2013. However, nearly 557,000 paper claims in our current 
inventory remain to be processed.
    It is difficult to extract the impact of each transformation 
initiative from the combined people, process, and technology model to 
determine individual initiative's contribution to productivity 
outcomes. At the end of April 2013, approximately 5,800 claims have 
been fully processed in VBMS in an average of 121.1 days fiscal year to 
date.
    B. Please quantify the increased productivity and reduced costs now 
expected in fiscal year 2014 as a result of VBMS, in terms such as 
individual productivity of claims processing staff, cost per case, or 
overall operating costs.
    Response. VBMS is projected to provide a 20 percent increase in 
productivity in FY 2014.

    Question 60. In connection with VA's fiscal year 2012 budget 
request, VA was asked to explain VA's plan to bring down the backlog of 
disability claims by 2015. In part, VA responded that ``productivity * 
* * will rise from 89 annual claims per [compensation and pension] 
direct labor FTE in 2012 to 129 in 2015.''
    A. Now, how many claims are projected to be completed during fiscal 
year 2015 per compensation and pension direct labor FTE?
    Response. Our current estimates suggest a productivity of 100 to 
101 per direct FTE in FY 2015 and 90 to 91 per direct FTE in FY 2014, 
after finishing FY 2013 at approximately 81 per direct FTE. The 81 
figure reflects a slow first six months of FY 2013 as the integrated 
lanes and accelerated fielding of VBMS approached completion and a very 
robust productivity the final six months of FY 2013.
    B. What specific metrics or performance outcomes lead VA to 
conclude that that level of productivity per FTE is attainable?
    Response. As discussed in question 51, our assumptions for FY 2014 
and FY 2015 productivity in the January 2013 plan reflected a high risk 
assumption of our ability to deal with a large number of VOW-related 
claims relatively quickly in comparison to the traditional receipts we 
expected. The final six months of FY 2013 showed a sustained production 
per direct FTE of almost 93 claims due to Transformation. Continued 
Transformation is expected to permit achieving even higher levels of 
productivity per direct FTE in FY 2014 and FY 2015.

    Question 61. According to information provided in connection with 
the fiscal year 2013 budget request, VBA planned to expend $46.9 
million in fiscal year 2013 to pay for claims processing staff to work 
overtime.
    A. During fiscal year 2012, how much in total was actually expended 
to pay for overtime work by claims processing staff and what outcomes 
were achieved as a result of those overtime hours?
    Response. In FY 2012, $42.9 million was spent on overtime for C&P 
claims processing. Approximately 50,000 rating claims were completed 
during overtime.
    B. During fiscal year 2013, how much is now expected to be spent on 
overtime by claims processing staff and what outcomes are expected to 
be achieved as a result of those overtime hours?
    Response. VBA recently reallocated an additional $32.9 million for 
mandatory overtime for C&P claims processing, bringing the total 
overtime for C&P claims processing in FY 2013 to $65.5 million. VBA 
anticipates approximately 80,500 claims completed on overtime in FY 
2013.
    C. For fiscal year 2014, what level of funding is requested to pay 
for overtime hours worked by claims processing staff and what outcomes 
are expected to be achieved as a result of those overtime hours?
    Response. Of the $45 million budgeted for overtime, VBA anticipates 
using approximately $40 million to fund overtime for C&P claims 
processing. FTE productivity is expected to be higher during FY 2014, 
resulting in an estimated 53,000 claims completed on overtime during FY 
2014.

    Question 62. In VA's testimony before the Committee on the fiscal 
year 2013 budget request, the Secretary indicated that ``VA plans an 
aggressive communications strategy surrounding the release of 
[additional Disability Benefits Questionnaires] that will promote the 
[fully-developed claims (FDC)] program.'' VA's responses to post-
hearing questions also indicated that VA was ``considering promoting 
the program by implementing an FDC training course for Veterans Service 
Officers * * * and disseminating FDC program information, benefit 
applications, and marketing materials, such as an FDC program trifold 
brochure, to VSOs, Veterans, and other potential claimants.''
    A. How many fully-developed claims are expected to be filed during 
fiscal year 2013 and during fiscal year 2014?
    Response. VA is on track to receive more than 80,000 fully 
developed claims (FDCs) in FY 2013, and projects to receive more than 
200,000 FDCs in FY 2014.
    B. To date in fiscal year 2013, how many days on average is it 
taking to complete fully-developed claims?
    Response. FDCs are taking an average of 121 days to complete as of 
September 17, 2013.
    C. For fiscal year 2014, how long is it projected to take to 
complete fully-developed claims?
    Response. In FY 2014, an FDC is projected to take an average of 100 
days.
    D. For fiscal year 2013, how much is expected to be spent on FDC 
marketing materials and on an FDC training course?
    Response. In FY 2013, VBA's Benefits Assistance Service has 
$450,000 allocated for FDC marketing materials and FDC training.
    E. For fiscal year 2014, what level of funding is requested for 
purposes of promoting the fully-developed claims program? Please 
specify the amounts, if any, requested for an FDC training course and 
for marketing materials.
    Response. In FY 2014, VBA's Benefits Assistance Service has 
$450,000 allocated for FDC marketing materials and FDC training.

    Question 63. VA processes claims at 56 regional offices around the 
country and those offices vary in the quality and timeliness of their 
decisions.
    A. For fiscal year 2012, please identify the specific regional 
offices with the highest attrition rates for claims processing 
personnel.
    Response.


------------------------------------------------------------------------
                                                                2012
                         Station*                             Attrition
                                                               Rate**
------------------------------------------------------------------------
Fargo.....................................................     17.18%
Honolulu..................................................     14.87%
Indianapolis..............................................     13.29%
Wilmington................................................     13.28%
Chicago...................................................     12.17%
Albuquerque...............................................     12.12%
Boston....................................................     11.05%
Anchorage.................................................     10.84%
San Juan..................................................     10.77%
Denver....................................................     10.65%
Reno......................................................     10.45%
Baltimore.................................................     10.40%
Oakland...................................................      9.79%
Newark....................................................      9.23%
------------------------------------------------------------------------
* Stations with > 9% attrition for claims staff
** VSRs, RVSRs and DROs only
Attrition defined as employees who left VBA

    B. What are the expected attrition rates for claims processing 
positions during fiscal year 2013 and fiscal year 2014?
    VBA Response. Based on a 5-year average of 7.57 percent and a 
slight downward trend, we can estimate VBA-wide attrition to be 7 
percent for each of the next 2 years. Please note: We define attrition 
for the purposes of this response as employees who leave VBA.

    Question 64. In response to questions regarding the fiscal year 
2013 budget request, VA indicated that it planned to provide disability 
examinations to veterans residing overseas using contractors as well as 
VA employees.
    A. How many examinations are expected to be provided through 
contractors during fiscal year 2013 and 2014 and how much would be 
expended for that purpose?
    Response. In FY 2013, $4.798 million was budgeted for disability 
exams and associated travel to support 1,500 Veterans in residing 
overseas, with $575,000 paid to VHA contractors for performance of 
these disability exams in supported locations (Germany and Japan). For 
FY 2014, $4.316 million was budgeted for disability exams and 
associated travel to support an estimated 1,550 Veterans.
    B. How many examinations are expected to be provided through VA 
employees during fiscal year 2013 and 2014 and how much would be 
expended for that purpose?
    Response. VHA employees have not conducted overseas examinations in 
FY 2013. There are no examinations scheduled for either the remainder 
of FY 2013 or FY 2014. The Office of Disability and Medical Assessment 
(DMA) plans to use the Disability Examination Management contract to 
the greatest extent possible to provide examinations to Veterans 
residing at specific geographic locations overseas. DMA has executable 
plans to deploy a small contingent of internal staff, if necessary.

    Question 65. In response to questions about the fiscal year 2013 
budget request, VA indicated that it was requesting $10 million in 
order to contract with private entities to retrieve medical records 
from private medical providers.
    A. In total, how much was spent on that initiative during fiscal 
year 2012 and what was the average time it took the contractors to 
obtain private medical records (or otherwise close out the development 
action)?
    Response. VBA spent $508K in FY 2012 on the private medical records 
initiative. The average time to obtain private medical records or 
acceptable responses (none available or destroyed) from medical 
providers was 11.5 days.
    B. How much is now expected to be spent on this initiative during 
fiscal year 2013 and how long on average is it currently taking the 
contractors to obtain private medical records (or otherwise close out 
the development action)?
    Response. VBA obligated $2.1 million in FY 2013 to continue the 
private medical records pilots at the ten pilot ROs: Chicago, 
Indianapolis, Houston, Jackson, Portland, Phoenix, New York, St. Louis, 
New York, and Waco. The average time for contractors to obtain private 
records remains around 11.5 days.
    C. Is any funding requested with respect to this initiative for 
fiscal year 2014? If so, please specify the amount.
    Response. VA requested $10 million in FY 2014, the estimated annual 
cost to run the program nationally.

    Question 66. According to the 2012 PAR, VA plans to continue 
efforts to revise the disability rating schedule during fiscal year 
2013.
    A. How much in total was actually expended during fiscal year 2012 
to update the disability rating schedule? Please provide an itemized 
list of how that funding was expended and what results were achieved 
with that funding.
    Response. VA is in the process of updating the VASRD. As part of 
this process, members of Compensation Service, Regulations Staff hosted 
multiple public forums and gathered scientific evidence regarding 
disabling conditions and their impact on the average impairment of 
earnings capacity. These public forums were also used as a platform to 
solicit public input regarding these deliberations. In addition, during 
these forums, working groups were formed to support the ongoing review 
process. For FY 2012, the non-payroll expenditures for the VASRD 
modernization project totaled $366,139. The table below shows a 
breakdown.
------------------------------------------------------------------------
                   Event                           Date         Expenses
------------------------------------------------------------------------
VASRD FORUM--NYC...........................    October 11-20     $84,626
VASRD Forum--NYC...........................    January 17-26     $52,688
Travel.....................................          FY 2012     $27,467
Medical consultation contract..............          FY 2012    $201,358
                                                              ----------
    TOTAL..................................  ................   $366,139
------------------------------------------------------------------------


    The medical consultation contract provided subject matter expertise 
to assist with medical content relevant to rating disabilities, consult 
on policy issues and revisions to the disability benefits 
questionnaires, and various other responsibilities.
    B. During fiscal year 2013, how much in total does VA currently 
plan to expend to revise the rating schedule? Please provide an 
itemized list of how that funding has been or will be expended and what 
results have been or are expected to be achieved with that funding.
    Response. So far in FY 2013, an event focused on mental health 
disorders was held on May 1 and 2, with expenses totaling $4,300, and a 
meeting focused on skin diseases was held from March 28 through 
April 5, with expenses totaling $2,000.
    VA plans to fund additional VASRD modernization project conferences 
this year. These conferences are needed for the body systems still 
pending final review and revision, which include the musculoskeletal 
system and mental disorders. The purpose of these work group 
conferences is to intensify the review process and to expedite 
research, development, and deliberations within these sections of the 
VASRD. The diverse work group includes medical doctors, psychologists, 
attorneys, Veterans Service Organization representatives, and VA 
adjudicators. The benefit of these conferences is the generation of 
more ideas and energizing of the collaborative process which is at the 
heart of the VASRD review. Each conference will require participants to 
travel, with estimated costs of $12,000 to $15,000.
    VBA medical officers responsible for drafting the VASRD regulations 
will also meet with SMEs to obtain clinical expertise and opinions 
useful in revising the VASRD regulations. The estimated cost for FY 
2013 is $15,000.
    C. What level of funding is requested for fiscal year 2014 for 
purposes of updating the rating schedule and how are those funds 
expected to be spent? What results are expected to be achieved with 
that funding?
    Response. It is anticipated that conferences, travel, and outside 
consultation will be completed in FY 2013. In FY 2014, remaining work 
including workgroup participation, regulation drafting, and internal 
and external concurrence, will be accomplished by VA without travel or 
outside consultation. VA has $15,000 in funding in FY 2014 to support 
any unforeseen travel or conferences. There are currently 5 FTE 
assigned to the VASRD modernization project. VA anticipates that two 
body systems (endocrine and hematologic/lymphatic) will progress 
through external concurrence during FY 2014, with final publication in 
FY 2015. For the remainder of the body sytems, VA anticipates that they 
will progress through the workgroup, drafting and internal concurrence 
phases during FY 2014. Final publication of all body systems is 
expected to be completed in 2016. A copy of the updated project 
management plan and operating plan, as well as the project schedule, 
will be provided when completed.

    Question 67. According to a September 2012 Government 
Accountability Office (GAO) report, VA has experienced delays and 
challenges in obtaining earnings loss studies needed to complete 
revisions to the disability rating schedule. The fiscal year 2014 
budget request reflects that ``VA is in the process of issuing a 
request for proposals for data-driven earnings loss studies.''
    A. Since 2009, how much has VA expended in relation to earnings 
loss studies and what results have been achieved with that funding?
    Response. Since 2009, VA has entered into two contracts for 
earnings loss studies. Both contracts were made with a single 
contractor and most of the work completed was in support of development 
of an earnings loss model. Other expected deliverables were not 
completed prior to the decision to terminate the contract, including 
the following: a database of comparison groups; a compilation of 
service-connected Veterans and comparison group(s); and a peer-reviewed 
final report. The contractor was also unable to apply the earnings loss 
model formula it had developed for data acquisition because the 
contract was terminated before the income data was supplied. VA has 
paid $158,820 with the last payment made on these contracts in FY 2011. 
The Contracting Officer is currently in the process of making a final 
termination determination on the total amount that is due to the 
contract based on the partial work completed. VA estimates that the 
total payment for both contracts is approximately $663,000. From this 
contractor, VA gained insight regarding limitations on the scope of any 
future earnings loss study. For example, VA learned that due to 
statutory limitations, individualized earnings data cannot be obtained 
from the Internal Revenue Service and therefore, any future plans for 
an earnings loss study cannot aspire to use individualized data. 
Additionally, earnings loss models cannot be designed to forecast 
earnings loss for each available diagnostic code because there is 
insufficient data available to build a statistically competent and 
reliable model for each diagnostic code.
    B. In fiscal years 2013 and 2014, how will funding for earnings 
loss studies be expended and what results are expected to be achieved?
    Response. For FY 2013, VA anticipates no costs for the earnings 
loss studies. VA is currently preparing for earnings loss studies in FY 
2014 and will seek bids from contractors with demonstrated experience 
in administering such studies for other government entities to yield an 
adequate analysis of earnings loss for each of the major diagnostic 
codes in the VASRD. VA estimates that $1.8 million will be spent on 
earnings loss studies in FY 2014.

    Question 68. In response to questions about VA's fiscal year 2013 
budget request, VA indicated that there were 15 full-time employees at 
the Louisville regional office dedicated to processing claims based on 
exposure to contaminated water at Camp Lejeune.
    A. Currently, how many employees at the Louisville regional office 
are dedicated to handling these claims?
    Response. There are currently 15 full-time employees at the 
Louisville RO dedicated to processing claims based on exposure to 
contaminated water at Camp Lejeune.
    B. If the fiscal year 2014 budget request is approved, how many 
employees would be dedicated to handling these claims at the Louisville 
regional office?
    Response. During fiscal year 2014, the number of full-time 
employees dedicated to processing Camp Lejeune claims will remain at 
15. Adjustments will be made as necessary based on the number of claims 
received including those received in connection with the Honoring 
America's Veterans and Caring for Camp Lejeune Families Act of 2012. 
While this law does not change the eligibility requirements for 
granting entitlement to compensation, it could potentially drive an 
increased volume of claims related to Camp Lejeune, as new healthcare 
benefits are provided to certain eligible Veterans and their eligible 
family members.

    Question 69. As one strategy to deal with VA's backlog of 
disability claims, VA has brokered claims between VA offices. In 
response to questions about the fiscal year 2013 budget request, VA 
indicated that it ``has not completed an analysis on the cost-
effectiveness of brokered work.''
    A. In total, during fiscal year 2012, how many paper-based claims 
were brokered by VA?
    Response. In support of its national priorities and workload 
management strategies, VBA brokers its claims processing workload among 
ROs and dedicated brokering sites as necessary. A total of 46,591 
paper-based claims were completed as part of the national brokering 
strategy. This represents 4.5 percent of the 1,044,207 claims completed 
during FY 2012.
    B. During fiscal year 2013 and fiscal year 2014, how many paper-
based claims does VA expect to broker?
    Response. Through April 2013, a total of 25,558 paper-based claims 
have been brokered this fiscal year. Workload demands and other factors 
may affect the actual volume of paper-based claims that are brokered. 
National deployment of Generation One of VBMS (our baseline system) 
began in 2012, with 18 ROs operational as of the end of the calendar 
year. Deployment to the remaining stations, originally scheduled to be 
completed by the end of CY 2013, was accelerated and completed as of 
June 2013, likely reducing the number of paper claims that will be 
physically brokered in FY 2014.
    C. What is the status of efforts to determine the cost-
effectiveness of brokering paper-based claims?
    Response. With the implementation of VBMS, a cost-effectiveness 
study is no longer warranted. As VBMS will allow for a completely 
electronic claims process, future brokering efforts will be conducted 
in a paperless environment, thus eliminating the need for the transfer 
of paper-based claims folders among ROs.

    Question 70. VA and the Department of Defense (DOD) have rolled out 
worldwide an Integrated Disability Evaluation System (IDES), through 
which an injured or ill servicemember, before being medically 
discharged from the military, completes both the DOD disability rating 
system and the VA disability rating process.
    A. During fiscal year 2012, how much in total did VA expend with 
respect to the Integrated Disability Evaluation System and how many VA 
employees were dedicated to the IDES process?
    Response. During FY 2012, VBA spent approximately $54.8 million for 
salaries and GOE for 490 FTE dedicated to disability claims processing 
in the IDES process. Compensation staff and VR&E Counselors are 
included in this count. Veterans filing claims through the IDES sites 
are captured in the nationwide Veteran caseload count and total 
compensation benefit obligations; therefore, mandatory funding cannot 
be separated for this program.
    B. During fiscal year 2013, how much in total does VA expect to 
expend with respect to the Integrated Disability Evaluation System and 
how many VA employees will be dedicated to the IDES process?
    Response. During FY 2013, VBA estimates it will spend approximately 
$63.0 million for salaries and GOE to support 580 FTE dedicated to 
disability claims processing in the IDES process.
    C. During fiscal year 2014, how much in total is VA requesting with 
respect to the Integrated Disability Evaluation System and how many VA 
employees would that level of funding support?
    Response. During FY 2014, VBA estimates it will spend approximately 
$63.6 million for salaries and GOE to support 580 FTE dedicated to 
disability claims processing in the IDES process.
Pension and Fiduciary Service
    Question 71. In response to questions about the fiscal year 2013 
budget request, VA indicated that the Pension and Fiduciary Service was 
``working with VA's Office of Enterprise Development (OED) to replace 
the current electronic workload management system, Fiduciary-
Beneficiary System (FBS)'' and that ``[c]ompletion of the first phase 
is expected in the Fall of 2012.'' Please provide an updated timeline 
for the replacement of FBS.
    Response. Pension and Fiduciary Service began its pilot of the 
replacement system, the Beneficiary Fiduciary Field System, on 
August 30, 2013. The fiduciary hubs at Louisville, KY and Lincoln, NE 
were selected as the initial sites to test the functionality and 
capability of this application. National deployment of the replacement 
system is scheduled for December 31, 2013.

    Question 72. In response to questions about VA's fiscal year 2012 
budget request, VA provided this information: ``The 2012 budget request 
does not include funds to develop an online training program for 
fiduciaries but we have conducted research to identify existing 
certification programs. We plan to develop a system in 2013.'' Then, in 
response to questions about the fiscal year 2013 budget request, VA 
indicated that ``[t]he online training program for fiduciaries is still 
in the initial stages of development.''
    A. Please provide an update on the status of this initiative.
    Response. The first phase of the fiduciary training initiative is 
publication of a new Fiduciary Guidebook for volunteer fiduciaries (92 
percent of VA fiduciaries); most of whom are the relatives, caregivers, 
and friends of beneficiaries in VA's fiduciary program and have a one-
on-one relationship with the beneficiary. The Guidebook will instruct 
fiduciaries on their responsibilities, their duty to act independently 
to determine the beneficiary's needs, the rights of beneficiaries, and 
the procedures for completing an accounting. The intent is to clarify 
the roles of VA, fiduciaries, and beneficiaries in the program, and 
improve communications. It will also provide helpful answers to 
frequently asked questions. The ``Guidebook for VA Fiduciaries'' is 
currently available online at: http://benefits.va.gov/fiduciary/Fid_
Guide.pdf. Hard copy guidebooks will be published by the end of the 
fiscal year.
    The second phase of the fiduciary training initiative will target 
paid and unpaid fiduciaries and will include web-based training, as 
well as self-certification of the training material. The second phase 
is expected to deploy in October 2014.
    B. Does the fiscal year 2014 budget request include any funding to 
advance this initiative?
    Response. Yes, current funding is available to advance the 
fiduciary training initiative into the second phase.

    Question 73. In response to questions about VA's fiscal year 2013 
budget request, VA indicated that the Pension and Fiduciary Service 
``entered into a contract with Accurint, which is a service of 
LexisNexis Risk Solutions, to provide instant criminal background 
checks on prospective fiduciaries.''
    A. How much is expected to be expended for this purpose during 
fiscal year 2013?
    Response. During FY 2013, Pension and Fiduciary Service expects to 
expend $82,565 for the purpose of contracting for instant criminal 
background checks on prospective fiduciaries.
    B. How much is requested for this purpose for fiscal year 2014?
    Response. Pension and Fiduciary Service does not anticipate an 
increase in the contract amount from FY 2013 to FY 2014.

    Question 74. In the fiscal year 2014 budget request, the 
discretionary request for the pension, dependency and indemnity 
compensation, burial, and fiduciary programs includes $17.5 million for 
Other Services for fiscal year 2014. Please provide a detailed itemized 
list of how that funding would be utilized during fiscal year 2014. To 
the extent any of the funds will be spent on contracts, please explain 
the nature of the contract and the expected outcomes.
    Response. The discretionary request for $17.5 million contains 
funding of $11.7 million for contracts that directly impact or support 
the delivery of pension claims:

     Contract Medical Examinations ($2.3 million)
     Program management, scientific, technical, and engineering 
support for Pension and Fiduciary Service ($1.2 million)
     Development of instructional methodologies and systems 
that support the training and skills development of the Pension and 
Fiduciary workforce ($8.2 million)

    The remaining $5.8 million is for administrative and management 
support costs associated with VBA-internal support agreements, such as 
Franchise Fund fees for Debt Management Center, Financial Services 
Center, Computer Data Center Operations services, and for support 
attained via interagency agreements with the Department of Homeland 
Security, the Department of the Treasury, and the National Archives and 
Records Administration.

    Question 75. The fiscal year 2014 budget submission reflects that 
VA ``is in the process of developing fiduciary regulations.'' What is 
the expected timeline for completion of these regulations?
    Response. The draft fiduciary regulations are among VA's highest 
priority regulations. VA anticipates publication in the second quarter 
of FY 2014.

    Question 76. Between 2009 and 2012, there was a 128.2 percent 
increase in the average days to complete burial claims. From 2010 to 
2012, there was a 3.2 percent decrease in the amount of initial burial 
claims submitted to VA, yet there was a 4.6 percent decrease in the 
amount of claims processed.
    A. What has led to the substantial increase in days to process 
burial claims even though the number of claims has decreased?
    Response. All burial claims are processed at the Pension Management 
Centers (PMC) in addition to Dependency and Indemnity Compensation 
(DIC) and pension claims. The PMCs have focused more resources on DIC 
and pension claims due to the dramatic growth in volume of incoming 
claims between FY 2010 and FY 2012. As a result, the average days to 
process burial claims has increased. VA recognizes that burial benefits 
are an important benefit and has reviewed the process for adjudicating 
burial claims to determine how to streamline the process and improve 
the timeliness of claims. To address these issues, VBA is working to 
simplify and automate the burial program.
    Current burial regulations require VA to obtain statements and 
receipts from claimants showing that funeral expenses were incurred. 
Upon receipt, VA calculates the precise payment, up to a statutory 
maximum, and reimburses claimants. The process is paper and time 
intensive and often requires claimants and service providers to cover 
some portion of burial and funeral costs until VA reimburses them for 
allowable costs.
    Because the average cost of a funeral far exceeds the available 
benefit and VA could pay certain burial benefits based on evidence in 
its records at the date of a Veteran's death, VA is drafting proposed 
regulations that, if approved, would enable it to automatically pay 
certain burial benefits to eligible survivors upon a confirmed notice 
of death. Such automatic payments are only possible with regulatory or 
legislative authority for payment of burial benefits at a flat-rate and 
without a formal claim. VA will, to the extent possible, seek such 
authority through regulatory change. By establishing flat-rate payment 
of burial benefits and automating the processing of burial claims, VA 
will expedite the delivery of benefits to survivors and other claimants 
and free up resources for working claims in the backlog.
    B. The 2014 target for average days to complete burial claims is 90 
days, while the strategic target is 21 days. What actions have been or 
will be taken to reduce the average days to complete a burial claim?
    Response. See answer provided in 76a, above.
Appeals Management Center
    Question 77. Since 2003, certain cases remanded by the Board of 
Veterans' Appeals have been handled at a centralized entity called the 
Appeals Management Center.
    A. During fiscal year 2012, how much was spent on the Appeals 
Management Center and what level of staffing did that funding support?
    Response. In FY 2012, $20.8 million was allocated to the Appeals 
Management Center (AMC) for payroll, non-payroll, and travel. This 
supported staffing of 249 FTE, of which 235 were production FTE.
    B. During fiscal year 2013, how much is now expected to be spent on 
the Appeals Management Center and what level of staffing will that 
funding support?
    Response. Approximately $20.4 million will be allocated to the AMC 
for FY 2013 to support staffing of 230, of which 222 are production 
FTE.
    C. In total, how much funding is requested for fiscal year 2014 for 
the Appeals Management Center and what level of staffing would that 
funding support?
    Response. Currently, estimated FY 2014 staffing levels are 
consistent with FY 2013 levels, and consequently, funding is also 
consistent with FY 2013.
    D. For fiscal years 2013 and 2014, what are the key performance 
targets for the Appeals Management Center?
    Response. The FY 2013 AMC key performance targets consist of the 
following metrics and corresponding targets:

     Average days pending for claims from homeless Veterans--70 
days
     Claims inventory--13,500
     Average days pending--145 days
     Average days to complete--270 days
     Claims production--30,000
     12-month claims accuracy--90%

    FY 2014 targets will be set at the beginning of the next FY, and 
will consider actual performance in FY 2013 and VBA's organizational 
goals for FY 2014.
Education
    Question 78. According to the 2012 PAR, one reason that VA did not 
meet its timeliness goals for processing education claims is that 
``[o]vertime for claims processing was limited.''
    A. How much was requested for overtime for fiscal year 2012, what 
amount was expended, and what amount would have been adequate to help 
prevent claims processing delays?
    Response. VBA initially allocated $8.8 million in overtime funds 
for education claims processing in FY 2012. In the second quarter of FY 
2012, some funds were reallocated for overtime for disability 
compensation claims processors. As VBA identified degradation in 
performance metrics for education claims, additional funding was 
secured for overtime. By the end of FY 2012, a total of $9 million was 
spent on overtime for education claims processing.
    B. How much has been allocated for overtime for fiscal year 2013 
and how much would be adequate?
    Response. VBA initially allocated $10 million in overtime funds for 
the processing of education claims in FY 2013. Through September 7, 
2013, $7.2 million has been spent. VBA anticipates reaching $8 million 
in total expenses for FY 2013. This is lower than our initial 
allocation due to the efficiencies resulting from the Chapter 33 Long-
Term Solution (LTS). We will continue to monitor the performance 
metrics of education claims and adjust overtime spending in order to 
maintain the expected levels of performance.
    C. How much is requested for overtime for fiscal year 2014 and what 
amount is expected to be adequate?
    Response. With the improved functionality of LTS, VBA anticipates 
allocating between $5 million and $7 million in overtime for education 
claims processing. VBA will monitor Education performance metrics and 
distribute additional overtime funding as needed in order to maintain 
performance.

    Question 79. According to the fiscal year 2014 budget request, the 
discretionary request for Education programs includes $16.6 million for 
Other Services. Please provide a detailed itemized list of how those 
funds would be utilized during fiscal year 2014. To the extent any of 
the funds will be spent on contracts, please explain the nature of the 
contract and the expected outcomes.
    Response. The $16.6 million request contains funding of $5.4 
million for contracts that support Education Service, including:

     Program management and systems engineering support 
services for the Post-9/11 GI Bill ($4.4 million),
     Development of instructional methodologies and systems the 
support the training and skills development of the Education workforce 
($600,000),
     Publication and distribution of outreach pamphlets and 
letters to satisfy intent of Public Law 101-237 and Public Law 105-368 
($200,000),
     National Student Clearinghouse Contract for degree 
attainment data ($100,000), and
     State Approving Agency Contract to support development and 
implementation of a RAM ($100,000).

    The remaining $11.2 million is for administrative and management 
support costs associated with VBA-internal support agreements, such as 
Franchise Fund fees for Debt Management Center, Financial Services 
Center, Computer Data Center Operations services, and for support 
attained via interagency agreements with the Department of Homeland 
Security, the Department of the Treasury, and the National Archives and 
Records Administration.
                         general administration
Office of the Secretary
    Question 80. According to the fiscal year 2014 budget request, 88 
FTE are requested for the Office of the Secretary, which is 1 less than 
VA requested for fiscal year 2013 (89 FTE) and 11 less than VA now 
expects for fiscal year 2013 (99 FTE).
    A. Please provide a list of what positions, including pay-grades, 
would be included in the Office of the Secretary and its subsidiary 
offices if the fiscal year 2014 budget is approved.
    Response.
------------------------------------------------------------------------
                            Grade                             #Positions
------------------------------------------------------------------------
SES.........................................................         15
15..........................................................         14
14..........................................................         28
13..........................................................         18
12..........................................................          4
11..........................................................          5
9...........................................................          3
8...........................................................          2
7...........................................................          1
6...........................................................          5
------------------------------------------------------------------------


    B. Please provide a list of the 10 additional positions that were 
added in fiscal year 2013.
    Response. The positions identified in the 2014 budget reflect the 
proper staffing to support the VA leadership initiatives that will move 
the Department forward in achieving the Secretary's stated goals to 
increase access, eliminate the claims backlog, and end homelessness for 
Veterans. Staff positions are added/deleted accordingly as emerging 
requirements develop from administration, Congressional, or other 
external sources.
------------------------------------------------------------------------
                            Grade                             #Positions
------------------------------------------------------------------------
15..........................................................          2
14..........................................................          3
13..........................................................          4
4...........................................................          1
------------------------------------------------------------------------


    C. If the fiscal year 2014 budget is adopted, what (if any) 
positions would be eliminated?
    Response. No positions would be eliminated.
    D. If the fiscal year 2014 budget is adopted, would any employees 
be transferred from the Office of the Secretary to other positions 
within VA? If so, please specify.
    Response. There would be no requirement to move employees.

    Question 81. According to the fiscal year 2014 budget request, the 
Office of the Secretary now expects to spend $4.3 million on Other 
Services during fiscal year 2013, which is $4.2 million more than VA 
originally requested for fiscal year 2013 for Other Services. Please 
provide an itemized list of how those additional funds ($4.2 million) 
are expected to be spent.
    Response. In FY 2012 the Presidents Management Council approved and 
launched the Leading Executives Driving Government Excellence (Leading 
EDGE) program. Ninety-five percent of the $4.2 million reflected in the 
2014 budget reflects the estimated cost to run this program. The 
program is funded through reimbursement funds provided from all Federal 
agencies including VA and any unused funds are returned to the 
appropriate organization.

    Question 82. The Office of the Secretary requests $3.7 million for 
Other Services for fiscal year 2014. Please provide an itemized list of 
how those funds are expected to be expended.
    Response. In FY 2012 the Presidents Management Council approved and 
launched the Leading Executives Driving Government Excellence (Leading 
EDGE) program. Ninety-five percent of the $4.2 million reflected in the 
2014 budget reflects the estimated cost to run this program. The 
program is funded through reimbursement funds provided from all Federal 
agencies including VA and any unused funds are returned to the 
appropriate organization.

    Question 83. According to the fiscal year 2014 budget request, the 
Office of the Secretary now expects to spend $495,000 on travel during 
fiscal year 2013, which is $216,000 more than VA originally requested 
for fiscal year 2013. Please provide an itemized list of how those 
additional funds ($216,000) are expected to be spent. For example, how 
many additional trips will that funding support and what would be the 
expected purposes of those additional trips.
    Response. Based on past trends the average travel budget for OSVA 
is approximately $450k; OSVA was approved additional funds through 
remaining carryover dollars, which allowed them to request a more 
realistic travel budget sufficient to support Senior Leaders, and 
related necessary staff, in executing travel that supports initiatives 
that will move the Department forward in achieving the Secretary's 
stated goals to increase access, eliminate the claims backlog, and end 
homelessness for Veterans. The additional funds also support travel to 
fulfill invitations from Members for constituent activities in their 
districts.

    Question 84. According to the fiscal year 2014 budget request, the 
Office of the Secretary now expects to spend $265,000 for supplies and 
materials during fiscal year 2013, which is $165,000 more than VA 
originally requested for fiscal year 2013 for that purpose. Please 
provide an itemized list of how those additional funds ($165,000) are 
expected to be spent.
    Response. Based on past trends the average supplies and materials 
budget for OSVA is approximately $200k; OSVA was approved additional 
funds through remaining carryover dollars, which allowed them to 
request a more realistic budget for supplies and materials including 
expenditures for increase in administrative requirements that support 
initiatives that will move the Department forward in achieving the 
Secretary's stated goals to increase access, eliminate the claims 
backlog, and end homelessness for Veterans.

    Question 85. According to the fiscal year 2014 budget request, the 
Office of the Secretary now expects to spend $43,000 for printing and 
reproduction during fiscal year 2013, which is $27,000 more than VA 
originally requested for fiscal year 2013 for that purpose. Please 
provide an itemized list of how those additional funds ($27,000) are 
expected to be spent.
    Response. The OSVA mission is support of the Secretary of Veterans 
Affairs, Deputy Secretary and Chief of Staff the execution of missions, 
goals, and priorities of the Administration to support our Nation's 
Veterans. Increase in printing and reproduction costs support strategic 
messaging initiatives necessary to effectively support initiatives that 
will move the Department forward in achieving the Secretary's stated 
goals to increase access, eliminate the claims backlog, and end 
homelessness for Veterans.

    Question 86. The Leading Executives Driving Government Excellence 
(Leading EDGE) Program is an executive level training and leadership 
program across the entire Federal Government and, according to the 
budget request, among one of its activities is ``[a]rchiving program 
benefits to the taxpayer in terms of savings and cost avoidance.''
    A. For fiscal year 2012, how much savings and cost avoidance did 
Leading EDGE produce?
    B. For fiscal year 2013, how much savings and cost avoidance does 
Leading EDGE expect to produce?
    C. For fiscal year 2014, how much savings and cost avoidance does 
Leading EDGE expect to produce?
    D. For each fiscal year, please describe in detail the savings and 
cost avoidances Leading EDGE achieved or expects to achieve.
    Response for A-D:
    The President's Management Council (PMC) initiated Leading EDGE 
(Executives Driving Government Excellence) to: 1) inspire a seamless 
and powerful senior executive corps with shared governmentwide identity 
and vision; 2) craft solutions that have impact across agencies; and 3) 
reignite the highest ideals of public service. To achieve these 
objectives, Leading EDGE employs five integrated learning components: 
workshops, leadership assessments, government performance projects 
(GPPs), executive coaching, and a web portal for increased cross-agency 
networking and problem-solving. In 2012, the program's first year, 
fifteen Federal Government departments (totaling over 150 individual 
bureaus) reimbursed Veterans Affairs (VA) to participate in Leading 
EDGE.
    Five teams of program participants engaged in the learning 
component most linked to cost savings and avoidance when they developed 
solutions to seven significant, cross-government challenges, 
subsequently reviewed by the Office of Management and Budget and the 
Office of Performance Management. The following list details the 
estimated cost savings based on the proposals of the 2012 government 
performance projects (GPPs):

     Review of Federal shared services procurement data 
suggests an annual possible savings of $5.5 billion (supported by 
Industry reports) through centralized acquisition
     Establishment of centralized disability hiring in the 
Federal Government acts as a catalyst for better return on human 
capital investment and could yield 0.01 percent in annual employment 
savings ($30 million)
     Reduction of Federal employee attrition gained through 
enhanced leadership development efforts across government could reduce 
annual employment costs by 10 percent ($30 billion)
     Establishing interagency security clearance reciprocity 
and convenient access to all government buildings in Federal agencies 
for all employees could yield annual cost savings of $38 million
     Establishment of a Grants Management University could 
yield $30 million in grant administration savings given the number of 
Federal employees engaged in grants management
     Establishment and monitoring of Do Not Pay performance 
metrics could substantially reduce the $115 billion in improper 
payments by the Federal Government
     A ``Shared-First'' approach to IT shared service delivery 
could yield annual cost savings of $50 million and represent increased 
buying power for IT investments

    Some of the qualitative benefits represented in these projects, 
such as expedited procurement processes, improved employee morale, and 
strengthened senior executive leadership are just as valuable as more 
easily quantified cost savings. The calendar year 2013 Leading EDGE 
effort began only recently and specific GPPs are as yet undecided, so 
estimated costs savings and avoidance for the year is not possible at 
this time.

    Question 87. The VA Center for Innovation was established in 2010 
to ``identif[y], prioritize[], fund[], test[] and evaluate[] the most 
promising solutions to VA's most important challenges to increase 
Veteran access to VA services, improve the quality of services 
delivered, enhance the performance of VA operations, and reduce or 
control the cost of delivering those services that Veterans, their 
families, and survivors receive.''
    A. Please provide the Committee with the number of staff assigned 
to the Center, the total cost for staff salaries, whether any of the 
staff is considered to be reimbursable and which office would be 
reimbursed, and whether any of the staff were reassigned from the 
Office of Information and Technology.
    Response. The VA Center for Innovation (VACI) is a matrixed 
organization, modeled on private sector best-practices to better ensure 
VA-wide collaboration and coordinated execution. Not all of the 
individuals who perform work associated with VA innovations are members 
of the Office of the Secretary staff. By design, only the Director and 
the Deputy Director function out of OSVA. Most members of the VACI team 
work full time on innovations while some contribute in an adjunct 
status as a collateral duty in addition to the work they perform for 
other parts of the Department. Ten staff are assigned to the Center, of 
which four are military Veterans. None are considered reimbursable and 
one is assigned from the Office of Information and Technology. The 
total cost for staff salaries is $742,774.
    B. Please provide the Committee with the amount of funding 
available for grants through Industry Competitions, Employee 
Competitions, Special Projects, and Prize Contests.
    Response. The VA Center for Innovation (VACI) uses contracts as 
opposed to grants to implement its work with private sector entities 
involved in the implementation of innovations. To further reduce risk 
to the government, VACI general requires use of firm fixed price 
contracts. For prize challenges, VACI uses cash prizes as authorized by 
the America COMPETES Act of 2010.
    Over 95% of the VACI annual budget is used for direct funding of 
innovations that increase access to healthcare and other services, 
reduce or control the cost of delivering those services, improve 
quality at VA, and enhance the Veteran experience with the services 
they receive from VA. VACI uses, among other things, the Industry 
Innovation Competition, Employee Innovation Competition, Special 
Projects, and Prize Contests to achieve this. To be responsive to 
Veteran needs across the VHA and VBA mission areas, VACI funding is 
contained in three appropriations. Annually, as much as $35 million in 
Medical Services, $11 million in IT, and $15 million in VBA General 
Operating Expenses (GOE) is budgeted to fund innovations through VACI. 
The amounts available in a given Fiscal Year for contracts through the 
Industry Innovation Competition, Employee Innovation Competition, or 
Special Projects varies depending on the specific focus areas for that 
operating year.
    C. How many proposals have been selected for implementation through 
the VA Center for Innovation and the VA Innovation Initiative? Of these 
proposals, how many have been fully implemented on a national scale?
    Response. Since its inception in mid-2010, the VA Center for 
Innovation (VACI) has selected and implemented 149 innovations. The 
Industry Innovation Competitions and Employee Innovation Competitions 
generate the vast majority of the selected innovations. Special 
Projects tend to target emergent opportunities and/or innovations that 
have a longer lifecycle than the typical 24-month period.
    VACI functions as a supplier of novel and innovative capabilities 
to the Department, principally VHA and VBA. VHA and VBA are responsible 
for selection and funding of completed innovation projects for 
implementation and deployment across their respective domains. The pace 
and extent of deployment depends on the availability of resources, 
project scope, and overall innovation maturity.
    Innovation projects execute over a period of performance of 12 to 
24 months following the selection, pilot design, and contracting 
processes. A substantial part of the VACI portfolio is in either the 
period of performance phase or the design and contracting phase. As 
these projects mature over the coming months and years, they move into 
the evaluation phase. Successful innovations compete for VHA and VBA 
resources required for adoption and wider implementation.
    20 innovation projects have already been or are being adopted by 
VHA and VBA or are operating independently of VA in service to the 
Department's mission. These completed innovations include 7 industry 
innovations, 8 employee innovations and 5 innovations from the prize 
competitions and special projects categories.
    The seven Industry Innovations adopted include a number of new Blue 
Button services that allow Veterans across the Nation to freely access 
their medical records in a format that is portable across health 
providers, projects that use technology to improve TBI care and mental 
health screening, and a cardiology mobile application that allows 
physicians to receive medical images on mobile devices for faster and 
better care for Veteran heart patients.
    Among the several successful Employee Innovations, eight projects 
have been selected for full implementation. These projects cover a wide 
range of clinical practices, such as radiology, patient safety, and 
novel approaches to caring for brain injuries and brain diseases 
affecting Veterans.
    The Special Project and prize competition category generated the 
first open source software community to lower costs and increase 
innovation rates for VA's electronic health record, the first automated 
claims processing prototype, a mobile application to connect any local 
services that can help Veterans in need, and a new way for Veterans to 
have their military service experience count for private sector 
employment.
Board of Veterans' Appeals
    Question 88. The fiscal year 2014 budget request includes $75 
million for the Board of Veterans' Appeals (Board).
    A. With that funding and funding provided in Public Law 113-6, what 
FTE level is expected during fiscal year 2013 and 2014?
    Response. With the additional $8 million in funding provided, the 
Board of Veterans' Appeals (BVA or Board) will be able to sustain 538 
full-time equivalents (FTE) in fiscal year (FY) 2013 and 613 FTE in FY 
2014.
    B. Please provide a breakdown of the positions that would be filled 
in fiscal year 2014 and the number of staff for each type of position.
    Response. All 100 positions hired in FY 2013 & FY 2014 with the 
additional $8 million in funding will be staff attorneys.
    C. With that funding and the funding provided in Public Law 113-6, 
what performance outcomes does the Board expect to achieve during 
fiscal years 2013 and 2014?
    Response. BVA has initiated an aggressive hiring plan to execute 
the $8 million in additional funding in FY 2013. In parallel to this 
aggressive hiring plan, BVA has developed and implemented a robust new 
training program that is designed to handle the high volume of incoming 
staff to maximize efficiencies at the earliest point. All new FTE will 
undergo this training. BVA expects production gains based on these 
efforts to be realized beginning in FY 2014. There is direct 
correlation between the number of FTE and the number of decisions 
produced; looking at recent years, each FTE produces up to 90 decisions 
per year.
    D. Of that funding, how much will be used to pay for union 
representation/union time?
    Response. The Board pays for union representation/union time in two 
ways:

          (1) costs (salary and benefits) of union representatives; and
          (2) costs (salary and benefits) of BVA's managers who work on 
        labor relations matters, labor relations counsel, and other 
        labor relations support staff.

    In total, the Board expects to pay approximately $2,011,926 for 
labor relations matters per annum.

    Question 89. According to the fiscal year 2014 budget request, the 
Board now expects to spend $2.3 million on Other Services during fiscal 
year 2013, which is $253,000 higher than the amount requested for 
fiscal year 2013, and the Board is requesting $2.3 million for Other 
Services for fiscal year 2014.
    A. Please provide an itemized list of how these funds are expected 
to be spent during fiscal year 2013.
    Response. The $2,253,000 for ``Other Services'' in FY 2013 will be 
allocated as follows:
------------------------------------------------------------------------------------------------------------------------------------------------
All Shred Document Shredding Contract for disposition of      $20,000.00
 sensitive records......................................
Lean Six Sigma Study of the Board's Operations for            344,000.00
 identification of possible efficiencies in processes...
West Group Contract--On-line Access to the Westlaw Legal      290,000.00
 Database for legal research by the Board's Veterans Law
 Judge and attorney staff...............................
Transit Benefits........................................      555,000.00
United Parcel Services (UPS) Appellant Records Shipment        70,000.00
 Contract...............................................
Transcription Service (2 Vendors).......................      663,000.00
Board's Share of VACO's Human Capital Investment Plan         130,000.00
 (HCIP) Training Support................................
Financial Service Center (FSC)..........................      123,000.00
Defense Finance and Accounting Services (DFAS)..........       50,000.00
Security Investigation Service..........................        8,000.00
                                                         ---------------
    Total Other Services................................   $2,253,000.00
------------------------------------------------------------------------


    B. Please provide an itemized list of how these funds are expected 
to be spent during fiscal year 2014.
    Response. The $2,333,000 for ``Other Services'' in FY 2014 will be 
allocated as 
follows:
------------------------------------------------------------------------------------------------------------------------------------------------
All Shred Document Shredding Contract for disposition of      $20,800.00
 sensitive records......................................
Public Key Infrastructure (PKI) Electronic Research           386,000.00
 Materials Service and Maintenance Contract.............
West Group Contract--On-line Access to the Westlaw Legal      298,000.00
 Database for legal research by the Board's Veterans Law
 Judge and attorney staff...............................
Transit Benefits........................................      558,200.00
United Parcel Services (UPS) Appellant Records Shipment        80,000.00
 Contract...............................................
Transcription Service (2 Vendors).......................      670,000.00
Board's Share of VACO's Human Capital Investment Plan         131,000.00
 (HCIP) Training Support................................
Financial Service Center (FSC)..........................      125,000.00
DFAS....................................................       51,000.00
Security Investigation Service..........................       13,000.00
                                                         ---------------
    Total Other Services................................   $2,333,000.00
------------------------------------------------------------------------

Office of General Counsel
    Question 90. According to the fiscal year 2014 budget request, VA 
is seeking total resources of $101 million for the Office of General 
Counsel and 701 FTE.
    A. Please provide a list of the positions that would be filled in 
fiscal year 2014 with that level of funding and the number of staff for 
each position.
    Response.
------------------------------------------------------------------------------------------------------------------------------------------------
Supervisory Attorney.......................................     78.0
General Attorney...........................................    400.8
Paralegal Specialist.......................................     86.1
Legal Assistant............................................     52.1
Other......................................................     84.0
                                                            ------------
  Total....................................................    701.0
------------------------------------------------------------------------


    B. For each regional counsel office, please identify the number and 
type of staff that would be located at the office during fiscal year 
2014.
    Response:
Region 1
  Supervisory Attorney.....................................      2
  General Attorney.........................................     14.3
  Paralegal Specialist.....................................      1
  Legal Assistant..........................................      3
  Office Automation Clerk..................................      0.5
                                                            ------------
    Total..................................................     20.8Region 2
  Supervisory Attorney.....................................      2
  General Attorney.........................................     12.5
  Paralegal Specialist.....................................      1.8
  Legal Assistant..........................................      1
                                                            ------------
    Total..................................................     17.3Region 3
  Supervisory Attorney.....................................      2
  General Attorney.........................................      8
  Paralegal Specialist.....................................      3
  Program Analyst..........................................      1
                                                            ------------
    Total..................................................     14Region 4
  Supervisory Attorney.....................................      2
  General Attorney.........................................      9
  Paralegal Specialist.....................................      4
  Administrative Officer...................................      1
                                                            ------------
    Total..................................................     16Region 5
  Supervisory Attorney.....................................      2
  General Attorney.........................................      8.4
  Paralegal Specialist.....................................      2
  Legal Assistant..........................................      4
                                                            ------------
    Total..................................................     16.4
Region 6
  Supervisory Attorney.....................................      2
  General Attorney.........................................     15.63
  Paralegal Specialist.....................................      9
  Legal Assistant..........................................      3
                                                            ------------
    Total..................................................     29.63Region 7
  Supervisory Attorney.....................................      2
  General Attorney.........................................     11
  Paralegal Assistant......................................      3
  Legal Assistant..........................................      3
  Program Assistant........................................      1
  Administrative Officer...................................      1
                                                            ------------
    Total..................................................     21Region 8
  Supervisory Attorney.....................................      2
  General Attorney.........................................      8
  Paralegal Specialist.....................................      6
  Legal Assistant..........................................      0
                                                            ------------
    Total..................................................     16Region 9
  Supervisory Attorney.....................................      2
  General Attorney.........................................      8
  Paralegal Specialist.....................................      2
  Legal Assistant..........................................      2
                                                            ------------
    Total..................................................     14Region 10
  Supervisory Attorney.....................................      2
  General Attorney.........................................     12
  Paralegal Specialist.....................................      2
  Legal Assistant..........................................      3
                                                            ------------
    Total..................................................     19Region 11
  Supervisory Attorney.....................................      2
  General Attorney.........................................      8.5
  Paralegal Specialist.....................................      3
                                                            ------------
    Total..................................................     13.5Region 12
  Supervisory Attorney.....................................      2
  General Attorney.........................................     10
  Paralegal Specialist.....................................      7
  Legal Assistant..........................................      2
                                                            ------------
    Total..................................................     21Region 13
  Supervisory Attorney.....................................      2
  General Attorney.........................................     10
  Paralegal Specialist.....................................      4.8
  Legal Assistant..........................................      5
                                                            ------------
    Total..................................................     21.8
Region 14
  Supervisory Attorney.....................................      2
  General Attorney.........................................     13
  Paralegal Specialist.....................................      5
  Legal Assistant..........................................      3
                                                            ------------
    Total..................................................     23Region 15
  Supervisory Attorney.....................................      2
  General Attorney.........................................      6.75
  Paralegal Specialist.....................................      1
  Administrative Officer...................................      1
                                                            ------------
    Total..................................................     10.75Region 16
  Supervisory Attorney.....................................      2
  General Attorney.........................................      8
  Paralegal Specialist.....................................      2
  Legal Assistant..........................................      1
                                                            ------------
    Total..................................................     13Region 18
  Supervisory Attorney.....................................      4
  General Attorney.........................................     21.483
  Paralegal Specialist.....................................      8
  Legal Assistant..........................................      1.6875
  Secretary................................................      2
                                                            ------------
    Total..................................................     37.17Region 19
  Supervisory Attorney.....................................      2
  General Attorney.........................................      9
  Paralegal Specialist.....................................      2
  Legal Assistant..........................................      1
                                                            ------------
    Total..................................................     14Region 20
  Supervisory Attorney.....................................      2
  General Attorney.........................................     10.58
  Paralegal Specialist.....................................      2.8
  Legal Assistant..........................................      2
                                                            ------------
    Total..................................................     17.38Region 21
  Supervisory Attorney.....................................      2
  General Attorney.........................................      8
  Paralegal Specialist.....................................      4
  Legal Assistant..........................................      0.8
                                                            ------------
    Total..................................................     14.8Region 22
  Supervisory Attorney.....................................      2
  General Attorney.........................................      6
  Paralegal Specialist.....................................      1
  Legal Assistant..........................................      2
                                                            ------------
    Total..................................................     11Region 23
  Supervisory Attorney.....................................      2
  General Attorney.........................................      8
  Paralegal Specialist.....................................      4
  Legal Assistant..........................................      3
                                                            ------------
    Total..................................................     17Grand Total
  Supervisory Attorney.....................................     46.00
  General Attorney.........................................    226.14
  Paralegal Specialist.....................................     78.40
  Legal Assistant..........................................     40.49
  Administrative Officer...................................      3
  Secretary................................................      2
  Program Analyst..........................................      1
  Program Assistant........................................      1
  Office Automation Clerk..................................      0.5
                                                            ------------
    Grand Total............................................    398.53
------------------------------------------------------------------------

    C. If the fiscal year 2014 budget request is adopted, what would be 
the expected total budget for each regional counsel office?
    Response.
------------------------------------------------------------------------------------------------------------------------------------------------
Grand Total Regions........................     398.53       $54,386,322
                                            ----------------------------
Front Office--VACO 101.....................       5             $883,170
Regs Office--VACO 101......................       9            1,267,152
PSG I--VACO 101............................      19.41         3,068,983
PSG II--VACO 101...........................      20            2,836,576
PSG III--VACO 101..........................      23            3,778,669
PSG IV--VACO 101...........................      19.75         3,057,628
PSG V--VACO 101............................      63.8          8,843,661
PSG VI--VACO 101...........................      41            6,891,740
PSG VII--VACO 101..........................     101.5         14,486,378
                                            ----------------------------
  Grand Total VACO.........................     302.46       $45,113,957
                                            ----------------------------
  Funded Where Needed......................  ...........      $1,484,721
                                            ----------------------------
    Grand Total OGC........................     701.0       $100,985,000
------------------------------------------------------------------------


    Question 91. According to the fiscal year 2014 budget request, VA's 
Office of General Counsel now expects to spend $1.3 million on Other 
Services during fiscal year 2013, which is $169,000 higher than the 
amount requested for fiscal year 2013 ($1.1 million). According to the 
budget request, that amount changed ``due to the transfer of all [human 
resources (HR)] functions from the regions into VACO.''
    A. Please provide an itemized list of how these funds are expected 
to be spent during fiscal year 2013.
    Response. Refer to charts below.

Notes:

    (1) Budget Object Classification (BOC) codes describe the 
``nature'' of the service or article for which obligations are first 
incurred.
    (2) In executing the fiscal year (FY) 2013 budget, the Office of 
General Counsel (OGC) now plans to spend $1.6 million on Other 
Services. Due to an unanticipated increase in the number of retirements 
among its leadership, OGC has incurred more household goods storage 
costs and relocation expenses associated with hiring replacements for 
the retired personnel. OGC offset the increased spending from its 
planned expenditures on equipment.


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                               BOC 2580/81
------------------------------------------------------------------------
                                                                  2013
                                               Classification    Budget
------------------------------------------------------------------------
Contracts--VACO--employee recognition,                  2580     $52,555
 framing, moving furniture, court reporters,
 transcription...............................
Contracts--Regions--Notaries, Shredding......           2580       8,702
Human Capital Investment Plan (HCIP).........           2580     178,000
Security & Investigation (S&I)...............           2580      11,615
Office of Resolution Management (ORM)........           2580     108,000
Financial Service Center (FSC)...............           2580     177,654
Record Center & Vault (RC&V).................           2580       1,811
Child Care Subsidy...........................           2580          --
Defense Finance and Accounting Service (DFAS)           2580      69,264
Financial Disclosure Management System (ARMY)           2580      10,000
PIV Card.....................................           2580      12,960
OA&L Contract Support........................           2580      57,054
eOPF Contract................................           2580      22,631
USA Staffing Contract........................           2580      17,534
USA Jobs Contract............................           2580       4,344
                                              --------------------------
    Total....................................           2580    $732,124
------------------------------------------------------------------------



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    B. Please explain what impact this transfer of H.R. functions had 
on the budget for each region.
    Response. The transfer of H.R. functions to Central Office did not 
impact the budgets of OGC's regions, in past years; the VA facility 
providing local fiscal support for each of the 22 regions would process 
our payroll and pay the associated fees. After the transfer, OGC must 
now pay all associated payroll processing fees for its personnel, 
wherever located. As a result, our Service Level Agreement with VA's 
Financial Service Center (FSC) increased from $35K to $178K. FSC 
charges OGC for common and administrative services included in payroll 
processing, financial reporting and accounting services, Permanent 
Change of Station travel, processing W-2's, and helpdesk support.

    Question 92. The Office of General Counsel is requesting $1.2 
million for Other Services for fiscal year 2014. Please provide an 
itemized list of how these funds would be spent during fiscal year 
2014.
    Response. See Chart below.



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    Question 93. In response to questions about the fiscal year 2013 
budget request, VA indicated that the Office of General Counsel planned 
to spend $14,000 in 2012 on a ``Tort training video.'' What was the 
purpose of this video and how has it been utilized?
    Response. The actual cost of producing this video training module 
was $1,478.90, which represented the cost of transporting a VA Office 
of Information Technology (OIT) employee and his video equipment to a 
Federal building in St. Louis at which OGC personnel were conducting 
previously-scheduled face-to-face training on administrative tort claim 
adjudication procedures. Editing and polishing the raw digital 
recordings in-house saved the Department over $12,000 in professional 
services and travel. The purpose of taping that session was to provide 
a Web-based, on-demand, re-usable training resource for OGC personnel 
regarding the processes and procedures to be followed in investigating 
and adjudicating administrative tort claims filed against the VA 
pursuant to the Federal Tort Claims Act (FTCA). The overall goal of 
creating this Web-based training was to improve the quality and 
consistency of legal service relating to torts across all of OGC's 
regions, thereby improving service to Veterans who avail themselves of 
the administrative tort adjudication process afforded by the FTCA. The 
project has not yet launched, as the editing work must be done as 
collateral duty and as other duties allow. OGC anticipates taking the 
training live in August 2013, at which point the training will be 
viewed by the approximately 150 OGC employees who are engaged in torts 
practice. VA anticipates cost savings will be realized by eliminating 
travel and other costs associated with bringing those employees 
together to receive this training.

    Question 94. Within the Office of General Counsel, Professional 
Staff Group VII represents VA before the U.S. Court of Appeals for 
Veterans Claims.
    A. Currently, how many employees are assigned to Professional Staff 
Group VII and what is the average number of active cases per attorney?
    Response. Professional Staff Group (PSG) VII has 101.5 FTE onboard 
and 43 active cases per attorney, on average. An ``active case'' is one 
in which the Secretary has yet to file his dispositive pleading.
    B. For fiscal year 2014, what level of funding is requested to 
support Professional Staff Group VII and how many employees would that 
level of funding support?
    Response.
------------------------------------------------------------------------
                                                    FTE        Funding
------------------------------------------------------------------------
PSG VII.......................................      101.5    $14,487,244
------------------------------------------------------------------------


    C. Please provide a list of the positions that would be filled with 
that level of funding.
    Response.
------------------------------------------------------------------------------------------------------------------------------------------------
Supervisory Attorney.......................................       11.0
General Attorney...........................................       57.0
Paralegal Specialist.......................................        4.5
Legal Assistant............................................       14.0
Clerks.....................................................       11.0
Management Analyst.........................................        1.0
Supervisory Program Specialist.............................        1.0
Support Services Specialist................................        1.0
Supervisory Program Analyst................................        1.0
                                                            ------------
  Total....................................................      101.5
------------------------------------------------------------------------


    D. With the requested funding level, what would be the expected 
average number of active cases per attorney during fiscal year 2014?
    Response. The average number of active cases per attorney will be 
maintained in the range between 45 and 50.
    E. How many motions for extension of time did Professional Group 
VII file during fiscal year 2012?
    Response. PSG VII filed a total of 2,129 extension motions in FY 
2012.
    F. How many motions for extension of time has Professional Staff 
Group VII filed to date during fiscal year 2013?
    Response. During the period between October 1, 2012, and April 30, 
2013, PSG VII filed approximately 1,053 extension motions.

    Question 95. In response to questions about the fiscal year 2013 
budget request, VA indicated that the Regulation Rewrite Project ``is 
not expected to require additional resources, but the implementation of 
these rules will require more resources over time'' for items such as 
``training program revisions, manuals and forms updating, skills 
certification materials, and [information technology] projects.'' VA 
also indicated that ``[i]mplementation budget planning will occur in 
2013.''
    A. Has VA developed a comprehensive implementation plan for these 
regulations? If so, please provide a copy of that plan to the 
Committee.
    Response. VA's implementation planning for the Regulation Rewrite 
Project has been deferred in order to avoid conflicts with VA's highest 
priority effort to eliminate the claims backlog by 2015. The timing for 
publishing a final rule and the manner of implementation will be 
determined by the Secretary at a future date depending upon the 
progress being made on the claims backlog. In the meantime, VA is 
preparing to publish the comprehensive 21st proposed rule responding to 
comments from the public and Veterans Service Organizations submitted 
for the previous 20 proposed rules. This consolidated proposed rule 
encompasses all of the previous proposed rules and is expected to be 
published in 2013.
    B. Please provide the Committee with an updated timeline for 
completion of this project.
    Response. The Rewrite Project's staff currently expects to seek a 
determination on implementation by the end of 2014 in order to afford 
the Veterans Benefits Administration time for the necessary advance 
implementation coordination and budget planning. This expectation could 
be delayed, however, depending upon the status of VA's claims backlog. 
VA's goal is to implement the Regulation Rewrite Project so that it 
does not conflict with VA's claims transformation initiatives or impede 
VA's progress in eliminating the claims backlog.
Office of Management
    Question 96. According to the fiscal year 2014 budget request, the 
Office of Management plans to spend $53 million on Other Services 
during fiscal year 2013, which is $16.3 million more than VA had 
requested for that purpose for fiscal year 2013. Please provide an 
itemized list of how those funds would be expended during fiscal year 
2013 and identify expenditures that were not anticipated in the fiscal 
year 2013 budget request.
    Response. The majority of the $16.3 million increase in obligations 
is due to higher-than-expected requirements for the Defense Finance and 
Accounting Service (DFAS) payroll processing services, which are funded 
through reimbursements and Department-level initiatives funded from FY 
2012 carryover. The following are details of how the funds will be 
expended.

     $5 million to DFAS for VA payroll processing. The Office 
of Management pays for this Departmental cost and is reimbursed from 
other VA programs that pay for their share of the costs.
     $3 million to fund activities for VA's Financial Statement 
Audit, which includes audit remediation, policy updates support, and 
vendor follow-up.
     $1.2 million to address Improper Payments Elimination 
Recovery Act requirements.
     $1 million to conduct Office of Management and Budget 
(OMB) Circular A-123 reviews under the Office of Business Oversight.
     $400 thousand to support the VA Center of Innovation.

    VA expects to obligate other contracts this fiscal year including:

     $2 million for enhanced data analysis capability to 
support better decisionmaking.
     $1.2 million for budgetary analytical support and 
development of an automation module to provide real-time budget data to 
improve the budget process and strengthen the quality of analysis.

    In addition, $2.5 million in Department-level carryover has been 
re-allocated within General Administration for additional outreach to 
increase Veterans' access to VA benefits and services.

    Question 97. According to the fiscal year 2014 budget request, the 
Office of Management requests $38 million for Other Services for fiscal 
year 2014. Please provide an itemized list of how those funds would be 
used.
    Response. The $38 million in ``Other Services'' includes:

     $30 million for DFAS support to the Department.
     $4 million for reviewing and testing internal controls 
over financial reporting, as required by Appendix A of OMB Circular A-
123.
     $1 million for service level agreements for the Financial 
Services Center, Security Investigations Center, and other service and 
maintenance agreements to conduct regular operations.
     $700 thousand for the Enterprise Risk Management program.
     $400 thousand for VA Center for Innovation programs.
     $350 thousand for training provided through the VA 
Learning University and the Human Capital Investment Plan.
     The balance of the costs within Office of Management's 
`Other Services' are for Office of Personnel Management fees related to 
USAJobs, USA Staffing, e-Classification, and e-OPF support.

    Question 98. According to the fiscal year 2014 budget request, the 
Office of Finance within the Office of Management manages the Debt 
Management Center.
    A. For fiscal year 2014, what level of resources is expected to be 
used to operate the Debt Management Center and what level of staffing 
would those resources support?
    Response. The VA Debt Management Center (DMC) is an enterprise 
center under the VA Franchise Fund, providing common administrative 
support services to VA and other government agencies on a fee-for-
service basis and receives no direct appropriated funding. Projected 
revenues in FY 2014 will support $20,943,647 in expenditures and a 
staffing level of 189 FTE.
    B. How many telephone lines does the Debt Management Center 
currently operate and how many would be operated during fiscal year 
2014?
    Response. The DMC currently has 144 telephone lines (toll-free). In 
2014, VA plans to continue to have 144 lines available unless Veterans' 
demands increase.
    C. During fiscal year 2012, how many debts were referred to the 
Debt Management Center, what was the total value of those debts, and 
how much did the Debt Management Center recoup?
    Response. During FY 2012, 667,524 debts valued at $1.3 billion were 
referred to the DMC. During the fiscal year, the DMC collected $1.1 
billion.
    D. How many new debts are expected to be referred to the Debt 
Management Center during fiscal year 2013 and 2014?
    Response. During FY 2013, VA expects referral of approximately 
795,000 new debts, and during FY 2014, VA projects referral of 
approximately 875,000 new debts.

    Question 99. According to the budget request for fiscal year 2014, 
the Office of Management is expected to spend $44.1 million and would 
have a staffing level of 262 FTE, if this budget were adopted. This 
would be a $4 million, or 8 percent, decline in budget authority; 
however, the staffing level is expected to increase by 7 percent.
    A. If the Office of Management's budget is set to decrease by 8 
percent, what accounts for a 7 percent increase in FTE?
    Response. The Office of Management is not requesting additional 
staff in FY 2014. The office is hiring additional personnel during the 
latter part of 2013, and these new hires will only account as partial 
FTE for this year. In FY 2014, these partial FTE will be annualized 
(i.e., a staff hired in June counts as one-fourth of an FTE in FY 2013 
but a full FTE in FY 2014). Due to the late hiring in FY 2013, the FTE 
will be lower but the on-board staffing level at year-end will be 
similar to the FY 2014 FTE request level.
    B. If the increase in staff is a result of reimbursable or detailed 
FTE, please describe the work performed by those FTE for the Office of 
Management and the office from which they are reimbursed or detailed.
    Response. The increase in staff is not related to reimbursable or 
detailed FTE and is explained in the response to 99A.
Office of Human Resources and Administration
    Question 100. In response to questions regarding the fiscal year 
2013 budget request, VA indicated that it planned to spend $242.3 
million on contract costs for ``Training and Transformation 
Initiatives.'' Please provide an itemized list of the specific 
activities this funding has supported or will support, the amount 
expected to be spent on each activity, and the expected outcomes.
    Response. The initiatives included in the Human Capital Investment 
Plan (HCIP), are expected to have immediate, tangible, and measurable 
impact on the services provided to Veterans. HCIP expected outcomes are 
programs that increase staff productivity and allow VA to more quickly 
address the needs of Veterans. Training provided improves competencies 
in the areas of human resources, financial management, project 
management, acquisition and information technology (IT) certification 
enabling VA employees to provide an improved level of service to 
Veterans. Programs developed and administered by the Veterans 
Employment Services Office, which includes the VA for VETS program, 
created to facilitate the reintegration, retention and hiring of 
Veteran employees at VA: http://vaforvets.va.gov/Pages/default.aspx, 
provide the means for Veterans to translate the skills acquired in 
military service to marketable skills for civilian employment.
    The revised cost estimate for FY 2013 is $217 million, which 
includes support and administrative fees. The reduction is primarily 
due to the realigning of contracts' periods of performance. Below is a 
list of the initiatives supported in FY 2013.
  VA Learning University--VALU  Transformational Leadership
    Support the VA's transformation into a leading 21st century organization by training managers, supervisors,
   and executives while providing tools to better serve veterans and their dependents.  Supervisory and Management Training
    Design and deliver supervisor and management training, including the Leadership Development Programs,
   leadership portal, and the training delivery of commercial-off-the-shelf content.  Training Evaluation
    Provide independent evaluation and quality assurance of the ADVANCE training Initiatives delivered by VALU
   training partners. Develop and deploy formative and summative evaluations to assess the learners during, at
   close, and post-training. Evaluate program and training effectiveness.  Program-Based Training/Career Technical Training
    Provide training for cross cutting-career fields, in particular those that impact all of the Department's
   administrations and multiple staff offices. The goals are to ensure training is: (1) competency based, (2)
   consistent in learning events and products offered across the Department, and (3) uses formative and
   summative evaluation in development, assessment of learners during, at the close, and post training.  Leadership Competency Assessment and Certification
    Develop a competency-based leadership assessment and certification program. Establish a leadership
   certification which enables VA to send a clear message about the importance of leadership as a recognized
   professional discipline equal to the status of a technical discipline.  VA Career Mapping
    The FY 2013 purpose of this project is to continue to expand the design, development, and implementation of
   an innovative Career Mapping and Development Program. The goal is to ensure that VA employees have access to
   the functional training, experience, and education necessary to enhance their job performance, career
   progression, and development as multifunctional leaders.  Leadership Infusion
    The FY 2013 purpose of this project is to continue to provide an OPM catalogue of training courses.  e-Content
    This Initiative provides support and required licenses for educational content for VA employees. The
   licenses allow access to online materials, books, and training on a wide variety of subjects at a very low
   cost per person. Support services include: importing the content into the VA Talent Management System,
   assigning VA defined core competencies to the courses, and creating and revising course catalog documents.  Talent Management System (TMS) Upgrade Training
    Provides training on the infrastructure system that is at the core of education, training and learning at
   the VA. The capabilities of the VALU TMS support significant portions of the Initiatives enacted by VA, but
   the VALU TMS is a tool that requires care and management itself. This Initiative ensures VA has the resources
   necessary to support the tools that the Department relies upon for meeting its mission.  Talent Management Support
    This Initiative provides resources to manage the TMS system and to support all aspects of the Directorate's
   business responsibilities.  VA Acquisition Academy
    The VA Acquisition Academy (VAAA) was created to address the growing challenge facing the Department of
   Veterans Affairs and the Federal Government overall. This challenge is largely faced by the acquisition
   workforce, which has been strained to keep pace with the increased amount of and complexities associated with
   contracted work in support of the VA mission.  National Center for Organization Development  Evaluation Services
    This Initiative funds an Intra-Agency Agreement (IAA) to extend a partnership between Office of Human
   Resources & Administration (OHRA) and National Center for Organization Development (NCOD), part of Veterans
   Health Administration (VHA), in order to complete projects that achieve goals for HRA and NCOD related to
   VA's organizational health and transformation and most efficient use of VA resources.  Staff Office Memoranda Of Understanding
    This Initiative provides funding to execute training events for the VA staff offices in order to achieve
   transformational impact, increase effectiveness, supports mission, and has investment justification.  Office of Human Resources Management--OHRM  HR Academy
    HR Academy supports the professional growth of VA H.R. professionals nationwide by closing the competency
   gaps.  Central Office Human Resources Services (COHRS)
    This Initiative provides professional services including: business process maps, workload tracking tool,
   staffing resources, and an on-boarding program designed to improve H.R. services enabling the COHRS to reduce
   hiring time.  Workforce Planning
    This Initiative develops and implements a corporate Workforce Planning (WFP) capability and forms strategic
   partnerships with Program Offices and Administrations enabling VA to identify and address department-wide WFP
   needs, make data-driven decisions, and capitalize on leading practices.  Knowledge Management
    This initiative helps transform organizations into a learning organization through a knowledge management
   culture by empowering employees to innovate and collaborate with peers.  Health and Wellness
    This Initiative develops, implements, and manages a health and wellness program resulting in a healthier,
   more productive, and motivated workforce.  HR Professional Services
    This Initiative provides H.R. and Project Management services using a variety of models and solutions to
   standardize position descriptions; improve training, and H.R. customer service, and increase efficiencies in
   H.R. processes across the VA.  Reclassification
    This project provides HRA with a customized positions classification system through Monster Government
   Solutions. The system includes planning, coordination, implementation, training and communication.  HR Line of Business (LOB)
    HR LOB enables efficient Human Resource Service delivery by providing personnel information management
   systems that meet Office of Personnel Management data requirements.  Veterans Employment Service Office--VESO  Case Management System (CMS)/ Coaching
    Provides support to VESO thru Case Management System and development, providing the VA for Vets Help Desk,
   training Veterans and providing coaching call center. VESO's goals are to: increase percentage of Veterans
   hired within VA, the Federal Government, and non-profit sectors; reduce voluntary Veteran turnover VA-wide;
   and, implement a supportive reintegration infrastructure.  Strategic Management Group (SMG)  Oversight and Program Management
    This Initiative provides Program Management support to SMG within HRA with oversight and integrated
   management of HCIP portfolio processes.  Contract Assistance
    This Initiative provides acquisition support to HCIP Program Offices within HRA to develop high-quality
   requirements packages.  HRA Strategic Support
    This Initiative provides expert, strategic planning, program management, organizational transformation and
   communications support to HRA, its supporting programs and initiatives. Support includes planning and
   investment support designed to help HRA determine its strategic priorities.  Office of Administration--OA  Workers' Compensation Interdisciplinary FTE Support, Training and Occupational Safety and Health Conference
    Provide training services and logistical support to improve the management of VA's Federal Workers'
   Compensation (WC) and Occupational Safety and Health (OSH) Programs. This ongoing effort aims to train more
   than 196 VA employees in the fundamentals of the WC interdisciplinary functions and OSH program management
   and helps drive cost avoidance.  Centralized Workers' Compensation (WC) Processing
    This initiative is a resource to support VA field locations reviewing WC cases. VA is seeking to continue
   contractor support providing WC case management services.  All Employee Safety Perception Survey
    The VA contracted with the National Safety Council (NSC) to conduct an all-employee Safety Perception
   Survey. In FY 2013, NSC's subject-matter experts provide training to improve lower scoring safety program
   management categories identified in the FY 2012 survey.  Medical Case Review
    This Initiative request funds for a Veterans Health Administration (VHA) employee physician to review
   Workers Compensation (WC) cases. The pilot of the Medical Case Review program has demonstrated the potential
   to save costs related to WC cases, primarily related to questionable treatment and diagnoses.  Agency Medical Exams
    This Initiative is to establish a centralized fund to be used by VA facilities nationwide for medical
   examinations to reduce unnecessary costs related to worker's compensation, as well as enhancing the
   management of those cases.  Administrative Investigations
    This Initiative establishes a central fund for field facilities to draw and issue small non-personal service
   contracts in accordance with micro-purchasing procedures to perform Administrative Investigations. Cases
   would be evaluated against a set of criteria to ensure that only the most deserving cases are included in
   this initiative.  Warehouse Operations Support
    The Office of Administration (OA) ensures that VA facility (office space), computer (laptop/workstation) and
   access costs (badges, access cards, etc.) are identified if the ``contract employee'' requires them to
   perform their work assignments.  Workspace Modifications
    A fund assisting organizations to redesign office space into smaller workstations, fewer offices, utilizing
   collaborative and touchdown spaces.  Employee Accountability/Emergency Preparedness (Personnel Accountability System (VA-PAS) Project)
    The purpose of the VA-PAS is to identify the location of VA employees and contractors. An interagency
   agreement with Space and Naval Warfare Systems Center, Pacific delivers a VA enterprise-wide Capability to
   identify personnel during an emergency and determine whether employees are safe, willing, and able to work
   through a Personnel Assessment and Accountability System (PAAS) and a VA Notification System (VANS).  Corporate Senior Executive Management Office--CSEMO  Executive Coaching
    Provides a one-on-one way to assist executives during their on-boarding experience to help identify and set
   clear goals, ways, and methods to make their transition process efficient and effective. Executive coaching
   supports the executive by offering personalized leadership development experience where coach, leader and key
   stakeholders collaborate over time to accelerate the executive's development, achieving results that
   positively impact his/her organization and ultimately Veterans.  SES Collaborative Website
    Continue development to content enhancement, implementation, and sustainment for CSEMO Connect, the
   collaborative Web site for senior executives across VA.  Senior Executive Talent Management System (TMS)
    Senior Executive TMS is an automated system to recruit, develop, deploy, and support executives across the
   Department to achieve VA's missions and support its transformational initiatives. The system contributes to
   analysis and improvement of VA's executive life cycle management.  Executive On-boarding Tool
    Establish an automated tool for all aspects of the executive on-boarding experience. CSEMO will be able to
   streamline processes, capitalize upon efficiencies in the process, and develop metrics and reporting
   capabilities by automating certain aspects of the on-boarding process through the use of a web-based
   automated system with dashboards.  Corporate Performance Management Training System
    Ensure the entire Senior Executive workforce receives annual performance management training as required by
   Office of Personnel Management (OPM). Works with VA's automated Performance Management System tool to (1)
   ensure the content is accurate and updated in a timely fashion, and (2) ensure newly appointed executives are
   trained on the use of the automated tool.  Business Process/Systems Architect
    Develop, deliver, manage and maintain CSEMO's Human Resources (HR) information systems.  Assistant Secretary for HRA--(AS)  Leading EDGE (Executives Driving Government Excellence)
    An executive-level training program that: (1) inspires a seamless and powerful senior executive corps with
   shared governmentwide identity and vision; (2) crafts solutions that have impact across agencies; and (3)
   reignites the highest ideals of public service. In 2012, 15 Federal departments participated in the program.  Labor Management Relations--LMR  Labor Management Relations (LMR) Training
    This initiative supports all five Unions with Master Agreement Training. The FY 2013 effort supports the
   unions with training products and training facilitation.  Office of Diversity and Inclusion--ODI  National Diversity Internship Program
    Provide a centralized fund providing VA offices with the ability to pay the salary of summer interns.  Reasonable Accommodations Centralized Fund
    Provide a centralized fund to reimburse VA offices required to provide reasonable accommodations (RA) for VA
   employees, such as those needing accommodations for disabilities. The secondary objective is to track the
   receipt and processing of the RA requests.  Diversity and Inclusion Training
    Develop and provide comprehensive, continuing, coordinated diversity and inclusion training to all VA SES,
   Title 38 Equivalents, managers and supervisors at the GS-13 level and above.  Workforce Recruitment Program
    Provide a centralized fund supporting VA offices with the resources to pay the salary of interns that may be
   converted to full-time VA employees.  Office of Resolution Management--ORM  Conflict Management Training
    Provide the VA with conflict management training for VA leadership, management and labor in an effort to
   reduce and resolve workplace conflict.

    Question 101. For fiscal year 2014, the Office of Human Resources 
and Administration is requesting $305 million for Other Services. 
Please provide a detailed itemized list of how those funds are expected 
to be spent, including any specific initiatives these funds would 
support. To the extent any of the funds will be spent on contracts, 
please explain the nature of the contract and the expected outcomes.
    Response. In addition to the ongoing initiatives provided through 
the Human Capital Investment Plan (HCIP), (initiatives listed in 
question 100), HRA requested funding in other services for Office of 
Resolution Management (ORM), Office of Administration, and Office of 
Human Resources Management (OHRM). The current estimate for FY 2014 has 
been reduced from the projected $305 to $236 million.
    HCIP is part of the Departmental effort to transform the VA 
workforce to better serve Veterans in the 21st century. Contracts are 
awarded to provide training in the areas of executive and leadership 
training, program and project management, human resources reform, IT 
certification and financial management. HCIP has been evaluated using 
industry standards for best practices by an external auditing firm 
(Deloitte) and VA's National Center for Organizational Development.
    ORM contracts include ADR Mediations, IT equipment, FSC, SIC, VHA 
Services Center, Temporary Services for a Visually Impaired Employee.
    OHRM included funding for the Child Care Subsidy Program (CCSP). 
CCSP is a Nation-wide program that assists lower income VA employees 
whose total family income is less than $59,999 per year with the cost 
of child care. Eligible employees receive a subsidy based on their 
total family income. Over 2,000 VA employees have applied to 
participate in the program and new applications are received daily. 
Employees submit monthly invoices that must be processed timely and 
accurately. Payments are made directly via electronic funds transfer to 
child care providers. The Child Care Records Management System (CCRMS) 
includes a process for capturing documents of participants in the Child 
Care Subsidy Program in an electronic and database format. The CCRMS 
provides a methodology for classifying, identifying, tracking, filing, 
retrieving and storing of documents as well as data used for 
statistical and reporting purposes. The Child Care Subsidy Program is a 
reimbursement program. Each organization supports the cost of daycare 
for their participants in the program and OHRM maintains the funding 
for distribution to child to child care providers upon request.
    A breakdown of current estimated FY 2014 contract costs of $236 
million follows:
----------------------------------------------------------------------------------------------------------------
                                                                                                       Cost (in
                     Office                                      Contract Description                 Millions)
----------------------------------------------------------------------------------------------------------------
Human Capital Investment Program................  Training and Transformation Initiatives..........     $217.5
----------------------------------------------------------------------------------------------------------------
Office of Resolution Management (EEO complaint    Contracts for Investigation of EEO complaints,         $11
 Processing).                                      Court Transcription Services.
----------------------------------------------------------------------------------------------------------------
Administration..................................  Contracts with Other Government Agencies for            $3
                                                   Mailroom Operations, Employee Health Unit and
                                                   Employee Fitness Center.
----------------------------------------------------------------------------------------------------------------
Office of Human Resources Management............  Child Care Subsidies.............................       $4
----------------------------------------------------------------------------------------------------------------
Miscellaneous...................................  Individual training,copier and equipment                 $.4
                                                   maintenance and other contracts.
----------------------------------------------------------------------------------------------------------------
    Total.......................................  .................................................     $235.9
----------------------------------------------------------------------------------------------------------------


    Question 102. According to the fiscal year 2014 budget request, the 
Office of Human Resources and Administration plans to spend $13 million 
on travel during fiscal year 2013 and requests $20 million for travel 
during fiscal year 2014.
    A. In total, how many employees are expected to travel during 
fiscal year 2013, how many unique travel trips are expected to occur, 
and what is the expected average cost per expected trip?
    Response. Please see the response to question 102 B.
    B. For fiscal year 2014, how many unique travel trips is the $20 
million expected to support?
    Response. The travel budget identified in the HRA chapter in the 
budget is primarily for travel provided for Human Capital Improvement 
Plan (HCIP) programs. The current estimates for travel have been 
reduced from what was originally submitted in the budget. The HCIP was 
initiated to transform the VA workforce to better meet the needs of a 
changing Veteran population.
    HCIP allocates most of its travel funds for training programs 
conducted by the VA Learning University (VALU). VALU provides training 
on a corporate level in the areas of leadership development, competency 
improvement, and technical training. These training courses are 
provided to all VA employees, not just HRA employees. VALU, through its 
HCIP funding, covers the cost not only of the training but all travel 
costs associated with attendance at the training. Travel associated 
with HCIP-funded, VALU-sponsored training is tracked separately in the 
travel management system from all other HRA travel and therefore is 
listed separately from other HRA travel in the tables below.
    Additional HCIP programs are also allocated funds for travel 
associated with special events such as Veterans Employment Hiring Fairs 
held at various locations throughout the country.
    Other travel not associated with HCIP, but included in the HRA 
budget is for the Office of Resolution Management, which handles the 
processing of discrimination allegations and conflict resolution for 
both field and VA Central Office Equal Employment Opportunity-related 
cases. HRA travel funds also provide reimbursements to other VA offices 
for travel incurred for attendance at training sessions associated with 
new union contracts as well as travel associated with normal HRA 
business.

                    HRA Travel Costs ($ in millions)
------------------------------------------------------------------------
                                                        FY 2013  FY 2014
------------------------------------------------------------------------
VALU sponsored travel.................................    $10.1    $10.3
All other HRA travel not included in VALU totals......     $1.1     $2.4
                                                       -----------------
    Total.............................................    $11.2    $12.7
------------------------------------------------------------------------



                            # of Unique Trips
------------------------------------------------------------------------
                                                        FY 2013  FY 2014
------------------------------------------------------------------------
VALU sponsored travel.................................    6,631    6,405
All other HRA travel not included in VALU totals......      712    1,412
                                                       -----------------
    Total.............................................    7,343    7,817
------------------------------------------------------------------------



                         Average Cost (whole $)
------------------------------------------------------------------------
                                                        FY 2013  FY 2014
------------------------------------------------------------------------
VALU sponsored travel.................................   $1,520   $1,611
All other HRA travel not included in VALU totals......   $1,513   $1,684
                                                       -----------------
    Total.............................................   $1,519   $1,624
------------------------------------------------------------------------


    C. What steps have been taken to avoid questionable travel expenses 
since issuance of the September 2012 Inspector General report entitled 
``Administrative Investigation of VA's FY 2011 H.R. Conferences in 
Orlando, FL?''
    Response. VA employs over 320,000 employees who provide high 
quality health care, benefits, and services to Veterans every day. VA 
is the Nation's largest integrated health care system with nearly 1,300 
centers of care serving 8.6 million Veterans across the country. A 
large number of VA doctors, nurses, claims processors and other 
employees directly benefit from training events every year. Continuous 
workforce training and development is essential to delivering timely 
and quality VA care and services our Veterans have earned and deserve. 
VA holds centralized training forums to enhance the delivery of health 
care, benefits, and memorial services unique to Veterans. This includes 
employee development through critical training to improve customer 
service and the timely delivery of benefits and services; clinical 
training, which includes post-deployment care, treatment of chronic 
conditions, mental health, suicide prevention; and strategies to 
eliminate Veteran homelessness. Our training events are designed to 
achieve our goals--better access, eliminate the backlog, and end 
Veteran homelessness by training and developing our employees and 
empowering them to provide the best care and services possible for our 
Nation's Servicemembers and Veterans.
    VA has implemented a comprehensive action plan to revise and 
strengthen policies and controls on the planning and execution of 
training conferences and events. These actions are consistent with the 
recommendations in the September 30, 2012 Inspector General report and 
are reflected in VA policy issued on September 26, 2012.
    Stringent internal controls for training conferences are in place 
and oversight is provided by the senior executives in the Department. 
Further, the newly established Training Support Office ensures 
consistency and the distribution of clear guidance regarding needed 
steps for adherence with all appropriate regulations and requirements 
as the Department balances critical training requirements to ensure 
achievement of stated goals and objectives while minimizing costs.
    Automating data collection is essential to provide accurate and 
timely information for senior leaders so they can execute their 
responsibilities and respond to queries for training related events 
from Congressional and other Federal oversight bodies. VA is currently 
engaged in developing and delivering an automated data collection tool 
to increase accountability, control training conference spending, and 
produce congressionally required reports.
    VA's Conference Oversight Memorandum dated September 26, 2012, 
supersedes all previously issued conference guidance.
    The approval authorities:

     A Senior Executive must approve any conference under 
$20,000.
     Two Senior Executives, the Conference Certifying Official 
(CCO) and the Responsible Conference Executive (RCE), are appointed 
when a conference exceeds $20,000 to ensure adherence to all applicable 
statutes, regulations, and policies when planning and executing the 
approved conference.
     An Under Secretary or Assistant Secretary must approve any 
conference within the threshold $20K to $100K.
     The Deputy Secretary is responsible for approving 
conferences exceeding $100K to $500K.
     Conferences exceeding $500K require a waiver by the 
Secretary.

    A Quarterly Conference Planning and Execution Briefing is now 
required at least 120 days prior to the quarter of execution. This 
briefing outlines all the conferences planned for the targeted quarter 
to include cost, attendees, location, purpose and outcomes.
    The VA conference process has four phases: Concept, Development, 
Execution, and Reporting.

     The Concept Phase is a disciplined conference 
authorization process. In October 2012, VA began our quarterly Concept 
Authorization Briefing as part of the quarterly Conference Planning and 
Execution Briefing Cycle where senior officials review all events to 
ensure the best value prior to being authorized to enter the 
Development Phase.
     The Development Phase builds the business case for the 
event; provides the guidance for the planning and execution of the 
potential conferences; appoints a Senior Executive as the CCO and a 
Senior Executive as the RCE. The CCO certifies the event details are in 
compliance with all directives. The event plan is then submitted 
through the appropriate channels to the approving official for 
approval, disapproval or modification of the planned event.
     The Execution Phase covers the period after the conference 
plan has been approved and the responsible organization begins to 
execute the approved plan. The RCE is responsible for executing the 
approved plan in accordance with laws, regulations, and policy. 
Additionally, the RCE oversees the spending and contract execution, 
approving any changes to contract agreements or increases in spending.
     The Reporting Phase covers the period after the execution 
of the conference. The RCE submits an After Action Review (AAR) 
reflecting how the event was conducted; providing conference attendance 
and details on how the spending was tracked and reported in accordance 
with Public Law 112-154 and OMB M-12-12. The Administrations and Staff 
Offices leadership review the AAR to verify that the event was executed 
in accordance with the plan and all applicable policies and 
regulations.

    Question 103. In response to questions regarding VA's fiscal year 
2013 budget request, VA indicated that it planned to expend $6 million 
during fiscal year 2013 on a ``Change Academy.''
    A. To date, how much has been expended on the Change Academy during 
fiscal year 2013, how many individuals have attended this training, and 
what outcomes have been achieved? Are any of the individuals who 
attended this training no longer employed at VA?
    Response. Change Academies are customized programs designed to 
address specific interests, problem solving or strategic initiatives 
for any leadership team to bring transformational change to a VA 
facility, region or network. Change Academy provides a venue to 
leverage actual VA work scenarios to help clarify goals and action 
plans and to build momentum for organizational sustainment. Change 
Academies are more than training events; they are partnerships to 
facilitate solving problems affecting VA and the needs of our Veterans. 
As of June 30, 2014, three events have been approved and one event, 
costing $11,000 for attendance by 12 employees, was completed. There 
are currently 20 Change Academy sessions undergoing coordination for 
delivery for the remainder of the FY, reaching over 4100 VA employees. 
The expense associated with managing the program is $1.54 million 
through April, 2013.
    B. During fiscal year 2014, how much does VA expect to spend on the 
Change Academy, how many individuals are expected to attend this 
training, and what outcomes are expected to be achieved?
    Response. There is currently $2.8 million budgeted for Change 
Academies for FY 2014. Task estimates are based on delivery of 12 small 
events of two or three day duration for up to 50 participants, 2 medium 
events of five day duration for up to 80 participants, and 1 large 
multi-event program for up to 2000 participants. This year, Change 
Academies will be delivered on an indefinite delivery/indefinite 
quantity (ID/IQ) basis. Change Academies have been an extremely 
successful organizational training delivery and have received strong 
reviews from VA participants. The outcome brings together an entire 
facility or department to open dialog and identify solutions to address 
urgent organizational needs.

    Question 104. According to the fiscal year 2014 budget request, 
funding for VACO is expected to be reduced by 5 percent; however, the 
staffing level for the Office of Human Resources and Administration 
would add 50 FTE above the 2013 level and the number of FTE has grown 
by 72 percent since 2009. The Office of Resolution Management, which 
handles equal employment opportunity (EEO) complaints within the Office 
of Human Resources and Administration, would have the single largest 
increase in staffing with an additional 24 reimbursable FTE. Has VA 
seen a growth in EEO complaints in the last year? If not, what accounts 
for the growth of these positions?
    Response. The higher FY 2014 FTE in ORM is largely due to the 
annualization of ORM FTE hired late in fiscal year FY 2013. ORM FTE is 
expected to reach 267 FTE in FY 2014, as a result, there is no FTE 
growth during FY 2014.

    Question 105. The Corporate Senior Executive Management Office 
(CSEMO), within the Office of Human Resources and Administration, was 
created to provide a ``centralized approach to the executive life cycle 
management.'' Under its responsibilities, CSEMO has created two 
training programs--Senior Executive Leadership Development Course I 
(SLC I) and Senior Executive Leadership Development Course II (SLC II). 
According to the budget request, 40 Senior Executive Service (SES) 
employees have completed SLC I and 476 SES employees have completed SLC 
II.
    A. For each training program (SLC I and SLC II), please provide the 
amount VA expects to spend in fiscal year 2014.
    Response. For SLC I--Core Training, the one-week senior executive 
onboarding course, VA projects holding three sessions (Cohorts 4, 5, 
and 6) in FY 2014 at a total cost of $127,578.84. For SLC II--Basic, 
the strategic decisionmaking course currently held at University of 
North Carolina-Chapel Hill, VA projects holding three sessions (Cohorts 
20, 21, and 22) at a total maximum projected cost of $649,627.95.
    B. How much was spent on each training course (SLC I and SLC II) 
for fiscal year 2009 through fiscal year 2013? Please breakdown by 
fiscal year, by category of spending (travel, facility rentals, course 
material, etc.), and by training program.
    Response. In 2012, VA Senior Executives called for a redesign of 
the VA's Senior Executive On-boarding and Development Programs. Based 
on senior executive feedback, the Executive Forum was terminated 
because it was not providing new VA executives what they needed to be 
successful. The Department piloted a new on-boarding program, the 
Senior Executive Strategic Leadership Course I--Core Training. This 
course was designed to acclimatize new senior executives to VA culture, 
highlight red lines or issues that posed a threat to new senior 
executives, set the conditions for a successful transition into the 
role of strategic leader, and promote corporate problem-solving through 
networking. About 80% of the program is delivered by VA Senior 
Executives.
    The SLC I--Core Training course is followed by the Strategic 
Leadership Course II--Basic. This university-based course builds on SLC 
I by focusing on critical thinking skills, strategic decisionmaking, 
tools to facilitate leading and driving change, and networking 
opportunities to promote corporate problem-solving. Additionally, VA 
senior executives work VA Strategic Challenges during SLC II. These 
challenge questions provide the senior executives an opportunity to 
apply what they are learning at SLC II to real-world VA challenges. 
They then brief their analysis and recommendations to a VA senior 
leader on the final day of SLC II. Not only does the activity reinforce 
lessons learned at SLC II, but the VA gains from a fresh perspective on 
a VA program or policy.
    For SLC I--Core Training:
------------------------------------------------------------------------
               Cohort                   Program     Travel       Total
------------------------------------------------------------------------
1...................................   58,728.96   32,938.28   91,667.24
2...................................   53,464.35   25,436.23   78,900.58
------------------------------------------------------------------------


    For SLC II--Basic:
----------------------------------------------------------------------------------------------------------------
                                                                     Contractor
                         Cohort                            Program     Support    OPM Fee    Travel      Total
----------------------------------------------------------------------------------------------------------------
1......................................................  177,687.50          --  7,995.94  17,500.00  203,183.44
2......................................................  187,714.50          --  8,447.15  21,000.00  217,161.65
3......................................................  163,584.76          --  7,361.31  16,800.00  187,746.07
4......................................................  189,525.00          --  7,107.19  18,725.22  215,357.41
5......................................................  194,940.00          --  7,310.25  25,032.66  227,282.91
6......................................................  204,445.00   24,282.33  8,577.28  17,761.46  255,066.07
7......................................................  202,732.50   24,282.33  8,513.06  23,624.59  259,152.48
8......................................................   203,107.5   24,282.34  8,527.12  22,355.11  258,272.07
9......................................................  197,255.00   24,282.33  8,307.65  22,426.96  252,271.94
10.....................................................  202,425.00          --  7,584.19  22,254.56  232,083.75
11.....................................................  169,577.50          --  6,359.16  20,974.88  196,911.54
12.....................................................  168,715.00          --  6,326.81  20,974.88  196,016.69
13.....................................................  188,237.50          --  7,058.91  19,782.60  215,079.01
14.....................................................  193,027.50          --  7,238.53  28,005.65  228,271.68
15.....................................................  163,025.00          --  6,113.44  17,036.47  186,174.91
16.....................................................  161,985.00          --  6,074.44  14,436.74  182,496.18
17.....................................................  138,110.00          --  5,179.13  12,186.36  155,475.49
18.....................................................  144,647.50          --  5,424.28  13,345.62  163,417.40
19.....................................................         TBD        0.00       TBD        TBD         TBD
----------------------------------------------------------------------------------------------------------------


    OPM Fee for use of contract vehicle in FY 2011 was 4.5%, then 3.75% 
in FY 2012.
    C. For training programs that are not conducted on VA property, 
please provide the dates and locations of each training program.
    Response. For SLC I--Core Training: Cohort 1 was conducted July 22-
27, 2012 and Cohort 2 during August 26-31, 2012, at the Bolger Center 
in Potomac, MD, which is a U.S. Postal Service facility. For SLC II--
Basic: All cohorts were held at the Rizzo Conference Center, Kenan-
Flagler Business School at the University of North Carolina, Chapel 
Hill, NC.
    Cohort dates follow:

                                 FY 2011
------------------------------------------------------------------------
         Cohort                                Date
------------------------------------------------------------------------
1                         March 20-25, 2011
2                         June 26-July 1, 2011
3                         September 18-23, 2011
------------------------------------------------------------------------



                                 FY 2012
------------------------------------------------------------------------
         Cohort                                Date
------------------------------------------------------------------------
4                         October 2-7, 2011
5                         November 13-18, 2011
6                         December 4-9, 2011
7                         January 22-27, 2012
8                         February 12-17, 2012
9                         March 11-16, 2012
10                        April 22-27, 2012
11                        May 6-11, 2012
12                        May 13-18, 2012
13                        May 17-22, 2012
14                        July 15-20, 2012
15                        August 12-17, 2012
16                        September 9-14, 2012
------------------------------------------------------------------------



                                 FY 2013
------------------------------------------------------------------------
         Cohort                                Date
------------------------------------------------------------------------
17                        October 14-19, 2012
18                        January 27-February 1, 2013
19                        June 16-21, 2013
------------------------------------------------------------------------


    Question 106. The Veterans Employment Services Office, under the 
Office of Human Resources and Administration, oversees the VA for Vets 
initiative. The VA for Vets initiative includes a Web site with a 
skills translator that helps veterans find employment at VA and other 
Federal agencies.
    A. What Federal agencies have signed a memorandum of understanding 
(MOU) with VA to utilize the capabilities of VA for Vets?
    Response. To date, the U.S. Departments of Agriculture, State, 
Homeland Security, and Interior have signed MOUs with VA to utilize VA 
for Vets. The American Red Cross, a non-profit organization, also has a 
MOU in place with VA. An MOU is forthcoming with the Department of 
Commerce. The Departments of Labor and Health and Human Services, the 
National Credit Union Association, and the National Aeronautics and 
Space Administration have all met with VA to discuss the MOU process.
    B. How is VA reaching out to other agencies in order to expand the 
usage of VA for Vets through MOUs?
    Response. VA's Veteran Employment Services Office (VESO) 
participates on the joint VA/DOD Veteran Employment Initiative Task 
Force to maximize the career readiness of all Servicemembers. The VESO 
Director serves as a co-chair for the Task Force's Veterans Employment 
Working Group. The Task Force developed and submitted a list of 
recommendations to the President outlining the steps needed to ensure a 
successful transition for Military Servicemembers.
    The recommendations included the development of a single portal for 
Servicemembers and Veterans to gain access to resources on employment 
and transition services and for employers to post jobs for Veterans.
    VA supports this effort by providing access to the VA for Vets 
platform throughout the Federal Government through MOU's. This access 
is at no additional cost to either the VA or other agencies that use 
VA4Vets.
    Specifically, VA is responsible for having MOUs in place by 2015 
with 35 percent of all the 24 agencies that comprise the Veteran 
Employment Council. This number equates to 9 MOUs by 2015. VA is on 
track to meet or exceed the target using the Task Force and the Veteran 
Employment Council as the avenue to reach out to the agencies to 
reinforce the benefits and importance of signing the MOU
    C. Please describe the assistance provided to veterans through the 
program (i.e., career coaching and counseling).
    Response. VA for Vets provides a fully integrated, online job-
search and career-building platform, the VA for Vets Career Center, 
which allows Veterans to assess their talents and strengths, translate 
their military skills and training, build resumes, and identify and 
apply for Federal job opportunities. Career Coaches work one-on-one 
with Veterans and provide guidance on resume writing, job searches and 
interview preparation. The program further supports Veteran employees 
at VA by offering career development services and reintegration support 
for Military Servicemembers.
    D. There are numerous veteran employment Web sites supported by 
various Federal agencies. Given the enhanced tools developed by VA for 
use by other Federal agencies, what efforts, if any, have been pursued 
by VA to establish one Federal Web site for veteran employment 
information and tools?
    Response. As mentioned in the response to subquestion 106 B above, 
the joint VA/DOD Task Force recommended a single portal for 
Servicemembers and Veterans to gain access to employment and transition 
services and to determine the feasibility of deploying the VA for Vets 
platform across government. VA is also undertaking internal initiatives 
to work toward establishing one Federal portal for Veterans to access 
employment information and tools by integrating its private employment 
Web site (VetSuccess.gov) with its Federal employment Web site, VA for 
Vets. VA will be integrating these two Web sites into one platform to 
create a seamless and consistent experience for Veteran users.
    These combined efforts will give Veterans instant access to open 
Federal and private sector job listings as well as provide access to 
the enhanced VA for Vets services in a single source.
    E. Please provide the Committee with the number of unique veterans 
who have used the VA for Vets site, the number of veterans utilizing 
the job coaching and counseling, and the number of Federal jobs 
obtained through the program.
    Response. As of June 30, 2013, 944,127 unique visitors, both 
Veterans and civilians, have visited the Web site. As of June 30, 2013, 
12,733 Veterans have utilized the job coaching and counseling. As of 
June 30, 2013, 1,921 Federal jobs have been obtained by Veterans 
through the program.

    Question 107. The Veterans Recruitment Appointment (VRA) is one of 
the hiring authorities that allow Federal agencies to hire eligible 
veterans. Veterans can be appointed to positions up to GS-11 or 
equivalent. Participating veterans are hired under excepted 
appointments to positions that would otherwise need to be competed. 
After 2 years of service, the veteran must be converted to a career 
position if they have performed satisfactorily.
    A. According to the fiscal year 2014 budget request, 35 percent of 
the VA workforce was comprised of veterans in 2013. Of those, how many 
veterans were hired using VRA, over the last five years?
    Response. Please see the chart provided in response to subquestion 
B.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



    B. Please provide the Committee the number of veterans, during the 
last five years, hired under other hiring authorities, such as the 
Veterans Employment Opportunities Act (VEOA) or 30 percent or more 
disabled.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]




    C. Of those initially hired under VRA, how many (number and 
percentage) were converted to career or career-conditional appointments 
after two years?


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]




    D. Of those hired in the last five years under other authorities, 
how many (number and percentage) are still employed at VA? Please 
detail, if employees are no longer with VA, whether their positions 
were terminated, the positions hired for were temporary, or they left 
for other reasons.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



Office of Policy and Planning
    Question 108. The fiscal year 2014 budget request includes $11 
million to be spent on Other Services by the Office of Policy and 
Planning. Please provide a specific itemized list of how these funds 
would be spent. To the extent any of these funds will be spent on 
contracts, please explain the nature of the contract and the expected 
outcomes.
    Response. See spreadsheet below.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



    Question 109. For fiscal year 2014, the budget request includes 
over $25 million for the Office of Policy and Planning and would 
support 114 employees. For each office within the Office of Policy and 
Planning, please identify the positions and pay-grades for employees 
that would be assigned to that office during fiscal year 2013 and 
fiscal year 2014 and the number of contractors that are expected to be 
assigned to each such office.
    Response.

                                  2013
------------------------------------------------------------------------
                     Title                       Series       Grade
------------------------------------------------------------------------
                    Office of the Assistant Secretary
Assistant Secretary............................     301  SES
Executive Assistant to the Assistant Secretary.     301  GS 15
Scheduler/Program Support to Assistant              301  GS 11
 Secretary.
Principal Deputy Assistant Secretary...........     301  SES
Scheduler/Program Support to Principal Deputy       301  GS 11
 Assistant Secretary.
Senior Policy Advisor..........................     343  GS 15                               Operations
Director of Operations.........................     343  GS 15
Human Capital Manager..........................     301  GS 14
Administrative Officer.........................     301  GS 13
Communications Specialist......................     343  GS 9
Budget Officer.................................     343  GS 13                     Office of VA/DOD Collaboration
Executive Director.............................     301  SES
Scheduler/Program Support......................     301  GS 11         Integrated Disability Evaluation System Service (IDES)
Director IDES..................................     301  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Pathways Intern................................     399  GS 9  Joint Executive Council/Senior Oversight Committee Service (JEC/SOC)
Director JEC/SOC...............................     301  GS 15
Special Assistant..............................     301  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 9/11
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 9                Corporate Analysis and Evaluation Service
Executive Director.............................     343  SES                           Programming Service
Director.......................................     343  GS 15
Budget Analyst.................................     560  GS 14
Operations Research Analyst....................    1515  GS 14
Budget Analyst.................................     560  GS 14
Operations Research Analyst....................    1515  GS 14
Management Analyst.............................     343  GS 14                      Analysis & Evaluation Service
Director.......................................     343  GS 15
Operations Research Analyst....................    1515  GS 14
Operations Research Analyst....................    1515  GS 14
Operations Research Analyst....................    1515  GS 14
Management Analyst.............................     343  GS 13
Operations Research Analyst....................    1515  GS 14
Operations Research Analyst....................    1515  GS 14                            Office of Policy
Deputy Assistant Secretary.....................     343  SES
Program Support................................     301  GS 9                         Policy Analysis Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 9/11
Management Analyst.............................     399  GS 13
Management Analyst.............................     301  GS 9                         Strategic Studies Group
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 12
Management Analyst.............................     343  GS 11                       Strategic Planning Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 11                 Office of Data Governance and Analysis
Deputy Assistant Secretary.....................     343  SES          National Center for Veterans Analysis and Statistics
Executive Director.............................     301  SES
Program Support................................     301  GS 11                     Analysis and Statistics Service
Director.......................................    1530  GS 15
Statistician...................................    1530  GS 14
Management Analyst.............................     343  GS 14
Statistician...................................     343  GS 13
Management Analyst.............................     343  GS 14
Statistician...................................    1530  GS 14
Statistician...................................    1530  GS 14
Management Analyst.............................     343  GS 13
Statistician...................................     343  GS 13                     Reports and Information Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 12
Pathways Intern................................     399  GS 9
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 12
Management Analyst.............................     343  GS 12                          Office of the Actuary
Chief Actuary..................................    1510  SL
Deputy Chief Actuary...........................    1510  GS 15
Actuary........................................    1510  GS 14
Economist......................................     110  GS 14
Actuary........................................    1510  GS 14
Actuary........................................    1510  GS 14
Actuary........................................    1510  GS 14
Management Analyst.............................     343  GS 14                  enterprise Program Management Office
Executive Director.............................     301  SES
Management Analyst.............................     343  GS 11
Deputy Director................................     301  GS 15
Executive Program Manager......................     301  SES                    Program Management Policy Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14                      Operational Management Review
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 14
Pathways Intern................................     399  GS 9
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14                       Resource Management Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 14
------------------------------------------------------------------------



                                  2014
------------------------------------------------------------------------
                     Title                       Series       Grade
------------------------------------------------------------------------
                    Office of the Assistant Secretary
Assistant Secretary............................     301  SES
Executive Assistant to the Assistant Secretary.     301  GS 15
Scheduler/Program Support to Assistant              301  GS 11
 Secretary.
Principal Deputy Assistant Secretary...........     301  SES
Scheduler/Program Support to Principal Deputy       301  GS 11
 Assistant Secretary.
Senior Policy Advisor..........................     343  GS 15                               Operations
Director of Operations.........................     343  GS 15
Human Capital Manager..........................     301  GS 14
Administrative Officer.........................     301  GS 13
Communications Specialist......................     343  GS 9
Budget Officer.................................     343  GS 13                     Office of VA/DOD Collaboration
Executive Director.............................     301  SES
Scheduler/Program Support......................     301  GS 11         Integrated Disability Evaluation System Service (IDES)
Director IDES..................................     301  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 11  Joint Executive Council/Senior Oversight Committee Service (JEC/SOC)
Director JEC/SOC...............................     301  GS 15
Special Assistant..............................     301  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 9/11
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 9                Corporate Analysis and Evaluation Service
Executive Director.............................     343  SES                           Programming Service
Director.......................................     343  GS 15
Budget Analyst.................................     560  GS 14
Operations Research Analyst....................    1515  GS 14
Budget Analyst.................................     560  GS 14
Operations Research Analyst....................    1515  GS 14
Management Analyst.............................     343  GS 14                      Analysis & Evaluation Service
Director.......................................     343  GS 15
Operations Research Analyst....................    1515  GS 14
Operations Research Analyst....................    1515  GS 14
Operations Research Analyst....................    1515  GS 14
Management Analyst.............................     343  GS 13
Operations Research Analyst....................    1515  GS 14
Operations Research Analyst....................    1515  GS 14                            Office of Policy
Deputy Assistant Secretary.....................     343  SES
Program Support................................     301  GS 9                         Policy Analysis Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 9/11
Management Analyst.............................     399  GS 13
Management Analyst.............................     301  GS 9                         Strategic Studies Group
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 12
Management Analyst.............................     343  GS 11                       Strategic Planning Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 11                 Office of Data Governance and Analysis
Deputy Assistant Secretary.....................     343  SES          National Center for Veterans Analysis and Statistics
Executive Director.............................     301  SES
Program Support................................     301  GS 11                     Analysis and Statistics Service
Director.......................................    1530  GS 15
Statistician...................................    1530  GS 14
Management Analyst.............................     343  GS 14
Statistician...................................     343  GS 13
Management Analyst.............................     343  GS 14
Statistician...................................    1530  GS 14
Statistician...................................    1530  GS 14
Management Analyst.............................     343  GS 13
Statistician...................................     343  GS 13                     Reports and Information Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 12
Management Analyst.............................     343  GS 9
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 12
Management Analyst.............................     343  GS 12                          Office of the Actuary
Chief Actuary..................................    1510  SL
Deputy Chief Actuary...........................    1510  GS 15
Actuary........................................    1510  GS 14
Economist......................................     110  GS 14
Actuary........................................    1510  GS 14
Actuary........................................    1510  GS 14
Actuary........................................    1510  GS 14
Management Analyst.............................     343  GS 14                  enterprise Program Management Office
Executive Director.............................     301  SES
Management Analyst.............................     343  GS 11
Deputy Director................................     301  GS 15
Executive Program Manager......................     301  SES                    Program Management Policy Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14                      Operational Management Review
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 11
Management Analyst.............................     343  GS 13
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 9
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14                       Resource Management Service
Director.......................................     343  GS 15
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 14
Management Analyst.............................     343  GS 13
------------------------------------------------------------------------


    Additionally, OPP has contracts in place with third parties that 
involve their employees working in VA facilities. However, VA does not 
control those companies' independent business decisions regarding 
staffing requirements. Thus, VA is unable to give a number of 
contractor's employees assigned to OPP.

    Question 110. According to the fiscal year 2014 budget request, 
approximately $7.3 million is expected to be spent in ``contract 
dollars'' managed by offices within the Office of Policy and Planning. 
Please describe, in detail, the contracts for the Office of VA/DOD 
Collaboration, the Office of Corporate Analysis and Evaluation, the 
Office of Policy, the Office of Data Governance, and the Enterprise 
Program Management Office. Please include a description of the work 
performed under the contracts, the total number of on-site and offsite 
contracted employees working under the contract, the length of the 
contract, the metrics to be used to determine if the contract would be 
renewed, and the expected outcomes.
    Response. See spreadsheet below.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


Office of Operations, Security, and Preparedness
    Question 111. For fiscal year 2014, the Office of Operations, 
Security, and Preparedness requests total resources of $31 million and 
133 employees. Please provide a list of the positions that would be 
filled with that funding and the pay-grades for those positions.
    Response. The Office of Operations, Security, and Preparedness 
(OSP) request of $31 million is the total fiscal year (FY) 2014 budget 
request for the Office. The personnel services portion of that request 
is $17.6 million to support 133 full-time employee equivalents.
------------------------------------------------------------------------
     Grade              TITLE           Organization         POSITION
----------------------------------------------------------------------------------------------------OSP Front Office0---------------------------
------------------------------------------------------------------------
Honorable......  Assistant           OSP...............  Assistant
                  Secretary (A/S).                        Secretary
GS-12..........  Special Assistant   OSP...............  Staff Assistant
                  to A/S.
------------------------------------------------------------------------
                     Office of Resource Management0
------------------------------------------------------------------------
GS-15..........  Director, Resource  Resource            Director, ORM
                  Management.         Management.
GS-13..........  Staff Assistant to  Resource            Staff Assistant
                  Director.           Management.
GS-12..........  Program Analyst...  Resource            Program Analyst
                                      Management.
GS-14..........  Budget Analyst....  Resource            Budget Officer
                                      Management.
GS-14..........  Administrative      Resource            Admin Officer
                  Officer.            Management.
GS-12..........  Staff Assistant...  Resource            Admin Officer
                                      Management.
GS-14..........  Resource Manager..  Resource            Management
                                      Management.         Analyst
------------------------------------------------------------------------
                  Office of Emergency Management (OEM)0
------------------------------------------------------------------------
SES............  Deputy Assistant    Emergency           DAS OEM
                  Secretary OEM.      Management.
GS-14..........  Senior Staff        Emergency           Support
                  Assistant.          Management.
GS-11..........  Staff Assistant...  Emergency           Support
                                      Management.
GS-12/13.......  Management Analyst  Emergency           Support
                  (Public Health).    Management.
------------------------------------------------------------------------
      Planning, Exercise, Training, and Evaluation Service (PETE)0
------------------------------------------------------------------------
GS-15..........  Dir - Emergency     OEM/PETE..........
                  Management Spec.
------------------------------------------------------------------------
                                Planning0
------------------------------------------------------------------------
GS-14..........  Lead Emergency      OEM/PETE..........  Planning
                  Mgt. Spec.
GS-11/12/13....  Emergency           OEM/PETE..........  Planning
                  Management Spec
                  (Planner/Liaison
                  Officer (LNO)).
GS-13..........  Program Analyst -   OEM/PETE..........  Planning
                  Geographic
                  Information
                  System (GIS).
  .............  Intern............  OEM/PETE..........  Planning
GS-11/12/13....  Emergency           OEM/PETE..........  Planning
                  Management Spec
                  (DHS LNO).
GS-9/11/12.....  Program Analyst -   OEM/PETE..........  Planning
                  GIS.
GS-11/12/13....  Management Analyst  OEM/PETE..........  Planning
                  (Planner/LNO).
------------------------------------------------------------------------
                   Exercise, Training, and Evaluation0
------------------------------------------------------------------------
GS-14..........  Team Lead/          OEM/PETE..........  Planning
                  Exercises.
GS-11/12/13....  Emergency           OEM/PETE..........  Planning
                  Management Spec
                  (Exercise).
GS-12/13.......  Emergency           OEM/PETE..........  Planning
                  Management Spec
                  (Continuity).
GS-12/13.......  Emergency           OEM/PETE..........  Planning
                  Management Spec
                  (Training).
GS-12/13.......  Emergency           OEM/PETE..........  Planning
                  Management Spec
                  (Evaluator).
------------------------------------------------------------------------
                 VA Integrated Operations Center (IOC)0
------------------------------------------------------------------------
GS-15..........  Director/(Supv.)    OEM...............  IOC
                  VA IOC (FY 12).
GS-14..........  (Supv.) Readiness   OEM...............  IOC
                  Operation Spec.
GS-13..........  Readiness           OEM...............  IOC
                  Operation Spec
                  (Team Lead).
GS-9/11/12.....  Readiness           OEM...............  IOC
                  Operation Spec.
GS-9/11/12.....  Readiness           OEM...............  IOC
                  Operation Spec.
GS-9/11/12.....  Readiness           OEM...............  IOC
                  Operation Spec.
GS-9/11/12.....  Readiness           OEM...............  IOC
                  Operation Spec.
GS-9/11/12.....  Readiness           OEM...............  IOC
                  Operation Spec.
GS-9/11/12.....  Readiness           OEM...............  IOC
                  Operation Spec.
GS-9/11/12.....  Readiness           OEM...............  IOC
                  Operation Spec.
GS-9/11/12.....  Readiness           OEM...............  IOC
                  Operation Spec.
GS-12/13.......  Program Analyst...    ................  IOC
GS-12/13.......  Program Analyst...  OEM...............  IOC
GS-12/13.......  Program Analyst...  OEM...............  IOC
GS-12/13.......  Readiness           OEM...............  IOC
                  Operations
                  Specialist
                  (National
                  Operations Center
                  Liaison).
------------------------------------------------------------------------
                     Operations & National Security0
------------------------------------------------------------------------
GS-15..........  Director (Supv.)    OEM...............  COOP/COG
                  RO Spec.
GS-14..........  Emergency           OEM...............  National
                  Management Spec.                        Security
------------------------------------------------------------------------
                               Operations0
------------------------------------------------------------------------
GS-14..........  Readiness           OEM...............  COOP/COG
                  Operation Spec
                  (Site B Director).
GS-13..........  Readiness           OEM...............  COOP/COG
                  Operation Spec
                  (Deputy Director
                  for Site B).
GS-11..........  Readiness           OEM...............  COOP/COG
                  Operation Spec.
GS-9/11/12.....  Readiness           OEM...............  COOP/COG
                  Operations Spe.
GS-9/11/12.....  Readiness           OEM...............  COOP/COG
                  Operations Spec.
GS-12..........  Readiness           OEM...............  COOP/COG
                  Operation Spec.
                  (Director Site C).
------------------------------------------------------------------------
                       National Security Service0
------------------------------------------------------------------------
GS-14..........  Special Security    OEM...............  National
                  Officer.                                Security
GS-13..........  Special Security    OEM...............  National
                  Representative.                         Security
GS-13..........  Special Security    OEM...............  National
                  Representative.                         Security
GS-13..........  Special Security    OEM...............  COOP/COG
                  Representative
                  (ROS).
------------------------------------------------------------------------
            Personnel Security & Identity Management (PSIM)0
------------------------------------------------------------------------
ES.............  Director,           PSIM..............  PSIM
                  Personnel
                  Security and
                  Identity
                  Management.
GS-12..........  Staff Assistant to  PSIM..............  PSIM
                  Director.
GS-15..........  Director, HSPD-12.  PSIM..............  HSPD-12
GS-14..........  Deputy Director,    PSIM..............  HSPD-12
                  HSPD-12.
GS-13..........  Physical Security   PSIM..............  HSPD-12
                  Specialist.
GS-13..........  Program Analyst...  PSIM..............  HSPD-12
GS-11..........  Director, PIV       PSIM..............  HSPD-12
                  Office.
GS-343-11......  Program Analyst...  PSIM..............  HSPD-12
GS-7...........  Program Specialist  PSIM..............  PIV Office
GS-7...........  Program Specialist  PSIM..............  PIV Office
GS-7...........  Program Specialist  PSIM..............  PIV Office
GS-7...........  Program Specialist  PSIM..............  PIV Office
GS-7...........  Program Specialist  PSIM..............  PIV Office
GS-7...........  Program Specialist  PSIM..............  PIV Office
GS-15..........  Director,           PSIM..............  PSS
                  Personnel
                  Security and
                  Suitability.
GS-14..........  Acting Director/    PSIM..............  PSS
                  Deputy Director,
                  PSS.
GS-12/13.......  Security            PSIM..............  PSS
                  Specialist.
GS-12/13.......  Security            PSIM..............  PSS
                  Specialist.
GS-12..........  Security            PSIM..............  PSS
                  Specialist.
GS-12..........  Security            PSIM..............  PSS
                  Specialist.
GS-11..........  Security            PSIM..............  PSS
                  Specialist.
------------------------------------------------------------------------
              Office of Security & Law Enforcement (OSLE)0
------------------------------------------------------------------------
SES............  Director for S&LE.  OSLE..............  OSLE Lead
GS-13..........  Program Analyst...  OSLE..............  Operations
GS-13..........  Administrative      OSLE..............  Operations
                  Officer.
GS-11..........  Staff Assistant...  OSLE..............  Operations
GS-15..........  Director, Police    OSLE..............  Police Lead
                  Service.
GS-07..........  Program Support     OSLE..............  Operations
                  Assistant.
------------------------------------------------------------------------
                           LEO/Investigations0
------------------------------------------------------------------------
GS-14..........  Chief.............  Oversight &         Lead
                                      Investigations.
GS-13..........  Criminal            Oversight &         Crim Inv
                  Investigator.       Investigations.
  .............  Criminal            Oversight &         Crim Inv
                  Investigator.       Investigations.
GS-13..........  Criminal            Oversight &         Crim Inv
                  Investigator        Investigations.
                  (Watch officer).
GS-13..........  Criminal            Oversight &         Crim Inv
                  Investigator.       Investigations.
GS-13..........  Criminal            Oversight &         Crim Inv
                  Investigator.       Investigations.
GS-12/13.......  Criminal            Oversight &         Crim Inv
                  Investigator.       Investigations.
------------------------------------------------------------------------
                     Intelligence & Crime Analysis0
------------------------------------------------------------------------
GS-14..........  Chief.............  Intell & Crime      Lead
                                      Analysis.
GS-12/13.......  Criminal            Intell & Crime      Crim Inv
                  Investigator        Analysis.
                  (Watch officer).
GS-13..........  Criminal            Intell & Crime      Crim Inv
                  Investigator        Analysis.
                  (Watch officer).
GS-13..........  Criminal            Intell & Crime      Crim Inv
                  Investigator        Analysis.
                  (Watch officer).
GS-12/13.......  Criminal            Intell & Crime      Crim Inv
                  Investigator.       Analysis.
------------------------------------------------------------------------
                     Executive Protection (EX Pro)0
------------------------------------------------------------------------
GS-14..........  Chief.............  Executive           Lead
                                      Protection.
GS-13..........  Criminal            Executive           EX Pro
                  Investigator.       Protection.
GS-13..........  Criminal            Executive           EX Pro
                  Investigator.       Protection.
GS-13..........  Criminal            Executive           EX Pro
                  Investigator.       Protection.
GS-11..........  Criminal            Executive           EX Pro
                  Investigator.       Protection.
GS-13..........  Criminal            Executive           EX Pro
                  Investigator.       Protection.
GS-13..........  Criminal            Executive           EX Pro
                  Investigator.       Protection.
GS-12..........  Criminal            Executive           Security
                  Investigator.       Protection.
GS-12..........  Criminal            Executive           Security
                  Investigator.       Protection.
GS-12..........  Security            Executive           EX Pro
                  Specialist.         Protection.
GS-12..........  Security            Executive           EX Pro
                  Specialist.         Protection.
WL-9...........  Motor Vehicle       Executive           EX Pro
                  Operator.           Protection.
------------------------------------------------------------------------
                    Infrastructure Security & Policy0
------------------------------------------------------------------------
GS-14..........  Chief.............  Policy &            Lead
                                      Infrastructure
                                      Protection.
GS-13..........  Security            Policy &            Security
                  Specialist.         Infrastructure
                                      Protection.
GS-12..........  Security            Policy &            Security
                  Specialist.         Infrastructure
                                      Protection.
GS-12/13.......  Criminal            Policy &            EX Pro
                  Investigator.       Infrastructure
                                      Protection.
------------------------------------------------------------------------
          Identity, Credentials, and Access Management (ICAM)0
------------------------------------------------------------------------
ES.............  Director,ICAM.....  ICAM..............  ICAM
GS-11..........  Staff Assistant...  ICAM..............  ICAM
GS-14..........  Administrative      ICAM..............  ICAM
                  Officer.
GS-12..........  Staff Assistant...  ICAM..............  ICAM
GS-14..........  Program Analyst...  ICAM..............  ICAM
------------------------------------------------------------------------
                          Identity Management0
------------------------------------------------------------------------
GS-15..........  Director--Identity  Identity Mgt......  Identity Mgt
                  Management.
GS-11..........  Staff Assistant...  Identity Mgt......  Identity Mgt
GS-14..........  Program Analyst...  Identity Mgt......  Identity Mgt
GS-14..........  Program Analyst...  Identity Mgt......  Identity Mgt
GS-11/12/13....  Program Analyst...  Identity Mgt......  Identity Mgt
GS-11/12/13....  Program Analyst...  Identity Mgt......  Identity Mgt
GS-7/9/11......  Program Support...  Identity Mgt......  Identity Mgt
GS-7/9/11......  Program Support...  Identity Mgt......  Identity Mgt
------------------------------------------------------------------------
                           Access Management0
------------------------------------------------------------------------
GS-15..........  Director- Access    Access Mgt........  Access Mgt
                  Management.
GS-11..........  Staff Assistant...  Access Mgt........  Access Mgt
GS-14..........  Program Analyst...  Access Mgt........  Access Mgt
GS-14..........  Program Analyst...  Access Mgt........  Access Mgt
GS-11/12/13....  Program Analyst...  Access Mgt........  Access Mgt
GS-11/12/13....  Program Analyst...  Access Mgt........  Access Mgt
GS-7/9/11......  Program Support...  Access Mgt........  Access Mgt
GS-7/9/11......  Program Support...  Access Mgt........  Access Mgt
------------------------------------------------------------------------
                       On-Board/Monitor/Off-Board0
------------------------------------------------------------------------
GS-15..........  Director-On-Board/  On-Board/Off-Board  On-Board/Off-
                  Off-Board.                              Board
GS-11..........  Staff Assistant...  On-Board/Off-Board  On-Board/Off-
                                                          Board
GS-14..........  Program Analyst...  On-Board/Off-Board  On-Board/Off-
                                                          Board
GS-11/12/13....  Program Analyst...  On-Board/Off-Board  On-Board/Off-
                                                          Board
GS-7/9/11......  Program Support...  On-Board/Off-Board  On-Board/Off-
                                                          Board
------------------------------------------------------------------------


    Question 112. For fiscal year 2014, the Office of Operations, 
Security, and Preparedness requests $10.6 million for Other Services. 
Please provide a specific itemized list of how these funds would be 
spent. To the extent any of these funds will be spent on contracts, 
please explain the nature of the contract and the expected outcomes.
    Response. OSP uses contract support in the following areas: 
Department of Homeland Security/Federal Protective Service Contract 
Guards for the Government Services Administration leased spaces in the 
Capital Region ($3.2 million) and Program support for the Homeland 
Security Presidential Directive-12 (HSPD-12) program management office 
($6 million). OSP also pays for support for Continuity of Operations 
sites and Continuity of Government sites, which are located outside of 
the National Capital Region ($750,000). OSP also has internal VA 
Service Level Agreements totaling $525,000 and some maintenance 
contracts.

    Question 113. According to the fiscal year 2014 budget request, the 
Office of Operations, Security, and Preparedness now expects to spend 
$10.2 million on Other Services during fiscal year 2013, which is $6.2 
million higher than the amount originally requested for fiscal year 
2013 ($4.1 million).
    A. Please explain what led to the expected increase in Other 
Services during fiscal year 2013.
    Response. Beginning in FY 2013, OSP assumed overall management 
responsibility for the VA Personal Identity Verification (PIV) card 
program, which had previously resided in the Office of Information and 
Technology (OI&T). This increase in Other Services ($6.2 million) is a 
direct result of that action. OSP is funding that program utilizing 
reimbursable funding from the other Offices and Administrations.
    B. Please provide an explanation of how these funds are expected to 
be expended during fiscal year 2013.
    Response. These funds ($6.2 million) will be used for contract 
support at the 200+ PIV card issuing stations across the Department as 
well as in the Project Management Office at headquarters.

    Question 114. According to the fiscal year 2014 budget request, the 
Office of Operations, Security, and Preparedness now expects to spend 
$1.8 million on supplies and materials in fiscal year 2013, which is 
$1.6 million higher than VA originally requested for fiscal year 2013.
    A. Please explain what led to the expected increase in supplies and 
materials during fiscal year 2013.
    Response. Beginning in FY 2013, OSP assumed overall management 
responsibility for the VA PIV card program, which had previously 
resided in OI&T. This increase in Supplies and Materials ($1.6 million) 
is a direct result of that action. OSP is funding that program 
utilizing reimbursable funding from the other Offices and 
Administrations.
    B. Please provide an explanation of how these funds are expected to 
be expended during fiscal year 2013.
    Response. This $1.6 million increase will be used to purchase 
consumable supplies for PIV card issuing stations across the agency. 
These supplies are mainly PIV card blanks that are centrally managed 
which are used to issue new or replacement cards to agency employees, 
contractors, and affiliates.
Office of Public and Intergovernmental Affairs
    Question 115. For fiscal year 2014, the Office of Public and 
Intergovernmental Affairs requests total resources of $25.7 million and 
101 employees. Please provide a list of the positions that would be 
filled with that funding and the pay-grades for those positions.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]




    Question 116. For fiscal year 2014, the Office of Public and 
Intergovernmental Affairs requests $9.5 million for purposes of the 
Paralympics program.
    A. During fiscal year 2013, how much is expected to be dispersed 
through this grant program, what percentage of those funds are expected 
to be used to pay the salary costs for employees of the U.S. Olympic 
Committee/U.S. Paralympics, and how much is expected to be spent on 
non-salary administrative costs by the U.S. Olympic Committee?
    Response. For FY 2014, OPIA requests $9.5 million for purposes of 
the Paralympics program. During FY 2013, the Paralympic program is 
expected to disperse $7.5 million through the Paralympic grant, with 13 
percent expected to be used to pay the salary costs for employees of 
the U.S. Olympic Committee/U.S. Paralympics, and no funds expected to 
be spent on non-salary administrative costs by the U.S. Olympic 
Committee. The U.S. Olympic Committee does not intend to use Paralympic 
grant funds for the allowed 5 percent administrative costs and intends 
to use non-governmental sources of funding for non-salary 
administrative costs.
    B. During fiscal year 2014, how much is expected to be dispersed 
through this grant program, what percentage of those funds are expected 
to be used to pay the salary costs for employees of the U.S. Olympic 
Committee/U.S. Paralympics, and how much is expected to be spent on 
non-salary administrative costs by the U.S. Olympic Committee?
    Response. During FY 2014, the Paralympic program is expected to 
disperse $7.5 million through the Paralympic grant, with 13 percent 
expected to be used to pay the salary costs for employees of the U.S. 
Olympic Committee/U.S. Paralympics, and no funds expected to be spent 
on non-salary administrative costs by the U.S. Olympic Committee. The 
U.S. Olympic Committee does not intend to use Paralympic grant funds 
for the allowed 5 percent administrative costs and intends to use non-
governmental sources of funding for non-salary administrative costs.

    Question 117. According to the fiscal year 2014 budget request, the 
Office of Public and Intergovernmental Affairs now expects to spend 
$4.4 million on Other Services during fiscal year 2013, which is $2.9 
million higher than the amount requested for fiscal year 2013 ($1.5 
million), and that office requests $1.5 million for Other Services for 
fiscal year 2014.
    A. Please explain what led to the expected increase in Other 
Services during fiscal year 2013.
    Response. OPIA received $2.5 million to execute an outreach 
initiative known as ``VA-Outreach.'' The goal of the initiative is to 
increase Veterans access to VA health care, benefits, and services.
    B. Please provide an itemized list of how these funds are expected 
to be expended during fiscal year 2013 and fiscal year 2014. To the 
extent any of these funds will be spent on contracts, please explain 
the nature of the contract and the expected outcomes.
    Response.

                                       FY 2013 Other Services $4.4 million
----------------------------------------------------------------------------------------------------------------
                                         Amount
            Contracts/Name               (Est.)                             Description
----------------------------------------------------------------------------------------------------------------
VA Outreach Initiative...............  $2,500,000  The goal of the initiative is to increase Veterans access to
                                                    VA health care, benefits, and services. ``VA Outreach'' is a
                                                    national marketing and advertising outreach campaign with
                                                    the goal of bringing new Veterans to VA.
Barbaricum LLC.......................    $231,000  To establish, maintain and distribute a customized executive
                                                    daily news summary.
Young & Rubicam Inc..................    $166,000  Vendor to provide graphic design services, custom computer
                                                    programming services and administrative and general
                                                    management consulting services is support of VA's Executive
                                                    Order 13175, Consultation and Coordination with Indian
                                                    Tribal Governments.
Rhinegold............................    $965,000  HVIO will have a continuing need for outreach support in FY
                                                    14. That support will include purchasing paid internet
                                                    advertising, developing and distributing public service
                                                    announcements (PSAs), partner development and support, and
                                                    distribution of materials promoting awareness and use of the
                                                    National Call Center for Homeless Veterans (NCCHV), and
                                                    other communications and public relations support in support
                                                    of the effort to end homelessness among Veterans by 2015.
                                                    Part of the effort on this contract serves the VHA Homeless
                                                    Office.
VA History Office and Archives.......    $300,000  DVA seeks to establish an agency-wide VA History Office and
                                                    Archives to preserve its heritage and material culture and
                                                    to develop history outreach programs to benefit VA,
                                                    Veterans, Congress and other stakeholders, and the American
                                                    public.
Misc. Contracts......................    $250,000  Rent, Transit Subsidy, UPS Service, Service Level Agreements,
                                                    Copier Maintenances
                                      -------------
    TOTAL............................  $4,412,000
----------------------------------------------------------------------------------------------------------------



                                         FY 2014 Other Services $1,506m
----------------------------------------------------------------------------------------------------------------
                                         Amount
              Contracts                  (Est.)                             Description
----------------------------------------------------------------------------------------------------------------
Barbaricum LLC.......................    $238,000  To establish, maintain and distribute a customized executive
                                                    daily news summary.
Rhinegold............................    $965,000  HVIO will have a continuing need for outreach support in FY
                                                    14. That support will include purchasing paid internet
                                                    advertising, developing and distributing public service
                                                    announcements (PSAs), partner development and support, and
                                                    distribution of materials promoting awareness and use of the
                                                    National Call Center for Homeless Veterans (NCCHV), and
                                                    other communications and public relations support in support
                                                    of the effort to end homelessness among Veterans by 2015.
                                                    Part of the effort on this contract serves the VHA Homeless
                                                    Office.
Misc Contracts.......................    $250,000  Rent, Transit Subsidy, UPS Service, Service Level Agreements,
                                                    Copier Maintenances
                                      -------------
    TOTAL............................  $1,453,000
----------------------------------------------------------------------------------------------------------------


    Question 118. According to the fiscal year 2014 budget request, the 
Office of Public and Intergovernmental Affairs requests $462,000 for 
travel for fiscal year 2014. How many trips is that level of funding 
expected to support and what is the average expected cost per trip?
    Response. OPIA's request of $462,000 for travel in FY 2014 is 
expected to support an estimation of 270 trips with an average 
estimation of $1,702.00 cost per trip.

    Question 119. In response to a question for the record regarding 
the fiscal year 2013 budget request, VA provided the Committee with 
information on advertising outreach activities for 2009 through 2013. 
For the five-year period ending in 2013, VA reported spending $83.7 
million. Please provide the Committee with updated amounts for 2013 and 
how much is expected to be spent on advertising in fiscal year 2014.
    Response. In FY 2013, OPIA received $15 million from VHA to support 
media buys for regional advertising and the development of an outreach 
Web site prior to the start of the national Ad Council advertising 
campaign that will be launched in October 2013. OPIA also received 
approval for $2.5 million in FY 2012 carry-over funds to support 
creative advertising development, and social media advertising.
    In FY 2014, the Ad Council campaign will be the lead advertising 
effort under OPIA. The budget for the campaign during FY 2014 is 
estimated at $1.3 million.
    [Note: All three VA administrations maintain separate advertising 
and outreach budget data on their efforts conducted in FY 2013.]

    Question 120. VA's response to prehearing questions for the fiscal 
year 2013 budget hearing stated that one of the missions of the 
National Veterans Outreach Office (NVO) was to ``evaluate and develop 
metrics to measure the effectiveness of outreach programs.''
    A. Please describe the metrics that have been developed by NVO for 
the purposes of evaluating VA outreach activities.
    Response. The metric established for outreach is new access to one 
or more of VA's programs. ``Access'' is defined as a Veteran, family 
member, or a Servicemember who enrolls, registers, and/or uses one or 
more VA benefits and services. The access baseline is the number of 
unique individuals who accessed VA in FY 2012. ``New access'' is 
defined as an individual accessing VA in FY 2013 who was not found in 
any VA database in FY 2012. FY 2012 baseline data and FY 2013 access 
data are both extracted from VBA, VHA, NCA and VA's e-Benefits portal.
    In order to track and measure VA access, a reporting process was 
established and approved by the VA Chief of Staff in December 2012. On 
a monthly basis, VHA, VBA, and NCA provide data within their respective 
areas of responsibility to the VA Office of Policy and Planning (OPP) 
to process and determine new clients accessing VA.
    B. What metrics will VA use to determine whether programs are 
duplicative in nature? If that determination is made, what steps will 
be taken to change or terminate the outreach?
    Response. NVO leadership and team members confer regularly with 
other VA Staff Offices and with all three VA Administrations to review 
the status of current programs and review proposals for new projects. 
Through this detailed process, potential for duplicity is identified 
and plans developed to ensure programs that may be duplicative in 
nature are not executed by NVO.
    C. Have any outreach programs or campaigns been terminated early by 
VA because they have been deemed ineffective?
    Response. Thus far, NVO has not terminated any outreach programs or 
campaigns due to ineffectiveness. All of NVO's outreach programs or 
campaigns have sufficient built-in flexibility to enable reinforcing 
efforts along a proven path of success and also have off-ramp 
capabilities to preclude following a path that is not producing the 
intended result(s) or effect(s).
    D. How does VA evaluate whether veteran participation in services 
offered by VA is a result of outreach activities undertaken by VA?
    Response. NVO presently uses the database tracking system discussed 
in Question 120 to determine how outreach is impacting new user access 
to VA benefits and services. Starting in October 2013, VA and the Ad 
Council are launching a national advertising campaign targeting 
Veterans and their families to increase their awareness and usage of 
all VA benefits, programs, and services. The campaign's messaging will 
direct the targeted audience to access a specially-created web page for 
more information about VA. Access to this web page will be tracked as 
one method of measuring the effectiveness of the advertising campaign.
    Additionally, the Ad Council uses the leading monitoring, audience 
and valuation services available in the industry to capture the data 
pertaining to the markets where the public service announcements aired 
during the campaign. The donated media support will be monitored and 
reported to VA approximately two months after the close of each quarter 
across the following:

     Local broadcast, network cable, and local cable television
     Radio (traditional and streaming)
     Print (magazine and newspaper)
     Web banners
     Outdoor
     Public Relations

    The Ad Council will also provide preliminary monthly reports to VA 
to assist with directional analysis. This information will include 
reports from:

     Local broadcast detections, dollar values, and specific 
placement
     Network cable detections and specific placement
     Banner placements and click-through rates
Office of Congressional and Legislative Affairs
    Question 121. According to the 2012 PAR, during 2012 VA 
``[i]mproved relations with Congress by improving responsiveness and 
communicating more effectively.''
    A. Please explain the statistics or information that were the basis 
for this conclusion.
    Response. The Office of Congressional and Legislative Affairs 
(OCLA) is responsible for maintaining open communications with Congress 
through briefings, meetings, office calls, hearings, site visits, 
written communications, reports, and responses to Congressional Member 
offices and Congressional Committee requests for information. OCLA also 
supports Congressional offices' Veterans constituent casework and is 
responsible for VA interaction with the U.S. Government Accountability 
Office (GAO). OCLA coordinates all VA-GAO meetings, correspondence, and 
reports.
    During FY 2012, OCLA supported 72 congressional hearings (57% 
increase over FY 2011), coordinated 688 briefings (52% increase over FY 
2011), responded to 1,404 questions for the record, processed over 
19,703 constituent casework inquires, supported 43 GAO Entrance 
Conferences, 41 Exit Conferences (41% increase over FY 2011), 65 Draft 
Reports (35% increase over FY 2011), and 72 Final Reports (53% increase 
over FY 2011). FY 2012 was the first year OCLA measured the number of 
formal responses to requests for information. In FY 2012, OCLA 
responded to 2,750 congressional requests for information.
    B. During fiscal year 2012, what was the average time it took to 
fulfill briefing requests by the Senate Committee on Veterans' Affairs?
    Response. During FY 2012, OCLA coordinated 688 briefs to Members of 
Congress and staff. This was a 52 percent increase over the 454 briefs 
conducted in FY 2011. Briefs were coordinated based on the priority set 
by the requesting committee and the Department.
    C. During fiscal year 2012, what was the average time it took to 
fulfill briefing requests by the House Committee on Veterans' Affairs?
    Response. During FY 2012, OCLA coordinated 688 briefs to Members of 
Congress and staff. This was a 52 percent increase over the 454 briefs 
conducted in FY 2011. Briefs were coordinated based on the priority set 
by the requesting committee and the Department.
    D. To date in fiscal year 2013, how many requests from the Senate 
or House Committees on Veterans' Affairs have gone unfulfilled for more 
than 2 weeks and for more than 4 weeks?
    Response. During FY 2013, OCLA coordinated 999 briefings to Members 
of Congress, congressional committees, and staff. This was a 45 percent 
increase over FY 2012. The priority for briefings was set by the 
requesting Member or congressional committee, and the Department.
    During FY 2013, OCLA developed and maintains a Workload Dashboard 
that identifies all of the congressional action items the office is 
currently working.
    As of October 17, 2013, the OCLA Dashboard listed the following 
outstanding items:

     133 Congressional Requests for Information
     86 Executive Congressional Correspondence items addressed 
to the Secretary
     732 Questions for the Record
     17 Hearing Deliverables

     Additionally, OCLA is also working:

         - 427 Congressional Constituent Casework Inquires
         - 17 GAO actions
         - 20 Requests for Technical Assistance on Legislation
         - 35 Briefings within the next 30 days

    The total current daily volume of work constitutes over 1,400 
action items. Given this extensive volume of work, OCLA reviews and 
prioritizes its efforts to support both the Department and Congress. 
Unfortunately, with such a large workload, there will be items that 
will take longer to complete than we would like.

    Question 122. For fiscal year 2014, the Office of Congressional and 
Legislative Affairs requests $6 million and 45 employees. Please 
provide a list of the positions that would be filled with that funding 
and the pay-grades for those positions.
    Response. The 45 positions and their corresponding pay-grades are 
as follows:
------------------------------------------------------------------------------------------------------------------------------------------------
Assistant Secretary..........................  EX
Director Congressional Affairs...............  SES
Associate Deputy Assistant Secretary.........  SES
Director of Operations.......................  GS-15
Director, Benefits Legislative Service.......  GS-15
Director, Health Legislative Service.........  GS-15
Director, Legislative Service................  GS-15
Director, Corporate Enterprise Legislative     GS-15
 Service.
Director, Congressional Reports and            GS-15
 Correspondence.
Special Assistant............................  GS-15
Special Assistant............................  GS-15
2 Administrative Officers....................  GS-14
Executive Correspondence Analyst.............  GS-14
13 Congressional Relations Officers..........  GS-12/13/14
GAO Liaison Officer..........................  GS-14
6 Program Analysts...........................  GS-9/11
Assistant Director, Congressional Liaison      GS-14
 Service.
Senior Congressional Liaison Representative..  GS-13
Congressional Liaison Officer................  GS-13
3 Congressional Liaison Representatives......  GS-12
Staff Assistant..............................  GS-11
3 Congressional Liaison Assistant............  GS-7/8/9
Program Assistant............................  GS-8
------------------------------------------------------------------------


    Question 123. In connection with VA's fiscal year 2013 budget 
request, the Office of Congressional and Legislative Affairs outlined 
the measures and metrics used to evaluate the performance of that 
office.
    A. In terms of those measures and metrics, please assess the 
performance of the Office of Congressional and Legislative Affairs 
during fiscal year 2012.
    Response. During FY 2012 OCLA continued to carry out its Strategic 
Plan to ``Enhance relationships with Congress by improving 
responsiveness and communicating more effectively'' though a pro-active 
strategy designed to provide accurate, relevant, and timely information 
to Congress. OCLA also achieved full operational capability of its 
congressional knowledge management system that provides a database to 
catalog the Department's congressional activities.
    OCLA's workforce, of whom 50% are Veterans, accomplished the 
following in FY 2012:

     Supported 72 Hearings (57% increase over FY 2011)
     Coordinated 688 Briefings (52% increase over FY 2011)
     Coordinated responses to 1,404 Questions for the Record
     Responded to 2,750 Requests for Information (first year 
for this performance measure)
     Supported 57 Congressional oversight travel visits
     Supported 43 GAO Entrance Conferences
     Supported 41 GAO Exit Conferences (41% increase over FY 
2011)
     Coordinated the Department's responses to 65 GAO Draft 
Reports (35% increase over FY 2011)
     Supported 72 GAO Final Reports (53% increase over FY 2011)
     Coordinated 19,703 Congressional Constituent Inquires
     Submitted 75% of questions for the record on time (Target 
goal was 85%)
     Submitted 88% of testimony on time (Target goal is 90%)
     Submitted 68% of Title 38 reports on time (Target goal is 
85%)

    B. In terms of those measures and metrics, what performance 
outcomes are expected during fiscal year 2013?
    Response. OCLA achieved the following outcomes in FY 2013:

     Supported 62 Hearings
     Coordinated 999 Briefings (45% increase over FY 2012)
     Coordinated responses to 310 Questions for the Record
     Responded to 3,544 Requests for Information (29% increase 
over FY 2012--first year this performance measure was kept)
     Supported 63 Congressional oversight travel visits
     Supported 51 GAO Entrance Conferences (19% increase over 
FY 2012)
     Supported 36 GAO Exit Conferences
     Coordinated the Department's responses to 31 GAO Draft 
Reports
     Supported 35 GAO Final Reports
     Coordinated 24,949 Congressional Constituent Inquires (27% 
increase over FY 2012)
     Submitted 13% of questions for the record on time (Target 
goal was 85%)
     Submitted 75% of testimony on time (Target goal is 90%)
     Submitted 24% of Title 38 reports on time (Target goal is 
85%)

    C. In terms of those measures and metrics, what performance 
outcomes are expected during fiscal year 2014 if the requested level of 
funding is provided?
    Response. OCLA will continue to advance responsive and effective 
congressional communications (i.e., proactive approach to briefings, 
meetings, hearings, site visits, and constituent service) to increase 
the information exchanged regarding the Department of Veterans Affairs 
among Members of Congress and staff.
    If the requested level of funding is provided, OCLA would look to 
efficiencies, technology, and effective prioritization to maintain its 
level of performance and achieve the following outcomes in FY 2014:

     100% Support of all Hearings set by Congress
     Conduct approximately 700 Briefings
     Respond to approximately 1,200 Questions for the Record
     Respond to approximately 3,750 Requests for Information
     Support 59 Congressional oversight travel visits
     Support approximately 60 GAO Entrance Conferences
     Support approximately 20 GAO Exit Conferences
     Coordinate the Department's response to approximately 60 
GAO Draft Reports
     Support approximately 25 GAO Final Reports
     Coordinate approximately 19,000 Congressional Constituent 
Inquires
     OCLA would strive to meet its target goals of:

         90% Percentage of questions for the record submitted 
        on time
         90% Percentage of testimony submitted on time
         85% Percentage of Title 38 reports submitted on time
Office of Acquisition, Logistics, and Construction
    Question 124. In response to questions about the fiscal year 2013 
budget request, VA indicated that the Office of Acquisition, Logistics, 
and Construction planned to spend $5 million during fiscal year 2013 on 
an ``Acquisition Improvement Initiative,'' which was described as 
developing the acquisition workforce.
    A. How much has VA expended on that initiative to date?
    Response. VA has spent $3,979,384 on the Acquisition Improvement 
Initiative as of August 31, 2013, and is spending an additional 
$916,000 in September 2013, for a total of $4,895,384.
    B. Please describe this initiative in more detail and outline any 
measureable outcomes that have resulted from this initiative.
    Response. The Office of Acquisition, Logistics and Construction 
(OALC) is committed to continuing the improvement of the acquisition 
process. To ensure that these improvements are sustainable, OALC 
embarked on an aggressive path to increase the capacity and capability 
of the acquisition workforce. OALC has begun to increase the size of 
the acquisition workforce and improve the training of all employees 
that have a significant impact to the process, to include the Major 
Construction and Leasing Program Managers and Resident Engineers.
    OALC increased the capacity of the acquisition workforce supporting 
major construction and leasing by hiring 19 contracting officers since 
fiscal year (FY) 2012. This represents an 80 percent increase in 
contracting expertise. OALC has also invested in training and 
technology to ensure sustained improvement. The legacy program 
management software is currently being replaced by a state-of-the-art 
system and nationwide training is ongoing. OALC has also invested in 
additional program management and coaching focused on the acquisition 
process. The table below details the distribution of the Acquisition 
Improvement Initiative funds:
------------------------------------------------------------------------------------------------------------------------------------------------
Program Management Software Services (TRIRIGA).............   $2,310,000
Program Management and Coaching Training...................   $1,185,384
Salary & Benefits..........................................   $1,425,000
                                                            ------------
                                                              $4,920,384
------------------------------------------------------------------------


    Question 125. For fiscal year 2014, the Office of Acquisition, 
Logistics, and Construction requests total resources of $87 million and 
492 employees, an increase of 146 FTE over the fiscal year 2012 level.
    A. Please provide a list of the positions added since fiscal year 
2012.
    Response.

                Proposed Positions Over the FY 2012 Level
------------------------------------------------------------------------------------------------------------------------------------------------
Resident Engineers.........................................       42
Project Managers/Program Managers..........................       34
Realty Specialists.........................................        3
Planners...................................................       18
Contracting Specialists....................................       23
Architect/Engineers........................................        3
Management Support.........................................       23
                                                            ------------
    Total..................................................      146
------------------------------------------------------------------------


    B. Have those positions been and will those positions generally be 
filled through hiring new employees or transferring employees from 
other VA offices?
    Response.

                         Actual Hired Positions
------------------------------------------------------------------------------------------------------------------------------------------------
Resident Engineers.........................................       20
Planners...................................................        4
Contracting Specialists....................................       19
                                                            ------------
    Total..................................................       43
------------------------------------------------------------------------


    To date, 43 positions have been hired with 77 percent of the 
positions being new hires from outside VA. The majority of the 106 open 
positions are currently projected to be filled from outside VA.

    Question 126. According to the fiscal year 2014 budget request, the 
Office Acquisition, Logistics, and Construction now expects to spend 
$19.6 million on Other Services during fiscal year 2013, which is $5.7 
million higher than the amount requested for fiscal year 2013 ($13.9 
million), and that office requests $7 million for Other Services for 
fiscal year 2014.
    A. Please explain what led to the expected increase in Other 
Services during fiscal year 2013.
    Response. Updated hiring plans reduced the requirement for personal 
services funds in FY 2013. $5.6 million from personal services was 
moved to other services and is targeted for contract needs. In FY 2014, 
hiring is expected to reach planned levels, and other services funding 
will decrease proportionately. Due to delays in hiring, OALC will 
pursue contracts to support efforts of the Construction Review Council 
(CRC) and other improvements to address issues noted in the GAO report, 
GAO-13-556T.
    B. Please provide an itemized list of how these funds are expected 
to be expended during fiscal year 2013 and fiscal year 2014. To the 
extent any of these funds will be spent on contracts, please explain 
the nature of the contract and the expected outcomes.
    Response. See charts below.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



    Question 127. According to the 2012 PAR, in April 2012 VA 
established a Construction Review Council (CRC). The stated purpose of 
the CRC is to ``oversee the Department's development and execution of 
its real property capital asset programs.'' The PAR also notes that VA 
has started ``initiatives to advance the timely delivery of first-rate 
facilities.''
    A. Please provide a list of the members of the CRC, including their 
positions and for which VA agency or department they work. If a member 
of the CRC is not an employee of VA, please include the agency, Cabinet 
level department, company, or association for which they work.
    Response. The following positions are members of the CRC and are VA 
employees:

     Secretary, Department of Veterans Affairs
     Deputy Secretary, Department of Veterans Affairs
     Under Secretary of Health
     Under Secretary of Memorial Affairs
     Under Secretary of Benefits
     Principal Executive Director, Office of Acquisitions, 
Logistics and Construction (OALC)
     Executive Director, Construction and Facilities Management
     Assistant Secretary for Management
     Director, Office of Asset and Enterprise Management
     Assistant Secretary for Human Resources and Administration
     Assistant Secretary for Information Technology
     Assistant Secretary for Policy and Planning
     Assistant Secretary for Congressional and Legislative 
Affairs
     General Counsel
     Assistant Deputy Under Secretary for Health for Policy and 
Planning, Veterans Health Administration
     The relevant Veterans Integrated Service Network and VA 
medical center Directors as well as relevant construction program 
executives and senior resident engineers will participate as required.

    B. What is the duration of the CRC, and for how long do the members 
of the CRC serve?
    Response. The CRC does not have a termination date. Members on the 
Council are by position; therefore, the incumbent will serve on the 
panel.
    C. Please describe, in detail, the initiatives (referenced above) 
VA has undertaken to improve or ``advance timely delivery of first-rate 
facilities to better serve our Nation's veterans.''
    Response. The CRC defined four areas of concentration in order to 
advance timely delivery of first-rate facilities to better serve our 
Nation's Veterans. They are:

     Requirements--Adequately develop requirements during the 
planning process of a construction project.
     Design--Improve design quality to minimize added costs 
and/or delays during construction.
     Budget--Effectively coordinate design, construction and 
activation costs
     Project Management--Streamline program management and 
automation enterprise-wide tools.

    The OALC initiatives to address these areas include:

     Develop policy to align with the Strategic Capital 
Investment Planning (SCIP) process and the move to a 35 percent design, 
to adequately develop requirements before requesting major construction 
funding.
     Examine the current peer review process, adequacy of 
current design guide, errors and omission rates, and guide 
specifications, to ensure all are current and effective, increase 
quality of the design, and allow fewer changes during construction.
     Establish mechanisms, such as activations funding, to 
coordinate the various funding streams required for major construction, 
to ensure funding for medical equipment and Office of Information and 
Technology equipment, to support the construction schedule.
     Field the construction project management software package 
(TRIRIGA) across the enterprise.

    Question 128. The 2012 PAR indicates that VA has seen a ``cost 
savings or avoidance'' of $82 million through selling property, space 
management, and other initiatives. It also notes that VA has reduced 
its vacant buildings by 23 percent over the last five years.
    A. As of the start of fiscal year 2013, how many vacant or 
underutilized properties does VA have in its inventory? Please break 
this out by building or property type (hospital, clinic, office 
building, etc.).
    Response. At the end of FY 2012/beginning of FY 2013, VA had 
approximately 974 vacant or underutilized buildings, of which 418 (43%) 
were historic buildings. Of the 974, approximately 228 were vacant and 
746 were underutilized.
    The 974 buildings account for approximately 10.5 million Square 
Feet (SF) of space in vacant or underutilized buildings. Of that total, 
4.1 million SF is located in vacant buildings and 6.4 million SF is 
located in underutilized buildings.

                                   End of FY 2012 Vacant/Underutilized Buildings
----------------------------------------------------------------------------------------------------------------
                                                    Sq Ft          #            Sq Ft
              Usage Type                # Vacant    Vacant   Underutilized  Underutilized   Total #    Total Sq
                                       Buildings  Buildings     Buildings      Buildings   Buildings      Ft
----------------------------------------------------------------------------------------------------------------
Dormitories/Barracks.................       2       110,200         0                 0         2        110,200
Hospital.............................      14     1,315,299        32           706,071        46      2,021,370
Housing..............................      58       294,004        52           233,414       110        527,418
Industrial...........................       2         2,278        57           243,619        59        245,897
Laboratories.........................       1       133,730        10           223,307        11        357,037
Office...............................      26       469,980        89         1,137,132       115      1,607,112
Other Institutional Uses.............       8       168,282        56           823,400        64        991,682
Outpatient Health care Facility......       1        74,551         3            22,319         4         96,870
Service..............................      16       145,115       193         1,342,195       209      1,487,310
Warehouses (Storage/Sheds)...........      21       177,237       143           787,358       164        964,595
All Other............................      79     1,186,290       111           859,117       190      2,045,407
                                      --------------------------------------------------------------------------
    Grand Total......................     228     4,076,966       746         6,377,932       974     10,454,898
----------------------------------------------------------------------------------------------------------------


    B. In fiscal year 2014, how many vacant or underutilized properties 
does VA expect to have in its inventory? Please break this out by 
building or property type (hospital, clinic, office building, etc.).
    Response. VA projects it will have approximately 941 vacant or 
underutilized buildings at the end of FY 2013/beginning of FY 2014. Of 
the 941, approximately 206 would be considered vacant and 735 
underutilized. In terms of SF, there will be 3.8 million SF in vacant 
buildings and 6.2 million SF in underutilized buildings, for a total of 
10.0 million SF in the portfolio.
    The reduction in vacant and underutilized buildings from end of FY 
2012 is the result of disposing of un-needed assets;, however, there 
are challenges in further reducing VA inventory in this area. Of the 
projected 941 vacant or underutilized assets, 409 (44%) are considered 
historic buildings, limiting VA's ability to dispose or reuse these 
assets in many cases.
    Competing stakeholder interests in some of these vacant or 
underutilized assets also has hampered disposal or reuse efforts. VA is 
looking at further opportunities to reduce our vacant and underutilized 
footprint, as mentioned earlier. Having tools in place, such as a fully 
restored Enhanced-Use Lease (EUL) authority or Civilian Property 
Realignment Act (CPRA), as proposed by the President of the United 
States, would help overcome some of these challenges and allow VA to 
more effectively reduce its inventory of vacant and underutilized 
assets.

                             Projected End of FY 2013 Vacant/Underutilized Buildings
----------------------------------------------------------------------------------------------------------------
                                                    Sq Ft          #            Sq Ft
              Usage Type                # Vacant    Vacant   Underutilized  Underutilized   Total #    Total Sq
                                       Buildings  Buildings     Buildings      Buildings   Buildings      Ft
----------------------------------------------------------------------------------------------------------------
Dormitories/Barracks.................       1        85,000         0                 0         1         85,000
Hospital.............................      14     1,315,299        32           706,071        46      2,021,370
Housing..............................      55       283,430        52           233,414       107        516,844
Industrial...........................       1           555        56           241,019        57        241,574
Laboratories.........................       1       133,730         8           213,034         9        346,764
Office...............................      22       424,172        89         1,137,132       111      1,561,304
Other Institutional Uses.............       6       163,892        55           719,161        61        883,053
Outpatient Health care Facility......       1        74,551         3            22,319         4         96,870
Service..............................      15       129,055       190         1,309,696       205      1,438,751
Warehouses (Storage/Sheds)...........      17       166,571       139           780,740       156        947,311
All Other............................      73     1,050,377       111           859,117       184      1,909,494
                                      --------------------------------------------------------------------------
    Grand Total......................     206     3,826,632       735         6,221,703       941     10,048,335
----------------------------------------------------------------------------------------------------------------


    C. For each of fiscal years 2012, 2013, and 2014, how much has VA 
spent or does VA expect to spend on maintenance of vacant or 
underutilized property?
    Response. VA does not track actual costs at the building level; 
however it does use a proration methodology to report building level 
costs to the Federal Real Property Profile (FRPP) annually. For FY 
2012, VA estimates it spent approximately $23.4 million on the 974 
vacant and underutilized assets in its portfolio. A further breakdown 
of those costs is an estimated $6 million on the 228 vacant buildings 
and $17 million on the 746 underutilized assets.
    The average cost for vacant buildings is $1.48/SF and is consistent 
with previous estimates on maintaining vacant assets. Underutilized 
buildings are still in use, therefore incur greater operating expenses 
than a purely vacant building. The average cost for maintaining 
underutilized buildings is $2.72/SF
    The average cost per SF to maintain a vacant or underutilized 
building would likely remain constant over the next several years. 
Given current disposal plans, the overall estimated cost to operate 
vacant and underutilized buildings would range from $22 to $24 million 
annually in FY 2013 and FY 2014.

    Question 129. Public Law 111-82 authorized VA to enter into leases 
for seven Health Care Centers (HCCs). The law provided $150 million to 
cover the startup costs and the first year's rent; however, VA has only 
obligated $40 million for construction costs.
    A. How much in total will be needed to construct theses HCCs and 
when will they start treating veterans? Please breakdown this funding 
by individual HCC.
    Response. VA obligates the build-out funds and first year's rent 
upon contract award. To date, four of the seven HCCs have been awarded 
and approximately $52.7 million has been obligated. Please see the 
table below for specific amounts related to each project. VA's request 
for authorization and actual costs expended are linked to the medical 
build-out requirements along with the rent payments, not necessarily 
the developer's cost to construct the facility. Please see below for a 
breakout of each HCC and anticipated or actual costs, which are 
dependent on the contract award (projects highlighted in gray have been 
awarded). Also included for each clinic is the anticipated date for 
first patient day.
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                          Charlotte,  Fayetteville,  Loma Linda,   Monterey,   Montgomery,    Winston-
                                                            Butler,  PA       NC            NC            CA           CA           AL        Salem, NC
--------------------------------------------------------------------------------------------------------------------------------------------------------
Annual Lease Cost--Year1($)...............................   5,755,683   14,232,000     7,662,113    16,249,000    6,183,000    3,723,855    10,986,664
Build-Out($)..............................................   2,813,953   16,225,000     8,936,545    14,905,000    5,445,000    3,214,237     9,604,089
Size (in net usable square feet)..........................     168,000      295,000       259,600       271,000       99,000      111,407       280,000
Date of Contract Award (Planned(P) &  Actual(A))..........   May-12(A)    Aug-13(P)     Sep-12(A)     Aug-13(P)    Aug-13(P)    May-13(A)     May-13(A)
Anticipated Date to Start Treating Veterans...............        TBD*       Jan-16        Aug-15        Feb-16       Jan-16       Nov-15        Nov-15
--------------------------------------------------------------------------------------------------------------------------------------------------------
* VA's Office of the Inspector General (OIG) completed an investigation of Westar and its related companies and principals and found that Westar made
  fraudulent misrepresentations in its offer during the procurement process. Due to these findings, VA issued a stop work order on June 21, 2013, and a
  ``Show Cause'' letter to Westar on July 12, 2013. The lease was terminated for default effective as of August 9, 2013. VA reopened the Butler HCC
  lease procurement on September 30, 2013, and expects a new lease award by May 2014.


    B. What is VA doing to track costs of the HCCs to ensure there is 
effective management of and supervision over the HCC leasing project?
    Response. VA's lease acquisition process utilized on the HCCs 
follows a number of methods to ensure effective cost management. Leases 
adhere to the Competition in Contracting Act to ensure that maximum 
competition is pursued, which yields the most competitive pricing 
possible on each contract. Each lease is conducted as a ``best-value'' 
procurement, meaning that both price and technical factors are 
evaluated and weighed prior to VA making the final award determination. 
In order to track and manage funds expended on the HCCs, VA is 
maintaining clear, consistent contract files that include spreadsheets 
of all obligations pertaining to each project. Each project is 
effectively managed by an acquisition team that includes a Real Estate 
Project Manager and Contracting Officer from OALC; representatives from 
leadership and engineering at the parent VA medical centers, and, as 
needed, technical support from architect and engineer firms and legal 
support from VA's Office of General Counsel. VA also assigns two to 
three resident engineers for each of the HCCs to oversee the project 
during the post-award design and construction phases, to ensure that 
the contract is executed in a quality and timely manner.

    Question 130. The 2012 PAR highlights the Warrior to Workforce 
Program implemented by the Office of Acquisition, Logistics, and 
Construction. The Warrior to Workforce Program is a three-year pilot 
program that trains service-connected disabled veterans to become 
contract specialists.
    A. What metrics will VA use to determine if this program will be 
expanded beyond the three-year pilot?
    Response. The Warriors to Workforce (W2W) program has garnered 
positive recognition for the great benefits derived by both the 
Veterans in the program as well as VA. The W2W program has earned both 
the Secretary's Award and the Chief Acquisition Officer's Council 
Award, for its innovative approach to training wounded Veterans. Many 
metrics have been collected and evaluated; below are some of the more 
meaningful outcomes:

     100 percent completion of the positive education 
requirement for the 1102 series; average college business course grade 
point average was 3.7 (4.0 scale) (Targeted metric was 95 percent). 
Peak performance training resulted in 154 percent improvement in 
attention; 58 percent brain speed improvement for working memory; 32 
percent improvement on short term memory recall, and many other notable 
achievements (Targeted metric was >30 percent improvement).
     22 percent of the cohort will receive a Bachelor's of 
Science in Business by May 2013; 65 percent of the cohort will receive 
a Bachelor's degree within the next year.
     VA acquisition organizations have embraced the W2W program 
which is demonstrated by an overwhelming willingness to host a W2W 
intern during their first on-the-job training period (which falls 
within the 2-year Acquisition Intern Program).

    Additionally, the VA Acquisition Academy (VAAA) established a 
continuous improvement process for the W2W program to measure learning, 
validate program effectiveness and incorporate lessons learned. VAAA 
monitors 28 key program metrics to assess program success and 
measurable benefit to the organization. Notable metrics demonstrating 
results include:

     W2W intern retention is 96 percent, as of May 14, 2013, 
compared to 90 percent retention for the overall VA acquisition 
workforce (Targeted metric was >80 percent).
     W2W courses rate 4.3 out of 5.0 for overall effectiveness 
(Targeted metric was 4.0 on a Lickert scale).
     Interns receive an average of 96 percent on course exams 
for the Federal Acquisition Certification in Contracting (Targeted 
metric was >80 percent).
     100 percent of interns received at least 95 percent 
``Acceptable'' and ``Mastery'' ratings for performance in training 
activities (Targeted metric was >90 percent).

    The W2W Program has a broad reaching impact on groups including the 
wounded Veteran participants and their families, Federal acquisition 
organizations and America's Veteran population. The specific short and 
long-term impacts, including lasting effects, on each of these groups 
are outlined below:

     The Veteran participant and their families:
           Are provided a long-term professional career with 
        valuable skills (Peak Performance Training) that will benefit 
        them professionally and personally; and
           Obtain a sense of purpose, pride, esteem, and 
        stability to be passed on to spouses and children.

     The Federal Acquisition Organizations:
           Receive an influx of well-rounded professionals 
        ready to hit the ground running; and
           Benefit from succession planning efforts to supply a 
        pipeline of acquisition professionals for VA and other 
        government agencies.

     America's Veterans:
           Receive world-class service by expertly training 
        acquisition professionals who understand Veteran needs and 
        issues; and
           Are provided increased career opportunities through 
        expanded programs for Veteran development.

    As a result of the positive results from the completion of the W2W 
program year one and the previously demonstrated success and metrics of 
the 2-year Acquisition Intern Program (AIP), OALC intends to launch 
additional intern cohorts as outlined in questions 2 and 3 below. The 
intention is to expand participation by other executive agencies (NOTE: 
GSA participated in the pilot program). Additionally, OALC is piloting 
a W2W cohort focused on a program management career track. This cohort, 
launched in January 2013, and sponsored and funded by VA's Office of 
Information and Technology, uses the same successful program design and 
focuses on the competencies required to become a program manager.
    B. How much is expected to be spent on the Warrior to Workforce 
Program for fiscal year 2014?
    Response. Our budget forecasts $2.2 million for FY 2014; which 
includes one acquisition-focused, and one program management-focused 
cohort, for a total of 48 W2W participants in the program for FY 2014. 
The funding covers staff cost, participants on-the-job training, 
curriculum delivery, contractual services, and administrative costs 
(supplies, printing, reproduction, materials, and equipment).
    Cost effectiveness is central to the design and delivery of the W2W 
program. Some examples include:

     Participants utilize their Veteran benefits to fund the 
college courses received in the program, resulting in a significant 
cost savings for their training during program year one.
     The program utilizes existing online courseware to 
supplement the interns' development at no additional cost.
     The program provides a supplement to existing proven 
career development programs (such as the VA Acquisition Internship 
School's Acquisition Intern Program for the inaugural W2W cohort).

    C. Please describe the program in detail, including the number of 
veterans currently in or who have completed the program, the courses 
the veterans take, and any internships required.
    Response. Twenty-eight interns have completed their first year and 
have moved into the AIP. There are 20 interns currently in the first 
year of the program management career track. OALC anticipates hiring 
another acquisition W2W cohort in FY 2014, and is in discussions with 
VA's Office of Information and Technology, to sponsor another FY 2014 
program management cohort. Implementation of these additional 
acquisition and program management cohorts would train an additional 48 
Veterans.
    VA launched the W2W program on December 5, 2011, to integrate 
wounded Veterans into the acquisition workforce and uphold President 
Lincoln's promise, ``to care for him who shall have borne the battle, 
and for his widow, and his orphan'' by serving and honoring the men and 
women who are America's Veterans. The mission of the program, 
supporting Executive Order 13518--Employment of Veterans, is to assist 
in the reintegration of wounded Veterans by preparing them for a career 
as a Contract Specialist (GS-1102) or as a Program Manager (GS-0343). 
As President Obama said in his address to Congress and the Nation, ``We 
ask these men and women to leave their careers, leave their families, 
and risk their lives to fight for our country. The last thing they 
should have to do is fight for a job when they come home.'' Ideal 
candidates are Veterans who have: (1) service-connected disabilities 
and (2) little or no post high school education. The W2W program 
addresses both the employment challenges facing wounded Veterans and 
the workforce development challenges of the acquisition community. The 
program design allows for participation from other government agencies.
    The W2W program took an innovative approach to hiring the wounded 
Veterans (including one GSA participant). The program utilizes the 
Veteran's Recruitment Authority to access and target Veterans most in 
need of career and development opportunities. VAAA also collaborated 
with VA Veterans Employment Coordination Service and Vocational 
Rehabilitation and Employment Program, DOD Wounded Warrior Transition 
Programs and Veterans Service Organizations in identifying wounded 
Veteran candidates.
    The W2W program is a 3-year holistic training program providing 
Veterans an opportunity to apply military experiences and skills to the 
contract specialist career field. In the program;'s first year, 
participants receive academic education, peak performance training, an 
introduction to acquisition or project/program management, and 
participate in mission service activities. Upon successful completion, 
participants transition to the 2-year Acquisition Intern or Program 
Management Fellows Programs.



[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]




    The initial year consists of 4 main components: Business Education, 
Foundational Curriculum, Peak Performance Training, and Mission 
Service. The purpose of these components is to build on the skill sets 
imparted by the military, and prepare the W2W interns for either the 2-
year AIP, or the 2-year Program Management Fellows Program.
    Business Education consists of accredited college-level courses to 
prepare the interns for either the contracting or project/program 
management career. The Foundational training consists of introductory 
technical courses to introduce the interns to the technical specialty 
of the career field and to prepare them in other office fundamentals 
(including Microsoft Office applications and essential business 
competencies). The Peak Performance training consists of highly 
intensive, customized workshops and one-on-one sessions with training 
coaches focused on mental and physiological conditioning to perform at 
peak levels under pressure and stress. The Mission Service component is 
designed to give the interns a chance to participate in efforts to 
serve Veterans and gain a better understanding of VA's mission, vision, 
and core values.
    The courses within the Business Education component vary slightly 
by the participant's track (acquisitions or project/program 
management):

Acquisition
(Business curriculum targeted to meet the positive education 
requirements of the 1102 career field):

     Business Writing
     Business Mathematics
     Introduction to Business and Decision-Making
     Computer Applications for Business
     Accounting Principles I
     Business Management and Organization
     Accounting Principles II
     Corporate Finance I
     Business Law I
     Business Communications: Written and Oral
Project/Program Management (PM)
(Combination of Business and Information Technology curriculum):

     Business Writing
     Business Mathematics
     Computer Applications for Business
     Computer Programming I
     Information Systems
     Operating Environments
     Intro to Business Decision Making
     Principles of Accounting I
     Data base Design
     Business Law
     Systems Analysis and Design
     Corporate Finance

    Interns also have over 200 online courses to complete during the 
first year as foundational curriculum in many topic areas including 
technical and business competency, and computer skills. Examples of 
foundational curriculum experienced by W2W acquisition interns include: 
Negotiation Essentials, VA Contract Security, Performance Based 
Services Acquisition, Simplified Acquisition Procedures, Overview of 
Acquisition Ethics, Influencing Key Decision Makers, Getting Started 
with Microsoft Word, Moving and Getting Around in Excel, Interpersonal 
Communications, Workplace Conflict, Business Etiquette and Customer 
Interactions. Examples of foundational curriculum experienced by W2W 
program management interns include: Introduction to Project Management 
Using Project, Monitoring Schedule, Building a Schedule with Project, 
Communicating Project Information with Project, Influencing Key 
Decision Makers, Getting Started with Microsoft Word, Moving and 
Getting Around in Excel, Interpersonal Communications, Workplace 
Conflict, Business Etiquette and Customer Interactions.
    Interns also participate in Peak Performance training that 
strengthens key mental skills (e.g., Goal Setting, Stress-Energy 
Management) to assist with challenges associated with Post Traumatic 
Stress Disorder and Traumatic Brain Injury. This approach boosts their 
attention, memory, flexibility, and problem solving to perform at a 
peak level under pressure and stress.
    The final component is Mission Service. The interns plan and 
participate in a wide range of Mission Service activities throughout 
the program in an effort to gain a better understanding of VA's 
mission, vision, and core values. Mission Service activities expose the 
interns to the Veteran community through hands-on experience with VA 
services and fellow Veterans. Interns take an active role in selecting 
and coordinating Mission Service activities, providing a valuable 
opportunity for development of teamwork and leadership skills.
    The interns are hired as a GS-5 for their transition year, and 
placed on a career ladder to GS-11. Interns in both the Acquisition 
track and the Project/Program Management track complete the transition 
year and move into their respective 2-year technical training. The 
technical training delivers the training and experience for either the 
Federal Acquisition Certification--Contracting or the Federal 
Acquisition Certification--Project/Program Management.
    The main goal of the W2W program is to transition the Veteran into 
the business workplace and to provide training leading to a productive 
career within VA. It serves VA by providing a valuable source of VA-
trained employees who bring valuable skills learned in the military 
(i.e. integrity, discipline, teamwork, etc).

    Question 131. The fiscal year 2014 budget request for Construction, 
Major Projects, includes a request of $44 million for the Advanced 
Planning Fund. This appropriated fund is comprised of ``no year money'' 
and is used to develop the early stages of construction projects for 
the Veterans Health Administration, the National Cemetery 
Administration, the Veterans Benefits Administration, and VA central 
office staff offices.
    A. What is the unobligated balance of the Advanced Planning Fund?
    Response. The balance is $141. million as of the September 30, 
2013. The table below reflects the anticipated balance in the Advanced 
Planning Fund at the end of FY 2014.
------------------------------------------------------------------------------------------------------------------------------------------------
Unobligated Balance as of September 30, 2013)..............    $141,106
FY 2014 Request............................................     $44,000
                                                            ------------
  Subtotal of Available Funds..............................    $185,106
  Less: Expected FY 2014 Obligations.......................    $182,042
                                                            ------------
Balance Remaining..........................................      $3,064
------------------------------------------------------------------------


    B. For fiscal year 2012, please provide a detailed description and 
amount for each project funded through the Advanced Planning Fund.
    Response. See table for 2012 below.
------------------------------------------------------------------------
                                                               FY 2012
                    Location/Description                     Obligations
------------------------------------------------------------------------
Alameda, CA--OPC...........................................     $694,963
Biloxi, MS--Mental Health Ctr Renovations..................     $209,583
Biloxi, MS--PM & RS /Prosthetics...........................     $209,583
Bronx, NY--Spinal Cord Injury (SCI)........................     $869,398
Canandaigua, NY--New Construction CLC and Domiciliary......     $380,180
Dallas, TX--Clinical Expansion of Mental Health............     $402,033
Dallas, TX--Long Term SCI..................................     $901,173
East Central Florida--New Cemetery (MP/SD/DD)..............   $1,664,339
Fayetteville, AR--Parking Garage...........................     $261,258
Ft. Sam Houston, TX--National Cemetery (Master Plan).......     $332,571
Las Vegas, NV--New Adminstration Building..................     $865,480
Lexington, KY (Leestown)--Clinical Campus Realignment           $610,409
 (Master Plan).............................................
Livermore, CA--Realignment & Closure.......................   $5,349,373
Long Beach, CA--Seismic Corrections Buildings 7 and 126....     $694,012
Los Angeles, CA (West LA)--Construct Essential Care Tower/      $574,000
 B500 Seismic Correction...................................
Louisville, KY--New VAMC...................................     $932,782
Omaha, NE--New Clinical Addition...........................     $461,885
Orlando, FL--SimLEARN (Medical Center).....................   $1,870,734
Palo Alto, CA--80 Bed Psychiatric Facility.................     $300,000
Palo Alto, CA--Ambulatory Care/Polytrauma Rehab............      $52,128
Pittsburgh, PA--Research Building..........................      $32,924
Portland, OR--Retrofit & Renovation Siesmic Studies........     $264,855
Riverside NC Master Plan Environmental Studies.............      $80,000
Southern Colorado, NC (MP/SD/DD)...........................     $353,360
St Louis, MO (JC Division)--Bed Tower Master Plan (NEPA and     $107,701
 106)......................................................
Tallahasee--New Cemetery (MP/SD/DD)........................   $1,283,441
Tampa, FL--Polytrauma Expansion............................     $367,227
Walla Walla, WA--Multispecialty Clinic.....................     $158,099
West LA--12 Bldgs Seismic Upgrade (B206 & 258).............     $384,862
West LA--New Bed Tower & Bldg 500 Seismic Correction.......     $500,000
                                                            ------------
    Total..................................................  $21,168,353
Other:
Various Planning/Design/Assessment Activities:.............  $19,250,859
  Updated Design Guides and Criteria.......................           --
  Facility Condition Assessments...........................           --
  Peer Review..............................................           --
  Master Planning..........................................           --
  Post Occupancy Evaluation................................           --
Transferred funds from APF to support: Miami, FL--           $14,000,000
 Renovation-Surgical Suite & Operating Rooms...............
                                                            ------------
    Grand Total............................................  $54,419,212
------------------------------------------------------------------------

    C. For fiscal year 2013, please provide a detailed description and 
amount for each project expected to be funded through the Advanced 
Planning Fund.
    Response. See table for 2013 below.
------------------------------------------------------------------------
                                                               FY 2013
                    Location/Description                     Obligations
------------------------------------------------------------------------
Alameda, CA--Outpatient Clinic (OPC).......................     $323,141
Biloxi, MS--B1 & B2 Renovations & PM-RS/Prosthetics........     $306,347
Bronx, NY--Spinal Cord Injury (SCI)........................   $1,091,888
Dallas, TX--Clinical Expansion of Mental Health............     $118,230
Livermore, CA--Realignment & Closure.......................      $26,117
Long Beach, CA--Seismic Correction Buildings 7 & 126 Phase      $141,108
 2.........................................................
Los Angeles, CA (West LA)--Capital Improvement Plan (Master   $1,788,441
 Plan).....................................................
Louisville, KY--New VAMC...................................  $15,940,404
Manhattan, NY--Medical Center-Flood Recovery...............   $5,815,299
National Cemetery of the Alleghenies.......................     $866,854
Omaha, NE--Replacement Facility............................     $628,380
Palo Alto, CA--80 Bed Psychiatric Facility.................     $433,180
Palo Alto, CA--Ambulatory Care/Polytrauma Rehab............   $8,127,955
Perry Point, MD--Replace Community Living Center...........     $107,617
Portland, OR--Retrofit & Renovation........................      $11,068
Reno, NV--Seismic & Life Safety Corrections B-1............   $4,298,543
San Juan, PR--Seismic Correction (Parking Structure).......      $16,455
St Louis, MO (JC Division)--Bed Tower......................      $41,100
Tallahasee--New Cemetery...................................      $79,527
Walla Walla, WA--Multispecialty Clinic.....................     $335,661
West LA--12 Bldgs Seismic Upgrade (B206 & 258).............   $1,788,441
West LA--New Bed Tower & Bldg 500 Seismic Correction.......   $4,600,816
                                                            ------------
    Total..................................................  $46,886,572
Other:
Various Planning/Design/Assessment Activities:.............  $12,399,045
  Cost Estimating, Environmental & Historic Preservation              --
   Services................................................
  Updated Design Guides and Criteria.......................           --
  NCA Facility Condition Assessments.......................           --
  Regional Strategic Master Plans..........................           --
  Post Occupancy Evaluations...............................           --
                                                            ------------
    Grand Total............................................  $59,285,617
------------------------------------------------------------------------

    D. For fiscal year 2014, please provide a detailed description and 
amount for each project expected to be funded through the Advanced 
Planning Fund.
    Response. See table for 2014 below.
------------------------------------------------------------------------
                                                               FY 2014
                   Location/Description                       Estimate
------------------------------------------------------------------------
Alameda, CA--Outpatient Clinic (OPC)......................    $5,000,000
Dallas, TX--Clinical Expansion of Mental Health...........      $548,387
Dallas, TX--Long Term SCI.................................      $500,000
Dallas/Ft. Worth--Gravesite Expansion.....................    $2,000,000
Livermore, CA--Realignment & Closure......................    $3,500,000
Ft. Sam Houston, TX--National Cemetery....................    $1,800,000
W. Los Angeles, CA--Seismic Corrections (blgs                 $4,700,000
 B156,B157,B258)..........................................
Louisville, KY--New VAMC..................................   $19,475,000
Manhattan, NY--Medical Center-Flood Recovery..............    $1,350,000
North Little Rock, AR--VBA Building Replacement Facility..      $900,000
Ohio Western Reserve, OH--National Cemetery...............    $1,500,000
Omaha--New Cemetery.......................................      $500,000
Omaha, NE--Replacement Hospital...........................   $15,000,000
Portland, OR--Retrofit & Renovation.......................    $5,000,000
Southern Colorado National Cemetery.......................    $2,000,000
Sacramento Valley, CA--NC.................................    $2,000,000
Barrancas, FL--NC.........................................    $2,000,000
Jacksonville, FL--NC......................................    $2,000,000
S.Florida, FL--NC.........................................    $2,000,000
Palo Alto, CA--Building 6 Seismic Replacement.............    $4,000,000
Pittsburgh, PA--Bridge....................................       $50,000
Perry Point, MD--Replace Community Living Center..........      $900,000
Long Beach, CA--Buildings 128 & 133.......................      $100,000
San Francisco, CA--Seismic Retrofit B 1, 6 & 8/Replace B12      $350,000
San Juan, PR--Seismic Correction (Parking Structure)......    $3,500,000
Seattle, WA--B101 Mental Health Services--Request for           $450,000
 Equit Adj................................................
Puerto Rico, PR--Gravesite Expansion......................    $2,000,000
Reno, NV--Seismic & Life Safety Corrections B-1...........    $4,300,000
St Louis, MO (JC Division)--Bed Tower.....................    $8,218,525
Tampa, FL--New Bed Tower Schematics & DDs (Polytrauma         $4,600,000
 Expansion)...............................................
West LA--New Bed Tower & Bldg 500 Seismic Correction......   $19,000,000
Williamette, OR--NC Columbarium Expansion.................    $2,000,000
Western New York--New Cemetery............................      $800,000
                                                           -------------
    Total.................................................  $122,041,912
Other:
Various Planning/Design/Assessment Activities:............   $60,000,000
  Cost Estimating, Environmental & Historic Preservation              --
   Services...............................................
  Updated Design Guides and Criteria......................            --
  NCA Facility Condition Assessments......................            --
  Regional Strategic Master Plans.........................            --
  Post Occupancy Evaluations..............................            --
                                                           -------------
    Grand Total...........................................  $182,041,912
------------------------------------------------------------------------


    Question 132. The Office of Small and Disadvantaged Business 
Utilization's (OSDBU) stated mission ``is to advocate for the maximum 
practicable participation of small business in VA acquisitions, with 
special emphasis on service-disabled veteran-owned (SDVOSB) and 
veteran-owned small business (VOSB).'' Within OSDBU is the Center for 
Veterans Enterprise (CVE) that is charged with verifying veteran 
businesses looking to take advantage of veteran specific VA contracting 
preferences.
    A. Many veterans have expressed the opinion that CVE's mission of 
approving or denying eligibility for veteran set asides is in direct 
conflict with the OSDBU mission of advocating for VOSBs and SDVOSBs. 
How does VA respond to that charge?
    Response. VA has unique legislation in support of meeting Veteran-
owned small business and service-disabled Veteran-owned small business 
procurement goals. This legislation is found in section 8127 of title 
38. The Executive Director is not the manager of the Center for 
Veterans Enterprise (CVE). He has direct supervisory authority over the 
Director of CVE.
    The Executive Director, OSDBU implements and executes all of the 
functions and duties of the office under section 644 and 637 of title 
15 of the United States Code with respect to VA. Of particular note, 
are the responsibilities of developing strategies to assure that a fair 
proportion of the total purchases and contracts for property and 
services for VA in each industry category are placed with small-
business concerns pursuant to sections 637(d)(1) and 644(a)(3). One 
avenue to increase the number of awards to small businesses, 
specifically SDVOSBs/VOSBs, is the verification program established by 
38 U.S.C. Sec. 8127. Section 8127 directs the Secretary to verify the 
Veteran status, ownership and control of all SDVOSBs/VOSBs to 
participate in the unique contracting program created in the 
legislation. The Secretary has directed that the Executive Director, 
OSDBU oversee CVE as a part of his duties under sections 637(d)(1) and 
644(a)(3).
    The VA VOSB Verification program provides VOSBs with access to VA 
procurement opportunities they would not have if they are not verified. 
VA contends that there is no conflict between advocating for Veterans 
and enabling VOSBs to participate in the Veterans First contracting 
program.
    B. In order to avoid the appearance of competing missions within 
OSDBU, has VA looked at whether CVE should be moved to another office 
or established as a standalone office under the Secretary? Please 
explain.
    Response. VA believes that the missions of verification and 
acquisition support are not competing missions, rather they are 
complementary missions. As such, VA has not explored moving CVE to 
either another office nor as a standalone office under the Secretary. 
The verification mission fits best with the mission of OSDBU, and VA 
believes it is best suited to be under the supervision of the Executive 
Director of OSDBU.

    Question 133. The chart ``Summary of Employment and Obligations'' 
for the Office of Acquisitions and Logistics Supply Fund does not 
include FTE information for OSDBU.
    A. Please provide the Committee with the FTE requirements for OSDBU 
for fiscal year 2014 and the preceding three years.
    Response. OSDBU has a standing authorization of 42 FTE since FY 
2012. Prior to that, the authorization was for 40 FTE.
    B. Please provide the Committee with a detailed budget for OSDBU 
and CVE.
    Response. Due to the nature of OSDBU's source of funding in the 
Supply Fund, OSDBU has traditionally negotiated its budget based on the 
current year's funding level and adjusted the request for the rapidly 
changing circumstances. The flexibility of the Supply Fund has been 
beneficial to Veterans, as the OSDBU needs can be quickly addressed, 
and more accurate projections made with the request coming much closer 
to the need.

                       OSDBU FY 2012 Expenditures
------------------------------------------------------------------------------------------------------------------------------------------------
FTE......................................................           42
Obligations:
  Personal services......................................   $4,252,488
  Travel.................................................      $64,752
  Transportation of things...............................           --
  Rents, communications and utilities....................     $359,492
  Printing and reproduction..............................       $4,594
  Other services.........................................  $15,604,719*
  Supplies and materials.................................     $196,988
  Equipment..............................................       $5,640
                                                          --------------
    Total obligations....................................  $20,488,672**
                                                          --------------
    Total budget.........................................  $33,000,000
------------------------------------------------------------------------
 * See breakdown of other services on page 5.
** $12,511,328 carried over to FY 2013.


    OSDBU expects that the FY 2013 budget will be approved by July 31, 
2013.

    Question 134. Last year, CVE announced the creation of a pre-
decisional letter to better assist veterans make the necessary changes 
to their businesses prior to receiving full verification decisions. The 
goal was to decrease the number of veterans who entered the appeals 
process after an initial denial.
    A. Since its creation, how many veterans have taken advantage of 
the pre-decisional letter to make the necessary changes?
    Response. The Pre-Decisional Findings (PDF) program was piloted 
from February to April 2013, and launched at full scale on May 1, 2013. 
Data on the program is very limited, due to the fact that it is a brand 
new program. It is important to note that not all businesses are 
eligible for the program. Those businesses, whose compliance issues are 
categorized among the list of correctible issues, not requiring full 
re-evaluation, are allowed to clarify their issues and/or make 
adjustments to their documentation within a specified time period with 
the intent to avoid denial. Those with more complex issues that would 
require a complete re-evaluation are offered the option to withdraw 
their application rather than to receive a denial letter. This allows 
them to take the time that they need to address the issues and 
resubmit, rather than receiving a determination, and then having only 
the 30 days allowed by regulation to submit the request for 
reconsideration.
    In the first 27 days from the full scale launch on May 1, 2013, 31 
Veterans have taken advantage of the program. Pulling in all results 
from both the pilot and the launch, 80 firms have taken advantage of 
the program through May 27, 2013. Of those firms, 71 percent were 
approved, ten percent were denied, and 19 percent withdrew their 
applications.
    B. What metrics have been established to determine whether the new 
process has been effective in decreasing the number of veteran 
businesses entering the appeal process?
    Response. The PDF process has helped to decrease the number of 
Veteran businesses entering the request for reconsideration (R4R) 
process. This process enables applicants to correct non-compliant 
aspects of their businesses established by the initial determination. 
CVE has developed a number of metrics to gage the program. One of the 
objectives of the PDF program is to reduce the number of requests for 
reconsideration and the time required to process them. The average 
number of R4Rs submitted monthly has declined from 92 in January 2013 
to 40 in May (as of May 28, 2013). The average time to process R4Rs has 
declined from 146 days in January to 66 days in May.
    Fewer denials directly affects the number of requests for 
reconsideration submitted, shortening the average processing time. At 
the end of FY 2012, the initial determination approval rate was 58 
percent. At the end of May 2013, the initial approval rate is 83 
percent. It is important to note that prior to the introduction of PDF, 
all of the firms that are now participating would have received an 
initial denial. Note that because the sample size is so small (about 
three percent of all initial determinations made in FY 2013 to date), 
the impact on the overall approval rate will become more significant 
over time.

       OSDBU FY 2012 Expenditures (+ breakdown of other services)
------------------------------------------------------------------------------------------------------------------------------------------------
FTE......................................................           42
Obligations:
  Personal services......................................   $4,252,488
  Travel.................................................      $64,752
  Transportation of things...............................           --
  Rents, communications and utilities....................     $359,492
  Printing and reproduction..............................       $4,594
  Other services.........................................  $15,604,719*
  Supplies and materials.................................     $196,988
  Equipment..............................................       $5,640
                                                          --------------
    Total obligations....................................  $20,488,672**
                                                          --------------
    Total budget.........................................  $33,000,000
 * Breakdown of other services:
    Verification support.................................   $9,925,585
    Outreach Support.....................................   $5,263,156
    Acquisition Support..................................     $365,607
    Training and security................................      $50,371
** $12,511,328 carried over to FY 2013.
------------------------------------------------------------------------

                      office of inspector general
    Question 135. For fiscal year 2014, the Office of Inspector General 
requests $11 million for Other Services. Please provide an itemized 
list of how those funds would be utilized.
    Response. The fiscal year (FY) 2014) request for Other Services 
includes the following contractual services, interagency agreements, 
employee training, VA cross-cutting services, and other procured 
services:

     Contract for the Consolidated Financial Statement Audit.
     Interagency Agreement for Human Resources/Payroll 
Processing Services--Department of Treasury and Department of 
Agriculture.
     Contract for the Federal Information Security Management 
Act Review.
     Employee Training.
     VA Franchise Fund Services--IT processing, financial 
services, background investigations, and records storage.
     Employee Relocation Services.
     Annual assessment for Council of the Inspectors General 
for Integrity and Efficiency.
     Building Security Services--Department of Homeland 
Security and VA.
     Investigative Data Base Access, Forensic Services, 
Communications Agreements.
     Other VA Administrative Services, including workers 
compensation, unemployment compensation, and EEO services.

    Question 136. With the requested level of resources for fiscal year 
2014, how many benefits inspections would the Office of Inspector 
General plan to conduct?
    Response. The Office of Inspector General (OIG) will conduct 18 
inspections of VA Regional Office operations in FY 2014. Our 
independent inspections provide recurring oversight focused on 
disability compensation claims processing and the performance of 
Veterans Service Center operations.
    We also plan to conduct the following two national reviews of key 
Veteran Benefits Administration (VBA) initiatives in meeting the VA 
Secretary's goals of processing claims in an average of 125 days and 
with 98 percent accuracy by FY 2015:

     Review of VBA's Statistical Technical Accuracy Review 
(STAR) Program--We will sample claims reviewed by STAR to determine the 
effectiveness of the program in assessing disability claims processing 
accuracy and identifying areas for improvement. The STAR program is 
VBA's quality assurance program. In our March 2009 report, Audit of 
Veterans Benefits Administration Compensation Rating Accuracy and 
Consistency Reviews, we found that while VBA identified a national 
compensation claim rating accuracy of 87 percent for the 12-month 
period ending February 2008, we projected that VBA officials 
understated the error rate by about 10 percent. This difference equated 
to approximately 88,000 additional claims where veterans' monthly 
benefits may be incorrect. In FY 2013, the risk of increased inaccurate 
ratings could occur due to VBA's reliance on Disability Benefits 
Questionnaires and provisional decisions on the oldest disability 
compensation claims in VBA's inventory.
     Review of the Veterans Benefits Management System (VBMS)--
We plan to audit claims processed using VBMS to determine whether the 
automated system is resulting in higher quality and more consistent 
disability benefits decisions. This review is expected to complement 
the results of a current ongoing audit of cost, schedule, performance, 
and information security in VBMS development.
                     veterans health administration
    Question 137. If VA cannot provide care for a veteran at a VA 
Medical Center (VAMC), the VAMC will provide that care to the veteran 
in the veteran's local community through purchased care. In fiscal year 
2014, VA is expected to spend $1.1 billion on purchased care. However, 
there are several Inspector General (IG) reports that have criticized 
various aspects of the Veterans Health Administration's (VHA) purchased 
care program, such as improper payments and some facilities having 
problems with managing purchased care.
    A. How much does VA expect to be spent on purchased care in fiscal 
year 2015?
    Response. In 2015, VHA estimates spending $6,177,600,000 on Non-VA 
care.
    B. What actions has VHA taken to meet the requirements of the 
Improper Payments Elimination and Recovery Act of 2010?
    Response. The VHA Chief Business Office (CBO) has implemented 
multiple corrective actions to reduce improper payments and meet 
Improper Payments Elimination and Recovery Act requirements. 
Improvements to reduce improper payments include:

     Implementation of the Quality Corrective Action Program 
(QCAP) was completed in December 2012. This internal program is 
designed to identify quality initiatives through various audit findings 
and reviews. The QCAP facilitates the development of appropriate 
corrective action teams and processes and tracks and trends results 
with the use of an automated tool.
     Implementation of the Fee Basis Claims System (FBCS) was 
completed in March 2012. FBCS is a graphical user interface based 
system that is layered on top of the VistA Fee system. The national 
implementation of FBCS included an initial 3-week training course on 
FBCS procedures that was provided to site Non-VA Care Fee staff during 
rollout. Supplemental online training was also provided. Ongoing FBCS 
training has been incorporated to share any recently installed patches 
and updates to process changes.
     National rollout of the FBCS Optimization launched in 
August 2012. FBCS Optimization is the next stage in a nationwide effort 
to improve and standardize the processes associated with the use of 
FBCS for claims processing across VHA in support of the Non-VA Care 
Program Offices in the field.
     Establishment of a Field Assistance Program in 2011 was 
expanded in 2012 to provide enhanced site visits designed to improve 
local operations by assessing site Non-VA Care claims processes and 
assisting with the development of effective internal controls. Findings 
are tracked at all sites to measure trends and identify lessons learned 
to share with all sites for training course development.
     The VHA Chief Business Office developed a duplicate 
payment report, accessed through a user-friendly tool called SnapWeb, 
which identifies potential improper duplicate payments. The report was 
available beginning in April 2012.
     The Non-VA Care Program Academy is the primary training 
program provided to VISN and VA medical center Fee employees 
nationwide. The Non-VA Care Program Academy is organized into a four-
tiered, progressive level of curriculums designed to improve 
performance, enhance internal controls, and be in compliance with 
program policies.
     The National Non-VA Care Program Office Intranet site was 
expanded in December 2012 to include updated training materials, 
procedure guides, notices, and FBCS alerts. This information is 
available to the field to alert staff to any changes and provide status 
of multiple projects related to Non-VA Care.
     In January 2011, a contract was awarded to assist VA in 
establishing an enhanced program integrity function to reduce fraud, 
waste, and abuse through implementation of industry standard 
applications and processes.

    C. How much did VHA pay in duplicate payments in the last fiscal 
year and how much of those duplicate payments did VHA recover?
    Response.
                          Duplicate Payments FY 2012 = $1,213,070
                          Duplicate Payments Recovered in FY 2012 = 
                        $776,450

    D. Some VAMCs have inappropriately authorized millions in non-VA 
care but did not have sufficient funding to pay for those services. 
Why, after several IG investigations on this matter, does this 
continue? What is VHA's plan to address this?
    VHA Response: The Chief Business Office Purchased Care (CBOPC) has 
instituted a comprehensive in-house auditing capability to cost-
effectively audit claims for all CBOPC programs and ensure compliance 
with applicable regulations and other guidance. We will also be 
focusing on improving processes within the financial management of the 
Non-VA Medical Care program to improve the financial integrity of the 
program throughout its lifecycle. Additionally, CBOPC provides guidance 
to the field concerning the need to obligate funds prior to authorizing 
care on an on-going basis through several venues to include:

     Policy and Procedure Guides
     Recorded training sessions on the use of estimation tools
     National conference call announcements
     Field Assistance Site Visits
     On-going audits to reduce improper payments

    In addition, guidance to the field is provided in Fiscal 
regulations published by the Office of Finance, available on-line and 
at local Finance offices.
    Sections of the NNPO Web site contain links to cost estimation and 
obligation of funds guidance to include:

     1601F Program Guide series Authorizations outlining the 
need to obligate the funds prior to issuance of the authorizations and 
a specific section titled, Fee Basis Obligations.
     Fee Internal controls and Continuous Monitors, Internal 
Controls and Continuous Monitors Attachment A.
     Obligation of Funds is outlined in M-1 Part 1, Chapter 18 
and in M-1 Part 1 Chapter 21.
     FBCS training modules outline the authorization and 
obligation process.
     An outpatient and inpatient cost estimation tool was 
developed and training provided to field staff.
     Routine National Conference calls update the field on 
regulatory changes, training events and review procedures related to 
obligation of funds prior to services rendered.

    If a facility requires additional funding in support of Non-VA 
Medical Care activities, this is addressed at the local level, where 
additional funds are secured from the respective VISN Office and/or the 
Office of Finance, VA Central Office as per the Office of Finance 
guidance.

    Question 138. An IG report, titled Audit of Non-VA Inpatient Fee 
Care Program, suggested VHA could find potential cost savings, about 
$134 million over five years, by consolidating the Fee Programs claim 
processing system. The Under Secretary for Health, Dr. Petzel, agreed 
there would be potential savings if the claims processing systems were 
consolidated.
    A. Has VHA consolidated its fee processing system into regional 
centers, similar to how VHA manages medical revenue collections?
    Response. No, VA has not regionalized in a similar fashion to the 
revenue centers; however, work on a centralized claims processing 
system, known as HCP, or Health Claims Processing has begun. The system 
is currently under development. VHA-wide implementation is expected to 
be complete in Fall 2015. Additionally, we have initiated an 
Improvement Roadmap (as of Sept 2012) that is focused on reducing 
improper payments, training, communications, and other programmatic 
fixes over a 6-12 month timeframe. The larger effort to consolidate fee 
processing systems and personnel will be approached through the 
completion of the HCP system and the design and implementation of a new 
organizational model that consolidates that claims processing from the 
present 140+ locations to 3-5 centers.
    B. If not, why has this consolidation not been completed and when 
does VA expect to complete the consolidation?
    Response. The effort is not completed because of the current focus 
on completing the Improvement Roadmap, which builds a solid foundation 
for the new organizational model. Due to the anticipated size and scope 
of the reorganization effort, it is expected that the planning and 
implementation will be spread over several years. There are over 140+ 
processing sites currently with over 2,500 personnel involved across 
those sites. Consolidating these sites must take a well-planned and 
implemented approach to prevent disruption to the critical services 
that this program provides to our Veterans. Implementing the 
Improvement Roadmap is a key first step in standardizing business 
process and reducing improper payments before the consolidation begins.

    Question 139. Staffing at VAMCs make up a large portion of VHA's 
funding obligations. However, VHA did not develop a mental health 
staffing plan until after several IG Combined Assessment Program and 
Community Based Outpatient Clinic reviews indicated problems with nurse 
staffing and the Committee requested that VHA develop one.
    A. Does VA have a staffing model in place for all clinical 
providers?
    Response. VHA continues to develop a staffing model for all 
clinical providers. In June 2012, the Under Secretary for Health 
established the Specialty Care Physician Productivity and Staffing Plan 
Task Force to develop a methodology for VHA specialty care physician 
staffing and productivity. Productivity coupled with access measures 
provide a framework for determining specialty physician staffing. This 
model was prototyped for the seven specialties of Cardiology, 
Gastroenterology, Dermatology, Neurology, Orthopedics, Urology, and 
Ophthalmology. VHA will establish productivity standards for five 
specialties in FY 2013 and the remaining specialties by the end of FY 
2015.
    B. Has VHA sought guidance from DOD Health Affairs or private 
health care providers, such as Kaiser Permanente, regarding how they 
developed their staffing models? If so, how did that guidance influence 
the development of VHA's staffing model.
    Response. VA recently established a partnership with DOD and is 
leading a joint study to better understand physician productivity and 
how to effectively design and implement staffing plans to improve 
clinical outcomes.
    C. Of the funding VHA is appropriated for staffing, how much will 
be used to pay for union representation/union time?
    Response. VHA does not have a tracking mechanism to provide this 
data.

    Question 140. The Committee has held several hearings highlighting 
the problem veterans have accessing mental health care at VHA. In 
response to an IG report that found VHA's measures for access to care 
are unreliable, VHA announced an increase of 1,900 mental health 
provider and administrative staff positions to address the problem. 
According to testimony VA submitted for the Committee's March 20, 2013, 
mental health hearing, as of March 5, 2013, a total of 1,089 new 
providers and 230 administrative staff have been hired.
    A. How will VHA ensure that these new providers are deployed where 
veterans' needs are the greatest?
    Response. As part of an ongoing comprehensive review of mental 
health operations, VA considered a number of factors to determine 
additional staffing levels distributed across the system, including:

     Veteran population in the service area,
     Mental health needs of Veterans in that population, and
     Range and complexity of mental health services provided in 
the service area.

    VHA's Mental Health Operations collaborated with VISNs and 
facilities to distribute the additional staffing based on this review 
and with the goal of ensuring that facilities had sufficient mental 
health staff to meet Veteran needs. In some areas, however, because of 
recruitment challenges, sites elected to develop regional telemental 
health programs or to develop Non-VA contracts to supplement staffing 
levels. VA continues to review the adequacy of staffing levels based on 
timeliness of care, quality of care, and patient and provider 
satisfaction.
    B. What changes has VHA made to make sure the metrics used to 
measure access provide an accurate picture?
    Response. VA has developed two new measures of Veterans' waiting 
times: (1) a new patient metric based on ``create'' date, and (2) an 
established patient metric using the prospective waiting time and based 
on the Agreed Upon Date (AUD). The data is currently being reported for 
these two new metrics as of December 31, 2012.
    VA is also developing internal metrics based on measuring the time 
from the date of referral to mental health care to the time of the 
completed appointment. These metrics will be piloted in late FY 2013 
for deployment in FY 2014. In addition, VA identified several metrics 
to assist clinic managers with reviewing access issues within their 
clinics. A ``Clinic Access Index'' group identified and defined key 
data elements needed by mid-level managers to improve the function of 
clinic operations. The database has been built and is available for use 
by all VA staff. Educational efforts are being developed to teach 
managers how to use the database. VA has also developed a Veteran 
survey to assess Veterans' perceptions of access barriers. The survey 
is currently being mailed to Veterans with results expected by the mid-
fall of 2013.

    Question 141. This budget request would provide a 92 percent, or 
$3.6 billion, increase for mental health care since fiscal year 2008. 
However, even with this significant spending increase, veterans have 
had significant problems with accessing care they need and deserve.
    A. How does VHA measure success of this program to ensure the 
significant increase in funding is spent wisely?
    Response. In September 2008, VA published the Uniform Mental Health 
Services (UMHS) VHA Handbook 1160.01 in VA medical centers and clinics. 
The handbook specified the range of services that must be available 
nationally to ensure that Veterans have access to a consistent set of 
services regardless of where they are seeking care. As a result of the 
handbook, the number and types of required services expanded and 
ensured that VA would provide outreach to Veterans in non-traditional 
clinics such as medical settings, primary care, and geriatric settings. 
VA has measured the success of this program in a number of ways 
including evaluating the increase in numbers of Veterans served across 
programs and by each service, the increase in the number of services 
provided, as well as the number of staff hired and trained in evidenced 
based therapies.
    In FY 2012, VA developed the Mental Health Information System in 
partnership with the mental health site visit protocol to 
comprehensively evaluate implementation of the UMHS handbook using 
administrative data, performance measure data, interviews with 
Veterans, mental health staff, facility/VISN leadership, and other 
stakeholders, as well as observations and other data to assess the 
status of implementation. As a result, VA developed quality improvement 
initiatives for areas that were not functioning as intended and 
developed a best practice SharePoint to allow facilities to share 
successful initiatives. In FY 2013, VHA is continuing the site visit 
process on a 3-year cycle while continuing to develop additional 
metrics including outcome metrics for leadership and mental health 
staff to use in evaluating the efficacy of mental health programs.
    B. To what extent does VHA consider patient outcomes as part of its 
metrics in evaluating VHA's mental health care program?
    Response. VA has committed to developing and using outcome metrics 
for use in evaluating its mental health program in FY 2013. The initial 
set of measures is currently being validated, as the measures are based 
on administrative data. VA will collect symptom improvement and 
functional measures for new patients to mental health starting in 
fiscal year 2014.

    Question 142. Recently, VHA has changed the way it delivers care 
with the development of the Patient Aligned Care Team (PACT) model. 
This model of care uses a team of professionals that includes doctors, 
nurses, medical assistants, and clerks. The intent of this team 
approach is to provide a more comprehensive model of care to veterans. 
These care team professionals are to be physically located close 
together to be able to consult easily with each other. More recently, 
VHA has included mental health professionals within the PACT.
    A. The budget request provides a limited list of metrics VHA uses 
to ``measure the progress toward the goals that we have set for these 
teams.'' Please submit to the Committee the complete list of metrics 
and the goals PACTs must meet.
    Response. The metrics and goals (targets) for PACT are listed 
below:

    1. Continuity with Veterans assigned to a primary care provider: 
Veterans are able to see their own primary care provider for regularly 
scheduled or urgent visits. Target >=77%
    2. Same day access with primary care provider: Veterans are able to 
see their primary care provider the same day they call for an 
appointment and want the appointment that day. Target >=70%
    3. Appointment in Primary Care within 7 days of desired date: 
Veterans can schedule an appointment within 7 days of the date they 
choose to be seen. Target >=92%
    4. Ratio of non-traditional primary care encounters: Ratio of the 
combination of shared medical appointments, telephone encounters, and 
secure messaging for the assigned panel of primary care patients. 
Target >=20%
    5. Primary care patients enrolled in home telehealth. Ratio of 
primary care patients for the assigned panel of patients enrolled in 
home telehealth for chronic disease management. Target >=1.6%
    6. Primary Care staffing ratio. Ratio of support staff FTE assigned 
to a primary care provider FTE to care for the assigned panel of 
primary care patients. Target >=3.0

    B. The budget request indicates that half of all PACTs will be 
trained by the end of this year. Which sites have fully trained PACTs 
and when will all of the PACTs be trained?
    Response. The attachment below contains the current training 
numbers of PACT team members to date. During FY 2012-13, there have 
been 9,855 total participants attending one of the training sessions 
although VHA calculated only those who either completed, or are 
currently active, somewhere along the longitudinal training continuum. 
Three Networks (4, 10, and 23) opted out of the Learning Center 
training and are managing their own training activities. For example, 
VISN 4 conducted a PACT Collaborative with the participation of all 
their PACTs in FY 2012.



[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]




    Limitations and other considerations related to this data include:

     Numbers do not reflect special population PACTs, specific 
extended team members, or mental health integration team members.
     Support staff numbers are available as FTEs (not 
reflecting the number of part-time employees).

    Conclusions:

     The actual number of targeted participants is higher than 
reflected in the table.
     The total of those needing training is a constantly moving 
target due to turnover and introduction of new members throughout the 
multi-year training roll-out.
     The longitudinal model and participant caps require more 
time to reach all PACT members.
     We will train a significant majority of all PACTs by the 
end of FY 2014.

    C. With the recent inclusion of mental health into the PACT, what 
has VHA done to ensure mental health providers assigned to a PACT are 
physically located with the rest of the PACT? Please provide a list of 
sites where a mental health provider is embedded with the PACT.
    Response. All VA medical centers and CBOCs with more than 5,000 
enrolled Veterans are required to have co-located mental health 
providers embedded within and collaborating with other members of PACT 
as members of the interdisciplinary team. Implementation is assessed 
with three related mechanisms:

    1. Self report in the quarterly UMHS Handbook survey.
    2. Self report in the annual Primary Care-Mental Health Integration 
survey with a subset of facilities visited to validate self-reports.
    3. During Office of Mental Health Operations site visits, 
leadership and front line staff are asked about co-located mental 
health staff presence in primary care.

    The attachment below contains a list of sites currently reporting 
mental health providers embedded within the PACT.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]




    Question 143. The President's budget includes $85 million in 
medical services in both fiscal years 2014 and 2015 to cover costs 
associated with the Affordable Care Act's (ACA) mandate that all 
Americans have health insurance by 2014.
    A. Please describe the metrics used to determine the amount of 
funding needed to cover the costs of ACA.
    Response. VA has conducted an analysis of the number of Veterans 
thought to be leaving the VA health care system, the number of Veterans 
to be accrued to the system, and the estimated costs for providing 
their care. The metrics used to estimate the amount of funding needed 
to cover ACA costs were: the health care utilization profiles designed 
to identify and sort Veteran enrollees into a spectrum of high users of 
VA health care services down to non-users of VA health care services; 
the resulting utilization rate; the disenrollment rate by profile; the 
expected utilization pattern for Veterans joining VA; and the average 
cost associated with their utilization.
    B. For each of fiscal years 2014 and 2015, how many veterans does 
VA estimate will leave VA for other options of care?
    Response. The Affordable Care Act (ACA) expands affordable, 
comprehensive health care coverage options for some Veterans, both 
through the Health Insurance Marketplaces and through expansion of 
Medicaid in states that choose to expand their programs to all 
individuals below 138 percent of the poverty level. VA assumes that 
currently enrolled Veterans who become eligible for Medicaid will 
generally choose to stay with VA. VA also assumes that some Veterans 
who would have enrolled in VA (under current Medicaid eligibility 
rules) and live in a state that expands its Medicaid program may choose 
to enroll in Medicaid instead of VA. ACA also provides premium tax 
credits for eligible individuals to purchase health care coverage 
through the Health Insurance Marketplaces. However, in order to receive 
the premium tax credit, a Veteran may not be enrolled in the VA health 
care system.
    C. For each of fiscal years 2014 and 2015, how many veterans does 
VA estimate will enroll in VHA to satisfy the individual mandate in 
ACA?
    Response. Starting in FY 2014, the individual shared responsibility 
provision under ACA calls for each individual to have minimum essential 
coverage (MEC), qualify for an exemption, or make a payment when filing 
his or her Federal income tax return. Under the law, VA health care 
benefits meet the definition of MEC. Additionally, under ACA, states 
have the option to expand their Medicaid programs but are not required 
to do so. VA continues to monitor state decisions to determine the 
impact on VA beneficiaries in each of these locations. VA anticipates a 
modest net increase in enrollment as a result of ACA. As previously 
stated, VA expects that there will be some increase in enrollment; VA 
also expects that there will be some people who will leave VA's system. 
VA has conducted an analysis of how many Veterans may enroll in VHA to 
satisfy the individual mandate in ACA. The estimated net number of 
Veterans projected to enroll with VA as a result of ACA is 66,000 for 
FY 2014.

    Question 144. Under the medical services account, VHA estimates it 
will spend $582 million in fiscal year 2014 and $95 million in fiscal 
year 2015 to activate facilities. And, within the Medical Facilities 
account, VHA projects it will spend $160 million in fiscal year 2014 
and $26 million in fiscal year 2015 to activate facilities.
    A. Please provide a full list of the facilities that will be 
activated with these funds, with the amount of funding estimated for 
each facility broken down into non-recurring and recurring costs.
    Response. Please see attached. The final 2015 funding level for 
this activity will be determined during the 2015 budget process when 
updated data and metrics on this program's funding needs are available.

                                                Fiscal Year 2014
----------------------------------------------------------------------------------------------------------------
                                                                                          Non-
VISN         Location        State        Description         Project     Recurring     Recurring       Total
----------------------------------------------------------------------------------------------------------------
   1Boston                   MA   Outpatient Clinic......     Lease    $17,320,522      $457,026   $17,777,548
   2Syracuse                 NY   Addition For SCI Center   528-708       $349,158    $5,988,729    $6,337,887
                                   (Overview - OV).
   4Butler                   PA   Health Care Center.....     Lease       $536,294   $10,817,135   $11,353,429
   4Pittsburgh               PA   Medical Center            646-500             $0    $2,672,993    $2,672,993
                                   Consolidation (OV).
   6Wilmington                NC  Outpatient Clinic......     Lease     $2,554,203    $1,574,230    $4,128,433
   6Greenville                NC  Outpatient Clinic......     Lease     $3,209,783    $4,724,993    $7,934,775
   6Fayetteville              NC  Health Care Center.....     Lease     $4,576,215   $21,859,321   $26,435,536
   6Winston-Salem             NC  Health Care Center.....     Lease             $0   $17,497,991   $17,497,991
   6Charlotte                 NC  Health Care Center.....     Lease             $0   $18,112,576   $18,112,576
   7Greenville                SC  Outpatient Clinic......     Lease             $0      $824,282      $824,282
   7Hinesville                SC  Community-Based             Lease     $3,452,265      $805,961    $4,258,226
                                   Outpatient Clinic.
   7Savannah                 GA   Community-Based             Lease     $3,261,329    $1,713,770    $4,975,099
                                   Outpatient Clinic.
   7Anderson                  SC  Outpatient Clinic......     Lease             $0      $729,953      $729,953
   7Montgomery               AL   Health Care Center.....     Lease             $0    $5,908,871    $5,908,871
   7Atlanta                  GA   Specialty Care.........     Lease             $0    $2,081,864    $2,081,864
   7Huntsville               AL   Outpatient Clinic......     Lease             $0    $1,922,599    $1,922,599
   7Birmingham               AL   Clinical Annex/             Lease             $0    $1,931,412    $1,931,412
                                   Outpatient Clinic.
   7Atlanta                  GA   Modernize Patient Wards   508-057    $35,277,925    $1,206,019   $36,483,944
                                   (OV).
   8Jacksonville             FL   Satellite Outpatient        Lease     $2,442,952    $9,900,225   $12,343,177
                                   Clinic.
   8Mayaguez                 PR   Satellite Outpatient        Lease             $0    $4,764,179    $4,764,179
                                   Clinic.
   8Tampa                    FL   Primary Care Annex.....     Lease     $1,763,264    $2,898,748    $4,662,012
   8Tallahassee              FL   Outpatient Clinic......     Lease             $0    $9,814,345    $9,814,345
   8Orlando                  FL   New Medical Facility      673-950    $39,160,665   $38,741,513   $77,902,178
                                   (OV).
   8Lee County               FL   Outpatient Clinic (Bay    516-400       $262,829    $7,501,365    $7,764,194
                                   Pines).
   8Bay Pines                FL   Inpatient/Outpatient      516-005        $91,716            $0       $91,716
                                   Improvements.
   8Gainesville              FL   Correct Patient Privacy   573-070    $27,054,777    $2,021,224   $29,076,002
                                   Deficiencies.
   8Tampa                    FL   Polytrauma and Bed        673-900     $2,004,046    $4,923,043    $6,927,089
                                   Tower (OV).
   8San Juan                 PR   Seismic Corrections       672-085             $0      $517,532      $517,532
                                   Bldg. 1 (OV).
  10Mansfield                OH   Satellite Outpatient        Lease     $2,172,849    $1,091,263    $3,264,111
                                   Clinic.
  11Fort Wayne               IN   Community Based             Lease     $1,077,374    $1,777,600    $2,854,974
                                   Outpatient Clinic.
  11Peoria                   IL   Community Based             Lease       $783,178      $492,343    $1,275,521
                                   Outpatient Clinic.
  11Toledo                   OH   Community Based             Lease     $1,068,704    $3,066,828    $4,135,533
                                   Outpatient Clinic.
  11Grand Rapids             MI   Community Based             Lease     $2,611,478    $7,601,926   $10,213,404
                                   Outpatient Clinic.
  11South Bend               IN   Community Based             Lease             $0    $4,652,872    $4,652,872
                                   Outpatient Clinic.
  12Crown Point              IN   Outpatient Clinic......     Lease             $0    $4,134,828    $4,134,828
  12Green Bay                WI   Outpatient Clinic......     Lease    $63,594,064   $12,429,484   $76,023,548
  15Columbia                 MO   Operating Suite           589-006       $182,127      $381,606      $563,734
                                   Replacement.
  15St. Louis (JB)           MO   Med Facility Improv &     657-313       $284,297    $4,229,655    $4,513,952
                                   Cem Expansion (OV).
  16Lafayette                LA   Community Based             Lease     $3,463,671    $2,689,598    $6,153,269
                                   Outpatient Clinic.
  16Lake Charles             LA   Community Based             Lease     $2,292,328    $2,286,639    $4,578,967
                                   Outpatient Clinic.
  16Fayetteville             AR   Clinical Addition......   564-302     $1,786,503   $11,212,702   $12,999,205
  16Biloxi                   MS   Restoration Of Hospital/  520-317    $24,587,218    $9,480,317   $34,067,536
                                   Consolidation (OV).
  16New Orleans              LA   Restoration/Replacement   629-401     $9,434,412   $45,842,871   $55,277,284
                                   Medical Facility (OV).
  17San Antonio              TX   Ward Upgrades And         671-047             $0      $709,106      $709,106
                                   Expansion (OV).
  17Temple                   TX   IT Building............   674-117             $0      $297,744      $297,744
  17Corpus Christi           TX   Outpatient Clinic......     Lease       $107,978    $1,302,693    $1,410,671
  17McAllen                  TX   Outpatient Clinic......     Lease       $237,414    $1,069,566    $1,306,980
  17Fort Worth               TX   Outpatient Clinic......     Lease       $727,239   $10,724,819   $11,452,058
  17Harlingen                TX   Outpatient Clinic......     Lease       $425,635            $0      $425,635
  17Austin                   TX   Outpatient Clinic......     Lease    $14,586,597    $5,937,983   $20,524,580
  17San Antonio              TX   Polytrauma Center, &      671-048     $5,988,569    $2,378,476    $8,367,045
                                   Renovation of Exist
                                   Bldg. 1.
  18Mesa                     AZ   Satellite Outpatient        Lease    $13,356,817    $1,448,934   $14,805,751
                                   Clinic.
  19Colorado Springs           CO Community-Based             Lease     $1,731,810    $7,264,216    $8,996,027
                                   Outpatient Clinic
                                   Relocation.
  19Billings                 MT   Satellite Outpatient        Lease     $4,127,973    $3,830,120    $7,958,093
                                   Clinic.
  19Denver                     CO Replacement Medical       554-501     $7,735,419   $54,455,961   $62,191,381
                                   Center Facility (OV).
  20Salem                    OR   Community-Based             Lease     $5,486,592    $1,623,365    $7,109,957
                                   Outpatient Clinic.
  20Eugene                   OR   Community-Based             Lease    $15,156,885    $4,470,620   $19,627,505
                                   Outpatient Clinic.
  20Seattle                  WA   Correct Seismic           663-406     $8,742,076    $8,495,652   $17,237,728
                                   Deficiencies B100, NT
                                   & NHCU.
  20Walla Walla              WA   Multi Specialty Care      687-400       $610,045    $1,093,449    $1,703,494
                                   (Overview).
  21San Francisco              CA Research Lease.........     Lease             $0    $1,798,163    $1,798,163
  21Palo Alto                  CA Seismic Corrections,      640-413        $30,980       $79,303      $110,283
                                   Bldg. 2.
  21Palo Alto                  CA Centers for Ambulatory    640-424             $0    $6,256,052    $6,256,052
                                   Care and Polytrauma
                                   Rehabilitation (OV).
  22Los Angeles                CA Seismic Corrections -     691-406             $0    $2,918,298    $2,918,298
                                   12 Bldgs..
  22Las Vegas                NV   Primary Care Clinic #1.     Lease        $86,161      $369,431      $455,591
  22Las Vegas                NV   Primary Care Clinic #2.     Lease        $86,161      $332,488      $418,648
  22Las Vegas                NV   Primary Care Clinic #3.     Lease        $86,161      $332,488      $418,648
  22Las Vegas                NV   Primary Care Clinic #4.     Lease        $86,161      $465,317      $551,478
  22Bakersfield                CA Community-Based             Lease             $0      $696,990      $696,990
                                   Outpatient Clinic.
  22Loma Linda                 CA Health Care Center.....     Lease             $0   $13,690,064   $13,690,064
  22Las Vegas                NV   New Medical Facility      593-202    $32,248,745    $1,407,631   $33,656,376
                                   (OV).
  22Long Beach                 CA Seismic Corrections/      600-402     $1,360,206    $2,157,870    $3,518,076
                                   Clinical, B-7 & 126.
----------------------------------------------------------------------------------------------------------------
                                  Total..................             $369,661,768  $428,889,232  $798,551,000
----------------------------------------------------------------------------------------------------------------



                                                Fiscal Year 2015
----------------------------------------------------------------------------------------------------------------
                                                                                           Non-
VISN         Location         State         Description         Project    Recurring    Recurring       Total
----------------------------------------------------------------------------------------------------------------
   2Rochester                 NY   Outpatient Clinic.......     Lease            $0   $2,594,855    $2,594,855
   4Butler                    PA   Health Care Center......     Lease      $345,228           $0      $345,228
   6Greenville                 NC  Outpatient Clinic.......     Lease    $1,540,621           $0    $1,540,621
   6Fayetteville               NC  Health Care Center......     Lease    $2,629,763           $0    $2,629,763
   6Winston-Salem              NC  Health Care Center......     Lease    $1,220,410   $4,718,419    $5,938,828
   6Charlotte                  NC  Health Care Center......     Lease    $1,787,028   $4,884,145    $6,671,173
   7Hinesville                 SC  Community-Based              Lease    $1,175,860           $0    $1,175,860
                                    Outpatient Clinic.
   7Savannah                  GA   Community-Based              Lease    $1,120,466           $0    $1,120,466
                                    Outpatient Clinic.
   7Anderson                   SC  Outpatient Clinic.......     Lease      $297,703     $196,835      $494,538
   7Montgomery                AL   Health Care Center......     Lease    $1,049,303   $1,593,356    $2,642,659
   7Atlanta                   GA   Specialty Care..........     Lease    $1,785,517     $561,385    $2,346,901
   7Huntsville                AL   Outpatient Clinic.......     Lease    $3,464,333     $518,438    $3,982,771
   7Birmingham                AL   Clinical Annex/              Lease    $3,912,878     $520,815    $4,433,693
                                    Outpatient Clinic.
   8Tampa                     FL   Primary Care Annex......     Lease      $730,925           $0      $730,925
   8Tallahassee               FL   Outpatient Clinic.......     Lease      $580,497   $2,646,486    $3,226,983
   8Bay Pines                 FL   Inpatient/Outpatient       516-005       $47,574           $0       $47,574
                                    Improvements.
   8Tampa                     FL   Polytrauma and Bed Tower   673-900    $1,204,469     $443,826    $1,648,295
                                    (OV).
   8San Juan                  PR   Seismic Corrections        672-085            $0     $418,665      $418,665
                                    Bldg. 1 (OV).
  11Fort Wayne                IN   Community Based              Lease      $290,519           $0      $290,519
                                    Outpatient Clinic.
  11Grand Rapids              MI   Community Based              Lease    $1,128,712           $0    $1,128,712
                                    Outpatient Clinic.
  11South Bend                IN   Community Based              Lease    $3,031,720   $1,254,670    $4,286,390
                                    Outpatient Clinic.
  15St. Louis (JB)            MO   Med Facility Improv &      657-313      $299,499   $1,414,548    $1,714,046
                                    Cem Expansion (OV).
  16Lafayette                 LA   Community Based              Lease      $933,996           $0      $933,996
                                    Outpatient Clinic.
  16Lake Charles              LA   Community Based              Lease      $618,137           $0      $618,137
                                    Outpatient Clinic.
  16Biloxi                    MS   Restoration Of Hospital/   520-317    $7,051,589           $0    $7,051,589
                                    Consolidation (OV).
  16New Orleans               LA   Restoration/Replacement    629-401    $9,795,425  $13,599,164   $23,394,589
                                    Medical Facility (OV).
  18Mesa                      AZ   Satellite Outpatient         Lease    $4,721,649           $0    $4,721,649
                                    Clinic.
  19Colorado Springs            CO Community-Based              Lease      $847,931           $0      $847,931
                                    Outpatient Clinic
                                    Relocation.
  19Billings                  MT   Satellite Outpatient         Lease    $1,708,731           $0    $1,708,731
                                    Clinic.
  19Denver                      CO Replacement Medical        554-501    $8,982,484     $832,040    $9,814,525
                                    Center Facility (OV).
  20Salem                     OR   Community-Based              Lease    $1,479,486           $0    $1,479,486
                                    Outpatient Clinic.
  20Eugene                    OR   Community-Based              Lease    $5,765,526           $0    $5,765,526
                                    Outpatient Clinic.
  20Seattle                   WA   Correct Seismic            663-406    $9,945,330     $127,171   $10,072,500
                                    Deficiencies B100, NT &
                                    NHCU.
  20Walla Walla               WA   Multi Specialty Care       687-400      $685,808     $351,214    $1,037,022
                                    (Overview).
  21Monterey                    CA Health Care Center......     Lease            $0   $1,136,277    $1,136,277
  21Palo Alto                   CA Centers for Ambulatory     640-424      $100,875   $5,060,925    $5,161,800
                                    Care and Polytrauma
                                    Rehabilitation (OV).
  22Bakersfield                 CA Community-Based              Lease      $264,985     $187,947      $452,932
                                    Outpatient Clinic.
  22Loma Linda                  CA Health Care Center......     Lease    $2,079,918   $3,691,593    $5,771,511
  22Long Beach                  CA Seismic Corrections/       600-402      $622,331           $0      $622,331
                                    Clinical, B-7 & 126.
----------------------------------------------------------------------------------------------------------------
                                   Total...................             $83,247,227  $46,752,773  $130,000,000
----------------------------------------------------------------------------------------------------------------


    B. Please describe the activation costs that fall within the 
Medical Services account and those costs that fall within the Medical 
Facilities account.
    Response. Activation costs are funded by the two appropriations 
based upon what those appropriations are used to purchase. For example, 
if the activation cost was the result of purchasing medical equipment 
or hiring new clinical staff, the Medical Services appropriation would 
be required. If the activation cost was to expand a sidewalk and 
install a wheelchair ramp to make the facility more accessible to 
Veterans with limited mobility, the Medical Facilities appropriation 
would be required.

    Question 145. The Medical Support and Compliance account contains 
funding for VHA central office, Veterans Integrated Service Networks 
(VISN) headquarters offices, and management of the medical centers. 
However, unlike last year's budget request, this year's request does 
not display funding for these three accounts separately.
    a. How much does VA expect to spend in fiscal years 2014 and 2015 
for VISN headquarters functions?
    Response. In the 2014 Congressional submission, VA anticipated 
spending $308 million in 2014 and $297.1 million in 2015. In the 2015 
Congressional submission, the 2014 estimate is revised to $291.6 
million and the 2015 estimate remains at $297.1 million.

    b. How much funding will be saved as a result of implementing VHA's 
staffing reorganization of VISN headquarters?
    Response. VA's 21 Veterans Integrated Service Networks (VISNs) are 
being restructured around a standard staffing structure for each VISN. 
As the result of this initiative, VA estimates savings of $25 million 
each in FY 2014 and FY 2015 in the Medical Support and Compliance 
account.

    c. When does VHA plan to start the second part of the 
reorganization, a review of the number of VISNs? Please provide a 
detailed description of the criteria VHA will use to evaluate whether 
21 VISNs are needed.
    Response. The Under Secretary for Health convened a workgroup on 
April 4, 2013, chartered with reviewing the number and composition of 
VISNs that currently comprise make up the Veterans Health 
Administration. As part of that charter, the workgroup was responsible 
for developing the criteria and methodology that would be used to 
review the size and composition of the VISNs. A copy of the workgroup 
charter follows.



[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]




    Question 146. Section 111 of Honoring America's Veterans and Caring 
for Camp Lejeune Families Act directs VA to develop a plan for recovery 
and collection of amounts for the Department of Veterans Affairs 
Medical Care Collections Fund (MCCF). This section provides a method to 
develop and implement a better process and system of controls to ensure 
accurate and full collections by VHA. Please provide details on VHA's 
efforts to implement section 111.
    Response. Public Law 112-154, Section 111 requires the VA to 
develop and implement a plan no later than 270 days after the date of 
enactment to ensure recovery and collection from Veterans' health 
insurance for medical care and services provided through VA's Fee Basis 
authorities. VA has completed all actions associated with the 
requirements of Section 111 as described below:

     Improved identification of billable fee claims: The VHA 
Chief Business Office chartered a workgroup to reengineer business 
processes that support maximizing the cost recovery of billable fee 
services. The team implemented Standard Operating Procedures to improve 
identification of billable fee claims as part of this effort.
     Training: Training on the identification of billable Fee 
claims was provided to Fee and revenue operations staff using both 
written guidebooks and fact sheets.
     Fee Revenue Goals: Utilizing VA's Integrated Collections 
Forecasting Model (ICFM), goals for Fee revenue were established 
beginning in FY 2012.
     Monitors: Comprehensive monitoring to benchmark 
performance and outcomes was deployed in FY 2012.
     Policies and Procedures for MCCF Recovery: Deployment of 
seven industry best practice Consolidated Patient Account Centers is 
the cornerstone of ensuring long term success in MCCF Recovery. As part 
of this effort, policies and procedures were implemented for all 
revenue cycle functional areas and are continually monitored for 
updates.

    Question 147. The issue of third party payers and MCCF have been 
the subject of a number of government reports over the years. These 
reports were critical of VHA's third party billing and collection 
practices. Because funds deposited in MCCF are retained by the medical 
centers and can be used to treat veterans, it is critical that VHA is 
able to collect all that is owed by third parties.
    A. Please provide the Committee with the total amount VA sought in 
third party billings and the total amount collected from third parties 
for the last six fiscal years.
    Response.
------------------------------------------------------------------------
                                                           Total Third
                      Fiscal Year                        Party Billings
------------------------------------------------------------------------
2007..................................................   $3,325,052,175
2008..................................................   $4,107,259,321
2009..................................................   $5,290,964,587
2010..................................................   $5,490,122,279
2011..................................................   $5,775,314,495
2012..................................................   $5,556,546,698
------------------------------------------------------------------------

    B. Please provide the Committee with the percentage increase in 
billings and collections for each fiscal year compared to the previous 
fiscal year's billing.
    Response.
----------------------------------------------------------------------------------------------------------------
                                                                 Percent (%)                       Percent (%)
                                                Total  Third     Change from      Total  Third     Change from
                 Fiscal Year                  Party  Billings   Prior  Fiscal        Party        Prior  Fiscal
                                                                     Year         Collections          Year
----------------------------------------------------------------------------------------------------------------
2007........................................   $3,325,052,175          --        $1,261,345,593          --
2008........................................   $4,107,259,321       23.52%       $1,497,448,632        18.7%
2009........................................   $5,290,964,587       28.82%       $1,843,201,251        23.1%
2010........................................   $5,490,122,279        3.76%       $1,904,031,955         3.3%
2011........................................   $5,775,314,495        5.19%       $1,799,951,647        -5.5%
2012........................................   $5,556,546,698       -3.79%       $1,847,530,762         2.6%
----------------------------------------------------------------------------------------------------------------


    C. Please provide the Committee with the collection rate for claims 
over $1,000 for the last six fiscal years.
    Response.
------------------------------------------------------------------------
                                                         Collection rate
                      Fiscal Year                       for Claims  over
                                                              $1000
------------------------------------------------------------------------
2007..................................................            44.5%
2008..................................................            42.2%
2009..................................................            40.9%
2010..................................................            39.2%
2011..................................................            35.8%
2012..................................................            36.5%
------------------------------------------------------------------------


    D. Please provide the Committee with the collection rate for claims 
under $1,000 for the last six fiscal years.
    Response.
------------------------------------------------------------------------
                                                         Collection rate
                      Fiscal Year                          for Claims
                                                           under $1000
------------------------------------------------------------------------
2007..................................................            50.3%
2008..................................................            45.1%
2009..................................................            41.3%
2010..................................................            39.5%
2011..................................................            35.5%
2012..................................................            35.5%
------------------------------------------------------------------------


    Question 148. In an explanation of health care benefits provided by 
the Honoring America's Veterans and Caring for Camp Lejeune Families 
Act, VA's budget request indicates ``[i]n 2015 [VA] expects to start 
treating family members'' and this budget, if adopted, would provide 
$25 million to treat Camp Lejeune families. The fiscal year 2013 
Continuing Resolution (CR), signed into law on March 26, 2013, included 
the appropriations and legislative language needed for VHA to treat 
Camp Lejeune family members in fiscal year 2014.
    A. Given that the CR provides the funding and language necessary to 
treat Camp Lejeune families, will VA be able to provide benefits 
earlier than fiscal year 2015? If not, please describe the barriers to 
providing treatment earlier than fiscal year 2015.
    Response. The earliest VA will be able to reimburse family members 
for hospital care or a medical service is dependent on the publication 
of an effective rule to implement the statute
    The family member regulations are currently going through 
Departmental review. Once completed, they will follow the regulatory 
development process established under the Administrative Procedure Act 
and will be submitted to the Office of Management and Budget (OMB) for 
review and approval. Concurrent with the finalization of regulations, 
VA will need to hire additional personnel to administer the family 
member program. VA anticipates that personnel will be hired and that 
other resources needed to implement this program will be in place when 
the regulations are published.
    B. Please describe the regulation drafting process as it pertains 
to providing treatment to Camp Lejeune families, including a timeline 
of when VHA began the drafting process, the stages of the process, when 
the regulations are expected to be final, and what stage in the current 
regulation process are those regulations.
    Response. For family members, VA is expediting its own internal 
regulatory process. The very earliest VA anticipates being able to 
provide benefits to family members is by the start of FY 2015. 
Immediately after enactment of the law, VA assembled a Steering 
Committee, including subject matter and policy experts from the entire 
organization, which made policy decisions regarding providing treatment 
to Camp Lejeune family members.
    The U.S. Marine Corps is preparing a memo to clarify the support it 
and DOD will provide to VA to determine administrative eligibility for 
Veterans and family members. VA has used subject matter expert 
briefings, Internet, social media, and traditional media to proactively 
reach out to stakeholders. Briefings and information papers have been 
provided to members of the Camp Lejeune Community Action Panel, 
concerned Veterans and their family members, Veterans Service 
Organizations, congressional staff, and the media.
Homelessness
    Question 149. A letter from VA, dated February 1, 2012, included a 
timeline of the ``VA Homelessness Reduction Strategy: 2009-2015.'' This 
timeline included decisions regarding increasing or decreasing budget 
requests, reallocating funding, and a decision whether to extend the 
timeline.
    A. When does VA expect to make a decision regarding reallocating 
funding and whether to extend the timeline?
    Response. The January 2013 PIT counts, projected to be released by 
HUD during quarter one of FY 2014, will provide an important snapshot 
of the Administration's progress in ending veteran homelessness.
    Reallocating resources, however, is an ongoing process. VA's 
success in moving toward ending Veteran homelessness is in part due to 
ongoing program evaluation and realignment. VA's ongoing program 
realignment has been a two-pronged approach of focused service 
adjustments and a realignment of resource investment.
    The SSVF Program, for example, is evidence of VA's ongoing efforts 
to realign program services and investments to end Veteran 
homelessness. Although still a relatively new program, it is already 
clear that the SSVF Program has been successful, which warrants 
continued, if not enhanced, investments. The SSVF Program provides 
grants to private non-profit organizations and consumer cooperatives to 
help Veteran families rapidly exit homelessness or to prevent at-risk 
Veterans from becoming homelessness. The SSVF Program is unique in that 
it can serve both the Veteran and his or her family member(s). The SSVF 
Program continues VA's efforts to realign services under a Housing 
First permanent supportive housing model.
    In FY 2012, during the SSVF Program's first full year of 
operations, the program surpassed expectations, serving approximately 
21,500 Veterans and over 35,000 persons. Of those served, 40 percent 
were at?risk for homelessness and seeking prevention services while the 
remaining 60 percent were provided rapid re?housing services to 
transition from homelessness into permanent housing. At the end of FY 
2012, VA awarded 151 SSVF grants in 49 states and the District of 
Columbia for operations in FY 2013.
    In recognition that this community-based resource needed to be more 
geographically available to all communities assisting Veterans and 
their families, VA announced a SSVF NOFA for an additional $300 million 
to further grow this program.
    B. What criteria will VA use to determine whether to decrease 
budget requests, reallocate funding, and make a decision whether to 
extend the timeline?
    Response. VA's budget focuses on preserving funding for mission-
critical and cost effective services that directly benefit Veterans, 
their families, and Survivors, prioritizing programs shown to be 
effective in ending Veteran homelessness. Decisions regarding future 
prioritization will continue to be informed by data from the PIT Count 
in addition to data from VA homeless programs.

    Question 150. In fiscal year 2012, Congress appropriated $1.023 
billion for homeless veterans programs. Please provide the Committee a 
detailed breakdown of how this funding was utilized within these 
programs and the number of veterans who accessed these programs.
    Response. VA operates the largest system of homeless medical, 
treatment, and assistance programs in the Nation. The hallmark of VA's 
programs for homeless Veterans is the provision of comprehensive care 
and benefits including medical, psychiatric, substance use, 
rehabilitation, dental care, and expedited claims processing for these 
Veterans. The following represent many programs included in VA's 
homeless continuum of care. All programs in this continuum are part of 
VA's plan to eliminate homelessness and contribute to the overall 
reduction of the homeless Veteran population.
    Supportive Services for Veteran Families (SSVF) Program: In FY 
2012, VA obligated approximately $100 million in funding for the SSVF 
Program for operations occurring in FY 2013. In FY 2012, the SSVF 
Program served over 35,000 Veterans and their family members based on 
$60 million in SSVF grants awarded in FY 2011. The SSVF Program makes 
available grant funds for private non-profit organizations and consumer 
cooperatives to help very low-income Veteran families rapidly exit 
homelessness or to assist Veteran families at-risk for homelessness. In 
addition to providing linkage to VA health care and other services, 
grantee organizations have the ability to directly address the type of 
emergent needs that, if unmet, can be deciding factors in a family's 
struggle to remain stably housed. Funds for emergency rental 
assistance, security and utility deposits, food and other household 
supplies, child care, one-time car repairs, and other needs will help 
to keep Veterans and their families housed--as families. In 2011, VA 
awarded the first SSVF grants, awarding approximately $60 million to 85 
grantees in 40 states and the District of Columbia for operations in FY 
2012. In FY 2012, SSVF grantees served over 35,000 Veterans and their 
family members, placing nearly 86 percent in permanent housing. In FY 
2012, $100 million was awarded in SSVF grants to 151 community agencies 
in 49 states, Puerto Rico, and the District of Columbia for operations 
in FY 2013. In FY 2013, the SSVF Program anticipates serving at least 
42,000 Veterans and their family members. In early FY 2013, a SSVF NOFA 
was published in the Federal Register, announcing the availability of 
$300 million for FY 2013. The application period closed on February 1, 
2013, and VA is currently reviewing applications.
    Veterans Homelessness Prevention Demonstration (VHPD) Program: In 
FY 2012, VA obligated $1.39 million in funding for VHPD and, during 
this time, VHPD provided services to over 730 Veteran families, of 
which 26 percent were female and 37 percent were OIF/OEF/OND Veterans. 
VHPD (also referred to as the HUD-VA Pilot Program) is designed to 
explore ways for the Federal Government to offer early intervention 
homeless prevention, primarily to Veterans returning from wars in Iraq 
and Afghanistan. This demonstration program provides an opportunity to 
understand the unique needs of a new cohort of Veterans and will 
support efforts to identify, provide outreach to, and assist them in 
regaining and maintaining housing stability. This 3-year HUD-VA 
prevention pilot is a partnership among VA, HUD, the Department of 
Labor (DOL), and local community agencies. VHPD will serve the 
following locations: MacDill Air Force Base in Tampa, Florida; Camp 
Pendleton in San Diego, California; Fort Hood in Killeen, Texas; Fort 
Drum in Watertown, New York; and Joint Base Lewis-McChord near Tacoma, 
Washington. As the lead agency, HUD is awarding grants for the 
provision of housing assistance and supportive services to prevent 
Veterans and their families from becoming homeless or to reduce the 
length of time Veterans and their families are homeless. In 
February 2011, grant agreements were signed by five Continuums of 
Care--regional or local planning bodies that coordinate housing and 
services funding for homeless families and individuals. VHPD sites 
began serving Veterans in March 2011.
    The National Call Center for Homeless Veterans (NCCHV): In FY 2012, 
VA obligated $3.9 million in funding for the NCCHV. The NCCHV received 
80,558 total calls in FY 2012, representing an increase of 123 percent 
over the same time period in FY 2011. The NCCHV was founded to ensure 
that homeless Veterans or Veterans at risk for homelessness have free, 
24/7 access to trained counselors. The hotline is intended to assist 
homeless Veterans and their families; VA medical centers; Federal, 
state, and local partners; community agencies; service providers; and 
others in the community. The NCCHV (877-4AID-VET) was fully implemented 
on March 1, 2010. The NCCHV received 80,558 total calls in FY 2012. Of 
the calls received, 14,386 callers identified as being homeless. The 
NCCHV made 50,608 referrals to VA medical center points of contact in 
FY 2012, representing an increase of 133 percent over the same period 
in FY 2011.
    Veterans Justice Programs: In FY 2012, VA obligated $18.3 million 
for Veterans Justice Programs. As part of VA's Plan to End Veteran 
Homelessness, VA is focused on serving Veterans involved with the 
criminal justice system, who may be homeless or at-risk for 
homelessness. Studies have shown that for adult males, incarceration is 
the most powerful predictor of homelessness. The Health Care for 
Reentry Veterans (HCRV) Program provides outreach and linkage to post-
release services for Veterans in state and Federal prisons. In FY 2012, 
10,572 Veterans were served through the HCRV Program. The Veterans 
Justice Outreach (VJO) Program focuses on Veterans in contact with law 
enforcement, jails, and courts, including the rapidly expanding 
Veterans Treatment Courts. In FY 2012, 27,251 Veterans were served in 
the VJO program.
    Grant and Per Diem (GPD) Program: In FY 2012, VA obligated over 
$208 million in operating funds for the GPD Program and over $26 
million in funding for VA GPD liaisons, who provide services and 
oversight of GPD-funded programs. During this time, over 41,000 
Veterans accessed GPD services. Under the GPD Program, VA offers GPD 
payments to public or non-profit private entities to develop 
transitional housing and supportive services for homeless Veterans. The 
goal of the program is to help homeless Veterans achieve residential 
stability, increase their skill levels and/or income, and obtain 
greater self-determination. VA awarded approximately $28.4 million in 
grants to fund transitional housing projects. Thirty-one of the funded 
projects are a TIP Housing Model, which will provide time-limited 
supportive services to homeless Veterans in which the services 
transition but the Veteran remains in the housing. During this fiscal 
year, VA activated 34 new transitional housing projects that can house 
up to 890 homeless Veterans.
    Over 41,000 Veterans utilized GPD services in FY 2012. There were 
22,148 discharges from GPD in FY 2012 with an average length of stay of 
approximately 183 days. The average cost per admission in GPD was 
$6,465. Approximately 56 percent (12,464) of homeless Veterans 
discharged from GPD moved into independent housing, and approximately 
17 percent were discharged to another treatment setting. Twenty-six 
percent of Veterans discharged were employed at least part-time or were 
participating in VA's Compensated Work Therapy (CWT) Program.
    Health Care for Homeless Veterans (HCHV) Program: In FY 2012, VA 
obligated approximately $119 million in funding for all programs funded 
through the HCHV Program. The HCHV Program is a three-pronged approach 
to eliminating homelessness among Veterans, consisting of contract 
transitional housing services, outreach, and case management. The HCHV 
Program is critical to VA's efforts to reach homeless Veterans living 
on the streets and in need of housing services. The program provides a 
means to contract with community-based residential treatment service 
providers to provide emergency housing and same-day placement of 
homeless Veterans identified in their outreach efforts. HCHV funds 
assist in supporting 16 CRRCs, which provide ``one stop services'' to 
assist homeless Veterans and Veterans and their families at-risk for 
homelessness. In FY 2012, HCHV outreach staff provided services to 
119,878 homeless Veterans. The Contract Residential Treatment component 
of the HCHV Program ensures that Veterans with serious mental health 
diagnoses can be placed in community-based residential treatment 
programs which provide quality housing and services. The HCHV Program 
provides ``in place'' residential treatment beds through contracts with 
community partners and VA outreach and clinical assessments to homeless 
Veterans who have serious psychiatric and substance use disorders. In 
FY 2012, the HCHV Program contracted residential programs provided 
transitional housing to over 11,500 homeless Veterans. The Veterans 
were supported in 3,399 operational beds at 299 sites, system-wide.
    Domiciliary Care for Homeless Veterans (DCHV): In FY 2012, VA 
obligated $19.98 million to the development of five new DCHV programs. 
The DCHV mission is to provide time-limited, state-of-the-art, high 
quality residential rehabilitation and treatment services for homeless 
and at-risk of homeless Veterans with multiple and severe medical 
conditions, mental illness, addiction, or psychosocial deficits. DCHVs 
provide a 24/7 structured and supportive residential environment as 
part of the rehabilitative treatment process. In FY 2012, there were 
2,342 DCHV beds dedicated to the treatment of homeless Veterans, an 
increase of 41 beds from FY 2011. The DCHV programs served 8,389 unique 
Veterans in FY 2012. In FY 2012, 54.8 percent of Veterans were 
discharged to permanent housing. An additional 25 percent of Veterans 
were discharged to another Mental Health Residential Rehabilitation and 
Treatment Program (MH-RRTP), health care institution, or transitional 
housing. Between FY 2007 and FY 2012, the number of homeless Veterans 
served yearly in all MH-RRTP programs increased by 68 percent from 
14,112 to 23,835. In FY 2012, VHA will develop five new DCHV programs 
in Philadelphia, Atlanta, West Palm Beach, Denver, and San Diego. The 
Denver DCHV opened at the end of May 2013. The Atlanta DCHV and the 
Philadelphia DCHV are scheduled to open in November 2013. The San Diego 
DCHV is scheduled to open by May 2014. The West Palm Beach DCHV is 
scheduled to open in 2016 after the construction of a new on-station 
building. VHA has also approved the development of a DCHV in San Juan, 
Puerto Rico, which is scheduled to open in 2015.
    Substance Use Disorder (SUD) Treatment Enhancement Initiative for 
VA Homeless Programs: In FY 2012, VA obligated approximately $3.5 
million for the SUD Treatment Enhancement. VHA's SUD Treatment 
Enhancement Initiative created community-based Homeless SUD Specialist 
positions designed to provide case management and referral services to 
homeless Veterans with SUDs. These specialists assist Veterans in 
obtaining and maintaining housing, increasing access to substance abuse 
treatment, and enhancing opportunities for recovery. In FY 2012, this 
initiative funded a total of 47 SUD Specialists at targeted sites 
around the country, providing critical services to 8,390 homeless 
Veterans.
    HUD-VASH Program: VA obligated $169.9 million for the HUD-VASH 
program during FY 2012, housing over 37,000 Veterans in this program. 
HUD-VASH is a collaborative program between HUD and VA for eligible 
homeless Veterans to receive a HUD-provided Housing Choice voucher and 
VA-provided case management and supportive services to support 
stability and recovery from homelessness. Case management services 
ensure the Veteran is able to obtain and sustain in permanent housing, 
thus exiting from homelessness. These case management services also 
ensure a wide menu of choices so the Veteran may care for his or her 
physical and mental health and SUDs as well as promote integration into 
the Veteran's chosen community. As of September 30, 2012, 44,020 HUD-
VASH vouchers were in use and 37,591 Veterans were housed through this 
program.
    Homeless Veterans Dental Initiative (HVDI): In FY 2012, 119 
participating VA facilities reported that 14,114 Veterans received 
dental care through the HVDI's total FY 2012 obligations of $27.3 
million. HVDI is jointly funded by VHA Homeless Programs and the Office 
of Dentistry. This initiative enhances the accessibility of quality 
dental care to homeless Veteran patients to help ensure success in VHA-
sponsored and VA partnership homeless rehabilitation programs. The HVDI 
facilitates the provision of limited outpatient benefits for a one-time 
course of dental care for VA health care eligible Veterans who are 
enrolled for at least 60 days in the following programs: GPD, DCHV, 
CWT--Transitional Residence (CWT-TR), Healthcare for Homeless Veterans 
Contract Residential Treatment, and Community Residential Care.
    Homeless Veteran Supported Employment Program (HVSEP): In FY 2012, 
VA obligated approximately $25 million for HVSEP and provided 
employment services to 12,815 Veterans. Homeless and at-risk Veterans 
need access to employment opportunities to support their housing needs, 
improve the quality of their lives, and assist in their community 
reintegration efforts. VA has committed to supporting this critical 
component to eliminating homelessness through HVSEP. HVSEP, jointly 
operated by CWT and VHA Homeless Programs, provides vocational 
assistance, job development, job placement, and ongoing employment 
supports to improve employment outcomes among homeless Veterans. 
Vocational and employment services are based on rapid engagement, 
customized job development, and competitive community placement with 
ongoing supports for maintaining employment.
    National Homeless Registry: In FY 2012, VA obligated $7.2 million 
in funding for the National Homeless Registry. Although not a program 
itself, VA's comprehensive National Homeless Registry is intended to 
track and monitor treatment outcomes in homeless program expansion and 
prevention initiatives. The Registry serves as a data warehouse and 
enhances VA's capability to monitor program effectiveness and the long-
term outcomes of Veterans who have utilized VA-funded homeless 
services. The Registry is currently populated with over 500,000 names 
of current and formerly homeless Veterans who have utilized VA's 
homeless programs. VHA will continue to refine its Registry to fully 
capture the scope of the homeless Veteran population, monitor treatment 
outcomes, and access to VA services.

    Question 151. The fiscal year 2013 budget request included $21 
million for 200 additional FTE to be Homeless Veterans Outreach 
Coordinators (HVOC) in VBA. Please provide the Committee with an update 
on the hiring status of the additional 200 HVOCs, where the additional 
HVOCs will be located, and when VA expects to have completed the hiring 
of additional HVOCs.
    Response. The FY 2013 President's Budget, submitted to Congress in 
February 2012, included a request for an increase of $21 million and 
200 FTE to serve as Homeless Veterans Outreach Coordinators (HVOCs) at 
the ROs. Homeless Veterans Outreach is one of several integrated 
programs woven into the Department's six strategies outlined in its 5-
year plan to end homelessness among Veterans--outreach/education, 
treatment, prevention, housing/supportive services, income/employment/
benefits, and community partnership--that encompass a wide continuum of 
interventions and services.
    By the summer of 2012, assessments of the Department's homelessness 
program indicated that existing outreach efforts were proving 
successful, as evidenced by a 58 percent increase in the number of 
claims received from homeless or at-risk Veterans. Concurrently, the 
C&P inventory pending more than 125 days was increasing rather than 
diminishing. As a result of this combination of factors, the Secretary 
decided in the Fall of 2012 to reprioritize the HVOC resources and 
allow them to be invested toward reducing the claims backlog.

    Question 152. The fiscal year 2014 budget request includes $1.393 
billion for fiscal year 2014 and $1.0 billion for fiscal year 2015 for 
homeless veterans programs. The fiscal year 2015 advance appropriation 
request includes the funding of several programs being eliminated, 
including Domiciliary Care for Homeless Vets-Initiative, Substance 
Abuse/Mental Health Enhancement, Expansion of Homeless Dental 
Initiative, Homeless Veterans Supported Employment Program, and 
Homeless Therapy Employment, Compensated Work Thearpy (CWT) & CWT/TR-
Sustainment.
    A. What metrics were used to determine that these programs were no 
longer needed in fiscal year 2015?
    Response. As VA's plan to end Veteran homelessness nears 2015, VA 
is gradually reducing funding for certain programs, moving other 
programs to sustainment, and generally realigning resources to preserve 
key homeless services for the long term. To this end, funding for 
several programs will be eliminated from VA's homeless programs budget 
in FY 2015. The programs and services are still being provided through 
local VA medical centers and funded through different mechanisms than 
specific program budget line items. VA's homeless programs budget 
focuses on preserving funding for absolutely necessary and mission-
critical services, prioritizing programs shown to be effective in 
ending Veteran homelessness. The rationale behind these budget 
decisions is outlined below. As VA considered these budget decisions, 
VA chose to fund many of these eliminated programs through the Veterans 
Equitable Resource Allocation (VERA) model. VA funds each VISN using 
the VERA model, a capitated funding model that allows equitable 
distribution of patient care, education, and research funding based on 
patient workload with an adjustment factor for geographic location. In 
summary, the decision to eliminate these program line items from VA's 
homeless programs budget was functional and fiscal in nature rather 
than performance/metrics-driven. The rationale behind these decisions 
are as follows:

     DCHV: Currently, there are 42 DCHV programs across the 
country. VA's plan to end Veteran homelessness called for the 
implementation of five new DCHV programs in Philadelphia, Atlanta, West 
Palm Beach, Denver, and San Diego. By design, DCHV programs throughout 
the country are funded primarily through VA's VERA model. The funding 
eliminated in FY 2015 specifically supported the implementation of 
these five new DCHV programs. It is expected that development and 
implementation efforts will be completed by FY 2015 and that ongoing 
operations can be funded through VERA along with all the other DCHV 
programs.
     Substance Abuse/Mental Health Enhancement: This initiative 
supported the creation of 47 Homeless Program Substance Use Disorder 
Specialists nationally. Since the inception of the enhancement, VA 
intended that funding for these positions would be shifted to VERA, 
consistent with the majority of SUD services offered by VA. These 
positions theoretically join the existing pool of SUD service providers 
in VA's system, thus ensuring the sustainability of such services for 
homeless Veterans.
     Homeless Dental Initiative: Homeless Dental Initiative 
funding is an enhancement to existing VA dental programs serving 
homeless Veterans. During a time of budget constraints, VA decided to 
eliminate this funding enhancement because dental services do not in 
and of themselves end homelessness. In order to preserve funding for 
and focus on the absolutely necessary and mission-critical services, VA 
eliminated enhanced dental funding in VA's homeless program budget. 
Currently, VHA Dental Services allocates approximately $17 million for 
the dental care of eligible Veterans who are enrolled for at least 60 
days in the following programs: GPD, DCHV, CWT-TR, HCHV Contract 
Residential Treatment, and Community Residential Care.
     HVSEP: From its inception, HVSEP was intended to 
transition from an initiative funded through VA homeless programs to 
the VERA system by its fourth year of operation. This transition is a 
strategic decision and is not a reflection on its value as a program. 
In fact, VHA Homeless Programs Office is currently working on ways to 
expand employment services to homeless Veterans through its ongoing 
programs as well as through non-homeless programs such as CWT and 
through enhanced use of community-based employment resources. This 
expanded focus on employment is in recognition of the critical role 
employment plays in helping Veterans' exit or preventing homelessness.
     CWT and CWT/TR--Sustainment: CWT and CWT/TR are funded 
through VERA and, thus, these services will be sustained despite any 
changes in funding within the VHA Homeless Programs Office.

    B. If VA does not meet its goal of reducing the number of homeless 
veterans from 62,619 in 2012 to 47,000 in 2013, how will this impact 
the funding requested for fiscal year 2015?
    Response. VA has already had significant and measurable success in 
ending Veteran homelessness. Based on HUD PIT Count, as available at 
the time of the FY 2014 Budget hearing, from January 2009 to January 
2012, the number of Veterans experiencing homelessness on a single 
night has decreased 17.2 percent (from 75,609 to 62,619), a reduction 
that occurred in a particularly challenging economic environment. The 
PIT Count is a count of sheltered and unsheltered homeless persons on a 
single night in January and is intended to be a snap shot in time. 
Consequently, it is important to note that in the event VA does not 
meet the PIT Count benchmark reduction to 47,000 homeless Veterans in 
FY 2013 (as measured in the January 2014 PIT Count), this does not mean 
VA is not on track to end Veteran homelessness.
    VA and HUD data sources inform the resource allocation and 
investment process for VA's homelessness programs. Programs such as 
SSVF and HUD-VASH, which are focused on both homeless prevention and 
permanent supportive housing, are critical to accelerating VA's 
progress in connecting Veterans to permanent supportive housing and 
providing crucial supportive services. For example, VA sees an urgent 
need for continued reinvestment in the HUD-VASH Program. To achieve 
more rapid engagement with chronically homeless Veterans, an additional 
10,000 vouchers with funding for long term case management services in 
FY 2015 will likely be needed to serve the most vulnerable homeless 
Veterans. Finishing the job of ending Veteran homelessness will require 
continued investment in Veteran-centric housing and health programs, 
the widespread adoption of evidence-based best practices such as 
Housing First, and resources that ensure that Veterans receive the 
proper treatment to achieve the best housing, income, and treatment 
outcomes.
    Finally, despite the comprehensive array of services and programs 
already proposed in VA's budget, VA cannot directly address all the 
needs of homeless Veterans and their dependents. If VA is to end 
Veteran homelessness, VA must continue to cultivate strong and 
productive relationships within the community. Veterans, their 
partners, and their dependent children have a number of unmet health 
care needs directly related to their housing instability, including: 
emergency cash assistance, temporary housing for family members 
separate from the Veteran, transportation, affordable housing, move in 
kits and supplies, and legal services. These are all essential 
resources that in many cases, VA cannot directly provide to homeless 
Veterans and their families. Continued coordination with Federal, 
state, local, faith-based, philanthropic, and Veterans Service 
Organizations is vital for connecting all Veterans and their families 
with the housing and supports needed to prevent and end Veteran 
homelessness.

    Question 153. In December 2011, VA signed 38 leases creating a 
public-private partnership to develop housing units for homeless 
veterans. Through the Building Utilization Review and Repurposing 
(BURR) initiative, VA identified unused or underutilized property which 
would create an additional 4,100 housing units.
    A. How many additional units of housing were available through this 
program in fiscal year 2012 and how many will be available by the end 
of fiscal year 2013?
    Response. The 38 enhanced-use lease (EUL) agreements signed in 
December 2011 as part of the BURR initiative created public/private 
partnerships whereby EUL lessee/developers, in exchange for a long-term 
leasehold interest in underutilized or vacant VA land and/or buildings, 
are responsible for the design, construction, operation, and on-going 
maintenance of supportive housing for homeless or at-risk Veterans. 
During FY 2012, all 38 projects were still in the design and/or 
construction phase; as a result, no new units went into operations 
during FY 2012.
    VA currently anticipates that 135 units will be placed into 
operations by the close of FY 2013 as a result of BURR EUL agreements. 
In addition, 258 units of supportive housing have or will become 
operational during FY 2013 as a result of three recent EUL agreements 
signed independently of the BURR initiative.
    B. What are the lessons learned from the leases that were executed 
in 2011 and how will these lessons learned be implemented to improve 
this program in the future?
    Response. The chief lesson learned from the BURR initiative 
concerns the inter-dependency between capital and operational 
financing. In many cases, state housing finance agencies (the entities 
responsible for dispersing Federal low-income housing tax credits 
(LIHTCs)) and investors (e.g., LIHTC syndicators) are unwilling to 
close on capital financing until developers have secured commitments of 
operational financing (e.g., rental subsidies like project-based HUD-
VASH or Section 8 vouchers). Capital financing must be finalized before 
construction can begin, and construction on these facilities typically 
takes a minimum of twelve months--often longer. However, the entities 
responsible for dispersing operational financing and subsidies (e.g., 
local Public Housing Authorities) are often unable to make commitments 
of operational support this far in advance. This creates a `Catch-22' 
of sorts for developers (like the BURR EUL lessees) who are attempting 
to leverage LIHTCs to create permanent affordable supportive housing 
for highly-vulnerable individuals, such as homeless Veterans.
    VA has been coordinating with HUD in an effort to identify 
solutions to this ``Catch-22''; currently, both agencies are hopeful 
that some mitigating measures have been identified. Going forward, VA 
will continue to coordinate with HUD, in an effort to identify these 
sorts of issues in advance, and to proactively generate solutions.
    C. What are the barriers identified that caused delays in these 
projects moving forward?
    Response. While the factors that have caused delays to some of the 
BURR projects' schedules are ultimately unique to each project, it is 
possible to categorize most of these sources of delays under three 
broad headings: (i) financing, (ii) local opposition, and (iii) 
unforeseen environmental/historical conditions. (i) Financing delays 
sometimes take the form of the Catch-22 described in response to 
Question 153(B) above, but other types of financing-related delays have 
impacted the BURR EUL projects as well. For instance: two states (Maine 
and Massachusetts) suspended housing finance programs during 2012, 
causing developers on three projects to have to await at least a year 
longer to apply for financing. In other cases, developers submitted 
applications for competitively-awarded tax credits, and simply were not 
awarded any--thereby requiring the developers to apply in the following 
year's cycle. (ii) Due to the nature of the contemplated housing 
facilities, EUL developer/lessees frequently face `Not In My Backyard' 
(`NIMBY') opposition from local residents and municipalities.. (iii) 
Finally, the consultation processes required pursuant to Federal 
environmental and historic preservation regulations, for example (the 
National Environmental Protection Act and the National Historic 
Preservation Act (NHPA), respectively) can uncover unforeseen issues 
which result in delays. For example: compliance with Section 106 of the 
NHPA often requires VA to perform archaeological surveys at EUL sites 
before construction can begin. These surveys can be lengthy, and 
furthermore they sometimes recommend follow-up studies or mitigation 
measures which are themselves costly and time-consuming.
Veterans Transportation Service
    Question 154. The Dignified Burial and Other Veterans' Benefits 
Improvement Act of 2012 provides VA with authority to transport 
veterans to or from a VA facility or other locations that provide other 
services, such as vocational rehabilitation, counseling, and health 
services.
    A. Please provide the Committee with which VA medical facilities 
are providing transportation through this authority.
    Response. Please see table below.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



    B. Please provide any analyses conducted to determine the need for 
this program.
    Response:
Challenges
    VTS was conceived with the goal of providing safe, reliable, and 
efficient transportation for Veterans to VA health care, especially 
those who are mobility impaired; suffered a Traumatic Brain Injury; 
severe PTSD, or other medical and mental health problems which make 
self-arranged transportation difficult or who reside in rural areas 
which lack public transportation. In the two years since, its 
inception, Veterans have increasingly relied on VTS transportation 
services. With almost 75% of the VTS sites depending on paid drivers 
for over 50% of Veterans' rides.
Volunteer Drivers
    While 48% of VTS facilities rely exclusively on VA staff to 
transport Veterans, most facilities use a combination of paid and 
volunteer drivers. The Disabled American Veterans organization (DAV) 
has long been a very positive contributor to Veterans receiving needed 
health care. In 2011, through the Volunteer Transportation Network 
(VTN) 702,867 Veterans were provided transportation to and from VA 
health care facilities. However, with increasing numbers of 
transportation disadvantaged Veterans, the number of volunteer drivers 
at most VA medical centers does not meet Veterans' transportation 
needs. Volunteer drivers are generally precluded from transporting 
Veterans who are not ambulatory, require portable oxygen or have 
significant medical issues. Additionally, some volunteers, for valid 
reasons, are reluctant to transport non-ambulatory or very ill 
Veterans. Across the country, VTS transportation requests surpass the 
capacity of the VTN.
Beneficiary Travel Program
    VA's Beneficiary Travel (BT)Program, as part of VA Medical Care 
Benefits, provides mileage reimbursement at $0.415 per mile, common 
carrier (plane, boat, taxi, bus etc.) transportation, and when 
medically indicated special mode (ambulance, wheelchair van etc.) 
transport to low-income or disabled Veterans for travel to receive 
treatment, care or services at VA or VA authorized medical facilities. 
VA may also provide or reimburse for the actual cost of bridge tolls, 
road and tunnel tolls, parking, and authorized luggage fees when 
supported by a receipt. BT eligibility is based upon receipt of VA 
service connection and/or low income (VA pension thresholds). 
Approximately 3.3 million of 5.5 million current VHA users are eligible 
for BT; however, only 1.3 million of those utilize the benefit. Some 
eligible Veterans choose not to use the benefit for personal reasons; 
however, others have noted inability to drive to appointments, limited 
or no local (common carrier) transportation services meeting their 
needs, and not meeting medical need for special mode transport at VA 
expense. Veterans without BT eligibility have noted similar issues. VTS 
allows access for many of these Veterans and anecdotal evidence 
indicates BT mileage costs are reduced when veterans are transported on 
a VTS vehicle or use a common carrier. Additional anecdotal evidence 
indicates BT special mode costs are also reduced when VTS provides 
transportation rather than VA purchased community special mode 
transport services. A decrease in available VTS services will likely 
require a return of many BT eligible Veterans to some form of that 
program.
Community Transportation Resources
    The VTS Program has funded Mobility Manager positions at facilities 
to identify available community transportation resources and to create 
partnerships among transportation providers in their region, so as to 
expand the range of viable options that Veterans have for 
transportation. To date, VA has trained 47 Mobility Managers. 
Additional training sessions have been scheduled for July and 
August 2012; however, 18 facilities have not yet filled their Mobility 
Manager positions.
    Coordination of transportation services is challenging due to 
differences in local, state, and Federal program requirements. Often, 
program rules are unclear about coordination of transportation services 
between different entities.
    Programs may also have statutory or regulatory barriers related to 
sharing costs or have differences in service requirements and 
eligibility. For example, VA only has authority to provide 
transportation at VA expense to certain qualifying Veterans and non-
Veterans in relation to VA health care: not all beneficiaries are 
eligible and there is no authority for transport of non-beneficiaries. 
HHS's Medicaid program is the largest source of Federal funds for non-
emergency medical transportation for qualified low-income 
beneficiaries; however, barriers to transportation coordination for 
Medicaid grantees exists due to concerns about commingling Federal 
program funds and the potential for fraud. In addition, local community 
providers often have policies that impose income criteria or limit 
transportation to certain geographic areas, such as within county 
lines.
    VTS analysis comprised environmental surveys which yielded the 
following results:

    Canceled appointments and missed opportunities are a high cost to 
the system:

     Resource utilization
     Lack of timely care causes health complication and 
spiraling costs

    Targeted VTS toward clinics with high Missed Opportunities:

     Temple TX demonstrated over 4% reduction in tracked 
clinics

    VTS Veteran Survey results:

     Veterans using VTS indicate they have previously missed 
health care appointments due to transportation problems
     25% of respondents (397/1591) indicated VTS was 
responsible for meeting appointment time
Readjustment Counseling Service
    Question 155. Public Law 111-163, the Caregivers and Veterans 
Omnibus Health Services Act of 2010, provided VA with the authority to 
provide services through the Readjustment Counseling Service (Vet 
Center) Program to members of the Armed Forces and members of the Guard 
and Reserve who served in Operation Enduring Freedom, Operation Iraqi 
Freedom, and Operation New Dawn.
    A. What is the status of implementing this provision? What are the 
barriers VA is facing to providing services to members of the Armed 
Forces under this law?
    Response. VA and DOD are currently in the final stages of the joint 
regulatory process that was required in Section 401 of Public Law 111-
163. Implementation is expected immediately after OMB's approval of the 
proposed rule, public comment, and the publishing of the final rule.
    B. Once this provision is fully implemented, does VA anticipate an 
increase in funding will be needed due to the program expansion?
    Response. In anticipation of the implementation of section 401 of 
Public Law 111-163, VA has requested an increase in FY 2014 funding to 
Readjustment Counseling Service for expansion of Vet Center services to 
certain active duty Servicemembers.

    Question 156. The fiscal year 2013 National Defense Authorization 
Act (NDAA) included the Mental Health ACCESS provision, which expands 
the eligibility criteria for those who are eligible to receive services 
at Vet Centers. Does the fiscal year 2014 budget request take into 
consideration the costs associated with the implementation of the 
Mental Health ACCESS provision within the 2013 NDAA regarding the 
expansion of the Vet Center program?
    Response. Yes, VA's budget request includes resources to support 
this provision, estimated at $4.8 million in FY 2014.
Medical and Prosthetic Research
    Question 157. According to VA, in 2011, 89 percent of VA facilities 
offered Complementary and Alternative Medicine to address physical and 
mental health conditions.
    A. Please provide the Committee with a list of facilities that 
currently provide Complementary and Alternative Medicine and what 
facilities offer these treatments for mental health conditions.
    Response. The attachment below contains a list of VHA facilities 
that currently provide CAM services.
Complementary and Alternative Medicine (CAM) Modalities Provided at VA 
                     by VA staff or non-VA Staff *
    as Noted in the Healthcare Analysis & Information Group (HAIG) 
           2011 Complementary and Alternative Medicine Report
         http://shfwire.com/files/pdfs/2011CAM_FinalReport.pdf
Bedford, MA 518
Manchester, NH 608
Northampton, MA 631
Providence, RI 650
Togus, ME 402
White River Junction, VT 405
VA Boston HCS 523
VA Connecticut HCS 689
Albany, NY 528A8
Bath, NY** 528A6
Canandaigua, NY 528A5
Syracuse, NY 528A7
Batavia, NY (VA Western New York HCS)*** 528A4
Buffalo, NY (VA Western New York HCS) 528
Bronx, NY 526
Northport, NY 632
VA Hudson Valley HCS 620
VA New Jersey HCS 561
Brooklyn, NY (VA New York Harbor HCS)** 630A4
New York, NY (VA New York Harbor HCS) 630
St. Albans-Queens, NY (VA New York Harbor HCS)** 630A5
Altoona, PA** 503
Butler, PA*** 529
Clarksburg, WV*** 540
Coatesville, PA 542
Erie, PA 562
Lebanon, PA** 595
Philadelphia, PA 642
Wilkes-Barre, PA* 693
Wilmington, DE 460
VA Pittsburgh HCS 646
Martinsburg, WV* 613
Washington, DC 688
Baltimore, MD (VA Maryland HCS)* 512
Fort Howard, MD (VA Maryland HCS)** 512A4
Perry Point, MD (VA Maryland HCS)*** 512A5
Asheville, NC 637
Beckley, WV** 517
Durham, NC 558
Fayetteville, NC 565
Hampton, VA 590
Richmond, VA 652
Salem, VA 658
Salisbury, NC 659
Atlanta, GA 508
Augusta, GA 509
Birmingham, AL 521
Charleston, SC 534
Columbia, SC 544
Dublin, GA 557
Tuscaloosa, AL 679
VA Central Alabama HCS* 619
Bay Pines, FL 516
Miami, FL 546
Orlando, FL* 675
San Juan, PR 672
Tampa, FL 673
West Palm Beach, FL 548
VA N. FL/S. GA Veterans HCS 573
Huntington, WV 581
Louisville, KY* 603
Lexington (Leestown), KY*** 596
Lexington (Cooper Dr.), KY* 596A4
Memphis, TN 614
Mountain Home, TN 621
VA Tennessee Valley HCS 626
Chillicothe, OH 538
Cincinnati, OH 539
Cleveland (Wade Park), OH* 541
Cleveland (Brecksville), OH** 541A0
Columbus, OH /OC/ 757
Dayton, OH 552
Battle Creek, MI 515
Detroit, MI 553
Indianapolis, IN 583
Saginaw, MI* 655
VA Ann Arbor HCS 506
VA Illiana HCS 550
VA Northern Indiana HCS 610
Hines, IL 578
Iron Mountain, MI** 585
Madison, WI* 607
Milwaukee, WI 695
North Chicago, IL 556
Tomah, WI 676
VA Chicago HCS 537
Columbia, MO* 589A4
Kansas City, MO 589
Marion, IL** 657A5
Poplar Bluff, MO* 657A4
St. Louis, MO* 657
Wichita, KS 589A7
VA Eastern Kansas HCS 589A5
Alexandria, LA 502
Fayetteville, AR 564 X X X X X X X X X X X X
Houston, TX 580 X X X X X X X X X X X
Jackson, MS 586 X X X X X X X X X
Muskogee, OK 623 X X X X X X X X X
New Orleans, LA* 629 X X X X X X X X X
Oklahoma City, OK* 635 X X X X X X X X
Shreveport, LA 667 X X X X X X X X X X X X
VA Central Arkansas HCS 598 X X X X X X X X X X X X X X X X X X X X
VA Gulf Coast HCS* 520
VA Central Texas HCS* 674
Bonham, TX (VA North Texas HCS)** 549A4
Dallas, TX (VA North Texas HCS) 549
VA South Texas HCS 671
Phoenix, AZ 644
El Paso VA HCS** 756
VA Amarillo HCS 504
VA New Mexico HCS 501
VA Northern Arizona HCS 649
VA Southern Arizona HCS 678
VA TX Valley Coastal Bend* 740
VA West Texas HCS* 519
Cheyenne, WY 442
Grand Junction, CO* 575
Sheridan, WY 666
VA Salt Lake City HCS 660
VA Sourhern Colorado HCS*** 554GD
Denver, CO (VA Eastern Colorado HCS) 554
VA Montana HCS*** 436
Boise, ID 531
Portland, OR 648
Spokane, WA*** 668
Walla Walla, WA 687
White City, OR /Ind Dom/* 692
VA Alaska HCS* 463
VA Roseburg HCS 653
VA Puget Sound HCS 663
Honolulu, HI 459
Manila, PI*** 358
San Francisco, CA 662
VA Central California HCS 570
VA Northern California HCS 612
VA Sierra Nevada HCS 654
Livermore, CA (VA Palo Alto HCS)** 640A4
Palo Alto, CA (VA Palo Alto HCS)
Loma Linda, CA 605
VA San Diego HCS 664
VA Southern Nevada HCS 593
VA Greater Los Angeles HCS 691
VA Long Beach HCS* 600
Fargo, ND** 437
Iowa City, IA 636A8
Minneapolis, MN 618
Sioux Falls, SD** 438
St. Cloud, MN 656
VA Black Hills HCS 568
VA Central Iowa HCS 636A6
VA Nebraska-W Iowa HCS*** 636

[References to *, **, and *** were not provided with this worksheet.]

    B. Please provide the Committee with a list of current and 
completed research studies on the efficacy of Complementary and 
Alternative Medicine for treatment of mental health conditions.
    Response. See attached CAM Studies spreadsheet.


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    Question 158. For the last few years, VA has been transforming the 
way health care is provided to veterans. A part of this transformation 
is the Patient-Center Care (PCC) model that VA is currently 
implementing. This ``approach to healthcare * * * prioritizes the 
Veteran and his/her values, and partners with him/her to create a 
personalized strategy to optimize their health, healing, and well-
being.''
    A. Please provide the Committee with a list of research studies 
that were used to define the PCC model.
    Response. Patient Centered Care (PCC) is a fundamental shift in the 
U.S. medical model and a cultural transformation in the way health care 
is delivered. There is not one single, specific model, but rather this 
approach is based on significant research from both within and outside 
VA. VHA charged the Universal Services Taskforce to review the evidence 
supporting the PCC Model. These findings were described in the 2009 
Universal Services Taskforce Report, ``Veterans Health Care: Leading 
the Way to Excellence.'' Consultation was obtained from the Institute 
of Medicine (IOM), Booz Allen Hamilton, Kaiser Permanente, the Samueli 
Institute, the American Nurses Credentialing Center (ANCC), and most 
recently the Planetree Organization has worked VHA. Notably, the Task 
Force reported that ``Numerous organizations have constructed 
supporting evidence and/or PCC delivery models.'' Among those 
Planetree, Picker, and the Institute for Family-Centered Care have 
surfaced as leaders in PCC through research and publication. Although 
each of these organization's models have distinctions, meta-analysis 
notes important areas of equivalence among leading organizations in 
their definitions, guiding principles and common themes (Shaller, 
2007), which are consistent with the approaches utilized by VHA.
    In addition, the Institute of Medicine (IOM) was established by the 
National Academy of Sciences to secure services of eminent members of 
appropriate professions to examine policy matters pertaining to the 
health of the public. IOM also serves as an advisor to Federal agencies 
and released two seminal reports informing the VHA PCC approach. The 
elements of the PCC approach, however, are rooted in the research and 
recommendations of the 2001 IOM Report, ``Crossing the Quality Chasm: A 
New Health System for the 21st Century,'' at http://iom.edu//media/
Files/Report%20Files/2001/Crossing-the-Quality-Chasm/
Quality%20Chasm%202001 %20%20report%20brief.pdf.
    In this report, IOM called for health care to transform from care 
based on visits, where professional autonomy drives variability and the 
professionals control care to one that is based on ``continuous healing 
relationships,'' ``care that is customized according to patient needs 
and values,'' and care where ``the patient is the source of control.'' 
These recommendations, as well as those of the IOM ``Summit on 
Integrative Medicine & the Health of the Public: Issue Background & 
Overview,'' have informed the key elements of the VHA PCC approach. 
(The IOM Summit report can be found at http://www.iom.edu//media/
Files/Activity%20Files/Quality/Integrative Med/
IM20Summit20Background20Paper20Weisfeld2022309.pdf.) The specific ways 
in which these key elements can and should be delivered are varied and 
are being developed and piloted in many different settings. Evidence 
continues to emerge supporting the PCC model as described by the Nuka 
System of Care (Gottlieb, 2013) and the Group Health Cooperative 
(Greene, 2012).

    B. What performance measurements are being used to determine the 
effectiveness of the PCC model and whether any improvements are needed 
to the model?
    Response. Given that this is a shift in the overall approach to 
health and health care, which truly constitutes a cultural 
transformation and not a specific model, the true outcomes will 
ultimately be improvement in the health and well-being of our Veterans. 
VA is committed to ongoing evaluation and adaption of these approaches 
and, as such, has several research initiatives underway.
    Since 2006, VA has used the Survey of Healthcare Experiences of 
Patients (SHEP) to track patient satisfaction. Currently, VA has 6 
composites within SHEP as it relates to this model (see attachment 
below). Since this tool does not sufficiently capture the impact of 
this new medical model, VA is in the process of developing and 
validating measurement tools to accurately reflect outcomes of patient 
centered care. The frameworks were reviewed by an expert panel of 
researchers and administrators involved in the development and adoption 
of patient-centered care across the organization. Measurement experts 
will determine which elements within each framework will be measured at 
the level of patients, providers, and/or facilities.
    It is expected that the measurement tool will be developed by 
September 2013 and that patient, provider, and facility level data will 
be obtained in 2014. Data from these tools will be analyzed to further 
refine the tools and serve as initial assessments of the implementation 
and outcomes associated with PCC.



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    Question 159. One of VA's major goals for VA Research and 
Development is the Million Veteran Program; this program collects 
genetic samples and general health information of veterans. How much 
does VA expect to spend on this research project in fiscal year 2014?
    Response. As of April 23, 2013, 153,803 Veterans have enrolled. 
They accomplished this by signing consent and Health Insurance 
Portability and Accountability Act (HIPAA) forms and providing a blood 
sample. Another 213,180 Veterans have completed the Baseline Survey and 
are awaiting appointments to fill out consent paperwork and conduct a 
blood draw. The FY 2014 Million Veteran Program (MVP) spending is 
projected to be $23.214 million.
    Our initial projections were that it would take 5 to 7 years to 
enroll 1,000,000 Veterans, reaching a maximum enrollment of 225,000 per 
year by the end of the study. Overall, we have found that enrolling 
younger Veterans at VA medical centers is more difficult than expected, 
and there are other administrative considerations as well. For this 
reason, we are currently exploring alternative methods such as Web-
enrollment. Further, in order to make enrollment possible for all 
Veterans nationwide, including those in rural areas, we are exploring 
mechanisms that do not require a visit to a VA hospital to donate a 
blood specimen.
    All MVP enrollees sign an informed consent form and a HIPAA 
authorization form. They agree to allow access to their medical records 
on an ongoing basis and add that information to the VA Central Research 
Data base so that approved MVP researchers can follow their health and 
care for as long as they are alive. If the MVP enrollee participates or 
has participated in any other VA studies, he or she gives permission to 
access data from these studies and add that data to the VA Central 
Research Data base. MVP enrollees also agree to donate a blood sample 
that will be used for future studies related to characteristics of 
health or any disease, illness, or condition. MVP enrollees also agree 
to future contact by MVP staff.
    The samples and/or medical information will be available to 
approved researchers in a coded manner at VA, other Federal health 
agencies, and academic institutions within the United States for 
research projects approved by appropriate VA oversight committees. VA 
takes precautions to protect this data, consistent both within VA and 
during any approved sharing with other Federal entities or approved 
academic institutions.
Rural Health
    Question 160. In fiscal year 2012, the Office of Rural Health was 
appropriated approximately $248 million; please provide the Committee 
with a detailed description of how this funding was utilized.
    Response. In FY 2012, the Office of Rural Health funds were 
distributed to VISNs and VA Central Office program offices to support 
new projects, sustain existing projects, and expand existing projects. 
Over 400 projects were funded and were allocated to the following 
activities:

Project ARCH Fee Care Pilot*......................................$26.8M
Access and Quality: transportation, outreach clinics, mobile 
    clinics.......................................................$34.3M
Community Based Outpatient Clinics................................$77.8M
Collaboration and Outreach: rural Veteran outreach program, mobile
Veteran centers, education of rural clergy........................$11.6M
Geriatrics: stroke, caregivers support for demented Veterans......$43.5M
Homelessness...................................................... $0.6M
Mental Health: Post Traumatic Stress Disorder, Traumatic Brain 
    Injury........................................................$13.2M
Specialty Care: Cardiology, Audiology, Prosthetics, Optometry, 
    Radiology, Dermatology........................................ $7.6M
Telehealth and New Models of Care.................................$28.8M
Training and Education............................................ $3.1M
Women Veterans.................................................... $1.2M
                                                                  ______
    Total........................................................$248.5M
                        =================================================================
                        ________________________________________________
---------------------------------------------------------------------------
* Project Access Received Closer to Home (ARCH) is a 3-year pilot 
program in five of the VISNs designed to provide Veterans with health 
care services closer to where they live. It implements Section 403 of 
P.L. 110-387: The Veterans' Mental Health and Other Care Improvements 
Act of 2008 and was amended by Section 308 of P.L. 111-163, the 
Caregivers and Veterans Omnibus Health Services Act of 2010. Each of the 
five pilot sites identified services that are most needed by the VHA-
enrolled Veterans in that region. Through Project ARCH, two sites 
provide primary care services (VISN 6--Farmville, Virginia, and VISN 
15--Pratt, Kansas) and three sites offer specialty care services (VISN 
1--Northern Maine; VISN 18--Flagstaff, Arizona; and VISN 19--Billings, 
Montana).
---------------------------------------------------------------------------
Women Veterans
    Question 161. In a question for the record regarding the fiscal 
year 2013 budget request, VA provided a list of women's projects from 
the fiscal year 2013 Strategic Capital Investment Process. Please 
provide the Committee with an updated list of construction projects 
relating to correcting patient privacy deficiencies.
    Response. Please see attached.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    
                  office of information and technology
    Question 162. In response to the fiscal year 2013 budget questions 
for the record regarding VA's scheduling package, VA stated that it 
would not be able to determine the timeline of deliverables and costs 
associated with the scheduling package until after the completion of 
the Concept Exploration and Life Cycle Cost Anaylsis in January 2013.
    A. Has the Concept Exploration and Life Cycle Cost Analysis been 
completed? If so, please provide the Committee with the expected total 
cost of a new scheduling package and the timeline associated with the 
project.
    Response. VA will procure a scheduling solution in two phases. In 
the first phase, which is now ongoing, VA is running a risk-reduction 
contest under the America Competes Act, with a call for scheduling 
application submissions. The purpose of this contest is to reduce 
procurement and deployment risk. VA will award up to three prizes for 
scheduling packages that demonstrate their compatibility with the Open 
Source version of VA's electronic health record, VistA. The contest had 
41 contestants registered and closed the week of June 17, 2013. The 
submissions are currently under review with a target of announcing a 
winner at the end of the current fiscal year.
    The second phase will involve the actual procurement of a 
scheduling solution. As this risk-reduction activity proceeds, VA will 
continue working with DOD and the VA/DOD Interagency Program Office 
(IPO) to determine joint requirements and a master development and 
acquisition plan. This plan will be based upon an evaluation of 
contestant responses for proposed functionality and compliance with 
integrated Electronic Health Record (iEHR) architecture.
    B. The fiscal year 2014 budget request expects VA to spend $30 
million for the development of a new scheduling package. Please provide 
the Committee with an outline of how VA expects to utilize that 
funding.
    Response. The purpose of conducting the contest described in 
question 162 A is to inform the process for procuring an actual 
scheduling replacement solution. For FY 2014, VA plans to use what it 
has learned through the contest and to spend approximately $4 million 
on pre-planning and acquisition activities. These activities center on 
two basic areas: (1) defining business needs, and (2) mapping technical 
and architectural requirements to meet those needs.
    The remaining $26 million of the $30 million mentioned in the 
question will be spent on initial schedule package development efforts, 
which are anticipated to begin in mid-FY 2014. Specifically, these 
funds will be used to acquire commercial off-the-shelf (COTS) software 
and configure it to the VA environment.

    Question 163. The fiscal year 2014 request includes $15.8 million 
for the Virtual Lifetime Electronic Record (VLER), Health. Currently, 
VLER is deployed at only 13 VA medical facilities across the country. 
GAO testimony provided to the House Committee on Veterans' Affairs on 
February 27, 2013, stated that both Departments had the ``goal of 
deploying VLER nationwide at or before the end of 2012.''
    A. It is clear that both Departments have missed this goal of 
achieving a national rollout of VLER by the end of 2012. Does VA plan 
to expand VLER out to additional sites in 2013?
    Response. The Virtual Lifetime Electronic Record (VLER) is the 
broad umbrella of information sharing. VLER will allow VA, DOD, and 
others to easily share information on Servicemembers and Veterans and 
will enable VA to provide proactive care and benefits to Veterans that 
they have earned and deserve. VA believes the question refers more 
specifically to the VLER Health Exchange capability, which provides 
health information exchange between VA, DOD, and private-sector 
facilities.
    VLER Health is currently deployed to 16 sites, with several more in 
the queue. As of April 30, 2013, VLER Health Exchange partner sites 
were added at:

     Boise, Idaho, with the Idaho Health Information Exchange 
(HIE)
     Biloxi, Mississippi Department of Veteran Affairs Medical 
Center (VAMC) (which includes the Joint Ambulatory Care Clinic in 
Pensacola, Florida), with the Pensacola HIE.

    Full deployment of the VLER Health Exchange capability is dependent 
on upgrading the technology to accommodate enterprise-wide deployment, 
and on gaining HIE private partners who are approved to exchange health 
information through the eHealth Exchange (formerly referred to as the 
Nationwide Health Information Network or NwHIN).
    The Department of Veterans Affairs (VA) can begin to add new HIE 
partners and develop a schedule for full deployment once HIE and 
Partner Integration contracts are in place.
    B. If so, what costs are associated with implementing VLER at these 
additional sites? Please provide the Committee with a detailed timeline 
of the rollout, including the additional sites and costs associated 
with implementation.
    Response. As of July 9, 2013, the actual costs for these two 
deployments are not available because contracts to support enterprise-
wide deployment activity are still pending award. The two existing 
deployments involved minimal costs, as they were accomplished by VLER 
Health Federal staff.
    C. Have the Departments developed a plan for VLER that includes the 
scope, cost and schedule estimation, and project planning documents? If 
so, please provide those documents to the Committee.
    Response. Again, VA assumes the question refers to the VLER Health 
activities within the larger VLER initiative. The VA/DOD Interagency 
Program Office (IPO) is responsible for VLER Health Program Management, 
including VLER Health systems, capabilities, and initiatives. IPO's 
VLER Health program focuses on a portfolio of programs that manage the 
electronic exchange of clinically relevant health information between 
DOD, VA, and other Federal and non-Federal health exchange partners.
    VLER Health is now working on an FY 2014 plan to present to the 
DOD/VA Joint Executive Council (JEC) in September 2013, which will 
include details on further scope, to include cost planning estimates of 
the national rollout. VA will provide this plan to the Committee when 
it becomes available.
    For VLER initiatives outside of VLER Health, the VLER Enterprise 
Program Management Office publishes all of their documents on their 
public Web site at http://www.va.gov/vler/.

    Question 164. According to GAO's testimony from the February 27, 
2013, House hearing, in 2001 the VHA began to ``modernize VistA by 
standardizing patient data and modernizing the health information 
software applications.'' To modernize VistA, VA decided to use an 
incremental approach based on six phases which was to be completed in 
2018. Between 2001 and 2007, VA spent $600 million on eight projects 
related to modernizing VistA. In April 2008, VA estimated that it would 
cost roughly $11 billion to complete the modernization of VistA by 
2018. However, in August 2010, this project was terminated.
    A. Since August 2010, how much has VA spent on upgrades to VistA?
    Response. The chart below shows the VistA DME obligations from FY 
2010 to YTD FY 13.
------------------------------------------------------------------------
                                                             VistA Total
                            FY                              Obligations*
------------------------------------------------------------------------
FY 10.....................................................    $350.948
FY 11.....................................................    $320.654
FY 12.....................................................    $227.567
FY 13 YTD.................................................     $65.739
                                                           -------------
    Totals................................................    $964.908
------------------------------------------------------------------------
* Total amounts VA obligated for upgrades to VistA, by fiscal year.


    B. Were these upgrades similar to the ones identified in VA's 
attempt to modernize VistA by 2018?
    Response. The chart below shows the subset of DME obligations (seen 
above) for projects that VA determined to be ``similar to the ones 
identified in VA's attempt to modernize VistA by 2018.''
                                   FY
------------------------------------------------------------------------
         Subtotal Similar to VistA Modernization**
------------------------------------------------------------
FY 10......................................................   $211.217
FY 11......................................................   $122.665
FY 12......................................................    $87.282
FY 13 YTD..................................................    $28.080
                                                            ------------
    Totals.................................................   $449.244
------------------------------------------------------------------------
** The projects that are similar to the ones previously identified in
  VA's ``attempt to modernize VistA by 2018'' are those that fall under
  HealtheVet VistA.


    C. How much in the fiscal year 2014 budget will be allocated to 
upgrade VistA?
    Response. $25 million will be allocated to upgrade VistA in fiscal 
year 2014.

    Question 165. According to the DOD and VA press conference on 
February 5, 2013, Secretary Shinseki stated that the Departments 
planned to expand the use of the graphical user interface (GUI) to 
seven additional VA sites and two additional DOD sites no later than 
July 2013.
    A. What is the anticipated cost of implementing the GUI at these 
additional nine sites?
    Response. The Janus Joint Legacy Viewer is a web-based application 
hosted at VA's Austin Information Technology Center and at the Military 
Health System Enterprise Service Operations Center. The cost to 
implement Janus includes hosting facility expenses as well as funds to 
support program contracts, including: WebSphere application licenses; 
MedWeb appliance server and licenses; and TRICARE Management Activity 
Cyber Security risk assessments. The total cost to implement this 
enterprise version of Janus is approximately $5.3 million.
    Since Janus is a web-based application, and no additional hardware 
is required at the nine pilot sites, these costs should be considered 
as enterprise-wide expenses, not attributable to the nine sites 
specifically.
    For the pilot deployment, a small team will be visiting each site 
to provide training and to ensure a smooth transition to Janus. 
Additionally, VA is developing a training video and has put together 
detailed guides to facilitate virtual delivery of future deployments 
and training.
    B. Do DOD and VA plan to implement the GUI at additional sites 
after July 2013? If so, what are the additional costs associated with 
the implementation of the GUI at the additional sites?
    Response. VA is developing a plan to expand Janus beyond the pilot 
sites. Since Janus is a web-based application, and hardware is not 
required at the local sites, we project decreasing marginal costs as 
Janus expands to more sites. Moreover, as virtual training will be 
available, it would be unnecessary to have a team visit each site.
    However, before expanding Janus to a larger enterprise base, 
performance and load testing--as well as analysis of feedback from the 
pilot sites--must occur. This will help determine requirements and 
costs in order to scale the system for enterprise-wide use.
    C. In addition, at the press conference, VA also stated that DOD 
and VA would select ``a core set of integrated Electronic Health Record 
(iEHR) capabilities no later than March 2013.'' Have DOD and VA 
selected the core set of iEHR capabilities? If so, please provide the 
Committee with the core set of iEHR capabilities.
    Response. The Interagency Clinical Informatics Board (ICIB)--a 
joint VA and DOD board established to oversee the functional aspects of 
interagency clinical information systems throughout the development and 
acquisition lifecycle--has identified 7 capabilities that are the core 
functions of an EHR.
    The iEHR Core is a foundational set of clinical and supporting 
functionality necessary to deliver health care that leverages IT 
capabilities and supports an electronic health record.
    Offering the Core functionality as a single set provides a stable 
foundation, supports integration integrity and reduces interface 
complexity when identifying the remaining medical capability 
selections.
    The Core provides the clinical capabilities of creating and 
managing orders; entering, analyzing and reviewing the patient's health 
record and other clinically relevant information; supporting the 
provider in decisionmaking and situational awareness.
    The 7 functions that have been identified as the iEHR Core are:

    1. Orders Service
    2. Documentation
    3. Document Management
    4. Clinical Decision Support/Alerts
    5. Access Control
    6. Information Management/Terminology Services
    7. Federal Data Repository/Data Warehouse

    VA has decided to deploy an iEHR Core based on VistA. DOD has 
decided to obtain their core functions through a competitive 
acquisition.

    Question 166. According to the fiscal year 2014 Budget Fast Facts 
information sheet, VA has allocated $344 million for the iEHR, 
including $252 million for the development, modernization, and 
enhancement of iEHR and VLER.
    A. Please provide the Committee with a detailed breakdown of the 
sustainment cost associated with iEHR and VLER for fiscal year 2014 and 
any licensing agreements that are associated with these projects.
    Response. The following table highlights iEHR and VLER Health 
sustainment funds for FY 2014.
------------------------------------------------------------------------
                                                                 FY 2014
                                                                   (PB)
------------------------------------------------------------------------
iEHR Sustainment...............................................   $87.5
VLER Health Sustainment........................................    $4.2
                                                                --------
    Total......................................................   $91.7
------------------------------------------------------------------------


    B. Please provide the Committee with an estimated sustainment cost 
associated with iEHR and VLER over the next five years.
    Response. The following table highlights iEHR enacted funds and 
estimated costs for sustainment for FY's 2013 through 2018. Funding 
beyond FY 2014 has not been formally developed.
----------------------------------------------------------------------------------------------------------------
                                                       FY 2013   FY 2014   FY 2015   FY 2016   FY 2017   FY 2018
----------------------------------------------------------------------------------------------------------------
iEHR Sustainment....................................    $65.0     $87.5    $153.1    $275.6    $231.6    $268.1
VLER Health Sustainment.............................     $0.8      $4.2      $7.7     $13.9     $11.7     $13.5
                                                     -----------------------------------------------------------
    Total...........................................    $65.8     $91.7    $160.8    $289.5    $243.3    $281.6
----------------------------------------------------------------------------------------------------------------


    C. Please provide the Committee with a detailed breakdown of the 
$252 million for the development, modernization, and enhancement of 
iEHR and VLER and any deliverables associated with the development, 
modernization, and enhancement of iEHR and VLER.
    Response. The following amounts have been allocated to VLER 
Benefits, VLER Core, and VLER Memorials:
VLER Benefits..............................................   $8,500,000
VLER Core..................................................  $27,056,666
VLER Memorials.............................................  $10,000,000

    The following spreadsheet provides the details for each project at 
the acquisition/increment level.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



    The $252 million in development, modernization, and enhancement 
(DME) funds will support the following major iEHR programs:

     Identify Management
     Access Control Services
     Immunization
     Laboratory
     Pharmacy
     Presentation Services
     VistA Modernization
     Service-Oriented Architecture (SOA) Suite Enterprise 
Service Bus (ESB)

    Question 167. According to the fiscal year 2014 Budget Fast Facts 
information sheet, VA has allocated $155 million for the total 
development and implementation of VBMS, which included $32.8 million 
for the development costs.
    A. Please provide the Committee with a detailed breakdown of the 
sustainment cost associated with VBMS for fiscal year 2014 and any 
licensing agreements that are associated with VBMS.
    Response. Sustainment funds support maintenance and operations for 
OIT systems and applications at the existing capability and performance 
level. Sustainment does not support new functionality or enhancements. 
In addition to maintenance or replacement of infrastructure on an as-
needed basis, sustainment involves correcting critical software defects 
that have an immediate, adverse impact on OIT's as well as our business 
partners' capability to support VA's daily mission critical objectives.
    There are two types of sustainment: mandatory and marginal. 
Mandatory sustainment funds existing systems and applications. Marginal 
sustainment funds newly deployed applications or systems from the point 
of deployment until the end of the fiscal year.
    For FY 2013, VBMS funding supported:

                Marginal Sustainment:  $50.582 million
                Mandatory Sustainment:  $28.476 million

    The cost of VBMS licenses are explained in the table below, which 
is broken out by fiscal year. Some licenses support development work, 
and some support sustainment.

                FY 2011:  $18,000
                FY 2012:  $2.334 million
                FY 2013:  $1.532 million
                FY 2014:  $1.692 million

    B. Please provide the Committee with an estimated sustainment cost 
associated with VBMS over the next five years.
    Response. Please see the spreadsheet below.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



    Question 168. The fiscal year 2014 budget request indicates the 
$32.8 million associated with the development of VBMS will allow VA to 
``retire legacy software applications.'' Please provide the Committee 
with a list of which legacy software applications will be retired, the 
anticipated timeline, and any costs associated with the retirement of 
the legacy software.
    Response. The FY 2014 budget request of $32.8 million includes 
Development, Maintenance and Enhancement (DME) funding for both VBMS 
($20.7 million) and VETSNET ($12.1 million).
    FY 2014 VBMS DME will support the development of VBMS ``Generation 
3,'' which will focus on achieving the following goals:

     Improving electronic claims processing by providing 
increased system functionality and more complex automation capabilities 
for all VBMS end-users;
     Making enhancements to VBMS that will reduce dependency on 
legacy systems for claims establishment, development, and rating;
     Developing capability to accept electronic Servicemember 
Treatment Records (STRs) and Personnel Records from DOD, in general and 
to support the Veterans Opportunity to Work (VOW) legislation; and
     Enabling end-users to leverage enhanced system 
functionality to perform their work more efficiently and accurately.

    The VBMS Project Management Office (PMO), together with VBA 
Compensation Services, has initiated the process to retire the legacy 
application ``RBA2000'' in FY 2014. RBA2000 is the VETSNET application 
that assists VBA decisionmakers with the preparation of disability and 
ancillary ratings. Upon the retirement of RBA2000, all RBA2000 
functionality will be replaced by the rating tool within the VBMS 
application.
    Because the effort to retire RBA2000 is still in a planning state, 
the exact cost and timeframe have yet to be determined. A timeline will 
be developed for complete retirement of RBA2000 as soon as business 
requirements have been identified.
    The retirement of legacy systems is an active objective of all IT 
projects. RBA2000 is the only legacy application that VA will be able 
to retire in the near term. VA anticipates that future enhancements to 
VBMS and other projects will enable it to further reduce legacy 
systems.

    Question 169. In fiscal year 2012, VA undertook a pilot project to 
determine the feasibility of using a cloud email system, which placed a 
number VA email users into the cloud system. Depending on successful 
outcomes, the project would be expanded to additional users.
    A. How many VA email users were originally placed in the cloud 
email system?
    Response. At this point, no production users have been placed in 
the cloud email system. Test mailboxes have been migrated successfully.
    B. Please provide the Committee with the metrics VA will use to 
determine the success of cloud email systems.
    Response. The goal of this project is to procure and implement a 
cloud-based, software-as-a-service (SAAS) e-mail system that will 
deliver cloud e-mail capabilities for up to 15,000 VA mailboxes while 
meeting VA functional and security requirements. The system will also 
be capable of scaling up to support a user base of 600,000 mailboxes.
    Upon completion of the project, recommendations and findings will 
be compiled and presented to VA's CIO to help him make an informed 
decision on the migration of the remaining VA mailboxes to the cloud e-
mail system.
    Overall success of this project will be determined according to 
three metrics:

    1. Success Factor: SaaS costs less than current e-mail systems
          Metric: Cost of Microsoft Exchange Server and associated 
        maintenance compared to cost per-seat offered by the new SaaS 
        vendor
    2. Success Factor: SaaS is secure
          Metric: Federal Information Security Management Act (FISMA) 
        and Federal Risk and Authorization Management Program (FedRAMP) 
        certifications are obtained for the SaaS solution
    3. Success Factor: Transition is seamless
          Metric: Results of project

    C. What is the timeline to determine whether this pilot project 
will be expanded?
    Response. Per the contract's period of performance, the project 
expansion will occur on or before September 27, 2013.

    Question 170. The Interagency Program Office (IPO), established in 
the fiscal year 2008 National Defense Authorization Act, serves as the 
``single point of accountability for DOD and VA in the rapid 
development and implementation of Electronic Health Record (EHR) 
systems and VLER Health capabilities.''
    a. Since the change in strategy regarding the iEHR, has the role 
and accountability of the IPO changed? If so, please provide the 
Committee with any changes that have taken place due to changes in the 
development of the iEHR.
    Response. VA and DOD remain committed to the IPO as the single 
point of accountability for achieving interoperability between the 
Departments' EHR systems. The Departments recently signed a charter 
outlining the IPO's responsibility for managing the interagency 
processes, having authority over dedicated resources and to ensuring 
those resources adequately support all IPO requirements. These 
responsibilities include overseeing, identifying, and approving health, 
domain, and messaging standards for the Departments to implement in 
their EHRs. VA delivered the new charter to the House and Senate 
Veterans' Affairs Committees on December 20, 2013.

    b. Please provide the Committee with a detailed staff organization 
chart and a breakdown of staff that are assigned to the IPO including 
VA, DOD, and any contract employees.
    Response. See the chart that follows.



[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



    Question 171. As part of the iEHR strategy, VA agreed to 
consolidate and move VistA systems into DOD-Defense Information System 
Agency (DISA) data centers. VA anticipates the complete migration for 
Regions 2 and 3 during fiscal year 2013 and complete migration for 
Regions 1 and 4 during fiscal year 2014. The migration of Regions 1, 2, 
3, and 4 will ``enabl[e] full iEHR connectivity with DOD systems.''
    A. What are the costs associated with the migration of Regions 2 
and 3 and with the migration Regions 1 and 4?
    Response. Approximately $15 million was spent on Region 2 and 3 
migrations in FY 2012, with $31.3 million planned for execution in FY 
2013. Migration costs for Regions 1 and 4 are being estimated for the 
out-year budgets (migrations will take place in 2016/2017).
    B. What are the cost savings associated with the complete migration 
of VistA into DOD-DISA data centers?
    Response. VA leveraged the VistA migration projects to accomplish 
multiple objectives:

    1. Data Center Consolidation
    2. Pre-standardization of networks, hardware, platforms, and 
applications in anticipation of VA/DOD Health Record System Merging
    3. Security hardening for mission critical health record systems 
(implementation of high availability, disaster recovery, and 
continuation-of-operations capabilities for mission critical systems)

    The individual costs of these objectives cannot be differentiated, 
and do not lend themselves to standard Total Cost of Operations 
modeling used for estimating savings and cost avoidance for pure 
consolidations. Because VA leveraged the three mandates in one effort, 
short-term cost savings are not expected. However, over the longer 
term, VA will avoid the cost of constructing space for security 
hardening at multiple existing facilities that do not have capacity for 
the required redundant equipment. VA also expects significant long-term 
operational cost savings stemming from use of more efficient 
``commodity hardware'' for both existing production systems and 
security hardening efforts.

    Question 172. Currently, VA is nationally implementing VA Point of 
Service (VPS) kiosks allowing veterans, who are seeking services at VA 
medical facilities, to use these kiosks to check into their 
appointments, update or confirm contact and demographic information, 
and review insurance information.
    A. Please provide the Committee with a list of: which VA facilities 
currently have these kiosks; how many kiosks are at each facility; a 
timeline of what additional facilities will receive a kiosk; and how 
many kiosks these additional facilities will receive.
    Response. Please see table below for kiosk data.

                Current State: Kiosk Deployed by Facility
------------------------------------------------------------------------
                           Kiosks                                Kiosks
 VISN       Facility      Deployed    VISN        Facility      Deployed
------------------------------------------------------------------------
     1 Maine              32            6   Richmond.......      78
     2 Syracuse           39            7   Atlanta........      55
     3 North Port         32            7   Atlanta--Carrol       6
                                             lton.
     4 Altoona            44            8   Gainesville....      62
     4 Butler             27           10   Dayton.........      41
     4 Clarksburg         21           16   Oklahoma City..      28
     4 Coatesville        33           17   Central Texas..      47
     4 Erie               20           19   Salt Lake City       60
                                             Health Care
                                             System.
     4 Lebanon            29           20   Anchorage......      33
     4 Philadelphia       89           20   Portland.......      63
     4 Pittsburgh         72           21   Hawaii.........      39
     4 Wilkes-Barre       35           22   Las Vegas......      40
     4 Wilmington         39                Test Devices*..      58
     5 Martinsburg        43
                                           -----------------------------
                                              Total            1165
                                               deployed.
------------------------------------------------------------------------
       * [There is no footnote for the asterisk above.]


    Response: Future State: National Deployment will be accomplished in 
WAVEs

    The schedule is provided below:
------------------------------------------------------------------------
                                                           Projected
 Wave    VISN             Site             Projected   Deployment Start
                                            Kiosks           Date
------------------------------------------------------------------------
    1 1       Bedford.................         22            8/5/2013
    1 1       Boston HCS..............         69            8/5/2013
    1 1       Central MA HCS..........         38            8/5/2013
    1 1       Connecticut HCS.........         56            8/5/2013
    1 1       Manchester..............         26            8/5/2013
    1 1       Providence..............         29            8/5/2013
    1 1       White River Junction....         43            8/5/2013
    1 6       Asheville...............         30            8/5/2013
    1 6       Beckley.................         27            8/5/2013
    1 6       Durham..................         61            8/5/2013
    1 6       Fayetteville............         56            8/5/2013
    1 6       Hampton.................         32            8/5/2013
    1 6       Salem...................         48            8/5/2013
    1 6       Salisbury...............         47            8/5/2013
    1 16      Little Rock.............         57            8/5/2013
    1 16      Muskogee................         35            8/5/2013
    1 16      New Orleans.............         31            8/5/2013
    1 16      Shreveport..............         41            8/5/2013
    1 16      Alexandria..............         21            8/5/2013
    1 16      Biloxi..................         30            8/5/2013
    1 16      Fayetteville............         35            8/5/2013
    1 16      Houston.................         50            8/5/2013
    1 16      Jackson.................         28            8/5/2013
    1 20      Boise...................         48            8/5/2013
    1 20      Puget Sound.............         52            8/5/2013
    1 20      Roseburg................         33            8/5/2013
    1 20      Spokane.................         26            8/5/2013
    1 20      Walla Walla.............         41            8/5/2013
    1 20      White city..............         17            8/5/2013
    2 2       Albany..................         34            8/5/2013
    2 2       Bath....................         15            8/5/2013
    2 2       Canandaigua.............         27            8/5/2013
    2 2       WNY HCS.................         24            8/5/2013
    2 3       Bronx...................         52            8/5/2013
    2 3       Brooklyn................         24            8/5/2013
    2 3       Castle Point............          7            8/5/2013
    2 3       East Orange.............         37            8/5/2013
    2 3       Lyons...................         11            8/5/2013
    2 3       Manhattan...............         30            8/5/2013
    2 3       Montrose................         10            8/5/2013
    2 3       St. Albans..............          8            8/5/2013
    2 21      Fresno..................         37            8/5/2013
    2 21      Palo Alto...............         66            8/5/2013
    2 21      Reno....................         22            8/5/2013
    2 21      Sacramento..............         74            8/5/2013
    2 21      San Francisco...........         70            8/5/2013
    2 22      Greater Los Angeles.....         97            8/5/2013
    2 22      Loma Linda..............         78            8/5/2013
    2 22      Long Beach..............         67            8/5/2013
    2 22      San Diego...............         54            8/5/2013
    3 7       Augusta.................         99           1/20/2014
    3 7       Birmingham..............         72           1/20/2014
    3 7       CAVHCS..................         68           1/20/2014
    3 7       Charleston..............         57           1/20/2014
    3 7       Columbia................         87           1/20/2014
    3 7       Dublin..................         22           1/20/2014
    3 7       Tuscaloosa..............         16           1/20/2014
    3 10      Chillicothe.............         28           1/20/2014
    3 10      Cincinnati..............         34           1/20/2014
    3 10      Cleveland...............         65           1/20/2014
    3 10      Columbus................         38           1/20/2014
    3 11      Indianapolis............         33           1/20/2014
    3 11      Danville................         33           1/20/2014
    3 11      Marion IN...............          9           1/20/2014
    3 11      Fort Wayne..............          7           1/20/2014
    3 11      Detroit.................         20           1/20/2014
    3 11      Ann Arbor...............         21           1/20/2014
    3 11      Battle Creek............         20           1/20/2014
    3 11      Saginaw.................         31           1/20/2014
    3 12      Lovell FHCC.............         29           1/20/2014
    3 12      Jesse Brown.............         50           1/20/2014
    3 12      Hines Jr VAH............         38           1/20/2014
    3 12      Middleton...............         28           1/20/2014
    3 12      Tomah...................         28           1/20/2014
    3 12      Milwaukee...............         39           1/20/2014
    3 12      Iron Mountain...........         15           1/20/2014
    4 8       Bay Pines VA HCS........         44           1/20/2014
    4 8       Miami...................         21           1/20/2014
    4 8       Orlando.................         31           1/20/2014
    4 8       San Juan................         48           1/20/2014
    4 8       Tampa...................         20           1/20/2014
    4 8       West Palm Beach.........         25           1/20/2014
    4 15      Eastern Kansas City.....         48           1/20/2014
    4 15      Harry S. Truman.........         10           1/20/2014
    4 15      St. Louis...............         51           1/20/2014
    4 15      John J. Pershing........         13           1/20/2014
    4 15      Kansas City.............         19           1/20/2014
    4 15      Marion..................         36           1/20/2014
    4 15      Robert J. Dole..........         22           1/20/2014
    4 17      North Texas.............         93           1/20/2014
    4 17      South Texas.............         61           1/20/2014
    4 17      Texas Valley Coastal....         50           1/20/2014
    4 17      Austin CBOC.............         19           1/20/2014
    4 19      Cheyenne................         22           1/20/2014
    4 19      Denver (ECHCS)..........         36           1/20/2014
    4 19      VA Montana HS...........         44           1/20/2014
    4 19      Grand Junction..........         18           1/20/2014
    4 19      Sheridan................         25           1/20/2014
    5 5       Maryland HCS............         29           1/20/2014
    5 5       Washington DC...........         20           1/20/2014
    5 9       Huntington..............         32           1/20/2014
    5 9       Lexington...............         30           1/20/2014
    5 9       Mountain Home...........         47           1/20/2014
    5 9       Tennessee...............         50           1/20/2014
    5 9       Louisville..............         34           1/20/2014
    5 9       Memphis.................         32           1/20/2014
    5 18      Tucson..................         49           1/20/2014
    5 18      Phoenix.................         46           1/20/2014
    5 18      Prescott................         19           1/20/2014
    5 18      Amarillo................         22           1/20/2014
    5 18      West Texas..............         21           1/20/2014
    5 18      El Paso.................         17           1/20/2014
    5 18      Albuquerque.............         52           1/20/2014
    5 23      Black Hills.............         16           1/20/2014
    5 23      Fargo...................         42           1/20/2014
    5 23      Minneapolis.............         77           1/20/2014
    5 23      Sioux Falls.............         25           1/20/2014
    5 23      Central Iowa............         22           1/20/2014
    5 23      Iowa City...............         23           1/20/2014
    5 23      Nebraska................         52           1/20/2014
    5 23      St. Cloud...............         17           1/20/2014
             ---------------------------------------
                 Total................       4524
------------------------------------------------------------------------

    B. Please provide the Committee with a detailed breakdown of costs 
associated with either leasing or purchasing these kiosks.
    Response. Please see table below.

                      Kiosk devices and Accessories
------------------------------------------------------------------------
                          Equipment                              Price
------------------------------------------------------------------------
Free Standing Kiosk..........................................  $4,308.80
Free Standing Headphone Jack.................................     $30.00
Free Standing Surge Protector................................     $20.00
Free Standing Card Scanner...................................    $856.00
                                                              ----------
    Free Standing Kiosk Total................................  $5,214.80
Desk Top Kiosk...............................................  $2,998.40
Desk Top Headphone Jack......................................     $30.00
Desk Top Surge Protector.....................................     $20.00
Desk Top Card Scanner........................................    $856.00
                                                              ----------
    Desk Top Kiosk Total.....................................  $3,904.40
Wall Mount Kiosk.............................................  $2,998.40
Wall Mount Headphone Jack....................................     $30.00
Wall Mount Surge Protector...................................     $20.00
Wall Mount Card Scanner......................................    $856.00
                                                              ----------
    Wall Mount Kiosk Total...................................  $3,904.40
------------------------------------------------------------------------


    C. What is the cost associated with the maintenance and sustainment 
of these kiosks?
    Response. Kiosk 2 year warranty (renewal): $235 (per kiosk). Three 
tier service desk support: $3,223,936 for 12 months ($415/kiosk 
annually).
    D. Please provide the Committee with a timeline of when additional 
functionality is expected to be delivered to these kiosks.
    Response. Kiosks Future Releases and Functionality

        Software Release 5.3 New Functionality (scheduled release 
        August 2013):
                Release of Information submission
                Patient Queuing (appointment-based pilot)
                Notification verbiage and categorization overhaul
        Software Release 5.4 New Functionality (scheduled release 
        September 2013):
                Beneficiary-Travel Application with optional queuing
                MVP Phase B
                Staff Patient Queue Improvements
                Alternative Patient Lookup (Last 5 or name lookup)
                Patient Queue Filter overhaul
                Notification filtering
        Additional Optional Workflow offerings
                Allergy Review (dependent upon VPS*1*3 VistA patch 
                approval)
                VetLink 5.4 aligns with VPS*1*2 VistA patch
                Pilot testing expected to begin FY14Q1
        Software Release 5.5 New Functionality: (scheduled release 
        February 2014):
                Staff-facing application improvements and redesign
                Approve Patient Update
                Patient Queue
                Bill pay
                Patient Question Queue
                Predictive update recommendations based on patient 
                actions
                Improved Queuing functionality and integration

    Question 173. The fiscal year 2014 budget request proposes to 
realign funding between the medical care and Information Technology 
Systems appropriations, which would fund 80 FTE at a cost of $4.495 
million out of the medical care appropriations.
    A. What metrics were used to determine that these 80 FTE should be 
funded through medical care instead of IT appropriations?
    Response. OIT and VHA propose to realign personnel in FY 2014 as 
follows:
----------------------------------------------------------------------------------------------------------------
    VHA/OIT Realignment (FTE Change                      FTE                           Obligations ($M)
               Analysis)                ------------------------------------------------------------------------
----------------------------------------             Medical                              Medical
                                          Medical   Support &   Information   Medical    Support &   Information
                                         Services  Compliance   Technology    Services  Compliance   Technology
----------------------------------------------------------------------------------------------------------------
Austin Human Resources Support Services                   +53          -53                 +$6.346      -$6.346
Clinical Applications Coordinator......       +53                      -53     +$6.138                  -$6.138
Information Technology Support Staff...                   -26          +26                 -$7.989      +$7.989
                                        ------------------------------------------------------------------------
    Total..............................       +53         +27          -80     +$6.138     -$1.643      -$4.495
----------------------------------------------------------------------------------------------------------------


     The FY 2014 budget request realigns 53 FTE and $6.346 
million to Austin Human Resources Support Services. These FTEs and 
funds are being moved from the IT appropriation to the Medical Support 
and Compliance (MS&C) appropriation. Note that certain human resource 
specialists that perform functions more appropriately aligned with the 
Veterans Health Administration (VHA) are still located within OIT. In 
FY's 2012 and 2013, following a reassignment effective as of 
December 2011, these staff were supported by OIT on a reimbursable 
basis.
     Clinical Application Coordinators (CACs) were assigned to 
OIT when the separate IT Appropriation was created in FY 2006. CACs 
provide direct support to clinical services, and coordinate facility 
efforts in support of VHA's Medical Center Management. Due to the 
nature of their functions, VA's intent now is to realign them back to 
VHA.
     In addition to the above realignments, 26 FTE and $7.989 
million were moved to OIT from VHA's Office of Informatics and 
Analytics. The functions corresponding to these FTEs are better aligned 
under OIT.
    B. Please provide a list of positions and pay-grades for the 80 FTE 
staff that would be affected by the realignment?
    Response. The following is a list of positions and pay-grades for 
the 79 FTEs that are proposed for realignment.
Austin HR Transfer (from OIT to VHA)

                        Human Resource Management
                     (HR Specialists/HR Assistants)
------------------------------------------------------------------------
                                                                    FTE
------------------------------------------------------------------------
GS-13...........................................................     3
GS-12...........................................................     7
GS-11...........................................................    26
GS-9............................................................     7
GS-7............................................................     9
GS-6............................................................     1
                                                                 -------
  Total.........................................................    53
------------------------------------------------------------------------
subject to change based on requirements


CAC Transfer (from OIT to VHA)

                    Information Technology Management
                    (IT Specialists/Program Managers)
------------------------------------------------------------------------
                                                                    FTE
------------------------------------------------------------------------
GS-13...........................................................     3
GS-12...........................................................    31
GS-11...........................................................    15
GS-9............................................................     4
                                                                 -------
  Total.........................................................    53
------------------------------------------------------------------------
subject to change based on requirements

IT Support Staff Transfer (from VHA to OIT)

          General Administrative, Clerical and Office Services
            (Management & Program Analysts/Program Managers)
------------------------------------------------------------------------
                                                                    FTE
------------------------------------------------------------------------
GS-15...........................................................     1
GS-14...........................................................    12
GS-13...........................................................    13
                                                                 -------
    Total.......................................................    26
------------------------------------------------------------------------
subject to change based on requirements

                    national cemetery administration
    Question 174. The fiscal year 2014 budget request for the National 
Cemetery Administration (NCA) is $5.1 million below the amount provided 
by the fiscal year 2013 Continuing Resolution. The chart entitled 
``Analysis of Increases and Decreases--Obligations'' shows a reduction 
of $15.4 million for change in contracts, other services and travel.
    a. Please provide the Committee with details on what is included in 
the ``[c]hange in contracts, others service and travel'' and what led 
to the expected reduction?
    Response. The reduction of $15.4 million shown in the fiscal year 
2014 budget request column for this line item is due to a decrease in 
funding for national shrine and other repair projects. The reduction of 
funds in these lines had to be used for workload increases, operating 
cost increases, and the initial activations of three new cemeteries, 
two urban cemeteries, and two National Veterans Burial Grounds in rural 
areas.
    b. What other factors or assumptions contributed to the $5.1 
million reduction in the fiscal year 2014 request?
    Response. American Recovery and Reinvestment Act (ARRA) funds 
($26.3 million) for national shrine projects were used to address the 
most immediate shrine needs that would have otherwise been accomplished 
through annual appropriations. In addition, increased use of beam 
system foundations that maintain the height and alignment of headstones 
and markers for longer periods of time will decrease the need for 
follow-up national shrine projects.

    Question 175. According to the fiscal year 2014 budget request, in 
2012, 82 percent of headstones, markers, and niche covers were clean 
and free of debris or objectionable accumulations; 69 percent of 
headstones and/or markers in national cemeteries were at the proper 
height and alignment; and 93 percent of gravesites had grades that were 
level and blend with adjacent grade levels. For fiscal year 2014, the 
annual target for these three metrics are 80 percent, 70 percent, and 
84 percent, respectively.
    a. All three annual targets in 2014, for the metrics mentioned, are 
lower than the 2012 and well below the strategic target. Why are the 
three annual targets below 2013 actual percent?
    Response. Projected increases in the number of gravesites in 
national cemeteries, along with expected flat or decreased national 
funding beginning in 2012, will lead to a short term projected decrease 
in performance in 2014 for these measures.
    b. Given the low percentages versus those stated in the strategic 
targets, what steps is NCA taking to meet the strategic targets?
    Response. NCA is implementing new operational techniques designed 
to produce more lasting results in the repair and appearance of 
gravesites. One example is the increased use of beam system foundations 
that maintain the height and alignment of headstones and markers for 
longer periods of time, thereby decreasing the need for follow-up 
national shrine projects.

    Question 176. Public Law 113-2, the Disaster Relief Appropriations 
Act of 2013, included $2.1 million for NCA to make necessary repairs as 
a result of Hurricane Sandy in October 2012.
    a. Please provide the Committee with a list of projects undertaken 
with funds from Public Law 113-2.
    Response. The funding was used to repair tree damage caused by 
Hurricane Sandy at three VA national cemeteries: Beverly National 
Cemetery in New Jersey, and Long Island National Cemetery and Cypress 
Hills National Cemetery in New York. The funding was used to remove or 
prune damaged trees and clean up debris.
    b. Has all of the additional $2.1 million been spent or obligated?
    Response. NCA has obligated $876,119 for damages caused by 
Hurricane Sandy. All damage has been repaired and no additional repair 
projects have been identified where these specific purpose funds could 
be used. Per Public Law 113-2, the funding was designated ``for 
necessary expenses related to the consequences of Hurricane Sandy.'' 
Accordingly, NCA cannot realign the funds for another purpose.

    Question 177. On February 7, 2013, the IG issued a report entitled 
``Audit of Internal Gravesite Review of Headstone and Marker 
Placement.'' The audit found that NCA's internal review of the 
placement of headstones and markers did not identify and report all 
misplaced headstones and unmarked gravesites. Specifically, at four of 
the 12 audited cemeteries, the IG found seven errors not previously 
reported. After revising its procedures, NCA identified an additional 
146 errors at four of the 12 cemeteries the IG audited.
    a. Given the findings of the IG audit, does NCA believe the 
information provided to Congress on its internal audit is valid?
    Response. Yes, the information provided to Congress is valid. NCA 
accepted the Department of Veterans Affairs (VA) Office of Inspector 
General's (OIG) recommendations made in a July 2012 Management Advisory 
Memorandum, which preceded OIG's final audit report. NCA immediately 
adjusted its methodologies to increase the accuracy of the headstone 
and marker review. As a result of OIG's recommendations, Memorial 
Service Network (MSN) executive leaders conducted independent gravesite 
reviews at every national cemetery and soldiers' lot administered by VA 
after the cemetery directors had completed reviews of their entire 
cemeteries. MSN senior leaders conducted these reviews either through 
statistically valid random sampling of gravesites or complete cemetery 
re-audits. With these reviews by independent MSN teams, NCA gained 
reasonable assurance that the audit results reported to Congress were 
valid in terms of the discrepancies reported at 147 of 164 national 
cemeteries and soldiers' lots administered by VA. Additionally, the NCA 
Headstone and Marker audit provided actionable data on which NCA is 
prioritizing efforts to ensure the accountability of remains at all 
national cemeteries now and in the future. These efforts will include 
full audit reviews at 17 cemeteries to achieve reasonable assurance 
that all gravesites are accurately marked at those facilities.
    b. How many additional errors were found using the revised 
procedures at other NCA cemeteries?
    Response. At four of the 12 cemeteries that OIG reviewed as part of 
its Phase I audit, NCA independent review teams reported 111 additional 
discrepancies. (The main differences between this number and the 146 
errors noted in the question are explained in Under Secretary Muro's 
January 15, 2013, response to OIG's draft audit report. This letter is 
Appendix F of OIG's final report; specific references about differences 
reported for Winchester and Philadelphia National Cemeteries are on 
page 23 of the final report.) NCA included these and other findings of 
the independent review teams in the Phase II report to Congress. NCA 
did not separately tabulate for all cemeteries the discrepancies 
identified by the independent review teams from those reported by 
cemetery directors in the Phase II report.
    c. Please provide a list of all errors identified by both phase one 
and phase two of the audit by cemetery and the difference in errors 
from what was originally reported and those discovered after the IG 
audit.
    Response. Phase I results reported to Congress on April 3, 2012, 
included a total of 251 corrective actions (243 headstone/marker errors 
and 8 reburials--see Attachment). The Phase I review was limited to 
sections of cemeteries that had undergone ``raise and realign'' 
projects. In July 2012, during OIG's audit which focused on NCA's 
administration of Phase I, OIG issued a Management Advisory Memorandum 
which preceded OIG's final audit report. NCA immediately adjusted its 
methodologies to increase the accuracy of the NCA headstone and marker 
review. As a result of OIG recommendations, Memorial Service Network 
executive leaders conducted independent gravesite reviews at every 
national cemetery and soldiers' lot administered by VA, that is, all 
cemeteries and all sections that cemetery directors reviewed under both 
Phase I and Phase II. NCA reported these findings with the Phase II 
report to Congress on February 6, 2013. The Phase II results included 
527 corrective actions: 520 headstone/marker errors, and seven 
potential reburials. (Phase II summary findings are attached. NCA later 
determined that two of the potential burials identified in the Phase II 
review were not necessary.) NCA did not categorize the findings of the 
independent review teams according to different sections reviewed under 
Phase I or Phase II.
    d. What personnel actions were taken by NCA in response to cemetery 
directors who did not accurately audit their cemeteries?
    Response. NCA is in the process of taking appropriate actions in 
response to the results of our gravesite review. In addition to looking 
at which cemetery directors did not accurately audit their cemeteries, 
NCA is also investigating whether, and which, employees can be held 
accountable for gravesites which were mismarked or unmarked. NCA is 
reviewing the circumstances of each case to ensure consistency in 
responses across the organization. Although the process is not 
complete, one of the cemetery directors whose audit results were called 
into question by OIG has voluntarily left NCA. Another cemetery 
director has been removed from the position of director and demoted--
actions related to the audit formed part of the basis for that 
personnel action.

    Question 178. The fiscal year 2014 budget request for Grants for 
Construction of Veterans Cemeteries includes $1.6 million less for 
fiscal year 2014 compared to the fiscal year 2013 Continuing 
Resolution.
    a. How many states have pending requests for state veterans 
cemeteries grants? Please list the grant applications by state and 
location.
    Response. As of July 29, 2013, there are 31 states, 11 tribal 
organizations, and the territories of Guam, the U.S. Virgin Islands, 
and the Commonwealth of the Northern Mariana Islands with pending 
requests.

                                    Grant Applications by State and Location
----------------------------------------------------------------------------------------------------------------
                                                    Date       Estimated
      State                  Location             Received       Amount             Description         Priority
----------------------------------------------------------------------------------------------------------------
AK                 Fairbanks..................    3/23/2009  $6,468,231.11  establishment.............        2
AR                 North Little Rock..........    4/19/2010    $753,495.00  operations and maintenance        4
AR                 North Little Rock..........    6/29/2010    $600,000.00  expansion.................        3
AZ                 Flagstaff..................    4/20/2009  $7,450,000.00  establishment.............        2
AZ                 Yuma.......................    4/20/2009  $6,800,000.00  establishment.............        2
AZ                 Kingman....................    4/20/2009  $6,800,000.00  establishment.............        2
AZ                 Chinle (tribal)............    4/20/2009  $9,600,000.00  establishment.............        2
AZ                 Northern Tucson............    6/24/2009  $5,300,000.00  establishment.............        2
AZ                 San Carlos (tribal)........    6/28/2013  $3,483,102.00  establishment.............        2
CA                 Rancheria (tribal).........    6/30/2008     $57,000.00  expansion Toulmne Band....        3
CA                 Monterey...................    2/25/2009  $15,944,487.0  establishment.............        2
                                                                      0
CA                 Yountville.................    6/26/2009  $4,695,760.00  improvement...............        4
CA                 Auberry (tribal)...........     6/7/2012  $1,143,000.00  establishment.............        2
CA                 Igo........................    6/28/2013     $95,377.00  improvement...............        4
CT                 Middletown.................    6/17/2013  $3,626,500.00  expansion.................        1
DE                 Millsboro..................    4/12/2010     $74,250.00  operations and maintenance        4
DE                 Millsboro..................    6/28/2013  $1,008,000.00  expansion.................        1
GU                 Agatna Heights.............    5/25/2011  $3,952,500.00  expansion.................        1
GU                 Agatna Heights.............    5/25/2011    $175,000.00  operations and maintenance        4
HI                 Hilo.......................    6/29/2010    $312,291.00  improvement...............        4
HI                 Lanai......................    6/29/2010     $88,287.00  improvement...............        4
HI                 Kauai......................    6/29/2010  $1,477,381.00  improvement...............        4
HI                 Hoolehua...................    6/29/2010    $438,408.00  improvement...............        4
HI                 Kauai......................    6/29/2010     $26,478.00  operations and maintenance        4
HI                 Kaneohe....................    6/29/2010  $3,092,939.00  operations and maintenance        4
HI                 Makawao....................    6/29/2010  $1,119,667.00  operations and maintenance        4
HI                 Hilo.......................    6/29/2010    $563,434.00  operations and maintenance        4
HI                 Hilo.......................    6/29/2010  $2,829,703.00  operations and maintenance        4
HI                 Kailua-Kona................    6/29/2012    $795,459.00  improvement...............        4
HI                 Makawao....................    6/29/2012  $6,556,200.00  expansion.................        1
HI                 Kaneohe....................    6/27/2013  $12,168,000.0  expansion.................        1
                                                                      0
ID                 Southeastern...............    8/13/2012  $11,150,100.0  establishment.............        2
                                                                      0
IN                 West Lafayette.............     7/1/2010          $0.00  operations and maintenance        4
KY                 South Eastern..............     4/7/1999  $7,255,000.00  establishment.............        2
KY                 Hopkinsville...............     7/1/2010    $149,048.00  operations and maintenance        4
LA                 Rayville...................   12/21/2006  $6,800,000.00  establishment.............        2
LA                 Jennings...................   12/21/2006  $6,800,000.00  establishment.............        2
MA                 Agawam.....................     7/1/2013  $2,173,025.00  expansion.................        1
MD                 Owings Mills...............    6/30/2010  $2,500,000.00  operations and maintenance        4
MD                 Hurlock....................    6/30/2010  $1,250,000.00  operations and maintenance        4
MD                 Flintstone.................    6/30/2010  $1,250,000.00  operations and maintenance        4
MD                 Crownsville................    6/30/2010  $1,630,000.00  operations and maintenance        4
MD                 Crownsville................    6/24/2011  $4,000,000.00  expansion.................        3
MD                 Cheltenham.................    6/25/2011  $3,773,450.00  expansion.................        3
MD                 Flintstone.................    6/24/2013  $2,600,000.00  expansion.................        1
MD                 Hurlock....................    6/24/2013  $2,240,000.00  expansion.................        1
ME                 Augusta-Civic Center.......     4/6/2012    $430,000.00  improvement...............        4
ME                 Augusta-Civic Center.......    2/20/2013  $1,763,250.00  expansion.................        1
ME                 Augusta-Mt. Vernon Rd......    2/21/2013  $1,852,500.00  expansion.................        1
MI                 Grand Rapids...............    6/30/2010    $100,100.00  operations and maintenance        4
MN                 Duluth.....................    6/30/2008  $8,350,000.00  establishment.............        2
MN                 Southwest Minnesota........     6/4/2009  $7,900,000.00  establishment.............        2
MN                 SE Minnesota...............    6/29/2010  $7,900,000.00  establishment.............        2
MN                 Little Falls...............    6/28/2013    $475,000.00  expansion.................        1
MO                 St. James..................    4/13/2010    $368,065.00  improvement...............        4
MP                 Rota.......................    6/30/2013    $500,000.00  establishment.............        2
MP                 Tinian.....................    6/30/2013    $500,000.00  establishment.............        2
MT                 Columbia Falls.............     8/4/2009    $100,000.00  improvement...............        4
MT                 Crow Agency (tribal).......     7/1/2013  $3,000,000.00  establishment.............        2
MT                 Poplar (tribal)............     7/1/2013  $5,150,000.00  establishment.............        2
NC                 Goldsboro..................     7/1/2011  $6,000,000.00  establishment.............        2
NE                 Grand Island...............   10/23/2000  $5,102,000.00  establishment.............        2
NE                 Grand Island...............    6/28/2012    $267,840.00  operations and maintenance        4
NJ                 Wrightstown................    2/14/2002  $3,400,000.00  public information center.        4
NJ                 Wrightstown................    4/15/2010    $701,750.00  operations and maintenance        4
NJ                 Vineland...................    6/28/2011    $300,300.00  improvement...............        4
NM                 Fort Stanton...............     4/9/2001  $3,500,000.00  establishment.............        2
NV                 Fallon.....................     7/1/2009  $1,250,000.00  establishment.............        2
NV                 Boulder City...............    4/20/2010  $1,402,076.00  operations and maintenance        4
NV                 Fernley (tribal)...........     6/7/2013  $1,379,874.00  expansion.................        1
NY                 Putnam County..............     7/1/2011  $5,000,000.00  establishment.............        2
OK                 Pawnee (tribal)............     7/1/2008  $1,950,000.00  establishment.............        2
OK                 Wewoka (tribal)............     7/1/2012    $100,000.00  establishment.............        2
OK                 Ponca City (tribal)........     7/1/2013    $205,000.00  establishment.............        2
RI                 Exeter.....................    6/28/2011    $885,947.00  expansion.................        1
SC                 York County (tribal).......    6/26/2013    $984,200.00  establishment.............        2
TN                 Knoxville..................     7/1/2010    $438,705.00  operations and maintenance        4
TN                 Nashville..................     7/1/2010    $307,265.00  operations and maintenance        4
TN                 Jackson....................     7/1/2011  $6,000,000.00  establishment.............        2
TN                 Nashville..................    4/13/2012  $1,447,975.00  expansion.................        1
TN                 Memphis....................    4/13/2012  $1,370,000.00  expansion.................        1
TN                 Knoxville..................    4/13/2012    $120,000.00  improvement...............        4
TN                 Eastern Region.............     5/8/2013  $6,000,000.00  establishment.............        2
TX                 Mission....................    2/26/2013    $598,860.00  expansion.................        1
TX                 Killeen....................    4/30/2013  $4,437,076.00  expansion.................        1
VI                 St. Thomas.................    6/30/2001  $1,200,000.00  establishment.............        2
VI                 St. Croix..................    6/30/2001  $1,200,000.00  establishment.............        2
VT                 Montpelier.................    6/29/2005  $2,750,000.00  expansion and improvement.        3
WA                 Medical Lake...............    6/29/2013  $1,000,500.00  expansion.................        1
WI                 Union Grove................    6/22/2010    $373,905.45  operations and maintenance        4
WI                 Union Grove................    4/13/2012  $4,638,700.00  expansion.................        1
WI                 Spooner....................    4/13/2012  $1,671,800.00  expansion.................        1
WY                 Evansville.................    2/13/2006  $1,100,000.00  improvement...............        4
----------------------------------------------------------------------------------------------------------------


    b. What metrics does NCA use to determine the funding requirements 
for the Grants for Construction of Veterans Cemeteries?
    Response. Each year, NCA's Veterans Cemetery Grants Service (VCGS) 
conducts a review of all pending pre-applications from the current year 
and previous years and creates a priority list that ranks all pre-
applications across four priority groups. The priority list is reviewed 
and signed by the Secretary of Veterans Affairs and published by 
October 1st of each year. The four priority groups are explained below:

     Priority Group 1: This group includes expansion projects 
required to prevent an interruption in burial service at existing state 
and tribal Veterans cemeteries within 4 years of the date of the pre-
application. These projects are assigned the highest priority.
     Priority Group 2: This group is comprised of new 
establishment projects. To determine the funding requirements for new 
establishment projects, VCGS reviews the estimated Veteran population 
that would be served by the proposed cemetery along with the estimated 
interment rate and partners with states and tribes to adjust their 
project scope accordingly.
     Priority Group 3: This group includes expansion projects 
required to prevent an interruption in burial service at existing state 
and tribal Veterans cemeteries outside of the 4 years since the date of 
the pre-application.
     Priority Group 4: This group is comprised of projects to 
improve existing state or tribal Veterans cemeteries and operation and 
maintenance projects that address NCA national shrine standards of 
appearance.

    VCGS reviews the submitted project scope, budget, and detailed cost 
estimates for all submitted pre-applications. When analyzing project 
budgets and their associated cost estimates, VCGS compares the 
projected costs against established NCA estimating methodologies. VCGS 
works closely with all states and tribal organization applicants to 
refine their cost estimates and budgets to reflect the most efficient 
and effective use of VCGS grants funds to serve Veterans and their 
families.
                vocational rehabilitation and employment
    Question 179. A significant increase in subsistence allowance 
payments was projected for fiscal year 2012 due to changes under Post-
9/11 Veterans Educational Assistance Improvements Act of 2010, Public 
Law 111-377, which allowed individuals eligible for the Post-9/11 GI 
Bill to receive subsistence allowance at the basic allowance for 
housing rate in lieu of the historical monthly allowance rate. The 
current estimated obligations for fiscal year 2013 are $136 million 
less than projected.
    a. Please describe the reasons why the significant increase of 
subsistence allowance did not materialize.
    Response. The current estimate for subsistence allowance was 
updated from $491.7 million to $386.3 million for FY 2013, a decrease 
of $105.4 million. While the current estimate of $386.3 million is a 
decrease from the initial FY 2013 estimate, it still represents a 28 
percent increase over FY 2012 subsistence allowance payments, and a 35 
percent increase over FY 2011 payments.
    The number of projected trainees receiving subsistence in FY 2013 
decreased from 68,093 to 64,864, based on actual FY 2012 experience. 
This resulted in a decrease of $23.3 million to the subsistence 
allowance estimate. In addition, the initial projection estimated that 
40 percent of trainees receiving subsistence would be eligible for the 
basic allowance for housing (BAH) rate by FY 2013. However, based on FY 
2012 actual experience, this assumption was reduced to reflect that 15 
percent of trainees would receive subsistence at the BAH rate in FY 
2013. This decreased the FY 2013 current estimate an additional $82.1 
million.
    b. Was the decrease due to eligible participants not taking 
advantage of the basic allowance for housing rate? Please explain and 
detail any other factors leading to the decrease.
    Response. Actual experience indicates that fewer trainees are 
receiving subsistence at the BAH rate than was initially projected. 
This could be due to an overestimate of the number of Veterans 
receiving subsistence that are eligible for the BAH rate, eligible 
participants not taking advantage of the BAH rate, or a combination of 
both. At this time, data are not available to determine the primary 
reason that fewer Veterans are receiving subsistence at the BAH rate 
than expected.
    When applying for benefits, Veterans are informed of which level of 
subsistence allowance they are eligible for and Veterans then determine 
which benefit they are electing to receive. It is unlikely that new 
participants are applying for the lower rate of subsistence when they 
are eligible for the BAH rate. However, Veterans that were already 
receiving subsistence prior to the enactment of Public Law 111-377 must 
ask their Vocational Rehabilitation Counselor to switch to the higher 
BAH rate. On August 9, 2011, VR&E Service directed field staff to 
provide a standardized letter to Veterans that were already receiving 
subsistence prior to the enactment of Public Law 111-377 notifying them 
about their potential eligibility for the higher BAH rate.

    Question 180. The fiscal year 2014 budget request includes ``$104 
million [for] a new Transition Assistance Program to help separating 
servicemembers better transition to civilian life.'' The $104 million 
will be used, in part, to implement the new Transition GPS (Goals, 
Plans, Success) program, which is part of the redesigned Transition 
Assistance Program.
    a. How many VA FTE or contractors will directly interact with 
servicemembers through the Transition GPS program?
    Response. At the end of FY 2013, VA will have 392 briefers that 
will directly interact with Servicemembers through benefits briefings, 
career technical training, and individual assistance to requesting 
Servicemembers. The 392 briefers will provide support to 208 locations.
    At the end of FY 2014, VA is projected to have an additional 321 
briefers directly interacting with Servicemembers through benefits 
briefings, career technical training, capstone events, individual 
assistance to requesting Servicemembers, and virtual briefings. The 
additional 321 will provide support at 247 stateside locations and 74 
overseas locations.
    b. Of the $104 million, how much has been requested for FTE or 
contractors participating in the Transition GPS program?
    Response. All of the $104 million has been requested for Transition 
Goals, Plans, Success (GPS) contracting.
    c. Please provide a detailed timeline for implementation of VA's 
portion of the Transition GPS program, including locations inside and 
outside the United States.
    Response. See attached implementation timeline, ``VBA-SVAC-
QFR180cattach.''
    d. Please detail the assumptions made for an increased workload due 
to the implementation of the Transition GPS program. Please include 
additional Vocational Rehabilitation and Employment (VR&E) and VBA 
workloads affected by implementation.
    Response. The following assumptions were made in determining 
briefer support for full implementation of mandatory Transition GPS, 
which incorporates requirements of Public Law 112-56, sections 201-265, 
125 Stat. 711.
     Transitioning Servicemember throughput of approximately 
307,000 as provided by the Services.
     100 percent mandatory participation by Servicemembers.
     Classroom size of no more than 50 participants.
     Contract briefers will conduct the VA Benefits I Briefing 
(4 hours), VA Benefits II Briefing (2 hours), and the Career Technical 
Training Track (16 hours curriculum with the assumption that 30% of 
transitioning Servicemembers will attend and seek individual 
assistance).
     Briefers will provide individual assistance to requesting 
Servicemembers with a planning factor of 1 hour per Servicemember.
     Contract Briefers will also support Capstone Events (1-2 
hours dedicated to each transitioning Servicemember). Service models 
for Capstone may differ.
     Travel time and cost to support itinerant installations 
where there is no permanent briefer support due to lower transition 
throughput.
     Initial briefer training for VA Benefits I and II 
Briefings as well as follow-on training for Career Technical Training 
Track.
     The end state by September 30, 2014, which includes 713 
briefers who will support both U.S. and overseas locations.

    Additional assumptions made for increased workload for second and 
third-order effects, to include VR&E and other VBA workloads:

     Assumed a 70 percent claims intake rate based on 
approximately 307,000 separating Servicemembers. The intake rate was 
adjusted by 67,000 to account for incoming claims with existing pre-
discharge programs.
     Under legacy TAP, only about 50 percent of Servicemembers 
attended Transition Assistance Program (TAP). With mandatory attendance 
required for Transition GPS and VOW/VEI, the assumption is to expect 
increases in VA benefit applications (across all 6 types of benefits) 
due to pre-separation counseling and information provided in the VA 
Benefits I and II Briefings, the Capstone event, individual assistance, 
military lifecycle planning, and the two-day Career Technical Training 
Track.

    Question 181. The Vocational Rehabilitation Counselor (VRC) Skill 
Certification Test ``is an internal, professional-level examination 
that tests technical and procedural knowledge, along with the 
situational judgment associated with the journey-level VRC position.''
    a. If a VRC fails the certification test, what additional training 
would a VRC be required to take?
    Response. According to the 5 U.S.C. 7106 (b)(1) Pilot Memorandum of 
Understanding, ``the supervisor and employee will identify training 
available to gain knowledge in deficit areas, to remediate knowledge 
gaps and allow sufficient time for employees to complete the 
training.'' VR&E leadership in the ROs identify the training that a VRC 
must complete if he or she fails the certification test. VR&E Service 
recommends VRCs complete the VRC Foundational Training and Performance 
Support Systems (TPSS) module in order to remediate their knowledge 
gaps and to pass the certification test.
    b. If a VRC does not meet the requirements of the certification 
test, would the VRC be required to pass prior to resuming his or her 
duties?
    VBA Response: If a VRC does not pass the certification test, the 
individual is not prohibited from resuming his or her duties.

    Question 182. Please provide the Committee with data on VR&E 
activities by regional office, including but not limited to: 1) number 
of counselors at each office, 2) number required at each office, 3) 
rehabilitation rate, 4) timeliness, 5) cases, and 6) number of veterans 
served.
    Response. The number of VRCs required is based upon the Office of 
Field Operations (OFO) RAM, which is a staffing model based on workload 
demands and performance. In addition to VRC FTE allocations, OFO also 
allocates VR&E contract counseling funds to augment counseling services 
provided by VA employees. The total GOE contracting allocation for VR&E 
contract counseling services for FY 2013 is $4,000,000. Station 
allocations are made based on workload demands and may be adjusted 
throughout the fiscal year to ensure coverage during workload surges 
and unexpected workload influx, or to assist in transitioning while 
vacant positions are being backfilled. The table below shows data as of 
April 30, 2013:
----------------------------------------------------------------------------------------------------------------
                                                                           Days to
                                    Vocational                           Notification                 Number of
                                  Rehabilitation     VRCs      Rehab          of        Chapter 31     Veterans
                                     Counselor     Required     Rate     Entitlement   Participants     Served
                                       (VRC)                            Determination                    (All
                                                                         (Timeliness)                 Chapters)
----------------------------------------------------------------------------------------------------------------
USA FYTD 2013...................        981          981        78.1%         44.2       116,121      124,682
----------------------------------------------------------------------------------------------------------------
Eastern Area (16 ROs)...........        193          195                                  26,495       26,965
----------------------------------------------------------------------------------------------------------------
Baltimore.......................         14           14        71.3%         29.9         1,938        2,039
Boston..........................         10           10        63.8%         80.7         1,406        1,453
Buffalo.........................         14           14        67.8%         41.0         1,823        1,961
Cleveland.......................         24           25        87.1%         52.5         4,336        4,340
Detroit.........................         30           30        79.5%         54.5         4,087        4,189
Hartford........................          9           10        95.9%         34.8         1,510        1,508
Indianapolis....................         20           20        72.8%         54.0         2,952        2,962
Manchester......................          5            5        30.2%         44.1           515          528
New York........................         16           16        91.3%         49.9         1,618        1,627
Newark..........................          9           10        39.2%         43.8         1,657        1,678
Philadelphia....................         14           14        77.5%         42.1         1,796        1,807
Pittsburgh......................          9            9        67.2%         43.4           782          801
Providence......................          7            6        52.0%         34.2           523          515
Togus...........................          8            7        82.4%         34.7           714          716
White River Junction............          2            3       100.0%         44.1           593          595
Wilmington......................          2            2        89.6%         48.6           245          246
----------------------------------------------------------------------------------------------------------------
Southern Area (12 ROs)..........        302          301                                  34,534       36,388
----------------------------------------------------------------------------------------------------------------
Atlanta.........................         45           45        81.8%         47.2         4,665        4,821
Columbia........................         28           27        78.4%         31.2         2,487        2,693
Huntington......................          9            8        35.6%         45.9           643          637
Jackson.........................          6            7        81.4%         45.7         1,025        1,050
Louisville......................         19           19        78.1%         41.0         2,345        2,376
Montgomery......................         27           27        90.6%         36.6         3,415        3,475
Nashville.......................         21           21        84.3%         51.6         2,615        3,061
Roanoke.........................         24           24        63.3%         38.8         2,934        3,007
San Juan........................          6            6        87.8%         42.0           701          732
St. Petersburg..................         62           62        84.8%         43.8         8,271        8,318
Washington......................         24           24        92.5%         39.5         2,389        2,505
Winston-Salem...................         31           31        79.8%         36.6         3,044        3,713
----------------------------------------------------------------------------------------------------------------
Central Area (14ROs)............        251          248                                  27,662       30,641
----------------------------------------------------------------------------------------------------------------
Chicago.........................         15           15        86.5%         38.0         1,875        1,962
Des Moines......................          8            8        84.5%         39.6         1,210        1,226
Fargo...........................          6            5        72.1%         29.3           385          384
Houston.........................         55           55        90.6%         41.4         6,243        6,493
Lincoln.........................          8            7        84.8%         36.4           680          686
Little Rock.....................         11           11        38.3%         24.0         1,320        1,313
Milwaukee.......................         11           11        88.1%         29.5         1,239        1,236
Muskogee........................         19           19        87.6%         48.3         2,126        2,229
New Orleans.....................         13           13        77.0%         34.4         1,305        1,375
Sioux Falls.....................          7            7        66.7%         33.5           673          683
St. Louis.......................         18           18        79.8%         37.4         1,661        1,716
St. Paul........................         11           11        83.0%         41.0         1,322        1,344
Waco............................         58           58        80.7%         52.1         6,872        9,049
Wichita.........................         11           10        80.0%         22.1           751          945
----------------------------------------------------------------------------------------------------------------
Western Area (16 ROs)...........        235          237                                  27,430       30,688
----------------------------------------------------------------------------------------------------------------
Albuquerque.....................          8            8        89.8%         53.5         1,068        1,090
Anchorage.......................          6            6        95.7%         47.4           866          863
Boise*..........................
Cheyenne**......................
Denver..........................         25           25        85.1%         33.8         3,178        3,377
Fort Harrison...................          6            6        88.0%         35.3           770          772
Honolulu........................         10           11        79.2%         65.9         1,347        1,647
Los Angeles.....................         25           26        76.4%         46.3         4,043        4,129
Manila..........................          2            2        85.7%         33.2           158          163
Oakland.........................         22           22        82.9%         47.8         3,242        3,331
Phoenix.........................         21           21        85.0%         46.6         2,176        2,465
Portland........................         20           20        75.3%         63.3         2,093        2,133
Reno............................          7            7        90.7%         42.9           788          807
Salt Lake City..................         18           18        86.2%         39.8         2,159        1,763
San Diego.......................         31           31        76.4%         38.5         2,220        4,038
Seattle.........................         34           34        83.2%         66.0         3,322        3,645
----------------------------------------------------------------------------------------------------------------

                                housing
    Question 183. The Committee recently received the following from VA 
in response to a question concerning the National Mortgage Settlement.

          In 2012, the Department of Justice (DOJ) worked to achieve a 
        settlement with five banks who participated in the VA home loan 
        program. The two-part settlement contained (1) approximately 
        $10M for violations related to mortgage loan origination and 
        servicing (the National Mortgage Settlement), and (2) 
        approximately $45M pursuant to the False Claims Act. The first 
        part of the settlement is intended to settle any potential 
        claims related to VA guaranty claim payments, which are paid 
        from the loan subsidy account of the Veterans Housing Benefit 
        Program Fund (VHBPF). The second part of the settlement 
        addresses impermissible loan transaction fees charged to 
        Veterans.
          None of the settlement money due VA, approximately $42M, will 
        be paid to VA home loan borrowers. Because the VA Home Loan 
        Program is subject to the Federal Credit Reform Act, the 
        following actions will be taken once funds are received from 
        DOJ. Funds associated with the National Mortgage Settlement 
        will be deposited in the VHBPF loan subsidy account and spread 
        over all loan cohorts to cover the potential guaranty claims 
        that VA may pay. Funds associated with the False Claims Act 
        portion of the settlement are not deemed ``funds incident to 
        housing loan operations,'' and will therefore be deposited back 
        to Treasury.

    a. How many guaranty claims does VA believe it will pay that would 
be covered by the $10 million portion of the settlement?
    Response. VA does not understand what is meant by ``sufficient'' 
with regard to the settlement funds. The funds were not tied to 
specific loans or specific mortgage origination/servicing violations. 
However, VA has not released its right to adjust claims if it finds 
specific instances of origination or servicing violations. As noted 
above, any excess funds within individual cohorts identified through 
re-estimates will be transferred to Treasury.
    b. Of those covered by funds put in the VHBPF loan subsidy account, 
does VA believe the $10 million will be sufficient? Please provide 
justification.
    Response. VA does not understand what is meant by ``sufficient'' 
with regard to the settlement funds. The funds were not tied to 
specific loans or specific mortgage origination/servicing violations. 
However, VA has not released its right to adjust claims if it finds 
specific instances of origination or servicing violations. As noted 
above, any excess funds within individual cohorts identified through 
re-estimates will be transferred to Treasury.

    Question 184. The fiscal year 2014 budget request housing workload 
section for 2014 states: ``The number of refinance loans will decrease 
as interest rates steadily rise.'' In questions for the record 
regarding the fiscal year 2013 budget request, the Committee asked 
about VA's interest rate assumptions, as VA had asserted that interest 
rates would steadily rise during 2012 and 2013. Since the February 29, 
2012, budget hearing, the 30-year fixed mortgage interest rate, 
according to Freddie Mac, has fallen from 3.9 percent on March 1, 2012, 
to 3.4 percent on April 25, 2013. In light of the continued decline in 
interest rates, has VA looked at other economic assumptions aside from 
those prepared by the Office of Management and Budget? If so, please 
explain what assumptions VA now utilizes.
    Response. VA's guidance for economic assumptions in the budget 
request is prepared by OMB; VA continues to use OMB assumptions under 
the requirements of the Federal budget process. VA does review outside 
mortgage industry projections, and these have been consistent with 
OMB's assumptions, including interest rate expectations. VA will update 
forecasts for refinance and purchase loan guaranties during the 2014 
Mid-Session Review budget cycle in June 2013.

    Question 185. The fiscal year 2014 budget request housing workload 
section indicates, ``[t]hese economic conditions have led to declining 
housing prices and tightening credit.'' The Standard & Poor's/Case-
Shiller 20-city home price index, released April 30, 2013, show housing 
prices increased from an 8.1 percent year-over-year gain in January to 
9.3 percent in February.
    a. Given the recent news on rising home prices, how would continued 
growth in the housing market effect VA's workload assumptions for 2013 
and 2014?
    Response. In general, housing price changes alone do not have as 
strong an impact on VA loan volume as do interest rate fluctuations and 
changes in credit underwriting in the conventional market. This was 
seen in the increase in VA loan volume following the mortgage market 
collapse (and decreased availability of conventional credit), and the 
surge of refinance volume in the recent low interest rate environment. 
But if housing price increases continue at a consistent rate, leading 
to a full recovery, VA loan volume is likely to increase moderately as 
a result.
    VA-guaranteed loan workload, and assumptions thereof, must be 
analyzed by the component loan types--purchase loans and refinance 
loans. Continued moderate housing price increases is not expected to 
have a substantial impact on the volume of VA purchase loans as this 
volume is not particularly sensitive to such increases and has 
historically been stable. However, slight increases in purchase loan 
volume could still result due to current homeowners who are now willing 
to move and obtain a new loan with the new ability to sell an existing 
home at a higher price.
    The ability to refinance may improve for certain borrowers if 
housing prices consistently increase as a lender's loan-to-value ratio 
refinance requirements may be newly achieved. There may be a slight 
increase in projected refinance volume as a result; however, this must 
be tempered with the forecasted increasing interest rates, which may 
hold some of these borrowers back from refinancing.
    Should housing prices continue to increase, VA would see more of an 
impact on the number of default resolution options available to 
borrowers than on loan volume. Underwater borrowers typically do not 
have the same default resolution opportunities available to them. 
Increasing home prices will reduce the number of underwater borrowers 
and increase those opportunities.
    VA will take into account recent changes in housing market 
conditions and forecasts in its mid-session review and update workload 
projections as necessary.
    b. How are VA's workload assumptions effected by regional 
differences in the housing market?
    Response. VA's workload assumptions are based on projected changes 
in the overall U.S. housing market. All regions constitute overall 
volume expectations, in aggregate. However, VA is currently exploring 
the procurement of a credit market's analytical tool that would provide 
regional housing data. It remains to be seen whether overall program 
workload assumptions would be adjusted based on the data available. The 
information would likely be more beneficial for targeting default 
resolution outreach to regions with higher projected defaults.
               filipino veterans equity compensation fund
    Question 186. The fiscal year 2014 budget request for the Filipino 
Veterans Equity Compensation Fund indicated that 3,500 Notices of 
Disagreement (NODs) have not been resolved. The estimate for fiscal 
year 2014 is that $45.1 million in unobligated funds will remain at the 
end of the fiscal year.
    a. When does VA expect that the remaining 3,500 NODs will be 
resolved?
    Response. Through May 8, 2013, the Manila RO received a total of 
4,515 notices of disagreement (NODs). Currently, only 495 of the NODs 
remain pending. Of those, 238 were certified to the Board of Veterans' 
Appeals (BVA) and 257 are pending at the RO.
    The majority of the 257 appeals pending at the RO are awaiting 
additional service records, service verification, or hearings. The 
Manila RO regularly provides the National Personnel Records Center 
(NPRC) a list of all pending requests for service verification. Weekly 
follow-ups are completed via email. Additionally, Filipino Veterans 
Equity Compensation (FVEC) appeals are given priority in the scheduling 
of hearings. At this time, all hearings have been scheduled.
    Typically, the appeals at the RO are resolved or certified to BVA 
in 30 to 60 days. This is dependent upon receiving documents from NPRC 
and can be extended if the claimant submits additional documents for 
review.
    b. Please detail what, if any, commonalities exist in the NODs and 
what steps VA is taking to address these.
    Response. There are two commonalities that exist among the NODs. 
Most of the NODs received (89 percent) are denials based on no 
qualifying military service and Question 11 percent were due to 
untimely filed claims, untimely filed NODs, or untimely substantive 
appeals.
    As stated earlier, the majority of the 257 pending at the RO are 
awaiting additional service records, service verification, or hearings. 
The Manila RO regularly provides NPRC a list of all pending requests 
for service verification and weekly follow-ups are completed via email. 
Additionally, FVEC appeals are given priority in the scheduling of 
hearings. At this time, all hearings have been scheduled.

    Question 187. The fiscal year 2014 budget request discusses two 
ongoing lawsuits that could affect the Filipino Veterans Equity 
Compensation Fund's unobligated balance.
    a. Please describe each lawsuit and how they could potentially 
affect the unobligated balance.
    Response. Both lawsuits challenge VA's administration of the 
Filipino Veterans Equity Compensation (FVEC) fund, and in particular 
the ways in which VA verifies whether a claimant had the service 
required by law.
    Recinto v. U.S. Dep't of Veterans Affairs was brought by individual 
Filipino Veterans alleging their claims were wrongfully denied because 
of reliance on faulty records, and by individual widows of Filipino 
Veterans challenging the statute on constitutional grounds. The number 
of individual claims directly involved in this case is small. However 
any ruling that the Government's process or the statute itself is 
legally deficient could conceivably expand the scope of the program in 
ways that are difficult to predict.
    De Fernandez v. U.S. Dep't of Veterans Affairs is a putative class 
action brought by three individuals and an organization seeking 
declaratory and injunctive relief. The suit principally alleges VA 
relies on faulty records and unjustified ``loyalty challenges'' to 
wrongfully deny legitimate claims. If a class were certified and 
plaintiffs were successful, plaintiffs would likely ask the court to 
force VA to re-adjudicate all denied FVEC claims under new procedures 
crafted by the court.
    VBA projects that the end of fiscal year 2014 unobligated balance 
for the Filipino Veterans Equity Compensation Fund will be $45.1 
million
    b. Does VA have a timeline for when the lawsuits will be resolved? 
If so, please provide that timeline to the Committee.
    Response. Recinto has been dismissed by the district court, and the 
dismissal was affirmed by the United States Court of Appeals for the 
Ninth Circuit (9th Circuit). Recinto v. U.S. Dep't of Veterans Affairs, 
706 F.3d 1171 (9th Cir. 2012). Plaintiffs have petitioned the United 
States Supreme Court for Certiorari. The case should be resolved in 
mid-October, if the Court does not grant the petition.
    Relying chiefly on Recinto, the district court dismissed De 
Fernandez. Plaintiffs have appealed to the Ninth Circuit. Because the 
case has not yet been briefed, the appeal is unlikely to be fully 
resolved in less than a year.
                                 ______
                                 
   Response to Posthearing Questions Submitted by Hon. Jon Tester to 
 Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs
    Question 188. The President has requested $7 billion to expand 
inpatient, residential, and outpatient mental health care for Fiscal 
Year (FY) 2014, an increase of $469 million from FY 2013. I appreciate 
steps taken by the Department of Veteran Affairs (VA) to increase its 
number of mental health professionals. In Montana and other rural 
states, we have not made much progress.
    a. What kinds of strategies is the VA currently using to retain our 
current mental health workforce, particularly those in rural areas?
    b. Do you currently have the tools and flexibility you need to 
ensure we maintain a high quality VA medical workforce in rural 
America? Are there any statutory obstacles?
    c. Can you speak to any ongoing collaboration with other Federal 
agencies, such as Health and Human Services or the Indian Health 
Service, to enhance our efforts? Are there opportunities to build upon 
these partnerships?
    Response to a, b, and c combined: VA has been working closely with 
outside resources to address any gaps and create a more patient-centric 
network of care focused on wellness-based outcomes. In response to 
President Barack Obama's Executive Order 13625, ``Improve Access to 
Mental Health Services for Veterans, Servicemembers, and Military 
Families,'' signed on August 31, 2012, VA is working closely with the 
Department of Health and Human Services (HHS) to establish 15 pilot 
projects with community-based providers. These providers include 
community mental health clinics, community health centers, substance 
abuse treatment facilities, and rural health clinics, to test the 
effectiveness of community partnerships in helping to meet the mental 
health needs of Veterans in a timely way. Both the Health Services and 
Resources Administration (HRSA) and the Substance Abuse Mental Health 
Administration (SAMHSA) of the HHS provided names of potential 
community partners. The fifteen pilots have been established across 
Georgia, Tennessee, Wisconsin, Mississippi, South Dakota, Nebraska, and 
Iowa.
    Pilot projects are varied and may include provisions for inpatient, 
residential, and outpatient mental health and substance abuse services. 
Some sites shall include capabilities for tele-mental health, staff 
sharing, and space utilization arrangements to allow VA providers to 
provide services directly in communities that are distant from a VA 
facility. The pilot project sites were established based upon community 
provider available capacity and wait times, community treatment 
methodologies available, Veteran acceptance of external care, location 
of care with respect to the Veteran population, and mental health needs 
in specific areas.
    VA currently collaborates with federally Qualified Health Centers 
(FQHCs) and community mental health clinics across the country. These 
community partnerships were developed locally as a means to provide 
mental health services to Veterans in areas where direct access to VA 
health care is limited by geography or workload. One of the most robust 
of the pilot sites is in Montana and serves as a prototype that other 
facilities may follow. Since 2001, the VA Montana Health Care System 
has followed a model utilizing community mental health contracted care 
to address the challenges of a geographically large area and the 
population dispersion of Montana's Veterans in need of mental health 
services. Montana has a population of 989,415 (46% reside in rural 
areas), a land area of 145,546 square miles and has the second-highest 
Veteran per capita population. Within Montana's 56 counties, part or 
all of 54 counties are designated mental health care shortage areas. 
For non-VA community mental health (MH) services, Montana is divided 
into four regions consisting of a regional mental health center and 
several satellite offices. Under these VA contracts, Veterans are seen 
by mental health providers at 45 sites. This allows VAMTHCS to provide 
mental health services at the local level to Veterans in all 56 
counties. In 2011, the number of Veterans treated under the contract 
was 2,221, increasing to 2,388 in fiscal year (FY) 2012. The choice of 
contract provider depends on the type of clinical services required. A 
contract provider may be utilized for one service while a VA provider 
may be utilized for a different mental health service.

    Question 189. Vet Centers are extremely beneficial to Montana 
Veterans, and it is vital that the number of Vet Centers increase 
throughout the state. Recent laws have expanded Vet Center eligibility 
to include a number of individuals still on active duty, as well as 
their families. While I am supportive of these efforts, I also believe 
it might be appropriate for the Department of Defense Health Program to 
fund their share of the caseload. Should the Department of Defense be 
authorized or directed to help supplement funding for Vet Centers if 
servicemembers begin making up a substantial portion of the caseload? 
Dr. Petzel, has this been part of the ongoing discussions with the 
Department of Defense during the regulatory process?
    Response. VA would like to thank the Senator and his staff for 
their continued interest and support of the Vet Center Program. The 
Veterans Health Administration appreciates the interest in this issue, 
and VA has had a discussion regarding this issue with staff from 
Senator Tester's office in June 2013. The VA's Readjustment Counseling 
Service (RCS) does have some concerns with a proposal that would ask 
DOD to reimburse RCS for services to active duty Servicemembers and for 
that additional funding to be used to expand the Mobile Vet Center 
(MVC) program. The below bullets outline the concerns:

     Reimbursement of services by DOD to RCS
         - There would be no way to ensure that Servicemember 
        confidentiality remains intact as some form of identifier would 
        have to be used and communicated from RCS to DOD to verify that 
        an individual received services at a Vet Center. Servicemembers 
        and Veterans alike use Vet Centers because they are safe and 
        confidential places where they can remain anonymous. Vet Center 
        staff only break confidentiality when clients allow through a 
        signed release of information or in situations to avert crisis.
         - VHA has already requested yearly increases to RCS's budget, 
        specifically to provide Vet Center services to Active Duty 
        Servicemembers (increase of staff and augmentation of space).
         - RCS is not set up to receive or process any form of third 
        party billing.

     RCS has recently expanded the MVC Program
         - In 2012, RCS expanded the MVC Fleet from 50 to 70 vehicles 
        to ensure increased access to Veterans and Servicemembers who 
        recently returned from Combat Zones or Areas of Hostilities as 
        well as those who are geographically distant from existing Vet 
        Center services. With this new expansion, a MVC is stationed 
        within a 120 minute drive time to all major Active Duty 
        Military Installations whose base population is over 10,000 and 
        Demobilization Sites. Further, MVCs are located within 
        reasonable driving distances to many of the military 
        installations and Reserve and National Guard Armories that are 
        below this population limit.
         - MVCs and staff regularly participate in events where Active 
        Duty Servicemembers are present such as demobilization events 
        or other events on military installations and armories.

    VA would welcome the opportunity to discuss the Vet Center Program 
in further detail with Senator Tester or his staff and appreciate his 
support of the program.

    Question 190. Proportionally, American Indians serve in our Armed 
Forces in greater numbers than any other ethnic group. The United 
States has unique responsibilities to them both, as veterans who have 
proudly served our Nation, and as American Indians who have sacrificed 
immeasurably. In Montana, providing health care for veterans on 
reservations is a difficult task. Rural isolation only adds to the 
challenge. I have advocated for the VA to improve its communication and 
outreach efforts with the tribes in relation to its funding for Tribal 
Veterans Representatives or Tribal Veteran Service Centers. Has the VA 
taken any recent steps to address this issue?
    Response. VA's Office of Rural Health provides fiscal assistance to 
support annual Tribal Veteran Representative training in Montana and 
other VA networks across the country. These training efforts ensure 
that every tribal community in Montana has a local point of contact for 
Veterans services. This serves as a critical point of access to VA 
services and benefits for Veterans living in some of Montana's most 
rural areas. The TVR training is also supported by VISN 19. VISN 19 
employs tribal outreach workers who support tele-health infrastructure 
established between the VA at tribal sites located throughout Montana. 
Most TVRs are paid by tribal funds or serve as volunteers.
    VA is also in the process of implementing reimbursement agreements 
to IHS and tribal health programs for direct care services provided to 
American Indian and Alaska Native Veterans. It is anticipated that 
through these agreements, additional partnerships will expand between 
the VA, IHS and tribal governments that will effectively serve the 
needs and priorities related to access for Veterans living on tribal 
lands in Montana.
                                 ______
                                 
Response to Posthearing Questions Submitted by Hon. Dean Heller to Hon. 
    Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs
    Question 191. I respectfully request that you provide a breakdown 
of the funding allocated to each Department of Veterans Affairs 
Regional Office (VARO) under the Veterans Benefits Administration 
(VBA). I would like to know the number of full-time employees at each 
VA Regional Office as well as the number of pending and backlogged 
claims at each VARO?
    Response. The respective funding allocations, the number of FTE, 
and the number of pending and backlogged claims per RO are broken down 
on the attached spreadsheet, entitled ``Question 192 funding allocation 
FTE backlog.'' The FY 2013 funding allocation is pending finalization; 
however, staffing levels and, consequently, funding levels are expected 
to remain relatively even with FY 2012. Many ROs administer several 
benefit programs and activities in addition to compensation (loan 
guaranty, education, fiduciary hubs, national call centers, pre-
discharge programs, brokering centers, pension centers, etc.). 
Therefore any comparisons cannot consider only compensation workload.

    Question 192. An integral tool of reducing the VA claims backlog is 
transitioning to a paperless system--the Veterans Benefits Management 
System (VBMS). Part of this transition includes the Veterans Claims 
Intake Program (VCIP), which scans and converts evidence in support of 
claims into digital information. In the VA's fiscal year 2014 budget 
request, VCIP is allocated $136.44 million--which the VA budget states 
is an increase of $119 million over 2013, an addition of 34 full time 
employees, and includes support contract costs to execute VCIP.
    I understand that VBA contracts with the private sector to perform 
large scale scanning operations of paper claims to feed them 
electronically to VMBS for electronic claims processing. I also 
understand that there is an internal scanning operation of medical and 
personnel records at the Records Management Center (RMC) in St. Louis.
    How does your internal scanning production at the RMC in St. Louis 
compare to the scanning production at the contractors facilities? If 
there is a difference in productivity, please explain any discrepancy. 
If there is no difference, why does VBA not keep the scanning work in-
house by expanding or replicating the operation performed in-house at 
the RMC?
    I want to ensure that if Congress provides a significant increase 
in funding to the VCIP that quality and timely production is maximized.
    Response. The limited scale scanning operation at the Records 
Management Center (RMC) provides document conversion services for 
Service Treatment Records and Military Personnel Files, and is 
configured differently than operations at the scan vendor sites. The 
current configuration of desktop scanners was specifically selected for 
the handling of these materials, and as a result the RMC scans fewer 
types of evidence, and at a lower page per minute rate than scan 
vendors. Currently, the RMC's maximum capacity is under 500,000 images 
per month.
    In contrast, the contracted scanning vendors employ dedicated 
facilities with high-speed and high-volume scanners to process more 
evidence types, at a much higher page-per-minute rate than the RMC. 
While this approach requires a significant initial investment, the 
current estimate for scan operations at these vendors is projected to 
routinely be in excess of 40 million images per month.
    Expansion of RMC to handle such large volume would require 
significant investment in developing the expertise, skills, and 
training of the VBA staff for this function, diverting attention from 
the priority goals of accurate and timely claims processing.
    The model used at the RMC is based on a specific type of evidence, 
with a narrow focus. To apply the approach used by contract scan 
vendors would require extensive rework of this configuration, and 
meeting the demand using internal VBA resources would require expansion 
of this staff and the facilities and systems infrastructure on 
significant scale. This would require an investment of time and money 
greater than the use of contractors, with a greater long-term cost to 
the taxpayer.
    In the first 11 months of operations, the contracted scanning 
vendors have enabled VBA to convert paper claims materials into over 
240 million images cumulatively, with an average 5-day turnaround time 
from date of receipt of paper claims materials to date of upload into 
VBMS, while maintaining 99 percent accuracy.

    Question 193. In Fiscal year 2014, what has the VA budgeted for its 
teleaudiology program?
    Response. In FY 2014, VHA will fund a total of $655,000 in staffing 
costs for technicians, equipment maintenance service, and warranty 
costs for the initial 10 TeleAudiology sites that are providing remote 
hearing aid fittings and adjustments. VHA will also continue its 
expansion of TeleAudiology sites to 19 of its 21 Veterans Integrated 
Service Networks (VISNs) in FY 2014. All costs for audiologists, 
additional technicians, and telecommunications are covered by the 
existing VHA budget that is not specific to TeleAudiology.

    Question 194. Between FY 2014-2018, what is the VA projected to 
spend on the teleaudiology initiative?
    Response. VA projects to spend $3,629,000 for currently projected 
budgets between FY 2014-2018 (excluding audiologists, additional 
technicians at expansion sites, and telecommunications as explained 
above):

     FY 2014 = $655,000 ($112,000 for VHA National 
TeleAudiology Lead + $528,000 for existing site technicians +$15,000 
for annual maintenance service and warranty for existing sites).
     FY 2015 = $743,500 ($640,000 for staff (see FY 2014 above) 
+ $103,500 for annual maintenance service and warranty for 69 original 
and expansion sites.
     FY 2016 = $743,500 ($640,000 for staff (see FY 2014 above) 
+ $103,500 for annual maintenance service and warranty for 69 original 
and expansion sites.
     FY 2017 = $743,500 ($640,000 for staff (see FY 2014 above) 
+ $103,500 for annual maintenance service and warranty for 69 original 
and expansion sites.
     FY 2018 = $743,500 ($640,000 for staff (see FY 2014 above) 
+ $103,500 for annual maintenance service and warranty for 69 original 
and expansion sites.

    Question 195. In fiscal year 2012, what did the VA spend on 
veterans' transportation to and from VA clinics for hearing evaluations 
and hearing aid services?
    Response. In FY 2012, the average waiting time for hearing aids was 
40.5 days.

    Question 196. In fiscal year 2012, what percentage of qualified 
veterans received two sets of hearing aids?
    Response. In FY 2012, 1.3 percent of the 281,893 purchase orders 
involved two sets of hearing aids. A total of 278,250 Veterans had one 
purchase order for hearing aids, and 3,643 Veterans had two purchase 
orders (65 of these Veterans had 3 purchase orders). The majority of 
orders (89.6 percent) were for binaural hearing aids (one for each 
ear).

    Question 197. In fiscal year 2012, what was the average wait time 
for a veteran to receive the following items: a hearing evaluation, 
follow up-service, and a hearing aid?
    VHA Response: VHA provides hearing evaluations for new patients and 
follow-on care for established patients in Audiology clinics identified 
by clinic stop code 203. VHA tracks waiting times for both new and 
established patients. In FY 2012 both new and established patient 
waiting times were measured from the desired date for the appointment 
to the completed appointment. VHA defines a new patient as one who has 
not seen a qualified provider in a specific clinic stop code in the 
past 24 months. An established patient is one who has already been seen 
at least once by a qualified provider in a particular clinic stop code 
within the last 24 months. A new patient seeking audiology care will 
need a hearing evaluation before any treatment can be provided, 
therefore we assume that a new patient appointment will have involved a 
hearing evaluation and the associated new patient waiting time will 
apply. An established patient has already had the initial hearing 
evaluation in the past 24 months or longer and any appointments now 
would be considered follow-on care and the associated wait times for 
established patients would apply.

    Chairman Sanders. General Shinseki, thank you very much.
    Let me begin by addressing an issue that is a serious one, 
that I think every member here has spoken of and you have 
acknowledged, and one that is of great concern to this country.
    Now my understanding is that the VA is now processing more 
claims today than they ever have before----
    Secretary Shinseki. That is true.
    Chairman Sanders [continuing]. In significant numbers.
    But my understanding is also that according to the most 
recent Monday morning workload report there were nearly 890,000 
claims for entitlement to benefits pending, almost 70 percent 
of which have been pending longer than the Department's goal of 
125 days. And this number does not even take into account other 
pending work, including award adjustments and appeals.
    I believe you established that goal not long after you took 
your position. You brought forth a very, very ambitious goal, 
and you said that you wanted to process all claims in 125 days 
and with a 98 percent accuracy by 2015. Is that correct?
    Secretary Shinseki. That is correct.
    Chairman Sanders. All right, let me ask you this: what 
benchmarks have you set and must VA meet to make sure that VA 
achieves those goals?
    In other words, I think all of us would agree that the task 
that you have undertaken, going from an unbelievable amount of 
paper, a system that was virtually all paper when you took 
office, to a paperless system is just a huge transformation.
    The concern here--and others have raised it--is, what 
reason do we have to believe that you are, in fact, going to be 
able to successfully undertake that transformation and meet the 
goals, ambitious goals that you have established?
    Secretary Shinseki. Well, thank you for that question, Mr. 
Chairman. I am going to call on Secretary Hickey to add some 
detail, but let me just describe what situation existed when we 
arrived.
    We were in paper and have been in paper for decades. We 
continue to get paper today.
    If you are going to manage a situation, it takes a certain 
kind of approach and resourcing. We thought that for the long 
term the benefit to veterans was to end the backlog, and so we 
set the goal of ending the backlog in 2015.
    We did some rough calculations, and the backlog when we 
arrived was not defined as 125 days, 98 percent accuracy. If we 
want to make a bold move here and help veterans, then we have 
to move quickly. And so we set ambitious goals, we did our best 
estimates, and we have laid out a plan in this budget that is 
resourced, that drives those numbers toward ending the backlog 
in 2015.
    I think all of you will remember after we established that 
goal of ending the backlog we also took on some unfinished 
business.
    We had Vietnam veterans--my first year here as I moved 
around--who were not very happy with the fact that they had not 
had their issues addressed. In many cases, I was told that we 
were just waiting for them to pass so we would not have to take 
care of that. I cannot think of a more demeaning circumstance--
for a veteran to feel that that is what their VA, who exists 
for them, looked upon the situation.
    I heard the same kinds of things from Gulf War veterans--20 
years after the Gulf War, no decisions regarding their health 
care issues.
    Then, as I think all of us can acknowledge, PTSD has been 
around as long as combat and had never been acknowledged as 
associated with combat--verifiable PTSD.
    So, even as we established ourselves at ending the backlog, 
we took on three pretty significant decisions--for the Vietnam 
generation, three new diseases for exposure to Agent Orange' 
nine new diseases never recognized before for Gulf War 
veterans; and then for all combat veterans with verifiable 
PTSD, access, a service connection so that they could submit 
their claims.
    I would say that those numbers, added to the paper process 
that we had, in fact, were going to grow the inventory and 
complicate the backlog, and we testified to that when those 
decisions were made. There were a number of hearings on this.
    And my prediction was we are going to go up, but at the 
same time we are going to put in place an automation system 
that would correct all of that, and in time we would bring the 
backlog back down.
    Well, we are in mid-stride here. We are now fielding that 
automation tool. It took us 2 years to develop it. It is called 
VBMS--Veterans Benefits Management System. It is in 30 of the 
56 regional offices. We are seeing some indications that it is 
having good success, and we intend to field the remaining 
offices as quickly as possible.
    We have some good learning that came out of automating the 
new 9/11 GI Bill process, and out of that, the learning 
indicated to us was that there is a tremendous lift that comes 
once you have the system fielded. We followed that model of 
fielding, incrementally, an IT program that is robust enough to 
handle our claims processing.
    As I say, we are scheduled to complete this year, 31 
December. We are pulling that as far to the left as we can and 
fielding as quickly as we can and doing it prudently, where we 
do not run the risk of overreach.
    Chairman Sanders. General Hickey, did you want to add 
anything to that?
    Ms. Hickey. I would just like to add to the discussion that 
the Secretary has said. I know that we are asked routinely 
about our milestone. So I wanted to give you just a few bits 
and pieces of the milestones that we have experienced in the 
education claims process that is literally being built by the 
same people building VBMS.
    We have tripled--tripled--our productivity through the 
spring season as a result of the automated rules engines that 
went into the long-term solution, our paperless IT system, last 
fall the 24th of September. We went from doing 79,000 claims a 
month to doing more than 285,000 claims a month. Reducing the 
days it took to do those claims down to 4.5 days on average is 
where we are right now today in the body and the bulk of our 9/
11 GI Bill claims.
    We are applying the exact same strategy to the rules-based 
capability going into VBMS where, quite literally, the veteran 
will go online, which exists today on e-benefits, file their 
claim like they do their taxes--apropos to say that today. It 
goes directly into VBMS.
    Without even advertising it--we completed that whole piece 
here this year in January. Without even advertising it, we have 
500 claims a week going into that system. And it goes directly 
into VBMS, never turns into paper, and allows us to immediately 
start working them.
    Today, we do not have 3 percent in paper anymore. We have 3 
percent electronic. We have 14 percent of our paper that has 
already been converted to electrons just since January the 
28th. I have more than 116,000 electronic claims now, 
electronic folders, that we did not have before January of this 
year.
    So we are well moving along in this process, and in fact, 
this week I will have another six regional offices on the new 
IT system.
    Chairman Sanders. OK. Thank you very much.
    Senator Burr.
    Senator Burr. Mr. Secretary, the VA backlog reduction plan 
shows that in order to eliminate the backlog by 2015 VA will 
need to decide 1.2 million claims this year, 1.6 million claims 
next year, and 1.9 million claims in 2015. But, VA is 
projecting in the budget submission that it will decide 335,000 
fewer claims in 2013 and 2014.
    So, can the VA reach 2 million claims in 2015? That would 
be a 92 percent increase in productivity over the 2012 level.
    Ms. Hickey. So, Senator Burr, I am sorry. I do not exactly 
know your numbers, but I am happy to take your numbers and go 
look at them and come back to you and sit down and visit with 
you.
    I can tell you----
    Senator Burr. Well, I would be happy to. I am pulling them 
right out of the backlog reduction plan which was submitted in 
January. I got it January 25 in my office.
    The math would work out. To eliminate the backlog by 2015, 
VA would need to decide 1.2 million claims this year, 1.6 
million claims next year, and 1.9 million claims in 2015.
    Now, in the projections under the budget submission from 
the President, that says that over the next 2 years you will 
decide 335,000 less claims than what the backlog reduction plan 
said.
    I am trying to figure out if 2015 is--if you are certain on 
that. Then that means that you have to process over 2 million 
claims in 2015. Is that how your math looks at it?
    Ms. Hickey. Senator Burr, I would love to come, sit down 
and talk to you about that. Those numbers are a little 
different to me than the numbers we sent across and then have 
followed up on in questions to your staff. So I am happy to do 
that with you.
    Senator Burr. Well, in the budget submission, you do say 
that you will decide 335,000 fewer claims in 2013 and 2014, 
right?
    Ms. Hickey. Senator, the budget submission is slightly 
different than the plan that you received in January that was 
based on some assumptions made last fall, and there have been 
some differences in what we have seen in terms of the actuals 
that have been submitted to us. We have seen a significant drop 
in--not significant. That is not a good word. We have seen a 
drop in the number of claims that have been submitted to us of 
late.
    So we have adjusted the budget based on those issues.
    Senator Burr. OK. Currently, nearly 70 percent of the 
claims are backlogged, meaning that they have been waiting for 
a decision for more than 125 days.
    The strategic plan you submitted less than 3 months ago 
projected that the backlog would be reduced to 68 percent in 
2013 and 57 percent in 2014, but according to the budget 
submission you now expect no more than 40 percent of the claims 
to be backlogged during either of these 2 years.
    So, in revising these projections, what metrics did you 
look at, and what did they show you?
    Ms. Hickey. Senator, I looked at the actual submissions of 
receipts of claims that we have received from our veterans over 
the last 5 months, and each month they have been lower than our 
expected volume.
    Senator Burr. So the math works out to where you would have 
only a 40 percent backlog situation in 5 months?
    Ms. Hickey. No, Senator, it does not. And I do not think 
that--you all would throw me out of here if I said that that 
would happen. That is not where we are.
    We are at about 69 percent of our claims right now that are 
older than 125 days, and we are working every single day to 
drive that number south. We are doing it by a focus on our 
people, process and technology solutions and, as far as we can, 
pushing up our productivity by our folks.
    I can tell you today that my raters are 17 percent more 
effective and at a higher productivity than they were prior to 
us moving into this new transformation plan.
    Senator Burr. But, General Hickey, last year you 
testified--or, excuse me, the Secretary testified that during 
2013 the backlog would be reduced from 60 percent to 40 percent 
and that would ``demonstrate that we are on the right path.''
    At the time, did you envision that the backlog would stay 
above 65 percent for the first half of the fiscal year or that 
it would be 70 percent in April?
    Ms. Hickey. Senator, we do have some APG guidance, our 
annual planning guidance, that we communicate with to our 
Federal Government partners, and they are usually aspirational 
in nature.
    When we see a change or a difference, as the Secretary has 
pointed out, in terms of the workload that we saw increase due 
to Agent Orange, Nehmer, the increased claims associated with 
PTSD and the like, we did note that we would probably not be 
able to meet that 40 percent APG guidance. But the thought was 
you leave your stretch goal out there so that you keep trying 
to work hard to get to it, and that is what we have done.
    Senator Burr. Here would be a simple question: is the 
strategic plan that you sent to Congress aspirational?
    Ms. Hickey. So, Senator Burr, I grew up as a strategic 
planner in the military for quite a while, and I know that 
every strategic plan I built over the years for the U.S. Air 
Force always was a plan. And plans are always in contact. You 
know, they change and they adjust for reality and actuals.
    So we have and will continue to improve upon that plan and 
continue to adjust.
    Senator Burr. But when you developed that plan was it 
developed to be aspirational, or was it developed to give us an 
accurate blueprint of how VA perceived the timeline would move 
on disability backlogs?
    Secretary Shinseki. Senator, I think in all planning there 
is an aspect of aspiration at the beginning, and then it is--
with assumptions and the availability of resources--it is 
adjusted for what we think is achievable.
    In a long-term plan like this one, with as much dynamics 
involved, we make an assumption, for example, that the flow of 
veterans out of uniform to the VA is going to follow a pattern 
that we have been provided by the Department of Defense. If 
that changes, that adjustment, then we will have to look and 
see whether we can accommodate that change, and if not, then we 
will have to say we have a requirement for resourcing.
    Senator Burr. Mr. Secretary, thank you very much.
    And, Ms. Hickey, I look forward to sitting down with you to 
look at the matrix that brought about such a change in only 3 
months.
    And let me just say, Mr. Secretary, that I was not really 
addressing the increased number of claims that come in the 
door. I was addressing the number of claims that are actually 
processed and determined.
    Secretary Shinseki. Yes.
    Senator Burr. And that does not seem to be getting better.
    I thank the Chair.
    Chairman Sanders. Thank you, Senator Burr.
    Senator Rockefeller.
    Senator Rockefeller. Thank you, Mr. Chairman.
    General, I am going to try to ask you two questions in too 
short a period of time.
    It is homelessness on the one hand, suicides on the other. 
How do you pick the tragedy--the worst tragedy?
    There are up to 22 suicides a day--so let me just 
concentrate on that for a second.
    You are making an enormous move in mental health. You are 
bringing in not only the mental health experts but also the 
support staff that they need to have. It will take time to get 
them into the system and trained.
    But how do you look at the general population--starting 
with PTSD and then, obviously, as it gets into mental health 
things clarify themselves--and raise red flags?
    How do you take somebody who is on a suicide watch list or 
something of that sort? How do you go to work on that person? 
How do you try to break through?
    Secretary Shinseki. Senator, the issue here is no one 
should have to wait for mental health care. And we have 
resourced our Veterans Health Administration by nearly 57 
percent, an increase from 2009 to the 2014 budget. We believe 
this is where we have to put our emphasis.
    Regarding the suicide number you cited--22--you know, 4 
years ago we were not receiving suicide information, veterans' 
suicide information, from the States. So we wrote, and the 
States have been very responsive. Now we have that information 
flowing into the CDC of which we have this latest number--22.
    Four years ago, we did an estimate by the best way we 
could, from our mental health experts, and they pegged the 
number at about 18. So, while this looks like a growth in the 
last 4 years, it is really a better number based on data we 
have received. Eighteen was a fair call, but we have better 
information with 22, and we can set about doing things that we 
could only speculate on 4 years ago.
    So an increase in the mental health budget allows us now to 
do things like increase staffing where we find that we need 
additional resources.
    Dr. Petzel will provide an update on where we are with 
regard to hiring additional mental health, and then I will come 
back and close out on suicides.
    Senator Rockefeller. Before he does that, can I ask my 
second question?
    Secretary Shinseki. Certainly. Absolutely.
    Senator Rockefeller. I remember a number of years ago the 
excitement that was felt generally when DOD and the Veterans 
Administration were planning to work together. I went to a 
number of common facilities, joint facilities, and everyone was 
full of optimism.
    Now all of a sudden, evidently, unless I am wrong, there 
has been a pullback from that. The electronic records and all 
kinds of benefits flow from this cooperation. There has been a 
pullback from DOD. I am curious about that.
    Secretary Shinseki. We are both still committed to a 
seamless transition of servicemembers into VA. That has not 
changed.
    We are both also committed to an electronic health record 
that we share in common. And in the language that we have come 
to use over the past 4 years of growing the concept, it is a 
single, joint, common, integrated, electronic health record, 
open in architecture, nonproprietary in design.
    All of those terms are code to keep us focused on what we 
want in an electronic health record--one that we share together 
and one that will be as good 5 years from now as it is on the 
day we first invest and purchase it as opposed to being faced 
over and over with an aging electronic health record that we 
somehow have to refinance years down the road.
    So this is the concept that we have committed ourselves to.
    I would say that my sense is we have not backed away from 
that although Secretary Hagel, who has just arrived, is in the 
midst of getting into this issue. I have agreed that he ought 
to have time to do that.
    Senator Rockefeller. But you do not know of any backaway.
    Secretary Shinseki. I am not aware of any backing away.
    Senator Rockefeller. I am happy to hear that.
    Thank you, Mr. Chairman.
    And I apologize for doing that to you--asking two 
questions.
    Secretary Shinseki. Should we answer the first one?
    Senator Rockefeller. No, because my time has run out. You 
know, I have got to play by the rules.
    Chairman Sanders. Senator Johanns.
    Senator Johanns. Thank you, Mr. Chairman.
    Mr. Secretary, in the fiscal year 2014 budget request, I 
note that there is funding for one--just one, across the entire 
country--major medical facility. That is about $150 million for 
a mental health facility in Seattle.
    I am not questioning at all whether that is needed or not, 
but in contrast, the minor construction request is for $715 
million, substantially more. That is an increase of 17.8 
percent from the 2013 level.
    Does the VA have an estimate of the amount of minor 
construction funding that is needed to keep aging facilities 
patched together until they finally make their way up the 
priority list, which, if we are only doing one a year, that is 
going to be a long, long wait?
    But how much of that money then is actually going into 
trying to keep aging facilities operating? Is it all that 
money?
    Secretary Shinseki. Well, Senator, let me answer the broad 
question of our construction budget. It includes $2.39 billion 
for major, minor construction which you have asked about, non-
recurring maintenance which has a lot to do with facility 
condition, and major medical leases.
    Minor construction, as you indicated, has increased by 17 
percent compared to 2013. This is important to us because this 
is money that gets into the hands of hospital erectors very 
quickly and impacts more facilities for the kinds of things you 
are concerned about and services directly to veterans.
    The major medical leases. Our request there is an increase 
of 12 percent compared to 2013. And, here, those leases are 
intended to provide health care delivery closer to where 
veterans live, and that is all this business of community-based 
outpatient clinics and so forth.
    Major construction. The request is for $342 million, and as 
you indicated, there is one major project here on the list. But 
it is a stable program, and we have a plan for in-phase funding 
the execution of a number of large projects.
    Non-recurring maintenance, $709.8 million, again remains 
stable in comparison to 2013. And, here, we are dealing with 
safety, facility condition deficiencies and other high priority 
needs to make sure that the facilities we do have are safe, 
secure and accessible to veterans.
    This is a balance across our programs. And I would just 
offer that it is a stable overall program with emphasis on 
minor, major leases, or medical leases, and assuring that the 
non-recurring maintenance is maintained at a stable level as 
well.
    Senator Johanns. You can kind of see where I am headed. My 
concern is that you have got a whole host of old buildings out 
there. It certainly would not be what you would want if you 
were going to build a facility today, obviously, because they 
are probably 50, 60, 70 years old. And I am worried that we are 
putting money into these old facilities, which to me seems 
almost like a waste.
    Has the VA studied any possibility of trying to jumpstart 
this program, to try to get more new construction versus 
putting money into old buildings, or are we just stuck where we 
are at?
    Secretary Shinseki. I do not describe us as being stuck. I 
mean, if there was another dollar to be had, there is a place I 
could put it in construction, but as I say, it is stable 
approach to a large footprint.
    Part of our responsibility is to decide what part of that 
footprint we no longer need. In the last several years we have 
reduced the amount of vacant space, and consolidated and 
reduced the amount of underutilized space; in both categories, 
some 25 or 26 percent reduction. So we do that as well.
    There are other pieces of our property that we can dispose 
of, and we do through either demolition or look for other means 
to find other uses for what we no longer need.
    We used to have an enhanced use lease authorization that 
expired in December 2011, and our efforts to have that 
authorization renewed and extended have succeeded in providing 
for an enhanced use lease arrangement for homeless requirements 
only. So we do have that.
    And, right now, we have a number of projects where we have 
created homeless housing for veterans. We have others that are 
in design, and other work is underway--about 5,500 units in 
all.
    So we do manage those older pieces of property. We have 
need for some of it, not all of it, and we need a way to 
efficiently dispose of it.
    Senator Johanns. Thank you, Mr. Chairman.
    Chairman Sanders. Thank you, Senator Johanns.
    Senator Tester.
    Senator Tester. Yes, thank you, Mr. Chairman.
    I have got more questions than we have got time, but we 
will start with the Caregivers Bill of 2010. In that bill was a 
provision to establish a rural veterans' coordination pilot so 
that OIF and OEF veterans could get care from community-based 
providers for mental health in cases where the VA did not have 
capacity. The provision gave the VA clear authority to contract 
out mental health services for OIF and OEF veterans in rural 
areas where mental health providers are at a premium.
    Can you give me any progress on this?
    Why I say that is because Montana has four community mental 
health centers serving the West, the South, Central, the East, 
and the North, too. None of those are contracted with.
    Just wondering, where are we as far as progress goes on 
this?
    Secretary Shinseki. Dr. Petzel.
    Dr. Petzel. Thank you, Senator Tester.
    Thank you, Mr. Secretary.
    The event of the bill has really been overtaken by the 
executive order from the President. We are in the process now 
of developing 15 contract pilots across the country with 
federally qualified, community-based clinics to pilot the 
concepts of the contract. If this is successful--and we are 
quite confident it is going to be--we are going to be doing 
this across the country.
    I was not aware that--you enlightened me. I was not aware 
of the fact that the Montana clinics were not contract pilots.
    Senator Tester. Well, you can correct me if I am wrong, but 
I do not believe that they are.
    Dr. Petzel. I will check.
    Senator Tester. They are not contracted with the VA.
    Now the question is, OK, so these 15 pilots which the 
executive order enhanced in 2010, where are they at? Are they 
up and running? Is the pilot running so you are going to assess 
them, and if they are not, when will they be?
    Dr. Petzel. Virtually all of them are delivering care.
    Senator Tester. OK.
    Dr. Petzel. A number of them are doing it by contract. Some 
others had difficulties getting the contracts executed 
immediately, so they are doing it on a fee basis. But the 
contracts are in process, and we expect that within a month or 
two everybody will be operating on a contract.
    Senator Tester. OK. And when would you anticipate an 
assessment of their effectiveness will be done?
    Dr. Petzel. I would hope that we could do that late summer.
    Senator Tester. Super.
    I want to talk a little bit about health care providers in 
general, mental health care providers specifically, and this 
can still go to you, Dr. Petzel, if appropriate; if not, you, 
Mr. Secretary.
    We have issues. It goes along with the partnerships, but we 
have issues with folks--mental health care professionals and 
health care professionals in general--being staffed up to 
snuff. We have had conversations off the grid with you on that.
    What kind of strategies are the VA using to retain the 
current mental health workforce, particularly in rural areas, 
and if it applies to regular health care folks, could you 
address them both?
    Dr. Petzel. Thank you, Senator Tester.
    The VA has got really very flexible possibilities when it 
comes to hiring and retaining people. First of all, for 
clinical psychologists, psychiatric social workers, nurse 
practitioners in mental health, and psychiatrists, we have 
great flexibility in terms of the salary. Our salaries are very 
competitive almost anywhere around the country.
    Senator Tester. Who has that flexibility? Is that locally 
with the State VA or is that with the VISN or is that with you?
    Dr. Petzel. The flexibility lies with the individual 
facilities.
    Senator Tester. OK.
    Dr. Petzel. There are certain circumstances where they 
would have to come in, but it is unusual. They have great 
ranges of salaries that they can work with.
    Senator Tester. Do you need any other tools for 
recruitment?
    Dr. Petzel. I think that the thing that limits us a little 
bit is the fact that our debt forgiveness stops at $60,000. 
Particularly for medical students and residents, that may be a 
drop in the bucket, so to speak. I would like to see if we can 
raise the limit on which we can forgive debt.
    Senator Tester. I would love to have a recommendation since 
you are in the business. I do not have any idea what a nurse 
practitioner with a mental health background would come out of 
college with as far as debt, but I would love to get some 
recommendations from you on where that $60,000 cap ought to be.
    Dr. Petzel. We will talk.
    Senator Tester. OK. The other I wanted----
    Secretary Shinseki. Senator, I would just----
    Senator Tester. Yes, go ahead.
    Secretary Shinseki. Senator, I would just like to put a 
fine point on the last statement. Sixty thousand dollars is 
$60,000. It is not a drop in the bucket, but increasing it 
would give us flexibility we do not have today.
    Senator Tester. I understand, General. And you are right, 
$60,000 is a lot of dough, but some of these folks are coming 
out college with maybe $200,000 of debt. I do not know how 
much. I just do not.
    So it would be good to--we will do some research on that 
end, too, so it is not all on your shoulders.
    The last thing that I have--well, I have got more but real 
quickly, if you might, and I am not going to play by the rules.
    What kind of impact does this have--I am talking about 
flexibility on salary. What kind of effect does that have on 
existing staff?
    I do not want to be the devil's advocate here, but if you 
have got somebody on staff that is making--I will just pick a 
figure--$75,000 a year and you offer somebody new in $100,000, 
what kind of impact does that have on morale, and is it 
something you are cognizant of?
    Is there some way you can address existing staff that are 
doing a hell of a good job and that are already there? We do 
not want to take those folks for granted.
    Dr. Petzel. The short answers to both questions is yes and 
yes. We are cognizant of the fact that, particularly with 
psychiatrists, that that could be a problem; and we have ways 
that we can address that with existing staff.
    Senator Tester. Super. Thank you very much.
    Chairman Sanders. Thank you, Senator Tester.
    Senator Isakson.
    Senator Isakson. Thank you, Mr. Chairman.
    Secretary Shinseki, I want to follow up just a second on 
what Senator Johanns was talking about on leases. In the 
President's budget, in the construction account, there is $6.4 
million for the relocation of a CBOC in Cobb County--it is an 
old facility of 7,900 square feet in Austell--to a newer 
facility in the northeastern part of that area. That is a huge 
area of metropolitan Atlanta that serves a lot of veterans that 
many times are forced to go to the veterans' hospital in 
Decatur, GA, which puts more pressure on that facility.
    I just wanted to say thank you to the President and to you 
because I know your request had to have something to do with 
that.
    I hope that is a two-for. One, it is a better facility for 
the veterans, but two, I think it is a lot more efficient on 
cost than anything else we could do, especially with the 
current facility. So, thank you very much.
    Second, Under Secretary Hickey, I notice you had a 
Washington moment last week when the Washington Examiner got a 
hold of one of your emails, which I read. First of all, having 
had my emails gotten into before, I know how it feels when 
somebody does that. But they commented on an email you had sent 
to someone--doesn't matter who it was--talking about assembling 
a bunch of big brains quickly to deal with the problem of 
timing in terms of claims approval.
    It was dated, I think, March 30, which was a couple weeks 
after the hearing we had here on claims, where you had 
indicated we were kind of on track on claims. Then this email 
goes out, looking for the best brains you can get to come in 
and help since you have got a real crisis.
    Can you kind of clarify that for me?
    Ms. Hickey. Thank you, Senator Isakson.
    Secretary Shinseki. Senator, can I just start and let 
Secretary Hickey finish up?
    Senator Isakson. You are the boss.
    Secretary Shinseki. I would just say from the perspective 
of innovation, this has been something we have been doing for 3 
years--going out and getting the best minds to come in and help 
us, inside VA, outside VA, casting a broad net. In that first 
year we got 40 initiatives which we have taken aboard. Not all 
of them work, but we investigated all of them. The next year we 
did the same thing.
    So, I would just say this sort of fits our always looking 
for a better way to do what we are doing to address the needs 
of veterans, get it to them as fast as we can. I think 
Secretary Hickey was a part of that.
    And I would say in 2015, when we hit the target we have set 
for ourselves, we will still be looking for good ideas.
    So, with that, Secretary Hickey.
    Ms. Hickey. Senator Isakson, the Secretary said it very 
well. We keep doing process improvement. In fact, it is now 
part of the culture and the governance in VBA. We actually have 
people whose job it is to create process improvement.
    So this was nothing more than let's keep thinking about 
this. Let's keep getting more and more ideas on the table, and 
let's keep charging hard with the plan we believe is going to 
get us there.
    But we were not even just looking at compensation claims. 
We were looking at our whole--I have six other business lines. 
We were looking at everything we do and how we can do more and 
better to increasingly serve our veterans, their family 
members, and their survivors. It was a course of action to keep 
going.
    Probably if you saw every other email in my box, you will 
see we have got an urgency in VBA, no matter what we are doing 
right now, to just do a much better job by our veterans, their 
family members, and their survivors.
    Senator Isakson. What you said was what I hoped the answer 
was to the question. Now I pose this to you--and I am speaking 
for myself now, though the Chairman and Ranking Member may 
disagree. We do not necessarily fall in the big brain category, 
I do not think, but I will speak for myself on that point.
    But, you know, it might be helpful to us, to call out to us 
to come down to see what your problems are, to look at them 
firsthand, just to get our eyes on them because sometimes we 
will ask questions about why something is taking so long to do 
or something is not happening, and you will give us the very 
best answer, I am sure, that you can give us at the time, and 
then the next meeting comes up, and we have the same tiny, 
little waltz.
    It just occurred to me when I read that email that it would 
be great to invite us down and say, ``Look, this is where we 
are having trouble; have you guys got any ideas?'' Because 
rather than us always being the critics in the peanut gallery, 
we can get down on the ground floor with you and see what those 
things really are.
    I think outreach is important, and I think it ought to be 
inclusive of all those who have a stake in the game. That was 
my reason for asking the question.
    Secretary Shinseki. Thanks, Senator. Great offer on your 
part, and we are happy to take you up on it.
    Senator Isakson. One last thing; a question for me. The 
Veterans Benefits Management System request is for $155 million 
in this year's budget. Is that right?
    Secretary Shinseki. That is correct.
    Senator Isakson. And I think $32.8 million is for 
development of the system. What would the other $122 million be 
used for? Personal services or personnel or payroll or what?
    Mr. Warren. Thank you, Senator, for that question.
    The balance is to pay for sustainment costs. So the systems 
that we have been bringing online for the past 2 years--you 
have to pay the bills, to pay the licensing on it, as well as 
the operations cost to continue the program going forward.
    Senator Isakson. When you say licensing, I guess you are 
talking about a site license for the use of the software.
    Mr. Warren. It would be the software license, the hardware 
maintenance, and system maintenance as well.
    Senator Isakson. And that is an ongoing cost, correct?
    Mr. Warren. Yes, it is, sir.
    Senator Isakson. OK. I just wanted to be sure.
    Thank you, Mr. Secretary.
    Chairman Sanders. Thank you, Senator Isakson.
    Senator Begich.
    Senator Begich. Thank you very much, Mr. Chairman.
    Again, Secretary Shinseki, thank you very much for being 
here.
    I know you have said it in your prepared comments and so 
forth, but let me just ask you to restate it. In regards to the 
disability claims, restate your goal on when you think you will 
have as much as you feel comfortable to have under control in 
the sense of the backlog.
    I know you have a target. Can you restate that for me, and 
then tell us what is your confidence level in that? That's what 
I guess I want to ask you.
    Secretary Shinseki. Well, there are assumptions----
    Senator Begich. It is a tricky question because whatever 
you say I am going to keep track of it.
    Secretary Shinseki. Well, I would like to provide a more 
specific answer to you, Senator, but again, this is based on 
our experience with the Post-9/11 GI Bill which, as you know, 
we started building in 2009. And by the spring of 2010 we had 
Version 1, and we have been building on it ever since. And 
Secretary Hickey described sort of this lift when it all kicked 
in.
    We are still in the process of fielding VBMS. We are 30 and 
soon to be 36 out of 56. So we are moving as fast as we can.
    We started in September in last year. We are barely 6 
months into it, and we are looking at a fielding much earlier 
than December this year, which is the plan. I think once we are 
fielded, fully fielded, we are going to begin to see production 
impacts.
    We are also tied with DOD providing us electrons beginning 
in January 2014.
    Senator Begich. If I can interrupt you on that, how much 
faith do you have that DOD will actually perform what you need 
them to do--because I know that has been a struggle in the 
past. So do you believe they will meet the goals that you have 
for the information flow so it becomes more seamless and 
electronic, that DOD will do actually what they say?
    Secretary Shinseki. They have committed to date and time 
specific. We have the date and time here.
    Senator Begich. Let me here that.
    Ms. Hickey. They have committed to give me immediately, 
point forward, full----
    Senator Begich. So all new that are leaving from now 
forward, they are going to complete electronically.
    Ms. Hickey. They are going to first give it to me in paper, 
which I would rather not have----
    Senator Begich. Right.
    Ms. Hickey [continuing]. But they are committed to building 
a system called HAIMS, the Health Artifact Information 
Management System.
    They are right now, today, giving me something we have 
never had in VBA before, which is they are going through and 
finding their medical records, going out and reaching out to 
TRICARE and pulling those medical records in, and they are 
pulling in their contract medical records. And they are doing 
the business on their end of pulling all that together, 
certifying it is 100 percent complete and handing me, for the 
first time ever, a fully complete medical record.
    Senator Begich. So that will be a complete written record. 
Then when will they go to electronic?
    Ms. Hickey. In December of this year.
    Senator Begich. Of this year? And that is of cases from 
that date forward? Then you have the backlog which is the 
longer challenge. Am I reading that right?
    Secretary Shinseki. That is correct.
    Senator Begich. OK. So now DOD is doing all the combining 
of the work, which is important because you have Guard and 
other folks all kind of in this mix now. That will come to you 
immediately. In December, the electronic efforts of anyone who 
then leaves after December 31 will be coming to you 
electronically. And then they will commit to move those others 
in which way?
    How will all the backlog information----
    Ms. Hickey. Essentially, the backlog information, I am 
handling by----
    Senator Begich. It is all piled on you now.
    Ms. Hickey [continuing]. Turning it to a scanning 
environment.
    Senator Begich. Your target for getting that moved into 
full implementation of electronic will be?
    Ms. Hickey. I am doing it right now. I have 116,000 that 
are already in an electronic folder right now, today, since 
January 28 of this year.
    I am also committed to any new claim that comes in the door 
gets immediately scanned by one of our two vendors--they are 
doing a very good job--turned into an electronic claim and 
worked through the VBMS electronically.
    If you are a veteran who is not going to come back to us, 
then I will not expend the resources to turn you into an 
electronic claim.
    Senator Begich. Can I try to ask two more quick things?
    First off, I know you have your patient-centered care 
program. You have budgeted 250-some million dollars for that 
investment, which we think is great. It is part of the 
implementation of your Patient Aligned Care Teams--PAC Teams.
    I know your PAC Teams went up to Alaska and looked at a 
system that we use, called NUCA, which is our native tribal 
system, which is very similar to what that hopefully will do. 
Can you tell me about a connection--if there are resources in 
there to try to utilize the NUCA model within the VA?
    I do not know who would like to answer that.
    Secretary Shinseki. Dr. Petzel.
    Dr. Petzel. Thank you, Mr. Secretary.
    Senator Begich, we are very much enamored of the NUCA 
model. It is very similar to what we want to do in terms of 
patient-centered care, proactive, personalized health care, but 
it is doing some things that we, frankly, had not thought 
about. We have sent four teams up there so far, for educational 
experience with them, and we plan on continuing that effort.
    I am going to be meeting with Kathleen Gottlieb----
    Senator Begich. Excellent.
    Dr. Petzel [continuing]. The CEO of NUCA.
    Senator Begich. You see a value in that program?
    Dr. Petzel. Absolutely. We can learn from them.
    Senator Begich. OK. The last question is, you had $52 
million, I think, in your budget for reimbursement to Indian 
Health Services for some of the new programs which you are 
doing now on reservations as well as within the Alaska rural 
component. Is that enough, or do you have a sense on that at 
this point?
    Again, I want to thank you for reaching out for first 
people in this country, especially Alaska Native and American 
Indians, and trying to do something very different with health 
care systems that exist already.
    Is that enough reimbursement or is it hard to say? Give me 
a sense.
    Secretary Shinseki. I think at this moment we are just 
standing up the agreements and beginning to activate them. I 
think that is a good start point.
    Let me ask Dr. Petzel and see if he has any more details.
    Dr. Petzel. No more details, but I would agree with the 
Secretary. We think that this is enough. There are 10 pilots 
that are being developed to get the business rules fixed for 
this environment, and we think that this $52 million will be 
sufficient in 2014, yes.
    Senator Begich. Very good. I will end there. I have some 
other questions for the record.
    Mr. Chairman, that last question I asked was something that 
I know you and I have talked about--of how to maximize this 
delivery to veterans in very tough locations, rural locations. 
So we will see more on that.
    I really do thank VA for that effort.
    Chairman Sanders. Senator Blumenthal.

             STATEMENT OF HON. RICHARD BLUMENTHAL, 
                 U.S. SENATOR FROM CONNECTICUT

    Senator Blumenthal. Thank you, Mr. Chairman, and I 
apologize for being late, but I have been following some of the 
testimony.
    I want to thank you all for your service and, Mr. 
Secretary, particularly for your active duty service to our 
Nation and now in the Department of Veterans Affairs; and I 
thank the President for increasing the resources available to 
our veterans in a very difficult time, fiscally.
    Let me begin with Senator Begich's area of inquiry relating 
to the electronic health records. I understood that you 
described what was going to happen, Ms. Hickey, but I am not 
sure that I heard what the target date was. Senator Begich 
asked for a target date for completing the program.
    Secretary Shinseki. We are talking about claims here? 
Completing the claims?
    Senator Blumenthal. The electronic medical records system.
    Ms. Hickey. I think we are talking two different issues. 
There is the electronic health record, and there is this other 
effort I am doing with the fully complete certified----
    Senator Blumenthal. Well, maybe you are not the right one 
to ask.
    The electronic health record system----
    Secretary Shinseki. Yes.
    Senator Blumenthal [continuing]. Is still going forward?
    Secretary Shinseki. As far as VA is concerned, we are 
committed to it, and we await the Department of Defense's 
signaling to us that we have agreement here, but I believe we 
are on track. Secretary Hagel has asked for the opportunity to 
get into and review his structure and process, and that is what 
he is doing right now.
    Senator Blumenthal. So you have no assurance right now from 
the Department of Defense as to when or whether it will go 
forward?
    Secretary Shinseki. I do not have when, other than both 
secretaries are pushing very hard on this.
    Senator Blumenthal. Both you and Secretary Hagel have 
indicated that you are agreed to go forward but no other 
details?
    Secretary Shinseki. For VA, it is we have chosen VistA as 
our core. We are committed to a 2014 initial operating 
capability of this integrated electronic health record in two 
locations that we have specified and then to follow on, full 
operating capability in 2017. That's the plan, and that is what 
both departments have agreed to.
    Senator Blumenthal. So the departments have agreed to that 
plan and have both committed to VistA?
    Secretary Shinseki. DOD is looking and reviewing what their 
decision on a core is going to be. We have selected VistA and 
offered VistA for their consideration, so Secretary Hagel and 
his acquisition folks at DOD are reviewing VistA at this time.
    Senator Blumenthal. Forgive me for revealing my limited IT 
knowledge, but how would the system work if you are committed 
to VistA and they are not; in other words, if they go to a 
different system?
    Secretary Shinseki. Well, we today have two different 
electronic records, health records. What we have committed to 
is solving that problem, that challenge, by coming up with a 
single, joint, common, integrated, electronic health record. 
And all of those terms are code words to get us on the same 
sheet of music.
    Senator Blumenthal. I apologize again for belaboring a 
point that may be obvious to everyone else in the room, but it 
strikes me from what you are saying that the details have not 
yet been resolved. Is that fair to say?
    Secretary Shinseki. We await a decision by DOD on their 
selection of a core.
    We have offered consideration of VistA, which is 
government-owned, government-operated. We have also put VistA 
into the open architecture, so anyone else can use the code 
that goes with VistA and will not have to pay for it.
    Senator Blumenthal. Thank you.
    To shift subjects here, unemployment among veterans is one 
of my major and paramount concerns. I wonder if you could tell 
us about new initiatives that you are contemplating to address 
unemployment among veterans.
    Secretary Shinseki. Yes. Well, Senator, we have taken the 
leadership of the White House in this as well. Joining forces 
has been a magnificent initiative--reaching out to the private 
sector for corporations to commit to hiring veterans as a part 
of their campaign to help us reduce the unemployment numbers 
for veterans, especially our youngest veterans. The request of 
the private sector was 100,000 new jobs for veterans or 
military spouses before the end of 2013. That goal was exceeded 
in late 2012, as I understand, and there are more commitments 
now to increase to something in the neighborhood of 250,000. So 
the commitment is there.
    I would also say that across government, we in the 
departments, we hire veterans. We have hired--we have over 
100,000 veterans as part of our workforce, fully 30 percent, 
and our goal is 40 percent.
    We have also held hiring fairs for veterans interested in 
employment. We have held three of them. It is not something we 
have expertise in, but we have learned with each of these how 
to bring together veterans looking for work and the employers 
with the jobs.
    We also encourage veterans who own small businesses to 
stand up. Our experience is a veteran business owner is more 
willing to hire veterans. So, the more successful small 
business owners we have, which is where the hiring really goes 
on, the more churn we have in the job market.
    Senator Blumenthal. And are there additional resources in 
your project for those types of efforts?
    Secretary Shinseki. We have resourced at least our hiring 
fairs, and as part of our hiring campaign for veterans, we 
continue to increase that within our allocations--budget and 
FTE allocations.
    Senator Blumenthal. Thank you.
    And if I could get from you at some point--I do not know 
that you have them here today--the latest numbers on employment 
among veterans in different age groups and so forth, any of the 
demographics that you have, I would appreciate it.
    Secretary Shinseki. We can do that.
    Senator Blumenthal. Thank you.
    Secretary Shinseki. The numbers are generally improving. We 
have month-to-month variations, but over time the unemployment 
rate for veterans overall has been below the national average 
for unemployment.
    For younger veterans, this is still a challenge for us, and 
we have to do more. All of us have to do more to take this on.
    Senator Blumenthal. Thank you.
    Thank you all--all the members of the panel--for your 
service to our country and thank you for your testimony.
    Chairman Sanders. Senator Moran.

                STATEMENT OF HON. JERRY MORAN, 
                    U.S. SENATOR FROM KANSAS

    Senator Moran. Mr. Chairman, thank you.
    Mr. Secretary, thank you very much.
    To follow on what Senator Blumenthal was talking about--
jobs for veterans--one of the aspects that we have focused on 
is entrepreneurship and startup businesses. In this Committee 
on Thursday, we will have a roundtable discussion in regard to 
the VA, to veterans' opportunities to support entrepreneurship 
and startup businesses as a method of earning a living and 
providing for families.
    So I appreciate that that is occurring, Mr. Chairman. Thank 
you very much.
    Mr. Secretary, when we last visited, which I think was in 
January, I, as usual, highlighted the shortage of professional 
health care providers within the VA system, especially at least 
what I am most familiar with is in Kansas. We talked about 
CBOCs.
    Kansas is a very rural State--long distances to travel to 
the VA hospital. We have been successful with the VA's help in 
opening CBOCs, but we have a tremendous shortage of physicians, 
nurse practitioners, and physician assistants. And most of our 
CBOCs no longer have a physician.
    And my understanding is that has not changed since we 
visited in January. So I want to highlight that problem once 
again.
    I also raise the topic of mental health professionals. The 
VA's plan in April was to hire 1,600 new clinical mental health 
staff, including marriage and family therapists and licensed 
professional counselors. And my understanding is--and maybe you 
have included this in your testimony--that a significant number 
of that 1,600, a little over 1,000, have been hired.
    But the numbers in Kansas are surprising, or discouraging, 
to me. And Kansas, again because of our rural nature, that is 
not an atypical way of providing mental health services, either 
utilizing MFTs or LPCs. From August 2011 to August 2012, there 
were no MFTs and no LPCs hired at any Kansas facility.
    On USAJobs.gov, VA has posted zero positions in Kansas for 
either one of those professions, for either one of those 
professional licenses.
    VISN 15, as a whole, in Kansas City, MO, had two MFTs and 
zero LPCs on staff.
    St. Louis had two LPCs and zero MFTs.
    These two groups represent 40 percent of the mental health 
professionals in the United States but only 1 percent of the VA 
workforce. I would be interested in your response and your 
suggestions of how we can provide mental health services to 
more Kansas veterans.
    Secretary Shinseki. Let me call on Dr. Petzel.
    Senator Moran. Thank you.
    Dr. Petzel. Thank you, Senator Moran.
    The MFTs and family counselors are new positions, 
relatively new positions to the VA. Less than 2 years ago we 
certified them and got them into the mix of people that we can 
hire. And we are behind the power curve in terms of hiring 
these people.
    I do not know specifically the numbers about Kansas. I will 
go back and find out and get back to you.

    [The information requested was received in July 2014 by 
Senator Moran's office and is not being reproduced here.]

    And you make an excellent point; hiring these people who 
are recruitable in rural areas, I think, is a very good 
alternative to the difficulty that we have in hiring 
psychologists and psychiatrists in those areas. So, I will be 
in communication with you about Kansas specifically and what we 
might be able to do.
    Senator Moran. I appreciate that and look forward to your 
response.
    It reminds me of the effort when I was the sponsor of 
legislation in the House, now years ago, to incorporate 
chiropractic care within the VA. Can you, Secretary Petzel, 
bring me up to date on chiropractic services within the VA?
    Dr. Petzel. I would like to take that for the record if you 
do not mind.
    We do employ them at virtually every one of our medical 
centers and a substantial amount of referral business outside.

    [The information requested during the hearing follows:]
From the Prepared Statement of Robert L. Jesse, M.D., Ph.D., Principal 
Deputy Under Secretary for Health, U.S. Department of Veterans Affairs 
     at the May 9, 2013, Hearing on Pending Health Care Legislation
          * * * * * * *
    s. 422, chiropractic care available to all veterans act of 2013
    S. 422 would require VA to establish programs for the provision of 
chiropractic care and services at not fewer than 75 medical centers by 
not later than December 31, 2014, and at all VAMCs by not later than 
December 31, 2016. Currently, VA is required (by statute) to have at 
least one site for such program in each VHA geographic services area.
    Section 3(a) would amend the statutory definition of ``medical 
services'' in section 1701 of chapter 17, U.S.C., to include 
chiropractic services. Subsection (b) would amend the statutory 
definition of ``rehabilitative services'' in that same section to 
include chiropractic services. Finally, subsection (c) would amend the 
statutory definition of ``preventive health services'' in that same 
section to include periodic and preventive chiropractic examinations 
and services.
    The bill would also make technical amendments needed to effect 
these substantive amendments.
    In general, VA supports the intent of S. 422, but believes the 
decision to provide on-site or fee care should be determined based on 
existing clinical demands and business needs. Chiropractic care is 
available to all Veterans and is already part of the standard benefits 
package.
    As VA increases the number of VA sites providing on-site 
chiropractic care, we will be able to incrementally assess demand for 
chiropractic services and usage, and to best determine the need to add 
chiropractic care at more sites.
    Currently, VA does not have an assessment that would support 
providing on-site chiropractic care at all VAMCs by the end of 2016. 
Such a mandate could potentially be excessive, given the availability 
of resources for on-site chiropractors and non-VA care to meet the 
current need for services. VA does not object to sections 3(a) and (b) 
as those changes reflect VA's consideration of chiropractic care as 
properly part of what should be considered medical and rehabilitative 
services. VA, however, cannot support section 3(c) for lack of a 
conclusive consensus on the use of chiropractic care as a preventative 
intervention.

    Senator Moran. It remains a priority for me. Again, the 
rural nature of Kansas chiropractic care is a significant way 
that health care services are delivered, and it may be the same 
pattern.
    The VA, in my view, was very slow. This is before either 
one of your time, but very slow in incorporating the mandate, 
the requirement that the VA provide for chiropractic care 
within the VA system.
    Let me raise one more topic before my time expires. I asked 
this question last January and I have not received a reply. It 
is apparently not in the fiscal year 2014 budget.
    There has been considerable planning for a joint VA/DOD 
medical facility at McConnell Air Force Base and not in the 
budget, and I asked for a status update last January about 
McConnell and the Dole VA in Wichita. And perhaps, again for 
the record--or if you have the information today, I would be 
pleased to know--what, if any, progress is being made?
    Secretary Shinseki. Dr. Petzel.
    Dr. Petzel. Thank you, Senator Moran.
    There is a proposal that has been developed for a major 
construction project that would be a joint venture with, as you 
point out, McConnell Medical Center. It is $154 million. It was 
submitted. It was in the mix of those projects that were rated 
in the SCIP process, which rates the construction projects. It 
did not score high enough to be funded in 2014.
    Senator Moran. And that scoring takes place at the VA or 
within the Administration? Where is that scoring done?
    Dr. Petzel. The scoring is done by the Department of 
Veterans Affairs.
    Senator Moran. OK. And what does that mean then for the 
future of this project?
    Dr. Petzel. Well, the expectation would be that this 
project will be submitted again and will be scored again.
    Senator Moran. I would like to follow up with you and see 
if I can find out where perhaps the need for greater 
information or any deficiencies that we ought to be addressing 
in regard to this project.
    Dr. Petzel. Certainly.
    Senator Moran. Thank you.
    Secretary Shinseki. What usually happens on the Strategic 
Capital Investment Plan--this rank ordering, this 
prioritizing--is the ones that are funded get worked off, and 
then there is a review, and then others move up in subsequent 
cycles.
    Senator Moran. We would like to work with you to see that 
it moves up as quickly as possible.
    Thank you, Mr. Secretary.
    Thank you.
    Chairman Sanders. Thank you, Senator Moran.
    Senator Hirono.

                STATEMENT OF HON. MAZIE HIRONO, 
                    U.S. SENATOR FROM HAWAII

    Senator Hirono. Thank you, Mr. Chairman.
    Secretary Shinseki, of course, I join my colleagues in 
thanking you and the rest of the panel for your service.
    I do apologize for missing some of the hearing, but I did 
have a chance to talk with you earlier, General Shinseki. So I 
appreciate that.
    I want to focus on women veterans' health. In your 
testimony, you noted that nearly 50 percent of VA facilities do 
have comprehensive women's clinics and that you have asked for 
more money for an increase in the budget for gender-specific 
medical care for women veterans.
    So is it your intention and goal that 100 percent of VA 
facilities will have these kinds of comprehensive care for our 
women veterans?
    Secretary Shinseki. I am going to call on Dr. Petzel for 
the specifics.
    But, Senator, I would just say today I believe women are 
maybe 6 percent of our veteran enrolled population, and we know 
in the active force they represent 15 percent of the 
population; in the reserve components, maybe 17 percent. So we 
know growth is going to occur, and we are doing everything we 
can to put in place the decisions that when they arrive we are 
not playing catch-up as has been previous experience of mine.
    So, if we were to look at women veterans' funding since 
2009, between 2009 and 2014, we have increased that by 134 
percent, and we will continue to put emphasis on this as one of 
our key areas.
    Dr. Petzel.
    Dr. Petzel. Thank you, Mr. Secretary.
    Senator, the specific question you asked about women's 
comprehensive clinics--there are three ways that we try to 
provide the primary basic care that women veterans might need.
    In our large medical centers, where we have large numbers 
of women, we have comprehensive clinics that bring together not 
only primary care providers but obstetricians, gynecologists, 
mental health professionals, endocrinologists, all in the same 
clinic--the same clinic area.
    Senator Hirono. Yes.
    Dr. Petzel. In places that are smaller, where we do not 
have--may not even have--all of that specialty expertise, we 
have primary care clinics that are devoted exclusively to 
women's issues and to women veterans. Those practitioners are 
trained to recognize and take care of the primary care needs of 
women veterans.
    And then in very small areas, where we might have a CBOC 
with only one or two providers, we train those primary care 
providers in the needs of women.
    I think there will be some increase in the number of 
comprehensive clinics, but I think most of the medical centers 
that have a large enough population to do that probably have 
already done that.
    I do want to point out that we have an obligation here to 
provide the kind of an atmosphere where women feel safe and 
feel as if the providers understand their specific needs, which 
are different than our male patients. And I think the VA has 
worked hard over the last 10 years to try to accomplish that. 
We still have work to do.
    Senator Hirono. Thank you.
    I think that that is really important, and I commend you 
for the steps you are taking to recognize that this is a 
different population of veterans than perhaps--so do you do 
outreach efforts to make sure that they are aware of the 
services and the kind of services that are available to women 
veterans?
    Dr. Petzel. Yes, we do. Under the direction of Dr. Patricia 
Hayes, who runs our women's program, we have an extensive 
outreach program including help lines, public service 
announcements and advertisements, first of all, trying to make 
women understand they are veterans. In many instances, they do 
not necessarily view themselves as being veterans, and then on 
top of that they do not necessarily see the VA as a friendly 
place for them to get health care.
    So we work hard to try to bring that message to them.
    Senator Hirono. Thank you.
    Secretary Shinseki, I know that one of your major 
priorities is to address the needs of homeless veterans, and 
that is a challenge. So, are there particular programs or 
things that you are doing that work with this population?
    I realize that it is not a monolithic group of folks. But 
any particular successes, programmatic successes, that can be 
ramped up?
    Secretary Shinseki. We committed to ending the rescue phase 
of veterans' homelessness in 2015. What that means is when you 
hear the word homeless you think of people on the street. That 
is a visible--it is an estimate, but that is a visible 
population.
    There is a larger invisible population of homeless veterans 
at risk--one paycheck, one more missed utility payment, away 
from being a foreclosure.
    So, while we are committed to ending the rescue phase, 
which is get out and find our veterans and ensure that we are 
moving them to treatment and safe housing--and to do that we 
have partnered with many of the experts in communities across 
the country, provided funding for supportive services to 
veterans' families, shelter grant per diem support where at the 
same time we are doing yeoman work on the prevention piece.
    GI Bill, the most generous education program we have--any 
youngster who does not complete schooling is at risk.
    Last year, we had 70,000 veterans who had defaulted on 
their home loans and at risk of foreclosure. Our analysts 
became involved, worked with them to lower payments and extend 
their payment periods with financial institutions. Those 70,000 
were kept in their homes and precluded from foreclosure.
    Part of the homeless issue is mental health and substance 
abuse. In our Veterans Health Administration--very large and 
aggressive programs to deal with depression, substance abuse 
and other issues of mental health. We want to get veterans in 
early and get them into treatment. Our experience is when we 
diagnose and treat, people generally get better.
    You know, this is a broad effort.
    Senator Hirono. That makes a lot of sense. Perhaps you can 
give us some data on how these prevention programs are working 
and the number of people you talk to or work with and what the 
outcomes are.
    Secretary Shinseki. Dr. Petzel.
    Senator Hirono. Thank you.
    You can send me the information or send the Committee the 
information.
    Secretary Shinseki. All right.
    Senator Hirono. Thank you, Mr. Chairman.
    Chairman Sanders. We have gone through the first round. I 
would like to ask a few more questions if we can keep it brief.
    Senator Burr, do you want to--all right. So, if it is OK 
with you, we will just ask a few more questions, and then we 
will get out of here.
    I wanted to pick up on a question that Senator Moran asked. 
He was concerned about chiropractic care. I am concerned more 
generally about complementary medicine, and I think people 
would be surprised to know that the VA has been a leader in 
that area, in this country.
    Recently I was at the VA facility in Brooklyn and the VA 
facility in Los Angeles, and the directors there told me that 
at both facilities complementary medicine is widely used and 
appreciated by veterans.
    I want to work with you to expand those concepts, to be 
more aggressive, because I think you have a lot of folks out 
there who are concerned about overmedication, the ways that we 
can deal with pain without a lot of drugs, et cetera.
    Can you tell us, Dr. Petzel, briefly, what ideas you have 
as to how we can expand complementary medicine? And I am 
talking about acupuncture, guided imagery, meditation, 
chiropractic care, yoga, et cetera.
    Dr. Petzel. Thank you, Mr. Chairman.
    I just wanted to point out that 89 percent of our 
facilities, 125 of them, actively have CAM programs.
    Chairman Sanders. That may be true, and correct me if I am 
wrong. If somebody is a well trained, qualified acupuncturist, 
for example--that person as an acupuncturist as opposed to, 
say, being an M.D. who practices acupuncture--that 
acupuncturist, himself or herself, could not be hired under 
that definition. That is my understanding. Is that correct?
    Dr. Petzel. I will have to find out, Mr. Chairman. I am not 
aware that that is the case.
    Chairman Sanders. That is my understanding.
    Dr. Petzel. I know that the places that I am familiar with 
that do acupuncture happen to have anesthesiologists who are 
acupuncturists and do acupuncture.
    We, as you mentioned, do a number of different things--
yoga, hypnosis, acupuncture, animal-assisted therapy, 
biofeedback, stress management, relaxation therapy and 
meditation.
    Chairman Sanders. Let me interrupt you. I am aware of that, 
and I think you guys should be very proud of that.
    My question is that while you are sitting here supporting 
those initiatives, there is also an argument that it has not 
quite filtered down with as much excitement and appreciation as 
it might. Is that a fair statement?
    Dr. Petzel. I think that is a fair statement, Mr. Chairman.
    And I think that one of the crucial parts of helping that 
to filter down is something that we are also engaged in, and 
that is research to demonstrate the efficacy in specific 
circumstances of certain alternative medicine therapies.
    Meditation would be an example. We are spending $5 million 
this year looking at meditation and its role in treating PTSD--
3 pilot projects and 4 research projects to, indeed, look at 
the 3 different kinds of meditation and how they work.
    And I think we need to do, quite frankly, more of that to 
demonstrate to the treating public--to the treating physicians 
that, indeed, these things are effective and do work.
    Chairman Sanders. I believe you are also looking at guided 
imagery in terms of sexual assaults and so forth.
    Dr. Petzel. Yes.
    Chairman Sanders. Sexual trauma.
    Dr. Petzel. That is also correct.
    Chairman Sanders. OK, Senator Burr.
    Senator Burr. Secretary, you said earlier that we will move 
out of the rescue phase on homelessness. Would that be the 
reason that there is a reduction between 2014's and 2015's 
budget for homelessness? We have got a drop from $1.2 billion 
to $857 million.
    Secretary Shinseki. I believe that adjustment is based on 
the fact that we think we will be making good progress toward 
our 2015 targets, and so the adjustment is in the level of 
energy here.
    Senator Burr. OK. A letter from the VA dated February 2012 
included the timeline of VA's homelessness reduction strategy, 
2009 to 2015. This timeline included decisions regarding 
increasing or decreasing budget requests, reallocating funding, 
and a decision as to whether to extend the timeline. Have any 
of those decisions been made to date?
    Secretary Shinseki. To extend the timeline?
    Senator Burr. Increasing or decreasing budget requests, 
reallocating funding, and a decision as to whether to extend 
the timeline.
    Secretary Shinseki. I am sure there may have been some 
discussions, but I have not participated in extending the 
timeline. Twenty fifteen remains our target.
    Senator Burr. OK. Mr. Warren, according to the fiscal year 
2014 Budget Fast Facts information sheet, VA has allocated $344 
million for the integrated electronic medical records system. 
In addition, the Office of Information and Technology's budget 
requests $252 million for the development, modernization, and 
enhancement of iEHR and VLER. Does the $344 million include the 
$252 million for the development of iEHR and VLER, or is the 
$252 million additional funding for those two?
    Mr. Warren. Thank you for the question, Senator Burr.
    The 344 includes the 250 for development.
    Senator Burr. Two fifty-two, OK.
    The Project Management Accountability System, or PMAS, 
creates and monitors milestones for IT projects to reduce risk 
associated with the development of large IT systems. How many 
milestones have iEHR and VLER missed?
    Mr. Warren. Let me take that for the record instead of 
flipping through the spreadsheet, which was delivered to your 
staff today, sir. We will get back to you.
    Senator Burr. I appreciate that.
Response to Request Arising During the Hearing by Hon. Richard Burr to 
    Stephen W. Warren, Acting Assistant Secretary for the Office of 
    Information and Technology, U.S. Department of Veterans Affairs
    Response. As a follow up to our prior correspondence to Senators 
Burr and Murray on September 12, 2102, VA provides the following update 
to its scheduling procurement efforts:

    VA will procure a scheduling solution in two phases. In the first 
phase, currently ongoing, VA is running a risk-reduction contest under 
the America Competes Act calling for scheduling application 
submissions. The purpose of this contest will be to reduce procurement 
and deployment risk. VA will offer up to three prizes for scheduling 
packages that demonstrate their compatibility with the Open Source 
version of VA's electronic health record, VistA. Contest submissions 
are due in June, and VA is scheduled to announce winners in September.
    The second phase will include the actual procurement of a 
scheduling solution. As this risk-reduction activity proceeds, VA will 
continue working with the Department of Defense and the Interagency 
Program Office to determine joint requirements and a master development 
and acquisition plan. The master development and acquisition plan will 
be based upon an evaluation of contestant responses for proposed 
functionality and compliance with iEHR architecture.
Office of Information and Technology
May 2013

    Senator Burr. Mr. Warren, according to the fiscal year 2014 
Budget Fast Facts information sheet, again, the Department of 
Veterans Affairs has allocated $155 million for the total 
development and implementation of the Veterans Benefits 
Management System. I am getting to a question that Senator 
Isakson talked to you about.
    The President's request includes roughly $33 million for 
the development of VBMS, a $71 million decrease.
    I think you answered that, if I remember correctly. If you 
did not, I will allow you to do it, but I also want a 
clarification. Did you tell the Committee that it was going to 
cost $122 million a year to sustain that program, in fees?
    Mr. Warren. No. The question was, of the amount stated, is 
it all development or did it include sustainment? It does 
include sustainment.
    Senator Burr. What is the estimated sustainment cost?
    Mr. Warren. For which year, Senator, please?
    Senator Burr. On an ongoing basis.
    Mr. Warren. One of the challenges we have, Senator Burr, is 
if you look at the elimination of the backlog and you think in 
terms of the ingest or the input of information, moving from 
paper to electrons, the engine--in terms of how do we make the 
decision about what the benefit is and then the payment process 
that comes out the end--so there is a multitude of systems out 
there.
    When you ask the question, based upon where you draw the 
boundaries, the dollars either go up or down. So, when we talk 
about the 155, it picks up $32 million to pay for the 
development of the engine, also portions of the payment piece 
once a decision is made through to the check.
    If I add all of the pieces up--so the multiple entries in 
the budget that cover not just the engine, which is the VBMS 
system, but includes all of the ingests in terms of e-benefits 
that portal that we use to bring the information in, that the 
veteran uses for self-service; the SEP or the VSOs are able to 
assist the veteran and do that work; the unified desktop or our 
call centers are able to give a complete view of the status as 
well as the output.
    The sum total is $275 million in fiscal year 2014, which is 
VBMS and VRM. So it is a large investment to make sure that not 
only the engine is working, once we get the electrons, but to 
pay for that change from paper to electrons.
    Senator Burr. Are we going to have to pay for any more of 
the engine after 2014?
    Mr. Warren. The program----
    Senator Burr. Or is the engine complete?
    Mr. Warren. The program plan today, as we turn the 
automation on, as we look at what the rules engines are and we 
get the same pick-up, the kick that we are able to get from 
chapter 33, it is possible that we are going to see more areas 
where we can automate.
    It is also subject to any change in laws passed as well as 
any court rulings in terms of needing to add automation for our 
partners in the benefits administration.
    Secretary Shinseki. Senator, I think we will continue to 
improve VBMS as we go forward where those opportunities show 
themselves. I do not think that the VBMS we field by 2014 is 
the end state.
    Senator Burr. I appreciate that, Mr. Secretary, and I 
encourage it. I do not want to bog us down, staying here any 
longer.
    But let me suggest, Mr. Warren, maybe you need to come up 
and meet with some of us on the Committee. We would like to 
know, of its original design, when will this program be paid 
for? When will we be fully invested?
    Hopefully, that coincides with some period before 2015 
since in 2015 it is our answer to backlog. There is not a plan 
B. This is plan A, B, C, D, E, and F.
    Mr. Warren. Glad to come up, Senator.
    Senator Burr. But, more importantly, I think we need to 
understand better, what is our long-term annual commitment to a 
program of this magnitude?
    I realize that there are parameters that might change 
that--court rulings, benefits, scope of benefits, that type of 
thing. But I think we need to better understand it, if, in 
fact, we provide fair but effective oversight to an IT program 
of this size.
    Mr. Chairman, you have been awfully generous.
    I know Under Secretary Muro is dying for me to ask him a 
question, but I am going to forego that today.
    [Laughter.]
    Chairman Sanders. I am sure he is deeply disappointed.
    Senator Burr. He is always neglected in these hearings, and 
I have asked him not to take it personally. I will follow up 
with some audit questions in writing, if I may.
    Mr. Muro. Thank you.
    Senator Burr. Mr. Secretary, thank you and thank you to 
your entire team.
    Chairman Sanders. OK. Secretary Shinseki, thank you for 
being here and thank you for your staff being here.
    This hearing is now concluded.
    [Whereupon, at approximately 4:33 p.m., the hearing was 
adjourned.]
                            A P P E N D I X

                              ----------                              


 Prepared Statement of Jeffrey C. Hall, Assistant National Legislative 
                  Director, Disabled American Veterans
    Chairman Sanders, Ranking Member Burr and Members of the Committee: 
On behalf of the DAV (Disabled American Veterans) and our 1.2 million 
members, all of whom are wartime disabled veterans, I am pleased to be 
here today to present recommendations of The Independent Budget (IB) 
for the fiscal year (FY) 2014 budget related to veterans benefits and 
the Veterans Benefits Administration (VBA). The IB is jointly produced 
each year by DAV, AMVETS, Paralyzed Veterans of America and Veterans of 
Foreign Wars. This year's IB contains numerous recommendations to 
improve veterans benefit programs and the claims processing system; 
however, in today's testimony I will highlight just some of the most 
critical ones for this Committee to consider.
    Mr. Chairman, the timely delivery of earned benefits to the 
millions of men and women who have served in our Armed Forces is one of 
the most sacred obligations of the Federal Government. The award of a 
service-connected disability rating does more than provide compensation 
payments; it is the gateway to an array of benefits that support the 
recovery and transition of veterans, their families and survivors. 
However, when these benefits are delayed or unjustly denied, the 
consequences to veterans and their families can be devastating. For 
those wounded heroes who file claims for disability compensation, the 
wait to receive an accurate rating decision and award can take anywhere 
from a few months to several years; longer if they have to appeal 
incorrect decisions.
    Today there are about 900,000 claims for compensation and pension 
awaiting decisions at VBA, more than double the number pending four 
years ago. Of those, fully 70 percent have been waiting more than 125 
days, VBA's official target for measuring the backlog, which is double 
the number from just two years earlier. Moreover, the length of time it 
takes to process veterans' claims also continues to rise, with the 
average processing time now almost 280 days, far from VBA's target of 
80 days. Looking at these numbers, it is clear that the challenges 
facing VBA are enormous, and in many ways they are the same core 
problems that have plagued VBA for decades. The solution will require 
new technologies and business processes, and most importantly, a 
cultural transformation built upon the foundations of quality, accuracy 
and accountability.
    In early 2010, Secretary Shinseki laid out an extremely ambitious 
goal for VBA to achieve by 2015: process 100 percent of claims in less 
than 125 days, and do so with 98 percent accuracy. Since that time, VBA 
has worked to completely transform their IT systems, business processes 
and corporate culture, while simultaneously continuing to process more 
than a million claims each year. VBA is actively rolling out new 
organizational models and practices, and continuing to develop and 
deploy new technologies almost daily. In the midst of this massive 
transformation, it can be hard to get the proper perspective to measure 
whether their final systems will be successful, but we believe there 
has been sufficient progress to merit continued support of the current 
transformation efforts. Now is not the time to stop or change 
direction.
    We urge this Committee and Congress to provide the support and 
resources necessary to complete this transformation as currently 
planned, while continuing to exercise strong oversight to ensure that 
VBA remains focused on the long term goal of creating a new claims 
processing system that decides each claim right the first time. In 
particular, the proposed FY 2014 budget for VBA includes additional 
funding for scanning and conversion of existing paper claims files that 
is absolutely critical for VBA to complete their transformation from an 
outdated, paper-based claims system to a modern, paperless, automated 
claims system.
    Mr. Chairman, one of the most important signs of positive change 
over the past four years has been VBA's unprecedented openness and 
partnership with VSOs. Our organizations possess significant knowledge 
and experience of the claims process and collectively we hold power of 
attorney (POA) for millions of veterans who are filing or have filed 
claims. VBA recognized that close collaboration with VSOs could not 
only reduce its workload but also increase the quality of its work. We 
make VBA's job easier by helping veterans prepare and submit better 
claims, thereby requiring less time and resources for VBA to develop 
and adjudicate them. The IBVSOs have also been increasingly consulted 
about initiatives proposed or underway at VBA, including Fully 
Developed Claims (FDC), Disability Benefit Questionnaires (DBQs), the 
Veterans Benefit Management System (VBMS), the Stakeholder Enterprise 
Portal (SEP), and the update of the Department of Veterans Affairs (VA) 
Schedule for Rating Disabilities (VASRD). Both Secretary Shinseki and 
Under Secretary Hickey have consistently reached out to consult and 
collaborate with VSOs and we are confident that this partnership will 
result in better service and outcomes for veterans.
    Since 2009, VBA has made some significant changes in how claims are 
processed. The most important amongst these is the development of the 
new Veterans Benefits Management System (VBMS), its new IT system. VBMS 
has been rolled out to 20 Regional Offices and is scheduled to be fully 
deployed to all remaining Regional Offices (ROs) by mid-year. It is 
important to remember that VBMS is not yet a finished product; rather, 
it continues to be developed and perfected as it is deployed so it is 
still premature to judge whether it will ultimately deliver all of the 
functionality and efficiency required to meet VBA's future claims 
processing needs.
    Another very important milestone was VBA's decision and commitment 
to scan all paper claims files for every new or reopened claim 
requiring a rating-related action, and creating digital e-folders to 
serve as the cornerstone of the new VBMS system. E-folders facilitate 
instantaneous transmission and simultaneous reviewing of claims files. 
At present, there are an estimated 200,000 e-folders and that number 
will continue to grow as the remaining ROs convert to VBMS this year. 
In addition, the Appeals Management Center (AMC) is now working in VBMS 
and able to review e-folders. The Board of Veterans Appeals (BVA) will 
also begin receiving appeals in VBMS on a pilot basis.
    VBA also continues to strengthen its e-Benefits and SEP systems, 
which allow veterans and their representatives to file claims, upload 
supporting evidence and check on the status of pending claims. VBA has 
rolled out a new transformation organizational model (TOM) to every 
Regional Office that has reorganized workflow by segmenting claims into 
different processing lanes depending upon the complexity of the issues 
to be decided for each claim. Other key process improvements that we 
strongly support include the FDC program, which expedites ready-to-rate 
claims, and DBQs, which standardize and encourage the collection of 
private medical evidence to aid in rating decisions. To improve the 
accuracy of their work, VBA also fulfilled one of our longstanding 
recommendations by creating local Quality Review Teams (QRTs), whose 
primary function is to monitor claims processing in real time to catch 
and correct errors before rating decisions are finalized.
                   claims processing recommendations
    Over the next year, Congress must continue to perform aggressive 
oversight of VBA's ongoing claims transformation efforts, particularly 
new IT programs, while actively supporting the completion and full 
implementation of these vital initiatives. In order for VBA's current 
transformation plans to have any reasonable chance of success, VBA must 
be allowed to complete and fully implement them. Congress must continue 
to fully fund the completion of VBMS, including providing sufficient 
funding for digital scanning and conversion of legacy paper files, as 
well as the development of new automation components for VBMS. At the 
same time, the IBVSOs recommend that Congress encourage an independent, 
expert review of VBMS while there is still time to make course 
corrections.
    Congress must also encourage and support VBA's efforts to develop a 
new corporate culture based on quality, accuracy and accountability, as 
well as strengthen the transmission and adoption of these values and 
appropriate supportive policies throughout all VBA Regional Offices. 
The long-term success of all of VBA's transformation efforts will 
depend on the degree to which these changes are institutionalized and 
disseminated from the national level to the local level. In addition to 
strengthening training, testing and quality control, VBA must be 
encouraged to properly align measuring and reporting functions with 
desired goals and outcomes for both its leadership and employees. For 
example, as long as the most widely reported metric of VBA's success is 
the Monday Morning Workload Reports, particularly the weekly update on 
the size of the backlog, there will remain tremendous pressure 
throughout VBA to place production gains ahead of quality and accuracy. 
Similarly, if individual employee performance standards set unrealistic 
production goals, or fail to properly credit ancillary activity that 
contributes to quality but not production, those employees will be 
incentivized to focus on activities that maximize only production. VBA 
must develop more and better measures of work performance that focus on 
quality and accuracy, both for the agency as a whole and for individual 
employees. Furthermore, VBA must ensure that employee performance 
standards are based on accurate measures of the time it takes to 
properly perform their jobs.
    Congress must also ensure that VBA does not change its reporting or 
metrics for the sole purpose of achieving statistical gains, commonly 
referred to as ``gaming the system,'' in the absence of actual 
improvements to the system. For example, VBA recently announced that 
they will change how errors are scored for multi-issue claims. 
Previously, a claim would be considered to have an error if one mistake 
on at least one issue in the claim was detected during a STAR review. 
Under the new error policy, if there are 10 issues in the claim and a 
single error is found on one of the issues, that would now be scored as 
only 0.1 errors for that claim. While this may be a more valid way of 
measuring technical accuracy, it also has the effect of lowering the 
error rate without actually lowering the number of errors committed.
    To make the system more efficient, Congress should enact and 
promote legislation and policies that maximize the use of private 
medical evidence to conserve VBA resources and enable quicker, more 
accurate rating decisions for veterans. The IBVSOs have long encouraged 
VBA to make greater use of private medical evidence when making claims 
decisions, which would save veterans time and VBA the cost of 
unnecessary examinations. DBQs, many of which were developed in 
consultation with IBVSO experts, are designed to allow private 
physicians to submit medical evidence on behalf of veterans they treat 
in a format that aids rating specialists. However, we continue to 
receive credible reports from across the country that many Veterans 
Service Representatives (VSRs) and Rating Veterans Service 
Representatives (RVSRs) do not accept the adequacy of DBQs submitted by 
private physicians, resulting in redundant VA medical examinations 
being ordered and valid evidence supporting veterans' claims being 
rejected.
    Although there are currently 81 approved DBQs, VBA has only 
released 71 of them to the public for use by private physicians. In 
particular, VBA should allow private treating physicians to complete 
DBQs for medical opinions about whether injuries and disabilities are 
service-connected, as well as DBQs for PTSD, which current VBA rules do 
not allow; only VA physicians can make PTSD diagnoses for compensation 
claims. Congress should work with VBA to make both of these DBQs 
available to private physicians.
    To further encourage the use of private medical evidence, Congress 
should amend title 38, United States Code, section 5103A(d)(1) to 
provide that, when a claimant submits private medical evidence, 
including a private medical opinion, that is competent, credible, 
probative, and otherwise adequate for rating purposes, the Secretary 
shall not request a VA medical examination. This legislative change 
would require VSRs and RVSRs to first document that private medical 
evidence was inadequate for rating purposes before ordering 
examinations, which are often unnecessary.
               vba staffing and resource recommendations
    Over the past five years, the VBA has seen a significant staffing 
increase because Congress recognized that rising workload, particularly 
claims for disability compensation, could not be addressed without 
additional personnel and thus provided additional resources each year 
to do so. More than 5,000 full time employee equivalents (FTEE) were 
added to VBA over the past five years, a 33 percent increase, with most 
of that increase going to the Compensation Service. In fiscal year (FY) 
2013, VBA's budget supports an additional 450 FTEE above the FY 2012 
authorized level, and the FY 2014 level adds less than 100 new FTEE.
Compensation Service Staffing
    Since VBA is in the middle of a comprehensive transformation that 
makes changes in the roles and responsibilities of its employees, it is 
difficult to determine whether Compensation Service's staffing levels 
are sufficient now or will be in the near future. Without knowing the 
outcome of the transformation, it is difficult to estimate whether they 
will require additional or even fewer personnel to address the future 
workload they will need to process. For this reason, the IB does not 
recommend a specific staffing increase for FY 2014, although it is 
important that Congress and VBA be certain that staffing levels are 
regularly adjusted to remain aligned with changes in workload and 
productivity.
    In this regard, it is imperative that VBA and Congress continue to 
closely monitor Compensation Service's actual and projected workload, 
measurable and documented increases in productivity resulting from the 
new organizational model and the VBMS, as well as personnel changes, 
such as attrition, in order to ensure that staffing is sufficient. 
Furthermore, VBA must develop a better, more consistent and data-driven 
method of determining future staffing requirements to more accurately 
inform future funding requirements.
Board of Veterans' Appeals Staffing
    Based on historical trends, the number of new appeals to the Board 
averages approximately 5 percent of all claims received, so as the 
number of claims processed by the VBA is expected to rise 
significantly, so too will the Board's workload rise accordingly. Yet 
the budget provided to the Board has been declining, forcing it to 
reduce the number of employees. Although the Board had been authorized 
to have up to 544 FTEE in FY 2011, its appropriated budget could 
support only 532 FTEE that year. In FY 2012, that number was further 
reduced to 510. At present, due to cost-saving initiatives, the Board 
may be able to support as many as 518 FTEE with the FY 2013 budget; 
however, this does not correct the downward trend over the past several 
years, particularly as workload continues to rise. The proposed FY 2014 
budget actually cuts funding for the Board and further reduces staffing 
down to just 492 FTEE, despite expected workload increases each year. 
Even adjusting for projected productivity gains, the IBVSOs believe 
that the Board should have at least 544 FTEE in FY 2014 in order to 
reduce its backlog.
Vocational Rehabilitation and Employment Service Staffing
    In FY 2012, VA's Vocational Rehabilitation and Employment (VR&E) 
program, also known as the VetSuccess program, had 121,000 participants 
in one or more of the five assistance tracks of VR&E's VetSuccess 
program, an increase of 12.3 percent above the FY 2011 participation 
level of 107,925 veterans. In FY 2012, VR&E had a total of 1,446 FTEE, 
and anticipates an increase of approximately 150 FTEE for FY 2013. 
Given the estimated 10 percent workload increases for both FY 2013 and 
FY 2014, the IB estimates that VR&E would need an additional 230 
counselors in FY 2014 in order to reduce their counselor-to-client 
ratio down to their stated goal of 1:125.
    An extension for the delivery of VR&E assistance at a key 
transition point for veterans is through the VetSuccess on Campus 
program. This program provides support to student veterans in 
completing college or university degrees. VetSuccess on Campus has 
developed into a program that places a full-time Vocational 
Rehabilitation Counselor and a part-time Vet Center Outreach 
Coordinator at an office on campus specifically for the student 
veterans attending that college. These VA officers are there to help 
the transition from military to civilian and student life. The 
VetSuccess on Campus program is designed to give needed support to all 
student veterans, whether or not they are entitled to one of VA's 
education benefit programs. VA is expected to increase its VetSuccess 
on Campus program from 34 colleges in FY 2012 to 84 colleges in FY 2013 
and Congress must ensure that sufficient funding is provided in the FY 
2014 budget for this program.
            recommendations for improvements to va benefits
Automatic Annual Cost-of-Living Adjustment (COLA)
    Congress has annually authorized increases in compensation and 
dependency and indemnity compensation (DIC) by the same percent as 
Social Security is increased. Under current law, the government 
monitors inflation throughout the year and, if inflation occurs, 
automatically increasing Social Security payments by the percent of 
increase for the following year, which the Congress then applies to 
veterans programs.
    While Congress has always increased compensation and DIC based on 
inflation, there have been years when such increases were delayed, 
which puts unnecessary financial strain on veterans and their 
survivors. The IB veterans service organizations urge Congress to enact 
legislation indexing compensation and DIC to Social Security COLA 
increases.
End Rounding Down of Veterans' and Survivors' Benefits Payments
    In 1990, Congress, in an omnibus reconciliation act, mandated that 
veterans' and survivors' benefit payments be rounded down to the next 
lower whole dollar. While this policy was initially limited to a few 
years, Congress eventually made it permanent. The cumulative effect of 
this provision of the law effectively levies a tax on totally disabled 
veterans and their survivors. Congress should repeal the current policy 
of rounding down veterans' and survivors' benefits payments.
Reject Any Proposal to Use the ``Chained CPI''
    In the past year, there has been much discussion about replacing 
the current CPI formula used for calculating the annual Social Security 
COLA with the Bureau of Labor Statistics (BLS) new formula commonly 
termed the ``chained CPI.'' Such a change would be expected to 
significantly reduce the rates paid to Social Security recipients, and 
thereby help to lower the Federal deficit. Since the Social Security 
COLA is also applied annually to the rates for VA disability 
compensation, DIC, and pensions for wartime veterans and survivors with 
limited incomes, its application would mean systematic reductions for 
millions of veterans, their dependents and survivors who rely on VA 
benefit payments. The IBVSOs urge Congress to reject any and all 
proposals to use the ``chained CPI'' for determining Social Security 
COLA increases, which would have the effect of significantly reducing 
the level of vital benefits provided to millions of veterans and their 
survivors.
    The IBVSOs also note that the CPI index used for Social Security 
does not include increases in the cost of food or gasoline, both of 
which have risen significantly in recent years. While no inflation 
index is perfect, the IBVSOs believe that VA should examine whether 
there are other inflation indices that would more appropriately 
correlate with the increased cost of living experienced by disabled 
veterans and their survivors.
    End Prohibition against Concurrent Receipt of VA Disability 
Compensation and Military Longevity Retired Pay
    Many veterans retired from the Armed Forces based on longevity of 
service must forfeit a portion of their retired pay, earned through 
faithful performance of military service, before they receive VA 
compensation for service-connected disabilities. This is inequitable--
military retired pay is earned by virtue of a veteran's career of 
service on behalf of the Nation, careers of usually more than 20 years. 
Entitlement to compensation, on the other hand, is paid solely because 
of disability resulting from military service, regardless of the length 
of service. Most nondisabled military retirees pursue second careers 
after serving in order to supplement their income, thereby justly 
enjoying a full reward for completion of a military career with the 
added reward of full civilian employment income. In contrast, military 
retirees with service-connected disabilities do not enjoy the same full 
earning potential since their earning potential is reduced commensurate 
with the degree of service-connected disability.
    In order to place all disabled longevity military retirees on equal 
footing with nondisabled military retirees, there should be no offset 
between full military retired pay and VA disability compensation. To 
the extent that military retired pay and VA disability compensation 
offset each other, the disabled military retiree is treated less fairly 
than is a nondisabled military retiree by not accounting for the loss 
in earning capacity. Moreover, a disabled veteran who does not retire 
from military service but elects instead to pursue a civilian career 
after completing a service obligation can receive full VA disability 
compensation and full civilian retired pay--including retirement from 
any Federal civil service position.
    While Congress has made progress in recent years in correcting this 
injustice, current law still provides that service-connected veterans 
rated less than 50 percent disabled who retire from the Armed Forces on 
length of service may not receive disability compensation from VA in 
addition to full military retired pay. The IBVSOs believe the time has 
come to remove this prohibition completely. Congress should enact 
legislation to repeal the inequitable requirement that veterans' 
military longevity retired pay be offset by an amount equal to the 
disability compensation awarded to disabled veterans rated less than 50 
percent, the same as exists for those rated 50 percent or greater.
                           survivor benefits
Increase DIC for Surviving Spouses of Servicemembers
    The current rate of compensation paid to the survivors of certain 
deceased veterans rated permanently and totally disabled and deceased 
servicemembers is inadequate and inequitable. Under current law, the 
surviving spouse of a veteran who had a total disability rating is 
entitled to the basic rate of Dependency and Indemnity Compensation. A 
supplemental payment is provided to those spouses who were married for 
at least eight years during which time the veteran was rated 
permanently and totally disabled. However, surviving spouses of 
veterans or military servicemembers who die before the eight-year 
eligibility period, or who die on active duty, respectively, only 
receive the basic rate of DIC.
    Insofar as DIC payments are intended to provide surviving spouses 
with the means to maintain some semblance of financial stability after 
losing their loved ones, the rate of payment for service-related deaths 
of any kind should not vastly differ. Surviving spouses, regardless of 
the status of their sponsors at the time of death, face the same 
financial hardships once deceased sponsors' incomes no longer exists. 
Congress should authorize DIC eligibility at increased rates to 
survivors of servicemembers who died either before the eight-year 
eligibility period passes or while on active duty at the same rate paid 
to the eligible survivors of totally disabled service-connected 
veterans who die after the eight-year eligibility period.
Repeal of the DIC-SBP Offset
    The current requirement that the amount of an annuity under the 
Survivor Benefit Plan (SBP) be reduced on account of, and by an amount 
equal to, DIC is inequitable. A veteran disabled in military service is 
compensated for the effects of service-connected disability. When a 
veteran dies of service-connected causes, or following a substantial 
period of total disability from service-connected causes, eligible 
survivors or dependents receive DIC from the VA. This benefit 
indemnifies survivors, in part, for the losses associated with the 
veteran's death from service-connected causes or after a period of time 
when the veteran was unable, because of total disability, to accumulate 
an estate for inheritance by survivors.
    Career members of the Armed Forces earn entitlement to retired pay 
after 20 or more years of service. Survivors of military retirees have 
no entitlement to any portion of the veteran's military retirement pay 
after his or her death, unlike many retirement plans in the private 
sector. Under the SBP, deductions are made from the veteran's military 
retirement pay to purchase a survivor's annuity. This is not a 
gratuitous benefit, but is purchased by a retiree. Upon the veteran's 
death, the annuity is paid monthly to eligible beneficiaries under the 
plan. If the veteran died from other than service-connected causes or 
was not totally disabled by service-connected disability for the 
required time preceding death, beneficiaries receive full SBP payments. 
However, if the veteran's death was a result of military service or 
after the requisite period of total service-connected disability, the 
SBP annuity is reduced by an amount equal to the DIC payment. When the 
monthly DIC rate is equal to or greater than the monthly SBP annuity, 
beneficiaries lose the SBP annuity in its entirety.
    The IBVSOs believe this offset is inequitable because no 
duplication of benefits is involved. Payments under the SBP and DIC 
programs are made for different purposes. Under the SBP, coverage is 
purchased by a veteran and at the time of death, paid to his or her 
surviving beneficiary. On the other hand, DIC is a special indemnity 
compensation paid to the survivor of a servicemember who dies while 
serving in the military, or a veteran who dies from service-connected 
disabilities. In such cases, DIC should be added to the SBP, not 
substituted for it. Surviving spouses of Federal civilian retirees who 
are veterans are eligible for DIC without losing any of their purchased 
Federal civilian survivor benefits. The offset penalizes survivors of 
military retirees whose deaths are under circumstances warranting 
indemnification from the government separate from the annuity funded by 
premiums paid by the veteran from his or her retired pay. Congress 
should repeal the inequitable offset between DIC and the SBP because 
there is no duplication between these two distinct benefits.
Retention of Remarried Survivors' Benefits at Age 55
    Congress should lower the age required for remarriage for survivors 
of veterans who have died on active duty or from service-connected 
disabilities to be eligible for retention of DIC to conform with the 
requirements of other Federal programs. Current law allows retention of 
DIC on remarriage at age 57 or older for eligible survivors of veterans 
who die on active duty or of a service-connected injury or illness. 
Although the IBVSOs appreciate the action Congress took to allow 
restoration of this rightful benefit, the current age threshold of 57 
years is arbitrary.
    Remarried survivors of retirees of the Civil Service Retirement 
System, for example, obtain a similar benefit at age 55. This would 
also bring DIC in line with SBP rules that allow retention with 
remarriage at the age of 55. Equity with beneficiaries of other Federal 
programs should govern Congressional action for this deserving group. 
Congress should enact legislation to enable survivors to retain DIC on 
remarriage at age 55 for all eligible surviving spouses.

    Mr. Chairman, that concludes my statement and I would be happy to 
answer any questions you or other Members of the Committee may have.
                                 ______
                                 
  Prepared Statement of Tom Tarantino, Chief Policy Officer, Iraq and 
                    Afghanistan Veterans of America
    Chairman Sanders, Ranking Member Burr, and Distinguished Members of 
the Committee: Iraq and Afghanistan Veterans of America (IAVA) would 
like to thank you for holding this hearing today on the critical 
priority of properly funding the Department of Veterans Affairs (VA). 
We also appreciate your continued dedication to improving the 
functioning and capabilities of the VA, and to improving the lives of 
America's veterans.
    IAVA is the Nation's first and largest nonprofit, nonpartisan 
organization for veterans of the wars in Iraq and Afghanistan and their 
supporters. Founded in 2004, our mission is simple--to improve the 
lives of Iraq and Afghanistan veterans and their families. With a 
steadily growing base of over 200,000 members and supporters, we strive 
to help create a society that honors and supports veterans of all 
generations.
    IAVA is acutely aware of our Nation's current fiscal situation. 
However, I think we are all in agreement that the VA should continue to 
be fully funded so as to enable the department to adequately care for 
and support those who have faithfully shouldered the burden of our 
Nation's defense. Our funding of the VA's budgetary requirements, 
including its discretionary accounts, is not generosity, it is not 
charity, and it is not a handout. It is part of a sacred obligation we 
as a society have to care for our Nation's veterans. It is part of an 
implicit social contract we entered into when we accepted each and 
every one of them into the ranks of our military--to provide for their 
needs should they leave the service less whole than they were when they 
entered.
    In light of this overarching philosophy we espouse in caring for 
our Nation's veterans, IAVA is pleased to see just over a 10% increase 
in the President's VA budget request above the previous fiscal year's 
funding levels, including both mandatory and discretionary accounts. 
IAVA is especially thankful to see a nearly 14% increase in funding for 
programs and initiatives that Iraq and Afghanistan veterans need to 
help them deal with the repercussions of more than a decade of war and 
to help them successfully transition back into civilian life. These 
programs, which span issues as diverse as access to mental health care 
and suicide prevention to job training and employment assistance, 
continue to be priorities for IAVA because they are priorities for our 
members.
    At IAVA, our broad and diverse membership is the backbone of our 
organization. As they communicate their needs, frustrations, 
suggestions, and wishes to us, we in turn translate that feedback into 
IAVA's policy priorities. And this year, IAVA's top policy priority has 
become ending the excessive VA disability claims backlog.
    This issue is not just a numbers problem for us, although the 
numbers alone are enough to astound even the most patient and forgiving 
of observers, including wait time averages on disability claims 
decisions of 619 days in Los Angeles, 612 days in Indianapolis, 586 
days in Houston, 642 days in New York, and 681 days in Reno.
    But for us, the problem has a human face and a real voice, like 
that of IAVA member Rachel McNeil, who joined the Army Reserves in 2002 
and deployed to Iraq in December 2004. Rachel filed a claim after she 
came home from Iraq in 2006, and it has been more than 827 days since 
the VA even acknowledged that she filed a notice of disagreement with 
their decision in 2010.
    IAVA member John Wypyszinski spent 16 years in the military in both 
the Army and the Navy as a nuclear, biological, and chemical operations 
specialist, and later?as a medic and a hospital corpsman with the 
Marines. He deployed twice to Iraq before he was medically retired in 
2007 due to injuries, but he was lost in the VA disability claims 
process for an excruciating 963 days.
    And then there's IAVA member Luis Cardenas Camacho, who served in 
the Marine Corps from 2004-2008 and deployed to Iraq three times. Upon 
returning home, Luis found himself fighting new enemies, including 
PTSD, depression, and his physical injuries. Luis has been dealing with 
the VA disability claims office for five years and still hasn't 
received his benefits.
    It is stories like these--the real stories and real lives of real 
heroes--that motivate us here at IAVA, that fuel our outrage at the 
slow pace of progress on the backlog, and that exacerbate our 
impatience sometimes with the Veterans Benefits Administration (VBA). 
So we are pleased to see the President requesting a 13.6% increase in 
funding for VBA. Yet we remain concerned about whether this is actually 
sufficient to provide VBA with what it really needs to end the backlog, 
even by it's protracted goal of 2015 (of which many remain skeptical). 
If, as the VA has said, the funding level requested for VBA would 
enable it to process 1.3 million claims in the next fiscal year, yet 
that amounts to roughly the same number of claims it processed last 
year, then VBA is simply requesting funding sufficient to tread water.
    It is details like this that call into question whether the VA's 
rhetoric on ending the backlog, even as far out as 2015, is realistic. 
By its own admission, the problems that led to and exacerbated the 
backlog were perfectly predictable. Yet what has clearly led to the 
existence of such a severe problem with the backlog is a failure on the 
part of the VA to adequately plan and prepare for these predictable 
spikes in claims. Given this record, we remain seriously concerned 
about whether the resources currently being requested are indeed 
sufficient to bring about an end to the backlog. These veterans stuck 
in this shameful backlog have waited long enough, whether they be Iraq 
and Afghanistan veterans, Gulf War I veterans, Cold War veterans, 
Vietnam veterans, Korean War veterans, or even World War II veterans, 
all of whom are a part of this excessively large backlog.
    While we remain gravely concerned about this problem, IAVA is also 
hopeful that Members of this Committee will use their platform and 
their power to not only hold the VA accountable, but also equip it with 
the financial resources it needs to better serve America's veterans. 
This is our constituency, this is the VA's constituency, and this is 
this Committee's constituency, and together we can accomplish the goal 
of ending the backlog, fully caring for veterans and their families, 
and improving the lives of all who have served.
    We again appreciate the opportunity to offer our views to the 
Committee on the VA's budget request, and we look forward to continuing 
to work with each of you, your staff, and the VA to improve the lives 
of America's veterans and their families.

    Thank you for your time and attention.
                                 ______
                                 
          Prepared Statement of Paralyzed Veterans of America
    Chairman Sanders, Ranking Member Burr, and Members of the 
Committee, As one of the four co-authors of The Independent Budget 
(IB), Paralyzed Veterans of America (PVA) is pleased to present the 
views of The Independent Budget regarding the funding requirements for 
the Department of Veterans Affairs (VA) for FY 2014.
    As the country faces a difficult and uncertain fiscal future, the 
VA likewise faces significant challenges ahead. Congress and the 
Administration continue to face immense pressure to reduce Federal 
spending. With these thoughts in mind, we cannot emphasize enough the 
importance of ensuring that sufficient, timely and predictable funding 
is provided to the VA. Unfortunately, we do not believe that the 
Administration's FY 2014 Budget Request, which includes advance 
appropriations for medical care for FY 2015, meets that standard. In 
fact, analyzing the projected increase in funding for all medical care 
in the Administration's budget from FY 2014 (based on the assumption of 
$157 million additional needed dollars) to the advance appropriations 
recommendation for FY 2015 suggests that the VA budget will not begin 
to meet the projected needs of veterans already in the system and those 
coming to the VA for the first time. In fact, we believe that the $1.1 
billion increase that the Administration projects from FY 2014 to FY 
2015 does not even meet current services increases impacted by 
inflation (conservatively estimated to be around 3.0 percent for 
general medical care). With that thought in mind, the Administration's 
budget would certainly not be sufficient to address the needs of new 
utilization.
    Meanwhile, The Independent Budget co-authors are particularly 
concerned that the broken appropriations process continues to have a 
negative impact on the operations of the VA. Once again this year 
Congress failed to fully complete the appropriations process in the 
regular order, instead choosing to fund the Federal Government through 
a 6-month Continuing Resolution and subsequently completing the 
appropriations work for the current fiscal year nearly 6 months into 
the year. As a result of the enactment of advance appropriations, the 
health care system is generally shielded from the difficulties 
associated with late appropriations (an occurrence that has become the 
rule, not the exception). However, we cannot be certain that health 
care operations have not been negatively impacted by this 6-month 
continuing resolution. Moreover, the rest of the operations of the VA 
have most certainly been hampered by this broken process.
    The Independent Budget co-authors remain concerned about steps VA 
has taken in recent years in order to generate resources to meet ever-
growing demand on the VA health-care system. In fact, once again this 
year the Administration continues to rely upon ``management 
improvements,'' a popular gimmick that was used by previous 
Administrations to generate savings and offset the growing costs to 
deliver care. The FY 2014 Budget Request includes estimates for savings 
as a result of presumed ``management improvements.'' As a result, the 
Administration concludes that it can reduce appropriations requirements 
for FY 2014 and FY 2015. The budget specifically outlines $482 million 
in proposed savings for both FY 2014 and FY 2015. Additionally, the 
budget projects $1.328 billion in operational improvements for both FY 
2014 and FY 2015. This is a wholly unacceptable way to fund the 
operations of the VA health care system. These savings are often never 
realized leaving VA short of necessary funding to address ever-growing 
demand on the health-care system.
    Additionally, the VA continues to overestimate and underperform in 
its medical care collections. Overestimating collections estimates 
affords Congress the opportunity to appropriate fewer discretionary 
dollars for the health care system. However, when the VA fails to 
achieve those collections estimates, it is left with insufficient 
funding to meet the projected demand. As long as this scenario 
continues, the VA will find itself falling farther and farther behind 
in its ability to care for those men and women who have served and 
sacrificed for this Nation. The fact that the VA continues to 
experience problems with its medical care collections reflects an even 
greater need to Congress to properly analyze, and if necessary, revise 
the advance appropriations from the previous year to ensure that the VA 
health care system is getting the resources it needs.
                          funding for fy 2014
    For FY 2014, The Independent Budget recommends approximately $58.8 
billion for total medical care, an increase of $3.3 billion over the FY 
2013 operating budget. Meanwhile, the Administration recommended, and 
Congress recently approved in Public Law 113-6, the ``Full-Year 
Continuing Appropriations Act,'' an advance appropriation for FY 2014 
of approximately $54.4 billion in discretionary funding for VA medical 
care. When combined with the $3.1 billion Administration projection for 
medical care collections, the total available operating budget 
recommended for FY 2014 is approximately $57.5 billion. We believe that 
this level is insufficient to fully meet the continually growing demand 
for the wide range of health care services in the VA. Unfortunately, 
the Administration only recommends an additional $158 million for 
funding for FY 2014. Once again, it appears that the Administration has 
offered limited analysis and only minor revision of those estimates 
originally recommended in the advance appropriations estimate for FY 
2014 last year.
    The medical care appropriation includes three separate accounts--
Medical Services, Medical Support and Compliance, and Medical 
Facilities--that comprise the total VA health-care funding level. For 
FY 2014, The Independent Budget recommends approximately $47.4 billion 
for Medical Services, approximately $800 million more than the advance 
appropriations (when medical care collections are also taken into 
account) included in Public Law 113-6, the ``Full-Year Continuing 
Appropriations Act for FY 2013.'' Our Medical Services recommendation 
includes the following recommendations:

    Current Services Estimate........................... $45,552,079,000
    Increase in Patient Workload........................   1,184,999,000
    Additional Medical Care Program Costs...............     675,000,000
                    --------------------------------------------------------
                    ____________________________________________________
        Total FY 2014 Medical Services.................. $47,412,078,000
                    ========================================================
                    ____________________________________________________
    Our growth in patient workload is based on a projected increase of 
approximately 81,200 new unique patients--priority groups 1-8 veterans 
and covered nonveterans. We estimate the cost of these new unique 
patients to be approximately $827 million. The increase in patient 
workload also includes a projected increase of 96,500 new Operation 
Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), as well as 
Operation New Dawn (OND) veterans at a cost of approximately $358 
million. Our recommendations represent an increase in projected 
workload in this population of veterans over previous years as a result 
of the withdrawal of forces from Iraq, the drawdown of forces in 
Afghanistan, and a potential drawdown in the actual number of 
servicemembers currently serving in the Armed Forces. And yet, we 
believe that growth in demand for this cohort specifically could be far 
greater given the changing military policies mentioned above. In fact, 
we believe that recent reporting from the VA suggests that the actual 
number of new unique OEF/OIF/OND veterans is greater than 120,000. This 
leads us to conclude that our estimate of cost for this population 
should be even greater.
    Finally, The Independent Budget believes that there are additional 
projected funding needs for VA. Specifically, we believe there is real 
funding needed to address issues in the VA's long-term care program and 
to provide additional centralized prosthetics funding (based on actual 
expenditures and projections from the VA's prosthetics service). In 
order to support the rebalancing of VA long-term care in FY 2014, we 
believe $112 million should be provided. Additionally, we believe $75 
million should be targeted at the VA's Veteran Directed-Home and 
Community Based Services (VD-HCBS) program. The remainder of the $375 
million that the IB recommends for long-term care services would begin 
to restore the VA's long-term care capacity to the level mandated by 
Public Law 106-117, the ``Veterans Millennium Health Care and Benefits 
Act.'' In order to meet the increase in demand for prosthetics, the IB 
recommends an additional $300 million. This increase in prosthetics 
funding reflects an increase in expenditures from FY 2012 to FY 2013 
and the expected continued growth in expenditures for FY 2014.
    For Medical Support and Compliance, The Independent Budget 
recommends approximately $5.84 billion. This recommendation is 
approximately $189 million less than the advance appropriation amount 
recently included in Public Law 113-6. Finally, for Medical Facilities, 
The Independent Budget recommends approximately $5.57 billion. While 
our recommendation does not include an additional increase for Non-
Recurring Maintenance (NRM), it does reflect a FY 2014 baseline of 
approximately $750 million. While we appreciate the significant 
increases in the NRM baseline over the last couple of years, total NRM 
funding still lags behind the recommended two to four percent of plant 
replacement value. In fact, VA should actually be receiving at least 
$1.7 billion annually for NRM. Meanwhile, we are very disappointed that 
the advance appropriation amount included in Public Law 113-6 
significantly reduces funding for Medical Facilities, particularly with 
regards to the NRM portion of that account. This level of funding, 
particularly if the trend continues in the coming years, will have a 
devastating impact on the ability of the VA to meet the maintenance 
needs of the health care system. The impact will be even more 
pronounced given the fact that the Administration's FY 2014 Budget 
Request decimates funding for Major Construction and provides only a 
marginal increase for Minor Construction. Given the current condition 
of VA's existing infrastructure, Congress and the Administration need 
to show greater commitment to these needs and provide truly adequate 
funding.
    For Medical and Prosthetic Research, The Independent Budget 
recommends $611 million. This represents approximately a $28 million 
increase over the FY 2013 appropriated level, and approximately $25 
million more than the Administration's FY 2014 recommendation. The VA 
research program is a jewel within the VA that we support without 
hesitation or reservation. That program and its nearly 4,000 principal 
investigators have made myriad improvements not only to veterans' 
health in VA care, but have elevated the standard of health care of the 
Nation and the world. Despite scientific discoveries and prosthetic 
inventions too numerous to mention here but that are well known, the 
Administration now for the fourth year in a row has requested 
essentially flat funding for VA research, and Congress has effectively 
acquiesced. From FY 2011 through the FY 2013 appropriation, virtually 
nothing has been added by Congress to that program's budget baseline. 
No allowance has been made to cover uncontrollable research inflation, 
which averages around 3 percent annually; no funds have been provided 
for new initiatives beyond the baseline; and no funds have been 
requested or provided to help repair or upgrade VA's research 
laboratories, concerning which a 2012 independent evaluation estimated 
that almost $800 million would be required to bring them up to par. And 
disappointingly, no funds have been requested for special research 
initiatives focused on the needs of Iraq and Afghanistan veterans. 
These are major lapses that deserve correction.
                   advance appropriations for fy 2015
    As explained previously, Public Law 111-81 required the President's 
budget submission to include estimates of appropriations for the 
medical care accounts for FY 2013 and subsequent fiscal years. With 
this in mind, the VA Secretary is required to update the advance 
appropriations projections for the upcoming fiscal year (FY 2014) and 
provide detailed estimates of the funds necessary for the medical care 
accounts for FY 2015.
    For the first time this year, The Independent Budget offers 
baseline projections for funding for the medical care accounts for FY 
2015. While we have previously deferred to the Administration and 
Congress to provide sufficient funding through the advance 
appropriations process, we have growing concerns that this 
responsibility is not being taken seriously. The fact that for two 
fiscal years in a row the Administration recommended funding levels 
that were not changed in any appreciable way upon review, and the fact 
that Congress simply signed off on those recommendations without 
thorough analysis, leads us to conclude that VA funding is falling 
farther and farther behind the growth in demand for services. We 
believe the continued feedback from veterans around the country about 
long wait times and lack of access to services affirms this belief. As 
such, we have decided to offer our own estimates of what we believe the 
true resource needs will be for the VA health care system in FY 2015.
    For FY 2015, The Independent Budget recommends approximately $61.6 
billion for total medical care, approximately $2.8 billion more than 
what the Administration has recommended for advance appropriations for 
FY 2015. We believe that this recommendation by the Administration is 
woefully inadequate to address the future needs of veterans seeking 
health care services from the VA. Our recommendation includes 
approximately $49.8 billion for Medical Services, approximately $1.6 
billion more than the advance appropriations recommendation (when a 
medical care collections estimate of $3.2 billion is taken into 
account). Our Medical Services recommendation includes the following 
recommendations:

    Current Services Estimate........................... $48,042,797,000
    Increase in Patient Workload........................   1,105,821,000
    Additional Medical Care Program Costs...............     675,000,000
                    --------------------------------------------------------
                    ____________________________________________________
        Total FY 2015 Medical Services.................. $49,823,618,000
                    ========================================================
                    ____________________________________________________

    Our growth in patient workload is based on a projected increase of 
approximately 60,000 new unique patients--priority groups 1-8 veterans 
and covered nonveterans. We estimate the cost of these new unique 
patients to be approximately $737 million. The increase in patient 
workload also includes a projected increase of 96,500 new OEF/OIF/OND 
veterans at a cost of approximately $369 million. Meanwhile, we are 
particularly interested to see the trends that the VA Budget Request 
projects for new utilization in the coming years. While the growth in 
utilization of some new unique patients seems to be trending downward, 
we believe that the OEF/OIF/OND population will continue to trend 
upward as the military services drawdown their forces and as worldwide 
conflicts end. Additionally, it remains to be seen what impact the full 
implementation of the Affordable Care Act will have on utilization of 
VA health care services.
    As with FY 2014, The Independent Budget believes that there are 
additional projected funding needs for VA. In FY 2015, the IB once 
again believes that $375 million should be directed toward VA's long-
term care program. Additionally, we believe that a continued increase 
in centralized prosthetics funding will be essential. In order to meet 
the continued increase in demand for prosthetics, the IB recommends an 
additional $300 million.
    Finally, for Medical Support and Compliance, The Independent Budget 
recommends approximately $6.14 billion, approximately $266 million more 
than the advance appropriation recommendation for FY 2015. Of greater 
concern to The Independent Budget is the continued effort to slash 
funding for Medical Facilities and particularly for NRM. For Medical 
Facilities, The Independent Budget recommends approximately $5.69 
billion, nearly $950 million more than the advance appropriation for FY 
2015. If the Administration, and ultimately Congress, continues this 
trend of woefully underfunding Medical Facilities, the long term 
condition of the infrastructure of VA will collapse. It is time for 
Congress to correct this wrong before it persists for too long.
    Additionally, GAO's responsibility is more important than ever, 
particularly in light of their findings concerning the FY 2012 budget 
submission last year. The GAO report that analyzed the FY 2012 
Administration budget identified serious deficiencies in the budget 
formulation of VA. Yet these concerns were not appropriately addressed 
by Congress or the Administration. This analysis and the subsequent 
lack of action to correct these deficiencies simply affirm the ongoing 
need for the GAO to evaluate the budget recommendations of VA. For this 
reason, we urge the Senate VA Committee to consider legislation similar 
to H.R. 806, the ``Veterans Healthcare Improvement Act.'' This 
legislation permanently establishes the Government Accountability 
Office's reporting requirements as a part of VA advance appropriations.
    Finally, we would also like to urge the Committee to consider 
legislation similar to H.R. 813, the ``Putting Veterans Funding First 
Act of 2013,'' introduced by House Committee on Veterans' Affairs 
Chairman Jeff Miller (R-FL) and Ranking Member Mike Michaud (D-ME). 
This legislation requires all accounts of the VA to be funded through 
the advance appropriations process. It would provide protection for the 
operations of the entire VA from the political wrangling that occurs as 
a part of the appropriations process every year.
    Ultimately, the health care, research, and construction accounts of 
the Administration's FY 2014 Budget Request and FY 2015 advance 
appropriations are totally unacceptable. Those funding levels 
specifically do not properly reflect the obligation that this country 
has to ``care for him who shall have borne the battle, and his widow 
and his orphan.''

    Once again, we thank you for the opportunity to submit our views 
for the record. The co-authors of The Independent Budget would be happy 
to answer any questions that you might have.
                                 ______
                                 
             Prepared Statement of Wounded Warrior Project
    Chairman Sanders, Ranking Member Burr and Members of the Committee: 
Thank you for inviting Wounded Warrior Project to submit our views on 
the President's VA budget for Fiscal Year 2014, and for your timely 
focus on this plan.
    WWP welcomes the commitment to veterans reaffirmed in this budget, 
and deeply appreciates the broad recognition it provides to the debt 
this country owes those who served and sacrificed. That recognition, 
manifest in funding increases at a time of fiscal constraint for 
important programs within the Department of Veterans Affairs signals an 
ongoing effort to stand by America's veterans.
    Nevertheless, one can rightly look deeper and ask--more than a 
decade into a war that continues to shatter bodies and minds--whether 
this budget truly meets the very profound needs experienced by many of 
our wounded warriors. This surely is an apt lens through which the 
Committee can look.
    VA does certainly have additional programmatic resource needs. 
Importantly, however, we see this budget as falling short in some key 
areas--both with respect to its failure to make timely programmatic 
investments in strategically important areas, and in maintaining a 
largely unchanging course in areas where we would have hoped for new 
and bolder vision.
    To illustrate the point, it is noteworthy that this budget asks 
Congress to make permanent two tax credits to encourage employers to 
hire veterans. For many warriors, however, military careers were cut 
short by life-altering injuries, and the challenge of finding 
employment is compounded by the need to develop new skills, tools, 
training or education, even as they attempt to re-integrate into their 
communities and rebuild their lives. While the Post-9/11 GI Bill is an 
answer for some, many others need good counseling and support. VA's 
vocational rehabilitation and education program (VR&E) should be an 
answer, a key transitional pathway. VA has failed, however, to give 
this program the priority and resource support needed for this 
generation of wounded warriors to get the kind and extent of help they 
need. For too long, for example, the size of counselors' caseloads has 
limited their ability to provide the extent of support needed, 
particularly for those with PTSD and Traumatic Brain Injury. It is 
disappointing, therefore, to see that VR&E staffing levels under this 
budget remain flat, despite a projected increase in workload. But 
absent any plan to increase funding for this important program, we urge 
consideration of another approach to better ensure adequate support for 
wounded warriors--establish a system of prioritization. Consistent with 
the system of prioritization already in law with regard to enrollment 
in the VA health care system,\1\ the vocational rehabilitation program 
could be structured to establish relative priorities, such that the 
most severely injured would have higher priority for receiving needed 
rehabilitative services than a veteran with a substantially lower 
percentage of disability.
---------------------------------------------------------------------------
    \1\ 38 U.S. Code section 1705.
---------------------------------------------------------------------------
    Last year, adopting provisions on long-term TBI care that 
originated in legislation introduced by Senator Boozman and Congressman 
Tim Walz, this Committee approved and Congress enacted the Honoring 
America's Veterans and Caring for Camp Lejeune Families Act. The 
Boozman-Walz provision requires that VA provide veterans suffering from 
TBI with the opportunity to maximize independence through community-
based services such as supported employment and life-skills coaching. 
It further requires that rehabilitation focus not only on achieving 
functional gains but on sustaining them. This important provision was 
intended to remedy VA's failure to meet such basic expectations of TBI 
rehabilitation. We see no indication in the fiscal plan for FY 2014, 
however, that VA is in any way budgeting to implement this important 
provision.
    In contrast, VA points with some pride to a significant increase in 
funding for mental health. While we applaud the commitment reflected in 
that budgeting decision, we do not see a commensurate basis for 
confidence that the funding will have the decisive impact for which one 
would hope. Nor do we see evidence of a clear strategic plan underlying 
the $7 billion mental health budget. Instead we see relatively little 
in the way of course-correction beyond a plan to increase funding. We 
see little in the budget to foster a belief, for example, that those 
warriors who need, but have been reluctant to seek, behavioral health 
care from VA will now visit VA facilities. Many warriors have begun--
only to drop out of--treatment; the budget suggests nothing to win them 
back or to keep others from following that course. One resource that 
many of our warriors cite with approval is the Vet Center program. But 
despite the drawdown and the likelihood of greater numbers in need of 
help, the budget projects no growth in that program. The mental health 
challenges facing wounded warriors alone would lead one to believe that 
VA should look beyond its own facilities and plan to work with the 
communities where our warriors live. But the budget is devoid of a real 
strategy for engaging communities, or even of a plan to increase 
substantially the numbers of veterans who would be afforded mental 
health care through fee or contract arrangements. We do, however, see 
two promising signs: the hiring and training of veterans to provide 
peer-support services is a very encouraging step, as is the steady 
growth in tele-mental health services. These are dwarfed, however, by a 
seeming need to be ``doing something,'' that translates into a plan 
simply to increase funding.
    In a similar vein, the budget proposes increases in funding in a 
number of high-visibility programmatic areas, several of keen 
importance to wounded warriors. To illustrate, the budget proposes 
increases in funding for prosthetics. What it does not do, however, is 
acknowledge the need to improve prosthetics care--an area in which VA's 
leadership role has declined and where a vision for change has yet to 
be realized.
    Finally, we welcome the priority given VA's effort to remedy the 
long-festering compensation and pension claims backlog. Wounded 
warriors certainly suffer as the result of shortcomings in a system 
intended to provide timely disability compensation. We encounter too 
many warriors who after sustaining severe wounds, receive only limited 
military retired pay (often because of too-hurried military 
processing), and too often experience many months of severe financial 
need while VA completes the process of adjudicating the warrior's 
claim. While we at WWP have provided monetary and other supports to 
individuals who find themselves in such straits, there should be no 
excuse for leaving combat-wounded warriors in limbo. It bears noting, 
however, that these problems are not exclusively of VA's making. While 
VA does ``own'' serious claims-adjudication problems, we should be 
cautious in believing that additional funding alone will produce an 
optimal system. (We recognize that VA has instituted some important 
streamlining efforts, though the promise in those efforts will take 
time to realize.) Not only are there ``upstream'' problems that require 
DOD resolution, but long experience persuades us that timely, effective 
claims-adjudication will continue to elude the Veterans Benefits 
Administration (VBA) until it effectively grapples with some underlying 
managerial problems. Indeed, in framing the challenge numerically--
viewing determinations of service-incurrence and extent of disability 
solely as work to be counted and sped through a system--VBA risks 
cementing in place a system that does not necessarily serve either the 
veteran or its workforce well. These are not after all assembly-line 
``widgets,'' but determinations critical to the well-being of a wounded 
individual. Understandably, the singular focus on ``moving claims'' has 
bred morale problems among adjudication staff. While appreciating that 
VBA is redesigning systems and harnessing technology to eliminate a 
claims backlog, there is room as well for a complementary focus--one 
aimed at instilling in leadership and management the goal of empowering 
employees to do good work, rather than instilling a fear of punishment 
for failing to meet numerical indicators. Leadership is a first step in 
establishing that much-needed cultural change.

    Thank you for considering our views.



                                  [all]
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