    [Senate Hearing 114-707]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 114-707

                         HEARING ON PENDING LEGISLATION

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

                                    HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                              UNITED STATES SENATE

                        ONE HUNDRED FOURTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 JUNE 29, 2016

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

                     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

             Available via the World Wide Web: http://www.fdsys.gov

                           U.S. GOVERNMENT PUBLISHING OFFICE

    22-272PDF                       WASHINGTON: 2017
      _____________________________________________________________________________
      For sale by the Superintendent of Documents, U.S. Government Publishing Office,
    Internet: bookstore.gpo.gov. Phone: toll free (866) 512-1800; DC area (202) 512-1800
                Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC 20402-0001

                         COMMITTEE ON VETERANS' AFFAIRS

                       Johnny Isakson, Georgia, Chairman
    Jerry Moran, Kansas                  Richard Blumenthal, Connecticut,
    John Boozman, Arkansas                   Ranking Member
    Dean Heller, Nevada                  Patty Murray, Washington
    Bill Cassidy, Louisiana              Bernard Sanders, (I) Vermont
    Mike Rounds, South Dakota            Sherrod Brown, Ohio
    Thom Tillis, North Carolina          Jon Tester, Montana
    Dan Sullivan, Alaska                 Mazie K. Hirono, Hawaii
                                         Joe Manchin III, West Virginia

                           Tom Bowman, Staff Director
                     John Kruse, Democratic Staff Director

                                C O N T E N T S

                                  ----------

                                 June 29, 2016
                                    SENATORS

                                                                       Page
    Isakson, Hon. Johnny, Chairman, U.S. Senator from Georgia........     1
    Blumenthal, Hon. Richard, Ranking Member, U.S. Senator from
      Connecticut....................................................    32
    Murray, Hon. Patty, U.S. Senator from Washington.................    13
        Prepared statement...........................................    14
    Tillis, Hon. Thom, U.S. Senator from North Carolina..............    34
    Heller, Hon. Dean, U.S. Senator from Nevada......................    38
    Cassidy, Hon. Bill, U.S. Senator from Louisiana..................    40
        Exhibit......................................................    42
    Sullivan, Hon. Dan, U.S. Senator from Alaska.....................    43
    Tester, Hon. Jon, U.S. Senator from Montana......................    45

                                   WITNESSES

    Inhofe, Hon. James M. U.S. Senator from Oklahoma.................     1
        Prepared statement...........................................     3
    Fischer, Hon. Deb, U.S. Senator from Nebraska....................     4
        Prepared statement...........................................     6
    Franken, Hon. Al, U.S. Senator from Minnesota....................     7
    Cotton, Hon. Tom, U.S. Senator from Arkansas.....................     8
        Exhibit......................................................     9
    McCaskill, Hon. Claire, U.S. Senator from Missouri...............    10
        Prepared statement...........................................    12
    Merkley, Hon. Jeff, U.S. Senator from Oregon.....................    48
    McLenachen, David, Deputy Under Secretary for Disability
      Assistance, Veterans' Benefits Administration, U.S. Department
      of Veterans Affairs; accompanied by Maureen McCarthy, M.D.,
      Assistant Deputy Under Secretary for Health for Patient Care
      Services, Veterans Health Administration.......................    15
        Prepared statement...........................................    17
        Additional views dated August 3, 2016........................    28
        Response to request arising during the hearing by:
          Hon. Dean Heller...........................................    39
          Hon. Jon Tester............................................    47
        Response to posthearing questions submitted by Hon. Mazie K.
          Hirono.....................................................    49
    Butler, Roscoe, Deputy Director of Health Care, National Veterans
      Affairs and Rehabilitation Division, The American Legion.......    52
        Prepared statement...........................................    53
    Fuentes, Carlos, Deputy Director, National Legislative Service,
      Veterans of Foreign Wars.......................................    62
        Prepared statement...........................................    63
    Weidman, Rick, Executive Director for Policy and Government
      Affairs, Vietnam Veterans of America...........................    69
        Prepared statement...........................................    70
    Ziober, Kevin, Member of the Reserve Component...................    74
        Prepared statement...........................................    76

                                    APPENDIX

    Cleland, Max, Secretary, American Battle Monuments Commission
      (ABMC); prepared statement.....................................    85
    Wilson, LeAnn, Executive Director, Association for Career and
      Technical Education (ACTE); prepared statement.................    87
    Kahn, Thomas S., Director, Legislative Affairs, American
      Federation of Government Employees, AFL-CIO (AFGE); letter.....    89
    Webb, Amy, Legislative Policy Advisor, AMVETS; prepared statement    89
    American Public Health Association (APHA); prepared statement....    98
    Ilem, Joy J., National Legislative Director, Disabled American
      Veterans (DAV); prepared statement.............................    99
    Doederlein, Allen, President, Depression and Bipolar Support
      Alliance (DBSA); prepared statement............................   107
    Civil Rights Division and the Servicemembers and Veterans Affairs
      Initiative, U.S. Department of Justice (DOJ); prepared
      statement......................................................   109
    Michaud, Hon. Michael, Assistant Secretary for Veterans'
      Employment and Training, U.S. Department of Labor (DOL);
      prepared statement.............................................   160
    Blumrosen, Alexander, President, The Lafayette Escadrille
      Memorial Foundation; letter....................................   163
    Salanti, MAJ Frederick R., US Army (Ret.), Founder/Executive
      Director, Missing in America Veterans Recovery Program (MIAP);
      prepared statement.............................................   165
    Military Officers Association of America (MOAA); prepared
      statement......................................................   171
    Military Order of the Purple Heart (MOPH); prepared statement....   173
    Kiefer, Keith, Director at Large, NAAV Minnesota State Co-
      Commander & Enewetak Radiological Cleanup Veteran (1978),
      National Association of Atomic Veterans (NAAV); prepared
      statement......................................................   177
    National Alliance on Mental Illness (NAMI); prepared statement...   181
    Wescott, Joseph W., II, Legislative Director, National
      Association of State Approving Agencies (NASAA); prepared
      statement......................................................   182
    Chaw, Terisa E., Executive Director, National Employment Lawyers
      Association (NELA); letter.....................................   185
    National Guard Association of the United States (NGAUS); prepared
      statement......................................................   195
    Lerner, Hon. Carolyn N., Special Counsel, U.S. Office of Special
      Counsel (OSC); prepared statement..............................   197
    Paralyzed Veterans of America (PVA); prepared statement..........   198
    Reserve Officers Association of the United States (ROA); prepared
      statement......................................................   202
    Southcentral Foundation (SCF); prepared statement................   205
    Fronabarger, Derek, Director of Policy, Student Veterans of
      America (SVA); prepared statement..............................   207
    Josten, Bruce R., Executive Vice President, Government Affairs,
      Chamber of Commerce of the United States of America; letter....   209

                         HEARING ON PENDING LEGISLATION

                                  ----------

                            WEDNESDAY, JUNE 29, 2016

                                           U.S. Senate,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 2:28 p.m., in
    room 418, Russell Senate Office Building, Hon. Johnny Isakson,
    Chairman of the Committee, presiding.
        Present: Senators Isakson, Heller, Cassidy, Tillis,
    Sullivan, Blumenthal, Murray, Brown, Tester, and Hirono.

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

        Chairman Isakson. I call this meeting of the Senate
    Veterans' Affairs Committee to order.
        We are going to start right on time. We have a number of
    members who wish to address legislation they have proposed. We
    have an agenda of 18 bills that are before the Veterans'
    Affairs Committee, so it is going to be a lengthy hearing. I
    know there are Senators that have places to be.
        I am going to waive my own opening statement, along with
    Ranking Member Blumenthal. We will make our statements later in
    the day in respect for the Senators that are here.
        As is tradition with our Committee, we will give each
    Senator up to 5 minutes to make a presentation on their
    legislation. As is tradition, we do not enter into questions
    and answers as Committee Members, but once you have made your
    testimony, you may leave if you would like. If you wish to
    stay, you are welcome to stay. We are delighted that you came.
        We will start with the first testimony from Senator Inhofe.

                  STATEMENT OF HON. JAMES M. INHOFE,
                       U.S. SENATOR FROM OKLAHOMA

        Senator Inhofe. Thank you, Mr. Chairman. I appreciate it
    very much.
        In 2010, Congress passed the Post-9/11 Veterans Education
    Assistance Improvement Act. This Act authorized veterans to use
    their benefits to pursue a technical or career certificate
    program as an option instead of traditional liberal arts
    opportunities at a college or university. It is kind of
    interesting. I am the right one to do this, because in the
    State of Oklahoma, I actually introduced the first legislation
    back in the 1970s to establish these technical training areas.
    So, I am very partial to them. The Career and Technical
    Education Centers, or CTEs, are public, not private, not-
    profit, non-degree granting institutions that provide skills
    and certificates important to every community and are found in
    over ten States.
        The city of Enid, OK, has been the home of the Autry
    Technology Center. Now, you and I may be the only two here old
    enough to remember who Gene Autry was. You, too? All right.
    [Laughter.]
        Well, anyway, he is an Oklahoman, in case you did not know.
    The Autry Technology Center, since 1967, has served over 10,000
    people annually through programs and services that enhance
    skills and employment opportunities. Autry currently offers 26
    full-time career programs, from air conditioning to culinary
    arts, radiology, and several other critically-applied skills
    used nationwide.
        Public, not-profit centers in the Oklahoma Career Tech
    System, like Autry, in Enid, are proven to significantly
    contribute to the economic development and quality-of-life in
    Oklahoma, especially to returning veterans. Career and
    Technical Education Centers are vital as post-secondary
    education options and workforce training system for our
    veterans.
        The administration recently took action to block certain
    technical center benefits from our veterans. Since March, the
    VA is not allowing the Post-9/11 G.I. Bill to pay for any form
    of independent study from a non-degree producing institution,
    including CTEs. In many cases, this hindrance precludes
    veterans from utilizing these courses in pursuing these
    certificate programs.
        CTEs, much like their college and university counterparts,
    are utilizing internet-based courses as a component of their
    programs to provide flexibility for working adults in expanding
    those programs. Unlike colleges and universities, however, CTEs
    are not technically degree producing, so the VA is preventing
    the use of G.I. Bill funds for any CTE program that has
    independent study.
        Marcie Mack, the State Director of Oklahoma's Career
    Technology System, told me last week that her--this is her
    quote--she said, ``Oklahoma's Career Tech System is committed
    to serving U.S. military veterans. However, with current
    Federal policy, there are obstacles for our veterans to be able
    to participation in the Oklahoma Career Tech System and receive
    their benefits.''
        Now, to address the current policy issues, I have
    introduced, and it is before this Committee now, S. 3021, along
    with Senator Lankford, clarifying the law to ensure accredited
    CTE programs can continue to receive G.I. Bill benefits even if
    a portion of the program is done through independent study.
        In the time since I introduced this legislation, I have
    heard concerns from this Committee about whether this would
    open the door for bad actors in the education space to take
    advantage of these benefits. Now, my staff has worked with your
    staff, your folks. They have explored these concerns and have
    modifications to the language that is in the bill now to ensure
    that the bill does not have negative unintended consequences.
    It is my hope that the Committee will quickly consider this
    legislation.
        I deeply appreciate the attention the Committee has given
    to my bill and I look forward to continuing my work to ensure
    that this problem is addressed.
        Now, there is not time to go into the other one, but I have
    another piece of legislation because there has been a problem
    with the VA centers in Oklahoma, the Muskogee Center, the
    Oklahoma City Center, the Tulsa Center. It has only been with
    my office's dedicated attention that these clinics have any
    progress being made. We have been helped by Ralph Gigliotti. He
    is the Veterans Integrated Service Networks, or VISN, Director
    for our area. He is really good. I sing his praises. He is
    outstanding. He has been very supportive. We have some
    legislation that is called S. 2554 that would give the VISNs
    more options, more authority to get things done, because they
    are the ones who are really capable of getting it done.
        So, while S. 2554 is in the Committee, it has not been
    considered yet. I would like to have you consider that at your
    earliest convenience.
        Chairman Isakson. Well, we appreciate your testimony on
    education as well as on the VISNs. We look forward to working
    with you on legislation and appreciate your interest in our
    veterans.
        Senator Inhofe. Thank you.
      Prepared Statement of Hon. James Inhofe, U.S. Senator from Oklahoma
        In 2010, Congress passed the Post-9/11 Veterans Educational
    Assistance Improvements Act. This Act authorized veterans to use their
    hard earned educational benefits to pursue a technical or career
    certificate program as an option instead of the traditional liberal
    arts opportunities at a college or university.
        Career technology centers, or CTEs are public, non-profit, non-
    degree granting institutions that provide skills and certificates
    important to every community and are found in over ten states.
        The city of Enid, Oklahoma has been home to the Autry Technology
    Center since 1967 and serves over 10,000 people annually through
    programs and services that enhance skills and employment opportunities.
        Autry currently offers 26 full-time career programs from air
    conditioning to culinary arts, to radiography, to welding, and several
    other critical, applied skills used nationwide.
        Public, non-profit centers in the Oklahoma Career-Tech system, like
    Autry Technology Center in Enid, are proven to significantly contribute
    to the economic development and quality of life in Oklahoma, especially
    our returning veterans.
        Career and technical education centers are vital as a post-
    secondary education option and workforce training system for our
    veterans, but the administration recently took action to block certain
    tech center benefits from our vets.
        Since March, the VA has not allowed the Post-9/11 GI Bill to pay
    for any form of independent study from a non-degree producing
    institution, including CTEs. In many cases, this hindrance precludes
    veterans from utilizing these courses or pursing these certificate
    programs.
        CTEs, much like their college and university counterparts, are
    utilizing internet based courses as a component of their programs to
    provide flexibility for working adults and veterans to better
    accommodate their lifestyles and encourage learning.
        Unlike colleges and universities, however, CTEs are not technically
    degree producing, and so the VA is preventing the use of GI Bill funds
    for any CTE program that has an independent study component.
        Marcie Mack, the State Director of the Oklahoma Career-Tech system,
    told me last week that, ``Oklahoma's Career-Tech system is committed to
    serving U.S. military veterans; however, with current Federal policy
    there are obstacles for our veterans to be able to participate in
    Oklahoma's Career-Tech system and receive their benefits.''
        To address the current policy issues, I have introduced S. 3021
    along with Sen. Lankford, clarifying the law to ensure accredited CTE
    programs can continue to receive GI Bill benefits even if a portion of
    the program is done by independent study.
        In the time since I introduced this legislation, I have heard
    concerns from this Committee about whether this would open the door for
    bad actors in the education space to take advantage of these benefits.
        My staff, along with the staff of this Committee, have explored
    these concerns and have modifications to the language to ensure the
    bill does not have negative, unintended consequences, and it is my hope
    that the Committee will quickly consider this legislation so that
    veterans in Oklahoma can achieve career success after leaving the
    service.
        I deeply appreciate the attention the Committee has given to my
    bill, and I look forward to continuing my work with you to ensure this
    issue is addressed.
        While I am here, I would also like to address the Committee on some
    of the VA health clinic challenges we have had in Oklahoma.
        We have had serious problems at both VA centers in Oklahoma--
    Muskogee and Oklahoma City. It has only been with my office's dedicated
    attention to these clinics that any measurable progress is being made.
        We have been helped by Ralph Gigliotti, our VISN director, who is
    outstanding. He has been very supportive of ensuring the changes that
    need to happen on the ground in Oklahoma actually take place. Both
    centers now have new directors because of his leadership.
        Recently, the VA contracted with the Joint Commission to do an
    investigation of Oklahoma's facilities together with the Inspector
    General. Having this outside entity come in and compare the VA
    facilities with private sector health care facilities is helping
    identify clear problems for the local and regional directors to go
    after and fix. It is always nice to have a second opinion.
        One section of S. 2554 provides permanent authority for VISN
    directors like Ralph Gigliotti, to contract with outside entities to do
    these kinds of investigations. I believe this is an important authority
    that needs to be explicitly provided to them, so that more of the VA
    health center problems, which we hear about all over the place, can be
    fully addressed.
        Thank you again for having me today.

        Chairman Isakson. Senator Fischer.

                    STATEMENT OF HON. DEB FISCHER,
                       U.S. SENATOR FROM NEBRASKA

        Senator Fischer. Thank you, Mr. Chairman. Good afternoon
    and thank you for holding this hearing.
        This Committee has addressed some of the most difficult
    issues that have faced our veterans. Across the country,
    people's confidence in the care we provide to veterans has been
    understandably shaken. As has been mentioned time and time
    again in this Committee, veterans deserve more from us. They
    expect more from us. They expect us to uphold our end of the
    bargain. The complications with the construction project in
    Denver, for example, have raised serious questions about our
    ability to provide veterans the high quality care that they
    have earned.
        Partnerships across the aisle and across the branches of
    government have been important to overcoming the issues facing
    our veterans in the past. By bringing more partnerships about
    between veterans, their communities, and the Federal
    Government, we have an opportunity to uphold our end of the
    bargain for our servicemembers. We can do this, and we can do
    this by tapping into the strength in our local communities.
    Through community partnerships, our family members, neighbors,
    and businesses can give back to those who have given so much
    for them.
        The VA has identified communities in Nebraska and across
    the country that are ready, willing, and able to contribute to
    improving our veterans' access to quality care. These
    communities do not want to wait for Washington. They are ready
    to restore the veterans' health care system and they want to
    take an active role in restoring our national confidence in
    that system.
        So, my bill, S. 2958, creates a pathway for local
    communities to do just that. Local leaders have expertise in
    aligning both design and medical teams in constructing medical
    facilities. Through the partnerships created in this bill,
    local leaders would have the opportunity to manage construction
    projects from start to finish. By allowing the private sector
    experts to lead these projects, the VA can avoid issues that
    have haunted previous projects.
        Our veterans and the American people deserve transparency.
    They deserve projects that are on time. They deserve projects
    that are on budget.
        The VA has already appropriated millions of dollars to
    construction projects that are not yet finished. This
    legislation would allow communities to contribute the remaining
    finances to complete these projects. The VA's financial
    obligation for the construction of these medical facilities
    would be limited to the previous appropriation and not one
    dollar more. This legislation can serve as a model for
    expediting the VA's efforts to coordinate its infrastructure
    with the needs of our veteran population.
        Communities across the country are willing to help take up
    this national responsibility of caring for our veterans. It is
    our responsibility, I believe, to fully explore ways that
    empower them to do so, and I believe that my legislation would
    do that.
        Thank you, Mr. Chairman.
        Chairman Isakson. Having dealt with the Denver hospital
    debacle and gone through that, I am glad that there are
    thoughtful members of the Senate looking at solutions to our
    future problems so we do not ever have to replicate those
    again. Thank you very much for your thoughtful proposal.
        Senator Fischer. Thank you, sir.
        [The prepared statement of Senator Fischer follows:]
       Prepared Statement of Hon. Deb Fischer, U.S. Senator from Nebraska

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Chairman Isakson. Senator Franken.

                     STATEMENT OF HON. AL FRANKEN,
                      U.S. SENATOR FROM MINNESOTA

        Senator Franken. Thank you, Chairman Isakson, and thank
    you, Senator Murray, for the opportunity to speak on behalf of
    the Atomic Veterans Health Care Parity Act, which I introduced
    with Senator Tillis. Thank you also to Senator Coons and
    Senator Wyden for cosponsoring the bill and the others
    testifying on behalf of this important legislation.
        Like the Members of this Committee, one of my highest
    priorities as a Senator is making sure that our veterans and
    their families get every benefit that they deserve. We need to
    help our veterans find a home and a job, recover from their
    physical and psychological wounds, and take full advantage of
    the benefits that they were promised when they enlisted,
    benefits they have earned with their service and their
    sacrifices as well as the sacrifices of their families.
        The veterans of the cleanup of the Enewetak Atoll have not
    gotten the benefits that they earned. During the 1940s and the
    1950s, the United States conducted more than 40 nuclear tests
    on the Enewetak Atoll in the Marshall Islands. Thousands of
    members of the U.S. Armed Forces participated in the clean-up
    of Enewetak between 1977 and 1980, so that was years later.
    Servicemembers removed radioactive fallout, soil, and debris,
    including significant amounts of plutonium, and dumped it into
    a crater on Runit Island, that was then covered with 18 inches
    of concrete.
        Now, we dropped so much nuclear material on Enewetak that
    it was as if we had dropped 1.6 Hiroshima bombs every day for
    12 years. That is what we are talking about. These
    servicemembers were typically without any form of protective
    gear. They wore Defense Department-issued T-shirts, shorts, and
    combat boots to remove highly contaminated material.
        Today, half of Enewetak, of the atoll, is still considered
    unsuitable for human habitation. Thirty-six years after the
    clean-up was completed, residents still must be tested for
    radiation levels, especially those that work closely with the
    soil, just like our veterans did.
        Now, our servicemembers who were actually part of the
    nuclear tests, the ones that were part of the nuclear tests
    during their active service, do receive extra benefits as
    atomic veterans to deal with illnesses that are assumed to be
    related to radiation exposure. However, servicemembers that
    were part of the clean-up do not receive these extra benefits,
    despite their exposure.
        Many of the veterans who served on Enewetak Atoll have
    already passed away. Many more of the clean-up veterans suffer
    from various types of cancer, respiratory and heart diseases,
    at early ages and at high rates. There are reports that their
    children may also be suffering from illnesses caused by having
    a parent who was exposed to radiation.
        Clean-up veterans are forced to pay out of pocket for their
    medical costs because the VA does not recognize them as atomic
    veterans. Despite being put in harm's way, these veterans that
    cleaned up after the nuclear tests are not being adequately
    compensated by their government.
        In order to right this wrong, Senator Tillis and I
    introduced the Atomic Veterans Health Care Parity Act. This
    bipartisan, bicameral legislation assures that the veterans who
    participated in the clean-up of the Enewetak Atoll receive the
    benefits they deserve, benefits that their service should have
    entitled to them years ago.
        Thank you, Mr. Chairman; thank you both Senators Murray and
    Hirono, for the opportunity to testify on this important piece
    of legislation. I look forward to working with you and the rest
    of the Committee to move this very important legislation along.
    Thank you very much.
        Chairman Isakson. Thank you very much, Senator Franken.
        Senator Cotton.

                     STATEMENT OF HON. TOM COTTON,
                       U.S. SENATOR FROM ARKANSAS

        Senator Cotton. Thank you, Mr. Chair. I would like to thank
    the Ranking Member, Senator Blumenthal. Thank you, Senator
    Murray and Senator Hirono, for the chance to appear before you
    today. My testimony did not require a grant of immunity.
    [Laughter.]
        I am here today to discuss my legislation, the Charles
    Duncan Buried with Honor Act, which would expand the cemetery
    burial options offered by the VA to financially insolvent
    veterans.
        I want to begin by telling a story about the bill's
    namesake, Mr. Charles Duncan, a Navy veteran from Little Rock,
    AR. Mr. Duncan died last year at the age of 66. He was
    financially insolvent and his family could not afford his
    funeral costs. Thanks to the past efforts of this Committee in
    passing the Dignified Burial and Other Veterans Benefits
    Improvement Act of 2012, Mr. Duncan was eligible for VA
    assistance with his burial costs. Unfortunately, because of a
    small gap in the law, Mr. Duncan and other veterans like him
    can only receive this assistance if they are buried in a
    national cemetery.
        In Arkansas, as I suspect in other States, this rule can
    necessitate hours of travel to reach the closest cemetery. For
    instance, we have three national cemeteries, one in Little
    Rock, one in Fort Smith, and one in Fayetteville. But the
    national cemetery in Little Rock is full, leaving Fort Smith
    and Fayetteville in the west as the only options.
        In Mr. Duncan's case, his adult daughter has no means of
    transportation and was unable to make the drive to Fort Smith
    from Little Rock and missed her father's funeral. Since then,
    she has been unable to visit her father's grave. Would it not
    make more sense to allow these veterans the option of a State
    veterans' cemetery if that cemetery is closer to the veteran's
    home?
        In Arkansas, we have two State cemeteries, one in Little
    Rock and one in east Arkansas at Birdeye. Both of them have
    plenty of room for more veterans, and as you can see, a large
    part of my State is closer to Little Rock and Birdeye than it
    is to either Fort Smith or Fayetteville.
        [Graphic follows:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Senator Cotton. Mr. Duncan could have been laid to rest in
    the Little Rock State cemetery, saving taxpayer money and
    allowing friends and families to attend the service or visit
    the gravesite. This is a small but important change.
        Since Senator Murray's bill took effect, the VA has
    reimbursed claims totaling almost $240,000 for the interment of
    203 veterans. The costs associated with this legislation as
    estimated at only $2 million over 10 years. I would suggest the
    cost is minimal when you consider the sacrifices our veterans
    have made and the solace this could provide their loved ones.
        Additionally, this change would not add additional stress
    to the VA or distract from their other efforts. It is a simple,
    straightforward change that the VA Veterans' Cemeteries Grant
    Program is well equipped to handle, and I would note that the
    VA submitted a no benefit cost or savings legislative proposal
    to make this type of change in its fiscal year 2017 budget
    submission, indicating its willingness to implement this
    legislation.
        Finally, in the interest of moving the bill forward, it
    retains the ``no next of kin'' provision in current law, which
    maintains the VA's commitment to our Homeless Veterans
    Initiative. This provision holds no cost, but also requires
    indigent veterans to disavow loved ones to be eligible for
    burial benefits. I hope there is a way to resolve that matter
    at a later date, and I look forward to working with the
    Committee and the VA on it.
        Charles Duncan was not the first veteran in this position,
    but we can help ensure that he is the last.
        Thank you for your time and thank you for your continued
    support for our veterans.
        Chairman Isakson. Thank you very much, Senator Cotton, for
    your thoughtful recommendation and presentation.
        Senator McCaskill.

                  STATEMENT OF HON. CLAIRE McCASKILL,
                       U.S. SENATOR FROM MISSOURI

        Senator McCaskill. Thank you, Mr. Chairman, and thank you
    to Senator Murray and Senator Hirono for being here today.
        I would like to address a very important topic with you
    today. I am here to speak in support of the Arla Harrell Act,
    legislation which I introduced to address a very serious
    injustice that has been perpetrated against veterans that were
    purposely exposed through our own military to chemical agents
    as part of U.S. Government experiments during World War II.
        The U.S. Government conducted classified chemical tests of
    mustard agents, including mustard gas and lewisite, on
    thousands of its own servicemembers. Mustard agents can cause
    painful blisters on exposed skin as well as damage to the eyes
    and respiratory system, leading to a lifetime of adverse health
    impacts. In total, 60,000 servicemembers are estimated to have
    participated in the tests, with about 4,000 of them facing the
    most extreme forms of full body exposure.
        One of these servicemembers is a constituent of mine, Arla
    Harrell, who was twice exposed to mustard gas while stationed
    for basic training at Camp Crowder in Neosho, MO, in 1945. Arla
    and his fellow subjects were told they would be helping the
    military, ``test summer clothing,'' in exchange for additional
    leave. It was not until they arrived at the testing site that
    they were told they would be exposed to mustard agents.
    Servicemembers who participated in chamber tests were
    repeatedly exposed to mustard agents until they developed
    moderate to intense erythema, a painful skin disorder.
        The servicemembers were threatened with court-martial if
    they did not continue with the testing. To make matters worse,
    they were sworn to an oath of secrecy, leaving them unable to
    share what had happened to them with anyone, including their
    own health care providers.
        Following his exposure, Arla was hospitalized twice, first
    at Camp Crowder while still in basic training, and again at the
    98th General Hospital in Munich, Germany. Due to the classified
    nature of the testing and the oath of secrecy, this meant
    decades of suffering and frustration for the impacted veterans
    as they sought medical care from doctors who were in the dark
    about their exposure.
        Seventy years after the experiments took place, the
    government has yet to appropriately assist and compensate many
    of these veterans. The VA finally established a process 25
    years ago to compensate these veterans, but it puts the burden
    on the veterans to prove that they were exposed to mustard gas
    in order to make a successful claim. These tests were
    classified. The young servicemembers were held to an oath of
    secrecy for more than 40 years. Records are incomplete, and for
    some veterans, a massive 1973 fire destroyed their entire
    service files. The VA established a burden of proof that is
    insurmountable to many impacted veterans.
        The VA has rejected approximately 90 percent of the
    applicants for VA benefits connected to exposure of mustard gas
    or lewisite. Of the thousands of veterans who were exposed
    during World War II during this testing, only 40 percent are
    receiving benefits today.
        Arla Harrell himself has been denied benefits multiple
    times, most recently just this month. The VA says it cannot
    confirm that mustard gas testing occurred at Camp Crowder and,
    therefore, cannot approve his benefits. This comes despite the
    clear statements from Arla regarding his treatment and the
    health effects he has suffered, and it comes despite the fact
    that the Army recovered mustard gas in vials in Camp Crowder
    more than 30 years ago and an Army Corps of Engineers report
    identifies gas chambers at Camp Crowder.
        I have put a document up on the easel that was made by the
    Army Corps of Engineers. They went to tear down Camp Crowder
    and someone operating the bulldozer had a smoke of something
    come up from the air and began coughing. They then recovered
    both the vials of mustard gas and found the actual gas chambers
    on the property.
        The Arla Harrell Act would improve the VA's consideration
    of mustard agent exposure claims and address this terrible
    situation. Simply, the bill would flip the burden of proof for
    veterans who have already been denied these benefits. And keep
    in mind, it only flips the benefit of who has to prove this for
    the people who have already applied, which there are less than
    400 of these folks still alive. So, for 400 individuals who
    have already applied, it would flip the burden of proof, but it
    would not open up claims for anyone else who has not previously
    applied. So, it is a very limited application.
        It would require the VA to reconsider all previously
    rejected claims for benefits under this program with the
    presumption that the veteran was exposed to mustard gas. Rather
    than require the veteran to prove exposure of a program
    classified for decades and decades and, frankly, only really
    known about within the bowels of the Department of Defense, or
    DOD, for many years, the bill would require the VA to prove
    that he was not. This is not a large universe of individuals
    and all of them have previously made a claim for benefits.
        Additionally, the bill would require the VA and DOD to
    establish a new policy for the processing of future mustard
    agent benefit claims so that other veterans do not go through
    what Arla Harrell has gone through.
        Arla and his wife, Betty, and their five children have
    fought for compensation for a service-related illness for
    almost 25 years. They just want somebody to believe them.
        After more than 70 years, Arla and veterans like him
    deserve recognition for their selfless service. I urge the
    Committee to support this legislation so we can keep our
    commitment and ensure that all veterans receive the respect,
    care, and benefits they have earned.
        Thank you, Mr. Chairman and Senators for being here, and I
    hope that this is something that would not be controversial and
    that we could move fairly quickly through the process.
        Chairman Isakson. Well, thank you for your testimony. I
    enjoyed our conversations during the markup on National Defense
    Authorization Act on this very subject, and we will continue to
    do the same thing here.
        Senator McCaskill. Thank you so much.
        [The prepared statement of Senator McCaskill follows:]
    Prepared Statement of Hon. Claire McCaskill, U.S. Senator from Missouri
        Chairman Isakson, Ranking Member Blumenthal, thank you for the
    opportunity to address the Committee on this important topic. I am here
    today to speak in support of the Arla Harrell Act, legislation I
    introduced to address a serious injustice perpetrated against veterans
    exposed to chemical agents as part of US government experiments during
    World War II.
        The U.S. Government conducted classified chemical tests of mustard
    agents--including mustard gas and lewisite--on thousands of its own
    servicemembers. Mustard agents can cause painful blisters on exposed
    skin as well as damage to the eyes and respiratory system, leading to a
    lifetime of adverse health impacts. In total, 60,000 servicemembers are
    estimated to have participated in the tests, with about 4,000 of them
    facing the most extreme forms of full body exposure.
        One of these servicemembers is a constituent of mine, Arla Harrell,
    who was twice exposed to mustard gas while stationed for basic training
    at Camp Crowder in Neosho, MO in 1945. Arla and his fellow subjects
    were told they would be helping the military ``test summer clothing''
    in exchange for additional leave. It was not until they arrived at the
    testing site that they were told they would be exposed to mustard
    agents. Servicemembers who participated in chamber testes were
    repeatedly exposed to mustard agents until they developed moderate to
    intense erythema, a painful skin disorder.
        The Servicemembers were threatened with court martial if they did
    not continue with the testing. To make matters worse, they were sworn
    to an oath of secrecy, leaving them unable to share what had happened
    to them with anyone, including their healthcare providers. Following
    his exposure, Arla was hospitalized twice, first at Camp Crowder while
    still in basic training and again at the 98th General Hospital in
    Munich, Germany.
        Due to the classified nature of the testing and the oath of
    secrecy, this meant decades of suffering and frustration for the
    impacted veterans as they sought medical care from doctors who were in
    the dark about their exposure. Seventy years after the experiments took
    place, the government has yet to appropriately assist and compensate
    many of these veterans.
        The VA established a process 25 years ago to compensate these
    veterans, but it puts the burden on the veterans to prove they were
    exposed to mustard gas in order to make successful claims. These tests
    were classified. The young servicemembers were held to an oath of
    secrecy for more than 40 years. Records are incomplete. And for some
    veterans, a massive 1973 fire destroyed their entire service case
    files. The VA established a burden of proof that is insurmountable for
    too many impacted veterans.
        The VA has rejected approximately 90 percent of applicants for VA
    benefits connected to exposure to mustard gas or lewisite. Of the
    thousands of veterans who were exposed during World War II, only 40 are
    receiving these benefits today.
        Arla Harrell himself has been denied benefits multiple times, most
    recently just this month. The VA says that it cannot confirm that
    mustard gas testing occurred at Camp Crowder and therefore cannot
    approve his benefits. This comes despite the clear statements from Arla
    regarding his treatment and the health effects that he has suffered.
    And it comes despite the fact that the Army recovered mustard gas in
    vials at Camp Crowder more than 30 years ago, and an Army Corps of
    Engineers report identifies gas chambers at Camp Crowder.
        The Arla Harrell Act would improve the VA's consideration of
    mustard agent exposure claims and address this terrible situation.
    Simply, the bill would flip the burden of proof for veterans who have
    already been denied these benefits. It would require the VA to
    reconsider all previously rejected claims for benefits under this
    program with a presumption that the veteran was exposed to mustard gas.
    Rather than require the veteran to prove exposure, the bill would
    require the VA to prove that he was not. This is not a large universe
    of individuals--and all of them have previously made a claim for these
    benefits.
        Additionally, the bill would require the VA and DOD to establish a
    new policy for the processing of future mustard agent benefit claims so
    that other veterans do not go through what Arla Harrell and others have
    been through.
        Arla, his wife Betty, and their five children have fought for
    compensation for his service-related illness for almost 25 years. After
    more than seventy years, Arla, and veterans like him, deserve
    recognition for their selfless service. I urge the Committee to support
    this legislation so we may keep our commitment and ensure all veterans
    receive the respect, care, and benefits they have earned.

        Chairman Isakson. Thank you, Senator McCaskill.
        We have one other member of the Senate, Senator Merkley,
    who has asked to testify, but he has not shown up yet. I do not
    know if we have a message that he is coming, so in his absence,
    we will go ahead and go to panel number 1.
        In the absence of Senator Blumenthal, we have a much more
    attractive Senator as Ranking Member, Senator Murray, and I
    recognize Senator Murray first.

                OPENING STATEMENT OF HON. PATTY MURRAY,
                      U.S. SENATOR FROM WASHINGTON

        Senator Murray. Well, Mr. Chairman, thank you. I want to
    thank you for holding this hearing on some really important
    pieces of legislation.
        I wanted to say, it is not on the agenda today, but I do
    want to take a moment to talk about my Servicemembers Civil
    Relief Act (SCRA) Enhancement and Improvement Act of 2016,
    which I believe is really important to upholding our country's
    commitment to veteran families. Part of that is making sure
    servicemembers have important legal protections so they can
    focus on their mission, and those protections recognize that
    while they are deployed or away from home, servicemembers often
    do not have the resources to respond to a range of financial
    and legal issues.
        Despite these protections, I am disappointed to learn that
    servicemembers continue today to be subjected to predatory
    practices and unfair treatment on their student loans, on their
    mortgages, and on their credit cards. It is why I have
    introduced the SCRA Enhancement and Improvement Act, which
    would put an end to many of these predatory practices and give
    servicemembers and our agencies the tools they need to fight
    back when banks and student loan servicers deny servicemembers
    their rights.
        I will put my statement into the record which explains what
    this does, Mr. Chairman, but it is about student loans, and it
    goes beyond that.
        I was concerned when, several years ago, some of our
    Nation's largest mortgage servicers improperly overcharged and
    foreclosed upon thousands of deployed servicemembers in
    violation of those current laws. So, our legislation deals with
    that, too. I just do not believe we should let our
    servicemembers be taken advantage of.
        Many of the provisions in our legislation have been
    considered by this Committee over the past years. Much of it is
    derived from requests by the Department of Justice for the
    tools it needs to protect our servicemembers.
        So, Mr. Chairman, it is not on the agenda today, but I
    really hope that our Committee can put it on a future agenda
    and deal with this important issue.
        [The prepared statement of Senator Murray follows:]
     Prepared Statement of Hon. Patty Murray, U.S. Senator from Washington
        Mr. Chairman, Thank you for holding this hearing on some important
    pieces of legislation.
        It is not on the agenda today, but I want to take a moment to talk
    about my SCRA Enhancement and Improvement Act of 2016, which I believe
    is so important to upholding our country's commitment to military
    families.
        Part of that is making sure servicemembers have important legal
    protections so they can focus on their mission. These protections also
    recognize that while they are deployed or away from home servicemembers
    often do not have the resources to respond to a range of financial and
    legal issues.
        Despite these protections, I've been disappointed to learn that
    servicemembers continue to be subjected to predatory practices and
    unfair treatment on their student loans, on their mortgages, and on
    their credit cards.
        That is so wrong.
        And, that is why I introduced the SCRA Enhancement and Improvement
    Act, which will help put an end to many of these predatory practices
    and give servicemembers and our agencies the tools they need to fight
    back when banks and student loan servicers deny servicemembers their
    rights.
        My bill will:

         Require automatic application of the interest rate cap,
    timely responses to all inquiries, retention of communications with
    servicemembers, and a full explanation of any denial of an SCRA
    protection.
         It will require student loan servicers to have a
    designated service representative or point of contact for
    servicemembers and ensure these individuals are properly trained.
         It will reduce the interest rate cap to provide meaningful
    protection to servicemembers, including a zero percent cap for
    servicemembers eligible for hostile fire or imminent danger pay.
         It will mandate that sufficient notice is given when a
    loan is transferred or sold, and that all benefits or protections
    seamlessly transfer to the new loan servicer.
         And it will forgive all Federal and private student loan
    debt in the event the servicemember dies in the line of duty.

        The SCRA Enhancement and Improvement Act also expands protections
    beyond student loans.
        I was concerned when several years ago some of the Nation's largest
    mortgage servicers improperly overcharged and foreclosed upon thousands
    of deployed servicemembers, in violation of the current law.
        To address those problems, and in addition to the interest rate
    cap, the bill would expand the interest rate protection to all of a
    servicemember's debt, regardless of when it was incurred, in order to
    cover consolidation loans and in recognition that the same challenges
    exist for military borrowers regardless of when a debt was first
    incurred.
        My bill will also give servicemembers and our agencies the legal
    and oversight tools they need to hold entities accountable, including
    giving the Attorney General greater authority for investigations and
    enforcement of the SCRA and doubling the fines against bad actors.
        Like everyone here I believe protecting our military men and women
    from predatory practices is an absolutely essential commitment. We will
    not allow our servicemembers to be taken advantage of.
        Many of these provisions have been considered by this Committee
    over the past few years, and much of it is derived from requests by the
    Department of Justice for the tools it needs to protect servicemembers.
        I look forward to working with you, Mr. Chairman, and my colleagues
    to advance this important bill.

        Chairman Isakson. For the record, the distinguished lady
    from Washington asked me to try to get it on the agenda for
    today. We were so, first of all, full, that was impossible.
    Second of all, I talked about a jurisdictional issue with
    Senator Alexander with regard to student loans, which I will
    talk to you about that after the meeting, but we will pursue it
    for you.
        Senator Murray. OK. Thank you.
        Chairman Isakson. Thank you for being here today.
        With that said, our first panel, Mr. David McLenachen,
    Deputy Under Secretary for Disability Assistance, Veterans
    Benefits Administration (VBA), U.S. Department of Veterans
    Affairs, accompanied by Dr. Maureen McCarthy, Assistant Deputy
    Under Secretary for Health for Patient Care Services, Veterans
    Health Administration (VHA).
        Mr. McLenachen, you are recognized.

       STATEMENT OF DAVID McLENACHEN, DEPUTY UNDER SECRETARY FOR
     DISABILITY ASSISTANCE, VETERANS BENEFITS ADMINISTRATION, U.S.
        DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY MAUREEN
    McCARTHY, M.D., ASSISTANT DEPUTY UNDER SECRETARY FOR HEALTH FOR
         PATIENT CARE SERVICES, VETERANS HEALTH ADMINISTRATION

        Mr. McLenachen. Mr. Chairman and Members of the Committee,
    thank you for the opportunity to present the views of the
    Department of Veterans Affairs on several bills that are
    pending before the Committee.
        As you said, joining me today is Dr. Maureen McCarthy,
    Assistant Deputy Under Secretary for Health for Patient Care at
    VHA.
        Because there are so many bills under consideration during
    this hearing, I am unable to address each one individually, Mr.
    Chairman. VA has indicated support for or concern with these
    bills in my accompanying written testimony.
        We provided cost projections for these bills as we can and
    we will provide projections for the remainder as we compile the
    necessary data. We will do that as soon as we possibly can.
        I would like to highlight a few of the bills that VA
    strongly supports that are on the agenda today. S. 2316, which
    affects a provision in current law that prevents VA from
    adequately compensating our most vulnerable beneficiaries when
    the fiduciary that serves them misuses their benefits. It would
    also allow VA to more easily and thoroughly investigate
    financial records in cases where a fiduciary misuse is
    suspected.
        S. 3021 would provide veterans with more flexibility in
    using their Post-9/11 G.I. Bill benefits to pursue independent
    study in a program at an institution that is not an institution
    of higher learning. VA recognizes the importance of career and
    technical education courses and the growth of online and other
    forms of modern non-degree training and supports expanding
    educational assistance to cover these programs.
        S. 3055 would make permanent a successful VHA dental
    insurance pilot program. VA welcomes the opportunity to
    continue offering dental insurance to interested veterans and
    hopes to see the program grow.
        S. 3076, the Charles Duncan Buried with Honor Act, which
    you just heard about, would allow VA to provide caskets and
    urns to indigent veterans with no next of kin who are laid to
    rest in State and tribal cemeteries. VA strongly supports this
    cost neutral expansion of benefits, but suggests clarifying
    that it would apply to veterans' cemeteries of a State or
    Indian tribe.
        S. 603 would expand travel benefits for rural veterans. VA
    strongly supports Sections 2 and 4, but would like to work with
    the Committee regarding Section 3.
        We would also like to work with the Committee to make some
    clarifying edits to S. 2210, the Veteran Partners' Efforts to
    Enhance Reintegration or Veteran PEER Act, and would like to
    discuss with the Committee S. 2279, the Veterans Health Care
    Staffing Improvement Act.
        VA strongly supports S. 2958, which would enable the
    Secretary to establish a pilot program to accept donations of
    real property that address needs identified through VA's long-
    range capital planning process. VA welcomes strategic
    partnerships such as the partnership proposed in this
    legislation. We look forward to working with the Committee and
    the bill's sponsors to address VA's technical concerns
    regarding the bill.
        VA has more difficulty supporting some of the other bills
    under consideration today. We fully support delivering benefits
    to veterans and survivors as quickly as possible, but we cannot
    support S. 3023, the Arla Harrell Act, which would create a
    presumption of full-body mustard gas exposure and resulting
    service connection for every World War II veteran who files a
    claim for related disability benefits. Nonetheless, these
    claims remain a high priority for VA and we will continue to
    fully and sympathetically develop and adjudicate every mustard
    gas claim that we receive.
        Delivering benefits to veterans exposed to radiation is
    also a high priority for VA, but we cannot support S. 2791, the
    Atomic Veterans Health Care Parity Act. Historical records and
    scientific evidence available to VA indicate that radiation
    exposure among servicemembers participating in the clean-up of
    the atoll were well below safe thresholds and unlikely to lead
    to any radiogenic disease. While VA is extremely grateful for
    every veteran's service and sacrifice, we believe that the
    paternalistic claim principles codified in current law and VA's
    mustard gas and radiation claim regulations already provide for
    fair and accurate resolution of these complicated claims.
        Finally, like several of our Veterans Service Organization
    partners, we cannot support S. 3081, Working to Integrate
    Networks Guaranteeing Member Access Now or the WINGMAN Act,
    which would give Congressional staff unprecedented access to
    veterans' personal records, even in the absence of those
    veterans' consent. We have outlined additional concerns with
    the WINGMAN Act and other bills in my written testimony.
        Mr. Chairman, this concludes my statement. We are happy to
    entertain any questions that you or other Members of the
    Committee may have. Thank you.
        [The prepared statement of Mr. McLenachen follows:]
      Prepared Statement of David McLenachen, Deputy Under Secretary for
    Disability Assistance, Veterans Benefits Administration, Department of
                                Veterans Affairs
        Good morning, Chairman Isakson, Ranking Member Blumenthal, and
    Members of the Committee. Thank you for inviting us here today to
    present our views on several bills that would affect the Department of
    Veterans Affairs' (VA) programs and services. Joining me today is Dr.
    Maureen McCarthy, Assistant Deputy Under Secretary for Health for
    Patient Care Services, Veterans Health Administration (VHA). While VA
    makes every effort to provide views on all bills that are on the
    hearing agenda, due to the time of receipt of the draft bill to
    authorize payment by VA for the costs associated with service by
    medical residents and interns at facilities operated by Indian tribes
    and tribal organizations, we are unable to provide views at this time.
    We look forward to sharing our views on the draft bill in a follow-up
    letter.
    s. 2316--to expand the requirements for reissuance of veterans benefits
    in cases of misuse of benefits by certain fiduciaries to include misuse
    by all fiduciaries, to improve oversight of fiduciaries, and for other
                                   purposes.
        This bill would amend Chapters 55 and 61 of Title 38, United States
    Code (U.S.C.), to expand the requirements for reissuance of Veterans'
    benefits in cases of misuse of benefits by certain fiduciaries to
    include misuse by all fiduciaries and improve access to financial
    records for purposes of oversight of fiduciaries.
        Section 1 of S. 2316 would amend 38 U.S.C. Sec. 6107, to authorize
    the VA to reissue benefits to a beneficiary in all cases of fiduciary
    misuse. This bill would extend VA's reissuance authority to include
    misuse by individual fiduciaries who manage benefits for fewer than 10
    beneficiaries, without regard to VA negligence in appointing or
    overseeing such fiduciaries. The bill would prescribe that VA will pay
    the beneficiary or the beneficiary's successor fiduciary an amount
    equal to the misused benefits in any case in which a fiduciary misuses
    a beneficiary's VA benefits.
        Section 2 of S. 2316 would add a new subsection to 38 U.S.C.
    Sec. 5502, which contains VA's authority to oversee and monitor the
    activities of fiduciaries. This new subsection would increase VA access
    to fiduciary-held financial accounts by requiring every fiduciary to
    authorize VA to obtain any record held by any financial institution
    regarding the fiduciary or the beneficiary whenever VA determines that
    such record is necessary:

         for the administration of a VA program; or
         to safeguard the beneficiary's benefits against neglect,
    misappropriation, embezzlement, or fraud.

        VA supports this bill. It would ensure equal treatment of all
    fiduciary misuse victims regardless of the nature and scope of the
    fiduciary's business or the fiduciary's relationship with the
    beneficiary. This bill would allow VA to promptly reissue benefits that
    have been misused, thereby avoiding any financial hardship to
    beneficiaries caused by the misuse or delays in obtaining restitution
    or VA determining negligence. It would also provide an additional
    measure of oversight and improve the accountability of fiduciaries
    serving our most vulnerable beneficiaries by facilitating VA's
    inspection of financial records when necessary. Any fiduciary who is
    found to have misused VA benefits is barred from future service.
        During calendar year (CY) 2015, VA reissued $2,507,657 to 76
    beneficiaries whose fiduciaries misused benefits as a result of VA's
    negligence, an average of $32,995 per beneficiary. Pension and
    Fiduciary Service estimates that, on average, an additional $2 million
    in VA benefits are misused annually by individual fiduciaries where the
    fiduciary managed the benefits of fewer than 10 beneficiaries, and VA
    was not negligent in its appointment or oversight. Based on the average
    reissuance amount of $32,995, $2 million in benefits would represent
    approximately 61 beneficiaries per year. Under this proposal, VA would
    make these Veterans or survivors whole by reissuing benefits without
    regard to the number of beneficiaries an individual fiduciary managed
    or VA's negligence in its appointment or oversight.
        There would be no additional full-time employee (FTE) costs or
    general operating expenses (GOE) associated with enactment of this
    proposed legislation.
      s. 2958--to establish a pilot program on partnership agreements to
        construct new facilities for the department of veterans affairs
        S. 2958 would authorize the VA Secretary to enter into up to five
    partnership agreements with a State or local authority; a 501(c)(3)
    corporation; a limited liability corporation; a private entity; a donor
    or donor group; or another non-Federal entity in order to secure
    donations of health care facilities and/or national cemetery assets.
        VA strongly supports this legislation, but seeks a critical change
    needed to preserve civil rights protections. It would enable VA to
    enter into agreements that could potentially assist in providing high
    priority assets that have been identified as a need through our long-
    range capital planning process and are considered to be important in
    order to serve Veterans in safe, modern, and secure facilities. VA
    believes that the proposed partnerships will enable the Department to
    use alternative financing mechanisms, beyond VA's traditional
    appropriations, to deliver needed facilities for our Veteran
    population.
        We strongly support the bill's authorization of these partnership
    agreements provided that the legislation preserves civil rights
    protections for Veterans and other employees who will be working to
    construct the facilities resulting from these partnership agreements.
    We look forward to working with the Committee to revise the language in
    section 1(b), which as currently drafted could be interpreted as
    excluding equal opportunity and employment protections.
        VA estimates that S. 2958 would be cost-neutral because it provides
    for the donation of assets at no additional cost to the Federal
    Government beyond funds that have been previously appropriated for a
    project at the time of the agreement. The bill would not create an
    obligation by VA to fund the construction of the facilities
    contemplated by the bill. There would also be no obligation for VA to
    use future appropriations to fund capital costs related to the
    partnerships authorized by this section. VA would be pleased to work
    with the Committee to address technical edits to the bill as drafted.
     s. 3021--to authorize the use of post-9/11 educational assistance to
     pursue independent study programs at certain educational institutions
                  that are not institutions of higher learning
        The proposed legislation would amend paragraph (4) of section
    3680A(a) to authorize the use of Post-9/11 educational assistance to
    pursue independent study programs at certain educational institutions
    that are not institutions of higher learning. Currently, under section
    3680A(a)(4), the Secretary is explicitly prohibited from approving
    enrollment in ``any independent study programs except an accredited
    independent study program (including open circuit television) leading
    (A) to a standard college degree, or (B) to a certificate that reflects
    educational attainment offered by an institution of higher learning.''
    As such, VA is not authorized to pay educational assistance for
    independent study courses at an institution not considered an
    institution of higher learning (IHL), or for any non-accredited
    independent study courses.
        VA supports the proposed legislation that would expand VA's
    approval authority to pay Post-9/11 GI Bill benefits for enrollment in
    accredited independent study certificate programs at educational
    institutions that are not IHLs. More specifically, VA supports non-IHL
    independent study programs that are accredited by an accreditor
    recognized by the Secretary of Education (which would help ensure the
    integrity of the accreditor) and, if career and technical, that lead to
    industry-recognized credentials and certificates for employment. VA
    understands and appreciates the importance of career and technical
    education courses and the growth in the utilization of online and other
    21st Century training modalities in the delivery of instruction for
    both degree and non-degree programs. As such, expanding the approval
    authority for certain independent study programs would be in the best
    interests of VA education beneficiaries.
        We note that because this bill would amend 38 U.S.C. Chapter 36,
    the expansion of benefits would not be limited to Post-9/11 GI Bill
    benefits. Benefit costs are estimated to be $49.2 million in the first
    year, $266 million over five years, and $599.4 million over ten years.
    There would be no additional FTE or GOE associated with enactment of
    this proposed legislation.
     s. 3032--veterans' compensation cost-of-living adjustment act of 2016
        S. 3032, the ``Veterans' Compensation Cost-of-Living Adjustment Act
    of 2016,'' would require the Secretary of Veterans Affairs to increase,
    effective December 1, 2016, the rates of disability compensation for
    service-disabled Veterans and the rates of dependency and indemnity
    compensation (DIC) for survivors of Veterans. This bill would increase
    these rates by the same percentage as the percentage by which Social
    Security benefits are increased effective December 1, 2016. Consistent
    with VA's processing of these benefit payments under current law, the
    bill would prescribe an increase in each benefit dollar amount without
    rounding down to the next whole dollar amount. The bill would also
    require VA to publish the resulting increased rates in the Federal
    Register.
        VA supports this Cost-of-Living Adjustment (COLA) bill because it
    would express, in a tangible way, this Nation's gratitude for the
    sacrifices made by our service-disabled Veterans and their surviving
    spouses and children and would ensure that the value of their well-
    deserved benefits will keep pace with increases in consumer prices.
    Although not included in S. 3032, VA would also support inclusion of
    the round-down provision in effect before December 1, 2013, which
    provided that ``each dollar amount, if not a whole dollar amount, be
    rounded down to the next lower dollar amount.'' This round-down
    methodology would provide the desired benefit increases, and ensure
    VA's fiscal responsibility. The 2017 President's Budget includes a
    legislative proposal to reinstate the round-down provision for five
    years, which would result in benefit savings of $21.5 million in 2017,
    $63.5 million in 2018, and $599.3 million over five years. Although the
    proposal would reinstate the round-down for five years, the cumulative
    effect of rounding-down COLAs for five years would total $2.0 billion
    in savings over ten years
        Benefits costs that would result from the COLA increase are
    estimated to be $490.8 million during the first year, $3.0 billion for
    five years, and $6.6 billion over ten years. The 2017 President's
    budget assumes annual COLA increases for disability compensation and
    DIC in its baseline estimate. There would be no increases to costs
    above the current baseline budget associated with the COLA.
        The current COLA estimate from the 2017 President's Budget,
    effective December 1, 2016, is 0.8 percent. The impact of the COLA was
    calculated by applying the 0.8 percent increase in payments to the
    projected caseloads in the fiscal year (FY) 2016 President's budget.
    The total cost was then compared to the estimated cost without COLA
    increases to calculate the impact of the COLA.
        There would be no FTE or GOE costs associated with enactment of
    this proposed legislation.
           s. 3055--department of veterans affairs dental insurance
                          reauthorization act of 2016
        S. 3055 would make the VA Dental Insurance Program (VADIP)
    permanent, which was initially implemented as a pilot program on
    November 15, 2013, through Section 510 of the Caregivers and Veterans
    Omnibus Health Services Act of 2010 (Public Law 111-163). The VADIP
    program offers enrolled Veterans and beneficiaries of VA's Civilian
    Health and Medical Program (CHAMPVA) the opportunity to purchase dental
    insurance at a reduced cost. Each participant pays a fixed monthly
    premium for coverage, in addition to any copayments required by his or
    her plan. Through the pilot, over 75,000 Veterans and CHAMPVA
    beneficiaries purchased plans as of December 31, 2014. In the 4th
    quarter of CY 2014, VA conducted a survey of Veterans who have
    purchased and utilized the insurance plans, and over 92 percent said
    they would renew and recommend the program to other Veterans,
    indicating strong overall satisfaction with the program. Providing
    Veterans, their families, and beneficiaries an opportunity to purchase
    dental insurance that contains coverage and quality defined by the VA
    Office of Dentistry at discounted rates is one step in improving the
    overall health of the Veteran population.
        VA supports S. 3055.
             s. 3076--charles duncan buried with honor act of 2016
        This bill would amend 38 U.S.C. Sec. 2306(f) which currently
    authorizes the VA Secretary to furnish a casket or urn, of such quality
    as the Secretary considers appropriate for a dignified burial, for
    burial in a national cemetery of a deceased Veteran in any case in
    which the Secretary is unable to identify the Veterans' next-of-kin, if
    any; and determines that sufficient resources for the furnishing of a
    casket or urn for the burial of the Veteran in a national cemetery are
    not otherwise available. By regulation, VA administers this benefit
    through a reimbursement program.
        S. 3076 would change the current authority by expanding the
    availability of the benefit to Veterans buried in a State or tribal
    organization cemetery. VA fully supports the bill. We suggest one minor
    amendment to the language in subsection (1); to add ``veterans'' before
    ``cemetery of a State or Indian tribe.''
        The authority to furnish caskets and urns was included in Public
    Law 112-260, the Dignified Burial and Other Veterans' Benefits
    Improvement Act of 2012. This vehicle was used to highlight the issue
    of Veterans without next-of-kin and without sufficient resources for
    burial, and the need for expanded benefits for this disadvantaged
    group. In addition to the new authority to furnish a casket or urn for
    Veterans without next-of-kin and without sufficient resources for
    burial who are buried in VA national cemeteries, the public law
    expanded the plot allowance and transportation allowance and directed
    specific procedural requirements for national cemetery officials to
    confirm remains were unclaimed and the final disposition of those
    remains.
        After publishing its final regulation on the casket and urn
    reimbursement program, on May 13, 2015, VA began accepting requests for
    reimbursement for caskets or urns purchased for the interment of
    deceased Veterans who died on or after January 10, 2014, without next
    of kin and sufficient resources for burial. Currently, any individual
    or entity may request reimbursement if they purchase a casket or urn to
    inter in a VA national cemetery an eligible Veteran who died on or
    after January 10, 2014, without next of kin and without sufficient
    resources to purchase a burial receptacle. VA will reimburse the actual
    cost of such a casket or urn, not to exceed an annually established
    rate based on the average cost of caskets and urns in any given CY. For
    claims received in CY 2016, the maximum reimbursement rates are
    $2,421.00 for caskets and $244 for urns. The maximum reimbursement
    amounts are adjusted for inflation on an annual basis.
        Regarding the amendment's change to provide the benefit for
    Veterans interred in a State or tribal organization Veterans cemetery,
    VA submitted a legislative proposal concept to make such a change in
    its FY 2017 budget submission, indicating the Department's willingness
    to implement this expansion to its current authorities. Through a
    grants program to establish, expand, and improve State and tribal
    organization Veteran cemeteries, NCA maintains a valuable partnership
    with States and tribal organizations to provide a final resting place
    to those who may not have access to a VA national cemetery burial
    option. Extending the casket and urn reimbursement benefit for the
    burial of Veterans without next-of-kin and without sufficient resources
    for burial who are in State or tribal Veterans cemeteries would support
    VA's efforts to ensure the unclaimed remains of Veterans receive a
    dignified burial. VA grant-funded State and tribal Veterans cemeteries
    conducted nearly 36,000 burials of Veterans and their families in FY
    2015. These cemeteries provide the same services and benefits to
    Veterans and their eligible family members and are required to comply
    with the same national shrine appearance standards as national
    cemeteries.
        There would be no benefit costs or savings associated with
    enactment of the provision to expand the benefit to State and tribal
    organization cemeteries.
                           s. 2210--veteran peer act
        S. 2210 would require the Secretary to phase in and conduct a
    program whereby peer specialists would be included in patient aligned
    care teams at VA medical centers (VAMC), to promote the use and
    integration of mental health services in a primary care setting. Not
    later than 180 days after the date of enactment, this program would
    have to be established at not fewer than ten VAMCs. By not later than
    two years (from this same date), it would have to be in place at not
    fewer than 25 VAMCs. Under the bill, the Secretary would be directed to
    consider specified factors when selecting sites for this program, but,
    not fewer than five would have to be established at VA designated
    Polytrauma Centers, and not fewer than ten would need to be established
    at VAMCs not so designated. S. 2210 would also require that all peer
    specialist programs established under this mandate: (1) ensure that the
    needs of female veterans are considered and addressed; and (2) include
    female peer specialists. Finally, this measure would establish initial,
    periodic, and final Congressional reporting requirements, as detailed
    in the bill.
        VA supports S. 2210 subject to the availability of additional
    funding, noting a few technical changes are needed for clarity. This
    legislation, if enacted, would complement VA's ongoing pilot program
    (commenced in 2014) whereby peer support through peer specialists has
    been extended beyond traditional mental health sites of care to include
    Veterans receiving mental health care in primary care settings. Under
    the pilot program, trained peer specialists work with VA primary care
    teams to, in general terms, help improve the health and well-being of
    other Veterans being treated in VA primary care settings. To date,
    seven medical centers have volunteered for the pilot, composing the
    first cohort of sites to deploy peers to primary care. Two more cohorts
    are being recruited for implementation in July 2016, and January 2017.
    Peers provide services for ten hours per week, and that time may be
    divided among two peers. As with VA's long established mental health
    peer support model, the pilot program recognizes the therapeutic value
    of having peer specialists share their own past recovery experiences
    with Veterans receiving mental health care in the primary care setting,
    particularly those who are experiencing challenges similar to what the
    peer specialist experienced.
        As mentioned, female peer specialists would have to be included in
    the program mandated by S. 2210. This is not necessary, however, as
    women peer specialists are already well represented, with 18 percent of
    the national peer specialist workforce being women. While at first
    glance 18 percent may seem a low rate, please bear in mind that this
    figure is higher than the percentage of Veterans seeking services
    through VA who are women. We do recognize, however, that the current
    number of women Veteran peer specialists in the pilot is unevenly
    distributed across the country, with some medical centers having
    greater difficulty than others in attracting qualified applicants.
        Also, it is unclear if the peers will address substance use
    disorders under the umbrella of their mental health duties. Given the
    comorbidity of these issues, the need for integration of substance use
    disorder identification and care, the need for overdose prevention and
    linkage as needed to Medication Assisted Treatment for opioid use
    disorder, and the need to increase the numbers of veterans achieving
    long term recovery, we recommend that this be clarified and if possible
    included.
             s. 603--rural veterans travel enhancement act of 2015
        S. 603, the Rural Veterans Travel Enhancement Act of 2015, would
    make amendments to VA's legal authorities governing transportation
    benefits.
        Section 2 would make permanent VA's authority under 38 U.S.C.
    Sec. 111A(a) to transport any person to or from a VA facility or other
    place in connection with vocational rehabilitation, counseling required
    pursuant to Chapter 34 or 35 of Title 38 U.S.C., or for the purpose of
    examination, treatment, or care.
        Section 3 would amend 38 U.S.C. Sec. 111 to authorize beneficiary
    travel benefits for travel to and from Vet Centers for readjustment
    counseling and related mental health services under 38 U.S.C.
    Sec. 1712A. As a technical matter, we note that counseling under 38
    U.S.C. Sec. 1712A is also available to certain Servicemembers and
    family members.
        Finally, Section 4 would extend the authorization of appropriations
    for the Grants for Transportation of Veterans in Highly Rural Areas
    program through 2020.
        VA supports Sections 2 and 4 of S. 603, assuming resources are
    provided to continue the operation of these programs. These provisions
    of the legislation would provide extended transportation authority for
    Veterans, particularly rural Veterans.
        VA does not support Section 3 of the bill. The historic nature of
    the Readjustment Counseling Service and the concept of ready access
    with minimal administrative and bureaucratic processing, together with
    the separate location of Vet Centers and the lack of infrastructure to
    support consideration payment of BT, are all factors VA considered in
    choosing not to support this bill.
        VA is, however, currently conducting a pilot program, as required
    in Section 104 of Public Law 112-154, to assess the feasibility and
    advisability of paying beneficiary travel under 38 U.S.C. Sec. 111 for
    travel from a residence located in an area that is designated by the
    Secretary as highly rural to the nearest Vet Center and from such Vet
    Center to such residence. Based on experience with this pilot, VA does
    not agree that Veterans traveling to Vet Centers should be reimbursed
    using the Beneficiary Travel (BT) Program.
        The pilot has demonstrated that a significant amount of
    coordination is necessary between the Vet Centers and corresponding VA
    medical centers. Because Vet Center visits are not entered into the
    Veteran's electronic medical record, increased paper documentation and
    communication with the VA medical center is required. Risk of improper
    payments would increase with the complexity of this process, as
    traditional methods of paying BT could not be used.
        Feedback from Veterans indicates that they find Vet Centers are
    more therapeutic and less bureaucratic than VA medical centers, and
    Veterans are afforded anonymity and the ability to speak freely without
    fear of repercussion. Participants cautioned that privacy was an issue,
    especially for police officers, fire fighters, and National Guardsmen,
    and expressed concerns that the information included in their file may
    negatively affect their employment. Some participants said they would
    be comfortable having VA medical center administrative staff see that a
    Veteran was a Vet Center client, but all participants agreed that they
    do not want the staff to have access to visit details, such as notes or
    specific diagnoses. This information is required in order to process
    most BT claims.
        Over time, as travel benefits have improved, VA health care
    facilities have noted a significant increase in the number of Veterans
    claiming travel, as well as visits by those Veterans. We anticipate
    that, if enacted, Vet Centers would see similar changes that could
    affect provision of services at those facilities or require additional
    staffing resources to handle the increase of visits. These Vet Center
    staff would have increased administrative burdens, including
    documentation of visits and determinations of whether treatment related
    to service-connected condition(s), which are not currently required.
        VA estimates the cost of this bill would be over $11 million in FY
    2017, nearly $12 million in FY 2018, $61 million over five years, and
    $136 million over ten years.
             s. 2279--veterans health care staffing improvement act
        Section 2 of S. 2279 would require the VA Secretary, in
    coordination with the Secretary of Defense, to carry out a program to
    increase efficiency in the recruitment and hiring by VA of health care
    workers that are undergoing separation from the Armed Forces. Under
    Section 2, the Department of Defense (DOD) would have to provide VA a
    list of members of the Armed Forces, including the reserve components,
    who served in a health care capacity in the Armed Forces, are
    undergoing or have undergone separation from the Armed Forces, and will
    be discharged or have been discharged under honorable conditions.
        Section 2 will support VA's ability to recruit qualified and
    trained health care professionals from the Armed Forces.
        VA anticipates that the costs for implementing Section 2 for FY
    2017 would likely amount to $4.9 million, and for a five-year period,
    from FY 2017 to FY 2021, the costs for implementing Section 2 would
    likely amount to $27.3 million.
        Section 3 of S. 2279 would require VA to create uniform
    credentialing standards for positions specified in 38 U.S.C.
    Sec. 7421(b). VA does not support this section as it already has
    uniform credentialing standards for its health care providers. VA
    prescribes these standards and the process for obtaining and retaining
    them through VA and VHA policy, including VHA Handbook 1100.19,
    Credentialing and Privileging, and VHA Directive 2012.030,
    Credentialing of Health Care Professionals. All credentialing occurs in
    VHA's electronic credentialing software platform, VetPro, and
    credentialing files can be easily shared and transferred throughout VA.
    At this time, VA does not have a cost estimate for this section.
        Section 4 of S. 2279 would require VA to provide full practice
    authority to advanced practice registered nurses (APRN), physician
    assistants (PA), and other licensed health care professionals. The
    Rulemaking for APRNs is currently open for public comment until
    July 25, 2016, and we have received many public comments on this
    regulation. VA will consider and respond to the issues raised by these
    comments in the final rulemaking
        At this time, VA does not have a cost estimate for this section.
         s. 244--independent comprehensive review of va assessment of
                            traumatic brain injuries
        S. 244 would require VA, within a reasonable period of time, to
    enter into an agreement with the Institute of Medicine (IOM) or another
    organization, if VA is unable to enter into an agreement with IOM, to
    conduct a comprehensive review of examinations provided by VA to
    individuals who submit claims to the Secretary for compensation under
    Chapter 11 of Title 38, U.S.C., for Traumatic Brain Injury (TBI). The
    comprehensive review would be required to include a determination of
    the adequacy of the tools and protocols used by VA to provide
    examinations for compensation claims for TBI and a determination of the
    credentials necessary for health care providers and specialists to
    perform such portions of such examinations that relate to assessment of
    cognitive functions. The IOM would be required to convene a group of
    experts in clinical neuropsychology and other related disciplines. VA
    would be required to submit a report to Congress within 540 days of
    entering into an agreement with IOM detailing the findings of the IOM
    with respect to the comprehensive review it would conduct and
    recommendations of the IOM for legislative or administrative action
    that could improve the adjudication of these claims.
        While VA appreciates the objective of this bill, we do not believe
    it is necessary. We are committed to ensuring that all Veterans receive
    comprehensive, quality compensation and pension (C&P) examinations by
    qualified professional health care providers in a timely manner. Mental
    health professionals must make a clinical determination when conducting
    a C&P examination as to whether any psychometric testing is to be done;
    if the examiner determines that testing should be utilized, it is up to
    the examiner to determine what test to administer, based on the
    specifics of the Veteran's case. VA subject matter experts have
    thoroughly reviewed the policies regarding TBI examinations and, based
    on best clinical practices and protocols, do not believe that TBI C&P
    examinations are insufficient. VA's existing regulations reflect the
    special nature of complicated TBI claims and the unique criteria and
    process used to evaluate TBI. Under these rules, VA employs a holistic
    approach using cognitive, emotional/behavioral, and physical criteria
    to evaluate TBI. Notably, S. 244 would direct the IOM to analyze VA's
    criteria for evaluating cognitive function, with no mention of
    emotional, behavioral, and physical symptoms. VA would characterize
    such a limited analysis as a step backwards. In an effort to provide
    continuous process improvement to evaluating disability under the VA
    Schedule for Rating Disability, VA employs legal, medical, and
    administrative experts who routinely review the sufficiency of
    examination and rating criteria and recommend changes necessary to
    maintain accuracy, fairness, and efficiency in the claims resolution
    process. Establishing an external reviewing body would essentially
    duplicate VA's existing process.
        VA currently has authority to work with IOM or others, and if we
    determine that such input is necessary, we will not hesitate to do so.
                 s. 2791--atomic veterans healthcare parity act
        This bill would amend Title 38, U.S.C. to provide for the treatment
    of Veterans who participated in the cleanup of Enewetak Atoll, as
    radiation exposed Veterans for purposes of the presumption of service-
    connection of certain disabilities by the Secretary of Veterans
    Affairs.
        DOD conducted atomic bomb testing on Enewetak Atoll in the Pacific
    Marshall Islands during the 1950s. Senate bill 2791 would provide that
    Veterans who participated in the cleanup effort on Enewetak Atoll from
    January 1, 1977, through December 31, 1980, engaged in a ``radiation-
    risk activity'' and will be classified as radiation-exposed Veterans
    for purposes of establishing a presumption of service connection for
    certain enumerated radiation-related diseases.
        When considering the creation of benefits presumptions, VA relies
    on science-based models that can be used to establish association
    between an in-service event and a post-service disability. VA has
    thoroughly reviewed the best available analysis of Enewetak cleanup
    exposure data, the 1981 Defense Nuclear Agency (DNA) Report, The
    Radiological Cleanup of Enewetak Atoll, and other available evidence.
    That evidence establishes that radiation doses among servicemembers
    participating in the cleanup were well below recommended thresholds for
    both acute and latent health effects, such as cancers. Since the best
    available evidence found radiation exposure among those individuals
    involved with the cleanup well below acceptable thresholds, there is no
    factual basis that would warrant a determination that this group of
    Veterans engaged in a radiation-risk activity sufficient to justify a
    presumption of service connection.
        VA continues to evaluate any individual Veteran involved with the
    Enewetak Atoll cleanup on a direct facts-found basis under the ionizing
    radiation dose-evaluation regulations at 38 Coode of Federal
    Regulations (CFR) Sec. 3.311. While the VA appreciates the Committee's
    attention and efforts to address this very important matter, the VA is
    unable to support S. 2791 as the proposed policy is inconsistent with
    known Enewetak Atoll exposure data and associated scientific analysis.
        The costs that would be associated with enactment of this bill are
    to be determined.
                         s. 3023--the arla harrell act
        S. 3023 would (1) provide for reconsideration of claims for
    disability compensation from Veterans who allege mustard gas or
    lewisite exposure during World War II (WWII) that were previously
    denied by VA; (2) create a presumption of full-body exposure to mustard
    gas or lewisite if VA or the Secretary of Defense makes a determination
    regarding such exposure; (3) preclude use of information in the DOD and
    VA Chemical Biological Data base or any list of known testing sites as
    the sole reason for finding that such veteran did not have full-body
    exposure; (4) require development by DOD and VA of a policy for
    processing future claims; (5) require a report by DOD regarding
    mustard-gas or lewisite experiments conducted by DOD during WWII,
    including each testing location, dates of experiments and number of
    members of the Armed Forces who were exposed; and (6) require VA to
    investigate and assess actions taken to notify exposed Veterans and
    investigate and assess the mustard-gas and lewisite claims from WWII
    Veterans that are filed and the percentage of these claims that are
    denied by VA.
        Section 2(a)(3) of the bill would provide that, in reconsidering
    claims for VA disability compensation based on exposure to mustard gas
    or lewisite, if VA or DOD ``makes a determination regarding whether'' a
    Veteran experienced full-body exposure to those substances, VA or DOD
    ``shall presume'' that the Veteran experienced such exposure. Section
    2(a)(3)(B), would prohibit VA from denying a claim based ``solely'' on
    the presence or absence of information in the DOD and VA Chemical
    Biological Warfare Data base, which was compiled based upon information
    available to DOD, or other lists maintained by the Departments.
        The VA appreciates the Committee's attention to this very important
    issue. Providing Veterans with the care they need when they need it
    remains VA's top priority. We owe it to Veterans to ensure our
    decisions are fair, clear, and consistent across the board. Due to a
    number of concerns, we are unable to support S. 3023. The direction
    that VA ignore certain evidence, which may already be in the Veteran's
    claims file, would not only be unfair to other Veterans, but would
    conflict with other applicable provisions of law. Under 38 U.S.C.
    Sec. 1154(a), in determining whether a condition is related to service,
    VA must give ``due consideration'' to the ``places, types, and
    circumstances of'' a Veteran's service ``as shown by such [V]eteran's
    service record, [and] the official history of each organization in
    which such [V]eteran served.'' In addition, 38 U.S.C. Sec. 5107(b)
    requires VA to ``consider all information and law and medical evidence
    of record in a case before the Secretary with respect to benefits under
    laws administered by the Secretary.'' Finally, under 38 U.S.C.
    Sec. 1154(b), in the case of a Veteran who engaged in combat with the
    enemy, VA must accept lay or other evidence of service regarding
    service incurrence of a disease or injury, notwithstanding the absence
    of an official record of such incurrence. However, the Veteran must
    first establish that he or she engaged in combat with the enemy, which
    usually involves consideration of service department records, and the
    lay or other evidence must be ``consistent with the circumstances,
    conditions, or hardships of such service.''
        The proposed presumption of exposure to mustard gas and lewisite,
    which would not be supported by service department records or other
    objective evidence, would be unprecedented if enacted. It appears that
    the presumption would be invoked solely on the basis of a Veteran's
    statement that such exposure occurred and generally would be
    irrebuttable. Existing presumptions of an in-service exposure or event
    apply to discrete groups of Veterans whose service records reflect
    unique circumstances of service. Examples include Vietnam and Korean
    Veterans who are presumed exposed to Agent Orange during certain time
    periods, Veterans whose records indicate participation in WWII and cold
    war nuclear weapon detonations who are presumed exposed to ionizing
    radiation, and combat Veterans of all eras who are presumed exposed to
    the sort of traumatic stressor that can cause Post Traumatic Stress
    Disorder. Each of these sets of Veterans will have service department
    evidence of an in-service event or circumstance that may have triggered
    post-service disability.
        Under the standard proposed in the bill, any WWII Veteran who has
    claimed participation in a mustard gas or lewisite test would be
    entitled to a presumption of full body exposure. This includes Veterans
    who may be confusing exposure to mustard gas or lewisite, with more
    routine agents such as tear gas, or even to placebo agents. All WWII
    claimants would essentially be presumed exposed to mustard gas--even
    Veterans who participated in no chemical testing.
        Section 2(b) of the bill proposes a joint VA/DOD policy for
    processing future disability compensation claims based on exposure to
    mustard gas or lewisite. VA notes that mustard gas and lewisite claim
    policies and procedures are already in place and have and continue to
    lead to fair and equitable outcomes. VA promulgated a regulation in
    1994 to address full-body mustard gas and lewisite claims (see 38 CFR.
    Sec. 3.316) and recently updated procedural guidance directing VA
    claims processors to consider all relevant evidence, including both
    service department data and information from outside sources.
        We share the Committees concern for these Veterans and we will
    continue to do everything we can, within the scope of the law, to
    provide care for those who have been identified by DOD as having had
    full body exposure to Mustard Gas and have been diagnosed with
    conditions due to that exposure. Changing the rules for one set of
    individuals is simply unfair for the thousands of other Veterans
    seeking care at VA. We value our Veterans lives equally and want to
    ensure that each and every Veteran seeking care is treated fairly under
    the law.
        Costs that would be associated with enactment of this proposed
    legislation are to be determined.
     s. 3081--working to integrate networks guaranteeing member access now
                               act (wingman act)
        Section 2 of this bill would amend Chapter 59 of Title 38, U.S.C.
    by adding new Section 5906 to direct the Secretary to, within 180 days,
    provide ``accredited,'' permanent congressional staffers designated by
    a Member of Congress with remote, read-only access to Veterans Benefits
    Administration's (VBA) electronic records of Veterans who reside in the
    area represented by the Member, regardless of whether the Veteran whose
    record is accessed has consented to the disclosure of information. The
    bill also clearly states that the provision of access to the
    congressional staffer is not for purposes of representing Veterans in
    the preparation, presentation, and prosecution of claims for Veterans'
    benefits.
        VA understands the interest of Members in Congress in having
    current casework information for their Veteran constituents. However,
    VA strongly opposes this bill because it would provide congressional
    employees with unprecedented access to the records of Veterans and
    other VA claimants, raising significant privacy concerns, and because
    it improperly conflates the concept of access to claims records with
    the distinct mission and function of VA's Accreditation Program in
    ensuring that Veterans have access to competent and qualified claims
    representation.
        Regarding the nature of the access provided, the bill would provide
    congressional staff who assist constituents of a Member of Congress
    with greater access to VA records than is provided to a VA employee or
    contractor. Under the Privacy Act, Federal employees generally may
    access private records only when necessary to perform their duties.
    This bill would impose no similar restriction on access by
    congressional staff. From a privacy and information security
    standpoint, granting congressional staff unrestricted access to the
    medical records of Veterans and other VA claimants is not in the best
    interest of Veterans and their families. VA patients and claimants
    entrust VA with their personal, medical, and other information, and
    they do not generally expect that such information could be viewed by
    Congress without their explicit consent. To the extent that
    congressional staffers require access to an electronic claims record
    for which the Member possesses an appropriate release from the
    individual, access may be provided in the form of a disc or under
    supervision at a VA facility because those types of access are within
    the current capabilities of VA systems.
        Regarding how the bill conflates the concepts of access to claims
    records and representation of claimants, accreditation by VA as
    attorneys, claims agents, and Veterans Service Organization (VSO)
    representatives is not done for purposes of providing access to VBA's
    electronic records system. Rather, as stated at 38 CFR Sec. 14.626,
    ``the purpose of [VA's accreditation and oversight] of representatives,
    agents, attorneys, and other individuals is to ensure that claimants
    for [VA] benefits have responsible, qualified representation in the
    preparation, presentation, and prosecution of claims for veterans'
    benefits.'' In contrast, as specifically stated in draft Sec. 5906(d),
    this bill is unrelated to that purpose. The laws governing
    accreditation do not address the issue of access to claimants' records,
    which are governed separately by other laws. Instead, the provisions in
    Chapter 59 address the authority for regulation and oversight of
    representation before VA, including the ethical standards of
    professional conduct for representatives, and whether fees charged in a
    particular case may be considered reasonable. VA's Accreditation
    Program serves the important function of ensuring that Veterans have
    information on and access to qualified and competent representatives
    who can assist with their claims for benefits and who are subject to
    appropriate VA regulation and oversight in that role. Making
    congressional employees' access to claimant records a function of VA's
    accreditation program would unnecessarily complicate the operation of
    that program. Referring to congressional staff as ``accredited'' can
    only create confusion about whether staffers are accredited by VA for
    purposes of claims representation and what their role is in the claims
    process.
        Access to claims records is authorized under Chapter 57 of Title
    38, U.S.C., as well as other privacy and information laws.
    Specifically, 38 U.S.C. Sec. 5701(b)(1) authorizes VA to disclose
    records to a ``duly authorized agent or representative of a claimant.''
    There are numerous provisions in Chapter 57 that provide for release of
    VA records and that have nothing to do with representation and or the
    status of being a VA-accredited representative. Because the bill
    pertains to congressional access to Veterans' records, placing this new
    authorization in Chapter 59 would be an additional source of confusion.
        Additionally, there are serious technological obstacles to
    implementing this bill. The bill would impose on VA a substantial
    burden to accommodate the contemplated access. Our system provides
    access to one representative per Veteran or claim and for only the
    records of a Veteran who has specifically authorized access. VA would
    need to re-design its system architecture to allow more than one
    representative per Veteran or claim. Absent such system changes, in
    order to provide the type of electronic access to congressional staff
    contemplated by the bill, VA would have to displace the electronic
    access of current representatives--VSO representatives, private
    attorneys, and claims agents--causing substantial administrative
    burdens on VA and hardships on those representing Veterans and the
    Veterans they represent, while also interfering with the relationship
    between Veterans and their representatives.
        Finally, Members of Congress and their employees already have
    access to claims status information through VA's regional offices and
    central office when specifically authorized by a Veteran constituent or
    when they have proper authority to conduct oversight. Each VA regional
    office has a Congressional Liaison, who may be contacted for claims
    information assistance, and VA's Office of Government Relations serves
    as a central point of contact for inquiries originating from Capitol
    Hill. If enacted, this bill would delay both the development of
    information technology components critical to VA's electronic claim
    process transformation, and the resolution of pending claims for
    benefits.
        Due to the short time-frame and the magnitude of the system changes
    needed, we are unable to provide an accurate cost-estimate at this
    time, although costs associated with changes to VA information systems
    would likely be substantial. VA is always ready to discuss with the
    Committee other ways VA can improve a Member of Congress' ability to
    effectively work with VA to resolve casework issues on behalf of their
    constituents.
    s. 3035--maximizing efficiency and improving access to providers at the
                   department of veterans affairs act of 2016
        Section 2 of S. 3035 would require VA, within 120 days of the date
    of the enactment of the bill, to carry out a pilot program to increase
    the use of medical scribes to maximize the efficiency of physicians at
    VA medical facilities. The pilot program would be carried out for a
    period of 18 months and would be located at not fewer than five VA
    medical facilities that VA has determined have a high volume of
    patients or that are located in rural areas at which the Secretary has
    determined there is a shortage of physicians and each physician has a
    high caseload. VA would be required to enter into contracts with one or
    more appropriate non-governmental entities, defined as an entity that
    trains and employs professional medical scribes who specialize in
    medical data collection and entry, to carry out the pilot program. VA
    would be required to collect various data on the pilot program to
    determine the effectiveness of the program. VA would be required within
    180 days after the commencement of the pilot program, and not less
    frequently than once every 180 days thereafter, to submit to Congress a
    report on the pilot program.
        VA does not support this bill. Currently, VHA has an Enterprise
    Wide Front End Speech Recognition contract that includes unlimited
    licenses for clinical end users for the Nuance Dragon Medical 360
    Network Edition (DMNE) Version 2.3, which is the current version. DMNE
    provides advanced, secure, speech recognition solutions that allow
    clinicians to document the complete patient story using voice while
    allowing healthcare organizations to deploy and administer medical
    speech recognition across the enterprise. VHA is in the process of
    administering a request for proposals that includes the use of scribes
    (contracted or hired) and transcription, as well as a health advocate.
    An evaluation plan of all methods of provider documentation support has
    been developed as well. The pilot should commence by end of this FY.
        VA estimates this bill would cost $464,427 in FY 2017, and $475,899
    in FY 2018.
        draft bill--readjustment counseling services for members of the
                      selected reserve of the armed forces
        The draft bill would authorize VA, in consultation with the
    Secretary of Defense, to provide VA readjustment counseling services to
    any member of the Selected Reserve of the Armed Forces who has a
    behavioral health condition or psychological trauma, to assist the
    individual in readjusting to civilian life. These services may include
    a comprehensive individual assessment of the member's psychological,
    social, and other characteristics to ascertain whether he or she has
    difficulties associated with readjusting to civilian life. Such a
    member would not be required to obtain a referral before receiving
    these services. If enacted, these amendments would become effective one
    year after the date of the Act's enactment.
        VA does not support this bill. The Readjustment Counseling Service
    (RCS) was created in 1979 to provide the specific and unique function
    of assisting individuals to life after combat related military service.
    This bill would authorize VA to expand RCS services related to
    assisting the individual in readjusting to civilian life to all members
    of the Selected Reserve of the Armed Forces who have behavioral health
    conditions or psychological trauma, regardless of connection to combat
    related service. VA currently has authority to provide readjustment
    counseling services to members of the Selected Reserve who meet other
    qualifying criteria; namely: (1) having served on active military duty
    in any combat theater or an area at a time during which hostilities
    occurred in that area; (2) having experienced military sexual trauma
    while serving on active military duty, active duty for training, or
    inactive duty training; (3) having provided direct emergency medical or
    mental health care or mortuary services to the casualties of combat
    operations or hostilities; (4) having engaged in combat with an enemy
    of the United States or against an opposing military force in a theater
    of combat operations or an area at a time during which hostilities
    occurred in that area by remotely controlling an unmanned aerial
    vehicle; or (5) having received readjustment counseling before
    January 2, 2013. We are concerned that this bill would expand the scope
    of RCS and would be inconsistent with the intended design of RCS.
    draft bill--to clarify the scope of procedural rights of members of the
     uniformed services with respect to their employment and reemployment
    rights, to improve the enforcement of such employment and reemployment
                        rights, and for other purposes.
        The draft legislation on employment rights for the uniformed
    services would amend Chapter 43 of Title 38 to clarify the scope of
    employment and reemployment rights of members of the uniformed services
    and to amend the enforcement of employment and reemployment rights of
    members of uniformed services with respect to a State or private
    employer. VA respectfully defers to the Department of Justice and the
    Department of Labor for views on this draft legislation.
    discussion draft--to authorize the american battle monuments commission
     to acquire, operate, and maintain the lafayette escadrill memorial in
                          marnes-la-coquette, france.
        The discussion draft would authorize the American Battle Monuments
    Commission to enter into an agreement to acquire, operate, and maintain
    the Lafayette Escadrille Memorial in Marne-la-Coquette, France. Because
    this bill concerns responsibilities under the purview of the American
    Battle Monuments Commission, VA defers to the views of that agency on
    the discussion draft.

        Mr. Chairman, this concludes my statement. Thank you for the
    opportunity to appear before you today. We would be pleased to respond
    to questions you or other Members may have.
                                     ______

          Additional Views of the U.S. Department of Veterans Affairs

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Chairman Isakson. Well, thank you very much for your
    testimony.
        I will start off with the questions. We will go with a
    round of 5 minutes for questions for each Member.
        Let us go back to the WINGMAN Act and your last statement.
    Would you walk us through how the information may be obtained
    by caseworkers now and how long it generally takes to get that
    information.
        Mr. McLenachen. Mr. Chairman, I do not have information on
    how long it takes. I can tell you that each of our regional
    offices has a Congressional liaison, that their specific job is
    to work with local Congressional caseworkers to provide that
    information as quickly as possible, and we are definitely
    willing to work with the Committee and other Members of
    Congress to speed that process up.
        What happens now is VA receives a release from the
    claimant, generally through the Congressional staff, that
    authorizes us to disclose information to the caseworker; we try
    to do that as quickly and as efficiently as we can, as well as
    to provide other information that the caseworker may need
    regarding what do these records mean.
        I will tell you that although we have concerns about, on
    behalf of veterans, privacy, we are working hard right now to
    do something that may help in this area, and that is exposing
    the e-folder in our Veterans Benefits Management System, or
    VBMS, to veterans and also to third parties that they may
    authorize for us to disclose that information to. So, that is a
    goal that we are actively working on now, where that
    information would be available electronically to veterans and
    the individuals that they authorize to have access.
        Chairman Isakson. Does not every inquiry on a benefit or
    appeal on a disability claim or any other benefit from the VA
    require a privacy release from the veteran?
        Mr. McLenachen. Yes, unless it is the veteran themselves
    asking for it. They have a right to it under the----
        Chairman Isakson. I understand that. But in terms of this
    deals with Congressional staff----
        Mr. McLenachen. Right.
        Chairman Isakson [continuing]. And every one of them, the
    first thing we are instructed to do, or we instruct our staff
    to do, is to get a privacy release before anything else
    happens. That is true nationwide, is it not?
        Mr. McLenachen. That is true with an exception of yourself,
    I believe, on behalf of the Committee asking for information. I
    believe the Committee has that authority to ask us for
    information.
        Chairman Isakson. And you said your objection to this bill
    was what?
        Mr. McLenachen. Well, this bill would essentially authorize
    all Congressional personnel to have access to our systems,
    regardless of the consent or authorization of the claimant. So,
    we think the veteran's privacy right is paramount to everything
    and they should have the ability to determine who they are
    going to--who VA should disclose their records to.
        Chairman Isakson. So, you want to maintain the privacy
    release signed by the veteran. But once you get the privacy
    release, how difficult is it for staff to get the information
    they need to assist the veteran?
        Mr. McLenachen. As long as we have that authorization, it
    should not be difficult.
        Chairman Isakson. Are you aware that Senator Rounds and
    Senator Manchin will be conducting a roundtable, if you will,
    for lack of a better term, here at the Committee during the
    break over the next 2 weeks to talk about this very issue?
        Mr. McLenachen. I am not aware of that.
        Chairman Isakson. A number of offices, and I have received
    as Chairman a number of complaints, if you will, for the lack
    of speed in responding to Congressional inquiries from the VA.
    I think part of the genesis of this particular legislation is
    some of the frustration with the response time it takes for
    many caseworkers to get veterans' information. So, I hope you
    will participate with whomever the Secretary decides to come
    and testify at that particular event.
        Mr. McLenachen. I would be happy to. I would like to say,
    Mr. Chairman, I am not downplaying the delay, and specifically
    in responding to veterans' own requests for Privacy Act
    information, their own records. We are working hard to address
    that particular problem. It does exist and we are working hard
    to address it. Veterans should be able to go online and see
    their own record.
        Chairman Isakson. One other question. You said that you
    were opposed to Senator Cotton's proposal with regard to burial
    of indigent veterans?
        Mr. McLenachen. No. We strongly support it.
        Chairman Isakson. You strongly support it?
        Mr. McLenachen. Yes, sir.
        Chairman Isakson. I am sorry. I misheard that.
        Senator Blumenthal.

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

        Senator Blumenthal. Thank you very much, Mr. Chairman, and
    thanks for having this hearing on a number of separate bills.
    If I count correctly, we have 18 bills on our agenda and they
    are extremely important to advance the interests of our
    veterans.
        One of them is the Veteran PEER Act, which complements the
    VA's ongoing efforts that I have strongly supported. The
    measure would expand the use of peer support specialists beyond
    traditional mental health sites of care. The VA has indicated
    support for the measure, ``subject to the availability of
    additional funding.'' Dr. McCarthy, can you tell us what the VA
    currently spends on the peer support program.
        Dr. McCarthy. Well, let me start by saying we currently
    have a peer support program in mental health and we have a
    pilot going on for encouraging individuals that are receiving
    mental health care right in primary care. So, we have seven
    sites that are up now, six more that will be starting in July,
    and nine more in January, and potentially four additional,
    where we would have peer support to encourage the veterans in
    the primary care clinics to receive mental health services that
    are embedded.
        As for the current costs, I am not sure I have those
    figures handy at this point for what we are spending right now
    on that particular pilot, but that would bring us to a total of
    26 sites that we currently have ongoing, and the bill is----
        Senator Blumenthal. The bill would bring to 26.
        Dr. McCarthy. No. We already have twenty----
        Senator Blumenthal. OK. Tell me----
        Dr. McCarthy. We have 13----
        Senator Blumenthal. Since we are short on time, let me just
    ask very directly.
        Dr. McCarthy. Sure.
        Senator Blumenthal. How much more spending would it cost to
    implement the Veteran PEER Act?
        Dr. McCarthy. So, the total for 3 years is projected to be
    $2.8 million.
        Senator Blumenthal. Two-point-eight million with an ``M.''
        Dr. McCarthy. Million with an ``M.''
        Senator Blumenthal. OK. Let me ask you, Mr. McLenachen, I
    was proud to introduce the FRAUD Act (Fiduciary Responsibility
    and Accountability for Unpaid Debts) with my colleagues,
    Senators Brown and Moran, to address the misuse--I think it is
    rampant--of VA benefits. That misuse is not by the veterans, it
    is by fiduciaries that are appointed to safeguard the finances
    of our veterans. Those fiduciaries all too often commit fraud.
    The misuse of these benefits is rampant.
        In your testimony, you state that during the calendar year
    2015, the VA reissued more than $2 million in benefits to
    veterans who have experienced the misuse of funds at the hands
    of fiduciaries, and that $2 million covers only the ones you
    know about and who have been processed, so there may be many,
    many more, as I understand it, that $2 million covers only ten
    veterans.
        This legislation is fruitful to ensure that the VA can
    reissue benefits in all cases of fiduciary misuse, which I
    think we need to do more to protect our most vulnerable
    veterans. They can be at the mercy of family, caregivers, all
    kinds of potential abuse.
        Would you please explain the process that is used to
    appoint a fiduciary for a veteran receiving these benefits, and
    how do you evaluate whether a fiduciary is going to be equipped
    in terms of expertise, but also be trustworthy, to administer
    those benefits.
        Mr. McLenachen. I would be happy to. Back in about 2004,
    Congress amended the law to require VA to use a specific
    investigation method when we appoint a fiduciary, with the
    standard being that we have to make a best interest
    determination on behalf of the beneficiary. Actually, the law
    requires us to do a number of things, such as a background
    check, a credit check, check character references, and so the
    statute itself establishes that standard for us.
        In our policy, we have determined that the first thing that
    we will look at for appointing a fiduciary is a family member.
    We are transitioning the program from one where, in the past,
    veterans, a lot of their benefits were used to pay fees to
    professional fiduciaries. We are shifting the program toward
    more family and friend caregiver-type oriented program and we
    have been very successful at that. The program is growing
    extremely fast.
        But our really important role that we play is oversight to
    detect misuse, and although I regret that there is any misuse
    in our program, the fact that we are doing sufficient oversight
    to detect misuse and provide reissuance of benefits according
    to the authority that we have now in one way is a sign that we
    are doing good oversight.
        Yes, I hope that we can do more to diminish that by
    appointing appropriate people to provide these services for
    these veterans and survivors, but it does happen. I
    respectfully disagree with you that it is rampant in our
    program. You are right, we do not know what is happening that
    we have not found, but we make every effort to find the misuse
    that is occurring. We do audits. We do follow-up field
    examinations. We do on-site visits of fiduciaries. This bill,
    in particular, will expand our authority for doing oversight
    because it would allow us to have access to financial records
    that we currently do not have.
        So that, in addition to the provision to reissue benefits,
    would strengthen our oversight. It is very important
    legislation.
        Senator Blumenthal. Thank you. Thank you for your response.
    My time has expired, but I hope to follow up in written
    questions. Thank you.
        Mr. McLenachen. Thank you.
        Chairman Isakson. Senator Tillis.

           HON. THOM TILLIS, U.S. SENATOR FROM NORTH CAROLINA

        Senator Tillis. Thank you, Mr. Chair. Thank you all for
    being here.
        I guess before I get started on questions about two bills,
    I do think that the Department's position on a bill that is
    sponsored by my senior Senator, the Department of Veterans
    Affairs Dental Insurance Reauthorization Act, you support?
        [Witness nodding.]
        Senator Tillis. Good. Thank you, on Senator Burr's behalf.
        I want to go back first to the Veterans Health Care
    Staffing Improvement Act. I think that there is a qualified
    support there. And before I ask you all to go through the areas
    that you have as concerns, there are a few pieces of the bill
    that I feel like we need to work on. One of them relates to--I
    know that the Department is making a decision, or has made a
    policy decision to extend or make some staffing decisions with
    respect to nurse anesthetists, for example.
        One thing that I think we have to be mindful of is that in
    States that have clear scope of practice laws, I hope that the
    Department is looking at instances where you have a bona fide
    shortage of the most qualified people before you would move
    that route, because I think that could create a slippery slope
    to where it is more of a lower-cost alternative rather than a
    most-qualified alternative. So, I recognize there are places in
    the country where you have the deficiencies and you may have to
    do them, but could you give me a reaction to that?
        Dr. McCarthy. Absolutely. As you noted, we have the final
    rule out for comment, and when we reached 10,000 comments,
    well, it was like nothing we had ever received before. We are
    now at 48,000 comments; the comment period extends until July
    28.
        I think the Certified Registered Nurse Anesthetist part of
    it is the one that has brought a lot of controversy. In VA,
    nurse anesthetists work closely with anesthesiologists and our
    model of care is team-based care. Teams define a lot of what we
    do. If you look across our system, we do have access challenges
    in primary care, in mental health, specialty care, and so
    forth, but we have not identified significant shortages of
    anesthesiologists, for instance. So, at this point, the
    proposed rulemaking is all inclusive with the idea that we
    would not necessarily implement all the changes in the
    rulemaking until it is clear what is needed. So, we would have
    flexibility.
        Senator Tillis. Well, thank you, because, again, it just
    speaks to a capability and training that if it is available, we
    want it in the hospital setting to make sure the veterans are
    getting the best possible care. That is taking nothing away
    from the nurse anesthetists. It is just making certain that
    this does not just change a model that is based more on
    business factors than medical outcomes. So, I appreciate that.
        Can you tell me other aspects, areas of concern, that you
    have? I do not think you necessarily had a concern with that
    aspect of it, but other areas where you are having problems
    with the Staffing Improvement Act.
        Dr. McCarthy. There were a couple of concerns. One was the
    desire to have a separate credentialing program. We do have a
    national program we call VetPro, which is actually quite
    functional and allows credentialing to be across our system.
    So, we do not need to really change that.
        We are excited about what we are doing with DOD in helping
    people come into our system now, all the possibilities for how
    we can partner and have folks supported with training options,
    and make the transition into VA easier. It is a win-win for
    those veterans who are being discharged and for us.
        So, the main concern, really, for us is to let the
    rulemaking comments happen. That is the main section that we
    are concerned about.
        Senator Tillis. All right. In my limited time, I want to
    get to the other one, which has to do with the Atomic Veterans
    Health Care Parity Act, and in some ways--there is no way we
    are going to get this done in 48 seconds, but I have been in
    the battles and, obviously, I think I have established good
    relationships within the VA. I am trying to do everything I can
    to support you all in efforts that I think are right minded.
        But, I almost feel like we are at a point where we were
    with the Camp Lejeune toxic substances, where people were
    saying there is not quite enough data for us to give the
    benefit of the doubt to the veteran. I am wondering whether or
    not the full complement of medical research, people that are
    looking at this, share the same position that the VA does right
    now, which is there is no presumption that their exposure--I am
    not a doctor, not a lawyer, but if we put these people on an
    island in T-shirts in close proximity to a mushroom cloud which
    is the aftermath of an atomic bomb, common sense says there may
    have been some exposure there that could have caused a
    condition.
        I am not going to ask you to respond to it because I am out
    of time, but I would like to maybe find a time to meet, as we
    did--and we got to a pretty good place with the Camp Lejeune
    toxic substances--to show me how that data would lead you to
    that position.
        Thank you, Mr. Chair.
        Chairman Isakson. Thank you, Senator Tillis.
        For a clarification for my purposes, with regard to the
    nurse anesthetists, you had a record response in terms of
    public input when you published that.
        Dr. McCarthy. Mm-hmm.
        Chairman Isakson. Now, my understanding is that you have
    determined that you have enough licensed and trained
    anesthesiologists to meet the demands of the Veterans
    Administration, so you are not going to be implementing at the
    present time a nurse anesthetist program to replace any
    anesthesiologists anywhere, is that correct?
        Dr. McCarthy. That is where we are right now, sir. Dr.
    Shulkin has talked about the fact that it took 6 years for us
    to bring it to the final rule at this point and a future Under
    Secretary, he would not want them to have to go through another
    6 years of waiting to bring that particular rule. He feels like
    having the rule published would be useful to us should we need
    to implement it in the future. But, it is really going to be
    facility-specific, what are the needs of that individual
    facility and the veterans that come there in terms of who are
    the right people to be prescribing or treating the veterans
    with anesthesia.
        Chairman Isakson. Given that the rule would allow at a
    future date a Secretary to determine to use some nurse
    anesthetists, what would be the requirement to let this
    Committee know about that before they make that decision? Is
    there anything in the rulemaking that determines that?
        Dr. McCarthy. I do not know that that is in the rulemaking,
    but in the spirit of cooperation, I think it makes a lot of
    sense for people to talk about that together.
        Chairman Isakson. My point is, I think the Committee should
    be made aware in advance of the rule being amended by the
    Secretary, and I wish you would share that with Dr. Shulkin.
        Dr. McCarthy. I will.
        Chairman Isakson. I appreciate that.
        Dr. McCarthy. Thank you.
        Chairman Isakson. Senator Murray.
        Senator Murray. Thank you very much.
        Dr. McCarthy, Vet Centers are one of the most successful
    programs VA runs, with some really high satisfaction scores. I
    strongly believe that this is really an important service that
    would help greatly our Guard and Reserve members when they
    return home from deployments, and as we do so, we want to
    protect the Vet Center system and make sure it can meet the
    demand.
        In Lacey, WA, in my home State, we created a new satellite
    office of our Tacoma Vet Center to meet the needs of the
    veterans in the area. It is already at full capacity and needs
    more staff and expanded hours, which I hope the Department will
    address.
        But, I wanted to ask you, if we expand eligibility for Vet
    Centers to members of the Guard and Reserve, how much
    additional resources will the VA need and will you make that in
    your request for your next budget?
        Dr. McCarthy. OK. Let me just address the specific
    legislation about rehab counseling services. It talks about
    members of the Guard and Reserve who are not otherwise
    eligible, so we are not talking about combat veterans or
    veterans who may have experienced military sexual trauma (MST)
    or been involved with emergency medical care or mortuary
    services. That is the highlight of this particular proposed
    legislation that we are a little bit concerned about.
        We do not want to destroy the special nature or culture of
    the Vet Centers. We do want to expand the role more. We have a
    staff that have been built up around trauma, counseling, and so
    forth, where this expands the roles of the Vet Centers to cover
    more than just trauma counseling, which is our concern. It is
    not that we do not want to do it, but it would be a major
    mission shift for those in the Vet Centers. About 80 percent of
    the staff are themselves people who have been trauma counselors
    for quite a while.
        We feel like the Guard and Reserves, they have eligibility
    for care for MST and for those who have combat services and
    even those who have been discharged dishonorably can come to
    the Vet Centers, as you know. We are really proud of the Vet
    Centers. They do have some capacity to help us with our access
    for mental health and we are really looking to partner with
    them to do more. But we really do not want to change the
    culture and the mission.
        There is a special clientele that go to the Vet Centers,
    often people that do not want to have, for instance, a trail of
    medical records about the care that they are receiving; people
    that might be police, National Guard, active duty, Reservists.
    And there is a culture of combat veterans and veterans with
    MST. So, changing it to allow those that are not part of that
    group in particular is the part of that bill that we have
    concerns about.
        Senator Murray. I also wanted to ask you, as you know,
    veterans living in our rural communities often experience
    barriers to accessing the health care that they need. The
    Veterans Travel Enhancement Act would permanently authorize the
    Veterans Transportation Service (VTS) to improve veterans'
    ability to access care and expand the definition of VA
    facilities to include Vet Centers. The Veterans Transportation
    Service has been very popular in my homestate of Washington and
    I understand it is also very cost effective for the VA. If this
    legislation is enacted, how much will you be able to expand VTS
    services?
        Dr. McCarthy. I want to first of all thank our VSO
    partners, who themselves have quite a transportation network.
        Senator Murray. Yes, they do.
        Dr. McCarthy. I would not want us to not thank them.
        Second, we are really excited about making that permanent.
    For us, the VTS made over 400,000 trips averaging 54 miles. It
    has been really quite significant for us. There has been a
    decrease in cost compared to beneficiary travel of 4 percent.
    That resulted in $1.7 million savings anticipated for fiscal
    year 2017.
        There is some concern about expanding to the Vet Centers.
    There is a pilot program going on that has allowed for
    transportation for rural veterans to Vet Centers and the
    reaction to it has been somewhat negative and not what we
    expected. The concerns are twofold. First of all, from the
    point of view of the veterans, again, when I talked about the
    culture, the people that like the anonymity of coming to the
    Vet Centers, to process claims related to travel requires
    listing diagnosis and treatment and so forth, which is
    something that they do not want to be revealed in particular.
    So, that is one administrative function.
        Then, there is the other side of the coin, the Vet Centers.
    I mean, they are set up for quick access, easy availability.
    They do not have a lot of overhead people that would be
    involved in all the fiduciary responsibilities, so it has been
    a concern for them, as well.
        We are really supportive of the bill, but we do question
    the Vet Centers being included, although we understand the
    needs for help with veterans being transported to the rural Vet
    Centers, in particular.
        Senator Murray. I am out of time. Thank you very much, Mr.
    Chairman.
        Chairman Isakson. Thank you, Senator Murray.
        Senator Heller.

               HON. DEAN HELLER, U.S. SENATOR FROM NEVADA

        Senator Heller. Mr. Chairman, thank you, and to our
    panelists, also, thank you for being here.
        I just had a couple of questions. I want to thank the
    Chairman for including my legislation, S. 3035 with Senator
    Tester. I certainly do appreciate his support on this. The
    title on the bill is Maximizing Efficiency and Improving Access
    to Providers at the Department of Veterans Affairs Act of 2016.
    It is a long title, Mr. Chairman. It was not my first choice,
    but I will take it.
        I think the bill is somewhat unique. It conducts a pilot
    program using medical scribes at the VA so that doctors can
    spend more time with their veteran patients. I am pleased that
    I have got the support of the VFW, the Disabled American
    Veterans organization, and The American Legion. Unfortunately,
    we do not have the VA on board yet. In fact, I am looking at
    some of the testimony. Doctor, you said the VA does not support
    this bill. Then you go on to say that the VHA is in the process
    of administering a request for proposals that includes the use
    of scribes. So, one, you say you are not for it, but then you
    say within the same paragraph that you have a proposal. Could
    you explain to me what your proposal is for the use of scribes
    and what the VA is envisioning here.
        Dr. McCarthy. First of all, thank you. I think most
    clinicians who work with electronic medical records worry about
    the time taken away from patients in documenting and how much
    typing goes on versus scribes and so forth. So, we understand
    what is behind this.
        Right now, VA has an enterprise-wide contract so that all
    front-end providers can use what is called a speech recognition
    contract, where it is Nuance Dragon Medical 360 Network
    Edition Version 2.3.
        Senator Heller. Another long title.
        Dr. McCarthy. I know. I am sorry about the long name, too--
    --
        Senator Heller. That is OK.
        Dr. McCarthy. But, you know, I used this a long time ago,
    which was probably version negative one or something, and when
    you do the Dragon dictate, you actually have to teach the
    device that is recording your voice and translating it into
    what is typed. You have to train it to your own personal voice
    or accent or whatever. But, this is available nationwide
    currently.
        Our Request for Proposal (RFP), which is what you asked
    about, includes for scribes, transcription, and a health
    advocate at the same time that might be able to help us with
    some of the public health screening kind of measures that we do
    at the same time. It is a kind of tweak on what this bill
    proposes, so that is why.
        We have a couple of pilots going on right now, but we also
    have that national contract and we are encouraging the use, as
    well.
        Senator Heller. Doctor, I spent some time in Las Vegas and
    Reno this March and hosted two military and veterans
    roundtables. I heard from these veterans both in Northern
    Nevada and Southern Nevada, and probably one of the biggest
    complaints I got was they are concerned with how little time
    they actually got to spend with their doctor. So, obviously
    what you are trying to propose and what we are trying to
    propose, hopefully, we can somewhat come together on this and
    understand that these patients, these veterans, need more eye-
    to-eye time with their doctors.
        I guess the question I have right now is, do you have any
    statistics that show how much time a doctor does spend with
    their patients at a VA facility?
        Dr. McCarthy. We have statistics about expectations and we
    include a typical primary care visit would be 30 minutes. I
    sympathize with what the veterans are saying. Do not treat the
    computer, treat me.
        Senator Heller. Yes.
        Dr. McCarthy. I fully understand that. We have worked to
    get our rooms set up so that you do not have to turn your back
    on the patient to enter things into the computer.
        A lot of our screening happens in the initial primary care
    visit, but in that 20- to 30-minute visit, there is a lot that
    goes on. I can get you statistics about average amount of time
    spent if that would be helpful to you.
        Senator Heller. Well, let me ask you this question. When
    you measure patient satisfaction, do you consider the time with
    the doctor as part of that satisfaction?
        Dr. McCarthy. There are measures that ask things like: did
    you feel like your need got met? Did you feel like the doctor
    understood what you were saying as what you brought to the
    appointment and so forth----
        Senator Heller. It is open-ended, also----
        Dr. McCarthy. Yes.
        Senator Heller [continuing]. For any comments that they may
    have?
        Dr. McCarthy. Yes, sir.
        Senator Heller. Do you have any statistics also that show
    how much time these doctors spend with these electronic health
    records?
        Dr. McCarthy. I do not, but I can look for them. I would be
    happy to take that for the record.
     Response to Request Arising During the Hearing by Hon. Dean Heller to
                    the U.S. Department of Veterans Affairs
        Response. VA does not currently collect this type of data as it is
    not easy to obtain. Simply asking physicians often leads to inaccurate
    estimates and there is no easy way to track this electronically. The
    research on this has general involved direct observation, ``time-
    motion'' studies which are expensive to conduct.

        Senator Heller. OK. My time has run out.
        Dr. McCarthy. OK.
        Senator Heller. Chairman, thank you very much.
        Chairman Isakson. Senator Cassidy.

             HON. BILL CASSIDY, U.S. SENATOR FROM LOUISIANA

        Senator Cassidy. Thank you, Mr. Chair.
        Dr. McCarthy, I am interested in the WINGMAN Act, which I
    gather you all oppose, but when I read the nature of your
    opposition, I am not quite sure why you oppose. For those who--
    in short, when my folks are working to try and facilitate
    something with the VA, they sometimes wait weeks and months to
    get the record from the VA. My chief, the person who is my guru
    on how to make work all things, she just kind of says, ``Bill,
    sometimes we cannot get anything from the VA and there is
    nothing I can do except drive down there.''
        Now, here, I look at your testimony as to why you oppose
    allowing our staff read-only access to the records contingent
    upon the veteran signing a release that that may occur, which
    is referenced in the bill; I think you raised privacy concerns.
    Let me be explicit. What we reference, which is 552(a)(B) of
    Title V, explicitly says there has to be an informed consent by
    the patient to allow this access. So, I guess that is one
    thing. The privacy concern does not seem to work with me.
        Second, we would expect that they would have the same
    training in use of these records as the VA folks. I understand
    that there is an online course that VA employees take to kind
    of do this sort of review, which is what we presume would be
    for the Congressional staff. Is there something besides this
    online course which makes someone working for the VA specially
    qualified, and if so, why could not the Congressional staff
    have access to the same training?
        Dr. McCarthy. I am going to pass that to my partner in VBA
    to answer that question.
        Mr. McLenachen. Yes, Senator. I will take the question.
    Thank you.
        Actually, Senator, our reading of the bill is apparently
    not the same as yours. We read the bill to mean that
    Congressional staff would actually have unprecedented access--
    --
        Senator Cassidy. Now, you define unprecedented, which is
    somewhat pejorative, so what do you base upon--it is
    unprecedented, right, in the sense that before, we have had to
    wait for somebody to send it to us----
        Mr. McLenachen. Sure.
        Senator Cassidy [continuing]. But it is----
        Mr. McLenachen. Let me explain. They would have access
    greater than the VA employees. VA employees currently have
    access to records only if they have a need in working a
    particular veteran's claim. The bill would allow----
        Senator Cassidy. That would be the case--let me interrupt,
    please--because the person would only have access if the
    veteran himself or herself signed a release. So, they would
    only have access for people in their district who had
    explicitly said, ``I need help with my benefits and I am not
    getting it,'' sort of thing.
        Mr. McLenachen. Actually, our reading of the bill indicates
    that the access would be regardless of the individual's
    consent.
        Senator Cassidy. No, that is wrong, and that is where I
    refer to--I can give it to you if you wish--552(a)(B) of Title
    V, and I will read from here, ``except pursuant to a written
    request or with a prior written consent of the individual to
    whom the record pertains,'' et cetera. So, I think I win on
    that one----
        Mr. McLenachen. Well----
        Senator Cassidy [continuing]. But go ahead.
        Mr. McLenachen. I will certainly go back and take a look at
    it, but our position is authorization from the veteran has to
    be there. If the legislation provides for that, then yes, there
    may be some change to our views on the bill.
        That is not the only issue in the bill. The bill creates
    some confusion about VA's accreditation program. VA accredits
    representatives for the purpose of providing representation on
    claims, not for purpose of access to our systems.
        As I said before, and I apologize, it may have been before
    you came in, but we feel the solution to this problem--and I do
    not disagree with you that we are too slow in providing
    veterans' records even to veterans themselves. So, to address
    that, we are going to make veterans' records available to them
    through e-Benefits, as well as to other individuals that the
    veteran authorizes to have access. I think that is the solution
    to this problem.
        Senator Cassidy. I guess I am not following. If the veteran
    authorizes Johnny Isakson's staff person who is working on
    their veteran's benefit claim to have access to the record and
    it is--you can trust me, I am right on this one, because we
    explicitly said it had to be approved--I am not sure that is
    different from what you just said. Oh, we are going to release
    the records to whomever the veteran tells us to release the
    records to. Did I miss something there? It seems substantially
    the same.
        Mr. McLenachen. The bill concerns electronic access, and we
    currently do not provide----
        Senator Cassidy. Oh. So, now we have to go back to waiting
    for you all to generate it. That is incredibly frustrating, let
    me tell you that.
        Now, you are drawing a distinction between our aides
    accessing this record to look up, OK, they say you have a
    hepatitis claim and you say you were exposed and they say not,
    and you are saying that that is somehow with claims. I do not
    quite follow why allowing someone to do a PDF search for the
    word ``hepatitis''--I am not following the distinction you are
    making, which is not to say there is not a distinction. I just
    do not follow it.
        Mr. McLenachen. I think you will hear some concerns from
    the next panel, as well. You know, simply providing access to a
    record does not really interpret what that record means. I
    would hope that some engagement between our Congressional
    liaison and your staffs is helpful, as well as engagement with
    representatives such as the VSO representatives for a
    particular claimant. We would be very happy to work with the
    Committee and any other member of Congress to figure out how we
    can get that information to you more quickly.
        Senator Cassidy. I know I am out of time, so I will just
    finish by saying this, I have not yet heard an objection that
    actually sounds like it is firm. We have the privacy addressed.
    That is clearly addressed in this section. I will submit this
    for the record, Mr. Chairman.
        [The information from Senator Cassidy follows:]

                   5 U.S.C.--United States Code, 2010 Edition

                 Title 5. Government Organization and Employees

                         Part I. The Agencies Generally

                      Chapter 5. Administrative Procedure

                    Subchapter II. Administrative Procedure

    SEC. 552A. RECORDS MAINTAINED ON INDIVIDUALS

        (b) Conditions of Disclosure.--No agency shall disclose any record
    which is contained in a system of records by any means of communication
    to any person, or to another agency, except pursuant to a written
    request by, or with the prior written consent of, the individual to
    whom the record pertains, unless disclosure of the record would be--
              (1) to those officers and employees of the agency which
            maintains the record who have a need for the record in the
            performance of their duties;
              (2) required under section 552 of this title;
              (3) for a routine use as defined in subsection (a)(7) of this
            section and described under subsection (e)(4)(D) of this
            section;
              (4) to the Bureau of the Census for purposes of planning or
            carrying out a census or survey or related activity pursuant to
            the provisions of title 13;
              (5) to a recipient who has provided the agency with advance
            adequate written assurance that the record will be used solely
            as a statistical research or reporting record, and the record
            is to be transferred in a form that is not individually
            identifiable;
              (6) to the National Archives and Records Administration as a
            record which has sufficient historical or other value to
            warrant its continued preservation by the United States
            Government, or for evaluation by the Archivist of the United
            States or the designee of the Archivist to determine whether
            the record has such value;
              (7) to another agency or to an instrumentality of any
            governmental jurisdiction within or under the control of the
            United States for a civil or criminal law enforcement activity
            if the activity is authorized by law, and if the head of the
            agency or instrumentality has made a written request to the
            agency which maintains the record specifying the particular
            portion desired and the law enforcement activity for which the
            record is sought;
              (8) to a person pursuant to a showing of compelling
            circumstances affecting the health or safety of an individual
            if upon such disclosure notification is transmitted to the last
            known address of such individual;
              (9) to either House of Congress, or, to the extent of matter
            within its jurisdiction, any committee or subcommittee thereof,
            any joint committee of Congress or subcommittee of any such
            joint committee;
              (10) to the Comptroller General, or any of his authorized
            representatives, in the course of the performance of the duties
            of the Government Accountability Office;
              (11) pursuant to the order of a court of competent
            jurisdiction; or
              (12) to a consumer reporting agency in accordance with
            section 3711(e) of title 31.

        Senator Cassidy. The other just seems to be kind of a
    nebulous sort of, well, we do not want them in our record, even
    though it is read-only, ``because.'' I do not know if you can--
    and I am out of time--respond maybe for the record as to why it
    is more than ``because.''
        Mr. McLenachen. I would be happy to.

        [See the Chairman's remarks below addressing this issue.]

        Senator Cassidy. That is all I get right now. I yield back.
        Chairman Isakson. Let me acknowledge how important your
    comments are. Before you arrived here, I raised exactly the
    same issues with the VA and reminded them that we are going to
    have a scheduled roundtable here with representatives from each
    Member's office back home and the VA to talk about the
    intercommunication between the VA and us in terms of case work
    matters with the Veterans Administration.
        And I, like you, am a WINGMAN supporter. I would like to
    see us work through the difficulties that the agency has to
    make sure we improve access to information so we can improve
    the speed with which we get back to our veterans who have
    claims. So, your time was well spent and I thank you for your
    input.
        Senator Sullivan.

              HON. DAN SULLIVAN, U.S. SENATOR FROM ALASKA

        Senator Sullivan. Thank you, Mr. Chairman, and I appreciate
    the witnesses coming today.
        I wanted to talk a little bit about a draft bill that I
    have been working on with the VA. It actually stemmed from a
    visit that Under Secretary Shulkin and I had in Alaska where we
    were out in several different communities. One of the big take-
    aways I believe he had from that trip was some of the big
    challenges that, not just Alaska, but rural States who have big
    veteran populations who do not have enough providers to
    actually help with regard to a lot of the challenges that the
    VA has.
        As you all probably know, there was a recent Association of
    American Medical Colleges survey that said close to 45 percent
    of doctors who do their residencies at certain medical schools
    end up staying there. Well, if you have a State like mine where
    you do not have a medical school, you kind of start with a
    challenge.
        So, we have been working closely with the VA for months
    now--it was actually really in many ways Dr. Shulkin's idea
    last year--to have a pilot program for the VA to work with
    tribal organizations, particularly in States with heavy veteran
    populations but are very rural States. So, not just Alaska, but
    Montana, Wyoming, other places like that.
        I know that--I guess that we were just outside of the
    timeframe to get your guys' official view on that. You said you
    needed 3 weeks. I think we got it to you 2 weeks and 3 days
    ago. So, if we did not make it under the deadline, I get that,
    though it would be nice to be able to get the response. I am
    almost certain that the VA is supportive, since in many ways it
    was Dr. Shulkin's idea, which we have been working with you and
    some of the other organizations interested in this for months
    now.
        So, Dr. McCarthy, would you mind just giving a view on
    that, whether it is official or not. I think we are very close
    and I would like to get your view. Then we are going to work
    hard to get others from other States, other Members on this
    Committee to be cosponsors of that, but we want to make sure
    the VA was good to go with it first.
        Dr. McCarthy. We would really like to get to yes. There are
    a few items that we want to work with you about. I totally
    agree with you about the training and where people stay. You
    are exactly right, and I do think that this would be really
    important.
        We are also, as part of the Choice Act, trying to expand
    residency programs significantly----
        Senator Sullivan. Yes. Right.
        Dr. McCarthy [continuing]. So, this is a good fit for us.
    There are some other regulations that we have to get through. I
    do not want to speak for all of them----
        Senator Sullivan. OK.
        Dr. McCarthy [continuing]. But I would be happy to talk to
    you more about it.
        Senator Sullivan. OK. Well, let us remember, though, we are
    also looking at statute, so obviously a law would trump a
    regulation.
        Dr. McCarthy. Yes.
        Senator Sullivan. I do not think, ``we do not want to
    violate any regulations,'' but we also want to make sure that
    we understand the hierarchy here. This is a pretty important
    issue and I know even Secretary McDonald has met with different
    Alaska groups----
        Dr. McCarthy. Right.
        Senator Sullivan [continuing]. And has been supportive of
    it. So, already, I know that we have top cover----
        Dr. McCarthy. Right.
        Senator Sullivan [continuing]. Support from Under Secretary
    Shulkin, Secretary McDonald. For me, it is just really
    important to move this, and if we can get your commitment to
    move this, I think the Chairman is aware of what we are trying
    to do on this.
        Let me ask--and you touched on it--let me ask a related
    question. There were 1,500 new graduate medical education spots
    given to the VA through the Choice Act, and I think only 372 of
    those spots have been filled to date. So, what is the issue
    there? Why have so few--relative to the number that Congress
    authorized--been filled; and is there anything we should be
    doing on that? Or, what should you be doing to make sure you
    take full advantage of the Choice Act provisions which you
    referenced and that, again, I think, dovetail nicely with the
    bill that we are working on with you guys?
        Dr. McCarthy. The Choice Act gives us a 5-year limitation
    and we really believe that building the relationships and
    building residency programs is going to take more than 5 years.
    So, there is a significant amount of lead time.
        I was involved in building residency programs in the site
    where I used to be a chief of staff and it is not something
    that is done overnight. I am a psychiatrist by training. I was
    working to partner on psychiatry residency programs. You have
    to set up, you know, relationships with child psychiatry
    programs and so forth, because we do not have that in VA. You
    have to get people that are willing to partner with you and so
    forth. So, it is not something that can happen overnight; those
    programs have to build their capacity and so forth. So, it
    takes a while to build.
        I do think that expanding the Choice recommendations to 10
    years would help us a lot, but that said, there are a lot of
    efforts underway right now to try to partner as much as we can.
        I, personally, have a heart for doing that, especially in
    the rural areas, particularly for what you said about when
    people train in an area, they stay. There are a number of, for
    instance, osteopathic medical schools that have set up
    residency programs in rural areas and that is exactly what is
    happening. More of them are staying in the area, which is, you
    know, not something that happened overnight; it does take a lot
    of time.
        So, when you set up one residency program, you know, family
    practice or mental health or whatever, there are other parts of
    the residency that you need to get going at the same time. So,
    it takes building relationships with community partners, which
    is very important work to do. There is a lot of good will out
    there. Some of the community partners are not of the--
    interested necessarily in building their own residency program,
    so there is convincing going on back and forth, and that is
    where we are right now.
        Senator Sullivan. Thank you.
        Thank you, Mr. Chairman.
        Chairman Isakson. Thank you, Senator Sullivan.
        Senator Tester.

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

        Senator Tester. Thank you.
        I would like to follow on. In the bill that we are trying
    to get through the Senate right now, I think there is a
    component to extend it to 10 years from 5, and I also think
    there is a component in it, if my memory serves me correctly,
    there are CMS caps right now and it will take those caps off,
    which will also help in a big, big way. So, once we get that
    done, then we are really going to get you if they are not
    filled up.
        Look, we appreciate the testimony. Sorry I was late, but I
    had two other committee meetings, Senator Tillis, just to let
    you know.
        In September 2014, I wrote a letter to Secretary McDonald.
    It was brought to my attention that the Montana Board of
    Psychologists had reprimanded a VA psychologist for practicing
    outside the scope of his qualifications when performing a
    compensation and pension exam for a Montana veteran with
    traumatic brain injury (TBI). I was and I still remain
    concerned about the implications of these exams not being
    carried out properly. What ultimately led to the VA conducting
    a national review of medical exams of veterans who have filed
    disability claims related to TBI?
        Mr. McLenachen. Senator, I will take that question. A while
    back, our facility in Minneapolis, on their own initiative,
    took a look to see if they were following VA policy about the
    specialists that are required to do the initial TBI exam. There
    are four specialists that VA requires to do those initial TBI
    exams, not the follow-on exams. What they learned was that, in
    fact, there were about 300 veterans who did not receive that
    type of exam.
        Senator Tester. OK.
        Mr. McLenachen. Based on that information, the Deputy
    Secretary asked us to do a nationwide review.
        Senator Tester. Mm-hmm.
        Mr. McLenachen. We did that. We recently discovered as a
    result of that review that there are about 24,000 veterans that
    did not receive an initial TBI exam by one of those
    specialists. About 70 percent of those veterans--actually,
    about 17,000 of those veterans--are already service-connected
    for TBI.
        Senator Tester. OK.
        Mr. McLenachen. Nonetheless, looking back at the policy
    that we had issued over the years, starting in about 2007, we
    concluded that the guidance was sufficiently unclear and
    perhaps confusing, that to be fair to all veterans, we needed
    to go back and offer them all an opportunity for a new exam.
        Senator Tester. So, would it be fair to say that the VA
    protocol was inadequate?
        Mr. McLenachen. It would be fair to say that if it created
    confusion, yes----
        Senator Tester. OK.
        Mr. McLenachen [continuing]. It would be fair to say that.
        Senator Tester. So, what are we doing? I mean, what, moving
    forward?
        Mr. McLenachen. Well, that guidance has been clarified. VHA
    has gone out and checked with each of its facilities that do
    these type of exams and confirmed that that guidance is being
    followed.
        Senator Tester. OK.
        Mr. McLenachen. One noteworthy point is that the
    overwhelming majority of these exams were done by a VBA
    contractor----
        Senator Tester. Yeah.
        Mr. McLenachen [continuing]. And the contract was amended
    in 2014 to specifically require that these type of exams be
    done.
        Senator Tester. OK.
        Mr. McLenachen. So----
        Senator Tester. So, let me ask you this, because there is a
    bill called S. 244 that we are taking up today that an
    independent assessment of these protocols would be done by a
    medical expert. Do you think this would be helpful?
        Mr. McLenachen. Senator, I think it is our view that it is
    unnecessary, given what I just explained about the specialists
    that are required to do these exams. In addition, and it is my
    understanding--I am not a physician--but the bill would
    require, or ask the Institute of Medicine to focus on cognitive
    issues, where we use a more holistic approach----
        Senator Tester. Yeah----
        Mr. McLenachen [continuing]. That is broader than that.
        Senator Tester. Even though it is my bill, I actually kind
    of like that. The question is, what do I do next time it
    happens----
        Mr. McLenachen. Well----
        Senator Tester [continuing]. When the exam is done
    improperly?
        Mr. McLenachen. I think----
        Senator Tester. Then----
        Mr. McLenachen. Our commitment to you should be that this--
    we have solved this problem and it should not happen again.
        Senator Tester. And if it happens again, does somebody's
    head roll?
        Mr. McLenachen. Well, if somebody was not following the
    policy that we have in place, there should be accountability.
        Senator Tester. OK. All right. OK.
        Well, I have got time for one more question. The Veterans
    Transportation Service program has been successful in
    connecting veterans to care. I think it is efficient from a
    taxpayer standpoint and I think it is good for a veteran. The
    VA has previously said that reauthorizing this program would
    save taxpayer dollars, maybe as much as $200 million over 5
    years--that is a fair amount of money in my book--because it is
    cheaper to hire drivers than to contract with an ambulance
    service. Would you agree with that?
        Dr. McCarthy. Yes, sir. We are very excited about the
    opportunity to extend this bill, but I am not sure the
    estimates that I have been given are of the level that you have
    talked about.
        Senator Tester. You do not think it saves that much?
        Dr. McCarthy. The most recent number I have been given is
    $1.7 million in fiscal year 2017.
        Senator Tester. OK. So, let me ask you this. Would it help
    with the veterans that might be missing exams now that would
    not miss them if you had this service?
        Dr. McCarthy. My understanding is this is more about care.
        Senator Tester. Is it not about--OK, yes, transportation to
    care, right?
        Dr. McCarthy. Yes. Yes, sir.
        Senator Tester. I guess the point was not made very well by
    me. If a veteran has transportation, it would seem to me that
    they are much more likely to meet an appointment for care----
        Dr. McCarthy. Right.
        Senator Tester [continuing]. Than if they did not.
        Dr. McCarthy. Right.
        Senator Tester. So, would this help reduce that number?
        Dr. McCarthy. One would expect that to be the case. When I
    heard exam, I was thinking VBA. I am sorry----
        Senator Tester. Yes, that is right. So, can you tell me
    what percentage of--I am sure it varies by region--what
    percentage of appointments are not met by the veteran?
        Dr. McCarthy. That does vary. I would not want to make a
    number. I would be happy to get back with you----
        Senator Tester. It would be really good to know from my
    perspective, and it is my bill, that if, in fact, the
    percentage is higher than it ought to be and if they are being
    missed because of transportation reasons.
     Response to Request Arising During the Hearing by Hon. John Tester to
                    the U.S. Department of Veterans Affairs

                   Veteran Missed Appointments by Fiscal Year
    ------------------------------------------------------------------------
                                                        # Appts
                    FY                    Total #       Veteran    % Veteran
                                       Appointments*     Missed      Missed
    ------------------------------------------------------------------------
    2013.............................   60,632,327    6,582,090      10.86%
    2014.............................   63,461,668    7,293,636      11.49%
    2015.............................   66,495,855    7,560,539      11.37%
    2016*............................   51,875,904    5,823,699      11.23%
    ------------------------------------------------------------------------
     * Total Appointments = Checked Out + No Show Combined
    ** 2016 is FYTD through 07/07/2016

        Note: ``Checked out'' appointments means that the scheduled
    appointment occurred as planned and that the required check-out
    elements of provider, procedure, and diagnosis were all entered into
    the record. This makes the appointment complete with a status of
    checked out.

        Dr. McCarthy. I am familiar more with by specialty----
        Senator Tester. I am sorry. I took way too much time now.
    Sorry, Mr. Chairman.
        Chairman Isakson. No apology necessary, Senator Tester.
    Thank you for coming.
        For the edification of the Members that are present as well
    as the audience, we have one other Senator who had asked to be
    recognized, Senator Merkley, who was supposed to be on the way,
    but he is not here yet----
        Senator Tester. He is right there.
        Chairman Isakson. Oh, I am sorry. Well, the Chairman's
    eyesight is getting bad, Senator Merkley.
        We will let the first panel be excused. Thank you for your
    time.
        I am going to give Senator Merkley up to 5 minutes to make
    his presentation, then we will go immediately to the second
    panel. There is a classified briefing at 4 p.m. for members of
    the Senate, so if you have only me left in the room, that would
    be the reason why.
        Senator Merkley, you are recognized for up to 5 minutes. As
    is the tradition of the Committee, there will be no exchange of
    questions at this time. We welcome hearing about your
    legislation.

                    STATEMENT OF HON. JEFF MERKLEY,
                        U.S. SENATOR FROM OREGON

        Senator Merkley. Thank you very much, Mr. Chairman. It is
    an honor to be able to introduce S. 2279, the Veterans Health
    Care Staffing Improvement Act. I want to thank my colleague,
    Senator Rounds, for co-leading this bill and to thank the
    Members of this Committee who are sponsoring it, including
    Senator Rounds, Senator Tillis, Senator Murray, Senator Brown,
    Senator Tester, as well as cosponsors who do not sit on this
    Committee.
        Our servicemen and women are the very best demonstration of
    our Nation's greatness, folks who have stepped up, taken the
    oath, and put on the uniform so the rest of us can live in a
    country that is safer and more secure. While we often offer
    warm words of thanks, we should be looking for ways to do more,
    and that is what our bill aims to do.
        Every day, hundreds of thousands of dedicated public
    servants at the VA help us honor that commitment. In VA
    hospitals across the country, many doctors and nurses work hard
    to deliver world class care. But we all recognize that we have
    more to do, we have further to go to improve VA hospitals, to
    reduce long wait times, to ensure that all of our veterans,
    every single one, gets the care they need, the care they
    deserve. And this bill, the Veterans Health Care Staffing
    Improvement Act, will help us meet that goal.
        This legislation makes common sense changes in staffing
    policies to improve veterans' care and working conditions at VA
    health care facilities. It would increase the ability of the VA
    to recruit veterans who served as health care providers while
    they are in the military. We call this the Docs-to-Doctors
    program. It makes common sense. We hear again and again from
    returning veterans that they want to have a new mission. They
    want to be able to continue helping their fellow Americans and
    their fellow soldiers. What better way than allowing veterans
    with a medical background to continue serving in the VA system,
    to streamline the red tape so these doctors and other health
    care providers can transition seamlessly into the VA system.
    That is a win-win.
        This legislation also creates uniform credentialing rules
    for medical professionals so VA doctors and other licensed
    health care providers do not have to wait weeks or months to
    recredential if they want to move hospitals or split their time
    and work at multiple VA facilities.
        It provides full practice authority to Advance Practice
    Registered Nurses (APRNs), nurses with post-graduate education,
    and physician assistants in the VA health system. This will
    help to make more primary care providers available, and
    certainly this is important in rural areas.
        That is why this bill is needed now more than ever, to
    ensure our veterans can get the care they need and staff can
    practice to the full extent of their education and training.
    Writing these measures into law will make the VA more
    effective, more efficient. It will make it easier for the VA to
    achieve the staffing levels they need and to ensure the VA can
    better carry out its mission and to put veterans first.
        Caring for our veterans is an area where Democrats and
    Republicans have worked together and should always be working
    together, and this bill represents that.
        This bill is endorsed by many veterans organizations and 37
    different nursing groups. The veterans groups include the
    Veterans of Foreign Wars, the Vietnam Veterans of America, the
    Iraq and Afghanistan Veterans of America, the National Guard
    Association, the Reserve Officers Association, The American
    Legion Department of Oregon.
        I am delighted to be able to come and testify on behalf of
    this bill. We have a huge problem affecting our entire health
    care system, which is so many of our practitioners are Baby
    Boomers and they are retiring. And so many of us are Baby
    Boomers and need more medical care. And, therefore, we have an
    increase in demand and a decrease in supply, and we see that
    affecting our VA system as it competes with the rest of the
    health care system.
        So, we have all of these soldiers coming home with
    experience, with the desire to have a significant mission, with
    the skills to be able to help in our VA health care system. Let
    us streamline that path, and that is what this bill does, and I
    would appreciate the support of the entire committee.
        Thank you, Mr. Chairman.
        Chairman Isakson. Thank you, Senator Merkley. We appreciate
    your interest and your testimony.
                                    ------

    Response to Posthearing Questions Submitted by Hon. Mazie K. Hirono to
      David McLenachen, Deputy Under Secretary for Disability Assistance,
     Veterans' Benefits Administration, U.S. Department of Veterans Affairs
        Question 1.  Mr. McLenachen, in your written testimony, you express
    concerns about the WINGMAN Act, which would provide congressional
    staffers ``with greater access to VA records than is provided to VA
    employees or contractors'' (p. 28). Can you elaborate on how expanded
    access to these records for congressional staffers, as outlined under
    the WINGMAN Act, would provide them with greater access than is
    currently provided to VA employees and contractors?
        Response. As stated in the Department of Veterans Affairs' (VA)
    written testimony, this bill would provide Congressional employees with
    unprecedented access to the records of Veterans and other VA claimants,
    raising significant privacy concerns. The bill also improperly
    conflates the concept of access to claims records with the distinct
    mission and function of VA's Accreditation Program in ensuring that
    Veterans have access to competent and qualified claims representation.
        Regarding the nature of the access provided, the bill would allow
    Congressional staff, who assist constituents of a Member of Congress,
    with greater access to VA records than is provided to a VA employee or
    contractor. Under the Privacy Act, Federal employees generally may
    access private records only when necessary to perform their duties.
    This bill would impose no similar restriction on access by
    Congressional staff. From a privacy and information security
    standpoint, granting Congressional staff unrestricted access to the
    medical records of Veterans and other VA claimants is not in the best
    interest of Veterans and their families. VA patients and claimants
    entrust VA with their personal, medical, and other information, and
    they do not generally expect that such information could be viewed by
    Congress without their explicit consent. To the extent that
    Congressional staffers require access to an electronic claims record
    for which the Member of Congress possesses an appropriate release from
    the individual, access may be provided in the form of a disc or under
    supervision at a VA facility because those types of access are within
    the current capabilities of VA systems.

        Question 2.  Mr. McLenachen, we know that nearly one in three
    veterans live in rural areas, and that rural veterans have been
    underserved due to a lack of access to health care, which can be caused
    by greater travel barriers and other factors. The permanent
    reauthorization of the Veterans Transportation Service (VTS) program,
    through the Rural Veterans Travel Enhancement Act of 2015, would
    address this issue, and would provide veterans with reliable
    transportation to health care. Can you elaborate on why it's so
    important to permanently reauthorize this program?
        Response. The Veterans Transportation Service (VTS) has
    historically been a voluntary participation program for VA medical
    centers. The VTS Program is currently operating at 99 VA medical
    centers across the Nation. Currently, 53 VA medical centers do not
    participate in the VTS program. Participation has been less than 100
    percent largely due to uncertainty regarding future authorization for
    the program. Each year since its enactment in 2013, Congress has
    extended the expiration date for the program for an additional year,
    but the legal authority for the program is currently set to expire on
    December 31, 2016. Granting permanent authority for VTS to operate
    provides reassurance of continued program support, which cannot
    otherwise be assured. VTS can transport any Veteran; however, disabled,
    aged, frail, and critically ill Veterans face the largest
    transportation challenges in accessing care. VTS specializes in
    transporting Veterans with these challenges.

        Question 3.  Mr. McLenachen, in your written testimony, you mention
    that VA would support the reauthorization of the VTS program assuming
    that resources are provided to continue its operations. What kinds of
    resources are you referring to? Would this be an appropriation? If so,
    then how much are we talking about?
        Response. As with VA Medical Care in general, resources would need
    to be provided in the annual appropriation. VA would then allocate
    funds to cover the following costs of the VTS program, as follows:

         Salaries for Mobility Managers, Transportation
    Coordinators (schedulers/dispatchers) and Drivers;
         Funds for purchase of Americans with Disabilities Act
    compliant wheelchair vehicles, stretcher vans (ambulettes), and
    ambulances;
         Fuel and maintenance;
         Expansion of current Vet Ride System, which provides
    transport scheduling; metrics reporting; vehicle on-board mobile data
    computer with Veteran Health Identification Card swipe for safe patient
    tracking and monitoring; Veteran web-based trip request portal; a
    Third-Party Vendor portal for assigning, as appropriate, Beneficiary
    Travel Special Mode Transports to contractors when VTS cannot perform
    the transport; and a Special Mode Tracker feature for tracking all
    Special Mode Transports from the medical authorization through the
    claims reconciliation and payment process.

        The VTS Program has demonstrated significant cost avoidance in
    Beneficiary Travel Special Mode Transport contract provider costs and a
    significant reduction in Beneficiary Travel mileage reimbursement
    payments. Table 1 below indicates the costs required to implement and
    operate the VTS program at all 152 VA medical centers through fiscal
    year 2026. VA proposed an extension of the VTS Program in its FY 2017
    Budget (see Volume I, page Leg Sum-11, FY 2017 Budget Submission of the
    Department of Veterans Affairs).

      Table 1: Resources Required for VTS for all 152 VA medical centers
                      reflecting Special Mode cost offset

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Chairman Isakson. Now it is time to recognize the second
    panel, if you will come forward and sit according to the
    nameplates as they are placed. [Pause.]
        Our second panel includes Roscoe Butler, Deputy Director of
    Health Care, National Veterans Affairs and Rehabilitation
    Division of The American Legion; Carlos Fuentes, Deputy
    Director, National Legislative Service, Veterans of Foreign
    Wars; Rick Weidman, Executive Director for Policy and
    Government Affairs, Vietnam Veterans of America; and Kevin
    Ziober, member of the Reserve Component.
        We welcome all of you and look forward to your testimony.
    You have got 5 minutes. We will start with Roscoe Butler.
        Senator Tillis. Mr. Chairman, if I just may--I am sorry to
    interrupt, but you all are one of the main reasons why I like
    coming to these meetings. I appreciate the VA, yet I do have to
    go off to this other meeting. So, with respect to bills that I
    am working on, I would appreciate your offices contacting mine
    so that we can work together.
        Thank you, Mr. Chair. Sorry for the interruption.
        Chairman Isakson. Well, thank you, Senator Tillis.
        I would advise everybody, we do have a secure briefing
    which begins in 4 minutes.
        Roscoe Butler, welcome.

      STATEMENT OF ROSCOE BUTLER, DEPUTY DIRECTOR OF HEALTH CARE,
      NATIONAL VETERANS AFFAIRS AND REHABILITATION DIVISION, THE
                            AMERICAN LEGION

        Mr. Butler. Thank you. On March 4, 1865, during President
    Lincoln's second Inaugural Address, the President addressed our
    Nation's veterans and called upon the Nation to care for him
    who shall have borne the battle, and for his widow and his
    orphan, which affirmed the government's obligation to care for
    those injured during the war and to provide for the family of
    those who perished on the battlefield. This became the
    Department of Veterans Affairs trademark motto. Across the
    Nation, from Maine to Washington State, veterans, their
    families, and Veterans Service Organizations have called out
    again for affirming the government's obligation to care for our
    Nation's heroes and their families.
        Chairman Isakson, Ranking Member Blumenthal, and
    distinguished Members of the Committee, on behalf of the
    National Commander, Dale Barnett, and The American Legion, the
    country's largest patriotic wartime service organization for
    veterans, comprising over two million members and serving every
    man and woman who has worn the uniform for this country, we
    thank you for the opportunity to testify regarding The American
    Legion's positions on the pending draft bills.
        There are several bills on the agenda today and you have
    our full written remarks for the record. Therefore, I will
    focus only on a couple of key bills.
        Operation Iraqi Freedom, Enduring Freedom, and New Dawn
    veterans are returning home in alarming numbers with Traumatic
    Brain Injuries. TBI has become one of the signature injuries of
    the current war on terror. Recently, VA acknowledged that it
    may have under-evaluated nearly 25,000 veterans suffering from
    TBI. In a June 2016 press release, VA stated veterans whose
    initial examination for TBI was not conducted by one of four
    designated medical specialists and provides them with the
    opportunity to have their claims reprocessed. TBI is an
    inherently complex medical condition and requires the opinions
    of specialized medical professionals to determine the level of
    severity and disability.
        S. 244 would require an independent comprehensive review of
    the process by which VA assesses cognitive impairments that
    result from TBI for purposes of awarding disability
    compensation and for other purposes. The American Legion
    believes that it is imperative that Congress ensure that
    veterans suffering from the devastating and debilitating
    effects of TBI are properly evaluated for the conditions and
    any symptoms associated with the conditions for those reasons
    mentioned. The American Legion supports S. 244.
        In 2014, The American Legion System Worth Saving program
    issued a report on rural health care and in 2014 issued a
    report on women veterans' health care. Both reports identified
    significant challenges veterans face in obtaining health care
    in rural locations as well as health care challenges women
    veterans face.
        S. 2210, the PEER Act, calls on the Department of Veterans
    Affairs to establish peer specialists to be assigned in
    patient-aligned care teams at designated VA medical centers, to
    include female peer specialists. Peer specialists in the
    private sector have become an integral part of health care
    teams and are vital in promoting the recovery of patients.
        The American Legion believes this bill will improve health
    care for male and female veterans living in rural areas. The
    American Legion supports developing a national program to
    provide peer-to-peer rehabilitation services based on the
    recovery model tailored to meet the specialized need of current
    generation's combat affected veterans and their families.
    Therefore, The American Legion strongly believes the Secretary
    of Veterans Affairs should utilize returning servicemembers for
    positions as peer support specialists in the effort to provide
    treatment, support services, and readjustment counseling for
    those veterans requiring these services. Therefore, The
    American Legion supports S. 2210.
        I want to thank you, Chairman Isakson, Ranking Member
    Blumenthal, and Members of the Committee. I appreciate the
    opportunity to present The American Legion's views and look
    forward to answering any questions you may have.
        [The prepared statement of Mr. Butler follows:]
    Prepared Statement of Roscoe G. Butler, Deputy Director of Health Care,
      National Veterans Affairs and Rehabilitation Division, The American
                                     Legion
        Chairman Isakson, Ranking Member Blumenthal, and distinguished
    Members of the Committee: On behalf of National Commander Dale Barnett
    and The American Legion; the country's largest patriotic wartime
    service organization for veterans, comprising over 2 million members
    and serving every man and woman who has worn the uniform for this
    country; we thank you for the opportunity to testify regarding The
    American Legion's position on the pending and draft legislation.
                                     s. 244
    A bill to require an independent comprehensive review of the process by
            which the Department of Veterans Affairs assesses cognitive
            impairments that result from Traumatic Brain Injury for
            purposes of awarding disability compensation, and for other
            purposes.
        Traumatic Brain Injury (TBI) has been identified as the ``signature
    injury'' of Operation Enduring Freedom (OEF), Operation Iraqi Freedom
    (OIF) and Operation New Dawn (OND). Servicemembers have experienced
    injuries related to their combat experiences that will likely
    negatively impact their earnings post-service. As a result, it is
    imperative that we ensure that veterans suffering from the devastating
    and debilitating effects of TBI are properly evaluated for the
    condition and any symptoms associated with the conditions.
        Recently, VA acknowledged that it may have under evaluated nearly
    25,000 veterans suffering from TBI. In a June 2016 press release, VA
    stated, ``Veterans whose initial examination for TBI was not conducted
    by one of four designated medical specialists and provides them with
    the opportunity to have their claims reprocessed.'' \1\ TBI is an
    inherently complex medical condition and requires the opinions of
    specialized medical professionals to determine the level of severity
    and disability.
    ---------------------------------------------------------------------------
        \1\ VA Office of Public and Intergovernmental Affairs: VA Secretary
    Provides Relief for Veterans with Traumatic Brain Injuries (June 1,
    2016)
    ---------------------------------------------------------------------------
        S. 244 directs VA to work with the Institute of Medicine (IOM) to
    conduct a comprehensive review of VA examinations to ensure that they
    are appropriately targeting symptoms and levels of disability by TBI
    sufferers. Additionally, it directs IOM to convene medical experts to
    determine the required credentials necessary to assess cognitive
    functions and provide recommendations to improve the adjudications of
    claims.
        The American Legion has over 3,000 accredited representatives
    responsible for the effective advocacy of veterans' benefits throughout
    the Nation. It is not uncommon to hear reports from these
    representatives of the under evaluation of claims associated with TBI;
    despite their determined efforts to have these claims adjudicated
    properly by a VA rater, they often are compelled to appeal these
    decisions and have veterans who suffer from the pain and trauma
    associated with TBI wait for years to finally have their claims
    properly adjudicated.
        The American Legion by resolution stated, ``That Congress and the
    Administration encourage acceleration in the development and initiation
    of needed research on conditions that significantly affect veterans,
    such as prostate cancer, addictive disorders, trauma and wound healing,
    Post-Traumatic Stress Disorder, Traumatic Brain Injury, rehabilitation,
    and others, jointly with the Department of Defense, the National
    Institutes of Health, other Federal agencies, academic institutions and
    the Department of Veterans Affairs.'' \2\
    ---------------------------------------------------------------------------
        \2\ American Legion Resolution No. 148 (August 2014): Request
    Congress Provide the Department of Veterans Affairs Adequate Funding
    for Medical and Prosthetic Research
    ---------------------------------------------------------------------------
        The American Legion supports S. 244.
             s. 603: rural veterans travel enhancement act of 2015
    A bill to make permanent the authority of the Secretary of Veterans
            Affairs to transport individuals to and from facilities of the
            Department of Veterans Affairs in connection with
            rehabilitation, counseling, examination, treatment, and care,
            and for other purposes.
        One out of every three veterans treated by the Department of
    Veterans Affairs (VA) lives in rural communities and rural veterans
    have been underserved due to a lack of access to health care, which can
    be attributed to greater travel barriers and a lack of public
    transportation. S. 603 would make it easier for veterans who live in
    rural areas to be reimbursed for expenses occurred as a result of
    traveling long distances for their medical and mental health
    appointments. This bill would permanently reauthorize the Department of
    Veterans Affairs (VA) Veterans Transportation Program (VTS). The VTS
    program provides funding to local VA healthcare systems to hire
    transportation coordinators and purchase vehicles that staff can
    utilize to transport veterans to the care they need. The Rural Veterans
    Travel Enhancement Act of 2015 would also provide mileage reimbursement
    for combat veterans traveling to receive mental health care at Vet
    Centers, and would amend the Caregivers and Veterans Omnibus Health
    Services Act of 2010 to reauthorize through FY 2020 a grant program to
    provide innovative transportation options to veterans in highly rural
    areas.
        Based on VA's interpretation of titles 38 U.S.C. Sec. 111,
    Beneficiary Travel, and 38 U.S.C. Sec. 1712A, entitled ``Eligibility
    for readjustment counseling and related mental health services,'' VA
    has interpreted these laws to mean they do not allow payment of
    beneficiary travel benefits to veterans traveling to Vet Centers.
    Veterans traveling to Vet Centers should be eligible for beneficiary
    travel benefits on the same basis as other veterans.
        The American Legion urges the Secretary to seek adequate funding to
    accommodate the needs of the increasing demand for care, to include the
    need for a Veterans Transportation System (VTS), accompanied by an
    increase in the beneficiary travel rate.\3\
    ---------------------------------------------------------------------------
        \3\ American Legion Resolution No. 106 (August 2014): Veterans
    Transportation System & Benefits Travel
    ---------------------------------------------------------------------------
        The American Legion supports S. 603.
     s. 2210: veteran partners' efforts to enhance reintegration (peer) act
    A bill to require the Secretary of Veterans Affairs to carry out a
            program to establish peer specialists in patient aligned care
            teams at medical centers of the Department of Veterans Affairs,
            and for other purposes.
        A peer support specialist is a person with significant life
    altering experience who works to assist individuals with chemical
    dependency, mental disorder or domestic abuse and other life effecting
    issues. Due to their life experiences, such persons have expertise that
    professional training cannot replicate. This is not to be confused with
    peer educators who may not consider recovery a suitable goal for
    everyone and may focus instead on the principles of harm reduction.
    There are many tasks performed by peer support specialists that may
    include assisting their peers in articulating their goals for recovery,
    learning and practicing new skills, helping them monitor their
    progress, assisting them in their treatment, modeling effective coping
    techniques and self-help strategies based on the specialist's own
    recovery experience, and supporting them in advocating for themselves
    to obtain effective services.
        S. 2210 would expand VA's current use of peer specialists from
    mental health clinics to be utilized in primary care settings. The PEER
    Act would require the Department of Veterans Affairs (VA) to establish
    a pilot program of peer specialists to work as members of VA's patient-
    aligned care teams (PACT), for the purpose of promoting the integration
    of mental health services in a VA primary care setting. This bill would
    authorize the establishment of this pilot program in 25 VA sites, to
    include the five VA's Polytrauma centers across the country. The bill
    would also require a series of reports, including a final report to
    recommend whether the program should be expanded beyond the pilot
    program sites.
        The American Legion urges the President of the United States and
    the U.S. Congress to call on the Secretary of Veterans Affairs to
    develop a national program to provide peer to peer rehabilitation
    services based on the recovery model tailored to meet the specialized
    needs of current generation combat-affected veterans and their
    families.\4\
    ---------------------------------------------------------------------------
        \4\ American Legion Resolution No. 284 (August 2014): Department of
    Veterans Affairs to Develop Outreach and Peer to Peer Programs for
    Rehabilitation
    ---------------------------------------------------------------------------
        The American Legion supports S. 2210.
             s. 2279 veterans health care staffing improvement act
        A bill to require the Secretary of Veterans Affairs to carry out a
    program to increase efficiency in the recruitment and hiring by the
    Department of Veterans Affairs of health care workers that are
    undergoing separation from the Armed Forces, to create uniform
    credentialing standards for certain health care professionals of the
    Department, and for other purposes.
        S. 2279 would make changes in staffing policies throughout the VA
    healthcare system to improve the recruitment of health care workers who
    are transitioning from military service. Throughout the country
    veterans are faced with waiting weeks or even months for a health care
    appointment. These barriers to receiving quality care can be attributed
    to a shortfall of tens of thousands of medical professionals to provide
    that care. This bill would decrease the bureaucratic red tape by making
    it easier for the VA to increase staffing throughout the VA healthcare
    system and ultimately reduce wait times for thousands of veterans. This
    bill also includes the ``Docs-to-Doctors'' program which allows
    servicemembers who have served in the medical field to transition
    directly into the VA which would allow veterans access to health care
    they need in a timely manner.
        The American Legion supports Sections 2 and 3 of S. 2279; however,
    at this time The American Legion does not have a position on Section 4,
    which is granting Nurses and Physicians Assistants full practice
    authority.
                                    s. 2316
    A bill to expand the requirements for reissuance of veterans benefits
            in cases of misuse of benefits by certain fiduciaries to
            include misuse by all fiduciaries, to improve oversight of
            fiduciaries, and for other purposes.
        Without question, veterans requiring a fiduciary are some of our
    Nation's most vulnerable. Unable to manage their financial affairs, VA
    will appoint a fiduciary to ensure that payments for bills are provided
    from their VA benefits. Due to their vulnerable states, veterans are
    exposed to abuse by their fiduciary and may face daunting challenges to
    recover lost payments.
        The American Legion has previously testified regarding the need to
    reform the fiduciary program. Repeatedly, we have heard from our
    accredited representatives about veterans being financially harmed by
    their appointed fiduciary.
        In 2011, the Federal Bureau of Investigation (FBI) detailed a
    conviction of two individuals, to include one former VA employee, of
    defrauding veterans of nearly $900,000 between 1999-2008.\5\ Based upon
    allegations received by VA's Office of Inspector General (VAOIG) in
    May 2013, an investigation of the Eastern Area Fiduciary Hub was
    conducted; as stated in the May 2014 VAOIG report, there were 12
    incidents of fiduciaries misusing funds, costing veterans approximately
    $944,000 in benefits.\6\
    ---------------------------------------------------------------------------
        \5\ The Federal Bureau of Investigation: Veterans' Benefit
    Fiduciary and Former U.S. Department of Veterans Affairs Employee Plead
    Guilty to Embezzling Nearly $900,000 (August 10, 2011)
        \6\ VA OIG report (May 28, 2014): Review of Alleged Mismanagement
    at the Eastern Area Fiduciary Hub
    ---------------------------------------------------------------------------
        Unfortunately, it is often noticed after years of a fiduciary's
    abuse of a veteran's funds. This can amount to hundreds of thousands of
    dollars lost by the veteran. Currently, the only way that a veteran can
    pursue the lost benefits are through civil court proceedings.
        S. 2316 removes the requirement of these vulnerable veterans to
    have to pursue civil litigation to recover the lost benefits. It places
    the requirement on VA; considering that VA is responsible for assigning
    a fiduciary, it stands to reason that they should inherit the
    responsibility of recovering the lost benefits by unscrupulous
    fiduciaries. Through this bill, we can move to protecting beneficiaries
    from the unlawful taking of benefits by unscrupulous fiduciaries from
    our Nation's veterans.
        Recognizing that veterans requiring fiduciaries are often some of
    our Nation's most vulnerable veterans, The American Legion supports
    legislation requiring the Department of Veterans Affairs to provide
    oversight over their fiduciary program and that it protects veterans
    and their beneficiaries who are unable to manage their financial
    affairs.\7\
    ---------------------------------------------------------------------------
        \7\ American Legion Resolution No. 103 (September 2015): Fiduciary
    Responsibility
    ---------------------------------------------------------------------------
        The American Legion supports S. 2316.
                 s. 2791--atomic veterans healthcare parity act
    A bill to provide for the treatment of veterans who participated in the
            cleanup of Enewetak Atoll as radiation exposed veterans for
            purposes of the presumption of service-connection of certain
            disabilities by the Secretary of Veterans Affairs.
        From 1977 to 1980, thousands of members of the United States Armed
    Forces participated in a radiation cleanup of United States nuclear
    test sites in the Marshall Islands. S. 2791 would provide for the
    treatment and service-connection presumption of certain disabilities
    related to those veterans who participated in the cleanup of the
    Enewetak Atoll and other areas that conducted nuclear testing. The
    Atomic Veterans Healthcare Parity Act would help veterans who were
    exposed through the cleanup at these atomic sites to access the
    benefits and treatment they earned.
        The American Legion highlighted the plight of these veterans, left
    behind and struggling to gain access to treatment and benefits due to
    the way the laws are written, in the March 2016 issue of The American
    Legion Magazine entitled, ``Toxic Paradise,'' as well as on our
    website.
        The American Legion urges ensuring medical examinations,
    compassionate treatment and just compensation for veterans exposed to
    environmental hazards ``through testing, transportation, storage, and
    disposal.'' \8\
    ---------------------------------------------------------------------------
        \8\ American Legion Resolution No. 125 (August 2014): Environmental
    Exposures
    ---------------------------------------------------------------------------
        The American Legion supports S. 2791.
                                    s. 2958
    A bill to establish a pilot program on partnership agreements to
            construct new facilities for the Department of Veterans
            Affairs.
        Veterans are frustrated and concerned with VA's construction
    processes and the continued delays and cost overruns and unsure whether
    VA's improvements will ensure VA major construction in the future will
    be within schedule and budget. S. 2958 would allow the VA to enter into
    public-private partnerships for the planning, design and construction
    of new buildings for the use by the Department of Veterans Affairs.
    This bill would allow improvements to be made to VA medical centers to
    better serve veterans by creating a pilot program that would allow the
    VA to create up to five partnerships to assist with their VA
    construction projects.
        The American Legion urges VA to consider all available options,
    both within the agency and externally, to include, but not limited to,
    the Army Corps of Engineers to ensure major construction programs are
    completed on time and within budget.\9\
    ---------------------------------------------------------------------------
        \9\ American Legion Resolution No. 24 (May 2015): Department of
    Veterans Affairs Construction Programs
    ---------------------------------------------------------------------------
        The American Legion supports S. 2958.
                                    s. 3021
    A bill to authorize the use of Post-9/11 Educational Assistance to
            pursue independent study programs at certain educational
            institutions that are not institutions of higher learning.
        This bill would provide student-veterans with expanded scope and
    usage of the Post-9/11 GI Bill education benefits to other forms of
    postsecondary institutions. This legislation adds needed options to
    student-veterans in the pursuit of their educational goals. The Post-9/
    11 GI Bill passed by Congress in 2008 has been an effective upgrade for
    21st century veterans using their college education benefits. It was
    not, nor can it be, a law so static that it cannot continue evolving to
    best meet the needs of student-veterans in an ever-shifting landscape
    of higher education and career training.
        Last, The American Legion has been encouraged by the growing
    recognition within Congress of the need to make basic, but critical
    information about the return on investment in higher education
    available to student-veterans.
        The American Legion seeks and supports any legislative or
    administrative proposal that improves, but not limited to, the GI Bill,
    Department of Defense Tuition Assistance (TA), Higher Education Title
    IV funding (i.e., Pell Grants, Student Loans, etc.) and education
    benefits so servicemembers, veterans, and their families can maximize
    its usage.\10\
    ---------------------------------------------------------------------------
        \10\ American Legion Resolution No. 312 (August 2014): Ensuring the
    Quality of Servicemember and Veteran Student's Education at
    Institutions of Higher Learning
    ---------------------------------------------------------------------------
        The American Legion supports S. 3021.
                         s. 3023--the arla harrell act
    A bill to provide for the reconsideration of claims for disability
            compensation for veterans who were the subjects of experiments
            by the Department of Defense during World War II that were
            conducted to assess the effects of mustard gas or lewisite on
            people, and for other purposes.
        For 10 years, Arla Harrell has sought VA disability compensation
    for conditions he attributes to his military service. While stationed
    at Camp Crowder, Missouri, during the waning days of World War II, he
    reports being subjected to mustard gas exposure as part of a secret
    experimental program. The exposure led to a lifetime of respiratory
    ailments.
        Unfortunately, like many World War II veterans, his military
    records were burned in the National Personnel Records fire of 1973. To
    further complicate the matter, neither the Department of Defense (DOD)
    nor VA have been able to produce accurate records indicating the
    impacted veterans. According to an article published on May 27, 2016,
    in the St. Louis Post Dispatch, National Public Radio uncovered in
    November 2015 that 3,900 veterans were exposed to mustard gas
    experiments, a list six times greater than VA previously
    acknowledged.\11\
    ---------------------------------------------------------------------------
        \11\ St. Louis Post Dispatch (May 27, 2016): ``World War II vet's
    mustard gas claim again denied, but VA boss pledges look at new
    evidence''
    ---------------------------------------------------------------------------
        38 CFR Sec. 3.316 identifies a host of medical conditions, to
    include respiratory conditions that are presumptively related to
    mustard gas exposure. The issue is not what conditions to service
    connect presumptively; S. 3023 will allow VA to presumptively service
    connect veterans for exposure to mustard gas based upon participating
    in mustard gas testing.
        The American Legion has long supported service connecting veterans
    presumptively due to environmental exposures. The American Legion
    supports ``the liberalization of the rules relating to the evaluation
    of studies involving exposure to any environmental hazard and that all
    necessary action be taken by the Federal Government, both
    administratively and legislatively as appropriate, to ensure that
    veterans are properly compensated for diseases and other disabilities
    scientifically associated with a particular exposure'' \12\
    ---------------------------------------------------------------------------
        \12\ American Legion Resolution No. 125 (August 2016):
    Environmental Exposures
    ---------------------------------------------------------------------------
        The American Legion supports S. 3023.
     s. 3032--veterans' compensation cost-of-living adjustment act of 2016
    A bill to provide for an increase, effective December 1, 2016, in the
            rates of compensation for veterans with service-connected
            disabilities and the rates of dependency and indemnity
            compensation for the survivors of certain disabled veterans,
            and for other purposes.
        This bill will provide a Cost of Living Allowance (COLA) effective
    December 1, 2016. Disability compensation and pension benefits awarded
    by the Department of Veterans Affairs (VA) are designed to compensate
    veterans for medical conditions due to service or who earn below an
    income threshold. With annual increases to costs of living, it is only
    appropriate that veterans' benefits increase commensurate with those
    increases.
        For nearly 100 years, The American Legion has advocated on behalf
    of our Nation's veterans, to include the awarding of disability
    benefits associated with chronic medical conditions that manifest
    related to selfless service to this Nation. Annually, veterans and
    their family members are subjects in the debate regarding the annual
    cost of living adjustment (COLA) for these disability benefits. For
    these veterans and their family members, COLA is not simply an acronym
    or a minor adjustment in benefits; instead, it is a tangible benefit
    that meets the needs of the increasing costs of living in a nation that
    they bravely defended.
        The American Legion would like to commend the members on this bill.
    Previous bills introduced have had ``round-down'' provisions, where
    veterans' benefits were rounded-down to the next whole dollar. This is
    a frustrating practice that has an insidious effect over years of
    receiving benefits.
        The American Legion supports legislation to provide a periodic
    cost-of-living adjustment increase and to increase the monthly rates of
    disability compensation.\13\
    ---------------------------------------------------------------------------
        \13\ American Legion Resolution No. 18 (August 2014): Department of
    Veterans Affairs Disability Compensation
    ---------------------------------------------------------------------------
        The American Legion supports S. 3032.
    s. 3035--maximizing efficiency and improving access to providers at the
                   department of veterans affairs act of 2016
    A bill to require the Secretary of Veterans Affairs to carry out a
            pilot program to increase the use of medical scribes to
            maximize the efficiency of physicians at medical facilities of
            the Department of Veterans Affairs.
        Veterans are experiencing long wait times for VA health care for a
    variety of reasons, but in part due to high patient load and not enough
    doctors to serve the population. This shortage is a nationwide problem.
        A medical scribe is a paraprofessional who specializes in charting
    physician-patient encounters in real time, such as during medical
    examinations. Depending on which area of practice the scribe works in,
    the position may also be called clinical scribe, ER scribe or ED scribe
    (in the emergency department), or just scribe (when the context is
    implicit). A scribe is trained in health information management and the
    use of health information technology to support it. A scribe can work
    on-site (at a hospital or clinic) or remotely from a Health Insurance
    Portability and Accountability Act (HIPAA) secure facility. Medical
    scribes who work at an offsite location are known as virtual medical
    scribes and normally work in clinical settings.
        A medical scribe's primary duties are to follow a physician through
    his or her work day and chart patient encounters in real-time using a
    medical office's electronic health record (EHR) and existing templates.
    Medical scribes also generate referral letters for physicians, manage
    and sort medical documents within the EHR system, and assist with e-
    prescribing. Medical scribes can be thought of as data care managers,
    enabling physicians, medical assistants, and nurses to focus on patient
    in-take and care during clinic hours. Medical scribes, by handling data
    management tasks for physicians in real-time, free the physician to
    increase patient contact time, give more thought to complex cases,
    better manage patient flow through the department, and increase
    productivity to see more patients.
        S. 3035 would require VA to carry out an 18 month pilot program in
    no less than five high-volume VA medical centers for the contract
    hiring of medical scribes to assist VA physicians with workload. This
    bill will ensure doctors have more time to see patients rather than
    entering in medical data and will serve as a recruitment tool for
    doctors who want a package comparable to the private sector.
        The American Legion supports any legislation and programs within
    the VA that will enhance, promote, restore or preserve benefits for
    veterans and their dependents, including timely access to quality VA
    health care.\14\
    ---------------------------------------------------------------------------
        \14\ American Legion Resolution No. 23 (May 2016):Support for
    Veteran Quality of Life
    ---------------------------------------------------------------------------
        The American Legion supports S. 3035.
           s. 3055--department of veterans affairs dental insurance
                          reauthorization act of 2016
    A bill to provide a dental insurance plan to veterans and survivors and
            dependents of veterans.
        S. 3055 would reauthorize the current veteran dental insurance
    pilot program that was included in the Caregiver and Veterans Omnibus
    Health Services Act of 2010. This bill would ensure that eligible
    veterans, survivors and dependents of veterans continue to access
    quality dental insurance at a low cost.
        Under current VA's dental authority, only certain enrolled veterans
    are eligible for outpatient dental care from the VA. If this bill was
    enacted into law, veterans not eligible for VA benefits would be also
    able to enroll in the VA Dental Insurance Program (VADIP). Each veteran
    enrolled in the plan shall pay the entire premium for coverage under
    the dental insurance plan, in addition to the full cost of any
    copayment.
        The American Legion urges Congress and the VA to enact legislation
    and programs within the VA that will enhance benefits for veterans and
    their dependents.\15\
    ---------------------------------------------------------------------------
        \15\ American Legion Resolution No. 23 (May 2016): Support for
    Veteran Quality of Life
    ---------------------------------------------------------------------------
        The American Legion supports S. 3055.
             s. 3076--charles duncan buried with honor act of 2016
    A bill to authorize the Secretary of Veterans Affairs to furnish
            caskets and urns for burial in cemeteries of States and Indian
            tribes of veterans without sufficient resources to provide for
            caskets or urns.
        The draft bill would amend Title 38 United States Code (U.S.C)
    Section 2306 entitled Headstones, markers, and burial receptacles
    subsection (f). Under current law, Title 38 U.S.C. Sec. 2306(f), the
    Secretary may furnish a casket or urn, of such quality as the Secretary
    considers appropriate for a dignified burial, for burial in a national
    cemetery of a deceased veteran in any case in which the Secretary is
    unable to identify the veteran's next of kin, if any; and determines
    that sufficient resources for the furnishing of a casket or urn for the
    burial of the veteran in a national cemetery are not otherwise
    available. The bill would allow for such burial in cemeteries of States
    and Native American Indian tribes of veterans without sufficient
    resources to provide for caskets or urns.
        The American Legion urges Congress and the Department of Veterans
    Affairs (VA) to enact legislation and programs within the VA that will
    enhance, promote, restore or preserve benefits for veterans and their
    dependents with final resting places in national shrines and with
    lasting tributes that commemorates their service.\16\
    ---------------------------------------------------------------------------
        \16\ American Legion Resolution No. 23: (May 2016): Support for
    Veteran Quality of Life
    ---------------------------------------------------------------------------
        The American Legion supports S. 3076.
     s. 3081--working to integrate networks guaranteeing member access now
                             act (``wingman act'')
    To amend title 38, United States Code, to provide certain employees of
            Members of Congress and certain employees of State or local
            governmental agencies with access to case-tracking information
            of the Department of Veterans Affairs.
        The WINGMAN Act would grant access to the Department of Veterans
    Affairs (VA) Veterans Benefits Management System (VBMS) for the purpose
    of assisting constituents. According to the bill, Members could select
    an employee, and at a cost to the employee or member, would receive the
    necessary training to gain accreditation to legally review veterans'
    records within VBMS. The American Legion has over 3,000 accredited
    representatives located throughout the Nation. These professionals
    receive regular professional training to ensure they have the most
    current understanding of the impact of changes in statutes,
    regulations, and case law. It is simply not a matter of receiving
    initial training and meeting the requirement of being accredited; like
    many professions, it requires on-going, thorough training.
    Additionally, veterans are repeatedly advised of their opportunity to
    elect to have a Veterans Service Organization (VSO) represent them in
    their quest to receive VA disability benefits without a cost to the
    veteran. The American Legion does not have a resolution to support the
    enactment of this bill; however, we urge Congress to consider the long-
    term ramifications of supporting legislation that only requires their
    own employees to have the minimal level of understanding in veterans'
    law assisting their constituents. To ensure their constituents receive
    the assistance they deserve, we highly recommend that a VSO advocate on
    their veterans' behalf.
        The American Legion Opposes the S. 3081.
                                   draft bill
    A bill to clarify the scope of procedural rights of members of the
            uniformed services with respect to their employment and
            reemployment rights, to improve the enforcement of such
            employment and reemployment rights, and for other purposes.
        With the number of Uniformed Services Employment and Reemployment
    Rights Act of 1994 (USERRA) cases across the country, The American
    Legion is deeply concerned with the protection of the servicemember and
    the prevention of the servicemember not being reemployed by their
    previous employer after deployment(s). USERRA cases have become more
    complex than in the past and frequently involve multiple issues. This
    is due to longer and more frequent deployments of National Guard and
    Reserve members. As currently drafted, USERRA fails to adequately
    support military personnel upon their return to civilian employment as
    numerous employers have violated the rules laid out in Title 38 of the
    United States Code.
        This bill would improve USERRA by clarifying the scope of USERRA
    rights and expand the enforcement authority of the Department of
    Justice (DOJ). This legislation adds essential authority to DOJ that
    provides the kind of protection for servicemembers' employment--which
    includes compensatory and punitive damages--which servicemembers have
    earned through their honorable service for the United States of
    America.
        The American Legion seeks and supports any legislative or
    administrative proposal that will mandate the use of automated
    recruitment, hiring and retention system that safeguard against hiring
    malpractice in the application and the hiring process.\17\ The American
    Legion supports legislation to amend Title 38, U.S.C., to prohibit
    discrimination and acts of reprisals by employers against veterans that
    seek treatment for their service-connected disabilities.\18\
    ---------------------------------------------------------------------------
        \17\ American Legion Resolution No. 301 (August 2014): Enforcing
    Veterans' Preference Hiring Practices in Federal Civil Service
        \18\ American Legion Resolution No. 341 (August 2014): Resolution
    No. 341: Support Legislation to Amend Title 38 United States Code, to
    Prohibit Discrimination and Acts of Reprisal by Employers against
    Veterans that Seek Treatment for Their Service-Connected Disabilities
    ---------------------------------------------------------------------------
        The American Legion supports the Draft Bill.
                                   draft bill
    A bill to expand eligibility for readjustment counseling to certain
            members of the Selected Reserve of the Armed Forces.
        Readjustment counseling is made up of a wide range of psychosocial
    services offered to eligible veterans and their families in the effort
    to make a successful transition from military to civilian life. The
    draft bill would amend Title 38 United States Code Section 1712A
    entitled Eligibility for readjustment counseling and related mental
    health services by adding new subparagraphs under the current law that
    includes: (D)(i) The Secretary, in consultation with the Secretary of
    Defense, may furnish to any member of the Selected Reserve of the Armed
    Forces who has a behavioral health condition or psychological trauma,
    counseling under subparagraph (A)(i),which may include a comprehensive
    individual assessment under subparagraph (B)(i) and (ii) A member of
    the Selected Reserve of the Armed Forces described in clause (i) shall
    not be required to obtain a referral before being furnished counseling
    or an assessment under this subparagraph.''
        The American Legion urges Congress and the Department of Veterans
    Affairs (VA) to enact legislation and programs within the VA that will
    enhance, promote, restore or preserve benefits for veterans and their
    dependents, including, but not limited to, the following: timely access
    to quality VA health care.\19\
    ---------------------------------------------------------------------------
        \19\ American Legion Resolution No. 23 (May 2016): Support for
    Veterans Quality of Life
    ---------------------------------------------------------------------------
        The American Legion supports the Draft Bill.
                                   draft bill
    A bill to authorize payment by the Department of Veterans Affairs for
            the costs associated with service by medical residents and
            interns at facilities operated by Indian tribes and tribal
            organizations, to require the Secretary of Veterans Affairs to
            carry out a pilot program to expand medical residencies and
            internships at such facilities, and for other purposes.
        This bill would require the Secretary of Veterans Affairs to
    implement a pilot program to establish graduate medical education (GME)
    residency training programs at covered facilities. According to Title
    25 U.S. Code Subchapter II--Indian Self-Determination and Education
    Assistance 450b Section 4 of the Indian Self-Determination and
    Education Assistance Act--VA defines a covered facility to mean a
    department facility, or a facility operated by an Indian tribe or a
    tribal organization.
        The American Legion supports any legislation or policies that will
    enhance, promote, restore, or preserve benefits for veterans and their
    dependents.\20\
    ---------------------------------------------------------------------------
        \20\ American Legion Resolution No. 23 (May 2016): Support for
    Veterans Quality of Life
    ---------------------------------------------------------------------------
        The American Legion supports the Draft Bill.
                                discussion draft
    To authorize the American Battle Monuments Commission to acquire,
            operate, and maintain the Lafayette Escadrille memorial in
            Marnes-la-Coquette, France
        The Lafayette Escadrille Memorial is dedicated to the memory of the
    American pilots who volunteered to assist the Allied Army in 1914. The
    central platform is crowned with a triumphal arch and flanked with
    porticos leading to the underground crypt. The ``art deco'' style
    highlights the pilots' sacrifice and the Franco-American friendship.
        There are statues of Lafayette and Washington facing one another
    and, on the ground, a mosaic of the famous Sioux warrior's head, the
    squadron's ensign. The crypt holds the ashes of 66 American pilots. It
    is decorated with 13 stained glass windows depicting the great aerial
    combats of the war. The monument was inaugurated on American
    Independence Day, July 4, 1928.
        The discussion draft would authorize the American Battle Monuments
    Commission (ABMC), which was established by the Congress in 1923, as
    the guardian of America's overseas commemorative cemeteries and
    memorials and honors the service, achievements and sacrifices of the
    United States Armed Forces by overseeing the operations of the memorial
    which has been erected to honor those who gave the ultimate sacrifice
    for their country.
        The American Legion urges Congress to appropriate adequate funding
    and human resources to the American Battle Monuments Commission in
    order to properly maintain and preserve the final resting place of
    America's war dead located on foreign soil.\21\
    ---------------------------------------------------------------------------
        \21\ American Legion Resolution No. 50 (August 2014): Support for
    the American Battle Monuments Commission
    ---------------------------------------------------------------------------
        The American Legion supports the Discussion Draft.
                                   conclusion
        As always, The American Legion thanks this Committee for the
    opportunity to explain the position of the over 2 million veteran
    members of this organization. For additional information regarding this
    testimony, please contact Mr. Warren J. Goldstein at The American
    Legion's Legislative Division at (202) 861-2700 or
    wgoldstein@legion.org.

        Chairman Isakson. Roscoe, you are always thorough and we
    appreciate your input on the Committee's work all the time.
    Thank you for coming today.
        Mr. Fuentes.

        STATEMENT OF CARLOS FUENTES, DEPUTY DIRECTOR, NATIONAL
             LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS

        Mr. Fuentes. Mr. Chairman, Ranking Member Blumenthal, and
    Members of the Committee, on behalf of the men and women of the
    VFW and our Auxiliaries, I would like to thank you for the
    opportunity to present our views on legislation pending before
    the Committee.
        The VFW supports most of the bills being considered today,
    but I will limit my remarks to those we urge the Committee to
    amend.
        The VFW supports the Maximizing Efficiency and Improving
    Access to Providers Act. However, we urge the Committee to
    require contractors hired as medical scribes to help VA
    providers locate medical documents in a veteran's electronic
    health care record, such as labs and private sector health
    records. This would ensure VA providers spend less time
    navigating electronic health care records and more time
    treating veterans.
        The VFW supports the VA Dental Insurance Reauthorization
    Act of 2016 but urges the Committee to consider expanding VA
    dental care eligibility instead of passing on the costs of
    dental coverage onto the veterans. Oral health has a direct
    impact on overall health. Additionally, several health care
    conditions prevalent among veterans, such as diabetes, have
    been found to directly impact oral health. Until January 2014,
    veterans enrolled in VA health care have little to no options
    for receiving dental care. While the VA dental insurance
    program provides dental care options to 100,000 veterans and
    their eligible families, VFW members consider this program as
    better than nothing. The VFW believes veterans have earned the
    best, not better than nothing.
        Additionally, veterans who participate in the dental
    insurance program do not have their dental records integrated
    into their VA electronic health care records. Thus, VA
    providers are unable to determine if these veterans have dental
    conditions that may impact their overall health. That is why
    the VFW supports expanding eligibility for VA dental care to
    all veterans who are enrolled in--who are eligible for VA
    health care.
        While the VFW agrees with the need to improve the ability
    of Congressional staff to assist veterans with their claims, we
    cannot support the WINGMAN Act at this time. We have several
    concerns that would need to be addressed before we could
    support this bill, and like VA, our reading of the bill did not
    require Congressional staff to have signed releases before
    having access to the records. We agree with VA and Senator
    Cassidy that that is necessary.
        When a power of attorney is held by an individual or
    organization, that entity must be notified of Congressional
    involvement. Congressional staff must pass VA certification
    tests and level-sensitive restrictions that apply to VA
    employees and service officers must also apply to Congressional
    staff, including consequences for staff found to have abused
    their authority.
        The VFW acknowledges the need for improved access to mental
    health care for Guard and Reserve servicemembers, but we cannot
    support the expansion of Vet Center eligibility to non-combat
    veterans. The rate of suicide among our servicemembers is
    equally as troubling as the rate of suicide among veterans.
    While DOD's suicide prevention programs have successfully
    reduced the rate of suicides among our active duty force, it
    has not been able to replicate those efforts in its Reserve
    components. To address this need, the VFW urges Congress and
    DOD to devote more efforts and resources to combat the rate of
    suicide among Guardsmen and Reservists. Additionally, DOD must
    leverage shared agreements with VA to ensure Guardsmen and
    Reservists who live in rural and remote areas have access to
    the mental health care they need.
        Mr. Chairman, this concludes my remarks. I am happy to
    answer any questions you or the Members of the Committee may
    have.
        [The prepared statement of Mr. Fuentes follows:]
        Prepared Statement of Carlos Fuentes, Deputy Director, National
       Legislative Service, Veterans of Foreign Wars of the United States
        Chairman Isakson, Ranking Member Blumenthal and Members of the
    Committee, on behalf of the men and women of the Veterans of Foreign
    Wars of the United States (VFW) and our Auxiliaries, I would like to
    thank you for the opportunity to testify on today's pending
    legislation.
                                     s. 244
    A bill to require an independent comprehensive review of the process by
            which the Department of Veterans Affairs assesses cognitive
            impairments that result from Traumatic Brain Injury for
            purposes of awarding disability compensation.
        The VFW supports this legislation and its efforts to address
    incorrect assessments of cognitive impairments suffered by veterans
    with Traumatic Brain Injury (TBI).
        With the current shallow understanding of TBI, it is of utmost
    importance we properly handle and treat the portions we do comprehend.
    If underqualified Department of Veterans Affairs (VA) doctors have
    possibly misdiagnosed thousands of veterans who may have cognitive
    impairments from TBI, then that issue must be addressed and those
    veterans need to be given the opportunity to receive treatment and
    disability compensation. VA must be sure it is delivering the highest
    quality of care to veterans. By bringing in an outside source such as
    the Institute of Medicine, there will be opportunity for unbiased
    assessment of protocols for VA psychologists carrying out physiological
    exams related to TBI.
             s. 603, rural veterans travel enhancement act of 2015
        The VFW strongly supports this legislation, which would authorize
    VA to continue a number of successful transportation programs to help
    veterans travel to their VA health care appointments. The lack of
    reliable transportation is a significant barrier to access for veterans
    throughout the country, especially in rural areas. The VFW strongly
    supports efforts to eliminate such barriers.
        Section 2 would permanently extend VA's authority to administer the
    Veterans Transportation Service (VTS). This program was commissioned by
    the Veterans Health Administration's Office of Rural Health in 2010,
    and greatly improved access to care for rural and severely disabled
    veterans by allowing VA facilities to establish and coordinate networks
    of local transportation providers, including community, commercial and
    government transportation services.
        VTS suffered a major setback in 2012 when it was temporarily
    suspended following a determination by the VA Office of General Counsel
    that VA lacked the statutory authority to hire paid drivers to
    transport veterans. Congress has passed one-year authorizations of the
    VTS program since January 2013, but a long term fix is still needed.
    The VFW supports permanently expanding this successful program.
        Section 3 would authorize VA to reimburse veterans for travel to
    Vet Centers. With the significant shortage of culturally competent and
    evidence-based mental health care available to veterans, we must do
    what is needed to ensure veterans have access to programs tailored to
    their unique needs. The combat-specific readjustment services offered
    at Vet Centers makes them a great source for mental health care for
    veterans struggling to readjust back to civilian life after their
    experiences during war. Unfortunately, accessing such readjustment
    centers may be difficult for certain veterans who cannot afford the
    transportation to and from Vet Centers. This bill would rightfully
    remove that barrier by expanding eligibility for VA beneficiary travel
    benefits.
        Section 4 would reauthorize grants which enable Veterans Service
    Organizations to transport veterans who live in highly rural areas to
    their VA and community care appointments. VFW posts and departments in
    California, Texas, Maine and North Dakota use these grants to help
    thousands of veterans access the health care and services they need.
    The VFW supports reauthorizing such grants to allow these successful
    programs to continue.
                           s. 2210, veterans peer act
        The VFW supports this legislation, which would require VA to
    integrate peer support specialists into Primary Care Patient Align Care
    Teams (PACT).
        Peer support specialists provide a valuable service to veterans
    coping with mental health conditions. Such veterans often look for
    guidance from fellow veterans who have successfully completed treatment
    and have learned to cope with conditions they are experiencing. While
    current law requires each VA medical center to hire a minimum of two
    peer support specialists, it does not require VA medical facilities to
    incorporate them into the clinical settings. As a result, many peer
    support specialists are not used to their full potential. Many peer
    support specialists currently lead successful mental health care
    programs and services. The VFW supports efforts to expand such best
    practices.
        The VFW is glad to see this legislation would require each medical
    center that participates in the pilot program to consider the gender-
    specific needs of women veterans when carrying out the pilot program.
    In our survey of women veterans, survey participants identified the
    lack of gender-specific services as the greatest need in VA health care
    facilities. Survey participants also indicated their desire to select a
    provider of the same gender, specifically for veterans who have mental
    health conditions that may be a result of military sexual trauma. The
    VFW supports efforts to hire women peer support specialists to ensure
    women veterans have the opportunity to seek guidance from women
    veterans who have learned to cope with military sexual trauma related
    mental health conditions.
             s. 2279, veterans health care staffing improvement act
        This legislation would improve the transition of health care
    providers between the Department of Defense (DOD) and VA, streamline
    the process for transferring health care professionals between VA
    facilities and expand the practice authority for certain health care
    providers. The VFW supports sections 2 and 3 and takes no position on
    section 4.
        Section 2 would streamline the VA hiring process for transitioning
    servicemembers who practice medicine in the Military Health System.
    Servicemembers with years of clinical experience with the Military
    Health System have the skills and cultural competency needed to treat
    service-connected injuries as VA health care providers. The VFW
    believes veterans who choose to continue serving their country and
    their fellow veterans must have access to expedited hiring authorities
    that enable them to seamlessly transition from military service to the
    civil service. This legislation would rightfully ensure applications
    for VA health care employment from transitioning servicemembers are
    given priority.
        Section 3 would eliminate the requirement for VA health care
    professionals to undergo credentialing every time such employees
    transfer to a new VA medical facility. During our site visits of VA
    medical facilities throughout the country, the VFW has heard from VA
    physicians that VA credentialing requirements delay their ability to
    begin treating veterans when they transfer between VA medical
    facilities. The VFW does not see a reason for VA physicians to endure
    the VA credentialing process every time they transition to a new VA
    medical facility. We support efforts to streamline this process to
    ensure VA is able to seamlessly transfer its health care professionals
    to areas of greatest need.
        Section 4 would grant independent practice authority for advanced
    practice registered nurses and physician assistants employed by the
    Department. VA recently published a proposed rule to grant its advance
    practice nurses full practice authority. The VFW does not take a
    position on scope of practice issues. The VFW defers to VA in
    determining the most efficient and effective scope of practice of its
    providers. However, we will hold VA accountable for providing timely
    access to high quality health care, regardless if such care is provided
    by an advance practice registered nurse or a physician.
                                    s. 2316
    A bill to expand the requirements for reissuance of veterans benefits
            in cases of misuse of benefits by certain fiduciaries.
        This legislation would ensure a veteran who is defrauded by his or
    her fiduciary can be fully reimbursed, regardless of VA negligence or
    the amount the fiduciary manages. Today, veterans can only be made
    whole if VA does not respond to the notification of fraud within 60
    days. For all other beneficiaries who have been defrauded, they can
    only be reimbursed the amount VA can collect back through fines placed
    on the fiduciary. This legislation would ensure that every veteran who
    has been defrauded can be made whole.
        This legislation would also require all fiduciaries to provide
    authorization for the Secretary to obtain the financial records of all
    accounts held by a fiduciary. This measure will provide VA with
    enhanced access to bank accounts held by fiduciaries for beneficiaries
    in its oversite function of safeguarding veterans' benefits.
        The VFW supports this legislation.
                 s. 2791, atomic veterans healthcare parity act
        When servicemembers answer the call of duty without hesitation, it
    is our duty to take care of the repercussions of their military
    service. The VFW supports this legislation, which would expand VA
    disability compensation to veterans who were exposed to nuclear
    radiation from 1977 to 1980 during the atomic cleanup of Enewetak
    Atoll. The VFW sees this as one more example of military toxic exposure
    causing adverse health conditions which has been ignored for far too
    long.
                                    s. 2958
    A bill to establish a pilot program on partnership agreements to
            construct new facilities for the Department of Veterans
            Affairs.
        This legislation would authorize a pilot program for VA to enter
    into five public-private partnerships (P3) for the funding and
    construction of major construction projects. This bill will allow
    ``entities'' to apply for and enter into a contract with VA. These
    entities would be made up of a board of directors that will submit an
    application to the Secretary that will describe the name and experience
    of the project manager; the proposed contributions and how funding will
    be secured; a description of the management plan and monitoring process
    that will be used; and finally the total cost and timeline for
    completion.
        The VFW has called on Congress to allow VA to enter into P3s for
    several years and fully believes that these partnerships are the future
    for VA major construction projects. That is why we fully support this
    legislation.
                                    s. 3021
    A bill to authorize the use of Post-9/11 Educational Assistance to
            pursue independent study programs at certain educational
            institutions that are not institutions of higher learning.
        Post-secondary education comes in various forms and is vital to the
    successful transition from military to civilian life. The VFW supports
    this legislation to expand the Post-9/11 Education Assistance Program.
    Current legislation does not allow veterans to use their education
    benefits to earn accredited certificates through independent study
    programs at institutions that are not deemed those of higher learning.
    Yet, there are institutions that offer these accredited programs for
    areas such as career and technical education. Allowing veterans to use
    their education benefits to earn such certificates would incentivize
    veterans to purse secondary education and open more windows of
    opportunity for their futures.
                         s. 3023, the arla harrell act
        During WWII, 60,000 servicemembers were human subjects of the
    military's chemical defense research program----some 4,000 of those
    servicemembers were exposed to high levels of mustard agents. Until the
    early 1990s, these veterans where forbidden to speak of the
    experiments, even though the program was declassified in 1975.
        Because of the classified nature of these exposures and the
    reliance on incomplete and conflicting data, the ability to accurately
    determine the level of exposure to mustard gas and Lewisite each
    veteran endured is difficult at best. Because of these facts, the VFW
    believes those veterans who have previously applied for benefits
    related to exposure to mustard gas and Lewisite and were denied because
    the evidence of ``full body'' exposure could not be proven, should be
    given the benefit of the doubt and have their claims adjudicated with
    the presumption of full body exposure.
        The VFW supports requiring VA to reconsider previously denied
    claims for mustard gas and Lewisite exposure with the presumption that
    the exposure was full body, unless available evidence proves otherwise.
     s. 3032, veterans' compensation cost-of-living adjustment act of 2016
        The VFW strongly supports this legislation, which would increase VA
    compensation for veterans and survivors, and adjust other benefits
    beginning December 1, 2016.
        Disabled veterans, along with their surviving spouses and children,
    depend on their disability and dependency and indemnity compensation to
    bridge the gap of lost earnings and savings caused by service-connected
    injuries and illnesses. Each year, veterans wait anxiously to find out
    if they will receive a cost-of-living adjustment (COLA). There is no
    automatic trigger that increases these forms of compensation for
    veterans and their dependents. Annually, veterans wait for a separate
    Act of Congress to provide the same adjustment that is automatically
    granted to Social Security beneficiaries.
        The VFW thanks the Committee for providing veterans the opportunity
    to receive their full COLA increase, by not including a ``round down,''
    which is nothing more than a money-saving gimmick that asked veterans
    and their survivors to bear the burden of budget austerity measures.
    s. 3035, maximizing efficiency and improving access to providers at the
                   department of veterans affairs act of 2016
        The VFW supports this legislation, which would require VA to carry
    out a pilot program to evaluate the efficacy of using medical scribes.
        A recent VA study evaluating common challenges faced by clinicians
    in their day-to-day environments, conducted by VA's Emerging Health
    Technology Service, concluded that burdensome non-clinician-centered
    electronic health care systems have a significant impact on morale and
    retention of VA physicians and the veteran's experience due to reduced
    facetime with providers. This legislation would reduce the time
    physicians spend on the keyboard and maximize face to face time with
    their patients.
        This legislation requires VA to contract with a nongovernmental
    entity that specializes in the collection of medical data and data
    entry into electronic health care records. The VFW urges the Committee
    to require the contractors to undergo training on VA's Computerized
    Patient Record System or the Enterprise Health Management Platform,
    including training on how to research required medical documents, such
    as labs and non-department health care records which have been scanned
    into a veteran's electronic health care record. The ``Day in the Life''
    assessment determined that searching and navigating disparate data
    systems consumes vast amounts of time that VA clinicians can spend
    interacting with their patients. The VFW believes medical scribes could
    assist VA providers in locating necessary medical records and spend
    less time navigating electronic health care records and more time
    treating veterans.
           s. 3055, department of veterans affairs dental insurance
                          reauthorization act of 2016
        This legislation would reauthorize the VA Dental Insurance Program
    (VADIP) for five years. While the VFW believes dental must be included
    in the health care benefits package for all veterans enrolled in VA
    health care, we support expanding the current program to ensure current
    beneficiaries do not have a gap in dental coverage.
        Dental care is a vital aspect of general health care. According to
    the Mayo Clinic and a myriad of peer-reviewed medical studies, oral
    health has a direct impact on severe diseases and conditions, such as
    heart disease and adverse birth conditions. Conversely, several health
    conditions which are prevalent among veterans, such as diabetes and
    Alzheimer's disease, have been found to directly impact oral health.
    Until the VADIP was implemented in January 2014, veterans enrolled in
    VA health care had little to no options for receiving dental coverage.
        Additionally, there is a large disparity between VA and DOD dental
    coverage, which can have a significant impact on the health care and
    quality of life for veterans. While in uniform, veterans were required
    to maintain a high level of dental readiness, to the extent that they
    would be placed on a non-deployable status if they failed to receive a
    dental evaluation every year. However, only veterans who were 100
    percent service-connected disabled, certain homeless veterans, and
    those who had a service-connected dental condition were eligible for VA
    dental care.
        While the VADIP provides dental care options for 100,000 veterans
    and their eligible families, VFW members consider this program as
    ``better than nothing.'' The VFW believes veterans have earned and
    deserve the best, not ``better than nothing.'' According to VFW members
    who have used or currently use this program, it provides lower coverage
    for higher costs than most dental plans, including dental plans
    available through TRICARE and the Affordable Care Act health care
    exchanges. Like many of my peers, I decided to terminate my VADIP
    coverage as soon as I became eligible for the VFW's dental coverage. I
    now pay lower monthly premiums and cost shares and have better dental
    coverage than when I participated in the Delta Dental's Comprehensive
    VADIP plan, which is the highest plan Delta Dental offers under the
    VADIP contract.
        However, similarly to the 100,000 veterans and eligible family
    members who participate in the VADIP, my dental records are not
    integrated into my VA electronic health care record. Thus, VA health
    care providers are unable to determine whether veterans who participate
    in the VADIP have dental conditions that may impact their overall
    health care conditions. Such disparate care could have a negative
    impact on the health care and quality of life of the veterans who
    participate in the VADIP program. That is why the VFW fully supports
    expanding eligibility for VA dental care to all veterans who are
    eligible for VA health care. Doing so would ensure veterans have access
    to needed dental care without having to bear the full cost of such
    care.
        The VFW understands the need for some form of dental coverage while
    Congress and VA work to expand VA dental care, thus we support
    expanding the current program for an additional five years to allow VA
    to rebid the contract and hopefully negotiate better coverage options
    than the current contract.
             s. 3076, charles duncan buried with honor act of 2016
        The VFW support this legislation, which would ensure deceased
    veterans without a next of kin who are buried in a state or tribal
    cemetery receive the same benefits as those buried in a national
    cemetery.
        The National Cemetery Administration's (NCA) strategic goal is for
    96 percent of all veterans to have interment options within 75 miles of
    their home. This includes viable burial options at cemeteries that have
    been built, expanded, or improved through NCA cemetery grants.
        When the demand exists, NCA proposes the construction of new
    national cemeteries. However, NCA also uses agreements and grants with
    states, United States territories and federally recognized tribal
    organizations to establish, expand, or improve veterans' cemeteries in
    areas where NCA has no plans to build or maintain a national cemetery.
    Cemeteries assisted by an NCA grant are required to be exclusively
    reserved for veterans and eligible family members and maintained by the
    same standards as an NCA managed national cemetery----meaning that
    veterans interred in NCA assisted state, territorial, or tribal
    cemeteries must be afforded the same honors as those interred in a
    national cemetery.
        However, VA can only furnish a casket or urn for veterans without a
    next of kin and without the means to purchase a casket or urn who are
    buried in a national cemetery. This bill would rightfully extend the
    right to a dignified burial to veterans who are buried or inurned in a
    tribal or state cemetery.
                              s. 3081, wingman act
        The VFW does not support this legislation at this time. While we
    agree there should be a more efficient way for congressional
    constituent services staff to assist veterans, there are current
    controls in place to limit access to veterans' records, and those
    controls must be preserved under any expansion of access.
        The VFW would insist that a release must still be signed before any
    access to records can be granted. There must be a limitation on access
    to only veterans who are constituents of the Member of Congress. When a
    Power of Attorney (POA) is held by an individual or organization, that
    POA must be notified of the request. Any ``accredited'' congressional
    employee must be viewed as an ``agent'' regardless of that employee's
    status with a State Bar Association. This will ensure the employee's
    certification includes passing a certification test. Currently, VA
    provides background checks at no cost to Veterans Service
    Organizations. If this will also be the case with accredited employees,
    funding must be provided. If the intent is for congressional offices to
    reimburse VA for the cost of such background checks, it must be
    explicitly defined in legislation.
        Under current law, there are level-sensitive restrictions on most
    VA employees, preventing them from viewing certain files without
    expressed consent. These restrictions must extend to these accredited
    employees as well. Last, VA must have a tracking system to ensure these
    employees are only assisting their congressional constituents.
    Additionally, there must be a consequence for congressional staff found
    to have abused any aspect of their authority.
                                discussion draft
    To clarify the scope of procedural rights of members of the uniformed
            services with respect to their employment and reemployment
            rights, to improve the enforcement of such employment and
            reemployment rights, and for other purposes.
        When servicemembers receive orders to deploy or for active duty
    responsibilities, they should not be burdened with the stress factor of
    not knowing if they will still be employed when they return home.
    Unfortunately, some employers have found ways to avoid current law
    protecting veterans from repercussions from job providers due to
    completion of orders. The VFW supports this legislation to protect
    employment rights of servicemembers by closing legal loopholes some
    employers have chosen to exploit. More specifically, this would allow
    servicemembers who signed forced arbitration agreements with their
    employers to not forgo their work contract, but still be able to void
    any forced arbitration written in. Also, if investigating attorneys
    general find wrongdoings by employers trying to evade the Uniformed
    Services Employment and Reemployment Act of 1994, this legislation lays
    out the groundwork for appropriate damages and compensation of
    servicemembers. Employers should not be able to require servicemembers
    to forgo their rights as a condition of employment. Those affected by
    this injustice should have the option to void this portion of these
    contracts, as well as receive compensation for punitive damages.
                                   draft bill
    To expand eligibility for readjustment counseling to certain members of
            the Selected Reserve of the Armed Forces.
        This legislation would expand eligibility for Vet Centers to
    members of the Selected Reserve who have not deployed in support of
    combat operations. While the VFW acknowledges the need for more mental
    health care and services for our Guard and Reserve servicemembers, we
    cannot support expanding Vet Center eligibility to non-combat veterans.
        Vet Centers have a sacred mission to assist combat veterans in
    coping with their experiences at war. These veterans face readjustment
    issues and concerns that are not faced by their non-combat veteran
    peers, and necessitates the confidential and high quality services
    provided at Vet Centers--especially servicemembers who are still in
    uniform and fear seeking mental health care could impact their careers.
    That is why the VFW has supported efforts to expand eligibility to
    servicemembers, including Guardsmen and Reservists, who have deployed
    to combat zones.
        The VFW agrees that suicide rates in our Armed Forces are equally
    as troubling as veteran suicides. While the DOD's suicide prevention
    programs have successfully reduced the rate of suicides among our
    active duty forces, it has not be able to replicate such efforts with
    its reserve components. Recent data from the Defense Suicide Prevention
    Office shows an increase in the number of suicides among Guardsmen and
    Reservists in the past year. This is due in large part to the fact that
    Guard and Reserve units often operate in rural and remote areas,
    without access to military treatment facilities. To address this need,
    the VFW urges Congress and DOD to devote more effort and resources to
    combat the rate of suicides among DOD's reserve components. To assist
    DOD in reducing the rate of suicide among Guardsmen and Reservists, the
    VFW would support authorizing DOD to enter into sharing agreements with
    VA to provide mental health care to Guard and Reserve servicemembers
    who live too far from a military treatment facility, but near a VA
    medical facility with excess mental health care capacity. To be clear,
    such agreements must not limit or erode the mental health care and
    services VA provides eligible veterans.
                               draft legislation
    To authorize payment by the Department of Veterans Affairs for the
            costs associated with services by medical residents and interns
            at facilities operated by Indian tribes and tribal
            organization.
        The VFW supports this legislation, which would expand partnership
    opportunities with medical facilities administered by tribal
    organizations.
        For more than 75 years, VA has partnered with medical schools
    around the country to train and teach America's health care workforce.
    This legislation would require VA to establish a pilot program to
    evaluate the feasibility of developing similar relationships with
    tribal health care facilities to incentivize health care professionals
    to practice medicine in tribal areas. The VFW believes this legislation
    would expand access to high quality care to our Native American
    veterans.
                                discussion draft
    To authorize the American Battle Monuments Commission to acquire,
            operate and maintain the Lafayette Escadrille Memorial in
            Marne-la-Coquette, France.
        The Lafayette Escadrille Memorial was built to honor U.S. pilots
    who flew combat missions with the French military prior to U.S. entry
    into WWI. As a result of the reduction in funds available through the
    Lafayette Escadrille Memorial Foundation, the memorial has fallen into
    a state of disrepair. To supplement the depleted foundation, the
    American Battle Monuments Commission (ABMC) provided $2.1 million to
    the project. However, a long-term care plan for this important monument
    is still uncertain. To ensure the memorial receives the care and
    recognition it deserves, the VFW supports placing it under the care of
    the ABMC.

        Mr. Chairman, this concludes my testimony. I will be happy to
    answer any questions you or the Committee members may have.

        Chairman Isakson. Thank you, Mr. Fuentes. We appreciate
    your testimony.
        Mr. Rick Weidman, Executive Director for Policy and
    Government Affairs, VVA.

     STATEMENT OF RICK WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY AND
            GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA

        Mr. Weidman. Thank you, Mr. Chairman. I appreciate the
    opportunity for VBA to share some of our views today.
        S. 244, Senator Tester's bill, we would strongly endorse
    that. One of the problems that VA has always had is consistency
    across the board and working to do quality assurance of every
    VA hospital. It is no different in this case than anything
    else. One of the things we would point out, however, that has
    never been mentioned by VA, is nobody ever tested previous
    generations of veterans no matter what other symptoms they
    might have. Vietnam veterans were subject to the same kinds of
    explosions as those of the more recent wars.
        The Rural Veterans Travel Enhancement Act, we are very
    strongly for. The Veterans' Partners Efforts to Enhance
    Reintegration Act, Senator Blumenthal's bill and others, we are
    strongly in favor of a patient having the peer review--excuse
    me--having the peer specialists but think it should not end
    there. There should be a ladder for young veterans to move up
    into any medical profession without regard to cost, even if
    they do not have available the 21st Century G.I. Bill, on a
    condition that they give back at least year for year in
    tuition. We are going to have to do many imaginative things in
    the next 10 years. Otherwise, we are not going to have the
    clinical resources we need to operate the system properly.
        In regard to the Atomic Veterans Health Care Parity Act, I
    would respectfully strongly disagree with the VA on this. I
    would point out that the VA has been wrong about every single
    darn toxic exposure in my adult lifetime. They are always
    wrong. They always say there is no problem. They always say, do
    not worry about it, and almost invariably, they are proven
    wrong. So, this bill is very much needed and we need to look at
    the whole area of VA of toxic exposures and what is happening
    with staff there and with policy about how they are carrying it
    out, because it is not right, what they are doing.
        Senator Fischer's bill, we have always been--VVA has been
    strongly in favor of giving as much private capital into the
    game as possible, particularly when it comes to capital
    construction, and think we should look not only to Senator
    Fischer's bill, but look to do the same when it comes to
    housing and permanent housing as well as transition housing for
    homeless veterans.
        S. 3021, we will take the Senator at his word that this is
    a great outfit, but it needs monitoring, and particularly if
    people want to do the same thing elsewhere.
        The Arla Harrell Act by Senator McCaskill, this is yet
    another place where we need to look hard and, frankly, do not
    trust VA's judgment when it comes to whether or not these
    veterans have been affected adversely, either, and it is
    something that oversight really needs to look closely at, Mr.
    Chairman. I am not sure what we do about that bill, or about
    that problem systemically, but I know it systemically needs to
    be adjusted, because the one thing that will be a constant from
    now until long after we are gone is toxic exposures of our
    military forces of one kind or another and we need to start to
    figure out how to do a better job and not just the answer of
    ``no'' and ``no problem.''
        The Veterans Compensation Cost of Living Act--frankly, we
    think the Consumer Price Index (CPI) is busted, and anybody who
    looks at what the CPI says about advance increases for the cost
    of living and then looks at their own household budget does not
    have any respect for it because it does not square with the
    reality that people see in front of them. So, while that is
    bigger than this Committee, to have compensation cost of living
    indexed to the CPI is always going to fall short on the part of
    our veterans.
        The dental insurance, we are in favor of it, since Congress
    has thus far been reluctant to move in that direction and VA
    just says no. But, frankly, VVA agrees with the VFW on this
    issue. We are long past the time when we consider dental health
    a frill and it is essential to health and moving forward.
        I do not have time to comment on the other bills, but the
    Integrate Networks Guaranteeing Member Access, we have
    significant problems with and we will be happy to discuss it
    with Senator Cassidy and his staff.
        Mr. Chairman, thank you for the opportunity to speak here
    today.
        [The prepared statement of Mr. Weidman follows:]
     Prepared Statement of Richard Weidman, Executive Director, Policy and
                Government Affairs, Vietnam Veterans of America
        Good afternoon Chairman Isakson, Ranking Member Blumenthal, and
    other distinguished Members of the Senate Veterans' Affairs Committee.
    On behalf of the members of Vietnam Veterans of America [VVA] and our
    families, we very much appreciate the opportunity to express our views
    regarding legislation pending before this very vital committee.

        S. 244, introduced by Senator Tester, would require an independent
    and comprehensive review of the process by which the Department of
    Veterans Affairs assesses cognitive impairments that result from
    Traumatic Brain Injury for purposes of awarding disability
    compensation.
        It is our understanding that troops who have returned from
    deployments to Iraq and/or Afghanistan and who have sought disability
    compensation from the VA receive varying clinical assessments for the
    same injury, assessments which, obviously, affect the award of
    disability compensation from the VA. This bill would--at least it
    should--set the stage for determining if what VA clinicians are doing
    is consistent, and equitable, across the board and, if not, what the VA
    must do to rectify this situation.
        VVA strongly supports enactment of S. 244.

        S. 603, the Rural Veterans Travel Enhancement Act, introduced by
    Senators Tester and Murray, would make permanent the authority of the
    Secretary of Veterans Affairs to transport individuals to and from VA
    in conjunction with rehabilitation, counseling, examination, treatment,
    and care.
        There is nothing not to like about S. 603; in fact, what it calls
    for should continue to be standard operating procedure for every VA
    healthcare facility. Therefore, VVA supports enactment of S. 603.

        S. 2210, the Veteran Partners' Efforts to Enhance Reintegration
    Act, introduced by Senator Blumenthal for himself and Senators Baldwin
    and Markey, would require the VA Secretary to carry out a program to
    establish peer specialists in the Patient Aligned Care Teams at VA
    medical centers. The bill stipulates that female peer specialists must
    be included in this program.
        The purpose of the PEER Act, which is essentially a pilot program,
    is ``to promote the use and integration of mental health services in a
    primary care setting.'' Because we believe that enactment and
    implementation of this bill can lead to a significant advancement in
    melding mental with physical health services, VVA fully supports the
    passage of the PEER Act.

        S. 2279, the Veterans Health Care Staffing Improvement Act, a
    bipartisan bill introduced by Senator Merkley along with Senators
    Brown, Rounds, Shaheen, Tester, Warner, Wyden, and Tillis, would
    require the SecVA to initiate and carry out a program to increase
    efficiency in the recruitment and hiring by the VA of health care
    workers in the process of exiting from the Armed Forces; and would
    create uniform credentialing standards for certain health care
    professionals in the department.
        It certainly is no secret that the VA is in dire need of additional
    medical professionals to handle an increasing demand for the healthcare
    services it provides eligible veterans. The unfilled vacancies for
    these clinicians in VAMCs and CBOCS across the country is a prime
    reason that VA personnel cut corners by finagling appointments with
    both primary care clinicians and specialists.
        VVA has long believed that the VA must do more--a lot more--to
    attract and retain health care workers leaving active duty to ``sign
    on'' with the VA.
        While we have long urged VA to do a much better job of recruiting
    and hiring physicians, as well as all of the allied health care
    professionals.

        S. 2316, introduced by Senator Blumenthal for himself and Senators
    Moran and Brown, would ``expand the requirements for reissuance of
    veterans' benefits in cases of misuse of benefits by certain
    fiduciaries to include misuse by all fiduciaries, [and] to improve
    oversight of fiduciaries.''
        Fiduciaries have what we consider to be a sacred obligation to
    assist honestly and transparently the veterans whose financial
    interests they take responsibility for. Unfortunately, there are some
    who are entrusted with this charge who are neither honest nor
    transparent, who in essence betray the veterans whom they represent.
        Because S. 2316 will give the VA Secretary the legal authority to
    reimburse veterans who have been ripped off by their fiduciary, as well
    as additional oversight powers to help ensure the honesty and integrity
    of fiduciaries, VVA enthusiastically supports enactment of this bill.

        S. 2791, the Atomic Veterans Healthcare Parity Act, introduced by
    Senators Franken and Tillis, would provide for the treatment of
    radiation-exposed veterans who participated in the cleanup of Eniwetok
    Atoll for purposes of the presumption of service-connection for certain
    disabilities.
        Far too many veterans who have been exposed to radiation and other
    toxic substances in the performance of their duties while in uniform
    have been denied healthcare benefits and disability compensation by the
    VA. Why? Because they cannot show a nexus between their exposure(s) and
    particular health conditions that erupt years after exposure.
        VVA supports enactment of this bill. Although S. 2791 is focused on
    a relatively small group of veterans who participated in the cleanup of
    Eniwetok Atoll between January 1, 1977, and December 31, 1980, we
    remind the honorable Members of this Committee that other veterans are
    suffering from a variety of maladies that can be associated with their
    exposure to toxic substances while in uniform; and that the progeny of
    many of these veterans have health conditions that may be caused by a
    parent's exposure to certain toxins; and that they, too, need
    additional protections under the law to access healthcare and
    disability compensation. Hence, we make a plea to those who serve on
    this most important committee to insist that S. 901, the Toxic Exposure
    Research Act, be voted upon by the whole Senate.

        S. 2958, introduced by Senator Fischer, would establish a pilot
    program on partnership agreements to construct new facilities for the
    Department of Veterans Affairs.
        Although we do not object to this pilot program, we question why it
    is limited to ``not more than five partnership agreements.''
        So, if this distinguished committee sees the wisdom of voting for
    the enactment of S. 2958, VVA would support this bill.

        S. 3021, introduced by Senators Inhofe and Lankford, would
    authorize the use of Post-9/11 Educational Assistance for independent
    study programs at certain institutions that are not institutions of
    higher learning.
        VVA has little doubt that the sponsors have in mind a particular
    institution in the state that they represent that will benefit from the
    enactment of this bill. Still, if a veteran can improve his/her chances
    to achieve their American Dream, and if any ``educational institution''
    that stands to benefit should this bill become law is legitimate and
    not one of the predatory institutions--most of which are colleges whose
    bottom line is profit and not the education of the students they
    ostensibly serve--then we may be able to endorse the enactment of
    S. 3021 in the future.

        S. 3023, the Arla Harrell Act, introduced by Senator McCaskill,
    would provide for the reconsideration of claims for disability
    compensation for veterans who were the subjects of experiments by the
    Department of Defense during the Second World War that were conducted
    to assess the effects of mustard gas or Lewisite on humans.
        There are not many of the 60,000 or so veterans left who
    participated in these experiments. Still, because they are deserving of
    a measure of justice long denied them, VVA strongly supports passage of
    this bill, and thanks Senator McCaskill for taking the lead on
    ameliorating this historic wrong.

        S. 3032, the Veterans' Compensation Cost-of-Living Adjustment Act
    of 2016, introduced by Chairman Isakson, Ranking Member Blumenthal, and
    most of the Members of this Committee, would provide for an increase,
    effective December 1, 2016, in the rates of compensation for veterans
    with service-connected disabilities and the rates of dependency and
    indemnity compensation for the survivors of certain disabled veterans.
        VVA of course joins in the chorus of support for passage of this
    bill. We would like to see, however, that the compensation adjustment
    for service-connected disabilities not be an annual affair but rather
    be added to black-letter law in perpetuity.

        S. 3035, Maximizing Efficiency and Improving Access to Providers at
    the Department of Veterans Affairs Act, introduced by Senators Heller
    and Tester, would require the Secretary of Veterans Affairs to carry
    out a pilot program to increase the use of medical scribes to maximize
    the efficiency of physicians at VA medical facilities.
        Instead of clinicians having to type up their notes, conclusions,
    and recommendations for each patient they see, this pilot program would
    test the efficacy of the use of ``medical scribes'' to assist them in
    this ``onerous'' task. Surely, a pilot might be worthy, particularly
    for those clinicians who are not particularly adept at writing and
    those surgeons who, obviously, cannot write up their conclusions in the
    middle of an operation. Yet even if a pilot program illustrated the
    value, however limited or extensive, of the use of such scribes, how
    many would have to be hired and trained across the VA healthcare system
    to be truly effective?
        Hence, VVA supports the concept but we have significant doubts that
    any future Congress will provide significant enough additional
    resources to ever realize the potential impact of this concept.

        S. 3055, the Department of Veterans Affairs Dental Insurance
    Reauthorization Act of 2016, introduced by Senators Burr and Tester,
    would provide a dental insurance plan for veterans and their survivors
    and dependents.
        Although full implementation of such a plan effectively puts the VA
    in the position of becoming an insurance agency, VVA supports the
    passage of S. 3055 because, for many veterans, it may be the insurer of
    last resort. VVA would further argue that dental health care is not a
    ``frill,'' but rather an integral part of overall health. If a person's
    dental health is a mess, it should come as no surprise that that
    veteran's overall health is not good.
        Given the reluctance of the Executive branch and the Congress to
    include dental health (with the notable exception of 100% service-
    connected disabled veterans and certain veterans who are homeless),
    providing this opportunity to purchase dental insurance through the VA
    is a good alternative.
        Speaking of insurance, the option for those who are 50% or more
    service-connected disabled to buy additional life insurance should be
    extended to the same higher level of insurance as that accorded to 100%
    disabled veterans. This problem of finding affordable life insurance is
    really a significant problem for those who have PTSD as part of their
    service-connected disability rating.

        S. 3076, the Charles Duncan Buried with Honor Act, introduced by
    Senator Cotton, would authorize the SecVA to furnish caskets and urns
    for burial in cemeteries of states and Indian tribes for veterans
    without sufficient resources to provide for caskets or urns.
        Just as the VA provides caskets or urns for the remains of veterans
    to be laid to rest in national cemeteries, this bill would extend this
    service to veterans to be buried in state and Indian cemeteries. As
    such, VVA strongly endorses enactment of this bill.

        S. 3081, the Working to Integrate Networks Guaranteeing Member
    Access Now Act, introduced by Senator Cassidy, would provide certain
    employees of Members of Congress with access to case-tracking
    information of the Department of Veterans Affairs.
        VVA does not advocate for this bill. Will this effectively speed up
    the adjudication of claims? We have our doubts. The VA is obligated to
    provide any Member of Congress who asks with the status of a veteran's
    claim for compensation. To give ``certain employees'' direct access to
    such information, however, opens up the unfortunate possibility that,
    by citing potential outlier cases, just puts the department in a bad
    light and does little to improve the efficiency of the adjudication
    process.

        S.       , introduced by Senator Blumenthal, would clarify the
    scope of procedural rights of members of the uniformed services with
    respect to their employment and reemployment rights, and would improve
    enforcement of these rights.
        Members of the National Guard and the Reserves now comprise just
    about half of the Nation's active duty Armed Forces on any given day.
    Since 9/11, more than 900,000 members of the Reserve components have
    been mobilized in the Global War on Terrorism. Despite the protections
    afforded them under the Uniformed Services Employment and Reemployment
    Rights Act (USERRA), there have been far too many instances in which a
    Reservist or Guardsman returns from a deployment to find that the job
    s/he has left to serve our Nation is no longer there for him/her.
        This is wrong. This is something USERRA has sought to provide
    protection for these Reservists and members of the National Guard.
    Because the Blumenthal bill would strengthen enforcement of USERRA,
    because it would provide additional protections for those who have
    served our Nation in uniform, often at great personal and professional
    cost, VVA supports swift passage of this bill.
        VVA would also urge that USERRA protection be in place from time/
    date of the first public knowledge of a deployment of a unit, instead
    of the date the orders are cut for an individual. Some employers are
    currently doing layoffs of workers at the first notice of a unit being
    deployed, which skirts the current law, and leaves these Reservists and
    National Guard members with no protection whatsoever.

        S.       , introduced by Senator Tester, would expand eligibility
    for readjustment counseling to certain members of the Selected Reserve.
        It is only right that those who serve in uniform and who are
    afflicted with ``a behavioral health condition or psychological
    trauma'' ought to be able to avail themselves of the readjustment
    counseling available in the VA's Vet Centers. Hence, VVA applauds and
    supports the swift enactment of this bill.

        S.       , introduced by Senator Sullivan, would authorize payment
    by the Department of Veterans Affairs for the costs associated with
    service by medical residents and interns at facilities operated by
    Indian tribes and tribal organizations, and would require the Secretary
    to carry out a pilot program to expand medical residencies and
    internships at such facilities.
        It should come as no surprise to anyone that the VA is in need of
    qualified, competent medical professionals. Because this bill has the
    potential of increasing the pool of these clinicians to serve veterans
    enrolled for VA health care, VVA supports enactment of this bill.

        A Discussion Draft, companion legislation to H.R. 5420 introduced
    by HVAC Chairman Miller, would authorize the American Battle Monuments
    Commission to acquire, operate, and maintain the Lafayette Escadrille
    Memorial in Marne-la-Coquette, France.
        Monuments and memorials to our men and women in uniform speak to
    their service and their sacrifices and, in many cases, to their last
    true measure of devotion. If the commission sees a need to take
    responsibility for this memorial, subject ``to the consent of the
    Government of France,'' VVA stands with the commission, and with the
    enactment of this bill.

        Vietnam Veterans of America appreciates the opportunity to present
    our views on this pending legislation before this Committee and will be
    pleased to respond to any question you may have. And we want to thank
    you for the work you do for the Nation's veterans.

        Chairman Isakson. Thank you, Mr. Weidman, very much.
        Kevin Ziober, member of the Reserve Component. Kevin, you
    are welcomed.

                      STATEMENT OF KEVIN ZIOBER,
                    MEMBER OF THE RESERVE COMPONENT

        Mr. Ziober. Mr. Chairman, Ranking Member Blumenthal, thank
    you for this opportunity to testify in support of S. 3042, the
    Justice for Servicemembers Act, and to share my personal views
    and experiences on the importance of strong Uniformed Services
    Employment and Reemployment Rights Act (USERRA) law.
        I applaud Senator Blumenthal for introducing this much
    needed legislation that would clarify that servicemembers and
    veterans cannot waive their substantive or procedural rights
    under USERRA, consistent with the original intent of Congress
    when it enacted USERRA in 1994.
        As a private citizen, a combat veteran and Reservist, I
    stand with the 32 Veterans Service Organizations in the
    military coalition who support this legislation. Without
    USERRA's strong substantive and procedural protections, it
    would be impossible for millions of Americans to serve in the
    Guard and Reserve to help protect our homeland and advance
    America's interests abroad.
        As the Committee is aware, USERRA guarantees servicemembers
    the right to return from their civilian jobs after serving in
    the military and prohibits employment discrimination based on
    military service or status. USERRA makes it possible for
    Reservists like me to serve our Nation in the Armed Forces.
        Several years ago, I lost a job that I loved because I
    chose to serve my country. But sadly, my story is not unique.
    Each year, thousands of Reservists lose their jobs or miss out
    on benefits because employers are not aware of USERRA or they
    find our military service to be inconvenient.
        In July 2010, I was hired by a Federal contractor called
    BLB Resources. From 2010 to 2012, as a manager, I helped BLB
    expand its operations and workforce from 18 employees to over
    90. In November 2012, I received active duty orders to deploy
    to Afghanistan for 12 months. As soon as I learned of the
    upcoming deployment, I gave BLB notice. On my last day of work,
    BLB hosted a lunchtime party to honor my military service.
    Forty coworkers gave me a standing ovation. I was presented
    with a large cake with an American flag and the inscription,
    ``Best Wishes Kevin,'' and my colleagues decorated my office
    with camouflage netting along with cards and gifts that were
    stacked on my desk.
        Around 4:45 on that same afternoon, I was called into the
    Human Resources Department, where I was promptly fired and told
    that my position would not be available upon my return from
    active duty. I was shocked to learn that I was being terminated
    from my job on the eve of my deployment to a combat zone. It
    created an unimaginable amount of concern and anxiety about how
    I would earn a living once my military orders had ended.
        Upon returning home from Afghanistan in 2014, I was further
    surprised by what happened when I tried to enforce my rights.
    After I filed a USERRA claim in Federal Court, BLB asked the
    court to compel me to arbitrate my USERRA case and the court
    agreed. This was shocking, because I knew that when Congress
    passed USERRA, it explicitly stated that veterans and
    servicemembers cannot waive any of their rights, that they are
    entitled to enforce their rights in Federal Court, and that
    they cannot be required to arbitrate their claim.
        Fortunately, my story did not end there. I found legal
    advocates who agreed to take my case to the U.S. Court of
    Appeals and, if necessary, to the U.S. Supreme Court. But the
    Nation's highest court should not need to decide whether
    servicemembers can waive their procedural rights under USERRA.
    By passing the Justice for Servicemembers Act now, Congress can
    clarify that all USERRA rights are protected against waiver and
    ensure once and for all that no servicemember is forced to
    choose his USERRA rights and a job that puts food on the table.
        Today, servicemembers face uncertainty when they enforce
    their USERRA rights. In 2005, the Bush administration issued a
    final rule stating that servicemembers cannot be forced to
    arbitrate their USERRA claims. Some courts have faithfully
    followed the intent of Congress on this issue while others have
    not. Due to this split within the courts, it is much harder for
    servicemembers to leave their civilian jobs with confidence
    when they are called to duty because they do not know what to
    expect if they ever need to enforce their USERRA rights.
        When servicemembers are required to arbitrate their USERRA
    claims, they do not just lose the right to file an action in
    court. They also lose many of the enforcement tools that make
    USERRA a strong law, such as the right to file in any district
    where the employer has a place of business, the lack of a
    statute of limitations period, and a ban on making
    servicemembers pay filing fees or an employer's fees and costs.
        By enacting the Justice for Servicemembers Act, Congress
    can send a powerful bipartisan message to all those who have
    served or are thinking about serving in the future. Congress
    can make clear that it understands the challenges we face and
    supports us so that no servicemember or veteran will ever again
    experience what happened to me. No warfighter who is asked to
    leave his job and risk his life for his country should ever
    need to worry about fighting for his job when he returns home.
        Thank you very much for your time and consideration of my
    views. I look forward to answering your questions.
        [The prepared statement of Mr. Ziober follows:]
      Prepared Statement of Kevin Ziober, Member of the Reserve Component

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Chairman Isakson. Well, thanks to all of you for your
    testimony.
        I will make a couple of comments probably rather than
    questions. I do have a couple questions, too.
        Comment number 1--and I think Mr. Weidman talked about the
    Consumer Price Index adjustment--Senator Blumenthal and I,
    along with every Member of the Committee, Republican and
    Democrat alike, have cosponsored the cost of living adjustment
    for this year. Your concerns about the calculations of CPI are
    duly noted and I am pleased that we have made it the unanimous
    recommendation of the Senate to adjust compensation wherever it
    is indexable by CPI, and there will be an increase in those
    benefits at the end of this fiscal year for next fiscal year.
    That was approved by everybody on the Committee.
        Second, Mr. Fuentes, as I understood it, you and a number
    of others, the way you read the WINGMAN Act was that it did not
    require a privacy release before the staffer could get the
    information, is that right?
        Mr. Fuentes. That is correct, Mr. Chairman.
        Chairman Isakson. But I also heard you say, if it did
    require the privacy release, you did not have any problem with
    the legislation, is that correct?
        Mr. Fuentes. Well, there are a couple other concerns that
    we have with the legislation, mainly that the restriction
    levels have to apply to Congressional staff, as well, meaning
    that they could only view records for folks for whom they have
    a privacy release from. Also, as a Veterans Service
    Organization, we hold power of attorney for a number of
    veterans and we would like Congressional staff to either
    notify--or VA to notify Veterans Service Organizations of any
    individual that holds a power of attorney for that veteran. And
    I have a couple other ones. Overall, I think there are four
    recommendations that are included in my written testimony.
        Chairman Isakson. We have that, and all that testimony will
    be made a part of the record, without objection.
        Mr. Fuentes. Thank you, Mr. Chairman.
        Chairman Isakson. I had one other point. We will deal with
    each of these pieces of legislation in the near future. As we
    have in the past, this Committee tries to do due diligence to
    the maximum extent possible before we act, just as we did in
    the Veterans First Act, which is a consolidation of 148
    recommendations that came out of Members of this Committee. We
    are looking forward to moving that legislation in the near
    future.
        I want to make an editorial comment and a plea to each of
    your Service Organizations, all of whom have been supportive of
    what we have done with Veterans First, to help continue to
    express that support to members of the U.S. Senate and the U.S.
    House so that we can get that legislation passed.
        With the decision of Loretta Lynch, who is the Attorney
    General of the United States, not to enforce the government's
    position granted to the government under the Veterans Choice
    Act, we have a serious problem of accountability with no remedy
    whatsoever, either from the Secretary or from the Attorney
    General's Office. The Veterans First bill which Senator
    Blumenthal and I worked very hard on, along with every Member
    of the Committee, has a complete, comprehensive accountability
    piece to it. It may not be everything everybody would have
    liked to have had, but it is one heck of a lot better than what
    they have got right now, which is absolutely zero.
        So, help from your organizations to support us with the
    other members of Congress would be greatly appreciated. I thank
    you for your input.
        Senator Blumenthal.
        Senator Blumenthal. Thanks, Mr. Chairman.
        I want to thank you, Mr. Ziober, for being here and for
    your participation earlier today in support of an event
    spreading awareness and raising concern. I am hoping that we
    will have bipartisan support on this Committee for the USERRA
    clarification that is in the legislation that I have proposed.
    I want to thank all of the Veterans Service Organizations that
    are supporting this measure--in fact, they all are--and I think
    it will make a significant difference in the lives of our
    Reservists and National Guard. I thank you and your attorney
    for being here today.
        Mr. Ziober. Yes, sir. Thank you.
        Senator Blumenthal. I want to thank the other witnesses. I
    appreciated your testimony. In the interests of time, since we
    have a classified briefing ongoing right now, I am going to
    talk to you individually about any questions that I might have.
    You have all been very generous with your time when I do have
    questions, so I thank you very much.
        Thanks, Mr. Chairman.
        Chairman Isakson. Thank you, Senator Blumenthal, and thanks
    to all of you for your attendance today.
        We will stand adjourned.
        [Whereupon, at 4:20 p.m., the Committee was adjourned.]

                                A P P E N D I X

                                  ----------

                 Prepared Statement of Max Cleland, Secretary,
                      American Battle Monuments Commission
        Thank you for this opportunity to offer written testimony on behalf
    of the proposed legislation to authorize the American Battle Monuments
    Commission to acquire, operate and maintain the Lafayette Escadrille
    Memorial in Marne-la-Coquette, France, a suburb of Paris. We submitted
    this legislative proposal with the concurrence of the Administration,
    following review by the Department of Defense, the Department of
    Veterans Affairs, and other interested agencies.
        The Lafayette Squadron was created on 16 April 1916, one year prior
    to U.S. entry into World War I. Forty-two fliers composed the original
    Escadrille (thirty-eight Americans and four French officers in
    command). As the number of American volunteers grew, Americans flew for
    several French units known collectively as the Lafayette Flying Corps,
    in which 269 fliers served in total. Out of the 269 total American
    volunteers, 68 died in the air war over France. Some of the best known
    fliers were Kiffin Rockwell, Norman Prince, Raoul Lufbery and Eugene
    Jacques Bullard, the only African-American fighter pilot in World War
    I. When the United States entered the war in 1917, most of the
    Escadrille pilots joined the U.S. Air Service, teaching air combat
    tactics to those who followed them to France. The Lafayette Escadrille
    ceased to exist on February 18, 1918 and the U.S. 103d Pursuit Squadron
    took on its symbols and traditions.
        The memorial to these air combat pioneers was constructed in the
    1926-28 period and inaugurated on July 4, 1928. The Lafayette
    Escadrille Memorial is a private memorial about five miles west of
    Paris. It honors these 269 American volunteers who flew for French and
    United States units during the Great War. But it is more than a
    memorial; it is a burial ground. A crypt beneath the memorial contains
    68 sarcophagi, one for each of the 68 Americans of the Lafayette
    Escadrille who died in the skies over France; 49 Americans and two
    French officers rest there in honor today. Seventeen sarcophagi have
    remained empty because either the remains could not be found or were
    transferred.
        ABMC has a history of involvement with the Lafayette Escadrille
    Memorial, approving the Foundation's construction plans in 1924, a
    predicate for any administrative agency of the U.S. Government, such as
    the State Department, to assist the founders. ABMC also managed the
    maintenance of the memorial for the Foundation from 1971 to 1983, using
    Foundation funds under the authority of our Monument Maintenance
    Program. The Foundation ended this arrangement in 1983 and over the
    years the original trust fund established to maintain the memorial
    dwindled and the memorial fell into a state of disrepair. As a World
    War I Centennial initiative, ABMC and the French Ministry of Defense
    partnered with the Foundation to complete a $1.7M restoration project,
    using funds provided by the Foundation, by private donors in the United
    States, and by the French government. The memorial was rededicated on a
    beautiful spring day in Paris, on the occasion of the Centennial
    Anniversary of the Escadrille's establishment on April 20, 1916. It
    again stands as a beautiful tribute to service and sacrifice, but the
    Foundation is no longer able to maintain the memorial to a standard
    commensurate to the American sacrifice it honors.
        It is time to bring the memorial and the pioneering airmen buried
    beneath it under the perpetual care of the U.S. Government. There are
    several compelling reasons to do so.

        1. The vision for the Lafayette Escadrille Memorial was to have the
    American pilots resting together in a memorial that allowed the spirit
    of their enlistment to live on. This spirit reflects the historical
    cooperation between the United States and France. Just as France came
    to the aid of the United States during our revolution, the United
    States came to France's aid in two world wars. The memorial has become
    an important part of the U.S. Ambassador's Memorial Day commemorations
    and in other ceremonies within the American community, such as the high
    school graduation of the American School of Paris.
        2. Since American participation in World War I began unofficially
    with volunteers in units such as the Lafayette Escadrille, the memorial
    could serve as a point-of-entry for ABMC's World War I interpretation
    efforts. Its location near Paris facilitates that purpose.
        3. The U.S. Air Force considers the Lafayette Escadrille to be an
    important part of its tactical origins. The Air Force ties it history
    to the American men who flew with that unit and later joined the U.S.
    Air Service. The American pilots of the Lafayette Escadrille were
    combat veterans, whose wartime experiences were extremely valuable to
    the newly-arrived American units and the development of combat tactics
    within the Air Service. The Marine Corps considers Belleau Wood, which
    is part of the Aisne-Marne American Cemetery, to be an important part
    of its heritage. The continued support of the Marine Corps and its
    active participation at Memorial Day ceremonies is a highlight for
    Aisne-Marne and ABMC. The Lafayette Escadrille Memorial will serve a
    similar purpose for the Air Force.
        4. Most importantly it's the right thing to do. The Foundation
    passed a resolution approving transfer to ABMC of full legal title to
    the memorial site, including the land, memorial, crypt and caretaker's
    cottage, by gift or in exchange for symbolic consideration. We have
    assurances that the French government is prepared to incorporate the
    Memorial into the bilateral treaty granting the U.S. perpetual use of
    French lands, at no cost or taxation, for the commemorative cemeteries
    and memorials that ABMC maintains in France. Representatives of the
    French Ministries of Defense and Interior sit on the LEM Foundation
    Board and voted to approve the Foundation resolution.

        With the concurrence of the Foundation and the Government of
    France, it is appropriate that ABMC, on behalf of the American people,
    assume responsibility for preserving and protecting in perpetuity this
    memorial tribute and final resting place for pioneering combat Airmen
    who gave their lives in one of the most pivotal wars of the twentieth
    century. ABMC will incur no costs to acquire or transfer the memorial.
    The Commission will operate and maintain the memorial within existing
    appropriations.

        Mr. Chairman, the American Battle Monuments Commission appreciates
    very much the Committee's support of our sacred mission. We believe it
    is time for the Lafayette Escadrille Memorial to become an important
    and significant addition to that mission, so that, in the words of
    General John J. Pershing, Commander of the World War I American
    Expeditionary Forces and our first Chairman, ``Time Will Not Dim the
    Glory of Their Deeds.''
                                     ______

    Prepared Statement of LeAnn Wilson, Executive Director, Association for
                         Career and Technical Education

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

      Letter from Thomas S. Kahn, Director, Legislative Affairs, American
                  Federation of Government Employees, AFL-CIO

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

       Prepared Statement of Amy Webb, Legislative Policy Advisor, AMVETS
        Chairman Isakson, Ranking Member Blumenthal, and distinguished
    Members of the Committee: Since 1944, AMVETS (American Veterans) has
    been one of the largest congressionally-chartered veterans' service
    organizations in the United States and includes members from each
    branch of the military, including the National Guard, Reserves, and
    Merchant Marine. We provide support for the active military and all
    veterans in procuring their earned entitlements, and appreciate the
    opportunity to present our views on the pending legislation being
    considered today.
     s. 244--a bill to require an independent comprehensive review of the
    process by which the department of veterans affairs assesses cognitive
      impairments that result from traumatic brain injury for purposes of
           awarding disability compensation, and for other purposes.
        This measure would require an agreement between the VA Secretary
    and the Institute of Medicine (IOM) for the performance of an
    independent comprehensive review of Department of Veterans Affairs (VA)
    examinations that assess cognitive impairments of those who submit VA
    disability compensation claims for Traumatic Brain Injury (TBI).
        The goals of the comprehensive review would be to determine the
    adequacy of the tools and protocols used by VA in providing cognitive
    examinations, and to study the credentials necessary for health care
    providers to perform assessments of cognitive function. The IOM would
    convene a group of experts in clinical neuropsychology and other
    related disciplines to carry out the wide-ranging review.
        Within 540 days of the agreement, the Secretary would submit a
    report to Congress outlining the IOM findings and recommendations for
    legislative or administrative action required to improve the
    adjudication of TBI claims.
        If an acceptable agreement between the Secretary and the IOM were
    unable to be reached, the Secretary would make an agreement with
    another organization that is not part of the Government, operates as a
    not-for-profit entity, and has expertise and objectivity comparable to
    that of the Institute of Medicine. In this case, any reference in the
    bill to the IOM would be treated as a reference to the other
    organization.
        It seems prescient that Senator Tester introduced this bill almost
    a year and a half prior to the recent VA news that Secretary McDonald
    has granted equitable relief to more than 24,000 veterans who received
    VA medical exams processed between 2007 and 2015 related to disability
    compensation claims for TBI. This group of veterans whose first TBI
    examination was not performed by one of four medical specialists
    qualified to diagnose the condition, now has the option to receive a
    new exam.
        The Secretary noted in the VA News Release that, ``We let these
    veterans down,'' and that VA was taking every step to ensure this group
    of veterans receives the full benefits they are entitled to. AMVETS is
    encouraged that VA publicly admitted the inconsistencies and mistakes
    made from 2007 to 2015, and that it believes the current TBI policy is
    clear and being followed.
        AMVETS supports this measure pursuant to our National Resolution on
    Traumatic Brain Injuries, and supports the additional oversight from an
    independent entity such as the IOM to ensure that there are vetted
    protocols in place with the correct type of physician for this type of
    diagnosis, which can be nuanced.
             s. 603--rural veterans travel enhancement act of 2015
        Section 2 of this Act would make permanent the authority of the
    Department of Veterans Affairs (VA) to transport individuals to and
    from VA facilities in connection with rehabilitation, counseling,
    examination, treatment, and care.
        Section 3 would include Vet Centers as VA facilities for the
    purpose of providing payment of actual expenses of travel, or allowance
    for travel, to or from a VA facility. A Vet Center is defined as a
    center for readjustment counseling and related mental health services,
    and the travel reimbursement allowed for under this new subsection
    would begin on or after the date of enactment.
        Section 4 would amend Section 307(d) of Public Law 111-163 to
    reauthorize grants for veterans' service organizations to provide
    transportation of highly rural veterans to and from VA facilities for
    appointments through 2020.
        AMVETS supports this Act based on our National Resolution for
    Services for Rural & Remote Veteran Populations which urges an increase
    of the travel reimbursement allowance to the actual cost of expenses.
    We are particularly pleased with the inclusion of Vet Centers as VA
    facilities, and support making the authority permanent for VA to
    provide transportation to and from medical facilities as well as
    reauthorizing the grants for VSOs to continue providing rides to
    veterans in highly rural areas. This transportation assistance can
    literally save lives, and AMVETS supports that this Act increases
    veterans' access to physical and mental health care.
     s. 2210--veteran partners' efforts to enhance reintegration (peer) act
        The PEER Act would establish a peer specialist program in patient
    aligned care teams (PACTs) at medical centers of the Department of
    Veterans Affairs (VA) to promote the use and integration of mental
    health services in a primary care setting. This would occur in at least
    ten VA medical centers within 180 days after date of enactment. Within
    two years of enactment peer specialists in PACTs would be present in at
    least twenty-five VA medical centers.
        The selection of medical centers would represent a balance of
    geographic locations; at least five medical centers that specialize in
    polytrauma and at least ten that do not; those in rural and underserved
    areas; and those not in close proximity to an active duty military
    installation.
        Each location selected would ensure that the needs of women
    veterans were specifically considered and addressed, and female peer
    specialists would be included in the program.
        Within 180 days of enactment, and at least once every following 180
    days until the program was fully implemented, the Secretary would
    submit a report to Congress detailing findings, conclusions, and an
    assessment of the benefits to veterans and their family members. Within
    180 days of the last location being selected, the Secretary would
    submit an additional report to Congress containing recommendations on
    the feasibility and advisability of expanding the program to additional
    locations.
        Peer specialists are noted for being engaged in their own recovery,
    and who provide peer support services to others engaged in mental
    health treatment. AMVETS supports the integration of mental health
    services into primary care, and also the patient-centric approach of
    the PACT model of care. Peer Specialist delivered interventions have
    been shown to improve patient activation in multiple studies. It is
    also important that women veterans receive access to care that
    specifically addresses their needs.
        AMVETS has a National Resolution on Mental Health Care Services and
    supports the PEER Act, but notes that in August 2014, the White House
    issued an Executive Action mandating that twenty-five VA medical
    centers place Peer Specialists on Primary Care Teams. An update from
    VA's Office of Research and Development, in collaboration with the
    National Center for Health Promotion and Disease Prevention, shows that
    the, ``Evaluation of Peer Specialists on VA PACTs (Peers on PACT)''
    officially began in January 2016, final data is projected to be
    collected in January 2018, and in September 2019 the study and findings
    are expected to be complete.
             s. 2279--veterans health care staffing improvement act
        Section 2 of this Act would require the Secretaries of Defense and
    Veterans Affairs to develop a ``Docs-to-Doctors Program'' aimed at
    recruiting those separating honorably from the Armed Forces and
    Reserves who have served in a health care capacity. Individuals in
    veteran status would be included if separation occurred during the
    period outlined.
        At least once a year the Secretary of Defense would submit a
    recruitment list to the Secretary of Veterans Affairs which would
    include, as available, contact information; military rank at
    separation; and a description of health care experience including any
    relevant credential, certificate, certification, or license.
        The Secretaries would work to resolve barriers related to
    credentialing or to specific hiring rules, procedures, and processes of
    the Department of Veterans Affairs (VA) that would potentially delay or
    prevent a qualified person's hiring, including reconciling different
    credentialing processes and standards between the VA and the Department
    of Defense.
        If the VA Secretary determined that a barrier was unable to be
    resolved, within 90 days a report would be submitted to Congress
    detailing recommendations for legislative and administrative action
    suitable to resolve the issue.
        Section 3 of this Act would implement a uniform credentialing
    process for each position held by Veterans Health Administration
    employees within one year of enactment.
        If a VA employee was credentialed under this section for purposes
    of practicing in a VA location, the credential would be sufficient for
    any VA location. VA would provide for renewal of credentials, which
    would not be required solely because an employee moved from one VA
    facility to another.
        Section 4 of this Act would provide full practice authority to
    advanced practice registered nurses (APRNs), physician assistants
    (PAs), and other licensed VA health care professionals as considered
    appropriate consistent with their education, training, and
    certification. Full practice authority would be provided without state
    limitations that would otherwise be imposed.
        All three sections of this Act support VA recruitment and
    retention. In the past, AMVETS has stated that VA must improve its
    recruitment, hiring and retention policies to ensure the timely
    delivery of high quality healthcare to our veterans. We appreciate the
    intent of this Act which works toward this goal.
        AMVETS has a National Resolution supporting Civilian Credentials
    for Military Training & Experience, and believes as a nation we need to
    be prepared to do our part to assist transitioning servicemembers
    obtain living-wage employment opportunities based on the experience and
    skills they developed in the military. We note that Section 2 pertains
    just to the medical field, and while AMVETS would hope that a broader
    measure would include all types of military occupation specialties for
    work inside and outside the VA, we do not oppose this program since the
    end result would be excellent providers of medical care inside VA, and
    quality treatment of veterans who receive VA medical care.
        AMVETS supports providing full practice authority to advanced
    practice registered nurses (APRNs), physician assistants (PAs), and
    other licensed VA health care professionals to allow them to provide
    care to the full extent of their training. VA has an access to care
    issue. This is a zero cost solution that would provide veterans with
    the access, continuity and quality of care, and reduce wait times for
    veterans needing care.
        A 2014 Federal Trade Commission report concluded ``that empirical
    research and on-the-ground experience demonstrate that APRNs provide
    safe and effective care within the scope of their training, and
    licensure.'' APRNs are not doctors, nor do they want to be doctors, but
    they are highly trained with more than 97 percent having graduate
    degrees and 99 percent having attained national certifications in
    specialty areas of healthcare. They want to take care of patients and
    they should be allowed to practice to their full scope to the advantage
    of veterans receiving care.
     s. 2316--a bill to expand the requirements for reissuance of veterans
       benefits in cases of misuse of benefits by certain fiduciaries to
    include misuse by all fiduciaries, to improve oversight of fiduciaries,
                            and for other purposes.
        S. 2316 authorizes the Department of Veterans Affairs (VA) to
    reissue veterans' benefits to a beneficiary in all cases of fiduciary
    misuse. The VA would pay the beneficiary or the successor fiduciary an
    amount equal to the misused benefits. VA access to fiduciary-held
    financial accounts would be increased and require VA access in order to
    obtain any financial records related to the fiduciary or the
    beneficiary whenever the VA determined that the financial records would
    be beneficial to view for the administration of a VA program, or to
    safeguard the beneficiary's benefits against neglect, misappropriation,
    embezzlement, or fraud.
        AMVETS does not have a National Resolution on this bill, and has
    taken no formal position at this time.
                 s. 2791--atomic veterans healthcare parity act
        This act would provide for the treatment of veterans who
    participated in the cleanup of Enewetak Atoll between January 1, 1977
    and December 31, 1980 as radiation exposed veterans for purposes of the
    presumption of Department of Veterans Affairs (VA) service-connection
    for certain disabilities.
        It has been historically documented that from 1946 through the Cold
    War, the U.S. military tested nuclear weapons in the Marshall Islands,
    including detonations over 1,000 times stronger than the atomic bombs
    dropped on Hiroshima and Nagasaki. Radioactive and other fallout
    remained and natives sued the Federal Government in 1962 for
    compensation for losing their homeland, or for its return. In 1977 the
    U.S. military began the clean-up in preparation to return the land to
    Marshall Island natives.
        Approximately 4,000 American servicemen assisted in what became
    known as the Enewetak Radiological Support Project between 1977 and
    1980, working to scrape 73,000 cubic meters of surface soil off six
    different islands on the atoll. They deposited the radioactive soil
    into the Cactus Crater on Runit Island, part of the atoll, and then
    capped the crater with a thick layer of concrete.\1\
    ---------------------------------------------------------------------------
        \1\ https://marshallislands.llnl.gov/
    ---------------------------------------------------------------------------
        AMVETS has two National Resolutions addressing toxic wounds, and
    advocating for those who suffer chronic conditions as a result of
    exposure to various contaminants while serving their country remains a
    top priority. The definition of a Toxic Wound is any adverse health
    condition, chronic or terminal, suffered by military personnel
    resulting from, or associated with, exposure to toxic substances or
    environmental hazards during their military service, the effects of
    which may not emerge until months or years after initial exposure.
        The veterans who served as part of the Enewetak Radiological
    Support Project are small in number, and evidence of their exposure to
    contamination is large. AMVETS supports swift passage of this Act.
    s. 2958--a bill to establish a pilot program on partnership agreements
      to construct new facilities for the department of veterans affairs.
        This bill would authorize partnership agreements between Secretary
    of Veterans Affairs and up to five entities defined as a state or local
    authority, a 501c3 nonprofit organization, a limited liability
    corporation, a private entity, a donor or donor group, or any other
    non-Federal Government entity.
        The purpose would be to conduct at least one super construction
    project; major medical facility projects; or major construction
    projects of new cemeteries or to develop additional gravesites or
    columbarium niches at existing cemeteries. Projects selected would
    already be partially funded by Congress or those that the Department of
    Veterans Affairs (VA) identified on the Major Construction Strategic
    Capital Investment Planning priority list. Approved partners would be
    required to enter into a formal agreement with the Secretary to
    independently finance or donate project funds leaving no additional
    cost to the Federal Government.
        The program would fall under Federal laws relating to environmental
    and historic preservation, and the Davis--Bacon Act of 1931 which
    established the requirement for paying the local prevailing wages on
    public works projects for laborers and mechanics.
        One of the five partnership agreements authorized is to design,
    finance, and construct a new ambulatory care center in Omaha, Nebraska.
        The Secretary may contribute up to $56,000,000 for the projects and
    the contribution or liability of the Secretary would not exceed this
    except to the extent that additional funds are appropriated.
        Each partnership agreement would provide that the entity:

         Practice due diligence and conduct any necessary
    environmental or historic preservation; comply with local zoning
    requirements except for studies and consultations required of VA under
    Federal law; and obtain any permits required before beginning
    construction.
         Use VA construction standards when designing and building
    the project, except to the extent the Secretary determines otherwise.
         Establish a Board of Directors to oversee the conduct of
    the project which would be comprised of five to ten members. At least
    one member would be a veteran who is not a VA employee, at least one
    would be a VA employee and function as a nonvoting member of the Board;
    a Chair would be designated to oversee the activities of the Board. All
    current or proposed members of the Board would promptly disclose any
    actual or potential conflicts to the Secretary and would agree to
    remove themselves from Board membership if the Chair and Secretary
    agreed that it was appropriate due to an actual or potential conflict.
         Within 180 days of inception of the Board, or another
    timeframe the Secretary approves, a written charter to describe the
    roles, responsibilities, policies, and procedures of operation of the
    Board would be created to ensure successful project management, design,
    construction, and completion of the designated project.
         In addition, the Board would be responsible for overseeing
    the activities needed to finance, design, and construct the designated
    project for the Department, and would submit written updates regarding
    the status of the designated project to the Secretary in a manner the
    Secretary specifies.
         The Board would defer to the Secretary on all matters
    inherent to the mission and operations of VA, including conditional or
    final acceptance of the designated project.
         The Board would not dissolve until after the Secretary
    provided final acceptance of completion of the designated project to
    the Board, plus such additional time or contingencies as the Board and
    the Secretary may jointly approve.

        To be eligible to participate in the program, entities would submit
    a detailed and thorough application to the Secretary to address needs
    relating to VA facilities identified in VA's Construction and Long-
    Range Capital Plan.
        The Secretary would include in the budget submitted to Congress by
    the President information regarding any projects conducted under this
    section during the year preceding the submittal of the budget. Each
    report would provide a detailed status of projects, including the
    percentage of completion of the project.
        The Comptroller General of the United States would submit a
    biennial report on the partnership agreements to Congress.
        There are many aspects to this complex bill, and AMVETS does not
    have a formal position at this time.
         s. 3021--a bill to authorize the use of post-9/11 educational
    assistance to pursue independent study programs at certain educational
           institutions that are not institutions of higher learning.
        This bill would authorize the use of Post-9/11 Educational
    Assistance to pursue independent study programs at certain educational
    institutions that are not institutions of higher learning. The
    independent study program would provide a certificate that reflects
    completion of a course of study, such as an area career or technical
    education school or vocational institution providing education at the
    postsecondary level.
        AMVETS does not have a National Resolution on this measure, but
    favors its passage. It is important that a veteran be able to utilize
    their earned educational assistance to learn a trade or to develop
    skills required for a career that are from facilities other than
    institutes of higher learning.
                         s. 3023--the arla harrell act
        The Arla Harrell Act would require the Secretaries of Defense and
    Veterans Affairs to reconsider all compensation claims related to
    exposure to mustard gas or lewisite during active military, naval, or
    air service during World War II, and make a new determination on claims
    denied before the date of enactment.
        In carrying this out, the Secretaries would determine if a veteran
    experienced full-body exposure to mustard gas or lewisite with a
    presumption that they did, unless it could be proven otherwise. The
    Secretaries would not use information contained in the Department of
    Defense (DOD) and Department of Veterans Affairs (VA) Chemical
    Biological Warfare Data base or any other VA or DOD list of known
    mustard gas or lewisite testing sites as the sole reason for
    determining whether this exposure occurred.
        Within 90 days of enactment, and at least once every 90 days
    thereafter, the VA Secretary would submit a report to Congress
    specifying any reconsidered claims that were denied during the
    preceding 90-days, including the rationale for each denial.
        Within one year of enactment, the Secretaries would jointly
    establish a policy for processing future compensation claims that VA
    determines are in connection with exposure to mustard gas or lewisite
    during active military, naval, or air service during World War II.
        Within than 180 days of enactment, the Secretary of Defense would,
    for purposes of determining whether a site should be added to the list
    of DOD sites where mustard gas or lewisite testing occurred,
    investigate and assess sites where the Army Corps of Engineers
    uncovered evidence of mustard gas or lewisite testing or where more
    than two veterans submitted claims for compensation where claims were
    denied.
        A report to Congress would be required covering experiments
    conducted by the DOD during World War II to assess the effects of
    mustard gas and lewisite on people and would include a list of each
    location where experiments occurred, including locations investigated
    and assessed related to review of claims; the dates of each experiment;
    and the number of members of the Armed Forces who were exposed to
    mustard gas or lewisite in each experiment.
        Within 80 days of enactment, the Secretary of Veterans Affairs
    would investigate and assess the outreach to individuals who had been
    exposed to mustard gas or lewisite in experiments; the claims for
    disability compensation that were filed, and the percentage of such
    claims that were denied. A report to Congress would be required related
    to findings of the investigations and assessments carried out under
    this bill, and a comprehensive list of each location where an
    experiment was conducted.
        According to Senator McCaskill, who AMVETS thanks for introducing
    this legislation, the military has acknowledged for decades that secret
    mustard gas tests were performed on troops at the end of World War II.
    A recent U.S. Senate investigation found that 90 percent of related
    disability compensation claims have been rejected by the Department of
    Veterans Affairs. This is an astounding statistic.
        AMVETS has two National Resolutions addressing toxic wounds, and
    advocating for those who suffer chronic conditions as a result of
    exposure to various contaminants while serving their country remains a
    top priority. The definition of a Toxic Wound is any adverse health
    condition, chronic or terminal, suffered by military personnel
    resulting from, or associated with, exposure to toxic substances or
    environmental hazards during their military service, the effects of
    which may not emerge until months or years after initial exposure.
        AMVETS supports swift passage of the Arla Harrell Act.
    s. 3032--veterans' compensation cost-of-living adjustment (cola) act of
                                      2016
        The COLA Act would provide for an increase in the rates of
    compensation for veterans with service-connected disabilities and the
    rates of dependency and indemnity compensation for the survivors of
    certain disabled veterans effective December 1, 2016.
        The dollar amounts to be increased would be wartime disability
    compensation, additional compensation for dependents, clothing
    allowance, dependency and indemnity compensation to surviving spouse,
    and to children.
        Each dollar amount would be increased by the same percentage as the
    Social Security Act, effective December 1, 2016.
        The Secretary of Veterans Affairs would publish the amounts
    specified as increased in the Federal Register no later than the date
    on which those pertaining to the Social Security Act are required to be
    published.
        AMVETS supports this COLA Act, and encourages its swift passage.
    s. 3035--maximizing efficiency and improving access to providers at the
                   department of veterans affairs act of 2016
        This act would establish an eighteen-month pilot program increasing
    the use of medical scribes to maximize the efficiency of physicians in
    at least five medical facilities of the Department of Veterans Affairs
    (VA). A medical scribe is a member of the medical team trained
    exclusively to perform documentation in an electronic health record to
    maximize productivity of a physician.
        The facilities chosen would have a high volume of patients, or be
    rurally located in areas determined to have a shortage of physicians
    which high caseloads.
        In carrying out the pilot program, the Secretary would enter into a
    contract with one or more appropriate nongovernmental entities that
    train and employ professional medical scribes.
        Data would be collected to determine the effectiveness of the pilot
    program in increasing the efficiency of physicians at VA medical
    facilities and would measure the following, both before and after
    implementation of the program:

         The average wait-time for a veteran to receive care from a
    physician.
         The average number of patients that such a physician is
    able to see on a daily basis.
         The average amount of time such a physician spends on
    documentation on a daily basis.
         The satisfaction and retention scores of each such
    physician.
         The patient satisfaction scores for each such physician.
         The patient satisfaction scores for their health care
    experience.

        Within 180 days after the start of the pilot program, and at least
    once every 180 days thereafter, the Secretary would submit a report to
    Congress including the number of VA medical facilities participating in
    the pilot, and an assessment of the effects that participation has had
    on maximizing the efficiency of physicians; reducing average
    appointment wait times; improving access of patients to electronic
    medical records; mitigating physician shortages by increasing the
    productivity of physicians as well as all of the data collected as part
    of the program. The report would also include recommendations with
    respect to the extension or expansion of the pilot.
        AMVETS does not have a National Resolution on this measure, but
    does not oppose its passage as it relates to increasing a physician's
    patient load with the goal of providing veterans more ready access to
    care.
                s. 3042--justice for servicemembers act of 2016
        As part of the Military Coalition (TMC), which is a consortium of
    uniformed services and veterans' associations representing more than
    5.5 million current and former servicemembers, their families and
    survivors, AMVETS recently signed a strong support letter for this
    bill.
        It was noted that this concise, straightforward bill ensures that
    our servicemembers and veterans can enforce the rights afforded to them
    under the Uniformed Services Employment and Reemployment Rights Act
    (USERRA).
        Some servicemembers have been unable to exercise their USERRA
    rights due to increased use of forced arbitration clauses. Usually
    presented on a take-it-or-leave-it basis, these clauses preclude access
    to the judicial system and instead funnel servicemembers' employment
    discrimination or wrongful termination USERRA claims into private,
    costly arbitration systems set up by the employers. The ``Justice for
    Servicemembers Act'' gives servicemembers the ability to pursue their
    USERRA claims in court while preserving the option to enter into an
    arbitration agreement after a dispute arises.
        AMVETS supports passage of this important legislation.
           s. 3055--department of veterans affairs dental insurance
                          reauthorization act of 2016
        This act would provide dental insurance to veterans and survivors
    and dependents of veterans who could enroll on a voluntary basis. This
    beneficiary group is defined as any veteran who is enrolled in the
    Department of Veterans Affairs (VA) system or any survivor or dependent
    of a veteran who is eligible for medical care under section 1781 of
    this title which is:

         the spouse or child of a veteran who has a total
    disability, permanent in nature, resulting from a service-connected
    disability,
         the surviving spouse or child of a veteran who (A) died as
    a result of a service-connected disability, or (B) at the time of death
    had a total disability permanent in nature, resulting from a service-
    connected disability,
         the surviving spouse or child of a person who died in the
    active military, naval, or air service in the line of duty and not due
    to such person's own misconduct, and
         an individual designated as a primary provider of personal
    care services under the caregiver program who is not entitled to care
    or services under a health-plan contract who are not otherwise eligible
    for medical care under chapter 55 of title 10 (CHAMPUS).

        VA would establish a contract with a dental insurer to administer
    the plan, and provide benefits for dental care and treatment as
    considered appropriate, diagnostic services, preventative services,
    endodontics and other restorative services, surgical services, and
    emergency services.
        Premiums for the dental insurance would adjust annually, and each
    person covered at the time of adjustment would be notified of the new
    amount and effective date. The entire premium would be paid by the
    individuals covered, in addition to the full cost of any copayments.
        Voluntary disenrollment would be allowed if it occurred within 30-
    days of enrollment, or in circumstances where disenrollment did not
    jeopardize the fiscal integrity of the dental insurance plan. Such
    circumstances include if an enrollee relocates outside the jurisdiction
    of the dental insurance plan which prevents use of the benefits, or if
    they have a serious medical condition preventing them from obtaining
    benefits. The Secretary would also establish procedures for determining
    permission for voluntary disenrollment in order to ensure timely
    decisions.
        This program would terminate on December 31, 2021.
        AMVETS does not have a National Resolution on this bill, and has
    taken no formal position at this time.
             s. 3076--charles duncan buried with honor act of 2016
        The Charles Duncan Buried with Honor Act would authorize the
    Secretary of Veterans Affairs to furnish caskets and urns for burial in
    cemeteries of states and Indian tribes of veterans without sufficient
    resources to provide for caskets or urns.
        It is noted that in 2013 Congress enacted the ``Dignified Burial
    and Other Veterans' Benefits Improvement Act of 2012'' which authorizes
    the U.S. Department of Veterans Affairs (VA) to furnish a casket or urn
    of such quality as the Secretary considers appropriate for a dignified
    burial in a national cemetery of a deceased eligible veteran who died
    with no known next of kin and without sufficient financial resources to
    furnish a casket or urn. While AMVETS does not have a National
    Resolution on this issue, we support this Act and believe that those
    who serve this country should be provided the dignity of having a
    proper burial if they or their survivors do not have the means to
    provide for a casket or urn.
     s. 3081--working to integrate networks guaranteeing member access now
                                 (wingman) act
        WINGMAN seeks to streamline the benefit claims procedure between
    the Department of Veterans Affairs (VA) and Congressional constituent
    advocates who process claims on behalf of veterans and their families.
        Under WINGMAN, an accredited, permanent Congressional employee
    would have access to electronic Veterans Benefits Administration (VBA)
    records in a read-only fashion in order to review the status of a
    pending claim, medical records, compensation and pension records,
    rating decisions, statement of the case, supplementary statement of the
    case, notice of disagreement, and Form-9 files. This eliminates the
    time-consuming step of using the VA as a middle-man to receive files
    the Congressional employee already has permission to possess.
        AMVETS supports this bill, which is in line with our National
    Resolution addressing the claims and appeals backlog which calls for
    improving the timeliness of all disability claims and appeals, and
    agrees that it is unacceptable for weeks or months pass before
    advocates are able to receive files they requested to help veterans.
     discussion draft to expand eligibility for readjustment counseling to
          certain members of the selected reserve of the armed forces.
        This bill would allow any member of the Selected Reserve of the
    Armed Forces who has a behavioral health condition or psychological
    trauma to receive counseling provided by the Department of Veterans
    Affairs (VA) which may include a comprehensive individual assessment.
    No patient referral would be required and this would take effect one
    year after date of the enactment Act.
        The Selected Reserve includes the Army, Navy, Air Force, Marine
    Corps and Coast Guard Reserves, and the Army and Air National Guard.
    These groups have served in unprecedented numbers since 2001, and of
    the nearly 2 million Iraq and Afghanistan veterans who have become
    eligible for VA Health Care in that time, nearly 40 percent served in
    the Reserves or National Guard. This group of veterans present with a
    wide range of health conditions, and mental disorders are among the top
    three.
        We must do all that we can to provide access for readjustment
    services and counseling for those who serve in the Armed Forces of the
    United States, to include those in the Selected Reserve. AMVETS has a
    National Resolution on Mental Health Services and supports this draft
    measure.
    discussion draft to authorize the american battle monuments commission
    to acquire, operate, and maintain the lafayette escadrille memorial in
                          marnes-la-coquette, france.
        This bill would authorize the American Battle Monuments Commission
    to acquire, operate, and maintain the Lafayette Escadrille Memorial in
    Marne-la-Coquette, France.
        The Commission would carry out its duties pursuant to an agreement
    with the Lafayette Escadrille Memorial Foundation and would be subject
    to the consent of the Government of France. Additionally, the
    Commission could only employ the personnel needed to carry out this
    Act.
        AMVETS has no National Resolution on this issue, but supports
    passage of this bill and believes that this memorial should be properly
    maintained in honor of the U.S. troops who served in WWI and the forty-
    nine American heroes who are entombed at this location.

        Mr. Chairman and Members of the Committee, this concludes my
    testimony and would be happy to answer any questions the Committee may
    have.
                                     ______

            Prepared Statement of American Public Health Association

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

       Prepared Statement of Joy J. Ilem, National Legislative Director,
                           Disabled American Veterans
        Thank you for inviting DAV (Disabled American Veterans) to submit
    testimony for the record of this legislative hearing, and to present
    our views on the bills under consideration. As you know, DAV is a non-
    profit veterans service organization comprised of 1.3 million wartime
    service-disabled veterans that is dedicated to a single purpose:
    empowering veterans to lead high-quality lives with respect and
    dignity.
     s. 244, to require an independent comprehensive review of the process
        by which the department of veterans affairs assesses cognitive
      impairments that result from traumatic brain injury for purposes of
                        awarding disability compensation
        This measure would require VA to enter into an agreement with the
    Institute of Medicine (IOM) to conduct an independent review of the
    process by which the Department of Veterans Affairs (VA) assesses
    cognitive impairments that result from a Traumatic Brain Injury (TBI)
    for purposes of awarding disability compensation.
        The independent review committee would include a group of experts
    in clinical neuropsychology and other related disciplines and would be
    charged with determining the adequacy of the tools and protocols used
    by VA for examinations relating to assessment of cognitive functions
    and the required credentials of the clinicians who perform such
    examinations. Finally, the bill would allow VA to contract with an
    alternate organization to perform the above mentioned review.
        According to VA, following revision of its Schedule for Rating
    Disabilities addressing neurological conditions and convulsive
    disorders and the related examination protocol for residuals of TBI,
    guidance on using certain clinicians for compensation examinations on
    the residuals of TBI was sent to field operations of the Veterans
    Health Administration (VHA) and Veterans Benefits Administration (VBA).
        VA conducted a review of VHA and contractor examinations for 24,588
    veterans from 2007 through 2015, which revealed psychiatrists,
    physiatrists, neurologists, or neurosurgeons were not accustomed to
    performing initial TBI examinations. Consequently, VA granted equitable
    relief on May 3, 2016, to affected veterans who are invited to exercise
    this remedy to include the ordering of a new initial TBI examination
    with one of the four designated specialists, submission of additional
    supporting evidence, leading to readjudication of the previous claim
    for residuals of TBI using the new examination and evidence.
        DAV has no resolution on this specific issue. Notably however, we
    commend VA for revising its Schedule for Rating Disabilities in order
    to provide more detailed and updated criteria for evaluating residuals
    of TBI. The previous version did not recognize TBI as a signature
    injury of the conflict in Iraq and Afghanistan, and did not properly
    address the needs of a statistically larger number of veterans
    returning from these conflicts with residuals of TBI. In addition, the
    effects of injuries stemming from blasts resulting from roadside
    explosions of improvised explosive devices, which have been common
    sources of injury in these conflicts, appeared to be different from the
    effects of brain trauma observed from other explosive sources.
        VA's new rating schedule for residuals of TBI and corresponding
    examination criteria focuses on three main areas of dysfunction that
    may result from TBI with serious effects: cognitive dysfunction;
    emotional/behavioral dysfunction, and physical dysfunction. However,
    this measure would require the independent review be limited to VA's
    process in assessing only cognitive impairments. This measure, if acted
    on favorably, should include in its requirements the processes of
    assessing physical and emotional/behavioral dysfunction, and that the
    convening groups of subject matter experts established in the bill
    should include individuals in the appropriately related disciplines.
             s. 603, rural veterans travel enhancement act of 2015
        Section 2 of this bill would make permanent the authority set to
    expire December 31, 2016, for VA to operate the Veterans Transportation
    Service (VTS) program. DAV opposes this measure and asks for the
    opportunity to work with the sponsors of this legislation and the
    Committee to find a resolution.
        As the Committee may be aware, our organization began our free
    transportation program in 1987. Since then, the DAV National
    Transportation Network continues to show tremendous growth as an
    indispensable resource for veterans. Across the Nation, 190 DAV
    Hospital Service Coordinators operate nearly 197 active programs, in
    which our volunteer drivers have logged over 24.7 million miles last
    year, providing over 700,000 rides for veterans to and from VA
    healthcare facilities. To date, DAV has purchased and donated 2,967
    vehicles to the VA, at a cost of $65.1 million. The Ford Motor Company
    has also donated 207 vehicles at a cost of over 4.7 million dollars.
    Thus far our vans have carried veterans more than 642 million miles to
    and from their medical appointments.
        The VTS provides an invaluable service in meeting the
    transportation needs of a special subset of the VA patient population
    that the DAV Transportation Network is not equipped to serve--veterans
    in need of special modes of transportation and accommodation due to
    severe disabilities. We believe that with a truly collaborative
    relationship, the DAV Transportation Network and VTS will be able to
    meet the growing transportation needs of ill and injured veterans in a
    cost-effective manner.
        DAV Resolution No. 113 urges the VA to operate an effective and
    efficient transportation program for all service-connected veterans and
    to simplify access to transportation benefits and services so they may
    receive timely and high-quality VA health care, benefits and services.
    Accordingly, we have been working with the VHA Chief Business Office,
    as well as VA medical facilities across the country to resolve
    weaknesses that we have observed in the VTS program, which operates on
    resources that would otherwise go to direct medical care and services
    for veterans.
        As one of the strongest advocates of sufficient and predictable
    funding for VA, we believe these precious resources should be used
    judiciously for ancillary programs to ensure veterans are not denied
    care when they most need it. Ensuring VTS works in concert with other
    existing and emerging transportation resources will help maximize the
    ability of veterans to access VA care while guarding against fraud,
    waste and abuse of these limited resources.
        Section 3 of this bill would require VA to treat Vet Centers as
    department facilities in connection with payments for beneficiary
    travel. DAV has a special connection to the VA Vet Center program and
    the counseling services it provides. In 1976, the DAV funded the
    groundbreaking Forgotten Warrior Project, which first defined the issue
    of Post Traumatic Stress Disorder (PTSD) among Vietnam War veterans.
    Vietnam veterans were experiencing serious post-war problems at that
    time, and DAV hoped our new study would make it impossible for
    Congress, the VA, and the American public to continue to ignore the
    lingering dilemma that prevented many of these veterans from gaining
    normal lives after serving in a very unpopular and difficult war.
        DAV initiated our own Vietnam Veterans Outreach Program in 1978.
    This DAV-sponsored study and the DAV's clinical outreach work spurred
    new, broad realization and additional research by others that forced
    the Federal Government to confront the psychological impact of war on
    veterans of Vietnam, and subsequently of all wars. When that movement
    finally occurred, the DAV Vietnam Veterans Outreach Program was already
    there to serve as an effective counseling model to be adopted by the
    VA's Vet Center program as we know it today.
        Since the Readjustment Counseling Service program was established
    by Congress in 1979, eligibility for Vet Center readjustment counseling
    services has expanded from Vietnam-era veterans to include all combat
    veterans, to veterans who experienced military sexual trauma, to
    certain family members, and to survivors of veterans who die in combat
    or on active duty. Vet Centers also offer other vital services,
    including counseling for Post Traumatic Stress Disorder (PTSD) and
    other readjustment challenges; marriage and family counseling; and
    family bereavement counseling.
        DAV supports this section based on Resolution No. 117, which calls
    on Congress to enact legislation to change beneficiary travel policies
    to meet the specialized clinical needs of veterans receiving MST-
    related treatment.
        Mr. Chairman, one key policy of Vet Centers is to ensure veterans
    seeking help are not required to wait to receive it. Vet Centers are
    known for minimal barriers with almost no bureaucracy and provide a
    non-medical setting in a safe environment with confidentiality and an
    emphasis on informed consent. Because of this type of delivery model,
    VA's current policy--to pay travel expenses for one-way travel to
    veterans who receive VA care for unscheduled appointments--needs to be
    adjusted to meet the full intent of this measure if enacted.
        Section 4 would extend the existing VA grant program to provide
    innovative transportation options to veterans in highly rural areas.
    DAV supports this section based on Resolution no. 226 calling for
    innovative improvements in providing health care to veterans living in
    rural and remote areas of the United States. We also urge the Committee
    to make appropriations to provide enhanced VA health care access to
    rural veterans.
        Finally, we recommend changing the language to be stricken from
    ``through 2014'' to ``through 2016'' to reflect current law as amended
    by Public Law 114-58, Title I, Section 106.
                           s. 2210, veteran peer act
        Enactment of the Veteran PEER Act would require VA to establish a
    program that includes peer specialists within patient aligned care
    teams (PACT) in medical centers of the VA to promote better integration
    of mental health services into the primary care setting. VA must carry
    out this program in at least 10 VA medical centers within the first 180
    days of the Act passing and in no less than 25 locations after two
    years of the enactment of the bill, including within five polytrauma
    center locations.
        The bill also would require VA to consider the feasibility of
    locating peer specialists in rural areas and other locations that are
    underserved by the Department. VA would be required to ensure that the
    unique needs of women veterans are considered and that female peer
    specialists are included in the program. The measure includes
    requirements for routine reporting to include findings and conclusions
    with respect to the program and recommendations related to the
    feasibility of expansion of the program.
        When a veteran is experiencing a mental health crisis and asking
    for help, there must be ready access to a mental health specialist and
    services must be provided. However, even when in crisis, many veterans
    are reluctant to reach out for help and are reluctant to seek the
    mental health services they need. Since 2012, VA has hired over 900
    Peer Specialists, and we have heard from mental health providers that
    peer-to-peer interactions have been extremely helpful to both patients
    and treating clinicians. Making that first contact with another veteran
    who has had a similar experience seems to lessen the stigma and has
    been a successful method for coaching veterans into care.
        We are pleased the bill also includes provisions that would require
    VA to address the needs of women veterans. Findings show that when
    women return from deployment, the camaraderie and support from their
    male peers is often short-lived, resulting in isolation for many.
    Studies have shown that peer support is important to a successful
    transition, but women report they often cannot find a network of women
    who can relate to their military or wartime service. Including the
    requirement that VA focus on hiring female peer specialists helps
    ensure the unique needs of women veterans will be addressed and that
    women veterans can benefit from access to peer-to-peer interactions.
        DAV is pleased to support S. 2210, which is consistent with the
    following DAV resolutions: DAV Resolution No. 103, which calls for
    program improvements for VA mental health services to include increased
    staffing levels, improved outreach to veterans with a focus on reducing
    stigma when seeking post-deployment readjustment and other mental
    health services; DAV Resolution No. 104, which calls for enhanced
    medical services for women veterans as well as additional methods to
    address barriers to care. Also, the bill is consistent with
    recommendations in DAV's 2014 report, Women Veterans: The Long Journey
    Home.
             s. 2279, veterans health care staffing improvement act
        This bill would require the VA, in conjunction with the Department
    of Defense, to recruit military medical service personnel to VA health
    care positions following their service. To promote this outcome, the
    bill would require DOD to submit to VA a list once each year (or more
    often if agreed) of such individuals, including reservists and Coast
    Guardsmen, who are approaching the discharge point, or afterwards,
    along with contact and other relevant information to identify these
    individuals and their prior duties in military health care, including
    credentials, licensure and related information.
        In respect to this program, the bill would require VA to work to
    resolve barriers in credentialing or other rules that could delay or
    prevent such VA hiring. In the event that an identified barrier cannot
    be resolved by VA, the bill would require VA to report its existence
    and nature to Congress, with recommendations for legislation or
    administrative action (including any barrier imposed by a state).
        The bill would require VA to treat applications for VA employment
    by the individuals contemplated by this authority as Federal civilian
    employees rather than outside applicants, if applications were made
    within one year of discharge.
        The bill would require VA to establish a national, uniform
    credentialing policy for any VA employee who needs credentials to
    practice, and that once an individual is VA-credentialed in one site,
    the bill would enable such an employee to practice anywhere in the VA
    health care system without further credentialing.
        The bill would authorize full practice authority for advance
    practice nurses, physician assistants (PA), and other categories of
    health personnel as identified by the Secretary. The bill would empower
    these individuals to conduct independent practices in VA health care,
    irrespective of limitations that might be imposed by state laws. The
    bill would define a number of terms associated with these authorities.
        With regard to easing transition from military careers to civilian
    careers, DAV strongly supports the intent of this bill on the basis of
    DAV National Resolution 130, which urges continuing support for
    veterans' preference in Federal, state and local employment. While the
    resolution does not specify employment in VA itself, the bill is a
    logical method of aiding VA's recruitment efforts for medical
    professionals and, therefore, DAV supports this provision.
        With respect to the credentialing provisions of this bill, setting
    aside differing requirements from state to state, or from VA facility
    to VA facility, could produce unintended consequences. While it is true
    that credentialing may often delay or complicate the employment of
    clinical professionals in VA health care (and elsewhere), such policies
    are put in place to protect the quality of care and health of patients
    and to ensure individual practitioners are in fact capable of providing
    patients the type and intensity of care they are licensed to provide.
    In VA, credentialing in a major, affiliated VA academic health center,
    generally a teaching center of health professions, is considerably
    different than in a secondary, non-affiliated VA facility, and these
    differences exist for good reason.
        Finally, on the issue of independent practice authority of advance
    practice nurses, PAs and others that might be identified by the
    Secretary, VA recently proposed new regulations affecting these groups.
    While DAV has no resolution specific to these issues in the bill, or in
    VA's proposed regulation, we ask the sponsors to consider the
    implications of setting aside VA's proposal and any public comment that
    it may generate, with such sweeping Federal supremacy legislation.
    s. 2316, to expand the requirements for reissuance of veterans benefits
    in cases of misuse of benefits by certain fiduciaries to include misuse
    by all fiduciaries, to improve oversight of fiduciaries, and for other
                                    purposes
        The bill would authorize the Department of Veteran Affairs (VA) to
    reissue benefits to veterans within the fiduciary program when
    fiduciaries are found to have misused or mishandled the administration
    of their benefits.
        VA would require that any person or entity appointed or recognized
    as a fiduciary for a beneficiary to provide VA with authorization to
    obtain from any financial institution any record held by the
    institution with respect to the fiduciary or beneficiary. This
    authorization would be utilized whenever a financial record is
    necessary for the administration of a VA program. The authorization
    could also be executed when it becomes necessary to safeguard a
    beneficiary's benefits against neglect, misappropriation, misuse,
    embezzlement, or fraud.
        Under this bill, in instances when a fiduciary refuses to provide
    or revokes an authorization to permit VA access to financial
    institution information concerning benefits paid to a beneficiary, VA
    would have the authority to revoke the appointment or the recognition
    of the fiduciary for each beneficiary for whom such fiduciary had been
    appointed or recognized.
        Although we not have a resolution specific to fiduciary matters,
    DAV appreciates the importance of safeguarding benefits of veterans
    within the fiduciary program; therefore, DAV supports the intent of
    this legislation because it protects the rights and benefits of ill and
    injured veterans.
                 s. 2791, atomic veterans healthcare parity act
        The Atomic Veterans Healthcare Parity Act would provide health care
    parity for veterans who participated in the atomic debris cleanup
    mission on Enewetak Atoll in the Marshall Islands between 1977-1980.
    Currently these veterans are not included in the definition of ``atomic
    veterans'' and are not considered to have experienced at-risk exposure
    to radiation while relocating radioactive materials contaminated by 43
    atomic tests at Enewetak Atoll. This measure would require VA to
    consider such veterans to be radiation exposed for presumption of
    service connection for recognized radiogenic diseases.
        DAV is pleased to support S. 2791 because it is consistent with DAV
    Resolution No. 089, which supports legislation authorizing presumptive
    service connection for atomic veterans with a recognized radiogenic
    disease including any veteran involved in clean-up operations following
    the detonation of a nuclear device. We urge the Committee to
    expeditiously pass this legislation that would establish eligibility
    for personnel who participated in this specific radiation-risk activity
    during military service to receive presumptive service connection for
    recognized radiogenic diseases.
    s. 2958, a bill to establish a pilot program on partnership agreements
       to construct new facilities for the department of veterans affairs
        This bill would provide VA a discretionary authority to enter into
    not more than five public-private partnerships to construct major VA
    medical facilities, new cemeteries, and expanded cemeteries. Under the
    bill, VA could choose any qualified entity to carry out this
    construction, including ``a donor group,'' an undefined term. The bill
    would require in each instance that a board of directors were chosen to
    guide each project, and the project chosen for this pilot program would
    come either from projects partially funded by Congress, or from VA's
    internal capital planning process and its priority list submitted
    annually to Congress as a part of VA's budget request.
        One of the five sites that would be authorized and required to
    participate in this pilot program would be located in Omaha, Nebraska,
    and would include a new ambulatory care clinic with sufficient space
    and parking facilities, and would be limited in cost to $56 million,
    unless Congress appropriated additional funds for this project.
        The bill would set rules for the conduct of the pilot program,
    including activities, actions, reports and dissolutions of these boards
    of directors, as well as for the entities chosen to partner with VA on
    the projects chosen, and would prescribe various terms and conditions
    applicable to both the five entities and VA. Finally, the bill would
    specify required elements in the application process, and would
    prescribe required reports to Congress by VA and the Government
    Accountability Office.
        DAV National Resolution No. 100 urges VA to request adequate
    funding to fulfill the intent of its strategic capital planning
    initiative; that Congress carefully monitor any intended VA changes in
    infrastructure that could jeopardize VA's ability to meet veterans'
    needs; and, that Congress continue to provide appropriated funding
    sufficient to fulfill the needs for infrastructure identified through
    the strategic capital planning process. Enactment of this bill would
    introduce a major change in VA's capital planning and construction
    management programs. This new approach may hold promise in reforming
    VA's capital infrastructure program. Nevertheless, because it is an
    untested concept, before advancing this bill in the legislative
    process, we would urge further discussions with VA officials on the
    impact and intent of the measure on normal VA construction operations,
    especially given that VA is currently managing 49 major construction
    projects system-wide.
         s. 3021, a bill to authorize the use of post-9/11 educational
    assistance to pursue independent study programs at certain educational
           institutions that are not institutions of higher learning
        This bill would authorize the use of Post-9/11 Educational
    Assistance to pursue independent study programs at certain educational
    institutions that are not institutions of higher learning as currently
    defined by law.
        Section 3452 of title 38 defines an ``institution of higher
    learning'' as one that grants an associate degree or higher degree.
    Post-secondary career and technical education (CTE) centers, which are
    public, non-profit, non-degree-granting institutions that award
    certificates, are an integral part of the postsecondary education and
    workforce training systems in many states--offering alternative routes
    for non-traditional students to obtain a postsecondary credential. To
    better accommodate working adult students, some CTE centers are
    utilizing technology by incorporating distance learning online.
    However, under current law, any independent study program offered
    through these institutions that includes an online component is
    ineligible because CTE centers are non-degree-granting and are
    therefore not considered institutions of higher learning.
        This bill would update existing law to mirror the Post-9/11
    Veterans Educational Assistance Improvement Act's incorporation of non-
    degree-granting institutions as an option for veterans, while also
    recognizing the expanding role of technology in these institutions.
    This legislation would accomplish this much-needed update by providing
    an exception for accredited independent study programs that lead to
    certificates from non-degree-granting institutions.
        DAV has no resolution concerning this issue; however, we would not
    oppose its enactment because it would appear to be beneficial to
    veterans.
                         s. 3023, the aria harrell act
        This bill would establish procedures to address mustard gas or
    lewisite testing done on servicemembers by the Department of Defense
    during World War II.
        This legislation would require the Secretary of Veterans Affairs,
    in consultation with the Secretary of Defense, to reconsider claims for
    compensation relative to these experiments and render new
    determinations. The legislation would establish a presumption of
    exposure, unless proven otherwise, thus creating a lower evidentiary
    standard to demonstrate exposure to mustard gas or lewisite.
        DAV is pleased to offer our support for this legislation consistent
    with Resolution No. 010, which calls on Congress to vigorously support
    VA's expeditious handling of veterans' claims and payment of fair and
    just compensation for all conditions associated with exposure to toxic
    and environmental hazards.
     s. 3032, veterans' compensation cost-of-living adjustment act of 2016
        This bill would provide for an increase in the rates of
    compensation, commensurate with an increase for Social Security
    recipients with no ``round down,'' effective December 1, 2016.
        Mr. Chairman, DAV strongly supports this legislation, especially
    since it does not mandate that the cost-of-living adjustment (COLA) it
    would authorize be rounded down to the next lowest whole dollar amount.
        Many disabled veterans and their families rely heavily, or solely,
    on VA disability compensation, or DIC payments, as their only means of
    financial support, and they have struggled during recent years. Their
    personal economic circumstances have been negatively affected by rising
    costs of many essential items, including food, medicines and gasoline.
        In FY 2016, no COLA increase was authorized due to depressed
    inflation, so it seems only fitting that no round-down be imposed in
    2017 to help offset the loss of COLA in 2016. It is imperative that
    veterans and their dependents receive a full COLA; on the strength of
    DAV Resolution No. 013, DAV supports enactment of this legislation.
        S. 3035, Maximizing Efficiency and Improving Access to Providers at
    the Department of Veterans Affairs Act of 2016
        DAV supports this legislation that would require VA to carry out an
    18-month pilot program in at least five VA medical centers to use
    medical scribes to transcribe provider comments during visits with
    patients, thereby saving the provider time to manage the medical
    documentation process while also allowing more visual contact and
    better communication between provider and patient.
        DAV resolution 126 calls for quality care for veterans to be
    achieved when health care providers are given the freedom and resources
    to provide the most effective and evidence-based care available. In
    response to the growing complexity of health care and the electronic
    medical record, medical scribes have been used in the private sector to
    improve productivity, clinical documentation, completion of medical
    records, as well as provider satisfaction.
        We understand VA has been exploring the scope of responsibilities
    for medical scribes. DAV believes this bill, if enacted, would help
    provide a wider scope through which meaningful information could be
    produced to help determine the most effective integration of scribes
    within the various patient aligned care teams and across care settings
    in VA.
              s. 3042, the justice for servicemembers act of 2016
        This bill would improve the scope of procedural rights under the
    Uniformed Services Employment and Reemployment Rights Act (USERRA), and
    improve the enforcement authority of the Department of Justice.
        Section 1 would clarify employment and reemployment rights of
    servicemembers by proposing any agreement to arbitrate a claim under
    USERRA is unenforceable, unless all parties consent to arbitration
    after a complaint on the specific claim has been filed in court or with
    the Merit Systems Protection Board and all parties knowingly and
    voluntarily consent to have that particular claim subjected to
    arbitration. Under the bill, consent would not be considered voluntary
    when a person is required to agree to arbitrate an action, complaint,
    or claim alleging a violation under USERRA as a condition of future or
    continued employment, advancement in employment, or receipt of any
    right or benefit of employment.
        Section 2 would enhance enforcement of employment and reemployment
    rights of servicemembers with respect to employment with State or
    private employers. This section would provide that the Attorney General
    may commence an action for relief under USERRA, further clarifying
    Congressional intent to effectively protect servicemembers.
        DAV has no specific resolution pertaining to the issues addressed
    by this bill; however, these changes would appear to improve
    servicemembers' employment and reemployment rights; thus, we would not
    oppose its favorable consideration.
           s. 3055, department of veterans affairs dental insurance
                          reauthorization act of 2016
        If enacted, this measure would make permanent and existing pilot
    program of VA dental insurance for veterans, survivors and dependents
    of veterans as mandated under Section 510 of Public Law 111-163, by
    allowing eligible veterans plus family members receiving care under the
    Civilian Health and Medical Program of VA (CHAMPVA), to purchase dental
    insurance.
        DAV recognizes that oral health is integral to the general health
    and wellbeing of a patient, and is part of comprehensive health care
    irrespective of service-connected disability. The law defines
    preventive health services as a broad collection of VA health services
    that improve, protect and sustain the general health and well-being of
    veterans enrolled in VA health care, to include ``such other health
    care services as the Secretary may determine to be necessary to provide
    effective and economical preventive health care.'' It is for this
    reason that DAV supports the intent of this bill in accordance with DAV
    resolution 049, which supports providing VA outpatient dental care to
    all enrolled veterans. However, DAV opposes any copayments that this
    program would require. DAV resolution 114, adopted at our most recent
    convention, calls for legislation to eliminate or reduce VA and DOD
    health care out-of-pocket costs for service-connected disabled
    veterans.
        Veterans, through service to their Nation, have made extraordinary
    sacrifices and contributions, and have earned the right to certain
    benefits in return. Premiums, health care cost sharing and deductibles
    are features of health care systems in which some costs are shared by
    the insured and the insurer in a contractual relationship between the
    patient and the insurer.
             s. 3076, charles duncan buried with honor act of 2016
        Currently, VA reimburses the purchase of a casket or urn used only
    when the deceased veteran is interred in a VA National Cemetery. The
    veteran must have no identifiable next of kin and insufficient
    resources to pay for a casket or urn. This bill would extend the
    benefit to such veterans interred in state and tribal cemeteries.
        DAV has no resolution pertaining to this issue; however, we would
    not oppose passage of this legislation because it appears to be
    beneficial to veterans.
     s. 3081, working to integrate networks guaranteeing member access now
                                      act
        This bill would provide certain permanent Congressional employees
    with read-only remote access to the electronic VBA claims records of
    veterans who are constituents of Members. These employees would be
    prohibited from modifying any data, processing, preparing or
    prosecuting of claims.
        These designated Congressional staff members could utilize this
    system to provide their constituents with information relevant to the
    processing of their claims or appeals. Designated staff members would
    require certification by the VA in order to access this system in the
    same manner currently required for agents or attorneys. Any costs
    associated with gaining access to these VA systems would be incurred by
    the particular Member of Congress whose staff accessed these records.
        DAV has no resolution relative to this issue, but would not oppose
    passage of the legislation.
       draft bill, to expand eligibility for readjustment counseling to
     certain members of the selected reserve of the armed forces (john b.)
        This bill, if enacted, would authorize VA Readjustment Counseling
    Centers to provide counseling in Vet Centers to members of the Selected
    Reserve, for psychological trauma or behavioral conditions, and would
    protect the privacy of these individuals in seeking out such counseling
    by not requiring them to obtain referrals, presumably from their
    commands or military medical authorities, before seeking counseling.
        VA Resolution No. 103 urges Congress, the Administration and VA to
    enable Vet Centers to continue expanding and extending their
    rehabilitative and readjustment services, including in more rural
    communities, to veterans of past, present and future military service,
    and to their family members when necessary to aid in the recovery of
    veterans suffering the latent effects of combat exposure. Therefore,
    DAV strongly supports this proposal.
    draft bill, to authorize payment by the department of veterans affairs
    for the costs associated with service by medical residents and interns
     at facilities operated by indian tribes and tribal organizations, to
    require the secretary of veterans affairs to carry out a pilot program
        to expand medical residencies and internships at such facilities
        This bill would expand into health care facilities of Indian tribal
    organizations VA's current responsibilities and costs incurred in its
    graduate medical education programs. The bill would require VA to
    establish a five-year program of residency training in Alaska and two
    as-yet unidentified locations, and to reimburse tribal facilities
    selected for some of their costs in hosting VA medical residencies as
    specified in the bill. After three years of operation, the bill would
    require VA to report to Congress on the feasibility and advisability of
    expanding the pilot program to additional tribal health care sites, and
    on making the program or any aspect of it permanent.
        VA has executed an extensive memorandum of agreement with the
    Indian Health Service to ensure that veterans of Indian ancestry
    receive adequate health care and other services. It is unclear from the
    language of this bill whether this new academic program would impact
    this agreement, and to what extent. Also, an authorization of $20
    million per year over a five-year period for a three-site pilot program
    seems excessive; we recommend the amount be reconsidered.
        While DAV has no resolution supporting this concept of VA medical
    residencies in Indian tribal facilities, we would not offer opposition
    to this bill; nevertheless, we recommend the sponsor consult with the
    VA Office of Rural Health, as well as the Office of Academic
    Affiliations, on the implications of the bill prior to its further
    advancement through the legislative process.
    discussion draft to authorize the american battle monuments commission
    to acquire, operate, and maintain the lafayette escadrille memorial in
                           marnes-la-coquette, france
        This bill would authorize the American Battle Monuments Commission
    to take ownership and operational control of an important World War I
    memorial in France. DAV has received no resolution dealing with this
    particular topic and takes no position on this bill.

        Mr. Chairman, this concludes DAV's testimony. We thank the
    Committee for inviting DAV to submit this testimony for the record. DAV
    is prepared to respond to any questions by Committee Members on the
    positions we have taken with respect to the bills under consideration.
                                     ______

              Prepared Statement of Allen Doederlein, President,
                    Depression and Bipolar Support Alliance

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

    Prepared Statement of the Civil Rights Division and the Servicemembers
          and Veterans Affairs Initiative, U.S. Department of Justice

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        [The Clark 50-page brief can be seen here:]
    https://www.justice.gov/archives/opa/blog-entry/file/861466/download

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

        Prepared Statement of Michael Michaud, Assistant Secretary for
          Veterans' Employment and Training, U.S. Department of Labor

        Chairman Isakson, Ranking Member Blumenthal, and Members of the
    Committee, Thank you for the opportunity to provide the views of the
    Department of Labor (DOL) on pending legislation aimed at helping the
    men and women who served, or are serving, this country succeed in the
    civilian workforce. As Assistant Secretary of the Veterans' Employment
    and Training Service (VETS), I look forward to working with the
    Committee to ensure that these brave and committed individuals have the
    employment support, assistance and opportunities they deserve.
        While this hearing will address numerous bills pending before the
    Committee, my statement will focus on Ranking Member Blumenthal's draft
    legislation, which would make a number of important amendments to the
    Uniformed Services Employment and Reemployment Rights Act of 1994, 38
    U.S.C. Sec. Sec. 4301-4335, (USERRA or the Act), which is enforced by
    VETS, the Department of Justice (DOJ), and the U.S. Office of Special
    Counsel (OSC). My statement also will briefly discuss S. 2958, which
    would ``establish a pilot program on partnership agreements to
    construct new facilities for the Department of Veterans' Affairs.''
        USERRA prohibits discrimination in employment based on an
    individual's prior service in the uniformed services; current service
    in the uniformed services; or intent to join the uniformed services. An
    employer is also prohibited from discriminating against a person
    because of such person's attempt to enforce his or her rights under the
    Act. In addition, an employer may not retaliate against an individual
    for filing a USERRA claim or testifying or otherwise providing
    assistance in any proceeding under the Act. USERRA also provides
    reemployment rights with the pre-service employer following qualifying
    service in the uniformed services. In general, the protected person is
    entitled to be reemployed with the status, seniority, and rate of pay
    as if he or she had been continuously employed during the period of
    service. USERRA applies to private employers, the Federal Government,
    and State and local governments. It also applies to United States
    employers operating overseas and foreign employers operating within the
    United States.
        USERRA protects civilian job rights and benefits for veterans and
    members of the Uniformed Services. VETS provides assistance to those
    persons experiencing service-connected problems with their civilian
    employment, and provides information about USERRA to employers. In
    Fiscal Year (FY) 2015, the Department reviewed a total of 1,288 USERRA
    cases. 77 of those cases were referred to DOJ and OSC for further
    review and possible litigation in either U.S. District Court or before
    the Merit Systems Protection Board (MSPB). In addition, DOL staff
    provided technical assistance to more than 10,000 servicemembers and
    other individuals in FY 2015, and well over a million individuals since
    September 11, 2001. The rights USERRA affords our servicemembers and
    veterans are critical, and we are committed to doing everything
    possible to ensure those rights are protected and preserved.
     s. xxxx--a bill to amend title 38, united states code, to clarify the
     scope of procedural rights of members of the uniformed services with
      respect to their employment and reemployment rights, to improve the
     enforcement of such employment and reemployment rights, and for other
                                   purposes.
        DOL strongly supports the Ranking Member's draft bill. The
    significant USERRA improvements it would provide mirror those we have
    urged the Congress to enact, as reflected both in the Administration's
    recent legislative proposal, and in several of our USERRA Annual
    Reports to Congress. We applaud this effort to strengthen enforcement
    of USERRA, and believe the proposed statutory amendments, some of which
    are discussed in more detail, below, will address several critical
    issues.
        Section 1 of the draft bill is intended to make clear the scope of
    employment and reemployment rights of covered individuals, by
    clarifying the definitions of ``rights'' and ``benefits'' under USERRA,
    and by clarifying the status of arbitration agreements under the Act.
    These amendments guarantee the availability and protection of
    procedural rights included in the statute, ensuring that USERRA
    operates to safeguard both substantive and procedural rights and
    benefits from reduction, limitation, or elimination. We are
    particularly grateful that, to ensure the procedural right of
    adjudication of USERRA claims, the bill expressly provides that
    agreements to arbitrate are unenforceable ``unless all parties consent
    to arbitration after a complaint on the specific claim has been filed
    in court or with the MSPB and all parties knowingly and voluntarily
    consent to have that particular claim subjected to arbitration.''
        DOL supports limiting the ability to consent to arbitration until
    after a claim is filed in court or with the MSPB because, at that stage
    of the adjudication process, claimants already have a sense of their
    rights and likely have consulted with an attorney. Section 1(c)(2) is
    not necessary, and is potentially harmful, because there may well be
    other circumstances, not specifically provided for, where a claimant's
    agreement might not be voluntary. DOL believes that the determination
    as to whether a USERRA claimant's consent to arbitrate is voluntary is
    best left to the adjudicator, who will decide that question based upon
    the particular facts and circumstances of the case.
        Federal judicial circuits are presently divided as to whether
    USERRA protections apply to procedural as well as substantive rights.
    It has long been the Department's interpretation of USERRA, as well as
    that of DOJ and OSC, that USERRA applies to procedural rights,
    regardless of how such rights may be construed. Clarifying that USERRA
    applies to both procedural and substantive rights provides certainty
    in legal interpretation, and would resolve the ambiguity that currently
    exists among Federal judicial circuits. It also reassures our
    servicemembers and veterans that they have proper recourse when they
    believe their USERRA rights have been violated.
        The amendments contained in Section 2 of the bill would make a
    number of substantial improvements to the enforcement of employment and
    reemployment rights with respect to a State or private employer.
    Significantly, subsection (a) would strengthen enforcement under USERRA
    by allowing the United States to serve as a plaintiff in all suits
    filed by the Attorney General (AG), rather than only in those suits
    filed against State employers. This amendment would ensure that USERRA
    is consistent with other civil rights laws by allowing the United
    States to bring suit in its own name as the plaintiff, to vindicate the
    public interest in ensuring the statute is enforced. The aggrieved
    person on whose behalf the AG files suit would retain the right to
    intervene in such suits, or to bring his or her own action if the AG
    declines to file suit.
        This section also grants independent authority to the AG to
    investigate and file suit to challenge employment policies or practices
    that establish a pattern or practice of violating USERRA. This
    amendment, modeled after Title VII of the Civil Rights Act of 1964 (42
    U.S.C. Sec. 2000e-6(a)), would strengthen significantly DOJ's ability
    to enforce USERRA to address a systemic violation (such as an employer
    policy prohibiting extended absences, including absences for military
    service) that could adversely affect the employment rights of multiple
    servicemembers.
        In support of this new pattern-or-practice authority, the bill also
    would amend USERRA to provide the AG with the authority to issue civil
    investigative demands to compel the production of relevant documentary
    materials and unsworn answers to written questions from the custodian
    of such documents. DOL has the power to issue subpoenas in the conduct
    of its investigations under USERRA. However, with no investigatory role
    under current law, the AG has no authority to compel the production of
    evidence prior to filing suit. Because the section now empowers the AG
    to initiate an investigation, this further amendment would provide
    appropriate and much-needed investigative tools.
        Finally, DOL also supports other amendments section 2 would make to
    enable servicemembers and veterans to more ably exercise their USERRA
    rights, and to enhance the available remedies for violations of USERRA
    rights. For instance, subsection (b) explicitly abrogates sovereign
    immunity to eliminate any question whether Congress intends that USERRA
    claimants be able to bring an action against a State employer in State
    court or Federal district court. And, subsection (d) adds compensatory
    and punitive damage provisions that are similar to damages provisions
    in Title VII of the Civil Rights Act of 1964.
    s. 2958--a bill to establish a pilot program on partnership agreements
      to construct new facilities for the department of veterans' affairs
        This bill would authorize the Secretary of Veterans' Affairs to
    enter into up to five partnership agreements with certain designated
    entities to conduct one or more super construction projects; major
    medical facility projects; or major construction projects to construct
    new cemeteries, or develop additional gravesites or columbarium niches
    at existing cemeteries. Section 1(b) of the bill provides that this
    authority may be carried out ``notwithstanding any other provision of
    law (including section 8103(e) of title 38, Untied States Code), except
    for Federal laws relating to environmental and historic preservation;
    and, subchapter IV of chapter 31 of title 40, United States Code
    (commonly referred to as the 'Davis Bacon Act').''
        Like VA, DOL strongly supports the bill's authorization of these
    partnership agreements, provided the legislation does not roll back key
    civil rights protections for veterans and other employees who will be
    working to construct the facilities resulting from these partnership
    agreements. These safeguards protect millions of workers, including
    veterans. DOL looks forward to working with the Committee to revise the
    language of section 1(b) to ensure that S. 2958 provides VA the
    authority it needs while maintaining the applicability of laws that
    protect against employment discrimination or that otherwise ensure
    equal employment opportunities.
                                   conclusion
        Every day, we at DOL do our best to serve the civilian employment
    needs of our veterans, transitioning servicemembers, and military
    families. It is the least we can do to honor the tremendous sacrifices
    made by our service men and women and their families. Secretary Perez
    and VETS strongly believe that the reforms included in Ranking Member
    Blumenthal's draft bill to amend USERRA will not only help our veterans
    and servicemembers find good jobs, but also ensure that they can retain
    their civilian employment when they must leave it to serve our Nation.
    We look forward to working with the Committee on these important issues
    and are available to provide any technical assistance you request with
    respect to these proposed amendments. DOL also stands ready to assist
    the Committee and VA to make certain that S. 2958 does not operate to
    exclude veterans and other workers from important equal opportunity and
    employment protections.

        I again thank the Committee for your commitment to our Nation's
    veterans and servicemembers and for the opportunity to submit this
    statement for the record.
                                     ______

     Letter from Alexander Blumrosen, President, The Lafayette Escadrille
                              Memorial Foundation

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

       Prepared Statement of Frederick R. Salanti, Maj, US Army (USAR),
       Founder/Executive Director, Missing In America Veterans Recovery
                                    Program

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

         Prepared Statement of Military Officers Association of America
        Chairman Isakson, Ranking Member Blumenthal, and Members of the
    Committee, The Military Officers Association of America (MOAA) is
    pleased to present its views on veterans' health care and benefits
    legislation under consideration by the Committee.
        MOAA does not receive any grants or contracts from the Federal
    Government.
                               executive summary
        On behalf of our more than 390,000 members, MOAA thanks the
    Committee for holding this important hearing and for your continued
    support of our Nation's servicemembers, veterans and their families.
    MOAA is especially grateful for the Committee's leadership in
    introducing S. 2921, the Veterans First Act, a comprehensive bill to
    improve the delivery of health care and benefits in the Department of
    Veterans Affairs (VA).
        We believe many of the bills being considered today will buildupon
    the work of the Committee in the Veterans First Act, further enhancing
    VA's health and benefits systems. Our Association looks forward to
    working with the Members and staff to strengthen and improve the
    legislation for enactment this year.
        MOAA's position and recommendations are provided on the following
    bills:

         S. 603, Rural Veterans Travel Enhancement Act of 2015
         S. 2210, Veteran Partners' Efforts to Enhance
    Reintegration (PEER) Act
         S. 2279, Veterans Health Care Staffing Improvement Act
         S. 3035, Maximizing Efficiency and Improving Access to
    Providers at the Department of Veterans Affairs Act of 2016
         S. 244, Review of the Disability Compensation Process for
    Traumatic Brain Injuries
         S. 2791, Atomic Veterans Healthcare Parity Act
         S. 3023, The Arla Harrell Act
         S. 3032, Veterans' Compensation Cost-of-Living Adjustment
    Act of 2016
         Draft Bill, Clarification of Procedural Rights Under the
    Uniform Services Employment and Reemployment Rights Act (USERRA)
                                  health care
        S. 603, Rural Veterans Travel Enhancement Act of 2015. The bill
    would give the Secretary of VA permanent authority to transport
    individuals to and from any VA facility which provides rehabilitation,
    counseling, examination, treatment, and care.
        The measure specifically authorizes the Secretary to cover the
    actual expenses of travel or allowances for a veteran using a VA
    Veterans Readjustment and Counseling Program or `Vet Center' facility.
        Vet Centers provide important services to help guide veterans and
    their family members through the major life changes that often occur
    when a member returns from combat. Services include individual, group
    and family counseling in such areas as post-traumatic stress, alcohol
    and drug assessment, and suicide prevention.
        Currently VA covers travel expenses for care at VA medical centers
    and community-based outpatient clinics. Vet Centers provide a critical
    capability within VA's health system, thus inclusion of these
    facilities for purposes of payments for beneficiary travel and
    allowances should also be a covered benefit for consistency and
    continuity of care throughout the system.
        MOAA supports S. 603, but recommends funds be appropriated to
    support the bill. We would urge against trading funding from other
    medical programs to offset these costs as MOAA believes medical care
    and services, including associated travel expenses and allowances, are
    central components to opening up access and delivering high quality
    health care to our veterans.
        S. 2210, Veteran Partners' Efforts to Enhance Reintegration (PEER)
    Act. MOAA strongly supports this measure which would establish a two-
    year pilot program to incorporate peer specialists in patient aligned
    care teams at 25 VA medical centers to promote the use and integration
    of mental health services in the primary care setting.
        MOAA has long endorsed peer support programs as a means to enhance
    the delivery of health care services. Extending VA's existing mental
    health peer support model into the primary care setting will help to
    further reduce barriers in accessing mental health services while
    concurrently increasing system capacity.
        We greatly appreciate Senator Richard Blumenthal's (D-CT)
    leadership on this significant issue. We are particularly grateful for
    the legislation's special consideration of gender specific peer support
    services for female veterans and focus on veterans living in rural or
    underserved areas.
        S. 2279, Veterans Health Care Staffing Improvement Act. This bill
    would increase efficiency in the recruitment and hiring of health care
    professionals in VA. The bill contains a number of innovative and much
    needed solutions to addressing critical health care staffing shortfalls
    and veterans' access to care.
        The Department of Defense (DOD) would be required, at least
    annually, to submit a list of transitioning military members serving in
    health care fields to the VA for recruitment and hiring consideration.
        Additionally, the measure would create uniform credentialing
    standards for certain health care professionals working in the agency
    so employees are allowed to practice in any location in the VA Health
    Administration (VHA) system.
        MOAA is also pleased to see a provision granting full practice
    authority to Advanced Practice Nurses and Physician Assistants,
    bringing VHA in line with other practicing professionals in the DOD,
    Indian Health Service, and the Public Health Service systems.
        Our Veterans need all the skills Advanced Practice Nurses can
    provide them. The implementation of the Veterans Health Care Staffing
    Improvement Act would help fill a critical system need today.
        VA's current health system, where 10 Advanced Practice Nurses in a
    single medical facility have 10 different state licensures, and 10
    different scopes of practice, imposes unnecessary supervision
    requirements, further limiting system capability and capacity. This
    aspect of the system needs to be corrected.
        By aligning VA nurse workforce with other Federal healthcare
    services, we better serve and honor our veterans.
        MOAA fully supports S. 2279 and urges immediate passage of the
    bill.
        S. 3035, Maximizing Efficiency and Improving Access to Providers at
    the Department of Veterans Affairs Act of 2016. MOAA also supports this
    measure which would require the Department to carry out an 18-month
    pilot program using medical scribes to support physicians in at least
    five VHA facilities.
        The purpose of the pilot is to collect data to determine the
    effectiveness of the program in increasing efficiency of physicians,
    reduce average wait times for appointments, improve access of patients
    to electronic medical records, and mitigate physician shortages through
    increased productivity.
        Medical scribes are a health care innovation broadly used outside
    of VHA to assist physicians by alleviating paperwork and electronic
    health record burdens, allowing physicians to spend more time treating
    patients while at the same time being able to see more patients.
        MOAA urges the Committee to support funding of this important
    program and swift passage of the bill. VA needs innovative solutions
    like S. 3035 to address its current physician shortages and growing
    demand for health care in the coming years.
                                    benefits
        S. 244, Review of the Disability Compensation Process for Traumatic
    Brain Injuries. MOAA supports this bill, which would fund research into
    Traumatic Brain Injuries. Traumatic Brain Injuries are tremendously
    complex, and a recent study found brain injuries incurred due to war-
    related events such as blasts differ from those incurred during sports-
    related activities. War-related brain injury requires further study,
    and VA should be provided the resources to buildupon current expertise
    in this arena and provide veterans with the most up-to-date options in
    treatment.
        S. 2791, Atomic Veterans Healthcare Parity Act. MOAA supports the
    inclusion of veterans who participated in the cleanup of Enewetak Atoll
    as radiation-exposed veterans. The nuclear testing performed at
    Enewetak Atoll should entitle these veterans to the same presumptions
    for radiation-related illnesses when applying for VA disability
    compensation as in other incidents of service-related toxic exposure.
    There is no discernable reason why these veterans should be denied
    equal treatment under the law.
        S. 3023, The Arla Harrell Act. MOAA supports the passage of this
    bill, which would require VA to reconsider claims that have previously
    been denied for veterans exposed to mustard gas or lewisite testing by
    the DOD. It is a matter of fairness to these veterans that our
    government should be obligated to compensate these human test subjects
    for the resulting effects of those studies. The bill would close this
    loophole for this group of veterans seeking relief.
        S. 3032, Veterans' Compensation Cost-of-Living Adjustment Act of
    2016. MOAA supports the passage of this bill to provide veterans with
    the same type of cost-of-living increases in their disability
    compensation and survivor annuities that Social Security recipients
    receive in theirs.
        Draft Bill, Clarification of Procedural Rights Under the Uniform
    Services Employment and Reemployment Rights Act (USERRA). MOAA supports
    passage of this bill to close the loophole that currently exists in
    USERRA. Presently, servicemembers returning to their civilian jobs who
    find their employer has violated USERRA may not be fully protected if
    he or she has signed an employment contract that requires disputes be
    mediated by an arbitrator vice litigated in court.
        Arbitration provides no opportunity for a servicemember to appeal
    an unfavorable decision and places the employer in a much more
    advantageous position than the servicemember. Closing this loophole is
    important to ensure our servicemembers are fully protected, as Congress
    intended in enacting USERRA.

        MOAA thanks the Committee for considering this important
    legislation and for your continued support of our veterans and their
    families.
                                     ______

          Prepared Statement of the Military Order of the Purple Heart
        Chairman Isakson, Ranking Member Blumenthal and Members of the
    Committee, on behalf of the Military Order of the Purple Heart of the
    U.S.A. (MOPH) we would like to thank you for including S. 3042, the
    Justice for Servicemembers Act of 2016 on today's hearing agenda. We
    are grateful for the opportunity to provide written testimony in
    support of this legislation and in support of restoring the rights of
    servicemembers in the face of forced arbitration. We would like to urge
    Congress to quickly pass this important legislation on behalf of all of
    our brave men and women who serve.
        Throughout history, Congress has enacted laws that provide
    additional rights and protections for the men and women who serve our
    country. Congress did so in recognition of the significant, additional
    burdens that being called away from your family and your job to serve
    our country places on these brave individuals; burdens that civilians
    do not face. One of these landmark laws is the Uniformed Services
    Employment and Reemployment Act (USERRA). Passed in 1994, the USERRA
    protects our servicemembers from employment discrimination and
    guarantees that when called for military service, they can perform
    their duties with the knowledge and security that they have the right
    to return to their jobs with the same pay, benefits, and status they
    would have attained had they not been called away.\1\ This law is one
    of the most important protections for members of the uniformed services
    and one of the strongest employment-protection laws in our country.
    ---------------------------------------------------------------------------
        \1\ Leisha Self, A Guide to the Uniformed Services Employment and
    Reemployment Rights Act and the Recent Hostile Work Environment
    Amendment, 28 ABA J. Lab. & Emp. L. 449 (2013)
    ---------------------------------------------------------------------------
        Just as important as the substantive rights afforded by USERRA are
    the procedural and enforcement rights guaranteed under the law. Under
    USERRA, when servicemembers' rights are violated, they have the right
    to bring a USERRA claim to court.\2\ The bill expressly dictates that
    any employment agreement that limits or eliminates a right or benefit
    provided by USERRA, including the establishment of additional
    prerequisites to the exercise of any such right, is facially void.\3\
    ---------------------------------------------------------------------------
        \2\ 38 U.S.C. Sec. 4323(a) (2).
        \3\ 38 U.S.C. Sec. 4302(b).
    ---------------------------------------------------------------------------
        Nevertheless, servicemembers and veterans are increasingly unable
    to enforce their rights under USERRA for one specific reason: forced
    arbitration clauses buried in the fine print of their employment
    contracts. Presented on a take-it-or-leave-it basis, employers across
    the country are requiring servicemembers to sign forced arbitration
    agreements that effectively eliminate the important rights afforded by
    USERRA. Forced arbitration clauses undermine the very protections of
    USERRA, and other laws that Congress has deemed necessary and
    appropriate to afford to our military, by kicking claims out of court,
    and funneling them into a rigged, secretive system where all the rules,
    including who decides the outcome of the forced arbitration, are chosen
    by the employer that violated the law in the first place.
        While forced arbitration clauses used in employment contracts can
    be harmful and oppressive for all employees, the ramifications are even
    more serious when these clauses are enforced against our men and women
    in uniform. When servicemembers become distracted from the mission at
    hand due to fears of unemployment, paying bills, providing for their
    family and other financial stresses upon returning home from duty, it
    directly impacts our national security.
        Congress intended for USERRA to ensure servicemembers did not lose
    their right to take an employer who wronged them to a court of law in
    order to have their story heard. This bill would honor that intent.
    Given the expansive use of these clauses by financial institutions and
    employers in contracts with servicemembers, prohibiting the use of
    forced arbitration clauses is now more critical than ever. We strongly
    urge you to support the Justice for Servicemembers Act and any other
    legislative efforts to prohibit the use of forced arbitration clauses
    against our Nation's heroes: our servicemembers and veterans.
        MOPH would also like to add our comments on several other pieces of
    legislation on today's agenda.
        MOPH supports S. 244, a bill to require an independent
    comprehensive review of the process by which the Department of Veterans
    Affairs assesses cognitive impairments that result from Traumatic Brain
    Injury for purposes of awarding disability compensation. Due in part to
    the devastating effects of improvised explosive devices used on the
    battlefields of Iraq and Afghanistan, more veterans than ever are
    claiming disabilities associated with Traumatic Brain Injuries (TBI).
    Still, not enough is currently known about TBI, and the way it affects
    veterans' abilities to function properly. By requiring the Institute of
    Medicine to conduct a review of TBI examinations provided by the
    Department of Veterans Affairs (VA), this bill will help ensure that
    injured veterans receive the proper health care and compensation they
    need.
        MOPH supports S. 603, the Rural Veterans Travel Enhancement Act of
    2015, which would improve transportation options for veterans traveling
    to and from VA for medical appointments. It would do so by permanently
    authorizing the Veterans Transportation Service program, which allows
    VA to offer rides to veterans that need them; allowing veterans to
    receive travel reimbursement for episodes of care received at Vet
    Centers; and reauthorizing grants for Veterans Service Organizations
    that provide veterans with transportation. These provisions are
    critical to ensuring that no veteran is forced to forgo VA medical
    care, simply because they cannot provide their own transportation due
    to impairment or financial reasons.
        MOPH supports S. 2210, the Veteran PEER Act, which would require VA
    to establish peer specialists in patient aligned care teams at medical
    centers of the department. The utilization of peer specialists at VA is
    a proven model of success. Veterans consistently report that having
    access to peer support greatly improves their comfort level at VA
    facilities, as well as their ability to navigate the often confusing
    processes they encounter there when newly enrolled. Adding peer
    specialists to patient aligned care teams would help grant veterans
    access to this important resource at every stage of their medical care.
        MOPH supports some provisions of S. 2279, the Veterans Health Care
    Staffing Improvement Act. We strongly support section 2, which would
    require VA and the Department of Defense (DOD) to cooperatively
    facilitate the recruitment of recently separated veterans who served in
    medical fields in the military as VA health care professionals, known
    as the ``Docs-to-Doctors Program.'' Not only have these personnel
    received superior training in the military, they have also proven their
    leadership and desire to serve their country, which can only benefit
    VA. Further, they are uniquely qualified to provide care to their
    fellow veterans, as they have a first-hand understanding of their
    military experience. We believe that this program will improve VA's
    ability to recruit top talent, while simultaneously increasing patient
    satisfaction. MOPH also supports section 3, which would require VA to
    implement a uniform credentialing process for employees of the Veterans
    Health Administration.
        MOPH does not support section 4 of S. 2279, which would require VA
    to provide full practice authority to advanced practice registered
    nurses (APRN), physician assistants (PA), and such other licensed
    health care professionals of the department. While we fully appreciate
    the importance of APRNs and PAs in in the modern health care industry,
    we would defer to VA on this matter. We note that VA recently published
    regulations to allow flexibility in full practice authority to meet the
    access needs of the department. This would allow VA to implement full
    practice authority in specialties where it is needed, but not require
    them to do so in specialties where it is not. Accordingly, we do not
    believe a legislative fix to this issue is necessary or appropriate at
    this time.
        MOPH supports S. 2316, which would improve VA oversight of
    fiduciaries, and allow for the reissuance of veterans benefits in cases
    of misuse by fiduciaries. Generally speaking, fiduciaries provide an
    invaluable service to veterans who are incapable of handling their own
    finances due to disability. However, there have been cases where
    fiduciaries, both family members and professional firms, have misused
    veterans' benefits for their own personal gain. MOPH believes it is
    critically important that vulnerable veterans in need of assistance
    with their finances be properly protected from theses unscrupulous
    actors. For this reason, we believe it is fully reasonable that all
    fiduciaries be subject to robust oversight, to include the auditing of
    their bank accounts. Furthermore, we believe it is the right thing to
    do to restore benefits that are found to have been intentionally
    misused, to ensure that veterans who are taken advantage of are made
    whole in those unfortunate cases.
        MOPH supports S. 2791, the Atomic Veterans Parity Act, which would
    grant a presumption of service connection for certain cancers to
    veterans who participated in the cleanup of Enewetak Atoll and the
    Marshall Islands between January 1, 1977 and December 31, 1980. These
    veterans would be treated the same as other veterans who were exposed
    to known sources of radiation for the purposes of VA benefits. Current
    law provides presumptive service connection for veterans who
    participated in atomic testing between 1944 and 1958, but not those who
    were assigned to clean up the debris years later. MOPH strongly
    believes that toxic wounds incurred in service are wounds just the
    same, and should be treated with the same urgency as physical or mental
    wounds. We are aware that many of these veterans are now suffering from
    tell-tale cancers associated with radiation exposure, and believe that
    granting them access to VA health care and benefits as a result is long
    overdue.
        MOPH supports S. 3021, which would allow veterans to use their GI
    Bill benefits to pursue programs of independent study at schools that
    do not meet the industry definition of an ``institution of higher
    learning,'' such as a state university or a community college. This
    bill would provide veterans with more options by allowing them to use
    their benefits to obtain certificates and professional credentials from
    institutions such as area career and technical education schools. We
    note that these programs would still be accredited and subject to
    review by State Approval Agencies, as provided in statute for all
    courses of study approved for GI Bill use.
        MOPH supports S. 3023, the Arla Harrell Act, which would provide
    for the reconsideration of claims for disability compensation for
    veterans who participated in DOD experiments with mustard gas and
    lewisite on a presumptive basis. During World War II, thousands of
    servicemembers were used as subjects in experiments to test the effects
    of these harmful agents on the human body. Not surprisingly, this left
    many of them with chronic health issues. However, most veterans were
    routinely denied disability compensation for these conditions, as the
    experiments remained classified for decades. MOPH strongly believes
    that these claims should be reconsidered on a presumptive basis in
    order to finally grant these veterans the health care and benefits they
    need and deserve.
        MOPH supports S. 3032, the Veterans' Compensation Cost-of Living
    Adjustment Act of 2016, which would increase the rate of compensation
    for disabled veterans and their survivors, effective December 1, 2016.
    Unlike Social Security benefits, which are automatically increased by
    statute, Congress must pass a bill each year to ensure that the
    benefits that disabled veterans and their survivors have earned are
    increased to keep pace with inflation. This is absolutely critical,
    given the ever rising prices of food, housing, health care, and other
    essential goods and services. By providing reasonable increases to
    those benefits, your legislation would ensure that the most basic needs
    of disabled veterans and their survivors are met. MOPH is especially
    pleased that your legislation does not include the ``round down''
    provision of previous years, which is nothing more than a cost-saving
    device that requires veterans to pay for their own benefits.
        MOPH supports S. 3035, the Maximizing Efficiency and Improving
    Access to Providers at the Department of Veterans Affairs Act of 2016,
    which require the Department of Veterans Affairs (VA) to carry out an
    18 month pilot program to increase the use of medical scribes at no
    fewer than five medical facilities in rural areas where there is a
    shortage of physicians and each physician has a high caseload. These
    medical scribes would be responsible for assisting VA physicians with
    administrative tasks that are normally done by support staff in the
    private sector.
        It is well documented that rural areas across the country suffer
    from physician shortages. This affects the ability of VA to recruit and
    retain an adequate number of physicians, resulting in longer
    appointment wait times. For this reason, MOPH believes that it is
    absolutely critical that VA physicians in these areas are able to
    practice medicine as efficiently as possible. The increased use of
    medical scribes would accomplish this by allowing VA doctors to spend
    less time on administrative tasks such as data entry and more time
    doing what is most important; providing care to veterans.
        MOPH supports S. 3055, the Department of Veterans' Affairs Dental
    Insurance Reauthorization Act of 2016, which would require VA to
    contract with a private insurance company to offer a voluntary dental
    insurance plan to veterans and certain dependents. Generally, VA only
    provides dental care to veterans who incurred dental trauma while in
    service, or who are rated 100 percent service-connected. Veterans who
    are service-connected but rated less than 100 percent are generally not
    offered dental care at VA. MOPH believes that dental care should be
    considered the same as health care, as a number of serious
    comorbidities affecting a veterans' overall health can arise from
    dental neglect, including diabetes and heart disease. These conditions,
    which may have been preventable with routine dental care, then have to
    be treated at far greater expense by VA. While MOPH would rather see
    full VA dental care eligibility extended to all service-connected
    veterans, we would still support the establishment of a voluntary,
    reasonably priced dental insurance program for veterans and their
    families, as envisioned by this legislation.
        Finally, MOPH opposes the draft bill entitled the Working to
    Integrate Networks Guaranteeing Member Access Now Act, or WINGMAN Act.
    While we appreciate Senator Cassidy's intent to provide faster service
    to veteran constituents who request assistance from congressional
    offices, we are concerned that there would be unintended consequences
    to allowing congressional staff access to veterans' VA claims files. It
    is yet unclear to us how VA would ensure that staff only gains access
    to the records of veterans who have provided them with privacy
    releases. Further, we are concerned that granting congressional staff
    this access would create confusion in their role in the claims process
    as it relates to veterans, VA and Veterans Service Organizations. While
    we cannot support the bill as written, we would be happy to work with
    Senator Cassidy and his staff on ways to improve congressional offices'
    ability to provide veteran constituents with more timely responses.

        Chairman Isakson, Ranking Member Blumenthal, and Members of the
    Committee, once again, we thank you for the opportunity to submit our
    views on these important bills.
                                     ______

     Prepared Statement of Keith Kiefer, Director at Large, NAAV Minnesota
      State Co-Commander & Enewetak Radiological Cleanup Veteran (1978),
                    National Association of Atomic Veterans

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

           Prepared Statement of National Alliance on Mental Illness

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

       Prepared Statement of Joseph W. Wescott II, Legislative Director,
                National Association of State Approving Agencies
        Chairman Isakson, Ranking Member Blumenthal, and Members of the
    Committee: The National Association of State Approving Agencies (NASAA)
    is pleased to provide its views on certain education benefits
    legislation under consideration by the Committee today, June 29, 2016,
    particularly S. 3021.
        NASAA does not receive any grants or contracts directly from the
    Federal Government, though its member organizations are state agencies
    operating in whole or in part under Federal contracts funded by
    Congress and administered by the Department of Veterans Affairs (VA).
        On behalf of fifty-five SAAs in 49 states and the territory of
    Puerto Rico, NASAA thanks the Senate Committee on Veterans Affairs for
    its strong commitment to a better future for all servicemembers,
    veterans and their families through its continued support of the GI
    Bill educational program.
         s. 3021, a bill to authorize the use of post-9/11 educational
    assistance to pursue independent study programs at certain educational
           institutions that are not institutions of higher learning
        State approving agencies take seriously our role as ``the
    gatekeepers of quality'' and the ``boots on the ground'' defending the
    integrity of the GI Bill and making sure that only quality programs are
    approved by applying Federal and state law and regulation. An
    additional and equally important role is the continued oversight of
    these programs after their initial approval. We do so in conjunction
    with other stakeholders in veteran and higher education, including
    state licensing agencies, state higher education departments, the
    Department of Veterans Affairs, the Department of Education and
    national and regional accrediting agencies.
        Congress, in establishing the laws and regulations governing the
    manner and method by which education could be approved for veterans,
    wisely provided that Non College Degree training could be delivered by
    way of independent study (on-line education) only when affiliated with
    or provided by an accredited institution of higher learning (IHL).
    Certainly, in view of the uncertain quality of distance learning in the
    early years of its development, it made sense to make sure that
    regionally accredited IHLs were the only places that online NCD
    training would be approved. This also recognized the fact that many
    unaccredited NCD programs are offered in a clock-hour as opposed to a
    credit hour format and as such, it is virtually impossible to ensure
    that veterans met approved program attendance standards outside of the
    classroom.
        S. 3021 seeks to expand Post-911 GI Bill to provide for the
    approval of independent study programs at certain educational
    institutions that are not institutions of higher learning, namely
    stand-alone NCD granting institutions. Though this bill does include
    language to restrict the extent of this expansion somewhat, some of
    that language could be problematical. As this is a radical departure
    from the inherent safeguard provided in the code of disallowing the
    approval of ``any independent study program except an accredited
    independent study program (including open circuit television) leading
    (A) to a standard college degree, or (B) to a certificate that reflects
    educational attainment offered by an institution of higher learning,''
    NASAA cannot support this legislation. However, we would not oppose it
    as long as the following concerns are addressed.
        First, as regards proposed subsection (C)(ii): The definition of a
    ``postsecondary vocational institution'' as defined in the Higher
    Education Act, does seem to contain adequate parameters to protect the
    integrity of the GI Bill. The institution must be limited to high
    school graduates or equivalent; authorized by the State to offer the
    program; is public or nonprofit; and is accredited by a nationally
    recognized accrediting agency or granted preaccreditation status by an
    agency authorized to grant such status. This definition would seem to
    bar predatory institutions providing training of questionable quality
    which might or might not lead to a job or career from seeking approval.
        However, NASAA is concerned that proposed subsection (C)(i) is
    problematical. If you solely look at the definition that is cited, the
    Perkins Act limits the institutions covered to public and nonprofit
    institutions, but it does not require that the institutions be
    accredited, nor does it require that the institution be authorized by
    the State. So, upon reviewing the definition that the proposed language
    cites, the schools might not be required to have a license to operate.
    Also, although the lead-in provision in 3680A(4) requires the
    independent study program to be accredited, there is nothing that
    requires the accrediting agency for career and technical education
    schools to be nationally or regionally recognized, as, unlike the
    definition of a ``postsecondary vocational institution,'' the
    definition of an ``area career and technical education school'' does
    not mention accreditation. Therefore, as the proposed language
    currently stands, an area career and technical education school could
    be accredited by an unrecognized accrediting entity, and still be able
    to qualify for the GI Bill. Finally, the Perkins Act definition of
    ``career and technical education'' includes entrepreneurship, which, as
    you'll recall, is currently restricted under the GI Bill when the
    program is a non-degree program.
        We would also seek to point out to the Committee that though we
    would not expect that a large number of proprietary schools would rush
    to become non-profits accredited by unrecognized accrediting entities,
    some predatory institutions might seek to do so in order to fit into
    the otherwise broad definition of an ``area career and technical
    education school.'' Also, some institutions might seek to provide
    programs of questionable quality under contract with institutions
    granted access under this proposed legislation. For these and other
    reasons cited above, NASAA respectfully requests that the language of
    this bill be changed so that only NCD institutions that are either
    public or not-for-profit institutions AND are accredited by a
    nationally recognized accredited agency be allowed to seek approval.
        Finally, we would respectfully remind the Committee that even with
    the passage of this legislation, it is important to note that programs
    would still have to meet appropriate statutory approval criteria in
    order for an SAA to grant approval. We are concerned that some CTE
    programs do not maintain appropriate standards of academic progress and
    that in other cases some CTE programs could not be approved as they are
    self-paced without any fixed limitation as to how long a student takes
    to complete the program. Given our very generous housing allowance
    under the Post-9/11 GI Bill, such policies would provide a disincentive
    for students to complete such a program in a reasonable time.
        Today, SAAs throughout our Nation, composed of approximately 175
    professional and support personnel, are supervising over 10,000 active
    facilities with 100,000 programs. We pledge to you that we will not
    fail in our critical mission and in our commitment to safeguard the
    public trust, to protect the GI Bill and to defend the future of those
    who have so nobly defended us.

        Mr. Chairman, NASAA thanks the Committee for the opportunity to
    share our concerns and suggestions and we commit to working together
    with you and your staff to enhance the pending legislation.
                                     ______

      Letter from Terisa E. Chaw, Executive Director, National Employment
                              Lawyers Association

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

             Prepared Statement of the National Guard Association
                              of the United States
        Dear Chairman Isakson and Ranking Member Blumenthal and other
    distinguished Senators of the Veterans Committee: On behalf of the
    almost 45,000 members of the National Guard Association of the United
    States and the nearly 500,000 soldiers and airmen of the National
    Guard, we deeply appreciate this opportunity to share with you our
    thoughts on today's hearing topics for the record. We also thank you
    for the tireless oversight you have provided to ensure accountability
    and improve our Nation's services to veterans and their families.
        Today's slate of bills under consideration bears witness to the
    importance of continuing reforms that improve choice, access and
    standard of care to our Nation's veteran population. In our testimony
    to the Committee in March, we have provided our views on some of these
    bills, so this testimony will focus on those bills that are
    specifically focused on veterans within the National Guard, as
    requested.
        Since 9/11, National Guardsmen have mobilized roughly 780,000 times
    in support of the Nation's national security objectives abroad,
    creating possibly the largest number of National Guard veterans since
    World War II.
        The vast majority of these deployments involve members of the Guard
    who also have civilian or government employers making the Veterans'
    Reemployment Rights statute and the Uniformed Services Employment and
    Reemployment Rights Act of 1994 two of the most important laws
    protecting the National Guard members who step away from their jobs to
    serve their country. Under USERRA, all uniformed servicemembers are
    protected within their civilian employment. Guard members may not be
    discriminated against because of their past, present or future service,
    including training or deployment. USERRA establishes a right to prompt
    reinstatement after service and ensures certain health care benefits
    during and after.
        At NGAUS, we receive calls from our members asking about their
    civilian employment rights as well as from citizens considering
    enlisting in the National Guard. USERRA enforcement offices of the
    Department of Labor and the Office of Special Counsel receive tens of
    thousands of calls annually asking for assistance. The National Guard
    is also heavily reliant on Employer Support for the Guard and Reserve
    (ESGR), a Department of Defense program established in 1972 to promote
    cooperation and understanding between reserve-component servicemembers
    and their civilian employers and to assist in the resolution of
    conflicts arising from an employee's military commitment. Many
    employers have rightfully received awards for their commitment to their
    National Guard employees, but there are still many instances where lack
    of understanding has caused problems.
        We strongly support Senator Blumenthal's efforts under S. 3042,
    legislation that will clarify in law the procedural rights of Guard
    members within USERRA. Unfortunately, current USERRA language
    surrounding forced arbitration is not clear, and there are conflicting
    court decisions that do not always protect Guard members' procedural
    rights. NGAUS asks you champion changes in law to clarify congressional
    intent, stop misinterpretations, protect our Guard members and grant
    them due process in these workplace circumstances.
        NGAUS also strongly supports Senator Tester's bill, S. 832 to amend
    Title 10, United States Code, to authorize the provision of behavioral-
    health readiness services to certain members of the Selected Reserve of
    the Armed Forces based on need and to expand eligibility to such
    members for readjustment counseling from the Department of Veterans
    Affairs.
        Guardsmen and Reservists struggle to access the same care as their
    active-component counterparts because they often live far from military
    installations. Additionally, outreach efforts to address mental-health
    conditions may not always reach those in need. The suicide rate for
    members of the National Guard and Reserve is consistently much higher
    than the rate for civilians and the rate for active-duty military as a
    result. Currently, members of the National Guard and Reserves undergo
    annual health assessments to identify medical issues that could impact
    their ability to deploy, but any follow-up care is often pursued at
    their own expense. Senator Tester's legislation would allow Guardsmen
    and Reservists to access Vet Centers for mental-health screening and
    counseling, employment assessments, education training, and other
    services to help them.
        We strongly urge you to champion language that will address the
    military's highest suicide rates . . . those men and women in the
    National Guard who have never deployed, yet stand ready and trained to
    serve when called.
        Although today this Committee is only considering part of Senator
    Tester's bill, NGAUS strongly supports the entire bill.

        Thank you again, Chairman Isakson and Ranking Member Blumenthal,
    for allowing NGAUS to submit testimony for this hearing, and for your
    interest and commitment to the members of the National Guard.
                                     ______

        Prepared Statement of Hon. Carolyn N. Lerner, Special Counsel,
                         U.S. Office of Special Counsel

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

              Prepared Statement of Paralyzed Veterans of America
        Chairman Isakson, Ranking Member Blumenthal, and Members of the
    Committee, on behalf of Paralyzed Veterans of America (PVA), we would
    like to thank you for the opportunity to submit our views on pending
    legislation before the Committee.
                                     s. 244
        PVA recognizes that the effects of Traumatic Brain Injuries (TBI)
    are under-studied, and there is a significant need with the current
    population of veterans for care and treatment. This bill seeks to
    ensure that when veterans submit disability claims related to TBI, VA
    is using the appropriate personnel and protocols to conduct the
    examinations. This measure is a common sense step toward ensuring
    veterans with TBI receive a fair analysis of their disability claim.
        Unfortunately, if implemented, this bill will likely be prevented
    from reaching its full potential because of current VA practices. Too
    often we see doctors doing Compensation and Pension exams outside of
    their practice area. For example, a claimant might have a podiatrist
    conduct an exam for a vascular disease, and this exam in turn forms the
    basis of his or her disability claim. Sometimes, an appropriate
    specialist is simply not available to provide an opinion, but more
    often it is because VA is inundated with the backlog of claims and
    appeals which creates an overwhelming incentive to complete as many
    exams as possible rather than ensure the right type of doctor is
    conducting the exam. Naturally, claims appeals based on faulty exams
    are an outcropping of this policy failure, and until issues like these
    are addressed we will continue to struggle to fix the bigger problems,
    such as appeals reform, that pervade VA.
         s. 603, ``the rural veterans travel enhancement act of 2015''
        PVA supports S. 603, the ``Rural Veterans Travel Enhancement Act of
    2015,'' a bill that would increase access to transportation options for
    veterans with disabilities who need vocational rehabilitation,
    counseling, and medical care from the Department of Veterans Affairs.
    This legislation includes three important components. First, it would
    make permanent the Secretary's authority to transport veterans to and
    from VA facilities. Second, it would make veterans who use the services
    provided by Vet Centers eligible for beneficiary travel. Finally, it
    would extend the authorization for grants to veterans service
    organizations and state departments of veterans' affairs for
    transporting veterans in highly rural areas.
        Paralyzed Veterans supports extension of VA's authority to
    transport veterans to and from VA facilities as these services are
    critical for veterans who have mobility impairments and benefit from
    the accessible transportation options available through VA. We also
    support allowing veterans to access needed financial assistance to help
    them benefit from the services provided through Vet Centers. Without
    this assistance, some veterans may be forced to forgo this important
    resource. Last, we also support the extension of the Highly Rural
    Transportation Grants. These grants provide additional transportation
    options for veterans with disabilities who live in hard to reach areas,
    particularly those with mobility impairments, because all vehicles must
    operate under Department of Transportation standards for accessibility
    under the Americans with Disabilities Act.
                       s. 2210, the ``veteran peer act''
        PVA supports S. 2210, the ``Veterans Partners' Efforts to Enhance
    Reintegration (PEER) Act.'' This bill would carry out a program to
    establish peer specialists in patient aligned care teams (PACTs) at VA
    polytrauma and rural medical centers. The effectiveness of the peer
    support model has been an overall success. These specialists help
    veterans access mental health services, navigate the healthcare system,
    and perhaps most importantly, they offer familiarity and acceptance to
    veterans who may find those experiences lacking. While the stigma
    surrounding mental health care is declining, for older veterans it can
    remain a firm barrier to care. In the wake of the jarring statistic
    that veterans over 50 are committing suicide in greater numbers than
    the post-9/11 generation, this bill is aptly timed, and necessary.
         s. 2279, the ``veterans health care staffing improvement act''
        PVA supports S. 2279, the ``Veterans Health Care Staffing
    Improvement Act.'' This bill would carry out a program to allow
    servicemembers who have served in medical roles to transition directly
    into the VA. By rapidly absorbing qualified, experienced health care
    providers, this bill could ease some of the strains on VA's hiring
    process. VA would be entitled to a list of recently separated
    servicemembers who have served in a health care capacity, allowing them
    direct access to recruit in a more expeditious hiring process. Further,
    it would allow for Advanced Practice Registered Nurses and Physicians
    Assistants to provide a wider range of health care, through full
    practice authority, based on the scope of practice recommended by the
    appropriate professional organizations. This in turn, would help expand
    care in rural areas.
                                    s. 2316
        S. 2316 would make changes to the Department of Veterans Affairs'
    fiduciary program by requiring the Secretary to reissue or promptly
    remit as recouped to beneficiaries any benefits misused by their
    fiduciaries in a broader range of situations than currently required
    under the statute. According to the VA's Office of Inspector General's
    August 27, 2015, report titled ``Audit of Fiduciary Program Controls
    Addressing Beneficiary Fund Misuse,'' in 16 of 16 cases reviewed,
    fiduciary hubs failed to restore approximately $347,000 of misused
    funds to beneficiaries. Some of the delay in restoring those funds
    appears to have been due to misunderstanding when a determination of
    negligence is currently required prior to reissuance. In all of those
    cases, a negligence determination was not required. We hope that
    simplifying the requirement for reissuing benefits to all beneficiaries
    when those funds are misused, without requiring a negligence
    determination in certain cases, will lead to prompt restoration of
    needed financial resources for these beneficiaries. This legislation
    would also provide increased access to the financial records of
    fiduciaries in an effort to improve oversight of the use of
    beneficiary's funds. Overall, these changes would likely be helpful to
    beneficiaries who have been harmed due to the actions of their
    fiduciaries.
            s. 2791, the ``atomic veterans health care parity act''
        While PVA has no formal position on this issue, we believe that
    this a clearly reasonable proposal. Over the years, significant numbers
    of veterans have been denied access to VA health care and benefits due
    to participation in highly classified and secret activities. Atomic
    testing and subsequent clean-up activities are no exception. These
    veterans should be afforded access necessary health care and benefits
    as a result of their service. Denying these men this opportunity simply
    because the Department of Defense would never admit to these secret
    activities at atomic sites is morally unjust.
                                    s. 2958
        PVA generally supports this proposed bill. Late last year, PVA,
    along with our partners in The Independent Budget--DAV and VFW--
    provided a framework for veterans health care reform that included a
    recommendation that Congress and the Administration consider the
    development of public-private partnerships to improve and expedite the
    process for major medical facility construction. It is a well-
    established fact that the process for designing and building new
    facilities currently takes far too long to complete. By leveraging
    public-private partnerships, VA can align its already limited capital
    infrastructure dollars to ensure adequate services are provided in
    given locations while allowing the efficiency of private sector capital
    planning and building to position the VA to actually provide those
    services. Ultimately, public-private partnerships will allow VA to
    bring new health care facilities online faster thereby assuring faster
    access to critically needed services.
                                    s. 3021
        PVA supports this legislation. Not all military members wish to
    pursue a standard college degree when they leave service. Career and
    Technical Education (CTE) at area career and technical centers comprise
    an important part of our education system. Credential-granting programs
    offered at these institutions span across many industries, from health
    care to information technology, and provide a solid pathway to
    employment for many of our veterans.
                       s. 3023, ``the arla harrell act''
        PVA supports the ``Arla Harrell Act.'' Veterans who have for so
    long quietly suffered the effects of Mustard Gas or Lewisite exposure
    as a result of Department of Defense testing deserve to receive
    critically need care from the VA. Senator McCaskill's report indicates
    that the number of servicemembers exposed numbers around 4,000, and yet
    only 610 have been identified. Currently, only 40 veterans have
    successfully filed claims and are receiving related benefits. The fact
    that only 1 percent of the veterans exposed are receiving benefits is
    attributed to the 90 percent rejection rate of claims. Shifting the
    burden of proof relating to events that occurred so long ago from the
    veteran to VA is an appropriate and deserved step toward rectifying the
    failure to fully identify this population and ensure they are receiving
    their earned benefits. We would also note that with a new presumption
    comes increased stress on VA resources. It is imperative that Congress
    ensure resources are appropriately adjusted to prevent VA from having
    to rob Peter to pay Paul.
    s. 3032, the ``veterans' compensation cost-of-living adjustment act of
                                     2016''
        PVA supports S. 3032, the ``Veterans' Compensation Cost-of-Living
    Adjustment (COLA) Act of 2016,'' which would increase, effective as of
    December 1, 2016, the rates of compensation for veterans with service-
    connected disabilities and the rates of dependency and indemnity
    compensation (DIC) for the survivors of certain disabled veterans. This
    would include increases in wartime disability compensation, additional
    compensation for dependents, clothing allowance, and dependency and
    indemnity compensation for children.
    s. 3035, the ``maximizing efficiency and improving access to providers
              at the department of veterans affairs act of 2016''
        PVA supports S. 3035, the ``Maximizing Efficiency and Improving
    Access to Providers at the Department of Veterans Affairs Act of
    2016.'' This legislation would allow for a pilot program to increase
    the use of medical scribes to maximize the efficiency of physicians at
    medical facilities of the Department of Veterans Affairs. A medical
    scribe helps to decrease the burden of data entry on the part of the
    medical provider. They accompany a provider to document the physician-
    patient interaction, and enter it into the Electronic Health Record
    (EHR) at that time. The physician later reviews and approves the data
    entry. This dynamic allows for the physician to spend more
    uninterrupted time interacting with the patient, and less time
    dictating notes. Multiple studies have indicated that medical scribes
    increase physician-patient satisfaction. Further, because the physician
    is relieved of data entry, they are able to see more patients, thus
    impacting wait times. We see no reason why VA would should not avail
    themselves of this pilot program. In a time when VHA is struggling to
    hire and retain physicians, allowing for medical scribes to help
    existing providers carry the patient volume is essential.
        s. 3055, the ``department of veterans affairs dental insurance
                         reauthorization act of 2016''
        PVA supports S. 3055, the ``Department of Veterans Affairs Dental
    Insurance Reauthorization Act of 2016.'' This bill would reauthorize
    the VA administered dental insurance program for five years, allowing
    current users to maintain their care. The original pilot program began
    in 2014 and will expire in 2017 without action. While PVA previously
    expressed concerns about the cost of the program, and the role of VA as
    insurer, the success of the program is unquestionable. Veterans and
    their families markedly agree that the care is high quality and low
    cost. As researchers are beginning to more clearly identify the links
    between dental care and overall care, particularly cardiac care, this
    program can only be considered a sound investment into the lifelong
    well-being of veterans and their families.
         s. 3076, the ``charles duncan buried with honor act of 2016''
        PVA supports this draft bill to furnish caskets and urns for burial
    in cemeteries of States and Indian tribes of veterans without next of
    kin or sufficient resources. Currently, veterans without next of kin or
    sufficient resources who are buried in state of tribal cemeteries are
    not furnished a casket or urn. These veterans buried in state and
    tribal cemetery are no less deserving of a dignified resting place than
    those in a national cemetery. This bill is, without question, the
    decent thing to do.
                          s. 3081, the ``wingman act''
        PVA supports the goal of ensuring veterans receive timely
    information regarding the status of their claims. We appreciate that
    this bill ensures that Congressional employees granted access to such a
    program undergo the same training and certification program that VA
    currently uses to certify VSO representatives and attorneys
    representing claimants. This legislation, however, allows access to a
    claimant's information regardless of whether the covered employees are
    acting under a power of attorney. Claims files contain the most private
    information about that particular veteran and, often times, information
    of other individuals consulted during the claim's development. PVA
    believes that in the interest of maintaining strict protection of such
    private information, this legislation should be limited to those who
    hold a power of attorney. Other logistical issues may also arise in the
    form of the added administrative burden on VA of managing the
    certification process and tracking users. Certainly we do not want to
    see resources that should be applied to adjudicating claims shifted to
    facilitating Congressional involvement unless it produces a significant
    increase in productivity. Finally, we believe that VSO national service
    officers and VBA employees are best suited to answering questions
    regarding a claimant's file. Unlike a Congressional aide viewing the
    file in isolation, they have the ability to view the file in context
    and identify the issues holding up the claim.
                          discussion draft, ``userra''
        PVA supports strengthening the Uniformed Services Employment and
    Reemployment Rights Act (USERRA). The Supreme Court of the United
    States has firmly established a ``liberal policy of favoring
    arbitration agreements.'' \1\ Courts of inferior jurisdiction have
    examined servicemembers' employment and reemployment rights under
    USERRA and determined that the forum in which a claim is adjudicated is
    a procedural consideration.\2\ Case law holds that whether the claim is
    adjudicated through arbitration or the U.S. District Courts has no
    bearing on the substantive statutory rights meant to be protected.
    While the Courts are free to believe enforcement of substantive rights
    is equally effected by arbitration and the courts, the servicemember
    may not be so persuaded and should be free to determine his forum.
    ---------------------------------------------------------------------------
        \1\ Gilmer v. Interstate/Johnson Lane Corp., 500 U.S. 20, 23 (1991)
    (citing Moses H. Cone Memorial Hospital v. Mercury Construction Corp.,
    460 U.S. 1, 24 (1983)).
        \2\ See Garrett v. Circuit City Stores, Inc., 449 F.3d 672 (5th
    Cir. 2006) and Landis v. Pinnacle EyeCare, LLC, 537 F.3d 559 (6th Cir.
    2008).
    ---------------------------------------------------------------------------
        One might argue that a servicemember exercised a choice by waiving
    his or her right to avail themselves of the court when they signed the
    arbitration clause. But this implies that job prospects are elastic to
    the extent that employees hold a bargaining position strong enough to
    reject a job solely on the basis of that clause. More and more
    employers are beginning to require arbitration clauses as conditions of
    employment. Current employment conditions effectively make that choice
    for the servicemember; few, if any, walk away from a job on this basis.
    As this pattern evolves, the servicemember is slowly being stripped of
    his or her choice to employ the court system. To put the choice back in
    the hands of the servicemember, Congress must specifically indicate its
    intent to preclude a waiver of judicial remedies for the statutory
    rights at issue.\3\ This bill would accomplish this by rendering
    arbitration agreements enforceable only after a complaint has been
    filed in court. There is an additional threshold requirement of the
    parties making a knowing and voluntary decision. We also support the
    additional touch of expanding the venue options to be more in line with
    those applied in the Federal Rules of Civil Procedure.
    ---------------------------------------------------------------------------
        \3\ Mitsubishi Motors Corp. v. Soler Chrysler-Plymouth, Inc., 473
    U.S. 614, 626-27 (1985).
    ---------------------------------------------------------------------------
      discussion draft, ``to expand eligibility to certain members of the
     selected reserve of the armed forces for readjustment counseling from
                     the department of veterans affairs.''
        While we appreciate the intent of this bill, PVA has concerns with
    this legislation as written because it extends the intended benefits to
    any and all members of the Selected Reserve but does not equally
    include veterans who served on active duty. The current law under 38
    U.S.C. 1712A provides certain mental health services to delineated
    groups of veterans or members of the Armed Forces, including a reserve
    component of the Armed Forces. To qualify for these services,
    individuals must meet one of the listed qualifications, such as
    deploying to a theatre of combat operations or participating in
    mortuary services to casualties of combat operations. In essence,
    current law requires a triggering event or circumstance which
    demonstrates a nexus between the servicemember or veteran's mental
    health condition and their military service. This bill would allow
    Selected Reserve members to avoid this requirement while still
    subjecting those who served on active duty to the existing
    requirements.
        draft bill on medical residents at facilities operated by tribes
        PVA supports the draft bill to authorize payment by the Department
    of Veterans Affairs for the costs associated with service by medical
    residents and interns at facilities operated by Indian tribes and
    tribal organizations, and to carry out a pilot program to expand such
    residencies and internships at those facilities. While recruiting and
    retaining capable providers continues to be a struggle for VA, rural
    communities feel these vacancies two fold. In Indian Country
    particularly, the minimal availability of consistent high quality
    health care has resulted in some of the worst health care outcomes in
    the United States. The United States government has a centuries-old
    legal obligation to provide health care to two groups--Native Americans
    and veterans. The overlapping, and at times inter-reliability of these
    two systems is necessary, as Native Americans serve the Armed Forces at
    the highest rate of any demographic. In Alaska, where this health care
    system interoperability is most prevalent, the need for primary care
    providers is critical. Vacancies are expected to increase in the coming
    decade, leaving health care systems with a high volume need and little
    capacity.
        This bill would likely provide some relief, by incentivizing
    medical residents and interns to work at tribal facilities that have
    existing reimbursement agreements with VA. The five-year pilot program
    would have VA reimburse the tribal facilities for the recruitment and
    training of residents. These participants would then be eligible for
    loan forgiveness through the Indian Health Services Loan Repayment
    Program. This bill offers a sound step forward to ensuring we meet the
    needs of those who have served, no matter their zip code.
            discussion draft on american battle monuments commission
        PVA has no formal position on this issue.

        This concludes our statement for the record. We appreciate the
    opportunity to submit our views before this Committee.
                                     ______

    Prepared Statement of Reserve Officers Association of the United States
                                   statement
        ROA appreciates the opportunity to discuss S. 3042, Justice for
    Servicemembers Act, which is proposed legislation to clarify the scope
    of procedural rights of members of the uniformed services with respect
    to their employment and reemployment rights, to improve the enforcement
    of such employment and reemployment rights, and for other purposes.
        The Justice for Servicemembers Act would amend section 4302 by
    adding a new subsection (c) to the Uniformed Services Employment and
    Reemployment Rights Act (USERRA), as follows:

              (1) Pursuant to this section and the procedural rights
            afforded by Subchapter III of this chapter [USERRA], any
            agreement to arbitrate a claim under this chapter is
            unenforceable, unless all parties consent to arbitration after
            a complaint on the specific claim has been filed in court or
            with the Merit Systems Protection Board and all parties
            knowingly and voluntarily consent to have that particular claim
            subjected to arbitration.
              (2) For purposes of this subsection, consent shall not be
            considered voluntary when a person is required to agree to
            arbitrate an action, complaint, or claim alleging a violation
            of this chapter as a condition of future or continued
            employment or receipt of any right or benefit of employment.
                                     userra
        Section 4302 makes it clear that USERRA is a floor and not a
    ceiling on serevicemember's rights as a person who is serving or has
    served. USERRA does not supersede or nullify any other law, policy,
    agreement, practice, or other matter that gives greater or additional
    rights. 38 U.S.C. 4302(a).
        Section 4302(a) of USERRA provides:

            Nothing in this chapter [USERRA] shall supersede, nullify, or
            diminish any Federal or State law (including any local law or
            ordinance), contract, agreement, policy, plan, practice, or
            other matter that establishes a right or benefit that is more
            beneficial to, or is in addition to, a right or benefit
            provided for such person in this chapter.

        USERRA does supersede state laws, contracts, policies, agreements,
    etc. that reduce, limit, or eliminate USERRA rights or that impose
    additional prerequisites on a servicemember's exercise of those rights.
    38 U.S.C. 4302(b).
        Section 4302(b) provides:

            This chapter supersedes any State law (including any local law
            or ordinance) contract, agreement, policy, plan, practice, or
            other matter that reduces, limits, or eliminates in any manner
            any right or benefit provided by this chapter, including the
            establishment of additional prerequisites to the exercise of
            any such right or the enjoyment of any such benefit.

        Despite section 4302(b), both the 5th Circuit and the 6th Circuit
    have held that USERRA does not override employer-employee agreements
    that purport to bind employees to submit future disputes about USERRA
    rights to binding arbitration, in lieu of filing suit or filing a
    formal complaint with the Veterans' Employment and Training Service of
    the United States Department of Labor (DOL-VETS). See Garrett v.
    Circuit City Stores, Inc., 449 F.3d 672 (5th Cir. 2006) and Landis v.
    Pinnacle Eye Care LLC, 537 F.3d 559 (6th Cir. 2008).
        ROA member, and USERRA drafter, Mr. Samuel F. Wright explains,
    ``Employers can make a mockery of USERRA by demanding that individuals
    agree to binding arbitration as a condition of initial employment or
    continued employment. S. 3042 is necessary to ensure effective
    enforcement of USERRA.''
                              binding arbitration
        Arbitration is defined as, ``The settling of disputes (especially
    labor disputes) between two parties by an impartial third party, whose
    decision the contending parties agree to accept. Arbitration is often
    used to resolve conflict diplomatically to prevent a more serious
    confrontation,'' as defined by dictionary.com. In and of itself this is
    not a bad thing. There are times when the problem between employee and
    employer does not rise to the level or complexity requiring court
    review.
        The problem is that binding arbitration takes away the employee's
    choice to pursue the level of resolution they consider necessary with
    their employment. If an employee believes his or her case should be
    reviewed by the courts and he or she is willing to accept the time,
    cost, and complexity of this legal review that should be the employee's
    choice. If an employee believes the case is not complicated but
    believes an independent person or body should settle the dispute, then
    arbitration should also be a choice.
        What is not right is when employees do not have a choice on
    resolution of future employment issues based on a boiler plate
    provision in an agreement he or she was required to sign as a condition
    of employment; especially as these decisions affect his or her ability
    to provide for their family.
        The Bill of Rights includes the right to ``life, liberty and the
    pursuit of happiness.'' In the decision of S. 3042, we should be
    reminded that liberty requires that no one can rule citizens without
    consent--each of us, whether as individuals or as companies, should
    respect the equal rights of others.
                        reserve component participation
        During the present war, nearly a million Guard and Reserve members
    have been mobilized, proving essential to the war effort. The reliance
    of the Nation on its Reserve Components will not diminish.
        Since September 11, 2001, more than 900,000 members of our reserve
    components--the National Guard and Reserves of our Army, Navy, Air
    Force, Marines and Coast Guard--have served in support of the war on
    terrorism. According to DOD more than 10,000 Guard and Reserve members
    were casualties in that fight. https://www.dmdc.osd.mil/dcas/pages/
    report--sum--comp.xhtml

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        ``War is a national challenge, and, for our part, we cannot execute
    without the Guard and the Reserve,'' said Army Chief of Staff Gen. Mark
    Milley. ``You can't talk to a general or admiral for more than five
    minutes without hearing a variation on that theme,'' according to ROA
    Executive Director, Jeff Phillips.
        The chart below shows that the Guard and Reserve have been used in
    increasingly higher amounts per year. While usage is dropping it will
    not go down to previous peacetime levels because threats to the Nation
    and world have increased.

                         Usage of the Reserve Components
    ------------------------------------------------------------------------
                                                                   Man-Days
                            Fiscal Year                            Per Year
    ------------------------------------------------------------------------
    1986-1989..................................................    1 million
    1996-2001..................................................   13 million
    2002.......................................................         41.3
                                                                     million
    2005.......................................................         68.3
                                                                     million
    2012.......................................................         25.8
                                                                     million
    ------------------------------------------------------------------------
    Data from the Office of the Assistant Secretary of Defense for Reserve
      Affairs (OASD/RA).

        The reserves are now considered ``operational.'' They are used
    continually, like the active force. In the late 1980s, usage of the
    reserves was 1 million man-days per year; it is now about 25 million
    man-days.
        Guard and Reserve members will continue to face employment issues
    as they support increased operational levels. They should not be
    penalized for serving their nation by being forced into binding
    arbitration.
                                   conclusion
        The Reserve Officers Association supports the enactment of S. 3042
    which would make clear that the individual servicemember cannot be
    forced to submit his or her USERRA complaint to binding arbitration.
    The matter of using arbitration or not should remain the employee's
    option. The choice should be made when a dispute has arisen--not 10
    years earlier when the servicemember is hired or rehired.
                                     ______

                 Prepared Statement of Southcentral Foundation
        Chairman Isakson, Ranking Member Blumenthal, and Members of the
    Committee: Thank you for the opportunity to submit testimony on behalf
    of the Southcentral Foundation (``SCF'') Thank you also to Senator
    Sullivan, for championing legislation today that will help SCF make
    important progress toward bridging the provider gap in isolated
    geographic communities and helping the next generation of doctors learn
    the holistic, customer-centered, and relationship-based systems of care
    we believe are vital to high-quality healthcare in our communities.
                                   background
        SCF is an Alaska Native owned and governed tribal health
    organization in Anchorage, Alaska. We provide medical, dental,
    optometry, a range of maternal child health services, behavioral
    health, and substance abuse treatment services to over 52,000 Alaska
    Native and American Indian beneficiaries living within the Municipality
    of Anchorage, the Matanuska-Susitna Borough to the north, and nearby
    villages. SCF also provides services to an additional 13,000 residents
    of 55 rural Alaska villages covering an area exceeding 100,000 square
    miles, extending from near the Canadian border in the east to the
    Pribilof Islands in the west. Finally, SCF provides statewide tertiary
    OB/GYN and pediatric services for approximately 150,000 Alaska Native
    people. We also co-manage the Alaska Native Medical Center, a 167 bed
    hospital, which is the tertiary care referral point for all IHS
    facilities in the state. We employ over 1900 people to do this work.
        SCF's Nuka System of Care is a name given to the whole health care
    system created, managed and owned by Alaska Native people to achieve
    physical, mental, emotional and spiritual wellness. This relationship-
    based Nuka System of Care is comprised of organizational strategies and
    medical, behavioral, dental, and traditional practices processes and
    supporting infrastructure that work together--in relationship--to
    support wellness. By putting relationships at the forefront of what we
    do we and how we do it, the Nuka System of Care will continue to
    develop and improve healthcare delivery for future generations.
        Our Nuka System of Care is acclaimed nationally and internationally
    for its numerous innovative practices including: same day access to an
    individual's own primary care provider; patient-centered medical home
    services that have received the highest level of certification; and
    provision of primary care through interprofessional teams that include
    behavioral health, health education, and pharmacy consultants. In 2011,
    we received the National Malcolm Baldrige Award for Performance
    Excellence from the United States Department of Commerce. SCF is the
    only Native organization to ever be honored with this distinction, and
    one of only about 20 United States healthcare organizations of any type
    to receive this difficult-to-achieve award.
                                   discussion
        The Veterans' Administration (``VA'') medical residency legislation
    being discussed today is intended to address several interlocking
    issues. In general, providing quality healthcare for veterans in rural
    areas is challenging for a number of reasons, but central to the issue
    is the lack of physicians. This legislation would increase the number
    of primary care physicians serving rural and remote areas by adding a
    new section to the existing provisions found in 38 U.S.C. Sec. 7406
    authorizing a pilot program that would make specific tribal health care
    providers eligible to work with the VA to expand or create new medical
    residency programs. The bill would allow non-VA facilities to access
    this critical funding and allow for additional expenses. SCF supports
    this effort and this legislation because we understand the need for
    more--and better trained--physicians to serve the veterans in the
    communities we serve, and communities like it.
        As this Committee well knows, the Nation is facing a shortage of
    primary care physicians, and this gap is exacerbated throughout rural
    Alaska. This shortage exists nationally, and is likely to increase over
    time. According to the Department of Health and Human Services, if
    changes do not occur to meet the physician demand, reports indicate a
    projected shortage by 2020 of 20,400 physicians. The Association of
    American Medical Colleges predicts a shortage of 12,500-31,100 primary
    care physicians by 2025. This provider shortage is likely to hit
    hardest in places like Alaska and Native American communities that are
    already struggling to attract primary care and other physicians to
    practice. In Alaska, for example, there will need to be a 40% increase
    in the total number of primary care physicians, an increase of 237
    positions, by 2030.
        One of the single most effective ways to increase the number of
    physicians practicing in our communities would be to train them in our
    communities. This legislation provides VA the authority to do just
    that. The VA system is uniquely situated to partner with Native
    American community healthcare providers because medical residents who
    train in these programs will help reduce this provider gap by serving
    multiple, overlapping underserved communities to whom the country has
    significant healthcare obligations: veterans and Native Americans. In
    addition, studies show that doctors who train in certain communities
    are more likely to stay, and we are confident that the opportunity to
    train directly in the Nuka System of Care both will not only increase
    the number of physicians who are likely to practice in rural and Native
    American communities, but will also enhance the quality of care they
    will be providing to veterans and other patients throughout their
    careers.
        Through the Nuka System of Care, SCF has been able to decrease the
    per-capita use of the Emergency Department by over 36% between 2000 and
    2015. In addition:

         SCF's diabetes management measures put SCF among the top
    5% of health care organizations in the country;
         SCF ranks in the top 10% for per-capita use of the
    Emergency Department and hospital admissions measures;
         SCF's customer-owner satisfaction ratings consistently are
    96-99% positive, well above the average compared to other health care
    organizations;
         SCF's total employee turnover is one quarter of earlier
    levels, and is now in the top 25% nationally, despite SCF's difficult
    location for recruiting and retention;
         SCF's Alaska Native Medical Center received magnet status
    in 2011 for nursing excellence, an honor bestowed only to 5 percent of
    hospitals, nationally; and
         SCF has had a Level III certified Patient Centered Medical
    Home since 2009.

        Despite these successes, workforce development is one of the major
    challenges SCF faces as an innovative, constantly-improving
    organization. And given the provider shortage, it is not likely to get
    any easier. Exacerbating the challenge is the gap between the knowledge
    and skills needed to perform in our health care system and the
    knowledge and skills of graduates from health professional training
    programs at United States colleges and universities. However, medical
    residents who are trained in the Nuka System of Care and similar
    systems will be able to help to transform health care throughout the
    United States by bringing the innovations SCF and other programs have
    developed to the VA and to healthcare systems around the country. The
    pilot program authorized by this legislation would serve as an
    incubator for positive change in our healthcare systems, and is worthy
    of your support.
                                   conclusion
        The Southcentral Foundation is an innovative healthcare
    organization on the cutting edge of holistic, customer centered, and
    relationship based healthcare delivery. We would be thrilled to
    participate in the pilot program authorized by this legislation, and
    are confident that the legislation would be a strong step in the right
    direction for the VA and rural healthcare providers. We thank the
    Committee for its consideration of this bill, and Senator Sullivan for
    his leadership on it.
                                     ______

     Prepared Statement of Derek Fronabarger, Director of Policy, Student
                              Veterans of America

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     ______

       Letter from Bruce R. Josten, Executive Vice President, Government
          Affairs, Chamber of Commerce of the United States of America

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]