[Senate Hearing 115-616]
[From the U.S. Government Publishing Office]
S. Hrg. 115-616
HEARING ON PENDING LEGISLATION
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
AUGUST 1, 2018
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
___________
U.S. GOVERNMENT PUBLISHING OFFICE
34-881 PDF WASHINGTON : 2019
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
Robert J. Henke, Staff Director
Tony McClain, Democratic Staff Director
Majority Professional Staff
Adam Reece
Gretchan Blum
Leslie Campbell
Patrick McGuigan
Maureen O'Neill
David Shearman
Jillian Workman
Minority Professional Staff
Dahlia Melendrez
Cassandra Byerly
Jon Coen
Steve Colley
Simon Coon
Michelle Dominguez
Amy Smith
C O N T E N T S
----------
August 1, 2018
SENATORS
Page
Isakson, Hon. Johnny, Chairman, U.S. Senator from Georgia........ 1
Brown, Hon. Sherrod, acting Ranking Member, U.S. Senator from
Ohio........................................................... 2
Boozman, Hon. John, U.S. Senator from Arkansas................... 20
Sanders, Hon. Bernard, U.S. Senator from Vermont................. 29
Manchin, Hon. Joe, III, U.S. Senator from West Virginia.......... 31
Cassidy, Hon. Bill, U.S. Senator from Louisianna................. 36
Hirono, Hon. Mazie K., U.S. Senator from Hawaii.................. 38
Sullivan, Hon. Dan, U.S. Senator from Alaska..................... 40
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 45
WITNESSES
Peters, Hon. Gary C., U.S. Senator from Michigan................. 3
Gillibrand, Hon. Kirsten E., U.S. Senator from New York.......... 4
Prepared statement........................................... 5
Daines, Hon. Steve, U.S. Senator from Montana.................... 6
Lawrence, Paul R., Ph.D., Under Secretary for Benefits, Veterans
Benefits Administration, U.S. Department of Veterans Affairs;
accompanied by Ralph Erickson, M.D., M.P.H., Dr. PH, Chief
Consultant, Post-Deployment Health, Veterans Health
Administration, Tammy Czarnecki, Assistant Deputy Under
Secretary for Health/Administrative Operations, Veterans Health
Administration; and Jessica Bonjorni, Acting Assistant Deputy
Under Secretary for Health for Workforce Services, Veterans
Health Administration.......................................... 8
Prepared statement........................................... 10
Additional views............................................. 26
Response to request arising during the hearing by:
Hon. Johnny Isakson........................................ 27
Hon. Mazie K. Hirono....................................... 40
Response to posthearing questions submitted by:
Hon. John Boozman.......................................... 47
Hon. Sherrod Brown......................................... 47,50
Hon. Joe Manchin III....................................... 48
Hon. Mazie K. Hirono....................................... 49
Nuntavong, Chanin, Director, National Veterans Affairs &
Rehabilitation Division, The American Legion................... 54
Prepared statement........................................... 56
Manar, Gerald T., Blue Water Navy Veteran, Former Director,
National Veterans Service, Veterans of Foreign Wars of the
United States.................................................. 69
Prepared statement........................................... 71
Snee, Thomas J., National Executive Director, Fleet Reserve
Association.................................................... 77
Prepared statement........................................... 79
Weidman, Rick, Executive Director for Policy and Government
Affairs, Vietnam Veterans of America........................... 81
Prepared statement........................................... 83
APPENDIX
Cantwell, Hon. Maria, U.S. Senator from Washington; prepared
statement...................................................... 91
Feinstein, Hon. Dianne, U.S. Senator from California; prepared
statement...................................................... 91
Advanced Medical Technology Association (AdvaMed); prepared
statement...................................................... 92
Appraisal Institute (AI); letter................................. 94
Webb, Amy, National Legislative Policy Advisor, American Veterans
(AMVETS); prepared statement................................... 95
McClain, Hon. Tim S., Chairman, Board of Directors and James
Lorraine, President & CEO, America's Warrior Partnership (AWP),
Augusta, GA; prepared statement................................ 100
Johnson, Cinthia, Interim Executive Director, Connecticut
Veterans Legal Center (CVLC); prepared statement............... 103
Villanueva, Jeremy M., Associate National Legislative Director,
Disabled American Veterans (DAV); prepared statement........... 109
U.S. Department of Defense (DOD); prepared statement............. 119
Denton, Ivan, Director, Office of National Programs, Veterans'
Employment and Training Service, U.S. Department of Labor
(DOL); prepared statement...................................... 123
Mortgage Bankers Association (MBA); prepared statement........... 129
Military Officers Association of America (MOAA); prepared
statement...................................................... 133
Military Order of the Purple Heart (MOPH); prepared statement.... 138
Wells, CDR John B., USN (Ret.), Executive Director, Military-
Veterans Advocacy (MVA); prepared statement.................... 139
Mendenhall, Elizabeth J., 2018 President, National Association of
REALTORS (NAR); letter........................................ 145
Murphy, Sharon L., President, National Association of State
Veterans Homes (NASVH); prepared statement..................... 146
Stewart, Joshua, Director of Policy, National Coalition for
Homeless Veterans (NCHV); letter............................... 147
Co-Directors, National Military and Veterans Alliance (NMVA);
letter......................................................... 149
Paralyzed Veterans of America (PVA); prepared statement.......... 150
Augustine, Ms. Lauren, Vice President of Government Affairs,
Student Veterans of America (SVA); prepared statement.......... 155
Tragedy Assistance Program for Survivors (TAPS); prepared
statement...................................................... 159
Bandzul, Thomas, Esq. Legislative Counsel, Veterans & Military
Families for Progress (VMFP); prepared statement............... 161
Bardorf, Rene C., Senior Vice President of Government and
Community Relations, Wounded Warrior Project (WWP); prepared
statement...................................................... 164
HEARING ON PENDING LEGISLATION
----------
WEDNESDAY, AUGUST 1, 2018
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 2:32 p.m., in
room 418, Russell Senate Office Building, Hon. Johnny Isakson,
Chairman of the Committee, presiding.
Present: Senators Isakson, Boozman, Heller, Cassidy,
Tillis, Sullivan, Sanders, Brown, Blumenthal, Hirono, and
Manchin.
OPENING STATEMENT OF HON. JOHNNY ISAKSON,
CHAIRMAN, U.S. SENATOR FROM GEORGIA
Chairman Isakson. Good afternoon. I call this meeting of
the Senate Veterans' Affairs Committee to order.
This is a hearing on legislation that will be pending
before the U.S. Senate at some point in time in the future, in
some cases the near future. I have had conversations with the
authors before and told them that we would have a hearing as
early as I could have one so we could get the preliminary
information out there. I appreciate everybody who is here today
from both the Senate and the members of the VA, plus VA staff
and the advisory committees.
We have a full agenda. We have 15 pieces of legislation to
address. We have two panels with four speakers each. We have a
number of big issues, but probably no bigger than the Blue
Water Navy issue, which has come up for some time in the past.
The House has passed a Blue Water Navy bill. Senator Gillibrand
and others in the Senate have asked me if we are going to
consider one in the U.S. Senate Veterans' Affairs Committee. I
said we are going to, but we are going to do it in regular
order. That is the way we did everything. We had some big
issues last year which we were able to get through, like the
Caregivers' bill, which had never gotten out of this Committee
before because of the way we handled it, which is the reason we
got it out.
I know from time to time I irritated some people during the
last couple of months by being deliberate, not slow but
deliberate, on the way we handled that. We will handle it the
same way this year in terms of Blue Water Navy, and I think we
will come out with a similar result in terms of a thorough
examination of the legislation.
This is all very important legislation. For everybody's
knowledge, we passed in the last 18 months 18 pieces of
legislation to reform the Veterans Administration. Every Member
of this Committee has had significant input into those reforms,
had a lot to say about them.
We have a new Secretary of the VA, Robert Wilkie, whom you
heard from when we had our hearing, who I was with Monday with
the President for the swearing in. He is a great individual, a
fine individual, and someone who is known to all of you that
are here. I know he will do a great job.
My opening statement is this: Be ready. Fasten your seat
belts. We have got a lot of work to do, and today is to find
out what the authors of the legislation want us to know about
the bills they have proposed and for the people who will be
affected to have testimony and input on that.
Each one of the Senators who are here, Mr. Peters, Mr.
Daines, and Ms. Gillibrand, will speak first and will be
welcome to leave as soon as your speech is over. You do not
have to, but I know you are busy and got other things to do, so
you are welcome to do that.
I am proud to recognize Sherrod Brown, my good friend from
the great State of Ohio, a good baseball State, and he, a good
baseball player. Senator Brown is filling in for Jon Tester,
our ranking member. We got out early today, as many of you
know, and Senator Tester had to leave town early, as I
understand it. I appreciate his tremendous help and cooperation
over the last year and a half. He has pledged it for the
remainder of this term as well. We are going to have a great
time together in this Committee, and we need to get good stuff
done.
So, Senator Brown?
OPENING STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown. I will be brief, Mr. Chairman. I would add
on behalf of everybody on this Committee that Johnny Isakson is
the least irritating member of the U.S. Senate. [Laughter.]
I think you would all agree with that. I think we all are
an irritating group of people, by and large, and he is not. So,
thank you, Johnny, for that.
Senators Daines, Gillibrand and Peters, thank you for
joining us, and I speak on behalf, in part, Senator Daines, of
the senior Senator, for Senator Tester.
Thanks for holding the hearing, Mr. Chairman.
There are two specific bills that I am interested in: (1)
Better Access to Technical Training, Learning, and
Entrepreneurship for Servicemembers Act, or BATTLE for
Servicemembers Act that I have worked on with Senator Rounds,
and I thank him; and (2) the Blue Water Navy bill, which is so
important. This Committee will review two different pieces of
legislation to address the needs of active-duty servicemembers
as they transition to civilian life. We need to do everything
we can to ensure they have the information and tools they need
to succeed. Additional days of training to pursue education,
technical training, entrepreneurship will help to set
servicemembers up for good-paying jobs when they reenter
civilian life, and I was pleased that this year's NDAA that
Senator Isakson was so helpful on, too, included a version of
this provision in the final conference report.
I will not be able to stay for the second panel's
discussion, but I wanted to say a few words about Blue Water
Navy veterans. I appreciate Thomas Snee being here from Lake
County, OH. I appreciate very much seeing him today. He knows
all too well, we all do, the energy it takes to push the VA to
do the right thing by those who have borne the battle,
particularly those who were drafted to fight and felt forgotten
when they returned home, only to develop conditions directly
tied to their service.
Our Vietnam vets, many of them, many of you, do not have a
lot of years left, and it is important that they get these
benefits regardless of whether they served on the land, in the
Brown Water, or in the Blue Water. It does not matter.
Mr. Manar will speak in a moment. I want to quote from him,
if I could sort of a little bit steal his thunder with this
quote: ``If there was dioxin in the water, we would have been
exposed to it while swimming. Week after week, patrolling up
and down the coast, we took in sea water and processed it
through our fresh water evaporator system. We know from the
Australian Navy study, validated by the National Academy of
Medicine. . . that fresh water evaporator systems concentrated
toxic material, including dioxin, which was then transmitted to
sailors through drinking water.''
``As a matter of observation,'' he goes on, ``absent the
cleaning and sanitation of the entire fresh water evaporator
system, it is conceivable that every person who ever served on
board my ship could have been exposed to dioxin after its first
visit to Vietnam. Further, by the time we completed our last
deployment. . . in 1972, the evaporator system would have
accumulated concentrated dioxin from dozens of visits to
Vietnam, not simply the final three that I experienced while on
board.''
Nobody could have said that better. My question for the
record will be: why hasn't the VA concluded that the science
behind the Australian study, in which NAM collaborated, is
sufficient? Why hasn't VA done right by our veterans?
So, Mr. Chairman, thank you for letting me offer those
words. And, I appreciate all the panel members being here.
Chairman Isakson. Thank you, Senator Brown. Thank you for
being here, and thank you for your opening statement.
Our first panel is made up of Senator Peters, Senator
Gillibrand, and Senator Daines. Senator Peters will be
recognized for 5 minutes, Senator Gillibrand for 5 minutes. I
understand you are going to yield some time, is that correct,
to Senator Daines, Senator Gillibrand? [Both nodding in
agreement.]
We will start with Senator Peters. You are recognized for 5
minutes. If it gets to 7 or 8, you are in trouble.
STATEMENT OF HON. GARY C. PETERS,
U.S. SENATOR FROM MICHIGAN
Senator Peters. I will be brief, Mr. Chairman.
Thank you, Mr. Chairman, and thank you to all my colleagues
for your service on this Committee. I certainly appreciate the
opportunity to speak in support of Senate bill 1596, which is
entitled the ``BRAVE Act.'' I was proud to introduce this
bipartisan legislation with Senator Rubio.
The BRAVE Act is a bicameral piece of legislation, and I
also appreciate the leadership of Representative Duncan Hunter,
who is shepherding this bill in the House of Representatives.
Our brave men and women in uniform have sacrificed so much
in the defense of our Nation. We owe it to them to ensure that
they receive the benefits that they have earned through their
service, including a dignified burial. Unfortunately, current
VA burial benefits are woefully insufficient.
The national median cost of a funeral in 2017 was $8,755.
However, the VA burial benefits provide a mere $2,000 for
service-connected deaths, $762 for non-service-connected deaths
for veterans who pass away in a VA facility, and $300 for all
non-service-connected deaths.
It is clear that these benefits have not kept pace with the
rising cost of funeral and burial expenses, which is why
Senator Rubio and I have introduced the BRAVE Act. The BRAVE
Act will make funeral benefits for non-service-connected deaths
the same, regardless of where the veteran passes away.
The legislation also ensures that all burial benefits are
indexed for inflation, eliminating the need for Congress to
make further readjustments and providing future generations of
our Nation's veterans with the dignified burial that they have
earned through their honorable service.
The BRAVE Act enjoys support from organizations including
the Veterans of Foreign Wars, Vietnam Veterans of America, the
National Funeral Directors Association, the Association of the
U.S. Navy, The American Legion, and Disabled American Veterans.
I believe we should honor our Nation's heroes by making
commonsense updates to VA burial benefits, ensuring that every
veteran has a proper funeral and burial no matter the
circumstances at the end of their lives.
Thank you again, Mr. Chairman and the Committee, for the
opportunity to speak today, and I look forward to working with
you as you pass this important legislation. I yield the rest of
my time to the Senator from New York, Senator Gillibrand.
Chairman Isakson. Senator Gillibrand, you are recognized
for 5 minutes plus whatever he yielded to you.
STATEMENT OF HON. KIRSTEN E. GILLIBRAND,
U.S. SENATOR FROM NEW YORK
Senator Gillibrand. Thank you so much, Mr. Chairman and Mr.
Ranking Member. I am very grateful for your leadership. I am so
grateful for this hearing--we really want to support our Blue
Water Navy veterans--and for your commitment to finally passing
this long overdue bill.
It is my sincere hope that now that we have an offset that
has been identified and passed in the House, 382-0, that we may
also quickly pass this bill and send it to President Trump as
expeditiously as possible.
As you know, during the Vietnam War, thousands of patriotic
Americans were exposed to the chemical Agent Orange, which we
now know is highly toxic. Some of our veterans were exposed to
Agent Orange on the ground, some patrolling rivers, some while
stationed on ships off the Vietnamese coast. These are called
the ``Blue Water Navy vets.''
Now, all these years later, Agent Orange has made many of
them very sick, many of them severely ill, and many of them
have already died because of Agent Orange. But, the VA is only
helping some of the veterans exposed to this dangerous
chemical. They are helping the Vietnam veterans who were
exposed to Agent Orange on land or on rivers, but excluding
those who served on the Blue Water. It does not make any sense.
It is arbitrary. It is a bureaucratic rule that is preventing
veterans who served in Vietnam from getting the treatment they
desperately need.
In Congress, we have been fighting for this legislation for
nearly a decade so that the VA could just deliver the benefits
that these men and women have already earned. With today's
markup, we are finally there. Thanks to the tireless effort of
both members of the House and Senator Veterans' Affairs
Committees, we have a bipartisan bill, and we have a bipartisan
pay-for.
Now, I want to address the pay-for because that is
important to a lot of our colleagues. The offset is nearly $1
billion to care for our Blue Water Navy veterans, their
families, and for some, their survivors. The way we pay for it
is from the VA Home Loan Program because it provides a home
loan guarantee benefit to help servicemembers, veterans, and
surviving spouses who become homeowners. Private lenders
provide VA home loans, but the VA guarantees a portion of that
loan, enabling veterans to receive more favorable terms.
Now, these loans are different from those that are offered
to nonveteran civilian populations. Instead of paying annual
fees or interest on the loan, the veteran only pays a one-time
up-front loan fee. Currently that fee is 0.25 percent lower if
you are active-duty versus National Guard or Reserve. All this
bill does is equalize that number at 2.4 percent. It pays for
the entire bill. It passed unanimously in the House of
Representatives.
So, I hope that our Senate colleagues can look at this pay-
for favorably and allow this bill to be fully paid for to help
our veterans.
Now, our Blue Water Navy veterans have waited a very long
time for basic health care and basic benefits they have already
earned. They have suffered consequences to their health, to
their families, to their lives. I think this is an injustice
that we can and must rectify, and I think we can do it in this
Congress. So, I ask all of you to please consider this bill
since it has had such bipartisan favorable response in both the
House and Senate. I think the time is now to actually pass it.
I would now like to yield the remainder of my time to my
colleague Senator Daines.
[The prepared statement of Sen. Gillibrand follows:]
Prepared Statement by Hon. Kirsten Gillibrand,
U.S. Senator from New York
blue water navy vietnam veterans act of 2017
Chairman Isakson and Ranking Member Tester, Thank you for the
opportunity to speak again before this Committee in support of the Blue
Water Navy Vietnam Veterans Act of 2017--and for your commitment to
finally passing this long overdue bill. It is my sincere hope that now
that an offset has been identified and passed the House 382 to ZERO,
that we may also quickly pass this bill and send it to President Trump
as expeditiously as possible.
As you know, during the Vietnam War, thousands of patriotic
Americans were exposed to a chemical called Agent Orange, which we now
know is highly toxic.
Some of our veterans were exposed to Agent Orange on the ground.
Some of them were exposed to Agent Orange while patrolling the rivers.
And some of them were exposed to Agent Orange while they were stationed
on ships off the Vietnamese coast--these are the Blue Water Navy
veterans.
And now, all these years later, Agent Orange has made many of them
sick. They are severely ill. Many of them have already passed away
because of Agent Orange.
But, the VA is only helping SOME of the veterans exposed to this
dangerous chemical. They're helping the Vietnam veterans who were
exposed to Agent Orange on land, or on rivers . . . but NOT the Blue
Water Navy veterans. That doesn't make any sense.
This arbitrary, bureaucratic rule is preventing veterans who served
in the Vietnam War from getting the treatment they need now.
In Congress, we have been fighting for nearly a decade to deliver
VA healthcare and benefits to the Blue Water Navy veterans exposed to
Agent Orange. And with today's markup of H.R. 299, we are finally
there. Thanks to the tireless efforts of both the House and Senate
Veterans' Affairs Committees, we have a bipartisan bill and a pay-for.
I think it is important, in this hearing, that we directly address
the pay-for in H.R. 299 that will offset the nearly $1 billion cost of
caring for our Blue Water Navy veterans, their families, and--for
some--their survivors.
The VA Home Loan program provides a home loan guaranty benefit to
help servicemembers, veterans, and eligible surviving spouses become
homeowners. Private lenders provide VA home loans, but the VA
guarantees a portion of the loan, enabling veterans to receive more
favorable terms.
These loans are different from those offered to the non-veteran,
civilian population. Instead of paying annual fees or interest on the
loan, the veteran only pays a one-time, up-front loan fee at the
initiation of their loan.
Currently, the rate of this fee is 0.25% lower if you are active
duty than if you are in the National Guard or Reserve. This bill would
equalize the rate at 2.40%.
I believe our colleagues in the Senate will agree with the
unanimous, bipartisan consensus in the House--that this pay-for is
appropriate and measured. The VA Home Loan program will remain a
powerful, unparalleled tool to help America's veterans become
homeowners, and the rates will remain far better than rates in the
private market.
Our Blue Water Navy veterans have waited far too long for the
healthcare and benefits owed to them. They've suffered health
consequences that left them and their families on the hook for medical
expenses that our government should have provided. Many have lost their
lives. This is an injustice we can--and must--address here in this
Congress.
I ask that each of you here vote today to move H.R. 299 out of
committee without changes or delay--so that our Nation can do right by
our veterans and their families as quickly as possible.
And now I'd like to yield to my colleague and lead cosponsor of
this legislation, Senator Daines.
Chairman Isakson. Senator Daines.
STATEMENT OF HON. STEVE DAINES,
U.S. SENATOR FROM MONTANA
Senator Daines. Chairman Isakson and Ranking Member Tester,
thank you for allowing us to be here today to testify at this
hearing.
I am the lead Republican on this bill, and I want to thank
my colleague and friend Senator Gillibrand for her leadership.
I urge the Committee to pass this critical bipartisan measure.
Since 2002, our U.S. Navy veterans who were exposed to
Agent Orange while serving in Vietnam have been denied proper
care through the VA. As background, you have to go back to the
Agent Orange Act of 1991, 27 years ago. That bill passed
unanimously by both Houses of Congress, and it extended
presumptive health care coverage for all illnesses linked to
Agent Orange.
Here is the problem: The VA thwarted congressional intent
by choosing the narrowest possible definition of ``service in
the Republican of Vietnam,'' which excluded the country's
territorial waters. Our Federal records show, the science shows
a documented 19 million gallons of herbicide was sprayed over
Vietnam between 1962 and 1971. No reasonable person would
conclude that the runoff from these powerful chemicals was
contained just to the shoreline.
I am encouraged by the recent action our colleagues in the
House have taken and the growing bipartisan push here in the
Senate to correct, frankly, a senseless disparity once and for
all. I urge this Committee to take a critical step toward that
end today.
Chairman Isakson. Thank you very much, Senator Daines. I
think we go to questions and answer on the first panel.
I am trying to exercise executive privilege over here. Just
a second. I will be right back to you. [Pause.]
The staff tells me I am out of order. [Laughter.]
That is not the first or would be the last time. Senator
Daines, thank you for coming.
Senator Daines. Thank you, Mr. Chairman.
Chairman Isakson. Ms. Gillibrand, thank you very much for
your comments.
Senator Gillibrand. Thank you all. Thank you for the time.
Chairman Isakson. Senator Peters has already left. I thank
him very much.
The first panel, which I will introduce right now, is
coming forward. Panel number 1 is Paul Lawrence, Ph.D., Under
Secretary for Benefits, Veterans Benefits Administration,
Department of Veterans Affairs.
Ralph Erickson will be accompanying him. Ralph is a doctor,
Chief Consultant, Post-Deployment Health, Veterans Health
Administration.
Tammy Czarnecki is Assistant Deputy Under Secretary for
Health/Administrative Operations, Veterans Health
Administration.
And, Jessica Bonjorni--I hope you are Italian; that would
be great--is Acting Assistant Deputy Under Secretary for Health
for Workforce Services, Veterans Health Administration.
Will you all please come forward and take your seats? Thank
you very much for being here. This is an important panel, and I
will get to ask you all questions. Just because the Senators
dodged the bullet, you all will not be able to.
We will start with Ms. Bonjorni--no, I am sorry. You are to
be an acting aide. You are not going to be the main presenter.
That is correct. I almost got you in trouble, too.
Mr. Lawrence, you are on. You have 5 minutes, but if you
take a little extra time because of the complexity of a couple
of these issues, that will be fine with me.
STATEMENT OF PAUL R. LAWRENCE, Ph.D., UNDER SECRETARY FOR
BENEFITS, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF
VETERANS AFFAIRS; ACCOMPANIED BY RALPH ERICKSON, M.D., M.P.H.,
DR. PH, CHIEF CONSULTANT, POST-DEPLOYMENT HEALTH, VETERANS
HEALTH ADMINISTRATION; TAMMY CZARNECKI, ASSISTANT DEPUTY UNDER
SECRETARY FOR HEALTH/ADMINISTRATIVE OPERATIONS, VETERANS HEALTH
ADMINISTRATION; AND JESSICA BONJORNI, ACTING ASSISTANT DEPUTY
UNDER SECRETARY FOR HEALTH FOR WORKFORCE SERVICES, VETERANS
HEALTH ADMINISTRATION
Mr. Lawrence. Thank you very much, sir. Good afternoon,
Chairman Isakson, Ranking Member Sanders, and Members of the
Committee. Thank you for inviting us here today to present our
views on several bills that would affect the Department of
Veterans Affairs. You generously introduced our panel, so I
will not repeat their names.
With 15 bills on the agenda, I will cover a few in my oral
statement.
We are glad to support the bill to provide grants to
coordinate suicide prevention efforts for veterans in our
communities. There is no bigger or more urgent priority for VA.
Other bills we support will provide long-overdue increases
in burial benefits as well as improving benefits for surviving
spouses.
There are other bills on the agenda that raise concerns,
including Blue Water Navy. We oppose this bill. Let me explain
why.
We know it is incredibly difficult to hear from groups of
veterans who are ailing and ill. Many of us in this room are
veterans with empathy and compassion. We also understand there
are practical effects from this bill that give us great concern
and pause. In the case of this legislation, we should be very
clear on the precedent this bill attempts to create and the
broad effects it will have over time.
As you know, when a veteran files a claim, our pledge is to
work hard to honor it. In the process of evaluating a veteran's
claim, we rely on science and medical opinions. For example, a
person suffers an injury during service or has a condition
later in life that we think is connected to their time in
service. They submit a claim for service-connected benefits
based on the injury or condition. We apply science, in this
case a medical exam, to demonstrate the injury or condition was
caused during military services or has rendered them with a
disability for which they should receive compensation.
But, with Blue Water Navy, there is no conclusive science
from the Institute of Medicine to support claims of toxic
exposure. This Committee set the standard to use science to be
fair and consistent in cases such as this. Once that standard
is removed from the equation, it becomes nearly impossible to
adjudicate a claim of this type on the merits. The resulting
lower threshold sets in motion the prospect of uncontrolled
demands for support. What remains eliminates this rationale,
and instead we are left with a situation where there are no
limits; therefore, no claims can be denied.
This in turn invites other sympathetic causes without valid
science to petition Congress for compensation. If this bill
becomes law, this Committee is setting a precedent for
potentially unwieldy policy with consequences to the future of
Veterans Benefits, VA, and in other areas of Government.
The bill before us today will then be referenced when other
exposure claims are presented to this Committee. At that point
Congress will be under greater pressure to accommodate these
requests, too, regardless of the evidence.
The National Academy of Medicine reviewed all available
scientific evidence, concluding that it was unable to state
with certainty that Blue Water Navy personnel were or were not
exposed to Agent Orange. They recognized that the oft-mentioned
Australian study does not directly support the contention that
Blue Water Navy personnel were exposed to the dioxins of Agent
Orange. This laboratory simulation was based on the false
premise that water for ship distillation would be drawn near
shore where pollution accumulates. To avoid these contaminants,
established U.S. Navy policy was only to draw water from 12
miles offshore where pollutants and dioxins would be diluted
from trillions of gallons of sea water.
Because we are always looking for new information, VA
continues to review and monitor the peer-reviewed scientific
and medical literature in collaboration with VSOs. To further
address the medical aspects of Section 2, Dr. Erickson is with
me today and is prepared to discuss ongoing VA studies of
Vietnam veterans, one of which compares the health effect of
Vietnam veterans with veterans who did not serve in Vietnam and
with U.S. nonveteran populations. It has the advantage of
including Blue Water Navy veterans on the steering committee.
Results will be published in peer-reviewed scientific
literature starting in 2019. Nearly 1,000 Blue Water Navy
veterans are included in the study at this time.
Additionally, VA is opposed to paying for the provisions of
this bill by increasing the costs that some veterans must pay
to access their benefits. Veterans will have to either finance
the VA funding fee with interest or pay up-front in cash. This
means fewer veterans will buy homes or buy homes using non-VA
options, potentially opening them to predatory lenders.
Another impact we need to raise regards the recent ongoing
efforts to reduce the appeals and claims backlog. These efforts
would be impacted through additional FTEs and costs, but also
adding time to the 125 days to process a claim due to the
verification study that would need to go into the processing of
that claim.
In summary, we oppose this bill because the science is not
there, and what we do depends upon science. We care so we keep
looking. Increased fees levied on home loans place additional
financial burdens on veterans who are trying to buy a home,
opening them further to predatory lending. The ongoing efforts
and momentum of appeals and claim backlog would be set back.
A final thought. Congress has always relied on science. If
this bill passes, the legacy of this Committee could be forever
changed.
Let me now briefly address the draft bill on Veterans
Dental Care Eligibility Expansion and Enhancement Act of 2018.
We feel part of the bill is unnecessary and that the
significant expansion of dental care called for in this bill is
simply not feasible. VA does not have the infrastructure to
provide that care, and the significant expense of adding the
benefit we fear would squeeze resources from other critical
veteran health care needs.
State nursing homes are addressed in S. 3184. We know
extended care for veterans is an important issue for the
Committee and every Senator. However, we believe S. 3184, as
drafted, could result in negative unintended consequences,
including move State veterans' homes away from their core
mission of serving veterans. We are glad to discuss ideas to
improve this bill further with the Committee.
This concludes my testimony. We look forward to answering
any questions the Committee has.
[The prepared statement of Mr. Lawrence follows:]
Prepared Statement of Dr. Paul R. Lawrence, Under Secretary for
Benefits, U.S. Department of Veterans Affairs
Good morning, Chairman Isakson, Ranking Member Tester, and Members
of the Committee. Thank you for inviting us here today to present our
views on several bills that would affect the Department of Veterans
Affairs' (VA) programs and services. Joining me today are Ralph
Erickson, M.D., M.P.H., Dr. PH, Chief Consultant, Post Deployment
Health, VHA; Tammy Czarnecki, Assistant Deputy Under Secretary for
Health/Administrative Operations, VHA; and Jessica Bonjorni, Acting
Assistant Deputy Under Secretary for Health for Workforce Services,
VHA.
h.r. 299--blue water navy vietnam veterans act of 2018
Section 2: Clarification of Presumptions of Exposure for Veterans Who
Served in Vicinity of Republic of Vietnam
Section 2 of H.R. 299 would add a new section 1116A to title 38,
United States Code (U.S.C.). The bill would expand the presumption of
Agent Orange exposure to all Veterans who served ``offshore'' of the
Republic of Vietnam, as defined in subsection (d) of the bill, and
would presume the in-service incurrence or aggravation of all diseases
covered in 38 U.S.C. Sec. 1116 for these Veterans. It would also
provide retroactive benefits for Veterans who had a previous claim for
a covered disease denied and then file a new claim, comparable to the
retroactive benefits available for Veterans who went ashore. This
retroactivity would be accomplished via a special effective date rule
contained in the bill. The bill would also expand the definition of
``Vietnam-era herbicide-exposed veteran,'' codified at 38 U.S.C.
Sec. 1710(e)(4)(A), to include Veterans with ``offshore'' service for
purposes of the provision of health care.
VA is opposed to section 2 of this bill. The legislative history of
Veterans' disease presumptions dates back to 1921 when Congress
established a presumption of service connection with an amendment (P.L.
67-47) to the War Risk Insurance Act (P.L. 63-193). In the following
years, additions to the presumptive list were made by regulation,
executive order, and legislation. In 1991, the Agent Orange Act (P.L.
102-4) established for Vietnam Veterans a presumption of a service
connection for diseases associated with exposure to Agent Orange and
certain other herbicides. For the first time, this Act required VA to
contract with the Institute of Medicine (IOM) to biennially conduct a
scientific review of the evidence linking certain medical conditions to
herbicide exposure. VA was instructed to use the IOM's findings, and
other evidence, to provide the rationale for establishing regulations
and determining that a presumption for any disease would be warranted
when there is scientific evidence of an association with herbicide
exposure.
VA's view is that the evidence-based approach to creating or
expanding presumptions should be maintained. Although presumptions
exist to assist in proving claims that may otherwise be difficult for
individual veterans to establish on a direct basis, the presumptions of
exposure and/or medical causation should always be supported by
historical, scientific, and/or medical evidence about the specific
population of Veterans affected. VA recognizes Congress's prerogative
in creating or expanding presumptions. However, VA is concerned that
new Congressionally-created presumptions that are not adequately
supported by evidence will erode confidence in the soundness and
fairness of the Veterans' benefits system. Such statutory presumptions
will lead to increased pressure on VA to create or expand additional
presumptions administratively, under a similarly liberal approach.
Because VA generally cannot establish regulatory presumptions that are
not reasonably grounded in evidence, Veterans petitioning VA for new
presumptions that are not supported by the required level of evidence
will likely be unsatisfied with VA's response. These Veterans may feel
that the system is inequitable in providing expansive presumptions
favoring certain groups of Veterans but not others.
As a means of further assessing the potential for Agent Orange
exposure, VA commissioned the IOM to produce the report, Blue Water
Navy Vietnam Veterans and Agent Orange Exposure (2011). The report
concluded that exposure among Blue Water Navy Veterans ``cannot
reasonably be determined,'' and it did not find supported and
compelling evidence of Agent Orange exposure due to aerial spray drift,
river water runoff, or potable sea water distillation. The report
indicated that Agent Orange was destroyed by sunlight within hours of
application and any that survived would rarely make it out to the South
China Sea because of the major dilution factor. Additionally, United
States Navy ships were required to draw up seawater for conversion to
shipboard potable water at least twelve miles offshore from any river,
a distance at sea where the presence of Agent Orange was unlikely.
Although there is insufficient scientific evidence to grant a
blanket presumption of Agent Orange exposure for all Navy Vietnam
Veterans, VA has a liberal policy of presuming exposure for all
Veterans who served aboard Brown Water vessels operating on Vietnam's
inland waterways, and for those Veterans serving aboard Blue Water
ships that temporarily entered the inland waterways. Additionally, if
evidence shows that a Blue Water ship off the coast sent crew members
ashore for duty or visitation, any Veteran on the ship at that time
will receive the presumption of exposure if they state that they
personally went ashore.
As such, VA opposes section 2 because there is insufficient
scientific evidence at this time showing Blue Water Navy Veterans were
exposed to Agent Orange. At VA's request, the IOM (now National Academy
of Medicine (NAM) ) reviewed all available scientific evidence,
concluding that it was ``unable to state with certainty that Blue Water
Navy personnel were or were not exposed to Agent Orange and its
associated TCDD'' (ref: Blue Water Navy Vietnam Veterans and Agent
Orange Exposure, 2011). VA continues to review and monitor the peer-
reviewed scientific and medical literature and is collaborating with
Veterans Service Organizations (including the Veterans of Foreign Wars
and the Blue Water Navy Vietnam Veterans Association) to gather more
information. A new VA health study of Vietnam Veterans that includes
the collection of data on Blue Water Navy Veterans is currently
ongoing. VA researchers are currently analyzing data from this effort.
The timeline for initial results is expected to be in 2019, with
publication of results potentially within 1-2 years. VA is committed to
examining all available evidence on this issue and gathering input from
stakeholders in order to make well-informed, scientific, evidence-based
decisions for our Nation's Veterans.
VA is also concerned with the special effective date provisions of
the bill. Our understanding is that these provisions are intended to
provide Blue Water Navy Veterans with effective date treatment that is
similar to that available under the Nehmer court decision and orders
for those who served in the Republic of Vietnam. However, in enacting
provisions extending benefits to other groups of Veterans, Congress
generally has not extended those benefits retroactively, much less for
such a significant time period. VA is concerned about the apparent
inequity of this disparate treatment of different groups of Veterans.
Further, VA is concerned that the procedures necessary for applying
these special effective date provisions, including determining proper
effective dates and establishing awards covering large retroactive
periods, would be complex and labor-intensive tasks that would divert
resources from other important claim adjudications.
Further, VA has concerns associated with the demarcation line used
in this bill. Implementation of this provision would be impracticable.
Currently, VA maintains a ship list for ships that operated on inland
waterways. This requires VA to research and review deck logs in
individual cases to assess the geographic coordinates of the ship, as
well as the time periods on which the ship operated on an inland
waterway. This bill would essentially extend that ships list to
encompass an area no more than 12 nautical miles seaward of a line
commencing on the southwestern demarcation line of the waters of
Vietnam and Cambodia and intersecting certain geographic points. VA
would be required to assess many more deck logs and coordinates to
place additional ships on that list for certain time periods. Because
of the nature of deck logs, it may be impossible to determine an exact
location and determine whether a ship did, or did not, cross this line
on a particular date. Additionally, based on the available scientific
and medical evidence, VA is unaware of any association between a line
twelve miles offshore and exposure to Agent Orange. VA understands that
the Department of State also has concerns regarding this provision of
the bill.
This bill would also add significantly to the number of benefit
claims pending over 125 days. Because of the retroactive provisions and
the intricacies of reviewing deck logs, each claim would take longer--
more than twice as long, on average--to review than claims VA generally
receives. In addition, a large volume of claims would be expected as a
result of this bill. Thus, unless additional employees are provided, VA
would expect the backlog to grow significantly due to this expected
claims burden.
Finally, VA does not support paying for the provisions of this bill
by increasing the costs that some Veterans must bear to access their
benefits. Section 6(b) of the bill would adjust the loan fee that
certain Veterans, Servicemembers, and surviving spouses must pay to
obtain home loans in VA's home loan program. In many cases, the
adjustment would require borrowers to pay higher loan fees to obtain
home loans. In other words, it appears that the bill would partially
offset the Government's cost of increased benefits spending on some
Veterans by raising loan fees for others. Granting new benefits for
some Veterans at the expense of other Veterans is counter to VA's
mission.
VA's cost estimate for the bill is broken down into four
categories: benefits, general operating expenses, information
technology (IT), and health care expenditures. VA estimates the total
benefits cost of this bill would be $1.8 billion during fiscal year
(FY) 2019, $3.4 billion over 5 years, and $5.7 billion over 10 years.
In addition to benefits cost, VA estimates the Veterans Benefits
Administration (VBA) General Operating Expenses (GOE) costs for the
first year would be $90 million and include salary, benefits, rent,
training, supplies, other services, and equipment. Five-year costs are
estimated to be $215.2 million and 10-year costs are estimated to be
$349.1 million. VA further estimates that the IT cost to support VBA
would be $2.9 million for the first year, $5.3 million over 5 years,
and $7.6 million over 10 years. This cost would include the IT
equipment for full-time equivalent employees, installation,
maintenance, and IT support. Regarding health care expenditures, VA
estimates the costs of section 2 of the bill would be $27.8 million in
FY 2019, $275.1 million over 5 years, and $625.0 million over 10 years.
In total, VA estimates section 2 of the bill would carry costs of
approximately $6.7 billion over 10 years.
Section 3: Presumption of Herbicide Exposure for Certain Veterans Who
Served in Korea
Section 3 would add a new section 1116B to title 38, U.S.C.,
extending the presumptions of service connection for diseases
associated with exposure to herbicide agents to all Veterans who served
in the Korean demilitarized zone (DMZ) between September 1, 1967, and
August 31, 1971. It would not provide retroactive benefits comparable
to those available for Veterans who served offshore of the Republic of
Vietnam, as proposed in section 2 of this bill.
VA is not opposed to presumptions for Veterans of service in the
Korean DMZ, but has concerns with the prescribed presumptive dates,
which we believe would unduly expand the start of the time period of
presumptive exposure.
Following consultation with the Department of Defense (DOD), VA
promulgated 38 Code of Federal Regulations (CFR) Sec. 3.307(a)(6)(iv),
which provides a presumption of exposure to an herbicide agent to
Veterans who served between April 1, 1968, and August 31, 1971, ``in a
unit that, as determined by [DOD], operated in or near the Korean DMZ
in an area in which herbicides are known to have been applied during
that period.'' As VA explained in the proposed and final rule notices
implementing 38 U.S.C. Sec. 1821, DOD has identified April 1968, as the
earliest known use of herbicides along the Korean DMZ. See 74 Fed. Reg.
36,640, 36,641 (Jul. 24, 2009) (''[s]pecifically, DOD has reported that
herbicides were applied between April 1968 and July 1969''); 76 Fed.
Reg. 4245, 4246 (Jan. 25, 2011).
Additionally, the lack of retroactive benefits for Veterans who
served in the Korean DMZ highlights the disparity between the treatment
of Veterans who served offshore of the Republic of Vietnam, as
addressed in Section 2 of this bill, compared to other groups of
Veterans.
Costs associated with Section 3 are estimated to be insignificant.
Section 4: Benefits for Children of Certain Thailand Service Veterans
Born with Spina Bifida
Section 4 would add a new section 1822 to title 38, United States
Code, authorizing VA to provide the same benefits to children of
Veterans with Thailand service, as defined in the bill, suffering from
spina bifida as the benefits required to be paid to children of Vietnam
Veterans suffering from spina bifida.
VA supports assisting family members who may have been adversely
affected by a Veteran's in-service exposure to Agent Orange. However,
VA is concerned with Section 4 because there is continued scientific
uncertainty surrounding the association of spina bifida and exposure to
Agent Orange. As found in the last relevant NAM report, an association
between spina bifida and exposure to Agent Orange is no longer shown.
Spina bifida was moved from the category of limited or suggestive
evidence of association in update 2012 to the category of inadequate or
insufficient evidence of association in update 2014.
VA estimates the total benefits cost of this bill would be $748,000
during FY 2019, $3.9 million over 5 years, and $8.1 million over 10
years. GOE and IT costs are not associated with this section. We are
unable to provide health care cost estimates at this time.
Section 5: Updated Report on Certain Gulf War Illness Study
Section 5 of the bill would require VA, within 180 days of the date
of the enactment of this Act, to submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate, an updated
report on the findings, as of the date of the updated report, of the
Follow-up Study of a National Cohort of Gulf War and Gulf Era Veterans
under VA's epidemiology program. VA has no objection to this
requirement, as we anticipate this update would be available within
that time period.
Section 6: Loans Guaranteed Under Home Loan Program of Department of
Veterans Affairs
Section 6(a) would amend 38 U.S.C. Sec. 3703(a)(1) by revising the
definition of maximum guaranty amount to tie the maximum guaranty
amount to the loan, regardless of whether the loan exceeds the Freddie
Mac conforming loan limit.
Subsection (b) would amend the loan fee table at 38 U.S.C.
Sec. 3729 to adjust the statutory loan fees charged to borrowers
obtaining loans made, guaranteed, or insured under VA's home loan
program. Certain Veterans, Servicemembers, and surviving spouses would
pay increased loan fees when obtaining purchase, construction, and
fully underwritten loans.
Subsection (c) would waive the statutory loan fees for
Servicemembers who have received the Purple Heart award. However,
subsection (c) would impose new statutory loan fees on disabled
Veterans that have a service-connected disability rated as less than
total and surviving spouses who are currently exempt from the loan fee.
VA does not support section 6(a). Under current law, the maximum
guaranty amount can prevent Veterans who live in high-cost areas from
being able to obtain a zero down payment loan. By tying the maximum
guaranty amount to the loan rather than to the Freddie Mac conforming
loan limit, subsection (a) would eliminate what has restricted
Veterans' use of their home loan benefits in certain high-cost areas.
However, this provision may increase risks to the portfolio by
increasing the effective loan-to-value ratio for these non-conforming
loans. Higher loan-to-value ratios may lead to higher claim payments
and lower recoveries in events of default.
VA does not support subsections (b) and (c) of the bill. As
previously explained, VA does not support paying for the provisions of
this bill by increasing the costs that some Veterans must bear to
access their benefits.
VA still is refining estimates for benefits savings associated with
section 6, but the 10-year savings likely will fall below $3 billion.
Therefore, VA anticipates that the bill's costs would far exceed any
savings associated with this section.
Section 7: Information Gathering for Department of Veterans Affairs
Home Loan Appraisals
Section 7 would amend 38 U.S.C. Sec. 3731 to permit appraisers to
make appraisals based solely on information gathered by a person with
whom the appraiser has entered into an agreement for such services. The
provision would result in less wait-time for Veterans who want to close
their loans, particularly those Veterans who live in remote areas.
Section 7 would also better align VA-appraisal policy and procedures
with industry standards. VA believes this provision would address
recent stakeholder concerns regarding timely delivery of VA-required
appraisals. VA estimates that there are no costs associated with this
section.
s. ___--veterans dental care eligibility expansion and enhancement
act of 2018
Section 2 of the draft bill would amend 38 U.S.C. Sec. 1710(c) to
authorize the Secretary to furnish dental services and treatment, and
dental appliances, needed to restore functioning in a Veteran that is
lost as a result of any services or treatment furnished under this
subsection.
VA does not support this section because it is unnecessary. VA
already has the authority to provide these services. While VA currently
has limited authority to furnish dental care and services, VA can
furnish care and services under a different provision of law to
Veterans who have been disabled by treatment. If the intent of this
section is otherwise, VA would appreciate the opportunity to discuss
this further with the Committee.
Section 3 of the draft bill would require VA to begin a 3-year
pilot program not later than 540 days after the date of the enactment
of this Act. Through this pilot program, VA would assess the
feasibility and advisability of furnishing dental services and
treatments to Veterans enrolled in VA health care who are not eligible
for such care under other authorities. VA would have to carry out the
pilot program at not fewer than 16 locations meeting certain criteria
and based on certain considerations. No more than 100,000 Veterans
could participate in the pilot program, and the Secretary would have to
distribute this limitation among locations selected for the pilot
program in a manner that takes appropriate account of the size and need
of dental services at each location. The services that would be
provided would have to be consistent with the services the Secretary
furnishes to Veterans with service-connected disabilities rated 100
percent disabling under VA's laws. Veterans would be able to
participate in the pilot at their election. VA would have the authority
to collect copayments for dental services in accordance with
authorities on the collection of copayments under VA's existing
authorities, but could not be more than the copayments for medical care
under chapter 17. VA would have to inform all Veterans eligible to
participate in the pilot program of the services and treatment
available, and VA could enter into contracts with appropriate entities
for the provision of dental care, although each contract would have to
specify performance standards and metrics and processes for ensuring
compliance with such standards. Within 540 days and again within 3
years of the commencement of the pilot program, VA would have to submit
a report to Congress on the pilot program, and 180 days after the
completion of the pilot program, VA would have to submit another report
to Congress. These changes would take effect on the date that is one
year after the date of the enactment of this Act.
While VA supports the expansion of dental services and oral health,
VA cannot support this section without additional resources,
specifically funding, infrastructure, and staffing, to support such an
effort. VA does not have the infrastructure or staff to furnish care to
an additional 100,000 Veterans in 16 or more locations without reliance
upon community providers. Therefore, implementation of this pilot
program would significantly increase VA's financial obligations for
community care at a time when VA is in the process of implementing the
new Veterans Community Care Program required by the Caring for Our
Veterans Act of 2018. We further note that, as this is structured to be
a pilot program, we have significant concerns on how we would implement
this and believe that Congress should make additional policy decisions
concerning how this program would operate. While VA may be able to make
these decisions through rulemaking, we expect these would potentially
be controversial and could delay implementation of the program if VA is
forced to decide these matters instead of Congress. For example, the
bill provides no guidance on how VA should administer this benefit
fairly--whether VA should rely upon first in time, a clinical
assessment, priority group, or some other criterion for determining
which 100,000 Veterans receive care under this program. Similarly, the
legislation offers no guidance on how VA should make determinations
concerning where such care would be furnished. Finally, as a term-
limited program, VA is concerned about how VA would manage care
authorized near the end of the pilot program, as some Veterans may
actually be worse off, if they received only a portion of a fuller
episode of care. We would appreciate the opportunity to discuss these
concerns in greater detail with the Committee.
VA anticipates that the total cost for clinical care (not including
administrative or other costs) during the three year pilot program
would exceed $600 million.
Section 4 would require VA to construct or lease a VA dental clinic
in any State that does not have a VA facility that offers onsite dental
services. Within 180 days of the date of the enactment of this Act, VA
would have to submit a plan to Congress for construction or lease of a
dental clinic in each applicable State and begin construction of any
such clinic not later than 1 year after such date of enactment. There
would be authorized to be appropriated, and would be appropriated, $10
million to carry out this section.
VA supports ensuring Veterans have access to dental services, but
we believe decisions about establishing a new VA health care presence,
whether leased or government-owned, should be made based upon an
analysis of local conditions, namely the density of the population of
eligible Veterans and the availability of other options to deliver
cost-effective care.
Section 5 would require VA to carry out a program of education to
promote dental health for Veterans who are enrolled in VA health care,
although nothing in this authority would alter or revise the
eligibility of any Veteran for dental care under VA's authorities. This
education program would have to provide information concerning the
association between dental health and overall health and well-being;
proper techniques for dental care; signs and symptoms of commonly
occurring dental conditions; and treatment options for commonly
occurring dental issues. The education program would also provide
information pertaining to options for obtaining access to dental care,
including information on eligibility for care through VA, State and
local governments or non-profit organizations; purchasing private
dental insurance; available and accessible options for obtaining low or
no-cost dental care, including through dental schools and federally-
qualified health centers; and such other matters relating to dental
health as the Secretary considers appropriate. The education material
would have to be provided through a variety of mechanisms, including
print, online, and through presentations.
VA does not support section 5 because it is unnecessary. VA already
develops, provides, and promotes educational information, including
training and the availability and accessibility of options for
obtaining low or no-cost dental care, including through dental schools
and federally-qualified health centers.
Section 6 would require VA, no later than 540 days after the date
of the enactment of this Act, to expand the dental insurance pilot
program established by 38 CFR Sec. 17.169 (as in effect on the date of
the enactment of this Act) to establish a mechanism by which private
sector dental care providers shall forward to VA information on dental
care furnished to individuals under the pilot program for inclusion in
the electronic medical records of VA with respect to such individuals.
VA could continue the dental insurance pilot program for 2 years in
addition to what is otherwise provided for in 38 CFR Sec. 17.169 if the
Secretary determines that the continuation is needed to assess the
mechanism required by this section. Individuals could elect whether to
participate in the mechanism. VA would have to include information on
the mechanism in each report to Congress on the dental insurance pilot
program. This section would take effect on the date that is one year
after the date of the enactment of this Act.
VA does not support this section. We are concerned about the
language in this section could create a requirement concerning medical
records interoperability that is separate from VA's efforts to
modernize its electronic health records generally. Many dentists are
not accustomed to providing health record information electronically to
other providers; the claims they submit to patients and insurers for
payment are generally all that they provide. As a result, this could
create additional requirements on individual providers, which could
either become difficult for them to implement or could result in their
refusal to participate in the Dental Insurance Program. We believe it
is necessary to balance the interests of a complete medical record with
the obligations and expectations of community providers. We further
note that the dental insurance program is no longer a pilot program,
but is now a permanent program that is codified at 38 U.S.C.
Sec. 1712C; moreover, the pilot program authority (Public Law 111-163,
section 510) was repealed through the Act that codified this authority
(Public Law 114-218). VA fully supports the existing VA Dental
Insurance Program.
Section 7 would authorize VA to carry out a demonstration program
to establish programs to train and employ alternative dental health
care providers to increase access to dental care for Veterans who are
entitled to such services from VA and reside in rural and other
underserved communities. VA would give priority for participation in
the demonstration program to VA medical centers or health systems in
States with a technical college within the State college system that
has established a degree or certificate level program for the training
of alternative dental health care providers. Services through the
demonstration program could be administered through telehealth-enabled
collaboration and supervision when appropriate and feasible.
Alternative dental health care providers would have the meaning given
that term in 42 U.S.C. Sec. 256g-1(a)(2).
VA is opposed to unproven alternative delivery of dental care
models. While we support programs that expand dental health care to
Veterans in a safe and effective manner, the scientific evidence does
not currently support the proposed model for Veteran patients who
require management of multiple physical and mental comorbidities and
multiple prescription medications. The average VA dental patient is
approximately 60 years old and is taking over 10 medications. Allowing
Veteran patients to seek restorative oral health care from a non-
dentist practitioner poses too great of a potential overall health
risk. VA strongly believes that the professional education and clinical
expertise of a licensed dentist is essential for the thorough
evaluation and comprehensive treatment of patients in VA.
Section 8 would authorize to be appropriated $500 million for
fiscal year 2020 to carry out this Act, other than section 4. The
amount authorized to be appropriated would be available for obligation
for the 5-year period beginning on the date that is one year after the
date of the enactment of this Act.
VA has no views on section 8.
s. 3184--to amend title 38, united states code, to modify the
requirements for application for construction of state home facilities
to increase the maximum percentage of nonveterans allowed to be treated
at such facilities, and for other purposes.
S. 3184 would amend one of the requirements for applications for
State home construction grants in 38 U.S.C. Sec. 8135(a)(4).
Specifically, it would require States that submit an application to
provide reasonable assurance that, for purposes of providing care to
spouses of Veterans, during a period in which a facility is operating
with a bed occupancy rate of 90 percent or less, not more than 40
percent of the bed occupancy at any one time will consist of patients
who are not receiving such level of care as Veterans.
While VA appreciates the intent of this legislation, we cannot
support it as drafted. First, it is inconsistent with the intent of
VA's grant program for State Veterans Homes, as this would allow a
significant portion of the population in a State Veterans Home to be
non-Veterans. This authority would only apply if the home has less than
90 percent occupancy, which suggests that there may be insufficient
demand for the Veterans Home in the first place.
VA also has concerns with this legislation because the technical
effects of the bill would result in adverse effects on Veterans and
non-Veteran residents. Initially, we note that the additional language
that would be added in Sec. 8135(a)(4)(B) only refers to providing care
to ``spouses of veterans,'' but State homes may also provide services
to other non-Veterans besides spouses, such as persons whose child or
children died while serving in the Armed Forces. We note that this
creates some ambiguity as to how VA is to calculate the percentages
further discussed in that subparagraph.
VA's greater concern, though, is that we believe that the language
concerning occupancy rates could lead to unfortunate outcomes. Our
reading of this language is that it would prohibit a State home from
having a relative percentage of non-Veterans above 40 percent; for
example, if a 100 bed facility only had 90 beds filled, there could be
no more than 36 non-Veterans (40 percent of 90). We would interpret
this language to mean that the occupancy rates would refer to the
relative percentage of residents; VA has interpreted similar language
concerning bed occupancy rates in VA's regulations at 38 CFR
Sec. 51.210(d) to refer to the total number of residents, rather than
the total number of beds in the home. Applying this interpretation to
this legislation, though, could result in significant disruptions in
care. For example, if the 40 percent occupancy rate is a percentage of
the relative number of beds and 90 beds were filled, 36 could be filled
with non-Veterans and 54 with Veterans. However, if the next applicant
for a bed were a Veteran, the facility would exceed the 90 percent
total occupancy rate, as it would have 91 residents if it admitted the
Veteran. Because of this, it would no longer be authorized to have 40
percent of its available beds for non-Veterans; instead, it could only
have 25 percent of its beds available for non-Veterans.
We think this requirement could force the facility to take actions
that could lead to unfortunate outcomes. First, the facility could
simply discharge a non-Veteran patient immediately and admit the
Veteran, which would be very disruptive to the discharged non-Veteran
patient. This also would be a perverse incentive because it would
discourage States to fully use the beds already in place. Second, the
facility could tell the Veteran to wait until a non-Veteran left the
facility on his or her own, but this would delay the Veteran's care and
would be a waste of resources, as the facility would have open beds
available. We think one of these results would be required by the
legislation because the bill would prohibit exceeding the 40 percent
occupancy rate ``at any one time,'' which we interpret to mean that if
at any point, even only momentarily, a facility is not in compliance
with this requirement, it cannot have the additional flexibility the
bill intends. The phrase ``at any one time'' has been very difficult
for State homes to administer in other contexts, as it requires them to
take action in anticipation of even momentary changes in their resident
population. If the legislation, instead, referred to an average over a
period of time (monthly or quarterly would likely be appropriate), that
would seem to provide more flexibility and prevent unnecessary
discharges as described in the scenarios above.
VA does not anticipate that this bill would result in any
additional costs.
s. ___--discussion draft regarding transition assistance reform
The draft bill would amend title 10, U.S.C., to improve the
Transition Assistance Program (TAP) for members of the Armed Forces,
and for other purposes. VA generally defers to DOD, to the extent that
it is responsible for administering title 10. However, we provide input
on sections of the bill affecting VA.
Section 2 of the draft bill would direct the interagency partners
for TAP to improve the counseling, information, and services currently
furnished to transitioning Servicemembers, and to provide these
services to transitioning Servicemembers' spouses as appropriate. It
would require that transitioning Servicemembers begin TAP no later than
one year before their date of separation. It further would require
sequencing of instruction and training provided by other agencies while
allowing Servicemembers to complete VA training at a pace and order
satisfactory to them.
VA appreciates Congress's interest in TAP and shares its desire to
make sure that the program serves as many transitioning Servicemembers
as possible, in the most effective way possible. To that end, VA and
our TAP interagency partners currently have several interagency
evaluations under way. These studies will provide us with the
information needed to continue to make evidence-based policy decisions
as to what improvements to TAP should be made, and how best to make
them. While these evaluations are under way, we believe that
legislation to mandate additional evaluations is premature at this
time; nevertheless, we look forward to working with the Congress to
improve TAP once we have completed these evaluations and have the
evidence available to make evidence-based policy decisions.
With regards to requiring Servicemembers to begin TAP no later than
one year before separation, VA continues to take action to fulfill its
commitment to integrate TAP into the Military Life Cycle in order to
inform, equip, and provide support to Servicemembers earlier and at
critical touchpoints throughout their career.
With regards to the specific elements of counseling to be provided,
VA supports the intent of proposed section 1142(f)(3)(A), regarding
information on programs and benefits related to Veteran status, but is
already providing benefits information to active duty Servicemembers
who are separating from military service. This has facilitated earlier
and easier enrollment and access to VA health care. Further, VA does
not support subparagraph (E), which would require the pre-separation
counseling include a description, developed in consultation with VA, of
the assistance and support services for family caregivers of eligible
Veterans furnished by VA under 38 U.S.C. Sec. 1720G, including the
Veterans covered by the program, the caregivers eligible for assistance
and support through the program, and the assistance and support
available through the program. VA does not support this subparagraph
because VA has been working closely with DOD to implement a similar
provision enacted in section 541 of the National Defense Authorization
Act for Fiscal Year 2018 (Public Law 115-91). VA fully supports
ensuring Veterans understand the benefits that may be available to
them, including those provided by VA and DOD (such as Special
Compensation for Assistance with Activities of Daily Living), and we do
not believe further legislation is required. VA supports the intent of
subparagraph (F), which would require the pre-separation counseling to
include information on survivor benefits available under the laws
administered by VA or DOD. VA supports efforts to increase awareness of
survivor benefits, such as the Civilian Health and Medical Program of
the Department of Veterans Affairs, which is an important health care
benefits program available for the family members of certain severely
disabled or deceased Veterans. However, VA already provides much of
this information.
Subsection 1142(g)(4), would also extend VA's current 6-hour
briefings into a one-day course of instruction. VA interprets a full
day of instruction as 8 hours. VA is in support of extending the VA
benefits briefings to a full-day of instruction, which will ensure that
VA can better prepare Servicemembers for their transition and help
foster what will be a lifetime relationship between their families and
the Department. A full-day will further ensure that transitioning
Servicemembers are presented information in a manner that is conducive
to promoting increased awareness and understanding of VA benefits,
services, and support tools. Increasing the VA benefits briefings to a
full-day of instruction would require additional funding. VA suggests
that the term ``registration'' in this section be replaced with the
term ``application.''
With regards to mandating the sequencing of TAP, VA encourages that
transitioning Servicemembers undertake the VA Benefits I/II training in
an order satisfactory to their own personal transition goals,
emphasizing that early and consistent training on VA benefits is
crucial to the Servicemember's successful transition outcomes.
In addition to the changes to TAP, the draft bill would require
changes to interagency data-sharing requirements. Section 4 would
require DOD to establish and maintain an electronic tracking system and
database that contains data on Servicemember participation, survey
answers, available resources, and counselor notes for the Department of
Labor (DOL), VA, commanders, and other TAP partners. Section 5 would
require the gathering of information and survey responses regarding TAP
participation at various stages by various agencies and would require
the information be made available electronically to VA, among other TAP
partners.
Section 11 of the draft bill also calls for the identification of
opportunities where VA can provide training to members which will lead
to employment in critically understaffed positions in VA, using the DOD
SkillBridge programs. With regards to identifying opportunities for job
training and employment with VA in SkillBridge programs, VA and DOD
have a shared goal to enhance services and employment opportunities at
VA for transitioning Servicemembers through SkillBridge programs. Since
2014, VA has offered opportunities for transitioning Servicemembers to
complete a national-level training program that leads to an opportunity
for an interview and potential job as a benefits claims examiner. More
recently, VA launched the Military Transition and Training Advancement
Course (MTTAC) which trains Servicemembers to become medical support
assistants. Furthermore, VA and DOD are working to develop an
overarching agreement that will expand these types of opportunities to
additional VA job fields.
In sections 5, 12, and 13, the bill would require several different
Servicemember studies and other evaluations of the effectiveness of
transition-related training. It would require Servicemember surveys in
order to assess the Servicemembers' and their spouses' experiences of
the assistance provided through TAP. It also would require the
evaluation of transition training and counseling relating to post-
secondary education and use of educational assistance. Last, it would
require VA, in consultation with interagency partners, to conduct a 5-
year longitudinal study on three separate cohorts of Servicemembers who
have separated from the Armed Forces.
VA has already begun development of a post-transitional
longitudinal program, which will survey Veterans over time to gain
detailed information about their outcomes and their evaluations of how
TAP helped them prepare for their transitions to civilian life. The
assessment instrument was submitted to the Office of Management and
Budget (OMB) for review in February 2018, and the Federal Register
notice has been published. To conduct full execution of this study, VA
will require additional funding.
With regards to Servicemember surveys, VA receives feedback from
participating Servicemembers and dependents through the Transition GPS
Participant Assessment, which is a web-based instrument designed to
measure and improve customer satisfaction with the curriculum and TAP
overall. Using this transitioning Servicemember feedback, VA conducts a
deep dive every other year to look for ways to improve the
instructional delivery and design of its curriculum. In addition, we
conduct a technical review every year to ensure all content is up to
date.
Section 14 would require the establishment of a board within the
Veterans Benefits Administration (VBA) to exchange information and
develop partnerships to support the prevention of suicides, substance
abuse, and homelessness among Veterans. This board would include
representatives from VBA, VHA, DOL, the Department of Homeland Security
(DHS), and DOD. The existing VA/DOD Joint Executive Committee
established during the 108th Congress and the TAP interagency Executive
Council have significantly enhanced interagency exchange of information
and partnership development to support the prevention of suicides,
substance abuse, and homelessness. Furthermore, the Federal Government
is improving collaboration on suicide prevention as a result of
Executive Order (EO) 13822. These existing governance bodies provide a
valuable forum for information sharing and collaboration on addressing
mental health and at-risk populations. VA agrees that there is a clear
need to improve coordination between the administrations and offices
within VA, as well as among other agencies, regarding suicide, drug
overdose, and alcohol-related mortality prevention efforts. As we
recently released in the National Strategy for Preventing Veteran
Suicide, data and surveillance form the foundation of a public health
approach to ending Veteran suicide. Coordination within VA has already
begun under our annual Veteran suicide data reports but there is more
to be done. While VA supports the intent of this section, VA is
concerned that the language prescribes that this board reside in an
office which no longer exists in the VBA organizational structure,
rather than affording VA the ability to determine which VA office
should lead this board, should it be established. In addition, VA notes
that the proposed board would have no experts on substance use
disorders.
Finally, section 15 would require VA, within 90 days of the
enactment of this Act, to submit to Congress a report on current and
future studies supported by VA's Office of Research and Development
(ORD) and others relating to economic risk factors affecting suicide
prevention and a report on how the Department's REACHVET program is
incorporating or will incorporate economic risk factors in its
algorithm for suicide prevention.
VA does not support this section, as we can already provide this
information, or will provide this information upon its completion, at
the Committee's request without legislation. Assessment of the effect
of economic-related variables on risk for suicide is already part of
the strategic plan within ORD that focuses on the transition period
from active military status to Veteran status. Epidemiological data
analyses indicate that the transition period is a high risk period for
suicide and related behaviors. The ORD strategic plan for suicide
prevention aligns with EO 13822, which requires VA, DOD, and DHS to
provide seamless access to mental health care and suicide prevention
resources for transitioning Servicemembers. The EO specifically
emphasizes access to services during the critical first year period
following discharge, separation, or retirement from military service.
In order to more closely examine the economic factors affecting
suicide, ORD will leverage the existing data coordinating center at the
Canandaigua VA Suicide Prevention Center of Excellence to identify,
extract, and analyze data critical for a comprehensive suicide
prevention program. ORD has identified funds (beginning in FY 2019) to
support the Canandaigua data coordinating center in this added effort.
It is expected the work will be conducted in collaboration with various
units across VA as well as with external agencies such as DOD and the
National Institutes of Health.
s. ___--va hiring enhancement act
Section 2 of this legislation proposes to exempt VA physician
hiring from the applicability of private sector covenants not to
compete by adding new language to Subchapter 1 of Chapter 74 of Title
38 U.S.C. The applicability of covenants not to compete or non-compete
clauses to Federal hiring has been a recurrent problem around the
country, especially for physician hiring. In short, the proposed 38
U.S.C. Sec. 7413 states that any covenant not to compete with a non-
departmental entity, facility or individual shall have no force or
effect as it relates to an appointment to a physician position within
VHA. It requires the appointee to provide clinical services at a VA
medical facility for the duration of the covenant not to compete or for
one year, whichever is longer. This service requirement may be waived
by the Secretary. If the physician's appointment is terminated for any
reason before the termination date of the covenant not to compete, then
the proposed 38 U.S.C. Sec. 7413 would no longer be applicable to the
covenant not to compete.
VA supports section 2 of this proposed legislation as written, as
it solves a problem known to medical facility Chiefs of Staff across
the country and clarifies that VHA hiring is not subject to private
sector covenants not to compete. This legislation should make it easier
to hire physicians with these contractual obligations. It should be
noted that exempting VA physician hiring from covenants not to compete
entered into with non-Departmental facilities, entities and individuals
should not result in additional costs to the Federal Government or VA.
While VA supports the intent of section 3, we do not support this
provision as written. VA supports raising the qualification standard
for physician hiring to completion of a full specialty residency
program. This is the community standard and elevates VA standards to
typical norms. VA changed the physician qualification standard over a
year ago, and this section brings the statutory language in line with
the current qualification standard. However, the inclusion of language
regarding contingent appointments is unnecessary and confusing. VA
already has the authority to extend job offers well before graduation
from residency. Applicants must always meet the qualification standard
prior to appointment. In addition, depending on state law, some
residents may not gain the ability to be licensed immediately upon
graduation from the residency program, as appears to be contemplated by
section (3)(C)(ii).
VA anticipates that this bill would result in no additional costs.
h.r. 5418--veterans affairs medical-surgical purchasing stabilization
act
H.R. 5418 would require multiple regional prime vendors to carry
out the Medical Surgical Prime Vendor (MSPV) Program and successors. It
would require each employee that conducts formulary analysis or makes
decisions on formulary management have medical expertise relevant to
the items being considered. The proposed legislation would also require
a quarterly report to Congress of the names and medical expertise of
employees who are participating in formulary management.
VA agrees that there is a need for a clinically driven sourcing
capability. The proposed legislation limits consideration of the full
spectrum of MSPV delivery solutions available to efficiently provide
medical products to VA healthcare facilities. The requirement to
provide quarterly reports on clinicians who participate in formulary
management is excessively burdensome.
Further, MSPV costs are affected by many variables including:
contract language; vendor geographic presence; mix of items purchased;
etc. These variables change in relation to one another and in relation
to how many vendors VHA uses. VA believes the MSPV legislation will
likely increase medical commodity identification and procurement costs.
Further, Congress has already provided tools for evaluating options for
changing the number of vendors in subsequent acquisitions. Statutes on
contract bundling and consolidation provide criteria for evaluating
potential cost savings or other acquisition benefits to determine if
such actions are necessary and justified. Thus, VA does not support
this proposed legislation as written.
VA is unable to provide a cost estimate at this time. MSPV costs
are affected by many variables including: contract language; vendor
geographic presence; mix of items purchased; etc. These variables
change in relation to one another and in relation to how many vendors
VA uses. VA believes the bill would likely increase medical commodity
identification and procurement costs.
s. 1596--brave act of 2017
S. 1596 would increase the basic non-service-connected monetary
burial benefit allowance and tie monetary burial benefit allowances to
the current rate of inflation according to the Consumer Price Index
(CPI). Under current law, VA may only pay a sum not exceeding $300
under section 2302 of title 38 U.S.C. for basic burial allowance. This
bill would increase the basic burial allowance payment to $749 and
increase it by the CPI on an annual basis. The bill would also increase
the service-connected burial benefit under section 2307, title 38
U.S.C. based on the CPI.
As a technical matter, VA notes that the burial allowance under
section 2303 is currently $762, after the CPI adjustment. The $749
amount in this bill may be derived from FY17's CPI calculation.
However, the legislation would apply to deaths that occur one year
after the bill's enactment. Therefore, we suggest changing the starting
amount from $749 to $762 in order to achieve parity between the burial
benefits in sections 2302 and 2303.
VA supports S. 1596 provided Congress finds corresponding funding
offsets. The last increase in the non-service-connected burial
allowance under section 2302 occurred October 1, 1978, through the
enactment of Public Law 95-479, increasing the allowance from $250 to
$300. The last increase in the service-connected burial allowance under
Sec. 2307 occurred December 27, 2001 through the enactment of Public
Law 107-103, increasing the allowance from $1,500 to $2,000.
In 2007, and 2008, VA's Office of Policy and Planning (OPP)
conducted a study to determine whether the burial program was achieving
expected outcomes and to determine the program's impact on Veterans and
families. OPP found that funeral costs had increased at a greater pace
than the cost of other services since 1990. OPP noted that in 1973, the
service-connected burial allowance covered 72 percent of a Veteran's
funeral and burial expenses, and the non-service-connected allowance
covered only 22 percent of a Veteran's funeral and burial expenses.
According to OPP, by 2007, the value of these benefits had decreased
significantly; the service-connected burial allowance reimbursed only
23 percent of the cost of a Veteran's burial, and the non-service-
connected burial allowance reimbursed only four percent of the cost of
a Veteran's burial. The National Funeral Directors Association (NFDA)
reports on its Web site, www.nfda.org, that the median cost of a
funeral and burial was $7,045 in 2012. The reported cost did not
include the cost of a vault or cemetery plot or other miscellaneous
cash advance charges, such as charges for flowers or obituaries.
Further, NFDA reports that the median cost for an adult burial and
funeral in the United States had increased from $708 in 1960, to $7,045
in 2012.
The proposal will allow VA to offer a more valuable reimbursement
for the costs of a Veteran's funeral during a very difficult and
vulnerable period of transition for the survivor. Additionally, the
proposal will tie the burial allowances to the current rate of
inflation consistent with burial benefits under section 2303.
Benefit costs are estimated to be: no budget impact in 2019, $75.8
million over five years, and $259.2 million over ten years. This
estimate is based on the rate of $749 for basic burial allowance in the
bill. The cost would increase slightly if the rate is corrected to
match the rate for burial benefits under section 2303.
s. 2881--mare island naval cemetery transfer act
S. 2881 would require VA to seek an agreement with the city of
Vallejo, California, under which the city would transfer all right,
title, and interest in Mare Island Naval Cemetery to the control of VA,
at no cost to VA. If the cemetery is transferred, VA would be required
to maintain the cemetery as a national shrine.
VA does not support S. 2881, because the transfer of the Mare
Island Naval Cemetery to VA could disrupt efforts currently underway to
address the condition of the cemetery, and because acquisition of the
cemetery by VA does not align with VA's current strategic objectives
with respect to providing burial access to Veterans and their families.
Finally, VA does not support S. 2881 because it sets an unwanted
precedent regarding Veteran cemeteries in disrepair managed by
localities, allowing them to eschew their responsibility to our
Nation's heroes.
In 2017, concerned citizens began an effort to persuade VA to
``take back'' the Mare Island cemetery to address the deteriorating
condition of the property. However, Mare Island cemetery has never been
under the jurisdiction of VA. Mare Island was a Naval Base and a Navy
shipyard that was closed in 1996; the on-base cemetery was closed to
new interments sometime prior to that. When the base closed in 1996,
the physical land and facilities, including the cemetery, were
transferred to the city of Vallejo, at its request, which agreed to
maintain the cemetery and has been solely responsible for its
maintenance since that time. Despite the subsequent sale of some of the
transferred land by the city of Vallejo, no funds were set aside to
ensure the upkeep of the cemetery.
VA is very concerned with the conditions observed at the Mare
Island Cemetery and has been aiding the city of Vallejo to find ways to
address the repairs needed. VA's National Cemetery Administration (NCA)
has provided expert advice to the city in developing its application
for support from DOD's Innovative Readiness Training (IRT) program. IRT
establishes partnerships between DOD and U.S. communities that provide
training for Servicemembers while addressing public and civic needs.
DOD assessed Mare Island Naval Cemetery as a potential IRT project in
May 2018 and has reported that a decision is pending evaluation of
legal and historical considerations, as well as Federal and state
environmental review requirements. DOD has indicated that the city's
application for IRT assistance would not transfer to VA should
ownership be transferred from the city of Vallejo to VA. Costs of
repairs and upkeep for the cemetery would become a VA responsibility,
one for which VA has received no appropriation.
In addition to disrupting the current efforts to address the
condition of Mare Island Naval Cemetery, transfer of the cemetery to VA
does not align with VA's strategic objective to provide reasonable
access to a burial option to 95 percent of eligible veterans and their
families. Because this cemetery is closed to new interments, it does
not offer new burial options for Veterans, and the transfer of the
cemetery to VA would divert resources that should be used to provide
additional burial options elsewhere. The service area within which Mare
Island is located is already covered by other open VA national
cemeteries. For instance, NCA currently operates the Sacramento Valley
National Cemetery in Dixon, California, to serve Veterans and families
members in the northern Bay Area. NCA also is seeking to improve burial
access in this area with development of a columbaria-only urban
cemetery (currently in design) at the new Alameda Point National
Cemetery, which will provide enhanced access to burial benefits for
approximately 420,478 Veterans, spouses and other eligible dependents.
Finally, transfer of Mare Island Naval Cemetery to VA would
establish an unwanted precedent with respect to Veterans cemeteries or
sections of cemeteries not managed by VA, a state or tribal government
that may fall into disrepair. VA could be asked to assume operational
responsibility for gravesites in some of these locations and does not
have the resources to address these requirements.
VA cannot accurately assess the costs associated with S. 2881,
because we have not performed our own assessment of the extent of
repairs necessary to remediate the deterioration of the cemetery. In
particular, we do not know the extent of structural problems that may
not be visible from the surface, nor the cost of addressing those
problems.
Issues noted on visual observation include headstones that are
misaligned and lacking proper maintenance, some of which may need to be
replaced; restoration or replacement of perimeter fencing, foundation
wall, and flagpole; turf restoration; and replacement of the irrigation
system and water source. Based on a subject matter expert comparison of
prior cemetery projects of similar size and potential scope, we
estimate the cost of these discernable repairs to have a rough order of
magnitude between $1.5 million and $3.2 million.
VA is aware of media reports that raised the possibility of sub-
surface issues with the property, but we are unable to verify these
reports without a complete survey and assessment of the cemetery. If
those reports are validated, the estimated costs to restore the
cemetery in compliance with S. 2811 could be $15 million or more.
s. 1952--va financial accountability act of 2017
Section 2 expresses the sense of Congress regarding VA's budgeting
process. We defer to Congress in expressing its sense.
Section 3 would require, not later than 90 days from the date of
the enactment of this Act, VA to enter into a contract with an
independent third party to, within 180 days, review and audit VA's
financial processes, including reporting structures, and actuarial and
estimation models, and develop recommendations for improving such
structures. Within 60 days of the completion of this review, VA would
have to submit a plan to Congress to implement the recommendations
developed by the third party. VA would have to appoint one individual
within the Office of the Secretary of Veterans Affairs to be
responsible for monitoring the status and progress of implementation of
recommendations submitted to the Secretary by third parties, including
those submitted pursuant to the contract described above, and all such
other recommendations as may be submitted to VA by the Comptroller
General, the Special Counsel, and the VA Office of Inspector General.
Subsection (c) would require VA to, not later than 45 days before the
date on which a budgetary issue would start affecting a program or
service, submit a justification for any supplemental appropriation
request it submits to Congress, including a plan for how VA intends to
use the requested appropriation, how long the requested appropriation
is expected to meet the needs of VA, and certification that the request
was made using an updated and sound actuarial analysis. Subsection (d)
would require starting in FY 2019 and in each FY thereafter, the VA
Chief Financial Officer (CFO) to submit to Congress a statement of
assurance that the financial projections included in the President's
annual budget request or the supporting materials submitted along with
such budget are sufficient to provide benefits and services under laws
administered by VA; a certification of the CFO's responsibility for
internal financial controls of the Department; and an attestation that
the CFO has collaborated sufficiently with the financial officers of
the facilities and components of VA to be confident in such financial
projections.
VA concurs with the intent to make our Departmental resource
requests more analytically based and transparent to Congress and other
stakeholders. However, we do not support this bill as we find it to be
duplicative of existing laws and policies within the Department. For
example, subsections (a) and (b) are duplicative of current processes.
VA's budget and financial processes are already the subject of frequent
external audits and reviews. In particular, the Enrollee Health Care
Projection Model (EHCPM) has been reviewed extensively by stakeholders,
including OMB, VA leadership, Congressional staff, the Congressional
Budget Office, , and the Government Accountability Office (GAO). GAO
published a review of the EHCPM in 2011, ``VA Uses a Projection Model
to Develop Most of Its Health Care Budget Estimate to Inform the
President's Budget Request'' (GAO-11-205) and is currently reviewing
the EHCPM as part their review of the VA Community Care Budget
(102732). The RAND Corporation has also conducted an external review of
the EHCPM The Department always takes the findings and recommendations
of external audit bodies, including GAO and the VA Inspector General,
seriously. Our progress in addressing these recommendations is
described annually in our Congressional Budget Justification books, and
we regularly monitor progress throughout the year via internal reviews.
Similarly, subsection (c) is redundant, as it was enacted through
section 141 of the VA MISSION Act of 2018. Moreover, as with all
appropriations requests to Congress, VA already provides the most
detailed justification possible to explain the need for resources and
the consequences should they fail to be provided. While we try to
anticipate funding needs well in advance of their becoming urgent, some
funding needs are true emergencies, and we are concerned that the
rigidity of the 45-day advance timeline required will constrain both
Congress and VA in ensuring Veterans' needs are adequately met in the
face of unexpected funding crises.
Finally, subsection (d) is duplicative of laws and administration
policies governing the Budget request and annual audit process,
including the Congressional Budget Act and the Chief Financial Officers
Act of 1990.
s. 1990--dependency and indemnity compensation improvement act of 2017
S. 1990 would change the formula for calculating Dependency and
Indemnity Compensation (DIC) payments, which would increase the payment
amounts. The bill would also lessen the number of years a Veteran must
be rated totally disabled prior to death for a surviving spouse to be
entitled to DIC and it would entitle a surviving spouse to all benefits
under Chapter 13 when the surviving spouse remarries after the age of
55.
VA supports the bill. Increasing the amount of DIC benefit payments
will help survivors continue to live a sustainable life. Lowering the
remarriage age to 55 creates parity with certain DOD survivor benefits.
VA is developing a cost estimate, but no estimate is available at
this time. Although the bill would not require additional employee
resources, there would be additional mandatory costs and associated
required PAYGO savings, as well as information technology development
costs.
s. 2485, medal of honor surviving spouses recognition act of 2018
S. 2485 would codify the current rate of $1,329.58 for the Medal of
Honor special pension paid to eligible Veterans. The bill would also
establish entitlement for surviving spouses of Medal of Honor (MOH)
recipients to this special pension at the same rate. To be eligible,
the surviving spouse must have been married to the Veteran for one year
or more prior to the Veteran's death or for any period of time if a
child was born of the marriage, or was born to them before the
marriage.
VA supports this bill provided Congress finds corresponding funding
offsets. Paying special pension to surviving spouses would provide
assistance to dependents of our most courageous Servicemembers and
Veterans.
Additionally, setting specific parameters concerning receipt of
only one special pension, regardless if a surviving spouse has been
married to more than one Veteran who was in receipt of a MOH,
remarriage, and age is in-line with the other survivor benefits VA
administers. Benefit costs are estimated to be $1.7 million in 2019,
$9.0 million over five years, and $19.1 million over ten years.
s. 2748--battle for servicemembers act
S. 2748 would make participation in the Transition Assistance
Program (TAP) to prepare for higher education, technical training, or
entrepreneurship mandatory for Servicemembers unless a waiver is
granted.
VA defers to DOD and DHS, as those Departments would have
responsibility to implement the bill. VA fully collaborates with our
interagency partners to address the complex challenges faced by our
transitioning Servicemembers and Veterans. VA notes that a complicating
factor in rapid identification of risk--or lack thereof for groups--is
that often the signs and symptoms that stem from the challenges
experienced during transition do not appear or begin until well after
transition from military service. This delayed onset presents further
challenges, as there are times when the Departments do not have regular
contact with the transitioning Servicemember/Veteran.
VA anticipates no additional costs to VA resulting from this bill.
s. ___--to require the secretary of veterans affairs to establish a
program to award grants to persons to provide and coordinate the
provision of suicide prevention services for veterans transitioning
from service in the armed forces who are at risk of suicide and for
their families, and for other purposes.
The draft bill would require VA, not later than 1 year after the
date of the enactment of this Act, to establish a program to award
grants to persons to provide and coordinate the provision of suicide
prevention services for eligible Veterans who are at risk of suicide
and for their families. A Veteran would be eligible for services under
this section if the Veteran is within the first 3 years of
transitioning from a member of the Armed Forces to civilian status.
Grant applicants would be required to submit an application that
describes the suicide prevention services to be provided; the
identified need for these services; a detailed plan describing how the
suicide prevention services would be delivered, including the community
partners with whom the applicant proposes to work, the arrangements
currently in place with such partners; and how long such arrangements
have been in place. Additional information required is a description of
the types of Veterans at risk for suicide and the families of such
Veterans to be provided such services; an estimate of the number of
Veterans at risk for suicide and the families of such Veterans proposed
to be provided such services and the basis for the estimate; evidence
of the experience of the person and proposed partners in providing
suicide prevention services to individuals at risk for suicide, and
particularly to Veterans at risk for suicide and the families of such
Veterans; and a description of the managerial capacity of the applicant
in several different areas.
VA would be required to give priority in awarding grants to
applicants who: have been providing or coordinating the provision of
suicide prevention services for Veterans at risk of suicide and the
families of such Veterans; have demonstrated the ability to provide or
coordinate such services to such persons; have demonstrated the ability
to provide opportunities for social connectedness for Veterans; and
have demonstrated how they measure the effectiveness of their program.
VA would also have to give priority to applicants providing services in
rural or tribal areas, or in areas that have experienced high rates of
or a high burden of veteran suicide and where no health care is
furnished by the Department. Grants awarded under this program would be
used to provide or coordinate the provision of suicide prevention
services for Veterans who are at risk of suicide and their families.
The suicide prevention services provided or coordinated would have to
include the following: outreach to identify Veterans at risk of
suicide, with an emphasis on Veterans who are at highest risk of not
receiving health care or services from VA; screening risk assessment
and referral to care; education of suicide risk and prevention to
families and communities; case management services; peer support
services; assistance in obtaining benefits from VA and other Federal,
State, and local government entities; temporary assistance in
transportation in the form of a voucher, when appropriate and
applicable, to be used in accessing services; personal financial
planning; legal services to assist with issues that interfere with
obtaining or retaining housing or supportive services; and other
services necessary for improving the resiliency of veterans at risk for
suicide and their families.
VA could require grantees to submit to the Secretary reports
describing the use of the grant amounts. Grantees would have to notify
each person who receives services that the services are being paid for
in whole or in part by VA. VA would have to establish evaluation
criteria for grantees under this section, require each grantee to
submit a report with information necessary to evaluate the grantee at
least annually, and evaluate each grantee at least annually. In
planning and preparing to carry out this program, VA would have to
consult with Veterans Service Organizations and various national and
local organizations. VA would be required to report to Congress within
1 year of starting the program on the program and on the grant
recipients under the program.
VA strongly supports the concept of this legislation subject to
Congress finding appropriate offsets. In June 2018, VA published a
report on its findings from the most comprehensive analysis of Veteran
suicide in our Nation's history, examining more than 55 million Veteran
records from 1979 to 2015 from all 50 States and four territories. The
report built on previous VA Suicide Data Reports. Key findings include
that in 2015, on average, 20 Veterans died by suicide each day. Six of
the 20 were users of VHA services, while 14 Veterans had not used any
VHA care in the calendar year of or prior to their death. While VA has
a number of programs devoted to reducing Veteran suicide, and we
continue to develop and enhance these programs and efforts, they are
designed to reduce risk of suicide in the population of Veterans who
are under VA care. Therefore, we believe this legislation could provide
a critical tool for coordinating with other entities in the community
to reach this population of Veterans who do not rely on VA for care.
VA's efforts to reduce the incidence of suicide ideation, behavior (and
suicide completions) among all Veterans could be complemented by
partnering with community-based providers who are able to replicate
VA's suicide prevention programs in the community and to connect with
Veterans that are currently beyond VA's reach. VA considers effective
partnering with eligible grantees key to being able to reduce the
number of Veterans dying by suicide.
We would appreciate the opportunity to work with the Committee to
explore some technical alternatives or modifying language that may
improve this proposal. For example, we have concerns about the narrow
scope of eligibility for Veterans, as the bill would exclude Veterans
who separated from the Armed Forces more than 3 years before; this
would include the population of Vietnam Veterans who have some of the
highest rates of suicide. We also recommend including members of the
Armed Forces (including members of the Reserve Forces and the National
Guard) up to a year prior to their separation. This would better inform
them of VA services and help facilitate needed wraparound services for
this high-risk population as they transition. It would also facilitate
a warm handoff to VA upon their separation should the new Veteran be
interested. Further, we recommend that the legislation authorize
eligible entities, rather than persons, to receive grants. We are also
concerned about the timeline for implementation, as pursuant to 38
U.S.C. Sec. 501, VA will need to publish regulations for this program
prior to awarding grants. Finally, we note that additional resources
would be needed to support a new grant program, including funding for
grant awards and program administration.
s. ___--modernization of medical records access for veterans act
The proposed legislation would require VA to establish a pilot
program that would provide patients with a physical device, the size of
a credit card, which would be used by patients to support the review of
their personal health information and the exchange of information with
other healthcare providers they might see, both inside and outside of
VA. VA would be required to conduct a full and open acquisition and
award a contract within 120 days of the enactment of the Act. VA would
need to conduct a pilot in at least one VISN for a one-year period.
VA agrees that patient-mediated health information exchange is a
valuable strategy to support making health information available
directly to patients and then under their direction, making that same
health information available to the providers across the health system
they entrust with their care. However, VA does not support this bill as
written.
Currently, VA has technologies that support interoperable patient
health information exchange nationwide. VA's My HealtheVet Blue Button
is piloting technology that allows Veteran patients to share their VA
health records with their community care provider directly from their
personal devices. VA's eHealth exchange technology is a rapidly growing
network that connects VA with community health providers who can then
securely share clinical information using a standardized approach.
As noted above, the proposed legislation would require VA to
establish a pilot program that would evaluate a physical device, the
size of a credit card, which would be used by patients to support the
exchange of information. Providing physical devices to patients with
their health information has not been a part of VA's strategy for
supporting patient-mediated data exchange, and we do not believe that
this approach would add significant value beyond current efforts. VA
believes Veterans would prefer to minimize the number of physical
devices or items they would need to manage. Given the near ubiquity of
smart mobile devices owned and used by health care consumers, VA
believes a strategy that focuses on improved health data availability
and exchange on a mobile platform would be preferred.
VA believes that continued work on expanding query based exchange
and on patient-mediated exchange via mobile and web applications
supported by Federal Health Interoperability Resource Application
Program Interfaces should remain top priorities at this time.
Additionally, VA is preparing for the Department of Health and Human
Services Trusted Exchange Framework direction that supports the ability
for patients to access their health information electronically without
any special effort. This direction supports a significant step toward
achieving interoperability for the patient.
Finally, no additional funding will be provided to support any
efforts that would be required, should this bill become law. This would
adversely affect other higher-priority health interoperability
programs.
s. 514--no hero left untreated act
S. 514 would require VA, within 90 days of enactment, to begin a
one-year pilot program in no more than two VA facilities by providing
access to magnetic EEG/EKG-guided resonance therapy (Magnetic
eResonance Therapy (MeRT)) to treat Veterans suffering from Post
Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI),
military sexual trauma (MST), chronic pain, or opiate addiction. VA
would provide access to MeRT to no more than 50 Veterans in carrying
out this program. VA would have to submit a report to Congress on the
program no later than 90 days after the completion of the program. The
bill would not authorize additional amounts to be appropriated to carry
out the requirements of this bill.
While preliminary experience with this technology is promising, a
study by the Newport Brain Research Laboratory to establish the
efficacy of MeRT in treating PTSD in veterans is still in progress. VA
offers repetitive transcranial magnetic stimulation (rTMS), which is a
treatment related to MeRT that has the Food and Drug Administration
(FDA) approval for treatment-resistant depression, a common comorbid
condition in PTSD, TBI, MST, and chronic pain and opioid addiction.
There is no existing evidence that MeRT is superior to rTMS for
treating any disorder. To date, no medical device using MeRT technology
has been cleared or approved by the FDA for the uses described in the
legislation. While VA research continuously examines new treatment
methods and modalities, independently collected evidence of the safety
and efficacy of this technology has yet to be obtained. The additional
pilot data that would be obtained under the proposed legislation would
not address the critical issues of determining MeRT's efficacy against
a placebo or against rTMS. For these reasons, VA does not support the
legislation. VA estimates the bill will have a one-time $1.83 million
cost to implement.
This concludes my testimony. We appreciate the opportunity to
present our views on these bills and look forward to answering any
questions the Committee may have.
______
Additional Views Provided by Hon. Robert L. Wilkie, Secretary, U.S.
Department of Veterans Affairs
The Secretary of Veterans Affairs,
Washington, September 6, 2018.
Hon. Johnny Isakson,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: By this letter, the Department of Veterans
Affairs (VA) is providing deliverables from the Committee's legislative
hearing on August 1, 2018, and reiterating our opposing views on House
Resolution (H.R.) 299.
We know it is incredibly difficult to hear from Blue Water Veterans
who are ailing and ill, and we have great empathy and compassion for
these Veterans and their families. However, we urge the Committee to
consider the scientific evidence, impact on other veterans, and costs
associated with this legislation:
Science Does Not Support the Presumption that Blue Water Navy
Veterans Were Exposed to Agent Orange.
In 2011, the Institute of Medicine (IOM), now the National
Academy of Medicine, reviewed all available scientific evidence
and concluded that exposure among Blue Water Navy Veterans
``cannot reasonably be determined.'' The IOM's report indicated
that Agent Orange was destroyed by sunlight within hours of
application and any that survived would rarely make it out to
the South China Sea because of the major dilution factor.
Media and several Veterans Service Organizations supporting the
legislation have relied on an Australian study from 2002 that
was designed to mimic Royal Australian Navy distillation
policies and procedures; however, this study is irrelevant to
U.S. Navy policy and practice. U.S. Navy ships were required to
draw up seawater for conversion to shipboard potable water at
least 12 miles offshore from any river, a distance at sea where
the presence of Agent Orange was highly unlikely. As points of
reference, 12 cubic miles of water is equal to 13.2 trillion
gallons, and 1 trillion gallons of water flow over Niagara
Falls in a single month. Thus, the dilution factor would have
been significant. IOM considered the Australian study in its
2011 review and stated the significance of the study's findings
was highly uncertain for U.S. Blue Water Navy ships.
VA continues to study the science behind this issue. In late
2019, VA will publish the peer-reviewed Vietnam Era Health
Retrospective Observational Study. The study will compare the
health and morbidity of deployed Vietnam Veterans versus a
cohort of non-deployed Veterans and similarly-aged U.S.
residents who never served in the military. VA collected data
from nearly 43,000 participants including nearly 1,000 Blue
Water Navy Veterans. VA recommends waiting on the findings of
the study instead of establishing a new presumption without a
scientific basis.
Disabled Veterans Would Be Negatively and Disproportionately
Impacted by Modified Funding Fees for VA-Guaranteed Home Loans.
Under this legislation, the funding fee would be a new
requirement for Veterans with service-connected disabilities
rated as less than total. This would be a departure from the
longstanding requirement that Veterans in receipt of VA
disability compensation are always exempt from the VA funding
fee.
Currently, Veterans with a disability rating of less than
``permanent and total'' pay $0 in VA funding fees, regardless
of loan amount. However, lenders generally require a down
payment for loans exceeding the conforming loan limit; that
down payment creates home equity for the Veteran.
Under H.R. 299, such Veterans might not need a down payment,
but they would be required to pay a funding fee. The fee is
non-refundable, and if rolled into the life of the loan, it is
paid with interest. For example, on a $500,000 non-conforming
purchase loan, a disabled Veteran could be required to pay
$12,000 to VA in funding fees (plus interest if rolled into the
life of the loan) rather than applying $11,725 as a down
payment which results in home equity.
Savings from Funding Fees Would Not Be Enough To Cover Blue
Water Costs.
VA estimates we will need $5.5 billion to support the net costs
of the bill, $5.4 billion more than the approximate $100
million that the Congressional Budget Office (CBO) estimates
for the bill. CBO significantly underestimated the number of
Veterans and survivors who would be newly eligible for Blue
Water benefits. VA's estimate is based on the actual number of
Vietnam-era Navy Veterans denied the presumption for Agent
Orange on the basis of never setting foot on the landmass of
the Republic of Vietnam or its inland waters. VA records show
nearly 30,000 of these Veterans were previously denied, but CBO
estimates only 4,730 of these Veterans were previously denied.
Similarly, CBO anticipates only 120 survivors receiving
benefits over 10 years, while VA estimates 2,817 survivors
would receive benefits in the first year alone. In addition,
CBO did not account for any expenses to implement this section
of the bill. The Veterans Benefits Administration (VBA)
estimates 803 employees would need to be hired in the first
year, and funding would be required for salaries and related
expenses such as training and information technology equipment.
VA is unaware of any plans for CBO to revise its estimate.
Impact on Claims Backlog.
Another impact we need to raise is in regard to the recent
ongoing efforts to reduce the appeals and claims processing
backlogs. The accomplishments we have made with congressional
assistance will be stymied due to the fact that we will have to
research and evaluate what could total over 30,000 potential
claims. VBA's current resources are not adequate to begin this
workload. Therefore, these efforts would not only be impacted
through hiring of additional full-time equivalents and costs
but also in adding time to the 125 days to process a claim due
to the verification and study that would need to go into the
processing of that claim.
Setting a New Precedent by Creating a Presumption without
Adequate Scientific Evidence.
The changes proposed in this legislation will have a greater
effect beyond what we believe Congress intends. The creation of
a new statutory presumption that is not adequately supported by
scientific evidence will encourage increased pressure on both
Congress and VA to create and expand additional presumptions
under a similarly liberal approach. This would present a choice
between taking a similarly unprincipled approach to other
circumstances where a presumption is sought, but not supported
by science, or treating different groups of Veterans
disparately without any reasoned basis for doing so. If we do
not allow standards in these cases, there is a greater chance
that such policies will spread to other agencies in the Federal
Government.
Unintended Consequences on Disabled Veterans.
To offset costs for non-housing related programs, a disabled
Veteran would be required to pay VA a new loan fee of up to 2.4
percent of the purchase price of a home instead of applying a
similar down payment amount toward the purchase price. In
short, certain disabled Veterans would bear the cost of
providing other benefits by paying a new loan fee, which
creates no home equity, instead of contributing funds toward
home equity. This would impose a steep price for many and a
cost that others may be unable to take on. We do not believe
that these unintended consequences have been fully considered
by Congress, and they should be completely understood before
this legislation is passed.
As for the deliverables requested during the hearing, VA was asked
to provide for the record:
An Estimate of the Additional Funds Generated by the Fee
Increases Proposed in H.R. 299.
VA estimates savings associated with modified funding fees
proposed in section 6 of H.R. 299 would be $140 million in
2019, $732 million over 5 years, and $1.2 billion over 10
years.
The Number of VA Home Loans Provided in 1 Year Based on the
Most Recent Data Available.
In 2017, 685,735 home loans were guaranteed by VA.
The Number of Those Loans that Included a Funding Fee.
In 2017, 285,282 home loans, or 42 percent of all VA-guaranteed
home loans, included a funding fee.
We appreciate this opportunity to comment on H.R. 299 and look
forward to working with you and the other Committee members on this
legislation.
Sincerely,
Robert L. Wilkie,
Secretary.
Chairman Isakson. I will open with questions, and the order
of questioning, by the way, is going to be all the Members that
are here; we are going to call on everybody in order of
arrival.
Let me just start with myself on the Blue Water Navy. You
made a statement just a second ago that the Australian study is
flawed?
Mr. Lawrence. That is correct.
Chairman Isakson. What is the principal flaw in that?
Mr. Lawrence. Let me draw on Dr. Erickson. He is the
medical----
Chairman Isakson. Dr. Erickson.
Dr. Erickson. Chairman Isakson, thank you for the question.
The Australian study--in fact, I even brought a copy of that in
case we need to refer to it. It is a good study insofar as it
purports to go after certain answers. In particular, this was
commissioned by the Australian Government. The lead author was
a fellow named Muller. It involved wanting to replicate or copy
the distillation process that we used in Australian ships.
Part of the problem here is that the Australian format for
drawing water into the distillation system allowed them to draw
water close to shore, quite frankly. So, in fact, this
experiment--it was a laboratory experiment. Think about high
school chemistry and the distillation apparatus. They wanted to
replicate an existing amount of sea water with dioxin that they
would approximate what was near shore.
The problem is you cannot go from that experiment to then
make a conclusion about U.S. naval personnel. And, in fact, the
Institute of Medicine in their report, which Dr. Lawrence
referred to this conclusion--there was not enough information
to determine whether Blue Water Navy personnel were exposed or
not.
The Committee that wrote this report had the Australian
study available to them and had an opportunity to really go
through this. This was not enough information for that
committee to conclude that U.S. Navy personnel had been
exposed.
Chairman Isakson. OK. Is anyone here familiar with the VA
loan program and the funding fee?
Mr. Lawrence. Yes. I am.
Chairman Isakson. It has been a while since I was in the
business, but if I heard Senator Gillibrand correctly, what she
wanted to do was raise the funding fee from 2.25 to 2.4
percent. Is that correct?
Mr. Lawrence. That is correct.
Chairman Isakson. That is 1\1/2\ percent of the loan
amount, correct? An increase?
Mr. Lawrence. Yeah, that is correct. It is $250 on every
$100,000 of loan.
Chairman Isakson. OK. Is that enough money based on the
number of VA loans that are closed in any 1 year to actually
fund the difference if it were to pass?
Mr. Lawrence. Not in our opinion, no.
Chairman Isakson. I would offer for everybody's benefit, I
did real estate sales my entire life and did a lot of VA loans
and FHA loans and things of that nature. You can make those
numbers look like a lot of things, but that is not a lot of
money, 1\1/4\ increase. It is a variable, too, because it
depends on the number of loans that are actually closed and it
is paid on. If you could get me your calculation, the best
calculation as to what that yield would be in any 1 year, I
would appreciate it, Dr. Lawrence.
Mr. Lawrence. Will do. We will provide that. Thank you.
[The information requested is included in VA's Additional
Views letter dated September 6, 2018.]
Chairman Isakson. I would like a copy of the Blue Water
Navy report, Dr. Erickson. I would like a copy of that report.
Not that I have the scientific acumen to understand it, but I
can learn to ask enough questions about it, because we are
going to make sure we do not leave any stone unturned in
getting the information out that is necessary to make an
educated decision. Our veterans deserve no less than that.
Senator Sanders?
HON. BERNIE SANDERS, U.S. SENATOR FROM VERMONT
Senator Sanders. Thank you, Mr. Chairman, and thanks for
holding this hearing. Let me thank the representatives of the
VA for being here.
I was not happy to hear that the VA is in opposition to
legislation that we have introduced which does something that I
think most Americans understand to be correct, and that is to
understand that when we talk about health care, we must talk
about dental care. Dental care is health care. Today, with the
exception of service-connected oral problems, the VA does not
provide dental care to veterans in this country. What that
means is that in Vermont and I think in every State in this
Nation, you have veterans who have teeth rotting in their
mouths, who have infections, who are in desperate need of
dental care, but are not able to afford to get that dental care
and are not getting it at the VA.
What ends up happening is, I think the panel will
acknowledge, that a poor dental situation causes other health
care problems. Many veterans, especially those exposed to Agent
Orange, suffer from diabetes. Diabetes has a relationship to
your teeth. So, the idea that we are compensating people
appropriately for exposure to Agent Orange and the diabetes it
causes, but not dealing with dental care does not make any
sense to me at all.
I think, Mr. Chairman, the time is long overdue for the VA
to acknowledge what most Americans acknowledge: dental care is
health care. Too many of our veterans are not getting the
dental care they need.
So, what our legislation is is a modest pilot program--and
I am prepared to discuss with you and others about how we can
modify it. Let us see how it works. Let us see if the need is
out there. I think it is. I hear from Vermonters all of the
time that it is a need. I heard from people around the country.
Our legislation is supported by the VFW, and I thank them for
that; The American Legion; the Fleet Reserve Association; and
the Vietnam Veterans of America; and we will hear from a
representative from the Vietnam Veterans of America in a few
minutes.
The bottom line is, Mr. Chairman, the time is long overdue
for the VA to understand that dental care is health care, and
it must be addressed for our veterans.
Thank you.
Chairman Isakson. Thank you, Senator Sanders.
Senator Boozman?
HON. JOHN BOOZMAN, U.S. SENATOR FROM ARKANSAS
Senator Boozman. Thank you, Mr. Chairman. Thank you so much
for holding this important hearing that really covers a lot of
different items.
We appreciate you all being here, and we appreciate the
second panel talking to us about the pros and cons, as you see
it.
First of all, I would like to start by saying how glad I am
to see the Blue Water Navy legislation move forward in the
Senate. This is an important piece of legislation that will
allow many deserving veterans to receive the care and benefits
that they have long earned and sought.
I am also very pleased to see that the House-passed version
of the Blue Water Navy bill includes a provision from my
Thailand toxic exposure legislation. The provision authorizes
the Secretary to provide any child of a veteran of covered
service in Thailand who is affected by spina bifida the same
health care, monetary allowance, and vocational training and
rehab required for the children of Vietnam veterans similarly
impacted by spina bifida.
We have a situation where people in Thailand who served, we
have recognized were affected, yet they are the only ones left
out in regard to the children with spina bifida that we know is
directly related to the other.
Is there a reason that--I mean, are you all for or against
that provision? Is there any reason, scientifically or not, not
to include them with every other besides the cost?
Dr. Erickson. Senator Boozman, thank you for the question.
Part of the challenge as it relates to spina bifida is that the
most recent ad hoc committee from the National Academy which
reviewed this issue actually downgraded the evidence for there
being an association of spina bifida in the children of Vietnam
veterans. That does not mean that VA withdrew that benefit.
However, at the present time, extending the benefit further is
a little bit tricky because the foundation, the scientific
foundation, per the National Academy of Medicine, has
diminished remarkably.
Senator Boozman. I guess the only argument I would make, a
benefit for one, a benefit for another is not--it is not the
way that we do things. So, we need to get that worked out.
In regard to the Blue Water bill--we would like to get the
Thailand exposure bill done, and we are going to work really
hard to do that. But, in regard to Blue Water, we really are
pleased that this is moving forward. I want to commend
Commander Wells for his dedicated work to seeing the bill
through the lengthy but rewarding process that we are
experiencing. I strongly believe that it is due to people
giving continued service pushing this forward--Commander Wells,
Mr. William Rhodes, an Arkansas veteran who served in
Thailand--that the Committee is able to advocate for
servicemembers and their families. It is my sincere hope that
this momentum will continue as we continue to seek care for the
needs of all of our Nation's veterans well into the future.
The other thing I would like to mention is a bill that we
have, the VA Hiring Enhancement Act and just spend a second.
That is a bill from myself, Senator Heller, and Senator Tester.
What we have tried to do, you know--we talk about all of these
situations, whether it is extending Blue Water Navy, Thailand,
and then all the problems we have at the VA, one of the major
problems we have right now is we do not have enough providers
in positions to fill. In talking to our provider community, in
talking to the people that are running the hospitals, one of
the things that they mention is that and a couple of other
things.
First of all, in their residencies, the ability to offer
them the opportunity like other providers do fairly early in
their residency to come to work for the VA. That is not done
now. I do not know if it is precluded, but it is not being
done. This bill specifically says let us do that.
The other thing is the noncompete contracts, which I think
many people feel like do not hold up anyway. Many people just
go ahead and do that regardless. We have had, I think, mixed
judicial things in regard to that. But, what we would like to
do is based on the fact that if you are in private practice,
you go to work for the VA, you are not pulling patients from
the private practice to the VA. It is a different class of
patients. So, we would like to get rid of that and make it such
that the VA is exempt from that.
Do you have any comments about that very quickly?
Mr. Lawrence. Sure. Let me direct the question to my
colleague Jessica Bonjorni.
Ms. Bonjorni. Thank you, sir, for the question. We are in
support of the provision to remove noncompete agreements. We do
not have data to suggest how often this is happening, but we do
certainly have incidents where we have had difficulty bringing
providers on board because of noncompete agreements in their
local market, and we have to use work-arounds to try and get
them on board or wait. We appreciate your support on that.
Senator Boozman. Thank you very much.
How about the issue regarding the residencies and trying to
offer a job earlier than we are now?
Ms. Bonjorni. We do have the ability to offer contingent
appointments now. However, this legislation may help clarify
that we have that ability now and make it more used in the
community.
Senator Boozman. Very good. Well, we will welcome you
working with us on language, if you have concerns about
specific things, and I do think little things like this really
are big things in the sense we desperately need the providers
that we can use in the VA system.
Thank you, Mr. Chairman.
Chairman Isakson. Thank you, Senator Boozman.
Senator Manchin?
HON. JOE MANCHIN III,
U.S. SENATOR FROM WEST VIRGINIA
Senator Manchin. Thank you, Mr. Chairman. I thank all of
you for being here. Just a few things.
The Blue Water Navy, so that I understand, that is for
anyone who served during the Vietnam era that basically was on
a ship 10-12 miles out supporting a carrier base, right?
Probably a carrier fleet.
Mr. Lawrence. That is correct.
Senator Manchin. OK. And, they were not coming in. They
were not combat. You are saying--I mean not ground combat. I
am----
Mr. Lawrence. Let me clarify. If your ship came in, in your
example, and you parked at a port, you went on shore, and you
make a claim, you would be covered by, as described earlier,
the ground base presumptive, right? Senator Gillibrand talked
about it. You were on the ground. So, in the example you are
talking about, your ship has to stay out of----
Senator Manchin. So, I never could touch land in Vietnam?
Mr. Lawrence. Generally speaking, that is correct.
Senator Manchin. But, now there are people that say that
basically their ships did come into port, and they are still
not getting that type--I mean, they are being rejected because
they were not in combat or not in a combat zone that would have
been exposed. I am just trying to understand.
Mr. Lawrence. Sure.
Senator Manchin. We all want to take care of our veterans,
OK? I cannot imagine even if a veteran was on a ship that never
came in and started showing all these symptoms that are
prevalent with Agent Orange, that that person would not be
taken care of.
Mr. Lawrence. Certainly, and he should be. I am unfamiliar
with the specifics you are referring to. But, we have logs
during this period of time from the Department of Defense of
where the ships traveled, where they moved. It is very detailed
and it is voluminous. So, we are able to track the people you
are describing. It does not say it does not happen, but, you
know, you then have to have the diseases or the disabilities
that are covered by the presumptives. So----
Senator Manchin. The presumptives are if you were exposed
in any way, shape, or form, these are the things that could
happen, and you all can detect that.
Mr. Lawrence. Correct. That is correct. So, ideally, the
situation----
Senator Manchin. But, you should be able to detect that
also even if they had not come to shore.
Mr. Lawrence. That is correct. Any veteran at any time can
apply for a claim, and we adjudicate it the way I described.
Senator Manchin. It looks like that you all--I mean, here
is the only thing I can tell you what I hear, is they are
automatically rejected if they had not been to shore. They are
automatically--it is not like saying it is unusual, it is rare,
but you do have the symptoms of being exposed even though you
were not on land.
Mr. Lawrence. The only thing I would quibble with, sir, is
hopefully they are not automatically rejected, because we do
each case on a case-by-case basis.
Senator Manchin. OK.
Mr. Lawrence. They are not automatically----
Senator Manchin. Tell me how, if I have my constituents--
and West Virginia has a large military population, a large VA.
How do I make sure they get proper evaluation and care, not
just rejected because they had never been--this bill might not
be needed if we were getting the care that a person showed the
symptoms and they were taken care of under those conditions. I
think that is what we are running into, the real stumbling
block, and the people that are so upset are thinking they are
just--there is no chance at all that I will get any care
because I did not--I was on that ship, I was on that fleet, I
did not come to shore.
Mr. Lawrence. Sure. We have many, many claims made covering
the way you are describing, and they are processed through our
process with quality control. If you would like, I would be
happy to talk to you about specifics to look in on them, but I
will tell you, the process I am describing is what we use, and
it is not automatic rejection the way you are describing. It
does not say that there could not be things like that which you
are describing happening, but that is not the intent----
Senator Manchin. Well, Doctor, that might not be the
intention, and I respect that. The only thing I can tell you is
you would not have a vote that you had so strong out of the
House if the people believed that. You would not have that many
people supporting it in the Senate if the constituents are
saying, ``Listen, we are just not being treated fair. We are
not even given a chance.'' That is why it has come to this
level.
So, whatever you have done, whether we have the bill or
not, we have got to get our veterans the care they need.
Mr. Lawrence. Sure.
Senator Manchin. That is the problem we are running into. I
assume this bill is going to pass, probably, if it comes out
and goes to the floor. I do not know anybody that would be
opposed, because we have all had constituents that have been
rejected without a fair evaluation. That is about it in a
nutshell.
I want you to know I am very much concerned about it. We
should not be at this level. We should have taken care of our
veterans.
I have a bill, Senate bill 1952, the Financial
Accountability Act. I know you all are not crazy about it
either.
Mr. Lawrence. Technically, sir, we do not support it.
Senator Manchin. I want to be as respectful as I can. On
that, it seems like, you know, you all--veterans is the one
group of people that keep us together in a bipartisan way.
There is not another group that we all respond in the same way,
no matter where you come from, because they have done so much
and given us a chance to be here. Every time you all need
money, it is an emergency. It is an emergency. We have run out
of money. I do not know whether you have got somebody that
cannot count, somebody that cannot keep track of it, or
whatever the problem may be, Doctor. I am not trying to be
facetious about this. But, this bill only asks for 45--I mean I
can see a crisis coming. If the VA cannot see a crisis coming
in 45 days to put us always in an emergency position, it is not
fair for us, not any of us, not to be able to do our job to
make sure.
We are very supportive of Mr. Wilkie coming in. We think he
will do a good job. He is no-nonsense. I think he got
bipartisan support. I think, from everything I am hearing, he
has done a pretty good job trying to get things straightened
out and moving in the right direction. But, I do not know why
anyone would--you tell me what you are so offended by on
holding you all accountable financially.
Mr. Lawrence. I am generally aware of the subject matter
covered by your bill, and I believe it has to do with----
Senator Manchin. It is also Mr. McCain's bill.
Mr. Lawrence. Sorry.
Senator Manchin. It is also Mr. Tester's bill.
Mr. Lawrence. All the cosponsors. I am generally familiar
with that. I believe it has to do with the duplication of yet
another set of requirements for things that are already in
place. I will offer to you and others to bring the subject
matter experts to talk to you directly about their concerns.
Senator Manchin. Well, I am also for eliminating that, so
if there is a duplication that we have that allows you all to
declare an emergency within a week or two and not give us
enough notice, we will do away with that one. What we believe
is there should not be anyone that has not done their finances
or done their due diligence telling us where you are going to
run into a jam if something hits. That is, I think, what we are
asking for.
I know I have used more than my time, Mr. Chairman, and I
appreciate it. Sir, I just believe our Blue Water veterans who
are in need of service, we should not even be here talking
about this. I mean, I do not think that they are asking for
that much. So, if we have to do the bill, we are going to do
the bill. But, I wish that we could find another way forward.
Thank you, Mr. Chairman.
Chairman Isakson. If I could beg the Committee's
indulgence, let me expand on Senator Manchin's question. I want
to make sure I understood your answer.
When he asked you the question about exposure to Agent
Orange of someone who had served in the Vietnam theater but was
in the Navy and was 12 miles out, do I understand you to say
that if they could demonstrate that they were on the ground
during that service at any point in time, they could possibly
be eligible for benefits, but if they were never on the ground,
they could not be?
Mr. Lawrence. Sure, let me be precise. As you recall, the
law that was referenced provides a presumptive for Agent Orange
for folks on the ground.
Chairman Isakson. Right.
Mr. Lawrence. It was expanded then to what was referred to
as ``Brown Water.'' So, that is why if you are in the Blue
Water and you are 12 miles offshore, you are not covered, hence
the conversation we are having now. But, by tracking the ships
and the flow, if your ship came in and parked on the land, now
you were in the water that is covered by the presumptive, and
you went ashore and you can document that you went ashore, and
you now have the disabilities, the diseases that are covered by
the presumptive, you would be covered by and be able to receive
benefits.
In the example he was talking about, for someone to be 12
miles off and never be less than 12 miles off, you would not be
covered. That is what Dr. Erickson was referring to about the
pollutants being diluted.
Chairman Isakson. That is the answer I expected, which I
wanted to hear again so that we are absolutely clear on that,
because that answer evolved during the course of your exchange.
Senator Manchin. Mr. Chairman, if I may, just one other
thing. That is the hardest thing we have to understand. If you
are exposed, you are exposed. We do not care whether it is
blue, brown, purple, green, yellow water, whatever it is. If
you are on a ship and you are carrying--and they are loading
tons and tons of napalm and tons and tons of Agent Orange, that
is what we are saying. They have these symptoms, and the
symptoms are directly involved with what they contacted. That
is the hardest thing that we have to understand. They are
automatically just saying, ``Listen, we are not even going to
test you for that because we do not think there is any way you
could have that because it is impossible since you were in Blue
Water.'' That is the thing that does not make sense. That is
the problem we have.
Mr. Lawrence. Sure. Let me pull apart your question in a
couple parts, OK?
Senator Manchin. OK.
Mr. Lawrence. So, again, anyone can file a claim, and you
are not automatically rejected. Let me draw on Dr. Erickson,
though, to clarify the science of what you described about
handling weapons with napalm on them and how you actually are
exposed to dioxin.
Senator Manchin. Well, basically the aircraft coming back
being exposed.
Dr. Erickson. Senator Manchin, there are a couple things
you referred to. Certainly we work with the Department of
Defense on a regular basis to try to learn where were these
agents shipped, how were they shipped, where were they stored,
where were they used. We actually rely upon them because many
of your constituents will contact and say, ``I was in country
X, and I am sure that I was covered with it.'' We talk to DOD.
DOD says, ``We used commercially available herbicides, but
those colored agents, such as Agent Orange, were not shipped,
stored, or used at that location.'' So, there is some precision
that we would need to know, and if you have specific cases,
please bring those to us, and we can help you with that.
The other thing I want to engage you with, sir, is this
issue of diseases being very clearly Agent Orange or, in
particular, dioxin caused. Chloracne is one of the 14
conditions, and that is probably the one of the 14 presumption
conditions that is sort of a smoking gun. There was a president
in Ukraine who, in fact, was poisoned with a dioxin, and you
probably remember his face changed dramatically. He has
chloracne. But, the other 13 conditions are ones actually that
are common with age. They are diseases that people who did not
go to Vietnam actually get. So, when an individual develops one
of those diseases, that is not immediate proof that it was
Agent Orange. We need to do other types of studies, other means
to get to that type of conclusion.
Senator Sanders. Mr. Chairman?
Chairman Isakson. Senator Sanders? And, we are going to
have to move on.
Senator Sanders. All of this discussion, picking up on
Senator Manchin's point, tells us why we need universal health
care. What you are saying, if I got it correctly, if I am on a
ship 11 miles offshore and I come down with an illness, I am
covered. If I am on a ship 13 miles offshore and I come down
with the same illness, I am not covered because under your
definition I cannot quite prove that it is attributable to the
water I may have drunk.
Meanwhile, veterans are becoming ill with the same type of
illnesses and they need care. Maybe our position should be if
you are a veteran and you served in the United States military
and you become ill, you are entitled to VA health care. End of
discussion.
Chairman Isakson. I think that is the way to end the
discussion. I am the one that violated the rule by doing a
follow-up question, so I hate to reprimand anybody else, but I
thought Senator Manchin's question was right on point, and we
needed to get that answer on record. I certainly would never
cut out the former Chairman from having his say.
So, with that said, Senator Cassidy.
STATEMENT OF HON. BILL CASSIDY,
U.S. SENATOR FROM LOUISIANA
Senator Cassidy. Thank you, Mr. Chair. I may come back to
Blue Water just because Commander Wells is from Louisiana. I am
very proud of him. I am also very proud of my Chairman for how
he is handling this, so thank you both for bringing great
consideration.
I will briefly mention, by the way, my Modernization of
Medical Records Access for Veterans Act, which I understand the
VA has opposition to the bill's pilot program, but I will
follow up on that at a later point because I want to focus on
our suicide prevention.
I noted, Dr. Lawrence, that the VA is in support. Thank you
very much. That said, I understand there is both internal and
external potential opposition to it, and so I would just like
to make the case for my colleagues and hopefully for those who
might not be sure about the bill.
To put this in perspective, when Dr. Lawrence came for his
nomination hearing, we spoke about suicide prevention and
veteran community. We know that there are socioeconomic risk
factors in addition to mental health issues associated with
suicide. We have spoken previously about so-called deaths of
despair.
[To staff: Can you put that chart up?]
We find from data prepared by Princeton using CDC data that
suicide, alcohol abuse, and drug abuse are in this unholy
trinity, which results in folks being at increased risk for
support. By the way, CDC notes that 54 percent of suicides have
no known mental health condition.
The socioeconomic factors, particularly isolation, should
be part of our approach. Here is the next graphic, put up by my
assistant; again, social isolation, foreclosure, life events,
addiction only being one of them, can be associated with so-
called deaths of despair.
So, the Community Grant Program that we are suggesting
would coordinate services within the community, helping
veterans by integrating and strengthening social networks. I
smile. My daughter thinks of a social network as being
Facebook. I do not think that most folks my age would consider
such.
The grant, by the way, is also about reaching the 70
percent of veterans who do not seek care in a VA facility.
Seventy percent of veterans who die by suicide have not been
seen within a VA in the past 12 months. We think this is an
incredibly important statistic and, if you will, a
vulnerability relying on a VA hospital-central approach.
So, Dr. Lawrence, you then enter. We are interested in kind
of a different paradigm. How could we use the Veterans Benefits
Administration, which is for many the gateway to the VA. In
fact, more veterans access VA benefits than health care, and in
many cases that might be their only connection.
I note that we talked about a VA loan program for homes.
That is one way a veteran who is probably a little bit better
off might interact with the VA, but she or he might never
interact with a hospital. So, we are trying to think of that.
The other thing--and I think we spoke about this before--
the Transition Assistance Program legislation which establishes
a governance board in this legislation to address deaths of
despair within the Benefits Administration, if you will,
breaking down the silos within the VA, leveraging all the
resources, not just the hospital system but also VBA in a
Department-wide suicide prevention effort.
I say that, again, per our previous conversation, that the
first 3 years after leaving service are when veterans are at
the highest risk of suicide, which is why the Transition
Assistance Program is a critical partner in our suicide
prevention effort. So, the Community Grant Program will augment
the VA's efforts in seeking out veterans in need and connecting
them to the VA and community services and benefits.
Defeating deaths of despair requires that we take a
comprehensive approach to reaching vulnerable veterans, and
that is why we want VBA.
Dr. Lawrence, we spoke about VBA's role in suicide
prevention during your confirmation hearing. Since then, and
knowing that you have looked at the bill we proposed, can you
give your thoughts on how you, the VBA, can support this effort
and place in the governance board within VBA to ensure suicide
prevention is a department-wide effort?
Mr. Lawrence. Certainly. I want you to know I took
seriously our conversation on April 12, and one of the first
things I did when I was confirmed was begin to understand what
is the relationship, as you point out, with that despair. VA
has a series of counselors, called ``voc rehab counselors,''
vocational rehabilitation. They begin the engagement you
actually were describing with veterans. One of the things I
learned from, you know, reports of GAO while watching the House
hearing, was the ratio of servicemembers to counselors was
above the ratio prescribed by law. It is supposed to be 125:1.
It was north of 140. The first thing I immediately did was
figure out how to streamline staffing to go and hire more of
these counselors, so by the end of this fiscal year, in a
couple of months, we will have enough counselors on board so
that ratio is in compliance with the law. We completely agree
with you, I completely agree with you that the engagement is
critical. Part of what these counselors do is exactly what the
second slide shows. What do you need from us? Is it benefits?
Perhaps you are homeless. We can expedite your claim. Perhaps
you need medical attention, and we connect you with VA. I
totally took our conversation seriously, and it had an impact
on my actions in the first less than 100 days.
The second thing, as you know, is transition assistance is
actually led by the Department of Defense and Department of
Labor. We work with them. So, you know, I would like to say we
have reignited--but I do not think it needed that much
igniting--engaging with them to really work these issues. We
are conducting a survey--it is now sitting with OMB, so we can
do that--to analyze servicemembers who are now veterans who
have gone through TAP afterwards. We get a very good survey
while it goes on, but sometimes we wonder if they do not know
what they do not know. We want to talk to them afterwards and
reflect on now that you have had a job and you have begun your
life again, how did we do getting you ready.
So, we are very much in agreement with you that what we
think about at VA is, you know, you are a member of the
military for a short period of time, in my case 3 years, but
you are a veteran forever. We have a longer relationship with
you that we need to think about how it is maintained and
continued.
Senator Cassidy. Thank you very much. I appreciate you all
looking at this and I look forward to its passage. I urge my
colleagues to support it when the time arises. Thank you.
Chairman Isakson. Thank you.
Senator Hirono?
HON. MAZIE K. HIRONO, U.S. SENATOR FROM HAWAII
Senator Hirono. Thank you, Mr. Chairman.
I am proud to join my colleagues and the veteran service
organizations here today in support of the Blue Water Navy
Vietnam Veterans Act. Passage of this bill is needed for
veterans in Hawaii, like Richard from Kaneohe, who served on
the USS Hancock in the Gulf of Tonkin from 1972 to 1975.
Richard was diagnosed with diabetes and is now on kidney
dialysis. Or veterans like Gordon, also from Hawaii, who served
in the Navy fleet on the USS Chipola from 1967 to 1969 and was
diagnosed with soft tissue carcinoma. Both Richard and Gordon
contend that their illnesses are due to Agent Orange exposure
while serving off the coast of Vietnam.
These are some of the thousands of Blue Water Navy Vietnam
veterans who have applied for VA health benefits, but were
denied because they happened to serve our country at sea rather
than on land. We would like to correct that wrong.
One thing I would like to ask you, Dr. Lawrence, is that
you said that even for these people who did not serve on land,
it is not an automatic denial of coverage. Is that correct?
Mr. Lawrence. That is correct.
Senator Hirono. So, if they are not automatically rejected,
what would the servicemember have to show to raise the
presumption that he or she would be covered?
Mr. Lawrence. It is very complicated--you have asked a
question that could easily be very, very complicated, but let
me try.
Senator Hirono. What I am getting to is: how much of a
burden are we placing on the servicemembers themselves to prove
that they were indeed exposed to Agent Orange? See, that can be
a burden that is way too high for any servicemember, so we may
as well just automatically deny them.
Mr. Lawrence. Let me make a couple of observations. At VBA
we have a duty to assist the servicemembers to help them find
the records and the information they need. Often, when you ask
why does it take so long for a claim to be processed, it is
because we are trying to help them find the medical records.
So, hopefully, it is less of a burden because we assist. But,
they are required to produce some information which we will try
to figure out and if they are qualified under, does this seem
presumptive or not.
In addition, we need a medical exam, as Dr. Erickson
pointed out, to figure out what is the cause of the situation
they find themselves in.
Senator Hirono. I have talked to a lot of veterans, and it
is hard enough to show that they do come within the parameters
for treatment even without exposure to Agent Orange. I can only
imagine what that is like for those who claim to have been
exposed to Agent Orange. So, I think the burden of proof of
showing, coming forward with that kind of evidence is very
high. In fact, it took decades for the VA to even cover or to
acknowledge that exposure to Agent Orange should be one that
would be covered under the VA. It took an act of Congress for
that to happen. So, it looks as though we are going to need to
have an act of Congress again.
Let us say that we do that, and obviously we need to work
with you to make sure that you have the resources necessary to
provide the kind of care that this additional group of veterans
are going to need. You did indicate in your testimony that this
would really strain your resources and that you would need to
hire more people, et cetera. Can you tell me what kind of
additional resources you would need to deal with the claims
burden that would be generated by the passage of this bill?
Mr. Lawrence. Sure. Based on our estimates that we provided
in the testimony, it is $500 million over 10 years.
Senator Hirono. OK. How many veterans are we talking about?
Something like 70,000?
Mr. Lawrence. Well, yes, that is an estimate. That is
correct.
Senator Hirono. OK. So, I think that, you know, in a
situation like this where the burden is really extremely high
for the veterans to show that they should indeed be covered, I
think we should go ahead with covering this. And, I am pretty
much in line with our former Chair in saying that, you know, we
should provide the health care that they need.
I have a question relating to S. 1990 that is also on this
agenda, Dependency and Indemnity Compensation Improvement Act.
I am a cosponsor of this bill, and I certainly applaud Senator
Tester's work in leading this effort. It has been a long
overdue increase of approximately $300 a month for DIC
recipients, including thousands of beneficiaries in Hawaii.
Dr. Lawrence, you state in your testimony that increasing
the amount of DIC benefits payment will help survivors continue
to live a sustainable life, which I wholeheartedly agree with.
Are there any other programs under your purview which need a
fresh look at--changing the formula for calculating payments
similar to how S. 1990 does for DIC payments?
Mr. Lawrence. None come to mind at this moment, but I would
like to take that back and perhaps come back and discuss this
with you.
Senator Hirono. Yes, because I think we share the goal of
enabling all these survivors to live, as you put it,
sustainable lives. I would appreciate that information.
Thank you, Mr. Chairman.
Response to Request Arising During the Hearing by Hon. Mazie K. Hirono
to Paul R. Lawrence, Ph.D., Under Secretary for Benefits, Veterans
Benefits Administration, U.S. Department of Veterans Affairs
Question. Dr. Lawrence, you state in your testimony that increasing
the amount of DIC benefits payment will help survivors continue to live
a sustainable life, which I wholeheartedly agree with. Are there any
other programs under your purview which need a fresh look at changing
the formula for calculating payments similar to how S. 1990 does for
DIC payments?
Response. Yes, the VA legislative proposals published in the Fiscal
Year 2019 President's Budget address identified areas for improvement
in how VA calculates and provides benefits, including proposals
pertaining to: (1) the reissuance of VA benefit payments to all victims
of fiduciary misuse; and (2) the removal of annual income from net
worth calculations for pension benefits.
Chairman Isakson. Thank you, Senator Hirono.
Senator Sullivan?
HON. DAN SULLIVAN, U.S. SENATOR FROM ALASKA
Senator Sullivan. Thank you, Mr. Chairman. And, Dr.
Lawrence and your team, I want to thank you. I know that with
Secretary Wilkie on board you guys are going to work hard, but,
you know, you have got a tough job here, right? These are good
bills, but there are some issues with them. Your job is to tell
us which are the good ones, which are the ones you have issues
with, how you can work with us on them.
I appreciate what you and your team are doing. It is not
easy. It is easier to say yes to all these bills. Now I am
going to ask you to say yes to one of my bills.
But, in all seriousness, we do appreciate what you are
doing.
I do want to talk about a rather simple bill that I know
you have looked at, and I want to get your view on it. It is
the Medal of Honor Surviving Spouses Recognition Act, which is
S. 2485. This was actually--it is kind of a story you have
probably heard a lot about from some Senate bills. It was
inspired by a constituent of mine, a gentleman in Alaska named
Dave Glenn, a Vietnam veteran from Wasilla, AK, who served as a
paratrooper in the 101st Airborne. Every Memorial Day and
Veterans Day, he stands for hours at attention on a bridge in
Alaska named after one of our two Medal of Honor winners, a
recipient, Army Sergeant First Class James Bondsteel, who was a
fellow Vietnam vet of his, who now rests at Fort Richardson
National Cemetery in Alaska. Dave's one-man Honor Guard on the
bridge twice a year--he is 73 now--pays respect not only to
Sergeant First Class Bondsteel, but, importantly, the wife and
the daughters he left behind after he died in a car accident on
that very bridge, which is why it was named after him.
Dave, about a year and a half ago, pitched an idea to me.
He said, ``Senator, you know this. Families serve in the
military as well as spouses, even if they are not wearing the
uniform. I always tell my wife and daughters, you know, they
have served as much as me or anyone else. Maybe sometimes they
have even a tougher job.''
So, in that spirit, and that respect from Dave Glenn, my
bill is simple. It extends the special pensions granted to
Medal of Honor recipients to the spouses that survive them
after they are gone. The spouses obviously have sacrificed as
well.
This is a rather small gesture. It is not expensive. I know
you guys have looked at the dollar amounts. When you are
talking to VA, there are rounding errors. But, it means a lot
to the families of these Medal of Honor families. I also think
it means a lot to Americans.
Mr. Chairman, I am going to submit for the record an
article from the Frontiersman in Alaska entitled ``Veteran
stands Honor Guard alongside the Glenn Highway.'' It is about
Dave Glenn's Honor Guard. He says, ``The fabric of our country
is heroes,'' and, ``These people''--Medal of Honor winners--
``inspire all of us.''
I would submit that for the record.
Chairman Isakson. Without objection.
[The article follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Sullivan. So, anyway, that is what the bill does. I
certainly agree with Rick Weidman, the executive director for
policy and government affairs for the Vietnam Veterans of
America, when he called this bill a ``no-brainer'' in his
written testimony. I would appreciate your assessment and your
team's assessment as well. Then, if I have time, I have a quick
question on transition assistance.
Thanks again for the good job you guys are doing. It is not
an easy job.
Mr. Lawrence. Thank you. We support the bill.
Senator Sullivan. Great. Well, I will leave it at that.
[Laughter.]
No, no follow-up. Thank you. Wow. OK. Good. I am glad. I
have another question for you.
Transition assistance, you know, a number of us right now--
and I think you guys are working with Senators Crapo, Tester,
Cassidy, myself--we are working on looking at ways to improve
that. One issue that I have thought might be something--and I
know you guys are doing studies on it--is, you know, last time
I got off active duty for a recall was in 2013. I went through
the TAP transition, and it is all right at the end there. It is
all right at the end. But, you get hit with a lot of stuff.
Now, if you are on active day, say a Marine, you have got a
4-year tour. You are getting out--usually these young men and
women, they do it all at the end. Is there any thought about
saying, hey, Marine, you are going to get out in 6 months, let
us start thinking about your career in 6 months or, you know,
maybe even a year so they can start thinking and strategizing,
as opposed to--and we know how it works. I was in this position
a couple times. You just want to get out, right? You are not
thinking about transition. You are just saying, ``I am going to
go through the classes, do all this, and leave.''
But, is there any thought about pushing that process kind
of deeper into the career of an active-duty military member so
they are actually strategizing and thinking a little bit more
seriously than, ``Hey, I know I have got to go through this; I
will check the box, and get out of here''?
Mr. Lawrence. The short answer is yes, especially at VA. We
very much think about that. We worry exactly as you described,
that it is all at the end, and sometimes things at the end,
events overcome and people miss it.
Senator Sullivan. Yeah, and you are just not that focused.
Mr. Lawrence. Right. And, as you know, DOD has the lead on
this; the Department of Labor is involved and we are involved.
So, these conversations we have with them are collaborative in
nature, and that is a perspective we bring. They bring
different perspectives, so we try real hard to work through
that. We have always advocated that the sooner we can begin to
teach people about the benefits they will have as a veteran,
the better it will be, especially when we think about things we
are talking about--home loan ownership, for example, not
something you probably think of right away, but later you will
look back and say, ``This is a very powerful benefit.'' Access
to health care, as we have talked about, understanding that,
you know, you will under certain circumstances be open to
health care and the like.
We are very much in favor of that. We try hard to work with
DOD and Department of Labor to get that point into the
conversation.
Senator Sullivan. Great. Well, we want to continue to work
with you on that, with those and other ideas on the transition
assistance.
Mr. Lawrence. Thank you very much.
Senator Sullivan. Thank you, Mr. Chairman.
Chairman Isakson. Thank you, Senator Sullivan.
Senator Tillis?
STATEMENT OF HON. THOM TILLIS,
U.S. SENATOR FROM NORTH CAROLINA
Senator Tillis. Thank you, Mr. Chair. I will tell my
colleague Senator Sullivan that, as Chair of the Personnel
Subcommittee, that is going to be the focus, TAP, the
transition assistance program being on VA, not only how much
earlier we weave it into the life cycle, but recognize some
young person transitioning may have very different needs than
someone that has been in 10 years, 15 years, 20 years. So, we
have got to do a better job of tailoring, we have got to do a
better job of understanding what sorts of assignments and MOS's
the military personnel had that may make them at risk for
certain things they may not even know they are at risk for. So,
there is a lot of work to be done there, and, Mr. Chair, I was
going to suggest that we possibly even have a subset of the
Veterans Committee and Personnel Subcommittee get together so
we are all hearing the same thing at the same time so the two
committees can work together.
Mr. Lawrence, when you were responding to Senator Hirono's
questions about the documentation and how you process the
documentation and try to take up claims for outside of which
you already have a presumption, I was reminded of a constituent
request that I had about a year and a half ago in my office. We
are approaching 20,000 cases in North Carolina. I have been in
3 years, 3\1/2\ years. The majority of them are for veterans.
This particular one was a veteran who came home with his wife.
While she was reading the mail, and she said, ``Honey, I did
not know you died.'' The VA had sent her, as a survivor, a
notice about the paperwork she needs to do for what was
apparently her living husband right next to her.
So, he called the VA, and the VA told him that there was
this paperwork and these documents that he would have to submit
to prove that he was, in fact, alive. He then called our
office. I said, ``Look, it is not our problem to fix your
problem.''
Now, I know you are coming in new, and you have got an
organization that has got a lot of problems to fix. But, I
would tell you there may be cases where you are trying to help,
but with the volume you have, I am sure there are a lot of
cases where people are not getting the kind of help they need,
and it is very difficult to navigate through the VA. So, I wish
you well on really trying to make those processes work where it
is less work for the veteran and more work for the Department
to get things done.
He, by the way, is now considered alive again, and he has
got VA benefits, so that was a happy ending.
Dr. Erickson, I want to talk with you about the science on
the Blue Water issue. You may not know--Jerry Ensminger I know
is on the Hill somewhere, but he was chasing the issue down
with Camp Lejeune toxic substances before I got here. We had a
tug and pull with the Department for a while, and to Dr.
Shulkin's credit, we made good progress there.
The way we arrived at that is making sure that we kind of
matched up competing views on the science to a large extent. I
think that is a fair way to characterize it.
So, if I look at the Blue Water Navy, I ask myself: how can
we get a process going that could be driven largely by science,
but in the same way that we had to pull people together and try
to bridge the gap, identify a potential class of people that
right now do not get the presumption? The main reason--I share
everybody's concerns. I would rather err on the side of the
veteran in every case. But, one of the concerns that I have
right now with the bill as proposed is the new pay-for. The
pay-for that was proposed in the past was an adjustment to the
COLA, kind of a broad base, relatively low impact, but it
impacted all veterans. Now, the new proposal is one that gets
right at loans, home loans. It is something that Senator Warren
and I worked on. We made some progress on that in terms of bad
actors for veterans. I am afraid that, one, it actually
concentrates the cost on a smaller group of veterans, so it
becomes a higher cost. Depending upon how you get the
presumptions, it could even be a greater cost. I think we are
talking about a spread of 25 to 50 basis points, and on certain
loans that could be a lot of cost borne by certain veterans.
So, how could we actually accelerate or create a construct
similar to what we did with Camp Lejeune to come to a good and
fair conclusion, but also manage the upside risk and costs
along the way?
Dr. Erickson. Senator Tillis, thank you for the question. I
do not know if you remember me. I was part of the tug and pull,
and I remember all that well.
Senator Tillis. That is why you got a question. [Laughter.]
Dr. Erickson. Thank you. I am sure you are aware but
perhaps other Members of the Committee are not aware that we
relied initially--and you in legislation relied in the Janey
Ensminger Act--on the National Academy. In fact, those 15
covered conditions came from a National Academy report, a 2009
report. Not a perfect report; I got that. But, that was the
basis for--the evidentiary basis that initially led to
legislation.
Likewise, within the tug and pull with Camp Lejeune, we
came together with other Federal agencies, in particular, the
Department of Health and Human Services, ATSDR, looked at a lot
of the same information together. It was a very profitable
exercise for us. It is one that, in fact, we are using now for
lots of other toxic exposure issues. And, in fact, that led to
our Secretary at the time then promulgating presumptions for
Camp Lejeune veterans. But, again, based in evidence; based in
evidence.
Our challenge right now is that the National Academy did
not help us out. They said, ``We do not know. We do not know.
We cannot say that they were exposed. We cannot say that they
were not exposed.'' So, we are stuck. We are stuck. And, I
think part of our concern is what are the second- and third-
order effects when we go beyond this law, as there might be
other groups that will say, ``Well, you know, our evidence is
equally strong or weak, and, why don't you take care of us
either through VA regulation promulgation or through
legislation?'' That is the challenge.
Senator Tillis. The main thing for me is I want to make
sure that those where the science leads us to say we absolutely
owe it to them--and I do not even mind a little gray area, a
gray area that favors the veteran. But, if you do not figure
out how to sustain it--what we do here is pass bills, which we
forget when we cut or change benefits somewhere else later on,
because we do not have the money to pay for it. I want to make
sure that the promises that we made we keep, and if we make a
promise in this area, it is driven in a way that is
sustainable, gives care to those who need it and deserve it,
but does not put us in a situation where, when we run out of
money and we are already out of money. I do not know if you
know about our $21 trillion debt. You have always got to be
mindful of making sure that you are not making empty promises,
you are not promising progress in one area at the expense of a
risk for future funding in the other area.
I look forward to the VSOs. Sorry I ran over, Mr. Chair.
Chairman Isakson. Thank you, Senator Tillis. We excuse the
panel and thank the panel for being here. If you wish to stay
to hear from the VSOs, I hope you will.
If our VSOs will come forward as quickly as possible, I am
going to make sure I do not cut you off like I did the last
time you were here.
While those testifying are being seated, I am going to ask
to make a unanimous consent request. I have 20 organizations
that have submitted written statements for today's hearing and
agenda. I ask consent that those statements be made part of the
record of this hearing. Hearing no objection--is there any? [No
response.]
Hearing no objection, we will enter them in the record.
[These statements can be found in the Appendix.]
------
Response to Posthearing Questions Submitted by Hon. John Boozman to
U.S. Department of Veterans Affairs
Question 1. I want to thank the VA for your foresight and
leadership on S. 769, The Medicare Access to Radiology Care Act of
2017, to require Medicare to recognize RAs. The VA has indicated that
they are in the process of authorizing Radiology Assistants at the VA
to align Medicare requirements with state requirements. Will you
provide a status update for this effort and your sense as to when this
process will be completed?
Response. The Department of Veterans Affairs (VA) Office of Human
Resources and Administration (HRA) is in the process of establishing a
new qualification standard for the Registered Radiologist Assistant.
Currently, the qualification standard is in the final stages of
concurrence for approval and publication. The qualification standard
provides that a Registered Radiologist Assistant practices under the
direction and supervision of a physician. HRA is working toward having
this qualification standard completed by November 2018.
______
Response to Posthearing Questions Submitted by Hon. Sherrod Brown to
U.S. Department of Veterans Affairs
Question 2. I am very happy the Committee will review two different
pieces of legislation to address the needs of active duty
servicemembers as they transition to civilian life. We need to do
everything we can to ensure that they have the information and tools
that they need to succeed. Additional days of training to pursue
education, technical training, or entrepreneurship will help to set
servicemembers up for good paying jobs when they reenter civilian life
and I was pleased that this year's NDAA included a version of this
provision in the final conference report. Under Secretary Lawrence, in
your testimony, you say we need to do more to communicate with veterans
after they transition because rapid identification of risk from
transition does not present until much later. Are you referring to the
VFW's suggestion that TAP programs should be offered to veterans once
they have reintegrated in their communities? Are you referring to risk
for medical/mental issues, unemployment? Walk me through what you mean
by that.
Response. VA agrees with our Veterans Service Organization (VSO)
partners that consideration must be given to assist transitioning
Servicemembers to identify and connect with national and community-
based resources within their new civilian communities--wherever they
choose to live. VSOs are introduced as a support resource early in VA's
Transition Assistance Program (TAP) curriculum, and additional
references are integrated throughout the curriculum to ensure
transitioning Servicemembers are aware of the support and services they
can provide. The curriculum highlights how VSOs can support the
military to civilian transition, including VSO support for filing for
disability compensation within the pre-discharge program. During the
curriculum, Servicemembers have the opportunity to use locator tools to
find their local VSO. The program also allows time to introduce local
VSO representatives in attendance at VA Benefits I & II Briefings.
However, VA is not referring to offering TAP to Veterans once they
have reintegrated into their communities. To that end, VA and its TAP
interagency partners are currently developing a Military Life Cycle
module that will introduce transitioning Servicemembers to resources
located in their civilian communities and inform them on how to connect
with those resources. VA will complete development of this module by
December 2018 and will be ready to pilot in coordination with the
Department of Defense (DOD) and the military services beginning in
January 2019.
Moreover, with regard to Servicemembers who are at-risk for
challenges during their transition, VA and its TAP interagency partners
recognize the need to be available during the entire transition to
civilian life. As such, we are working to implement Executive Order
13822, ``Supporting Our Veterans During Their Transition from Uniformed
Service to Civilian Life,'' to ensure these at-risk transitioning
Servicemembers are identified and receive a warm handover to the
support they need. However, VA notes that the signs and symptoms
associated with these areas of risk do not always appear or begin until
after transition from military service. The delayed onset of symptoms
presents challenges for VA and other agencies, as there are times when
the Government does not have regular contact with the transitioning
Servicemember/Veteran.
In keeping with our enduring commitment to those who have worn the
uniform, VA and its Federal partners have developed a Joint Action Plan
which, when fully implemented by July 2019, will improve our ability to
provide a seamless handoff to VA and ensure early and consistent
contact with Veterans to keep them informed of access to peer support,
availability of mental health care after separation, and eligibility
for health care and VA benefits.
______
Response to Posthearing Questions Submitted by Hon. Joe Manchin III to
U.S. Department of Veterans Affairs
In your testimony on S. 1592, VA Financial Accountability Act of
2017, you stated an independent review of VA financial processes would
be redundant and that the VA's Enrollee Health Care Projection Model
(EHCPM) has been extensively reviewed. The two reports you cited, a GAO
report and a report by The RAND Corporation are from 2008 and 2011
however, i.e. well before the VA Choice Program was enacted. One of the
conclusions of the 2008 RAND report was that the EHCPM model could
yield misleading results, especially in a changing policy and budgetary
environment.
Question 3a. Has the EHCPM been updated to model the changing
demand for healthcare obtained outside of the VA system through Choice
and other community care initiatives?
Response. Yes. The 2016 Enrollee Health Care Projection Model
(EHCPM) that informed the 2019 President's Budget was enhanced to
differentiate health care provided in VA facilities and care purchased
in the community. Key enhancements included developing unit costs that
reflect what VA is expected to pay for purchased care and
differentiating reliance and other assumptions in the EHCPM by location
of care.
The EHCPM has been enhanced to model changes in Veteran demand for
VA health care recognizing that greater access to care in the community
closer to the enrollee's home is expected to increase enrollee reliance
on VA health care and the proportion of that care expected to be met
outside of the VA system through community care. Since enrollees
currently rely on VA for less than 40 percent of their health care,
small changes in reliance can have a significant impact on expenditure
requirements.
The total enrollee demand for VA health care projected by the EHCPM
can be reported separately for care expected to be provided in VA
facilities and expected to be purchased in the community. However, the
proportion of total care that will be provided in VA facilities and
purchased in the community can vary significantly depending upon
eligibility criteria, operational guidelines, and resource
availability.
Health care is very dynamic. Further, the EHCPM projections
supporting the VA budget are developed based on data that are three
years removed from the beginning of the budget year (four years for the
Advance Appropriation). During this time, new policies, legislation,
regulations, and external factors, such as economic recessions, can
occur and change the projected demand for VA health care. If so, the
EHCPM can be updated to reflect this emerging experience, and the
Budget is updated to reflect the revised projections.
Question 3b. Has EHCPM been reviewed, by an independent body, since
the VA Choice program was enacted?
Response. The EHCPM has been reviewed extensively by independent
stakeholders, including the Office of Management and Budget,
Congressional staff, the Congressional Budget Office, and the
Government Accountability Office (GAO). GAO, which reviewed the EHCPM
in 2011, is currently reviewing the EHCPM as part their review of the
VA Community Care Budget (GAO Report 102732). VA is providing extensive
information on the enhancements to the EHCPM in order to differentiate
health care provided in VA facilities and purchased in the community
and will address any recommendations included in GAO's final report.
Question 3c. Given the sweeping reforms that are part of the VA
MISSION Act doesn't make sense to have a new, independent review of the
VA's cost projection models?
Response. Please see response to Question 3b.
Question 4. In your testimony, you state that the Blue Water Navy
bill would add significantly to the number of benefit claims pending
over 125 days and additional employees would have to be hired to handle
the case load. How many people would you need to hire if the bill
passed into law?
Response. The Veterans Benefits Administration (VBA) would require
an additional 803 full-time employees (FTE) for 2019 to successfully
and timely address any new reviews and claims that would be a result of
the bill passing into law.
Question 5. In the introduction of the 2011 Institute of Medicine
(IOM) report on Blue Water Navy, they say the following in the
introduction: ``The Committee was surprised and disheartened to find a
dearth of information on environmental concentrations of TCDD during
the Vietnam War, in spite of large volumes of Agent Orange sprayed
throughout South Vietnam. Such information is vital to determining
possible exposures not only of Navy veterans but also veterans who
served on the ground and on the land waterways of Vietnam.'' Can you
elaborate on ways the Department of Defense and Department of Veterans
Affairs have improved service record keeping and transfers of
information so that they accurately reflect possible toxic exposures
while in service?
Response. VA defers to DOD for a full description of initiatives
and efforts to improve recordkeeping of military exposure events.
However, VA and DOD work closely to identify situations where
Servicemembers may be at risk. The Deployment Health Working Group,
comprised of both DOD and VA officials, meets monthly to discuss
ongoing and emerging environmental issues and oversees development of
initiatives to improve interagency sharing of vital information.
The Individual Longitudinal Exposure Record (ILER) is an example of
an ongoing joint enterprise initiative between DOD and VA. The purpose
of this initiative is to establish a complete record of every
Servicemember's exposure over the course of his or her career. ILER
will provide a real-time, long-term exposure record matched to health
status and matched to a Servicemember to a place, time, location, and
event.
______
Response to Posthearing Questions Submitted by Hon. Mazie K. Hirono to
U.S. Department of Veterans Affairs
Question 6. Dr. Lawrence, you state in your testimony that
increasing the amount of DIC benefits payment will help survivors
continue to live a sustainable life, which I wholeheartedly agree with.
Are there any other programs under your purview which need a fresh look
at changing the formula for calculating payments similar to how S. 1990
does for DIC payments?
Response. Yes, the VA legislative proposals published in the Fiscal
Year 2019 President's Budget address identified areas for improvement
in how VA calculates and provides benefits, including proposals
pertaining to: (1) the reissuance of VA benefit payments to all victims
of fiduciary misuse; and (2) the removal of annual income from net
worth calculations for pension benefits.
______
Response to Additional Posthearing Questions Submitted by Hon. Sherrod
Brown to U.S. Department of Veterans Affairs
blue water navy
Mr. Manar's testimony is very convincing, and so was the Australian
study. ``If there was dioxin in the water, we would have been exposed
to it while swimming. Week after week, patrolling up and down the
coast, we took in sea water and processed it through our fresh water
evaporator system. We know from the Australian Navy study, validated by
the National Academy of Medicine (formerly the Institute of Medicine),
that fresh water evaporator systems concentrated toxic material,
including dioxin, which was then transmitted to sailors through
drinking water.\1\
---------------------------------------------------------------------------
\1\ Blue Water Navy Vietnam Veterans and Agent Orange Exposure,
Institute of Medicine, 2011, pg 13, https://www.nap.edu/read/13026/
chapter/2#13.
---------------------------------------------------------------------------
As a matter of observation, absent the cleaning and sanitation of
the entire fresh water evaporator system, it is conceivable that every
person who ever served on board my ship could have been exposed to
dioxin after its first visit to Vietnam. Further, by the time we
completed our last deployment to Vietnam in 1972, the evaporator system
would have accumulated concentrated dioxin from dozens of visits to
Vietnam, not simply the final three that I experienced while on
board.''
Question 7. Dr. Erickson, to date, why hasn't VA concluded that the
science behind the Australian study, which NAM corroborated, is
sufficient? What additional science is VA waiting for?
Response. We thank the Senator for this question and for his
careful consideration of the evidence underlying this bill. We
recognize that this is a complex exposure issue that is important to
our Veterans, and we have been working diligently over the years to
gain as much understanding as possible and to recommend policies that
are facts based. The Senator has noted that he finds both the
Australian study and the Veteran's testimony to be strong evidence in
support of concluding that Blue Water Navy Veterans were exposed to
Agent Orange and other tactical herbicides during the Vietnam War;
however, the statements and conclusions made in both of these, in terms
of the consumption of water distilled aboard ships while at sea, are
contingent upon the assumption and requirement that tactical herbicides
and the contaminant Tetrachlorodibenzo-p-dioxin (TCDD) were present in
the water. VA's understanding of the science related to that issue,
including the policies regarding the spray missions, the properties of
the herbicides, the environmental fate of the herbicide components, and
the expected behavior of the components in bodies of water off the
coast of Vietnam, is that it is unlikely that this was a significant
pathway of exposure to tactical herbicides for most Blue Water Navy
Veterans.
australian study (muller, et al., 2002)
Researchers in Australia demonstrated it may have been possible to
concentrate dioxin during the distillation of contaminated water, based
on laboratory recreations of the major aspects of the distillation
systems used aboard most ships during the Vietnam War. The theoretical
nature of this series of experiments and differences in U.S. and
Australian Naval policies at the time, however, restrict the
extrapolation of these findings in terms of representing the experience
of U.S. Navy Veterans who served on the offshore waters of Vietnam.
The authors attempted to determine this by recreating the major
principles of the distillation system in a laboratory setting and
assessing the potential for the co-distillation of several chemicals.
It is important to note that most of the variables in the experiments,
including the concentrations of chemicals, were not chosen to directly
mirror the conditions in the offshore waters of Vietnam but rather to
evaluate the effects of the physico-chemical properties of water and
different types of compounds on distillation in this type of system.
Thus, it was not meant to model the exposure scenario in Vietnam, but
rather, the type of distillation system aboard the ships that were
used. Based on the findings of the study, the authors concluded that
``the distillation process of water contaminated with TCDD would result
in contamination of potable water. Subsequent ingestion by sailors on
board ships (as well as soldiers and airmen, who were passengers) is
thus a vector for exposure to these chemicals.
While it is unlikely that accurate exposure of the personnel on
board ships can be estimated, the study findings suggest that the
personnel on board ships were exposed to biologically significant
quantities of dioxins.'' This conclusion may be appropriate for the
Royal Australian Navy members who served during the war, as their
protocol at that time was to draw water for drinking from turbid,
estuarine type waters (or those closer to shore), which would include
higher levels of salt, suspended particles, and potentially,
contaminants from herbicide spray drift, while reserving the drawing of
more pristine waters that were several miles off shore exclusively for
their steam engines. The U.S. Navy protocol, however, was starkly
different during that conflict. Per Sec. 2.4.2 of the Naval Ships'
Technical Manual (NAVMED P-5010-6; Department of the Navy, 1990), which
is titled ``Polluted Water,'' states that ``unless determined
otherwise, water in harbors, rivers, inlets, bays, landlocked waters,
and the open sea within 12 miles of the entrance to these waterways,
shall be considered to be polluted . . . The desalting of polluted
harbor water or seawater for human consumption shall be avoided except
in emergencies.'' Therefore, U.S. Navy ships that served only on the
offshore waters several (at least 12) miles off the coast of Vietnam
were not likely to have drawn contaminated water for drinking.
2011 institute of medicine (iom) report
At the request of VA, IOM reviewed the evidence on this topic and
issued a report in 2011. In this comprehensive review, the Committee
detailed several factors that would affect the potential for TCDD-
contaminated water to reach U.S. ships that were several miles
offshore, including:
It has been estimated that 87 percent of the Agent Orange
sprayed reached the forest canopy, while only 13 percent was lost to
drift, and of the 13 percent, an appreciable amount was likely degraded
due to the Vietnamese environment.
Agent Orange and TCDD would have entered waterways via
riverbank spraying or runoff; however, a considerable fraction would
absorb in organic materials that would be deposited in the delta
regions or estuaries.
Agent Orange and TCDD would have entered marine water from
river discharge and spray drift; however, any amount in marine waters
would be greatly reduced by the initial dilution in river water and
dispersion in air and further dilution in coastal waters.
The Committee also reviewed the Australian study and considered
another theoretical model that appeared to support its findings on the
potential to concentrate TCDD through the distillation process. The
Committee concluded that ``it is theoretically possible to concentrate
dioxin in distilled water, at least experimentally.'' While the
Committee noted that, based on the available science, ``if Agent
Orange--associated TCDD was present in the marine water that U.S. ships
drew for drinking water, distilled potable water would be a plausible
pathway of exposure,'' they ultimately concluded that ``without
information on the TCDD concentrations in the marine feed water, it is
impossible to determine whether Blue Water Navy personnel were exposed
to Agent Orange--associated TCDD via ingestion, dermal contact, or
inhalation of potable water.'' Additionally, regarding the Australian
study, the Committee stated: ``If the purpose of this experiment was to
demonstrate the plausibility of TCDD exposure to sailors via distilled
water, then this study is useful; however, the application of these
findings to actual shipboard distillation systems requires knowledge of
several factors not addressed in the experiment. The significance of
this study's findings for contaminant exposures on Blue Water Navy
ships is highly uncertain.'' Therefore, IOM did not corroborate the
Australian study in terms of its applicability to U.S. Navy Veterans
that served during the Vietnam War, but they noted that the study
findings do support that the concentration of TCDD during distillation
aboard ships is theoretically plausible.
current va study that may provide additional scientific evidence on
blue water navy
VA recently conducted a survey study on the health of Vietnam-era
Veterans that included an ``over-sampling'' of Blue Water Navy Veterans
as a subpopulation. The study will compare the health of this group to
that of Vietnam Veterans, Vietnam-era Veterans, and the general U.S.
population. In the absence of adequate exposure data, we hope to gain
an understanding of the health of Blue Water Navy Veterans and may be
able to make some determinations about whether outcomes they are
experiencing could be related to exposure to tactical herbicides during
their service. The results are currently being analyzed and are slated
to be published as early as 2019.
Question 8. Why has VA denied claims for veterans who were exposed
to Agent Orange if VA has records of specific ships and the veterans
who were on those ships within the 12 mile demarcation line?
Response. Under current laws and regulations, there is not a 12-
mile demarcation line for determining whether a vessel operated in the
inland waterways.
Background:
VA, under the law, may only pay compensation based on a presumption
of service connection for an Agent Orange-related disease if the
Veteran was exposed to Agent Orange or any other covered herbicide.
Under the law, 38 United States Code Sec. 1116, a Veteran is presumed
to have been exposed to Agent Orange only if he or she ``served in the
Republic of Vietnam'' during the period beginning on January 9, 1962,
and ending on May 7, 1975.
VA regulations, 38 Code of Federal Regulations
Sec. 3.307(a)(6)(iii), defines service in the Republic of Vietnam to
only include service in the offshore waters if the service included
duty or visitation in the Republic of Vietnam. VA has further clarified
``service in the Republic of Vietnam'' to consist of ``boots on the
ground'' service or service in the inland waterways. VA's
interpretation of ``service in Vietnam,'' to include encompassing
inland waterways, but excluding offshore waters has been upheld by the
courts, to include the United States Court of Appeals for the Federal
Circuit in its seminal decision in Haas v. Peake, 525 F.3d 1168 (Fed.
Cir. 2008).
VA's regulatory definition of service in Vietnam excludes service
in the offshore waters, as there is no evidence that Agent Orange was
applied to the waters off the shore of Vietnam, nor is VA aware of any
valid scientific evidence showing that individuals who served in the
offshore waters were subject to the same risk of Agent Orange exposure
as those who served in the geographic land boundaries of Vietnam.
Therefore, VA would not necessarily award benefits for a claim for
disability compensation due to Agent Orange exposure for a Veteran who
had served aboard a ship within 12 miles of the Vietnamese coast, as
offshore service is not considered service in the inland waterways,
which meets the statutory and regulatory definition of ``service in
Vietnam.'' Inland waterways include rivers, canals, estuaries, and
deltas. Deep-water bays and harbors are not inland waterways but are
considered to be offshore waters of Vietnam because of their deep-water
anchorage capabilities and open access to the South China Sea. For
example, we would consider service aboard a swift boat, landing ship,
or tank to be service in the inland waterways because those types of
vessels operated primarily on Vietnam's inland waterways. Agent Orange
exposure would be conceded for any Veteran who served aboard this type
of Naval vessel.
We also would concede exposure to Agent Orange if a Veteran who
served in a ship operating in the offshore waters that temporarily
entered an inland waterway. Additionally, we concede Agent Orange
exposure if the ship docked to a pier or shore or was in the offshore
waters and delivered personnel or supplies if there is evidence that
the Veteran went ashore, as this was would be consistent with service
that ``involved duty or visitation in the Republic of Vietnam.''
Veterans who are not presumed to have been exposed to Agent Orange,
including those who served in ships in offshore waters that did not
enter inland waterways, may submit evidence of actual exposure, and VA
evaluates such evidence on a case-by-case basis.
medical surgical prime vendor (mspv) program reforms
My office has heard that the lack of a comprehensive approach to
manage medical products throughout the VA system, could lead to an
inefficient acquisition strategy for the Department. There have been
efforts to revamp the MSPV program and I would like to know more about
what the Department's next steps will be.
Question 9. What additional steps could VA take to reorganize the
Medical Surgical Prime Vendor (MSPV) Program, and would VA use the
Pharmaceutical Prime Vendor program as a model?
Response. VA should continue its efforts on multiple fronts now
underway to improve the MSPV program, which are:
The Veterans Health Administration (VHA) Healthcare
Commodities Program Office (HCPO) near-term efforts to improve the MSPV
program to increase VA medical centers (VAMC) and clinician access to
the medical/surgical supplies required to treat patients, and improve
flexibility for adding supplies to the list of available items, as
feasible under legal and regulatory constraints. Simultaneously, we are
pursuing longer term program goals that focus on leveraging VA's buying
power to deliver more consistent, faster distribution services to the
facilities, lower costs, and increase enterprise spend visibility via
the MSPV 2.0 and our Clinically-Driven Strategic Sourcing (CDSS)
initiative.
The VHA CDSS initiative will improve processes and tools
to better involve clinicians in identifying and validating supplies.
The VHA HCPO's MSPV 2.0 effort is planning new,
competitively awarded supply and distribution services contracts for
Prime Vendors to improve VAMC with a more seamless and compliant, end-
to-end supply chain solution focused on lowering costs, reducing
acquisition wait times, and delivering essential supplies for Veteran
care.
The VHA HCPO has been working closely with the Strategic
Acquisition Center, Office of Small and Disadvantaged Business
Utilization, and Office of General Counsel to ensure facility
requirements and requests are pursued within relevant Federal
Acquisition Regulations and Veterans Administration Acquisition
Regulation framework and are compliant with legal statutes, which
include the Rule of Two and Vets First.
VHA is evaluating parts of the Pharmaceutical Prime Vendor
(PPV) program for incorporation into the MSPV Program. One of the
potential courses of action is to utilize the Federal Supply Schedules
to make a larger market basket of medical surgical products available
to all facilities.
PPV program does currently rely on a single Prime Vendor
to cover all regions, which is not the preferred approach for the VHA
MSPV. VHA will propose to have more than one MSPV to reduce dependency
risk. H.R. 5418, the Veteran Affairs Medical-Surgical Purchasing
Stabilization Act, would set the expectation to have more than one
prime vendor for VA medical/surgical supplies.
The mechanism for communicating pharmaceutical prices to
PPV may not be scalable for the volume of items that are required by
the MSPV program. In the existing PPV model, the VA/National
Acquisition Center (NAC) provides the prices electronically to PPV. PPV
is only permitted to load prices provided by NAC. In the event the
contracting office is delayed or unable to provide pricing, item
availability may be at risk as MSPV would not have the information
required to effectively procure the necessary items. Given that one of
the key goals of the new MSPV program is to increase item availability,
the risks associated with the current PPV model would run counter to
the future intentions of HCPO.
Question 10. Has VA consulted with other interagency partners such
as DOD?
VA Response:
As part of the MSPV 2.0 program, we are analyzing
different course of action for medical/surgical items--which include
VA's Federal Supply Schedule and Defense Logistics Agency's (DLA)
Distribution and Pricing Agreements (DAPA). Utilizing the DLA DAPA
option is a possible solution that DLA has made available to VA.
VHA views a partnership with DLA as a potential long-term
solution given the comparable nature of the Department of Defense's
(DOD) medical programs in terms of service and scope across hundreds of
facilities; DLA's MSPV program is generally regarded as effective and
efficient. VHA is including subject matter experts from DLA to assist
in the MSPV 2.0 development efforts. DLA experts have shared best
practices for their MSPV program and highlighted key differences
between the two organizations to provide a more comprehensive
understanding of the advantages and disadvantages of the different
supply programs.
As VA continues to explore migration to DOD's Defense
Medical Logistics Supply System (DMLSS)/LogiCole solution to replace
the legacy Integrated Funds Distribution, Control Point Activity,
Accounting and Procurement system, the synergies of leveraging the DLA
MSPV contract and DAPAs increase. A migration to DMLSS/LogiCole may
need to include utilizing the DLA MSPV contracts, to achieve the
efficiencies desired from this program.
Question 11. What steps would VA take to ensure the new program is
staffed properly with individuals who have both clinical and medical
supply chain expertise?
Response. CDSS initiative will be piloted next year to better
leverage and integrate clinical, supply chain, and contracting
expertise to provide clinicians with the medical supplies and equipment
required to provide improved patient care for our Veterans. CDSS will
include comprehensive and extensive coordination with the National
Clinical Program Offices, clinicians, and supply chain personnel at
both the facility and the Veterans Integrated Service Network levels.
The strategy will be driven by clinician feedback and requests, and the
supply catalog will include items that are safe, effective, and
clinically sourced. Constant communication and transparency with
clinicians is essential for the success of CDSS, and every CDSS-sourced
medical item will leverage the medical expertise of our clinicians in
the field.
Current VA Ordering Officer training materials will be updated to
reflect lessons learned as well as the changes introduced by the MSPV
2.0 (future state) program.
Question 12. Would the reorganization include a program office to
manage the new enterprise?
Response. In June 2018, VA's Healthcare Commodities Program Office
in its reorganization established a Medical/Surgical Future State
effort to support the development of the MSPV 2.0 and other future
medical/surgical programs. As the future MSPV program transitions from
development to implementation and sustainment, additional
reorganization may be required to best support the VAMCs.
Question 13. Would a reorganization require additional resources,
either personnel or funding?
Response. VA is assessing the need for additional resources, in the
form of both personnel and funding, that may be required to support the
MSPV 2.0 program as it moves into implementation and sustainment.
Additional resources may be required to support a successful
implementation, provide contract oversight and administration, and
provide general program management support.
Question 14. Does VA need legislative language to facilitate a
program reform?
Response. VA is reviewing ideas for legislation that could
contribute to its efforts in these areas. We are glad to discuss
potential improvements with the Committee.
Chairman Isakson. Those testifying in panel 2 are as
follows: Chanin Nuntavong--did I get that right, Chanin?
Mr. Nuntavong. Yes, Senator.
Chairman Isakson. OK. Chanin Nuntavong is Director of
Veterans Affairs and Rehabilitation, The American Legion;
Gerald Manar, former Director, National Veterans Service,
Veterans of Foreign Wars; Thomas Snee, National Executive
Director of the Fleet Reserve Association; and Rick Weidman,
Executive Director for Policy and Government Affairs, Vietnam
Veterans of America.
We welcome all four of you to testify, and we will begin
right now with Mr. Nuntavong. I am sorry if I am not doing well
with the name. I apologize.
STATEMENT OF CHANIN NUNTAVONG, DIRECTOR, NATIONAL VETERANS
AFFAIRS & REHABILITATION DIVISION, THE AMERICAN LEGION
Mr. Nuntavong. Michael Kvintus, a resident of Cambridge,
OH, deployed twice aboard the USS Buchanan during the Vietnam
War. Michael was exposed to the chemical known as Agent Orange
while guarding aircraft, searching boats, providing field naval
fire support, and while anchored near Da Nang harbor in August
1966.
Chairman Isakson, Senator Sanders, and distinguished
Members of this Committee, on behalf of National Commander
Denise Rohan, representing 2 million dues-paying members living
in every State and American territory, it is my duty and honor
to present The American Legion's position on the pending
legislation being discussed here today.
Michael has been happily married for 55 years, is the
father of three, and lives with the daily illnesses of exposure
to Agent Orange. Michael had a heart attack, not one but two
stents placed in his heart, and quadruple bypass surgery. At
the age of 72, he currently lives with heart disease, diabetes,
neuropathy, and erectile dysfunction. All, he believes, is
connected to Agent Orange exposure.
H.R. 299 is a massive step forward in recognizing the men
who were impacted by Agent Orange. Mr. Chairman, it is time we
as a Nation give veterans like Michael the benefits they
deserve.
Beyond the benefits for Blue Water Vietnam veterans, all
veterans deserve comprehensive health care. The American
Legion's System Worth Saving program routinely conducts town
hall meetings across the Nation allowing veterans to share
their VA experience. We frequently meet with veterans who
express concerns about VA dental benefit eligibility. A
majority of the veterans treated by VA do not qualify for this
benefit. Bottom line, dental care is health care, and The
American Legion supports this legislation.
In the 1990s, BRAC was created to assess and close military
installations no longer paramount to our national defense. An
unintended consequence of the closures was Mare Island
Cemetery. The cemetery is in total disrepair. It fell out of
the purview of the U.S. Navy and is currently under the control
of the city of Vallejo, CA.
The proposal in S. 2881 is simple, Mr. Chairman: Transfer
the cemetery that has more than 850 veterans, including 3 Medal
of Honor recipients, to the VA's National Cemetery
Administration, whose mission is to ensure that those who have
departed us are treated with the respect they deserve. We
firmly believe NCA is the best authority and only authority to
restore Mare Island Cemetery to greatness.
Shifting topics, ensuring servicemembers receive world-
class training as they transition out of the military has been
and always will be a priority of The American Legion. The draft
bill before you would increase the number of DOD TAP employees,
collect data for studying long-term effectiveness, and
establish a governing board to help prevent overdoses, suicide,
and alcoholism, among other provisions. The American Legion is
thankful for the ability to review and provide feedback on this
proposed bill.
In short, we support the draft bill but recommend the
following changes: require commanding officers to attend TAP so
they can understand what the program offers to their troops;
require DOD to report data to Congress on troops who have
completed TAP, broken down into useful information to enhance
the program; and, finally, eliminate the postsecondary
education assessment. This program needs significant
participation before it can yield helpful results.
In terms of VA staffing, The American Legion, along with
Members of this Committee, continues to highlight the shortages
of more than 30,000 jobs within VHA. Filling these vacancies
with qualified professionals is a priority for The American
Legion, the 9 million veterans using VA, and future veterans.
This legislation will allow physicians to complete their
education, then immediately begin treating veterans in the VA
system. The VA Hiring Enhancement Act aligns the hiring
practices of VA to those of the private sector, ensuring top-
quality health care is provided to our veterans. We encourage
you to support this initiative.
I conclude by thanking this Committee and you, Chairman
Isakson, for holding the confirmation hearing, ensuring the
full Senate to vote, and giving veterans of our Nation a
Secretary of Veterans Affairs. The Department was without
Senate-confirmed leadership for 124 days. The American Legion
stands ready to assist Secretary Wilkie in doing what is best
for veterans.
We thank Chairman Isakson and Ranking Member Tester for
their incredible leadership and for always keeping veterans at
the core of their mission. It is my privilege to represent The
American Legion before this Committee. I look forward to
answering any questions you have. Thank you.
[The prepared statement of Mr. Nuntavong follows:]
Prepared Statement of Chanin Nuntavong, Director, National Veterans
Affairs & Rehabilitation Division, The American Legion
h.r. 299; s. 3184; h.r. 5418; s. 1596; s. 2881; s. 1952; s. 1990;
s. 2485; s. 2748; s. 514; and all subsequential draft bills
Chairman Isakson, Ranking Member Tester, and distinguished Members
of the Committee; On behalf of National Commander Denise H. Rohan, and
the 2 million members of The American Legion, we thank you for this
opportunity to testify regarding The American Legion's positions on
pending legislation. Established in 1919, and being the largest
veterans service organization in the United States with a myriad of
programs supporting veterans, we appreciate the Committee focusing on
these critical issues that will affect veterans and their families.
h.r. 299
To amend title 38, United States Code, to clarify presumptions relating
to the exposure of certain veterans who served in the vicinity
of the Republic of Vietnam, and for other purposes.
Veterans who served on open sea ships off the shore of Vietnam
during the Vietnam War are called ``Blue Water Veterans.'' Currently,
Blue Water Veterans must have physically set foot on the land of
Vietnam or served on its inland waterways between January 9, 1962 and
May 7, 1975 to be presumed to have been exposed to herbicides when
claiming service-connection for diseases related to Agent Orange
exposure.
Blue Water Veterans who did not set foot in Vietnam or serve aboard
ships that operated on the inland waterways of Vietnam must show, on a
factual basis, that they were exposed to herbicides during military
service in order to receive disability compensation for diseases
related to Agent Orange exposure. These claims are decided on a case-
by-case basis.
We are aware the Department of Veteran Affairs (VA) previously
asked the National Academy of Sciences' Institute of Medicine (IOM) to
review the medical and scientific evidence regarding Blue Water
Veterans' possible exposure to Agent Orange and other herbicides. IOM's
report, ``Blue Water Navy Vietnam Veterans and Agent Orange Exposure''
was released in May 2011. The report concluded that ``there was not
enough information for the IOM to determine whether Blue Water Navy
personnel were or were not exposed to Agent Orange.''
However, Vietnam veterans who served on the open sea now have
health problems commonly associated with herbicide exposure. Just as
those who served on land were afforded the presumption because it would
have placed an impossible burden on them to prove exposure, Congress
should understand the injustice of placing the same burden on those who
served offshore. Clearly, all the toxic wind-blown, waterborne, and
contamination transfer stemming from aircraft, vehicle, and troop
transfer makes it impossible to conclude that Agent Orange-dioxin
stopped at the coastline.
Through Resolution No. 246: Blue Water Navy Vietnam Veterans, The
American Legion supports legislation to expand the presumption of Agent
Orange exposure to any military personnel who served on any vessel
during the Vietnam War that came within 12 nautical miles of the
coastlines of Vietnam.\1\
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\1\ American Legion Resolution No. 246 (Sept. 2016): Blue Water
Navy Vietnam Veterans
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The American Legion supports H.R. 299.
draft bill: veterans dental care eligibility expansion and
enhancement act of 2018
To improve dental care provided to veterans by the Department of
Veterans Affairs, and for other purposes.
The American Legion's System Worth Saving program routinely
conducts town hall meetings allowing veterans to share their Department
of Veteran Affairs (VA) healthcare experiences. In addition to hosting
town hall meetings, The American Legion frequently receives letters and
telephone calls from veterans expressing concerns about VA dental
benefit eligibility. Under VA's current eligibility for dental care,
the majority of veterans treated by VA do not qualify. Generally,
veterans who suffer from poor dental hygiene are not eligible for basic
dental care through the VA. These veterans are often not able to afford
the high cost associated with dental care, especially veterans who live
on a fixed income.
Further, the average age of a veteran in the United States is
currently 58 years old; and The American Legion is concerned the demand
for dental care will increase as the population ages.\2\ In addition to
obvious ailments associated with oral care, dental care is a vital
aspect of general healthcare. Diabetes \3\ and Alzheimer's,\4\
conditions commonly associated with veterans, have been linked to poor
oral health. The need to take care of our Nation's veterans dental
needs should be apparent and a priority.
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\2\ Veterans Average Age: https://www.va.gov/VETDATA/docs/
SurveysAndStudies/VETPOP.pdf
\3\ Prevalence of and Trends in Diabetes Among Veterans, United
States, 2005-2014: available at https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC5737977/
\4\ Veterans and Alzheimers: Meeting the Crisis Head on: available
at https://www. usagainstalzheimers.org/sites/default/files/
USA2_Veterans_Issue_Brief_April_10_2018.pdf
---------------------------------------------------------------------------
The Veterans Dental Care Eligibility Expansion and Enhancement Act
of 2018 is a comprehensive plan to provide needed dental care to
veterans. This legislation, in addition to expanding needed dental
services to veterans includes: carrying out pilot programs; acquiring
new dental facilities; and hiring additional dental healthcare
providers.
Section 2 would provide discretionary authority to the Secretary to
furnish restorative dental services to a veteran, as well as replace
lost appliances and restore function loss suffered as a result of
services or treatment furnished by the VA.
Section 3 would require the Secretary to carry out a pilot program
to assess the feasibility and advisability of furnishing dental
services and treatment to all veterans enrolled in the VA healthcare
system, even those not currently receiving dental healthcare.
Section 5 would require the Secretary to carry out a program of
education to promote dental health for veterans who are enrolled in VA
healthcare system.
The potential benefits to the veteran community from these expanded
services is self-evident. The American Legion supports these sections
through Resolution No. 377: Support for Veteran Quality of Life \5\ and
No. 186: Department of Veterans Affairs Dental Care.\6\ The American
Legion believes veterans should have access to timely and quality
dental care and will support legislation to provide outpatient dental
care to veterans. We also support legislation or programs within the VA
that will enhance, promote, restore, or preserve benefits for veterans
and their dependents with timely access to quality VA healthcare and
receipt of earned benefits.
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\5\ The American Legion Resolution No. 377 (2016): Support for
Veteran Quality of Life
\6\ The American Legion Resolution No. 186 (2016): Department of
Veterans Affairs Dental Care
---------------------------------------------------------------------------
In addition to expanding services, this draft bill is likely to
improve the access and quality of care received by veterans through
sections 4 and 7. These sections have the ability to greatly expand
access to dental healthcare to veterans. Section 4 of the act would
require the Secretary to construct or lease a VA dental clinic in any
State that does not have a VA facility offering onsite dental services.
Additionally, section 7 provides discretionary authority for the
Secretary of VA to carry out a demonstration program to train and
employ alternative dental healthcare providers in rural areas. These
sections would provide dental healthcare where none currently exists
and provide healthcare professionals that are not currently available.
Similarly increasing flexibility and access for veterans receiving
dental care through VA, section 6 requires VA to expand the VA Dental
Insurance Program (VADIP) Electronic Health Record capabilities.
Section 6 would establish a mechanism by which private sector dental
care providers could forward the VA information on dental care provided
to individuals under the pilot program for inclusion in the VA's
electronic medical records. Increased access to medical information
ultimately translates into better care for veterans.
Through our Support for Veteran Quality of Life resolution, we
support enhancing service to veterans by creating services for veterans
not currently being provided vital health services. The American Legion
has also long recommended VA's electronic medical records be revised to
read DOD's electronic health records. Similarly, The American Legion
believes ensuring VA has the ability to share electronic health records
with private sector dental care providers is common sense and should be
a priority for the VA. The American Legion through Resolution No. 83:
Virtual Lifetime Electronic Record, supports any legislation that would
allow the electronic sharing of medical record information.\7\
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\7\ The American Legion Resolution No. 83 (2016): Virtual Lifetime
Electronic Record
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The American Legion supports this Draft Bill.
s. 3184
To amend title 38, United States Code, to modify the requirements for
applications for construction of State home facilities to
increase the maximum percentage of nonveterans allowed to be
treated at such facilities, and for other purposes.
The provisions of this bill fall outside the scope of established
resolutions of The American Legion. As a large, grassroots
organization, The American Legion takes positions on legislation based
on resolutions passed by the membership or in meetings of the National
Executive Committee. With no resolutions addressing the provisions of
the legislation, The American Legion is researching the material and
working with our membership to determine the course of action which
best serves veterans.
The American Legion has no current position on S. 3184.
discussion draft bill: transition assistance program
To amend title 10, United States Code, to improve the Transition
Assistance Program for members of the Armed Forces, and for
other purposes.
The American Legion supports Congress' continued attention and
efforts in ensuring that Federal agencies and their valued partners
properly identify and implement necessary changes/improvements to the
Transition Assistance Program (TAP). We understand that in order for a
servicemember to transition seamlessly, and successfully, it requires
the collaboration between all agencies including Department of Defense
(DOD), Department of Labor (DOL), Department of Veteran Affairs (VA),
etc., along with congressional oversight. The key is to combine the
talents, expertise, and innovations of Veterans Service Organizations,
non-governmental organizations, and private sector organizations in
bringing solutions forward to champion initiatives with the Federal
Government for the purpose of improving opportunities of transitioning
servicemembers.
Improving employment opportunities for transitioning servicemembers
includes introducing both service delivery, business process, and
technology innovations in support of TAP and credentialing of
servicemembers. Further, this includes examining all aspects of TAP and
credentialing from resume writing, financial planning, goal setting,
job search, interviewing, networking, peer-to-peer support, family
transition support, higher education, individual career development
plans, entrepreneurship, VA benefits, and other elements of holistic
support of veterans ``for life'' and transitioning servicemembers.
Finally, Congress holding all stakeholders accountable is vital; from
garrison commanders and Federal officials to partnering organizations,
there must be metrics regarding efficiency and effectiveness in TAP
with capable managers implementing policy. The primary objective must
always be to provide a seamless transition from military service to the
private sector for our Nation's warfighters leaving the Armed Forces,
along with their families.
Sec. 2. Recodification, consolidation, and improvement of
certain transition-related counseling and
assistance authorities.
TAP is now mandated for all servicemembers and optional for their
spouses. TAP is presently five-days long with optional two-day classes.
The Department of Labor and Veterans' Employment and Training Service
(DOL-VETS) portion, which is three-days long, is responsible for most
of the information in TAP. Despite the appearance of TAP being widely
accessible there are still some concerns. First, according to the
Government Accountability Office report, Transitioning Veterans, less
than 15 percent of transitioning servicemembers have attended the two-
day classes.\8\ Second, TAP provides a tremendous amount information
that at times can be extremely intricate and overwhelming in a
stressful time for transitioning servicemembers.
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\8\ Government Accountability Office: Transitioning Veterans
https://www.gao.gov/assets/690/688203.pdf
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To help alleviate these two issues, The American Legion first
recommends that TAP be mandated for servicemembers at different
intervals of their careers prior to separation or transitioning into
the civilian sector along with pre-counseling for those servicemembers
intending to leave military service. Second, we stress the importance
of the continued evaluation and revamping of TAP to ensure
transitioning servicemembers are up-to-date on new trends in the
civilian marketplace. Last, we look to lead by example, by offering The
American Legion Job Fairs and other related activities with TAP
personnel in order for them to promote and publicize these activities
that may benefit transitioning servicemembers.
Through American Legion Resolution No. 70: Improve Transition
Assistance Program, we recommend that the DOD expand and standardize
their existing pre-separation counseling policies to ensure that
separating servicemembers receive information regarding Federal and
private sector employment opportunities, GI Bill, and vocational
rehabilitation and employment programs.\9\
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\9\ The American Legion Resolution No. 70 (2016): Improve
Transition Assistance
---------------------------------------------------------------------------
The American Legion supports Section 2.
Sec. 3. Personnel matters in connection with Transition
Assistance Program.
Section 3 adds full-time personnel to the TAP program with real
world experience in making the transition to civilian life.
The American Legion believes adding full-time personnel, with
experience transitioning to the civilian workforce, to the DOD for the
purposes of TAP counseling is constructive for transitioning
servicemembers on their own quest to obtain gainful employment. DOD
personnel with relevant experience in the civilian workforce will
provide the necessary information for servicemembers and their spouses
to make quality decisions on careers, education, and training. TAP is
vital to assisting servicemembers in mapping out employment
opportunities and benefits through their honorable military service.
Through American Legion Resolution No. 70: Improve Transition
Assistance Program, we recommend that the DOD expand and standardize
their existing pre-separation counseling policies to ensure that
separating servicemembers receive information regarding Federal and
private sector employment opportunities, GI Bill, and vocational
rehabilitation and employment programs.\10\
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\10\ The American Legion Resolution No. 70 (2016): Improve
Transition Assistance
---------------------------------------------------------------------------
The American Legion supports Section 3.
Sec. 4. Tracking of participation in Transition Assistance
Program and related programs.
Section 4 requires the Secretary of Defense to establish and
maintain an electronic tracking system and database applicable across
the Armed Forces.
The American Legion believes an electronic data system and database
would be useful in determining participation, access, progress, and
overall performance of TAP. This database may be utilized by Federal
agencies to improve, adapt, or change the information shared with
servicemembers. We believe this section supports The American Legion's
goal for transitioning servicemembers to view TAP as a high quality,
engaging, and relevant experience, which leads to opportunities in the
civilian sector.
Through American Legion Resolution No. 70: Improve Transition
Assistance Program, we recommend that the DOD expand and standardize
their existing pre-separation counseling policies to ensure that
separating servicemembers receive information regarding Federal and
private sector employment opportunities, GI Bill, and vocational
rehabilitation and employment programs.\11\
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\11\ The American Legion Resolution No. 70 (2016): Improve
Transition Assistance
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The American Legion supports Section 4.
Sec. 5. Information on members of the Armed Forces
participating in pre-separation counseling and
surveys on member experiences with Transition
Assistance Program counseling and services and in
transition to civilian life.
Section 5 requires the collection of basic information from
transitioning servicemembers.
The American Legion believes the accumulation of data for
transitioning servicemembers is critical in properly evaluating the
different needs of this community. For example, National Guardsmen and
Reservists have unique challenges differing from those servicemembers
transitioning from active duty. Other variables of transitioning
servicemembers include rank, age, marital status, dependents, and time
in service.
Additionally, we would implore Congress to require DOD to submit a
report of servicemembers who have attended TAP, broken down in three
areas: 1) those attending TAP counseling under their chosen track; 2)
those attending the other two optional tracks; and 3) those who have
not attended TAP counseling. The American Legion supports legislation
that requires conducting an independent assessment of the effectiveness
of TAP. The purpose of this assessment would be to ensure that
transitioning servicemembers are receiving the right skills and
training needed to complete a seamless transition from the military to
the private sector. The need for verifiable outcomes will aid in
allocating resources to the appropriate areas of TAP.
Through American Legion Resolution No. 12: Accountability and
Enhancements of Transition Assistance Program; Outcomes and Delivery
for Today's Digital Transitioning Servicemembers, we urge Congress to
mandate Federal agencies to conduct a survey and assessment of the
efficacy and efficiency of delivering ``for life'' support to veterans
and transitioning servicemembers in the digital era; innovations
responsive to the digital age warrior and digital era employer in the
TAP.\12\
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\12\ The American Legion Resolution No. 12 (2018): Accountability
and Enhancements of Transition Assistance Program; Outcomes and
Delivery for Today's Digital Transitioning Servicemembers
---------------------------------------------------------------------------
The American Legion supports Section 5 with amendments.
Sec. 6. E-mailing transition assistance materials to
supporters of members of the Armed Forces
transitioning to civilian life.
Section 6 requires the DOD to solicit, from each member of the
Armed Forces transitioning from military life to civilian life, an e-
mail address of a supporter of the departing member to whom they can
send transition assistance materials.
Transitioning from military life to civilian life can be a
stressful time for servicemembers; therefore, it is encouraged that
servicemembers have a support system. In most cases, servicemembers are
encouraged to bring their spouses to TAP; however, this may not always
be feasible. The American Legion believes emailing transition
assistance materials to servicemembers and their spouses (or caregiver)
can be the missing link that would assist servicemembers in attaining
gainful employment and financial stability.
Through American Legion Resolution No. 12: Accountability and
Enhancements of Transition Assistance Program; Outcomes and Delivery
for Today's Digital Transitioning Servicemembers, we urge Congress to
mandate Federal agencies to conduct a survey and assessment of the
efficacy and efficiency of delivering ``for life'' support to veterans
and transitioning servicemembers in the digital era; innovations
responsive to the digital age warrior and digital era employer in the
TAP.\13\
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\13\ The American Legion Resolution No. 12 (2018): Accountability
and Enhancements of Transition Assistance Program; Outcomes and
Delivery for Today's Digital Transitioning Servicemembers
---------------------------------------------------------------------------
The American Legion supports Section 6.
Sec. 7. Command matters in connection with transition
assistance programs.
Section 7 requires each command climate assessment to include
information about TAP participation.
The American Legion believes the importance of the Transition
Assistance Program cannot be overstated. Not only is it essential that
commands ensure all servicemembers are given the opportunity to attend
TAP, but it is also vital that servicemembers are authorized the
appropriate time to participate, at minimum, in one of the optional
tracks in the allotted time specified. In the event that a
servicemember is unable to attend TAP due to unforeseen reasons deemed
mission critical, both the Commander and servicemember would need to
submit in writing with justification as to why the servicemember was
unable to attend TAP. Further, The American Legion, recommends
commanding officers be mandated to attend a condensed version of TAP as
a requirement to assuming command at least once every three years.
Through American Legion Resolution No. 70: Improve Transition
Assistance Program, we recommend that the DOD expand and standardize
their existing pre-separation counseling policies to ensure that
separating servicemembers receive information regarding Federal and
private sector employment opportunities, GI Bill, and vocational
rehabilitation and employment programs.\14\
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\14\ The American Legion Resolution No. 70 (2016): Improve
Transition Assistance
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The American Legion supports Section 7 with amendments.
Sec. 8. Comptroller General of the United States report on
participation in transition assistance programs at
small and remote military installations.
Section 8 requires the Comptroller General of the United States to
submit a report on the participation in covered transition assistance
programs of members of the Armed Forces assigned to small military
installations and remote military installations.
All transitioning servicemembers should attend TAP without regard
to command size or remoteness. According to the Transition Assistance
Program Lead, there are 206 installations DOD-wide that conduct
TAP.\15\ The American Legion recommends that Commanders ensure that
transitioning servicemembers be given temporary duty orders to the
nearest military installation that offers TAP.
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\15\ The American Legion Resolution No. 12 (2016): Transition
Assistance Program Employment Workshops for National Guard and Reserve
Members
---------------------------------------------------------------------------
Through American Legion Resolution No. 81: Transition Assistance
Program Employment Workshops for National Guard and Reserve Members, we
support legislation that will provide every member of the Armed Forces
(including those in the National Guard and Reserves) who are activated
for 12 months or longer, an adequate amount of time to attend the TAP
workshop in entirety, within 90 days of separation.\16\
The American Legion supports Section 8.
Sec. 9. Education of members of the Armed Forces on career
readiness and professional development.
This section requires the DOD to carry out a program to provide
education on career readiness and professional development.
The American Legion believes experience differences between
separating servicemembers should be considered during their pre-
separation counseling. There are notable differences between a
transitioning servicemember who served one enlistment in contrast to
one who is retiring after 20-plus years of service. Similarly, we
recognize servicemembers who are being separated for medical reasons
and/or other unexpected reasons may present different issues.
Therefore, The American Legion believes pre-separation counseling
should begin at the time of their first and subsequent duty stations
with follow-on counseling conducted at different intervals of military
careers.
Through American Legion Resolution No. 70: Improve Transition
Assistance Program, we recommend that the DOD expand and standardize
their existing pre-separation counseling policies to ensure that
separating servicemembers receive information regarding Federal and
private sector employment opportunities, GI Bill, and vocational
rehabilitation and employment programs.\17\
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\17\ The American Legion Resolution No. 70 (2016): Improve
Transition Assistance
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The American Legion supports Section 9.
Sec. 10. Employment skills training--by amending striking
``The Secretary of a military department may'' and
inserting ``The Secretary of Defense shall.''
Expansion of Eligible Participants, such as a
spouse of a member of the Armed Forces.
Section 10 states the DOD should now be responsible for ensuring
that priority service training is provided to ``covered individuals''
and not just ``eligible members'' which includes spouses.
In a recent Chamber of Commerce survey over 44% of military spouses
reported that they are living paycheck to paycheck or struggling
financially, with 80% reporting that the employment search process
created stress between them and their active duty spouses. The anxiety
that this induces in families already struggling with the challenges of
potential deployments and family responsibilities presents a clear
threat to military readiness.
The American Legion supports legislation that will afford spouses
the same level of job training and employment skills training that
would otherwise have be given to only eligible members only. Spouses of
an active-duty member are considered a ``dislocated worker'' and should
be afforded the opportunity to receive priority service within the DOL,
just as their military spouse.
Through American Legion Resolution No. 70: Improve Transition
Assistance Program, we recommend that the DOD expand and standardize
their existing pre-separation counseling policies to ensure that
separating servicemembers receive information regarding Federal and
private sector employment opportunities, GI Bill, and vocational
rehabilitation and employment programs.\18\
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\18\ The American Legion Resolution No. 70 (2016): Improve
Transition Assistance
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The American Legion supports Section 10.
Sec. 11. Identification of opportunities for Job training
and employment skills training for employment with
the Department of Veterans Affairs in SkillBridge
programs of the Department of Defense.
Section 11 requires the Secretaries of the military departments to
identify opportunities where the VA can provide training.
Since 2014, the DOD's ``Skillbridge Initiative'' has authorized
transitioning servicemembers to participate in employer-driven job
skills training, apprenticeships and internships that provide industry-
recognized skills needed to move into high-demand jobs and careers.
Since its inception, more than 5,500 servicemembers have graduated from
135 Skillbridge-authorized programs according to an August 2017 DOD
report to Congress.\19\ VA has utilized this authority to launch the
``Warrior Training Advancement Course (WARTAC),'' which trains
transitioning servicemembers to become a Veterans Service
Representatives (VSRs) at the VA.
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\19\ Report on job training, employment skills training,
apprenticeships, and internships & skillbridge initiatives for members
of the Armed Forces who are being separated
---------------------------------------------------------------------------
The American Legion is encouraged by the success of the WARTAC
program. Additionally, The American Legion believes that transitioning
servicemembers can serve the VA in a myriad of capacities beyond
processing veterans' claims. This section will mandate that the VA
learn from the success of this inaugural program, and identify further
internal employment needs that can be fulfilled utilizing DOD's
Skillbridge authority.
Through American Legion Resolution No. 79: Expanding Department of
Veterans Affairs Employment Pathways, we support innovative retention
practices that provide education and training incentives for VA veteran
employees to achieve credentials and licenses to fill critical
vacancies.\20\
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\20\ The American Legion Resolution No. 79 (2017): Expanding
Department of Veterans Affairs Employment Pathways
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The American Legion supports Section 11.
Sec. 12. Evaluation of transition training and counseling
relating to postsecondary education and use of
educational assistance from the Department of
Defense and Department of Veterans Affairs.
Section 12 would establish standardized assessment criterion for
evaluating the quality of training and counseling provided through TAP
that has a focus on postsecondary education or the use of VA
educational assistance programs.
While The American Legion applauds efforts to increase quality
assurance of education training, existing information on TAP education
module participation indicates that significant restructuring is needed
before proper evaluation can be applied. A 2017 Government
Accountability Office study found that only 10.5 percent of all
transitioning servicemembers receive any additional training on higher
education.\21\ This level of participation suggests the central
structure of the two-day `Accessing Higher Education' module has proven
inimical to widespread adaptation. Before focusing on assessing the
quality of the existing TAP education syllabus, The American Legion
urges that its contents be reorganized to increase participation.
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\21\ https://www.gao.gov/assets/690/688203.pdf
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Through American Legion Resolution No. 12: Accountability and
Enhancements of Transition Assistance Program; Outcomes and Delivery
for Today's Digital Transitioning Servicemembers, we urge Congress to
mandate Federal agencies to conduct a survey and assessment of the
efficacy and efficiency of delivering ``for life'' support to veterans
and transitioning servicemembers in the digital era; innovations
responsive to the digital age warrior and digital era employer in the
TAP.\22\
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\22\ The American Legion Resolution No. 12 (2018): Accountability
and Enhancements of Transition Assistance Program; Outcomes and
Delivery for Today's Digital Transitioning Servicemembers
---------------------------------------------------------------------------
The American Legion opposes Section 12.
Sec. 13. Longitudinal Study on changes to Transition
Assistance Program of Department of Defense.
Section 13 requires the secretaries of VA, DOL, and DOD along with
the Small Business Administration Administrator to conduct a five-year
study on TAP.
The American Legion believes the longitudinal study for the several
different components would be valuable for the overall performance of
TAP. This study would identify specific developments or changes in the
characteristics of transitioning servicemembers. Further, the research
should drive the design of TAP, while providing confidence in
servicemembers as they transition into the civilian workforce.
Through American Legion Resolution No. 12: Accountability and
Enhancements of Transition Assistance Program; Outcomes and Delivery
for Today's Digital Transitioning Servicemembers, we urge Congress to
mandate Federal agencies to conduct a survey and assessment of the
efficacy and efficiency of delivering ``for life'' support to veterans
and transitioning servicemembers in the digital era; innovations
responsive to the digital age warrior and digital era employer in the
TAP.\23\
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\23\ The American Legion Resolution No. 12 (2018): Accountability
and Enhancements of Transition Assistance Program; Outcomes and
Delivery for Today's Digital Transitioning Servicemembers
---------------------------------------------------------------------------
The American Legion supports Section 13.
Sec. 14. Establishment of Governing Board to Support
Prevention of Drug Overdoses, Death by Suicide, and
Alcohol-Related Mortality.
Section 14 directs VA to establish a governing board to support
VA's efforts to prevent suicide. The bill directs the board to exchange
information and investigate impacts of financial insecurity,
homelessness, and substance abuse contribute to suicide.
In 2015, The American Legion supported H.R. 271: The COVER Act,
also known as the Jason Simcakowski PROMISE Act, which established a
commission to examine the evidence-based therapy treatment model used
by the Secretary of Veterans Affairs for treating mental illnesses of
veterans and the potential benefits of incorporating complementary
alternative treatments available in non-VA medical facilities.
Through American Legion Resolution No. 377: Support for Veteran
Quality of Life, The American Legion urges Congress and the VA to enact
legislation and programs within the VA that will enhance, promote,
restore or preserve benefits for veterans and their dependents.\24\
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\24\ The American Legion Resolution No. 377 (2016): Support for
Veteran Quality of Life
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The American Legion supports Section 14.
Sec. 15. Review of economic risk factors in suicide
prevention.
Section 15 calls for two reports to be developed within 90 days of
this bill becoming law. The first report would include how economic
risk factors affect suicide prevention efforts. The second report topic
is about the predictive analytics program Recovery Engagement and
Coordination for Health--Veterans Enhanced Treatment (REACHVET) that
utilizes economic risk factors in its algorithm to determine
suicidality.
Through American Legion Resolution No. 132: Request Congress
Provide the Department of Veterans Affairs Adequate Funding for Medical
and Prosthetic Research, The American Legion urges Congress and the
Administration to encourage acceleration in the development and
initiation of needed research on conditions that significantly affect
veterans, as we firmly believe more research should be conducted on
this very critical topic.\25\
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\25\ The American Legion Resolution No. 132 (2016): Request
Congress Provide the Department of Veterans Affairs Adequate Funding
for Medical and Prosthetic Research
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The American Legion supports Section 15.
Sec. 16. Grants for provisions of Transition Assistance to
members of the Armed Forces after separation,
retirement, or discharge.
Section 16 requires DOL, in consultation with VA, to award grants
to eligible organizations for TAP that include services like legal aid
and financial services.
The American Legion supports DOL and VA awarding grants to
organizations assisting in transition services to servicemembers and
veterans. In our daily work with veterans, we find many of them having
difficulties with writing resumes, interview skills and job searches.
In addition, servicemembers need help with financial literacy and legal
assistance. These grants would fill a need as servicemembers determine
their next steps and career goals. We understand the value of these
programs. In 2018, The American Legion has conducted more than 50
hiring events, resume, interview workshops, education seminars, and
small business development workshops. We've witnessed the positive
impact of these activities on transitioning servicemembers and veterans
in finding and maintaining suitable employment.
Through American Legion Resolution No. 70: Improve Transition
Assistance Program, we recommend that the DOD expand and standardize
their existing pre-separation counseling policies to ensure that
separating servicemembers receive information regarding Federal and
private sector employment opportunities, GI Bill, and vocational
rehabilitation and employment programs.\26\
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\26\ The American Legion Resolution No. 70 (2016): Improve
Transition Assistance
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The American Legion supports Section 16.
The American Legion supports this Draft Bill with the noted amendments
and improvements.
draft bill: va hiring enhancement act
To amend title 38, United States Code, to provide for the non-
applicability of non-Department of Veterans Affairs covenants
not to compete to the appointment of physicians in the Veterans
Health Administration, and for other purposes.
The American Legion has long expressed concern about staffing
shortages at Department of Veteran Affairs (VA) and the Veterans Health
Administration (VHA) medical facilities to include physicians and
medical specialist staffing.
The VA Hiring Enhancement Act will help address the shortcomings in
recruitment and retention of highly qualified physicians. The bill
allows VA to make binding job offers up to two years prior to
completion of medical residency, eliminating much of the bureaucratic
red tape that slows the hiring of newly recruited individuals. This
legislation allows physicians to complete their education then
immediately begin treating veterans. By allowing VA to make binding
offers, veterans will receive treatment by qualified physicians that
have completed their medical residency. This bill aligns the hiring
practices of VA to those of the private sector ensuring top quality
healthcare is provided to our veterans.
Further, this common-sense bill also releases physicians from
``non-compete agreements'' for the purpose of serving in the VHA. The
American Legion believes enforcing non-compete agreements to VHA hires
is overbroad and should be unenforceable under public policy.
Traditional reasoning behind non-compete agreements is to bar
competitive advantages or protect sensitive information, both of which
simply do not exist in this context.
Through American Legion Resolution No. 115, Department of Veterans
Affairs Recruitment and Retention, we support legislation addressing
the recruitment and retention challenges of the VA.\27\
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\27\ The American Legion Resolution No. 115 (2016): Department of
Veterans Affairs Recruitment and Retention
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The American Legion supports this Draft Bill.
h.r. 5418
To direct the Secretary of Veterans Affairs to carry out the Medical
Surgical Prime Vendor program using multiple prime vendors.
In terms of contracting, private sector hospitals use multiple
Group Purchasing Organizations (GPOs) who bid down the price of
manufactured medical equipment. This practice forces the GPOs to
compete among themselves, yielding the lowest possible prices, which
benefits hospitals and the general market place. In summary,
competition drives down prices.
Utilizing Medical Surgical Prime Vendor (MSPV) Gen2, VA has
proposed using only one large single vendor as opposed to the current
model of using multiple vendors. When purchasing from only one vendor,
prices may be inflated, simply because of the lack of competition.
Ensuring there is competition, the VA, and the government as a whole,
typically receives better pricing, which is ultimately a benefit to the
U.S. taxpayer.
The American Legion understands the simplification of utilizing
only one vendor; however, this practice does not yield the best result
for the veteran, agency, or the Federal Government. Using a singular
vendor may be easier, but this procurement shortcut undermines the
competitive system, and can result in VA overpaying for equipment, or
not being able to obtain quality materials necessary to supply the
largest medical network that treats veterans.
In the current model that VA is employing, Service Disabled Veteran
Owned Small Businesses (SDVOSBs), works with prime vendors, which not
only assist and encourages veterans to work in this realm, but also
allows for competition and to drives down costs. SDVOSBs add value to
the procurement process by providing last mile delivery, customer care,
and maintenance services for prime vendors.
In short, The American Legion opposes the VA switching to a system
that allows them to simply use one vendor, and urges Congress to force
VA to allow for competitive bidding.
Through American Legion Resolution No. 154, Support Reasonable Set-
Aside of Federal Procurements and Contracts for Businesses Owned and
Operated by Veterans, we support reasonable set-asides of Federal
procurements and contracts for businesses owned and operated by
veterans. Allowing the VA to essentially encourage a monopoly on
medical supplies and equipment is not only wrong, but it could also
decrease SDVOSB participation, potentially harming the quality care
that veterans receive at VA, all while overspending taxpayer
funding.\28\
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\28\ The American Legion Resolution No. 154: Support Reasonable
Set-Aside of Federal Procurements and Contracts for Businesses Owned
and Operated by Veterans
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The American Legion supports H.R. 5418.
s. 1596
To amend title 38, United States Code, to increase certain funeral
benefits for veterans, and for other purposes.
The American Legion believes all veterans who have honorably served
our Nation should be provided adequate funeral benefits and that those
benefits should be indexed for inflation. It is our Nation's
responsibility to ensure the families and loved ones of our veterans
are financially supported in their time of mourning. Further, our
membership has, by resolution, committed to support increases to burial
allowances for veterans who have died as a result of service-connected
conditions and that those benefits be tied to the Consumer Pricing
Index.\29\
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\29\ The American Legion Resolution No. 181 (2016): National
Cemetery Administration
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According to the National Funeral Directors Association, the
national median cost of a funeral in 2017 was $8,508.\30\ Over the past
decade, the median cost of an adult funeral in the United States has
increased 28.6 percent and Department of Veterans Affairs (VA) benefits
have not kept up with the pace of inflation.\31\ For instance, in 1973,
the benefit for a veteran with no next-of-kin and a non-service-
connected death would have been 22 percent of the national average,
versus the 2 percent it covers today.
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\30\ National Funeral Directors Association: Statistics http://
www.nfda.org/news/statistics
\31\ National Funeral Directors Association: Statistics http://
www.nfda.org/news/statistics
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Currently, VA burial benefit provides: $300 for non-service-
connected deaths and for veterans who have passed without a next-of-
kin; $749 if a veteran passes away in a VA facility, and; $2,000 if a
veteran passes away from a service-connected disability. The Burial
Rights for America's Veterans' Efforts (BRAVE) Act would update the
current funeral and burial benefit system to ensure all non-service-
connected deaths are treated equally, regardless of where the veteran
passes away. Veterans with no next-of-kin that pass away in a VA
facility are currently afforded greater funds to cover the costs of
their funerals and burials than veterans who pass away in a private
home or other facilities.
The BRAVE Act will increase the $300 for non-service-connected
deaths to $749 to equal the benefit received if a veteran passes away
in a VA facility. The BRAVE Act additionally indexes for inflation both
the non-service and service-connected passing funeral benefits, thereby
eliminating the need for Congress to make further readjustments. The
American Legion supports these provisions recognizing existing non-
service-connected and service-connected burial allowances benefits have
been significantly eroded by inflation as they now only cover a small
fraction of the actual cost of a burial.
Additionally, The American Legion urges The BRAVE Act be amended to
reflect the resolution passed by our membership, consisting solely of
wartime veterans, to increase the burial allowance for service-
connected causes from the current $2,000 amount to $4,000. This will
enhance the quality of life for veterans' survivors to increase the
value of these benefits, especially during their greatest hour of need.
Through American Legion Resolutions No. 181: National Cemetery
Administration\32\ and No. 377: Support for Veteran Quality of Life,
\33\ we support legislation increasing burial allowances and programs
within the VA that will enhance, promote, restore or preserve benefits
for veterans and their dependents.
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\32\ The American Legion Resolution No. 181 (2016): National
Cemetery Administration
\33\ The American Legion Resolution No. 377 (2016): Support for
Veteran Quality of Life
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The American Legion supports S. 1596 with the noted amendments and
improvements.
s. 2881
To direct the Secretary of Veterans Affairs to seek to enter into an
agreement with the city of Vallejo, California, for the
transfer of Mare Island Naval Cemetery in Vallejo, California,
and for other purposes.
The American Legion's 100-year history is integrally intertwined
with endeavors to preserve the legacy of this Nation's servicemembers.
With the creation of the Graves Registration and Memorial Affairs
Committee in 1962 to the current National Cemetery Committee, The
American Legion has maintained professional staff dedicated to
formulate and recommend to our National Executive Committee, through
the Veterans Affairs & Rehabilitation Commission, polices, plans and
programs as they relate to the Department of Veterans Affairs (VA)
national cemeteries, and the interment of veterans, servicemembers, and
their dependents. The American Legion through its National Cemetery
Committee believes that all veterans and their eligible dependents are
entitled a final resting place to commemorate their service to the
country to include perpetual care of the gravesite.
Mare Island Naval Cemetery, the oldest military cemetery on the
West Coast, was deeded to the city of Vallejo, California, under Base
Realignment and Closure (BRAC) in 1996. Following BRAC, there was no
mechanism to handle the financial responsibility for these hallowed
grounds. Since then, the city of Vallejo has struggled financially and
has not been able to provide for the maintenance and upkeep of the
cemetery. Due to the lack of maintenance many of the headstones are
broken, perimeter fences have collapsed, and the vegetation is
overgrown. More than 800 military veterans who served our country,
including three Medal of Honor recipients eternally rest in the
cemetery. Now the lack of upkeep is presenting problems for proud
veterans.
S. 2881, directs the Secretary of Veterans Affairs to seek out an
agreement with the city of Vallejo, under which the city would transfer
control of the Mare Island Naval Cemetery to the VA. The cemetery would
specifically be placed under the purview of the National Cemetery
Administration (NCA). The VA would pay no fee to acquire the land, but
would assume the obligation of maintaining the cemetery in the future.
The American Legion has full confidence that the NCA with its proven
track record of maintaining over 135 cemeteries nationwide, will bring
dignity and respect to the veterans buried at Mare Island Naval
Cemetery. NCA's mission is simple: to honor veterans and their families
with final resting places in national shrines and with lasting tributes
that commemorate their services and sacrifice to our Nation.
Through American Legion Resolution No. 181, National Cemetery
Administration, we support the establishment of additional national and
state veterans cemeteries and columbaria wherever a need for them is
apparent.\34\
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\34\ The American Legion Resolution No. 181 (2016): National
Cemetery Administration
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The American Legion supports S. 2881.
s. 1952
To improve oversight and accountability of the financial processes of
the Department of Veterans Affairs, and for other purposes.
The provisions of this bill fall outside the scope of established
resolutions of The American Legion. As a large, grassroots
organization, The American Legion takes positions on legislation based
on resolutions passed by the membership or in meetings of the National
Executive Committee. With no resolutions addressing the provisions of
the legislation, The American Legion is researching the material and
working with our membership to determine the course of action which
best serves veterans.
The American Legion has no current position on S. 1952.
s. 1990
To amend title 38, United States Code, to increase amounts payable by
the Department of Veterans Affairs for dependency and indemnity
compensation, to modify the requirements for dependency and
indemnity compensation for survivors of certain veterans rated
totally disabled at the time of death, and for other purposes.
The Department of Veterans Affairs (VA) Death and Indemnity
Compensation (DIC) Benefit supports surviving family members of
servicemembers who died in the line of duty, Gold Star families, and
survivors of disabled veterans who died from a service-connected
condition. DIC is paid to the widows and widowers of service-connected
disabled veterans who die as a result of their service-related
condition or who at the time of death were rated 100% service-connected
disabled for at least 10 years. Currently, survivors are denied any
benefit if a veteran passes away before the arbitrary 10-year
threshold.
Unfortunately and unfairly, many veterans do not reach the 100%
level until they are much older because their condition has worsened
with time. They often pass away before they have received their 100%
rating for the required length of time. In many of these instances the
spouse has been the primary caregiver and companion for these disabled
veterans throughout their lifetime and the VA compensation has been
their primary means of support. Consequently, the surviving spouse can
no longer count on VA benefits for assistance due to a 100% rating for
less than 10 years. This causes a dramatic change in the quality of
life of the surviving spouse.
This detriment to their quality of life is something members of The
American Legion recognized when we passed Resolution No. 255: Reducing
Eligibility for Dependency Indemnity Compensation (DIC) Payments for
100% Disabled Veterans from 10 Years to 5 Years.\35\ Through this
resolution, we commit to sponsor and support legislation to reduce the
number of years a veteran must be rated 100% from 10 years to 5 years
for eligibility of DIC payments. Therefore, we support legislation
reducing the eligibility requirement from 10 to 5 years, but OPPOSE the
bill's pro-rated reduction of DIC benefits if the veteran was rated
100% service-connected for a period less than 10 years. The American
Legion would support a modified bill that reduces the eligibility
requirements from 10 to 5 years, with NO reduction of benefits if the
5-year requirement is met.
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\35\ The American Legion Resolution No. 255 (2016): Reducing
Eligibility for Dependency Indemnity Compensation (DIC) Payments for
100% Disabled Veterans from 10 Years to 5 Years
---------------------------------------------------------------------------
The American Legion supports S. 1990 with noted amendments and
improvements.
s. 2485
To amend title 38, United States Code, to provide payment of Medal of
Honor special pension under such title to the surviving spouse
of a deceased Medal of Honor recipient, and for other purposes.
The provisions of this bill fall outside the scope of established
resolutions of The American Legion. As a large, grassroots
organization, The American Legion takes positions on legislation based
on resolutions passed by the membership or in meetings of the National
Executive Committee. With no resolutions addressing the provisions of
the legislation, The American Legion is researching the material and
working with our membership to determine the course of action which
best serves veterans.
The American Legion has no current position on S. 2485.
s. 2748
To amend title 10, United States Code, to require members of the Armed
Forces to receive additional training under the Transition
Assistance Program, and for other purposes.
The Better Access to Technical Training, Learning, and
Entrepreneurship Act (BATTLE Act) seeks to ensure that servicemembers
who leave the military receive the specific training they need to
successfully transition to civilian life, whether they choose to pursue
higher education, a career in a technical field, or entrepreneurship.
An average of 200,000 servicemembers transition into the private
sector annually. The American Legion's National Veterans Employment and
Education Division's mission is to assist with the reintegration of all
veterans returning to civilian life after service in the Armed Forces,
to include when necessary, initiating actions concerning all matters
affecting the economic well-being of veterans. We understand the value
of additional training because through our programs we conduct hiring
events, resume workshops, interview workshops, education seminars, and
small business development workshops. Additional training helps
veterans find jobs.
Under current law, the Department of Defense (DOD) is required to
ensure that eligible departing servicemembers participate in the
Transition Assistance Program (TAP). In response to this statutory
requirement, DOD has published regulations and issued instructions that
require eligible servicemembers to complete TAP and require commanding
officers to make certain that servicemembers complete TAP. Beyond the
mandatory curriculum, departing servicemembers have the option to
participate in a specialized two-day workshop in one of the following
areas: higher education, conducted by DOD; technical and skills
training, conducted by the Department of Veterans Affairs; or,
entrepreneurship, conducted by the Small Business Administration.
While the core curriculum is mandatory (five days) for all
servicemembers, the two-day workshops are less emphasized and
therefore, sparsely attended. In a recent Government Accountability
Office report, it was noted that less than 15 percent of transitioning
servicemembers attend the two-day optional track for various
reasons.\36\ This information can be vital for a seamless transition
for a servicemember separating or retiring from the military.
Therefore, The American Legion believes DOD's TAP should require
servicemembers to choose one of the specific career-oriented tracks
that best suit their post-service plans and require servicemembers take
part in one-on-one counseling a year prior to separation to evaluate
which transition pathway suits them best.
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\36\ Transitioning Veterans: DOD Needs to Improve Performance
Reporting and Monitoring for the Transition Assistance Program GAO-18-
23: Published: Nov 8, 2017. Publicly Released: Nov 8, 2017. Available
at https://www.gao.gov/products/GAO-18-23
---------------------------------------------------------------------------
Through American Legion Resolution No. 70: Improve Transition
Assistance Program, we recommend that the DOD expand and standardize
their existing pre-separation counseling policies to ensure that
separating servicemembers receive information regarding Federal and
private sector employment opportunities, GI Bill, and vocational
rehabilitation and employment programs.\37\
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\37\ The American Legion Resolution No. 70 (2016): Improve
Transition Assistance
---------------------------------------------------------------------------
The American Legion supports S. 2748.
draft bill: suicide prevention
To require the Secretary of Veterans Affairs to establish a program to
award grants to persons to provide and coordinate the provision
of suicide prevention services for veterans transitioning from
service in the Armed Forces who are at risk of suicide and for
their families, and for other purposes.
The provisions of this bill fall outside the scope of established
resolutions of The American Legion. As a large, grassroots
organization, The American Legion takes positions on legislation based
on resolutions passed by the membership or in meetings of the National
Executive Committee. With no resolutions addressing the provisions of
the legislation, The American Legion is researching the material and
working with our membership to determine the course of action which
best serves veterans.
The American Legion has no current position on this Draft Bill.
draft bill: modernization of medical records access for veterans act
To direct the Secretary of Veterans Affairs to carry out a pilot
program establishing a secure, patient-centered, and portable
medical records system that would allow veterans to have access
to their personal health information.
The American Legion, through Resolution No. 83: Virtual Lifetime
Electronic Record, has long endorsed and supported the Department of
Veterans Affairs (VA) in creating a Lifetime Electronic Health Records
(EHR) system.\38\ Additionally, The American Legion has encouraged both
the Department of Defense (DOD) and the VA to either use the same EHR
system, or, at the very least, systems that were interoperable.
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\38\ The American Legion Resolution No. 83 (2016): Virtual Lifetime
Electronic Record
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In 2009, The American Legion was pleased when the Obama
administration announced that the DOD and the VA would finally create a
path to integrate the flow of patients' information between DOD's Armed
Forces Health Longitudinal Technology Application (AHLTA) and VA's
Veterans Information System and Technology Architecture (VistA) EHR
platforms.
In 2015, DOD announced that Cerner was awarded a $4.3 billion, 10-
year contract to overhaul the Pentagon's electronic health records for
millions of active military members and retirees. However, around the
same time, VA announced it would maintain and modernize VistA.
On June 6, 2017, VA Secretary David Shulkin announced that the VA
would adopt the same Cerner EHR system as the DOD during a news
briefing at VA's headquarters in Washington, D.C.
On May 18, 2018, Acting VA secretary Robert Wilkie announced that
VA signed a 10-year contract with Cerner.
This information sharing system will set the standard for record
transferability and standardization in American medicine. This new
national standard will increase patient access, decrease wait times,
and enhance good medicine for all Americans, not just veterans.
Congress should refrain from advancing any recommendation or
legislation that does not directly support implementation of the VA EHR
modernization effort.
The American Legion opposes this Draft Bill.
s. 514
To direct the Secretary of Veterans Affairs to carry out a pilot
program to provide access to magnetic EEG/EKG-guided resonance
therapy to veterans.
In the wake of serious concerns about over prescription of
medications by Department of Veteran Affairs (VA) physicians, The
American Legion believes that VA can do more to ensure veterans and
servicemembers have the most dependable and precise treatment available
to alleviate their combat-related illnesses and injuries with the least
amount of negative side effects.
We have previously testified on the Veterans Health Administration
(VHA) implementation of a pilot program at approximately 23 VA medical
centers across the country using Electromagnetic Therapy to treat
veterans with depression. VHA is using Repetitive Transcranial Magnetic
Stimulation (RTMS) therapy, which involves up to 30 sessions over a
six-week period. Recently we learned that VHA's Repetitive Transcranial
Magnetic Stimulation pilot program fell short in VA trials. The
American Legion was hopeful the pilot program would conclude that this
non-pharmaceutical noninvasive therapy would prove successful and
provide VA with another tool to help deal with depression and Post
Traumatic Stress Disorder (PTSD).
The American Legion has long advocated for complementary and
alternative medicines (CAM) to be further explored by VA and applauds
this pilot. The American Legion's PTSD/TBI (Traumatic Brain Injury)
Committee has reviewed several promising CAM treatments that include
using electroencephalogram (EEG) technology to help better determine
the efficacy of certain medications on patients with correlating
quantitative EEG neuroethics. We believe the EEG/EKG
(electrocardiogram) pilot program will provide VA with additional
information to determine whether veterans can benefit from this
therapy.
The American Legion has reservations due to VA's March 29, 2017
testimony before the House of Representatives Subcommittee on Health.
During that testimony VA stated there is no medical device using MeRT
technology that has been cleared or approved by the Food and Drug
Administration (FDA) for the uses described in this legislation.\39\
Providing non-approved FDA treatment to our Nation veterans is still a
concern of The American Legion. With the assurance that the EEG/EKG
pilot program meets FDA approval, The American Legion supports S. 514
and companion legislation in the House of Representatives, H.R. 1162.
---------------------------------------------------------------------------
\39\ What is MeRT: https://www.braintreatmentcenter.com/mert
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Through American Legion Resolution No. 377: Support for Veteran
Quality of Life, we support legislation and programs within the VA that
will enhance, promote, restore or preserve benefits for veterans and
their dependents.\40\
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\40\ The American Legion Resolution No. 377 (2016): Support for
Veteran Quality of Life
---------------------------------------------------------------------------
The American Legion supports S. 514 with amendments as noted above.
conclusion
The American Legion thanks this Committee for the opportunity to
elucidate the position of the 2 million veteran members of this
organization. For additional information regarding this testimony,
please contact the Assistant Director of the Legislative Division, Mr.
Larry Lohmann Esq., at The American Legion's Legislative Division.
Chairman Isakson. Thank you for your testimony.
Mr. Manar.
STATEMENT OF GERALD T. MANAR, BLUE WATER NAVY VETERAN, FORMER
DIRECTOR, NATIONAL VETERANS SERVICE, VETERANS OF FOREIGN WARS
OF THE UNITED STATES
Mr. Manar. Chairman Isakson, Senator Sanders, Members of
the Committee, on behalf of the men and women of the Veterans
of Foreign Wars and its Auxiliary, thank you for the
opportunity to testify today.
We talk in support of the Blue Water Navy Vietnam Veterans
Act of 2017. I am a veteran of the Navy who served on a ship
which participated in 11 campaigns during the Vietnam War. From
1964 through 1972, the USS Whitfield County (LST 1169) was sent
to Vietnam at least 31 times. During those deployments it
landed Marines and army units in Vietnam. It patrolled endless
days off the coast, supported riverine patrol boats on the
rivers of Vietnam, and went up the river to Saigon.
I served aboard from July 1971 until she was decommissioned
in March 1973. During that time our ship went to Vietnam three
times.
During the Vietnam War, many hundreds of U.S. Navy ships
spent weeks or longer off the coast, many of them not just once
or twice, but repeatedly.
On my first cruise to Vietnam in 1971, we patrolled up and
down the coast. We were on the lookout for small boats trying
to infiltrate supplies and personnel into South Vietnam--north
and south, day after day, within sight of the shoreline. We
were a floating warehouse, carrying hundreds of tons of
supplies on our tank deck. We carried extra ammunition for
patrol gunboats and other smaller ships which might need
resupply. Whenever we went to Vietnam, we carried extra fuel
for ships and JP-5 for helicopters.
We anchored off the coast several times to conduct shore
bombardment with our 3-inch/50 guns. We spent Christmas Day in
1971 taking on supplies from a stores ship, then transferred
some of those supplies and fuel to two patrol gunboats and a
mine sweeper. We anchored off the coast 1 day, lowered the
captain's gig into the water, and went swimming. We followed
that with a barbecue on the main deck. We did this all within
sight of the beaches of Vietnam.
I mention these events as an illustration of the kinds of
activities we performed close to the shore of Vietnam. If there
was dioxin in the water, we would have been exposed to it while
swimming. Week after week, patrolling up and down the coast, we
took in sea water and processed it through our fresh water
evaporator system. We know from the Australian Navy study,
validated by the National Academy of Medicine, that fresh water
evaporator systems concentrated toxic material, including
dioxin, which was then transmitted to sailors through drinking
water.
Absent the cleaning and sanitation of the entire fresh
water evaporator system, it is conceivable that every person
who ever served on board my ship could have been exposed to
dioxin after its first visit to Vietnam. Further, by the time
we completed our last deployment to Vietnam in 1972, the
evaporator system would have accumulated concentrated dioxin
from dozens of visits to Vietnam, not simply the final three
that I experienced while on board.
From 2015 through September 2017, I was a member of the
Steering Committee for the Vietnam Era Health Retrospective
Observational Study, abbreviated VE-HEROeS. The aim of the
study was, in part, to obtain self-reported data on the health
of Blue Water Navy veterans. Instead of the expected 200
respondents, a total of nearly 1,000 Blue Water Navy veterans
answered the questionnaire. The raw data is currently under
analysis and adjustment to assure accurate comparisons between
other Vietnam and Vietnam era veterans.
While the results of this study will be published over the
next few years, there is more than sufficient data, in our
view, to show that Blue Water Navy veterans suffer from a
higher incidence of cancers, hypertension, and ischemic heart
disease than other populations of similar size and similar age.
It has been 43 years since the war ended in 1975, and even
the youngest of Blue Water Navy veterans are over 60 years old.
Many thousands suffer from the same disabilities as do veterans
who served in-country. Rather than continue studying the health
of Blue Water Navy veterans for another 10 years while those
veterans sicken and die from diseases related to exposure to
herbicides, Congress must grant Agent Orange presumptions to
the thousands of veterans who served their country off the
shores of Vietnam.
In addition, the VFW supports expansion of benefits to
Korean DMZ veterans who suffer from diseases directly linked to
exposure to herbicides without forcing them to prove individual
exposure.
We also support the expansion of benefits for children of
Thailand veterans who were born with spina bifida.
Finally, we believe the elimination of the distinction
between the National Guard, Reservists, and active-duty
servicemembers in requirements to pay certain home loan fees is
an appropriate recognition of their service to our country.
This concludes my testimony. I will be happy to answer any
questions you may have for me.
[The prepared statement of Mr. Manar follows:]
Prepared Statement of Gerald T. Manar, Blue Water Navy Veteran, Former
Director, National Veterans Service, 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 offer our views on legislation pending before the
committee.
h.r. 299, blue water navy vietnam veterans act of 2017
I am a veteran of the Navy who served on a ship that participated
in 11 campaigns during the Vietnam War. From 1965 through 1972, the USS
Whitfield County (LST 1169) was sent to Vietnam at least 31 times.
During those deployments it patrolled endless days off the coast,
supported riverine patrol boats on the rivers of Vietnam and went up
the river to Saigon. I served aboard from July 1971 until she was
decommissioned in March 1973. During that time our ship went to Vietnam
three times.
When you think of navies, you think of aircraft carriers,
destroyers, submarines. If you are older, or a fan of WWII movies,
cruisers and battleships figure into the equation as well. However,
over its history, the United States Navy has had thousands of ships,
many of which were not the fastest, stealthiest or biggest. Our fleets
cannot stay at sea for extended periods without oilers, ammunition, and
stores ships to support them. They cannot land Marines on distant
beaches without amphibious ships of all sizes and descriptions. The job
of our Navy is to project power, wherever and whenever that power is
needed. To do that, dozens of different types of ships are needed to
make that happen.
The United States Navy was in Vietnam from start to finish. While
the war did not start with the Gulf of Tonkin Incident in 1964, it was
the catalyst for ramping up American participation to its peak in the
late 1960s. It ended with the evacuation of American personnel and
thousands of Vietnamese to ships off the coast in April 1975. In
between, many hundreds of ships spent weeks or longer off the coast,
many of them not just once or twice, but over and over again. While
many of those ships put into Vietnamese ports, many others did not.
Forty years after I last saw the coast of Vietnam from the deck of
the USS Whitfield County, I spent two days at the National Achives
pouring over the deck logs, trying to find entries that supported my
recollection of tying up to a pier in Cam Ranh Bay, beaching the ship
on the LST ramp at Vung Tao, putting into port at Qui Nhon and sailing
off the coast of Da Nang. My search revealed much more than I recalled.
On my first cruise to Vietnam in 1971, we patrolled up and down the
coast. We were on the lookout for small boats trying to infiltrate
supplies and personnel into South Vietnam--north and south, day after
day, within sight of the shoreline. This was not just a random
assignment. Operation Market Time started in 1965 and continued through
the end of American participation in 1973. We were a floating
warehouse, carrying hundreds of tons of supplies on our tank deck. We
carried extra ammunition for Patrol Gunboats and other smaller ships
that might need resupply. Whenever we went to Vietnam, we carried extra
fuel for ships and JP-5 for helicopters.
We put into port as needed. We once picked up the pieces of a
patrol boat that had been blown in half by a mine attached to its hull,
and carried them to another port in Vietnam. We never knew why. We
anchored off the coast to conduct shore bombardment with our 3''/50
caliber guns. We spent Christmas Day in 1971 taking on supplies from a
stores ship, then transferred some of those supplies and fuel to two
Patrol Gunboats (USS Asheville and Tacoma) and a mine sweeper (USS
Guide). We anchored off the coast one day, lowered the Captain's gig
into the water and went swimming. We followed that with a barbeque on
the main deck. We did this within sight of the beaches.
I mention these events as an illustration of the kinds of
activities we performed close to the shore of Vietnam. If there was
dioxin in the water, we would have been exposed to it while swimming.
Week after week, patrolling up and down the coast, we took in sea water
and processed it through our fresh water evaporator system. We know
from the Australian Navy study, validated by the National Academy of
Medicine (formerly the Institute of Medicine), that fresh water
evaporator systems concentrated toxic material, including dioxin, which
was then transmitted to sailors through drinking water.\1\
---------------------------------------------------------------------------
\1\ Blue Water Navy Vietnam Veterans and Agent Orange Exposure,
Institute of Medicine, 2011, pg 13, https://www.nap.edu/read/13026/
chapter/2#13
---------------------------------------------------------------------------
As a matter of observation, absent the cleaning and sanitation of
the entire fresh water evaporator system, it is conceivable that every
person who ever served on board my ship could have been exposed to
dioxin after its first visit to Vietnam. Further, by the time we
completed our last deployment to Vietnam in 1972, the evaporator system
would have accumulated concentrated dioxin from dozens of visits to
Vietnam, not simply the final three that I experienced while on board.
From 2015 through September 2017, I was a member of the Steering
Committee for the Vietnam Era Health Retrospective Observational Study
(VE-HEROeS). The Committee had input into the study design, the
questionnaires, communications, and types of analyses and order of
analyses. The aim of the study was, in part, to see whether Blue Water
Navy veterans would respond to the survey and describe their health.
Based on the sample size of all Vietnam and Vietnam Era veterans, the
researchers estimated that 200 Blue Water Navy veterans would respond.
In fact, 987 Blue Water Navy veterans answered the questionnaire. As a
result, the data gathered is more extensive and richer than
anticipated. The raw data is currently under analysis and adjustment to
assure accurate comparisons between other Vietnam and Vietnam Era
veterans.\2\
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\2\ Blue Water Navy Characteristics, Presentation to the Steering
Committee Meeting, September 27, 2017.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
While results of this study will be published over the next few
years, there is more than sufficient data to show that Blue Water Navy
veterans suffer from a higher incidence of cancers, hypertension, and
ischemic heart disease than other populations of similar age.
It has been 43 years since the war ended in 1975. Even the youngest
of Blue Water Navy veterans are over 60 years of age. Many thousands
suffer from the same disabilities as do veterans who served in-country.
Rather than continue studying the health of Blue Water Navy veterans
for another 10 years while Blue Water Navy veterans sicken and die from
diseases related to exposure to herbicides, Congress must grant Agent
Orange presumptions to the thousands of sailors who served their
country off the shores of Vietnam.
The VFW supports expansion of benefits for Korean DMZ veterans who
suffer from diseases and illnesses directly linked to Agent Orange.
While many of these veterans receive presumptive disability
compensation for their service-connected disabilities, hundreds of them
are unjustly required to prove individual exposure. This legislation
would provide them the benefits they have been unjustly denied.
This legislation would also provide benefits to children suffering
from spina bifida because of their parents' exposure to Agent Orange
while serving in Thailand during the Vietnam War. Spina bifida is a
debilitating birth defect, which has been found to be more prevalent
among children of veterans exposed to Agent Orange. This expansion
would make equal the level of benefits that other children receive due
to their parents' exposure to Agent Orange.
The VFW also supports the reporting and outreach requirements in
this legislation. Research related to Gulf War Illness is vital to
ensuring veterans receive the care and benefits they have earned as a
result of illnesses and injuries caused by their service. The outreach
and reporting components related to the Blue Water Navy portion of this
bill would ensure veterans receive the retroactive payments they have
earned, and allow Congress to oversee proper implementation of the
legislation. On their behalf, the VFW urges you to approve this
legislation so these veterans can receive the treatment and
compensation they have earned through their service to our country.
Ensuring equality between the active, Guard, and Reserve components
of the military is a key goal of the VFW. For the past decade and a
half, our country has been sending National Guardsmen and Reservists
into harm's way at an unprecedented level, and some of them have been
wounded in the line of duty. The VFW is pleased that H.R. 299, would
end arbitrary differences in home loan fees and show that service in
uniform earns equal opportunity to be a homeowner.
h.r. 5418, veterans affairs medical-surgical purchasing stabilization
act
The VFW encourages the expansion of opportunities for veteran-owned
small businesses to compete for Department of Veterans Affairs (VA)
contracts, but we also see the value in having a single supplier if the
situation is necessary. Mandating VA to use regional prime vendors
could have a positive impact on competition in the market place,
however, we would not want to see it negatively impact overall cost.
The VFW does not have a position on this portion of this bill.
We do, however, support prohibiting a single prime vendor from
developing the formulary for medical surgical supplies. Allowing a
single vendor to tailor the formulary to fit specific needs that only
they could provide can lead to unfair advantages in competitive
bidding. Creating a comprehensive formulary that is designed solely
with the patients in mind is how they should be developed, and not in
favor of a particular vendor.
s. 514, no hero left untreated act
The VFW opposes this legislation, which would require VA to carry
out a pilot program to provide veterans Magnetic eResonance Therapy
(MeRT) to treat Post Traumatic Stress Disorder (PTSD) and other mental
health conditions.
The VFW supports expanding access to integrated and complementary
therapies that have proven to effectively treat veterans who have not
responded to conventional or evidence-based mental health care.
However, MeRT is not approved by the U.S. Food and Drug Administration
(FDA) and has shown little to no evidence of effectiveness in treating
PTSD or other behavioral health conditions. VA has a current pilot
program studying Repetitive Transcranial Magnetic Stimulation, or rTMS.
While this form of therapy is FDA approved, recent data from this
research shows the therapy is successful on approximately 40 percent of
patients, which is the same percentage of success in patients receiving
sham treatments.
There is currently no evidence that MeRT would outperform treatment
for any disorders. Additionally, this legislation would not provide VA
additional funding to test the efficacy of MeRT. The VFW believes that
VA must spend its already scarce health care resources on therapies
that have shown promise or have a proven track record.
s. 1596, brave act of 2017
The VFW supports this important bill, which would increase the
funeral and burial benefit for eligible veterans. Specifically, this
important bill would also ensure all three benefits are indexed for
inflation.
The cost of funeral expenses in the private sector has increased
nearly sevenfold since 2001, but VA benefits to cover such costs have
failed to keep pace with inflation. The VFW urges Congress to ensure
the loved ones of veterans who do not have access to a state or
national veterans cemetery within 75 miles are not required to
accumulate debt to provide their loved ones a final resting place that
honors their sacrifice to our nation.
s. 1952, department of veterans affairs financial accountability act of
2017
The VFW supports this bill, which would require a third-party
review of VA's financial projections. VA's inability to accurately
project its budgetary needs, or overestimating its medical collections,
has impacted its ability to provide veterans timely access to high-
quality care and benefits.
When evaluating VA's budget requests and financial projections, the
VFW urges Congress to consider the impact outdated Budget Control Act
discretionary budget caps have on the amount of resources VA is allowed
to request. While VA budget requests should be based on need, they are
often based on what VA is able to get approved by the Office of
Management and Budget. For this reason, the VFW urges this Committee to
include an analysis on the impact of sequestration on VA budget
requests.
s. 2881, mare island naval cemetery transfer act
The VFW strongly supports this bill, which would transfer the Mare
Island Naval Cemetery to the National Cemetery Administration (NCA) for
management. The United States Navy used this cemetery as the final
resting place of more than 800 veterans. Concern that non-veterans had
been buried there has been raised as a possible reason to prevent NCA
from managing the cemetery. The VFW feels that the Navy made the
decision to bury those people there, that the decision should be
respected, and that this is not a reason to oppose the legislation.
This cemetery is in disrepair and the VFW will never support allowing
the final resting place of veterans to be forgotten.
The lasting legacy of those who have served our country is on
display in cemeteries and is a testament to the cost of freedom. While
our Nation remembers the service of veterans who are no longer with us
on Memorial Day, NCA, and the American Battle Monuments Commission
ensure that a daily reminder withstands the test of time.
s. 3184, to modify the requirements for applications for construction
of state home facilities to increase the maximum percentage of
nonveterans allowed to be treated at such facilities.
The VFW supports this legislation which would allow a small
increase in non-veteran care at State Home Facilities. If certain
facilities are not operating at full capacity and have the ability to
treat non-veteran spouses, the facilities should be allowed to do so.
The VFW believes these decisions should be driven by compassion and
respect for the aging veterans and their loved ones. If there are open
bed spaces in State Home Facilities that could be occupied by veterans'
spouses, we should make that happen.
transition assistance legislation
The period of moving from active duty to civilian life can be
challenging for many transitioning servicemembers (TSMs). Leaving a
structured life in the military and moving to an entirely different
atmosphere brings with it many difficulties. Finding a new job, moving
away from base, going to school, or leaving friends and comrades are
just some of the issues servicemembers face with transition.
The Transition Assistance Program (TAP) is the Department of
Defense's (DOD) program in cooperation with the Department of Labor,
VA, and the Small Business Administration to ensure a seamless path for
servicemembers to civilian life. TAP has improved drastically over the
past few years, but there are still many changes that need to be made
to this vital program.
The VFW supports the discussion legislation on transition
assistance reform, which would consolidate and streamline the TAP
overview process. This bill would provide insight and proper reporting
of the entire TAP curriculum that would provide accurate information
regarding which parts of TAP are working and which parts need
improvement. However, there are items we feel should be included in any
transition legislation in order to improve the entire process.
The VOW to Hire Heroes Act of 2011 requires TSMs to attend TAP
class prior to 90 days before leaving active duty service. Currently,
less than half are attending by the required date. Additionally, less
than 15 percent are attending the supplemental classes for education,
entrepreneurship, or career technical training. Late attendance can
lead to TSMs not having certain VA benefits available as soon as they
leave active duty service. The VFW supports early participation in TAP
classes for all servicemembers. We feel beginning TAP 12 months before
leaving the service will set up TSMs for success better than the
current three month path.
The VFW supports S. 2748, BATTLE for Servicemembers Act, and the
effort to make the supplemental TAP classes mandatory. More than half
of TSMs utilize their GI Bill benefits after leaving the service, but
nowhere nearly that many attend classes or briefings dedicated to
education during their transition classes. Adding the supplemental
classes to the main curriculum of TAP would expand the knowledge of
TSMs and better prepare them for civilian life.
The VFW also recognizes the value in connecting TSMs with the
communities where they seek to reside. Having the TSMs connect with
community groups or resources prior to separation could help mitigate
various hardships as they transition to the civilian sector. There are
many different organizations that help with education, employment, and
financial management in communities across the country. Providing a
connection to local resources during TAP classes is another tool for
servicemembers to further their success.
Expanding access for veterans to TAP-style information and
resources after they leave military service is important for veterans.
The VFW urges the Committee to revisit the pilot program to offer TAP
in the community for veterans. Once veterans reintegrate into their
communities, it is important for them to be able to access specific
transition resources that apply strictly to their local communities.
Veterans who participated in the original pilot program were able to
access information and resources they may have missed during their
initial TAP classes.
Another key element the VFW would like to see added to any
transition legislation is the removal of the 12-year expiration date
for the Vocational Rehabilitation and Employment (VR&E) Program.
Education and training are continuous efforts that do not end after 12
years. Many veterans seek to reeducate and retrain themselves later on
in life, and removing the expiration date will eliminate an unnecessary
barrier to do so. There are exemptions that will allow veterans to
utilize VR&E after the expiration date, however, if a veteran does not
meet at least one of the exceptions, the veteran is denied due to the
arbitrary expiration date. Last year, the expiration date on the GI
Bill was removed so veterans could engage in education and training
later on in life. The VFW feels Congress must do the same for VR&E.
veterans dental care eligibility expansion and
enhancement act of 2018
The VFW supports this draft legislation which would improve dental
care provided to veterans by VA through a pilot program, as well as
increase the ability for VA to construct and lease dental clinics.
Though the VFW would prefer to see legislation that would expand
eligibility for VA dental care to all veterans who are eligible for VA
health care, the VFW supports this bill.
Dental care is a vital aspect of general health care. According to
the Mayo Clinic and a myriad of peer-reviewed medical studies, oral
health has a direct impact on severe diseases and conditions, such as
heart disease and adverse birth conditions. Conversely, several health
conditions that are prevalent among veterans, such as diabetes and
Alzheimer's disease, have been found to directly impact oral health.
Until the VA Dental Insurance Program (DIP) was implemented in
January 2014, veterans enrolled in VA health care had little to no
options for receiving dental coverage.
Additionally, there is a large disparity between VA and DOD dental
coverage, which can have a significant impact on the health care and
quality of life for veterans. While in uniform, veterans were required
to maintain a high level of dental readiness, to the extent that they
would be placed on a non-deployable status if they failed to receive a
dental evaluation every year. However, only veterans who were 100
percent service-connected disabled, certain homeless veterans, and
those who had a service-connected dental condition were eligible for VA
dental care. The majority of veterans enrolled in VA health care are
unjustly denied access to VA dental care. Instead, they are offered the
ability to purchase dental insurance through VA, which has high costs
and poor coverage. VFW members who are asked for feedback on VADIP
report that it is better than nothing. Those who have worn our Nation's
uniform deserve the best, not ``better than nothing.''
This draft legislation would create a pilot program to expand
dental care services and treatment to veterans who are enrolled in VA
at 16 locations across the country. These 16 locations would include
four VA medical centers with an established dental clinic, four VA
medical centers with a contract for dental care, four community-based
outpatient clinics with available space, and four facilities from
federally qualified health centers and Indian Health Service clinics.
These pilot sites would assess the feasibility to furnish dental
services and treatment to no more than 100,000 veterans who volunteer
to participate in the program.
This draft legislation would also provide the Secretary with the
authority to construct or lease a dental clinic for any state that does
not currently have a VA facility that offers dental services. The VFW
finds this to be incredibly important, as veterans must have access to
dental care and they should not have to cross state lines to obtain
that care.
draft legislation, modernization of medical records access for veterans
act
This draft legislation would provide a portable ``credit card
sized'' health record for veterans. The VFW understands the intent of
this bill, but opposes its passage. Veterans already have easy access
to their health care records. Veterans have the ability to get copies
by using their My HealtheVet account. After logging into their account,
the first page a veteran sees offers a selection of four large
``buttons'' and accessing their medical record is the fourth option.
VFW staff tested the ability to download their records using this
method, and in less than 90 seconds an electronic version had been
downloaded. For those who do not use My HealtheVet, a compact disc copy
can be obtained by veterans from their local VA medical centers.
To ensure that the veteran's medical record follows them after
military service, VA has recently begun the process of adopting a
commercial off-the-shelf system for the future electronic health
record. The Electronic Health Record Modernization Program (EHRMP) will
allow veterans to have more access to their medical records. This
legislation allows the discharging servicemember to electronically
``carry'' their record to VA, and for various portions of VA to
interact with itself and with community care providers while caring for
the veteran. The VFW believes this bill could create a competing
medical record that would prevent VA and the veteran from having all
needed information on one platform, thus slowing the delivery of care.
Because of a lack of vital information, this could lead to decisions
being made that could harm the health of the veteran.
In looking at our first two concerns together, the VFW worries
about interoperability between the device that would be created and
other VA systems, and security of the information stored on it. There
is no requirement for the device to ever be connected to, or even
interoperable with, the electronic health record that will result from
EHRMP. A lost device could also lead to compromised information, and
this is a real threat in the modern day.
Finally, the VFW opposes this bill because it specifically bans new
appropriations for implementation. Unfunded mandates harm other
programs by forcing VA to take money from other parts of its IT budget.
The VFW is already concerned about VA's IT budget funding levels. This
legislation would cause VA to divert precious and limited resources
from other programs, thus hindering modernization of IT capabilities
and implementation of EHRMP.
draft legislation, to require the secretary of veterans affairs to
establish a program to award grants to persons to provide and
coordinate the provision of suicide prevention services for veterans
transitioning from service in the armed forces who are at risk of
suicide and for their families.
The VFW supports this draft legislation, but has concerns the
current language could provide grants to organizations that compete
with, rather than complement, VA mental health care.
This draft legislation would authorize VA to provide grants to
organizations offering suicide prevention services ranging from
outreach and education to peer support and referrals to care. While
providing grants to organizations that complement the care being
provided by VA is of benefit, Congress and VA must ensure grants will
not be received by groups competing with VA's suicide prevention
treatments, or providers who should be enrolled in VA's community care
program.
This draft legislation would require the Secretary to consult with
organizations such as veterans service organizations (VSO's) about
recipients of these grants. The VFW is grateful to see this, as VSO's
have extensive background and understanding in programs such as this.
For example, the VFW has its own mental wellness campaign. Through this
campaign we have partnered with VA and other groups such as Change
Direction, One Mind, PatientsLikeMe, Give an Hour, and the Elizabeth
Dole Foundation. While the VFW does not provide clinical care, members
work with our partners to provide outreach at home-grown levels to
educate veterans and their families about recognizing emotional
distress, as well as what benefits and programs are locally available.
PatientsLikeMe provides peer support and Give an Hour provides clinical
care for veterans in need of emergency counseling.
The VFW also believes the reporting requirement stating the
Secretary ``may'' require a grant recipient to report how the funding
is used must be changed to ``shall.'' There are many honest programs
which can benefit from grants. Still, Congress must work with VA to
ensure these grants are not used to bankroll bad actors.
I thank you for the opportunity to testify today and I will answer
any questions you may have.
Chairman Isakson. Thank you very much, Mr. Manar.
Mr. Snee.
STATEMENT OF THOMAS J. SNEE, NATIONAL EXECUTIVE DIRECTOR, FLEET
RESERVE ASSOCIATION
Mr. Snee. Chairman Isakson, Senator Sanders, Committee
Members, thank you and on behalf of the veterans for your
leadership and caring spirit. I am Tom Snee, the national
executive director for the Fleet Reserve Association, the
oldest sea service association serving our men and women in the
U.S. Navy, Marine Corps, and Coast Guard since 1924. We are
most honored and pleased to have been asked to return again to
express and share our viewpoints for the Senate's favorable
vote of H.R. 299 on behalf of the Blue Water Navies.
I am also a retired Navy master chief petty officer,
surface warfare, with over 30 years of active duty and a
Vietnam veteran who probably served on a Blue Water Navy ship
that was exposed to Agent Orange in the coastal waters off
Vietnam. Like other ships, we, too, lost a great number of our
crew due to Agent Orange. Today I am here to put a human face
on Agent Orange victims and their families. Simply, H.R. 299
will protect and ensure the poignant care for all Blue Water
Navy veterans and actions today.
Mr. Chairman, allow me to read a quote from President
George Washington: ``The willingness with which our young
people are likely to serve in any war, no matter how justified,
shall be directly proportionate on how they perceive veterans
of earlier wars and how they were treated and appreciated by
our Nation.''
Mr. Chairman, every day we delay the well-being of earned
benefits, quality treatments, and life's sustainability for our
Blue Water Navy veterans, we are losing their confidence and
credibility as a Nation. Through despair, addictions,
homelessness, and suicides, our aging Vietnam veteran
population can only wonder and frequently ask, do they really
care?
For me, as that young 19-year-old from northeast Ohio, I
never knew that the war was going on, never heard of Vietnam.
Instead, I took my oath of enlistment seriously. I swore to
protect and to defend the Constitution of the United States. We
can all agree on one thing: that the Vietnam era was a very
unpopular and emotional time back then. I, however, chose to
serve toward a more deliberate and positive course for our
country and invest in its national interests and securities.
The House recently overwhelmingly voted 382-0 for H.R. 299.
On that day veterans across the Nation lit up phone lines and
social media that in hope and trust they were finally realized
and valued for their service. Today this Committee and the
Senate can further seal that confidence to secure those
mandates for care and prevention. For those, we have been told
no. For our Australian counterparts and allies, with the same
at-sea lifestyles, experienced the same anguish, however,
initiated the means to provide the needed care for their
Vietnam sea service veterans. The VA Mission Act of 2018,
sponsored appreciatively by Chairman Roe, will ensure a
continuity of care and services for our Blue Water Navy
veterans. Please consider these points:
Measurable Blue Water Navy issues have been
addressed to the House and to the Senate. An identifiable and
affordable pay has been established.
The VA Mission Act provides the needed assurances
of hope and promise of care and sustainability in their own
personal lives.
The VA report of 2008 can be qualitatively
referenced, ``given the availability of evidence, the Committee
recommends that members of the Blue Water Navy should not be
excluded from the set of Vietnam era veterans with presumed
herbicide exposures.''
A letter sent by 14 Senators in January 2016
stated, ``There seems to be ample reason for you, the Secretary
of VA, to make the policy decision in favor of many veterans
who are suffering from painful and debilitating diseases for
whom justice is long overdue.''
Even the statement on dioxin regarding Agent
Orange brings the point home as requested. ``Dioxins are in
nature chemical residues from manufacturing processes and are
often cancerous.'' Typically, the side effects of dioxins in
human exposures include sarcoma, lymphoma, blood diseases, and
various birth anomalies and defects of varying magnitudes of
seriousness.
And, recently, the VA established a qualitative
framework to put into practice a positive stance and five
courses of actions that would support and endorse and decrease
in suicide instances to match the needs of our service.
Mr. Chairman, Committee Members, now is the time. We must
act to forge an informative action for our Blue Water Navy
veterans. Every day we suspend its passage again, we further
continue the loss of confidence and psychological setbacks for
our veterans, including death itself.
I quote another instance of a widow of a Navy master chief
who is buried at Arlington Cemetery, who said, ``It is cheaper
for the VA to bury our veterans than to take them and give them
the treatment that they need.'' She also said, ``They should
never have been excluded.''
The making of fresh water is a universal process on every
Navy ship. Admiral Zumwalt--I spoke with his daughter and his
son, and the daughter said at a Navy memorial conference that
if her Dad had known the following effects of Agent Orange, he
would never have allowed it.
In closing, Mr. Chairman, these are the faces and stories
of the Blue Water Navy vets. We took an oath, we served, we
made a commitment to the sea--breathing, bathing, drinking,
cleaning, even brushing our teeth while absorbing Agent Orange.
Our caretakers are suffering patiently as well and wondering
just when will that day be.
Sir, people are not science projects. We are the
consequences of an era gone by. Vote for H.R. 299.
Please remember my earlier quote from George Washington,
because this could have a future impact, as I recently had down
in Charleston, SC, by a 19-year-old who said, ``Sir, is the
Government and VA going to take care of me if I should get
ill?'' just before he went to boot camp.
Remembering the Vietnam veteran, our resistance will long
be painful. Sir, we have the means. Let us make sure it does
not happen to us.
Mr. Chairman, I thank you and the Ranking Member and the
Committee and all the members here today, and I respectfully
request that my statement be placed in the record. I await your
questions.
[The prepared statement of Mr. Snee follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of the Thomas J. Snee, USN (Ret), M.Ed, MCPOC (SW),
National Executive Director, Fleet Reserve Association
introduction
Distinguish Chairman Johnny Isakson, Ranking Member Jon Tester, and
members of the Veterans Committee, We thank you, for the opportunity to
present the FRA's views on, The ``Blue Water Navy Vietnam Veterans Act
of 2018,'' sponsored by Rep. David Valadao (R-CA) and other legislation
listed on the agenda. We would like to recognize and thank Rep Valadao
for his leadership and direction in the recent House passage of this
Bill, (382-0) on June 25, 2018. FRA also thanks Senator Kirsten
Gillibrand (D-NY) for her companion legislation (S. 422), to (H.R. 299)
as it was introduced in the House. The House bill has 330 co-sponsors
and the Senate bill has 51 co-sponsors. FRA also thanks House Veterans'
Affairs Committee Chairman Dr. Phil Roe (Tenn.) and Ranking Member Tim
Walz (Minn.) for working in a bi-partisan manner to pass the
legislation out of committee and that recently passed in the House.
agent orange/blue water navy reform
The ``Blue Water Navy Vietnam Veterans Act'' (H.R. 299) not only
clarifies, but further defines eligibilities for sea service personnel
that served on ships in the coastal waters off the coast of the
Republic of Vietnam. This bill also provides a presumptive eligibility
statute for disability claims submission to the VA for disease and
ailments from the toxic exposures of the Agent Orange herbicide. FRA
requests that Congress recognize all ``Blue Water'' veterans who were
exposed to the Agent Orange herbicide and to authorize immediate and
presumptive status for VA disability claims submissions. Current
presumption of service connection only exists for Vietnam veterans who
served in-country, on land and inland waterways, but limited to those
who served off its coastal waters. Enactment of H.R. 299/S. 422 will
ensure a well justified and earned treatments and benefits to the
thousands of Navy/Marine Corps/Coast Guard personnel who may have been
denied service-connected claims by the VA since 2002.
Upon passage of this bill, these servicemembers will no longer have
to continually prove direct exposures from Agent Orange, and be
eligible to receive the consideration from the VA for benefits
associated from presumptive and known associated health conditions
incurred from exposure from this defoliant while serving on these
ships. From 1964-1975 more than 500,000 deployed servicemembers serving
off the coastal waters of Vietnam may have likely been openly exposed
to the chemical herbicide Agent Orange in the daily performance of
their shipboard duties. In response to this concern, Congress passed
the Agent Orange Act of 1991, (P.L. 102-4) under President George H.W.
Bush.
Based upon the 1991 Agent Orange Act, the VA policy (1991-2001)
only recognized servicemember file claims if they received the Vietnam
Service Medal/Vietnam Campaign Medal with a ``boots on the ground''
status. These restrictions of service were not applicable to sea
service personnel on ships in the coastal waters. Agent Orange
presumption connections were never extended for those shipboard
personnel in the performance of their daily duties. The herbicide's
primary use was to destroy foliage on river banks and shores where the
Viet Cong hid, in order to fire upon passing ships and small vessels.
The chemical sprayed found in those rivers, eventually had a
``natural'' runoff into the coastal waters off Vietnam. As a result,
shipboard desalination processing, as used daily for bathing, drinking,
laundering, dish washing, and other onboard daily use were never
considered from this contamination. It was later determined, that the
onboard desalinization process for water intensified the toxicity in
the amounts used in the daily use from these herbicide exposures. In
addition, consideration must be taken into account from these same
sprayings, the atmospheric surroundings that were affected on these
ships.
FRA is grateful to the 14 Senators, who in joint 2016 letter to the
Secretary of Veterans Affairs, requested that the VA reconsider its ban
on presumption for those who served on ships off the coastal waters as
well as to those who had ``boots on the ground.'' The FRA strongly
endorsed this letter with its reassurances in the lifting of those
restrictions. This same letter referenced the recent Gray v McDonald
decision by the Court of Appeals for Veterans Claims that found that
VA's exclusion of Da Nang Harbor from the definition of ``inland
waterways'' to be ``arbitrary and capricious.'' FRA was disappointed
that the VA issued a court-ordered and ``clarified'' definition of
inland waterways for the purpose of determining presumption for
coverage that still maintained its exclusion of the ``Blue Water''
Vietnam veterans. For the VA, to state with such confidence that the
toxin, Agent Orange, could not cross from inland water ways and harbors
into open coastal waters is a total `rejection in itself to the laws of
nature'. It was as if some imaginary line drawn across the mouth of any
river or bay had the ability to stop the herbicide from entering into
coast waters and currents from flowing.
house amendments to agent orange legislation
This current legislation, as amended in the House Veterans' Affairs
Committee, now extends the presumption of herbicide exposure for
veterans who served on or near the Korean DMZ between September 1, 1967
and August 31, 1971. This legislation will now permit and allow
extended health care, vocational training & rehabilitation and monetary
allowances to children born with spina bifida, provided that at least
one parent of the affected child served in Thailand between January 9,
1962 and May 7, 1975 as determined by the VA Secretary and had been
exposed to the herbicide Agent Orange during that period.
This bill also will allow improvements to the VA's home loan
program. Currently, VA-designated appraisers rely solely on information
from approved third parties, who, for an example, would use a desktop
appraisal, when determining a home's value for a VA home loan. This new
method would combine traditional appraisal methods with modern data
analytics and market data to expedite and improve VA's appraisal
process. This bill also eliminates the current conforming loan limit on
the price of a loan that VA can guarantee. This rate is set by Freddie
Mac and the amount of the current cap varies depending on the cost of
living in a particular area. Any veteran who chooses to their benefit
to purchase a home above the current cap would be required to pay a
funding fee unless they were rated at the 100 percent service-connected
level.
other legislations
FRA would like to briefly indicate its position on the other
legislative proposals being reviewed at this hearing. The FRA's
position on the other legislative proposals is as follows:
FRA supports the draft legislation sponsored by Senator
Bernie Sanders (VT) to authorize a pilot program for expanded dental
services for certain veterans;
FRA has no position on Senator Michael Bennet's (CO)
legislation (S. 3184);
FRA supports the draft legislation sponsored by Senator
Michael Crapo (ID) that addresses the streamlining the Transition
Assistance Program (TAP).
FRA has no position on Senator John Boozman's ``VA Hiring
Enhancement Act;''
FRA has no position on Rep. Jack Bergman's (MI) ``Veterans
Affairs Medical-Surgical Purchasing Stabilization Act'' (H.R. 5418);
FRA strongly supports Senator Gary Peters (MI) the ``BRAVE
Act,'' (S. 1596) that increase benefits for burial, funeral and other
death related expenses;
FRA strongly supports Senator Diane Feinstein's (CA)
``Mare Island Naval Cemetery Transfer Act,'' (S. 2881);
FRA supports Senator Jon Tester's (MT) ``VA Financial
Accountability Act'' (S. 1952);
FRA strongly supports Senator Jon Tester's (MT)
``Dependency and Indemnity Compensation Improvement Act'' (S. 1990);
FRA strongly supports Senator Dan Sullivan's (AK) ``Medal
of Honor Surviving Spouse Act'' (S. 2185);
FRA supports the draft legislation, sponsored by Senator
Bill Cassidy (LA), to require the VA to create a program to provide
grants for persons to provide and coordinate provisions of the suicide
prevention services for certain veterans;
FRA strongly supports Senator Bill Cassidy's draft bill
``Modernization of Medical Records Access for Veterans Act;'' and
FRA supports Senator David Perdue's ``No Hero Left
Untreated Act'' (S. 514).
conclusion
In closing, please allow me again, to express our sincere
appreciation on behalf of the Association in allowing FRA to express
its views on legislation at this hearing.
Chairman Isakson. Your statement will be placed in the
record, as will the statements of all the members of the panel.
Thank you, Mr. Snee.
Mr. Weidman, you are recognized.
STATEMENT OF RICK WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY AND
GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA
Mr. Weidman. Thank you, Mr. Chairman. I appreciate it.
There are a number of bills that are really worthy bills
and discussion drafts for consideration today, but I am not
going to comment on all of them. I will just concentrate on
two.
First, H.R. 299 with the amendments is a bill that deserves
passage. One of the statements by the VA panel--the Under
Secretary can certainly be forgiven because he is brand-new--
but when that Blue Water Navy special study was released by the
Institute of Medicine, I was there, one of Mr. Snee's
colleagues who was also present in the room was there, and
about six VSOs. It did not say that people were not exposed.
What the report said was that, yes, it was biologically
plausible and that probably some were exposed. We said, ``So,
why aren't you recommending upping among the categories that
the National Academy of Medicine,'' as it is now called, ``has
the opportunity to do under the 1991 law?''
The response back to that was, ``We do not know how much
you were exposed.'' To which I said, ``So what? You do not know
how much I was exposed versus my friends who is down in I Corps
who served on the ground?''
Then we asked a key question: ``What is a safe dose of
dioxin?'' Of course, her eyes got as big as dinner plates,
because there is no such thing as a safe dose of dioxin.
We believe that the report itself has been misinterpreted
by the so-called public health and toxic exposure section of
VA, because if you go back and read the actual report, it says
that, in fact, people who served in the Blue Water Navy were
exposed. How much makes no difference. You do not know how much
different folks who served in the delta versus the central
highlands where I served. Who knows? And, you cannot put it
together 40 years later.
I do want to comment and save my remaining time for the
Veterans Dental Eligibility Expansion and Enhancement Act of
2018. How in the world dental care and periodontal care got
separated from the rest of physiological care in our society is
one of those things that you really have to scratch your head
about. What do we know about people who use VA? They are older,
they are sicker, and they have multiple and complex
interactions of physical conditions. Some of that is due to
poor nutrition. Some of it is due to bad teeth and other dental
diseases that make it hard for people to eat real food, and so
they go for processed foods. It is way past time for the VA to
do this pilot study. Frankly, we believe that there is enough
evidence in the general literature about overall health in
general in regard to dental care, good dental care, that you
cannot do good overall care, physiological care, unless you
have good dental care.
Because of the vagaries of the C&P system, there are a lot
of people--if you served and applied in one regional office,
you would have ended up 100 percent. If you apply at another
regional office, you end up being 60 or 70 percent. Whether or
not you have dental care, which is absolutely necessary to good
health, should not depend on where you live and the vagaries of
even adjudicator to adjudicator within the same office.
So, we urge early passage of both of these bills and that
science and justice demand early passage of both, because you
cannot take care of people's health if you ignore the dental,
and because what the IOM report really said was that, yes, it
was plausible that people were exposed. That was what we
needed.
One last point about the VA. They were under pressure to
make a definitive statement about who was in the river and who
was in the harbor. If you were in the harbor, you, ``were not
exposed.'' But, if you sit where Senator Sanders and the
Chairman are sitting and the people behind them, you were
exposed. They literally drew a line on a map across the mouth
of the river. I mean, you do not have to be an ocean
hydrologist to know how stupid that is. The Tombigbee River and
other rivers in Georgia empty into the ocean. How do you say
whether if you threw orange dye upstream it is going to end up
in the harbor? Same with the Lamoille River dumping into Lake
Champlain. While you can say, ``Yes, that is the mouth of the
river,'' but anything that is in the water that is coming down
is going to go out into the larger body of water.
So, I thank you for your indulgence. I know I am over time,
Mr. Chairman, and thank you so much for this hearing. I look
forward to discussing these issues, of each one of these
discussion drafts and bills, with your staff. Thank you.
[The prepared statement of Mr. Weidman follows:]
Prepared Statement of Rick Weidman, Executive Director for Policy &
Government Affairs, Vietnam Veterans of America
Chairman Isakson, Ranking Member Tester, and your distinguished
colleagues of the Senate Veterans' Affairs Committee, Vietnam Veterans
of America (VVA) wants to thank you for your stellar efforts on behalf
of veterans of all eras. And we appreciate the opportunity to offer for
your consideration our testimony regarding legislation pending before
this distinguished committee.
H.R. 299, the Blue Water Navy Vietnam Veterans Act of 2018,
introduced by Congressman David Valadao (R-CA). VVA, along with just
about every other VSO and MSO, has pressed for the passage of
legislation that will right a long-standing wrong for veterans of the
so-called Blue Water Navy during the years of the Vietnam War. Its fate
now rests in this Committee, at this time. We hope you will see the
wisdom in bringing, at long last, a measure of justice to these worthy
veterans, men who did the Nation's bidding during that difficult and
turbulent time.
background
During the war in Vietnam, from the early 1960s through the first
years of the 1970s, some 20 million gallons of Agent Orange and other
toxic chemicals were sprayed to defoliate jungle flora for two
important reasons: to kill foliage surrounding fire bases that would
otherwise provide cover for enemy forces, and to deny the enemy the
ability to grow crops. Toxic chemicals in the herbicide, have been
associated with serious, life-threatening health conditions, e.g., non-
Hodgkin's Lymphoma, various cancers, Type II diabetes, and Parkinson's
disease.
Agent Orange was sprayed across the former South Vietnam, including
coastal areas and along the banks of rivers and streams that empty into
the South China Sea. The dioxin in this defoliant wound up in harbors
and coastal byways heavily trafficked by military as well as civilian
vessels. It is virtually certain that this contaminated seawater was
taken in by ships to be desalinated into potable water for drinking,
cooking, and showering. Today, too many of the sailors and Marines
aboard these vessels are afflicted with the same maladies as are so-
called boots-on-the-ground Vietnam vets.
We wonder how many in this hearing room remember the words of one
veteran suffering from cancer who stated, ``I died in Vietnam and
didn't even know it.'' He was not alone. In 1991, Congress enacted the
Agent Orange Act in an attempt to rectify what had become a persistent
outcry from veterans suffering from diseases that peer-reviewed
scientific studies have associated with exposure to dioxin, the toxic
element in Agent Orange.
There was a time when the Veterans Benefits Administration treated
claims from sailors in the same manner as they did for claims by in-
country veterans. This was ended, abruptly, in March 2002. The former
Secretary who made that decision in 2002, without any justification,
scientifically or otherwise, published an Opinion piece last week
urging that the Congress ``not ignore science.'' Between 2002 and 2009,
the VA denied some 32,880 claims, as the VA limited the scope of the
Agent Orange Act to only those veterans who could provide proof of
``boots on the ground'' in Vietnam. Today, approximately 90,000 claims
by ``Blue Water'' sailors are awaiting adjudication by the VBA.
(The Department of Veterans Affairs has published on its website a
listing of ``Navy and Coast Guard Ships Associated with Service in
Vietnam and Exposure to Herbicide Agents.'' Most of these vessels,
dubbed ``Brown Water Navy,'' plied inland waterways in the former South
Vietnam.)
h.r. 299
On June 25, 2018, the House passed an amended version of H.R. 299,
382-0. The original bill clarified that servicemembers aboard vessels
in Vietnamese territorial waters (for the most part up to 12 miles from
shore) during the Vietnam War can claim service connection for ailments
associated with exposure to Agent Orange when filing a disability
claim. The House bill was amended to include certain veterans who
served near the demilitarized zone in Korea and in Thailand.
Congress, we believe, should recognize that it is as likely as not
that these veterans were in fact exposed to Agent Orange and should be
accorded presumptive status for their disability claims citing such
exposure. When signed into law, this bipartisan legislation would
reverse the VA's 2002 decision which prevented Blue Water Navy
veterans--and those veterans who served near the DMZ in Korea and in
bases in Thailand--from claiming presumptive status for the diseases
associated with herbicide exposure.
VVA supports passage of H.R. 299 as amended, and urges swift action
by you and your colleagues in the Senate.
S.____ the Veterans Dental Care Eligibility Expansion and
Enhancement Act of 2018, introduced by Senator Bernie Sanders (I-VT),
calls for the VA to carry out a 3-year pilot program at no fewer than
16 VA healthcare facilities. The purpose of this program is to assess
the feasibility and advisability of furnishing dental services and
treatment, and related dental appliances, to enrolled veterans who are
not deemed to be eligible for such services and treatment, who
volunteer to participate in the program, and who agree to copayments
for such treatment and services same as they would for medical care.
This bill also calls for the VA to initiate a program to educate
enrolled veterans on the importance of good dental health, a program
that illustrates the association between dental health and overall
health and well-being.
VVA most definitely endorses and fully supports this pilot project,
and Senator Sanders' initiative. As he has noted, ``Untreated oral
health conditions can lead to tooth loss, pain and infection, and
contribute to an increased risk for serious medical conditions such as
diabetes and poor birth outcomes.'' The bill requires, within a year
and a half after this pilot program commences, that the VA submit a
report to both SVAC and HVAC that describes the implementation and
operation of the project and includes ``an assessment of [its] impact
on medical care, wellness, employability, and perceived quality of
life.''
VVA recommends that the VA be required, within six months of the
date of enactment of this act, to submit an exhaustive study/literature
review of all peer reviewed articles in reputable medical journals
pertaining to the effect of dental/periodontal health on overall health
of adult individuals. Further, that VA submit a complete and documented
study of the effect of providing dental services to homeless veterans
and other veterans who receive such services, by cohort group, at VA.
If this pilot project proves successful, as we believe it will, the
introduction of full dental services for veterans who have a disability
rating of less than 100 percent will have a salutary effect on their
overall wellness.
The arbitrary division of health and dental health has never made
any real sense to us at VVA, since the two are so inextricably
intertwined.
S. 2881, the Mare Island Naval Cemetery Transfer Act, introduced by
Senator Diane Feinstein (D-CA), directs the VA to enter into an
agreement with the city of Vallejo, California, for the transfer to the
VA of the Mare Island Naval Cemetery in Vallejo, to be maintained as a
national shrine.
Because of persistent fiscal uncertainties, Vallejo has been, and
will continue to be, unable to properly maintain this cemetery. It is
certainly appropriate for the VA's National Cemetery Administration to
add this to its roster of national shrines. To not do so would be an
abdication of presumed responsibility, because to honor the memory of
those buried there, this final resting place must be accorded proper
maintenance. The Navy should have properly transferred it to the
National Cemetery Administration (NCA) when the Navy pulled out of Mare
Island.
VVA supports the passage of S. 2881 and would request that, if it
cannot be enacted as a stand-alone bill, it should be added via
amendment to the 2019 National Defense Authorization Act.
S. 1596, the Burial Rights for America's Veterans' Efforts
(``BRAVE'') Act of 2017, introduced by Senators Gary Peters (D-MI) and
Marco Rubio (R-FL). This bill would increase the maximum amount payable
by the Department of Veterans Affairs for the burial and funeral
expenses of certain veterans, an amount that would increase each fiscal
year by the percentage increase in the Consumer Price Index.
The demise of thousands of veterans can be connected to health
conditions connected to their military service. Just as the CPI
fluctuates (usually upward) year to year, recompense for burial
expenses also ought to be aligned with changes in the CPI. S. 1596
should achieve this. It makes sense, is logical, and we can see no
reason not to urge Congress to embrace it.
S. 3184, introduced by Senator Michael Bennet (D-CO), would modify
the requirements for applications for construction of State home
facilities to increase the maximum percentage of non-veterans allowed
to be treated at such facilities.
The intent of this legislation is righteous. It would provide
``care to spouses of veterans, during a period in which a facility is
operating with a bed occupancy rate of 90 percent or less, not more
than 40 percent of the bed occupancy at any one time will consist of
patients who are not receiving such level of care as veterans.''
While we have no qualms about the spouses of veterans to be
admitted to these homes, the language of S. 3194 is ambiguous. It seems
to us that with the aging of the Vietnam veteran cohort, more and more
of us will need to avail ourselves of what State homes can provide.
Just as VA healthcare facilities are for veterans of the Armed Forces,
so too, we believe, should homes for veterans be just that: homes for
veterans who can live in dignity at a place where they can bond with
other veterans. This also avoids having different levels of care, which
can result in conflict when non-vets feel discriminated against.
S. 3184 needs to go back to the drawing board.
Discussion Draft on Transition Assistance reform, to be introduced
by Senators Mike Crapo (R-ID), Jon Tester (D-MT), Bill Cassidy (R-LA),
and Dan Sullivan (R-AK).
This is an ambitious bill, one that seeks to improve DOD's
Transition Assistance Program, including pre-separation counseling and
services on such areas as financial planning, transition and
relocation, and programs and such benefits as health care; educational
assistance; preparation and requirements for employment; small business
ownership and entrepreneurship programs; employment and reemployment
rights; veterans preference; vocational rehabilitation; home loan and
housing assistance; support services for family caregivers; and
survivor benefits. This is commendable, and an attempt to bring
organization and context to an often haphazard conclusion of a
servicemember's time on a deployment overseas and/or an end to his/her
active duty.
Of particular importance is that section of this bill that calls
for establishing a governing board to support prevention of drug
overdoses, deaths by suicide, and alcohol-related mortality. This is
timely and necessary, and should lead to a more sensible allocation of
resources Vis a Vis prevention activities involving overdoses, alcohol
dependence, and suicides. Over the past several years, for instance,
hundreds of millions of dollars have been appropriated in an attempt to
better understand and hence be able to prevent active-duty troops and
veterans from taking their life; very little seems to have been
achieved that can be ascribed as having made a positive impact on
cutting the numbers of suicides and overdoses.
Of particular interest and relevance to VVA and other VSOs and MSOs
is ``a course of instruction, of at least one day, on the benefits and
services available under the law administered by the Secretary of
Veterans Affairs.'' There is far too much ignorance by far too many
veterans on the benefits and services which they have earned by virtue
of their service in uniform. For this alone we would endorse this
legislation.
There are, however, elements of this extremely prescriptive bill
that ought to be rethought, e.g., the requirement that while all
members eligible for assistance must participate, no servicemember
``shall be required to attend more than one class or counseling session
in any one-year period.'' This seems self-defeating. And the sheer
amount of analysis and paperwork that this bill would mandate will
provide reams of statistics that, we fear, accomplishes little.
S. 2748, the Better Access to Technical Training, Learning, and
Entrepreneurship for Servicemembers--or BATTLE--Act, introduced by
Senators Sherrod Brown (D-OH) and Mike Rounds (R-SD), would require
members of the Armed Forces receive additional training under the
Transition Assistance Program.
It is a far more modest piece of legislation that attempts to
improve DOD's Transition Assistance Program.
VVA has no objection to the enactment of this bill.
S.____, to be introduced by Senator Bill Cassidy (R-LA), would
require the Secretary of Veterans Affairs to establish a program to
award grants to organizations (not ``persons'') to provide and
coordinate the provision of suicide prevention services for eligible
veterans transitioning from the Armed Forces who are at risk of
suicide, and for their families.
Suicide, it has been said, is a permanent solution to a temporary
problem. Still, despite all manner of attempts by Congress, DOD, the
VA, and communities to research the reasons why servicemembers and
veterans attempt or succeed at suicide, and hence to devise initiatives
and programs to steer them to sources of comfort and assistance,
suicide still claims far too many of those who have served the Nation
in uniform.
Despite the panoply of suicide prevention efforts, especially the
VA's well- disseminated call-in number which connects those
contemplating taking their life with well-trained professionals who can
help them, the VA still does not do consistent evaluations of all
potential psycho-social, economic, and other material factors in
suicides, both attempted and completed, in each and every instance.
This gross failure on the part of VA after 15 plus years of this being
a major public concern is simply inexcusable, and must be corrected
prospectively as well as retrospectively before any more funding is
just thrown at this problem.
S.____, the Modernization of Medical Records Access for Veterans
Act, also to be introduced by Senator Cassidy, would direct the
Secretary of Veterans Affairs to initiate a pilot program to establish
``a secure, patient-centered, and portable medical records system that
would allow veterans to have access to their personal health
information.''
It seems to us at VVA that any VA patient can request his/her
medical records simply by asking, because of the VA's pioneering
electronic health record system, which should be made even more
efficient as the $16 billion IT modernization effort gets online.
Certainly, the kernel of this bill can, and should, be incorporated
into this effort. And implementation of the pilot program called for in
this bill ought to help in the re-design of the VA's IT. However, this
needs to be coordinated with DOD's upgrade of its IT system. With this
caveat, VVA supports enactment of this legislation.
S.____, the VA Hiring Enhancement Act, introduced by Senator John
Boozman (R-AR), would ``provide for the non-applicability of non-
Department of Veterans Affairs covenants not to compete to the
appointment of physicians in the Veterans Health Administration.''
It appears that the goal of this bill is to make it somewhat easier
for the VHA to hire medical professionals, to unencumber them from a
covenant they may have entered into that could conceivably be used by a
soon-to-be ex-employer to thwart their hiring by the VA. Inasmuch as
there is a crying need in the VHA for more clinicians, so long as this
bill is on solid legal footing, VVA fully supports its enactment, and
thanks Senator Boozman for his leadership.
H.R. 5418, the Veterans Affairs Medical-Surgical Purchasing
Stabilization Act, introduced by Congressman Jack Bergman (R-MI), would
require the VA, in procuring medical, surgical, dental, or laboratory
items for its medical facilities through the Medical Surgical Prime
Vendor (MSPV) program, to award contracts to multiple regional prime
vendors instead of a single nationwide prime vendor. It would prohibit
a prime vendor from solely designing the formulary of items available
for MSPV purchase. And it would mandate that the VA ensure that each
employee who conducts formulary analyses or makes decisions about
including items on the formulary has relevant medical expertise; and
that the VA provide Congress, on a quarterly basis, with periodic lists
of these individuals and their medical expertise listed by categories
of formulary items.
VVA endorses the intent of this bill, but we balk at the
requirement of naming individual employees as a matter of course,
unless said individual is a SES or other senior VA manager. Certainly,
if there is a question about a particular action by a specific
employee, said employee needs to be named and called to task. The
Accountability Act was supposed to make it easier to hold these senior
managers accountable, not make it easier to scapegoat and fire those
they manage. With this caveat, we endorse enactment of H.R. 5418.
S. 1952, the VA Financial Accountability Act of 2017, introduced by
Senators Jon Tester (D-MT), John McCain (R-AZ), Joe Manchin (D-WV), and
Tim Kaine (D-VA), would improve oversight and accountability of the
financial processes of the Department of Veterans Affairs.
We have no dispute with the statement that ``the normal budget
process for the VA should be grounded in sound actuarial analysis based
on accurate demand forecasting,'' or that ``supplemental requests for
appropriations should be used sparingly and for unforeseen demand or
natural occurrences.'' We do question, however, the underpinnings of
this legislation. Certainly, the VA does not come up with its budgetary
needs in a void, although VVA has long contended that the so-called
``Millman formula'' always underestimates the needs of every
generation. And then . . . the Office of Management & Budget (OMB) gets
ahold of the VA request, and shrinks an already underestimated set of
figures. Ultimately it is up to Congress to determine how much is to be
appropriated.
The concern, however, seems to be the unanticipated costs of
fulfilling Congress' promise to give veterans Choice. And going to
private doctors and hospitals is only going to cost more and more--with
which both the VA and you in Congress have to come to grips. If some
``independent third party'' can be contracted with to review and audit
the financial processes, and actuarial and estimation models of the VA,
and make recommendations for improving the reporting structures, fine.
Perhaps, however, Congress might first want to review the Final
Report of the Commission on Care, which you created while initiating
the Choice program back in 2014. Its estimates and forecasts seem
pretty clear; the only issue is how much ``Choice'' do you want to
fund--without further undermining the current already inadequate
organizational capacity at the service delivery point of VA medical
centers.
S. 1990, the Dependency and Indemnity Compensation Improvement Act
of 2017, introduced by Senators Jon Tester (D-MT), Richard Blumenthal
(D-CT), and Mazie Hirono (D-HI). This bill would increase amounts
payable by the VA to modify the requirements for Dependency and
Indemnity Compensation (DIC) for survivors of certain veterans who had
been rated totally disabled at the time of their death.
Although this bill does not attempt to correct the inequities
inherent in the SBP-DIC issue, it does seek to increase the amount of
DIC compensation payable to surviving spouses. This is commendable. It
should be of significant help to spouses in financial need. And we
support its enactment into law.
However, VVA must again state unequivocally that the gross
injustice done to the widows ``of those who have borne the battle'' by
deducting what is essentially an insurance program payout on which the
soldier's family paid into for years (SBP payments) from Death &
Indemnity Compensation (DIC) is just wrong, both morally and in every
other way. And all to save the Federal Government a few bucks on a dead
GI, ignoring the survivors.
S. 514, the No Hero Left Untreated Act, introduced by Senators
David Perdue (R-GA) and Gary Peters (D-MI), would require the VA to
carry out a one-year pilot program to provide access to magnetic EEG/
EKG-guided resonance therapy to treat veterans suffering from PTSD,
TBI, MST, chronic pain, or opiate addiction.
``Congress recognizes the importance of initiating innovative pilot
programs,'' this bill asserts, ``that demonstrate the use and
effectiveness of new treatment options for Post Traumatic Stress
Disorder, Traumatic Brain Injury, military sexual trauma, chronic pain,
and opiate addiction.'' If in a pilot project this therapy proves to be
promising or effective, initiating the pilot will be well worth
whatever it might cost. This program should be funded from Deployment
Health and other virtually useless programs, including Research &
Development programs that do not in any way contribute to understanding
toxic or other wounds of servicemembers and veterans, or improving
veteran health treatments.
S. 2485, the Medal of Honor Surviving Spouses Recognition Act of
2018 , introduced by Senator Dan Sullivan (R-AK), would provide payment
of the Medal of Honor special pension to the surviving spouse of a
deceased Medal of Honor recipient.
Bearing in mind that those who have been awarded the Medal of Honor
are true heroes and not the ``hero'' appellation that so many in
Congress feel compelled to honor all those who serve in uniform. To
provide a modest--$1,329.58 a month--special pension to the surviving
spouse of one of this Nation's heroes should be a no-brainer, and VVA
is on board for the swift passage of this bill.
VVA thanks you for the opportunity to present our views on
legislation pending before this Committee, and we look forward to
passage of H.R. 499, the Blue Water Navy Vietnam Veterans Act, and will
be happy to answer any question the Committee may have.
Chairman Isakson. You may be over time, but you are always
informative, and we appreciate it. [Laughter.]
Mr. Weidman. Thank you very much, Mr. Chairman.
Chairman Isakson. Do you have a question, Senator Sanders?
Senator Sanders. I do. Let me start off by thanking The
American Legion, the VFW, the Fleet Reserve Association, and
the Vietnam Veterans for all supporting the dental legislation
that we have. I appreciate that very much, and I think the time
is long overdue, as Rick just mentioned, for us to pass that.
I would appreciate from Mr. Weidman or any of the other
distinguished panelists their thoughts about the need for the
VA to begin a pilot project to take a look at the dental care
needs of veterans. Rick, do you want to begin it?
Mr. Weidman. I come back to what we know about the
demographics of who uses VA, and the demographics are generally
veterans who are poor. And what do we know about poor people?
They do not eat as well as upper-middle-class or middle-class
people. Some of that is because they cannot access it in the
inner cities, but even in the countryside, what you have easy
access to in a place like Vermont or rural Georgia or rural
North Carolina is the little stores that are nearest you, which
generally do not carry fresh produce. So, people eat stuff out
of a can or they hit the fast-food joint. When you have got a
number of kids, the easiest thing, if you are poor, is to take
them to a fast-food joint because that will fill them up. It is
not the right thing, and for the person to eat it, the veteran
to eat it, they know very well it is not the right thing, but
it is cheap and they are hungry. So, that is what poor people
eat.
Senator Sanders. All right. Let me just jump in and ask
anybody, are you aware of veterans who have serious dental
needs?
Mr. Weidman. Yes.
Senator Sanders. OK. Mr. Manar?
Mr. Manar. Well, certainly, and it is really frustrating
for veterans when they come to seek dental treatment at the VA
and they are told they need to file a claim. Then, it can take
months while they are suffering from their dental conditions.
And, more often than not, they are going to get denied for
treatment because the evidence is lacking that their condition
started in service or whatever the reason may be.
I think that if we looked hard enough at the history of why
dental treatment got separated from health care, it is the same
reason vision was separated. First, they are very common and,
second, they are very expensive over the long run. And, they
decided to save money, your predecessors decided to save money
and focus on other things.
I am really thankful, we are really thankful that you have
presented this legislation, you are supporting it, and we hope
that the Senate will move on it and grant the veterans this
opportunity to participate in a test.
Senator Sanders. Good. Does The American Legion want to
comment on that?
Mr. Nuntavong. Senator, The American Legion believes in
timely and quality dental care for veterans. I am a retired
Marine, 22 years. I was required to go to medical once a year,
but I was required to go to dental twice a year. It is very
important that our veterans receive the health care they need
in the form of dental care.
Senator Sanders. Thank you. Fleet Reserve, Mr. Snee?
Mr. Snee. Yes, sir, the same. I agree with The American
Legion's statement. You have got to remember that when these
individuals come out of the service, they are given their final
dental care, their final check. Then, it comes down to where do
they go when they get out? It is where they are settling down,
then access to that dental care. And, of course, the
availability of socioeconomics that plays on the family. That
is very important. They have never had to do that, to go out to
a civilian dentist, not because of disgust or anything else,
but where do we go next? That is a factor also. Having that
availability as a total medical picture for the entire body
being taken care of, it is very important, yes, sir.
Senator Sanders. Well, let me thank all of the
organizations here for their support. What we are proposing is
nothing terribly radical. It is a pilot project to see what
kind of need is out there, to see how the VA can best address
that need. I suspect the pilot project will prove positive, and
we will go from there. I do appreciate all of your support and
will look forward to passing this legislation.
Chairman, thank you very much.
Chairman Isakson. Thank you, Senator Sanders.
Senator Tillis?
Senator Tillis. Thank you, Mr. Chair. I will be very brief.
First, I want to thank Matt sitting in the front row.
Because you are in the office a lot, I have mistaken you for
staff once or twice, so we really appreciate your advocacy on
behalf of The American Legion.
My wife's uncle died of Agent Orange exposure, very
personally important. I have worked on toxic burn pits to try
and get ahead of what I think could be the next Agent Orange. I
worked on the Camp Lejeune toxic substances. I want you to know
that I am very sympathetic to what we are trying to do with the
Blue Water Navy, and I would like to meet in my office so that
we can have a more fulsome discussion than we can have here. I
want to see how we can really move on track to where we can
bring people together, address some of the concerns I have
about the pay-for. I think when it was previously proposed, you
all had some--or some of the VSOs, I will not speak for you,
had concerns with the pay-for. So, it is important to get it
right. I think we do need to get it right.
With respect to science, I think on dental health--I have
done a lot of work in State public policy; dental health and
physical health are inextricably linked. We need to make
progress on that.
I just wanted to thank you all for your service and let you
know that our office is willing to work with you. We all know
that the hearings are important, but what happens in the
offices every day in meetings where we can drill down and talk
about how you take positive steps and gain support for the
measures is the way we get things done.
Thank you all for your past service and your continued
service.
Chairman Isakson. I am glad Senator Tillis wants to work on
this Blue Water Navy because I had the privilege of working
with him on the Camp Lejeune issues here a couple years ago.
Many of those questions leading up to that were not any more
difficult than the ones we are talking about trying to solve
with the Blue Water Navy. So, I look forward to working with
him on that and the others.
I thank all the Members for being here. I ask unanimous
consent that the testimony of Dianne Feinstein--which was to
have been made orally at the first panel, but she could not be
here. She later submitted it in writing to be submitted for the
record of today's hearing. Is there any objection?
[No response.]
Chairman Isakson. Hearing none, so ordered.
[The prepared statement of Senator Feinstein can be found
in the Appendix.]
Chairman Isakson. Second, we received testimony for a
February 7, 2018, legislative hearing which we had to postpone
at the last minute due to inclement weather. I ask unanimous
consent that the testimony received for that hearing be added
to today's record for the purpose of making it public
information. Any objection?
[No response.]
Chairman Isakson. Hearing none, so ordered.
[The testimony submitted for February 7, 2018, for which an
updated version was not received, is found in the Appendix.]
Chairman Isakson. We thank you for your participation. We
have more to do on these issues. This is not the end. This is
the beginning. I appreciate you all being here very much.
We stand adjourned.
[Whereupon, at 4:19 p.m., the Committee was adjourned.]
A P P E N D I X
----------
prepared statement submitted by hon. maria cantwell,
u.s. senator from washington
(brought forward from February 7, 2018, postponed hearing)
Thank you Chairman Isakson and Ranking Member Tester for moving
this bill through your committee.
I would also like to thank Senator Fischer for her co-sponsorship
and support of servicemembers on this very important issue.
Currently, the SCRA provides servicemembers the ability to get out
of term contracts for wireline and wireless telephone service--without
penalty--upon the servicemember's deployment.
This bill would extend the same relief for servicemembers that need
to terminate term cable and Internet service contracts because of a
deployment. By creating parity with other types of technology that
servicemembers and their families regularly use we are protecting them
from unfair termination fees and penalties that may arise when duty
requires that they, and in some cases their families, move, in order to
fulfill their duties.
The text conforms to technical assistance we received from the FCC.
We vetted with industry, veteran and armed services stakeholder groups.
The broad support that the bill enjoys speaks to how timely and
necessary these proposed changes are to bring the SCRA up to date so
that servicemembers and their families can access the internet and
cable services we all rely on to stay in touch with their friends and
loved ones, stay informed about the news and remain connected around
the world, no matter where they are deployed.
______
Prepared Statement by Hon. Dianne Feinstein, U.S. Senator from
California
s. 2881--the mare island naval cemetery transfer act
Chairman Isakson, Ranking Member Tester and Members of the
Committee, Thank you very much for inviting me here today to discuss my
legislation.
S. 2881, the bill I have introduced with several of my colleagues,
is straightforward and would transfer control of the Mare Island Naval
Cemetery from the city of Vallejo to the Department of Veterans
Affairs.
I'd like to briefly provide some background on the history of this
cemetery. The Mare Island Naval Cemetery is the oldest military
cemetery on the West Coast. The cemetery was part of a U.S. Navy base
that closed down in 1993. After the base closed, the nearby city of
Vallejo assumed control of the property including the cemetery.
The cemetery has over 900 graves, including over 800 veterans and
three Medal of Honor Recipients. There are approximately 80 nonmilitary
graves, the majority of which belong to military family members.
Unfortunately, the city of Vallejo didn't have the necessary funds
to care for the cemetery, which has only been maintained by volunteers
with limited resources. The cemetery is very damaged: gravestones are
toppled over, broken or sinking into the ground, serious drainage
issues exist, and plants and weeds are overgrown. The current state of
the cemetery requires urgent action to restore these graves and the
grounds to a respectable condition.
The bill is a simple transfer of the cemetery from the city to the
Department of Veterans Affairs. This means that the VA would have the
responsibility to restore the cemetery and maintain the grounds in a
respectable condition.
I want to thank you all for considering this bill and I want to
thank Senators Harris, Markey, Menendez, Warren, Cardin and Booker for
cosponsoring this legislation.
We owe our veterans a great deal. By passing this bill we can
ensure that the Mare Island Naval Cemetery is restored and maintained
to honor our veterans who are buried there. For those veterans and
their family members who sacrificed so much for our Nation, it is
fitting that we do so.
Thank you.
______
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement from The Advanced Medical Technology Association
(AdvaMed)
AdvaMed is the leading trade association representing medical
technology manufacturers and suppliers that operate in the United
States. Our members range from the largest to the smallest medical
technology innovators and companies. Collectively, we are committed to
ensuring patient access to life-saving and life-enhancing devices and
other advanced medical technologies.
The sacrifice our Nation's veterans and their families make on our
behalf cannot be overstated. We all have an obligation to ensure they
receive the highest quality care and have access to the best medical
technology available. AdvaMed and its member companies believe strongly
in our collective relationship with the U.S. Department of Veterans'
Affairs (VA) and share the Department's goal of providing our veterans
with the highest quality health care possible.
There are approximately 8 million U.S. veterans of the armed
services accessing the VA health care system, with another nearly 2.3
million currently serving in the military on active duty that may do so
in the future. Through earlier diagnosis and intervention, less
invasive procedures and more effective treatments, medical technology
is revolutionizing health care across the continuum of service and
enhancing the lives of America's troops in the field and beyond.
Technologies include: spinal cord stimulation; joint/limb replacements;
wound care products; neurological devices; cardiac technologies; and
many others. Through these technologies, our companies can help provide
the standard of care reflective of the respect and commitment we owe to
our Nation's veterans.
One person's experience exemplifies our industry's mission when it
comes to our Nation's veterans. Justin Minyard's story reflects the
kind of people we are working every day to help--a combat veteran
injured at the Pentagon while lifting and moving rubble in the search
for survivors, who has found relief from his chronic back pain thanks
to Boston Scientific's spinal cord stimulator.
However, recent changes in VA's procurement of these critical
medical technologies have created new barriers within the veteran
health care system. These changes have resulted in significant
inefficiencies in veterans obtaining access to care and reductions in
the quality of health care accessible to veterans. In the long term,
these changes risk pushing high caliber providers and suppliers of
innovative products out of the VA system.
Our overarching concern is that, collectively, these problems will
severely restrict timely patient access to critical technologies and
quality care, delay access to the right product at the right time and
in the right setting for veterans and their providers, and possibly
impact the ability of VA to attract and retain medical professionals.
Thankfully, Congress has begun to address some of these issues and
work with both the VA and industry on constructive solutions. H.R.
5418, the Veterans Affairs Medical-Surgical Purchasing Stabilization
Act authored by Rep. Bergman, is an important step in improving one
component of the VA's procurement process. This legislation would place
procurement decisionmaking for the Medical-Surgical Prime Vendor (MSPV)
in the hands of clinical experts who are best equipped to advise the VA
on the most appropriate medical technology to meet the health care
needs of our Nation's veterans. At the same time, it would preserve the
ability of the VA to obtain a range of products at a competitive price
from multiple suppliers. AdvaMed supports the Committee's review of
this legislation today and looks forward to working further with
Congress on its adoption into law.
A well-managed MSPV program would have significant benefits, make
the VA a more efficient medical system, and reduce overall costs. More
specifically, a well-run MSPV will give the VA: 1) a full spectrum of
critical medical products for clinicians to be able to meet every
veteran's needs that does not exist in today's MSPV program, 2) reduce
the instances of procedure delays and cancellations at Veterans'
Affairs Medical Centers (VAMCs) due to lack of needed devices in the
current MSPV program, 3) reduce excessive and costly medical supply
inventory levels that currently exist at VAMCs, 4) reduce costs to
procure products, especially the rampant government purchase card use
that exists today in VA medical centers due to a poorly run MSPV
program, 5) reduces the time that VHA physicians and nurses are now
required to spend away from veteran medical care in order to perform
medical logistics functions, and 6) reduce the risk of gray market
medical devices being procured by VA when products re not available in
the MSPV.
It is important for the VA to have an efficient procurement system
across the board that allows for faster adoption of new medical
technologies and standards of care, while also ensuring appropriate
reimbursement times for those critical products. Improvements to the
MSPV program are just one aspect of ensuring veterans have access to
these life-saving and life-enhancing technologies. It is just as
important to consider similar improvements to the implant procurement
program, which includes permanently implantable products not available
through the MSPV program, like joint replacement technologies, stents,
etc.
We welcome today's hearing as another opportunity to understand on
how the VA, Congress, and industry can take a solutions-oriented
approach to these issues and work together on the most effective
resolution. We support efforts to ensure the VA, Congress, and industry
to work together to review and seek ways to better implement processes
and to ensure that all procurement policies evaluate technologies based
on the value to patients. Ultimately, the most important measure of the
success of the VA's new procurement policies is whether the veterans
that they serve are getting access to the best medical care in a cost-
effective manner.
Again, we are grateful for the Committee's leadership on this issue
and especially appreciate the work of Chairman Isakson, Ranking Member
Tester, and their staff.
______
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Prepared Statement of Amy Webb, National Legislative Policy Advisor,
AMVETS
Executive Summary
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
H.R. 299--Blue Water Navy Vietnam Veterans Act of 2018 Support
----------------------------------------------------------------------------------------------------------------
S.514--No Hero Left Untreated Act Support
----------------------------------------------------------------------------------------------------------------
S.1596--BRAVE Act of 2017 Support
----------------------------------------------------------------------------------------------------------------
S.1952--VA Financial Accountability Act of 2017 Support
----------------------------------------------------------------------------------------------------------------
S.1990--Dependency and Indemnity Compensation Improvement Act of 2017 Support
----------------------------------------------------------------------------------------------------------------
S.2485--Medal of Honor Surviving Spouses Recognition Act of 2018 Support
----------------------------------------------------------------------------------------------------------------
S.2748--BATTLE for Servicemembers Act Support
----------------------------------------------------------------------------------------------------------------
S.2881--Mare Island Naval Cemetery Transfer Act Support
----------------------------------------------------------------------------------------------------------------
H.R. 5418--Veterans Affairs Medical-Surgical Purchasing Stabilization Act Support
----------------------------------------------------------------------------------------------------------------
DISCUSSION DRAFT on Transition Assistances Reform Support
----------------------------------------------------------------------------------------------------------------
DRAFT Veterans Dental Care Eligibility Expansion and Enhancement Act of 2018 Support
----------------------------------------------------------------------------------------------------------------
DRAFT VA Hiring Enhancement Act Support
----------------------------------------------------------------------------------------------------------------
DRAFT bill to require the Secretary of Veterans Affairs to establish a program to award grants to Support
person to provide and coordinate the provision of suicide prevention services for veterans
transitioning from service in the Armed Forces who are at risk of suicide and for their families
and other purposes
----------------------------------------------------------------------------------------------------------------
DRAFT Modernization of Medical Records Access for Veterans Act Oppose
----------------------------------------------------------------------------------------------------------------
Chairman Isakson, Ranking Member Tester, and all Members of the
Committee; Thank you for the opportunity to provide a statement for the
record on behalf of AMVETS' 250,000 members. We are particularly
thankful for your efforts to address some of the most challenging and
longstanding veteran policy issues and appreciate the dedication of
your staff members who listen to us and work tirelessly to formulate
policies intended to ensure our Nation's veterans and their families
are properly cared for.
h.r. 299--blue water navy vietnam veterans act of 2018
AMVETS supports H.R. 299
This bill proposes to slightly raise Department of Veterans Affairs
(VA) home loan fees to fund Agent Orange benefits for the estimated
90,000 Blue Water Veterans who served during the Vietnam War. AMVETS
supports this as the fees are minimally raised, and there hasn't been
an increase in some time. Blue Water Veterans have advocated staunchly
for this measure, and it is time that they are finally made whole after
suffering the toxic wounds they incurred during their service to this
Nation.
AMVETS is also pleased that this bill allows for a presumption of
herbicide exposure to certain veterans who served in or near the Korean
Demilitarized Zone any time from September 1, 1967 to August 31, 1971
who have conditions covered under section 1116 of title 38.
Additionally, this measure recognizes the children of veterans who
served in Thailand between January 9, 1962 and May 7, 1975 who were
born with spina bifida. Those now adult children will be provided
benefits including health care, vocational training and rehabilitation
and a monetary allowance matching the same benefits provided to
children of Vietnam Veterans who were born with spina bifida.
AMVETS looks forward to the reporting requirement in this measure
requiring the Secretary of Veterans Affairs to provide an update report
on the most recent findings of the Follow-up Study of a National Cohort
of Gulf War and Gulf Era Veterans to the House and Senate Committees on
Veterans Affairs.
While slightly increasing VA home loan fees as a source of revenue,
we are pleased that Purple Heart recipients and those veterans with a
service-connected disability rated as permanent and total will have
said fees waived.
s. 514--no hero left untreated act
AMVETS supports S. 514
AMVETS is pleased to support the No Hero Left Untreated Act, which
seeks to establish a pilot program for two Department of Veterans
Affairs (VA) medical centers to treat fifty veterans using magnetic
EEG/EKG-guided resonance therapy.
Magnetic EEG/EKG-guided resonance therapy has successfully treated
more than 400 veterans with Post Traumatic Stress Disorder, Traumatic
Brain Injury, military sexual trauma, chronic pain, and opiate
addiction. This small pilot would be instructive to VA in understanding
the benefits and deciding whether to offer this promising therapy to
those receiving VA health care.
AMVETS is encouraged by the initial results of those treated with
magnetic EEG/EKG-guided resonance therapy and supports the pilot which
would allow VA to see the results first-hand, with the eventual goal of
supporting this alternative therapy. If it were fully understood how to
treat these nuanced disorders and health issues, VA would already be
doing so--and suffice it to say--the veteran suicide rate would most
assuredly be lower than it is now. It is imperative that we study new
ways to help those who have stood up and walked the walk and suffer the
consequences day after day.
s. 1596--burial rights for america's veterans efforts (brave) act of
2017
AMVETS supports S. 1596
AMVETS has a National Resolution, voted on by our membership, which
advocates for the Department of Veterans Affairs to increase burial
benefits. This measure seeks modest increases with built-in future
increases related to the Consumer Price Index for funeral expenses for
veterans receiving, or eligible to receive compensation who have no
next of kin or other person claiming the body of the deceased veteran,
and when there are not available sufficient resources to cover burial
and funeral expenses. It also increases funeral expenses for those
veterans who died as a result of a service-connected disability, which
we wholly support.
s. 1952--department of veterans affairs financial accountability act of
2017
AMVETS supports S. 1952
This bill cuts to the heart of what seems to have become regular
emergency appropriations requests from the Department of Veterans
Affairs (VA) to Congress. Often, this includes an appeal that if
Congress fails to act then veterans will suffer. The processes put in
place with the passage of this bill would indeed create VA financial
accountability, and a system of checks and balances that can prevent
needless emergency appropriation requests. The end result of
implementation would be a more fiscally sound Department, that would
have knowledge of every avenue of spending, how to forecast needed
funds in advance, and how to stop ``living paycheck to paycheck'' where
one emergency, or the inability to forecast necessary funding, cleans
out the account. Our veterans and taxpayers deserve better, and we
applaud the bipartisan leadership that introduced this bill.
s. 1990--dependency and indemnity compensation improvement act of 2017
AMVETS supports S. 1990
AMVETS supports the long overdue increase in dependency and
indemnity payments made to survivors of eligible servicemembers or
veterans, and the modifications in the measure which eliminates the 10-
year rule for veterans rated at 100 percent disability and creates a
five-year rule where eligible survivors can receive a payment prorated
relative to a percentage of the full 10-year amount of compensation.
s. 2485--medal of honor surviving spouses recognition act of 2018
AMVETS supports S. 2485
AMVETS supports honoring Medal of Honor survivors with this modest
increase to their special pension.
s. 2748--better access to technical training, learning and
entrepreneurship (battle) for servicemembers act
AMVETS supports S. 2748
This measure takes a common-sense approach by allowing groups or
classifications of those under the purview of the Secretaries of
Defense or Homeland Security to obtain a waiver to opt out of
additional training. This would be permitted after consultation with
the Secretaries of Labor and Veterans Affairs who would need to agree
that the members in question would not benefit from additional training
and present a strong reason to believe that they are unlikely to face
major readjustment, health care, employment and other transition
challenges that some face. The member may also elect not to receive
additional training by requesting so in writing, or because they are
needed to support the imminent deployment of a unit. AMVETS believes
this could be a cost and time-saving policy, while recognizing that
many do benefit from such training.
s. 2881--mare island naval cemetery transfer act
AMVETS supports S. 2881
S. 2881 directs the Secretary of Veterans Affairs to seek out an
agreement with the city of Vallejo in California, under which the city
would transfer control of the Mare Island Naval Cemetery to the
Department of Veterans Affairs (VA) National Cemetery Administration.
The VA would pay nothing to acquire the land, and would assume the
obligation of maintaining the cemetery in the future.
The cemetery, which dates back 160 years as part of the oldest West
Coast military base, is the final resting place of 800 veterans,
including three Medal of Honor recipients. The Federal Government
closed the Mare Island Naval Base in 1996 without allotting funds for
the care and maintenance of the cemetery. After more than twenty years
of neglect, the state of disrepair at the Mare Island Naval Cemetery is
a national embarrassment, and a disgrace.
Congress must move swiftly to enact this measure to repair and
maintain the Mare Island Naval Cemetery.
h.r. 5418--veterans affairs medical-surgical purchasing stabilization
act
AMVETS supports H.R. 5418
This measure adds a needed level of accountability to the
Department of Veterans Affairs (VA) Medical Surgical Prime Vendor-Next
Generation (MSPV-NG) program. One vendor should not be permitted to be
the sole, uncontested provider of medical surgical supplies in a
certain region, and this would require that multiple contracts be
awarded while prohibiting a prime vendor from solely designing the
formulary of supplies.
It also ensures that VA employees in charge of formulary analyses
or who makes decisions regarding to including items on the formulary
have relevant medical expertise. GAO issued a report at the end of 2017
outlining the improvements needed in purchasing medical and surgical
supplies and noted how implementing the improvements could yield cost
savings and efficiency. AMVETS agrees with the GAO recommendations and
believes passage of this bill can assist in implementing needed change.
discussion draft on transition assistances reform
AMVETS supports this Discussion Draft
AMVETS supports this Discussion Draft which consolidates sections
1142 and 1144 of Chapter 58 of title 10 into one cohesive section, with
large expansions geared toward improving the Transition Assistance
Program for members of the Armed Forces.
Some highlights from the draft include that it allows the
natiSecretary of Defense to not require attendance in more than one
class or counseling session per year, yet strengthens the
accountability of reporting attendance for covered counseling,
information, and services and rates of attendance in-person, online,
and the number of waivers granted when the mission prevented attendance
by a member of the Armed Forces. This is information will be part of a
new reporting requirement to Congress.
The discussion draft also would require surveys of those in the
Armed Forces to assess their experiences with the TAP counseling,
information and services provided to include quality of instruction and
courses and their opinion on if their transition needs were adequately
met. The survey will also seek to identify barriers or obstacles of
members in accessing the services or counseling. There will be a second
survey undertaken after transition has fully taken place which will ask
about their employment history since separation or retirement, if they
have been in receipt of unemployment benefits, if they pursued further
education, have joined a Veterans Service Organization or other
veterans support group, and will seek details on the satisfaction of
their separation, and any challenges they may have faced. If married
during separation some of the survey questions would include the spouse
experiences. The survey will also request recommendations for
improvement in the counseling and assistance provided in connection
with transition.
AMVETS is excited about the provisions which focus on career
readiness and professional development to include resume assistance,
interview and job recruitment training, behavioral, educational and
financial services, legal and benefits assistance, and non-clinical
case management.
We are also pleased that the measure would establish a governing
board to support prevention of drug overdoses, suicides, alcohol-
related deaths and homelessness among veterans through strategic
partnerships with a vast array of established Federal and community
entities. The board would also track substance abuse and suicide rates
in addition to its outreach and support. Economic risk factors which
may affect suicide prevention efforts will also be reported on.
AMVETS believes this is a strong discussion draft, and that if the
new measures are added to enhance the current Transition Assistance
Program are implemented correctly, that it will go a long way toward
not only encouraging post-transition employment but will address risk
factors that can lead to feelings of desperation and sometimes suicide.
We applaud the work of the Senators Crapo, Tester, Cassidy and Sullivan
on this in-depth, well thought out reform plan.
draft veterans dental care eligibility expansion and enhancement
act of 2018
AMVETS supports this Draft measure
AMVETS supports Section 2 of this measure and amending Section
1710(c) of title 38 to ensure that eligible veterans may be provided
dental services and treatment and dental applications needed to restore
functioning that was lost due to the hospital care, medical services or
nursing home care the veteran received under Section 1710.
Section 3 would initiate a three-year pilot program that would
provide dental services and treatments to veterans currently enrolled
as a patient in the Department of Veterans Affairs (VA) who are not
eligible for dental services, treatment and related appliances. The
services provided would be consistent with those currently provided to
veterans who are 100% service-connected, and applicable co-pays would
be collected commensurate to current copays authorized for medical care
under chapter 17 of title 38.
The pilot would take place in at least 16 locations and serve up to
100,000 veterans and there would be a reporting requirement to include
assessments and cost analysis of the pilot.
Sections 4 and 5 would allow the VA to lease a dental clinic in
states where VA does not have a facility that offers onsite dental
services along with an appropriation of $10,000,000 to carry this out;
and would develop a dental health education program for enrolled
veterans.
Section 6 expands the dental insurance pilot established by section
17.169 of title 38 to allow private sector dental care providers
information to VA on dental care furnished to veterans within the pilot
and extend the pilot for two years.
Section 7 would establish a VA demonstration program to establish
programs to train and employ alternative dental health care providers
to increase access to dental care for veterans who are eligible to
receive dental services from VA.
The full amount of appropriations for this Act, if implemented is
$500,000,000, over a five-year period not including section 4.
AMVETS understands that dental care is vital to the overall health
of an individual, and a common complaint we hear from our members is
their inability to either access affordable dentistry or that a dental
procedure was delayed to the point that something small turned into an
incredibly expensive procedure. Sometimes due to delays they have to
have teeth pulled. AMVETS supports the proposed pilot and the positive
health outcomes it can provide veterans.
draft va hiring enhancement act
AMVETS supports this Draft measure
AMVETS supports the intention of this draft, which seeks to allow
the Department of Veterans Affairs the ability to waive non-compete
covenants made with a non-VA facility when aiming to hire a VA
physician. This step can assist in widening the pool of those eligible
to apply to become a physician at the VA, and lead to filling vacancies
in a more effective manner.
draft bill to require the secretary of veterans affairs to establish a
program to award grants to person to provide and coordinate the
provision of suicide prevention services for veterans transitioning
from service in the armed forces who are at risk of suicide and for
their families and other purposes
AMVETS supports this Draft measure
AMVETS strongly supports this draft, and is pleased that it seeks
to reach our most vulnerable transitioning veterans at the highest risk
of suicide by not only working with people who are trained in
understanding when someone is at high risk, but who have developed
strategies to meet them where they are an assist in multiple levels
including mental health, peer support, financial planning, temporary
transportation if needed, and child care.
We think the establishment of a VA Program that offers grants to
persons/groups to coordinate suicide prevention services to veterans
who would be eligible for 3 years after separating. It gives priority
to veterans who are currently not being seen within VHA, but the
veteran must be notified that the Department is funding the care. It
also prioritizes rural areas, those areas that have experienced a high
rate of veteran suicide, and places where no health care is furnished
by VA.
draft modernization of medical records access for veterans act
AMVETS opposes this Draft measure
We owe it to our veterans to protect them and sensitive information
regarding their health care. HIPPA laws exist for a reason and we are
concerned that, encrypted or not, a portable credit card device could
easily be lost, or tampered with, or could put sensitive information in
the wrong hands. We also owe it to our veterans, as more and more are
being seen in the private sector, to have the Department of Veterans
Affairs devise a secure information sharing framework where a patient's
information can be shared with private sector medical providers with
the approval of the patient. This bill relieves VA of that
responsibility and at what cost? At some point, we have faith that
CERNER will have developed just this capability, but in the meantime
this type of measure can easily go down a dangerous road, especially
with no authorization of appropriations. We have seen all too much
recently, the proposals to cut one form of veterans' benefits in order
to fund another. In this situation we have faith that record sharing
can be made amenable for the veterans of all populations, some of whom
are homeless, and that the burden will not be placed on them to protect
their own information, but that the system designed to care for them
will figure out a way to do just that. The private sector has figured
it out and there is no reason to complicate this.
Thank you for the opportunity to provide a statement for the record
for this legislative hearing.
Please do not hesitate to reach out to AMVETS with any follow up
questions or concerns.
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Joint Written Testimony of Hon. Tim S. McClain, Chairman, Board of
Directors and Mr. James Lorraine, President & CEO, America's Warrior
Partnership, Augusta, GA
Testimony in Support of:
``Discussion Draft on Transition Assistance reform''
S.___(Cassidy), An Act to establish a program to award grants
to coordinate the provision of suicide prevention
S. 1990 (Tester/Blumenthal/Hirono), Dependency and Indemnity
Compensation Improvement Action of 2017
S. 2485 (Sullivan), Medal of Honor Surviving Spouses
Recognition Act of 2018
Chairman Isakson, Ranking Member Tester, and Members of the
Committee: Thank you for the opportunity to provide testimony today on
several pieces of proposed legislation that offer the potential to have
tremendous impact on our Nation's veterans. I am Tim McClain and have
had the honor of serving our country on active duty for more than 20
years as a Navy Surface Warfare Officer and JAG Corps Officer, and the
privilege of serving as a former General Counsel for the U.S.
Department of Veterans Affairs (VA).
I am currently the Chairman of the Board of Directors of America's
Warrior Partnership, a nonprofit organization serving veterans and
their families. Our mission at America's Warrior Partnership is to
empower communities to empower veterans. Our approach to the mission
takes many forms, but it starts with connecting community organizations
with local veterans to understand their unique needs and situations.
After gaining this knowledge, we connect local veteran-serving
organizations with the appropriate resources, services and partners
that the veteran requires. Our ultimate goal is to create a better
quality of life for all veterans.
Our Community Integration model provides the framework for
organizations to conduct proactive outreach to veterans and
holistically serve all of their needs. We have seen incredible results
from this model, which has established relationships with more than
42,000 veterans since February 2014 in our eight Affiliate Communities
across the country. Proactive outreach is having a tremendous impact on
these veterans. More than 90% of our veterans self-report that
America's Warrior Partnership's proactive engagement and support give
them a greater level of overall satisfaction, and they believe their
community really cares about their well-being. America's Warrior
Partnership's Community Integration model works.
Providing testimony with me today is the president and CEO of
America's Warrior Partnership, Mr. Jim Lorraine, who is also a veteran
of our great country having served for 22 years as an Air Force Officer
and Flight Nurse. Prior to founding America's Warrior Partnership, Mr.
Lorraine served as the founding director of the United States Special
Operations Command Care Coalition, a wounded warrior advocacy
organization recognized as the gold standard in supporting more than
4,000 special operations force wounded, ill, or injured and their
families. He has also served as Special Assistant for Warrior and
Family Support to the Chairman, Joint Chiefs of Staff, during which
time he transformed the Chairman's ``Sea of Goodwill'' concept into a
strategy. Mr. Lorraine will provide America's Warrior Partnership's
testimony regarding four pieces of proposed legislation.
Mr. Lorraine. Thank you, Mr. McClain. In my testimony today, I will
first address the draft of the proposed legislation on Transition
Assistance Program reform.
We believe this reform establishes a very important goal for
improving services to our Nation's warriors and that, in theory, it
could have a very positive impact on veterans and the community. We
fully support and embrace a holistic approach to serving veterans'
needs, as evidenced by our mission and work at America's Warrior
Partnership. We have seen first-hand the positive effects that
proactive outreach has on veterans, and we are pleased that this reform
both acknowledges this fact and empowers organizations to conduct this
outreach. Specifically, including communities in the Transition
Assistance Program reform through the proposed grant program will be
revolutionary in the ability to locally transition veterans and measure
long-term outcomes. The draft legislation is the first comprehensive
legislative approach to assisting military members in their transition
to civilian life. All of the requirements in the draft are sorely
needed. However, we would like to state how important collaboration
among the Department of Defense (DOD), Department of Labor (DoL) and
the VA is to the success of this reform. Each department brings their
strength to transition, but we strongly feel DoL is in the best
position to administer the community interface since the path to
success is employment. With greater DoL emphasis during pre-transition
training, the end result will prove measurable and impactful.
Additionally, the notion of these departments working together to
implement the Transition Assistance Program has been the mission for
many years, but it has not proven as effective as intended. Strong
engagement and support from the DOD, DoL and the VA collectively is
essential to achieving the goal of real and lasting reform in warrior
transition. I want to reiterate that we at America's Warrior
Partnership fully support the goal of this reform, and respectfully
offer our constructive input based on experience in order to make this
reform even stronger by stressing the importance of collaboration, a
principle that also forms the foundation of our own organization's
work.
The second piece of legislation I would like to comment on concerns
the establishment of a grant program to support suicide prevention
services. The VA reported earlier this year that, on average, 20
veterans die by suicide every day. This is an alarming public health
concern that affects every community in the country, and this
legislation is a step in the right direction of ensuring veteran-
serving professionals have the means to proactively help at-risk
veterans. The financial support offered by this program will bolster
the work of researchers who are currently studying the indicators and
risk factors of suicide and self-harm among veterans. Our team at
America's Warrior Partnership is collaborating on one such study with
University of Alabama researchers through funding from the Bristol-
Myers Squibb Foundation. This project, called Operation Deep Dive, is
the first of its kind to evaluate the role that community environments
and less-than-honorable discharges may have in suicide among veterans,
among other factors. The goal of the study is to provide actionable
insights that can guide the development of effective programs for
reducing self-harm among veterans. The findings provided by projects
such as Operation Deep Dive, combined with the support of this grant
program, are critical elements that will empower communities to help
veterans live and thrive long after their service is complete.
My third testimony addresses Senate Bill 1990, which would increase
dependency and indemnity compensation to surviving family members of
veterans who were rated totally disabled at time of death. Military
families serve in their own way by supporting their loved ones both
during active duty and in their transition to civilian life. The
service and sacrifice of our veterans may at times result in a
disability that puts significant strain on the veteran and their family
members who care for them. Our team at America's Warrior Partnership
and the affiliate communities that we collaborate with understand these
sacrifices, which is why our holistic approach to serving veterans is
always inclusive of their families as well. This bill has the potential
to offer a lifeline to the families of disabled veterans who need it
most.
Finally, I would like to comment on Senate Bill 2485, which would
provide payment of a special pension to the surviving spouse of a
deceased Medal of Honor recipient. Our Nation's Medal of Honor
recipients go above and beyond the call of duty, and we as a nation owe
them nothing less in return. America's Warrior Partnership is honored
to have two Medal of Honor recipients serve on our board of directors.
Their integrity and example continue to guide our mission of empowering
communities to empower veterans, and the support provided by this
legislation can help the families of Medal of Honor recipients continue
their legacy long after their service is complete.
I appreciate the opportunity to comment on these critical areas and
will now let Mr. McClain conclude our testimony.
Mr. McClain. Thank you, Mr. Lorraine.
Chairman Isakson, thank you for inviting us to provide testimony
today. We are both honored and pleased to have this opportunity. Our
mission is the same as the mission of this Committee: to ensure that
all veterans are taken care of and provided the benefits that they have
rightfully earned through their service to our country. There is much
work to be done, and we look forward to continue collaborating with the
Department of Veterans Affairs and our partners across the country to
empower veterans from all walks of life as they transition to civilian
life.
Thank you again for the invitation to share our testimony today.
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Prepared Statement Submitted by Cinthia Johnson, Interim Executive
Director, Connecticut Veterans Legal Center
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Prepared Statement of Jeremy M. Villanueva, Associate National
Legislative Director, Disabled American Veterans
Mr. Chairman and Members of the Committee: Thank you for inviting
DAV (Disabled American Veterans) to submit testimony for the record of
this legislative hearing of the Senate Veterans' Affairs Committee. As
you know, DAV is a non-profit veterans service organization comprised
of more than one million wartime service-disabled veterans that is
dedicated to a single purpose: empowering veterans to lead high-quality
lives with respect and dignity. DAV is pleased to offer our views on
the bills under consideration by the Committee.
h.r. 299, blue water navy vietnam veterans act of 2018
H.R. 299 was passed by the House of Representatives with a vote of
382 to 0 on June 25, 2018.
Section 2 (Clarification of Presumptions of Exposure for Veterans
Who Served in Vicinity of Republic of Vietnam) would provide
presumption of service connection for herbicide exposure for Vietnam
era veterans with service in the waters offshore. The bill defines a
location as being offshore of Vietnam if the location is not more than
12 nautical miles seaward of a line commencing on the southwestern
demarcation line of the waters of Vietnam and Cambodia and intersecting
specific points as noted.
The Agent Orange Act of 1991 required the Department of Veterans
Affairs (VA) to provide presumptive service connection to Vietnam
veterans with illnesses that the National Academy of Sciences directly
linked to Agent Orange exposure. Yet, in 2002, the VA decided to cover
only veterans who could prove that they had ``boots on the ground''
during the Vietnam War. Because of this decision, thousands of Vietnam
veterans were excluded from receiving benefits although these ``Blue
Water'' Navy veterans had significant Agent Orange exposure from
drinking and bathing in contaminated water just offshore. It is simply
inequitable that veterans who served on ships no more distant from the
spraying of herbicides than many who served on land have been
arbitrarily and unjustly denied benefits because they are excluded from
the presumption of service connection for herbicide-related
disabilities.
DAV strongly supports Section 2 (Clarification of Presumptions of
Exposure for Veterans Who Served in Vicinity of Republic of Vietnam)
based on DAV Resolution No. 033, which calls for legislation to
expressly provide that the phrase ``served in the Republic of Vietnam''
include service in the territorial waters offshore.
Enactment of this legislation would provide ``Blue Water'' Navy
Vietnam veterans the disability and health care benefits they earned as
a result of exposure to Agent Orange. Eligibility for VA benefits under
this legislation would be retroactive to September 25, 1985, the date
VA began providing disability compensation to veterans with medical
disorders related to Agent Orange providing long overdue justice to
thousands of veterans who were excluded by the VA in 2002.
Section 3 (Presumption of Herbicide Exposure for Certain Veterans
who served in Korea) would recognize September 1, 1967 as the earliest
date for exposure to herbicides on the Korean demilitarized zone (DMZ).
Currently, VA regulations provide that any veteran who, during
active military, naval, or air service, served between April 1, 1968,
and August 31, 1971, in a unit that, as determined by the Department of
Defense, operated in or near the Korean DMZ in an area in which
herbicides are known to have been applied during that period, shall be
presumed to have been exposed during such service to an herbicide
agent. Section 2 would define the exposure to herbicides as a veteran
who, during active military, naval, or air service, served in or near
the Korean DMZ, during the period beginning on September 1, 1967, and
ending on August 31, 1971.
In accordance with DAV Resolution No. 090, we also support Section
3, to recognize September 1, 1967, as the earliest date for exposure to
herbicides on the Korean DMZ. This change will provide veterans exposed
to herbicides on the Korean DMZ with greater equity with respect to
herbicide exposure and the presumptive diseases associated therein.
Section 4 (Benefits for Children of Certain Thailand Service
Veterans born with spina bifida) would provide children of veterans
exposed to herbicides in Thailand, who are suffering from spina bifida,
the health care, vocational training and rehabilitation, and monetary
allowance required to be paid to the children of Vietnam veterans who
are suffering from spina bifida.
VA provides spina bifida-related benefits for the children of
Vietnam veterans exposed to herbicides in Vietnam and on the DMZ in
Korea. This bill would provide the same entitlements to the children of
Vietnam era veterans exposed to herbicides while serving in Thailand.
In accordance with DAV Resolution No. 090, we support Section 4, as it
provides relief and equity to veterans' children suffering from the
devastating effects of spina bifida.
Section 5 (Updated Report on certain Gulf War Illness study) would
require the VA to submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate an updated report on the
findings, as of the date of the updated report, of the Follow-up Study
of a National Cohort of Gulf War and Gulf Era Veterans under the
epidemiology program of the VA.
The VA has recognized certain illnesses associated with Gulf War
service in the Southwest Asia theater of military operations from
August 2, 1990 to the present. These medically unexplained illnesses
are long-term health problems with significant impairments.
DAV has significant concern regarding the multitude of ailments
reported by a growing number of Persian Gulf War veterans who were
exposed to both identified and unknown health hazards. In accordance
with DAV Resolution No. 261, we support Section 5, the requirement for
the updated report of the Follow-up Study of a National Cohort of Gulf
War and Gulf Era Veterans under the epidemiology program of the VA.
Section 6 (Loans Guaranteed Under Home Loan Programs of Department
of Veterans Affairs) would make several changes to the VA Home Loan
Guaranty program. First, it would remove the current limit on maximum
loan guaranties to align it with other Federal home loan programs that
allow nonconforming, or ``jumbo'' loans. Second, it would increase the
fees charged to veterans using the program by approximately .25 percent
for nine years, thereafter reverting to the fee schedule as it
currently exists. It is important to note that veterans with a service-
connected disability are currently exempt from paying any home loan
guaranty fees. Third, it would require that veterans with less than a
total disability rating be required to pay fees for loan guaranties if
they require a jumbo loan guaranty above the conforming limits. These
fees would apply to the entire loan guaranty, not just the portion
above the limit.
DAV Resolution No. 002, adopted at our most recent National
Convention this July in Reno, Nevada, `` . . . vigorously opposes any
recommendations made for the purpose of reducing, adding limitations on
or eliminating benefits for service-connected disabled veterans and
their families.'' By imposing fees for the first time on VA home loan
guaranties for service-disabled veterans, this Section would
effectively reduce the value of benefits that have already been paid
for through their service and sacrifice. DAV opposes Section 6 of the
bill.
DAV does not have a resolution specific to Section 7 (Information
Gathering for Department of Veterans Affairs Home Loan Appraisals) and
takes no position on this section.
h.r. 5418, veterans affairs medical-surgical purchasing stabilization
act
This measure would require the VA to use multiple vendors in
procuring medical supplies and ensure that the employees responsible
for selecting the supplies have medical expertise regarding those
items. VA currently uses four vendors to purchase its medical supplies
and employs clinicians on its integrated product teams to select those
supplies. VA would also be required to submit quarterly reports to the
Congress identifying the individual employees at VA who determine which
items to purchase for VA's formulary and describing their medical
expertise.
We urge the Committee ensure this bill requires VA support
businesses controlled by service-disabled veterans in its medical
surgical prime vendor program. DAV Resolution No. 306 calls for
legislation requiring the Federal Government make mandatory set-asides
of not less than 3 percent of the total value of all prime and
subcontract awards to businesses controlled by service-disabled
veterans each fiscal year. Additionally, it calls for effective
monitoring and accountability for Federal agencies that are not meeting
the set-aside goal of not less than three percent, and a mandate to
list in their annual reports their prior fiscal year's actual
percentage of meeting this goal, the results of which would serve as an
annual report card of which agencies need the most assistance in the
development and implementation of stronger contracting compliance.
In addition, DAV Resolution No. 277 calls for the provision of all
supplies, prosthetic devices and medications, including over-the-
counter medication, necessary for the proper treatment of service-
connected disabled veterans. This recognizes VA's more recent efforts
to aggressively standardize durable/disposable equipment, including
prosthetics and similar items, to realize greater savings by buying
fewer distinct items in greater quantity from fewer suppliers while
minimizing the volume of government purchase card usage to the
detriment to the veteran patient. We support the provision in this
measure that would require clinically driven sourcing to ensure
adequate input from frontline clinical providers with the expertise on
the specific items within the formulary to ensure veterans receive the
prosthetics and similar items that promote, preserve, and restore the
veteran's whole health and not merely for medical necessity.
s. 514, no hero left untreated act
S. 514 would require the VA secretary to carry out a pilot program
to provide veterans access to magnetic EEG/EKG-guided resonance therapy
(also known as transcranial magnetic stimulation or TMS). The year-long
pilot program would take place at not more than two VA facilities for
not more than 50 veterans. VA would be required to submit a report
about the pilot 90 days after the termination of the pilot.
In 2008, the Food and Drug Administration (FDA) approved TMS for
drug resistant major depression. Other applications of TMS to such
conditions as to Post Traumatic Stress Disorder (PTSD), Traumatic Brain
Injury, chronic pain, and opiate addiction (conditions targeted by this
bill) are considered ``off-label'' meaning that doctors may employ
them, but the therapy has not been approved for these purposes.
Emerging research has shown that TMS does reduce symptoms of PTSD
and helps with some other issues such as autism and Alzheimer's
although many questions remain about the duration of symptom relief,
how to most appropriately administer the treatment and whether TMS is
more effective for all conditions than more conventional treatments.
As we understand it, VA does own a significant number of these
machines. Some are being used in studies, but some are beginning to
offer treatment for depression under the accepted FDA protocol.
DAV Resolution No. 277 calls for VA to provide access to
complementary and integrative medicine. Likewise, we have consistently
called on VA to develop innovative approaches to manage and treat
mental health conditions (Resolution No. 293).
While the empirical evidence for TMS applications continue to
emerge, DAV believes that veterans deserve access to the promising
results of treatment claimed by veterans who have used TMS and hopes
that additional studies using this technology will yield more
information in support of the treatment for other conditions. For these
reasons, DAV supports S. 514.
s. 1596, the burial rights for american veterans' efforts (brave) act
of 2017
S. 1596 would increase the burial allowance payable to the
veteran's beneficiary regardless of whether the death occurs in a VA
facility and provides for automatic annual adjustments to keep up with
future inflation.
The passage of Public Law 111-275, the Veterans Benefits Act of
2010, resulted in an increase in both plot and burial allowance from
$300 to $700 for nonservice-connected deaths in VA facilities. It is
indexed to the Consumer Price Index for annual adjustments and
currently pays $762. However, it did not address nonservice-connected
deaths that did not occur in VA facilities nor did it address service-
connected death burial payments currently at $2000.
The current $300 burial allowance for nonservice-connected deaths
not in VA facilities was last increased in April 1988 and the current
$2000 burial allowance for service-connected death was last increased
in December 2001.
In 1973, the burial allowance for veterans with no next of kin and
non-service-connected death was 22 percent of funeral and burial costs.
The current $300 burial allowance for nonservice-connected deaths not
in VA facilities in comparison to the average cost of a funeral is
about $9,000, decreasing the value of this allowance significantly to
approximately 3 percent.
Service-connected death burial allowance in December 2001 was
$2,000 and the average funeral cost at that time was $6,000. The
payment value was 33 percent of the cost. Today, the average funeral
cost has increased to $9,000, decreasing the value down to 22 percent
of the burial allowance benefit, a decrease of 11 percent.
We note that the median cost of funerals and burials is rising
higher than the Consumer Price Index for all urban consumers (CPI-U).
S. 1596 would tie the benefit to the CPI-U, providing some needed
adjustment; however, in the long-term, the benefit will erode if this
discrepancy continues.
Notwithstanding, DAV strongly supports S. 1596, in accordance with
DAV Resolution No. 054, adopted at our most recent national convention.
Our resolution calls on Congress to support legislation to increase the
burial allowance payable in the case of death due to service-connected
disability regardless of whether the death occurs in a VA facility and
provide for automatic annual adjustments indexed to the cost-of-living
increases.
s. 1952, va financial accountability act of 2017
This bill would require VA to contract with a third-party to review
and audit its financial processes and models for estimating veterans'
demand for services that inform its budget request. It would further
require the contractor to make recommendations about improving such
models within 180 days of being awarded the contract. VA would then be
required to submit a plan for implementing these recommendations within
60 days of completion of the review. VA would appoint an individual to
ensure that the third party recommendations are implemented along with
those pertinent recommendations of the Government Accountability
Office, the Special Counsel and VA's Inspector General. The Secretary
would have to justify, within 45 days, any requests for supplemental
appropriations. The bill would also require VA's Chief Financial
Officer (CFO) to certify that the budget request is sufficient to
provide benefits and services for veterans required by law, and that
the CFO has made consultations with budget officers throughout the
Department to estimate budgets.
DAV has a long history of supporting predictability and
transparency in VA's budget process under DAV Resolution No. 112. We
strongly advocated for the passage of Public Law 111-81 which required
advanced appropriations for VA's Medical Care account and has
subsequently protected veterans from delayed or denied care due to
government shutdowns. This same law required that GAO submit an
analysis of VA's actuarial models versus its actual obligations in
fiscal years 2011, 2012, and 2013. We note that in recent years VHA has
been compelled to deal with a series of major transitions in health
care delivery such as the Veterans Choice Program, and now the VA
MISSION Act of 2018 that have drastically changed how the Department
estimates demand for services. These changes likely account for much of
the lack of precision in recent budget requests and the subsequent need
for supplemental funding. Yet it is important to ensure transparency in
these efforts, which is why DAV opposed the proposal to consolidate
Medical Services and Medical Community Care accounts.
We believe as VA continues to evolve its practices such as
recording community care obligations at the date of payment rather than
at the date of authorization and gains experience with its new
contracting authorities, its estimations will likely become more
accurate. Nonetheless, DAV understands the importance of accurate
budget models and processes and therefore are pleased to support
S. 1952.
s. 1990, dependency and indemnity compensation improvement act of 2017
S. 1990 would increase dependency and indemnity compensation (DIC)
for surviving dependents and would lower the threshold of eligibility
to allow certain survivors to receive this benefit who currently do not
meet the requirements.
Under title 38, United States Code, Sec. 1318(b)(1), a survivor, is
eligible for DIC if the veteran was 100 percent permanently and totally
disabled for ten years prior to death. S. 1990 would ease the 10-year
rule for eligibility and replace it with a graduated scale of benefits
that begins after five years. If a veteran is rated as totally disabled
for five years and dies as a result of a non-service-connected cause, a
survivor would be entitled to 50 percent of total DIC benefits. This
concept of the percentage of benefits payable based the number of years
is applicable for payments at 60, 70, 80, 90, and then 100 percent of
the DIC amount.
This bill would increase the DIC base rate as equal to 55 percent
of the rate of compensation paid to a totally disabled veteran, making
it more equitable with rates provided to Federal civilian employee
survivors, and it would reduce the age allowed for a surviving spouse
to remarry and maintain their benefits from 57 to 55, consistent with
other Federal survivor benefit programs.
DAV's Resolution No. 036, which was approved by our members during
our most recent National Convention, supports legislation to reduce the
10-year rule for DIC qualification.
DAV strongly supports S. 1990. Not only would this bill reduce the
threshold of eligibility for certain survivors, it would also create
equitable relief in increasing the compensation rates paid, and reduce
the age allowed for the surviving spouse to remarry and retain their
benefits.
s. 2485, medal of honor surviving spouses recognition act of 2018
S. 2485 would increase the monthly special pension for Medal of
Honor recipients and extend eligibility to surviving spouses.
The bill would codify the increase in the monthly special payment
from $1,000 to $1,329.58 under title 38, United States Code, Sec. 1562.
The bill would allow the special pension to be paid to a surviving
spouse upon the veteran's death.
DAV does not have a resolution calling for an increase of the
monthly special pension for Medal of Honor recipients or expanding
eligibility to the pension benefit to the surviving spouse upon the
death of the veteran. While we have no formal position on S. 2485, we
have no objection to its favorable consideration by the Committee.
s. 2748, battle for servicemembers act
S. 2748 would encourage greater participation in the additional two
day training program that occurs after the three day required portion
of the Transition Assistance Program (TAP). Specifically, a
servicemember could choose a two day training session on either higher
education, technical training, or entrepreneurship. Instead of
continuing with an opt-in option, the bill would make the training opt-
out so that more transitioning servicemembers would utilize this
important training. According to a 2017 GAO report (GAO-18-23), only 14
percent of separating servicemembers completed at least one additional
two-day training program after completing the three day required
portion of TAP.
Mr. Chairman, DAV has no resolution on this particular issue, but
believes the intent of this legislation is in keeping with the goal of
ensuring that all servicemembers have the tools and information needed
to successfully transition into civilian life. We therefore have no
objection to this legislation's favorable consideration.
s. 2881, mare island naval cemetery transfer act
S. 2881 would direct the Secretary of Veterans Affairs to seek to
enter into an agreement with the city of Vallejo, California, to hand
over ownership and care of the Mare Island Naval Cemetery to the
National Cemetery Administration (NCA). Mare Island Naval Shipyard
(MINS) was the first United States Navy base established on the Pacific
Ocean in 1853. During its time of service, it served as the main
shipyard for naval operations in the Pacific and housed the United
States Marine Corps' Recruit Depot from 1911 to 1923. The shipyard was
identified for closure during the Base Realignment and Closure (BRAC)
process of 1993 and was decommissioned in 1996. Since that time the
city of Vallejo has owned the property.
The Mare Island Naval Cemetery was established in 1854 and
continued internments until 1921. Notable internments are the daughter
of Star Spangled Banner composer Francis Scott Key and three Medal of
Honor recipients. It currently is the final resting place for more than
800 individuals, most of them veterans. It was included in the National
Register of Historic Places in 1975.
After the closure in 1996, the cemetery fell into disrepair.
Multiple structural issues have been noted--tombstones are crumbling,
and most of the maintenance is done through volunteer efforts. The
estimated cost for repairing the cemetery and future upkeep is
currently at $15 million.
DAV does not have a resolution that addresses this issue and takes
no position on this bill; however, we understand that there are local
options that could be pursued to resolve this issue that would not
divert resources and funding from National Cemeteries that are still
accepting new internments.
s. 3184, to modify the requirements for applications for construction
of state home facilities to increase the maximum percentage of non-
veterans allowed to be treated at such facilities
State Veterans Homes are long term care facilities operated by
states in partnership with the Federal Government. States receive
matching grants from VA to construct, expand, rehabilitate and repair
State Veterans Homes, with VA providing up to 65 percent and states
providing at least 35 percent of the cost of the project. State
Veterans Homes are constructed and operated principally to care for
veterans, and current law requires that no more than 25 percent of
occupied beds can be filled by non-veterans, such as spouses or parents
as determined by individual states. State Veterans Homes offer three
levels of care: Nursing Home Care; Domiciliary Care; and Adult Day
Health Care (ADHC), with VA providing per diem payments to states for
the care of eligible veterans for each level of care. For nursing home
care, the State Veterans Home receives a basic per diem payment for
each eligible veteran, equal to approximately 30 percent of the total
daily cost of care, with states required to cover the balance through
other sources, including payments from veterans. Some veterans qualify
for a higher per diem rate due to their service-connected disabilities,
which is intended to cover the full cost of their care, and constitutes
payment in full to the State Veterans Home.
This bill would amend current law to allow spouses or parents of
veterans to occupy up to 40 percent of the total occupied beds in a
State Veteran Home if its occupancy rate is less than 90 percent. This
legislation is intended to allow additional spouses or parents to
occupy open beds, often joining their veteran spouse or child, when
there are no eligible veterans seeking admission to the State Veterans
Home.
DAV is a strong supporter of State Veterans Homes. This bill
intends to assist State Homes utilize available capacity, thereby
increasing cost-effectiveness and financial viability, while also
improving the quality of life for certain veterans and spouse by
keeping couples together. DAV has no resolution on this specific issue
and takes no formal position on the bill. Because we do not know how
this proposed policy will affect State Veterans Homes across the
country, we want to ensure service-connected veterans are not
disadvantaged or otherwise delayed or denied placement. Accordingly, we
recommend the Committee consider other reasonable options, such as
adding reporting requirements to the bill to assess how it affects
service-connected veterans' admission to State Veterans Homes, using a
waiver authority to the current occupancy rule, or a starting a pilot
program in select locations.
draft bill, va hiring enhancement act
This draft bill would render ``non-compete'' agreements between an
applicant for VA employment and a previous employer non-applicable with
regard to VA employment. Employees appointed with this understanding
would be required to serve out the length of their non-compete
agreement within their VA position or serve in that position for at
least one year (whichever is longer). The bill intends to allow VA, on
a contingent basis, to begin recruiting and hiring physicians up to two
years before they complete their residency, as well as physicians who
have completed their residencies leading to board certification. These
contingent appointed physicians must satisfy VA's requirements to
receive a permanent appointment.
We appreciate the goal of this legislation aimed at creating as
large an applicant pool for qualified medical professionals to treat
our service-disabled veterans as possible in VA. DAV Resolution No. 129
calls for effective recruitment, retention and development of the VA
health care workforce. Because this measure attempts to reduce barriers
for employment at VA for physicians; we are pleased to support the
bill's passage.
draft bill, veterans dental care eligibility expansion and
enhancement act of 2018
The ``Veterans Dental Care Eligibility Expansion and Enhancement
Act of 2018'' would require VA to offer restorative dental services to
those who lose functioning as a result of dental services or treatment
rendered by VA. It would also require the Secretary to develop a pilot
program to assess the feasibility and advisability of offering dental
care to all enrolled veterans.
The pilot program would begin 540 days after enactment and take
place in at least 16 medical centers including: four centers with
established dental clinics; four centers with a contract for dental
services; four community-based outpatient clinics with space available
to furnish care; and, four federally qualified health centers of which
at least one must be a facility the Indian Health Service with
established dental clinics. Not more than 100,000 veterans would
participate in the program on a voluntary basis. Services would include
those available to veterans with service-related disabilities rated by
VA at 100 percent. Veterans must contribute to the cost of their dental
care in a manner consistent with the copayments required of them for VA
medical care and services.
Site selection for the selected participating medical centers would
consider rural facilities; facilities distant from military
installations and would represent the various geographic locations (or
census tracts) identified by the Bureau of the Census. VA would
determine the appropriate performance standards and metrics for each
contract entered under the pilot, as well as specifying how compliance
is to be measured.
VA would be required to report 540 days after enactment and 3 years
after the date the program commences about the implementation and
operation of the pilot program in addition to the number of veterans
receiving services, an analysis of the costs and benefits associated
with the program as well as findings and conclusions.
The bill would also require the Secretary to construct or lease
dental clinics in states in which the Department does not have onsite
dental services and would appropriate $10 million in emergency funding
to support construction or lease of such facilities.
The legislation further specifies an educational program VA would
be required to operate. The program would promote dental health and
include information about common dental conditions, treatment options
and options for obtaining access to dental care including defining
eligibility for VA services, options available through State or local
governments or nonprofit agencies; purchasing private dental insurance
or obtaining free or low cost care through federally qualified health
centers or dental schools. It would also require VA to develop written
material with this information, including for blind or visually
impaired veterans.
The bill would further require VA to develop a mechanism for
private sector providers working with veterans under the dental
insurance pilot program (established under Sec. 17.169 of title 38,
Code of Federal Regulations) to share information in VA electronic
medical records. The bill would give the Secretary the discretion to
continue the pilot for an additional two years after the termination
date in order to assess the mechanism for sharing this information.
Individual veterans would be given the option of participating in this
part of the pilot.
The draft legislation contains a demonstration program to train and
employ alternative dental health care providers in rural and
underserved areas to increase veterans' access to dental care.
Finally, the bill would authorize an additional $500 million in
fiscal year 2020, to be available for five years, for the provisions of
this act excluding the construction or major lease funding.
DAV recognizes that oral health is integral to the general health
and well-being of a patient and is part of comprehensive health care.
According to a 2000 report by the Surgeon General of the United States,
Oral Health in America, individuals who are medically compromised or
who have disabilities are at greater risk for oral diseases, and, in
turn, oral diseases further jeopardize their health. Likewise, such
diseases are progressive, cumulative and become more complex over time,
and can affect economic productivity and compromise the ability of
someone to work, and often significantly diminish their quality of
life.
Irrespective of service-connected disability, section 1701(9),
title 38, United States Code, defines ``preventive health services'' as
a broad collection of VA health services that improve, protect and
sustain the general health and well-being of veterans enrolled in VA
health care, to include ``such other health care services as the
Secretary may determine to be necessary to provide effective and
economical preventive health care''
For these reasons, DAV supports a dental benefit for all enrolled
service-connected veterans in accordance with DAV Resolution No. 018.
draft bill, to require the secretary of veterans affairs to establish a
program to award grants to persons to provide and coordinate the
provision of suicide prevention services for veterans transitioning
from service in the armed forces who are at risk of suicide and for
their families
This draft bill would authorize grants to individuals for the
purpose of providing and coordinating suicide prevention services for
eligible veterans or a family member of a veteran who is within 3 years
of being discharged from military service and may be at risk of
suicide.
The grant applicant would be required to identify how they would
deliver suicide prevention services and any previous experience with
providing or coordinating such services with veterans and their family
members including outreach to at risk veterans, screening, education
about veterans at risk for families and communities, case management,
peer support, and assistance with obtaining benefits, temporary
assistance with transportation, personal financial planning, legal
services, and other services, such as family support and child care.
The Secretary would be required to give priority to applicants
serving areas of the country that have experienced a high burden of
veteran suicide, areas where no health care is furnished by the
Department or rural and tribal areas of the country.
DAV is extremely sensitive to the post-deployment mental health and
readjustment needs of veterans and the challenges they often face
during transition from military to civilian life. The intent of this
draft legislation and its apparent goal of utilizing individuals to
help prevent veteran suicides in locations where services are limited
or non-existent is notable.
While we appreciate the intent of the bill, DAV is concerned about
the quality of care that may be delivered by applicants and the
difficulty in providing oversight for such an award program and
individual grant recipients. DAV believes that the range and intensity
of mental health programs VA and VA's Readjustment Counseling Service
offers and delivers--from peer-to-peer support, outpatient, in-patient
and a compliment of specialized services for PTSD, substance use
disorder and homelessness provide the depth, breath and quality of care
necessary to meet the mental health care needs of veterans during their
initial transition period.
In addition, as VA grapples with establishing the new contract
program combining existing contracting policies and programs into one
under the VA MISSION Act of 2018, DAV has concerns about embracing a
new grant program that would require VA to fund and monitor the
provision of additional care in the private sector to individual
persons. We also believe that, under the auspices of the VA MISSION
Act, many of the goals of promoting access and availability to remote
vulnerable veterans can be achieved with knowledgeable vetted
providers. We, therefore, do not support this discussion draft bill.
draft bill, modernization of medical records access for veterans act
VA is in the process of a sea change in managing its medical
information. Last June, VA announced it would contract with Cerner to
create a new platform for managing electronic health records. The goal
of this contract is for VA to have information that is more
interoperable with the Department of Defense, academic affiliates, and
other community providers. This is a critical tool enabling providers
to transfer information within the VA and with its partners--done
correctly, it could assist in coordinating care, timely scheduling of
appointments, eliminating duplicative services, ensuring patient
safety, assessing organizational performance and easing administrative
burdens, including quality assurance and billing. It is a massive
undertaking that will likely take billions of dollars and staff and
contractor hours to implement.
This draft bill would require VA to develop a pilot program to
assess the use of a portable medical records storage system to store
patient information in order to share timely information between VA and
community providers. The pilot program would run in one VISN for at
least one year using a competitively awarded contract to develop a
portable device no bigger than a credit card to allow veterans to carry
at least 4 gigabytes of medical information between VA and non-VA
providers. While some of the goals of this pilot may be similar to
those being considered by Cerner, it is difficult to understand whether
this undertaking would add or detract from the larger effort underway.
Because the bill appears to approach personal storage of medical
information using external hard drives and limits the use of cloud
storage, we urge the Committee consider including provisions that
require tracking and mitigation when the security of the portable
device is compromised. DAV does not have a resolution on VA medical
records management and therefore takes no position on this draft bill.
transition assistance reform (discussion draft)
The discussion draft bill on Transition Assistance Reform would
provide changes to the Transition Assistance Program (TAP) and specific
requirements on the Departments of Defense (DOD) and Homeland Security
(DHS), to include training requirements, reports to Congress, creation
of a five year longitudinal study, inclusion of veteran service
organizations in TAP, and establishment of a governing board to support
suicide prevention and substance abuse prevention efforts.
Section 2 (Recodification, Consolidation, And Improvement of
Certain Transition-Related Counseling and Assistance Authorities) would
eliminate the existing title 10, United States Code, Sec. Sec. 1142 and
1144 and provide a new statue defining the Transition Assistance
Program. The proposed new statute would incorporate all of the current
language from both statutes and continue to address information on
civilian employment including labor market information, instruction on
resume preparation, job interview techniques and certification and
licensure requirements in civilian occupations that correspond to
military occupational specialties.
DAV Resolution No. 298 urges Congress to establish a clear process
for military training to meet civilian certification and licensure
requirements. It is vital to break down employment barriers for
transitioning servicemembers to successfully adapt to civilian life by
obtaining the required certification and licensure based on their
military occupational specialties.
The proposed statue would add very specific training requirements
for conducting TAP. Those requirements would include at least a full
day course on general professional development and employment
assistance and a full day on the benefits and services available under
the laws administered by the VA. TAP would also be required to include
at least two consecutive days of training on post-service pathways. The
servicemember would be able to choose from topics such as, employment,
higher education, entrepreneurship, and career and technical training.
Another major addition in the proposed new statute is a requirement
of reports and notices from the Secretaries of Defense and Homeland
Security to the Secretaries of Labor and Veterans Affairs, and the
heads of any other departments and agencies of the Federal Government
involved in the furnishing of counseling and other assistance under the
program. The Secretaries of Defense and Homeland Security would be
required to provide an annual report to Congress. The reporting would
require information regarding the timeliness of receipt of covered
counseling, information, and services, and rates of participation on an
in-person basis and an online or other electronic basis.
DOD has publicly reported 92 to 97 percent compliance rates with
mandated TAP elements. However, a 2017 GAO report (GAO-18-23) found
that actual TAP participation rates based on DOD internal monitoring
reports for eligible servicemembers are lower, particularly for Reserve
Component members (approximately 47 percent compliance). In the 2017
report, top reasons affecting TAP participation included instances
where members were separated on short notice, and mission- or duty-
related requirements that interfered with ability to attend the course.
DAV Resolution No. 304 calls for expansion of the required training
of TAP, standardization of all provided training, tracking of member
participation, and monitoring and oversight of TAP. As noted in the
above GAO report, there are inaccuracies in the current reporting
mechanisms of the DOD, therefore, we support the additional
requirements of training for TAP and the inclusion of reporting by the
Secretary of Defense and Secretary of Homeland Security to the
Secretary of Labor, the Secretary of Veterans Affairs, and the annual
report to Congress. Reporting and oversight will lead to closer
evaluations and determinations of the effectiveness of TAP for
transitioning servicemembers. DAV strongly supports the provisions in
Section 2 (Recodification, Consolidation, and Improvement of Certain
Transition-Related Counseling and Assistance Authorities) based on DAV
Resolutions No. 298 and 304.
Section 3 (Personnel Matters in Connection with Transition
Assistance Program) provides the minimum number of DOD personnel
dedicated to TAP, the designation of transition coordinators and an
annual report to Congress.
This provision notes the Secretary of Defense shall take
appropriate actions to ensure that the minimum number of full-time
personnel of the DOD dedicated to counseling and other activities under
TAP at each military installation is not less than one for every 250
members of the Armed Forces currently eligible for participation in the
TAP at such military installation. It further provides that the
requirement for full-time personnel cannot be satisfied through the use
of contractor personnel.
Section 3 would further require the Secretary to designate at least
one member of the Armed Forces in each field grade unit of the Armed
Forces as a transition coordinator to support the transition of members
in each such field grade unit to civilian life and to support
completion of the requirements of the Transition Assistance Program.
Included is a requirement to report annually to Congress on the action
to implement Section 3.
DAV Resolution No. 304 notes that it is essential for
servicemembers to gain full understanding of entitlements and free
assistance available to them. Mandatory TAP personnel requirements, at
all grades, provide assurance of dedicated resources and manpower for
TAP success. Reporting and oversight will lead to closer evaluations
and determinations of the effectiveness of TAP for transitioning
servicemembers. In accord with DAV Resolution No. 304, we support
Section 3 (Personnel Matters in Connection with Transition Assistance
Program).
Section 4 (Tracking of Participation in Transition Assistance
Program and Related Programs) would require the Secretary of Defense to
establish and maintain and electronic database and tracking system.
Section 5 (Information on Members of the Armed Forces Participating in
Pre-separation Counseling and Surveys on Member Experiences with
Transition Assistance Program Counseling and Services and in Transition
to Civilian Life) would provide for tracking of members TAP experiences
and TAP surveys.
The database would track information on individual member
participation in TAP, track member surveys and experiences, and notes
form counselors in connection with TAP. This information would be
available to the Secretaries of Labor, Veterans Affairs, and the heads
of any other departments and agencies of the Federal Government
involved in the furnishing of counseling and other assistance under the
program. Members of the Armed Forces and commanders will have access to
the information as well.
DAV Resolution No. 304 urges Congress to monitor and review TAP,
its classes, training methodology, delivery of services, and collection
and analysis of surveys and comments. As noted in the 2017 GAO study
(GAO-18-23), it was determined that many servicemembers were not able
to attend TAP or had experiences they felt were not effectively
preparatory for a successful transition to civilian life.
Our mission includes the principle that this Nation's first duty to
veterans is the rehabilitation and welfare of its wartime disabled.
This principle envisions assisting disabled veterans to prepare for and
obtain gainful employment and enhanced opportunities for employment and
job placement. This includes providing servicemembers with the right
resources and oversight to ensure successful transitions into civilian
life. Based on DAV Resolution No. 304, we support Section 4 and
Section 5.
DAV does not have a position on Sections 6 through 12 of the
discussion draft.
Section 13 directs the Secretary of Veterans Affairs, in
consultation with the Secretaries of Defense and Labor, and the
Administrator of the Small Business Administration, to conduct a five-
year longitudinal study regarding TAP that includes those
servicemembers who have attended the program before the enactment of
this bill, those who have attended after the implementation of the
proposed changes, and those who have not attended the program. This
study would note the percentage of those studied that received
unemployment benefits, the number of months each member was employed,
annual starting and ending salaries, suicide rates (to include attempts
and substance abuse issues), and other pertinent info that occurred
during the time studied. After the five year period, and every year
thereafter, the Secretaries of Veterans Affairs, Defense and Labor, and
the Administrator of the Small Business Administration shall report the
findings to the House and Senate Veterans' Affairs Committees.
DAV supports the provisions of this section to monitor and report
on the effectiveness of TAP. This coincides with the intent of DAV
Resolution No. 304, which supports monitoring the success rates of TAP
to ensure the program is meeting its objective and to follow up with
participants to determine if they found gainful employment following
training. According to a March 2016 RAND Corporation article, ``merely
placing veterans in jobs is not enough: veteran employment efforts
should also enable veterans to build successful careers over the long
term. To reach this goal, research must provide evidence to inform
these efforts and ensure their effectiveness.''
Section 14 directs the Secretary of Veterans Affairs to establish a
governing board within the Veterans Benefits Administration (VBA) that
would partner with community and Federal entities whose mission would
be to support the prevention of suicides, substance abuse, and
homelessness amongst veterans. This board would consist of
representatives from the Departments of Labor, Homeland Security,
Defense, and various representatives from within the VA. The duties of
this board would be to track suicide rates for each business line,
dissemination of educational products to veterans participating in
programs of the VBA, supporting communication between the Veterans
Health Administration and the VBA to support suicide and substance
abuse prevention efforts, and management of the VA's Gun Safety Lock
program in support of suicide prevention efforts.
DAV Resolution No. 293 supports program improvements, data
collection and reporting on suicide rates among servicemembers and
veterans, improving outreach through general media for stigma reduction
and suicide prevention, and enhanced resources for VA mental health
programs. DAV appreciates the goal of this section of the bill, which
would enhance the support between the various Federal entities to lower
the rate of veteran suicides. This section of the draft measure
coincides with the intent of our resolution.
Section 17 states, in part, that the Departments of Defense, Labor,
and Veterans Affairs should work together with veteran service
organizations, such as the DAV, to establish points of contacts for
relocating members of the Armed Forces and provide them employment,
education, and other appropriate information about the State or locale
to assist in relocation.
The transition from military service to civilian life is very
difficult for many veterans who must overcome obstacles to successful
employments, such as relocation. TAP was created to help our separating
servicemembers successfully transition to the civilian workforce, start
a business, or pursue training or higher education. DAV Resolution No.
304 states, in part, that participation by DAV and other veterans
service organizations in TAP is essential to servicemembers to gain a
full understanding of the entitlements and free assistance available
upon discharge from military service and the inclusion of DAV and other
veterans service organizations in the process. We are pleased to
support this section of the draft bill aimed at addressing this need.
This concludes my testimony, Mr. Chairman. DAV would be pleased to
respond for the record to any questions from you or the Committee
Members concerning our views on these bills.
______
Prepared Statement of the Department of Defense
Chairman Isakson, Ranking Member Tester, and Members of the
Committee, The Department of Defense (DOD) appreciates the opportunity
to provide this statement for the record addressing legislation pending
before the Committee. This statement focuses on the S. 2748, ``Better
Access to Technical Training, Learning, and Entrepreneurship for
Servicemember Act'' or the ``BATTLE for Servicemember Act,'' and the
Discussion Draft on Transition Assistance Reform. We defer to the
Department of Veterans Affairs and the Department of Labor to provide
responses on those bills and sections of pending legislation with no
significant DOD impacts.
s. 2748, ``better access to technical training, learning and
entrepreneurship for servicemember act'' or the battle for
servicemembers act
DOD has no objections to H.R. 2748. This bill amends title 10,
U.S.C., which requires members of the Armed Forces to receive
additional training under the Transition Assistance Program (TAP), and
for other purposes. In addition to ensuring members of the Armed Forces
eligible for the TAP receive additional training in any of the
supplemental subjects prescribed in section 1144(f) of title 10,
U.S.C., the Secretary of Defense and the Secretary of Homeland Security
will have the authority to waive the training for certain groups or
classifications of members as the Secretaries determine, in
consultation with the Secretaries of Labor and Veterans Affairs. A
member may also elect in writing to not receive such additional
training.
s.____, discussion draft regarding transition assistance reform
This draft bill ``amends title 10, U.S. Code to improve the
Transition Assistance Program for members of the Armed Forces and for
other purposes.'' This draft legislation directs the Secretaries of
Defense, the Department of Veterans Affairs, Department of Labor, and
the Department for Homeland Security to take certain actions to improve
transition assistance to members of the Armed Forces who separate,
retire, or are discharged from the Armed Forces, and for other
purposes. DOD objects to this proposed legislation due to significant
concerns identified by our review.
Servicemember feedback, as well as outside of government research
indicate the Transition Assistance Program works well to meet the needs
of our transitioning Servicemembers. Despite anecdotal comments, DOD
has yet to see strong data or evidence that would indicate the need to
revamp TAP with remedial legislation. Additionally, when Veterans
Service Organizations were briefed on the updated TAP curriculum in
June 2018, DOD received overwhelmingly favorable responses. Several
interagency evaluation efforts currently underway will provide more
robust evidence to determine what improvements should be made to the
TAP. For example, a study led by the Department of Labor, a
longitudinal study led by the Army, and a Post-Separation Assessment
led by the Department of Veterans Affairs will help DOD identify and
develop sound improvements. DOD assesses the proposed legislation as
premature for improving Servicemember transition outcomes. While
refinements and improvements can always be made to programs (we
continue to update TAP annually), changes are most effective when made
based on evidence-based program evaluations and best practices.
DOD and its partners are extremely careful when implementing
changes that impact approximately 308,000 transitioning Servicemembers
and spouses each year. When changes are to be made to TAP, we prefer to
experimentally evaluate such changes and their outcomes via a pilot
study to closely analyze the impact of these changes on a smaller group
of Servicemembers rather than proceeding immediately to full-scale
implementation. If the pilot confirms that the proposed changes would
result in a more positive outcome for transitioning Servicemembers, we
would then implement the changes more broadly. We urge Congress to
allow time for the TAP interagency governance team to continue to
collect and analyze the data from our evaluation efforts in progress
before legislating mandated changes to TAP. Each section of this draft
bill is discussed in detail below.
Section 2. Recodification, Consolidation, and Improvement of Certain
Transition-Related Counseling and Assistance Authorities
The statute should align organizational authorities and
responsibilities based on the missions, roles, and responsibilities of
the Federal agencies and departments; thus, DOD has serious concerns
about the elimination of section 1144, title 10, U.S.C. By striking
section 1144, and consolidating it with section 1142, the proposed
legislation assigns the authority and responsibilities from the
Secretary of Labor to the Secretary of Defense for employment
assistance, job training assistance, assistance in identifying
employment, and training opportunities, and other information and
services. As the Secretary of Labor is responsible for employment-
related programs and services for transitioning Servicemembers and
veterans, DOD requests that section 1144 remain.
DOD supports eligible transitioning Servicemembers (including
National Guard and Reserves) to receive resources, counseling,
information, and services they need for their transition from the
military to civilian life. The proposed legislation, however, lacks
clarity about its applicability to members of the National Guard and
Reserves. National Guard and Reserve Servicemembers eligible for TAP do
not retire or separate upon demobilization or deactivation. They are
``released from active duty'' (REFRAD). Therefore, DOD recommends the
phrase, ``release from active duty'' be inserted in paragraph (a) (1)
to read as follows: ``The Secretary of Defense and the Secretary of
Homeland Security with respect to the Coast Guard when it is not
operating as a service in the Navy shall, in cooperation with the
Secretary of Labor and the Secretary of Veterans Affairs, carry out a
program to furnish individual counseling, information, and services
described in paragraph (2) to members of the Armed Forces under the
jurisdiction of the Secretary of Defense or the Secretary of Homeland
Security, as applicable, whose retirement, separation, or release from
active duty is anticipated as of a specific date, and to the spouses of
such members.'' This recommended change will clarify in statute the
applicability of TAP to the National Guard and Reserve members.
DOD is also concerned about the lack of clarification as to when
eligible members of the National Guard and Reserves shall commence and
complete TAP. While the proposed legislation addresses when members of
the National Guard and Reserves shall commence TAP, the proposed
legislation falls short of addressing the completion date for TAP (to
include all covered counseling, information, and services). The
legislation does not state how and when members of the National Guard
and Reserves will receive transition assistance. Given the unique
operational requirements for demobilizing and deactivating Reserve
Component Servicemembers and short notice separations, DOD recommends
the proposed legislation provide the Secretary of Defense waiver
authority to allow National Guard and Reserve members to complete any
TAP requirements not accomplished prior to release from active duty,
not later than 120 days from the date of release from active duty.
DOD does not support the requirement for ``Preliminary
Assistance.'' Not all Military Occupational Codes align with a
credential. Not all Servicemembers wish to pursue employment in their
same military occupation. Evidence-based research shows that more than
half of our transitioning Servicemembers want to pursue a civilian
occupation that is different from their military career. DOD
effectively utilizes existing GAP Analysis Career Readiness Standard to
accomplish the objective of ``Preliminary Assistance.'' We recommend
the requirement for ``Preliminary Assistance'' be deleted from the
proposed legislation.
Practices for hiring counselors, vetting and establishing
contracts, developing training curriculum, and testing information
technology data fields do not allow DOD to meet the deadlines as
written in the section of the proposed legislation titled
``Commencement of Certain Instructions.'' DOD requests the deadline be
at least 18 but not later than 24 months after enactment. Additionally,
DOD requests the Secretary of Defense be given two-year funding
authority to implement requirements for this proposed legislation.
Section 3. Personnel Matters in Connection with Transition Assistance
Program
DOD recommends synchronizing the staffing ratios to support
approximately 308,000 eligible Servicemembers and spouses transitioning
annually because the language specified in Sec. 1142, paragraph (a) (1)
requires the Secretary of Defense to carry out a program to members of
the Armed Forces and to the spouses of such members. The proposed
legislation bases its ratio on military members at installations and
does not take into account their spouses. We believe the Military
Services are best positioned to determine the requirements for
transition counselors.
Section 4. Tracking of Participation in Transition Assistance Program
and Related Programs
DOD's primary concern is to protect Servicemember privacy,
including each member's Personally Identifiable Information (PII). The
Military Services capture most, but not all of the data requirements as
outlined in Section 4 (case work and other services). DOD's existing
system tracks transitioning Servicemembers. We support enhancing our
existing TAP web service; however, the cost to develop the enhancements
necessary to capture all the new data and information prescribed in the
proposed legislation will require further review and study. DOD
supports sharing specific data through approved data-sharing agreements
that preserve the integrity of each individual's PII.
Section 5. Information on Members of the Armed Forces Participating in
Pre-separation Counseling and Surveys on Member Experiences
With Transition Assistance Program Counseling and Services and
In Transition to Civilian Life
DOD supports sections 5(a) and (b). We defer to the Department of
Veterans Affairs regarding the provisions in section 5(c).
Section 6. E-mailing Transition Assistance Materials to Supporters of
Members of the Armed Forces Transitioning to Civilian Life
DOD does not support this provision of the proposed legislation.
Departmental policy gives Servicemembers the option to include their
email address in the Remarks section of the DD Form 214, ``Certificate
of Release or Discharge from Active Duty.'' Members may elect a State/
Locality Veterans Affairs office to receive information. In addition,
transition assistance materials, to include the Transition GPS (Goals,
Plans, Success) curriculum, described in the proposed legislation, can
be obtained through public web sites as presented during TAP.
Transitioning Services members and their spouses can avail themselves
of the websites and the materials at any time before, during and after
transition. DOD does not support obtaining a third party email address
to provide information readily available online. TAP materials, to
include all TAP curricula, can be accessed free of charge through
public web sites.
Section 7. Command Matters in Connection with Transition Assistance
Programs
DOD accomplishes the requirements of section 7(a) through DOD
policy, which requires the Inspectors General to assess TAP at military
installations. The Military Services provide professional military
education to inform Commanders, at all levels, about all aspects of
command, including TAP. Therefore, DOD recommends Section (b) be
deleted.
Section 8. Comptroller General of the United States Report on
Participation in Transition Assistance Programs at Small and
remote Military Installations
DOD supports Section 8 of the proposed legislation.
Section 9. Education of Members of the Armed Forces on Career Readiness
and Professional Development
DOD recognizes the important role career readiness and professional
development pursuits can play in professionalizing the Force and in
enhancing the Servicemember's ability to transition to the civilian
workforce upon completion of military service. Providing opportunities,
whether academic-or certification-related, is an investment in our
people. Whether an individual is acquiring knowledge, skills, or
abilities needed to perform mission functions or make a seamless
transition to an industry profession, DOD supports education,
certification, training, and employment assistance that maximize
opportunities both in and out of service. DOD collaborates with the
Departments of Labor and Veterans Affairs on a Servicemember outcomes
initiative that aligns career readiness and professional development
opportunities to better ensure Servicemembers are prepared to
successfully enter the civilian workforce upon completion of service,
and that veterans are able to capitalize on their Service training,
education, and experiences in pursuit of civilian career opportunities.
Although DOD is generally supportive of the proposed provisions of
section 9, and has already aligned and coordinated appropriate assets
to support Servicemember lifecycle development opportunities and career
pathway programs, we recommend removal of the below listed provisions.
Remove section 9(b)(1) as DOD already informs the transition plan
required by section 1142(g)(1)(C) through various established tools
including the Joint Services Transcript, the Community College of the
Air Force Transcript, and the Verification of Military Experience &
Training document.
Remove section 9(b)(2)(B), as DOD has no capability to collect,
store, and update information provided by hundreds of local communities
across the Nation. However, DOD is postured to support a trusted
external data source that provides centralized insight into such civic
programs and resources.
Remove section 9(d), as DOD does not support mandating an Alumni
Network Program. DOD would support language that encourages the
Military Services to establish a Network Program; however, we recommend
the decision be left to each Military Service's discretion. Further,
DOD recommends consideration of alternative terminology such as
``Professional'' or ``Veteran'' to describe the Network Program vice
``Alumni.'' Alumni historically refers to graduates or formal students
of a particular school, college, or university, and such a naming
convention might not properly convey the intent of Congress to focus on
career mentoring, networking, and advice and not higher education
solely.
Last, DOD has significant concerns with section 9(c) as there is
potential duplication between this effort, those under section 2 of
this proposal, and numerous other personal and professional development
authorities of DOD. Additionally, this provision mandates the provision
of information beyond that available, yet provides no additional
manpower or financial resources. DOD's Voluntary Education enterprise
employs approximately 500 professional guidance counselors. Each year,
this workforce counsels more than 256K Tuition Assistance
beneficiaries, as well as another 350K Servicemembers participating in
other Voluntary Education programs such as college-level examination
and academic skills improvement. Increasing the requirement to provide
information, without appropriate resources, would jeopardize the impact
of such legislation.
Section 10. Employment Skills Training
DOD supports an expansion of eligible participants under the DOD
SkillBridge authority with the below comments. Further clarify section
10(2)(A)(ii). Eligibility does not appear to be limited to spouses of
transitioning Servicemembers for which 10 U.S.C. 1143(e) was enacted.
Recent statistics indicate that 54 percent of Servicemembers are
married. This potential pool of participants far exceeds the roughly
200K transitioning Servicemembers for which the program was intended
each year. DOD is concerned that the new eligibility parameters
drastically change the scope of the program and may have significant
implications for program implementation.
Further clarify section 10(2)(A)(iii). Eligibility does not appear
to be limited to recently transitioned Servicemembers for which 10
U.S.C. 1143(e) was enacted. With roughly 200K transitioning
Servicemembers each year becoming eligible in perpetuity, DOD is
concerned that the new eligibility parameters drastically change the
scope of the program and may have significant implications for program
implementation. Additionally, DOD is concerned about the authority to
expend its operations and maintenance appropriation in support of
separated Servicemember participation. There is some precedent for this
in the form of stipends and bonuses paid to veterans participating in
the Troops-to-Teachers program. However, in this example, eligibility
for the program expires 3 years after separation.
The proposed legislation is unclear about whether spouses and
Veterans may utilize base housing, receive compensation-type benefits,
etc. For example, spouses and veterans would not be eligible for
compensation while participating, to include housing and allowances
funded by DOD. A policy review would need to be accomplished to
determine whether unemployment compensation paid by DOD would be
permissible in conjunction with participation in SkillBridge programs.
Further clarify the intent of the $10M identified in section 4. The
DOD SkillBridge is intended to be a low/no cost program whereby
providers fund the necessary job training and employment skills
training opportunities.
Section 11. Identification of Opportunities for Job Training and
Employment Skills Training for Members of the Armed Forces for
Employment with the Department of Veterans Affairs in
SkillBridge Programs of the Department of Defense
DOD supports the proposed change of section 11 with two comments:
(1) Replace ``the Secretaries of the military departments shall . . .
'' with ``the Secretary of Defense shall . . . ;'' (2) Consider
broadening the language, including authority to work with all Federal
agencies in support of critically understaffed and high-skilled
positions. While DOD is already working with the Department of Veterans
Affairs to establish such opportunities, we have been approached by
other Federal agencies requesting consideration as well (e.g.,
Department of Homeland Security for cybersecurity professionals).
Section 12. Evaluation of Transition Training and Counseling Relating
to Post-secondary Education and Use of Educational Assistance
from Department of Defense and Department of Veterans Affairs
DOD supports the proposed evaluation of section 12, with one
recommendation. Remove Section (d), contract organization. In
accordance with the Code of Federal Regulations, DOD may leverage
federally Funded Research and Development Centers (FFRDC) for the
purpose of the proposed analysis.
Section 13. Longitudinal Study on Changes to Transition Assistance
Program of Department of Defense
DOD defers to the Department of Veterans Affairs for comments on
section 13.
Section 14. Establishment of Governing Board to Support Prevention of
Drug Overdoses, Deaths by Suicide, and Alcohol-related
Mortality
DOD defers to the Department of Veterans Affairs for comments on
section 14.
Section 15. Review of Economic Risk Factors in Suicide Prevention
DOD defers to the Department of Veterans Affairs for comments on
section 15.
Section 16. Grants for Provision of Transition Assistance to Members of
the Armed Forces After Separation, Retirement, or Discharge
The DOD defers to the Department of Labor for comments on section
16.
Section 17. Sense of Congress on Transition Assistance Program and
Other Transition-related Assistance for Members of the Armed
Forces
DOD concurs with the provisions of section 17.
This large and complex piece of proposed legislation brings
potentially huge resource implications in the form of more counselors,
Information Technology enhancements, veterans' surveys, the creation of
professional networks, opening counselor notes to other Federal
agencies, and adding TAP to command climate assessments, with
unintended consequences. This proposed legislation would move DOD to a
TAP case management system and would require more resources to fulfill
all the mandates outlined. Additionally, requirements that span the gap
from Servicemember to veteran will require additional attention to data
privacy, collection, and storage requirements, as well as increased
public disclosures and opportunity for comment through the Federal
Register process.
The Department of Defense thanks the Committee for its outstanding
and continuing support of our Servicemembers, veterans, and their
families.
______
Prepared Statement from Ivan Denton, Director, Office of National
Programs, Veterans' Employment and Training Service, U.S. Department of
Labor
introduction
Chairman Isakson, Ranking Member Tester, and Members of the
Committee, thank you for the opportunity to submit a statement for the
record of today's hearing. I thank you all for your tireless efforts to
ensure that America fulfills its obligations to our servicemembers,
veterans, and their families. As the Director of the Office of National
Programs in the Veterans' Employment and Training Service (VETS) at the
Department of Labor (DOL, or Department), my office is responsible for
managing DOL's Employment Workshop (DOLEW, or Workshop) and Career
Technical Training Track (CTTT) courses, as part of the Transition
Assistance Program (TAP). The move to a civilian career is critical for
transitioning servicemembers (TSMs) and their entire families as they
conclude their military service, and it can also prove to be stressful.
More broadly speaking, successful career transition is vital to
attracting an All-Volunteer Force, and to building the American
economy. I appreciate the opportunity to discuss DOL's collaborative
work with the Department of Defense (DOD) and the Department of
Veterans Affairs (VA) to administer the TAP and improvements that can
be made to better assist servicemembers with employment preparation as
they transition to civilian life.
The Department stands firmly behind our Nation's servicemembers,
veterans, and their families. The Secretary has set several clear
priorities to assist our veterans and military spouses. They include:
(1) supporting America's veterans by helping veterans, servicemembers,
and their spouses find family-sustaining jobs; (2) expanding
apprenticeships in America; and, (3) removing barriers to employment
through occupational licensing reform.
DOL is the Federal Government's focal point for workforce
development, employment services, and information related to the
economic health of all Americans. The Department maintains the
expertise and a nationwide network of American Job Centers (AJCs) to
provide workforce education and employment opportunities for all
Americans. Within this network, veterans receive priority of service.
This integrated network and the programs DOL administers are best
suited to continue generating positive employment outcomes for the men
and women who serve our country. I am pleased to report the employment
situation for veterans continues to improve. The unemployment rate for
veterans was down to 3.7 percent in 2017, which is the lowest since
2001, and I continue to hear from employers who are hiring veterans
because veterans provide the technical and leadership skills that
businesses need. There are 6.6 million job openings in the United
States.\1\ Transitioning servicemembers and veterans can help to fill
these jobs, and employers are eager to hire them.
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\1\ BLS. (2018, July 10). Job Openings and Labor Turnover Summary.
Retrieved from https://www.bls.gov/news.release/jolts.nr0.htm.
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While this hearing is focused on several bills under consideration
by the Committee, I will focus my remarks on the two pieces of
legislation that would directly impact the programs administered by
DOL, specifically S.__, ``Improving Preparation and Resources for
Occupational, Vocational, and Educational Transition,'' or the
``IMPROVE Transition for Servicemembers Act, and S. 2748, ``Better
Access to Technical Training, Learning, and Entrepreneurship for
Servicemembers Act,'' or the ``BATTLE for Servicemembers Act.''
s._____, ``improving preparation and resources for occupational,
vocational, and educational transition,'' or the ``improve transition
for servicemembers act''
As a retired Infantry Officer with 35 years of total service, I was
blessed with the opportunity to command both a battalion and a brigade
in Iraq on two separate mobilizations. Sadly, I found these deployments
to be, in total, less stressful than my transition off of active duty
in 2016. I trained all of my adult life to lead soldiers; however, I
only had a fraction of that time to make the transition to civilian
life. I know firsthand the importance of TAP and fully understand the
necessity of getting TAP right.
The IMPROVE Transition for Servicemembers Act would amend title 10,
U.S. Code, by striking sections 1142 and 1144 and inserting a new
section 1142, which directs the Secretary of Defense and the Secretary
of Homeland Security, with respect to the Coast Guard, in cooperation
with the Secretaries of Labor and VA, to take certain actions intended
to improve the transition assistance provided to members of the Armed
Forces who separate, retire, or are discharged from military service.
The Department opposes this bill as currently drafted, as we
believe it would negatively impact the transition to civilian
employment and successful careers for many transitioning
servicemembers.
The draft bill removes the Secretary of Labor's statutory authority
to establish and maintain an employment assistance program for
transitioning servicemembers and their spouses. This authority and
responsibility is rightly, and most appropriately, entrusted to DOL;
however, this bill would place that authority, and concomitant burden,
on the Secretary of Defense, whose essential and fundamental mission is
to lead DOD in the defense of our Nation. This bill would unnecessarily
disrupt an effective interagency Federal program that DOL has
supported, without fail, for over 25 years.
The bill would reduce the five-day combined employment-related
curriculum that is currently available to TSMs to a three-day mandatory
combined curriculum. For the majority of TSMs, it would also reduce the
existing three-day mandatory employment workshop, administered by DOL/
VETS, to a mandatory one-day workshop. This significant reduction may
decrease the likelihood that our transitioning servicemembers will be
able to secure meaningful, gainful employment that can lead to a
successful family-sustaining career. Employment is arguably the most
important factor in a successful transition, impacting all areas of the
servicemember's life. We owe it to our servicemembers and their spouses
to thoroughly prepare them for a smooth transition into the next phase
of their career.
To inform any future discussion and collaboration with regard to
TAP reform, I offer several observations on the contents of the draft
bill for the Committee's consideration and defer to our partners at DOD
and VA to discuss other sections which are specific to their TAP
responsibilities.
Sec. 2. Recodification, Consolidation, and Improvement of Certain
Transition-Related Counseling and Assistance Authorities
Section 2 of the bill would amend title 10 of the U.S. Code to make
a number of changes to the structure and content of the existing TAP.
In particular, section 2 would require the Secretary of Defense, and
the Secretary of Homeland Security with respect to the Coast Guard, in
cooperation with the Secretary of Labor and the Secretary of VA, to
carry out a program to furnish individual counseling, information, and
services to retiring and separating servicemembers. Section 2 further
requires the Secretaries to work together to: develop and revise
necessary training documents, resources, and curriculum; use experience
gained from implementation of the pilot program under section 408 of
Pub. L. No. 101-237 in providing the pre-separation counseling required
under section (f)(4) of the bill; work with Military Service
Organizations (MSOs), Veterans Service Organizations (VSOs), and other
appropriate organizations to promote and publicize job fairs for TSMs;
and, furnish covered counseling, information, and services to TSM
spouses, when appropriate and at the discretion of the servicemember
and the spouse, as well as job placement counseling for the spouse in
connection with the transition of the servicemember to civilian life.
Section 2 of the draft bill also: makes participation in TAP mandatory,
unless the Secretary of Defense or Homeland Security waives the
requirement, based upon delineated criteria; requires a servicemember
to attend TAP no later than 120 days before retirement or 90 days prior
to separation; establishes the parameters for pre-separation
counseling, preliminary assistance, introduction of specific post-
service pathways, instruction on professional development and
employment assistance, and introduction to VA benefits; and, outlines
the use of personnel and organizations. This section would also reduce
the mandatory three-day employment workshop to only one day.
The Administration believes that the three-day employment workshop
conducted by the Department is contributing to reduced unemployment
among TSMs and should continue to be mandatory.
As the Department interprets this draft bill, the delivery of DOLEW
and CTTT would no longer be the responsibility of DOL, but would
instead become the responsibility of DOD and DHS. DOL has significant
concerns with this fundamental programmatic change, as it fails to
recognize the Department's expertise and experience in employment and
training. The draft bill states, ``It is the sense of Congress to
acknowledge that the Armed Forces face significant and often competing
pressures in carrying out its essential and fundamental mission to
defend the Nation.'' However, this bill further adds to these competing
pressures by dismantling an effective interagency program and placing
the full responsibility for transition onto the DOD and DHS. Providing
employment assistance to transitioning servicemembers and veterans is
an integral program function that the Department has unfailingly
supported for over 25 years. DOD and DHS should be assisting
servicemembers in developing and documenting the skills that will make
them successful both inside and outside of the military, and DOL is
best equipped to assist them in transitioning to a civilian career.
Since the Department began providing the Employment Workshop more
than 25 years ago, the number of workshops, participants, and locations
has grown considerably and the quality and relevance of the course
material improves each year. In 2011, the VOW to Hire Heroes Act of
2011, Title II, Pub. L. No. 112--56 (the VOW Act) made participation in
the DOLEW mandatory for most transitioning servicemembers, including
those demobilizing from the National Guard and Reserve Components. Last
year, DOL conducted more than 6,000 Workshops for over 164,000
participants at 187 sites worldwide. Of the over 164,000 participants,
more than 4,800 were National Guard and Reserve. The three-day DOLEW is
standardized so that all attending servicemembers and their spouses can
receive the same high level of instruction. The current three-day
employment workshop has contributed to:
The unemployment rate for veterans aged 18-24 decreasing
from a high of 30.2 percent in 2011 to 7.9 percent (2017);
Overall veteran unemployment being at its lowest rate of
3.7 percent (2017) since 2001; and
Unemployment Compensation paid to ex-servicemembers (UCX)
being reduced by over 72 percent from $944 million to $258 million,
lower than pre-recession levels.
Employment is arguably the most important element of a successful
transition to civilian life, and the existing DOLEW and CTTT are key
elements of TAP. Removing the requirement for participation in the
current DOLEW, or reducing by two-thirds the required employment
preparation instruction, would have a negative impact on a TSM's
readiness for civilian employment and career success. The vast majority
of the courageous men and women who serve our country will enter the
workforce, whether immediately following their transition, or after
pursuing additional education or training. The DOLEW provides them with
employment preparation that is vital for a positive transition and a
successful future.
Moving forward, and as discussed in our November 2017 written
testimony before the House Veterans' Affairs Committee's Subcommittee
on Economic Opportunity, DOL is working to advance two primary goals
for TAP. First, DOL will continue to work with our interagency partners
to improve TAP's timeliness of completion rates. Second, we will also
work with interagency partners to increase the percentage of TSMs that
participate in the two-day supplemental career tracks.
All TSMs are eligible to begin TAP activities, which start with
pre-separation counseling, as soon as 24 months prior to retirement or
12 months prior to separation. By law, TSMs are also required to
complete TAP within 90 days of transition. However, based on statistics
contained in the November 2017 U.S. Government Accountability Office
report (GAO-18-23), Transitioning Veterans, DOD Needs to Improve
Performance Reporting and Monitoring for the Transition Assistance
Program,\2\ fewer than half of all TSMs actually complete TAP on time.
DOL's first goal is important because survey data from the
November 2016 Hiring Our Heroes report from the U.S. Chamber of
Commerce Foundation,\3\ indicates veterans continue to face challenges
as they transition from the military, but the survey results show a
clear relationship between a successful transition and when
transitioning servicemembers start their job search. Those who begin to
plan for transition early (more than six months before separation) fare
better than those who wait.
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\2\ U.S. Government Accountability Office (2017, November).
Transitioning Veterans: DOD Needs to Improve Performance Reporting and
Monitoring for the Transition Assistance Program. (GAO-18-23).
Retrieved from https://www.gao.gov/assets/690/688203.pdf.
\3\ Chamber of Commerce. (2016, November 02). Veterans in the
Workplace: Understanding the Challenges and Creating Long-Term
Opportunities for Veteran Employees. Retrieved from https://
www.uschamberfoundation.org/reports/veterans-workplace.
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The GAO report also noted that only 22,468 (14.1%) of active duty
TSMs, out of the 160,000 who were eligible, participated in the two-day
supplemental career tracks. DOL believes that this number is far too
low and that greater participation in these tracks would allow TSMs to
identify career opportunities that could increase their long term
earnings.
According to the Bureau of Labor Statistics (BLS), the median wage
for a U.S. worker with only a high school degree was about $37,000 per
year in 2017. However, four-year degree wages are $60,000 per year.\4\
Graduates of Apprenticeship programs earn an average of $60,000 per
year, and more than 8 in 10 graduates retain their employment nine
months after exiting their apprenticeships. Although participation in
the supplemental two-day tracks does not guarantee higher wages, our
assessment shows that attendance metrics for each of the career tracks
provide an indication of whether or not a TSM is selecting a career
path that increases the chances of obtaining a meaningful career.
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\4\ BLS. (2018, April 13). Usual Weekly Earnings of Wage and Salary
Workers Second Quarter 2018. Retrieved from https://www.bls.gov/
news.release/pdf/wkyeng.pdf.
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Sec. 3. Personnel Matters in Connection with Transition Assistance
Program
Section 3 of the draft bill requires the Secretary of Defense to
employ full-time DOD personnel dedicated to counseling and other TAP
activities at each military installation (no less than one for every
250 members eligible for transition services in the Armed Forces), and
prohibits the use of contractor personnel to satisfy this requirement.
Section 3 also requires the Secretary of Defense to submit a report to
Congress on the actions taken to implement this section.
The Department is concerned with the long-term ramifications of
administering TAP with Federal employees, when contract facilitators
offer a flexible and cost effective way to provide workforce
development services to transitioning servicemembers to meet the ever-
changing needs of the civilian employment sector. The DOLEW and CTTT
are currently administered by contract facilitators, as directed by the
VOW Act. The use of contractors allows the Department to ensure that
the instruction for DOLEW and CTTT is consistently of high quality. The
use of contractor personnel also made the program more nimble to manage
as we are able to rapidly schedule or reschedule classes as required by
the military services.
Sec. 4. Tracking of Participation in Transition Assistance Program and
Related Programs
Section 4 requires the Secretary of Defense to establish and
maintain an electronic tracking system and database, applicable across
the Armed Forces, to collect, assemble, and make available information
on: the participation and progress of individuals in TAP, data
collected in surveys; resources available for members of the Armed
Forces and their spouses; and, notes to TAP counselors in connection
with the provision of casework and other programmatic services.
Information collected in the tracking system and database is to be made
available to members of the Armed Forces who are undergoing transition
from military life, Commanders of the Armed Forces at all levels, the
Secretaries of Labor, VA, and the heads of any other departments and
agencies of the Federal Government involved in TAP.
The Department does not oppose this section and believes that
tracking information on the progress of TSMs is important. The
Department continues to process data from the Defense Manpower Data
Center (DMDC) for the Veterans' Data Exchange Initiative (VDEI). As we
work with DOD to improve data quality, information about TAP timeliness
of completion metrics and career technical training track attendance
metrics will be shared by DOD and DOL leaders at the national and local
level. The Department will eventually establish a data dashboard that
allows DOL to see performance metrics for each individual service and
individual bases within each service branch.
Sec. 5. Information on Members of the Armed Forces Participating in
Pre-separation Counseling and Surveys on Member Experiences
with Transition Assistance Program Counseling and Services and
in Transition to Civilian Life
Section 5 requires the Secretary of Defense to collect the
demographic data on servicemembers entering into pre-separation
counseling, requires the Secretaries concerned (as that phrase is
defined in section 101 of title 10, U.S. Code) to conduct surveys of
the members of the Armed Forces at the conclusion of the receipt of
counseling, information, and services under section 1142, and requires
the Secretary of VA, in consultation with the Secretaries of Defense,
Homeland Security, Education, and Labor, to conduct surveys of veterans
recently retired, discharged, or released from the Armed Forces, in
order to assess the experiences of such veterans in the transition from
military life to civilian life.
DOL is generally supportive of section five. The Department
recommends that language also be included to amend the Social Security
Act to authorize the Secretaries of Labor and Veterans' Affairs to
access the National Directory of New Hires (NDNH) for purposes of
tracking veterans' employment. Like VA, DOL strongly supports this
access to the NDNH, and believes that the information would provide the
interagency TAP partners with a more complete understanding of post-
transition employment outcomes and greatly assist us in evaluating the
efficacy of our transition assistance efforts.
Sec. 6. E-mailing Transition Assistance Materials to Supporters of
Members of the Armed Forces Transitioning to Civilian Life
Section 6 requires the Secretaries of Defense and Homeland Security
to solicit an e-mail address from each TSM and the e-mail address of a
supporter so that the Secretary concerned may send transition materials
as set forth in section 1142(f) of title 10 and additional information
as the Secretary concerned considers appropriate.
The Department does not oppose this section. DOL currently receives
email addresses from DOD via the eForm data. The Department sends
emails to TSMs to highlight the importance of participating in the
supplemental career tracks and DOLEW as early as possible. To date, DOL
has sent nearly 290,000 messages to TSMs on these topics.
Sec. 10. Employment Skills Training
Section 10 amends section 1143(e) of Title 10, U.S. Code, by
directing the Secretary of Defense, in consultation with the Secretary
of Labor, to carry out job training and employment skills training,
including pre-apprenticeship programs under the SkillBridge program, to
transitioning servicemembers and their spouses who are within six
months of their transition out of the military. Veterans, as defined in
section 101 of title 38, U.S. Code, who have completed at least 180
days of active duty or have been awarded the Purple Heart are also
eligible to receive services from this program, but at a lower level of
priority than TSMs. Finally, this section authorizes $10 million to the
Secretary of Defense to carry out this program.
The Department is supportive of the concept as it would not require
transitioning servicemembers and some veterans to be excluded from
training programs like SkillBridge just because they will transition
off of active duty before completing it. The Department notes that the
required consultation between DOD and DOL will be necessary to ensure
that these programs are integrated with and not duplicative of the
training and employment services for veterans that are funded by DOL.
Sec. 13. Longitudinal Study on Changes to Transition Assistance Program
of Department of Defense
Section 13 tasks the Secretary of the VA, in consultation with the
Secretaries of Defense, Labor, and the Small Business Administration,
to conduct a five-year longitudinal study.
DOL is generally supportive of section 13. Once again, DOL believes
that access to NDNH would provide the interagency TAP partners with a
more complete understanding of post-transition employment outcomes.
Sec. 16. Grants for Provision of Transition Assistance to Members of
the Armed Forces After Separation, Retirement, or Discharge
Finally, section 16 requires the Secretary of Labor, in
consultation with VA, to award grants to eligible organizations for the
provision of transition assistance to members of the Armed Forces who
are separated, retired, or discharged from the Armed Forces, and
spouses of such members.
The Department supports the intent of section 16, but believes it
is duplicative of services that are already available through the DOL-
funded State Workforce System and VA. The Department suggests that the
grants emphasize case management and referral to Federal, state, and
local resources that can meet the needs of transitioning servicemembers
and their families.
s. 2748, ``better access to technical training, learning, and
entrepreneurship for servicemembers act,'' or the ``battle for
servicemembers act''
S. 2748 would amend section 1144(f) of title 10, U.S. Code, to
require members of the Armed Forces to receive additional training
under TAP.
The Department supports S. 2748 because, if passed, it would
increase the amount of days of employment-related curriculum for most
servicemembers by making the attendance of TAP's Optional tracks
mandatory. Currently, TSMs have the option to participate in a series
of two-day tailored tracks within the Transition GPS curriculum: (1) an
Accessing High Education Track (provided by DOD), for those pursuing a
higher education degree; (2) CTTT (provided by DOL), for those
interested in obtaining job-ready skills through apprenticeship or
other industry-recognized credentials; and (3) the ``Boots to
Business'' Entrepreneurship Track (provided by Small Business
Administration), for those wanting to start a business. CTTT is an
additional two-day workshop focused on apprenticeships and industry-
recognized credentials for transitioning servicemembers and their
spouses. The CTTT provides these servicemembers with an opportunity to
identify their relevant skills, increase their awareness of workforce
development programs and apprenticeship programs that can lead to
industry-recognized credentials and meaningful careers, and develop an
action plan to achieve their career goals. DOL believes that the
optional courses in TAP provide servicemembers with resources critical
to their success in the civilian world. By making the attendance of an
optional track mandatory, the Department expects the number of TSMs who
would attend these courses, and obtain enhanced employment-related
curriculum, would increase significantly.
conclusion
In conclusion, our long-term goal continues to be that military
service is universally recognized as a path to high-quality civilian
careers. The future of the Nation's All-Volunteer Force depends upon
this recognition, as does our economy. The Department views employment
as a vital element of a successful transition to civilian life. The
Department thanks the Congress for addressing TAP participation through
the VOW Act, and for your continued partnership in removing barriers to
employment.
The Department remains committed to working with our interagency
partners to continuously review and improve TAP curricula, including
the DOLEW and CTTT, through our regular review cycle that incorporates
input from employers and the public related to the best practices
across the Nation. Moving ahead, we look forward to preparing
transitioning servicemembers and their spouses even more effectively by
improving the timeliness of DOLEW participation and increasing
participation rates in the supplementary career-related tracks.
The Department looks forward to working with the Committee to
ensure that our separating servicemembers have the resources and
training they need to successfully transition to the civilian
workforce. The improving employment situation for veterans is a
resounding testament to the nationwide recognition from stakeholders,
both public and private, at the national level and within local
communities, of the value veterans bring to the workforce.
Mr. Chairman, Ranking Member, and Members of the Committee, this
concludes my statement for the record. Thank you for the opportunity to
be a part of this hearing.
______
Prepared Statement of the Mortgage Bankers Association
Chairman Isakson and Ranking Member Tester, The Mortgage Bankers
Association (MBA) appreciates the opportunity to submit written
testimony on the pending legislation being considered before the Senate
Committee on Veterans' Affairs. In particular we are pleased to share
our views on H.R. 299, the Blue Water Navy Vietnam Veterans Act of
2017.
MBA is the national association representing the real estate
finance industry, an industry that employs more than 280,000 people in
virtually every community in the country. The association works to
ensure the continued strength of the Nation's residential and
commercial real estate markets, to expand homeownership, and to extend
access to affordable housing to all Americans. MBA promotes fair and
ethical lending practices and fosters professional excellence among
real estate finance employees through a wide range of educational
programs and a variety of publications. MBA's membership of over 2,300
companies represents all elements of real estate finance, including
firms serving both the single-family and commercial/multifamily
markets. Our membership features commercial banks, community banks,
credit unions, independent mortgage bankers, investors, brokers, and
industry vendors, among others.
We applaud the Committee for its efforts to provide adequate
medical benefits for veterans who were exposed to dangerous chemicals
in the course of their service. And while H.R. 299 contains a number of
provisions relevant to such healthcare-related concerns, MBA will limit
its views to Sections 6 and 7 of the legislation, which address the
U.S. Department of Veterans Affairs (VA) Home Loans program. We also
wish to draw the Committee's attention to another pressing problem in
the market for VA-guaranteed refinances, which has prevented some loans
from serving as collateral in Government National Mortgage Association
(Ginnie Mae) pools.
Section 6(a)
Section 6(a) of H.R. 299 adjusts the size of the VA loan guaranty
for a subset of loans. Under existing law, the VA guaranty on loans
greater than $144,000 cannot exceed the lesser of: (1) 25 percent of
the government-sponsored enterprise (GSE) conforming loan limit,
reduced by the amount of entitlement previously used and not restored;
or (2) 25 percent of the loan. The proposed changes in the legislation
would adjust the VA guaranty on loans greater than $144,000 to 25
percent of the loan, reduced by the amount of entitlement previously
used and not restored.
For veterans who have not used their entitlement, or have had their
entitlement fully restored, the new calculation would not change the VA
guaranty on loans at or below the GSE conforming loan limit. It would,
however, increase the VA guaranty on loans above the GSE conforming
loan limit. We believe this adjustment is warranted, as it will promote
access to credit for veterans living in higher-cost areas of the
country.
However, the proposed adjustment would have the effect of lowering
the VA guaranty on second properties purchased by the veteran, in cases
in which the second loan is at or below the GSE conforming loan limit.
As such, this adjustment would make it more difficult for veterans to
obtain zero-down payment financing for many second properties. Given
the frequency with which veterans may be required to relocate due to a
permanent change of station, it is common for veterans to purchase a
second home in their new station, while continuing to own and rent
their first home. In such a scenario, we believe it is appropriate to
allow for zero-down payment financing for the second home, particularly
if the loan is at or below the GSE conforming loan limit.
In order to address this concern while maintaining the increased VA
guaranty on more expensive properties, we recommend that the language
in Section 6(a) be further amended so as to use the existing
calculation for loans at or below the GSE conforming loan limit and the
new calculation contained in Section 6(a) only for loans above the GSE
conforming loan limit. This amendment would not change the VA guaranty
for veterans who have not used their entitlement or have had their
entitlement fully restored, relative to H.R. 299. It would, however,
allow veterans greater opportunity to use zero-down payment financing
for their second homes. We would also recommend that such amendments
clarify the application of existing VA policies regarding restoration
of entitlement, including any changes to this process.
We therefore support this section of the legislation, provided that
it is amended per the recommendations described above.
Section 6(b)
Section 6(b) of H.R. 299 changes the VA loan fee schedule. The
changes to the schedule, which are summarized below, would increase the
overall fees collected from veterans in association with VA-guaranteed
loans. The changes would also equalize the fees paid by active duty
veterans and reservists, as reservists often pay higher fees in the
current system.
It appears that these increased loan fees are serving to offset
other expenditures contained in the legislation. And while we are not
offering comments on the efficacy of the healthcare provisions of the
legislation, we firmly believe that mortgage borrowing costs should not
be increased to pay for non-housing-related expenditures. The loan fees
charged to veterans should reflect the credit risk associated with the
VA guaranty, and any fee increases that are unrelated to this risk
unnecessarily raise the cost of mortgage credit for veterans. As such,
we oppose any changes to VA loan fees that do not correspond to the
credit risk associated with the VA guaranty.
The table that follows displays the change in VA loan fees from the
existing baseline for each loan type, borrower type, and closing
date.\1\
---------------------------------------------------------------------------
\1\ Fees are expressed as a percentage of the total amount of the
loan guaranteed, insured, or made, or, in the case of a loan
assumption, the unpaid principal balance of the loan on the date of the
transfer of the property. Red cells indicate an increase in the fee.
Green cells indicate a decrease in the fee. Yellow cells indicate no
change in the fee.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Section 6(c)
Section 6(c) of H.R. 299 requires VA loan fees to be collected from
veterans with service-connected disabilities rated as less than total,
surviving spouses of such veterans, or veterans that receive a loan in
excess of the GSE conforming loan limit. This section also exempts
veterans serving on active duty who were awarded the Purple Heart from
paying VA loan fees. Under existing law, VA loan fees are not collected
from veterans receiving compensation (or eligible to receive
compensation) due to a service-connected disability or from surviving
spouses of veterans who died due to a service-connected disability.
As noted above with respect to Section 6(b), it is unclear that
this provision, which would have the effect of increasing the overall
fees collected through the VA Home Loans program, is being proposed due
to a commensurate change in the credit risk profile or the financial
health of the program. Veterans with service-connected disabilities
have sacrificed for their country, and the existing waiver from paying
VA loan fees is an appropriate benefit. We would strongly oppose
removing this benefit for the purpose of raising funds to offset non-
housing-related expenditures.
Similarly, the purchase of a home with a loan that exceeds the GSE
conforming loan limit is unrelated to the veteran's service-connected
disability. Because the VA loan fees are expressed as a percentage of
the loan, veterans who purchase more expensive homes already pay higher
absolute fees than comparable veterans who purchase homes using loans
below the GSE conforming loan limit. The proposed legislation would
prevent veterans with service-connected disabilities from utilizing
their fee waiver if they purchase a more expensive home, but the
purpose of the waiver is not influenced by the size of the loan. If
Congress determines that veterans with such disabilities warrant a fee
waiver, the size of the loan should not be a relevant factor in that
determination. In other words, we believe that veterans with similar
disabilities should be treated equally, regardless of the value of
their home or the size of the loan that is used. As such, we oppose
Section 6(c)(2) of the legislation.
Section 7
Section 7 of H.R. 299 allows VA-approved appraisers to conduct
appraisals solely on the basis on information gathered and provided by
a third party. Under existing law, VA maintains a list of approved
appraisers who are selected on a rotating basis to conduct appraisals
for properties to be financed with loans that will feature a VA
guaranty. Such appraisers must meet minimum qualifications to obtain
approved status, which are verified through written testing, sample
appraisals, training experience, and recommendations from other
appraisers. This process better ensures that the VA guaranty is
properly protected from inflated or otherwise inaccurate valuations.
In recent years, however, VA-guaranteed financing has been
inhibited in certain parts of the country due to appraiser shortages or
other difficulties in obtaining appraisals from approved individuals.
This problem is often more acute in rural communities where it may take
an approved appraiser many hours of travel to reach the property. In
these situations, appraisal ``turn times'' can be lengthy, which can
then delay closings, force extension of rate locks, or result in
penalty fees or the loss of earnest money deposits should the borrower
opt for a non-VA-guaranteed loan.
Allowing appraisers the ability to receive property information
from third parties could effectively address this problem by scaling
back the travel time required of appraisers. This provision could also
allow appraisers to make better use of the improved technology that is
facilitating large-scale data collection by industry vendors.
Importantly, while the appraiser is relying on information provided by
a third party, the responsibility for conducting the appraisal remains
with the approved individual.
However, the legislation as currently drafted provides that VA
``may'' issue guidance prior to prescribing regulations to implement
this change. We would recommend that VA instead be required to issue
guidance ahead of any regulations that are prescribed. This guidance
should include details regarding the standards that must be met in
terms of the collection of property information by third parties. VA
has already issued similar guidance with respect to third parties that
provide loan underwriting services, such as verification of borrower
income, employment, and assets.\2\ And while VA may clarify standards
for the use of third parties in any implementing regulations, it is
important that there be no confusion in the market prior to the
issuance of these regulations, and therefore guidance should be
required prior to the effective date of this section.
---------------------------------------------------------------------------
\2\ VA, ``Clarification of Third-Party Verification Requirements,''
Circular 26-17-43, December 29, 2017. Available at: https://
www.benefits.va.gov/homeloans/documents/circulars/26_17_43.pdf.
---------------------------------------------------------------------------
Similarly, to allow for additional flexibility in VA's
implementation of this provision, we would recommend that the language
be amended to clarify that VA may also enter into such agreements with
third parties.
We therefore support this section of the legislation, provided that
it is amended per the recommendations described above.
Further Improvements to the Seasoning Requirements for VA Refinances
We also respectfully urge the Committee to support technical
amendments to the recently passed S. 2155, the Economic Growth,
Regulatory Relief, and Consumer Protection Act. In particular, Section
309 of the legislation, which provides enhanced requirements on VA
refinances that we believe will effectively address the problem of loan
churning, has caused inadvertent disruptions in this market and is in
need of revision.
We appreciate and endorse the urgent need to respond to the
increased churning of veteran borrowers in recent years. In many
situations, borrowers are the target of aggressive and potentially
misleading advertising that encourages them to continually refinance
their VA-guaranteed mortgage so as to lower their interest rate, even
if only by a small amount. However, when fees are then added to the
principal balance of the loan, the borrower may be put in a position in
which there is no realistic possibility that the fees can be recouped
through the lower monthly payments. This practice directly harms
veterans and lowers demand for Ginnie Mae mortgage-backed securities
(MBS), thereby raising borrowing costs for loans guaranteed or insured
through a wider array of government mortgage programs.
To address this problem, MBA supported Section 309 of S. 2155,
which includes new requirements on refinanced loans to achieve
eligibility for a VA guaranty and Ginnie Mae pooling. One such
requirement is a minimum seasoning period for the prior loan. For both
VA and Ginnie Mae eligibility, at least 210 days must have passed
between the date of the first payment made by the borrower on the prior
loan and the note date of the refinance. This seasoning period is
intended to slow the pace of refinances, thereby deterring extreme
cases of serial refinancing.
While we support the use of a minimum seasoning requirement, the
implementation of Section 309 has led to unexpected disruptions in the
market. This result has occurred because the seasoning calculation
described above differs from--and is longer than--that of the seasoning
requirement instituted by Ginnie Mae through a prior All Participant
Memorandum.\3\ Ginnie Mae's existing standard requires 210 days to pass
between the first payment due date of the prior loan and the first
payment due date of the refinance. The seasoning calculation in Section
309 differs in both the start point and end point for this timeline.
---------------------------------------------------------------------------
\3\ Ginnie Mae, ``APM 17-06: Pooling Eligibility for Refinance
Loans and Monitoring of Prepay Activity,'' December 7, 2017. Available
at: https://www.ginniemae.gov/issuers/program_ guidelines/Pages/
mbsguideapmslibdisppage.aspx?Para mID=82.
---------------------------------------------------------------------------
Because there was no effective date provided in the legislation,
the new requirements took effect immediately. Notably, VA implemented
the requirements of Section 309 for all loans with applications taken
on or after May 25, 2018.\4\ Ginnie Mae, however, has followed a
Department of Housing and Urban Development (HUD) interpretive rule
which states that, while Ginnie Mae securities issued in May 2018 or
earlier are unaffected, no VA refinances can be included in issuances
in June or later unless they are compliant with the new
requirements.\5\
---------------------------------------------------------------------------
\4\ VA, ``Policy Guidance Update: VA Refinance Loans and the
Economic Growth, Regulatory Relief, and Consumer Protection Act,''
Circular 26-18-13, May 25, 2018. Available at: https://
www.benefits.va.gov/HOMELOANS/documents/circulars/26_18_13.pdf.
\5\ HUD, ``Government National Mortgage Association: Loan Seasoning
for Ginnie Mae Mortgage-Backed Securities--Interpretive Rule,'' July 3,
2018. Available at: https://www. Federalregister.gov/documents/2018/07/
03/2018-14354/government-national-mortgage-association-loan-seasoning-
for-ginnie-mae-mortgage-backed.
---------------------------------------------------------------------------
As a result, some VA refinances that were in process or recently
closed at the time the legislation was signed into law in late May lost
their eligibility to serve as collateral for Ginnie Mae MBS. These
``orphaned'' loans cannot be delivered to Ginnie Mae despite carrying a
valid VA guaranty and being fully compliant with the requirements in
place at the time the applications were taken and (in some cases) the
loans were closed. This situation has caused liquidity strains for some
lenders, particularly if they have originated a significant volume of
affected loans.
MBA has noted in formal comments to HUD that this outcome does
nothing to advance the legislative aim of the statute, actively
frustrates the purpose of the statute, and ignores both congressional
intent and the historical relationship between VA and Ginnie Mae.\6\ To
effectively address this problem, we strongly urge Congress to
undertake technical corrections needed to restore Ginnie Mae
eligibility for the orphaned loans and align the VA seasoning
requirements with those of the other government mortgage programs.
---------------------------------------------------------------------------
\6\ MBA, ``Re: Government National Mortgage Association: Loan
Seasoning for Ginnie Mae Mortgage-Backed Securities--Interpretive Rule
[Docket No. FR-6112-IA-01],'' July 12, 2018. Available at: https://
www.mba.org/Documents/MBA_HUD_Interpretive_Rule_Ginnie_Mae_Loan_
Seasoning(0).pdf.
---------------------------------------------------------------------------
These technical corrections would entail two components. First, the
Ginnie Mae seasoning requirement in Section 309(b) of the legislation
should be eliminated. By striking this language, Ginnie Mae would no
longer be prohibited from guaranteeing MBS backed by the orphaned VA
refinances, which would effectively restore the eligibility of the
loans for pooling. This correction would not diminish the anti-churning
purpose of the legislation, as the seasoning requirements would remain
a condition of the VA guaranty, which itself is a condition of Ginnie
Mae pooling. Therefore, VA loans that do not meet the seasoning
requirements prior to refinancing would not be eligible to serve as
collateral for Ginnie Mae MBS.
Second, the seasoning period defined in Section 309(a) of the
legislation should be amended to match that of the earlier Ginnie Mae
requirements. That is, 210 days should be required to pass between the
first payment due date of the prior loan and the first payment due date
of the refinance. This amended calculation would align the VA seasoning
requirement with those of the other government mortgage programs. And
importantly, it would also facilitate improved adoption in the market,
as the current calculation suffers from the fact that many lenders are
unable to determine the date on which the first payment on the prior
loan was made by the borrower. Without this information, it is
impossible for lenders to be certain that they are compliant with the
new requirements.
These technical corrections would address a pressing need in the
current market and would allow for more sensible implementation of
these important anti-churning provisions on an ongoing basis. We
strongly urge the Committee to work with the Committee on Banking,
Housing, and Urban Affairs and other relevant stakeholders to enact
these corrections as soon as possible.
* * *
MBA appreciates the opportunity to provide our views regarding H.R.
299, as well as the ongoing problems related to VA refinances that are
ineligible to serve as collateral for Ginnie Mae securities. We look
forward to our continued work with the Committee as it undertakes
issues that are critical to maintaining veterans' access to safe,
reliable, and affordable mortgage credit.
______
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Military Officers Association of America
Chairman Isakson, Ranking Member Tester, and Members of the
Committee on Veterans' Affairs, The Military Officers Association of
America (MOAA) is pleased to submit its views on pending legislation
under consideration.
MOAA does not receive any grants or contracts from the Federal
Government.
executive summary
On behalf of the 350,000 members of MOAA, the largest military
service organization representing the seven uniformed services,
including active duty and Guard and Reserve members, retirees,
veterans, and survivors and their families, thank you for your
commitment and enduring support of our Nation's servicemembers and
veterans and their families.
MOAA offers our position on the following bills.
H.R. 299, Blue Water Navy Vietnam Veterans Act of 2018
S. __, Veterans Dental Care Eligibility Expansion and
Enhancement Act of 2018
Discussion Draft on Transition Assistance Reform
S. 1596, BRAVE Act of 2017
S. 1952, VA Financial Accountability Act of 2017
S. 1990, Dependency and Indemnity Compensation Improvement
Act of 2017
S. 2748, BATTLE for Servicemembers Act
S. __, Grant Program on Provision of Suicide Prevention
Services for Veterans
S. __, Modernization of Medical Records Access for
Veterans Act
S. 514, No Hero Left Untreated Act
MOAA takes no position on: S. 3148; S. __, VA Hiring Enhancement
Act; S. 5418, Veterans Affairs Medical-Surgical Purchasing
Stabilization Act; S. 2881, Mare Island Naval Cemetery Transfer Act;
and S. 2485, Medal of Honor Surviving Spouses Recognition Act.
pending legislation
H.R. 299, Blue Water Navy Vietnam Veterans Act of 2018.
MOAA supports this legislation.
MOAA has always supported restoring the presumption of herbicide
exposure to Blue Water Navy Veterans. MOAA further supports the
extension of the presumption to veterans who served on the Korean DMZ
from Sept. 1, 1967, to Aug. 31, 1971, as well as benefits to children
born with spina bifida of veterans who served in Thailand during the
Vietnam conflict.
MOAA is disappointed that the only way found to fund these benefits
was raising VA home loan fees. This places the financial burden solely
on the 1 percent of the U.S. population who served their nation in time
of conflict and relieves the remaining 99 percent of our Nation's
population of bearing any financial responsibility or liability. Those
who sacrificed will continue to sacrifice and subsidize a solution to
resolve the toxic exposure of veterans who provided our Nation's
security and defense.
MOAA is grateful the legislation includes a provision proposed by
MOAA to use a portion of these funds toward a report on a follow-up
study on certain Gulf War illnesses. It is clear the reason Vietnam
veterans have had exceptional difficulty in obtaining VA benefits for
their conditions was the direct result of the failure of the Department
of Defense to accurately and adequately maintain records of toxic
exposures. MOAA asks for this Committee to work collaboratively with
the Committee on Armed Services to ensure future generations of
veterans are not placed in the same predicament.
S. __, Veterans Dental Care Eligibility Expansion and Enhancement Act
of 2018
MOAA supports this legislation and requests Congress provide the
associated funding needed to support the legislative requirements of
this bill.
It is well established that dental health correlates to overall
health and affects vital functions such as overall nutrition. According
to studies, cost barriers are the biggest burden to obtaining dental
services and the burden is considerably higher than it is for other
health care services.\1\ Many disabled veterans are unable to either
afford paying for the cost of private dental care out-of-pocket or they
lack access to dental insurance, so they go without. MOAA supports a
pilot program to determine the overall health improvements made in
veterans' health given access to dental care, particularly in rural
areas.
---------------------------------------------------------------------------
\1\ Wall T, Guay A. The per-patient cost of dental care, 2013: a
look under the hood. Health Policy Institute Research Brief. American
Dental Association. March 2016. Available from:
http://www.ada.org/ /media/ADA/Science%20and%20Research/HPI/Files/
HPIBrief_0316_4.pdf
---------------------------------------------------------------------------
MOAA believes the cost of the initiative could be reduced by making
the pilot program smaller and still be able to assess overall health
improvements. Any pilot program, however, should include rural areas.
Discussion Draft on Transition Assistance Reform
MOAA supports this draft bill.
Military spouses experience some of the same issues servicemembers
face when transitioning out of the military; one of the most common
being finding employment. After having a resume filled with gaps in
employment and multiple moves, spouses often need the same
professional-development advice servicemembers need and receive through
the Transition Assistance Program (TAP). Additionally, it is vital
spouses are equally informed on veterans' benefits that not only affect
the servicemember but also their families. Often, spouses of
servicemembers handle family matters such as health care and financial
decisions, which are impacted by transition. TAP addresses these
changes, and it is important spouses, especially those who handle these
benefits for their families, are able to receive the information and
ask questions from the TAP instructors. MOAA is pleased to see
discussion on including military spouses in TAP, whereas previously
spouses could attend only if space was available.
MOAA understands the intent behind the waiver provision for members
who might not benefit from attending the program. The waiver provision,
however, does not contain a way for the member to express a desire or
ability to attend the program even though he or she might be eligible
for a waiver. The waiver is dictated by the services upon entire groups
who are ``unlikely to face major readjustment . . . to civilian life''
with no option for the member to override the waiver. This is
problematic, as individuals within those groups might, nonetheless,
have circumstances that would present them with such challenges and
have no way of accessing the program. MOAA recommends, for groups or
classifications designated by the service secretaries as being waived
from the program, that individual members have a way to opt into the
program nonetheless. The program, after all, is meant to benefit the
member, not the service, so the ultimate decision to waive off should
reside with the member and not the service.
For members ``possessing specialized skills'' who are unable to
attend the program ``to support the imminent deployment of a unit,''
MOAA would like the program to be made available to them within a year
of their separation from service. The November 2017 Government
Accountability Office report titled ``Transitioning Veterans; DOD Needs
to Improve Performance Reporting and Monitoring for the Transition
Assistance Program,'' noted over one-third (37 percent) of
servicemembers surveyed did not attend TAP at all, not even the core
curriculum portion, because they were not released from their duties
due to having mission-critical skills. Having over one-third of
transitioning servicemembers unprepared for their follow-in careers is
simply unacceptable. Allowing these servicemembers to participate
within a year of separating from service would ensure they still are
able to receive the training and assistance in a fashion that does not
compromise the mission.
MOAA further recommends the inclusion of information specific to
women veterans in the program. A Department of Veterans Affairs (VA)
employee recently shared a sentiment that MOAA has heard echoed both
from women veterans and the VA: ``Women veterans are still coming to us
in the VA not even knowing how to apply for all the benefits they rate.
They need to be educated prior to leaving service to ensure we can
effectively assist them once they get here.'' Data and experience have
identified areas where women veterans have unique experiences and needs
following transition, yet women veterans still are bypassing the VA or
are arriving there unaware of what they should be doing to access the
women-specific benefits and services available to them in the
department. This indicates a failure in the agencies communicating
about the benefits and resources for women veterans.
S. 1952, Department of Veterans Affairs Financial Accountability Act of
2017
MOAA supports this legislation.
The VA Financial Accountability Act introduced by Sens. Jon Tester
(D-Mont.), John McCain (R-Ariz.), Jerry Moran (R-Kan.), and Tim Kaine
(D-Va.) would improve the oversight and accountability of VA financial
processes.
The bill provides a sense of Congress as to what a normal or
standard budget process should look like for the VA in seeking future
appropriations:
The process should be grounded in sound actuarial analysis
based on accurate demand data for forecasting.
The regular budget process should be the norm.
Requests for supplemental appropriations should be used
sparingly and for unforeseen demand or natural occurrences.
More specifically, the VA would be required to contract with an
independent third party to: review and audit financial processes and
reporting structures, including actuarial and estimation models and
develop recommendations for financial system improvements. The
secretary of the VA then would submit a plan for implementing the
report recommendations to both the Senate and House Committees on
Veterans' Affairs. One individual within the Office of the Secretary
would be responsible for monitoring the status and implementation of
the recommendations.
The secretary also would be required to notify Congress not later
than 45 days in advance of a request for supplemental appropriation for
budgetary issues outside of the standard budget process. The VA chief
financial officer (CFO) would be required to provide a statement with
supporting materials to the Committees assuring financial projections
submitted with the president's annual budget request is sufficient to
provide benefits and services in the department. Additionally, the CFO
must certify responsibility for internal controls and collaboration
with department financial officers of all facilities and components
when submitting the VA's annual budget.
MOAA, like lawmakers, recognizes VA fiscal problems cannot continue
to be fixed by adding more money to the budget, particularly during
fiscally constrained times. Implementation of the Choice Program and
ongoing funding crises in recent years have brought to light a number
of problems associated with VA financial, data management, and
forecasting systems. MOAA supports the VA Financial Accountability Act
and believes the audit and certification provisions in the bill are
long overdue and a much needed move in the right direction to get the
VA's fiscal house in order.
S. 1596, BRAVE Act of 2017
MOAA supports this legislation and requests Congress provide the
associated funding needed to support the legislative requirements of
this bill.
The BRAVE Act would correct a long-overdue shortfall that places an
unnecessary burden on surviving families. In 2017, the average funeral
cost over $8,000.\2\ The current VA reimbursement rate of $300 for
veterans not dying of a service-connected disability amounts to less
than 4 percent of the costs a surviving family may incur. The current
reimbursement rates for the family of a veteran dying of a service-
connected cause amounts to 25 percent of the total potential cost.
Using the Consumer Price Index to increase these amounts periodically
is a logical solution to attempting to alleviate some of the burden
that results from these low reimbursement amounts.
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\2\ National Funeral Directors Association, Statistics, available
at http://www.nfda.org/news/ statistics
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S. 1990, Dependency and Indemnity Compensation Improvement Act of 2018
MOAA is supportive of this legislation, pending modification. We
request Congress provide the associated funding needed to support the
legislative requirements of this bill.
The Dependency and Indemnity Compensation Improvement Act would
make important changes to Title 38: It would change the computation of
Dependency and Indemnity Compensation (DIC); it would reduce from 10
years to five the number of years a veteran must be rated permanently
disabled for a survivor to become eligible for DIC; and it would reduce
from 57 to 55 the age at which a surviving spouse may remarry and
retain DIC.
The Dependency and Indemnity Compensation Improvement Act would
change the computation of DIC to 55 percent of the rate of pay for a
100-percent-disabled veteran. Changing the formula for how DIC is
calculated would make the benefit more in line with that of other
Federal programs. The change would provide approximately $300 more per
month for qualified survivors.
MOAA commends the desire to increase DIC payments. The increase in
tax-free compensation would be a welcomed addition to qualified
survivors. However, the bill, as currently written, omits an important
provision contained in previous military survivor bills. MOAA would
like to see the following language incorporated into the bill:
(g) In the case of an individual who is eligible for Dependency
and Indemnity Compensation under this section who is also
eligible for benefits under another provision of law by reason
of such individual's status as the surviving spouse of a
veteran, then, notwithstanding any other provision of law
(other than section 5304(b)(3) of this title), neither a
reduction nor an offset in benefits under such provision shall
be made by reason of such individual's eligibility for benefits
under this section.
The bill also lowers the number of years a veteran must be rated
100 percent disabled for a survivor to qualify for DIC. MOAA supports a
graduated scale of benefits after five years of being rated permanently
and totally disabled for surviving spouses of veterans.
The bill also would lower from 57 to 55 the age at which a
surviving spouse may remarry and retain DIC benefits. The change would
align DIC with other Federal programs. MOAA supports this change.
As Members of the Committee know, the Survivor Benefit Plan (SBP)
and DIC are benefits paid for two distinct reasons. SBP is a voluntary,
member-purchased annuity provided by DOD, allowing a continuation of a
portion of military retired pay upon the death of the servicemember.
DIC is a VA-paid monetary benefit for eligible survivors whose sponsors
died of a service-connected injury or disease. MOAA remains steadfast
believing the only way to end the unfair treatment of survivors of
military retirees and those killed in the line of duty is to repeal
SBP-DIC offset.
S. 2748, BATTLE for Servicemembers Act
MOAA supports this legislation and requests Congress provide the
associated funding needed to support the legislative requirements.
The November 2017 Government Accountability Office report titled
``Transitioning Veterans; DOD Needs to Improve Performance Reporting
and Monitoring for the Transition Assistance Program,'' noted that
participating in the two-day additional classes offered through TAP was
thwarted by ``lack of commander support'' and that 57 percent of the
installations that GAO spoke to stated ``commanders and direct
supervisors were less inclined to allow servicemembers to attend these
classes because they were considered optional.'' The lack of
opportunity by these servicemembers to participate in such an important
transition program element defies the intent and institutional rigor
dedicated to transition programs in the first place.
Changing the two-day classes from an opt-in model to a member opt-
out model has the potential to minimize this level of command
interference and to reinforce the importance of the program to a
transitioning servicemember's future career.
S. __, Grant Program on Provision of Suicide Prevention Services for
Veterans
MOAA supports this legislation and requests Congress provide the
associated funding needed to support the legislative requirements.
The bill requires the secretary of Veterans Affairs to establish a
program to award grants to persons to provide and coordinate the
provision of suicide prevention services for veterans transitioning
from service in the Armed Forces who are at risk of suicide and for
their families, and for other purposes. It augments existing VA
programs and is a natural extension of those resources.
The bill is comprehensive in its attempt to capture the key
functional requirements to provide suicide prevention services for
veterans and their families. The focus and priority is placed on
veterans and families who live away from any VA medical center and are
located in more rural or tribal areas, which MOAA supports given the
sparsity of resources in those areas. MOAA would like the legislation
to emphasize that this legislation will not compete with or be a
replacement for existing VA suicide prevention services, but is
intended only as a compliment to what VA provides.
It is anticipated that programs selected will have a history of
providing these services along with the relevant programmatic and
professional credentialing. A brief review of grants and activities of
SAMSHA (Substance Abuse and Mental Health Services Administration)
shows a wide variety of public/private and community partnership
activities and programs and certified community behavioral health
clinics. Given the existing precedent in other areas, veterans should
be allowed to benefit from such arrangements, as well.
MOAA specifically appreciates including services for families under
grant uses as family members feel the direct impact of the mental
health of their veteran and this, in turn, can influence their own
mental health.
S. __, Modernization of Medical Records Access for Veterans Act
MOAA does not support this legislation.
This bill would direct the VA to carry out, in at least one
Veterans Integrated Services Network (VISN), a pilot program for at
least a 12-month period during which veterans enrolled in the VA's
patient enrollment system will use a portable medical records storage
system to store and share with VA health care providers and community
health care providers records of their individual medical histories.
This is specified to be similar in nature and characteristics to a
standard credit card. The bill also prohibits new appropriations in
carrying out this pilot.
MOAA is supportive of a system that would enable veterans who
receive care from non-VA providers to be able to consolidate their VA
and non-VA records in an effective and efficient manner. This is
important to ensure continuity of care and accuracy of treatment. MOAA
does not support, however, the express prohibition on new
appropriations to carry this initiative out. Unfunded mandates have the
significant potential to harm other VA programs from which the funds
are extracted. Further, MOAA has supported the implementation of the
current VA electronic health record initiative and believes that a
solution for needs such as these could be satisfied through that system
if properly implemented.
S. 514, No Hero Left Untreated Act
MOAA supports this legislation.
This legislation would establish a pilot program within the VA on a
promising neurological treatment option for mental trauma called
magnetic EEG/EKG-guided resonance therapy, also known as Magnetic
eResonance Therapy (MeRT). This is an individualized non-
pharmaceutical, non-invasive neuromodulation procedure that applies
magnetic stimulation to restore proper brain function. To date, open
label trials and placebo-controlled, double-blind studies indicate over
400 veterans have reported a marked improvement in symptoms associated
with PTS, TBI, MST, chronic pain, and opiate addiction. One study done
at Tinker Air Force Base, after four weeks of testing, specifically
concluded, ``Transcranial MeRT is a promising adjuvant treatment
modality to help veterans suffering from PTSD.''
MOAA believes there is sound research to support a pilot on 50
veterans. MOAA also notes the bill prohibits new appropriations to
carry out the pilot program. Although MOAA generally objects to
unfunded mandates, the fact this pilot is limited to 50 veterans and
only requires VA to provide ``access to'' the treatment vice directly
rendering the treatment, MOAA believes the cost will be negligible.
MOAA thanks the Committee for considering these important pieces of
legislation, and we look forward to working with Members of Congress in
making the necessary changes listed above and to move the bills quickly
through the Congress for final passage.
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Prepared Statement Submitted by Aleks Morosky, National Legislative
Director, Military Order of the Purple Heart
Chairman Isakson, Ranking Member Tester, and Members of the
Committee, On behalf of the Military Order of the Purple Heart (MOPH),
whose membership is comprised entirely of combat wounded veterans, I
thank you for inviting us to submit our views on pending legislation.
For the purposes of this statement, we will focus our comments on H.R.
299, the Blue Water Navy Vietnam Veterans Act of 2018, specifically
section 6(c), which extends the Department of Veterans Affairs (VA)
Home Loan funding fee waiver to Purple Heart recipients serving on
active duty in the Armed Forces.
As its name implies, the Blue Water Navy Vietnam Veterans Act deals
in large part with extending presumptive service connection for
conditions related to Agent Orange exposure to veterans who served
offshore of the Republic of Vietnam from January 9, 1962 to May 7,
1975. It would also grant the same presumptive service connection for
veterans who served on the Korean Demilitarized Zone from September 1,
1967 to August 31, 1971, extend benefits to the children born with
spina bifida to certain veterans who served in Thailand, and require VA
to submit an updated report on its Gulf War Illness study. MOPH
supports all of these provisions.
This legislation also makes a number of technical changes to the VA
Home Loan Program. Among those is section 6(c), which would extend the
VA home loan funding fee waiver to active duty Purple Heart recipients.
Since VA home loans require no down payment or mortgage insurance, the
funding fee is used to cover any losses VA may incur in guaranteeing
the loans. The fees for first time users of the program are between
2.15 and 2.4 percent of the loan amount, and may be paid upfront or
financed as part of the loan. While the VA Home Loan Program is a
valuable benefit, the funding fee generally adds thousands of dollars
to the final amount of the loan. However, disabled veterans and
surviving spouses of veterans who died of service-connected
disabilities are eligible to have the funding fee waived as a benefit
of their service.
Combat wounded veterans still serving on active duty, however, are
required to pay the funding fee in all cases. MOPH strongly believes
that these veterans, the vast majority of whom will almost certainly be
eligible for some level of service-connected disability rating upon
separation, should be entitled to the funding fee waiver on the same
basis as disabled veterans who have already been discharged. Many
active duty Purple Heart recipients were severely wounded in Iraq and
Afghanistan, and spent many months recovering in military hospitals
before they were able to return to duty. Others may spend months or
years in military hospitals before ultimately receiving medical
discharges, but may wish to purchase homes during that period of
recovery. MOPH sees absolutely no reason why they should be penalized
by the VA Home Loan Program in any way, simply because they continue to
serve on active duty in some capacity.
This issue was first brought to our attention by a MOPH member,
Major Byron Owen, United States Marine Corps. A multiple Purple Heart
recipient, Major Owen was wounded twice in Iraq in 2006, and again in
Afghanistan in 2008. After recently deciding to use his VA Home Loan
benefit, and being aware that veterans with service-connected
disabilities are exempt from the funding fee, he was frustrated to
discover that he was not eligible for the waiver as an active duty
servicemember. In his own words:
``I think they (VA) unfairly punish active duty personnel who
choose to remain in uniform instead of accept medical
separation or retirement. I was medevac'd out of Iraq in 2006
and had to undergo months of therapy to return to service. Why
should I have to pay 20 grand to get a VA loan when someone
with a non-combat related disability gets to waive it? Some of
my friends are amputees in uniform. They're paying the funding
fee. Does that seem right? I think someone should advocate on
the behalf of active duty Purple Heart recipients who would
almost certainly receive service-connected disability payments
if we were out.''
MOPH strongly agrees with Major Owen, and stands with him and the
approximately 8,000 other Purple Heart recipients currently serving on
active duty in the U.S. military. Veterans who have been wounded in
combat with the enemies of our Nation have made incredible sacrifices,
and under no circumstances should they be excluded from a benefit as
significant as the VA Home Loan funding fee waiver, simply because of
their duty status. We strongly urge the Committee to correct this
injustice by passing H.R. 299 without delay.
Chairman Isakson, Ranking Member Tester, this concludes my
statement. On behalf of the Order, I thank you for the opportunity to
submit our statement, and would be happy to answer any questions for
the record that you or other Members of the Committee may have.
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Prepared Statement Submitted by CDR John B. Wells, USN (Ret.),
Executive Director, Military-Veterans Advocacy
introduction
Distinguished Chairman Johnny Isakson, Ranking Member Jon Tester
and other Members of the Committee, Thank you for the opportunity to
present Military-Veterans Advocacy's views on H.R. 299, the Blue Water
Navy Vietnam Veterans Act of 2017.
about military-veterans advocacy
Military-Veterans Advocacy Inc. (MVA) is a tax exempt IRC 501[c][3]
organization based in Slidell, Louisiana that works for the benefit of
the Armed Forces and military veterans. Through litigation, legislation
and education, MVA seeks to obtain benefits for those who are serving
or have served in the military. In support of this, MVA provides
support for various legislation on the State and Federal levels as well
as engaging in targeted litigation to assist those who have served.
Along with the Blue Water Navy Vietnam Veterans Association, Inc
(BWNVVA) and the Fleet Reserve Association (FRA), MVA has been the
driving force behind the Blue Water Navy Vietnam Veterans Act
(H.R. 299). Working with Members of Congress and United States Senators
from across the political spectrum, MVA and BWNVVA provided technical
information and support to sponsors who have worked tirelessly to
partially restore the benefits stripped from the Blue Water Navy
veterans sixteen years ago. H.R. 299 passed the House of
Representatives by a bi-partisan and unanimous vote of 382-0.
military-veterans advocacy's executive director
commander john b. wells, usn (ret.)
MVA's Executive Director, Commander John B. Wells, USN (Retired),
has long been viewed as the technical expert on H.R. 299. A 22-year
veteran of the Navy, Commander Wells served as a Surface Warfare
Officer on six different ships, with over ten years at sea. He
possessed a mechanical engineering subspecialty, was qualified as a
Navigator and for command at sea, and served as the Chief Engineer on
several Navy ships. As Chief Engineer, he was directly responsible for
the water distillation and distribution system. He is well versed in
the science surrounding this bill and is familiar with all aspects of
surface ship operations. This includes the hydrological effect of wind,
tides and currents.
Since retirement, Commander Wells has become a practicing attorney
with an emphasis on military and veterans law. He is counsel on several
pending cases concerning the Blue Water Navy and has filed amicus
curiae briefs in other cases. He has tried cases in state, Federal,
military and veterans courts as well as other Federal administrative
tribunals. Since 2010 he has visited virtually every Congressional and
Senatorial offices to discuss the importance of enacting a bill to
partially restore benefits to those veteran who served in the bays,
harbors and territorial seas of the Republic of Vietnam. He is also
recognized in the veterans community as the subject matter expert on
this matter.
historical background surrounding h.r. 299
In the 1960's and the first part of the 1970's the United States
sprayed over 12,000,000 gallons of a chemical laced with 2,3,7,8-
Tetrachlorodibenzodioxin (TCDD) and nicknamed Agent Orange over
southern Vietnam. This program, code named Operation Ranch Hand, was
designed to defoliate areas providing cover to enemy forces. Spraying
included coastal areas and the areas around rivers and streams that
emptied into the South China Sea. By 1967, studies initiated by the
United States government proved that Agent Orange caused cancer and
birth defects. Similar incidence of cancer development and birth
defects have been documented in members of the United States and Allied
Armed Forces who served in and near Vietnam.
Throughout the war, the United States Navy provided support for
combat operations ashore. This included air strikes and close air
support, naval gunfire support, electronic intelligence, interdiction
of enemy vessels and the insertion of supplies and troops ashore.
Almost every such operation was conducted within the territorial seas
of the Republic.
The South China Sea is a fairly shallow body of water and the
thirty fathom curve (a fathom is six feet) extends through much of the
area designated in the bill. The gun ships would operate as close to
shore as possible. The maximum effective range of the guns required
most operations to occur within a few thousand yards of shore.
It was common practice for the ships to anchor while providing
gunfire support. Digital computers were not yet in use and the fire
control systems used analog computers. By anchoring, the ship's crew
was able to achieve a more stable fire control solution, since there
was no need to factor in their own ship's course and speed. It was also
common for ships to steam up and down the coast at high speeds to
respond to call for fire missions, interdict enemy sampans and other
operational requirements.
agent orange act of 1991
In 1991, the Congress passed and President George H. W. Bush
signed, the Agent Orange Act of 1991, Pub.L. 102-4, Feb. 6, 1991, 105
Stat. 11. This Federal law required VA to award benefits to a veteran
who manifests a specified disease and who ``during active military,
naval, or air service, served in the Republic of Vietnam during the
period beginning on January 9, 1962, and ending on May 7, 1975.''
The Department of Veterans Affairs (hereinafter VA) drafted
regulations to implement the Agent Orange Act of 1991 and defined
``service in the Republic of Vietnam'' as ``service in the waters
offshore and service in other locations if the conditions of service
involved duty or visitation in the Republic of Vietnam.'' 38 CFR
Sec. 3.307(a)(6)(iii) (1994). This was in contrast to a previous
definition which defined ``service in the Republic of Vietnam'' as
``service in the waters offshore, or service in other locations if the
conditions of service involved duty or visitation in Vietnam.'' 38 CFR
Sec. 3.313 (1991). The placement of the comma became critical in the
VA's interpretation. As a result of the comma's omission, benefits were
stripped from those who served in the bays, harbors and territorial
seas of Vietnam.
Originally, the VA interpreted the regulation to allow the
presumption of exposure throughout the Vietnam Service Medal area,
which is the dark solid line marked on the Exhibit. Under this
definition, a ballistic missile submarine was covered as were the
aircraft carriers on Yankee Station and submarines conducting
operations where no Agent Orange was sprayed. These ships would not be
covered under H.R. 299.
In 1997 the VA General Counsel issued a precedential opinion
excluding servicemembers who served offshore but not within the land
borders of Vietnam. The opinion construed the phrase ``served in the
Republic of Vietnam'' as defined in 38 U.S.C. Sec. 101(29)(A) not to
apply to servicemembers whose service was on ships and who did not
serve within the borders of the Republic of Vietnam during a portion of
the ``Vietnam era.'' The opinion stated that the definition of the
phrase ``service in the Republic of Vietnam'' in the Agent Orange
regulation, 38 CFR Sec. 3.307(a)(6)(iii), ``requires that an individual
actually have been present within the boundaries of the Republic to be
considered to have served there,'' and that for purposes of both the
Agent Orange regulation and section 101(29)(A), service ``in the
Republic of Vietnam'' does not include service on ships that traversed
the waters offshore of Vietnam absent the servicemember's presence at
some point on the landmass of Vietnam.''
After lying dormant for a few years, this General Counsel opinion
was incorporated into a policy change that was published in the Federal
Register during the last days of the Clinton Administration. The final
rule was adopted in Federal Register in May of that year. Comments by
the VA concerning the exposure presumption recognized it for the
``inland'' waterways but not for offshore waters.
Historically the VA's Adjudication Manual, the M21-1 Manual,
allowed the presumption to be extended to all veterans who had received
the Vietnam service medal, in the absence of ``contradictory
evidence.'' In a February 2002 revision to the M21-1 Manual, the VA
incorporated the VA General Counsel Opinion and the May 2001 final rule
and required a showing that the veteran had set foot on the land or
entered an internal river or stream. This ``boots on the ground''
requirement is in effect today.
One exception to this rule deals with Non-Hodgkins Lymphoma. A
punctuation difference in the regulation allows the VA to exclude Navy
veterans suffering from other Agent Orange related illnesses.
hydrological effect
The Agent Orange that was sprayed over South Vietnam was mixed with
petroleum. The mixture washed into the rivers and streams and
discharged into the South China Sea. In addition, the riverbanks were
sprayed continuously resulting in direct contamination of the rivers.
The dirt and silt that washed into the river can be clearly seen
exiting the rivers and entering the sea. This is called a discharge
``plume'' and in the Mekong River it is considerable. Although the
Mekong has a smaller drainage area than other large rivers, it has
approximately 85% of the sediment load of the Mississippi. In two
weeks, the fresh water of the Mekong will travel several hundred
kilometers. Notably, the Agent Orange dioxin dumped off the east coast
of the United States was found in fish over one hundred nautical miles
from shore.
Eventually, the Agent Orange/petroleum mixture would emulsify and
fall to the seabed. Evidence of Agent Orange impingement was found in
the sea bed and coral of Nha Trang Harbor. During the Vietnam War, the
coastline, especially in the harbors and within the thirty fathom curve
was a busy place with military and civilian shipping constantly
entering and leaving the area in support of the war effort. Whenever
ships anchored, the anchoring evolution would disturb the shallow
seabed and churn up the bottom. Weighing anchor actually pulled up a
small portion of the bottom. The propeller cavitation from military
ships traveling at high speeds, especially within the ten fathom curve,
impinged on the sea bottom. This caused the Agent Orange to constantly
rise to the surface. Tidal effects mixed the contaminated river water
with the salt water in the territorial seas. The contaminated water was
ingested into the ship's evaporation distillation system which was used
to produce water for the boilers and potable drinking water. Navy ships
within the South China Sea were constantly steaming through a sea of
Agent Orange molecules.
judicial impact
This matter first came before the judiciary in 2006. Haas v.
Nicholson, 20 Vet. App. 257. The Haas court found that the veteran, who
was operating off the shoreline, was within the scope of the statutory
definition and invalidated the VA ``boots on the ground'' policy. The
Federal Circuit reversed in Haas v. Peake, 525 F.3d 1168, 1196 (Fed.
Cir. 2008) reh'g denied Haas v. Peake, 544 F.3d 1306, 1309 (Fed. Cir.
2008).
In 2015, the Court of Appeals for Veterans Claims considered
another Blue Water case, as it applied to bays and harbors, in Gray v.
McDonald, 27 Vet. App. 313 (2015). The Gray Court found the Secretary's
exclusion of Da Nang from their inland waterways definition was
arbitrary and capricious. Gray, 27 Vet. App. at 313. The Gray court
went on to note that the VA failed to address their rationale in
excluding areas where brown water and blue water mix, such as Da Nang
Harbor. Gray, supra., at 322. Stopping short of applying a definition
of inland waters, the Gray Court ruled that they would vacate the BVA
decision and remand the matter to the VA. The Secretary did not file an
appeal. The Secretary failed to follow the Gray court's guidance. A new
regulation issued in the M21-1 Manual on February 5, 2016 renewed the
same exclusionary policy used to deny the veterans their benefits. A
petition for review, pursuant to 38 U.S.C. Sec. 502, was filed in the
Court of Appeals for the Federal Circuit. The petition was dismissed
due to lack of jurisdiction. Gray v. MacDonald, 830 F.3d 570 (D.C. Cir.
2016). A petition for rehearing en banc was also denied 7-3. Gray v.
Sec'y of Veterans Affairs, 884 F.3d 1379 (Fed. Cir. 2018). A petition
for certiorari is pending in the Supreme Court of the United States.
Additionally, there is a case pending in the United States Court of
Appeals for the Federal Circuit, Procopio v. O'Rourke, 17-1821.
Briefing and oral argument have completed. Procopio asks the court to
extend the presumption of exposure to the territorial seas. Procopio,
assuming it is decided in favor of the veterans, will not resolve the
problem. Without the geographic designations incorporated into the
bill, the VA would be free to define the territorial seas as they
desired. Accordingly, H.R. 299 is needed to fix the area to be covered.
cost of h.r. 299
The Congressional Budget Office has scored H.R. 299 at $894 million
over ten years. This includes $882 million for the Blue Water component
and the remainder to provide expanded benefits to Korea DMZ veterans
and additional Spina Bifida benefits. H.R. 299 also called for an
increase in loan guarantee fees which will generate $1.165 billion over
ten years. Accordingly, H.R. 299 will result in a $271 million dollar
savings to the government over ten years.
The loan guarantee fees vary depending on whether there is a down
payment and whether it is the first or subsequent use of the home loan
benefit. The increased rates will vary between 1.25% and 3.30% and are
expected to cost the veteran $2.00 to $2.50 per month. Disabled
veterans will generally be exempt from the provision. The cap on jumbo
loans will be removed which will allow the VA to provide a guarantee on
the full amount of the loans. The disabled veteran exemption for jumbo
loans will not apply however, unless the veteran is 100% disabled.
The bill and the offset have generally received the support of the
Veterans Service Organizations. The exception seems to be a real estate
agent, George Varrato II, a Phoenix Realtor has objected to the offset
although he does not object to the bill. Varrato contacted the
undersigned several weeks ago but was unable to provide any substitute
offset significant enough to finance these benefits. He was also unable
to provide information on how many veterans would be affected by the
fees.
Although Military-Veterans Advocacy is unhappy with any offset for
additional veterans benefits, the reality of the situation is that they
are required by Pub. L. 111-139. Of the various offsets reviewed by
MVA, this offset seems the most innocuous.
common va misrepresentations
The VA has consistently opposed the expansion of the presumption of
exposure. On October 24, 2017, however, former Secretary Shulkin
expressed support for H.R. 299 in his testimony before the House
Veterans' Affairs Committee. Given the previous opposition, and the
lack of a confirmed Secretary to articulate the present VA position,
MVA feels compelled to address previous VA misrepresentations.
Some common VA misrepresentations are as follows:
Misrepresentation: The Australian distillation study was never peer
reviewed.
MVA Comment: The report was presented for review at the 21st
International Symposium on Halogenated Environmental Organic Pollutants
and POPs and is published in the associated peer reviewed conference
proceedings: Mller, J.F., Gaus, C., Bundred, K., Alberts, V., Moore,
M.R., Horsley, K., 2001. It was also reviewed and confirmed by two
separate committees of the Institute of Medicine.
Misrepresentation: There is no evidence that the evaporation
distillation process used by the Australians was the same as used on
United States ships.
MVA Comment: All steam ships used a similar system which remained
in place until the 1990's. In addition many of the Australian gun ships
were the United States Charles F. Adams class and were built in the
United States. Both the MVA Executive Director and another experienced
Navy Chief Engineer have reviewed the Australian report. They concluded
the distillation systems therein were the same as used by United States
Navy ships.
Misrepresentation: There is no evidence that Navy ships distilled
potable water.
MVA Comment: Ships carried a reserve of potable water but it was
normally replenished by distillation daily or every other day. A
Destroyer sized ship carried less than 20,000 gallons for a crew size
between 275 and 300 men. The water was used for cooking, cleaning,
laundry, showering and drinking. As Vietnam is in the tropics,
significant hydration was necessary. In addition, the warmer sea
injection temperature below the 17th parallel resulted in less
efficient water production. Water hours, where showers were limited or
banned, was common during tropical deployments. Water was constantly
being distilled to meet the requirements for boiler feed water and
potable water.
Misrepresentation: The Australian study monitored the reverse
osmosis system rather than the evaporation distillation system used on
United States Navy ships.
MVA Comment: The only time that the reverse osmosis system was used
in the Australian study was to purify the baseline sample prior to
adding the solids and sediments consistent with the estuarine waters of
Vietnam. The actual distillation process, as confirmed above, was the
same distillation system used by United States Navy ships.
Misrepresentation: The IOM found more pathways of Agent Orange
exposure for land based veterans than those at sea.
MVA Comment: Technically this is true but irrelevant. The IOM noted
that discharges from rivers and steams was a pathway unique to the Blue
Water Navy and that it was one of the plausible pathways of exposure.
The number of possible pathways is not determinative. What is
conclusive is that pathways of exposure existed. Misrepresentation: The
IOM could not quantify any Agent Orange in the water.
MVA Comment: This again is a red herring. Any amount of exposure
can do damage to the human body. The IOM also found that the
evaporation distillation process enriched the dioxin by a factor of
ten. This is consistent with Australian studies showing a higher cancer
incidence among Navy veterans and a Center for Disease Control study
showing a higher incidence of Non-Hodgkins Lymphoma among Navy
veterans.
Misrepresentation: Ships operating hundreds of miles off shore who
were not exposed will be given the presumption of exposure.
MVA Comment: Not true. This bill applies only to the territorial
seas which at their widest point off the Mekong extends out to 90
nautical miles from the mainland. In the central and northern part of
the Republic of Vietnam, the territorial seas would only extend 20-30
nautical miles from the mainland.
Misrepresentation: Submarines would come into the area to obtain
the Vietnam Service Medal for their crews and would be eligible for the
presumption.
MVA Comment: One ballistic missile submarine the USS Tecumseh, SSBN
628 did enter the VSM area for that purpose but there is no indication
that they entered the territorial seas. Submarines operating off of
Haiphong or near Hainan Island would not have been within the
territorial seas and are not covered by H.R. 299.
Misrepresentation: No Agent Orange was sprayed over water.
MVA Comment: Not true. MVA is in possession of statements from
witnesses that ships anchored in Da Nang Harbor were inadvertently
sprayed as the ``Ranch Hand'' planes made their approach to the
airfield. Additionally, there are anecdotal reports of defective spray
nozzles resulting in spray over the ships at anchor or operating in the
South China Sea. Finally, the IOM recognized that the offsetting winds
would blow some spray intended for the landmass over water.
Misrepresentation: Navy regulations prevented ships from distilling
water within ten miles of land.
MVA Comment: This statement was taken out of context from a
preventive medicine manual and was not a firm requirement. Ships were
encouraged to not distill potable water near land because of the
possibility of bacteriological contamination. Commanding Officers could
allow potable water to be distilled close to land and often delegated
that authority to the Chief Engineer. The IOM noted that the
recommendation contained in the manual was widely ignored. More
importantly, the recommendations in the manual did not apply to the
distillation of feed water for use in the boilers. Since the same
equipment was used for potable water, distillation to feed water would
contaminate the entire system down to the final discharge manifold.
Additionally, feed water used in auxiliary systems was discharged to
the bilges via low pressure drains. Crew members would also be exposed
to Agent Orange residue while cleaning and inspecting the watersides of
boilers and the steam sides of condensers as well as other equipment.
Misrepresentation: The IOM confirmed that there was no likelihood
of exposure to herbicides in Da Nang Harbor.
MVA Comment: The court in Gray v. McDonald, took the VA to task for
this statement noting that this was not the conclusion of the IOM.
conclusion
MVA urges the adoption of H.R. 299. It will restore the earned
benefits to tens of thousands of Navy veterans that were taken from
them over a decade ago. This bill is supported by virtually all
veterans organizations including the American Legion, Veterans of
Foreign Wars, Vietnam Veterans of America, Reserve Officers
Association, Fleet Reserve Association, Military Officers Association
of America, Association of the U.S. Navy and other groups. We have
always enjoyed the support of the Military Coalition. Enactment of this
legislation is overdue and Military-Veterans Advocacy most strongly
supports its passage.
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Prepared Statement of Joshua Stewart, Director of Policy, National
Coalition for Homeless Veterans
Chairman Isakson, Ranking Member Tester, and distinguished members
of the Senate Committee on Veterans' Affairs: The National Coalition
for Homeless Veterans (NCHV) is honored to present this statement for
the record for the legislative hearing of February 7, 2018. On behalf
of the 2,100 community- and faith-based organizations NCHV represents,
we thank you for your commitment to serving our Nation's most
vulnerable heroes.
This statement reflects NCHV's mission of ending veteran
homelessness and the bill presented at the hearing today that has the
potential to most strongly impact that mission. There are three actions
we should be carrying out as a country to further the goal of ending
veteran homelessness: 1) supporting and--only where necessary--
expanding current services, 2) spurring the creation of affordable
housing, and 3) filling service gaps in our current system. If passed
into law S. 1072, the Homeless Veterans Prevention Act of 2017, would
accomplish the first and last of these.
S. 1072 would fill long-standing, critical gaps in our service
delivery system. Despite years of progressively better services,
accumulated expertise, and best practices, there are still areas in
which we know we need to do better. For decades, the U.S. Department of
Veterans Affairs has conducted the CHALENG report and survey which
among other things identifies the unmet needs of homeless veterans. And
for decades, this report has consistently revealed that among the
highest unmet needs of male and female homeless veterans are help with
legal issues of all kinds. Family law plays a particularly prominent
role, but also legal issues revolving around restoring driver's
licenses, discharge upgrades, and financial issues are reported
annually. And of course, legal assistance to prevent eviction and
foreclosure is frequently reported.
The long term, consistent nature of this unmet need points to a
very real gap in our services. Section 3 of the Homeless Veterans
Prevention Act would go a long way to ameliorating these issues for
many veterans. The provision is well crafted and highlights the exact
service need, while also allowing the Secretary leeway to add
additional areas for legal services as he or she finds necessary.
Similar to legal service's frequent appearance on the CHALENG
report is the issue of dental care. The provision of dental care has
consistently appeared on the top unmet needs list of homeless veterans
for decades; in the most recent CHALENG report it was particularly
pronounced in the female homeless veteran population. Though important
in their own right, dental care is not merely a comfort or confidence
concern. Untreated dental needs can cause severe health issues, and
constant pain can be a trigger for self-medication and/or substance
abuse. Furthermore, pain or unsightly dental features can wreck the
confidence of a job seeker- causing a negative impact on the employment
potential of a veteran.
Extending dental care eligibility to homeless veterans in the HUD-
VA Supportive Housing and Grant and Per Diem (GPD) programs, as well as
those in the care of a Domiciliary, would be a huge step in the right
direction. And that is exactly what Section 4 of S. 1072 accomplishes.
In addition to filling these critical gaps in our service delivery
system, this bill would also support our existing programs in two
important ways; it allows the payment of per diem to GPD providers who
serve the dependents of homeless veterans, and it extends the authority
for the Supportive Services for Veteran Families (SSVF) program.
As we modernize GPD, our transitional housing program at the VA, it
becomes more and more clear that these providers need the authority to
serve dependents of homeless veterans. While there are a very few
providers who already do this, they must scrape together funding from
other sources to make it work. Many providers who see the importance of
this work and who wish to expand into it simply cannot make the math
work. They need support from VA to make this shift possible. As it is
now, veterans--in particular female veterans who statistically are more
likely to be accompanied by children in their homelessness--are faced
with the choice to get only themselves off the street or to stay with
their children. Many understandably choose family unity and wait for
permanent housing options together, out-of-doors. Section 2 of S. 1072
would open the door for many more GPD providers to serve dependents;
keeping families together, and improving the efficiency of our system.
Finally, S. 1072 supports our existing programs by extending the
authority for the SSVF program. But this is not merely a mundane annual
re-authorization, and nor can it be. Because of an historical quirk in
funding, there are 56 communities whose ``surge funding''--awarded in
FY 2015--expired at the end of FY 2017. To maintain the normal schedule
of funding ($300 million per annum) and prevent the loss of services
from the surge grants ($207 million over the next three years) the
funding for the SSVF program for FY 2018 must be no less than $400
million. A list of communities who received surge funding and who are
at risk of losing services without an increased FY 2018 appropriation
can be found at https://www.va.gov/HOMELESS/ssvf/docs/
SSVF_September2014_GrantRecipients.pdf.
Section 6 of S. 1072 provides the SSVF program an authorization of
$500 million, which would allow VA to redistribute another round of
surge funding at almost the same level as the FY 2015 round. This is
the best scenario, and one which NCHV heartily supports. Of course, we
must also point out that Section 6 would now need a technical
correction to proposed subparagraph (F), changing ``fiscal year 2017''
to ``fiscal year 2018,'' or even to ``fiscal year 2019.'' The latter
change would exacerbate the gap in services felt in communities, but
would allow the appropriations committees time to fully fund the
increased authorization.
This one technical correction notwithstanding, the Homeless
Veterans Prevention Act of 2017 is an outstanding piece of legislation.
NCHV strongly supports S. 1072, and asks the Senate and the House to
quickly pass it in its entirety. We thank the Senate Committee on
Veterans' Affairs for its tenacity on these issues, as well as the
bills long-time sponsor, Senator Burr. All of your work on behalf of
homeless veterans is commendable.
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Letter from Co-Directors of National Military and Veterans Alliance
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Prepared Statement of Paralyzed Veterans of America
Chairman Isakson, Ranking Member Tester, and Members of the
Committee, Paralyzed Veterans of America (PVA) would like to thank you
for the opportunity to submit our views for the record on the important
legislation pending before the Committee. The bills considered today
can have a significant positive impact on veterans and their families
who depend on the benefits and services available through the
Department of Veterans Affairs (VA). Our comments will be limited to
those bills in which PVA has a specific interest.
h.r. 299, the ``blue water navy vietnam veterans act of 2018''
PVA supports H.R. 299, the ``Blue Water Navy Vietnam Veterans Act
of 2018.'' This legislation would extend presumption of exposure to
herbicides containing dioxin, including Agent Orange, to veterans who
served in ``blue water'' areas. Before 1997, Vietnam Veterans were
eligible for a presumption of exposure to Agent Orange and other
herbicides if ``during active military, naval or air service they had
served in the Republic of Vietnam'' unless there was evidence they had
not been exposed to Agent Orange. This policy was later amended so that
service on the ground in Vietnam and service in inland waterways,
``brown water,'' was required to receive a presumption of exposure. PVA
applauds you for making the necessary amendments to include veterans
who served in ``blue water'' areas in the presumption.
draft bill, the ``veterans dental care eligibility expansion and
enhancement act of 2018''
PVA supports this draft legislation to improve dental care provided
to veterans by VA. This legislation would establish a pilot program on
expansion of dental services and treatment to all veterans enrolled in
VA health care. Due to a lack of dental service providers within VA and
the strict eligibility criteria for veteran patients to access such
care, few veterans are able to access oral health care at VA. Veterans
who do access VA dental care are generally those with service-connected
dental conditions or injuries or other dental conditions that are
aggravated by a service-connected injury or illness. For all other
veterans there are some limited dental insurance plans that can be
purchased through VA.
The pilot program would expand dental care services and treatment
to veterans who are enrolled in VA health care at 16 locations across
the country. These 16 locations would include four VA medical centers
with an established dental clinic, four VA medical centers with a
contract for dental care, four community based outpatient clinics with
available space, and four facilities from federally qualified health
centers and Indian Health Service clinics. These pilot sites would
assess the feasibility and ability to furnish dental services and
treatment to no more than 100,000 veterans who volunteer to participate
in the program.
As the research of the last several years has made clear, oral
health and overall health are not independent of one another. In 2012,
the American Heart Association released a statement acknowledging an
association between periodontal disease and cardiovascular disease.
Recent studies suggest a connection between periodontal disease and
kidney disease, diabetes, and strokes. VA must explore resources to
properly integrate dental care and awareness into their holistic
approach to veterans' health care.
s. 3184, to amend title 38, united states code, to modify the
requirements for applications for construction of state home facilities
to increase the maximum percentage of nonveterans allowed to be treated
at such facilities, and for other purposes
PVA supports S. 3184. This bill would allow state veterans' homes
to provide care to spouses of veterans under certain conditions.
Although many state veterans' homes are at capacity, there are some
that are not. In these instances, veterans in need of, or already in a
state home, may wish to have their spouse reside in the state home with
them. If there is not enough demand by veterans needing access to state
homes, PVA sees no reason why families need to separate for the sake of
rigid adherence to the current 25 percent occupancy rules.
draft bill, to amend title 10, united states code, to improve the
transition assistance program for members of the armed forces, and for
other purposes
PVA supports the intent of the draft legislation which would
improve the Transition Assistance Program (TAP) for members of the
Armed Forces. This bill would make the first significant changes to the
TAP since 2011. One of the notable changes this legislation would make
is to tailor the transition program based on the servicemember's time
in service, rank, age, and disability status. This will provide more
specific opportunities to the servicemember instead of one blanket
program for everyone.
This legislation also provides transition assistance starting a
year from the date of separation. One of the reasons servicemembers
have such a difficult time transitioning is the fact that the TAP
program is offered just a few months prior to their separation. To be
fully prepared, servicemembers should begin the transition process much
sooner. Earlier preparation would help them be better prepared to
transition to civilian life, which would also support their mental
health and overall wellbeing.
draft bill, the ``va hiring enhancement act''
PVA supports the ``VA Hiring Enhancement Act.'' The bill would end
the applicability of non-VA covenants not to compete to the appointment
of certain Veterans Health Administration (VHA) personnel. It would
also permit VHA to make contingent appointments and require VA
physicians to complete residency training.
This bill intends to fill vacancies and make VA more competitive by
authorizing VHA to begin the recruitment and hiring process up to two
years prior to the completion of required training. This would allow
for physicians to quickly begin work at VA medical centers upon the
completion of their education. This could help to stem the flow of the
ever recurring stories of young clinicians who wished to serve veterans
but were unable to endure the months of an uncertain onboarding
process. Veterans deserve the best this country can offer. Congress
should explore every means to ensure VA does not lose out on these
young professionals due to inefficient hiring practices.
h.r. 5418, the ``veterans affairs medical-surgical purchasing
stabilization act''
PVA supports H.R. 5418, the ``Veterans Affairs Medical-Surgical
Purchasing Stabilization Act.'' This legislation would direct the
Secretary of VA to carry out the Medical Surgical Prime Vendor program
using multiple vendors and prohibiting a prime vendor from solely
designing the formulary of supplies.
In the private sector, hospitals use multiple Group Purchasing
Organizations that bid down medical equipment prices. With Medical
Surgical Prime Vendor, VA proposed using only one large vendor as
opposed to multiple vendors. Arguably, the lack of competition has
ensured higher prices for VA and thus the taxpayer than would otherwise
be the case with competing vendors. While one vendor ensures
consistency and a reliable timeline, it may not be an improvement on
quality. What we do know is the procurement shortcut can undermine the
competitive system, and result in VA overpaying for equipment.
s. 1596, the ``burial rights for america's veterans' efforts act of
2017,'' or
the ``brave act of 2017''
PVA supports S. 1596, the ``Burial Rights for America's Veterans'
Efforts Act of 2017,'' or the ``BRAVE Act of 2017.'' This legislation
would increase the amount payable through VA for burial and funeral
expenses for non-service-connected veterans regardless of whether the
death occurred in a VA facility. Under the bill, the benefit would
increase from $300 to $749. The legislation also requires VA to
increase burial benefits based on the percentage increase in the
Consumer Price Index. This legislation is critical to ensuring that
veterans' survivors have additional financial resources available to
them to help address funeral and burial expenses.
s. 1952, the ``department of veterans affairs financial
accountability act of 2017''
PVA supports S. 1952, the ``Department of Veterans Affairs
Financial Accountability Act of 2017.'' This legislation would require
VA to engage in several efforts to ensure more accurate budgeting for
the programs and services provided by the Department. First, the
legislation would require VA to engage the services of a third party to
conduct a review of its financial processes and to develop a plan to
address any recommendations that result from the review. Second, it
would require a member of the Secretary's office to be accountable for
tracking VA's progress in implementing recommendations received from
the Comptroller General of the United States, the Special Counsel, and
the VA's Inspector General. Third, the legislation would require VA to
provide any special requests for funding to Congress within 45 days of
when the funding would be needed. Such requests would need to include a
justification for the extra funds. Last, it would require VA to give
attestations regarding financial projections concurrent with the
President's annual budget.
In order to properly implement the critical legislation that
Congress has passed in recent months to reform the claims appeals
process, implement a new community health care program, and expand
access to comprehensive caregiver benefits, VA needs to ensure that it
is using appropriated funds in an efficient and effective manner.
Improved fiscal accountability will help to ensure that VA is able to
more accurately project expenses and request adequate budgets. Congress
will in turn be able to provide the funding needed to ensure that VA is
able to meet its responsibilities to veterans with disabilities and
their families.
s. 1990, the ``dependency and indemnity compensation improvement act of
2017''
PVA supports S. 1990, the ``Dependency and Indemnity Compensation
Improvement Act of 2017.'' This legislation would increase the amounts
payable for Dependency and Indemnity Compensation (DIC) by
approximately $300 per month. It would also provide eligibility to a
portion of the DIC benefit for survivors whose veterans were rated
totally disabled for at least five years prior to their death. Last,
the bill would change the age at which a spouse could remarry and
retain DIC benefits from age 57 to age 55. The critical changes
provided by this important legislation will ensure that survivors are
better able to meet their living expenses following their veteran's
death.
s. 2485, the ``medal of honor surviving spouses recognition act of
2018''
PVA supports S. 2485, the ``Medal of Honor Surviving Spouses
Recognition Act of 2018.'' This legislation provides a pension for
survivors of veterans who were awarded the Medal of Honor. The pension
would compensate surviving spouses $1,329.58 monthly. To be eligible,
the surviving spouse must have been married to the veteran for one year
or more prior to the veteran's death; or, for any period of time if a
child was born of the marriage, or was born to them before the
marriage. This pension will ensure that the families of America's
heroes are properly provided for by our Nation.
s. 2748, the ``better access to technical training, learning and
entrepreneurship for servicemembers act,'' or the ``battle for
servicemembers act''
PVA supports S. 2748, the ``Better Access to Technical Training,
Learning and Entrepreneurship for Servicemembers Act,'' or the ``BATTLE
for Servicemembers Act.'' This legislation provides opportunities for
servicemembers to receive additional training under TAP. Servicemembers
will have the ability to receive this training unless they fall into
specifically exempted categories. PVA supports any efforts that will
better prepare transitioning servicemembers for returning to civilian
life.
draft bill, to require the secretary of veterans affairs to establish a
program to award grants to persons to provide and coordinate the
provision of suicide prevention services for veterans transitioning
from service in the armed forces who are at risk of suicide and for
their families, and for other purposes
PVA supports the intent of the draft bill requiring the Secretary
of VA to establish a program to award grants to persons to provide and
coordinate the provision of suicide prevention services for veterans
transitioning from service in the Armed Forces who are at risk of
suicide and for their families. We would encourage, however, that the
program also focus in equal measure on veterans 50 and older, who are
committing suicide in greater numbers than the post-9/11 generation.
While we recognize the window in which a servicemember is transitioning
from active service is a critical time that can correlate with the
potential for suicide ideation, there is an equal and growing need to
reach out to older veterans.
Similarly, women veterans commit suicide at nearly six times the
rate of other women. Of the annual suicide deaths per 100,000 people in
the United States, male veterans comprised 32.1, and non-veteran men
20.9. Among women veterans they comprised 28.7 compared to just 5.2
among non-veteran women. This is a particularly concerning statistic
since men, on average, are far more likely than women to commit
suicide. Thus, this program must give particular heed to interrupting
the unique factors that lead to such a risk for suicide among women
veterans.
Last, 14 of the 20 veterans who complete a suicide every day have
never touched the VA system. We hope an introduced bill will offer
further details about how community prevention experts are to be made
aware of the grant opportunities.
draft bill, the ``modernization of medical records access for veterans
act''
PVA supports the intent of the draft bill, the ``Modernization of
Medical Records Access for Veterans Act.'' We believe, however, that
some points of the draft bill should be clarified prior to its
introduction. For example, it is unclear how the proposed medical
records card will help to efficiently address the issues of
interoperability for VA electronic health records. Since the card must
be brought back to VA before VA's records can be updated, we are
uncertain about how this solution would be more beneficial than cloud
sharing medical records. This is particularly the case due to the
inherent delays in updating a veteran's records through such a card. We
look forward to learning more about how the medical records card could
address current concerns about medical records access.
s. 514, the ``no hero left untreated act''
PVA has no official position on S. 514, the ``No Hero Left
Untreated Act.'' This legislation would establish a pilot program with
VA to use Magnetic eResonance Therapy technology, or MeRT technology.
This therapy, while not yet FDA approved, is used to treat Post
Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI),
military sexual trauma (MST), chronic pain, and opiate addiction. The
legislation would establish a one-year pilot program on MeRT technology
for 50 veterans at two VA medical centers.
VA currently offers veterans access to repetitive transcranial
magnetic stimulation (rTMS). This treatment is FDA approved to address
treatment-resistant depression, a comorbid condition in PTSD, TBI, MST,
and chronic pain and opioid addiction. While it is functionally similar
to MeRT, there is no existing evidence that MeRT is superior to rTMS
for treating any disorder.
Again, PVA thanks you for the opportunity to present our views on
these bills. We would be happy to take any questions you have for the
record.
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Prepared Statement of Ms. Lauren Augustine, Vice President of
Government Affairs, Student Veterans of America
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Prepared Statement Submitted by Tragedy Assistance Program For
Survivors (TAPS)
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Chairman Isakson, Ranking Member Tester, and distinguished members
of the Senate Veterans' Affairs Committees, The Tragedy Assistance
Program for Survivors (TAPS) thanks you for the opportunity to make you
aware of issues and concerns of importance to the families we serve,
the families of the fallen.
While the mission of TAPS is to offer comfort and support for
surviving families, we are also committed to improving support provided
by the Federal Government through the Department of Defense (DOD), the
Department of Veterans Affairs (VA), Department of Education (DoED),
Department of Labor, state governments, government contractors, and
local communities for the families of the fallen--those who fall in
combat, those who fall from invisible wounds and those who die from
illness or disease.
TAPS was honored to enter into a new and expanded Memorandum of
Agreement with the Department of Veterans Affairs in 2017. This
agreement formalizes what has been a long-standing, informal working
relationship between TAPS and the VA. The services provided by TAPS and
VA are complementary, and in this public-private partnership each will
continue to provide extraordinary services through closer
collaboration.
Under this agreement, TAPS continues to work with surviving
families to identify resources available to them both within the VA and
through private sources. TAPS will also collaborate with the VA in the
areas of education, burial, benefits and entitlements, grief counseling
and other areas of interest.
The VA Office of Survivor Assistance, including Director Moira
Flanders and her staff, works closely with TAPS to answer questions and
concerns that are raised by surviving family members. We also
appreciate the opportunities provided by the DOD/VA Survivors Forum,
held quarterly, which works as a clearinghouse for information on
government and private sector programs and policies affecting surviving
families. This is ably facilitated by Craig Zaroff of the VA Benefits
Assistance Service.
pending legislation
s. 1990
TAPS applauds Senator Tester and his staff for this legislation
which offers an increase to the Dependency and Indemnity Compensation
(DIC) provided for surviving spouses of those servicemembers who die on
active duty or die of a service-connected disability. A second
provision provides a graduated scale of benefits and addresses an
arbitrary eligibility restriction. The third provision provides equity
with other survivor benefits by allowing surviving spouses who remarry
after age 55 to retain DIC benefits.
History of DIC
According to the Congressional Research Service (CRS), survivor
compensation has been paid in some form to survivors since the
Revolutionary War.
During the Civil War, survivor compensation was expanded to cover
all servicemembers at a rate that would be payable to totally disabled
veterans. The Civil War also led to other changes to survivor
compensation, especially for survivors of servicemembers with service-
connected disabilities. They were covered under the Act of July 14,
1862, which was referred to as General Law, and amended various times
in the 19th century.
In 1917, Congress passed the War Risk Insurance Act to eliminate
the need for non-service pensions and highlighted that service-
connected payments for death and disability were compensation payments.
The act changed the system to meet the current needs of World War I
veterans and their survivors and eliminated the pay discrepancy between
officers and soldiers.
The Servicemen's Indemnity Act of 1951 replaced this life insurance
system with a new system where the servicemembers did not contribute to
the insurance program, but the government provided monthly payments to
eligible survivors of $120 with a 2.25% increase per year until a
$10,000 insurance maximum was reached. Potentially eligible survivors
included spouses, children, parents, and siblings.
Because legislation had been written in response to need,
dependency and indemnity compensation was unorganized and administered
by four different administrations by the mid-1950s, and congressional
and executive committees were formed to make the issuance of
compensation more streamlined and manageable. Death compensation was
set up similar to the way it is now by the time the final report of the
President's Commission on Veterans' Pensions, Veterans' Benefits in the
United States: Report to the President by the President's Commission of
Veterans Pensions (hereafter referred to as the Bradley Report) was
written in 1956. Death compensation was provided to survivors (except
for dependent parents) regardless of income. The rate of compensation
depended on whether the veteran served in peacetime or wartime.
In 1969, after review of the Bradley Report, recommendations from a
commission headed by Robert M. McCurdy in 1967, and extensive testimony
from several other Federal administrations and veterans' service
organizations, Congress devised a different, more equitable system for
survivor compensation that gave fixed rates to each pay grade. The base
rate was adjusted for a cost-of-living increase to reflect changes in
the cost of living since the last base rate had been determined in
1956, 13 years earlier. In 1969, years of service were no longer a
factor in determining DIC. There were no subsequent changes of
significance to DIC legislation until 1993, when the rate tables for
surviving spouses were eliminated and one flat monthly rate was
reinstated. In 2003, surviving spouses who remarried after reaching the
age of 57 were able to retain DIC.
DIC, along with other VA disability payments, are usually increased
annually by the Federal cost of living adjustment (COLA), when there is
a COLA. This COLA has been the only increase to the DIC since the new
rate tables were established in 1993.
Provision 1
TAPS appreciates the 12 percent increase to the DIC to bring it up
to 55 percent of the rate of compensation paid to a totally disabled
veteran. It is something that we have supported for many years and, for
those survivors whose only recompense is the DIC payment, long overdue.
We also appreciate the provision of an additional $350 increase to
the Special Survivor Indemnity Allowance (SSIA) for those survivors who
are in receipt of both DIC and the Survivor Benefit Plan annuity. This
would go a long way to make some survivors who are impacted negatively
by the DIC offset to SBP whole, i.e. their offset would be completely
eliminated when combined with the SSIA they currently receive.
However, we have heard concerns from some survivors. Would the
proposed SSIA increase also be tied to COLA? Is there a time limit for
this provision? Where would the funding come from? We hope these
questions will be addressed.
Provision 2
We support the intent of provision 2.
Provision 3
TAPS fully supports the provision to allow surviving spouses who
remarry after age 55 to retain DIC benefits. This makes the DIC program
consistent with other Federal programs, including the Department of
Defense survivor benefit plan and the Federal Employees survivor
benefit plan.
h.r 299
TAPS strongly supports H.R 299, the Blue Water Navy Vietnam
Veterans Act of 2018. We stand with our friends in the Military
Coalition and the Association of the United States Navy in encouraging
quick passage of this long over due legislation. Many of the families
impacted by Agent Orange from time in the Navy have become surviving
families now, and TAPS believes those families should be eligible for
the same survivor benefits as all other Agent Orange families.
s. 2881
TAPS supports S. 2881, the Mare Island Naval Cemetery Transfer Act,
so as to ensure veterans buried in Vallejo, CA are treated with the
respect they deserve. As the oldest military cemetery on the West
Coast, it should be treated as a national shrine and elevated to a
Department of Veterans Affairs national cemetery. We thank Senator
Feinstein for bringing this issue to light.
s. 2485
TAPS honors the service and sacrifices made by Medal of Honor
recipients and their families and is grateful to Senator Sullivan for
introducing S. 2485 to establish a special pension for surviving
spouses of Medal of Honor recipients.
s. 541
New and innovative programs have proved time and again to be
helpful in treating PTSD/TBI and preventing suicide. If there is a
possibility that magnetic EEG/EKG therapy can help in treating veterans
with PTSD/TBI and preventing veteran suicide, then TAPS supports the
one-year pilot program.
s. 1596
TAPS supports the BRAVE Act of 2017, which increases the amount
provided for the burial of a veteran from $300 to $749 with annual COLA
increases.
draft text--cassidy
Suicide prevention is one of TAPS' top legislative priorities.
Suicide is the second leading cause of death for active duty
servicemembers and the numbers are growing. TAPS currently serves over
12,000 surviving family members whose loved ones died by suicide and we
are grateful to Senator Cassidy for bringing forth the draft
legislation to create a grant program through VA for organizations
working in suicide prevention.
draft text--transition assistance program (tap)
Veterans who make a good transition into civilian life are less
likely to die by suicide, so TAPS is grateful to see such effort put
into overhauling the Transition Assistance Program. While many key
aspects were updated by the 2019 NDAA, there is still much work to do.
TAPS supported the House version H.R. 5649, the Navy Seal Chief Petty
Officer Bill Mulder Transition Improvement Act, and we look forward to
seeing the House and Senate versions conferenced to best improve
transitions for veterans.
TAPS thanks the Committee and the original sponsors of all this
important legislation for your thoughtful consideration of the needs of
our Nation's veterans and surviving families.
It is the responsibility of the Nation to provide for the support
of the loved ones of those who have paid the highest price for freedom.
Thank you for allowing us to speak on their behalf.
______
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement Prepared by Ralph Parrott, Captain, Supply Corp., US
Navy (Ret.) and Thomas Bandzul, Esq., Legislative Counsel, Veterans &
Military Families for Progress
Senate Committee Members, We'd like to take this opportunity to
thank Chairman Isakson, Ranking Member Tester and all the Members of
the Senate Veterans' Affairs Committee, to present our position on the
Mare Island Cemetery Restoration bill, S. 2881. This bill, offered by
Senator Diane Feinstein (D-CA), will allow for the future care of this
historic landmark at the discretion of the Department of Veterans
Affairs (VA).
The Mare Island Naval Cemetery was established in 1856 on the
grounds of the Mare Island Naval Shipyard in Vallejo, CA. It is the
oldest military cemetery on the west coast. The last burial in the
cemetery occurred in 1921. The following is a summary of the
internments in the cemetery:
860 Veterans Navy and Marines, 3 Medal of Honor
recipients,
8 Russian sailors killed fighting a fire in San Francisco
in the 1860s while their ship was visiting at the invitation of
President Lincoln
4 French sailors authorized by the US Navy for reasons
lost to history
33 Children of Veterans buried there
40 Spouses of Veterans buried there (includes the daughter
of Francis Scott Key)
7 Other civilians authorized by the US Navy for reasons
lost to history
TOTAL: 952
The cemetery was turned over by the Navy to the City of Vallejo in
1996 as part of BRAC '93. There were no provisions made for the
perpetual care, maintenance and restoration as part of the turnover
agreement. The City of Vallejo has been unable or unwilling to provide
the necessary resources to maintain the cemetery and it has fallen into
disrepair. The City has also formally requested the Federal Government
to take over the Cemetery. The VA, who runs the National Cemetery
Administration, does not have the legal authority to take over the
cemetery. Senator Feinstein's introduction of S. 2881 will give the
necessary authority to the VA. Congressman Mike Thompson has introduced
a similar bill (H.R. 5588) which is currently before the House
Veterans' Affairs Committee.
VMFP and our partner Veteran Service Organizations (VSO's) along
with the many people in California, urgently requests the Senate
Veterans' Affairs Committee report this bill to the floor of the US
Senate and provide this historic site the perpetual care, maintenance
and restoration it so justly deserves.
h.r. 299, blue water navy vietnam veterans act of 2018
VMFP full supports this as an issue long overdue. There is some
trepidation this will cause a large increase to the Veterans Health
Administration (VHA) overhead and Veterans Benefits Administration
(VBA) will have a large increase in claims. Since there are no specific
numbers published on this, my belief is, MOST Veterans with issues
caused by exposure to Agent Orange (AO) have already qualified for
benefits, are eligible for care within another program (TRICARE for
Life, Medicare/Medicaid, etc.) or have some other form of health
insurance.
s. ___ (sanders), veterans dental care eligibility expansion and
enhancement act of 2018
It has always been an objective of VMFP to improve the health of
Veterans everywhere. The one thing missing in society in general is a
comprehensive dental care program. In VA, unless there is extreme need
tor most Veterans comprehensive dental care is also missing.
We believe this legislation will help to measure the costs and
needs and will help define the alternatives for Veterans for healthy
teeth and gums. VMFP support this bill as a path to improving
understanding the needs for this care for veterans.
s. 3184
To amend title 38, United States Code, to modify the requirements
for applications for construction of State home facilities to increase
the maximum percentage of nonveterans allowed to be treated at such
facilities, and for other purposes.
VMFP Strongly supports this bill. ft has long been the history of
other organizations (Gary Sinise Foundation; Habitat for Humanity,
etc.) to have been helping with the construction of housing for
deserving Veterans. We support the expansion. of this as a government
initiative and the inclusion of more Veterans with housing needs.
s. ___ (boozman), va hiring enhancement act
For many years, VMFP has been a strong proponent of hiring
qualified Veterans, trying to transition from the military to civilian
life. One of the roadblocks for this transition has been certification
and review of necessary qualification. We believe this bill is a good
step to improving the staffing shortages at VA with highly skilled
medical persons.
VMFP believes this bill will create a more ``level playing field''
in competition for many of the skilled people needed to fill the array
of openings in the healthcare field for VA. We strongly support this
legislation.
VMFP believes this bill will create a more ``level playing field''
in competition for many of the skilled people needed to fill the array
of opening in the healthcare field for VA We strongly support this
legislation.
h.r. 5418, veterans affairs medical-surgical purchasing stabilization
act
VMFP has no position on this legislation since there are many bills
with similar clauses. We have not had enough time to review this to
make a recommendation one way or the other.
s. 1596 (peters/rubio), brave act of 2017
The cost of a funeral has risen over the years and is now estimated
to be between $7,000 and $10,000 in North America (according to
PARTING; a funeral home rating website). Through the increase in this
legislation does provide for more variable adjustments in the future
and the initial suggested increase is substantial, we believe this
value should be increased to a minimum level of $3,000.00 (the average
cost of a cremation funeral--Source: National Funeral Directors
Association).
An argument can be made, many Veterans can be interred in a
cemetery cared for by VA at substantially less, but not everyone can
take advantage of this benefit. While VMFP supports this bill, we would
like to see an increase in funding.
s. 2881 (feinstein), mare island naval cemetery transfer act
Statement at Page 1 (separate).
s. 1952 (tester/mccain/manchin), va financial accountability act of
2017
With budgetary issues, financial accountability and several years
of increases in VAs budget with proportional instances of overspending,
cost overruns and program demands (unfunded mandates) left unfulfilled,
it is VMFP's opinion this legislation would be a good step in the right
direction.
s. 1990 (tester/blumenthal/hirono), dependency and indemnity
compensation improvement act of 2017
VMFP takes no position on this legislation.
s. 2485 (sullivan), medal of honor surviving spouses recognition act of
2018
VMFP fully support this legislation. While some believe this may
have consequences in personal relationships in the future, the intent
of the bill meets a need we feel is long be unfulfilled as an
obligation by the government to the spouse of a Medal of Honor hero.
s. 2748 (brown/rounds), battle for servicemembers act
Our group fully supports this legislation as a necessary step to
full and timely access to employment and training to meet any need of a
returning Veteran.
s. ___ (cassidy)
To require the Secretary of Veterans Affairs to establish a program
to award grants to persons to provide and coordinate the provision of
suicide prevention services for veterans transitioning from service in
the Armed Forces who are at risk of suicide and for their families, and
for other purposes.
Suicide prevention, in all it's forms, has always been a top
priority for Veterans and their families within our organization. As a
person who has dealt directly with suicide (as a police officer) and
directly involved with the family (my brother). I know this has
horrible consequences and is a preventable tragedy; given the proper
resources, awareness and education.
Any effort to help recognize the symptoms of depression, despair
and hopelessness leading to a suicidal ideation is a priority for VMFP.
We fully support this legislation.
s. ___ (cassidy), modernization of medical records access for veterans
act
VMFP has no position on this legislation.
s. 514 (perdue/heller), no hero left untreated act
VMFP takes no position on this bill but we believe a pilot program
on Magnetic EEG/EKG-guided resonance therapy could yield significant
information so as to make a more informed decision on the benefits and
cost of this treatment program.
Respectfully Submitted,
Thomas Bandzul, Esq.
Legislative Counsel.
______
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Rene C. Bardorf, Senior Vice President of
Government and Community Relations, Wounded Warrior Project
Chairman Isakson, Ranking Member Tester, and distinguished Members
of the Senate Committee on Veterans' Affairs, Thank you for inviting
Wounded Warrior Project (WWP) to submit this statement for the record
of today's hearing on pending legislation.
Since our inception in 2003, WWP has grown from a small
organization delivering comfort items in a backpack at the bedside of
wounded warriors here in our Nation's capital, to an organization of
nearly 700 employees in more than 25 locations around the world
delivering over a dozen direct-service programs to warriors and
families in need. Through our direct-service programs, we connect these
individuals with one another and their communities; we serve them by
providing mental health support and clinical treatment, physical health
and wellness programs, job placement services, and benefits claims
help; and we empower them to succeed and live life on their own terms.
As we advocate for this community before Congress, we appreciate you
inviting us to speak on these issues and look forward to helping any
way we can.
h.r. 299--blue water navy vietnam veterans act of 2018
Although we have few alumni that served in Vietnam, Korea, and
Thailand during the Vietnam war, we consider the military toxic
exposure problem a cross-generational issue. It is important that if
servicemembers are exposed to harmful toxins while serving this
country, the government ensures they have proper health care and
assistance if any injuries or illnesses arise from their exposures.
This philosophy was the impetus behind our current partnership with
Vietnam Veterans of America (VVA) and the Tragedy Assistance Program
for Survivors (TAPS) to conduct a needs assessment of the landscape
facing post-9/11 generation warriors who were or who may have been
exposed to toxic substances during service.
As individual organizations, VVA, TAPS, and WWP have shared
concerns for several years about the emergence of toxic exposure as a
common thread among former servicemembers who are sick, dying, or
already deceased from uncommon illnesses or unusually early onset of
more familiar diseases like cancer. In the past, we have advocated for
initiatives such as the creation of the Airborne Hazards and Open Burn
Pit Registry in June 2014 and the more recent passage of the Toxic
Exposure Research Act of 2016 (P.L. 114-315, Sec. Sec. 631-34). Given
our collective interest in prevention, treatment, and awareness,
Wounded Warrior Project decided in October 2017 to coordinate efforts
with TAPS and VVA and invested $200,000 in a needs assessment to guide
our future advocacy. Wounded Warrior Project remains committed to
continued investments of resources and expanding its partnerships to
include others passionate about this important issue. More can be read
about our partnership from our recent House Committee on Veterans'
Affairs submitted on June 7, 2018.\1\
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As this partnership continues to address the challenges faced by
servicemembers and veterans who served on or after September 11, 2001,
WWP is pleased that the Committee is considering legislation to provide
recourse for ``blue water'' Vietnam veterans. We are particularly
encouraged by Section 5 of this legislation (``Updated Report on
Certain Gulf War Illness Study'') and further request that future
legislation add additional research between the Veterans' Affairs (VA)
and the Department of Defense (DOD) on toxic exposure for Gulf War-era
veterans as well as for those who served after 9/11.
Wounded Warrior Project Supports H.R. 299.
draft bill--veterans dental care eligibility expansion and enhancement
act of 2018
This draft bill will increase VA's internal dental capabilities by
expanding its clinical capacities in rural locations and creating a
pilot program that would open dental coverage to all veterans
regardless of disability status at select VA hospitals. The pilot
program will determine if expanding VA-provided dental services to all
veterans enrolled in the VA healthcare system is feasible. Although we
agree with the intent of the pilot program and overall dental
expansion, we have concerns over how the bill will be paid for and how
the current dental care program is administered to veterans.
Anecdotally, WWP has heard from veterans struggling to get service-
connected disability ratings for injuries to the mouth which occurred
during service. Additionally, only veterans with 100% service-connected
disability or former prisoners of war (POW) qualify for VA dental
care.\2\ Before the VA expands dental coverage to all veterans, WWP
would like to see VA review the current rating system for dental
eligibility. We recommend that Congress instruct VA to conduct a report
of how many veterans with face and mouth service-connected injuries are
not getting needed health care and how many veterans are denied for
dental coverage when applying for this type of service-connected
disability. Additionally, we would like to see full coverage of dental
services expanded to homeless veterans. Dental needs for homeless
veterans is one of their top three unmet needs and WWP feels that VA is
not meeting its obligation in supporting homeless veterans when it
comes to individual dental problems and its impacts in retain suitable
long-term employment.\3\
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Wounded Warrior Project supports the provisions to construct
additional dental clinics in rural areas, increase dental health
education, establish an electronic health record system, and authorize
the Secretary to carry out a program to train and employ alternative
dental health care providers. WWP suggests increasing the appropriated
funding of this section to include the construction of dental
facilities at any major VA hospital that does not currently offer
onsite dental services. Furthermore, Congress needs to appropriately
fund this dental expansion. As with the current VA MISSION Act funding
shortfall, Congress should not pass legislation without appropriate
funding mechanisms attached.
Wounded Warrior Project supports this legislation with alterations
to the language as stated above.
s. 3184--to modify the requirements for application for construction of
state home facilities to increase the maximum percentage of nonveterans
allowed to be treated at such facilities, and for other purposes
Wounded Warrior Project does not have a current position on this
legislation but welcomes future discussions with the Committee on this
proposal.
discussion draft on transition assistance reform and
s. 2748--battle for servicemembers act
With approximately 200,000 servicemembers leaving the military each
year, it is critical that DOD and VA disseminate information pertinent
to transition success, VA benefits, and job opportunities.\4\ Wounded
Warrior Project supports a holistic approach to reforming Transition
Assistance Program (TAP) that reflects the input of all relevant
stakeholders. The Departments of Veterans Affairs, Defense, and Labor,
the Small Business Administration, Congress, and multiple veteran
service organizations committed to meeting the needs of transitioning
servicemembers and all have critical voices that must be adequately
considered, and WWP would support a comprehensive bill that has been
thoroughly vetted by all parties.
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Wounded Warrior Project was pleased to host leaders from VA, DOD,
DOL, and over 10 veteran service and nonprofit organizations in
November 2017 to explore the components of wellness and their
relationship to a successful military civilian transition. WWP has been
an active participant in VA's Military-to-Civilian Summits and remains
committed to being deeply involved with government and nongovernment
leaders alike who have a stake in the success of TAP. Additionally, we
are hearing from our transitioning alumni that the current the TAP is
not comprehensive enough. We have some concerns that the proposed House
Veterans'
Affairs Committee (HVAC), Senate Armed Services Committee (SVAC),
and the National Defense Authorization Act (NDAA) changes to the TAP
does not expand the overall amount of TAP days. Where the current
changes look to streamline the TAP while keeping it within the current
five days, we recommend expanding the overall days dedicated to the TAP
curriculum.
While we are encouraged by the time and attention that has been
given to TAP to date, we believe both bills under consideration by the
Committee today fall short of what is necessary for meaningful TAP
reform. Our concern is that there are other proposed changes to TAP
currently under consideration by the HVAC, the House Armed Services
Committee (HASC), and the Senate Armed Services Committee (SASC).
Before supporting any one piece of legislation, we request that
Congress identify the best provisions in each proposal and work
collaboratively to form a single TAP bill supported by all relevant
stakeholders. To this end, we request that Congress have a joint
hearing between SVAC, HVAC, HASC, and SASC to clearly inform all
committees of jurisdiction about the issues surrounding the TAP. In our
opinion, this approach would afford all stakeholders--including outside
organizations and government agencies--to clearly identify key
priorities and considerations to improve transition.
We are concerned that the community is not on the same page when it
comes to new TAP legislation. We are submitting the following thoughts
on the TAP bills under consideration at this hearing; however, we
request Congress to take a step back and develop one piece of
legislation in conjunction with DOD, VA, community partners, and both
sides of Congress.
(1) Discussion Draft on Transition Assistance Reform
Section 2. Recodification, Consolidation, and improvement
of certain transition-related counseling and
assistance authorities:
Wounded Warrior Project is encouraged by section (D) ``the
availability of mental health services and the treatment of Post
Traumatic Stress Disorder, anxiety disorders, depression, suicidal
ideation, or other mental health conditions [ . . . ] and information
concerning the availability of treatment options and resources to
address [these issues].'' We would request that WWP programs are
included as resources for transition servicemembers dealing with mental
health issues. Wounded Warrior Project has developed a significant
amount of mental health programming for post-9/11 veterans, and we are
doing so in concert with VA and several leading community-based health
providers. We've built these programs within a ``continuum of support''
designed to meet warriors wherever they are in their recovery while
also investing substantial resources in other organizations in the
community, including four of the Nation's leading academic medical
centers that have come together within our Warrior Care Network®.
Section 3. Personnel matters in connection with transition
assistance program:
Ensuring that military installations have the proper personnel to
administer TAP programming is essential. Section 3 would require the
military to have ``not less than one [full-time TAP personnel] for
every 250 members of the Armed Forces currently eligible for
participation in the Transition Assistance Program.'' Additionally,
this provision would ensure that TAP personnel teaching these classes
have at least two years of civilian employment experience before they
can teach transition classes. This is to ensure that the people
teaching these TAP classes have themselves gone through a successful
transition. Last, this section would require DOD to identify one point
of contact (POC) to coordinate all the on-post TAP programming at each
field grade unit. This will help ensure that information being
distributed throughout the military is consistent from base to base.
Section 5. Information on members of the Armed Forces
participating in preseparation counseling and
surveys on member experiences with transition
assistance program counseling and services and in
transition to civilian life:
Collecting and analyzing programmatic data is essential for
ensuring positive outcomes from programs. Something that the current
TAP program has failed in is surveying members after they have
transitioned out of the military and the effectiveness of their TAP
experience. This section would require the Secretary of Veterans
Affairs to consult with the Secretary of Defense, the Secretary of
Homeland Security, the Secretary of Education, and the Secretary of
Labor to conduct surveys of veterans that have been recently retired,
discharged, or released from active duty to assess their experiences
transiting from the military to civilian life. This data can help
identify areas where the TAP program is assisting and areas where it is
lacking.
Wounded Warrior Project suggests editing this section to include a
set number of veterans that shall be surveyed. We recommend the survey
track their success over a period of no less than five years after
separation. Additionally, WWP encourages committee staff to review The
Veterans Metric Initiative (TVMI) study commissioned by the Henry
Jackson Foundation--and funded, in part, by WWP--that focuses on post-
military well-being. The TVMI study's findings regarding vocation,
finances, health, and social relationships may provide compelling
evidence to guide the approach under this section.
Section 6. E-mailing transition assistance materials to
supporters of members of the Armed Forces
transitioning to civilian life:
Wounded Warrior Project is particularly interested in this section.
Section 6 would require DOD to email TAP program materials to family
member of transitioning servicemembers. The Secretary of Defense will
solicit an email address from the servicemember to disseminate TAP
information. When a servicemember transitions out of the military it
affects the whole family. Ensuring that TAP information is shared with
the spouse of the servicemember will help the entire family transition
from DOD to the civilian world. We recommend making this optional for
those servicemembers who are not interested in share an email with DOD.
As currently written, it is not clear if the servicemember can opt-out
of supplying an email address to DOD.
Section 9. Education of members of Armed Forces on career
readiness and professional development:
Wounded Warrior Project is interested in the Alumni Network Program
defined in section (d); ``[the] Secretary concerned shall establish an
alumni network program to connect veterans with members of the Armed
Forces for mentorship, networking, and career advice.'' In our
experience, peer-to-peer support is critical to recovery for many
warriors. According to our 2017 Wounded Warrior Project Survey, more
than half of those surveyed, or 51.6 percent, used talking with another
Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New
Dawn veteran as a resource to address mental health issues. The only
more frequently utilized resource was VA medical centers.\5\ In this
context, WWP is highly supportive of permanently authorizing
reintegration and readjustment counseling services for transitioning
servicemembers. VA pilot programs that study peer-to-peer or alumni
networks have been highly successful and WWP has seen similarly
encouraging results in its own programming. Because of this, WWP
supports the proposed Alumni Network Program. WWP requests the
legislation require DOD to partner with and promote successful peer-to-
peer programs administered by veteran service organizations and
military service organizations to servicemembers transitioning out of
the military.
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Section 10. Employment Skills Training:
Currently, spouses may attend TAP classes if space is available.
This provision would require DOD to authorize access to TAP classes to
spouses. A strong military family is important. A strong civilian
family is equally as important. Wounded Warrior Project supports the
concept in ensuring the TAP classes are available to spouses as it will
assist in the entire family's transition.
Section 14. Establishment of Governing Board to support
prevention of drug overdose death by suicide, and
alcohol-related mortality:
This section would require the Secretary of VA to establish a
governing board within the Veterans Benefits Administration (VBA) to
facilitate the transfer of information and to create partnerships that
would prevent suicide, substance abuse, and assist homes veterans. The
board would include representatives from DOD, DHS, and DoL, inducing
representatives from VA staff offices that focus on these issues.
Wounded Warrior Project requests including veteran service
organizations into the board as well.
Section 16. Grants for provision of transition assistance
to members of the Armed Forces after separation,
retirement, or discharge:
This section would require DOL to work with VA to award grants to
outside organizations who provide transition assistance services to
members of the military that have separated. These grants would be
awarded to organizations that focus on career skills, behavioral
health, and education. $10 million dollars would be authorized for the
grants. WWP has in the past supported increasing the outside
capabilities of transitioning servicemembers access to information and
assistance to successfully integrate into the civilian population and
has invested a substantial amount of fund in peer-to-peer mental health
and employment transition programs.
WWP's Warriors 2 Work (W2W) is one such successful program. W2W
assists veterans transitioning from the military into the civilian
workforce. WWP does this through resume building, job coaching,
assistance with building local networks, online LinkedIn workshops, and
one-on-one job referrals to partnering companies. Currently, we work
with over 400 companies and focus on small-scale hiring fairs called
``micro job fairs.'' WWP feels that there is a natural synergy between
our peer-to-peer mental health network, our peer-to-peer W2W programs,
and the proposed grants defined in this section.
(2) S. 2748--BATTLE for Servicemembers Act
Under the current TAP, there is a mandatory ``core curriculum''
consisting of a three-day employment workshop that is conducted by DOL;
six hours of briefings on veterans' benefits, conducted by VA; and 8-10
hours of briefings on topics such as translating military skills to
civilian jobs and preparing a financial plan, conducted by DOD.
Following completion of the core curriculum, transition servicemembers
can opt to take one of three additional transition tracks that include
(1) higher education, conducted by DOD; (2) technical and skills
training conducted by the VA; or (3) entrepreneurship, conducted by the
Small Business Administration. Although these additional tracks are
available, they are often not utilized. This legislation would require
transitioning servicemembers to take one of the three additional
tracks. Wounded Warrior Project agrees that transitioning
servicemembers need all the resources they can get to properly
transition back into the civilian world. Because of this, we support
expanding the amount of training given to servicemembers as they leave
the military. We would request that a fourth track be added for those
interested in additional employment information.
draft bill--va hiring enhancement act
Wounded Warrior Project does not have a current position on this
legislation but welcomes future discussions with the Committee on this
proposal.
h.r. 5418--veterans affairs medical-surgical purchasing stabilization
act
H.R. 5418 would require the Secretary to award contracts to
multiple regional prime vendors instead of a single nationwide prime
vendor and prohibits the prime vendor from solely designing the
formulary of such supplies. Wounded Warrior Project is concerned that
restricting the Secretary of Veterans Affairs' ability to purchase
medical equipment, the VA may adversely affect veteran safety and
health because Congress has limited the agency's purchasing options.
Wounded Warrior Project recommends changing the wording on page 2, line
8 from ``Secretary of Veterans Affairs shall carry out . . .'' to
``Secretary of Veterans Affairs may carry out . . . .''
Wounded Warrior Project opposes this legislation.
s. 1596--brave act of 2017
Wounded Warrior Project is here to assist injured, ill, and wounded
veterans and servicemembers. When these disabilities lead to the death
of a warrior, appropriate assistance should be rendered to the family
by the Federal Government. S. 1596 would increase funeral benefits for
veterans and fallen servicemembers and establish a percentage increase
of this benefit each year. The current $300 payment would be increased
to $749. With the average cost of burials exceeding $7,000 in 2016,\6\
this payment increase would represent a small step in the right
direction in assisting families during this time of mourning; however,
WWP requests that burial benefit payments be increased to match the
average cost of a burial.
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Wounded Warrior Project supports this legislation with amendments.
s. 2881--mare island naval cemetery transfer act
Mare Island Naval Cemetery is one of the oldest West Coast military
burial sites. Over the past decade, the cemetery has fallen into
disrepair. The cemetery, which is currently owned and operated by the
city of Vallejo, California does not have the necessary funds to
maintain the cemetery appropriately. This legislation would direct the
Secretary of Veterans Affairs to enter into an agreement with the city
of Vallejo, California to ensure that the cemetery is properly
maintained. Wounded Warrior Project feels that the final resting place
of military servicemembers and veterans should be kept to a high
standard of maintenance. In the rare instance that a local community
has the responsibility to maintain a veteran cemetery, and is unable to
maintain that standard, the VA should step up and assist.
Wounded Warrior Project supports this legislation.
s. 1952--va financial accountability act of 2017
Wounded Warrior Project does not have a current position on this
legislation but welcomes future discussions with the Committee on this
proposal.
s. 1990--dependency and indemnity compensation improvement act of 2017
S. 1990 aims to increase the Dependency and Indemnity Compensation
(DIC) benefits rate so that it is equivalent to the rate paid to
survivors of Federal civilian employees. The increase would provide
approximately $300 more per month to spouses of servicemembers and
veterans who die while on active military duty or as a result of a
service-connected injury or illness. Additionally, a spouse will be
authorized to receive the DIC benefit if the servicemember was rated
totally disabled for a period of five years. Currently, DIC payments
are provided to survivors or those rated totally disabled for a period
of ten years. Wounded Warrior Project has always supported the spouses
of those injured, ill, or wounded while serving this country. WWP will
continue to support them after these warriors pass on. We support this
bill as it will also ensure that these individuals are financially
supported after their loved one dies.
Wounded Warrior Project supports this legislation.
s. 2485--medal of honor surviving spouses recognition act of 2018
S. 2485 would provide a special pension payment to the surviving
spouses of a deceased Medal of Honor recipient and increase the special
pension amount from $1,000 to $1,329.58. Medal of Honor recipients, and
their families have gone above and beyond in service to this Nation.
Their sacrifices should not go unnoticed. This pension does not nearly
cover the gratitude this Nation owes these heroes. Because of this,
Wounded Warrior Project fully supports this legislation.
Wounded Warrior Project supports this legislation.
draft bill--to require the secretary of veterans affairs to establish a
program to award grants to persons to provide and coordinate the
provision of suicide prevention services for veterans transition from
service in the armed forces who are at risk of suicide and for their
families, and for other purposes
This draft bill would establish a program to award grants to
organizations that are providing and coordinating suicide prevention
services to veterans. Through offerings such as Warrior Care
Network®, Project Odyssey, and WWP Talk, WWP has served 17,822
warriors and family members through interactive programming,
rehabilitative retreats, and other professional services to address
their mental health needs.
The Warrior Care Network® (WCN) has a critical mission to heal
the invisible wounds of war by increasing access to some of the highest
quality care for wounded warriors and their families. Launched in 2016
with a vision of becoming a national leader, innovator, and integrator
in the delivery of treatment for warriors living with psychological
injuries as well as those suffering from Traumatic Brain Injury, the
WCN has enjoyed early success due in part to collaboration with the
Department of Veterans Affairs (VA).
In FY 2017, the partnership provided 3,707 hours of transition
services, 2,612 professional consultations, 383 briefings, and 401
referrals into VA care. As the need for professional mental health
treatment for Veterans and their families is great (and growing), the
WCN is committed to expanding its efforts in the coming years and we
wish to continue the collaborative partnership with the VA. In the next
five years, the WCN will invest over $160 million to the care of
approximately 5,000 Veterans and family members in the intensive
outpatient program and approximately 6,500 Veterans in traditional
outpatient care where the partnership with the VHA will be even more
critical for the continuity of care.
Additionally, Project Odyssey and the WWP Talk programs support
veterans through peer-to-peer counseling and rehabilitative retreats.
With over five Project Odyssey events happening across the Nation each
week and thousands of one-on-one calls to warriors happening each
month, WWP is committed to addressing today's mental health needs in a
variety of ways.
While WWP has many successful direct programs serving the needs of
warriors and their families, we alone cannot meet every need this
generation of wounded servicemembers and veterans face. Because of
this, WWP supports any effort by VA to increase funding for suicide
prevention to outside partners. We would suggest increasing eligibility
into the program to current servicemembers. Additionally, on page 7,
line 19, we would suggest changing ``The Secretary may require a person
receiving a grant under this section to submit to the Secretary a
report that describes the use of the grants amounts by the person or
such other information as the Secretary considers appropriate'' to a
``shall'' statement. WWP feels that it is important for an organization
that applies for a grant to be required to describe how the funds will
be utilized.
Wounded Warrior Project supports this legislation with amendments.
draft bill--modernization of medical records access for veterans act
Wounded Warrior Project does not have a current position on this
legislation but welcomes future discussions with the Committee on this
proposal. Wounded Warrior Project assists ill, injured, and wounded
warriors, family members, and Caregivers. We stand ready to assist
Congress in legislation affecting these individuals. Although we do not
have a position on this bill we do caution Congress in implementing
another technological pilot program while there is no VA Chief
Information Officer and with the electronic health record project
between DOD and VA ramping up. We request more discussions with
committee staff before formulating a position.
s. 514--no hero left untreated act
S. 514 would direct the Secretary of Veterans Affairs (VA) to carry
out a pilot program to provide access to magnetic EEG/EKG-guided
resonance therapy to veterans. Based on trends we have identified from
our work through direct mental health programming and partnerships in
the community, WWP strongly believes that more can be done to address
the invisible wounds of war, particularly PTSD, TBI, depression, and
other related conditions; however, we must ensure that new forms of
treatment are safe for Veterans. Currently, EEG/EKG-guided resonance
therapy is not approved by the Federal Drug Administration (FDA);
however, we understand that EEG/EKG-guided resonance therapy is
primarily used for research applications and therefore not typically
approved by the FDA. Additionally, the VHA has implemented a pilot
program at approximately 23 medical facilities. This pilot program uses
Repetitive Transcranial Magnetic Stimulation, or rTMS therapy, and WWP
has followed the outcomes of the pilot program. The most recent report
on the rTMS therapy pilot program indicated that rTMS therapy did not
assist in reducing PTSD symptoms any more than the control study
group.\7\ It is obvious that more research is needed regarding this new
form of mental health treatment. Given the most recent rTMS program
findings, WWP would support this legislation if the bill language were
changed to include a double-blind research provision on the outcomes of
the pilot program. WWP would like to see this research program compared
to the most recent rTMS pilot program to understand it's longer-term
viability as a treatment for PTSD, MST, TBI, and depression.
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Wounded Warrior Project would support this legislation if it were
presented as a research pilot program as opposed to a treatment pilot
program and sufficient language addressing this was included in the
bill.
conclusion
Wounded Warrior Project thanks the Senate Committee on Veterans'
Affairs, its distinguished members, and all who have contributed to the
policy discussions surrounding the bills under consideration at today's
hearing. We share a sacred obligation to serve our Nation's veterans,
and Wounded Warrior Project appreciates the Committee's effort to
identify and address the issues that challenge our ability to carry out
that obligation as effectively as possible. We are thankful for the
invitation to submit this statement for record and stand ready to
assist when needed on these issues and any others that may arise.
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