[Senate Hearing 116-258]
[From the U.S. Government Publishing Office]
S. Hrg. 116-258
NOMINATION OF JAMES M. BYRNE TO BE DEPUTY SECRETARY, U.S. DEPARTMENT OF
VETERANS AFFAIRS
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
MAY 16, 2019
__________
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
41-279 PDF WASHINGTON : 2020
COMMITTEE ON VETERANS' AFFAIRS
Johnny Isakson, Georgia, Chairman
Jerry Moran, Kansas Jon Tester, Montana, Ranking
John Boozman, Arkansas Member
Bill Cassidy, Louisiana Patty Murray, Washington
Mike Rounds, South Dakota Bernard Sanders, (I) Vermont
Thom Tillis, North Carolina Sherrod Brown, Ohio
Dan Sullivan, Alaska Richard Blumenthal, Connecticut
Marsha Blackburn, Tennessee Mazie K. Hirono, Hawaii
Kevin Cramer, North Dakota Joe Manchin III, West Virginia
Kyrsten Sinema, Arizona
Adam Reece, Staff Director
Tony McClain, Democratic Staff Director
C O N T E N T S
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May 16, 2019
SENATORS
Page
Isakson, Hon. Johnny, Chairman, U.S. Senator from Georgia........ 3
Tester, Hon. Jon, Ranking Member, U.S. Senator from Montana...... 1
Moran, Hon. Jerry, U.S. Senator from Kansas...................... 34
Blackburn, Hon. Marsha, U.S. Senator from Tennessee.............. 37
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 39
Sullivan, Hon. Dan, U.S. Senator from Alaska..................... 40
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 43
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 46
Boozman, Hon. John, U.S. Senator from Arkansas................... 49
WITNESSES
Byrne, James M., nominee to be Deputy Secretary, U.S. Department
of Veterans Affairs............................................ 4
Prepared statement........................................... 6
Response to prehearing questions submitted by Hon. Jon Tester 9
Posthearing questions submitted by Hon. Sherrod Brown........ 15
Questionnaire for Presidential nominees...................... 16
Letter from the Office of Government Ethics.................. 30
Letter from the nominee to the Office of General Counsel,
U.S. Department of Veterans Affairs........................ 31
NOMINATION OF JAMES M. BYRNE TO BE DEPUTY SECRETARY, U.S. DEPARTMENT OF
VETERANS AFFAIRS
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THURSDAY, MAY 16, 2019
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10 a.m., in room
418, Russell Senate Office Building, Hon. Johnny Isakson,
Chairman of the Committee, presiding.
Present: Senators Isakson, Moran, Boozman, Cassidy, Rounds,
Tillis, Sullivan, Blackburn, Tester, Brown, Blumenthal, and
Sinema.
Chairman Isakson. I call this meeting of the Senate
Veterans' Affairs Committee to order. Welcome everyone who is
here for the proceedings this morning. We will go right into
the opening statements. My able Ranking Member is not very able
today. He is disabled by a cold or something. So, I am going to
let him go first because he wants to excuse himself after that.
I will try and make it without him. It will be tough, but we
will do the best we can.
OPENING STATEMENT OF HON. JON TESTER, RANKING MEMBER, U.S.
SENATOR FROM MONTANA
Senator Tester. That will be just fine. Thank you, Mr.
Chairman. Yeah, I do not--normally I do not look too good;
today not only do I not look too good, I do not feel too good
either. I want to thank you, Mr. Chairman, and I want to thank
you, Mr. Byrne. I appreciate your willingness to perform the
duties as the Deputy on an interim basis since last summer. Our
job today is to determine whether you are up to the task of
serving as the permanent number 2 at VA.
Given that you are already performing most of the duties,
and have served as general counsel, my expectations for you
during this hearing will be different. You come here not only
as a newly nominated individual but as representative of the
Department who has had a key role in the development and roll-
out of a number of significant programs. I need to know whether
you have the proper temperament and judgment and will do what
is best for our veterans.
For example, you served as general counsel when the
Secretary was contemplating whether to recommend that Justice
Department challenge the Blue Water Navy case on VA's behalf.
Earlier this week the House of Representatives unanimously
passed--that is 410-0--legislation that is in keeping with the
recent court decision.
You served as general counsel in June 2018, when the VA
picked a needless fight with the Office of Inspection General,
denying basic information to the Office entrusted with
independent oversight. The following week this body unanimously
approved an amendment to the fiscal year 2019 VA Appropriations
Bill to prevent the denial of such information.
After all, despite what VA leadership may have thought had
been advised, it was not and is not above the law; and now, in
just three short weeks, be able to align with its
implementation of the MISSION Act. I want to know what your
role has been in implementing that law and whether you believe
the VA is going to be ready to rock and roll on June 6.
Your testimony points to a recognition of the human
resources apparatus at the VA that needs to be modernized, so I
know that you understand the VA has more work to do to improve
the processes involved in hiring and related tax. However, the
inability of the Department to address recruitment and
retention issues in places like my home State of Montana,
coupled with the Department's gutting of the agreement with
Labor that has been in place since 2011, gives me concern, to
say the least. VA management absolutely needs to get along with
its employees. They are our most important asset.
Unfortunately, VA's unwillingness to work well with others
does not end with its workforce. We continue to hear concerns
that the VSOs are not being asked for input on important
decisions made at the VA. We hear that the VA does not want to
sit on the same witness panel for congressional hearings as the
IG office.
And, when all eight of the VA-authorizers and appropriators
from both parties and both chambers send a letter to the VA
asking for more timely, accurate, and consistent information,
VA countered with--said that it was the most transparent agency
anyone has ever seen. I question that. The VA simply cannot
continue treating its partners as adversaries--as adversaries,
as the key stakeholders and bystanders.
Yesterday we found out that a lawsuit had been filed in
which you are a party of interest. I believe that you are--you
were unaware of this lawsuit until Tuesday night, and I
appreciate you being very forthcoming since that time. In my
view, that lawsuit really boils down to the fact that you
refuted an investigation that was carried out by the IG,
whether or not you appropriately decided that particular action
lends itself to whether you have good judgment.
But, to the larger point, the trend from this agency to
undercut everyone charged with oversight of this agency,
whether it is Congress or the IG office, needs to stop and
needs to stop now. There are too many critical issues that
require all of us to work together, whether it is the epidemic
of suicides that ends the lives of way too many veterans every
day and the ongoing struggle of veterans, particularly rural
and women veterans, to access the care they need, or the IT
setbacks that have hindered or delayed critical initiatives. I
need to know that you are committed to the priorities such as
these and that, at the end of the day, you have the temperament
and judgment to do this job.
Thank you again for your willingness to serve on behalf of
our Nation's veterans and their families.
In closing I would say this. The IG is one of the tools
that we use to hold you accountable. If we do not support the
IG in the work that they do I think we are making a big
mistake, whether it is IG for the VA or any other agency. So, I
would appreciate if Members on both sides had adequate time to
review Mr. Byrne's qualifications and potentially follow up
this hearing with additional meetings--not you, necessarily,
Mr. Chairman, but if I have to call him, or, Mr. Byrne, I could
do that. We could get it out. I do not want to extend this
thing, but I just want to make sure we do our due diligence.
Johnny, thank you very, very much for letting me go first
so I can leave and crash.
Chairman Isakson. Well, I want you to leave and crash and
get well. That is what I want.
Senator Tester. Thanks, buddy.
Chairman Isakson. We are not a good Committee without you
here and I appreciate your being here so promptly. I will just
say this as you leave, I associated myself with every remark
that Jon made. We, as a team, want the VA to be the best it can
be. We think the VA is moving in the right direction in many
areas. We think your nomination is a good one. We want to make
sure we continue on that path, that we do not backslide, and we
can prove to you--we have got a long way to go, but we have
come a long way in the last few months.
So, Jon, thank you for your testimony, and thank you for
not using this lawsuit as an excuse for us to hold up this
hearing today, which I really appreciate a lot. We have had a
lot of stonewalling going on in the Senate in the last couple
of months, over appointments and getting meeting scheduled, but
Jon has been very helpful in supporting those, which I
appreciate very much.
OPENING STATEMENT OF HON. JOHNNY ISAKSON, CHAIRMAN, U.S.
SENATOR FROM GEORGIA
Chairman Isakson. Mr. Byrne, welcome. You are not a
stranger to the VA. You are there now. You, like many people,
have been in an acting position. You are going to stop acting
soon and be appointed and confirmed, I am sure. The purpose of
this hearing is to have a hearing on your confirmation and on
your appointment, to satisfy any questions the Members may
have.
Let me say at the outset, so if I do not say it at the end,
what I have already said and I did not forget it, we will leave
the record open for, how many, 5 days for any questions any
Member who is not here wishes to ask, or any additional
information that wishes to be submitted by them. I would ask
you to be as prompt as you can in responding to those, because
it is in our hands to get this meeting called, and once it is
announced it is for you. The responsibility is on your back to
get us the information as quickly as possible so we can get
your confirmation finished as quickly as possible and move
forward.
I read your testimony last night and I appreciate very much
your candor, your supportive nature of the Secretary. I
particularly appreciate that you have embraced the suicide
goals that all of us have on the VA Committee and at the VA;
our number 1 goal is slowing down the rate of suicide and
eventually, if it is possible, preventing it.
Whether it is possible or not is something you want to make
sure you never get in to or say it is not impossible to correct
because you do not want to do that. We have had a rash
recently, including in the Atlanta area, of veterans who have
taken their life either on the property or near the property or
in proximity to an appointment they have had with the VA, which
bothers me some, as well.
We have got to continually review our processes and the
timeliness of getting a veteran in danger to a professional for
help and counseling. We have learned that the number 1 failure
of anybody when someone is at risk for their own life is to not
get timely counseling from somebody who understands what is
going on in someone's mind when they are contemplating taking
their own life.
I am going to be talking a lot more about that in the
months ahead, as Chairman, because I think it is the one thing
we can do. It is a subject nobody wants to talk about. It is
one of those things that has a stigma to it, but it is
absolutely something that needs to be done, absolutely
something that needs to be done quickly, and absolutely needs
to be something we never give up on trying to find the right
answers to the questions that are asked of us.
I am delighted that you are here today. I appreciate your
prioritization of serving Secretary Wilkie as you have. He is a
good Secretary. He is a demanding task-maker but he will not
ask of you any more than he asks of himself, and that is the
kind of leadership we know we want and have needed in the VA.
Now the rules require me to swear you in before you make
your testimony. That way you cannot change it later on, after
you have made your testimony. So, if you will please raise your
right hand, Mr. Byrne, and repeat after me.
Do you solemnly swear or affirm that the testimony you are
about to give before the Senate Committee on Veterans' Affairs
will be the truth, the whole truth, and nothing but the truth,
so help you God?
Mr. Byrne. I do.
Chairman Isakson. You may be seated. Thank you.
I will recognize you for 5 minutes of opening statement
followed by questions by, it looks like me, but I will try not
to be too boring and hopefully we will have somebody save you
from that. But you are welcome and congratulations on your
nomination.
STATEMENT OF JAMES M. BYRNE, NOMINATED TO BE DEPUTY SECRETARY,
U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Byrne. Thank you very much, sir, and if I may, may I
introduce my family that has joined me today?
Chairman Isakson. You sure can.
Mr. Byrne. My wife Becky--my wife of 32 years--joins me
here today, along with our daughters, Hannah and Gabby. I will
not call them number 5 and 6, but they are our fifth and sixth
children. We were just blessed recently with our fifth
grandchild, James Michael Byrne III.
Chairman Isakson. Well, Hannah and Gabby are two great
names, and they have got beautiful smiles too, so we are
delighted that you are here.
I learned a long time ago, and have known since I was in
the service, that when you serve the country in the service or
in the service of the Congress it is the spouses that come with
you to serve as well, so thank you for your support of your
husband.
Mr. Byrne. Well, good morning, Chairman Isakson. Thank you
for the opportunity to appear before you. Almost 2 years ago I
was here as the nominee to be the General Counsel of the
Department of Veterans Affairs. Today I am asking for your
support once again as I am humbled and honored to appear as
President Trump's nominee to be the Deputy Secretary of
Veterans Affairs.
You may recall that we are a service-oriented family. My
father and father-in-law served in the military, as did I, a
tradition our two sons and our son-in-law have followed. Our
Army son, Dan, is stationed in Maryland, and our Navy son,
Mick, is at sea on the USS Alaska, a fleet ballistic nuclear
submarine on a deterrent patrol out of Kings Bay, GA. Our son-
in-law, Aaron, is a Navy veteran.
I want to thank the Committee for moving promptly on my
nomination, as it is important for Mr. Wilkie to have full
senior leadership team in place given the rapid changes taking
place at the VA.
As a U.S. Naval Academy graduate and a full or deployed
marine infantry officer, I understand first-hand the importance
of our Nation's commitment to veterans, and I am excited about
the prospect of continuing to help Mr. Wilkie carry out that
commitment. Mr. Wilkie has brought stability to the VA's
Central Office, which has allowed us to make significant
progress toward modernizing the Department and improving
service for veterans, and I am proud to have played a role in
these momentous changes.
I was delegated the chief operating officer duties of the
Deputy Secretary 9 months ago, and that makes me operationally
responsible for the VA's vast network of hospitals and clinics,
our benefits programs, and our national cemeteries. I have
provided leadership to our various teams as they implement the
MISSION Act, work toward electronic health records
modernization, and set and achieve new customer service goals
like shorter wait times and improved quality of care. And,
based on what I have seen so far from our leadership and staff,
I am very bullish on the VA.
I am also proud to be part of our effort to prevent veteran
suicide. Stopping these tragic events is our top clinical
priority. But, we know the VA cannot do it alone, and that is
why we are very happy with President Trump's Executive order on
veteran suicide, which is aimed at providing a nationwide
response to this problem. Secretary Wilkie will lead a Federal
Government task force that will recommend ways for private
companies, academia, nonprofits, and all levels of government
to work together to identify at-risk veterans and get them the
help they need.
I want to use this as an opportunity to praise the
thousands of VA employees who are doing so many good things to
further our mission, which is to care for America's heroes who
have borne the battle. I am amazed with the employees I have
met at our facilities across the country and the care they take
with our veterans. From what I have seen, the drumbeat of
negative news about our workers is a false narrative that goes
against new surveys that find veterans are very happy with the
care they receive from us.
For all these reasons, I am very optimistic about where the
VA is headed under Secretary Wilkie's leadership, and if
confirmed I pledge to you, to President Trump, Secretary
Wilkie, VA employees, and, of course, the veterans we serve to
continue working as hard as I can to fulfill our mission and
uphold the oath of office.
Thank you, sir, and I look forward to your questions.
[The prepared statement of Mr. Byrne follows:]
Prepared Statement of Hon. James M. Byrne, Nominee to be Deputy
Secretary, U.S. Department of Veterans Affairs
Good morning Chairman Isakson, Ranking Member Tester, and
distinguished Members of the Committee. Thank you for the opportunity
to appear before you. Almost two years ago, I was here as the nominee
to be the General Counsel of the Department of Veterans Affairs. Thank
you for your support then, and I hope I can count on your continued
support, as I am humbled and honored to appear as President Trump's
nominee to be Deputy Secretary of Veterans Affairs.
It is a privilege to serve under the leadership of Secretary Robert
Wilkie, who has turned the VA into a dynamic, responsive, accountable
organization.
The VA is undergoing a transformation unlike anything seen since
General Omar Bradley arranged health care benefits and implemented the
GI Bill for millions of Veterans after World War II. Virtually every
corner of this very large department is doing things differently.
I was delegated the chief operating officer duties of the deputy
secretary nine months ago, and that makes me operationally responsible
for the VA's vast network of hospitals and clinics, our benefit
programs and our national cemeteries.
That means I have been privileged to play an integral role in the
fundamental changes taking place across the department. I have provided
leadership to our various teams as they implement the MISSION Act and
work toward electronic health record modernization, as they set new
customer service goals like shorter wait times and improved quality of
care, and as we strengthen our governance structures.
As someone who has helped lead the effort to bring about these
historic changes, I can tell you that the VA is headed in the right
direction. Secretary Wilkie has brought much-needed stability to the VA
Central Office, and that stability has brought progress toward a range
of goals that are supported by both parties.
I am extremely bullish on the VA. I believe in where we are going,
and I am frankly very eager to be confirmed so I can continue to help
the secretary implement these and other important initiatives on behalf
of our Veterans.
In my current dual role, I see firsthand the importance of making
sure Secretary Wilkie has his full senior leadership team in place, so
I thank you for so quickly moving ahead with this nomination.
I pledge to you, President Trump, Secretary Wilkie, VA employees
around the country and our Veterans that I will continue to use my
leadership role at the VA to uphold the oath of office, and make sure
the VA continues to evolve to ensure the highest level of service for
the heroes who sacrificed so much for their country.
First, and perhaps most importantly, we are focused intently on
Veteran suicide prevention, which is our top clinical priority. Under
Secretary Wilkie's leadership, we are doing all we can to reduce the
number of Veterans who die by suicide, which averages 20 per day.
The VA's suicide prevention program is guided by the National
Strategy to Prevent Veteran Suicide. That strategy calls for
identifying priorities, organizing efforts, and focusing national
attention and community resources to prevent suicide anywhere an at-
risk Veteran may be found. No single factor is responsible for suicide,
and the VA takes a whole-health approach that considers both physical
and mental health, as well as alcohol or substance abuse and life
events.
The VA's primary prevention approach aims to stop suicidal behavior
before it occurs. As a result, every Veteran seeking medical care for
potential indications for suicide ideation receives a mental health
screen, and can receive same-day mental health services at every VA
health care facility. We have given more than 1.5 million mental health
screenings to Veterans and are caring for nearly 11,000 Veterans deemed
to be at risk for suicide.
Our Veterans Crisis Line fields more than 1,700 calls a day, and
more than 80 of those calls lead to a decision to dispatch emergency
services. The average wait-time to have a call answered on that line is
8 seconds, well below the 20 second target set by other crisis
hotlines.
VA employees have played an important role in our effort, in many
cases because they know their patients well and know when something is
wrong. Since the VA started tracking suicide attempts on our campuses
in October 2017, our employees have prevented more than 240 of these
incidents from taking place, a testament to how much they care about
their patients, and the skill and understanding they have to work with
Veterans in such a personal capacity.
But the scope of this problem is far beyond the ability of one
program or even one agency to solve. Of the 20 Veterans on average who
die each day from suicide, 14 of them never seek VA care. That's why
the VA is reaching out to other Federal agencies, and communities
around the Nation for assistance. We are working with Governors in
major U.S. cities to help streamline the process for Veterans to access
local care.
The VA welcomed President Trump's decision to sign an Executive
Order in March that calls for government at all levels, the private
sector and non-government organizations to ensure Veterans get help.
The President issued a challenge to the Nation to do a better job on
this critical issue and put Secretary Wilkie in charge of a task force
aimed at making recommendations on how we can all work together to
identify at-risk Veterans and treat them, either by the VA or by
private providers.
Our renewed focus on suicide prevention is just one of several
changes happening at the VA. We are on the cusp of implementing the
MISSION Act, which will put Veterans at the center of their health care
decisions. Carrying out this law has been among our top priorities
since President Trump signed it last year, and it's the cornerstone of
the fundamental changes the VA is making to better serve Veterans.
The MISSION Act is the culmination of several years of lessons
learned from the Veterans Choice Act, and we believe the Republicans
and Democrats who voted for the bill have struck the right balance
between helping Veterans at the VA and allowing them to find doctors in
their community.
Once the law is implemented on June 6, Veterans will be free to
continue receiving care at the VA but will also be able to seek out
community care for a range of different reasons. Those reasons include:
when it would take too long to drive to a VA facility, when the VA
doesn't provide the care or services required, when a Veteran has a
medical condition that affects his or her ability to travel, or when
there is any other compelling reason for the Veteran to seek outside
treatment.
Putting Veterans at the center of their healthcare decisions is
not, as some insist, a step toward privatization. The VA is now
competitive with most hospitals around the country, and our budget is
bigger than ever, and the law poses no risk to Veterans who want to
continue seeking healthcare at the VA.
We expect the MISSION Act to result in the best of both worlds--a
VA that works better than ever for its patients, coupled with the
option of seeking care outside the VA system when the need arises.
We launched an effort to modernize our electronic health records so
they are compatible with those at the Department of Defense. Once fully
implemented, providers will be able to see in one place the entire
health history of our Veterans, and more effectively give them the care
they need. And while this is a project that has posed a challenge to
implement in years past, the Trump administration is on the path to
getting it done.
The goal is to create a single record of a Veteran's health
history, one that captures all the events from service that might
affect a future diagnosis. It is also meant to make it easier on our
Veterans to get care wherever they need it, without worrying whether
healthcare providers have all the information they need.
Once implemented, this change will better support Servicemembers as
they transition from military service to Veteran status, and help
ensure that pharmacies, labs and specialty care providers have a full
picture of the Veterans they treat.
The VA has put forward a 10-year rollout plan for electronic health
records modernization, in part to ensure a methodical change that
minimizes the risk of disruption to Veterans. Part of the process
involves creating a uniform electronic record within the VA, which has
never existed. VA clinics across the country have been allowed to
operate their own systems for years, and the VA is working to harmonize
that record system as part of the process.
Early next year, the VA will roll out a unified record system with
the Department of Defense in three locations in the Northwest--the
first of many rollouts that will happen over the next decade. We are on
track to making this long-delayed dream a realization.
Achieving that goal fits in perfectly with Secretary Wilkie's
commitment to doing a better job at customer service for our Veterans,
which is already yielding results.
Polls say wait times at VA medical facilities are shorter than wait
times at private facilities, and that the VA is providing the same or
better-quality care compared to their private counterparts.
The secretary has stressed the need for a bottom-up organization
that depends on our dedicated, motivated employees for success. A 2018
Partnership for Public Service poll showed that goal is being
achieved--the group ranked the VA as the 6th best place to work among
large Federal agencies, after the VA was second-to-last on that list a
year earlier.
Improved morale at the department shows that cultural change is
happening, and that employees have more of a stake in the outcomes we
deliver for Veterans.
One example of the high level of customer service we are delivering
is the growth of Medical-Legal Partnerships, in which the VA works with
law firms and associations, law school clinics and others to provide
free legal advice to Veterans at the same place they get their
healthcare.
Our studies show that at least 5 of the top 10 unmet needs cited by
homeless Veterans are legal in nature, not medical. Legal staff on the
premises have helped thousands of Veterans with things like renewing a
driver's license, debt relief, and resolving child support and custody
issues.
The VA is studying how this legal help is making a positive impact
on the health of the Veterans who visit us. This innovation is not a
formal, budgeted program, but it shows how communities around the
country have helped to rally support for those who served their
country. It shows the dedication of our staff, many of whom volunteer
at these legal-medical partnerships.
We are also doing a better job serving women Veterans. In the last
five years, women accounted for 30 percent of the increase in Veterans
we treat. The number of women patients we see has more than tripled
since 2000 from 160,000 to more than 500,000.
Today, women make up about 10 percent of all U.S. Veterans, but we
expect that number to grow in the years ahead, and we're already
adjusting. The VA is providing more services for women than ever,
including primary care, gynecology and mental health care.
Recent studies show women are getting good care when they come to
the VA. They are more likely to get breast cancer and cervical cancer
screening at the VA that women in private sector health care. The VA
continues to put a special focus on helping women Veterans who are
homeless, and women Veterans who are at risk for suicide.
Importantly, we are taking steps to eliminate all forms of sexual
harassment at our clinics. We're training our staff to intervene when
they see it, part of our mission of making women comfortable when they
come to our hospitals to get the care they've earned.
The VA is also pursuing the broad goal of transforming how the
organization itself operates, to ensure more efficient delivery of
services to Veterans and the best use of taxpayer funds. Today, for
example, the VA relies on outdated methods of running our human
resources departments and our supply chain.
The supply chain problem is particularly in need of an update. We
are working vigorously to make sure that stories about VA hospital
workers having to borrow equipment and supplies from neighboring
hospitals are a thing of the past.
A healthcare network as large as the VA can no longer rely on an ad
hoc system of procurement. The department is looking to partner with
the Department of Defense's medical supply-chain system to create a
more efficient procurement system that is more respectful of U.S.
taxpayers.
Financial management and human resources modernization are a part
of this process. The VA's financial management system for accounting
and financial activities is more than 30 years old.
The VA established the Financial Management Business Transformation
Initiative to put in place a state-of-the art cloud IT solution, which
will improve the efficiency of its financial transactions and its
accounting procedures.
Human resources modernization is needed to improve the VA's ability
to track leave and vacation time, and to help recruit and retain top
talent. Any organization the size of the VA will have several
outstanding vacancies, and H.R. modernization will help us move more
quickly to get the right people in the right places.
The VA's H.R. system has been decentralized, and we believe
centralizing it will make us more efficient, more effective, and more
able to focus our resources on Veterans instead of internal management
issues.
None of these dramatic changes taking place at the VA could be
happening without Secretary Wilkie's commitment to transparency and
accountability.
The secretary and I continue to make site visits to VA Medical
Clinics around the country to ensure quality standards are being met.
Those visits supplement ratings comparisons between VA hospitals and
non-VA hospitals that we publish in order to keep up pressure on this
organization to improve.
That rating system not only rewards those VA hospitals that are
performing well, it informs the VA on how to focus its attention on the
hospitals that need improvement.
The VA was the first hospital network in the country to post wait-
times, and that gives us a tool we can use to ensure Veterans are
getting speedier access to health care around the country.
We were also the first to publicly post opioid prescription rates,
and we are seeing reduced prescriptions over the last several months,
in part by considering alternative pain mitigation therapies.
As a result of our focus on this critical issue, we have seen a 45
percent reduction in the number of Veterans receiving opioids, and a 51
percent drop in the number of patients on long-term opioid therapy.
We've seen a 66 percent drop in the number of patients on high-dose
opioid prescriptions.
The VA has another layer of accountability that is unique among
agencies in the Federal Government--the Office of Accountability and
Whistleblower Protection. That office is aimed at making sure we pay
attention to complaints that our employees bring against other
employees or practices that may not be in the Veterans' best interest.
The leader of that office reports directly to Secretary Wilkie,
assuring that pervasive and sensitive personnel or management problems
are getting attention from our Cabinet-level leader.
Our commitment to transparency and accountability, the improved
morale of our employees, and our readiness to take on reforms like the
MISSION Act and challenges like Veteran suicide have turned the VA into
a rising star in the Federal Government, and I thank you again for the
privilege of considering my nomination to help lead the department in
accomplishing its important mission.
______
Response to Prehearing Questions Submitted by Hon. Jon Tester to James
M. Byrne, Nominee to be Deputy Secretary, U.S. Department of Veterans
Affairs
Question 1. Have you discussed with Secretary Wilkie the duties he
would like you to perform, or the role he would like you to assume, as
the permanent Deputy Secretary?
Response. I do not anticipate any significant change in duties if I
am confirmed as the permanent Deputy Secretary. I meet with Secretary
Wilkie daily.
a. What specific projects have you managed since you took over the
Deputy duties?
Response. For the past nine months I have performed the chief
operating officer duties of VA Deputy Secretary where I focused my
efforts on providing leadership to the new governance constructs for
our mission focused operations in VHA, VBA and NCA, large modernization
efforts, and big initiatives such as Electronic Health Records
Modernization (EHRM) and MISSION Act. I head the Operations/Management
Board, Modernization Board, and program management reviews where senior
leaders identify risks and requirements, measure progress toward
defined metrics, and hold leaders accountable.
b. What were the major decisions you made while performing the
duties of the Deputy Secretary that did not turn out to have the impact
you anticipated, and what problems did you try to address that are
still challenges today? How do you anticipate handling them differently
if confirmed?
Response. Our initial response to the Colmery IT delay indicated
that we didn't fully appreciate the impact on affected Veterans. Our
promise to pay Veterans at the 2017 rates and our efforts to make them
as whole as we can while system work continues is a much better and
pragmatic answer. I will ensure the Department keeps making progress on
meeting the full intent of the Colmery law.
Question 2. Will you be VA's Chief Operating Officer? If so, please
describe in detail what you understand the position of COO to be.
Response. Yes. As discussed above the duties of the Chief Operating
Officer are to keep the Department of Veterans Affairs fully engaged
and supported in the delivery of a nationwide system of health care
services, benefits programs, and national cemeteries for Veterans and
dependents.
Question 3. What do you see as the biggest challenges facing VA at
this time--as to the Department as a whole, and specifically in VBA,
VHA, NCA, and OIT?
Response. As we discussed in our meeting, the Department as a
whole, is under extreme pressure to implement fully and well several
large transformations in the way we do business, simultaneously keeping
any degradation in healthcare, administration of benefits, and
disruption to services to an absolute minimum. Those business
transformations are specifically:
VHA: The VA MISSION Act provides Veterans and VA providers more
opportunities for collaboration to ensure Veterans have access to the
care they need. The challenges are ensuring a seamless transition from
seven complex community care programs under Choice to one under
MISSION.
In the coming months, VA will be deploying a new referral and
authorization system that will streamline information sharing between
VA and community providers and expand its deployment of Electronic
Claims Adjudication Management System (eCAMS), which is a tool that
will modernize our claims processing systems and improve both
timeliness and accuracy of payments to community providers.
NCA: One of the greatest challenges facing NCA is modernizing the
systems that support its mission. The Memorial Benefits Management
System (MBMS) will upgrade various NCA systems that support burial
operations, scheduling, headstone/marker ordering, and other important
activities. The MBMS project is managed by VAOIT and is just one of
their many IT challenges.
OIT: Financial Management Business Tool (FMBT), Electronic Health
Records Modernization (EHRM), Defense Medical Logistics Standard
Support (DMLSS), HRSmart, are all major programs requiring more support
and information technology to enable them. Additionally, VA is a
growing enterprise requiring more and more in the areas of technology
to include bandwidth, computers, storage, and software. The biggest
challenge for OIT is garnering the resources in terms of its workforce,
technology, and budget to meet these demands and satisfy the business
needs of VBA, VHA, and NCA as they support the Veterans we serve.
VBA: The biggest challenge facing VBA at this time is the
implementation of the recent ruling of the U.S. Court of Appeals for
the Federal Circuit regarding ``Blue Water Navy'' Veterans who served
in the Republic of Vietnam between January 9, 1962, and May 7, 1975.
[TDCE1]Currently, VBA is analyzing policies and developing procedures,
identifying affected populations and their eligibility for benefits and
healthcare, and developing a robust outreach and communications plan.
We are currently conducting an analysis of delivery and actual benefit
costs, which we will discuss with OMB and Congress.
Question 4. What will be your top three priorities after assuming
the role of Deputy Secretary?
Response. (a) Model and ensure SECVA's tone from the top and
leadership principles of integrity, performance, and selflessness
continue to maintain a stabilizing effect throughout VA, (b) Execute on
SECVA's priorities: (i) customer service, (ii) implementation of EHRM
and MISSION Act, (iii) business transformation, and (iv) and his top
clinical priority of reducing the number of Veteran suicides through a
``whole of government'' approach which was established through the
PREVENTS Executive Order. (c) Ensure continuity of operations, and
sustainment of timely execution of business transformation efforts
beyond this Administration.
Question 5. If confirmed, what efforts will you undertake to make
certain that VA is aware of, and responsive to, the needs of the
veterans' community? Do you plan to meet regularly with veterans'
organizations?
Response. I value the service and guidance provided to the Veteran
community, VA, and me personally by Veteran Service Organizations. The
VA's awareness and response comes, in large part, as a direct result of
listening to our Veterans. If honored to serve Veterans as the Deputy
Secretary for the Department I will continue engaging veterans'
organizations with robust dialog as I have done while performing the
duties of the Deputy Secretary.
In that time, I have experienced the need to be both proactive and
reactive with respect to meeting with Veterans' organizations. We must
balance between meetings that are habitual and frequent such as our
monthly VSO breakfast and our VSO quarterly day-long sessions on the
one hand, and meetings that are opportune and sensitive to emerging
issues that provide opportunities to conduct meetings falling outside
the normal habits and scheduled meetings.
Question 6. How would you, as Deputy Secretary, work with the
Office of Inspector General? Please describe your interactions with the
IG's office since arriving at VA.
Response. As VA General Counsel and more recently performing the
duties of Deputy Secretary, I meet with the VA Inspector General
monthly and additionally as needed. He has always made himself
available to brief or meet with me or SECVA. I intend to continue this
collaborative relationship for the betterment of VA, the Veterans we
both serve, and the American taxpayers.
Question 7. Do you agree to supply the Committee with such non-
privileged information, materials, and documents as may be requested by
the Committee in its oversight and legislative capacities for so long
as you serve in the position of Deputy Secretary?
Response. Yes. VA has been responsive and cooperative to
Congressional oversight and will continue to do so.
Question 8. VA has always struggled to tell its success stories.
What would you do to help the Agency tout its accomplishments?
Response. Our Secretary and senior leaders are, with increasing
frequency, speaking to local, regional and national online, TV, and
print media. The department has also delivered a great number of
opinion pieces written for a wide variety of outlets. I will join the
Secretary in engaging media and Veterans Support Organizations to
better inform Veterans, their families and the general public about
what VA is doing. Finally, an important element in providing news is
regular communication with our elected officials and their staffs.
Question 9. What would you do to ensure that Members of Congress
are advised in advance of problems, issues and emerging matters--
particularly when those matters are specific to the area a member
represents?
Response. The Secretary and I work closely with our Office of
Congressional and Legislative Affairs (OCLA) to make timely
notifications of all emerging issues based on the Member's state or
district, previous interest in the issue, as well as those on the
Committee and affected delegations regardless of their Committee
assignments. We proactively push information including email blasts
through gov delivery and Bloomberg. The Assistant Secretary, OCLA, his
leadership team, and the congressional relations officers make phone
calls to Professional Staff Members, Chiefs of Staff in the personal
offices of Members, and legislative staff such as the Directors,
Assistants, and Correspondents. Additionally, our legislative team is
in constant touch with any Member of Congress who asks for Technical
Assistance on a bill or amendment to a bill.
Question 10. According to the Department of Housing and Urban
Development, the fastest growing subpopulations of homeless veterans
are female veterans and the post-9/11 generation. What will you do to
ensure that VA homelessness programs address the needs of these
specific groups?
Response. The VA is committed to serving the needs of homeless sub-
populations such as female Veterans and post-9/11 Veterans through an
array of programs and services specially designed to help homeless
Veterans live as self-sufficiently as possible. Presently, VA's on-
going, transitional and permanent housing programs provide services as
follows:
Grant and Per Diem (GPD) Program
In GPD a Veteran can be served in transitional housing and
considered homeless if fleeing, attempting to flee, domestic violence,
dating violence, sexual assault, stalking, or other dangerous or life
threatening conditions in the individual's or family's current housing
situation, including where the health and safety of children are
jeopardized, and who have no other residence and lack the resources or
support networks to obtain other permanent housing.
Supportive Services for Veteran Families (SSVF)
SSVF seeks to help at-risk veteran families avoid homelessness
through family reunification and offers additional assistance to those
fleeing domestic violence. This provision allows the full range of SSVF
services, including financial assistance, to be offered to victims of
domestic violence whether they are veterans or the victim of violence
in a veteran's household. By training staff on mediation techniques,
supported by limited financial assistance, SSVF seeks to work with
families and friends to prevent the trauma of homelessness.
Housing and Urban Development--VA Supportive Housing (HUD-VASH) Program
The HUD-VASH Program represents a collaborative effort between HUD
and VA to provide subsidized permanent housing targeted primarily to
those long-term homeless Veterans. Veterans receive rental support from
HUD as well as case management and supportive services from VA. The
program's goals include housing stability while promoting Veteran
recovery and independence in the community for the Veteran and the
Veteran's family, a unique need of female Veterans.
Health Care for Homeless Veterans (HCHV) Program
The HCHV programs aim to reduce homelessness among Veterans by
engaging and connecting homeless Veterans with health care and other
needed services.
HCHV programs provide outreach, case management and HCHV Contract
Residential Services ensuring that chronically homeless Veterans,
especially those with serious mental health diagnoses and/or substance
use disorders, can be placed in VA or community-based programs that
provide quality housing and services that meet the needs of these
special populations.
Question 11. In your role as Deputy Secretary, what will you do to
improve legal services for underserved veterans and how will you
increase partnerships with legal assistance clinics and other pro-bono
services to address the unmet needs of veterans?
Response. VA has a robust, partnership-driven approach to improving
legal services for Veterans. In January 2016 we had 77 legal clinics
co-located at VA facilities. That number has grown to more than 170 co-
located legal clinics housed at VA facilities Nation-wide, where
Veterans can be referred for on-site legal assistance when visiting the
VA. Five of the top ten unmet needs of homeless and at-risk Veterans
are legal needs, such as evictions, child support issues, outstanding
warrants, and discharge upgrades. These critical needs must be
addressed by providing a connection to on-site legal assistance at VA
care locations.
As Deputy Secretary, I plan to amplify VA's role in providing
access to legal services by establishing a legal clinic in every single
VA Medical Center. This continues to be a goal of mine since I began
serving Veterans at VA as General Counsel.
In particular, I will be working with our Office of General Counsel
and Veterans Justice Program to conduct outreach to pro bono legal
services organizations, including legal aid, law firms, bar
associations and law school clinics, to seek out partnerships to bring
legal services to Veterans at VA.
And--as I have done for the past nine months while performing the
duties of the Deputy Secretary--I will continue to make a point of
asking, whenever I visit a VA medical facility in any corner of our
country, about whether the facility has a Medical-Legal Partnership on-
site for Veterans, and if not, why not.
Question 12. VA outreach to Native American reservations and other
highly rural areas is challenging but insufficient. How will you use
your role as Deputy Secretary to improve and increase outreach to these
underserved populations so that they can receive the benefits and care
they deserve?
Response. VA plans to increase the tribal consultation efforts as
well as initiate collaborative work on care coordination with both the
Indian Health Service and tribal health partners. This will serve to
enhance the already robust outreach efforts made by agency leadership
and staff in recent years.
VA continues to partner with tribal governments to conduct claims
clinics across Indian Country in order to increase access to benefits
for Veterans. Last fiscal year, VA assisted over 1,100 Native American
Veterans with their claims. Other outreach efforts include Tribal
Veterans Representative trainings, tribal consultations/listening
sessions, and senior VA/tribal leadership intergovernmental site visits
with Veterans and service providers across Indian Country.
In addition, we have convened a VA Outreach Council to better align
and consolidate agency-wide outreach efforts to provide the most
effective and efficient mechanisms to deliver VA benefits and services.
The Council is working now to develop a VA-wide outreach operating plan
and form a group of subject matter experts to implement recommendations
from the VA-wide Outreach Operating Plan.
Through the Veterans Cemetery Grant program, NCA has provided over
$34 million in funding for Tribal Veterans Cemeteries since 2011. There
are currently 11 Tribal Veterans Cemeteries throughout the country. Two
more are expected to be dedicated in FY 2019 (Minnesota and North
Dakota).
NCA continues outreach through the Office of Tribal Government
Relations as interest in the grant program continues to grow. In this
FY, NCA has provided outreach to the United South Eastern Tribes and
Yakama Nation on opportunities for new Tribal Veterans Cemeteries.
I will ensure that VA continues to operate an extensive outreach
program to Veterans in rural areas which, includes Native American
reservations. One such item from our efforts will be an outreach
campaign in the State of Alaska that our own Veterans Benefits
Administration (VBA) will be leading and we anticipate it will be one
of the largest of the year. This campaign will reach highly rural,
frontier, and tribal Veterans. The campaign includes partnerships with
several Alaska Tribal Veteran Representatives and focuses a large
portion of VBA's attention to reach this remote population.
In addition to the Alaska Campaign, VA is planning approximately 40
tribal claims clinics in FY 2019. These events are held on tribal land
and include experts from VA who assist with on-the-spot claims
processing and providing information on VA benefits and services face-
to-face.
Finally, during this fiscal year, VBA has travelled over 7,000
miles to participate in over 20 outreach events targeting tribal
Veterans. This has resulted in contact with over 700 tribal Veterans
who may not have previously worked with VA.
Question 13. What do you see as your role in the Department's
effort to reduce veteran suicides? How will you use your position to
promote veteran suicide prevention and mental health outreach?
Response. My role within VA's suicide prevention program is to
ensure that the suicide prevention team has the right resources and
strong leadership support--at all levels of VA--to fully implement
their work.
VA's suicide prevention program is guided by the National Strategy
to Prevent Veteran Suicide, a framework for identifying priorities,
organizing efforts, and focusing national attention and community
resources to prevent suicide across all sectors in which Veterans may
interact.
Suicide prevention is a top priority for VA, and we are developing
key partnerships to amplify VA's efforts and ensure that Veterans have
access to the care they need, when they need it, through VA or in the
community.
Additionally, as the co-chair of the Joint Executive Council (JEC),
I am working to ease the burden of transition and minimize suicide risk
for servicemembers moving from DOD to VA and ensuring we have sound,
evidence-based practices in place across both agencies.
Question 14. Please describe your role in implementing the VA
MISSION Act.
Response. To effectively implement the MISSION Act and address
impacts within and reaching beyond VHA, the Secretary chartered a
governance structure which I direct. Governance of the MISSION Act
implementation includes an Executive Steering Committee (ESC) which I
chair. The ESC directs efforts of the Enterprise Project Management
Organization (EPMO) and a cross-enterprise Tiger Team. All work efforts
report strategy and progress through these governance mechanisms.
Question 15. As Co-Chair of the Joint Executive Council, what would
be your priorities?
Response. I have had the privilege of serving as the VA Joint
Executive Committee (JEC) Co-Chair in my capacity as General Counsel
performing the duties of the Deputy Secretary and have worked closely
on important joint issues with my DOD counterpart. In addition to the
quarterly JEC meetings we hold bi-weekly teleconferences to obtain the
latest status on key issues and to remain in synch. On March 18th, 2019
we issued the Joint Strategic Plan (JSP) for FY 2019-2021 which details
the priorities for the JEC.
As Co-Chair of the Joint Executive Council and in coordination with
my DOD counterpart, my priorities are to promote rapid and agile
decisionmaking on VA resources (e.g., human resources, information
technology, and acquisition), minimize EHR deployment and change
management risks, and promote interoperability through coordinated
clinical and business workflows, data management, and technology
solutions while ensuring patient safety.
Question 16. How do you see the VA's leadership role in the joint
governance of the Electronic Health Record Modernization?
Response. VA recognizes the differences in patient population,
scope, and capability requirements of its new EHR solution from DOD's
MHS GENESIS. I will advocate on behalf of VA to meet its unique needs
while ensuring there is optimal collaboration between the Departments,
eliminating the long-standing barriers between DOD and VA. I will
promote an effective joint decisionmaking structure that provides a
single point of accountability. Additionally, I will promote synergies
and efficiencies between DOD and VA while ensuring that VA's new EHR
solution is fully interoperable within VA, with DOD, and with community
care providers.
Question 17. In your role as Deputy Secretary, what specifically
will you do to ensure that VA's clinical and technical needs for the
new Electronic Health Record are fully achieved when joint decisions
are elevated to you?
Response. VA planned eight national workshops to encourage
collaboration amongst diverse end-users from clinical specialties and
business operations to design, validate, and configure clinical and
technical requirements of VA's EHR solution. Given the joint nature of
this program, DOD participates at these workshops to provide context on
its decisionmaking processes and clarification of lessons learned. The
workshops facilitate joint decisionmaking at the lowest level. If
necessary, decisions are raised to higher levels of joint governance
where DOD and VA are equal partners. Where joint decisions are
required, as Co-Chair of the Joint Executive Council, I will ensure
that VA's EHR solution is configured to meet the Department's unique
clinical and technical requirements and interoperability objectives,
without expense to patient safety and care for Veterans.
Question 18. What do you see as the role of the Interagency Program
Office in both the implementation and continued operation of the new
Electronic Health Record?
Response. In its current construct, the IPO is not empowered as an
agile, single decisionmaking or governance authority to efficiently
adjudicate potential functional, technical, and programmatic
interoperability issues in support of the Departments' single, seamless
integrated EHR objectives. The FEHRM Program Office will provide a
comprehensive, agile, and coordinated management authority to execute
requirements necessary for a single, seamless integrated electronic
health record and provide a single point of authority for each
Department's EHR modernization strategies. As such, the FEHRM will
direct each Department to execute joint decisions for technical,
programmatic, and functional functions under its purview and provides
oversight regarding required funding and policy as necessary.
Question 19. Do you believe that the Electronic Health Record
Modernization should be operated as an acquisition or clinical project?
Response. Given the scope and complexity of VA's EHRM effort, VA
requires both acquisition and clinical expertise to ensure a successful
transition to its new EHR solution. VA leadership appreciates the
complexity of a holistic, enterprise-wide clinical business
transformation. It is important to note that the EHRM effort will not
be successful without technical and clinical configuration to meet end-
users' needs. Through national and local workshops, VA encourages
collaboration between business operations experts and clinical end-
users so that VA's EHR solution is designed, validated, and configured
to promote interoperability and quality care for our Nation's Veterans.
Question 20. As you know, current law states that the VA's Director
of Construction and Facilities Management (CFM) reports to the Deputy
Secretary. While the Director of CFM has a wide range of
responsibilities in law as it relates to construction including
planning, leasing, facility repair and maintenance, etc., in reality,
much of that work also takes place in other parts of the Department
including the Veterans Health Administration and the Office of
Management who have their own reporting chains and priorities. This can
create inefficiencies, coordination challenges, and unclear lines of
authority. With a huge capital asset portfolio to manage, a significant
pipeline of major, minor, non-recurring maintenance and leases and
planning for the Asset and Infrastructure Review Commission, do you
believe that the Department is optimally organized to effectively
carryout the wide range of current and future capital asset
responsibilities? Please explain why or why not. If you do not believe
the Department is optimally organized, what are your suggestions for
changing roles, responsibilities, and organizational structure?
Response. As Congress directed, the VA has a new Chief Acquisition
Officer (CAO), who is aggressively bringing program and lifecycle
management to the Enterprise and has already led an initiative to begin
our market assessment effort in preparation for the Asset and
Infrastructure Review Commission. This provides a catalyst to improve
how we develop and achieve basic asset management functions throughout
the lifecycle. We do envision working toward an organizational
structure that supports these good practices at the Enterprise level.
For example, provide an innovative approach to asset management by
streamlining the lifecycle of how we plan, deliver, and maintain
facilities; and to ensure consistency and clarity regarding how we make
investment decisions. I will ensure our execution and delivery is
efficient, practical, and flexible. I will implement a formal program
management methodology by using the same metrics and tools to manage
risks and timely delivery. I will ensure we have clear accountability
for facilities management that will protect those assets and their
ability to serve veterans for years to come. Additionally, we will
review opportunities for future organizational changes to centralize
functions and improve efficiencies across the Enterprise. Any changes
will be driven by evidence and leading practices and will be brought
forward to SVAC leadership for review.
______
Posthearing Questions Submitted by Hon. Sherrod Brown to James M.
Byrne, Nominee to be Deputy Secretary, U.S. Department of Veterans
Affairs
Question 1. Mr. Byrne, please provide me with a detailed breakdown
of VA's decisionmaking process related to the National Academies
recommendations regarding bladder cancer, hyperthyroidism, hypertension
and Parkinson's like symptoms?
Please provide me with VA's analysis regarding total number of
veterans effected, and the cost associated with extending service
connection to each specific illness.
Question 2. Provide a breakdown of employees disciplined or
terminated under section 202 of the VA Accountability and Whistle
Blower Act, which affects Sec. 714. Please include by race, grade,
discipline, and the issue that led to discipline or termination.
Question 3. Provide a breakdown of employees disciplined or
terminated under section 201 of the VA Accountability and Whistle
Blower Act, which affects Sec. 713. Please include by race, discipline,
and the issue that led to discipline or termination.
Question 4. In the past three years, how times did a deciding
official overturn a proposing official's personnel action
recommendations?
Please breakdown all of those actions to detail what the proposing
official recommended, what the deciding official's decision was, and
whether the employee complied.
Question 5. Recent studies have demonstrated shorter wait times for
primary care and certain types of specialty care appointments at VA
facilities, and better outcomes at VA compared to private sector
hospitals. A recent Annals of Internal Medicine study compared VHA
hospitals with non-VHA hospitals and found that VA facilities provided
the best care in most referral regions and that several of VHA's
mortality safety results were markedly better than those for non-VHA
hospitals.
Understanding that many VA facilities provide exceptional,
specialized care, Section 133 of the MISSION Act, stipulates that VA
must establish competency standards for VCCP clinicians treating PTSD,
MST, and TBI.
How will VA ensure that consistent, high quality and
specialized care is being provided in these service lines in the
community?
How will VA craft a program that allows veterans to go
into the community when deemed necessary by their provider, without
compromising or draining resources from the critical fields within VA?
Question 6. We are about two weeks away from implementing the new
Veteran Community Care program and there are concerns related to how
the Department is deciding drive time. As of right now, it is based on
low volume traffic. Please explain why low volume traffic would be the
appropriate metric, or whether there other factors that you have taken
into account?
a. Additionally, please detail the training procedures that the
Department has implemented for front line employees--who will be the
face of the new Program to veterans and their families.
b. Are there in person trainings, or are they conducted via
webinars?
c. Are the frontline employees able to provide feedback to make
improvements?
Question 7. What is the status of the new scheduling software-the
Decision Support Tool (DST)? Please detail what the program currently
does and what it will ultimately do to ensure veterans get accurate
information about community care, so they can make an informed decision
with their VA provider?
Question 8. Proposed Question on Staab:
a. I'd like to ask about how VA is implementing policy related to
the Staab ruling, and what payments VA can make for veterans who
receive care at non-VA emergency rooms. There are thousands of claims
pending related to Staab, is that correct?
b. And, as of right now, VA will only approve claims for 2016-post
the court ruling-not back to 2010 when Congress initially passed the
legislation, is that correct?
c. And, will it take another act of Congress for VA to fully
reimburse veterans for non-VA emergency room care, per Congressional
intent?
[Posthearing responses were not received within the
Committee's timeframe for publication.]
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[The Committee questionnaire for Presidential nominees
follows:]
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[A letter from the Office of Government Ethics follows:]
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[Letter from the nominee to the Office of General Counsel,
U.S. Department of Veterans Affairs:]
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Chairman Isakson. Well, thank you for being here today and
thank you for your service already at the VA. We appreciate and
look forward to the years--hopefully years, that is plural--we
will have together, and continue striving to make the VA even
better. And, I appreciate you restating your commitment to
Secretary Wilkie, who I believe has done an excellent job in
kind of settling down the temperature at the VA to a stable
98.6, rather than going up to 102 every now and then. We were
putting out too many fires and I appreciate that very much.
How much time have you spent, or are you spending, on the
question of suicide?
Mr. Byrne. I will tell you, sir, personally, every day we
touch it in some way. It is the number 1 clinical priority for
the Department of Veterans Affairs, and Mr. Wilkie beats that
drum every day. A $222 million budget has been allocated for
2020, regarding suicide prevention. I will share with you what
I have learned and what my involvement is.
What I have learned is we have robust programs at all areas
involving suicide prevention. At the further extreme of the
chain we have a Veteran Crisis Line that handles 1,700 calls a
day, 80 of which require emergency intervention to veterans in
crisis. We have had 240 saves, if I could call them that, on VA
properties over the last 18 months, veterans that were in the
process of committing suicide. That is at the extreme end of
suicide prevention.
What we are trying to do, which I am sure you would agree,
is back up the chain of events so that we do not have to have
saves, that we do not have to have 80 emergency interventions
every day. So, moving it back up the chain we have, of course,
the President's Executive order, which directs Mr. Wilkie to
put together a task force and a framework for rallying the
resources of the Federal Government, local communities,
academia, and private industry, which we are very excited about
that, as hopefully a needle mover.
But, within the VA, that $220 million is well spent. We
have 400 suicide prevention coordinators throughout the
country, amazing employees who do a number of things. We have a
program in the VA called Reach Vet. It is an analytical program
that takes several data points regarding the data that we have
on veterans and identifies those veterans that are at risk.
Those coordinators, those 400, reach out to those veterans and
intervene, try to get them treatment and care. And, that is
within the veterans that we can actually reach.
The veteran coordinators are also an extensive outreach
program. Last year they reached 200--I am sorry--they reached
two million people, and I say people because not all of them
are veterans. In fact, the majority of them are not veterans,
because we want to put the word out about the treatment and
care that the VA can provide and the communities can provide to
veterans that are in distress. So, those community coordinators
talk to families, they talk to community leaders, and try to
rally them to get the support they need, whether it is in the
VA or elsewhere.
We have looked at it as a public health approach, instead
of looking at it through some other paradigm, and I think that
is the proper way to be looking at suicide prevention across
the United States, as well as within the veteran community.
We have also launched the #BeThere campaign, which is a
communication campaign really for the general public, just to
be there for each other, be there for veterans. A lot of
factors go into committing suicide, as I am sure you are well
aware. But, ones that are probably not in dispute are:
loneliness, lack of connection, and hopelessness. Those are
major contributors, in general, to the psyche.
But, we have also found, with our specific community of
veterans, that homelessness, legal troubles, and things along
that line contribute as well. So, all those programs, working
together, we are hoping are going to reduce this horrible
tragedy across the United States. Twenty veterans a day are
taking their lives, 14 of which are not within our system.
So, we are taking extensive efforts. I try to touch each
and every one of these initiatives, to some degree, and I
assure you we talk about it every day, sir.
Chairman Isakson. Well, the thoroughness alone of your
answers shows the commitment that you are making to yourself,
and I appreciate that very much because it is a work in
progress and always will be, but as long as we are moving in
the right direction and we are preventing suicides from
happening and we are intervening early enough to make that
happen, then we are doing our job, or at least doing a better
job of it.
You mentioned the MISSION Act. That is a critical act. How
much have you had to say or do in the creation of the new
access standards for the MISSION Act?
Mr. Byrne. The specific access standards or MISSION Act at
large?
Chairman Isakson. Both.
Mr. Byrne. Well, the MISSION Act access standards, there
was a lot of deliberation. Mr. Wilkie being the great leader
that he is, he wanted input from all different sort of corners
and views on the access standards. You are aware of the ones we
settled on with 30 minutes, 60 minutes, and then the wait
times. So, I was deeply involved in that and supportive of the
decision that was made. I thought it was a reasonable access
standard to expand the aperture just a little bit further.
But, to the larger question about MISSION Act, we have a
big railroad to run. There are a lot of operations going on.
But, I can tell you the drumbeat for MISSION Act is every day,
and that one is loud, particularly as we spring toward the June
6th implementation date for a good portion of the MISSION Act.
Chairman Isakson. Yeah, that is going to be a critical
time. That first 12 months from that date on are going to be a
critical time to judge the progress we have made and ultimately
get to the point where the MISSION Act is carrying out its
mission for the veterans of the United States of America.
Senator Moran.
HON. JERRY MORAN, U.S. SENATOR FROM KANSAS
Senator Moran. Mr. Chairman, thank you. Mr. Byrne, thank
you for your presence here and your willingness to serve our
veterans and serve our country.
Let me outline for you a set of facts and ask for how you
would handle this circumstance. The facts, as I know them, is
that Senator Tester and I introduced legislation dealing with
providing hearing aid specialists within the VA. This question
is more than just about hearing aid specialists. It is about a
process or a way that the VA responds to Members of Congress
and whether or not they abide by the law as passed.
So, in 2016 legislation was signed into law, requiring that
the VA establish standards for hearing aid specialists and then
hiring them into the VA. Last March, some 3\1/2\ years later,
the Secretary was in front of this Committee and I asked--in
fact, I reminded the Secretary that the VA has not established
those standards, as the law requires, nor has it hired any
hearing aid specialists. Of course, that resulted in a
commitment from the Secretary and his team that they would be
back in touch with us and we would receive a briefing on what
was transpiring on this issue.
Shortly thereafter, I received a written response that
said, quote, ``Given that the VA has no plans to use its
discretionary authority to hire hearing aid specialists, we are
uncertain how such a briefing would be useful.'' So, we went
from a law being passed, requiring that VA act in a certain
manner to a conversation with folks at the VA in a hearing
setting in which I would be briefed, to a ``we are not going to
hire any specialists so there is no reason to brief you.''
How would you handle that circumstance in your new
position? Is there a better way of doing that, and do you
understand how the law requires--when the law requires the VA
to do something that it does it?
Mr. Byrne. I am very clear on that, as a lawyer and as a
leader within the Federal Government, sir. If your thought that
you passed is very clear that we are required to do something,
we certainly will. I am not sure how to answer it beyond that.
If it is required, it is required. If it is optional, that is a
different discussion.
Senator Moran. Absolutely it is a different discussion.
However, that discussion cannot occur, or will not occur
because the VA says it is not a benefit to them to have such a
conversation with me.
Mr. Byrne. That is not acceptable. We will have that--I
will give you assurances we will look into this, we will have
that dialog, and we will comply with the law. That is not--
there is no wiggle room or gray area in that, sir.
Senator Moran. Mr. Byrne, first of all, I know that you
would answer you will comply with the law, and I appreciate
that, and I am not trying to put you in an awkward position.
But I have been on the Veterans' Committee for 23 years now and
one of the things that I think is important is for the VA to
implement laws as passed by Congress. I do not think it is just
the VA. I think that is the nature of our constitutional system
of government. On too many instances, over 23 years, I have
seen where the VA has found ways to avoid doing what Congress
has directed them to do.
So, this is a much broader issue for me. I am not intending
to--I have great regard for Secretary Wilkie, too--I am not
trying to put you in a position between answering my question
and being in an uncomfortable position with what he committed
to do with me.
But, I want to hear from you that you are committed not
only to the law, which I would expect you to say, but that so
many times nominees come before our Committee, and, of course--
and it is generally the Democrat side asking, ``Will you deal
with us? Will you make certain that we are briefed and that you
will respond to our questions?''
I just want to, again, highlight how important it is for
the VA to have a relationship built on trust and cooperation
between me and my colleagues, as Members of Congress, and you
and your colleagues at the Department of Veterans Affairs.
Mr. Byrne. Most certainly, sir. You have my full commitment
to that.
Senator Moran. Thank you very much. Let me ask, in the
short time I have left--although I do not know who we are going
to next, Mr. Chairman--the issue of MISSION Act. Let me just
mention a couple of things. I am hopeful that there is a field
manual so that the VA personnel in the field who are actually
implementing the MISSION Act know what the----
Chairman Isakson. What it is.
Senator Moran [continuing]. What it is, what the mission
is. Thank you, Johnny. What the mission is. Too many times,
again, this is an experience that I have had with the VA, the
answers that I receive here, what I see as the policy, what I
see as the direction is not understood or implemented by folks
who actually are doing the work in Kansas and across the
country.
So, I would encourage--we have been told that there will
be, although we have never seen a field manual, but we think
the staff at the VA, in the field, need to understand. I always
say this. Mostly what I do in regard to veterans issues is what
is influenced by what I call casework, what Members of Congress
do in trying to solve problems of their constituents. VA
casework is a significant component of what my office does.
In this week's report, there was veteran who called our
office to say he needed community care. The VA told him that
the Choice Act has expired and that the MISSION Act had not
been implemented; therefore, there was no community care for
him available. None of that, of course, makes any sense. We had
community care before we had Choice, we have community care
today, but it is how do we translate what is the law, how we
translate what is the policy at VA Central to the folks who are
actually dealing with the veterans on a day-to-day basis.
So, I would encourage you to pursue making certain that
that information, whatever it is called--a field manual of some
kind--is clearly available and understood. I had the VISN folks
from Kansas City, from our VISN in the office yesterday. They
are indicating that the training is going exceptionally well
and they think this is one of the best experiences in training
VA employees in the field. I am very pleased to hear that and
to see their delight, their enthusiasm for the way this is
going. But, again, I would highlight the distinction that often
happens between what is said here and what is said back home in
Kansas or across the country.
One of the other pieces of casework that appeared recently
is this. A patient and a provider reached a conclusion that it
was in the best interest of a veteran to go outside the VA for
that care and treatment. That decision was overturned by the
hospital director. And, I would again highlight what the law
says. Once the provider and the veteran make a determination of
what is in the best interest of the veteran, that is the
decision. It is not something that works its way up the chain
of command. MISSION Act will only work if there is a
relationship that is solid and viable between the provider and
the patient.
So, I highlight again, and maybe that is related to my
manual question, is even perhaps the higher level of VA
employees need to know what the process is for making a
determination about what is in the best interest of a veteran.
Finally--I will try to conclude really quickly, Mr.
Chairman--we have requested a claims processing information
sheet. She is the same--I am beating the same drum. Our
providers need the same kind of education and information. The
VA has been very helpful to us. We have had the Kansas Hospital
Association, others who have meetings. We have had VA personnel
present to have workshops and forums about implementation of
the MISSION Act.
But, as I have seen many times, there are difficulties in
the veteran knowing what he or she is entitled to, difficulty
in knowing what the--it is difficult for the employee of the VA
to know what he or she is able to offer. It is also confusing,
particularly in light of the slowness in payment and the
difficulty in being in-network with Choice.
We need to make sure that the providers now know the
opportunities are different and the circumstances for prompt
payment, episode of care, all those things are different than
it was under Choice. So, there is a lot of educating to be done
in addition to the two categories I previously mentioned, but
also with our hospitals, our doctors, our rural health clinics.
Mr. Byrne, anything I said that does not make sense to you?
Mr. Byrne. No, sir. I think you were spot on.
Senator Moran. OK. Thank you, sir.
Mr. Byrne. Thank you, sir.
Senator Moran. Thank you, Mr. Chairman.
Chairman Isakson. Thank you, Jerry, and to that end, if you
want to think of one or two more questions you want to ask, we
will have the time to do it. I will tell all the staff that are
here, for Members, if you have a Member that is coming that
wanted to ask questions, he or she needs to get here because I
am not going to waste his time or my time or Jerry's time
putting it off until we get somebody else here, after I have
asked my questions and Jerry has followed up with everything he
has to say.
Both of his points were well taken. I want to--in the
business that I ran for a long time, I always said, ``I do not
know is not an answer. It is an excuse.'' I think for years in
the VA, and a lot of government bureaucrats give the answer ``I
do not know,'' and then they shut up. So, there is no--so
somebody makes the call to inquire about a need they have or a
service they need, there is not any answer or response so they
are left hanging.
I think that particularly hits true with medical type
questions and decisions which are right down the line of the
Veterans Administration. So, I want to compliment Senator Moran
on what he said and raise the visibility of what you said,
because what you said was very important. There is no excuse
for not knowing the answer to a question that you are asked,
and if you do not know the answer, the answer should be, ``I do
not know, but I will find out,'' and you ought to take their
number down and you ought to call them back.
If we can just do the simple courtesies of life, that all
of us appreciate, and do it well, it will be much more of a
customer-oriented, service-oriented type of an organization and
not one that is as frustrating as it sometimes can be.
I think Secretary Wilkie is bringing that type of attitude
to the VA. I have seen that happen, and I have had people tell
me the same thing. So, I just wanted to follow up on that point
and say that is the most--the most important thing we can do,
starting the 6th of June, when this is implemented in the
MISSION Act is to say--``I do not know'' is not the answer. ``I
do not know, but I will find out'' is the answer. Then, finding
out is the next thing you do, and getting that information to
the person is the next thing. If we do that we will raise the
confidence of the people who use the VA immensely, because it
will end a real problem we have had, and it will also help us
to find out where we have got real problems we need to cure.
So, I want to thank the gentleman from Kansas for bringing
that issue up. Mission one for us is the MISSION Act: getting
it implemented and making it work. We are going to have some
things fall through the cracks. We cannot have that many
people, that many moving parts and not have them, but at least
we can get on top of them, solve them, and make them better.
Senator Blackburn.
HON. MARSHA BLACKBURN, U.S. SENATOR FROM TENNESSEE
Senator Blackburn. Thank you, Mr. Chairman.
Chairman Isakson. Five minutes for questions.
Senator Blackburn. I appreciate that so very much, and
appreciate that you are here and that you took the time to
visit with us in advance.
I know you understand my concerns about the supply chain
and modernizing that. So, for the record, if you will talk just
a moment about what you are going to do to modernize that
procurement and supply chain and to mitigate some of the risk,
fraud, abuse in that, I think that would be important, as well
as--and it ties into implementation of the MISSION Act. We have
discussed this: the control measures and the efforts on
modernizing the IT structure, whether it is dealing with supply
chain or with records.
Mr. Byrne. Thank you, ma'am, for that question. There are a
lot of modernization efforts going forward that we discussed
earlier and I appreciate your focused question on the supply
chain and the risk that is apparent in the system right now. I
will give you an example that Mr. Wilkie has presented several
times, and I think I might have mentioned it in your office.
We have upwards of four million credit card transactions
for some of the things we need across the enterprise. That--I
will try not to use too dramatic of a word, but that is just
ridiculous, right? Accountability on that is challenging, at
best. The economy of scales and the costs are horrible. So, Mr.
Wilkie, very quickly, had an appreciation of what the Defense
Logistics Agency brings to the table, not a perfect system, but
probably--not probably--a much better system than we have. And,
there are a lot of reasons why we should partner up with them.
So, we have some agreements and some test pilots right now,
working with them, but that is the intent, is that we are going
to tuck up under the Defense Logistics Agency for the majority
of our equipment, material, and things that we need.
Senator Blackburn. Right. I would just say, also, my hope
is as we had discussed, that you will seek guidance and seek
some best practices from some of the hospital management groups
and practice management groups who employ far fewer people to
buy a much broader base of supplies at a much lower cost, yet
higher quality.
Mr. Byrne. Yes, ma'am.
Senator Blackburn. We would hope that.
Let me go to--you all may have discussed the lawsuit that
we found out about, that has been issued, in which your name
appears. In the circumstances referenced in the lawsuit you
were to determine the actions of consequence as the deciding
official of a complicated investigation. Correct?
Mr. Byrne. Correct.
Senator Blackburn. OK. Considering your professional acumen
and all of the information you had at the time, do you feel you
made a fair and just decision with the utmost integrity,
relating to the circumstances?
Mr. Byrne. Yes, ma'am, I do.
Senator Blackburn. OK. Looking back, is there any reason to
believe you may have violated any Department policy procedure
or even the spirit of the accountability and Whistleblower's
Protection Act?
Mr. Byrne. No, ma'am.
Senator Blackburn. You are comfortable with your decision.
Mr. Byrne. Very comfortable. Yes, ma'am.
Senator Blackburn. With that I yield back.
Chairman Isakson. Thank you very much, Senator Blackburn.
We are going to go to Senator Blumenthal, then Senator
Sullivan, then Senator Tillis, in that order, unless we get
another alternating party member in between. We try and
alternate Republican and Democrat while we are going in order
of appearance. It kind of reminds me of when my drill sergeant
in basic training told us all to fall in, in alphabetical
order, by height. That kept us going for 3 days before we
figured out how to do that.
Senator Blumenthal.
HON. RICHARD BLUMENTHAL,
U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. Thanks, Mr. Chairman, and thank you,
Mr. Byrne, for your service to our Nation. Thank you for being
here, and thanks for stopping by my office to talk about your
nomination, about some of the very pressing issues that I know
you have been addressing, even as you have been acting in this
position.
I am very concerned that, to date, the VA has failed to
compensate and care for veterans who were exposed to burn pits.
It seems like we are repeating the same mistake that we did on
Agent Orange, on toxic substances, and other kinds of poisons.
In the modern battlefield we have failed to address the health
problems of veterans who suffer from the painful and
debilitating effects of the battlefield.
And, I would like to just mention one of my constituents,
Army veteran Peter Antioho. He served in Vietnam--I am sorry,
in Afghanistan in 2012. While serving in Afghanistan, Mr.
Antioho would routinely walk by open burn pits riddled with
toxic waste and chemicals. Five years after he served he was
diagnosed with terminal brain cancer at the age of 31.
He is now fighting for compensation, literally fighting for
compensation for his illness. He has been rejected for that
compensation. With the help of my staff, the Connecticut
Veterans Legal Center, and The American Legion he has submitted
medical records as well as statements from his doctors and
commanders to prove a link between his cancer and the exposure
to burn pits.
I would like your commitment, if you are confirmed, to
personally look into his situation, but also to put the VA on a
path to support veterans who have been exposed to these toxic
substances in burn pits and other spaces around the modern
battlefield.
Mr. Byrne. Yes, sir.
Senator Blumenthal. Thank you. Speaking of Agent Orange and
the Blue Water Navy, as you well know, and we discussed it in
my office, this Secretary recommended that the VA not appeal
the recent Federal Circuit Court ruling, a 9-2 ruling in
January, that Blue Water Navy veterans are eligible for
benefits to treat their illnesses. The Department of Justice is
now reviewing that recommendation. Do you know what is stalling
the Department of Justice reaching a decision?
Mr. Byrne. No, sir, I do not. They have a 30-day extension
that I think ends within the next couple of days.
Senator Blumenthal. Do you expect within the next couple of
days there will be a decision?
Mr. Byrne. Yes, sir, and I do not believe they are going to
ask for an additional extension.
Senator Blumenthal. I hope you are right. And, I understand
that the Office of Management and Budget is in agreement with
your recommendation. Is that correct?
Mr. Byrne. Yes, sir.
Senator Blumenthal. Let me turn to another topic that,
again, you and I discussed--capital investment necessary for
our health care facilities, West Haven being a prime example.
As we noted and we agreed, the West Haven facility is sadly
obsolete and out of date in terms of its structural adequacy--
no other word for it. It is inadequate by today's modern
standards, to provide health care. Despite the valiant efforts
of a very dedicated and highly skilled professional staff--
doctors, nurses, volunteers--at the VA facility in West Haven,
that structural defects, or set of failings, is gravely
imperiling the health care provided in surgical facilities and
a variety of other areas.
So, I would like your commitment that you will undertake a
thorough review of that facility, put it on a priority list,
and enable all of our VA facilities to be brought into the 21st
century.
Mr. Byrne. Certainly. The review we can conduct, sir, but I
am hesitant to make a promise to you, in front of this body,
under oath, that I will ensure that West Haven, in particular,
is a priority. I hope you could appreciate that.
Senator Blumenthal. Well, at least I would like your
assurance that it will be put on a list, that it will be under
consideration, that it will be given----
Mr. Byrne. Certainly.
Senator Blumenthal [continuing]. The attention that it
deserves.
Mr. Byrne. Most certainly, sir.
Senator Blumenthal. As far as the sterilization facility, I
would like your commitment that you will report to me any
delays in the current schedule to have the temporary trailer
facility operational by no later than this fall, and to put the
permanent surgical sterilization processing facility on an
expedited track.
Mr. Byrne. Yes, sir. That is happening. That is a patient
safety issue. Thank you for putting a light on that for us.
Senator Blumenthal. Thank you. Again, thank you for your
service.
Mr. Byrne. Thank you, sir.
Chairman Isakson. Senator Sullivan.
HON. DAN SULLIVAN, U.S. SENATOR FROM ALASKA
Senator Sullivan. Thank you, Mr. Chairman, and, Mr. Byrne,
good to see you again. Thanks for your service already, not
only to the VA but to our country, the military, and the
Marines.
It is great to see your family here. It is really nice. It
is not always easy, having daughters myself, to watch your dad
go through these confirmation hearings and get a little roughed
up, but it is a family effort, so we are really glad and
appreciative of your family being here, because these kind of
public service jobs are--you know, they are all in for
everybody. I want to thank you and your family and your kids
for----
Mr. Byrne. Sir, for the record, this is a fraction of my
family.
Senator Sullivan. That is what I heard.
Mr. Byrne. We have been very blessed.
Senator Sullivan. That is impressive. That is great;
actually. It is wonderful.
We had a good conversation a couple of days ago, especially
around the idea of giving States like Alaska the flexibility
and autonomy to manage its VA resources in a manner that best
serves the veterans and the communities, while mindful of the
taxpayer dollars. You had cited the--what I view as kind of the
innovative--and I think you view it--innovative example of the
North Chicago Federal Health Care Center (FHCC) as a leading
example with the Great Lakes DOD facilities and the VA
facilities, which bridges kind of the local VA, the DOD, and
integrates all of that into a single Federal health facility
with a combined mission.
A system like this is designed to improve access,
readiness, quality, cost effectiveness, and health care
delivery for both veterans and active duty members, plus their
beneficiaries. Do you agree with that characterization of that
FHCC model there in North Chicago?
Mr. Byrne. Yes, sir. I think it is a wonderful, wonderful
pilot program that hopefully will get some traction. In our
discussion the other day you had proposed Elmendorf, I think--
--
Senator Sullivan. Yeah.
Mr. Byrne [continuing]. As one of those facilities, and it
makes perfect sense.
Senator Sullivan. Well, good. We would like--and I am
confident you are going to get confirmed--but as you know,
Alaska, despite having more vets per capita than any State in
the country, actually has no full-service VA medical facility,
which I think surprises a lot of people. As you mentioned, we
do have this opportunity at JBER, Joint Base Elmendorf-
Richardson, for a full-service Federal health care center,
similar to North Chicago.
If confirmed, can you commit to me to work with my office,
this Committee, and the VA on collectively looking at how to
move forward a proposal like that?
Mr. Byrne. Yes, sir. Certainly.
Senator Sullivan. Let me ask another kind of related
question. We actually have, I think, a really good-news story
in Alaska. When I got here in the Senate a little over 4 years
ago, when it was kind of a meltdown as we talked about the
Choice Act essentially destroyed the system in Alaska. It was a
total disaster.
We had many CBOCs that had not had physicians for years,
literally years, and with some of the great work the Chairman
and others have done and a highly-motivated local leadership,
Dr. Ballard, who runs our VA in Alaska, we are getting more
physicians into CBOCs across the State, and, at the same time,
there has been requests, and I think the headquarters has
looked upon these favorably, to--with more doctors, more
veterans, looking at space expansion requests for these key
Alaska CBOCs throughout the State.
Unfortunately, the ability to expedite or even kind of
juggle these, it looks like they are kind of being lined up
sequentially, because of, I think, essentially one person
within the VISN contracting office works on them. If confirmed,
can you work with me, Mr. Byrne, and again, this Committee, on
looking at ways to help expedite that? The fact that we have
kind of pent-up demand, now that we are getting physicians
there to help expedite, or at least look at these different
requests from the Alaska VA simultaneous would be very helpful
in trying to move these forward. Can I get your commitment on
doing that?
Mr. Byrne. Yes, sir.
Senator Sullivan. Let me ask one final question that is
more general. The first bill that I cosponsored in the Senate
was the Clay Hunt Suicide Prevention Act, which was named after
a young Marine who unfortunately took his own life after a
couple, you know, tours in Afghanistan, I believe, as a sniper.
It was a very bipartisan bill. But, we are still having huge
challenges with our veteran suicide issue. What more can the VA
be doing, in your view, and what more can this body be doing? A
number of us have cosponsored another bill that builds on the
Clay Hunt Suicide Prevention Act, but how can we really get our
arms around this, and what should we all be doing collectively?
Mr. Byrne. Thank you for that question, sir. Earlier in the
hearing I gave kind of a long answer, which I would be glad to
deliver again. But, this body has been very helpful,
particularly the $222 million that they have allocated for us
specifically for suicide prevention, and all the programs that
go with that, from the end of the chain--we are trying to work
our way back up the chain--the end of the chain being the
crisis line, the Veteran Crisis Line, intervention in hospitals
of veterans that are trying to take their own lives, back to
programs as in the veteran care coordinator--I mean, sorry--the
suicide prevention coordinators, the 400 that we have within
the VA. We are trying to move things back in using that $222
million.
There is not--we can always do more. So, any creative idea,
any thoughts are welcome. The President just signed an
Executive order to try to harness the resources of the
Executive branch and then local communities and academia. I
mean, he opened the aperture wide open. Mr. Wilkie is leading
that effort.
But, we are not winning right now. I mean, it is the ground
truth. It is a reality. We are still at 20 a day, which is not
moving, though it needs to. There are so many factors that are
involved in it that I do not fully understand or appreciate; I
am not sure anybody does, which is part of the challenge.
We, the experts, say there are 25 factors--the loneliness,
financial instability, maybe homelessness, maybe substance
dependency. There are 25 of those factors. So, what I hope the
VA is doing is they are looking at those factors and trying to
address those as well, as far up the chain of events as
possible so that we do not have to do saves with the call
center, we do not have to do saves like the 240 we had over the
last 18 months on our properties and in our facilities.
So, your question was what can you do to help. I think you
all have been very helpful, and we are very appreciative of the
resources. If was as simple as saying, ``Hey, we need some more
money so that we can have more public service announcements,''
or ``have more police officers patrolling our campuses'' or
``have Tom Hanks do more PSAs,'' we would do that. We do not
think that is necessarily the answer. It is a comprehensive--
and there is a culture in our country right now that is, I
think, different than it was 20 or 30 years ago, and I probably
should not go down that path necessarily.
But, the stigma with mental health is, I think, something
that is kind of troubling and concerning, and if you could
shine a light on that in your talks and in your speeches around
the country, I think that would be tremendously helpful. Our
leadership position, maybe explaining that the continuum of
mental health is similar to the continuum of physical health.
There are days--a person in this body, probably not--he
left early from the hearing. Senator Tester is not physically
at his peak today. Is that fair to say, sir? Is that--is that
maybe protected health information? He is not at his peak
today, like some of us may not be at our peak today physically.
We talked about that. I am feeling a little punk today, a
little under the weather. I have got a sprained ankle. I have
got a chronic pain; my back hurts. We do not do that in the
mental health arena because there is a stigma that surrounds
it. Yet, they are both very much the same, right? Some of these
issues are chronic, and some of these are just episodal.
If we can get the dialog out there to say, ``If you have a
dip in your mental health, there is treatment and care,
medication that can help you get back on path.'' If you all
would be a bully pulpit for that I think you would be
tremendously helpful. I plan on doing that in the talks that I
hope to be giving over the next however long I am in this
position. Add that to sort of my spiel that I give when I go
out on the street.
Senator Sullivan. Great. Thank you. Thank you, Mr.
Chairman.
Chairman Isakson. That was a great question and also a
terrific answer. I have been in public life a long time, 41
years, and the two biggest problems or challenges we face are
suicide in veterans and homelessness in America, which both of
those are mental health issues. We abandoned mental health
coverage for a while and that is why we have got a lot of
homelessness. The same thing is somewhat true with the
accessibility of the counseling for our veterans. So, your
priority is exactly correct and that is where we need to spend
our time.
I think--am I right?--that we go to Senator Brown and then
Senator Tillis. Am I right. OK.
Senator Brown.
HON. SHERROD BROWN, U.S. SENATOR FROM OHIO
Senator Brown. Thank you, Mr. Chairman.
Mr. Byrne, thank you for joining us and thanks for the
discussion last week in my office about Agent Orange and burn
pits and the Blue Water Navy; you know, those toxic exposure
issues. I want to thank Senator Isakson for his comments on
veteran suicide. Just recently a veteran in Cleveland Heights
VA, from Cleveland Heights, took his own life, which has just
happened far too often.
I want to follow up on a point that Senator Tester raised.
The Office of the Inspector General and the invaluable
independence of that office. During our meeting, your comments
about one of its upcoming reports gave me some pause. We
recently learned about your role adjudicating the discipline of
an OGC employee found by OIG of violating VA's anti-nepotism
statutes. According to the VA, ``The anti-nepotism statutes and
regulations prohibit a public official from appointing,
employing, promoting, or advancing a relative or advocating
such an action in favor of the relative.'' You know that.
It is my understanding during your meeting with staff
yesterday that you said you can only find on the very narrow
issue of whether this individual improperly shared VA
sensitivity--that sensitive data not nepotism, conflict of
interest, or false statements, because of actions taken by the
proposing official.
The VA, however, sent a document, to just the majority,
mind you, and that cannot happen in this Committee.
Fortunately, the Chairman shared it with the minority. That is
your responsibility. We do not do things that way, pick
partisan channels in this Committee. Maybe in your previous
life or maybe other places they did, but our Committee does not
operate that way, so do not do that again.
Anyway, the Department sent the document to the majority
that OIG found a conflict of interest. The Office of
Accountability and Whistleblower Protection recommended conduct
unbecoming related to the conflict of interest and so did the
proposing official. Reporting from the document, ``Actions with
respect to his wife's hiring created the appearance of legal
and ethical impropriety.'' You, however, did not sustain that
recommendation, based on information that the accused sent to
you, the deciding official.
I will withhold my final judgment of the specific outcome
while I review, and my staff reviews additional documents, but
this is not how we intended the accountability bill to be
implemented. These conflict of interest cases are exactly what
we should be going after, not low-wage employees. The deputy
needs to show unimpeachable judgment. Undercutting the
independent IG is just simply wrong.
Let me shift to something else and ask you a couple of
questions. I am the Ranking Member of the Senate Banking
Committee, and have been following the issues related to VA
mortgage lenders closely. In a rulemaking last year, the VA
stated that some VA mortgage lenders' aggressive refinance
practices were essentially, quote ``subprime lending under a
new name,'' unquote. Yet VA did not begin a rulemaking to
protect veterans until Congress mandated it. I continue to hear
that VA's new rule is insufficient. I would add the CFPB
(Consumer Financial Protection Bureau) has not been helpful in
this. They do not advocate for veterans, this new CFPB. It just
means that much more we need you to.
The VA Inspector General is also concerned. Just last week,
the VA Inspector General and the U.S. Attorney for the Eastern
District of New York reportedly subpoenaed loan files as it
began investigating VA lenders.
My question is this: If confirmed, what will you do to
protect veteran homeowners from aggressive and misleading
lending practices, and is the VA actively working with CFPB to
address financial harm to veterans? I ask those two questions
in the context of this new CFPB director has shown no interest
in supporting veterans, no interest in the military loan--in
the Military Lending Act, all the things that the former CFPB
seemed to care about. This one does not. The responsibility is
really on the VA because of that, so your thoughts on that,
sir.
Mr. Byrne. Thank you for the question, sir; and ``I do not
know, but I will find out the answer'' regarding the CFPB. I
can tell you that it is very much on the senior leadership's
radar screen about some of the aggressive refinancing practices
on our veterans. I believe you said it accurately, that we are
in the rulemaking process that I do know is not popular in
certain segments of our country that do this.
So, I believe you said that right, that we have not
completed the rulemaking process and maybe we disagree on
whether it is aggressive enough or not. But, it should be
implemented very soon; and, I will get back to you with an
answer on that.
But, I agree. I agree. That refinancing puts these veterans
further and further in debt, and that is not the intent of
refinancing. That is not the intent of the VA-backed loans. So,
I will--I will assure you I will look into this and get some
resolution on it. It is an important matter.
Senator Brown. Thank you. And, I will reiterate that there
are three people at this table right now who are on the Senate
Banking Committee. We all recognize that the CFPB has shown--
and I do not want to speak for Mr. Tillis, but at least I
recognize the CFPB has shown not nearly the level of interest
in protecting veterans from the kind of predatory practices of
non-bank, shady oftentimes lenders. Sometimes bank lenders too,
but especially non-bank lenders.
You know, outside of every military base in the country
there are all kinds of opportunities, if you will, for veterans
to be ``served''--I use that term in quotation marks--by all
these lenders. We need, you know, in a very vulnerable time in
these families' lives, when their husband or wife, or sister or
brother, or father or mother, whatever, is overseas,
especially, we need a government standing with those veterans
to protect them against these practices.
I again say the CFPB has been less than aggressive. It just
means we need you that much more to weigh in. If you think you
cannot act in certain circumstances call us and we will work to
get the CFPB to act, or we will act. So, that is my really only
admonition to you.
Mr. Byrne. Thank you, sir.
Senator Brown. Thank you, Mr. Chairman.
Chairman Isakson. At the risk of putting off Mr. Tillis any
longer I want to say one thing about what you just said. This
is one thing I know a lot about because I did it in my private
life, and that is real estate sales and VA loans, et cetera.
One of the biggest mistakes everybody makes is to think the VA
makes loans. They do not make loans. They insure loans. They
have an underwriting procedure for the insurance of those
loans, but the private sector makes those loans.
The biggest case of flipping I ever saw was a few years
when VA lawyers were closing a VA refinance, when the VA caught
them flipping refinances over and over and over again to get a
$150 fee, but the only way they could get it was to get the
veteran to refinance the loans. So, their motivation for the
veteran to get a refinanced loan was for them to get a $150
fee. I am not going to name anybody, but to the credit of a
large bank in this country, they solved their problem. They
fixed it and a lot of people got their money back, which I
appreciate.
Yet, there have continued to be those in the mortgage
business who are originators and creators of mortgages, that
flip them. In fact, the nature of the business of a mortgage is
you make it as fast as you can, you underwrite it as well as
you can, and then you sell it as fast as you can. The people
that make the money are the people who service, over the long
term--they collect the payment, they send the payment in, et
cetera--and the person who originates it, they get a 1 percent
fee at the beginning and that is it.
Since I do know a little bit about it--enough to get in
trouble anyway--about the subject, I would be glad to work with
you and work with the VA to sit down and take a look at the
current practices on VA lending, because I got involved in it 4
or 5 years ago and we stopped some stuff that was--where people
were abusing the rules in the interest of a provider service,
i.e., a closing attorney, not in the interest of the veteran,
and we ought to never let that happen.
So, I am sorry for interrupting you.
Mr. Tillis.
HON. THOM TILLIS, U.S. SENATOR FROM NORTH CAROLINA
Senator Tillis. To put one more note in that regard, that
is why we--you know, there are probably not a whole lot of
things that Senator Warren and I share in common, in terms of
banking regulations, but this happened to be something that we
took up, Mr. Chair, as a bill for some of the churn that was
going on. I appreciate Ginnie Mae working with us to actually
put something forth that we did on a bipartisan basis.
Look, military families and veterans need access to
capital, but it always has to be beneficial to them, so we will
work with you all as well. We are always looking for other
opportunities to make sure we are taking care of military
families and veterans and veterans' families.
I want to go back. I think you made a very important point
on suicide prevention. I think it does go back to awareness and
removing the stigma. I really do think that members need to
think about what that means. Because, oftentimes, I have gone
into meetings, specifically on mental health, where people want
to remove the stigma. Then, you hear them whispering about a
challenge that they may have in their own family. Well, you are
perpetuating the stigma when you do that. A mental health
condition is no--it is a different physiological condition. We
need to talk about it or we are a part of the problem that has
this unacceptable rate, not only among veterans, but society as
a whole. So, I appreciate you calling on us to do our part. I
think more of us need to do it, and I, for one, will.
One thing, which relates to the electronic health record. I
know that you are the senior accountable officer for that
implementation. I think that is something that we should be
looking at. I know that you are moving through the systematic
implementation and I want to get a brief update on that.
I think now is also the time to engage the DOD to find what
kind of information, what kind of markers could we potentially
identify over a servicemembers active status that could be
helpful to identifying, almost predicting possible mental
health challenges before the man or woman even knows it exists.
I think we need to find a way to get the DOD and the VA to work
together so that as you go through the implementation we make
sure that we are passing along that kind of information.
I think it could be instructive to the transition process.
I believe one of the reasons why we are seeing the rate of
suicide that we do is we do not really understand the condition
of the veteran from the time that they move from active or
reserve status into veteran status. I think that we should
focus on that as one of the first things that we should be able
to exploit and leverage by having common and compatible
electronic health record system.
Now, I would like a general update on the implementation.
By the way, I will be supporting your nomination. You are going
to get confirmed. Congratulations in advance. Family,
congratulations.
So, with that I just really want an update, unless you give
me a really bad answer on the electronic health record
implementation. Directionally, that is where I am going, but a
quick update, Mr. Byrne.
Mr. Byrne. Sure, quickly can I take 20 seconds on
reachback? You were not here earlier when I gave a little talk
on an analytical program that we have called Reach Vet that
does exactly what you are talking about with the analytics, of
data points, of records that we have in the VA system. If we
could reach back into DOD to get those indicators before they
come over during transition you are exactly right; we can catch
them better.
Senator Tillis. Well, count on me to help you get that
done.
Mr. Byrne. Yes, sir. And, I am putting some of that on me.
I serve as the co-chair with my DOD colleague over at the
Department of Defense on the Joint Executive Council, and those
are the exact types of issues that we actually talk about. So,
I promise you that I will carry that back to the right bodies
that can actually hopefully execute on that.
Electronic health records modernization (EHRM), a $16
billion effort over almost 10 years. IOC, the beginning of the
second quarter of next year, in the three sites in Washington
State. We have done a ground-up training, a lot of lessons
learned from DOD, and we have a great leader in charge, a
gentleman named John Windom who came over from the Department
of Defense, a retired Navy captain.
Senator Tillis. Right guy for the job.
Mr. Byrne. Exactly. Glad you agree, sir. We are on track to
get not only executed at the IOC here next year, but we are
planning ahead, right. I mean, this is not a do three then let
us regroup, and then do three more sites. We are laying the
foundation to roll this out across the country.
And, simultaneous with the rolling out of the Cerner
project, we made the decision to go ahead and roll out the
scheduling tool in a dual track across the country. So, it will
be done--scheduling capacity will be done all across the VA
well in advance of the rollout of the actual Cerner product.
So, I am really feeling pretty optimistic about that. As
you know, there is a lot of coverage around that. There are IT
modernization efforts that have to go on contemporaneously with
that, around with that, and then the VHA training of the work
flows and the providers. I think we are doing a really good job
as far as having these workshops and working--and when I said
ground up, I mean, we are talking to the practitioners, like
how are you going to use this? What can we do to make this
easier for you to use to provide that treatment to the
veterans? And, I think that is why we are going to have a
little more success than DOD has had.
Senator Tillis. What about this general--I do not see
anybody else here, Mr. Chair, so if I could just ask one more
question?
How about just general key performance indicators on the
project. Are we tracking well on date and cost?
Mr. Byrne. Yes, sir, we are. As a matter of fact, we are
under-running, and we have gotten some queries--I do not want
to say pushback--but some queries about under-running in the
funding. So, I have an answer for that which I think is
acceptable and proper, plus I think you would like to hear.
One, John Windom is being very fiscally responsible; and two,
he is purchasing, for example, equipment ``just in time,'' I
think is the phrase. Instead of buying technology now, having
it sit in a warehouse for 6 months or 5 months, he is waiting
to buy that later on.
So, we are on track financially, we are on track with the
schedule. We have identified limiting features. This is
something that I pounded pretty hard at some meetings recently.
We have some challenges or some concerns with communications
closets. I know a little bit more about communication closets
that I ever probably wanted to know. But, that is a limiting
feature for us to be able to role out EHRM across the country.
And, we do not yet know what these communication closets look
like in our various facilities, which is a limiting feature.
So, I kind of digressed on that but I am pretty bullish and
pretty optimistic about where we are with EHRM, yet I do not
want to make any promises that we are going to accelerate it.
Ten years seems like a long time for me. We are setting the
foundation and the governance to have it be executed, but when
we roll out the IOC I think we are going to get a much clearer
picture of our ability to accelerate this rollout across the
country. Ten years is an incredibly long time.
Senator Tillis. Well, thank you. One thing I would like to
do, just outside of the Committee setting, but I would like to
get your commitment to have--since I have had a background in
large-scale systems integration work in my prior job, I would
very much appreciate some briefings on a regular basis with the
project team, just so I can see your dashboard and the
implementation as you hit certain milestones. Our office will
be in touch, so that we can have that meeting.
And, as I mentioned to you, when you came into the office,
I would like to do that on you all's turf too, so you do not
have to come over here. I would like to come visit the project
teams and see it in action.
Mr. Byrne. Certainly. If you are interested in going to any
of our IOC sites or the second-phase sites, we welcome that as
well.
Senator Tillis. The last thing I would leave you with is I
just want to thank the VISN 6 leadership. They are doing a
great job. They have done a really good job of us meeting,
either through conference call or in person on a regular basis.
I really appreciate them taking the time to do that. We are
going to continue to do it in North Carolina. Thank you.
Chairman Isakson. Senator Boozman.
HON. JOHN BOOZMAN, U.S. SENATOR FROM ARKANSAS
Senator Boozman. Thank you, Mr. Chairman, as always.
Thank you for your leadership and great work. We appreciate
you being here, and I appreciate your leadership and getting to
know you and working with you. Also, your service in the Marine
Corps--once a Marine, always a Marine. That is a good thing.
Then, again, your willingness to serve. You are a talented guy.
You could be doing lots of different things. You and others
that are willing to do these jobs--they can be very, very
difficult jobs--we really do appreciate that.
As you know, I am chair of the MILCON/VA Subcommittee on
Appropriations, so something that I felt very strongly is the
IG work. We were able, last year, to develop a bill that had
$192 million in it for the IG for VA, $20 million over the
President's budget. We did that because the VA is a huge
organization. It has such a broad portfolio--it is into
everything. Sadly, at different times in its history has had,
you know, some troubles. So, it is important that the oversight
is there, and I know you know that because you used to be an IG
earlier in your career, overseeing Iraq reconstruction, which
was another area that had some problems.
So, in the office we had a good visit and I think that, you
know, I understand that you share that concept of how important
these things are. But, I would like to ask a couple of
question, just to get it straight, so that Congress can get
your commitment that as Deputy Secretary of the VA you will use
the IG as a tool for managing and maintaining the Department to
meet the high standards of professionalism and integrity?
Mr. Byrne. Certainly.
Senator Boozman. Good. Very good. Thank you.
As the Deputy Secretary of the VA, if you find that an IG
report was improperly handled, is incomplete, or lacks
credibility, how do you plan to handle that situation in the
future? And, what steps will you take to ensure the reliability
of IG reports?
Mr. Byrne. Sir, I have a good working relationship and an
open line of communication with the IG, Mr. Mike Missal. So,
any issues or challenges that I have had or will have, I would
go directly to him. He has been very, very responsive, so I
will continue to do that, sir.
Senator Boozman. Good. That is so important; I know you
will. Certainly, we will encourage that in collaboration. That
is just how it has to be.
Congress has been clear about our intent that VA hold all
employees accountable for misconduct, regardless of their
seniority in the organization. Employees at the VA need to be
confident that their decisionmakers will address misconduct
professionally and without bias or undue influence. How will
you use your role as Deputy Secretary to ensure that there is
confidence in how senior leaders hold employees accountable?
Mr. Byrne. Well, Mr. Wilkie has set the tone from the top,
right? Perform with excellence, perform with integrity. So,
from my position that is the message that I hopefully exhibit
and demonstrate. But, I do have operational oversight,
leadership responsibility of OAWP, HR, OGR, legal department,
and I say that as sort of performing the duties of the deputy
now. And, I will continue to do that.
I think I have been very clear that that is incredibly
important in a bureaucracy such as ours, that there is
integrity and trust in the system, trust in leadership, and
that needs to start with the role models at the top, period. I
do not have any issues holding people accountable. I take that
very seriously because these are real people with real futures,
and I look at the totality of things. But, we have moved people
on from senior leadership positions who were not serving the
veterans as well as we thought they should be and what the
American people expect us to do.
So, I hope I have a pretty good track record in that areas.
At least that is what I believe you are hearing.
Senator Boozman. No, no. Very much so. And, again, as you
say, Secretary Wilkie, yourself have set that tone, and we do
appreciate that. It is so, so very important.
We look forward to continuing to serve with you in the
future. We do appreciate all of your hard work and all of us
working together to try to make sure that our veterans are
taken care of in the way that was promised. You know, it is
easy to forget that these are earned benefits versus, you know,
just gimmes.
So, again, thank you very much. It is good to see your
family here. I have got three daughters. I understand all about
you gals. So, take care.
Mr. Byrne. Thank you, sir.
Chairman Isakson. Thank you, Senator Boozman.
Mr. Byrne, thank you very much for your time and all you
have done for your country already. We appreciate your service
very much.
We will conclude this hearing. We will leave the record
open for 5 days for any questions from Members or any responses
that you want to leave with the Committee in writing. Is there
any further business to come before the Committee? If there is
none we stand adjourned.
[Whereupon, at 11:16 a.m., the Committee was adjourned.]
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