[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
[email protected].
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]