[Senate Hearing 115-387]
[From the U.S. Government Publishing Office]
S. Hrg. 115-387
THE STATE OF VA SERVICES IN OHIO
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 21, 2017
__________
Printed for the use of the Committee on Veterans' Affairs
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Available via the World Wide Web: http://www.govinfo.gov
__________
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COMMITTEE ON VETERANS' AFFAIRS
Johnny Isakson, Georgia, Chairman
Jerry Moran, Kansas Jon Tester, Montana, Ranking
John Boozman, Arkansas 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 Richard Blumenthal, Connecticut
Dan Sullivan, Alaska Mazie K. Hirono, Hawaii
Joe Manchin III, West Virginia
Thomas G. Bowman, Staff Director \1\
Robert J. Henke, Staff Director \2\
Tony McClain, Democratic Staff Director
Majority Professional Staff
Amanda Meredith
Gretchan Blum
Leslie Campbell
Maureen O'Neill
Adam Reece
David Shearman
Jillian Workman
Minority Professional Staff
Dahlia Melendrez
Cassandra Byerly
Jon Coen
Steve Colley
Simon Coon
Michelle Dominguez
Eric Gardener
Carla Lott
Jorge Rueda
\1\ Thomas G. Bowman served as Committee majority Staff Director
through September 5, 2017, after being confirmed as Deputy Secretary of
Veterans Affairs on August 3, 2017.
\2\ Robert J. Henke became the Committee majority Staff Director on
September 6, 2017.
C O N T E N T S
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November 21, 2017
SENATORS
Page
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 1
WITNESSES
Hon. Beatty, Joyce, Congressional Representative, 3rd District of
Ohio........................................................... 5
Tansill, Chip, Director, Ohio Department of Veterans Services.... 7
Prepared statement........................................... 8
Supplemental statement................................... 10
Harman, Keith, Commander-in-Chief, Veterans of Foreign Wars of
the United States.............................................. 12
Prepared statement........................................... 14
Twine, Melissa M., Veteran, Batavia, OH.......................... 19
Prepared statement........................................... 21
Powers, James, Veteran, Massillon, OH............................ 22
Prepared statement........................................... 24
Burke, Ronald, Assistant Deputy Under Secretary for Field
Operations, Veterans Benefits Administration, U.S. Department
of Veterans Affairs; accompanied by Robert Worley, Director of
Education Service, Veterans Benefits Administration; Robert
McDivitt, Director of Veterans Integrated Service Network 10,
Veterans Health Administration; Kameron Matthews, M.D., Deputy
Executive Director, Provider Relations and Services, Veterans
Health Administration.......................................... 36
Prepared statement........................................... 39
Response to posthearing questions submitted by Hon. Sherrod
Brown...................................................... 57
APPENDIX
Fitzgerald, Benjamin, Veteran, Westlake, OH; prepared statement.. 67
THE STATE OF VA SERVICES IN OHIO
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TUESDAY, NOVEMBER 21, 2017
U.S. Senate
Committee on Veterans' Affairs
Columbus, OH.
The Committee met, pursuant to notice, at 1:15 p.m., at the
Columbus Metropolitan Library, Columbus, OH, Hon. Sherrod Brown
presiding.
Present: Senator Brown [presiding].
HON. SHERROD BROWN, U.S. SENATOR FROM OHIO
Senator Brown. Thank you again. I introduced the head of
the library, Patrick. Thank you.
Thanks for all of you to join us. It is the first hearing I
have done with the Senate Veterans' Affairs Committee here in
Columbus, so thank you all for joining us.
I will make an opening statement, an official opening
statement for the Committee, followed by one from Congresswoman
Beatty. We are in her district. She represents a district in
most of the center of Columbus, representing some 700,000-plus
people. She has been an ally to me on veterans' issues and
other things. I am very appreciative that she is here with us
today.
Then, we will ask for opening statements from our four
witnesses to tell us what you want to tell us, and then I will
begin questioning each of the you. That is the way we do a
Washington, DC, hearing with Senate Veterans' Affairs. Then, I
will have a couple questions, then Joyce will ask questions.
Joyce is having a meeting with the Speaker later today
about a project in Columbus, and we will be glad if that
meeting is successful. Joyce will not be here as long as I
will, because I want to stay, obviously, through the whole
hearing.
OPENING STATEMENT
Hearings like this are important because the best ideas,
frankly, do not come out of Washington. They come from
conversations like the ones we will have today with the women
and men who served this country, and the VA officials who serve
them.
For today's hearing, we not only invited veterans to
testify, we solicited questions online. I have spent much of
the last week, as Anna and Amber in my office have, asking
veterans all over to come to Brown.Senate.gov to express
concerns, ideas, and thoughts they have about the services,
health, and education benefits that the VA provides.
If there are veterans in the audience who need assistance
to access health care benefits, please get in touch with Anna
or Amber or anybody on my staff, and John in the back. John and
Anna are here from our Washington, DC, staff. John himself is a
veteran.
We will hear first from Ohio veterans, including Director
Chip Tansill. Mr. Tansill, thank you for being here for the
Department of Veteran Services. Next, Keith Harman, who is
commander-in-chief of the VFW. Later we will hear from VA
officials. The two veterans I will introduce in a moment will
give their remarks.
Ohio, as you probably know, has almost 800,000 veterans,
where we proudly have one of the largest veteran populations of
any of the 50 States. The majority of veterans in our State,
like in our country, are over the age 55.
I thank every veteran in this room. Could all veterans
raise their hands, please? Thank you. I thank all of you.
I also never forget to thank the families of soldiers,
sailors, Marines, and air men, because their sacrifice maybe
just about as great when their loved ones are overseas. The
anxiety and the worry and the financial struggles that family
members have are always there. Thank you for supporting your
men and women, your loved ones, who serve our country.
Many veterans describe hurdles when transitioning from
active duty to civilian life. Whether it relates to claims
processing or simply obtaining a medical appointment, or using
education benefits, veterans and their families face far too
many obstacles in using the benefits that they have earned
serving our country. We should be doing more to ease that
transition for those who have served.
I will be asking both of you about your transitions,
because I know that is something particularly you and I have
worked on, Ms. Twine, that is so important and that needs
improvement.
That is really why the Committee is here, to hear firsthand
from Ohioans about the experiences they are facing as veterans,
so we can do better.
We must continue to fight to ensure the VA is delivering
the highest quality health care, that veterans have the
flexibility to receive care in the community when it is in
their clinical interests to do so. I have heard from veterans
who believe that only the VA can give them the comprehensive
care to meet their specific needs.
I was asked on the way in about the privatization efforts.
Some people want to privatize the VA. I think that is just
simply wrong, and I know that most veterans' organizations
agree with that. If people want to speak about that, I am
certainly open to talking about it.
Many VA employees, as we know, are veterans themselves.
They have a shared experience. Go to the Chillicothe VA, you
will walk down the hall, and many, many of the people you meet
taking care of patients are veterans themselves.
We must do what we can to shore up service lines at medical
facilities, so veterans have access to more timely, quality
care that meets their specific needs. We must work to shorten
the time it takes for a veteran or a family member to receive a
response to a claim or to an appeal. VA has made strides in the
last few years to reducing the claims processing time, but 97
days is simply, without doubt, too long to wait.
We made improvements in VA education programs, like the Fry
Scholarship and the Yellow Ribbon Program. But too often,
veterans fall prey to predatory, for-profit recruiting tactics.
For-profit schools that have closed abruptly have left men and
women who served our country unable to secure the good-paying
jobs that those schools and their fancy marketing have
promised. They have left too many veterans trapped under a
mountain of debt. They have defrauded too many veterans out of
their G.I. education benefits. The Forever G.I. Bill took steps
to help veterans recoup their losses, but we must do more to
protect them on the front end.
With congressional support, the VA has made inroads to
combat veterans' homelessness. One of the best programs in the
country is just 60 miles or so south of here in Chillicothe.
There are many other topics we will cover during the
hearing, including steps the VA has taken to combat the opioid
epidemic; toxic exposure, especially in Vietnam from Agent
Orange; and health implications for veterans and their
families; and to never forget the burden that caregivers face
taking care of veterans and their illnesses in their older age.
As I said earlier, if there are veterans in the audience
who need assistance to access health care benefits, get in
touch with me directly or with Jonathan or with Anna behind me.
Most importantly, I want to continue this conversation to
hear directly from you.
I will turn it over to Congresswoman Beatty.
STATEMENT OF HON. JOYCE BEATTY, CONGRESSIONAL REPRESENTATIVE
FROM 3RD DISTRICT OF OHIO
Ms. Beatty. Thank you so much, Senator Brown.
First, let me just say welcome to the Third Congressional
District. You are sitting in the heart of my district, but I am
here because there is a great Senator; a Senator who is not
afraid to stand up for people; a Senator, as you heard, who has
served on the Veterans' Committee and continues to fight and
advocate for veterans.
It was a delight for me when I received his call telling me
that he wanted to do this field hearing. First of all, I would
have probably driven to Chillicothe, to Cleveland, or anywhere
else to spend some time with those who have served and make it
possible for me to be here today.
Earlier, I saw a gentleman as we were coming in, a veteran.
He had been in my office in Washington. I want to thank him
because he remembered me telling the story about my father who
served, and served with honor, and said to me before he passed,
``Always make sure that you fight for those who fight for
you.'' When he said that, it was interesting because he said
sometimes those are not the people who are sitting at the head
of the table. It is the folks who are out in the trenches. It
is the folks who could be doing something else, but they put
their lives on the line.
I am here today to not only say thank you and to join our
Senator, but I am also here because I think it is important for
you all to understand that we need you, and we need you more
than ever now, because, certainly, as you know, our Nation has
made a commitment to those who serve. I believe that we must
honor that obligation by providing the best benefits, the best
education, the best health care possible.
Now, with that said, there are predators everywhere. As
Senator Brown talked about higher education, we have to make
sure that we protect the G.I. Bill funds from institutions that
would want to take those dollars and not provide appropriate
education.
While I want to be positive and give hope and say that
there is great opportunity, I also have to be honest and say
that we have fallen short. That is another reason that we are
here to hear from you.
In the Third Congressional District--as you heard Senator
Brown say, we have some 800,000 veterans in Ohio--we have some
45,000 who live right here in the Third Congressional District.
So, we must do better for all veterans.
I was so pleased when the Senator asked you to raise your
hands and I saw women power. Would the women just raise your
hands again? Thank you for your service, and thank you for
being here. We must do better about women's health and access
for you as well.
Today, we are going to ask a lot of questions, and I will
be here, as the Senator said, for most of the first panel. I
want you to know, I am not just showing up today. I want you to
know that I have been a strong advocate. I serve on the
Financial Services Committee, but the subcommittee that is
equally as important to me is the Subcommittee on Housing.
I have only been in Congress for three terms, so to some, I
am the baby on the Hill. But, I can tell you that I have
introduced and signed on as a cosponsor to bills, and I can
tell you a large number of those bills are centered around
Veterans Affairs, making sure that there are adequate and
appropriate legal services for veterans, housing for homeless
veterans.
So often, people only look at veterans like those of you
who are here on the panel and in the audience. Far too many of
our veterans were not able to get up this morning. They will
not be thankful as we will be tomorrow on Thanksgiving because
they have not had all of the benefits that we have had.
That has not gone unnoticed by us, which is why having a
voice like Senator Brown's voice there speaking up--he is
making a difference. That is one of the reasons I am here.
This is not a gender or race or ethnicity or partisan
issue. One of the first things I did was I went to my two
colleagues, my two white, male, Republican colleagues, and
asked how can I be part of the partnership to make a difference
for veterans? We introduced a bill to help veterans.
Last, let me just say one of the greatest honors for me
that will go down in the history of my term as a Member of the
U.S. Congress will be that, right here in my district, I played
a major part in the writing, the orchestrating, the going and
testifying this month, that we passed in the House to have
right here in the Third Congressional District the National
Veterans Memorial and Museum--one of a kind, the first and only
one in the country. We know that is going to go over to the
Senate, and Senator Brown will probably just single-handedly
walk it through. [Laughter.]
We will get that signed.
We have started it and got it through the House, and it
will be a wonderful museum of artifacts for people to come and
live part of the history, to say thank you to you for your
service.
Thank you. Again, I am Congresswoman Joyce Beatty from the
Third Congressional District. I have my deputy outreach
director, Larry Seward, with me. We want to say thank you,
thank you, and thank you.
Senator Brown. This hearing will begin.
Thank you, Congresswoman Beatty, for your serious and
sometimes humorous introduction. I appreciate that.
I will ask the four of you to give opening statements. I
will introduce all four of you right now.
Mr. Tansill, we will start with you, and then on the
questions, I am going to start with the two veterans who are
here as veterans, not as what you do with Veteran Services.
Chip Tansill is Governor Kasich's director of the Ohio
Department of Veteran Services, a relatively new department, 10
years old maybe, something like that. He will testify.
Keith Harman, Commander-in-Chief of the Veterans of Foreign
Wars, one of our great veterans' service organizations that
really keeps the VA--always gives guidance to me personally, to
my staff, and to the VA. Thank you for the work you do.
James Powers is a veteran from Massillon, OH, Northeast
Ohio.
And, Melissa Twine, my office has worked with Melissa Twine
on a number of issues, and I appreciate seeing you here in
person. She is from Batavia, which is a community just east of
Cincinnati.
Mr. Tansill, we will start with you.
STATEMENT OF CHIP TANSILL, DIRECTOR,
OHIO DEPARTMENT OF VETERANS SERVICES
Mr. Tansill. Senator Brown, Congresswoman Beatty, thank you
so much for allowing me to testify today.
I had the privilege of serving in the U.S. Army for 32
years, including serving as chief of staff for the Ohio
National Guard. Following my military retirement, I served as
the executive director of the Franklin County Veterans Service
Commission.
I am proud to continue serving former members of our
military as the director for the Ohio Department of Veteran
Services under Governor John Kasich. Our department is a State
Cabinet agency, which was created in 2008 to partner with
county veterans service commissions and the U.S. Department of
Veterans Affairs in order to serve those who have served our
country.
Ohio is home to nearly 800,000 veterans and their families,
the sixth-largest population of veterans in the United States.
Our team actively identifies, advocates for, and connects
Ohio's veterans with jobs, education, and the local, State, and
Federal benefits for which they are eligible.
Last fall, we established a Regional Veterans Workforce
Team. They engage businesses across the State to highlight the
unique and advantageous skill sets veterans contribute to our
workforce. The team provides customized training for employers
on areas such as understanding military culture, how to
interview veterans, how to review their resumes, and how to
create a veterans hiring process. In their first year alone,
our Regional Workforce Team conducted nearly 100 trainings for
representatives from nearly 800 of Ohio's employers.
I have had the pleasure of visiting some of the employers
that they have worked with who have truly embraced the concept
our team introduces to recognize their significant improvement
in veteran hiring processes.
During one of these visits at a veteran-owned business, I
was told that if we could connect them with 50 qualified
veterans, they would hire them that very day. We commonly see
this type of incredible support and demand for hiring veterans
across Ohio.
Our trainings also make a big impact on human resources
directors who experience first-hand what a huge contribution
Ohio's veterans make to their team.
Ohio employers' efforts to recruit and retain veterans go a
long way in developing a framework for the successful
transition of military members back into civilian life.
Building a network of military-friendly employers across the
State, currently totaling over 2,800 businesses, is just one
way that our department seeks out ways to ease the often-
stressful transition back to civilian life.
Our department also works in collaboration with the
Department of Defense and other veteran and military support
organizations to examine opportunities for improved
coordination between Federal, State, and local resources to
help servicemembers transition to civilian life. I am aware the
discussions surrounding ways to improve this process are well-
established and ongoing.
Currently, most State resources for recently-transitioned
veterans and their families require the veterans themselves to
be proactive in seeking out services and benefits. This is
problematic because many veterans are unaware that resources
are available and, therefore, are not inclined to seek them
out, especially while they are balancing the many other
challenges that accompany transitioning from the military to
civilian life.
Going from an environment where lifestyle and career paths
are very predictable to suddenly being on your own is not
something that comes with an instruction manual. The transition
experience would be improved if State veteran support agencies
like our department were provided with the contact information
for individuals as early as possible prior to their separation
from the military, primarily by sharing the nonmilitary
civilian email address they intend to use.
If this email address were included as part of the DD-214
discharge document, it could better facilitate not only rapid
and successful transition to civilian life with support from
State and local services, but also improve communication with
veterans who still have an Individual Ready Reserve commitment.
This new method of communication would enable the Ohio
Department of Veteran Services to proactively inform military
members about services and benefits relevant to their
experiences, health concerns, and other personal interests.
These might include: targeted career and education
opportunities; veterans' claims and financial assistance
locally available; and enrollment in VA health care facilities.
We hear frequently from stakeholders and peers in other
States that increased avenues for communication would make a
big impact on our ability to ensure that veterans are presented
with significant opportunities for success instead of ambiguity
upon their military discharge.
Our experiences have demonstrated that the most successful
transitions are those in which the veteran and their family are
quickly connected to employment, education, housing, benefits,
healthcare, and veterans service organizations that empower
them to thrive in their new community.
It is my hope that by contributing to continuing
conversations, the next generation of veterans can garner the
benefits of improved procedures.
I understand that there are many topics of interest today,
and I will be glad to answer any questions regarding the other
services, benefits, and resources available to Ohio's veterans
or the areas outlined in the supplemental information that I
submitted with my testimony.
[The prepared statement of Mr. Tansill follows:]
Prepared Statement of Chip Tansill, Director,
Ohio Department of Veterans Services
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Senator Brown. Thank you, Mr. Tansill, especially your
comments about transition and how important that is. We know
that the VA and the Department of Defense do not always work
together as well as they should. I think we are seeing
improvements, but not enough yet.
Commander Harman, thank you for your service and for being
here.
STATEMENT OF KEITH HARMAN, COMMANDER-IN-CHIEF, VETERANS OF
FOREIGN WARS
Mr. Harman. Senator Brown, Congresswoman Beatty, on behalf
of the Veterans of Foreign Wars of the United States, the
Nation's largest organization of combat veterans, and its
Auxiliary, thank you for giving us the opportunity to discuss
issues important to Ohio's veterans.
In the past 3 years, the VFW has assisted hundreds of
veterans who have faced delays receiving care through the
Choice Program, identified issues with the program, and
compiled several reports with common-sense recommendations on
how to address these issues. The VFW must commend the VA,
Congress, and the program administrator for resolving or
addressing most of the issues that we have identified.
However, the Choice Program continues to face several
challenges that must be addressed, to include ensuring that the
decision of whether a veteran will receive care with the VA or
the community is determined by the veteran and their health
care team, consolidating all community care programs into one
easy to understand and to administer program, and establishing
one appropriations account.
The VFW urges this Committee to quickly pass a community
care bill that will develop a consolidated care program that
supplements, not supplants, the VA's health care system.
In September 2016, the VFW partnered with five excellent
organizations to launch our mental wellness campaign, which
helps servicemembers, veterans, and their families, with mental
health conditions. We did so to address the stigma associated
with seeking metal health care, but this is not new.
Thirty years ago, people were ashamed to talk about cancer.
It was a shameful word. Today, people are ashamed to admit they
have a mental health condition. Why? The brain is an organ. It
is part of our body. It needs treatment to address injuries,
but can recover just as any other part of the body can.
The VFW has worked tirelessly in the past 2 years to get
people talking about mental health, to notice when someone may
be in a mental health crisis, and to finally eliminate the
stigma our society has placed on mental health. VFW posts
around the world have hosted nearly 300 events within their
communities to share with their members about the resources
available to veterans and family members suffering from mental
health conditions, and it is working. Just 2 weeks ago, I had a
veteran tell me at a Veterans Day event in our Nation's capital
that the VFW had saved his life.
In order to completely eliminate veteran suicides, VA must
increase access to military competent health care and conduct
more studies to find innovative ways to treat mental health
conditions. The VA has conducted research on therapies such as
service animals, but other therapeutic alternatives, such as
medical marijuana, must be studied.
Women veterans are the fastest growing population within
the military and veteran community. There are currently 2
million female veterans, with nearly 68,000 of them in Ohio.
Now more than ever, it is important that the VA and Congress
address their gender-specific needs.
The most common recommendation the VFW has received from
Ohio women veterans is that the VA must increase access to
gender-specific VA providers. We also hear from women veterans
that VA outreach efforts are increasingly ineffective because
the VA relies heavily on electronic communications such as
social media. The VA must reach all generations of women
veterans who have earned the ability to receive their health
care at the VA.
While the VFW applauds Congress for passing S. 1025, the
Veterans Appeals Improvement and Modernization Act of 2017, we
have significant concerns with regard to how the VA intends to
implement the prescribed changes by way of the Rapid Appeals
Modernization Program, and we would call on Congress to conduct
oversight on this process.
The VFW would like to thank this Committee for its hard
work and dedication on the swift passage for the Forever G.I.
Bill, which will make a difference for countless veterans in
Ohio and throughout the country. Specifically, we would like to
thank Senator Brown for his continued push to ensure survivors
can achieve their educational goals without accruing large
student debt.
With more than 187,000 overpayment notices being sent to
veterans nationwide in this past year alone, one would hope
that the VA would not only be prepared to share the most
precise information that triggered that notice in the first
place, but also be prepared to assist the veteran in a timely
manner. Sadly, this is not the case.
In our experience, we have found legitimate overpayments
most often occur with G.I. Bill benefits when a veteran's
enrollment status changes at his or her college. If a student
decides they are having a difficult time meeting their
educational obligation and chooses to switch to part time, it
is the responsibility of the school, not the student, to notify
the VA.
To address the overpayment issues, the VFW urges passage of
H.R. 3705, the Veterans Fair Debt Notice Act of 2017, which
would require VA to use certified mail to notify veterans about
the collection of debt.
Ending sequestration has been the top priority for the VFW
since it was created by the Budget Control Act of 2011. It has
forced VA and DOD to work within the confines of outdated
spending caps that fail to account for increased demands for VA
benefits and services, or for the cost required to man and
equip a force capable of deterring and defeating emerging
global threats. While Congress has negotiated temporary deals
in the past to avoid dangerous cuts, the issue of sequestration
has not been addressed, and it continues to impact our
servicemembers, veterans, and their families.
In my travels across the country and the world, I have seen
firsthand the impact sequestration is having on our troops:
pilots barely flying enough to maintain their certifications; a
shortage of replacement parts to maintain equipment; and the
lack of troop training needed to combat the ever-increasing
threats to national security. Congress must end sequestration
once and for all.
Mr. Chairman, this concludes my remarks. I would be happy
to answer any questions that you or Members of the Committee
may have. Thank you.
[The prepared statement of Mr. Harman follows:]
Prepared Statement of Keith Harman, Commander-In-Chief, Veterans of
Foreign Wars of The United States
Chairman Isakson, Ranking Member Tester and Members of the
Committee, On behalf of the men and women of the Veterans of Foreign
Wars of the United States (VFW) and its Auxiliary, thank you for the
opportunity to discuss the issues important to Ohio's veterans, which
also impact veterans throughout the country.
Community Care: In the past three years, the VFW has assisted
hundreds of veterans who have faced delays receiving care through the
Choice Program, and has surveyed more than 8,000 veterans specifically
on their experiences using Department of Veterans Affairs (VA)
community care. Through this work, the VFW has identified a number of
issues and has proposed more than 15 common sense recommendations on
how to improve this important program. Some of these common sense
recommendations include making VA the primary payer for Choice Program
care, removing restrictions on when VA is able to share medical records
with Choice providers and making clinical necessity the trigger for
community care.
The VFW must also commend VA and the third party administers for
their willingness to work with us to address issues veterans encounter
when obtaining care through the Choice Program. VA has made more than
70 modifications to the Choice Program's contract to address many of
the pitfalls that have plagued the program, such as allowing the
contractors to conduct outbound calls when they have the proper
authorization to begin the scheduling process.
However, the Choice Program continues to face several challenges
that must be addressed. Some of these challenges include assuring the
decision of whether a veteran will receive care within VA or the
community is determined by a patient and their provider, consolidating
all community care programs to one and making the program discretionary
instead of mandatory.
The VA health care system delivers high quality care and has
consistently outperformed private sector health care systems in
independent assessments. The VFW's numerous health care surveys have
also validated that veterans who use VA health care are satisfied with
the care they receive. In fact, our latest survey found that 77 percent
of veterans report being at least somewhat satisfied with their VA
health care experience. When asked why they turn to VA for their health
care needs, veterans report that VA delivers high quality care which is
tailored to their unique needs and because VA health care is an earned
benefit.
VA has made significant strides since the access crisis erupted in
2014 when whistleblowers across the county exposed how long veterans
were waiting for the care they have earned and deserve. However, VA
still has a lot of work to do to ensure all veterans have timely access
to high quality and veteran-centric care. Veterans deserve reduced wait
times and shorter commutes to their medical appointments. This means
turning to community care when needed, but also means improving VA's
ability to provide direct care.
The VFW urges this Committee to quickly pass a community care bill
that would continue to invest in VA's ability to improve its internal
system and develop a consolidated care program that supplements, not
supplants, the VA health care system. The VFW looks forward to working
with this Committee to pass veteran-centric reforms to VA's community
care programs.
Mental Health: In September 2016, the VFW launched our mental
wellness campaign. We partnered with five organizations in our efforts
to help servicemembers, veterans and their families cope with their
mental health conditions. During this process we consistently heard
from our members that the biggest barrier they face when trying to
address the health of their brains is stigma, but this is not new.
Thirty years ago people were ashamed to talk about cancer. It was a
shameful word. Nobody used to talk about diabetes either. It was
embarrassing to admit you had a health condition people wrongly
associated with an improper diet. Today, people are ashamed to admit
they have a mental health condition. Why? The brain is an organ. It is
part of our body. It needs treatment to address injuries and illnesses,
but can recover just as any other part of the body can.
The VFW has worked tirelessly in the past two years to get people
talking about mental health; to notice when someone may be in a mental
health crisis; and to finally eliminate the stigma our society has
placed on mental health. The more we talk about it, educate people
about it and address the actualities of mental health and suicide, the
more comfortable society and individuals suffering from mental health
conditions are going to become with accessing the care they need. Most
citizens can identify somebody experiencing a heart attack. People who
have a heart attack know they must seek medical treatment. Now it is
time for people to recognize the five signs of mental distress and to
know when to seek help.
This is why VFW Posts throughout the world have hosted nearly 300
events in the past two years in partnership with the Campaign to Change
Direction. Many of these Posts partnered with VA, Given an Hour
providers and Walgreen pharmacies to ensure their communities know
about the resources available to veterans and family members suffering
from mental health conditions. Now they know to identify the five signs
of mental distress: personality change, agitation, withdrawn behavior,
poor self-care and feelings of hopelessness.
This past year VA released the most extensive study ever conducted
on veteran suicide. This study was possible thanks to interagency
cooperation and the necessity for VA, the Department of Defense (DOD)
and more than 30 states to fully understand the details such as who is
more at risk, how many veterans are dying by suicide and where these
veterans reside.
The study found that on average, twenty veterans die by suicide
each day, yet only six out of these twenty use VA health care. To the
surprise of many, 65 percent of veterans who die from suicide are 50
years old or older. Additionally, the risk for suicide in the female
veteran population is 2.4 times higher when compared to their civilian
counterparts. While these numbers are all alarming, they are also
incredibly insightful for purposes of helping Congress and VA work
toward eliminating this current plague of suicide in the veteran
population.
This summer, VA released a more thorough analysis of last year's
study. This analysis focused on the data broken down at a state level.
With the national veteran suicide rate being 38.4, the state of Ohio is
doing better than the national average at 32.1, but is not a
statistically significant difference. In 2014, 244 veterans died by
suicide in the state of Ohio.
In order to eliminate veteran suicides, VA must increase access to
competent mental health care that is individualized to the patient.
While the data shows VA mental health care is making a positive impact
on those who use it, there is still room for improvement. More studies
must be conducted to find more innovative ways to treat mental health
conditions. VA has conducted research pertaining to areas such as
service animals and emerging technologies, but other therapeutic
alternatives, such as medicinal marijuana, need to be studied.
The VFW continues to hear from veterans that VA needs to hire more
mental health care providers. This shortage of providers has been
continually highlighted by Government Accountability Office and VA
Office of Inspector General (OIG) reports in past years. Specifically,
the VAOIG's yearly determination of occupational staffing shortages
across the VA health care system has placed psychologists among the top
five VA health care professions' staffing shortages. This is due in
large part to a general lack of mental health care professionals in the
United States.
But we must not forget about the importance of public-private
partnerships. Providing veterans with resources such as Ohio's Star
Providers is absolutely crucial in addressing needs for veterans who
may not trust VA or be able to access the care they need and want in a
timely manner.
Whether PTSD or any other mental health conditions stem from combat
in Afghanistan or rape, veterans deserve the treatments that work best
for them. Yet, VA struggles to arrange group therapy sessions for
sexual trauma survivors, simply due to the lack of patients willing to
partake in group therapy. Though there may only be one, two or three
veterans wanting group therapy, it does not mean they should be denied
access or placed in uncomfortable group therapy sessions. That is why
the VFW supports expanding VA's telemedicine authorities to ensure
sexual assault patients within VA have the opportunity to talk
comfortably in a virtual group setting of people who endured the same
traumas.
Women Veterans: Women veterans are the fastest growing population
within the military and veteran community. There are currently two
million female veterans, with nearly 68,000 of them in Ohio. Of the
women who have served in Iraq and Afghanistan, more than 160 of them
have paid the ultimate sacrifice and, as of 2016, women servicemembers
are able to serve in any career field they desire. Now more than ever,
as their population and roles in the military continue to increase, it
is important VA and Congress address their gender-specific needs.
There are certain gender-specific needs for both men and women. Our
Nation's women veterans are younger than the average male veteran. They
are more likely to have served in Gulf War or Post-9/11 eras than in
previous conflicts. Women veterans are also more likely to come from
diverse racial backgrounds. They are more likely to have a service-
connected disability and are more likely to use VA health care when
compared to their male counterparts.
VA reports that more than 447,000 women veterans used the VA health
care system in fiscal year 2015, which is a 123 percent increase since
fiscal year 2003. VA has worked to improve their gender-specific care
for this population of veterans, but more work needs to be done. In
2016, the VFW conducted a survey of nearly 2,000 women veterans as a
way to identify the most important issues they were facing in VA. Of
those respondents, three percent were from Ohio. The most common
feedback the VFW received from Ohio respondents was clear--increase the
number and accessibility to gender-specific providers. With 58 percent
of Ohio's women veterans using VA's gender-specific care, this concern
must be addressed.
To make sure these issues are addressed, and the voices of women
veterans are heard, the Ohio Department of Veterans Affairs hosts a
quarterly women veteran's advisory committee meeting. The Committee
also hosts a statewide conference every two years, which is open to all
veterans and has seen turnouts of as many as 750 attendees.
This Committee has found that funding and outreach are the largest
barriers for VA's gender-specific care in Ohio. When outreach is
conducted to women, the outreach does not appear to the population as
being targeted specifically toward them. The Committee commonly hears
back that outreach to get women veterans into VA seems to be heavily
reliant on electronic outreach and social media, when women veterans in
Ohio report to the Committee that they would rather have face-to-face
outreach conducted. This makes sense as 46 percent of VFW's survey
respondents from Ohio were 55 or older. VA must ensure its outreach
efforts are effective with all generations of women veterans.
Last, the Ohio committee has found recognition of women veterans
within VA to be a continuing struggle. As one member put it, ``Women
are not as likely to have on a ball hat or t-shirt that states she is a
veteran.'' Women veterans who use women's clinics in Ohio VA medical
facilities have reported an increase in recognition of their service,
but for women not using women's clinics there are still continuous
battles. When a woman walks into a clinic there is no reason for VA
staff to ask what her spouse's information is--it should be assumed
that she is a veteran.
Oversight: Earlier this year, a damning report was released by the
VA Office of Inspector General concerning the Louis Stokes Cleveland VA
Medical Center (VAMC). The report identified discrepancies regarding
patient safety, environmental cleanliness, and VAMC staff training
related to disruptive and violent behavior, just to name a few. Even
more reprehensible was that the report concludes by stating that the
VAOIG was not confident that the facility employees were properly
trained; that clinicians were effectively monitoring patients receiving
high-risk medications, such as anticoagulants; nor that patient
equipment was clean.
To be frank, this is beyond unsatisfactory. A facility with a
yearly budget of approximately $1B which serves more than 110,000
veterans per year should not have untrained staff and dirty equipment.
Since 2014, VA has told us the situation is improving, but to the
veterans' community, this is not good enough. VA's obligation is to
provide our veterans with the best health care our Nation has to offer.
This investigation only adds to the hundreds of concerns we heard from
veterans at VA facilities from coast to coast over the past three
years.
In light of these findings, we must reject any urge to paint
Veterans Health Administration (VHA) as an overall failure that should
be abandoned in exchange for privatized care. If the system is failing,
it is the duty of the leadership to fix it. While this task at one time
was daunting and yielded little in the way of results, thanks to the
recent passage of the Department of Veterans Affairs Accountability and
Whistleblower Protection Act, leaders now are empowered to hold
underperforming employees accountable, regardless of seniority.
Appeals Modernization: Currently, Ohio is home to 769,267 veterans
of which 470,192 are receiving VA benefits in some form or another. An
all-out push by the Veterans Benefits Administration (VBA) in the past
few years has reduced the disability compensation and pension workload
by more than 164,000 claims. In doing so, VBA continued to define its
``workload'' and ``backlog'' as only initial disability and pension
claims, diverting nearly all its people to working on those cases.
As a result, the significant backlog reduction came at the expense
of more difficult work. Appeals soared by more than 28,000 during this
period, bringing the total number of appeals pending to more than
300,000. Appeals continue to average more than three years before the
Board of Veterans Appeals makes its first decision. Initial pension
claims continue to rise, and disability claims with eight or more
conditions remain unreasonably high at nearly 43,000. Pending
dependency claims remain unreasonably high at over 231,000--up from
40,000 just a few years ago.
In 2015 alone, the Cleveland VA Regional Office processed 32,187
claims. Since the first discussions on appeals reform with VA, the VFW
has been very clear that any changes to the system must be coupled with
aggressive initiatives to adjudicate legacy appeals in a timely manner
through both legislative authority and proper resourcing.
While VFW applauds Congress for passing S. 1024, the Veterans
Appeals Improvement and Modernization Act of 2017, we have significant
concerns with regard to how VA intends to implement these prescribed
changes by way of the Rapid Appeals Modernization Program. Furthermore,
the VFW urges Congress and VA to properly resource VBA and the Board of
Veterans Appeals to ensure they are able to timely adjudicate appeals
from veterans who do not opt into the new appeals process, and the
potential influx of supplemental claims and higher level review
requests at VA Regional Offices. VA must be empowered to manage its
workload if the new framework to expected to succeed.
Forever G.I. Bill: The VFW would like to thank this Committee for
its hard work and dedication on the swift passage of the Forever G.I
Bill, which will make a difference for countless veterans in Ohio and
throughout the country. Specifically, we would like to thank Senator
Brown for his continued push to ensure survivors who use the Marine
Gunnery Sergeant John D. Fry Scholarship can achieve their educational
goals without accruing large student loan debts. The VFW is
particularly proud that the G.I. Bill is now a lifetime benefit.
Veterans who were discharged after 2013 no longer have to worry about
an expiration date for their G.I. Bill benefits. This rightfully
recognizes that many transitioning servicemembers do not need to use
their G.I Bill benefits immediately after separating from military
service. The VFW will closely monitor the implementation of the Forever
G.I. Bill to ensure veterans are aware of their expanded educational
benefits and ensure VA meets its obligations to America's student
veterans.
Overpayments: With more than 187,000 overpayment notices being sent
to veterans nationwide in the past year alone, one would hope that VA
would not only be prepared to share the most precise information that
triggered the notice in the first place, but also be prepared to assist
the veteran in a timely fashion. Sadly, this is not the case.
In the past year, the VFW's National Veterans Service (NVS) has
directly assisted more than 200 veterans who have experienced issues
stemming from overpayments. According to our estimates, about 60
percent of the cases where NVS has intervened have resulted in the
veteran being granted either partial or full relief from the debt from
VA's Debt Management Center.
In our experience, we have found that legitimate overpayments most
often occur with G.I. Bill benefits when a veteran's enrollment status
changes at his or her college. If a student decides that they are
having a difficult time meeting their educational obligations and
chooses to switch to part-time, it is the responsibility of the school,
not the student, to notify VA. In the event that the school fails to
notify VA of the change in status, the veteran will continue to receive
the full living stipend and the school will continue to be paid the
full-time rate for tuition.
Once the error is noticed, VA will send an ambiguously worded
notification of overpayment, which also provides options for repayment.
If the veteran is unable to contact VA to establish that the debt is
erroneous, make a repayment in a timely manner, or enter into a payment
agreement with VA, their debt is sent to collections and VA will
garnish payments from their disability compensation benefits until the
debt is satisfied.
The VFW understands that overpayments must be recouped in order for
benefit programs to work efficiently. However, it is important to state
that not only must debt notices be clear and provide the proper
information regarding what steps veterans need to take in order to
resolve any outstanding debts as soon as possible; but it is also
imperative that these notices actually reach the veterans in the first
place.
That is why the VFW fully supports H.R. 3705, the Veterans Fair
Debt Notice Act of 2017, which directs VA to require that certified
mail be used to send a veteran any debt demand or debt information
notification concerning collection of debts resulting from the
veteran's participation in a VA benefit or home loan program. This
piece of legislation passed the House earlier this month and we urge a
swift passage by the Senate.
Sequestration: Ending sequestration has been a top priority for the
VFW since it was created by the Budget Control Act of 2011, which set
spending caps for the Federal budget through fiscal year 2022 and
included a provision to activate automatic cuts if such spending caps
are exceeded. As a result, VA and DOD are forced to work within the
confines of spending caps that were set more than six years ago which
fail to account for increased demand for VA benefits and services, or
for the costs required to man and equip a force capable of deterring
and defeating emerging global threats. While Congress has negotiated
temporary deals in the past to avoid the dangerous cuts, the issue of
sequestration has not been addressed and continues to impact the
resources afforded to DOD and VA.
Compounding the problem is Congress' increasing reliance on
continuing resolutions (CRs) to fund the government. CRs bring
instability and uncertainty into the funding process by limiting long-
term decisionmaking, preventing new acquisitions and constraining
spending to predetermined category levels. For DOD, this means canceled
training, penalties on contracts, delayed maintenance on weapons
systems, lack of equipment, cuts to quality of life programs, longer
deployments, wear on materials, and an overall decreased readiness
status.
In my travels across the country and the world, I have seen
firsthand the impact sequestration is having on our troops stationed
overseas. Pilots barely fly enough hours to maintain their
certifications and troops lack the training needed to combat the ever-
increasing threats to our national security. The effect mandatory
sequestration will have on recruiting and retention, when combined with
better job opportunities in a healthy civilian market, could jeopardize
the continued viability of the all-volunteer force. For example, the
Army Reserve has nearly 5,800 soldiers and more than 2,600 civilians
employed (DOD and non-DOD combined) in Ohio. It is projected that
sequestration has an impact of $16.7 million for fiscal year 2018 just
in Ohio as it relates to the Army Reserve.
What this means for veterans is that the resources VA is given to
care for our Nation's veterans has increased in past years, but
outdated and arbitrary budget caps on Federal discretionary spending
have prevented budget increases from keeping pace with the growing
demand on the VA health care system. Budget caps have forced VA to
request less resources than needed to accomplish its mission and
required Congress to provide VA less resources than it has requested,
which hinders VA's ability to meet its obligation to our Nation's
veterans.
Until now, VA has been exempt from sequestration, but no one said
that will be the case in the future since nearly half of VA's budget
comes through the discretionary process. Despite recent legislative
victories, sequestration could dramatically affect VA's ability to
reduce the claims backlog or improve hospital infrastructure that is
already in rapid decline, potentially diminishing access and timeliness
of care. Additionally, programs that have not been exempt from
sequestration would have a direct impact on our Nation's veterans, such
as services the Department of Labor-VETS provides for veterans seeking
employment, as well as the number and size of housing grants that the
Department of Housing and Urban Development would have available for
homeless veterans.
Blue Water Navy: When asking my fellow Ohio veterans what issues
are important to them, one that continued to come up is the frustration
with continued inaction to provide Blue Water Navy veterans the
benefits they deserve. The VFW strongly supports S. 422, the Blue Water
Navy Vietnam Veterans Act of 2017, which would expand disability
compensation benefits to veterans who were exposed to Agent Orange
while serving in the territorial seas of the Republic of Vietnam in
support of ground operations during the Vietnam War.
Currently, VA relies on what the Court of Appeals for Veterans
Claims has called an ``arbitrary and capricious'' interpretation of
inland waterways, which unjustly denies veterans who served aboard
ships in the coastal waters of Vietnam the benefits they deserve. The
VFW calls on Congress to swiftly pass the Blue Water Navy Vietnam
Veterans Act of 2017. However, we recognize the position that Congress
is in concerning the cost of this legislation. To help move this issue
forward, the VFW has written a letter to President Trump asking him to
change the regulations associated with Title 38 of the United States
Code. Doing so would alleviate the need for congressional action or
reduce the cost associated with the passage of S. 422. The VFW call on
this Committee to move this important bill as soon as possible.
Burn Pits: The use of open air burn pits in combat zones has caused
invisible but grave health complications for many servicemembers, past
and present. Particulate matter, polycyclic aromatic hydrocarbons,
volatile organic compounds and dioxins--the destructive compound found
in Agent Orange--and other harmful materials are all present in burn
pits, creating clouds of hazardous chemical compounds that are
unavoidable to those in close proximity.
The VFW is glad to see that nearly 100,000 veterans have enrolled
in VA's burn pit registry. The VFW is also anxiously awaiting the
results of the National Academies of Science's study on the burn pit
registry which will serve to determine whether veterans exposed to
airborne hazards from burn pits experience certain pulmonary
conditions. The VFW urges VA and Congress to act swiftly on
recommendations from this important study.
VA must also take measures to improve the Airborne Hazards and Open
Burn Pits Registry. For example, a similar registry operated by Burn
Pit 360 allows the spouse or next of kin of registered veterans to
report the cause of death for veterans. VA must add a similar feature
to its registry to ensure VA is able to track trends. Other
improvements include streamlining the registration process, updating
duty locations, and eliminating technical glitches to ensure veterans
are able to register.
While the VFW is glad to see VA has commissioned independent
research on the burn pit registry, more independent research is
necessary. That is why the VFW supports funding for research through
the Congressional Directed Medical Research Program (CDMRP)
specifically for burn pit related conditions. The CDMRP for Gulf War
Illness has shown some progress in identifying causes, effective
treatments and biomarkers for Gulf War Illness, and the VFW is
confident that similar research for burn pits will help veterans
finally determine whether their exposure to burn pits during combat is
associated with their negative health care outcomes.
Senator Brown. It is an honor to have the national
Commander-in-Chief of VFW, and thank you especially for your
comments about the stigma of mental health. That issue is so
important, and women veterans, and veteran student debt. Thank
you.
Next, we would like to hear from Melissa Twine.
Ms. Twine, thank you for joining us.
STATEMENT OF MELISSA TWINE, VETERAN, BATAVIA, OH
Ms. Twine. First, I would like to thank Senator Brown for
inviting me to participate in today's hearing, sharing my
experiences with the Veterans' departments here in Ohio, both
in Cincinnati and in Dayton, where my husband is buried.
There is nothing more important than gaining insight from
customers--in this case, the actual veterans. Having State or
regional hearings to gain this valuable information can only
lead to the betterment of the entire VA program, from
educational services, health care access, and all entities in
between. In addition, these hearings afford a collaborative
bridge between the veterans and their lawmakers.
A little about myself: I was a military brat and brought up
in the military way of life, as my father was retired Air Force
and a Vietnam veteran. When I was 17, I entered the U.S. Air
Force and served for 10 years. I separated from the Air Force
in 1998 with the label of a disabled veteran with 40 percent
service connection.
My husband, who was Active Duty Air Force, died at Langley
Air Force Base in August 2002. I then gained a new label of a
surviving spouse, a military widow, and a Gold Star wife. Our
fourth child arrived 3 weeks later, and I moved myself and all
four children home to Ohio to the Cincinnati area.
I have been an advocate in supporting the initiatives
brought forth by Senator Brown and many others for increasing
survivors benefits via the VA's Forever G.I. Bill in
conjunction with the Fry Scholarship for surviving spouses, and
I hope to go back to school to continue my education, which was
halted when I became a widow raising four children alone.
Regarding access to the VA health care here in Ohio, I
personally try to avoid the VA system at all costs. When I did
try to utilize the VA system several years ago, over 12 years
ago, I experienced only hassle and frustration. I quickly
learned that using my survivors benefits for TRICARE was much
easier and allowed for many more options, even though it came
with a higher monetary cost to myself and family. Any attempt
to see a VA medical provider was met with long wait times and a
run-around when attempting to get medications for my diabetes,
high blood pressure, and high cholesterol. When I did get an
appointment, I waited a long time through a confusing process
of lab testing and shuffling around through several hallways
and departments.
Additionally, I have a very close friend that tried to get
help for substance addiction last year, which is a huge issue
here in Ohio, a former marine. He was put through a month-long
process of three appointments to different departments and tons
of paperwork only to be told he did not qualify in the VA
program because his wife had insurance, so he would not qualify
for VA help, something that could have been identified up front
in the very first appointment and not have caused a delay in
him obtaining treatment that he so desperately needed.
This only reiterated to me that avoiding the VA medical
system was a no-brainer.
I will continue to assist in the fight for increased
awareness in the VA medical system struggle, fairness for
survivor benefits for all surviving family members, and
increased availability to all veterans' benefits that we earned
while serving our country.
Again, thank you for allowing me to appear here and testify
today, and to achieve the previously mentioned topics.
Thank you, Senator Brown and Congresswoman Beatty, for
inviting me to appear today; for all the work that you do and
that your office does; for helping military families, military
veterans, and surviving spouses.
[The prepared statement of Ms. Twine follows:]
Prepared Statement of Melissa M. Twine, Veteran, Batavia, OH
First, I would like to thank Sen. Brown for inviting me to
participate in today's hearing by sharing my experiences with the VA
departments here in Ohio, both in Cincinnati and in Dayton.
A little about myself: I was brought up in the military way of
life, as my father retired from the USAF. When I was 17, I entered the
USAF and served for 10 years. I separated from the AF in 1998 and am a
Disabled Veteran of over 40% service related. My husband, who was ADAF
died at Langley AFB, VA in Aug of 2002. I then gained a new title or
label of a Surviving Spouse. Our 4th child arrived 3 weeks after his
death. I moved myself and all 4 children home to Ohio.
Before separating from the AF, I gained an Associate's Degree in
Allied Health Sciences. I then returned to school at the University of
Cincinnati, where I earned my Undergraduate Degree in Biology, pre-med
while taking care of 3 children; my husband was sent overseas without
the family during this timeframe, also serving a tour with the United
Nations in the Western Sahara. The VA helped me achieve this degree
from UC via the VocRehab Program for DAVs.
I have been an advocate in supporting the initiatives brought forth
by Sen. Brown and many others for increasing Survivor's Benefits in
Education via the VA's Fry Scholarship Program and hope to go back to
school to continue my education that was halted when I became a widow
raising 4 children alone.
Regarding access to VA Healthcare in Ohio, I personally try to
avoid the VA system at all costs. When I did try to utilize the VA
system several years ago, I experienced only hassle and frustration. I
quickly learned that using my Survivor's benefits for TRICARE was much
easier and allowed for many more options, even though it came with a
higher monetary cost to myself. Any attempt to see the VA medical
provider was met with long wait times and a run-around when attempting
to get medications for Diabetes, Hypertension, and high cholesterol.
When I did get an appointment, I waited for a long time through a
confusing process of lab testing and shuffling around through several
hallways and departments . . . all the while being handed donuts and
coffee from a push cart by volunteers . . . not exactly what Diabetics
and patients with heart disease should be eating!
I have a very close friend that tried to get help for substance
addiction last year; a former Marine. He was put through a month-long
process of 3 appointments to different departments and tons of
paperwork only to be told that because his wife had insurance, he did
not qualify for VA help . . . something that could have been identified
up front and not have caused a delay in him obtaining treatment he so
desperately needed. This reiterated to me that avoiding the VA Medical
system is a no-brainer.
I will continue to assist in the fight for:
increased awareness in the VA Medical System struggle
fairness in Survivor Benefits for all Surviving Family
Members
and increased availability to all Veterans benefits that
we earned while serving our country
Again, thank you for allowing me to appear and testify today to
help achieve the previously mentioned topics. Thank you, Sen. Brown,
for inviting me to appear today and for all of the work that you and
your office does to help the military and their families.
Senator Brown. Thank you, Ms. Twine. Thank you for your
testimony. [Applause.]
Thank you for pointing out to us what happens with benefits
expiring. It is ideas like that that come from veterans in
places like Batavia that really help me do this job. Thank you
so much for that.
Mr. Powers, welcome. We would love to hear your testimony.
STATEMENT OF JAMES POWERS, VETERAN, MASSILLON, OH
Mr. Powers. Thank you, Senator. Let me begin by thanking
yourself and this Committee for an invitation to testify
regarding topics concerning veterans.
Of the over 850,000, of course, 8 percent of the State's
population, the sixth most here nationally, veterans here in
Ohio, and over 20 million nationally, this Committee has given
me, of all people, the opportunity to give testimony regarding
veteran issues.
I personally view this as a great honor but also a great
responsibility to tell my story and to be a voice for veterans
that need to be heard.
Senator Brown. Take your time.
Mr. Powers. My name is James Powers. I served in the U.S.
Army and the Ohio Army National Guard for a combined 12 years.
I deployed in support of Operation Iraqi Freedom in 2009 to
2010. During my career, I served as an infantryman, an
instructor, and a recruiter. I achieved the rank of sergeant E-
5. And I, like any good soldier, held our creeds, our oaths,
our ethos sacred and served to the best of my abilities.
During my service, I, like over 3.8 million other veterans,
became injured. The majority of my injuries I sustained over my
military career, they are not easily visible, but one of them
almost cost me my life, PTSD.
When I came home from Iraq in 2010, my transition, like
many others, did not go well. My life for the next 4 years
slowly spiraled out of control. It was like quicksand. The more
I tried to fix it, the worse things got.
I let it consume everything, my livelihood, my military
career, relationships, and my overall well-being. I turned to
drugs and alcohol. I would do anything to numb what I still
today trouble to describe until, finally, on a Tuesday morning
in May 2014, when I had no other choice, I thought, put a
pistol in my mouth and pulled the trigger. Click. A misfire
occurred. I had improperly loaded a pistol that I had loaded
and unloaded millions of times in my career because of how
drunk I was.
Fortunately, for me in that moment, something else clicked
in my mind and I said something is not right. This is not you.
Three and a half years later, I sit here before this Committee.
It has been a bumpy road, to say the least. I completed an
intensive 10-week residential treatment program. Had it not
been for the PTSD substance use disorder residential treatment
program at the Wade Park VA, I do not think I would be here to
testify today. That program and the providers involved should
serve as the standard of care for veterans with mental health
issues, especially PTSD.
It is unfortunate that VA funding and availability for
programs like this are next to none.
I have had to learn the art of finding a parking spot at
overcrowded VA facilities. I have gotten used to going back and
forth with the VA about trying to double collect on a debt. I
got to experience the Integrated Disability Evaluation System.
I spent 9 months at the Warrior Transition Unit in Fort Knox,
Kentucky, for that. At least it seemed more efficient to me
than the VA's traditional claim processing.
I finally got the torn ligament in my wrist repaired. It
only took 5 years from when I originally presented with pain.
I continued to try things to ease the chronic pain in my
left foot during that time, too. I drove 6 hours back home on
the weekends, as my wife was expecting our now 2-year-old son.
Finally, in February 2016, my military career ended, and I
was medically discharged retired. Since then, I keep to myself.
I am Sergeant Powers turned Mr. Mom to my little man Connor and
my soon-to-be-little dude Luke.
I strive to be a good husband to my wife, Shannon. She
keeps me grounded and coolheaded. I only wish that the VA would
do a better job with the caregiver program. At times, too, she
has questioned the VA's shortcomings, which at least helps me
feel validated my issues and not that I am just losing my mind.
She was even understanding and simply said, ``Drive safe
and call me when you get there,'' when I made the spur-of-the-
moment decision and drove all the way to D.C. in July to see my
elected officials about the congressional inquiry that the VA
seemed to be stalling on. To my luck, Senator Brown and his
staff were able to finally get answers about a grossly
inaccurate $11,000 VA overpayment debt. The VA's eventual
response was that the debt was miscalculated due to a ``manual
processing system failing to properly communicate with an
automated system.'' If you ask me, it sounds like a fancy way
of saying human error.
I just keep my routines, and I try to stay mindful. I still
struggle daily, but not nearly what I used to. For that, I am
happy.
I surround myself with a small group of veterans, some that
I have known since childhood, others that I have had the
pleasure of meeting along the way in my life. Two of them,
fortunately, join me here today. We look out for each other
just like we did in the service, covering each other's six. I
think I did this for them just as much as for myself.
I have been prescribed medications over the years, at times
three-to-five medications, some requiring routine lab work,
some that would be to counteract side effects of the other
medications, which cause new side effects. I began to feel like
the VA doctrine was increase the dosage or increase the number
of medications, and that will fix any problem.
All of this became too much for me. I finally broke down
and turned to medical marijuana. I figured that it cannot be
any worse than all the pills. For the last 10 months, I have
been using it. I only hope the Federal Government might change
the law and see the medical benefits of marijuana, like the 29
States that have medical marijuana programs in place. I have no
adverse side effects, and I feel the combination of therapy has
been far greater managing my symptoms than the traditional
medication regimens that the VA prescribes.
Some things that I and veterans all across this country
would like for this Committee to think about: Tonight, when we
go to sleep, around 40,000 veterans will go to bed homeless.
Men and women this great Nation of ours hold in such high
regard for the selfless service are being lost to suicide at a
rate of 22 per day. That is 18.5 percent of all daily suicides.
Thirty-plus day wait times are still happening for
appointments. Female veterans, who account for 10 percent,
about 2 million, as has been said here today, of all veterans,
still struggle to get access to women's health services. The VA
is still unable to provide the same quality of care that is
available in the private sector. Evening and weekend primary
mental health care appointments, and access to the urgent,
convenient, and emergency services, are next to nonexistent.
Claims are still taking too long for initial processing, being
improperly processed, and taking even longer to be reviewed in
the appeals process. Automated phone systems and Web services
are helpful, but still need improvement. How hard would it be
to ensure all needed phone extensions are available online when
you pull up a VA facility, or printing the extension on the
appointment reminder when you need to reschedule? The Choice
Program concept is great; however, implementation and execution
of it were ill-conceived and lackluster. Disability claims and
issues regarding burn pit exposure are beginning to seem just
like Vietnam veterans who are still fighting about Agent
Orange.
This list is far from inclusive, not to mention these
things are far from anything new. These issues continue to be
echoed by veterans of all generations.
If this Committee really wants to know about the issues
that are facing veterans, it is not hard. Go back to your
homestates, walk in the nearest VA facility, and ask the
nearest veteran. Talk to 20 percent of your States law
enforcement and first responders who are veterans. Walk into a
VFW and American Legion or AMVETS post. Heck, talk amongst
yourselves. Twenty percent of politicians are veterans. Get on
social media. Listen to the veterans' organizations in D.C. who
represent us.
Now, I know that only so much can come from my testimony
here today. I know this will not be the turning point in the
care of this Nation's veterans. Effective change and progress
do not happen overnight. I more than anything hope this
testimony and any results it produces helps even one veteran.
This is my measure of success: that my words have not fallen on
deaf ears and blind eyes, that this Committee has been reminded
of how big of a responsibility they have in ensuring this
country's veterans are not forgotten.
[The prepared statement of Mr. Powers follows:]
Prepared Statement of James Powers, U.S. Army and
Ohio Army National Guard (Ret.)
Let me begin by thanking both Senator Brown and this Committee for
the invitation to testify regarding topics concerning veterans.
Of the over 850,000+ (8% of population 6th most nationally)
veterans here in Ohio and over 20 million nationally, this Committee is
giving ME the opportunity to give testimony regarding veteran issues. I
personally view this as a great honor but an even greater
responsibility. To tell my story and to be a voice of veterans that
need to be heard.
My name is James Powers. I served in the U.S Army and Ohio Army
National Guard for a combined 12 years. I deployed in support of
Operation Iraqi Freedom in 2009-2010. During my career I served as an
Infantryman, Instructor, and Recruiter. I achieved the rank of SGT/E5.
I, like any good soldier, held our creeds, oaths, and ethos scared and
served to the best of my abilities. During my service I, like over 3.8
million other veterans, became injured.
The majority of my injuries I sustained over my military career are
not easily visible. But one has almost cost me my life. PTSD. When I
came home from Iraq in 2010 my transition back didn't go well. My life
for the next 4 years slowly spiraled out of control. It was like
quicksand. The more I tried to fix what was wrong the worse I made
things. I let it consume everything. My livelihood, military career,
relationships, and my overall well-being. I turned to alcohol and
drugs. I would do anything to numb what I still to this day find
trouble describing. Until finally on a Tuesday morning in May 2014 when
I felt I had no other choice but to put my pistol in my mouth and pull
the trigger. CLICK! A misfire occurred, I had improperly loaded the
pistol because of how drunk I was. Fortune for me in that moment
something else ``clicked'' in my mind and said ``something isn't right,
this isn't you.''
Three-\1/2\ years later and here I sit before this Committee. It
has been a bumpy road to say the least. I completed an intensive 10
week residential treatment program. Had it not been for the PTSD/SUD
residential treatment program at the Wade Park VA Medical Center I
don't think I would be here to testify before you today. That program
and the providers involved should serve as the standard of care for
veterans with mental health problems especially PTSD. It is unfortunate
that VA funding and availability for programs like this one are next to
none. I have learned the art of finding a parking spot at crowded VA
facilities. I have gotten used to going back and forth with the VA
about them trying to double collect on a debt. Got to experience the
Integrated Disability Evaluation System (IDES) process. Spent 9 months
at the Warrior Transition unit in Fort Knox, KY for that. At least it
seemed more efficient that traditional VA claim processing. I finally
got the torn ligament in my wrist repaired. Only took 5 years from when
I originally presented with pain. I continued to try things to ease the
chronic pain in my left foot during that time too. I drove 6 hours back
home on the weekends as my wife was expecting our now almost 2 year old
son. But finally my military career ended when I was medically
discharged/ retired in February 2016.
Since then I keep to myself. I'm SGT Powers turned Mr. Mom to my
little man Connor and soon to be little dude Luke who is expected to
join us in February. I strive to be a good husband to my wife Shanon.
She keeps me grounded and cool headed. I only wish that the VA would do
a better job with the caregiver program. At times she too has
questioned the VA shortcomings, which at least helps me feel valid in
my issues and it not be me just losing my mind. She even was
understanding simply saying ``drive safe and call me when you get
there'' when I made the spur of the moment decision and drove all the
way to D.C. in July to see my elected officials about a Congressional
Inquiry that the VA seemed to be stalling on responding to. To my luck
Senator Brown and his staff were able to help finally get answers about
a grossly inaccurate $11,000 VA overpayment debt. The VA's eventual
response was that the debt was ``miscalculated'' due to a ``manual
processing system failing to properly communicate with an automated
system.'' If you ask me it sounds like a fancy way to say human error.
I keep routines so to help me stay mindful. I still struggle daily. But
not nearly what I used to and for that I am happy.
I surround myself with a small group of veterans. Some that I have
known since childhood and others I have had the pleasure to meet along
the course of my life. We look out for each other. We know each other's
signs and symptoms. Many times they are just like our own. Just like in
the service we are covering each other's six o'clock. I think I agreed
to this for them more than for myself.
I have been prescribed medication over the years. At times being on
3-5 medications. Some requiring routine lab work. Some that would be to
counteract side effects of other medications while causing new side
effects. It began to feel as if VA doctrine was increased dosage or
increase number of medications that will fix any problem. All of this
became too much for me. I ended up turning to medical marijuana. I
figured it can't be any worse than all of the pills. For the last 10
months I have been using it. I only hope the Federal Government might
change the law and see the medical benefits of marijuana like the 29
states that have medical marijuana programs. I have no adverse side
effects and feel with in combination with therapy has been far better
at managing my symptoms than with traditional medication regimens.
Some things that I and veterans all across this country would like
for this Committee to think about:
Tonight when we all go to sleep, around 40,000 veterans
will go to bed homeless.
Men and women this great nation of ours holds to such high
regard for their selfless service are being lost to suicide at a rate
of 22 a day (18.5% of all daily suicides). 30+ day wait times are still
happening for appointments.
Female veterans who account for 10 percent (about 10
million) of all veterans still struggle to get access to Women's Health
services. The VA is still unable to provide the same quality of care
that is available in the private sector.
Evening and weekend primary or mental health care
appointments, Access to urgent, convenience, and emergency services are
next to nonexistent.
Claims are still taking too long for initial processing,
being improperly processed, and taking even longer to be reviewed in
the appeals process. Automated phone systems and web services are
helpful but still need improvement. Like how hard would it be to ensure
all needed phone extensions are available online when you pull up a VA
Facility. Or printing the extension on an Appointment reminder should
we need to call and reschedule.
The CHOICE program conception is great. However
implementation and execution of it were ill conceived and lack luster.
Disability claims/issues with Burn pit exposure are
beginning to seem just like Vietnam veterans who are still fighting
about Agent Orange.
This list is far from being all inclusive. Not to mention these
things are far from anything new. These issues continue to be echoed by
veterans.
If this Committee really wants to know about the issues that are
facing veterans it's not hard. Go back to your home state's, walk into
the nearest VA facility and ask the nearest veteran. Talk to the 20% of
your state's law enforcement and first responders that are veterans.
Walk into a VFW, American Legion, or AMVETS post. Heck talk amongst
yourselves. 20% of politicians are veterans. Get on social media.
Listen to the veterans organizations in DC who represent us.
Now I know that only so much can really come from my testimony here
today. I know this won't be the turning point in the care of this
Nation's veterans. Effective change and progress don't happen
overnight. I more than anything hope this testimony and any results it
produces helps even 1 veteran. That is my measure of success . That my
words haven't fallen on deaf ears and blind eyes. That this Committee
has been reminded of just how big of a responsibility they have in
ensuring this country's veterans are never forgotten.
Senator Brown. Thank you, Mr. Powers.
Thank you for talking about transition. Your survival has
meant a better life for a lot of veterans and especially,
obviously, for Shannon, Connor, and soon, I understand, for
Luke.
Mr. Powers. Super Bowl Sunday--I only hope that it is
slightly before kickoff. [Laughter.]
Senator Brown. I assume you do not expect the Browns or the
Bengals to be in that game either. Just guessing. Just
guessing.
Mr. Powers. I am expecting to be at the--parade.
Senator Brown. Yes, since where you come from, there is a
tradition in your city, isn't there, in Massillon, OH?
Mr. Powers. In Massillon, of course, football is everything
down there. They are getting ready to play in the State
semifinals against another team, but if they win,
unfortunately, they will be losing to my alma mater----
Senator Brown. Glad you pointed that out. Thank you.
Also, I want to recognize two people: Mike Dustman from
Senator Portman's office and Luke Crumley from Congressman
Tiberi's office. Thank you for joining us also.
I want to start with the two of you, Mr. Powers and Ms.
Twine. I want to read you--we asked earlier, a couple weeks
ago, in anticipation of this hearing, just for veterans to go
on Brown.Senate.gov, go on my Web site and give us thoughts,
ideas, and questions. I want to just read you a few kind of
random thoughts from about a half dozen different veterans, and
I would like you to listen to these statements. Then, starting
with you, Ms. Twine, tell me what you think.
Just react in any way you want, in terms of: is the VA
doing what it should? What about our obligation? Just any kind
of thoughts you have on any of these statements. I will just
read the half dozen of them.
``It was very hard to come from killing in a jungle to
adjusting into life. The demons never go away.''
``It was a long time ago, but I remember it as being
OK.''
``Difficult. I was medically discharged, felt like I
wasn't given enough guidance on what to do next,
especially with the disability.''
``I went from Active Duty to Reserves then civilian
completely, so not too bad.''
``Several employers told me I just wasted 8 years of
my life due to PTSD. I had many altercations with
strangers. I once hit my wife when she bent over me
while I was sleeping. I still sleep with a spotlight
and a gun.''
``It sucked. While no one would come out and say it,
no one would hire a vet or even someone that was on
drill status. I was unemployed for a bit over 2 years
because of this.'' And,
``I am still in transition in some ways. It will never
leave you.'
Ms. Twine, any thoughts about any of that?
Ms. Twine. I think it is very representative of the
veterans of today. What you just said speaks to 80 percent of
veterans who were having issues and problems, not only
transitioning but also with continued care, while 10 to 20
percent say, ``I served my time. I'm OK. I don't need any other
services.'' So, I think those are absolutely very
representative of what we are seeing today.
Senator Brown. If I could follow up, how many of those, you
just said 20 percent who come back do not need to use services.
I hear so many stories in part from what the two gentlemen here
said of soldiers that come back: they do not know, Mr. Tansill,
they do not know the veterans service organization, the
veterans service office, the commissioners in Delaware or
Newark or Circleville. They do not get in touch with anybody.
Then their sister calls and says, ``My brother is having
problems.'' They came back without needing anything. How often
do you hear that?
Ms. Twine. I hear it all the time. I was just explaining to
him earlier that I had never been approached by any of the
veterans organizations except the Gold Star Wives organization.
Senator Brown. Even though you are a veteran yourself.
Ms. Twine. I am a veteran, and I live in Clermont County,
which tends to be one of the highest counties in the State of
Ohio for loss of veterans. I have not been approached by VFW,
the VA, Disabled American Veterans, other than for a donation
when I leave Sam's Club. I have not been approached by The
American Legion, any of those organizations.
I absolutely agree that there is a huge disconnect in
communication. In fact, it took them 1.5 years to find me to
give me more benefits from the changing of life insurance for
my husband after he died, and I go to Wright-Patterson all the
time. But, because Langley could not connect with Wright-
Patterson to know anything, I was in a hole.
I agree. When I separated from the service, I was a
captain's wife. I went back to school. I did what I needed to
do. I did not need any services from the VA at that point--
until my husband died, until I got a letter from the VA saying
you have a primary care provider. It may take you 6 months to
see him, but here is your letter with who your PCP is.
I think it is a huge disconnect. There are veterans who are
well-adjusted, do not need any services. But then, you have
veterans that obviously need help and services and cannot get
that access.
Senator Brown. I would argue that Ohio is better served
than many States because we have Mr. Tansill's previous job, we
have a Franklin County Veteran Services office, and I believe
half the States do not have that, more or less, something like
that.
Mr. Tansill. Senator, most States do not have a county-
specific office. They may have people who work out in a county,
but not a specific county office for every county.
Senator Brown. Mr. Powers, those five or six statements I
was reading, what comes to mind for you as you heard those?
Mr. Powers. For me, those statements, I mean, they are
nothing new. I have said them myself or have heard my friends
say them.
Transition is rough. When it comes to the VA, I feel like
you get the benefits book, which I call the VA bible. To try
reading through that and understanding the programs and
everything else, it is dry, it is bland, and if you can make it
past 10 pages trying to find something in there, you are doing
better than me.
You have that book, and that is about it. I mean, you try
asking about programs from the VA, and it is, ``Fill out a
form,'' not information about the program or anything.
My wife did try doing the caregiver program, and it almost
felt like they were more concerned with eliminating her for a
caregiver's stipend, which we were not interested in, as
opposed to really providing her with the support that she
realistically needs to deal with my symptoms. I am not always
the most pleasant person. Prior to today, in grocery shopping,
the last time I went out and did something for myself was
probably about a month ago.
I keep to myself. I have a small circle, which shouldn't be
the case. Organizations, myself, personally, when I came home
from Iraq, I was telling Colonel Tansill before this that I
took my DD-214 and ran to the VFW like I was Charlie and I got
the golden ticket to go to the chocolate factory. That is what
the VFW was for me. That is what I thought it was going to be.
For the year that I was a quartermaster of a post up in
Sandusky, it was an extension of being in the military, the
brotherhood, the tribe, so to speak. There needs to be a
continuity of that when you move from the service back into the
civilian world, because if you spend even 3 years away from
what you called home for the first 18 years of your life, you
come home and everybody has changed, but you still feel like
the same person. I mean, kids get older, you lose friends,
friends move away. What was once your life is not anymore, and
now you are trying to jump right back into it.
We need to ensure that the availability is there for us to
connect. Some of the veterans' service organizations, they do
fantastic work both in their communities and nationally, but
their active ranks, they are aging and declining,
unfortunately. The younger generations are not coming in.
I get it, to some extent. I mean, reaching out to a whole
different generation of veterans, it is different every time.
It was different for World War II veterans who were welcomed
home with parades, and different for Vietnam veterans who were
welcomed home to protest. We have to find a way, both as
veterans and veterans' organizations, of how to stay connected
to the guy to the right and the guy to the left, and look out
for each other.
Also, Congress and this country needs to step up and have
real-world solutions for looking out for us, because I know
when I served, and everyone that I have known, that I have had
the pleasure of knowing, who has served, we served this country
no questions asked. We took oaths that still to this day I can
recite it verbatim, and most still probably can, too. It is
time for this country to be reminded that we are here, and we
are equals, and sometimes we need help.
Some of us do not. Some of us always land on her feet. But,
even when you land on your feet enough, you are liable to break
a leg. It happens.
It is time for the transition to be eased.
Senator Brown. Thank you, Mr. Powers.
Mr. Tansill, Mr. Powers mentioned one of the challenges is
employment, obviously. Employment is difficult for a whole lot
of reasons, coming back, obviously, in civilian life. Talk to
us about your role now, what you see now and what you saw when
you were in Franklin County. Talk about the specific challenges
that veterans face, particularly newly returned veterans, about
employment.
Maybe give us a short, little scenario of what a veteran
faces when looking for a job coming home, especially maybe if
they were a medic in Iraq; they come back and they could maybe
get certified a little quicker if they had done it right--we
still have not done it quite right--to be a first responder,
and those that do not have sort of a specific skill that
translates, other than serving their country really well and
being a good soldier.
Talk that through, if you would.
Mr. Tansill. A couple of things, Senator.
First, the transition is the most difficult for a veteran
when they come home, the first 120 days, typically, especially
if they have a family, because they are assimilating back into
what they had as a civilian life prior to that. That is a very
critical time, the biggest transition. Just like if you move
from one country to another, the first few months is a very
difficult time.
The issue is no one knows they are coming back until they
are here. They are actually home 3 months to 4 months before we
actually know that they are home, so there is 3 or 4 months
that they have not had any contact to get jobs because they do
not know where to go.
Right now, we receive the DD-214s from DOD when they come
home. The problem is the average length of time to receive
those is 120 days. That means they have been home 120 days.
That is the struggle they have to find out where they need to
go for jobs.
One of the biggest problems----
Senator Brown. What do they do for money in those 120 days?
Mr. Tansill. Many of them have some terminal leave, so they
have built up some leave and they are using it. For the most
part, they go on unemployment, and DOD is paying them
unemployment.
Senator Brown. Unemployment, I assume, is never contested
by the government, I hope?
Mr. Tansill. I do not know the answer to that. I have not
heard of anyone complaining.
Senator Brown. Let me ask it this way. Do you know of men
and women who have had trouble getting unemployment?
Mr. Tansill. I personally do not. I personally do not.
Senator Brown. OK. If any of you in the audience know,
particularly those in veterans' service organizations like VFW,
if you hear of those stories, you should always contact
Congresswoman Beatty or me or Senator Portman. We will go to
bat on that. That should never happen.
Go ahead. I am sorry.
Mr. Tansill. There are many vets who come home and do not
know what they want to do. They have served their country in
whatever capacity, an infantryman or whether they were a medic.
Many veterans come home and do not want to use those same
skills. They want to get a different skill.
One of the things that has been really advantageous to
veterans coming home to Ohio is our apprenticeship programs.
They come home. They do not want to be a medic anymore.
They want to be a carpenter. The problem is they do not know
about those programs until they are here a year because they
have no visibility of those things while they are still on
Active Duty transitioning back.
Senator Brown. Are the union apprenticeship programs, if
you decide you want to be a carpenter, you want to be a union
carpenter, or you want to be a union electrician, and you go
through the apprenticeship program being paid a decent wage
while you are going through it--it is a several years'
prospect, but you make a living doing it--newly returned
veterans, how do they find out about those?
Mr. Tansill. In the cases that I know of, they have heard
it from a friend or a family member who is part of a union and
tells them to go to that apprenticeship program.
Senator Brown. Nothing more formal than that?
Mr. Tansill. Nothing more formal than that.
Senator Brown. There is a program Helmets to Hardhats.
Mr. Tansill. There is a program.
Senator Brown. But, that does not reach far enough that
enough people know about it, I assume?
Mr. Tansill. It does not. It is very difficult, again, when
a veteran comes home, they are here for 120 days before most
people know that they are here. That is a real challenge.
If the availability to reach them before they leave, let's
say, Fort Sill, Oklahoma, to say, ``Hey, we know you are coming
home in 6 months. Here are all the educational opportunities.
Here are all the job opportunities. If you go to Ohio, it means
veterans jobs''----
Senator Brown. Why are we not doing that?
Mr. Tansill. We have no way of knowing that they are coming
home, at this point.
Senator Brown. Who is responsible? Is the DOD the problem?
The local veterans' service commission, could they play a role?
Why is this not happening?
Mr. Tansill. Senator, we can all play a role. Right now,
the communication needs to be greatly improved between the
Department of Defense, the branches of the military, and the
States that these folks are returning to.
My counterparts and I across the country are looking for
ways to reach out to the servicemember before they become our
veteran, so we can help them understand what is available to
them.
One of the common problems that we have is a veteran will
come home, and most veterans go where? Back to mom and dad's or
the same town that mom and dad lived in. Well, there may not be
a lot of great jobs in the hometown. Yet, they have a skill set
that they could have moved three towns over and utilized that
skill set to get a job. But, they did not know that until they
moved home, and now they are out of money, and now they are
trying to figure out how to get a job.
Getting information to these folks before they come back to
Ohio's borders is the best way to help them transition into
their civilian life, not after they have been here 3 months to
4 months.
Senator Brown. Thank you.
Commander Harman, Mr. Powers said, rightly, that veterans,
soldiers, air men, sailors, and Marines coming home now may see
a parade, while your era of veteran too often saw a protest.
Talk to us, if you would, about Agent Orange exposure,
everything from Navy veterans to burn pit exposure in Iraq and
Afghanistan, too, for that matter.
What steps should this Committee, this Congress, and the
Administration take to improve the lives of veterans suffering
from exposure to toxic materials?
Mr. Harman. Any veteran exposed to any type of toxin,
whether it is burn pits, Agent Orange, radiation, or whatever,
during their time of service must be given the benefits and
care that they have earned. To deny those individuals that care
and medical benefits forces them to incur sometimes
insurmountable amounts of medical expenses to treat those
illnesses and injuries.
We have heard reports of many veterans dying because they
have been denied that particular benefit, again, which just
amounts to a huge amount of huge expense incurred by that
family when it should have been the government's responsibility
to pay them for that disability or award them a disability
rating due to that exposure to any toxin.
Senator Brown. You have been an advocate. You would not be
the national commander if you had not been an advocate for
pretty much your whole life for veterans. You went through a
period where government, because Congress did not respond
quickly enough, where soldiers that developed cancer from Agent
Orange in Vietnam in the 1990s were seeing that become more and
more common. They had to go to the VA and prove it was
connected to Agent Orange. Congress then responded, in the
right way, and put those illnesses on a presumptive eligibility
list, right?
Mr. Harman. Correct.
Senator Brown. Is that list, I think most people here know
that, but there is a list of, how many? Sixteen or 18,
something like that, illnesses that are connected that are
believed to have been contributed to or caused by Agent Orange,
are now eligibilities for any soldier, sailor, air man, or
Marine who put a foot on the ground that were on a ship that
docked in Saigon or whatever.
That list, we have added some illnesses to it over time.
Mr. Harman. Correct.
Senator Brown. Is that list up-to-date? First question.
Second question, does that list reflect Iraq and
Afghanistan? Or is that list really just too reflective of
Vietnam and not more recent history?
Mr. Harman. I think, for the most part, it is pretty much
reflective of Vietnam and exposure to Agent Orange. There are
some presumptive conditions as a result of burn pit exposure,
and I know that Secretary Shulkin is looking at some potential
new presumptive conditions due to exposure to Agent Orange and
toxic exposure.
Senator Brown. I would ask you, with your prestige and
reach around the country, to update us as much as you can, and
really you too, Mr. Tansill, and the two of you also, Ms. Twine
and Mr. Powers. I mean, I think we are always looking to
perfect this.
Mr. Harman. Sure.
Senator Brown. We have not done that. But, when medical
science connects an illness to an environmental condition like
burn pits or Agent Orange, that Congress needs to know it and
move quickly. Anything you know that you feed to us is really
important.
Mr. Harman. I will have our Washington office be in touch
with you.
Senator Brown. Thank you, Commander.
Congresswoman Beatty for questions.
Ms. Beatty. Thank you, Senator.
Let me say thank you to all our witnesses for your powerful
testimony.
As I was sitting here, I had a list of questions, Senator,
but I want to go to one that just came to me as I listened to
the testimony. I guess it becomes a question that it seems like
we are hearing a lot about the lack of access when there is a
need, first, just maneuvering through getting access and then
the timeliness of access.
Certainly, for all of us, whether you are a veteran or
served in the military, when you are in crises, you need quick
intervention. I guess the question becomes, maybe Mr. Tansill,
or even to us, are there exit plans? Are there counseling
sessions, exit plans?
I am thinking about the biggest thing young folks do today
if they are not going into the military, let's say they are
going to college. In addition to having their commanders who
are their professors and who are their lab tech folks, they
have counselors. You know, people change their majors. They get
ready to graduate. They find out a month before graduation or
the quarter before that they have to take another class.
Should we in Congress be looking at what is there along the
way. Whether I am here or in the district, I hear this
constantly. ``I could not get access to my X, Y, Z. I was in
depression,'' or, ``My wife couldn't,'' or my spouse couldn't.
We know this; this is not new. I am hearing powerful stories
that I have heard before.
What is it that we need to put in place that helps us to
have quicker and better access for those who have served who
are coming back? What should I be looking at as a Member of
Congress for getting that access? Is it more of something? Is
it simplifying something? We know eventually somebody is going
to leave. If they are here for 120 days, even if someone has a
medical crisis and they are injured, they are in the hospital,
they cannot get released--let me give you a good one.
If you are home, I had a relative who went to the hospital
the other day, and the outcome was not good, but they would not
release them until I went out and found a rehab center. They
would not release them to go home. We had to have a rehab
center for them to go to, so they would not be in crisis at
home.
It seems like we could have some plan that says Jane and
John Doe are going to be released whether it is for medical
reasons, whether it is they have served their time, that there
is some type of 30-day, 120-day exit plan.
If I knew that I was going to mom's but I could go 60 miles
up the street and get in a program, why didn't somebody know
that to tell me that?
Mr. Tansill. Congresswoman, the military does out-process
the folks. It is called Transition Assistance Program. TAP is
the acronym for it. It is typically done within the last 12
months of their service that they start going through this
process.
The process is more about getting them to understand that
they are going to need to look for a job. They need to get
connected to the VA. They need to do different programs like
that.
I will circle back to the best way to help a veteran coming
home is to get them information before they get here.
DOD installations do a pretty good job of out-processing
them, but it ends at the front gate. We need to make sure we
get to them before they leave whatever installation under DOD
they are stationed at to ask them: Are you coming back to
whatever State? What are you going to do? Are you going to
college? If you are going to look for a job; what are you
interested in? If you are looking for an apprenticeship
program, here is where you can go to find out all the
apprenticeship programs in all of the cities.
Finding out at the 120-day mark that someone has returned
to Ohio has put them at an extreme disadvantage to get their
life jump-started back as a civilian. Being able to reach them
prior to their exit from the military, to allow them to
understand all the things that are available to them back in
whatever State they are going to--by the way, we want every
veteran to come to Ohio even if they are not from Ohio. They
need to know what is available.
Most people coming out of the military getting ready to go
to college, they already know that. They know what college they
want to go to. They have already done most of the work online.
But, it is the jobs and the apprenticeship programs and those
folks that have not figured out yet what they are going to do.
A lot of people leave the military and say, ``I need time
to figure out what I want to do.'' If we are able to frontload
them with all the available opportunities for them, it sure
might make their decision a little easier when they get home.
Ms. Beatty. Thank you.
Senator Brown. Thank you very much.
Ms. Beatty. Let me just say thank you for allowing me to
participate. We will follow up, our staff with your staff.
Senator Brown. Good.
Ms. Beatty. Thank you for being here.
Senator Brown. Thank you, Congresswoman. [Applause.]
Thank you for changing your day around to join us. I really
appreciate it.
I would add, I was just informed there are 14 illnesses, 14
diseases, that are presumptive eligibility with Agent Orange.
Secretary Shulkin is making a decision on three more, so there
will likely be up to 17 illnesses that are connected, that
someone is automatically eligible for benefits if diagnosed
with that illness.
One more question for this panel, and for you specifically,
Ms. Twine. I know you do not speak for all women veterans. I
understand that you do not speak for all Gold Star wives, but I
want to ask you two things.
One is, talk about, if you would, how the VA can improve
services and health care outcomes for veterans, for female
veterans. About 10 percent of Ohio veterans now, slightly under
10, are female. That percentage, obviously, is going up because
among young veterans, the percentages are obviously higher.
Talk about that.
Talk about, if you would, if you have thoughts on what we
should do to reduce sexual violence in the military, if you
feel comfortable answering that. You have been out for a while,
I understand.
Ms. Twine. That is huge, open-ended----
Senator Brown. Yes, I know those are two really broad
questions.
Ms. Twine. Personally, I did not experience sexual violence
as a veteran, and as an Active Duty military person, so I
cannot speak for those people. However, being a woman in the
military and also in the medical field, even today, there is
always a good old boys club. Unfortunately, that has been the
accepted norm for many, many and thousands of years. So,
overcoming that----
Senator Brown. It is not just the military, is it?
Ms. Twine. No, it is everywhere. You turn the TV on and all
you are going to hear, every update on your iPhone is going to
be some new person coming out because they were kissed hard. It
is going to be a huge issue.
Unfortunately, the lack of communication and the lack of
holding those accountable has created an environment that
allows for that type of behavior to be considered the norm.
I do not have a good answer to that other than people need
to step up and do what is right. They also not only need to
step up and do what is right, they need to speak up.
That is a huge problem with women and men, is speaking up
when there is a problem. We are seeing now, you turn the TV on,
``Twelve years ago, I had a problem.'' ``Thirty years ago, I
had a problem.'' ``Forty years ago, I had a problem.'' But,
nobody spoke up.
Now we are looking at this issue that was an issue 30, 40
years ago. It is a huge problem.
It creates a huge problem in the mental health field for
women who have PTSD because of those issues. I can only assume
that that is another area of major concern for women.
Personally, the issues that I have heard about from
patients that I treat or from people that I know personally is
that the VA has very little tolerance for women's health
issues, such as annual Pap smears or birth control or the need
for different surgeries for birth control or for hysterectomies
and different type of programs. And, getting access to those
from the VA is difficult.
Senator Brown. We will hear from the VA in a moment.
Ms. Twine. My understanding, my experience with the VA,
like I said, I have avoided it like the plague, and I will go
civilian. But, then again, in the civilian world, it is not
always easy either, if you go to a Catholic hospital versus a
regular hospital.
I cannot really answer to a lot of those questions,
unfortunately.
Senator Brown. Thank you.
Did you want to add something?
Mr. Powers. Yes, Senator Brown.
As a member of the IAVA, our major bill initiative, your
cosponsor on it, I believe. I think it is S. 681. That would be
the Deborah Sampson Act. It is common-sense legislation to get
the VA priority funding for peer-to-peer-women's programs for
the mental health care, for the primary care.
There is a common-sense bill in Congress right now, both in
the House and in the Senate. Fortunately, there are 21
cosigners to it, I believe, right now. I am wondering, I mean,
what is it going to take to get the rest to do this? This
should be common-sense legislation, getting 10 percent of our
veterans the care that they need.
Unfortunately, short of you guys holding a hearing on it
over 6 months ago, it almost feels as if it has stalled. I
mean, common-sense legislation for appropriations for veterans
should be a no-brainer, as long as it is going to be effective.
Given the fact of the scarcity of the resources to female
veterans for their care, I could not see any more of an urgency
for a bill like that to get passed.
The solutions are out there, and the VA has the programs,
depending on where you live, to help address this for veterans,
like the 10-week program I spoke of in my opening statement.
That program in Cleveland helps 50 veterans a year. That is it,
50 veterans. There is another one, I believe, in San Diego. The
other one recently closed in Baltimore.
That is all they can help. They have an 80 percent
reduction in symptoms for PTSD and substance abuse. They have
the military sexual trauma group and individual programs that
are there, but most of them tend to be pilot programs. There
are 3-, 5-, 6-, and 10-year pilot programs. If it is effective
after a year, we have frontline issues with PTSD, with military
sexual trauma, with substance abuse, if the treatments seem
effective, it would only make sense to get them out there
further to where you have a larger veteran population being
treated so we can find out for sure that it is going to work,
to where we can get the help that is needed for whatever our
veterans issue is.
It should not be so hard for us to access care, especially
female veterans. I mean, my own sister, my own little sister,
she was a medic in the National Guard. She hurt herself during
her initial training with her hip, and I know that she still
has problems with fighting with the VA for treatment on a host
of things related to women's health.
I personally can say that I have been affected by it, and
it did not even pass my mind sitting here. I mean, it is
affecting everybody, and it needs addressing. That is why we
are here right now having this hearing.
Senator Brown. All right.
Ms. Twine, thank you for serving, and thank you for your
activism, and thank you for testifying. Mr. Tansill, thank you.
Commander Harman, you make us proud--over near the Indiana
border. Thanks to all four of you.
I will call up the next panel. Thank you. [Applause.]
It is my honor to resume the Senate Veterans' Affairs
Committee. Thank you all again for joining us in the audience.
I asked the others if they wanted to stay. I know Mr.
Powers is staying. Thank you all for all of that.
The second panel, only Mr. Burke will speak, but I will
have questions of all four of the panelists. We will start with
Ronald Burke, who is Assistant Deputy Under Secretary for field
operations with the Veteran Benefits Administration, Department
of Veterans Affairs. Welcome to Columbus.
He is accompanied by Robert Worley, who is the director of
education service, Veterans Benefits Administration, Department
of Veterans Affairs. Mr. Worley, welcome to Ohio.
Robert McDivitt, who is director of Veterans Integrated
Service Network 10, Veterans Health Administration, Department
of Veterans Affairs, I see Mr. McDivitt pretty often. Welcome.
Dr. Kameron Matthews, deputy executive director, provider
relations and services with Veterans Health Administration,
Department of Veterans Affairs. Welcome to Ohio to you, too.
Mr. Burke, give us your statement, and then I will begin
the question period of all of you. Thank you.
STATEMENT OF RONALD BURKE, ASSISTANT DEPUTY UNDER SECRETARY FOR
FIELD OPERATIONS, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY ROBERT WORLEY,
DIRECTOR OF EDUCATION SERVICE, VETERANS BENEFITS,
ADMINISTRATION; ROBERT MCDIVITT, DIRECTOR OF VETERANS
INTEGRATED SERVICE NETWORK 10, VETERANS HEALTH ADMINISTRATION;
AND KAMERON MATTHEWS, M.D., DEPUTY EXECUTIVE DIRECTOR, PROVIDER
RELATIONS AND SERVICES, VETERANS HEALTH ADMINISTRATION
Mr. Burke. Good afternoon, Senator Brown. Thank you for
inviting the VA to this important hearing to discuss topics
that affect veterans nationwide and here in Ohio.
My colleagues have already been introduced. We are here
today and happy to discuss the topics included in your
invitation.
As you know, on August 16, 2017, the President signed the
Harry W. Colmery Veterans Educational Assistance Act of 2017,
commonly referred to as the Forever G.I. Bill, which made
numerous changes to the post-9/11 G.I. bill. This new law
enhances or expands education benefits for veterans,
servicemembers, families, and survivors.
This law will, however, require a significant IT effort.
Rough estimates place this number up to $40 million in addition
to the authorized $30 million, bringing the IT costs to $70
million.
The implementation of the Forever G.I. Bill will require
approximately 200 additional claims examiners at the regional
processing offices. The VA has begun the process of bringing
those full-time equivalents on-board in the form of temporary
employees. All employees are expected to be on-board by May 30,
2018.
With regard to overpayments, VA makes every attempt to
timely and accurately process payments to veterans and their
family members based on benefits to which they are entitled to
receive under the law. However, in certain instances where an
individual is not entitled to a benefit payment, such as
changes in life events or dual payments for multiple agencies,
the VA is required by law to recoup these payments.
VA's policy for recovering these types of overpayments
includes notifying veterans and beneficiaries about the reasons
for and amounts of overpayment, along with the steps they must
take to make repayment. The VA also take steps to minimize the
overpayment amounts and has established recoupment policies
that allow veterans to request repayment plans or waivers of
these amounts.
VBA is also committed to providing veterans with the care
and services they have earned and deserve. For the eighth
consecutive year, VBA has completed over 1 million disability
claims and anticipates completing a record number of claims in
2018. As of October 28, 2017, VBA had 321,208 compensation and
pension claims pending, with an average age of 93.8 days; 22.4
percent of that inventory has been pending for over 125 days.
For Ohio veterans, the average age of a pending claim for
compensation was 97.5 days, with 22 percent pending over 125
days.
VA's modernization efforts focus on improving its
performance to better serve veterans, their families,
caregivers, and survivors, while being good stewards of
taxpayer dollars. As such, VBA has initiated several process
improvements, leveraged operational tools such as its National
Work Queue, and implemented new employee performance standards
to improve claims processing timeliness and quality.
Another way that VBA is striving to improve the veteran's
overall experience is through realignment of its appeals policy
and operations under its appeals management office and its work
with the Board of Veterans Appeals, veterans' service
organizations, and other stakeholders to design a modern
appeals process for veterans.
The current VA appeals process, which is set in law, is
broken and is providing veterans a frustrating experience. In
the current process, appeals have no defined endpoint and
require continuance evidence-gathering and re-adjudication.
Veterans wait much too long for final resolution of their
appeals.
With the current legal framework, the average processing
time for all appeals resolved in fiscal year 2017 was 3 years.
For those appeals that reach the Board of Veterans Appeals, on
average, veterans waited 7 years from the date they filed their
notices of disagreement for a decision, which means that many
are waiting much longer.
We appreciate the Committee's work on this issue, which was
enacted as the Veterans Appeals Improvement and Modernization
Act of 2017, and signed into law by the President on August 23,
2017.
Although the appeals modernization act ensures that
veterans who disagree with the VA's benefit decisions after
February 2019 will have all of the benefits of the new modern
review process, the VA is also committed to addressing the
470,000 appeals that are currently pending in the legacy
process.
On November 1, 2017, VBA initiated its Rapid Appeals
Modernization Program, otherwise known as RAMP, for veterans
with pending appeals. This program allows participants the
option to have their decisions reviewed in the higher level
review or supplemental claim lanes outlined in the new law.
Participation in RAMP is voluntary. However, veterans can
expect to receive a review of VA's initial decision on their
claim much faster in RAMP than if they were to remain in the
legacy appeals process.
The program will continue through monthly invitation
mailings to eligible veterans until February 2019, when VA
expects to fully implement the appeals modernization act.
Now to the health-related issues that face VA. Recent
research suggests that 20 veterans die by suicide every day,
putting veterans at even greater risk than the general public.
The VA is committed to ensuring the safety of our veterans,
especially when they are in crisis. Losing a veteran to suicide
shatters their family, loved ones, and caregivers. Veterans who
are at-risk or reach out for help must receive assistance when
and where they need it in the terms that they value. Our
commitment is to do everything possible to prevent suicide
among the veterans who we serve.
The VA has developed the largest integrated suicide
prevention program in the country. We have more than 1,100
dedicated and passionate employees, including suicide
prevention coordinators, mental health providers, veterans
crisis line staff, epidemiologists, and researchers who spend
each and every day working on suicide prevention efforts and
care for our veterans.
Every veterans suicide is a tragic outcome. Regardless of
the number or rates, one veterans suicide is too many.
We continue to spread the word throughout VA that suicide
prevention is everyone's business. The ultimate goal is to
eliminate suicide among veterans via strategic community
partnerships, identification of risks, training, treatment
engagement, effective treatment, lethal means education,
research, and data science.
Although we understand why some veterans may be at
increased risk, we continue to investigate and take proactive
steps to understand all risk factors for all veterans.
The VA is also committed to providing timely access to
high-quality, evidence-based mental health care that
anticipates and responds to veterans' needs and supports the
reintegration of returning servicemembers into their
communities.
While focusing on suicide prevention, we know that
preventing suicide for the population we serve does not begin
with an intervention as someone is about to take an action that
could end his or her life. Just as we work to prevent fatal
heart attacks, we must similarly focus on prevention, which
includes addressing many factors that contribute to someone
feeling suicidal.
We are aware that access to mental health care is one
significant part of preventing suicide. VA is determined to
address systemic problems with access to care, in general, and
to mental health care, in particular.
VA has recommitted to a culture that puts the veteran
first. Making it easier for veterans to receive care from
mental health providers has allowed more veterans to receive
care. Furthermore, VA is leveraging telehealth by establishing
11 regional tele-mental health hubs across the VA's health care
system.
The VA remains focused on providing the highest quality
care our veterans have earned and deserve, and which our Nation
trusts us to provide.
The VA appreciates the support of Congress, and we look
forward to responding to any questions that you may have. Thank
you.
[The prepared statement of Mr. Burke follows:]
Prepared Statement of Ronald Burke, Assistant Deputy Under Secretary
for Field Operations, U.S. Department of Veterans Affairs
Good afternoon, Senator Brown, and distinguished Members of the
Committee. Thank you for inviting us to discuss Veterans health care,
educational, and disability benefits. I am accompanied today by Robert
Worley, Director of Education Services, Mr. Robert McDivitt, Network
Director for the Veterans Integrated Service Network (VISN) 10, and Dr.
Kameron Matthews, Deputy Executive Director, Provider Relations and
Services. We have provided a brief background and important context for
all of the topics that this hearing will cover since there are a wide
range of issues.
post-9/11 gi bill
The Post-9/11 GI Bill (Chapter 33) provides eligible Veterans,
Servicemembers, dependents, and survivors with educational assistance,
generally in the form of tuition and fees, monthly housing allowance,
and a stipend for books-and-supplies all to assist these men and women
in reaching their educational or vocational goals. This program also
assists in the Veteran's readjustment to civilian life, supports the
armed services recruitment and retention efforts, and enhances the
Nation's competitiveness through the development of a more highly
educated and productive workforce.
Since inception of this benefit in August 2009, VA has issued over
$80 billion in benefit payments on behalf of approximately 1.8 million
individuals. In fiscal year (FY) 2017 alone, all of VA's education
programs (chapters 30, 32, 33, 35, 1606 and 1607) provided 1 million
beneficiaries with educational assistance. Of those, 21,000 direct
beneficiaries received education benefits in the state of Ohio.
Further, VA provided Post-9/11 GI Bill benefits to approximately
790,000 Veterans, Servicemembers and dependents in this same period; of
those, approximately 15,000 were in Ohio. Since FY 2013, VA has
processed an average of 4 million education claims per year. In fiscal
year 2017, the average time to process all education claims was
approximately 25 days for original claims and nine days for enrollment
certifications.
Colmery Act
On August 16, 2017, the President signed the Harry W. Colmery
Veterans Educational Assistance Act of 2017, also referred to as the
``Forever GI Bill.'' This law made numerous changes to the Post-9/11 GI
Bill. The Harry W. Colmery Veterans Educational Assistance Act of 2017
contains 34 new provisions, the vast majority of which will enhance or
expand education benefits for Veterans, Servicemembers, Families and
Survivors. Most notably, the new law eliminates the 15-year time limit
on the use of Post-9/11 GI Bill benefits for Veterans who transitioned
out of the military on or after January 1, 2013. This law also restores
benefits to Veterans impacted by school closures since 2015, expands
benefits for certain Reservists, surviving dependents, Purple Heart
recipients, and provides many other enhancements to education benefits.
13 of the 34 provisions were effective on the date of enactment, while
the remaining provisions have future effective dates ranging from
January 1, 2018, to August 1, 2022.
VA is utilizing social media to inform individuals about these
changes. In addition, VA has launched a multifaceted campaign (social
media, website, targeted emails, and traditional media) to highlight
the Colmery Act. The campaign will heavily focus on restoration of
entitlement, Reserve Educational Assistance Program (REAP), work-study
permanent authorization, and expansion of independent study to career
and technical education schools.
The implementation of the Forever GI Bill will require additional
claims examiners at regional processing offices. VA has begun the
process of bringing those full time equivalents on board in the form of
temporary employees. All employees are expected to be on board by
May 30, 2018.
To manage the overall process for implementing this legislation, VA
Education Service established a program executive office comprised of
business-line managers, management analysts, individuals with program
and project management experience, and contract support. This office is
responsible for monitoring and coordinating all Forever GI Bill
implementation activities. In addition, we will need to make targeted
investments in our IT infrastructure to support the expanded access to
education benefits the new law provides. We look forward to working
with the Administration and the Congress to ensure these initiatives
are properly resourced.
overpayment/debt issues
VA makes every attempt to timely and accurately process benefit
payments to Veterans and their family members, based on benefits to
which they are entitled to receive under the law. However, in certain
instances where the Veteran is not entitled to receive payments, such
as those resulting from life events or dual payments from multiple
agencies, VA is required by law to recoup payments in excess of what is
allowable. VA's policy for recouping such overpayments includes
notifying Veterans and beneficiaries regarding the reason(s) for and
amounts of overpayment, along with the steps they must take to make
repayment. VA also takes steps to minimize overpayments and has
established policy regarding the recoupment processes by which Veterans
can arrange repayment or waivers.
Reasons for Overpayments
In general, VA identifies an overpayment when it finds a Veteran or
other beneficiary has received monetary payment for benefits to which
he or she was not entitled. Overpayments are considered improper
payments under the Improper Payments Elimination and Recovery Act of
2010. VA is required by law to retroactively recover overpayments to
the extent the Veteran or beneficiary was not entitled to them. Title
38 of the U.S. Code Sec. 5112, and Title 38 of the Code of Federal
Regulations Sec. 3.500, directs the effective dates of reduction or
discontinuance of an award.
Overpayments may occur when Veterans or beneficiaries, receiving
disability compensation or pension benefits, fail to timely notify VA
of certain circumstances or life events such as divorce, incarceration,
return to active duty, or other loss of dependent status. They may also
occur when Veterans or beneficiaries advise VA of changes but VA is
untimely in processing the claim. It is important to note VA does not
require repayment when VA employees make claims processing errors. Such
cases are resolved as administrative errors and are not required to be
recouped.
Process of Notifying Beneficiaries of Overpayments
Before a debt can be established, VA is required by law to provide
due process notice to the Veteran or beneficiary, advising him or her
of the proposed adjustment to his or her benefits. The beneficiary then
has 60 days to submit evidence regarding why VA should not make the
proposed adjustment to the award. Veterans or beneficiaries may also
request a predetermination hearing to provide information pertaining to
this proposed action. After the due process period expires, VA reviews
all evidence submitted and makes the final decision to create a debt or
to adjust the proposed action based on the evidence received. VA
notifies the Veteran or beneficiary of the decision or date of benefit
termination, and provides applicable appeal rights. If VA determines
there has been an overpayment, the beneficiary also receives a letter
explaining the debt owed and repayment options.
Steps VA is Taking to Prevent Overpayments
VA employs a number of measures to minimize overpayments. First,
the Veterans Benefits Administration (VBA) includes important reminders
in benefit decision notification letters about the need for Veterans
and beneficiaries to inform VA immediately of issues or life events
that could impact monthly payment amounts.
Second, VA has data matching agreements with the Social Security
Administration, Federal Bureau of Prisons, and other Federal agencies
to minimize individuals receiving benefits that are not statutorily
permissible. VA also works with these agencies to ensure critical data
feeds, such as information for dates of death, dates of incarceration,
etc., are transmitted to VA as timely and efficiently as possible.
Third, VBA is deploying technological solutions and leveraging
automation to reduce overpayments. For example, drill pay from the
Department of Defense (DOD) has been a major contributor to VA
overpayments. By law, Servicemembers are not entitled to receive both
drill pay and VA disability compensation for the same periods of time.
In 2016, VA automated the notification process required when Guardsmen
and Reservists receiving VA compensation actively drill and receive
pay. The new process, with DOD collaboration, has improved VA's
management of drill pay adjustments. Prior to the new process, drill
pay claims took a monthly average of 308 days (May 2016) to complete
compared to a current monthly average of 97 days (August 2017) to
complete. This progress results in Veterans receiving more timely
adjustments.
VA's Policy Regarding Recouping Overpayments and Potential Waivers
VA's Debt Management Center (DMC) provides the collection
guidelines and practices for recouping overpayments that have been
established against a beneficiary. VA navigates recoupment of the
overpayment (or debt collection process) in a manner that provides the
best care to our Veterans and beneficiaries and complies with Federal
debt collection statutes and policy. The DMC services beneficiary debts
through a centralized debt collection program while offering all
Federal collection tools provided by the Department of the Treasury.
Most importantly, DMC counselor's work with Veterans and beneficiaries
individually to resolve debts through extended payment plans, benefit
offsets, waivers, compromises, dispute resolution and hardship refunds.
A Veteran can request a waiver of his/her debt within 180 days of
receiving the debt notice. If the Veteran requests a waiver outside of
the 180 day timeframe, the debtor receives appeal rights. If received
timely, the waiver request goes to the VBA Committee on Waivers and
Compromises (COWC) at the Regional Offices in St. Paul, MN, or
Milwaukee, WI. Once the COWC receives a waiver request, elements such
as fault, unjust enrichment, and financial hardship are considered when
deciding to grant, partially grant, or deny the request following the
principles of equity and good conscience.VA will not demand payment
when it would be unfair, unconscionable, or unjust. However, the COWC
will automatically deny a waiver if there is any indication of fraud,
misrepresentation, or bad faith. If the waiver is not approved, the
debtor receives applicable appeal rights. Completed waiver decisions
are returned to DMC for processing. If denied, the debt collection
process resumes. If the waiver is granted, collection action is
terminated, and any collections received are refunded, if required.
A separate process also enables Veterans and/or beneficiaries to
submit a compromise offer for acceptance of a partial payment in
settlement and full satisfaction of the offeror's indebtedness.
disability claims backlog
VBA is committed to providing Veterans with the care and services
they have earned and deserve. For the eighth consecutive year, VBA has
completed over a million disability compensation claims and anticipates
sustaining this effort in FY 2017. As of October 28, 2017, the average
age of pending compensation and pension (C&P) claims was 93.8 days. For
Ohio Veterans, the average age of pending C&P was 97.5 days. 321,208
C&P claims were pending nationally, with 23.1 percent pending over 125
days. In Ohio, there are 8,945 compensation claims pending, with 22.4
percent pending over 125 days.\1\
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\1\ Source: 30 October 2017--Monday Morning Workload Report--WHCO:
Please provide a full citation and a link.
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VA's claims modernization efforts focus on improving its
performance to better serve Veterans, their families, caregivers, and
Survivors while being good stewards of taxpayer dollars. As such, VA
has initiated several claims process improvements and leveraged
operational levers to improve claims timeliness.
Overtime
Mandatory overtime was re-instituted at all VBA regional offices
effective March 7, 2017, in a strategic effort aimed at reducing the
number of claims pending longer than 125 days. Overtime requirements
are assessed every 30 days and guidance provided to the regional
offices based on workload management needs.
VA executed $114.6M in Compensation and Pension overtime nationally
in FY 2017, while executing $2.6M at the Cleveland Regional Office.
Through October 28, 2017, VA has executed nearly $10M in C&P
overtime nationally in FY 2018, while executing $208.SK at the
Cleveland Regional Office.
National Work Queue
In 2016, VBA transitioned to the National Work Queue (NWQ), which
nationally prioritizes and distributes rating claims to VBA's network
of stations, matching their capacity with resources available, and
minimizing the time to adjudicate a claim. . Implementation of NWQ has
improved timeliness for several phases of the claim processing process.
Average time for initial development of a claim has improved from 25
days in January 2016 to 8 days is September 2017. In the rating phrase,
average time for rating decisions on claims has improved from 29 days
in January 2016 to 3 days in September 2017. In award and
authorization, NWQ has improved timeliness by 2.9 days, down to 5.9
days. Combined, these improvements result in more timely service for
Veterans and move VBA closer to the goal of processing 90 percent of
claims within 125 days.
These administrative adjustments are part of VBA's non-rating
workload. During FY 2017, VBA made several changes to allow for a more
balanced approach to the overall workload. VBA appreciates Congress'
support in providing resources to staff specific teams across the
Nation dedicated to the non-rating workload, and we have prudently used
these additional resources to lower the non-rating claims inventory. As
of April 2017, NWQ is distributing non-rating claims, which allows this
work to be moved efficiently based on capacity. Additionally, VBA has
adapted a strategic approach to how we use our overtime resources. We
now target specific claims and steps within the claims process to
ensure we direct our overtime expenditures on where we receive the most
benefit. These enhancements have led to improvements in performance.
Overall non-rating inventory dropped by 23 percent with a 19 percent
decrease in the average number of days pending for these claims. The
inventory of Dependency claims decreased by 26 percent with a 50
percent improvement in timeliness, and the inventory of Drill pay
claims dropped by 58 percent. We still have work to do and will remain
focused on continuing our work on appropriate preventative measures.
Decision Ready Claims
Beginning in May 2017, VBA initiated a pilot program in the St.
Paul Regional Office (RO) called Decision Ready Claims (DRC), an
expedited claims submission option available to Veterans who have
elected accredited Veterans Service Organizations (VSOs) to assist them
with preparing and submitting their supplemental disability claims. ,
National implementation of this program was completed in September 1,
2017.
Under the DRC Program, VSOs work with Veterans to ensure all
supporting evidence for a claim is included at the time of submission.
This program will also enhance partnerships with VSOs by improving
access and capabilities to assist with gathering all required evidence
and information to accelerate claims decisions. Claims submitted in the
DRC Program will result in a supplemental claims decision within 30
days of submission to VA.
Centralized Mail
VBA completed deployment of the Centralized Mail Program to all ROs
in 2015, and to the Pension Management Centers in FY 2016. Since
deployment, VBA has gained proficiency in electronic mail processing
and is now able to provide assistance with virtual mail processing, as
needed across ROs. In FY 2017, VBA focused on File Bank Extraction
(FBE), an effort to rapidly extract all inactive paper claims from ROs
on a national level while having the Office of Business Process
Integration and its Veterans Claims Intake Program assume logistical
tracking control at the point of origin. FBE is a continuation of VBA's
transformation and transition from paper-based to electronic claims
processing. The benefits of FBE are it ensures claim materials are in
the Veterans Benefits Management System (VBMS) on day 1 of future
claims, as well as reduces the overall amount of space dedicated to
storage and directly supports VBA's strategic transformation goal to
become completely paperless.
appeals modernization
VBA is striving to improve its appeals processing, support appeals
modernization, and provide relief for Veterans with pending appeals
particularly in light of recently enacted legislation. The system is
complex, inefficient, ineffective, confusing, and splits jurisdiction
of appeals processing between VBA and the Board of Veterans' Appeals
(Board). Veterans wait much too long for final resolution of an appeal.
Within the current legal framework, the average processing time for all
appeals resolved in FY 2017 was 3 years. For those appeals that reach
the Board, on average, Veterans are waiting at least 7 years from the
date that they filed their notice of disagreement for a decision, which
means that many are waiting much longer. In an effort to maximize its
appeals resources, effective January 4, 2017, VBA realigned its appeals
policy and operational control under a single responsible office, the
Appeals Management Office (AMO). This realignment provides direct
control of appeals policy activities, field staffing and resource
allocation, the appeals budget, and program performance by AMO.
Critical to VBA's success in transforming its administration of appeals
is the ability to quickly and directly influence operational staffing
and resource allocation, and accountability for policy implementation,
program performance, and Veterans' and stakeholders' satisfaction with
the program. By the end of FY 2017, VBA had processed 272,986 appeal
actions and resolved 124,666 appeals, which was 24 percent above its
appeals production in FY 2016. Moreover, despite receiving
approximately 160,000 new appeals in 2016, VBA reduced its total
appeals inventory by 10 percent.
The Cleveland VA RO, which serves approximately 800,000 Ohio
Veterans and their families, has shown significant progress in its
appeals processing metrics since the realignment. Consistent with the
AMO's guidance of processing the oldest appeals first, the RO has
decreased its appeals inventory in each appeal stage, to include a 62
percent decrease in its inventory of Veterans waiting for certification
of their appeal to the Board and a reduction of remands by 29 percent.
VA was aware that increased oversight and accountability alone
would not resolve the pending legacy appeals inventory. Accordingly, VA
also sought legislation to replace the current VA appeals process with
a new legislative framework that makes sense for Veterans, their
advocates, VA and other stakeholders. On August 23, 2017, President
Trump signed into law, the Veterans Appeals Improvement and
Modernization Act of 2017 (Appeals Modernization Act), creating a new
claims and appeals process for disagreements with VA's decisions on
benefit claims. The new process provides streamlined choices for
claimants seeking review of a VA decision. The framework for the new
process features three lanes: a higher-level review lane, which
consists of an entirely new review of the claim by a senior
adjudicator, a supplemental claim lane, which provides an opportunity
to submit additional evidence, and an appeal lane that provides an
opportunity to appeal directly to the Board. VA's goals in this new
process are an average of 125 days in the supplemental claim and
higher-level review lanes and 1year in the Board's appeal lane for
those Veterans who do not seek a hearing or wish to submit additional
evidence.
In an effort to provide some of the benefits of the new law's
streamlined process, VA has initiated the Rapid Appeals Modernization
Program (RAMP) for Veterans with pending appeals. This program allows
participants the option to have their decisions reviewed in the higher-
level or supplemental claim lanes outlined in the new law.
Participation in RAMP is voluntary; however, Veterans can expect to
receive a review of VA's initial decision on their claim much faster in
RAMP than if they were to remain in the legacy appeals process. The
program began on November 1, 2017, and will continue through monthly
invitation mailings to eligible Veterans until February 2019 when VA
expects to fully implement the Appeals Modernization Act.
suicide prevention
Recent research suggests that 20 Veterans die by suicide each day,
putting Veterans at even greater risk than the general public . After
adjusting for age and sex, the risk for suicide is 22% higher among
Veterans than among non-Veterans. (The National suicide rate is 17.0
suicides per 100,000 and the Ohio Veteran suicide rate is 32.1 suicides
per 100,000). VA is committed to ensuring the safety of our Veterans,
especially when they are in crisis. Losing a Veteran to suicide
shatters their family, loved ones and caregivers. Veterans who are at
risk or reach out for help must receive assistance when and where they
need it in terms that they value. Our commitment is to do everything
possible to prevent suicide among the Veterans we serve and to reach
all Veterans. To accomplish this objective, VA is instituting public
health approach to reach all Veterans, whether or not they are enrolled
in VA care, through partnerships and collaboration.
VA has developed the largest integrated suicide prevention program
in the country. We have over 1,100 dedicated employees, including
Suicide Prevention Coordinators, Mental Health providers, Veterans
Crisis Line staff, epidemiologists and researchers, who spend each and
every day working on suicide prevention efforts and care for our
Veterans. Screening and assessment processes have been set up
throughout the system to assist in the identification of patients at
risk for suicide. VA also has developed a chart ``flagging'' system to
ensure continuity of care and provide awareness among providers about
Veterans with known high risk of suicide. Patients who have been
identified as being at high risk receive an enhanced level of care,
including missed appointment follow ups, safety planning, weekly
follow-up visits and care plans that directly address their
suicidality.
We also have two centers devoted to research, education, and
clinical practice in the area of suicide prevention. VA's Veterans
Integrated Service Network (VISN) 2 Center of Excellence in
Canandaigua, New York, develops and tests clinical and public health
intervention strategies for suicide prevention. VA's VISN 19 Mental
Illness Research Education and Clinical Center in Denver, Colorado,
focuses on: (1) clinical conditions and neurobiological underpinnings
that can lead to increased suicide risk; (2) the implementation of
interventions aimed at decreasing negative outcomes; and (3) training
future leaders in the area of VA suicide prevention.
Every Veteran suicide is a tragic outcome, regardless of the
numbers or rates; one Veteran suicide is too many. We continue to
spread the word throughout VA that ``Suicide Prevention Is Everyone's
Business.'' The ultimate goal is to eliminate suicide among Veterans
via public health strategies, which include initiatives focusing on
strategic community partnerships, identification of risk, training,
treatment engagement, effective treatment, safe storage of lethal means
(such as medications and firearms), research, and data science.
Although we understand why some Veterans may be at increased risk, we
continue to investigate and take proactive steps to understand all risk
factors for all Veterans. VA's strategy for suicide prevention
addresses suicide prevention as a public health issue for all Veterans.
This requires programs designed to help individuals and families
problem solve effectively, and to engage in care when needed, with
ready access to high-quality mental health services.
Suicide prevention is VA's highest clinical priority. As part of
VA's commitment to make resources, services, and technology available
to reduce Veteran suicide, VA initiated Recovery Engagement and
Coordination for Health Veterans Enhanced Treatment (REACH VET) in
November 2016, and fully implemented it by February 2017. REACH VET
uses a new predictive model to analyze existing data from Veterans'
health records to identify those who are at a statistically elevated
risk for suicide, hospitalization, illnesses, and other adverse
outcomes. Once a Veteran is identified, his or her mental health or
primary care provider reviews the Veteran's treatment plan and current
condition(s) to determine if any enhanced care options are indicated.
The provider will then reach out to Veterans to check on their well-
being and inform them that they have been identified as a patient who
may benefit from enhanced care. This allows the Veteran to participate
in a collaborative discussion about his or her health care, including
specific clinical interventions to help reduce suicidal risk.
DOD and VA have a new joint effort to institute a public health
approach to suicide prevention, intervention, and post intervention
using a range of medical and non-medical resources through data and
surveillance, messaging and outreach, evidence-based practices,
workforce development, and Federal and non-government organization
partnerships. We know that 14 of the 20 Veterans who die by suicide on
average each day did not receive care within VA in the past two years.
We need to find a way to provide care or assistance to all of these
individuals. Therefore, VA is expanding access to emergent mental
health care for former Servicemembers with other than honorable (OTH)
administrative discharges. This initiative specifically focuses on
expanding access to assist former Servicemembers with OTH
administrative discharges who are in mental health distress and may be
at risk for suicide or other adverse behaviors. It is estimated that
there are a little more than 500,000 former Servicemembers with OTH
administrative discharges.
VA has authority to furnish care for service-connected conditions
for former Servicemembers with OTH administrative discharges if those
individuals are not subject to a statutory bar to benefits. Individuals
with OTH discharges may access the system for emergency mental health
services by visiting a VA emergency room, outpatient clinic, Vet Center
or by calling the Veterans Crisis Line. Services may include
assessment, medication management/pharmacotherapy, lab work, case
management, psycho-education, and psychotherapy. We may also provide
services via telehealth.
VA, we have the opportunity and the responsibility, to anticipate
the needs of returning Veterans. As they reintegrate into their
communities, we must ensure that all Veterans have access to quality
mental health care. To serve the growing number of Veterans seeking
mental health care, VA has deployed significant resources and increased
its staff for mental health services. The number of Veterans receiving
specialized mental health treatment from VA has risen each year, from
over 900,000 in FY 2006, to more than 1.65 million in FY 2016 Executive
Leadership Board within VISN 10 founded a time-limited workgroup
entitled: Suicide Prevention--Overdose Prevention (SPODP). The
workgroup was designed to enhance regional VA capabilities and
collaboration among State and community partners to improve outcomes
for Veterans at high risk of death from suicide or accidental opioid
overdose. Several strong practices have been identified and shared
throughout the VISN via this group. For example, efforts are underway
to spread practices such as: Community based outreach workers carrying
naloxone kits, Community Police training on Veteran issues, and public
displays focused on suicide prevention (e.g. https://www.facebook.com/
CincinnatiVAMC/photos/pcb.1440977745941595/ 14409756059418 09/
?type=3&theater). Furthermore, all facilities are participating in
``REACH Vet'' which is designed to identify, and escalate care, for the
most vulnerable Veterans we serve.
mental health
VA is committed to providing timely access to high-quality;
recovery-oriented, evidence-based mental health care that anticipates
and responds to Veterans' needs and supports the reintegration of
returning Servicemembers into their communities.
While focusing on suicide prevention, we know that preventing
suicide for the population we serve does not begin with an intervention
as someone is about to take an action that could end his or her life.
Just as we work to prevent fatal heart attacks, we must similarly focus
on prevention, which includes addressing many factors that contribute
to someone feeling suicidal. We are aware that access to mental health
care is one significant part of preventing suicide. VA is determined to
address systemic problems with access to care in general and to mental
health care in particular. VA has recommitted to a culture that puts
the Veteran first. To serve the growing number of Veterans seeking
mental health care, VA has deployed significant resources and increased
staff in mental health services. Between 2005 and 2016, the number of
Veterans who received mental health care from VA grew by more than 80
percent. This rate of increase is more than three times that seen in
the overall number of VA users. This reflects VA's concerted efforts to
engage Veterans who are new to our system and stimulate better access
to mental health services for Veterans within our system. In addition,
this reflects VA's efforts to eliminate barriers to receiving mental
health care, including reducing the stigma associated with receiving
mental health care.
Making it easier for Veterans to receive care from mental health
providers also has allowed more Veterans to receive care. VA is
leveraging telemental health care by establishing eleven regional
telemental health hubs across the VA health care system.
Hubs are located in Seattle, WA; Long Beach, CA; Salt Lake City,
UT; Harlingen, TX; Charleston, SC; Sioux Falls, SD; Battle Creek, Ml;
Pittsburgh, PA; Brooklyn, NY; West Haven, CT; and Honolulu, HI. VA
telemental health provided more than 427,000 encounters to over 133,500
Veterans in 2016.
Telemental health reaches Veterans where and when they are best
served. VA is a leader across the United States and internationally in
these efforts. VA'swww.MaketheConnection.net, Suicide Prevention
campaigns, and the PTSD mobile app (which has been downloaded over
280,000 times) contribute to increasing mental health access and
utilization. VA has also created a suite of award-winning tools that
can be utilized as self-help resources or as an adjunct to active
mental health services.
Additionally, in 2007, VA began national implementation of
integrated mental health services in primary care clinics. Primary
Care-Mental Health Integration (PC-MHI) services include co-located
collaborative functions and evidence-based care management, as well as
a telephone-based modality of care. By co-locating mental health
providers within primary care clinics, VA is able to introduce Veterans
on the same day to their primary care team and a mental health provider
in the clinic, thereby reducing wait times and no show rates for mental
health services. Additionally, integration of mental health providers
within primary care has been shown to improve the identification of
mental health disorders and increase the rates of treatment. Several
studies of the program have also shown that treatment within PC-MHI
increases the likelihood of attending future mental health appointments
and engaging in specialty mental health treatment. Finally, the
integration of primary care and mental health has shown consistent
improvement of quality of care and outcomes, including patient
satisfaction. The PC-MHI program continues to expand, and through
May 2017, VA has provided over 7.2 million PC-MHI clinic encounters,
serving over 1.6 million individuals since October 1, 2007.
VA recognizes the importance of the Veterans Crisis Line (VCL) as a
life-saving resource for our Nation's Veterans who find themselves at
risk of suicide. Of all the Veterans we serve, we most want those in
crisis to know that dedicated, expert VA staff, many of whom are
Veterans themselves, will be there when they are needed. The primary
mission of VCL is to provide 24/7, world class, suicide prevention and
crisis intervention services to Veterans, Servicemembers, and their
family members. However, any person concerned for a Veteran's or
Servicemember's safety or crisis status may call VCL.
VCL is the strongest it has been since its inception in 2007. VCL
staff has forwarded over 504,000 referrals to local Suicide Prevention
Coordinators on behalf of Veterans to ensure continuity of care with
their local VA providers. Initially housed in 2007 at the Canandaigua
VA Medical Center (VAMC) in New York, it began with 14 responders and
two health care technicians answering four phone lines. Since 2007, VCL
has answered over 3 million calls and dispatched emergency services to
callers in crisis more than 84,000 times. Consistent with our mission,
we have implemented a series of initiatives to provide the best
customer service for every caller, making notable advances to improve
access and the quality of crisis care available to our Veterans, such
as:
Launching ``Veterans Chat'' in 2009, an online, one-to-one
chat service for Veterans who prefer reaching out for assistance using
the Internet. Since its inception, we have answered nearly 359,000
requests for chat.
Expanding modalities to our Veteran population by adding
text services in November 2011, resulting in nearly 78,000 requests for
text services.
Opening a second VCL site in Atlanta in October 2016, with
over 250 crisis responders and support staff.
Hiring a permanent VCL Director in July 2017,
psychologist, Dr. Matthew Miller.
Prior to the opening of our new Atlanta call center in
October 2016, VCL had a call rollover rate to back-up call centers of
more than 30 percent. Currently, the average rate is 1.24 percent, with
calls being answered by the VCL within an average of 8 seconds.
Overall, VCL performance is above the National Emergency Number
Association service level standard of answering greater than 95 percent
of calls in less than 20 seconds; specifically, the VCL's average
service level exceeds 98 percent.
VCL continues to exceed these metrics, despite overall call volume
continuing to rise. Overall call volume has increased 12 percent since
April 2017, and increased 15 percent over the course of the 2 weeks
marked by notable adverse weather events earlier this month.
Today, the combined VCL facilities employ more than 500
professionals, and VA is hiring more to handle the growing volume of
calls. VA will also be opening a third VCL site in Topeka, Kansas,
which will give VCL the additional capacity needed as we expand the
'automatic transfer' function, Press 7, to all of its community-based
outpatient clinics (CBOC) and Vet Centers. Despite all of these
accomplishments and plans, there still is more that we can do.
The No Veterans Crisis Line Call Should Go Unanswered Act (Public
Law 114-247) directed VA to develop a quality assurance document to use
in carrying out VCL. It also required VA to develop a plan to ensure
that each telephone call, text message, and other communication
received by VCL, including at a backup call center, is answered in a
timely manner by a person. This is consistent with the guidance
established by the American Association of Suicidology. In addition to
adhering to the requirements of the law, VCL has enhanced the workforce
with qualified responders to eliminate routine rollover of calls to the
contracted backup center. VA also implemented a quality management
system, to monitor the effectiveness of the services provided by VCL.
This will enable VA to identify opportunities for continued
improvement. As required by law, VA submitted a report containing this
document and the required plan to the House and Senate Veterans'
Affairs Committees on May 23, 2017. The Veterans Crisis line can be
reached by dialing 1-800-273-8255, Press 1.
VA's Office of Readjustment Counseling Service (RCS) operates VA
Vet Centers (www.vetcenter.va.gov), which are welcoming community-based
counseling centers situated apart from larger VA medical facilities and
placed in convenient, easily accessible locations. Based on the Veteran
peer model, clinical staff at these Centers provide confidential
professional mental health services and psychosocial counseling
services as needed to help assist Veterans and active duty
Servicemembers (ADSM) (including members of the National Guard and
Reserve components) who served in a combat-theater or area of
hostilities achieve a successful readjustment to civilian life.
Readjustment counseling services and other services (e.g.,
consultation, counseling, training, and mental health services) are
available to their family members if essential to the effective
treatment and readjustment of the Veteran or ADSM. Readjustment
counseling services include, but are not limited to, individual
counseling, group counseling, marital and family counseling for
military-related readjustment issues. Use of non-professional Veteran
peer counselors at the Vet Centers also helps contribute to the RCS
mission. Readjustment counseling services are provided through 300 Vet
Centers, 80 Mobile Vet Centers, and the Vet Center Call Center. In FY
2016, Vet Centers provided over 258,000 Veterans, ADSMs, and their
families with 1,797,000 visits.
In addition, Vet Center staff facilitates community outreach and
the brokering of services with community agencies that link Veterans
and ADSMs with other VA and non-VA services that can help with their
successful readjustment to civilian life. One of the Vet Center core
values is reducing barriers to access to readjustment counseling
services. To this end, all Vet Centers offer services during non-
traditional times such as early mornings, evenings, and weekends.
Barriers to access based on distance (i.e., communities distant from
the 300 ``brick and mortar'' Vet Centers) are ameliorated by having Vet
Center staff regularly deliver readjustment counseling services in Vet
Center Community Access Points (CAP). Generally speaking, CAPs are
established when community partners, pursuant to a no-cost arrangement,
permit Vet Center counselors to provide readjustment counseling
services on their premises on a regular recurring schedule (ranging
from service provision once a month to several times a week). CAPs
allow Vet Center clinicians to provide services at a level that is in
line with the fluid readjustment demands and needs of that community.
Currently, Vet Center staff operates over 820 CAPs. In FY 2016, Vet
Center CAPs provided 236, 435 readjustment counseling visits, a 6%
increase over FY 2015.
RCS leadership is also working in close collaboration with the
Veterans Health Administration's Office of Mental Health and Suicide
Prevention to implement improved collaboration to better improve
coordination and referral between Vet Centers and VA medical
facilities. A memorandum of understanding was signed in August 2017 to
formalize this relationship and outline improved communication
processes, training, collaboration, and access to important suicide
predictive data to help decrease suicide within the Veteran population.
Vet Center counselors are trained, as part of assessment, to identify
Veterans or ADSMs who are at high risk of harm or suicide. They refer
these clients to their treating mental health providers (or for
emergency services, if appropriate). And if a Veteran client is getting
his/her care through VA, Vet Center staff refers the shared Veteran
client to the local VAMC and the Vet Center counselor also contacts the
facility's Suicide Prevention Coordinator to ensure that enhanced care
delivery procedures for suicide prevention are in effect.
In 2017, VISN 10, whose average was 2.62 percent, exceeded national
averages of 1.9 percent in the provision of Evidence-Based
Psychotherapy to Veterans suffering from PTSD, Depression, and Serious
Mental Illness.
community care
VA is extremely grateful the House and Senate Committees on
Veterans' Affairs are actively working on legislation concerning the
future of VA's community care program. We appreciate the Committees
willingness to meet with VA and discuss the various proposals,
including the Department's Veteran CARE Act, and look forward to seeing
the swift enactment of legislation to this effect. While progress has
been made, there is still more work to be done to serve our Nation's
Veterans. VA needs a different approach to ensure we can fully care for
Veterans. We believe that a redesigned community care program will not
only improve access and provider greater convenience for Veterans, but
will also transform how VA delivers care within our facilities.
This redesigned program must have several key elements. First, we
need to move from a system where eligibility for community care is
based on wait times and geography to one focused on clinical need and
quality of care. This will give Veterans real choice in getting the
care they need and ensure it is of the highest quality. At a minimum,
where VA does not offer a service, Veterans will have the choice to
receive care in their communities. Second, we need to make it easier
for Veterans to access convenient care services when they need it. This
will ensure that Veterans will always have a choice and pathway to get
more immediate needs addressed. Third, the new program must maintain a
high performing integrated network that includes VA, Federal partners,
academic affiliates, and community providers. We need to ensure that VA
is partnering with the best providers across the country to take care
of our Nation's Veterans. Fourth, it must assist in coordination of
care for Veterans served by multiple providers. Finally, we must apply
industry standards for quality, patient satisfaction, payment models,
health care outcomes, and exchange of health information. By doing so,
Veterans can make informed decisions about their care and VA can have
the tools to better compete within communities.
We believe redesigning community care will result in a strong VA
that can meet the special needs of our Veteran population. Where VA
excels, we want to make sure that the tools exist to continue
performing well in those areas. Veterans need the VA and for that
reason, community care access must be guided by principles based on
clinical need and quality. VA needs the support of Congress to level
the playing field with industry by making it easier to modernize our
infrastructure, leverage IT technologies, hire the best talent, and
operate more like the private sector. A good example is management of
our real property and infrastructure portfolio, where numerous barriers
prevent VA from being agile in response to Veterans health care needs
in different geographic areas. We want to work with Congress to discuss
the best ways to bring common sense to this area.
VA also needs tools to improve our recruitment, hiring and
retention of the best professionals to serve our Veterans. These tools
could include improvements to hiring and pay authorities to better
address vacancies in our medical center and VISN director positions, to
help at least in part address disparities with the private sector. As a
final example, there is Federal law that requires VA facilities to have
a smoking area. We all know the impact on health from smoking, and
smoking cessation is the most immediate and dramatic step a Veteran, or
anyone, can take to improve their health. VA strongly supports H.R.
1662 which would repeal this requirement. Action in these areas will
make VA more modern, and be an enabler for our dedicated workforce to
be more effective in their service to Veterans.
VA is committed to moving care into the community where it makes
sense for the Veteran. Finally, I want to make sure that everyone
understands that making better use of community care must be done in a
fiscally responsible way. We cannot continue to grow our funding in the
same way we have done over this past decade. And, I want to be clear
that I am committed to strengthening the VA system and will not support
efforts to privatize this much needed and essential system. The
ultimate judge of our success will be our Veterans. With your help, VA
can continue to improve Veteran's care, in both VA and the community.
VA continued to maintain exceptional management in the area of
Community Care throughout the fiscal year despite many program
challenges and system wide changes to program model. These challenges
coupled with re-work challenges due to contractor inefficiencies; have
had great impact on expediency of care coordination for Veterans.
Despite these challenges, VISN 10 has performed well; specifically
leveraging our internally created network of community providers
through our robust use of provider agreements. VA is able to quickly
coordinate care through this network when our contractor support fails
to make the Veteran's appointment. In FY 2017, VISN 10 coordinated the
care of over 34,000 Veterans using our robust community provider
network of over 1,600 providers in the VISN; second in the Nation in
terms of volume and third in use.
In addition, VA has formed a robust partnership with our DOD
sharing partner, Wright Patterson Air Force Base; establishing a
consortium designed and developed to standardize business processes to
increase the quality of care for Veterans, reduce the overall cost of
care, expedite Veteran access to care, and support Air Force combat
preparedness. VISN 10 has successfully referred over 4,600 Veterans to
Wright Patterson over the last 2 years from VA facilities in
Cincinnati, Dayton, Chillicothe and Columbus. VA has realized
substantial cost avoidance using VA/DOD partnership over traditional
NVCC -Saving realized over $3M through July 2017.
There are also weekly community care huddles to share strong
practices, implement changes and provide VISN level support to each
VISN 10 facility to support our Veterans. VISN 10 strongly supports
learning, sharing, and growing together to support Veterans in the
delivery of their care needs.
In 2017 the VA Central Office made a change in the distribution and
participation in the formulation of policies, memorandums and handbooks
which have greatly enhanced field staff ownership and accountability.
These documents are distributed for field input and subsequently
finalized and distributed. VISN program leads share and discuss the
direction and subsequently cascade it down to the field for
implementation.
conclusion
VA remains focused on providing the highest quality care our
Veterans have earned and deserve and which our Nation trusts us to
provide. VA appreciates the support of Congress and look forward to
responding to any questions you may have.
Senator Brown. Thank you, Mr. Burke.
You said in your testimony Ohio averages 97 days to decide
a claim. Twenty-two percent of Ohioans wait at least 125 days.
Walk through the claims process. It is pretty hard to
understand why we cannot do better.
A veteran walks in and what happens?
Mr. Burke. There are actually five distinct points in our
claims process, Senator, that transpire.
The first is actually putting the veteran's claim under
control and initiating the first phase of development. This is
where we start to go out to private treatment facilities,
obtain records, or even in some cases request a VA examination.
The second step in our process is the largest part of our
overall inventory. It is also the most time-consuming. About 85
percent of our 125-day window takes place is step two. This is
where we continue to develop evidence. We go out to obtain
every piece of information, whether it is private records, VA
exam results, clarification of medical opinions, et cetera,
before we make a claim what we call ready for decision.
Once a claim gets to step three out of five, that is the
ready for decision, we can actually move those claims from
start to finish in less than 30 days.
To that end, VA just kicked off a campaign we call
decision-ready claims. That decision-ready claim initiative is
designed to bypass the first two steps in the claims process.
We are celebrating progress. We have not celebrated
completion because 97 days, we are not content with that.
Senator Brown. How long should it take?
Mr. Burke. There are some claims, Senator, that we would
disadvantage a veteran if we rushed to a decision in less than
125 days. There are some complex claims. There are those that
we need verification from other agencies, other entities, that
do require longer than 125 days.
Senator Brown. Is there anything like an ordinary, routine
claim? I guess nothing fits exactly if it is you, right? But,
how long should it take in a case like that?
Mr. Burke. If we can change the dynamics of claim filing to
where the claim comes into VA fully developed with all the
evidence there at that third step, our guarantee on decision-
ready claims is that we will render that start to finish in
less than 30 days.
Senator Brown. How long should it take for an appeal?
Mr. Burke. Our goal under the new appeals framework, if you
take the higher level review path or the supplemental claim
path, is to have that done on an average of 125 days, and for
claims going to the Board of Veterans Appeals in under a year.
Senator Brown. Your comments about suicide are troubling,
as all comments about veteran suicide are troubling. My
understanding is that a veteran in Ohio is twice as likely to
commit suicide as a nonveteran. Ohio's numbers are slightly
better maybe than the national average, but every suicide, as
you say, is a tragedy.
What can this Committee do to help?
Mr. Burke. I think I would like to engage my partners from
VHA, as they are the experts in VA's efforts on suicide
prevention. So, if anyone from VHA would like to chime in, that
would be great.
Mr. McDivitt. Sure. Thank you, Mr. Worley and Senator.
The tragedy of veteran suicide, as you know, is one of
Secretary Shulkin's five priorities. His only clinical priority
is to prevent veteran suicide.
There are a lot of initiatives going on in the State of
Ohio, as you indicated. For those of us in the Veterans Health
Administration, we are part of the #BeThere initiative to make
sure that both our staff, our community members, our partners
are aware of the symptoms of suicide, are aware of what to look
for, are aware of the questions that they should be asking
veterans.
We do save training of all our staff and of community
partners. We utilize the REACH-VET tool to identify veterans at
high-risk and provide special support to them.
We have the veterans' crisis line, 1-800-273-TALK, where we
encourage any veteran in crisis, family members, or others to
call. The next day after the crisis is resolved, they are
connected with a suicide prevention coordinator at one of our
VA medical centers.
We have initiated a program----
Senator Brown. Let me interrupt.
Mr. McDivitt. Yes. Go ahead, Senator.
Senator Brown. I appreciate that litany, and that is
important.
Mr. McDivitt. Sure.
Senator Brown. When Mr. Powers talked about his attempted
suicide, would anybody at the VA have known that that happened?
I do not mean him personally, but if someone attempts suicide,
something like his situation happened, there is a good chance
the VA would not know that happened, I assume? I am not
pointing fingers here.
Mr. McDivitt. Yes, it is certainly possible. It depends. As
I said, we have veterans who are on the suicide watch list. We
have veterans who are part of the REACH program. We try to
connect----
Senator Brown. He might have been on the watchlist? It is
possible?
Mr. McDivitt. I do not know that.
Senator Brown. He might have been.
One thing that really stood out as I prepared for this
hearing, and just what I have learned being on this Committee
for a decade, is that my understanding is that most of the
suicides that happen, when veterans commit suicide, most of
them have not had contact with the VA in a couple years.
Correct?
Mr. McDivitt. Of the 20 veterans who commit suicide a day,
only six are part of the Veterans Health Administration.
Senator Brown. So, isn't the most important thing for all
of you is to find those 14?
Mr. McDivitt. Right. That is a key part of our initiative.
We have a pilot program in this vision, which rolled out in the
Toledo area to connect with churches. We are working with over
100 churches in Northwest Ohio to, again, make members of the
church aware of what they should be looking for in terms of
veteran suicide, aware of VA resources that are available, and
to make those connections.
We are doing it across-the-board, whether it be working
with Mr. Tansill and the Ohio Department of Veteran Services,
with the service organizations who are represented here, with
many, many community health care partners. We do mental health
forums at our all our facilities and oftentimes have 100
partners come, and at every one of those, we talk about suicide
prevention and how we can better connect with the community.
Senator Brown. Dr. Matthews, obviously, you know this
country well and you know the VA from the inside well. You
probably know that Ohio has more opioid deaths than any State
in the country. We are not the highest per capita, but we are
pretty damn high, and we literally had the most 2 years in a
row. I assume that means we have some of the highest opioid
addiction among veterans.
Can you teach sort of civilian Ohio what works? When you
answer the question of what is unique or interesting or
particularly successful things that the VA is doing on opioid
addiction, understanding the State Legislature has pretty much
been absent on scaling up opioid treatments in this State,
understanding Congress makes good speeches but does not really
fund scaling up opioid treatment programs.
Right now, in Ohio, literally in Ohio, 200,000 Ohioans
right now are getting opioid treatment because they have
insurance from the Affordable Care Act. I understand that
component.
What can you tell me the VA is doing well? What are your
plans in the future? And, how can civilian Ohio learn from what
you are doing in the VA?
Dr. Matthews. Sure. Thank you so much, Senator. It is an
excellent question.
I am actually a primary care physician as well who actually
does opioid treatment. I am very familiar with this, even
during my time prior to the VA.
I can definitely say up front that no State has this right
yet, but one thing that I am quite proud of within the VA is
that we have jumped leaps and bounds ahead of a lot of larger
health systems in the private industry with our opioid safety
initiative. We have really added processes and performance
metrics to what is otherwise becoming the standard of care
within health care, which is based on the CDC guidelines for
approaching opioid prescribing.
We are monitoring our veterans. We are monitoring the
prescribing practices of our providers. We are approaching it
from a clinical perspective, as far as history-taking and
actually dealing with pain as a larger concept, as opposed to
just throwing a medication at it, but dealing with causes of
it, looking at non-pharmacological approaches to actually
treating pain.
We are actually quite advanced and actually do have a lower
rate of prescription for opioid than most of the private
industry. What we are now trying to do----
Senator Brown. Is that long term? There is a book that I
recommend to anybody here. It is much about Ohio,
unfortunately, from Portsmouth to Columbus especially, called
Dreamland. Much of the opioid addiction in this country sort of
began--the writer really does kind of tag Portsmouth, OH--I do
not think that is entirely fair--as the beginning over 30
years, 20 years, I guess.
Is that a long-term thing that? Clearly, the drug companies
are guilty as hell in this in how they peddled these drugs,
saying they were not addictive, OxyContin, oxycodone, Vicodin,
other drugs, Percocet and all. Doctors overprescribe. We can
point fingers. We are all guilty, I guess.
Have you sort of set examples, in terms of prescribing, in
terms of this?
Dr. Matthews. Yes.
Senator Brown. Tell me how that has worked.
Dr. Matthews. It has actually worked quite well. One of our
expectations for VA prescribers and soon-to-be, hopefully, in
our community network as we work with other States, is the
checking of State prescription drug monitoring programs. This
is for all controlled substances typically, so more than even
just opioids, are actually in a State-level registry, so that
providers can look to see when the last time prescriptions were
written in a specific veteran's name, can have information so
that they know that perhaps there might be potential for any
overprescription or just acknowledgment that treatment is
already in place, perhaps with another provider, so that a new
prescription is not necessary.
Our pharmacy records now feed into these State programs, so
that even outside providers can see that the VA prescribers now
have opioid prescriptions in a specific veteran's name.
Senator Brown. Is there a uniform policy on not
overprescribing?
Dr. Matthews. Yes.
Senator Brown. It would be every bit as good in Ann Arbor,
or it would be pretty similar in Ann Arbor to Chillicothe to
Dayton to Cincinnati?
Dr. Matthews. We have a national clinical guideline on
opioid treatment that is expected across the Nation. It is
really equivalent to a lot of the standards of care that other
health systems--in fact, in Ann Arbor, the University of
Michigan has a similar set of pain policies that other private
health systems adopt as well.
Yes, our expectation is that VA providers are following
those guidelines, that our pharmacy records are looking into
any prescriptions that are coming in from community providers
that may be seeing our veterans, so that we can attack the
issue proactively.
Senator Brown. Thank you for that, Dr. Matthews.
Mr. McDivitt, talk about VA hiring and how you anticipate
staffing shortages. One of the things that this Committee has
taught me is to stay in touch closely not just with directors
in Chillicothe or Dayton or Cincinnati or Wade Park, or even
the community-based clinics in Springfield and Mansfield and
Zanesville and all, but also to stay in touch with the work
staff, the medical personnel and the personnel that are not as
well-paid and perhaps not as highly skilled as Dr. Matthews.
One of the things we see is medical staff shortages
sometimes are not filled quickly enough. What you do in
Cleveland or what you do in Dayton to anticipate medical staff
shortages so the wait times for people coming into the VA do
not get longer because there are not enough medical personnel?
How do you anticipate that? How do you fill those jobs more
quickly?
Mr. McDivitt. Sure. Absolutely. Thank you, Senator.
Senator Brown. I know it is a huge system, and it is
difficult.
Mr. McDivitt. In our VISN, the three-State area, we have
around 30,000 employees. Yet, I think as you said, it really
goes to the frontline. We hire directors, and we have three of
our directors here, Ms. Hepker from Columbus, Mr. Murdoch from
Chillicothe, and Ms. Hudson from Cincinnati.
We hire directors who do not spend all their time in the
board room. They spend a lot of time out in the clinic or on
the frontlines talking to staff, as you do when you do town
halls, seeing where the pressure points are in the
organization.
We do have an overall human resource strategy. We have
professions that are challenging to recruit. We try to make
sure that we are ahead of the game on that, whether it be ICU
nurses, some medical specialty areas.
In the last year, I am pleased to report, that in the State
of Ohio, we added over 380 full-time equivalent employees from
the beginning of fiscal year 2017 to the end, and pretty much
across-the-board. Here in Columbus, Cleveland, Cincinnati, and
Dayton.
We try not to be a market-leader in our hiring process, but
we try to be competitive across-the-board.
I would also say, with Dr. Matthews here, on occasions when
we have short-term vacancies, and we had a short-term vacancy
for orthopedic surgeons here in Columbus, we can turn to
community care now. Community care can fill a gap while we are
recruiting in the VA.
Senator Brown. Pay, I assume, the same job at every VA I
assume does not pay the most. Dayton's cost-of-living is less
than San Francisco's. Do they get paid more for those jobs in
San Francisco because the cost-of-living is higher?
Mr. McDivitt. There are geographic adjustments for larger
markets in places like New York City and San Francisco and so
on. However, our physician pay package has two components. One
is a base pay, and the second is a market pay, knowing that the
salaries for certain physicians--it may be more challenging to
recruit someone in Toledo as opposed to Columbus or
Chillicothe. We try to make adjustments, so we can compete in
that market.
Senator Brown. This is not typical in a congressional
hearing, but would you introduce the directors you mentioned so
people can see them?
Mr. McDivitt. Of course. Wendy Hepker, Vivian Hudson, and
Mark Murdoch are directors here representing the VAs in Ohio.
[Applause.]
Both Mark and Vivian are military retirees. Mark retired
from the Air Force. Vivian just retired last year from the U.S.
Army.
Senator Brown. Thank you. Two of you, thank you for
welcoming both me and my staff to your hospitals and for the
work you do.
We have seen major progress in all three of those
hospitals. It is always a challenge. Thank you for your
service.
Thanks for taking that question.
Let me shift to something very different, Mr. Worley. This
will be mostly for you, but may be Mr. Burke, too.
I am concerned that the VA was seeking blanket waivers to
conflict-of-interest rules that would allow VA employees to
benefit financially from for-profit colleges and universities.
I was glad that Secretary Shulkin listened to veterans and VSOs
and educators and policymakers who opposed this decision.
Why was VA interested in waiving this requirement?
Mr. Worley. Senator, I think as was stated in the Federal
Register notice originally, we believe that the statute had
unintended and illogical consequences in its full application,
meaning someone who had a job at a hospital that had entirely
nothing to do with educational benefits going to a for-profit
school would have to be fired, or waived under this provision,
for attending a for-profit school where the G.I. Bill was being
used.
I think it was in that context. That I think was a large
part of the motivation.
Senator Brown. Did this waiver request come out of the
White House?
Mr. Worley. I cannot speak to that, Senator. I don't know.
Senator Brown. You do not know or you cannot speak to it?
Mr. Worley. I do not know.
Senator Brown. Mr. Burke, do you know?
Mr. Worley. This was handled primarily out of our----
Mr. Burke. I do not know, sir.
Senator Brown. There has been, as more and more veterans
have been cheated by some of these for-profit colleges and
universities--and ``cheated'' is the right word, not just
veterans but lots and lots of people have been cheated. These
for-profit schools spend lots of money recruiting, lots of
money helping you find financial aid. Then they spend almost no
money helping you find a job.
When these for-profit colleges go out of business, or even
if they do not go out of business, people rack up huge student
debt, and the diploma is not worth as much.
There is some political movement in this country to and in
Washington to protect these for-profit colleges and to protect
their profits. I am just always concerned, as concerned as I am
about the VAs.
You begin to hear more and more on the news that some
people inside the government want to privatize the VA. I do not
know exactly what direction that is and what that means, but
you always hear those warning bells come from my office and
from a lot of us in Congress, and I hope in both parties.
Thank you for that answer.
I want to talk about the 90/10 loophole used to crack down
on for-profit colleges and universities that use abusive,
deceptive practices to recruit veterans, servicemembers, and
their families. As you know, veterans especially, they have
gamed the loophole to count veterans in that number, which I
find pretty despicable. That is why I have reintroduced the
Military and Veterans Education Protection Act.
My question to both of you, are there other improvements in
the G.I. Bill not included in the Forever G.I. that would help
the VA better serve veterans pursuing higher education?
Mr. Worley?
Mr. Worley. First of all, I would thank you and the
Committee for all the incredible improvements that have been
made just in my time in this job, which has been about 5 years.
We have seen the educational provisions out of the Choice Act
of 2014, the Blumenthal-Miller Benefits Improvement Act had 15
provisions, and, of course, the Forever G.I. Bill. These are
huge improvements to so many of our beneficiaries and have
really addressed numerous of VA's legislative proposals as well
as, of course, numerous VSOs.
I think there are a few things left to do, as I think you
are no doubt aware. I think it is called the Valor Act that was
recently passed, which will help us with apprenticeships.
Off the top my head, I would have to go back to our 2018
budget proposal where we had various legislative proposals.
But, there are fewer of those out there because the Forever
G.I. Bill covered so many of them.
Senator Brown. Thanks.
Do you want to add anything, Mr. Burke?
Mr. Burke. No, sir. Nothing else to add. I think Mr. Worley
is the expert with the G.I. bill.
I would like to echo the appreciation for the support in
getting the large overhaul done that Rob mentioned. Thank you.
Senator Brown. My last question of the hearing, and if any
of you want to add anything else, I am certainly open to that.
One of the real successes--I think hearings like this and
reading newspapers and going online, we hear only about the
problems and the waiting lists and the people who fell through
the cracks, or when government does not do a good job.
Well, some years ago, the VA--I believe it was Secretary
Shinseki; it may have been Principi, I am not sure--set a goal
on homelessness to eliminate homelessness among vets,
understanding actually getting it to zero was virtually
impossible.
Since 2010, we have reduced veterans' homelessness by 47
percent. The HUD-VASH voucher program has been instrumental in
making this progress. It helps veterans. We know, as I said
before, and Shinseki actually told me this when he was
Secretary of the VA, that Chillicothe may be the single best
homelessness program center of any of the VA hospitals
anywhere.
Unfortunately, in September, the VA decided to take
dedicated HUD-VASH supported services funds and combine them
with other funding needs in general purpose funds, which meant
housing and veterans' service organizations in our State--I
think our directors could probably speak to that--and across
the country are concerned that this decision will undermine the
success of the HUD-VASH program and set back our efforts as we
have made measurable, significant progress in reducing the
homeless veteran population since 2010.
Is there any chance, Mr. Burke, the VA would reconsider
this decision? If not, how do you plan to ensure that they are
going to remain steady to support the struggling veterans
across Ohio that are on the edge of homelessness?
Mr. Burke. Sir, that is a great question. I am going to ask
my colleagues from VHA to chime in as well.
I will say, we have not given up the fight on trying to
eradicate veterans' homelessness. In fact, we are using tools
and technology, such as our National Work Queue, to move those
veterans with pending claims that we know are homeless kind of
to the front of the line to expedite decisions on that.
Mr. McDivitt, if you want to add anything?
Mr. McDivitt. Sure. Thank you, Mr. Burke.
This is a very important issue to us, Senator, as you know.
The decision you talked about is actually on hold right now. I
think the Committee had asked that it be reconsidered, so it is
on hold.
Regardless of how it plays out----
Senator Brown. The decision to move the funds out of the
VA----
Mr. McDivitt. The decision to move the money from special-
purpose into the general purpose fund.
Regardless of how----
Senator Brown. I am sorry to interrupt. How do we get that
from putting it on hold to putting it in the trash, for want of
a better term? You said that decision is on hold to make the
move. How do we get that decision to be permanently on hold?
Mr. McDivitt. There is an active debate with the CFO in the
Veterans Health Administration about that. My network director
colleagues and I had a chance to talk with him last week.
I would say, ultimately, whether the money comes as special
purpose or it comes as part of the overall appropriation, it
will come here to Ohio, and it will be part of our overall
homeless program. Dr. Jessie Burgard, our mental health lead
for the division, oversees those programs. We have a
coordinator for the State of Ohio, Jim Kennelly. We have
homeless veteran coordinators at all our facilities.
The HUD-VASH funding will continue to come here. It may not
come as what we call special-purpose dollars, but it would come
as part of the overall general appropriation. The commitment to
homeless veterans continues to be very strong here in Ohio.
Senator Brown. I think about two things that have been
brought up here. Congresswoman Beatty in her opening statement
said something very passionately, that it is our duty to serve
those who served us. I do not know if that is a slogan at the
VA, but it should be.
I know that all four of you have dedicated a big part of
your lives to serving veterans. I know on our previous panel
that every witness had served this country and was now serving
veterans either in a voluntary or a paid capacity.
When you think of two things, in particular, to measure us
as a Nation, when you think of the veteran suicide rate and the
veteran homelessness rate, it really has to be more than a goal
of our country to eradicate homelessness, of course, for
everybody, and to eradicate suicide for everybody, but
especially when we fall short so that the number among veterans
is higher, it is something that we always need to work to
ameliorate.
Thank you for the work that the four of you are doing.
Thank you all for joining us today. Anybody that has
comments, certainly, outside the process of this Committee,
come to Brown.Senate.gov and give any comments you have, any
questions, any of you as veterans. Those of you who represent
other veterans, if you are from the local DAV or Polish
American Veterans or VFW or American Legion or any other
veterans group, or if you are in a Veterans Services commission
office in a county, certainly feed any information directly to
Jonathan or Anna in my office, or Amber in the back, or
directly to me. That is my job to represent you in that way.
I so appreciate all of you who came. The three directors,
thank you for joining us. The four of you up here, thank you so
much.
The Committee is adjourned.
[Whereupon, at 3:20 p.m., the hearing was adjourned.]
------
[Responses to posthearing questions follow:]
Response to Posthearing Questions Submitted by Hon. Sherrod Brown to
Ronald Burke, Assistant Deputy Under Secretary for Field Operations,
Veterans Benefits Administration, U.S. Department of Veterans Affairs
Despite progress in recent years, the suicides among veterans
remain a critical issue. In the testimony, you note that the suicide
rate among Ohio veterans specifically is nearly double that national
rate. I hear from the families of Ohio veterans who have committed
suicide far too often.
Their heartbreaking stories vary but each is tragic. You note that
a majority of the 20 veterans on average that we lose to suicide each
day have not received care from VA in at least two years.
This is evidence that VA care contributes to a decreased risk of
suicide and I commend the employees--often veterans themselves--who are
on the front lines working every day to support veterans in crisis.
However, there have to be ways for the Department to do better.
Mr. Burke, you've highlighted improvements VA has made in its
approach to suicide prevention.
Question 1. What specific weaknesses remain and what steps are
being taken to mitigate those shortfalls?
Department of Veterans Affairs (VA) Response: Approximately 70
percent of Veteran suicides are among Veterans who have not been
recently engaged in our healthcare system. The Veterans Health
Administration (VHA) provides excellent care to Veterans at risk for
suicide through enhanced care from facility Suicide Prevention
Coordinators, and predictive risk programs like REACH VET; however,
Veterans who do not receive care at VA cannot avail themselves of these
programs. We are committed to building a national network of
partnerships to ensure that all Veterans have the care and support they
have earned, whether or not they are enrolled in VA healthcare. Solving
Veteran suicide will take a community based approach across the Nation.
One example of that approach is VA's work with the Substance Abuse and
Mental Health Services Administration (SAMHSA) on a Mayor's Challenge
in 7 communities, in order to enable that each of these communities to
identify unique local solutions to Veteran suicide. That is the type of
approach we think is necessary to reduce suicide rates for all
Veterans.
Question 2. How can this Committee help?
Response. We ask for Senate Veteran Affairs' Committee support in
engaging communities to address Veteran suicide through expansion of
the Mayor's Challenge program to include grant making authority.
Question 3. Mr. Burke, the first panel of witnesses discussed the
barriers veterans and their families face transitioning to civilian
life and accessing the benefits they earned and deserve.
What are your goals for VBA's distribution of education benefits
and how will you measure success?
Response. The Department is working to exceed our timeliness goals
of 28 days for original claims and 14 days for supplemental claims, and
to automate original claims as part of the Colmery Act implementation.
Veterans Benefits Administration (VBA) works to ensure beneficiaries
make informed decisions concerning their education and training
benefits, and to protect GI Bill beneficiaries in other ways. VBA's
Education Service is collaborating with the Veterans Experience Office
to utilize a new Customer Experience Management System to collect
Veteran feedback via surveys and electronic comment cards, and to use
the latest data to identify emerging patterns to improve value to
Veterans. This will help VBA modernize, prioritize, and focus on issues
impacting Veterans' experience. Additionally, our academic progress
measures are being developed and will report on a more complete picture
of an individual's use of the GI Bill and their outcome (in line with
Public Law 114-315, Section 404-7). These, combined efforts will allow
VBA's Education Service to make data-driven decisions to achieve
program and policy successes, while providing avenues for stakeholder
engagement.
Question 4. From a veterans and military family education and work-
readiness perspective, how can this Committee work with the Department
to meet the needs of those who served and their loved ones?
Response. Recent legislation introduced by the Committee and signed
into law by the President significantly improves educational and work-
readiness opportunities for Veterans and their loved ones.
Specifically, on August 16, 2017, the President signed the Harry W.
Colmery Veterans Educational Assistance Act of 2017, also referred to
as the ``Forever GI Bill.'' This law contains 34 new provisions, the
vast majority of which will enhance or expand education benefits for
Veterans, Servicemembers, Families and Survivors. On November 21, 2017,
the President signed H.R. 3949, the Veterans Apprenticeship and Labor
Opportunity Reform Act (VALOR Act), into law. This law will make it
easier for multi-state companies and organizations (that operate
apprenticeship programs) to provide veteran apprentices with access to
their earned GI bill benefits. VA is working hard to successfully
implement both laws and remains committed to working closely with the
Committee as we deliver the accurate and timely educational benefits
our Veterans have earned.
Question 5. Mr. Burke, I have heard from many veterans who are
ineligible for VA-provided healthcare because their income is
considered too high. Additionally, former reserve component members
whose service did not involve combat deployments and did not retire,
medically or otherwise, have noted their ineligibility because their
service does not meet VA's stated criteria for Veteran status.
Please take a moment to explain how VA considers eligibility and
how it relates to income, time in service, and deployments. And, how
will veteran status relate to eligibility for the Department's eventual
roll-out of a veteran's ID card program?
Response. For the purposes of VA health benefits and services, a
person who served in the active military service and was discharged or
released under conditions other than dishonorable is considered a
Veteran and may quality for VA health care benefits. Current and former
members of the Reserves or National Guard who were called to active
duty by a Federal order and completed the full period for which they
were called or ordered to active duty may be eligible for VA health
benefits as well. Reserves or National Guard members with active duty
for training purposes only do not meet the basic eligibility
requirements.
NOTE: Most Veterans who enlisted after September 7, 1980, or
entered active duty after October 16, 1981, must have served 24
continuous months or the full period for which they were called to
active duty in order to be eligible. This minimum duty requirement may
not apply to Veterans who were discharged for a disability incurred or
aggravated in the line of duty, for a hardship or ``early out,'' or
those who served prior to September 7, 1980. Since there are a number
of other exceptions to the minimum duty requirements, VA encourages all
Veterans to apply so that we may determine their enrollment
eligibility.
Veterans who do not have a VA-rated service-connected disability
and who do not receive a VA pension payment or have a special
eligibility, such as a recently discharged Combat Veteran or a Purple
Heart recipient, may also receive VA health care if their income is
below VA's National Income or Geographical-Adjusted Thresholds. To see
if they qualify, Veterans must provide their gross household income
(which includes spouse/partner and dependent children, if applicable)
for the previous year when applying for enrollment for VA health care.
This part of the application process is called an ``income assessment
or financial assessment'' (also formerly called a means test) and is
used to determine if these Veterans are eligible for enrollment and
whether or not they have to pay copays for their health care or
prescription medication. Additional information regarding healthcare
eligibility is available online at: https://www.va.gov/HEALTHBENEFITS/
index.asp.
For the Veteran ID card, only those Veterans with honorable service
will be able to apply. The Veteran ID card provides proof of military
service, and may be accepted by retailers in lieu of the standard
military discharge documents (DD214) to obtain promotional discounts
and other services.
Question 6. Mr. Burke, you heard from the previous panel about
their experience with VA regarding debt collection. I have heard from
many Ohio veterans about this, and subsequently sent a letter to
Secretary Shulkin. Can you answer the following questions for me:
How does VA ensure that veterans are receiving an accurate
determination of benefits, and what processes and safeguards are in
place to mitigate the risk of overpayment and subsequent debt
collection?
Response. VA makes every attempt to accurately and expeditiously
process benefit payments to Veterans and their Survivors. VA
authorization experts review all monetary awards before approving
decisions. National quality experts routinely assess the accuracy of
regional office (RO) actions while local quality experts review the
actions of individual adjudicators. Regular enforcements, such as
mandatory training, consistency studies, and Systematic Analyses of
Operations by management, also help ensure timeliness and accuracy of
decisions. VA has also deployed the National Work Queue to manage
workload nationally and take full advantage of RO capacity.
Question 7. Has VA identified any circumstances or sources that
account for the sharp increase in the rate of overpayment notices in
the last few years?
Response. Department of Defense (DOD) drill pay to Veterans has
substantially contributed to the number of VA overpayments in VA's
disability compensation program. By law, Veterans may not receive both
drill pay and disability or the same periods. Prior to February 25,
2016, when VBA processed drill pay adjustments, the adjustments were
applied to future disability payments. This caused the Veteran's future
payments to be reduced or stopped for a period of time and may have
caused financial hardship to the Veteran. Accomplishing drill pay
adjustments from this perspective, only allowed the Veteran to request
relief from the repayment by requesting a hardship waiver. Effective
February 25, 2016, VBA changed its policies and began processing drill
pay adjustments retroactively verses prospectively. This process
created a debt in VA systems but allowed Veterans additional options to
repay the overpayment based on their financial situation. Veterans with
overpayments related to drill pay adjustments are automatically placed
on a 12-month repayment plan. Other options available once overpayments
are established, include:
Request a waiver for the overpayment due to financial
hardship;
Request a payment plan for the overpayment;
Request a compromise of the overpayment due to financial
hardship;
Have the amount repaid with future disability payments; or
Pay the full amount of the overpayment and continue
receiving their disability payments.
The success of the Rules-Based Processing System, which
automatically processes dependency claims without user intervention, as
well as increased automation of drill-pay adjustments, have helped
increase overpayments because VA is completing these types of claims,
which can generate overpayments, in greater numbers.
Additionally, VBA is working collaboratively with DOD to receive
drill pay information monthly so we can process these drill pay
adjustments more frequently resulting in Veterans receiving this
information in a timelier manner. Currently, VBA receives this data
annually through an electronic data sharing agreement with the DOD.
However, VBA's ability to process these monthly adjustments is
dependent upon a regulation change that would allow an upfront issuance
of due process for military payment adjustments. The regulation change
is currently undergoing legal review as part of VA's internal
concurrence process. We do not have an anticipated date of publication
at this time.
Question 8. What is VA doing to ensure that veterans know their
responsibilities in reporting a change to their status, especially in
complicated circumstance when benefits overlap with other departments,
such as DOD?
Response. A number of measures alert Veterans to report
circumstances that may affect their VA benefits. Benefit decision
letters include paragraphs about the need for beneficiaries to
immediately inform VA of specific situations that could impact their
monthly payments. In December 2017, VA clarified these conditions that
may affect Veterans' rights to continued payment. VA also informs
Veterans of conditions impacting benefits using such forms as VA Form
8764, Disability Compensation Award Attachment Important Information,
and cost-of-living adjustment letters.
In addition, VA has data matching agreements with the Social
Security Administration, Federal Bureau of Prisons, and other Federal
agencies to reduce both the number of individuals receiving dual
benefits contrary to law and the time during which they receive such
benefits. VA also works with these agencies to ensure VA receives
critical data, such as dates of death, dates of incarceration, etc., as
timely and efficiently as possible.
Finally, VA is deploying technological solutions and leveraging
automation to reduce overpayments. For example, in 2016 VA worked with
DOD to automate notifications required when Guardsmen and Reservists
receive both VA compensation and DOD drill pay. This new automation
process improves VA's management of drill pay adjustments.
Question 9. Mr. Burke, The HUD-VASH voucher program helps veterans
escape homelessness through a combination of HUD-funded housing
vouchers and VA supportive services and case management. Since 2010, we
have reduced veterans' homelessness by 47 percent and HUD-VASH has been
instrumental in that progress. In September, the VA decided to take
dedicated HUD-VASH supportive services funds and combine them with
other funding needs in a General Purpose Fund. Housing and veterans'
services organizations in Ohio and across the country are concerned
that this administrative decision will undermine the success of the
coordinated HUD-VASH model and set back our efforts to end veteran
homelessness.
Will the VA reconsider this decision? How do you plan to ensure
that VA will remain ready to support struggling veterans across Ohio?
Response. As of December 7, 2017, the decision to move Special
Purpose Funds to the General Purpose budget is on hold for this fiscal
year (FY). All Special Purpose funding will go through the Veterans
Integrated Services Network (VISN) as previously allocated. VISN 10's
commitment to homeless Veterans in Ohio, and in the other states we
serve will remain strong.
Question 10. Mr. Burke, the Department of Veterans Affairs recently
released its first ``WARNO'' or ``warning order'' jointly with the
Consumer Financial Protection Bureau to notify veterans about VA
mortgage refinance scams. Illegal and misleading advertising for these
products includes claims of lower interest rates or thousands of
dollars in cash back. In reality, borrowers have received much less
cash than they were promised, or the overall balance of their loan has
gone up. According to the CFPB, mortgage refinances accounts for as
much as 14 percent of the complaints submitted to the Bureau by
servicemembers and veterans.
Why is it common for predatory financial firms like these to target
veterans and servicemembers?
Response. Based upon our knowledge concerning advertisements
referred to us by Veterans and Veteran employees, VA believes the
number of lenders engaging in questionable or misleading advertising
practices is small, relative to the total number of lenders approved to
make VA loans. This small group of lenders may view the recent boom in
VA-guaranteed home loans as an opportunity to expand their refinance
lending businesses through solicitation of Veteran borrowers with print
ads. Consequently, these lenders may have targeted Veterans with
mortgages without clear and transparent terms.
VA plans to address churning practices by issuing a proposed
rulemaking. In determining what policy actions to take, VA is
evaluating a range of possible measures--such as net tangible benefit
tests, seasoning requirements, recoupment requirements, and others--and
the effects that the measures might have on Servicemembers' or
Veterans' access to their earned benefits, as well as, the impact on
lenders, servicers, and mortgage investors.
In addition to longer-term measures like regulatory action, VA has
also focused attention on policy changes that can be implemented rather
quickly. On October 12, 2017, Government National Mortgage Association
(GNMA) and VA released a joint statement that addresses lenders whose
patterns of behavior are potentially harming Veterans and/or increasing
risks and costs to our programs. VA and GNMA meet regularly to discuss
areas of concern and potential next steps. GNMA issued additional
guidance on December 7, 2017, to strengthen the seasoning requirements
for GNMA pool mortgage-back securities. In addition, on February 1,
2018, VA issued policy guidance regarding initial and closing
disclosures for IRRRLs to provide Veteran advance notification of the
terms of the refinance. On February 8, 2018, GNMA issued a statement
and worked with VA to release letters to nine lenders who are outliers
among market participants regarding prepayment speeds, and are seeking
corrective action plans from those lenders. (https://www.ginniemae.gov/
newsroom/Pages/PressReleaseDispPage.aspx? ParamID=129).
Question 11. While this is the first ``WARNO,'' has the VA worked
with the CFPB to provide other consumer education and assistance to
veterans?
Response. VA's Loan Guaranty Service (LGY) partners with
stakeholders both inside government and in the private sector to ensure
that Veterans are getting access to the benefits they have earned
through their service to our country. VA's LGY and the Consumer
Financial Protection Bureau (CFPB) collaborate frequently to ensure
Veterans are well-served when shopping for or obtaining a home loan.
Examples of that collaboration is the sharing of data on complaints
received. VA and CFPB are looking at additional messaging through
social media and through their websites.
Question 12. Does the VA work with the CFPB to make sure Ohio
veterans get responses from their banks or lenders if they believe
they've been harmed in some way?
Response. VA does provide information, such as misleading
advertisements, to the CFPB Office of Enforcement and encourages VA
Loan Specialists to refer Veterans to the CFPB complaint line and/or
website. VA works with CFPB on a wide range of issues important to
borrowers using their VA home loan benefit. VA has met with CFPB
officials to discuss topics such as refinancing, lender refinancing
marketing policies and laws, and tools available through CFPB to help
Veteran borrowers determine their financial health and ability to take
out a loan for a home.
Question 13. How does the VA ensure that important consumer
education resources like this are made available to veterans in Ohio?
Have you worked with the Office of Servicemember Affairs directly?
Response. VA has a forward facing website which contains
information about the VA Home Loan Guaranty program. As with the recent
warning order (WARNO), in addition to the CFPB distribution, VA
distributed this document to 1.8 million Servicemembers and Veterans
through a listserv e-mail distribution. VA has 8 Regional Loan Centers
and Loan Guaranty personnel in Honolulu, Hawaii to provide Veterans and
Servicemembers with verbal and written correspondence on how to obtain,
retain, and adapt a home through VA's Home Loan program.
VA collaborated with the Division of Servicemember Affairs on the
CFPB WARNO message. In 2012, VA established a relationship with the
CFPB Division of Servicemember Affairs, which resulted in consistent
communication between the agencies. In 2017, a new Director was
appointed for Servicemembers Affairs and VA renewed its engagement with
the Division and presently meets on a monthly basis.
Question 14. Does the VA have the capacity to make sure veterans
have access to financial education and that their consumer rights are
being protected, or do you think it has been helpful to have the CFPB
dedicated to that task?
Response. VA currently relies on entities such as the CFPB and the
Department of Housing and Urban Development to deliver financial
education and protect consumer rights regarding homeownership. It has
been a tremendous help to have CFPB dedicated to this task with regards
to our Veteran borrowers. The CFPB ``Know Before You Owe'' campaign is
beneficial to all potential homeowners, including Veterans.
Question 15. Mr. Burke, your testimony mentions a social media
campaign to inform individuals of the changes in the Forever GI [sic].
What kind of communication has VA had with defrauded veterans who
attended ITT Tech and Corinthian Colleges regarding the restoration of
benefits since the Forever GI Bill passed?
Response. VA notified approximately 8,000 individuals regarding
their potential eligibility for entitlement restoration, of which,
nearly 6,000 were ITT Tech or Corinthian students. The notification
included an application form to seek restoration of entitlement. As of
December 16, 2017, approximately 400 applications for restoration have
been received, of which 209 have been approved for a total of 1,800
months. In circumstances where VA does not have a beneficiary's email
or an email is undeliverable, VA is sending notifications through
direct mail.
VA created a dedicated webpage (https://benefits.va.gov/gibill/
fgib/ restoration.asp) that speaks specifically to Restoration of
Entitlement. It includes the form that beneficiaries can use to apply
for benefit restoration, and VA is using social media including
Facebook and Twitter to let beneficiaries know that VA can now restore
entitlement and encourage those potentially eligible to apply.
Question 16. Has that included direct email and mail in addition to
social media?
Response. In circumstances, where VA does not have a beneficiary's
email or an email is undeliverable, VA sends notifications through
direct mail.
Question 17. What is the projected timeline for future
communication regarding restoration and when can these veterans expect
to have their GI Bill benefits restored?
Response. This communication effort will remain ongoing as VA is
committed to restoring entitlement to all eligible beneficiaries. VA
will continue to leverage social media platforms and its website to
encourage and instruct those potentially eligible to apply.
Question 18. Dr. Matthews, I have heard from several veterans about
the onerous referral and authorization process for the Veterans Choice
Program. Some veterans saying that it take weeks or months to receive
authorization for an appointment.
Can you walk me through why it might take this long?
Response. After a Veteran has been referred for community care
under the Veterans Choice Program (VCP), the VA staff must ensure the
Veteran understands the process. VA staff members discuss VCP with the
Veteran and offer the option for the Veteran to Opt In. Once a Veteran
has opted in, the referral and supporting medical documentation is
uploaded to the contractor's portal electronically. The contracting
partner then contacts the Veteran to discuss scheduling with the
Veteran, after they have accepted the referral which can take up to two
days after the referral has been uploaded. The contracting partner will
then work with a network provider to obtain an appointment. In certain
circumstances the provider will request to review supporting medical
documentation before an appointment can be given. After an appointment
has been given, the Veteran is notified. This process takes on average
27.2 days from consult to authorization, which is below the 30-day
target.
Question 19. What is VA doing to ensure that the TPAs- Healthnet in
Ohio- don't become a bottleneck in the process?
Response. VHA has taken additional steps to show how the Veteran
experience has improved through streamlined processes. VHA has
implemented 22 total processes and procedures since FY 2015. These have
significantly streamlined or otherwiseimproved processes, and reduced
the burden on Veterans when requesting, scheduling, and receiving care.
VHA links the improvements to the five fundamentals supporting VA care:
Eligibility, Referral and Authorizations, Care Coordination, Community
Care Network, and Provider Payment.
VA nationally deployed a new Operating Model on October 17, 2017.
The model is a key component to the delivery of VA's goal for community
care. It is a standardized model for how resources (people, process,
technology, and data) should be organized within local VA Community
Care departments to enable access and the future state community care
vision. The model clarifies eligibility requirements, builds on
existing infrastructure to develop a high-performing network,
streamlines clinical and administrative processes, and implements a
continuum of care coordination services. The Operating Model is
comprised of the foundational elements of clear roles and
responsibilities, consistent processes, active partnerships,
standardized care coordination, and responsive customer service.
Question 20. Dr. Matthews, Southern Ohio is ground zero in the
opioid epidemic.
How does VA currently educate community providers about VA policy
regarding opioid prescribing and documentation? I have a fear that with
veterans using both VA and community providers there could be a lack of
consistency and accountability in how our veterans are treated within
the system and beyond.
Response. The VA Office of Community Care has developed a training
module for community providers in an online educational system that
provides evidence-based guidelines for prescribing opioids as outlined
in the VA Opioid Safety Initiative (OSI). The module and additional
information are being distributed by thes VA's third party
administrators (TPA) as well as to providers who have contracted
directly with a VA Medical Center (e.g., sharing agreements, affiliate
agreements, and direct contracts). VHA Office of Community Care will
also ensure availability of evidence-based guidelines as outlined in
the Opioid Safety Initiative through online access.
Question 21. Dr. Matthews, building on that last question,
Are there things that you think the VA has done particularly well
in addressing the opioid epidemic that we could replicate across other
programs to address the epidemic more broadly?
Response. OSI by the Department of Veterans Affairs (VA) aims to
reduce over-reliance on opioid analgesics for pain management and to
promote safe and effective use of opioid therapy when clinically
indicated.
OSI was implemented nationwide in August 2013, and is
producing the intended results. The basis for the OSI is to
make the totality of opioid use visible at all levels in the
organization. The OSI includes key clinical indicators such as
the number of VA pharmacy users dispensed an opioid, the number
of VA pharmacy users receiving long-term opioids who also
receive a urine drug screen, the number of VA pharmacy users
receiving an opioid and a benzodiazepine (which puts them at a
higher risk of adverse events) and the average morphine
equivalent daily dose (MEDD) of opioids. Overall, VA has seen a
41 percent reduction in the number of Veterans who have
received opioids for greater than or equal to 90 days.
In order to assist community providers in replicating our
successes through OSI, VA has released a STOP PAIN tool kit
described below.
STOP PAIN stands for:
Stepped Care Model--Adapted from the National Institutes
of Health, this model encourages a continuum of care with effective
monitoring and management of the condition from onset through
treatment. It incorporates self-management through participation in
such groups as Narcotics or Alcoholics Anonymous; counseling; treatment
programs; involvement of primary care; and other medical specialists.
Treatment alternatives/complementary care--Complementary
and Integrative health expands the availability of provider options
beyond the use of standard care in the treatment of chronic pain.
Complementary Health may include such evidence-based treatments as
acupuncture, yoga, and progressive relaxation.
Ongoing monitoring of usage, which relies on multiple
tools for tracking and monitoring individual usage of and risk of
opioid therapy.
Practice Guidelines--Key Clinical Practice Guidelines
updated and utilized in VA for combating the opioid epidemic include
both the VA/DOD Clinical Practice Guidelines for Management of
Substance Use Disorder (SUD) and the VA/DOD Clinical Practical
Guidelines for Management of Opioid Therapy for Chronic Pain. These
guidelines provide clear and comprehensive evidence-based
recommendations for practitioners to minimize harm and increase patient
safety in patients requiring SUD treatment and opioid therapy. They can
be found online at https://www.healthquality.va.gov/guidelines/MH/sud/
and https://www.healthquality.va.gov/guidelines/Pain/cot/. Prescription
monitoring--VA has a number of data sources to allow it to monitor
opioid use to target specific education in real time. The practice
patterns of providers differ, along with the case mixes, so a provider
with relatively high opioid prescribing may have an appropriate
practice, or be someone who could benefit from education. These tools
allow the VA to drill down to the patient level to evaluate use. Other
tools can evaluate the treatment of patient panels and the Veterans
risk of potential abuse. Together, these allow identification of
potential problems, educational targeting, and tracking of progress.
Academic Detailing--The academic detailing program is a
one-to-one peer education program targeted to front line providers. It
gives specific information on practice alternative and resources,
opioid safety, and can compare the practice of the provider to that of
their peers. Veterans have improved pain control as a result of it.
Information about this may be found at: https://www.pbm.va.gov/PBM/
academic detailingservicehome.asp and https://www.pbm.va.gov/PBM/
academicdetailingservice /Pain_and_Opioid_Safety.asp.
Informed consent for patients--VA requires an informed
consent process prior to long-term opioid therapy. This process
includes the risks of opioid therapy, discusses opioid interactions
with other medicines, and reviews safe prescribing practices such as
urine drug screens.
Naloxone distribution--The Opioid Overdose Education &
Naloxone Distribution, has focused on education of providers on
Naloxone distribution to Veterans on long-term opioid therapy.
Question 22. Does VA need any additional authority from Congress to
play a larger role to address this epidemic among veterans?
Response. VA is in constant collaboration with public and private
health care entities to explore and investigate all opportunities to
improve our practices and where applicable apply them to our own
programs. A key example of this is our work on Clinical Practice
Guidelines. VHA, in collaborations with DOD and other leading
professional organizations, has been developing clinical practice
guidelines since the early 1990s. In 2010, the Institute of Medicine
identified VA/DOD as leaders in clinical practice guideline
development.
Implementation of evidence-based clinical practice guidelines is
one strategy VHA has embraced to improve care by reducing variation in
practice and systematizing ``best practices.'' Guidelines address
patient cohorts, serve to reduce errors, and provide consistent quality
of care and utilization of resources throughout and between the VA and
DOD health care systems. Guidelines are also cornerstones for
accountability and facilitate learning and the conduct of research.
Question 23. Mr. McDivitt, a common issue I hear from veterans is
the inconsistent information and quality of care they receive from
different VA medical facilities.
How do you ensure consistent, quality care and services across VSN
10 facilities?
Response. As a healthcare enterprise, we work from all points of
patient care and services to the VISN office to ensure the delivery of
the highest quality care to Veterans. Components include, but are not
limited to the following:
Quality Management Systems and Internal Controls
Continuous improvement, redesign, systems engineering and
efficiency management
Patient Safety
Internal and External Reviews
Utilization Management
Risk Management
Performance Measurement and Evaluation
Veteran and family engagement, activation, satisfaction
and transparency
Credentialing and Privileging
Environment of Care Safety and Engineering
Each of these components is operationalized at the facility and
VISN levels to maximize outcomes for Veterans. As a VA health care
system, ``VA hospitals had better outcomes than non-VA hospitals for 6
of 9 patient safety indicators. There were no significant differences
for the other three indicators. In addition, VA hospitals had better
outcomes for all mortality and readmission metrics.'' (Atkins, David,
Clancy, Carolyn, Advancing High Performance in Veterans Affairs Health
Care. JAMA, Nov 2017. Volume 318, Number 19, 1927, 1928P). VISN 10 has
a robust system of continuous improvement efforts monitored locally,
regionally and nationally.
We are considered a 5 Star VISN (on a 5 Star system called SAIL, a
compendium of patient outcome measures) which is the highest rating
obtainable. We excel in the following outcomes: patient safety (low
rate of complications), standardized mortality rate, mental health
population coverage. The Joint Commission performance outcomes,
Registered Nurse turnover and call responsiveness. We work at all
levels of the organization to ensure consistency; compliance and
excellence; and have robust systems in place to monitor and support
staff to achieve the best outcomes for Veterans. We seek Veteran input
and use it to improve quality of care and Veteran outcomes throughout
the VISN. VISN 10 has a Veteran representative on the Executive
Leadership Board who is active, engaged and passionate about improving
outcomes to Veterans.
Question 24. What is your process for identifying and expanding
best practices from one facility to others?
Response. Fortunately, the VISN 10 network has a strong, well-
established system of sharing and spreading strong practices. We
sponsor workgroups where outstanding outcomes are highlighted and
shared openly, as well as committees that spread strong practices
throughout the system. We openly share best practices at the Executive
Leadership Board that are subsequently spread throughout the system. A
recent example of shared strong practices includes our medication
reconciliation process. Additionally, we have a strong mentoring
process that allows leaders to openly share their experiences with
newer facility leaders
Question 25. Mr. McDivitt, veterans have brought to me their
concerns over VA hiring practices, specifically the medical staff
shortages.
What methods do you use to anticipate employee shortages?
Response. Each facility has a resource management forum that
includes executive leadership and service chiefs. All resources are
discussed in the context of immediate critical, clinical needs, future
vacancies, and supply and demand for resources, new development,
retention and attrition. Critical, clinical needs are highly
prioritized and strategies to recruit and retain these positions are
developed and executed. We have had some issues in rural areas of the
VISN, as well as some medical sub-specialty areas, and as such have
aggressively implemented telehealth strategies throughout the network.
Additionally, when the demand for services exceeds our capacity we have
coordinated care in the community for Veterans in need. Methods to
recruit and retain staff include, but are not limited to, recruitment
and retention bonuses, education payback and incentives, active,
engaged workforce and environment and a shared governance model. Our
dedicated staff is passionate and committed to the mission, often
attracting and recruiting their peers and colleagues from outside of
the VA health care system.
Question 26. Have these strategies proven to be accurate when
forecasting vacancies for critical positions across the VISN?
Response. The process is generally accurate for forecasting
vacancies, but does not resolve the issues related to the scarcity of
providers, specifically certain specialties in some areas of the VISN.
Operating as a large network with telehealth capacities has helped with
the supply and demand issues raised by a scarcity of candidates. The VA
is not allowed to be the highest payor, but offers a highly competitive
salary and benefits package which can be enticing to potential
candidates.
Question 27. How do you ensure that VA remains a competitive work
environment that retains talented medical professionals? The last thing
we want to do for our veterans is to push bright, accomplished workers
out of the agency meant to help vets the most.
Response. Retention is critical to the maintenance of a dedicated,
passionate workforce. Numerous mechanisms are in place to foster
retention including retention incentives, repayment of educational
debts, and an engaged workforce using a shared governance model.
In the event an employee chooses to leave VA, we conduct a
comprehensive exit interview. These interviews track and trend reasons
for employees leaving and help us strengthen our resources and
commitment to each and every employee.
There are many educational and advancement opportunities within the
VA. Many leaders within the VA started at entry-level positions and
through education and experiences have become service, facility, and
network level leaders.
Question 28. How many Ohio vets will have their GI Bill benefits
restored as a result of the Forever GI bill? Please provide my office
with updated numbers, disaggregated by institution, of veterans and
their families from Ohio who will be eligible for GI Bill benefits
restoration in light of the Forever GI bill.
Response. For the Special Application provision VA has identified
three Ohio schools where students are eligible for restoration as
follows:
------------------------------------------------------------------------
Number of
Name of School students
------------------------------------------------------------------------
Brown Mackie College-North Canton........................... 12
Miami-Jacobs Career College-Sharonville..................... 1
Sanford Brown College....................................... 3
------------------------------------------------------------------------
This number does not include beneficiaries who may have resided in
Ohio, and attended a school that closed out of state or online.
Question 29. Mr. Worley, Forever GI Bill will allow the restoration
of Post-9/11 GI Bill benefits to veterans who were impacted by schools
that closed from 2015 until the date of enactment.
What will happen to veterans' GI Bill benefits if vets are using
their benefits and their school closes suddenly in the future?
Response. The Forever GI Bill provisions in Section 109 allow
restoration of entitlement for VA students if a school closes from date
of enactment (August 16, 2017) and continues into the future. This
means that VA will not make a charge against a student's entitlement
for the portion of the period that the student did not receive credit
toward a program (or lost training time toward the completion of a
program). For example, if a student was enrolled in a semester full-
time, and the school closed 60 days after the semester started, the
student would have used two months of their entitlement. VA will
restore those two months allowing the student to use them at another
time.
Additionally, for school closings on or after August 16, 2017, VA
may continue the housing allowance for Post-9/11 GI Bill students
beyond the date of closure up to the end of the term, quarter or
semester, not to exceed 120 days. The law requires VA begin making
housing allowance payments on August 1, 2018. No charge to a student's
entitlement will be made for the extended period of eligibility for
housing allowance.
Question 30. Are they currently eligible for benefits restoration?
Response. Yes, the restoration of entitlement provisions in the
Forever GI Bill took effect 90 days after the date of the enactment
(August 16, 2017), and apply retroactively to school closures on or
after January 1, 2015.
Question 31. Mr. Worley, the Forever GI Bill allows for additional
funding for State Approving Agencies and instructs SAAs to include
risk-based surveys in their oversight tasks.
How can strong oversight from SAAs protect veterans pursuing their
education?
Response. Strong oversight by the State Approving Agencies (SAAs)
helps protect Veterans in several ways. First, oversight ensures
approved programs meet all statutory approval criteria in 38 U.S.C.
chapter 36, as well as any individual state requirements the SAAs used
in their assessment to initially approve a course for Veteran's
training.
Second, SAAs are familiar with the responsibilities of School
Certifying Officials (SCO's). SCOs certify students' enrollments to VA
to ensure proper payment of benefits. Through oversight, SAAs can
identify out of line situations that require additional training that
VA or SAAs can provide, ensuring VA students are certified properly for
payment, are in courses necessary for completion of their program, and
that appropriate credit has been granted for their prior training. In
that oversight review, the SAA may identify violations that could
result in disapproved programs.
Finally, using information VA obtains from students through VA's GI
Bill complaint system, SAAs can conduct an immediate risk-based
unscheduled school visit to resolve issues, or assess potential
violations that may require program disapproval or suspension of VA
student enrollment. The following are areas of focus in the complaint
system:
------------------------------------------------------------------------
Recruiting/Marketing Practices Quality of Education
------------------------------------------------------------------------
Accreditation............................. Grade Policy
Financial Issues (e.g. Tuition/Fee Release of transcripts
charges).
Student Loans............................. Transfer of Credits
Post-Job Opportunities.................... Other (as identified by
student)
------------------------------------------------------------------------
The SAAs assisting in oversight visits for approval compliance,
reviews of SCO reporting, and conducting risk based surveys helps
ensure VA students are in proper programs for their educational
objective, and receive proper payment. The SAAs strong oversight also
assists by identifying and resolving issues. The VA's GI Bill complaint
system is an important tool for early detection of potential problems.
Question 32. Mr. Worley, I know I would like to see the 90/10
loophole closed to crack down on for-profit colleges and universities
using abusive and deceptive practices to recruit veterans,
servicemembers, and their families. That is why I reintroduced the
Military and Veterans Education Protection Act this year.
Are there other improvements to the GI Bill, not included in the
Forever GI that would help VA better serve veterans pursuing higher
education?
Response. While VA defers to the Department of Education on the 90/
10 rule, the FY 2019 President's Budget contains two proposals that
would help VA better serve Veterans pursuing higher education. The
first proposal would amend title 38 U.S.C. section 3313(c) and add a
new section (j) to impose tuition and fee payment caps at institutions
of higher learning offering flight training programs and establish a
maximum allowable fee structure for all VA-funded flight programs.
Savings for this proposal are estimated to be $43 million in 2019, $230
million over five years, and $540 million over ten years. The second
proposal would amend 38 U.S.C. section 3002(3)(B), to add a preparatory
course for a test that is required to enter into, maintain, or advance
in a given vocation or profession. Costs are estimated to be $1 million
in 2019, $7 million over five years, and $16 million over 10 years.
Question 33. What kind of oversight efforts has VA anticipated
needing to ensure that new offerings from Forever GI, including the
STEM Scholarship and the High Tech pilot program, are actually serving
veterans?
Response. The Department is actively reviewing, planning, and
preparing for implementation of these two Colmery Act sections in 2019.
This includes hiring additional temporary full-time employees to
support standing these initiatives up, processing related claims, and
providing the necessary oversight to ensure statutory requirements are
met.
A P P E N D I X
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Prepared Statement of Benjamin Fitzgerald, Veteran, Westlake, OH
I truly appreciate Senator Brown for inviting me to talk on behalf
of veterans, like myself, about topics of discussion concerning Veteran
Affairs.
Today I want to highlight some of the questions and concerns that I
have heard while working as a VA Work/Study at Cuyahoga Community
College, and through Team RWB Cleveland, Akron, and Columbus Chapters.
One of the biggest concerns is the transition from military to
civilian lifestyle. When processing out there is so much on your mind,
and there are only a few hours that you have learning about benefits,
and addressing concerns, during this transition. It can become quite
confusing, stressful, and exciting all at the same time. Knowing this,
when we return home, you forget what was available to you . . . and it
happens very easily. I will say however, that Team RWB, a nonprofit
veterans organization, whose mission is to enrich the lives of Veterans
through Exercise, Volunteer work, and social interaction, has been the
greatest thing I have the pleasure to be a part of since coming out of
service 9 years ago.
I joined the Cleveland Team about a year and a half ago now, and
I've never felt more at home. The Team greeted me with open arms, and
as fellow veterans, that comradery and sense of understanding made me
feel at home. What's even better, is the team consist of civilian
members as well, and with their help, we are able to bridge that gap
between those who serve, have served, and the civilian population. The
problem is, I didn't even know about Team RWB until 7.5 years after I
had already got out. In fact, other than the GI Bill, which we
appreciate Senator Brown making the Forever GI Bill, I had no idea so
much was available for veterans and their families.
Next, and quickly, I want to see if there is a solution where our
medical records aren't taking up to a year to get from our perspective
Regional Center's?
Though there are more questions and concerns, which I hope will be
brought up, I truly appreciate your time, and allowing me to speak on
behalf of my brothers, sisters, and myself. Thank you!
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