[Senate Hearing 117-559]
[From the U.S. Government Publishing Office]
S. Hrg. 117-559
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS FOR FISCAL YEAR 2022
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HEARINGS
before a
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
on
H.R. 4355/S. 2604
MAKING APPROPRIATIONS FOR MILITARY CONSTRUCTION, THE DEPARTMENT OF
VETERANS AFFAIRS, AND RELATED AGENCIES FOR THE FISCAL YEAR ENDING
SEPTEMBER 30, 2022, AND FOR OTHER PURPOSES
__________
Department of Defense
Department of Veterans Affairs
__________
Printed for the use of the Committee on Appropriations
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: https://www.govinfo.gov
_________
U.S. GOVERNMENT PUBLISHING OFFICE
44-187 WASHINGTON : 2023
COMMITTEE ON APPROPRIATIONS
PATRICK J. LEAHY, Vermont, Chairman
PATTY MURRAY, Washington RICHARD C. SHELBY, Alabama, Vice
DIANNE FEINSTEIN, California Chairman
RICHARD J. DURBIN, Illinois MITCH McCONNELL, Kentucky
JACK REED, Rhode Island SUSAN M. COLLINS, Maine
JON TESTER, Montana LISA MURKOWSKI, Alaska
JEANNE SHAHEEN, New Hampshire LINDSEY GRAHAM, South Carolina
JEFF MERKLEY, Oregon ROY BLUNT, Missouri
CHRISTOPHER A. COONS, Delaware JERRY MORAN, Kansas
BRIAN SCHATZ, Hawaii JOHN HOEVEN, North Dakota
TAMMY BALDWIN, Wisconsin JOHN BOOZMAN, Arkansas
CHRISTOPHER MURPHY, Connecticut SHELLEY MOORE CAPITO, West
JOE MANCHIN, West Virginia Virginia
CHRIS VAN HOLLEN, Maryland JOHN KENNEDY, Louisiana
MARTIN HEINRICH, New Mexico CINDY HYDE-SMITH, Mississippi
MIKE BRAUN, Indiana
BILL HAGERTY, Tennessee
MARCO RUBIO, Florida
Charles E. Kieffer, Staff Director
Shannon Hutcherson Hines, Minority Staff Director
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Subcommittee on Military Construction, Veterans Affairs, and Related
Agencies
MARTIN HEINRICH, New Mexico, Chairman
BRIAN SCHATZ, Hawaii JOHN BOOZMAN, Arkansas, Ranking
JON TESTER, Montana MITCH McCONNELL, Kentucky
PATTY MURRAY, Washington LISA MURKOWSKI, Alaska
JACK REED, Rhode Island JOHN HOEVEN, North Dakota
TAMMY BALDWIN, Wisconsin SUSAN M. COLLINS, Maine
CHRISTOPHER A. COONS, Delaware SHELLEY MOORE CAPITO, West
JOE MANCHIN, West Virginia Virginia
MARCO RUBIO, Florida
BILL HAGERTY, Tennessee
Professional Staff
Michelle Dominguez
Joanne Hoff
Jason McMahon
Patrick Magnuson (Minority)
Jennifer Bastin (Minority)
Lucy Gardner (Minority)
Administrative Support
Drew Platt
C O N T E N T S
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hearings
Wednesday, June 16, 2021
Page
Department of Defense
Military Construction and Family Housing......................... 1
Wednesday, June 23, 2021
Department of Veterans Affairs................................... 53
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back matter
List of Witnesses, Communications, and Prepared Statements....... 99
Subject Index:
Department of Defense........................................ 101
Department of Veterans Affairs............................... 102
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS FOR FISCAL YEAR 2022
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WEDNESDAY, JUNE 16, 2021
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 10:01 a.m. in room SR-192, Dirksen
Senate Office Building, Hon. Martin Heinrich (chairman)
presiding.
Present: Senators Heinrich, Tester, Boozman, Murkowski,
Hoeven, Collins, and Hagerty.
DEPARTMENT OF DEFENSE
Military Construction and Family Housing
STATEMENT OF PAUL CRAMER, PERFORMING THE DUTIES OF
ASSISTANT SECRETARY OF DEFENSE FOR
SUSTAINMENT
opening statement of senator martin heinrich
Senator Heinrich. Good morning, everyone. This hearing of
the Military Construction Veteran's Affairs and Related
Agencies Appropriation Subcommittee is now called to order.
I would very much like to thank our witnesses for being
here today. From OSD we have Mr. Paul Cramer performing the
duties of assistant secretary of defense for sustainment.
Representing each of the Services are: Lieutenant General Jason
Evans, Deputy Chief of Staff, G-9 Installations; Vice Admiral
Ricky Williamson, Deputy Chief of Naval Operations for Fleet
Readiness and Logistics; Lieutenant General Charles Chiarotti,
Deputy Commandant, Installations and Logistics; and Lieutenant
General Warren Berry, Deputy Chief of Staff for Logistics,
Engineering, and Force Protection.
This year the Department has sent over a budget request of
9.85 billion for the Military Construction and Family Housing
accounts. That is a 20 percent increase over last year's
request. I am encouraged to see DOD taking seriously the need
to invest in its infrastructure, which is the foundation of
military readiness.
In addition to significant increases to most Service
accounts, the request demonstrates a clear intent to prioritize
quality of life projects for our Service members and their
families. While the request rebounds from a significant
decrease last year, it remains lower than fiscal years 2019 and
2020, and still accounts for just over 1 percent of the total
DOD budget.
At the same time the need for recapitalization of existing
facilities and new mission infrastructure continues to grow.
Our subcommittee hearing last month highlighted the vulnerable
state of many of our aging and outdated facilities. Broadly,
this is a step in the right direction, but we need sustained
and dedicated investment over more than just 2 years. The
request, notably, does not include funding for overseas
contingency operations, shifting those projects which are part
of the European Deterrence Initiative into the base budget,
which is a more appropriate place for them. This move is long
overdue and I applaud it.
I am encouraged by the Department's increased focus on
energy resilience, specifically the Energy Resilience and
Conservation Investment Program, or ERCIP, saw a 73 percent
increase over last year's budget. This program which is a
critical resource to improve energy resilience had been held
flat in budget requests for the past decade, relying on
congressional increases to address rising demand and more
complex and expensive projects.
Within this program there is also a $10 million request for
planning and design funds associated with electric field--
vehicle infrastructure upgrades. I have been vocal about the
need for the United States to embrace and accelerate
electrification. And the Department needs to understand its
capacity and plan for its requirements at an installation and
at a community level.
I look forward to hearing from the witnesses about what the
funding request for ERCIP will achieve, and whether it is
meeting the existing need. I am encouraged by the increase for
ERCIP, but I would also note that there are 10 projects on the
ERCIP unfunded priority list totaling some $162 million, which
may not even account for the full need. So I look forward to
hearing from our witnesses today about the need for these
additional projects and the ability to execute them in fiscal
year 2022 should additional funding be provided.
While this request includes many positive stories, we also
continue to see the negative impacts of the previous
administration's decision to raid funding for military
construction projects for border wall construction. There are
16 projects that were defunded and that are included in the
fiscal year 2022 request for Congress to appropriate funding to
again. The cost of these projects is $221 million more than the
level at which they were originally appropriated.
I understand these projects were anticipating some
unrelated cost increases prior to the diversion, but we lost 2
years of trying to tackle those challenges because of the
decision to pull funding and stop design, and taxpayers are
paying for that now.
For example, in my home state, the MQ-9 Formal Training
Unit Operations Facility at Holloman Air Force Base originally
funded 3 years ago, remains in a dilapidated state, and our
airmen have been working in unsafe conditions for far too long.
General Berry, I appreciated our conversation on the
subject yesterday and look forward to working together to find
a solution in the fiscal year.
I would also call attention to the fact the Federal
government will need to address critical safety concerns and
undertake environmental remediation projects that are now
necessary because of some of this construction. I understand
that the Department of Defense will likely not be the lead
agency for this effort, but I will remain engaged on this
front.
Lastly, I must note my disappointment that the budget
documents do not include FY DPs. I understand the delays
associated with the Presidential transition this year, and that
it is not your decision to withhold this information, but these
lists are truly critical to our ability to conduct oversight,
understand the Department's planning and appropriately resource
its military construction needs. I hope you will bring that
message back with you after today.
And with that, I will recognize the Ranking Member.
statement of senator john boozman
Senator Boozman. Thank you, Mr. Chairman. And again, I also
would like to extend a welcome to our witnesses here today, and
we certainly appreciate your service to our country, and look
forward to discussing the President's fiscal year 2022 Budget
Request for military construction, family housing, and base
realignment and closure for the Department of Defense.
This year's budget request of $9.8 billion reflects a 22
percent increase over the fiscal year 2021 enacted level of 8.1
billion. While that appears to be a large increase it is worth
noting that the fiscal year 2021 was such a low year for MILCON
that even with an almost $2 billion increase this year's budget
request is still one of the lowest MILCON request in recent
years.
Additionally, this year's request includes $329 million of
European Deterrence Initiative projects that in the past would
have been part of the OCO request, which has been shifted to
the base. More than 1 billion of the budget is made up of
increments on--for previously appropriated projects, and 661
million is to restore deferred projects. This accounts for
approximately 22 percent of the budget request, leaving less
for new requirements.
Further, large projects continue to take up a greater share
of the budget, the increased complexity of facilities needed to
support today's weapons systems combined with multi-billion
dollar recapitalization initiatives to culminate in large and
complex projects.
Without a corresponding increase in top line, affordability
will continue to decrease as the cost of construction projects
continues to rise. This is a recurring theme and a familiar
talking point. We have the same discussion year after year, and
I am worried that MILCON requirements will continue to exceed
the resources put towards it as the Department continues to
take risk in infrastructure.
The reality is, we will likely continue the same discussion
with flatter declining top lines anticipated in the years
ahead. We need to, therefore, make progress and realize
efficiencies with the MILCON reform efforts being worked by the
Department in Services. This is another frequent talking point,
and it is something we point to year after year, but I am not
sure that has yet translated to tangible improvements. We need
to identify and implement best practices to lower cost, reduce
schedule, and ultimately increase project delivery success.
I would also like to highlight the disservice we do to
ourselves when we do not adequately invest in the sustainment,
restoration, and modernization of our existing facilities.
While new mission requirements drive the need for new MILCON,
replacing existing or failing facilities also drives up
requirements. While buildings will eventually exceed their
expected life, deferred maintenance and repairs can accelerate
the need for major recapitalization in MILCON.
More importantly, infrastructure in poor condition takes a
toll on the Service members that work, train and live in these
facilities. We need to improve our existing infrastructure, not
just to possibly reduce future MILCON requirements, but we owe
it to our Service members and their families to provide safe
and secure facilities, from mission-critical facilities to
dorms, barracks, and quality of life supporting infrastructure.
Our infrastructure is a critical part of our national
security and directly contributes to current and future force
readiness. We must work smarter and find innovative solutions
to deliver facility investments. And with a constrained
environment, I look forward to working with the Department to
achieve this goal.
And, again, we appreciate your efforts that this is--as I
said, this is not unique to this administration. This is
something that we face year after year. MILCON has been, you
know, and is significantly underfunded. So again, we look
forward to working with you to figure out how we can do more
with the dollars that we have.
Thank you, Mr. Chairman.
Senator Heinrich. Thank you, Senator Boozman. And we will
now turn to the witnesses for their opening statements; your
full written testimony will be included in the record and you
will each be recognized for three minutes to summarize those
remarks.
And Mr. Cramer, you may start.
summary statement of mr. paul cramer
Mr. Cramer. Senator, can you hear me?
Senator Heinrich. I can.
Mr. Cramer. Okay.
Senator Heinrich. I think your mic is on.
Mr. Cramer. Okay, good. Thank you. Chairman Heinrich,
Ranking Member Boozman, and distinguished members of the
subcommittee. On behalf of myself and my Service colleagues,
thank you for the opportunity to present the President's fiscal
year 2022 Budget Request for the Department's Energy,
Installations, and Environment Program.
While my written statement has been submitted for the
record, I will highlight a few key areas. Our installations
remain one of our primary weapon systems, while we have been
able to operate from these bases that afforded us unprecedented
power projection capabilities, today the stark reality is that
the homeland is no longer a sanctuary. Therefore, we must
ensure that our installations are not only postured to support
the Joint Force, but they are resilient against the full range
of man-made and natural threats.
Our fiscal year 2022 budget request supports our efforts to
address mission requirements, ensure Service members have a
full, have a safe and resilient place to live and work, and
also begins to address resilience challenges. We are requesting
$26.1 billion for military construction and sustainment
restoration and modernization funding to address critical-
mission requirements, and life, health, and safety concerns
within our current fiscal environment.
This funding will be used to replace, repair, and modernize
facilities to enhance their resilience to climate events and
promotes elimination of excess or obsolete facilities. A key
focus of this year's budget request is addressing climate
change. The changing climate will continue to amplify
operational demands on the force. The great installations and
infrastructure, increased health risks to the Service members,
and require modifications to much of our existing and planned
equipment.
Extreme weather events are already costing billions of
dollars, and those costs are likely to increase. In response to
Executive Order 14008, tackling the climate crisis at home and
abroad, the Department developed the DOD Climate Adaptation
Plan, which will be finalized later this month.
The plan identifies five key lines of effort. The first
one, eliminate or develop a climate-informed decisionmaking
process, train, test, and equip a climate-ready force,
resilient, build, and natural infrastructure, supply chain
resilience, and innovation, and enhanced adaptation and
resilience through collaboration. We are also committed to
protecting the quality of life for our personnel and families.
Our primary focus here is ensuring access to safe, high
quality, affordable family and unaccompanied housing. Our
budget includes $1.4 billion to support our worldwide non-
privatized family housing inventory, which includes more than
34,000 in government owned, and 5,800 lease units. This request
also demonstrates our continued commitment to modernizing
unaccompanied family housing was more than $477 million
requested for eight construction projects.
With regard to privatized housing, the Department continues
to prioritize actions that improve the tenant experience and
rebuild tenant trust. Our initial phase was predominantly
focused on implementing the Military Housing Privatization
Initiative (MHPI) Tenant Bill of Rights, and the NDAA
requirements embedded in those rights. The Department has
issued all policy guidance necessary to implement all rights at
all MHPI projects to date. With few exceptions, all 18 tenant
rights are now available.
Finally, the Department depends on the resilient delivery
of energy to prepare for peer competition where even the
homeland is contested. The Department is addressing a range of
technological, operational, and policy initiatives to enhance
the use of energy and warfighting. To that end, we are
requesting 4.3 billion in energy investments, including both
installation energy, and operational energy. This includes
approximately 287 million for the ERCIP, as previously
discussed.
A significant increase over last year's budget reflects our
investment in energy systems. We appreciate Congress and this
subcommittee's continued support as we work together to provide
the best support possible for our soldiers, sailors, airmen,
marines, guardians, and their families. I look forward to your
questions.
[The statement follows:]
Prepared Statement of Mr. Paul Cramer
introduction
Chairman Heinrich, Ranking Member Boozman, and distinguished
members of the Subcommittee: Thank you for the opportunity to discuss
the Department of Defense's (DoD) posture as it relates to energy,
installations, and environment in the President's Fiscal Year (FY) 2022
budget request.
Our installations remain one of our primary weapon systems. For
nearly 80 years, we have been able to operate from our bases around the
world with near-impunity, which has afforded us unprecedented power
projection capabilities. However, the stark reality is that the
homeland is no longer a sanctuary. Therefore, we must ensure that our
installations are not only postured to support the Joint Force, but
that they are resilient against the full range of man-made and natural
threats. The FY 2022 President's Budget Request supports our efforts to
address these resilience challenges, while also addressing mission
requirements and ensuring Service members have a safe and resilient
place to live and work.
key areas of concern
Before I review the details of the budget request, I would like to
provide updates on two key issues, specifically climate change and the
Military Housing Privatization Initiative (MHPI).
climate change
In the words of Secretary Austin, the Department faces a ``growing
climate crisis that is impacting our missions, plans, and capabilities
and must be met by ambitious, immediate action.'' Climate change will
continue to amplify operational demands on the force, degrade
installations and infrastructure, increase health risks to our service
members, and require modifications to much of our existing and planned
equipment. Extreme weather events are already costing the Department
billions of dollars and those costs are likely to increase as climate
change accelerates.
As the Department's Chief Sustainability Officer, ASD (Sustainment)
oversaw the development of the DoD Climate Adaptation Plan (CAP), that
was developed per Executive Order (EO) 14008, Tackling the Climate
Crisis at Home and Abroad, and will be finalized later this month. The
CAP identifies five lines of effort: Climate-Informed Decision-Making;
Train, Test, and Equip a Climate-Ready Force; Resilient Built and
Natural Infrastructure; Supply Chain Resilience and Innovation; and
Enhance Adaptation and Resilience Through Collaboration. The four
cross-cutting enablers for these lines of effort are continuous
monitoring and data analytics, innovation, climate literacy, and
environmental justice.
To enhance the oversight and execution of these initiatives, the
Department recently established the Deputy Assistant Secretary of the
Defense for Environment and Energy Resilience with OASD (Sustainment).
Given the alignment between mission and climate priorities and the
energy-related nature of climate initiatives, this integrated team is
ideally positioned to review, prioritize, and oversee the Department's
holistic climate and energy portfolio. The FY 2022 President's Budget
request increases resources, staff, and expertise needed to achieve the
goals of the Secretary of Defense and the President.
military housing privatization initiative (mhpi)
Under the overall direction of the Chief Housing Officer, the
Department has made significant progress implementing actions to
enhance the Military Housing Privatization Initiative (MHPI) program,
consistent with our commitment to ensuring that MHPI projects provide
safe, quality, well-maintained housing where our members and their
families will want and choose to live.
The Department continues to prioritize MHPI reform actions that
will improve the tenant experience, rebuild tenant trust, and maintain
MHPI housing project financial viability. This includes implementing
MHPI reforms enacted as part of the National Defense Authorization Acts
for Fiscal Year (FY) 2020 and FY 2021, including requirements for a
Tenant Bill of Rights, a universal lease, a dispute resolution process,
and other elements.
Our initial phase has predominantly focused on implementing the
MHPI Tenant Bill of Rights and the NDAA requirements imbedded in those
rights, as a visible commitment to military members and their families.
Based on our efforts to date, the Department has issued all policy
guidance necessary to implement all rights at all MHPI housing
projects.
As Congress recognized in the FY 2020 NDAA, retroactive application
of the requirements at existing projects requires voluntary agreement
by the respective MHPI company; the Department cannot unilaterally
change the deal terms of the complex, public-private partnerships that
established the MHPI projects. Nearly all of the MHPI companies have
agreed to implement all eighteen tenant rights at their existing
projects; however, the final right--standard documentation (focused on
a universal lease framework)--is available at more than 30
installations with MHPI housing; with few exceptions, we expect all
eighteen tenant rights to be fully available by the end of FY 2021.
The Department issued housing policies to reinforce and expand the
Department's programmatic oversight over MHPI housing projects,
focusing on five key aspects that include: 1) senior leader engagement
to collaborate internally and with MHPI companies on housing issues and
necessary corrective actions; 2) rebuilding trust with military members
and their families; 3) accountability at all levels within DoD and by
MHPI companies to perform our oversight as originally intended at the
outset of housing privatization; 4) transparency and more frequent
communication with MHPI Tenants; and 5) ensuring the long-term
financial viability of the MHPI projects and MHPI program. Further, the
Department recently established a Deputy Assistant Secretary of Defense
for Housing to enhance execution of the statutorily-defined Chief
Housing Officer duties and responsibilities.
Our priority going forward is to implement the remaining MHPI
reform provisions that improve safety, quality, and maintenance of the
privatized housing, and to ensure accountability at all levels within
DoD and the MHPI companies to perform our oversight as originally
intended at the outset of housing privatization.
The Department of Defense understands that family is important and
honors the sacrifice that military members and their families make to
serve our nation. We recognize the environment where Service members
(and their families) live impacts their quality of life, their ability
to do their jobs, and the Department's ability to recruit and retain
the force. We are committed to working closely with you and the
committee staff to ensure the long-term success of the MHPI program,
and will continue to remain diligent in our oversight to ensure
delivery of quality housing for military members and their families
over the life of the projects.
military construction and family housing
The President's FY 2022 budget requests $9.8 billion for the
Military Construction (MilCon) and Family Housing appropriation. This
represents a $2.0 billion or 26% increase from the FY 2021 budget
request of $7.8 billion.
The request reflects the Department's priorities in supporting the
Administration's Interim National Security Strategy to address critical
mission requirements and life, health, and safety concerns within the
current fiscal environment. In addition to new construction needed to
recapitalize the nuclear enterprise, this funding will be used to
restore and modernize enduring facilities to enhance their resilience
to climate events and promotes elimination of excess or obsolete
facilities. The FY 2022 MilCon request includes projects that directly
support operations, training, maintenance, production, and projects to
take care of our people and their families, such as medical treatment
facilities, unaccompanied personnel housing, and schools.
military construction
We are requesting $8.4 billion in the budget for Military
Construction across the Department, an increase of 30% from last year's
request, primarily due to infrastructure requirements for the beddown
of the B-21 aircraft, investments in KC-46A depot maintenance
facilities, recruit dormitories, F-35A facilities in the United
Kingdom, continued Guam relocation efforts, investments in the Shipyard
Infrastructure Optimization Program, and the inclusion of previously
deferred Section 2808 projects (16 projects totaling $661 million).
Slightly more than half of this request provides readiness improvements
in facilities to support operations, training, maintenance and
production, and supply. Another $1.1 billion funds medical facilities,
troop housing, and community support, and $206 million funds DoD's
continued support to the NATO Security Investment Program.
This request also includes $2 billion for the Defense-Wide
Components, including
--$192 million for dependent educational facilities
--$110 million for fuel infrastructure;
--$238 million for recapitalization of National Security Agency
facilities;
--$304 million to address new capabilities/mission, force structure
growth, and infrastructure for Special Operations Forces;
--$51 million for Washington Headquarters Services facilities; and
--$247 million for the Energy Resilience and Conservation Investment
Program.
In addition, the Defense-Wide request contains $508 million for
medical facility recapitalization including $153 million for the fifth
increment (of a $695 million project) for the Walter Reed Medical
Center Addition/Alteration; $160 million for the fourth increment (of a
$381 million) for a new hospital at Fort Leonard Wood, Missouri; $73
million for three veterinary treatment facilities; and $122 million for
four smaller medical treatment facilities. These projects are critical
for our continued delivery of the quality health care that our service
members and their families deserve.
facilities sustainment and recapitalization
Facilities sustainment represents the Department's largest category
of facilities spending by providing for the regularly-scheduled
maintenance and repair or replacement of facility components. These
ongoing and predictable investments must be made throughout the service
life of a facility to optimize its performance and support the safety,
productivity, and quality of life of our personnel, while also reducing
avoidable costs associated with premature deterioration.
The Department's FY 2022 budget request includes $12.3 billion for
the Military Services and the major Defense-wide organizations. This
represents a sharp increase from the $11.3 billion in the FY 2021
budget request but a slight decrease in the overall sustainment rate
from 83 percent to 81 percent due to increased sustainment requirements
resulting from a combination of higher sustainment costs, increased
inventory, and the inclusion of costs for project design and
standardized facility inspections.
In addition to facilities sustainment funding, the Department
relies upon its Restoration and Modernization (R&M) program funding to
provide ongoing support to assigned missions by countering obsolescence
and reversing degraded conditions of existing facilities. The
Department's FY 2022 budget request includes $4.0 billion in Operations
and Maintenance appropriations for facilities R&M, a slight decrease
compared to our $4.3 billion FY 2021 budget request.
family and unaccompanied housing
One of the Department's principal priorities is to support military
personnel and their families and improve their quality of life by
ensuring access to suitable, affordable housing. Service members are
engaged in the front lines of protecting our national security and they
deserve the best possible living and working conditions. Sustaining the
quality of life of our people is crucial to recruitment, retention,
readiness and morale.
Our FY 2022 budget request includes $1.4 billion to fund
construction, operation, and maintenance of government-owned and leased
family housing worldwide; provide housing referral services to assist
military members in renting or buying private sector housing; and
oversight of privatized family housing. The FY 2022 request is $72
million (5.3%) higher than the FY 2021 request, and $22 million (1.6%)
higher than the FY 2021 enacted amount to sustain our increased focus
on ensuring the delivery and maintenance of quality housing for
military families. The FY 2022 request includes $293.2 million for
construction and improvements to meet the Department's goal to maintain
at least 90 percent of the world-wide Family Housing inventory at Good
and Fair condition levels, to include $92.3 million for construction of
130 Army housing units at Vicenza, Italy. The O&M budget request of
$1.12 billion represents a $38.4 million (3.5%) increase compared to
the FY 2021 request. This funding request supports more than 34,000
government-owned family housing units, most of which are on enduring
bases in overseas locations, and approximately 5,800 government-leased
family housing units where government-owned or privatized housing is
unavailable. The requested funding will ensure that U.S. military
personnel and their families continue to have suitable housing choices.
The Department's FY 2022 budget request demonstrates our continued
commitment to modernize Unaccompanied Personnel Housing (UPH) to
improve privacy and provide greater amenities. The FY 2022 budget
request includes more than $477 million for eight construction projects
that will improve living conditions for permanent party personnel. This
includes $81 million for an Army barracks complex at Fort Meade,
Maryland; $172 million for two Air Force dormitory projects at Joint
Base San Antonio, Texas, and $43 million for a Navy barracks project in
Joint Region Marianas, Guam.
environmental programs
Installations are key platforms for our nation's defense. We must
maintain our ability to conduct realistic training and flexible
operations. The Department's environmental investments support this
objective through activities ranging from managing critical habitat and
avoiding training restrictions to addressing drinking water health
advisories and making the best use of our cleanup dollars. The
President's FY 2022 Budget requests $3.6 billion for environmental
programs, keeping pace with our FY 2021 request.
defense environmental restoration programs
We are requesting $1.3 billion to continue cleanup efforts at the
remaining Installation Restoration Program (IRP) sites and Military
Munitions Response Program (MMRP) sites. The IRP is focused on cleanup
of hazardous substances, pollutants, and contaminants, while the MMRP
is focused on responding to unexploded ordnance and munition
constituents at former military ranges. This includes $1.0 billion for
``Environmental Restoration,'' which encompasses active installations
and Formerly Used Defense Sites (FUDS--sites that DoD transferred to
other Federal agencies, States, local governments, or private
landowners before October 17, 1986). The remaining $264 million is for
``BRAC Environmental.''
Progress Towards Cleanup Goals
Goal: Achieve Response Complete at 90% and 95% of Active and BRAC IRP and MMRP sites, and FUDS IRP sites, by FY
2018 and FY 2021, respectively
----------------------------------------------------------------------------------------------------------------
Projected status
Status as of the Status as of the atthe end of
endof FY2019 endof FY2020 FY2021
----------------------------------------------------------------------------------------------------------------
Army................................................ 91% 91% 92%
Navy................................................ 83% 83% 84%
Air Force........................................... 88% 85% 86%
DLA................................................. 84% 84% 85%
FUDS................................................ 87% 88% 89%
Total........................................... 88% 87% 88%
----------------------------------------------------------------------------------------------------------------
By the end of FY 2020, the Department, in cooperation with State
agencies and the Environmental Protection Agency, completed cleanup
activities at 87 percent of Active and BRAC IRP and MMRP sites, and
FUDS IRP sites, and is now monitoring the results. During FY 2020
alone, the Department completed cleanup at 312 sites. Of the roughly
40,000 restoration sites, more than 33,900 are now in monitoring status
or have completed cleanup.
Our focus remains on continuous improvement in the restoration
program: minimizing overhead, adopting new technologies to reduce cost
and accelerate cleanup, refining and standardizing our cost estimating,
and improving our relationships with State regulators through increased
dialogue. All of these initiatives help ensure that we make the best
use of our available resources to complete cleanup.
Per- and polyfluoroalkyl substances (PFAS) are a top priority and
may cause the DoD to reopen previously-made decisions, which could
cause delays in achieving our goals. Additionally, some sites have no
feasible solution for cleanup and, as a result, the Department is
making significant investments in environmental technology to identify
new potential remediation methods.
per- and polyfluoroalkyl substances
The presence of per- and polyfluoroalkyl substances (PFAS) in the
environment is a national issue due to its wide-spread use in many
industrial and consumer products. The Department recognizes the
importance of this issue and is committed to addressing PFAS in a
deliberative, holistic, and transparent manner, as we continue to
pursue a PFAS-free fire-fighting alternative and address our PFAS
releases.
The PFAS Task Force
The Department established a PFAS Task Force in July 2019. This
Task Force provides strategic leadership and direction to ensure a
coordinated, aggressive, and holistic approach on DoD-wide efforts to
address PFAS. The Task Force continues unchanged and is postured to be
responsive to the direction of this Administration. The Task Force
continues to focus on four main goals:
--Mitigating and eliminating the use of the current aqueous film
forming foam (AFFF);
--Fulfilling our cleanup responsibilities, and
--Understanding the impacts of PFAS on human health
--Public outreach
AFFF Replacement Research
AFFF formulations in use by DoD today do not contain detectable
amounts of PFOS or PFOA, but they still contain PFAS. We have an
aggressive initiative to develop and demonstrate PFAS- free
alternatives for AFFF. We have identified a number of commercially-
available and developmental PFAS-free alternative formulations that
have acceptable fire extinguishment performance against jet fuel fires.
Evaluation of the aging, materials compatibility, and toxicity of these
formulations is underway. The Department is committed to finding an
effective firefighting alternative that meets the life-saving
performance standards of AFFF and does not have negative health or
environmental effects.
PFAS Cleanup and Drinking Water Mitigation
DoD follows the existing federal cleanup law (Comprehensive
Environmental Response, Compensation and Liability Act (CERCLA)) and
the long-standing EPA regulations for all chemicals in our cleanup
program, including PFAS. The Defense Environmental Restoration Program
statute provides authorities to DoD to perform and fund cleanup actions
and requires they be carried out in accordance with CERCLA.
As of March 31, 2021, the Department has identified 698
installations where DoD used or potentially released PFAS. DoD has
completed the initial assessment at 129 of these installations and of
those, 63 were found to require no further action, while 66 are
proceeding to the next step in the CERCLA process. During these initial
assessments, DoD evaluates both groundwater and drinking water. If DoD
identifies PFOS and/or PFOA from DoD activities in off-base drinking
water above EPA's LHA, we quickly take action (i.e., a CERCLA removal
action) to provide treatment or an alternative water source.
In addition, as part of our normal operations, the Department has
sampled over 500 on-base DoD drinking water systems worldwide. Of
those, we identified 34 with PFOS and/or PFOA above EPA's LHA and took
quick action to bring those systems below 70 ppt. As of today, no one
is drinking water above EPA's lifetime HA of 70 ppt where DoD is the
known source.
environmental technology
The overall FY 2022 budget request for Environmental Technology is
$131.9 million, centered on two key programs: the Strategic
Environmental Research and Development Program (SERDP) and the
Environmental Security Technology Certification Program (ESTCP). These
Defense-wide environmental technology programs coordinate closely with
the Military Services to ensure research, demonstration, test and
evaluation are focused on the Departments most pressing environmental
needs. Our request for SERDP, which is focused on basic and applied
research, is $51.9 million. For ESTCP, which is focused on validating
more mature technologies to transition them to widespread use, we are
requesting $31.5 million for environmental technology demonstrations
and $39.9 million for energy technology demonstrations.
These programs have already achieved impactful results and have the
potential to significantly reduce long-term costs by implementing new
ways of treating sediment and groundwater contamination, to increase
installation resilience by providing effective tools to planning staff
to anticipate the impacts of climate change, and to reduce the life-
cycle costs of multiple weapons systems through development and
demonstration of innovative coatings and materials that avoid
increasingly unavailable hazardous elements.
SERDP/ESTCP continue to invest in alternatives to incineration for
disposal of AFFF-related per- and polyfluoroalkyl substances (PFAS) and
development of analytical methods for PFAS in media other than drinking
water in conjunction with the Environmental Protection Agency. In the
critical area of installation energy, we are focused on proving
technologies and solutions that cost-effectively incorporate energy
storage into installation-level microgrids to improve the energy
security and resiliency of our installations.
the native american lands environmental mitigation program
Our budget request includes $12 million for the Native American
Lands Environmental Mitigation Program (NALEMP) to address
environmental impacts to Indian lands, Alaska Native Claims Settlement
Act (ANCSA)-conveyed properties, and tribal treaty rights attributable
to past DoD activities. Impacts are typically associated with hazardous
materials, munitions debris, underground fuel storage tanks, unsafe
buildings, lead-based paint and asbestos, and abandoned equipment. Most
Indian lands and ANCSA-conveyed properties are located in rural and
remote areas with low population densities; thus, they might not
qualify as high priority sites under DoD's traditional environmental
restoration programs. The NALEMP seeks to bridge the gap between tribal
needs and these traditional risk-based environmental restoration
programs and incorporate tribal priorities to address potential impacts
to Indian lands, ANCSA-conveyed properties, and tribal treaty rights.
The goal of the NALEMP is to complete mitigation of sites by restoring
health and human safety, protecting natural resources, protecting
cultural resources, and returning tribal lands to optimal use.
Under the NALEMP, the DoD fosters government-to-government
relationships with tribes through a Memorandum of Agreement (MOA) and
then enters into two-year Cooperative Agreements (CAs) with the tribal
governments. Funding provided through CAs enables tribal governments to
lead NALEMP projects, incorporate ``traditional ecological knowledge''
into design for cleanup, and build tribal capacity regarding
environmental services and technical remediation skills. Tribal
governments conduct the cleanup with technical assistance and
mentorship from DoD and the U.S. Army Corps of Engineers.
Eighty-eight sites in the lower 48 states and Alaska have been
fully mitigated. Ninety percent of the 1,000+ potential tribal impacts
reported to DoD have been assessed and 294 have been found eligible for
NALEMP or are under review. In FY 2020, DoD executed a total of 13
NALEMP CAs, of which nine CAs were with Alaska Native tribes and four
with Pueblo Indian tribes in New Mexico. By the end of FY2021, DoD will
execute an additional 16 CAs, of which 11 CAs will be with Alaska
Native tribes and five Indian tribes in the lower 48 states.
environmental conservation and compatible development
The Department's lands and waters are vital to readiness. However,
they also support a diverse array of fish and wildlife species, as well
as significant historic sites and resources. DoD lands provided
habitats for nearly 500 that are federally protected under the
Endangered Species Act, over 130,000 recorded archaeological sites, and
45 National Historic Landmarks. Our $577 million request for
Conservation will allow us to protect these resources in compliance
with applicable federal statues, and manage for healthy and resilient
natural landscapes to reduce climate driven risks such as flooding and
wildfire.
Regulatory protections related to threatened and endangered species
and their habitats continue to pose significant mission challenges by
restricting use of our existing ranges and training areas, or limiting
our development of new infrastructure. However, these investments in
conservation are making significant progress towards alleviating these
restrictions by promoting species recovery. In partnership with the
Department of the Interior and US Fish and Wildlife Service, DoD has
worked to identify priority species and conservation actions which has
led to the proposed down-listing or de-listing of 10 species affecting
20 military installations. Building on this success, we will continue
to work with our federal, state and non-governmental partners to
develop new and innovative regulatory approaches that streamline
processes and provide greater mission flexibility.
Additionally, developing and implementing climate adaptation and
resilience into both the natural and cultural resource programs will be
a priority moving forward. Using the data and information currently
available through the Defense Climate Assessment Tool (DCAT) and
emerging adaptation planning guidance related to natural and cultural
resource management programs, the DoD will be evaluating the use of
nature based solutions, and sustaining our natural infrastructure to
address climate driven risks such as restoring salt marshes or wetlands
to reduce flood risk, or altering forest management practices to reduce
fire risks.
Continued investments in conservation will maximize our flexibility
to use our land, water, and airspace for military purposes and to
address incompatible land uses beyond our fence lines, and will ensure
that our military and civilian personnel have the access they need to
conduct mission- essential activities. Strategies to address these
conservation and climate adaptation priorities can be most effective
through landscape-scale initiatives to better capitalize on both our
on- installation conservation programs and our off-installation
conservation partnerships through the Readiness and Environmental
Protection Integration (REPI) Program.
The Readiness and Environmental Protection Integration (REPI) program
Of the Department's $577 million budget for conservation, $150
million is directed to the Readiness and Environmental Protection
Integration (REPI) program. REPI uniquely supports DoD's ability to
seamlessly operate across domains by stimulating innovative and diverse
partnerships between local communities, federal and state agencies, and
non-governmental organizations to limit incompatible development and
promote climate resilience around our installations and ranges. Through
FY 2020, DoD has leveraged $1.08 billion with over $975 million in non-
DoD partner contributions to protect over 757,000 acres of land across
115 installations in 35 states and territories.
The increased request for FY 2022 will allow the REPI program to
build capacity and significantly expand projects that promote
resilience to climate change. This includes opportunities that maintain
and improve ``natural infrastructure,'' implementing solutions outside
installation boundaries to enhance the benefits provided by natural
systems. Natural infrastructure solutions encompass a wide range of
possible actions that can help promote installation resilience,
preserve access to critical installation and range assets and
capabilities, and enhance DoD's core training, testing and operational
missions.
The FY 2022 funding will also enable increased investment in the
Pacific region, preserving and enhancing key mission capabilities
critical to deterring adversaries in the Pacific, including missile
defense; intelligence, surveillance, and reconnaissance; and joint
force capabilities. In the Pacific region alone, DoD and its partners
have invested over $136 million at seven REPI projects across Hawaii,
Alaska, and Guam.
Finally, the increased funding will enable DoD to expand the
interagency Sentinel Landscapes Partnership between DoD, the U.S.
Department of Agriculture, and the U.S. Department of the Interior. The
Partnership promotes shared land use priorities, and works to identify
landscapes across the country where the missions of the federal
agencies--strengthening national defense, promoting sustainable
agriculture and forestry, and building community resilience to climate
change--intersect. From FY 2012 to FY 2019, DoD has contributed $141
million and leveraged $542 million in funds from federal, state, local,
and private partners to advance the goals and shared land use
priorities of the seven sentinel landscapes. In cooperation with our
federal partners, DoD intends to designate additional Sentinel
landscapes in FY 2022.
Military Aviation and Installation Assurance Siting Clearinghouse
The Military Aviation and Installation Assurance Siting
Clearinghouse continues to protect the Department's ability to train,
test, and operate as the nation expands its renewable and other
commercial energy and power transmission capacity. Commercial wind
development typically poses the greatest compatibility challenge to DoD
due to physical obstruction of low-level flight routes and
electromagnetic interference with DoD radar systems. DoD resolved
project concerns though collaboration among the Clearinghouse, the
Military Departments, local communities, states, and energy developers,
thereby maintaining the Department's ability to train, test, and
operate while enabling development of alternative energy resources. DoD
negotiated and signed 29 Mitigation Agreements with wind energy
developers to minimize the impacts from proposed projects on DoD
missions. Through our collaborative efforts, none of the proposed
projects warranted a DoD objection to the Secretary of Transportation
or Administrator of the FAA.
The Department is actively implementing new approaches to protect
DoD missions. The Clearinghouse intensified efforts to advocate for
state-level legislation to protect military installations and
operations from incompatible wind energy development. Indiana, Wyoming,
and Alabama have passed protections for military missions in wind
turbine permitting. Although DoD and developers have had success
resolving issues related to incompatible energy development, state
support is invaluable in the rare cases where developers choose not to
voluntarily coordinate with DoD.
The Department has developed active interactions with the Bureau of
Ocean Energy Management (BOEM) to manage increasing plans for offshore
energy development. The Clearinghouse, Department of Interior, and BOEM
have updated and implemented offshore review practices to allow for DoD
input at every stage of planning, permitting and development.
department of defense energy programs
The FY 2022 President's Budget aligns with direction from the
President and the Secretary of Defense to ensure installations and
forces are resilient in the face of a wide range of challenges to
include climate change, disruptions to energy or water supplies, and
direct physical or cyber- attacks. The FY 2022 President's Budget
includes approximately $4.4 billion in energy investments, including
both installation energy (the energy used to power permanent
installations and non-tactical fleet vehicles) and operational energy
(the energy required for training, moving, and sustaining military
forces and weapons platforms for military operations). Achieving Joint
lethality, forward force maneuver and posture resilience, and resilient
and agile logistics in support of military combat operations, each
require the Department to reconsider the assured availability of fuel
and power around the globe.
In support of operational energy resilience, the Department is
requesting $3.2 billion to upgrade and procure new vehicles and
aircraft, increase the range and endurance of platforms, enhance energy
resiliency at contingency bases, and plan and execute wargames to
account for increasing risks to logistics and sustainment. As the
Department prepares to operate in contested environments around the
globe, these investments increase range, endurance, and lethality while
decreasing risks to warfighters.
In support of installation resilience, we are requesting $1.2
billion for energy resilience and energy conservation initiatives, most
of which are directed to existing buildings. This includes $595 million
in the Services' operation & maintenance accounts for sustainment and
recapitalization projects, which generally involve retrofits to install
improved lighting, high- efficiency HVAC systems, double-pane windows,
facility related control systems (FRCS), and new roofs. In addition,
the Energy Resilience and Conservation Investment Program (ERCIP)
provides $287 million in military construction funding, including
planning and design, to enhance energy resilience through installing
microgrids with renewable and clean energy generation and energy
storage alternatives and projects that will improve energy efficiency
at our installations. In particular, the FY 2022 request includes $10
million in ERCIP design funds specifically to plan and design projects
to enable the installation of electrical vehicle charging stations in
support of the President's Executive Order 14008, Tackling the Climate
Crisis at Home and Abroad, which requires the Department to electrify
its non-tactical vehicle fleet.
threats to energy
Energy is an essential enabler of military capability, and the
Department depends on energy- resilient forces, weapon systems, and
facilities to achieve its mission. At home and abroad, installations
are reliant on commercial, municipal, and host nation power grids for
day-to-day operations, including command and control systems,
communications, lighting, heating, and cooling. Similarly, the
Department relies on organic capabilities and commercial partners to
provide refined petroleum products to globally deployed forces, and
maximizes the use of local sources to minimize the time, resources, and
effort associated with acquiring, moving, and delivering fuel to
deployed forces.
Adversaries recognize the strengths of U.S. power projection and
sustainment, and possess long- range weapons, significant anti-access/
area-denial (A2/AD) systems, and substantial cyber capabilities able to
degrade the ability of the Department to provide energy to forces and
facilities. In response to these threats and in alignment with statute,
the Department shall ``ensure readiness of the armed forces for their
military missions by pursuing energy security and energy resilience''
(10 U.S.C. Sec. 2911) and ``ensure the types, availability, and use of
operational energy promote the readiness of the armed forces'' (10 USC
Sec. 2926).
In addition, the Department's ability to provide energy to critical
missions is affected by the climate. A climate-resilient supply chain
is one in which the Department has ensured that key suppliers and
industries can still operate though impacted by climate change, with
special attention given to ``last-mile'' resilience.
enterprise-wide energy initiatives
Facing the imperative to sustain critical operations in contested
environments while also reducing our carbon footprint, the Department
is implementing a series of initiatives to enhance the use of power or
fuel and support informed decision-making with regard to investments
and future force capabilities. In partnership with the Joint Staff,
Defense Agencies, and the Services, the Department is pursuing the
following initiatives to transform how the Department considers energy
in planning and operations.
10 U.S.C. Sec. 2912 Energy Cost Savings
With the passage of the FY 2020 and FY 2021 National Defense
Authorization Acts, 10 U.S.C.Sec. 2912 now allows the Military
Departments to retain amounts equal to installation and operational
energy cost savings in order to fund additional energy resilience,
energy efficiency, and installation quality of life projects. In FY2019
and FY2020, the Military Departments piloted efforts to retain $115
million in installation energy cost savings and $20 million in
operational energy cost savings using the authority. Presently, OASD
(Sustainment) is supporting pilot initiatives by Military Departments
to implement this authority across both installation and operational
energy activities, pursuant to the statute and DoD financial
regulations.
Integrating Climate Mitigation Considerations into DoD Procurement
While the Department has procured sustainable goods and services
for many years, the Department now is preparing to consider greenhouse
gas emissions in a broader set of energy procurement decisions. For
instance, based on Executive Order 14008, the Department is evaluating
how to procure carbon-free electricity for our installations. The
Deputy Secretary of Defense also tasked OASD(Sustainment) to develop
policy recommendations for the application of the social cost of carbon
into DoD procurement. Finally, the FY 2022 President's Budget provided
an additional $2.0 million to support additional testing and
qualification of drop-in compatible alternative fuels already in
commercial use to ensure the Department's ability to use any drop-in
compatible fuels available in the global marketplace.
operational energy resilience
In FY 2020, the Department consumed nearly 78 million barrels of
fuel to power ships, aircraft, combat vehicles, and contingency bases
at a total cost of $9.2 billion. To respond to the needs of a global
force, the Department purchased 48% of this fuel outside of the U.S.
Beyond liquid fuels, the Department also is relying on advanced energy
storage to enable long-range, autonomous, directed energy, high-power
sensors, and other warfighting capabilities across air, sea, and land
domains.
The Department depends on the resilient delivery of energy to
forces, weapon systems, and facilities around the globe. To prepare for
peer competition where even the homeland is contested, the Department
is addressing a range of technological, operational, and policy
initiatives to enhance the use of energy in warfighting.
Investments in Operational Energy
FY 2022 President's Budget significantly enhances resources
dedicated to reducing operational energy risks and applying energy
technologies to improve warfighter capabilities. Relative to the FY
2021 President's Budget, these operational energy enhancements include:
--Operational Capability Improvement Fund (OECIF): +$74.3 million
--Operational Energy Prototyping Fund (OEPF): +$23.2 million
--Alternative Fuels Certification: +$2 million
--Air Force/Navy Operations and Planning Tools: +$38.6 million
--Air Force Large Aircraft Drag Reduction: +$14.1 million
--Navy Platform and Propulsion Upgrades: +$19.5 million
--Army Tactical Vehicle Electrification: +$5.2 million
The Department also uses the budget certification authority in 10
U.S.C. Sec. 2926 to quantify operational energy investments across the
Military Departments and Defense Agencies and evaluate the alignment of
the President's Budget with the operational energy strategy. ASD
(Sustainment) judged the FY 2022 President's Budget as sufficient to
meet the previous operational energy strategy and will provide this
assessment to the Congress by the end of July 2021. As the Department
develops a revised energy strategy that reflects the new guidance
related to resilience and climate, the ASD(Sustainment) will use the
budget certification authority to rigorously review the sufficiency and
direction of investments in operational energy resilience.
Contested Logistics and Risks to Energy
To ensure that energy considerations are included in Joint and
Service capability development and planning, we are participating in
the Joint Concept for Contested Logistics (JCCL) as part of the broader
Joint Warfighting Concept (JWC). We also promote capabilities that
identify solutions to overcome fuels distribution challenges in
contested environments, and support the development of interoperable,
mobile, and survivable operating concepts. These capabilities include,
but are not limited to, the Joint Petroleum Over the Shore (JPOTS)
system of systems and the Navy's Light Amphibious Warship (LAW). The
JPOTS system of systems refreshes and advances the capability required
to transfer bulk fuel from offshore to a land-based termination point
during future contingency and crisis response operations.
Advanced Energy Storage
Faced with increasing kinetic and non-kinetic threats, the
Department is shifting toward more distributed, austere, and autonomous
operational concepts carried out by platforms and installations with
escalating power requirements. Advanced energy storage is emerging as a
critical enabler of these new capabilities. Similar to the Nation as a
whole, however, the Department lacks a strong domestic supply chain and
depends on foreign sources.
As part of this response, the ASD(Sustainment) joined four other
inter-agency partners in September 2020 to establish the Federal
Consortium for Advanced Batteries (FCAB) to accelerate the development
of a robust secure domestic industrial base for advanced batteries. DoD
was part of the inter-agency team that developed an inter-agency
national strategy for lithium batteries designed to guide future
investments in the domestic lithium battery manufacturing value chain;
Department of Energy will release the strategy later this year. The
Department also is supporting the implementation of Executive Order
14017, America's Supply Chains, and ASD (Sustainment) will continue to
provide a single voice regarding advanced energy storage requirements
for national security applications.
installation energy resilience
At over 500 worldwide military installations, the Department spent
$3.5 billion in FY 2020 on energy to power over 500 installations and
170,000 non-tactical vehicles.
Investments in Installation Energy
The FY 2022 President's Budget includes $1.2 billion in investments
in installation energy. Reflecting a strong track of record and
alignment with Administration priorities, the FY2022 President's Budget
included enhancements totaling over $181 million relative to the
previous budget request. These enhancements include:
--ERCIP for resilience and conservation: +$104.1 million
--ERCIP Planning & Design for resilience and conservation: +$15.9
million
--ERCIP Planning & Design for electric vehicle charging
infrastructure: +$10 million
--Smart Grid pilot initiatives: +$48 million
--Net Zero Installations: +$3 million
Installation Energy Resilience Policy and Governance
The Department continues to be proactive in developing policy,
guidance, and tools to advance installation energy and climate
resilience.
The Department is coordinating an updated policy with the Military
Departments to implement energy resilience requirements (10 U.S.C.
2920) that resulted from the Fiscal Year 2021 National Defense
Authorization Act, and anticipates issuing the guidance this fiscal
year. The policy memorandum sets forth energy availability standards
for critical missions. In addition, it directs the military departments
to promote the use of multiple and diverse sources of energy in their
planning, prioritization of energy resources originating on the
installation, encourages the use of micro grids, and favors the use of
full-time, installed energy sources rather than emergency generation in
their energy resilience solutions.
Black Start Exercises
Black start exercises are a growing component of the Department's
approach to risk assessment. In alignment with statute, the Department
is conducting full-scale black start exercises to evaluate risks to the
readiness of our military installations. These exercises have proven
invaluable in identifying gaps in our installations' electrical
infrastructure, such as previously- unknown interdependencies between
various systems, so that we can best prioritize our resilience
resources and planning.
Last year, the Department issued the ``Framework for Planning and
Executing Black Start Exercises'' that facilitates the planning and
execution of future exercises. An ``Energy Resilience Tabletop Exercise
Framework'' was also issued to promote continued modeling of black
start exercises in times of restricted travel and social distancing. In
FY 2021, the Department has executed an additional two exercises at
Marine Corps Air Station Miramar and Joint Base McGuire-Dix-Lakehurst.
In the remainder of FY 2021 and beyond, the Department will execute
exercises at Eielson AFB, Wright-Patterson AFB and Springfield-Beckley
Air National Guard Base, Robins AFB, JB Langley-Eustis, Fort Hood, Fort
Leavenworth, Rock Island Arsenal, Naval Construction Battalion Center
Gulfport and more.
Energy Resilience and Conservation Investment Program (ERCIP)
Supported by black start exercises, installation energy plans
provide the basis for prioritizing resources toward critical gaps.
ERCIP is a critical element of DoD's strategy to improve the energy
resilience, energy security, and energy conservation of its fixed
installations.
The Department increased the budget request for ERCIP to reflect
the significance of risks to energy systems as well as the need to
mitigate the causes of climate change. In FY 2022, DoD's combined ERCIP
request is $286.75 million for ERCIP, including $243.64 million for
energy/water resilience projects, $2.96 million for energy/water
conservation projects, $30.15 million for associated planning and
design efforts, and $10 million to plan and design EV utility
infrastructure upgrades.
The FY 2022 ERCIP request include two energy resilience projects,
including a 10 megawatt (MW) Microgrid Project at Fort Bragg and a
Landfill Gas (LFG) Power Meter Station at Marine Corps Air Station
Miramar. Fort Bragg's ERCIP project consists of a 10 megawatt microgrid
to increase energy resilience by providing continuous power for
critical missions. Even during a commercial power outage, this
microgrid technology will route continuous power to Joint Special
Operations Command during contingency operations, increasing
reliability of operations and mission assurance. Marine Corps Air
Station Miramar is developing one of the nation's largest renewable
energy microgrids to create a resilient and self-sustaining air
station. The Landfill Gas Power Meter Station will enhance the
microgrid controls as well as it will also incorporate and store
renewable energy for use. The enhanced MCAS Miramar microgrid will
result in improved energy resilience during grid outages in support of
mission assurance.
For FY 2022, the Department is taking a more proactive approach
with an ERCIP program comprised of a variety of technologies such as
renewable and clean energy power generation, energy storage systems,
industrial control systems, microgrids, and improvements to
distribution systems to enhance installation energy resilience,
security, and control. Just as the Department ERCIP Construction
request increased, our Planning and Design request increased from
$14.25 million to $40.15 million to support increasingly complex
microgrids, renewable and clean energy generation, and advanced energy
storage. Included in this amount is $10 million specifically for
planning and design of the charging infrastructure needed to
accommodate the electrification of DoD's non-tactical vehicle fleet.
The Energy Resilience Assessment Tool
The Department is enabling the identification of solutions beyond
backup generators to meet critical energy requirements. To accomplish
this, the Department continues to upgrade the Energy Resilience
Assessment (ERA) Tool for use by the DoD Components. The ERA Tool
allows users to evaluate and select energy resilience investments that
best meet the cost and performance requirements of their critical
missions. In addition to conducting continuous virtual training for
installation energy personnel, recent upgrades include improved
visualization of results and site-specific courses of action. Use of
the ERA Tool to validate energy resilience enhancements is a
requirement for all ERCIP project submissions throughout the
Department.
Performance Contracting Authorities
The Department continues to utilize performance contracting (i.e.,
ESPCs/UESCs) as a significant part of its efforts to enhance energy
resilience through energy efficiency. Guided by the installation energy
planning process, DoD will continue to use these contracts where they
enhance DoD mission readiness, mission assurance, and ultimately DoD's
warfighting capability.
For example, through an ESPC at Marine Corps Recruitment Depot
(MCRD) Parris Island the Marine Corps has enhanced readiness through
the installation of a 3.5 megawatt combined heat and power plant
(CHPP), 6.7 megawatts of solar photovoltaic panels with integrated
energy storage, and a microgrid control system. Built above the flood
zone, the CHPP is less susceptible to hurricanes, storms and sea level
rise. Based in part to savings from the ESPC, MCRD Parris Island
decreased its electricity purchased from the commercial grid by more
than 50% in FY 2020 compared to FY 2019, which is contributing to
greenhouse gas reductions.
Additionally, Misawa Air Force Base awarded a $206 million-dollar
ESPC that includes energy conservation and resilience measures such as
a smart grid, solar arrays, and a cogeneration power plant capable of
generating 6.2 MW of power and 83,000 lbs/hour of steam. The new
generation plant will cut energy waste by an estimated 20% across 679
buildings, generate 70% of the peak electrical demand, and reduce 60%
of the annual electrical load.
Cyber Resilience
To enable the projection, sustainment, and direct support to forces
around the globe, DoD installations rely on a range of Facility-Related
Control Systems (FRCS) to operate critical missions and facilities.
FRCS in DoD are subject to a growing range of cyber threats as these
systems have increasingly become more automated and connected. The
attack surface for potential adversaries has increased exponentially as
result of the integration of network-based building management systems,
Internet of Things (IoT) devices, as well as the connection of legacy
control systems into these networks.
As cyber threats continue to expand, the Department has responded
by integrating cybersecurity into the overall policy and governance for
energy resilience. For example, DoD installations now include
cybersecurity considerations in the development of installation energy
plans, and cyber secure FRCS are now integral to utility privatization
agreements, energy savings performance contracts (ESPCs), and utility
energy service contracts (UESCs). The Department now requires the DoD
Components to submit annual FRCS Cybersecurity Plans to capture their
efforts to collect inventory, complete assessments, implement
mitigations, and maintain sustainment for FRCS cybersecurity. These
complement installation energy plans and are due by the end of June
2021. The Department has also codified an FRCS Master List and
associated security rankings to standardize the resourcing, training,
education, and budgetary spend around a common definition of FRCS.
energy innovation
OASD (Sustainment) oversees three Department-wide research,
development, test, and evaluation programs that support resilient,
efficient, and clean energy for use by installations and forces.
The overall FY 2022 budget request for Operational Energy
Technology is $97.5 million, centered on two key programs: the
Operational Energy Capability Improvement (OECI) program and the
Operational Energy Prototyping (OEP) program. These Defense-wide energy
technology programs coordinate closely with the Military Services to
ensure research, demonstration, test and evaluation are focused on the
Departments most pressing operational energy needs. For OECI, which is
focused on advanced technology demonstrations, we request $59.3 million
for baseline efforts and $15.0 million for nuclear fuel efforts. Our
request for OEP, which is focused on demonstration of operational
energy technology and validation prototyping, is $23.2 million.
To prepare for tomorrow's energy challenges and combat climate
change, OECI/OEP invest in three lines of effort. Projects focused on
Powering the Force support the deployment of more mobile and
distributed operations with decreased and more agile logistics,
especially through contested environments. Efforts in Electrifying the
Battlespace enable the electrification of weapons, platforms, unmanned
systems, and soldiers which drastically reduces fossil fuel resupply
and enables new capabilities such as silent watch and exportable power.
Finally, Commanding Energy efforts focus on capturing and understanding
platform and weapon system energy profiles, including adversarial
profiles, to transform the Joint Force from reactive to predictive with
energy management and control.
The FY 2022 budget request for Installation Energy Technology is
$39.9 million, implemented through the Environmental Security
Technology Certification Program's (ESTCP) Installation Energy and
Water Program Area (EW). The ESTCP EW Program Area focuses on improving
the resilience of DoD's energy and water systems and reducing carbon
emissions from buildings and non-tactical vehicles. To achieve these
outcomes, the Program identifies, demonstrates, and transitions
innovative technologies that increase the energy and water efficiency
of DoD buildings, improve the security and reliability of energy and
water supply, reduce the life-cycle cost of DoD facilities, and reduce
carbon emissions from on-site fuel consumption.
conclusion
Thank you for the opportunity to present the President's FY 2022
budget request for DoD programs supporting energy, installations, and
environment. We appreciate Congress' continued support for our
enterprise and look forward to working with you as you consider the
budget request.
Senator Heinrich. General Evans
STATEMENT OF LIEUTENANT GENERAL JASON EVANS, DEPUTY
CHIEF OF STAFF
General Evans. Thank you, Chairman.
Senator Heinrich. General. I apologize. Can you pull your
mic a little bit closer? I think it is not quite picking up.
General Evans. Thank you.
[Technical issues.]
[The statement follows:]
Prepared Statement of LTG Jason T. Evans
Chairman Heinrich, Ranking Member Boozman and members of the
Subcommittee: on behalf of the Soldiers, Families, and Civilians of the
United States Army, thank you for the opportunity to present the Army's
Fiscal Year (FY) 2022 budget request for installation infrastructure.
We would like to express our gratitude to members of this committee
for your strong support of Army installations, Soldiers, and Families.
Thank you for supporting our budget request and providing additional
funding for key programs such as barracks, Family housing, and
childcare facilities. This year, we are requesting $7.1 billion for
Army's installation infrastructure-$1.7 billion for Military
Construction, and $5.4 billion in Facilities Sustainment, Restoration,
and Modernization (FSRM).
The Army strategy provides a clear path to transform and achieve
overmatch against its adversaries in great power competition. The Army
priorities are People, readiness, and modernization. This
reprioritization and recognition of the importance of alliances and
partnerships, reflect the Army's success in rebuilding and sustaining
tactical readiness over the past six years, establishing strategic
readiness, investing in critical capabilities, and recognizing the
fundamental role of our People and facilities in driving readiness and
modernization. In support of the Army Strategy and priorities, the Army
published additional supporting strategies, amongst them, the Army
People Strategy, The Army Modernization Strategy and the Army
Installations Strategy, all of which help to guide resource and
programmatic allocations.
The Chief of Staff of the Army has said, and the Secretary agrees,
People are our number one priority, our greatest strength, our most
valuable asset, and our most important weapon system. The Army People
Strategy describes how we will more deliberately manage the talents of
our Soldiers and Civilians. The Secretary has said she will prioritize
the full range of People issues to ensure our Soldiers and civilians
have the best quality of life possible and strive to continue improving
Army housing, healthcare, childcare, and spouse employment. People
drive our success in readiness, modernization, and reform.
Our FY 2022 Budget and our Quality of Life initiatives are guided
by the Army Installations Strategy in developing modern, resilient,
sustainable installations; enhanced strategic readiness that can
operate in a contested environment; and provide quality facilities,
services, and support to our Soldiers, Families, and Civilians.
the army installations strategy
Installations are platforms from which we sustain Army culture,
care for our People, and project and sustain forces essential to
strategic readiness and the Army's ability to deploy, fight, and win
our nation's wars. With timely, adequate, predictable, and sustained
funding, we will ensure that our People remain a priority and this will
help us continue to recruit, train, and retain an Army of high quality
Soldiers, supported by their Families and civilians, and prepared to
win our Nation's wars.
The Army's Installations Strategy published in December 2020,
represents a pivot from Industrial-Age facility design concepts of
single-function, single-tenant buildings and purpose-built
specialization, to Information-Age infrastructure that is multi-
functional, multi-tenant, and easier and less expensive to customize or
reconfigure. A forthcoming Army Infrastructure Investment Strategy will
tie planned Army investments to measurable effects.
taking care of people
The Army wins through its People. Adaptable and tailorable quality
of life programs for Soldiers, Civilians, and Families improve Army
readiness and reduce uncertainty. Our People promote the Army as a
great team to join, and installations as the best places to work and
live. Facility conditions; modern services; Family programs; and
Morale, Welfare, and Recreation functions are essential components for
taking care of our People. Winning matters-the Army must be able to
compete for and win the fight for talent-both for those who serve in
uniform and those who seek to be part of our civilian workforce. What
matters most to our People is not whether the Army owns or operates a
facility but whether the services are delivered in a quality, safe
facility, which are responsive, user friendly, and convenient.
quality of life priorities
Recognizing the important role quality of life plays in
recruitment, retention, and readiness, we are focused on improving
military housing and barracks, ensuring the best health care, expanding
access to child care, improving opportunities for spouses to gain
meaningful employment and build their own careers, and reducing the
turbulence of moving. Another priority is support and resilience where
our focus is on increasing support and resources to some of our remote,
isolated, and challenged installations. These focused efforts help
strengthen the Army team.
family housing and barracks
Our Soldiers and Families deserve high quality, safe housing. Our
focus is on fixing the privatized housing issues were first brought to
light in fall of 2018, while simultaneously working with the Military
Housing Privatizing Initiative (MHPI) companies to strengthen the long-
term financial health of the Army's Residential Communities Initiatives
(RCI) privatized housing portfolio. We are conducting 100 percent
quality assurance inspections on change of occupancy and life, health,
and safety maintenance work orders.
The Army continues to prioritize privatized housing reform actions
that will improve the tenant experience, rebuild tenant trust, and
maintain RCI housing project financial viability. This includes
implementing requirements for a Tenant Bill of Rights, a universal
lease, a dispute resolution process, and other elements set out in the
FY 2020 and FY 2021 NDAAs. Six of seven of the Army's RCI partners have
agreed to implement the 18 tenant rights set out in the FY20 NDAA at
their existing projects, and at least 17 of those rights are now
available at nearly every Army installation with privatized housing.
The final right--standard documentation (focused on a universal lease
framework)--is available at 37 or 84% of Army's installations with RCI
housing, and with few exceptions, we expect all 18 tenant rights to be
fully available by the end of FY 2021.
Our priority going forward is to continue implementing MHPI reforms
that improve safety, quality, and maintenance of the privatized
housing, continue engagement with residents, and ensure accountability
at all levels within the Army and the MHPI companies to perform our
oversight as originally intended at the outset of housing
privatization. We continue to host weekly housing meetings with key
stakeholders and RCI companies on a rotating basis to review physical
and financial condition of privatized housing. We conduct quarterly
Town Hall meetings with Commanders and residents; we have hired
independent third-party experts to perform comprehensive financial and
development reviews; we have established an enforceable incentive fee
metric to reward improved work order response times, achieve better
quality work, and increase resident satisfaction. We also have worked
with our MHPI companies to accelerate investment in RCI home
renovations and replacement. Our MHPI companies have obtained $1.5
billion of additional private sector financing and are reinvesting
another $1.3 billion from privatized project reinvestment accounts to
perform significant improvements to the housing they own and operate on
Army installations.
Over the past three years, the Army has invested $1.73 billion in
Army Family Housing, to include government-owned housing improvements
and construction. In addition, the Army has also invested $2.1 billion
in barracks for construction, operations & maintenance, and restoration
& modernization over the last three years. The Army is focused on
modernizing barracks standards that incorporate user feedback and the
latest technology. We must continue to work to increase the overall
quality of housing- Army-owned and privatized housing, and Army-owned
barracks.
Over the next 10 years, the Army has programmed over $11.5 billion
to improve barracks. Our investment in military construction and repair
and maintenance projects will help ensure that Army meets DoD's goal to
maintain 90 percent of our unaccompanied housing in good or better
condition. We also are requiring greater leadership presence in the
barracks, as part of the Army Barracks Management Program. This program
empowers leaders to exercise oversight and upkeep of barracks.
The Army Maintenance Application (App) allows Soldiers to submit a
maintenance claim quickly from their cell phone without having to wait
for their chain of command or make an appointment. The app will
eventually become the primary tool for maintenance inquiries for
residents of Army-owned Family housing and barracks across the Army.
historic housing program
The Army is faced with the extraordinary challenge of managing the
largest inventory of historic housing in the federal government. The
Army must provide quality of life for Soldiers and their Families;
manage high renovation costs for historic housing; address hazards
found in historic building materials such as lead-based paint and
asbestos; and address the need for expanded living space and
modernization of mechanical systems, all while preserving the historic
and architectural character of its huge inventory of over 30,000
historic homes. Issued in September 2020, the Program Comment for
Department of the Army Inter-War Era Historic Housing, Associated
Buildings and Structures, and Landscape Features (1919-1940)
establishes a new paradigm for integration of National Historic
Preservation Act requirements as part of the solution to the Army's
most critical military Family housing concerns for over 3,200 Inter-War
Era homes. The management actions addressed by the Program Comment
directly improve the material living conditions and the quality of
life, health, and safety for the thousands of Army Family members who
live in Inter-War Era housing, while mitigation measures ensure the
historic and architectural character of this housing is preserved.
health care
Access to high-quality healthcare is an essential part of taking
care of Soldiers and their Families. Attending to our beneficiaries'
medical needs improves their quality of life, enabling Army readiness.
Partnering with Defense Health Agency, Army Medicine will continue to
deliver world-class care for our beneficiaries across our installations
to maintain our Army Family's health. As the Military Health System
reforms, our focus is readiness. This means that we will emphasize
operationally oriented training, modernized capabilities, and
innovative operational concepts. We are grateful to Congress for
increases in Health Professional Officer special pay caps. This needed
investment ensures we can sustain the recruiting and retention of the
best quality healthcare professionals for the sustainability of the
force.
child care
Army Families do not always have the stability of an established
neighborhood or the proximity of relatives to allow for a constant and
reliable child care plan; thus Soldiers look to the Army to provide
services that assist them in safely caring for their children so that
they can focus on their mission and spouses on their careers.
The Army is challenged by child care capacity, mainly for infants
and toddlers. Additionally, availability of quality off-post care is
limited in many communities, reducing options for Soldiers who cannot
access on-post care. This drives longer wait times at some locations
like Hawaii, the National Capital Region, and Joint Base Lewis-
McChord. The Army is implementing mitigation strategies to maintain
and, in some cases, increase access to care. This includes planning an
additional 21 Child Development Centers over the next ten years, which
will add up to 4,000 new spaces. Expanding Family Child Care, with
aggressive marketing, recruitment and retention incentives, will
increase the number of providers from 149 to 275 by the end of FY 2022.
Finally, improving retention of staff through a comprehensive
recruitment and retention strategy, including staff compensation
adjustments in accordance with updated DoD guidance to remain
competitive in local job markets.
spouse employment
Spouses are the ``force behind the force,'' balancing professional
careers, Family, health, and well-being, all in the context of the
unique Army lifestyle that includes deployments, frequent moves, and
mission requirements. They often sacrifice their personal career goals
for the benefit of the Army. Supporting spouse employment and careers
without excessive delay or extra expense reduces Permanent Change of
Station (PCS) move stress, improves quality of life, and contributes to
readiness and retention. The Army is grateful for the attention and
support that Congress has provided in this area.
The Army continues to make improvements in the spouse employment
arena. We are improving policies for military spouse preference and
non-competitive civil service appointments and conducting a pilot
program for advanced application of Military Spouse Preference in
certain foreign overseas locations. We are also assessing an initiative
that better connects spouses to hiring officials prior to an overseas
move. We reimburse up to $1,000 for qualified relicensing costs for
fees or costs associated with getting the same or similar license in a
new state after a move. We improved the portability of home-based
businesses, streamlining the application and approval process to
operate home-based businesses on our installations. We have 582 home-
based businesses on installations and 478 are operated by spouses. The
Army Civilian Employment Assignment Tool allows certain non-
appropriated fund employees to transfer between installations quickly.
Since inception in August 2018, there have been 449 successful
transfers; 259 were military spouses. We are adding an additional 31
Employment Readiness Program Staff in the next 90 days. The Army
continues to work with Office of the Secretary of Defense to promote
workforce development scholarships, improve state license reciprocity
and professional license compacts, and reduce barriers to overseas
employment.
permanent change of station (pcs) moves
PCS moves are significant, and at times frustrating, events for
Army Families. To ease the stress and reduce financial burdens, the
Army is making great strides to improve the household goods and
relocation experience. We continue to follow health protection
protocols to ensure safety of everyone involved in the moving process.
We are issuing orders earlier (120 days prior to report date) to help
Soldiers and Families better plan moves. We are hiring additional
quality assurance inspectors with approximately 365 inspectors on board
to include 41 spouses or Family members to ensure moving companies
comply with DoD standards. Finally, we have increased the Personally
Procured Move monetary allowance from 95% to 100% of the estimated cost
the government would have paid a moving company.
Last year, we also launched a new interactive app, ``Army PCS
Moves,'' which includes information on entitlements, move types,
planning/scheduling moves, and claims procedures; with more than 13,000
downloads.
strengthen readiness and resilience
Climate Change
The Army recognizes climate change as a growing global security
threat. In line with the President and the Secretary of Defense's
direction, we are prioritizing climate change considerations in our
threat picture, strategic plans, operations, and infrastructure design.
We will include climate risk analyses in our war-gaming, modeling and
simulation activities, and our daily operational missions. The Army is
poised to build on past efforts with a focus on integrating climate
security factors within assessments and planning, installation
resilience, science and technology, operational energy, sustainable
land management, and procurement. We are taking significant steps to
address climate change and extreme weather impacts, which include the
Army Directive 2020-08, U.S. Army Installation Policy to Address
Threats Caused by Changing Climate and Extreme Weather, the Army
Climate Assessment Tool, and the Army Climate Resilience Handbook. In
March 2021, the Army established the Army Climate Change Working Group
to synchronize and direct Army activities to address climate
implications and policy, planning, and implementation across the force,
and execute climate change objectives.
Energy and Water Resilience
The Army is the largest consumer of installation energy in the
Department of Defense, spending more than $1 billion per year on
facility energy and water. Our installations rely, with few exceptions,
on commercial energy and water sources to accomplish critical missions.
The vulnerabilities in the interdependent electric grids, natural gas
pipelines, and water resources supporting our installations jeopardize
mission infrastructure, installation security, and the Army's ability
to project power and sustain global operations.
The Army Installation Energy and Water Strategic Plan sets a vision
and establishes goals, strategic objectives, and measurable targets to
shape efforts to achieve long-term infrastructure resilience,
efficiency, and affordability. Building and measuring resilience
enables Army readiness by improving the ability to prevent and recover
from disruptions to vital energy and water utility services.
We gain valuable insights into our existing infrastructure
condition and capability gaps, resource access, and system operations
and plans through planning and condition assessments. Installation
Energy and Water Plans (IEWPs) outline critical mission needs,
characterize energy and water baseline conditions, and propose
prioritized approaches for projects and operational activities to
increase energy and water resilience. The Army has 30 IEWPs at or near-
completion; all remaining installations are scheduled to be completed
by the end of FY 2022. IEWP results will be incorporated into
installation master plans. Black Start Exercises assess capabilities
and reveal gaps, which are not always discoverable during table top
exercises. They have also resulted in improved communications between
the Army, local community, and utility companies that service an
installation.
modernize and innovate
The Army Modernization Strategy states installations must modernize
``at pace'' with the rest of the Army to support a modernized Army by
2035. To do this, installations must provide facilities, ranges,
airfields, and support infrastructure that possess the appropriate
physical characteristics required by new Army weapons systems.
Army modernization requires that installations provide the
facilities, systems, and connectivity to support the Army on its path
toward full multi-domain operations readiness by 2035. Installation
management practices must transform to accommodate new information-era
technologies. Innovation efforts support the Army priority of Reform.
We will prioritize those that create efficiencies, expand workforce
productivity, and generate resilience.
The Army will plan for upgrades to maintenance facilities, motor
pools, ranges, network infrastructure, administrative facilities,
housing, barracks, secure facilities, and utilities upgrades to keep
pace with other modernization efforts. Force projection also requires
assessment of roads and highways, bridges, ramps, marshaling yards,
ammunition supply points, railways, and airfields. Real property master
plan processes will expand in technical sophistication, using data-
informed analysis and modeling to accommodate new specifications for
modern equipment and achieve better environmental analysis necessary to
fulfill requirements of the National Environmental Policy Act.
The Army is updating its facilities standards and standard designs
to meet and support fielding of new weapon systems. The objective Army
of 2035 will have systems that exceed the current facilities criteria.
Examples of change include the tactical equipment maintenance facility
at Fort Hood where the revised Army Standard will include minimum
dimensions for bay space clearance and an additional 35-ton crane for
overhead lift capability. The Supply Support Activity is a specialized
facility from a general purpose warehouse with changes to include
adding a second floor/mezzanine for automation and robotics
capabilities and climate control for corrosion prevention.
The Army Standard and Standard Design for permanent party barracks
will also change to take care of our number one asset, the Soldier.
We'll be improving resilience, readiness, and Quality of Life of our
Soldiers by equalizing the have and have-nots and take care of HVAC as
part of health/life/and safety issues and promote promising changes
from research on behavioral and social health of barracks residents.
Additional changes, like replacing communal laundries with built-in
washer dryers and adding self- service food kiosks to common areas,
will improve Quality of Life.
fy 2022 budget request for installation infrastructure
The Army's FY 2022 budget requests funding to take necessary near-
term actions to help make installations multi-domain ready and
resilient.
military construction
Army Military Construction. The Army's FY 2022 Military
Construction request for $1.7 billion (appropriation and authorization
of appropriations) will improve Installation readiness, Industrial Base
readiness and Soldier Quality of Life. The Quality of Life investments
consist of five new barracks projects for $262 million and one Family
Housing project for $92 million. The total request includes $835
million for the active component, $257 million for the National Guard,
$65 million for the Army Reserve, $491 million for Army Family Housing
(Construction and Operations), and $65 million in the Base Closure
Account for environmental remediation, caretaker services, and program
management costs at BRAC sites.
Military Construction, Army (MCA). Inside the Active Army's request
there is $399 million supporting installation readiness ($141 million
Training, $95 million Command & Control and $51 million Maintenance,
$96 million Industrial Base and $16 million in support of European
Combatant Command) and $249 million for barracks. The Active Component
also has $27 million for Host Nation Support.
Pilot Program for Additional Child Development Center Construction.
In the FY 2021 National Defense Authorization Act, section 2865, the
Services were directed to conduct a pilot program under which the
services may carry out military construction projects not otherwise
specified in law. The Army plans to utilize the existing $27 million
authorization provided in FY 2020 to accelerate a Child Development
Center project at Fort Gordon.
Military Construction, Army Reserve (MCAR). The FY 2022 MCAR budget
request supports three major construction projects: Area Maintenance
Support Activity facility in Southfield, Michigan, valued at $12
million; Wright Patterson AFB Army Reserve Training Center, valued at
$19 million; and Fort McCoy, Wisconsin transient training building,
valued at $12.2 million.
Military Construction, Army National Guard (MCNG). The National
Guard's request supports readiness by funding $139 million for
Readiness Centers and $43 million for Maintenance Facilities. It also
provides $13 million for barracks.
Minor Construction/Planning & Design. All three components have
funds planned for Unspecified Minor Construction and Planning and
Design.
Army Family Housing (AFH). The Army's request for $92.3 million in
construction funding supports one new/replacement project providing 130
new homes (Vicenza, Italy) and necessary planning and design funds. The
Army's request for $391.2 million in Family Housing Operations funding
provides for Army Family Housing operations, maintenance and repair,
utilities, leasing, and management of Residential Communities
Initiative.
Base Realignment and Closure (BRAC). The Army's request for $65.3
million includes $7.1 million for continuing caretaker and program
management requirements at remaining BRAC installations closed or
realigned under the five previous BRAC rounds (BRAC (1988, 1991, 1993,
1995, and 2005) and $58.2 million for environmental cleanup
requirements. Additionally, the Army has included $21 million in prior
year funds for Polyfluoroalkyl Substances (PFAS) cleanup requirements,
a carryover from the $35 million PFAS funding provided to the Army in
FY 2021. The Army continues to work with federal and state regulators
to resolve complex environmental issues, including in regard to PFAS,
that exist on Army's BRAC sites, to allow the property to be conveyed
and used for a beneficial non-military purpose.
operation and maintenance of facilities
Facilities Sustainment, Restoration, and Modernization (FSRM). The
Army is requesting $5.4 billion in FSRM to address our backlog of
facilities maintenance and provide sustainment to slow degradation of
facilities and demolish facilities ($90 million) no longer required.
Army Sustainment. The Army's FY 2022 Facilities Sustainment request
for $3,767 million (Active $2,832 million, USAR $255 million, ARNG $682
million) will provide 80% of the Facility Sustainment Model
requirements for all Components. It will allow maintenance work orders
on all facilities and preventative maintenance orders on Quality of
Life and mission readiness facilities. Army intends to ramp to the
Office of the Secretary of Defense goal of 90% of FSM in future years.
Restoration and Modernization (R&M), Active Army. The FY 2022
request for the Active Army is $1,142 million and will primarily fund
restoration projects for barracks and Child Development Centers across
the Army and readiness facilities including vehicle maintenance
facilities and transportation infrastructure at key installations.
Restoration and Modernization (R&M), Army Reserve. The FY 2022
request for the Army Reserve is $87 million and will primarily fund
restoration projects for barracks, maintenance activities, and Reserve
Centers.
Restoration and Modernization (R&M), Army National Guard. The FY
2022 request for the Army National Guard is $263 million and will
primarily fund restoration projects for barracks and training
facilities.
beyond the budget
Leveraging Partnerships: The Army has a long history of leveraging
public- public, public-private, and/or third party partnerships to
optimize use of other than appropriated funds, improve Army readiness,
and address underfunded requirements. These partnerships come in a
variety of forms, but generally lead to increased investment on Army
installations, enhanced provision of services, modernized
infrastructure, and improved cooperation with other Services,
communities, and organizations. The Army appreciates Congressional
support for partnerships.
conclusion
Army readiness begins on our installations. We need ready and
resilient installations to ensure our Soldiers are properly trained and
can be deployed anywhere in the world in order to fight and win our
Nation's wars. Your continued advocacy helps to ensure we will remain
an attractive option for current and future generations who want to
serve their Nation and also retain the current force by meeting the
expectations of an all-volunteer Army with capable, high-quality, and
modernized installations.
Thank you for the opportunity to present this testimony and for
your continued support of our Soldiers, Civilians, and Families.
Senator Heinrich. Admiral Williamson.
STATEMENT OF VICE ADMIRAL RICKY WILLIAMSON, DEPUTY
CHIEF OF NAVAL OPERATIONS FOR FLEET
READINESS AND LOGISTICS
Admiral Williamson. Chairman Heinrich, Ranking Member
Boozman, and distinguished members of the subcommittee. In
conjunction with the other members of the panel, I appreciate
the opportunity to provide an overview of the Navy's fiscal
year 2022 Military Construction Budget Request. On behalf of
our sailors and their families, thank you for your continued
support to the Navy's and its military construction program in
our 70 installations around the world, which enable us to
strengthen readiness, to support and deliver new and more
lethal platforms.
The Navy's fiscal year 2022 MILCON budget request of
approximately 1.3 billion with 14 projects, which optimize Navy
installations to enable global logistics and warfighter
development, generation and employment from the shore, the
proposed investments are deliberately targeted to slow further
degradation of our facilities, and to address the existing
backlog of facilities' maintenance and repair.
Our facilities, sustainment, restoration and modernization
request of 3 billion will help to improve sustainment of our
most critical facilities in support of overall mission
readiness.
The additional request of 4.8 billion in base operating
support allows ongoing focus on critical shore investments to
include targeted climate resilience projects. This budget
request will help to reduce the backlog, but it will take
several years of consistent resourcing to achieve full
recovery.
Finally, in support of our sailors and family, the Navy is
committed to improving our privatized housing program through
regaining the trust, and reinforcing oversight, and exercising
active leadership. Over the past year, we have made significant
progress on near-term efforts to better advocate for Service
members and their families, increase awareness of problem
resolution process, and increase involvement of Navy government
housing team. We are committed to continuing these improvements
moving forward.
It is a privilege to testify before the committee today, we
are committed to being good stewards of taxpayers' dollars, and
we will invest smartly to drive efficiency, and ensure best
return of investment for the Nation, our sailors and civilians.
I will look forward to your questions.
Thank you, Senator.
[The statement follows:]
Prepared Statement of VADM Ricky Lee Williamson
Chairman Heinrich, Ranking Member Boozman, and distinguished
members of the Committee, it is an honor to appear before you
representing the thousands of Navy Sailors and civilians at our seventy
installations worldwide. Thank you for the opportunity to testify about
the importance of our infrastructure, its resiliency, and all of the
base operating support required to meet the Navy's critical missions.
One innovative way that we look at installation resilience is by
viewing our installations as military platforms with assigned missions.
We then assess the ability of the installation platforms around the
world to accomplish their missions despite deliberate actions by
adversaries or natural events that may deny, disrupt, exploit, or
destroy the ability of the installation platform to carry out those
assigned missions. The operation and maintenance of these platforms, as
well as their future development and ability to support missions,
require long-term planning, careful investment, and timely program
execution.
Energy and climate resiliency are critical, as they are integral to
the long term ability of our Navy to support ongoing operations, and
ensure our Sailors are equipped to meet adversity. Energy resilience
and climate resilience focus on consideration of environmental
vulnerabilities in installation master planning, management of natural
resources, design and construction standards, utility systems, and
emergency management operations. Moving forward, the Navy will continue
to prioritize all facets of resilience in installation decisions to
ensure the ongoing, highest level of mission capabilities.
The Navy must deliver affordable, sustainable, environmentally
compliant and safe shore platforms through improved processes. The
Navy's FY 22 Military Construction (MILCON) program optimizes Navy
installations to enable global logistics and force development,
generation and employment from the shore. Targeted sustainment of
existing assets and prioritized modernization of our infrastructure
will ensure readiness at the lowest overall lifecycle cost. Investments
in increased resilience of Navy installations to extreme weather events
and sea-level rise will result in long term cost avoidance. Continued
use of standard design criteria, increased use of expeditionary
standards, and mandated use of standard designs for new construction
will reduce delivery costs and increase buying capacity. Finally, in
order to optimize the shore footprint and maximize resources, the Navy
must consolidate and divest infrastructure that does not contribute
directly to Fleet readiness and lethality.
milcon execution
The Navy's Fiscal Year 2022 Military Construction request includes
a total of $1,307 million for fifteen projects, which includes $258
million for Planning and Design, and $41 million for Unspecified Minor
Construction projects. These fifteen projects include five that are
overseas totaling $295 million to enhance global reach and persistent
presence of forward- deployed naval forces, and $485 million in funding
associated with follow on increments of previously approved projects.
infrastructure sustainment and restoration
When viewed as platforms, Navy installations missions enable fleet
operations, equipment reconstitution, material sustainment, Total Force
training, unit recovery, Sailor administrative support, and quality of
life programs. Facility Sustainment, Restoration, and Modernization
(FSRM) investment is necessary to ensure these missions can be carried
out. The FSRM program maintains the working order of our facilities
inventory and prevents premature condition degradation of mission
critical facilities. We are prioritizing investments in our critical
readiness infrastructure. Our public shipyards, dry docks, maintenance
facilities, and aviation depots are vital national assets. The Shipyard
Infrastructure Optimization Plan (SIOP) will deliver efficient and
modernized shipyards through upgrading existing dry docks and building
new ones, reimagining the physical layout of the shipyards, and
replacing antiquated capital equipment with modern machines.
Additionally, we are investing in our fleet support infrastructure, the
global network of bases and stations, that generates naval power from
the shore. Navy Shore leadership is preparing a long-term strategic
investment plan that focuses our resources on the locations that best
support our future force.
Base Operating Support (BOS) comprises Fleet Operations, Safety and
Security, Facility Support, Navy Quality of Life, and Mission Support
and Management programs provided to seventy Navy Installations. BOS
funding remains essentially flat, creating challenges as new priorities
arise each year. BOS funding is prioritized to support increased Fleet
operational and installation security requirements.
Additionally, the Navy will address climate change and resiliency
within the FSRM program. These projects enhance the Navy's waterfront
resiliency against environmental and other vulnerabilities and improve
utility infrastructure, increasing the Navy installations' energy and
water resiliency, efficiency, and security.
military housing
The Navy is committed to providing quality and safe housing for all
of our Sailors and their families. Our family housing Fiscal Year
budget request supports renovation of Navy Family Housing units as well
as continued support of our Public Private partnerships. Over the past
two years, all levels of leadership across the Navy have been laser-
focused on improving the privatized housing experience for our service
members and their families. Installation Commanding Officers are
personally involved in resolving privatized housing issues and
advocating for military families. Finally, we have made significant
progress on near-term efforts to better advocate, increase awareness of
the problem resolution process, and increase involvement of the Navy
government housing team.
conclusion
Thank you for the opportunity to testify before you today. We look
forward to working with you to continue enhancing and enabling
warfighting capability and readiness through optimization and increased
resiliency of our installation platforms to support Navy critical
missions across the spectrum of competition.
Senator Heinrich. General Chiarotti.
STATEMENT OF LIEUTENANT GENERAL CHARLES CHIAROTTI,
DEPUTY COMMANDANT, INSTALLATIONS &
LOGISTICS
General Chiarotti. Chairman Heinrich, Ranking Member
Boozman, and distinguished members of the subcommittee, I
appreciate the opportunity to discuss this year's Marine Corps
Installations and Family Housing Budget. Our installations are
critical to the ability to train our forces and maintain
readiness. And thanks to the strong support we have received
from Congress, the Marine Corps continues to improve the
quality and resiliency of its installation's infrastructure.
I would like to start by expressing my gratitude for the
support provided to rebuild the infrastructure damaged by
Hurricane Florence in 2018. The effects of that storm
highlighted the need to modernize our infrastructure so that it
was more resilient to the effects of extreme weather. We
sincerely appreciate your rapid support in providing the
resources to restore our facilities on the East Coast.
The Marine Corps' fiscal year 2022 MILCON budget request is
for $1.1 billion for 15 projects, eight projects totaling about
500 million to support the Defense Program Review Initiative,
as well as modernization and recapitalization projects. The
Marine Corps operates installations and support infrastructure
worldwide valued at more than $110 billion. These assets must
be properly maintained to prevent degradation of our ability to
train and generate readiness for global employment to support
our mission essential tasks.
Our installations must be resilient to the wide variety of
threats, this resiliency rest in the ability to maintain
reliable access to critical functions, such as an effective
power grid, clean water distribution, and communications
capabilities.
The Marine Corps has undertaken several initiatives to
retain this access. For example, at Marine Corps Logistics Base
Albany, the Marine Corps' first net-zero installation, and at
Marine Corps Recruit Depot Parris Island, and Marine Corps Air
Station Miramar, we also are conducting black start exercises
earlier this year, which shows our independence from the
commercial grid, and our ability to operate an extended period
of time off of the grid.
The Marine Corps is undergoing a significant transition in
how it is organized, trained, and equipped to meet the current
and evolving threats from our peer adversaries. The future
force will have new capabilities whose installations
requirements are difficult to fully determine at present. The
Marine Corps has continued to evaluate the facilities'
requirement of this force, as the Service's experimentation
efforts continues, these new requirements for support and
protection will come into greater focus.
Finally, the quality of life of our marines, and sailors,
and their families is integral to the effectiveness of the
force. The overall goal of Military Family Housing
Privatization Program is to provide safe, quality, and
affordable housing to our Military and Marine Corps, and the
Marine Corps views its role in providing these homes as a top
priority.
In conclusion, the Marine Corps' installations must prove
resilient against a variety of threats we face, and must
modernize our installations to protect our ability to generate
combat power in support of our Title X responsibilities. Our
operational capabilities are adapting to meet these threat
changes, and we need to invest in the next generation of
installation infrastructure to sustain the force of the future.
Thank you for the opportunity to testify before you today,
your oversight input and support as we determine the
infrastructure requirements that will best position the Marine
Corps for mission accomplishment. I look forward to working
with you to sustain our war-fighting capabilities and the
readiness of our power projection platforms. Thank you, sir.
[The statement follows:]
Prepared Statement of Lt. Gen. Charles G. Chiarotti
Chairman Heinrich, Ranking Member Boozman, and distinguished
Members of the Committee, I appreciate the opportunity to discuss this
year's Marine Corps installations budget. Our installations are
critical to our ability to train forces and maintain readiness, and
thanks to the strong supportwe have received from Congress, the Marine
Corps continues to improve the quality and resiliency of its
installations infrastructure.
First, I'd like to express my sincere gratitude for the swift
response and support that was provided to rebuild the infrastructure
that was damaged when Hurricane Florence made landfall in North
Carolina in the fall of 2018. The effects of that storm highlighted the
need to modernize and our infrastructure and make it more resilient so
it can withstand the effects of extreme weather, with minimal
interruption to training and operations. We appreciate your rapid
support in providing the resources to restore II Marine Expeditionary
Force's ability to train and generate combat readiness.
The Marine Corps operates installations and support infrastructure
worldwide valued at more than $110 billion that are used to train,
house, and provide quality of life support for our Marines, Sailors,
and their families. This infrastructure must be properly maintained to
prevent degradation of our capability to train and generate readiness
for global employment to support our mission-essential tasks.
Protecting our installations, supporting new warfighting and training
capabilities, and sustaining infrastructure are top priorities for the
Marine Corps.
The Marine Corps' Fiscal Year 2022 Military Construction request is
$1.133 billion for 15 projects, which includes $112 million for
planning and design, $18 million for unspecified minor construction
projects, and $136 million associated with follow-on increments of
previously approved projects. These 15 projects include 8 projects
totaling $498 million to support the relocation of forces to Guam
enhancing force posture in the Pacific.
installations resiliency and resiliency initiatives
We define installation resilience as the ability of our
installations around the world to achieve mission accomplishment in the
face of threats, both kinetic and non-kinetic, that may deny, disrupt,
exploit, or destroy critical infrastructure elements which would
inhibit our ability to generate combat readiness. Our installations
must be resilient to a wide variety of threats--from asymmetric
attacks, to the effects of climate change and extreme weather.
Additionally, installation resiliency must be continually assessed in
response to the rapid technological changes that define this
increasingly complex security environment. We must maintain the
flexibility to adapt and evolve our infrastructure protection measures
to be resilient not only to today's threats, but also to provide
protection against the threats of the future. Effective operations and
maintenance of installations as well as thoughtful future development
and employment requires long-term planning, careful investment, and
timely program execution.
Installation resiliency rests in the ability to maintain reliable
access to critical functions, such as an effective power grid, clean
water distribution, and communications capabilities. The Marine Corps
has undertaken several initiatives to retain this access. For example,
Marine Corps Logistics Base Albany is the first United States Marine
Corps Net Zero Installation: the base produces as much electricity from
renewable ``green'' energy sources as it consumes from the utility
providers in the surrounding community. The transition to Net Zero has
improved the resiliency of the base while reducing reliance on
traditional energy sources and cutting back on greenhouse gas
emissions.
The Marine Corps has also installed two smart grids at Marine Corps
Recruit Depot Parris Island and Marine Corps Air Station Miramar, which
enable continuity of critical installation functions in the event of a
power outage. MCAS Miramar was the first Marine Corps installation to
conduct a Black Start exercise earlier this year, which provided
critical lessons learned to understanding how to improve installation
resilience in the face of power outages and other utility failures.
Continuing to invest in projects such as Net Zero initiatives and smart
grids will place the Marine Corps on a trajectory to meet future
requirements while withstanding disruptive weather events.
force design and installations
The Marine Corps is currently undergoing a significant transition
in how it is organized, trained, and equipped, to meet current and
evolving threats from our peer adversaries. In addition to developing
new operating concepts, increasing integration with the Navy, and
modernizing the equipment we employ, the Marine Corps' installations
infrastructure must also evolve. Our installations are more than a
collection of buildings, ranges, and airfields. They are global
warfighting platforms that support execution of our Title X
responsibilities and provide a home for our Marines, Sailors, and their
families.
In this effort, sound infrastructure is a critical capability. The
readiness of our infrastructure cannot just be measured in terms of the
physical condition of our buildings but must also consider the optimal
posture of the force around the globe and our resilience against the
impacts of climate change and extreme weather events.
The Future Force will have new capabilities whose installation
requirements are difficult to fully determine at present. Further, due
to the rise of peer and near peer threats, several of our bases and
stations must persist inside the Weapons Engagement Zone of our
adversaries which presents unique challenges for installation
resilience. The Marine Corps is continuing to evaluate the facilities
requirements of the force. As the service's experimentation effort
continues, these new requirements for support and protection will come
into greater focus.
ppv housing
The quality of life of our Marines, Sailors, and their families, is
integral to the effectiveness of our force, and the overall goal of the
Military Family Housing Privatization program is to provide safe,
quality, and affordable housing to our military families comparable to
what is available on the local economy. Our Public Private Venture
(PPV) partners are responsible for providing the day-to-day operations
and the management of the PPV portfolio, and the Marine Corps is
responsible for providing the required oversight of the homes to ensure
that they are habitable, that any identified health concerns are
properly addressed, and that residents are being charged fairly for
services received.
The Marine Corps, along with our partners and sister services,
continues to implement the requirements of the FY20 and FY21 NDAAs and
the Tenant Bill of Rights. The Marine Corps views its role in providing
homes to our Marines, Sailors, and their families as a top priority and
we are committed to providing the necessary tools and resources to our
installation commanders and other senior installation leadership.
budget uncertainty and the milcon process
With Congress' strong support, the Marine Corps has made
significant progress over the last decade in replacing aging and
underperforming infrastructure, and we are extremely grateful for the
rapid infusion of financial support in response to Hurricane Florence.
However, the possibility of future budget uncertainty has the potential
to erode readiness and negatively impacts the service's ability to make
the long-term decisions required for maintaining healthy installations.
Predictable budgets over a sustained period are critical for
installation readiness, and enable the Marine Corps to effectively
respond to both operational and climate-related threats using a
deliberate MILCON process.
conclusion
The Marine Corps' installations must prove resilient against the
myriad threats we face. We must modernize our installations to protect
our forces. Our operational capabilities are adapting to meet threat
changes, and we need to invest in the next generation installation
infrastructure to match the Marine Corps' evolving capabilities. Thank
you for the opportunity to testify before you today, and for your
oversight, input, and support as we determine the infrastructure
requirements that will best position the Marine Corps for mission
accomplishment. I look forward to working with you to sustain our
warfighting capability and the readiness of our power projection
platforms.
Senator Heinrich. General Berry.
STATEMENT OF LIEUTENANT GENERAL WARREN BERRY, DEPUTY
CHIEF OF STAFF FOR LOGISTICS, ENGINEERING,
AND FORCE PROTECTION
General Berry. Good morning, Chairman Heinrich, Ranking
Member Boozman, and distinguished members of the subcommittee.
I am honored to appear before you today to discuss Air Force,
Military Construction and Family Housing.
I am pleased to tell the subcommittee that the Department's
investment in this portfolio returned to historic norms in
fiscal year 2022 request. Throughout the last year we have made
great strides at improving our processes to build a more mature
and stable MILCON program, ultimately increasing the likelihood
of successful award and execution.
We anchored on 35 percent design criteria, created a two-
year program lock to further stabilize the program, and
optimize planning and design expenditures, and enforced
admissibility criteria with requirement owners to ensure only
the most ready projects were included in the budget proposal.
As a result, our fiscal year 2022 MILCON request of $2.38
billion is a significant step up from fiscal year 2021. As you
know, our installations are not only power projection platforms
for our many weapons systems and missions; they are also home
for many of our airmen, guardians, and their families. And
those that don't live on base often rely on the many services
those installations provide.
Throughout this portfolio, we strive to strike that balance
between mission and people, so we can continue to provide safe,
secure, and resilient bases for both. In that vein, our fiscal
year 2022 request includes $637 million for efforts which
directly support Service members and their families, including
housing, construction, housing, operations, and maintenance,
privatized housing oversight, as well as new construction of
dorms and a child development center.
For information, our MILCON program focuses on three key
areas: nine projects worth $431 million supporting
modernization of the nuclear triad, specifically ground-based
strategic deterrent and the B-21 Raider, 20 projects worth $793
million to support combatant commanders, particularly in Europe
and the Pacific, and $229 million for planning and design to
ensure continued MILCON execution success going forward.
While not part of the fiscal year 2022 request, our
enterprise remains heavily invested in natural disaster
recovery efforts. The Air Force is extremely thankful to this
subcommittee for the support of these efforts. With the $3.6
billion provided in fiscal years 2019 and 2020, the Air Force
is rebuilding Tyndall and Offutt Air Force Bases, in a more
efficient and resilient way.
The first MILCON project at Tyndall, a child development
center, was awarded in September. Design efforts are underway
for the rest of the program, and I expect to start seeing
additional construction contract awards this summer, with
approximately two-thirds of the remaining requirements on
contract by the end of the fiscal year.
And finally, I would like to quickly mention our efforts to
support the standup of the United States Space Force. Though
details are still being worked out, the Space Force will
continue to leverage current Air Force installation support
processes.
In fiscal year 2022, the Department transferred facility
restoration, modernization, and sustainment, along with
unaccompanied housing and facilities operations funds to the
Space Force for execution. We then expect MILCON funds to be
transferred by fiscal year 2024.
For the fiscal year 2022 program bill, Space Force MILCON
priorities were considered in our existing Department of the
Air Force, MILCON prioritization process. This portfolio is
essential to the health of our vast infrastructure,
infrastructure that is not only critical to mission success,
but also to the wellbeing of our airmen, guardians, and their
families.
We thank the subcommittee for your interest and support.
And I thank you for the opportunity to testify today. I look
forward to answering your questions.
[The statement follows:]
Prepared Statement of Lt. Gen. Warren D. Berry
introduction
Every Department of the Air Force (DAF) mission begins and ends on
an installation. They are the foundations from which we project power,
generate readiness, test new platforms, and support Joint operations.
Our installations also provide safe and healthy communities for more
than 330,000 Airmen, Guardians, and their families. In order to ensure
Joint Force mission success in the future fight, we require an
integrated network of ready and resilient Air and Space Force
installations that are postured to deliver critical warfighting
capabilities around the world and withstand any threat our adversaries
may present.
Our nation's military faces several challenges, including the rise
of great power competition with China and Russia, increasing complexity
of simultaneous multi-domain threats, ever-present fiscal pressures,
and rapidly evolving technologies. Climate change and severe weather
events also pose a significant threat to our installations that must be
accounted for in our infrastructure investments. The Fiscal Year 2022
(FY22) President's Budget Request supports the Interim National
Security Strategic Guidance and lays out a plan to modernize our
military capabilities in order to successfully overcome these
challenges. The Military Construction (MILCON) budget prioritizes
nuclear enterprise modernization and Combatant Command (CCMD)
infrastructure support to deter our adversaries in the European and
Pacific theaters. The budget request also provides important quality of
life investments in housing, dorms, and community support facilities.
The result is a budget request that supports installations' capacity to
fulfill mission requirements and ensures we meet the needs of our
Airmen, Guardians, and their families.
challenges
Within the installation investment portfolio, the DAF also faces a
variety of challenges that influence our investment decisions and
budget execution. We remain committed to addressing these challenges
and appreciate the continued support from Congress to overcome them and
ensure the Air and Space Forces may continue to successfully defend the
Nation and her allies.
Seeking to balance readiness, modernization, and recapitalization
has forced the DAF to accept risk in installation investment as limited
resources are prioritized to the Joint Force's most critical needs.
Over time, deferral of facility and infrastructure requirements has
resulted in a maintenance and repair backlog of more than $30 billion.
If left unchecked, the declining condition of infrastructure will
impact the Department's ability to safely and effectively execute our
mission. Additionally, atrophied facilities and infrastructure are more
susceptible to impact from routine and severe weather events. The
damage caused by Hurricane Michael at Tyndall Air Force Base (AFB)
serves as an example of this, where recently constructed facilities
using updated building codes weathered the storm better than degraded
or older facilities which were constructed under outdated building
codes and subjected to longer term deferred maintenance. We also
observed the impact of deferred infrastructure investments during
damage assessments from recent severe winter storms across the United
States. In many instances, degraded facility systems and components
failed, causing water and fire suppression liquids to freeze, expand,
and eventually burst the pipes.
The DAF has also struggled to award MILCON projects in the year of
appropriation. Sub- optimal design maturity, as a result of
insufficient budgeting for Planning and Design (P&D), significantly
contributed to cost overruns and drove the need to request additional
funds or reprogramming. Design maturity issues also led to the need to
finish or re-design projects after funding was appropriated leading to
additional cost increases and construction award delays. These delays
have also left MILCON funds susceptible to rescission or reallocation.
overcoming challenges
The DAF is working to overcome these challenges through continued
implementation of our Infrastructure Investment Strategy (I2S) and
reforms within our MILCON program. First introduced in 2019, the I2S is
the Department's long-term strategy to cost-effectively modernize and
restore infrastructure readiness, improve the resiliency of mission-
critical nodes, and drive innovation in installation management
practices. This strategy informs efforts to optimize facility and
infrastructure investment decisions and project prioritization within
the MILCON and Facilities Restoration, Sustainment, and Modernization
(FSRM) programs. The I2S also focuses on the recapitalization of
facilities and infrastructure by identifying opportunities to reduce
costly infrastructure in poor condition which no longer sufficiently
meets mission requirements.
In an effort to leverage advanced infrastructure risk analytics,
the DAF continues to develop predictive models, which use current
building condition information, to drive project prioritization and
funding decisions. As a result, the DAF developed our first five-year
Integrated Priority List (IPL) for FSRM projects for the FY21-25
program and continues it this year. This is a key step in our
intentional shifting from a ``worst-first'' prioritization approach to
investing at the optimal time of the lifecycle for a facility,
otherwise known as ``sweet spot'' investing.
In building the FY 22 program, the DAF took great strides to build
a mature, stable MILCON program to address award timeline issues and
cost overruns. We anchored on 35% design criteria to ensure project
documentation was consistent for every project, created a two- year
program lock to stabilize the program and optimize P&D expenditures,
and enforced admissibility criteria with requirement owners across the
enterprise to ensure only ready projects were included in the budget
proposal. The FY 22 program includes only two projects (Royal Air Force
Lakenheath Weapons Load Training Facility and Munitions Inspection
Facility) that did not meet the Financial Management Regulation 35%
design milestone by August 31st, 2020, but these projects reached 35%
design on January 29th, 2021, and are on track to award in the year of
appropriation. Additionally, all projects exceeding $40 million include
Design/Construction Agent cost assessments to further build confidence
in our program and estimates. We were also able to address under-
designed projects over the last year. We used a portion of our FY 21
appropriation to provide funding to bring all previously authorized and
appropriated projects to full design.
The I2S also recommends programming annual Maintenance and Repair
(M&R) funding at a minimum investment level of 2% of Plant Replacement
Value (PRV), with an ultimate goal of 2.3% of PRV, to reduce the
growing backlog of deferred maintenance and restore our facilities and
infrastructure. M&R consists of our FSRM portfolio as well as the
portion of the MILCON program that recapitalizes existing
infrastructure. The baseline funding level request for FY 22
demonstrates our deliberate efforts to align our budget request to the
I2S.
special interest items
COVID-19
The COVID-19 pandemic has challenged the DAF to adapt to sustain
our global operations. In particular, travel restrictions and social
distancing measures affected personnel access at some installations,
material production and delivery, and construction design reviews.
Access and material production and delivery issues were alleviated as
the world came to grips with the pandemic and markets and processes
adapted to the new normal. The DAF adapted to design review challenges
by utilizing virtual platforms to complete remote design reviews and
charrettes, which typically require group gatherings, to prevent design
delays and maintain quality reviews. Should any delays arise in the
future, the DAF is prepared to work with our Design/Construction Agents
and base level contracting professionals to address any Requests for
Equitable Adjustments. While no significant requests for delay-driven
compensation have arisen yet, contractors may quantify COVID-related
costs in the future.
Additionally, the DAF is gathering data on potential footprint
reductions resulting from implementation of long-term telework business
models. We are looking at operational impacts and more subtle effects
like DAF culture. The outcome of this analysis may inform future policy
changes.
Tackling the Climate Crisis
Secretary of Defense Austin recently released his top three
priorities for the Department of Defense (DoD): Defend the Nation, Take
Care of our People, and Succeed through Teamwork. He identified
tackling the climate crisis as one of the lines of effort under the
priority to defend the nation, elevating climate consideration as a
national security priority for the DoD. Changing climate and severe
weather events are a continual threat to our installations. Over the
past several years, the DAF has directly witnessed the impacts climate
and severe weather can have on our installations. We are leveraging
these lessons learned through our rebuild efforts at Tyndall AFB,
Florida, following the devastation caused by Hurricane Michael in 2018
and Offutt AFB, Nebraska, following historic flooding in 2019. We are
also recovering from recent winter storms that brought extreme cold to
much of the United States, impacting dozens of DAF installations.
In recent years, Congress has passed several legislative
initiatives to enhance installation resilience efforts across the DoD.
The DAF, in conjunction with the Office of the Secretary of Defense
(OSD), works to implement these provisions at our installations. We are
incorporating climate and energy resiliency considerations in our
Installation Development Plans (IDPs). Last year, we published a Severe
Weather and Climate Hazard Screening and Risk Assessment Playbook,
which gives installation-level planners a consistent and systematic
framework to screen for severe weather and climate hazards and assess
current and future risks. We have completed initial assessments at all
major installations and will be incorporating results into an addendum
to our IDPs with a focus on installation resilience over the next
several years. Additionally, we have completed twenty four Installation
Energy Plans (IEPs) to identify risks and track and adjust requirements
to advance energy and water resilience goals. We expect to complete an
additional twenty IEPs this year.
The DAF is incorporating resiliency planning directly into MILCON
projects as well. All projects are assessed to determine if the planned
facility could be impacted by current or future mean sea level
fluctuations or if it is located in a 100 year floodplain. We implement
mitigation actions to raise the elevation when required by the mission.
One mitigation action example from Offutt AFB, addresses future flood
concerns. As part of the rebuild of three critical campuses, we are
importing approximately 600,000 cubic yards of fill material, or about
40,000 dump trucks, to raise the elevation of the entire site at least
three feet above the 100 year floodplain. Additionally, the DAF
provides inputs to drive changes to the Unified Facilities Criteria
(UFCs) and then applies those evolving building codes to all MILCON
projects. Many of these UFCs have been updated recently to specifically
incorporate resilience considerations such as sea level rise scenario
planning and updated structural engineering criteria to address wind,
seismic, and flood threats.
Natural Disaster Recovery Efforts
In 2019 and 2020, Congress appropriated $3.6 billion for the
recovery and rebuild of Tyndall AFB, Florida, from the devastation
caused by Hurricane Michael and Offutt AFB, Nebraska, from the effects
of historic flooding. The funding also enables construction at Joint
Base Langley-Eustis, Virginia, to support the relocation of the F-22
Raptor training mission from Tyndall AFB. To date, the DAF has awarded
five construction projects for a total of $72 million, and design
efforts continue for the rest of the program. The DAF expects to award
an additional $2.25 billion of construction contracts by the end of
2021.
Through the Natural Disaster Recovery program, the DAF will rebuild
these installations more efficiently and resiliently. Facilities are
being designed and constructed using the latest Department of Defense
building codes, or UFCs. Additionally, given the extensive damage at
Tyndall AFB, the DAF made a policy decision to design beyond the
minimum UFC criteria for civil and structural engineering. The minimum
design wind speed being used for all new facilities is 165 miles per
hour, exceeding the highest wind speed captured during Hurricane
Michael, and incorporates best practices from the Florida Building
Code's High Velocity Hurricane Zone for Miami-Dade, Broward, and
coastal Palm Beach Counties. Facilities are also being designed 14 to
19 feet above today's mean sea level, which incorporates a 7-foot
projected sea level rise scenario through the year 2100. Additionally,
coastal resiliency is one of the most important aspects to the plan at
Tyndall. This partnered approach includes cost-shared investments which
combine with DAF FSRM and MILCON investments to attenuate storm energy
through natural infrastructure before it reaches built infrastructure.
Key partners such as the Defense Advanced Research Projects Agency,
Fish and Wildlife Service, Bay County, the Florida Department of
Environmental Protection, and the University of Florida are working
together as part of OSD's Readiness and Environmental Protection
Integration Program on key initiatives. We are exploring several low
life-cycle cost Engineering with Nature initiatives to include sand
fencing, submerged shoreline stabilization, living shorelines, oyster
reefs, and marsh and seagrass enhancements. At Offutt AFB, we are
consolidating facilities to higher ground out of the 100-year
floodplain. Where relocation is not possible due to mission
requirements, we are raising the finished floor elevation above the
floodplain and building in a way to minimize clean- up should flooding
occur again.
Winter Storms of 2021
Recent extreme winter storms throughout much of the Midwest and
southern United States had a considerable impact on DAF installations.
Initial assessments indicate some degree of damage at 28 installations.
The DAF continues to assess the damage and will restore facilities to
full mission capability.
A majority of the damage was the result of burst water and fire
suppression lines due to freezing. Our personnel prepared our
installations admirably, but numerous factors, including sustained
periods of extreme cold, degraded facilities and infrastructure, and
off-base power and water supply issues, led to damage and temporary
interruptions. Several installations experienced limited power or water
interruptions consistent with interruptions experienced by the local
communities. Back-up energy sources and contingency plans, as well as
effective coordination with commercial power and water suppliers, were
generally effective in minimizing the length and impact of utility
interruptions. In some cases, such as at Offutt AFB, installations were
able to use on-base power plants and generators to supply their own
power. These efforts were instrumental in helping the utility provider
stabilize the power grid and minimize rolling blackouts in the
community.
Taking Care of Airmen
In December 2020, the Chief of Staff of the Air Force, General
Charles Q. Brown, released a series of action orders providing guidance
to implement his strategic approach, ``Accelerate Change or Lose.'' The
first action order focuses on Airmen. If the Service is to ensure it
has a quality future force where Airmen see continued service as an
attractive career choice, we must consider the environments we provide
for these Airmen and their families at DAF installations. Taking care
of Airmen, and now Guardians, and their families is not just about
quality of life, it is also about readiness. It is at the forefront of
ensuring the DAF can continue to provide critical warfighting
capabilities to the nation. Two programs with direct ties to quality of
life are Child Development Centers (CDC) and dormitories.
In early 2020, the DAF established a cross-functional Child Care
Capacity Initiative Working Group to address unmet child care needs.
This team has prioritized child development and school age care
facility projects based on unmet childcare demand, staffing, and
building conditions. We issued a Strategic Enterprise Executive
Decision memo directing installations to initiate planning actions for
14 projects identified on the prioritized list. The DAF is using the
$11 million in MILCON P&D funds provided in FY 20 to initiate designs
and posture these projects for future execution. Five of our top
priority CDCs--Sheppard AFB-Texas (TX), Joint Base San Antonio (JBSA)--
Lackland-TX, JBSA--Fort Sam Houston-TX, Wright Patterson AFB-Ohio, and
Royal Air Force (RAF) Lakenheath, in the United Kingdom--will be ready
for execution in FY 22. The Sheppard AFB CDC is included in the FY 22
budget request. The fifth CDC at Royal Air Force Lakenheath in the
United Kingdom is required due to the new F-35A mission bed down. CDCs
historically have not completed well against other mission-related
priorities in the MILCON program. We are addressing childcare facility
concerns with FSRM and MILCON in FY 2022. Additionally, we are
posturing MILCON projects for future execution. Eleven FSRM projects,
valued at $44 million, are in development and will be ready for award
in FY 22. As previously stated, the DAF will construct a new child
development center at Sheppard Air Force Base, Texas for $20 million.
The DAF is also committed to ensuring unaccompanied service members
are provided quality housing on our dormitory campuses. The Department
has re-emphasized the roles and responsibilities of commanders in
protecting the health and safety of unaccompanied Airmen and Guardians.
Commanders are responsible for enforcing inspection criteria to
identify and report conditions requiring immediate and future
maintenance, as well as sustaining an adequately resourced maintenance
and repair program to effectively address requirements. Funded from the
DAF FSRM account, the investment strategy for dormitories focuses on
restoration and modernization of these facilities in their existing
configurations. This strategy will ensure the Service continues to meet
the DoD goal whereby 90% of dormitory rooms are in good or better
condition, based on the Facility Condition Index score, for permanent
party unaccompanied Airmen and Guardians and will reduce the
requirement for replacement construction. We are focused on ensuring
the Air Force continues to invest in maintenance and repair work as
required to keep these facilities functioning as originally intended.
This enables the DAF to focus MILCON funds on modern, formal training
facilities for newly recruited Airmen, such as the Airman Training
Center at Joint Base San Antonio--Lackland, Texas, included in the FY
22 budget request.
Space Force
The FY20 National Defense Authorization Act NDAA established the
United States Space Force (USSF) as the sixth branch of the armed
forces. In accordance with DoD direction that the Space Force be
established as a lean, agile, mission-focused military Service, the
Space Force will rely on the Air Force for infrastructure, logistics,
security, medical services, and a host of other support functions.
Formal agreements and implementation plans are being finalized to
codify all stakeholder roles and responsibilities. From an installation
engineering perspective, Air Force civil engineer squadrons will
continue to support Space Force installations as they did prior to
establishment of the Space Force. Air Force Materiel Command's Air
Force Installation and Mission Support Center will continue to provide
enterprise level support for all installation and mission support
programs and processes. In FY 22, the DAF will transfer FSRM,
unaccompanied housing, and facilities operations funds to the Space
Force for execution. MILCON authorization is expected to be transferred
to the Space Force by FY 24. The Space Force is in the process of
developing a separate governance process, leveraging current Air Force
processes, to ensure strategic alignment of investments to Space Force
priorities.
fy22 milcon program
In FY 21, the DAF focused on MILCON program stability to ensure we
are postured to award projects in the year of appropriation. Having
improved policy to correct these measures in FY 21, the FY 22 program
returns to a level similar to funding requests from previous years. In
FY 22, the DAF MILCON request is $2.38 billion, approximately double
the FY 21 enacted amount. This return to previous funding levels will
support the DAF's commitment to fulfilling National Defense Strategy
requirements and posturing for the future high-end fight.
The FY 22 MILCON program supports Combatant Commanders with a focus
on the Pacific and European theaters and modernizing the nuclear
enterprise. Our request also focuses on P&D to reinforce the
Department's MILCON program stability and consistency. Additionally,
the MILCON program continues efforts to beddown new weapons systems and
seeks to recapitalize facilities that have outlived their useable life
or no longer meet mission requirements.
Combatant Commander Infrastructure
The FY 22 MILCON program prioritizes Combatant Commander
requirements with a particular emphasis on the Pacific and European
theaters. Support to Indo-Pacific Command will enhance the United
States defensive posture in the region, reassure allies and partners,
and increase readiness capabilities. The request includes $571 million
for projects in Alaska, Guam, Japan, and Australia to recapitalize key
facilities, disperse resources, and construct operational facilities as
well as Pacific focused P&D. The request includes the construction of
three warehouses to store pre-positioned Airfield Damage Repair
equipment and materials in Guam and Japan, aircraft operations and
maintenance facilities in Australia and Japan, munitions storage
structures in Guam and Japan, and a runway extension to increase
airfield capacity in Alaska.
The DAF remains committed to European Defense Initiative (EDI)
efforts to reassure North Atlantic Treaty Organization allies and other
European partners of United States commitment to collective security
and territorial integrity. In FY 22, the DAF requests $162.4 million
for EDI and other European theater projects to include support for the
prepositioning of equipment in the United Kingdom, and airfield
upgrades in Hungary and Spain. These projects will further improve
deterrence efforts in the theater and enable Joint and coalition forces
to quickly respond to aggressive regional actors. The DAF request also
includes support to CCMDs within the United States to include a
continued focus on Weapons Generation Facilities and Joint Air Defense
Operations which directly supports Strategic Command and Northern
Command, respectively.
New Mission Beddowns
The FY 22 budget request also supports the beddown of new weapons
systems and missions, with a heavy focus on modernizing the nuclear
enterprise. The request includes six projects at Ellsworth AFB, South
Dakota, to bed down the first B-21 Raiders and three projects at Hill
AFB, Utah, and Vandenberg AFB, California to support the transition
from the Minuteman III intercontinental ballistic missile weapon system
to the Ground Based Strategic Deterrent (GBSD). The NDS directs the
Department of Defense to build a more lethal force by modernizing key
capabilities, the first of which are nuclear forces. Once on-line,
these weapons systems will ensure the DAF can effectively supply two
thirds of the nation's nuclear triad well into the future.
The DAF is appreciative of the legislative authorities which
posture the Ground Based Strategic Deterrent (GBSD) program for
success. The FY 21 NDAA provided significant flexibility for the Launch
Facility/Launch Center conversion under MILCON authorization, enabled
all GBSD construction to be carried out under direction and supervision
by the Secretary of the Air Force, and allowed a single prime
contractor to plan, design, and construct all GBSD projects.
Furthermore, it established authorization expiration in 15 years or
until GBSD fielding is complete (whichever is earlier). The DAF will
continue to inform Congress on the Department's progress during design,
construction, and commissioning of GBSD facilities.
The FY 22 President's Budget also requests funding for two projects
at Royal Air Force Lakenheath to construct operational facilities for
the F-35A bed down. Additionally, the request re-integrates two F-35A
projects at Luke AFB, Arizona, to provide flight training and planning
space and additional maintenance capacity. The Air Force cancelled
these projects in 2019 due to a strategic basing decision which
promoted the efficient use of existing facilities, training airspace,
and command and control at Eglin AFB, Florida. FY 22 is the optimal
time to re-integrate these projects, as they are critical to receive
new F-35A aircraft at Luke AFB. Lastly, the budget request includes a
three-bay depot maintenance hangar at Tinker AFB, Oklahoma to directly
support reliable and responsive infrastructure for the KC-46A weapons
system.
Existing Mission Recapitalization
The FY 22 budget request also seeks $447.4 million to recapitalize
facilities that have outlived their useable life or no longer meet
mission requirements. This request includes additional funding for our
Basic Military Trainee Recruit Dormitory modernization, to include
reinserting Dormitory 7 back into the program at Joint Base San
Antonio--Lackland, Texas. The Air Force previously cancelled Dormitory
7 to cover funding disconnects with the other dormitories in the
program, but in FY 22, the time is right to bring this requirement back
into the budget to construct the final dormitory required for bringing
new Airmen and Guardians into the Department. Other recapitalization
projects include the Nuclear Command Control and Communications
Acquisitions Management Facility at Hanscom AFB, Massachusetts, which
provides a critical facility for the Air Force Nuclear Weapons Center,
a crash fire rescue station at Joint Base Andrews, Maryland, and a gate
project at Davis-Monthan AFB, Arizona.
Additionally, the request includes a CDC at Sheppard AFB, Texas,
which is the DAF's top priority to address child care capacity
shortfalls.
Planning and Design
P&D remains a central focus of the DAF MILCON program to reinforce
program stability and consistency. Sufficient P&D enables projects to
progress rapidly through design and meet maturity criteria for
admissibility into the program, provides more accurate cost estimates,
and maximizes opportunity to award projects in the year of
appropriation. Without sufficient P&D, the DAF must award designs by
design phase, which adds risk associated with costs and timely delivery
of design. With the FY 22 P&D request of $253.5 million, the DAF
intends to complete remaining design requirements for our FY 22
program, fully fund designs for our planned FY 23 and FY 24 projects,
and initiate design for FY 25. Our two year budget lock policy outcome
is a stable MILCON program allowing us to efficiently use P&D for
future projects.
facilities sustainment, restoration, and modernization (fsrm)
The FSRM and MILCON programs are interdependent. Together, these
two funding streams are the foundation of DAF installations. FSRM
provides a non-MILCON pathway to repair facilities and infrastructure
maximizing their lifespan. The FY 22 budget request of $3.9 billion in
FSRM funding is an 18% increase from FY 21 enacted levels. The increase
shows our deliberate focus on ramping funding toward the I2S
recommended floor of 1.9% of PRV to address degrading infrastructure.
Our I2S drove changes in how we execute the FSRM program by
prioritizing projects based on mission risk and timing investments at
the optimal point in the asset lifecycle. The centralized FSRM scoring
model targets investments at an asset's ``sweet spot'' in its life
cycle rather than at end-of-life failure, which is significantly more
expensive. FSRM funding distributed directly to installations
(considered decentralized FSRM), empowers Commanders to make the right
local investment decisions, including day-to-day maintenance and
smaller scale repair and sustainment projects, based on mission
requirements and I2S guidance.
housing construction and operation and maintenance
The DAF prioritizes providing safe and healthy homes to our
families. The FY 22 budget request seeks $441 million for housing
construction, P&D, and operation and maintenance. These funds will
support a continued focus on eliminating inadequate housing from the
DAF inventory. The military family housing construction request of $116
million will fund planning studies and design for future construction
projects, the renovation of existing homes, and supports the
restructures of two privatized housing projects that are under
currently under negotiation with the privatized housing project
companies.
The high cost of construction in the Pacific, specifically at
Okinawa, Japan, continues to present challenges where the DAF is the
executive agent for more than 7,800 family housing units. The increased
cost of construction requires solutions within the DAF family housing
construction program to include cancelling projects that are no longer
necessary due to European theatre posture changes and using existing
resources to achieve full scope on multiple projects. The DAF continues
to focus investment in the Okinawa housing inventory to provide
adequate housing for all service members and their families residing on
the island.
Our military family housing operation and maintenance request of
$325 million will fund efforts to sustain, improve, and modernize our
Government-owned inventory of approximately 15,200 family housing units
and provide and sustain enhanced oversight of more than 55,000
privatized homes. The additional $20 million in Family Housing Support
and Management funding provided in FY 21 will ensure continued support
for the housing needs of Airmen, Guardians, their families, and our
Army, Navy and Marine Corps teammates housed in government-owned and
privatized inventory.
privatized housing
The DAF, with the support of Congress, has taken substantive
actions to address the concerns and make meaningful, enduring changes
to our privatized military housing program. Over the past two years,
DAF leadership at all levels has been focused on improving the living
experience for service members and their families living in privatized
housing while we implement housing reforms set out in the FY 20 and FY
21 NDAAs. Nearly all of Air Force's MHPI companies have agreed to
implement all eighteen tenant rights at their existing projects, and
with few exceptions, we expect these rights to be fully available at
Air Force installations with privatized housing by the end of FY 2021.
In addition, the Air Force has taken action to increase oversight and
increase accountability to ensure identified hazards have been
corrected and, if not, contractors are held accountable.
Some highlights regarding the improvements the DAF implemented last
year include increased program and project oversight. The DAF added and
filled 218 manpower authorizations, and has filled them all, to improve
oversight, quality assurance, and advocacy at all installations. The
DAF also added 147 manpower authorizations to increase installation-
level oversight. These additional personnel are receiving training to
conduct change of occupancy inspections consistent with national
industry standards. Additionally, the DAF added 60 manpower
authorizations to provide Resident Advocates to directly support
residents ensuring they have multiple avenues to raise and resolve
issues. Resident Advocates report directly to the wing leadership to
increase commander awareness of concerns raised by residents. The DAF
has also added 11 manpower authorizations for Headquarters DAF, Air
Force Civil Engineer Center and our legal staff. Finally, the
Department instituted a revised governance structure to review
programmatic and systemic issues, best practices, and financial health
of the program. The revised governance structure culminates with a
council that includes the uniform chain of command and is advised by
military housing office professionals.
The DAF also approved a revised performance incentive fee (PIF)
framework to increase both the commander and resident voice in
assessing earned PIFs. The new performance incentive fees will improve
tracking and reporting of maintenance operations at each project. The
DAF is in the process of re-negotiating the PIF framework with project
owners, reaching agreement with two of the nine project owners that
have a PIF as part of their agreements. As part of the DAF's plan to
increase transparency and accountability, all the project owners
implemented automated work order systems, allowing residents to submit
electronic work orders, schedule repairs, and provide satisfaction
feedback. Lastly, the DAF centrally contracted for the annual tenant
satisfaction survey, coordinating with the Army and Navy to ensure a
consistent survey DoD-wide as well as issuing the survey to collect
resident input from both privatized and government owned housing.
In spite of these successes, the DAF is working with our MHPI
project companies, in coordination with the Office of the Secretary of
Defense and the Office of Management and Budget, on restructures for
two financially challenged projects in order to address health and life
safety, sustainment, and reinvestment needs. There is still more work
to accomplish to ensure quality and safe homes for our Airmen,
Guardians and their families. Our priority going forward is to remain
focused on improved oversight, long-term project health, and
sustainment of the housing inventory to provide military families
access to safe, quality, affordable, and well- maintained housing
communities where they choose to live, and to ensure accountability at
all levels within DAF and the MHPI companies to perform our oversight
as originally intended at the outset of housing privatization. Our FY
22 request provides funding to ensure our DAF has the staffing and
resources they need to ensure that housing privatization projects
provide safe, quality, well-maintained housing, and address resident
concerns in a timely, transparent, and responsive manner.
base realignment and closure (brac)
Through the BRAC process the DAF has closed 40 installations and
sites and transferred more than 98% of the property back to communities
for beneficial use, producing $2.9 billion in annual savings. Property
transfer is complete for 34 former installations, and we expect to
complete transfer of fewer than 2,000 acres at the remaining six former
installations by 2027.
Our BRAC cleanup program focuses on protecting human health and the
environment, projects that transfer acreage and achieve beneficial
reuse of property, and investigations and response actions associated
with PFAS.
conclusion
The DAF's FY 22 budget request supports President Biden's Interim
National Security Strategic Guidance and lays out a plan to modernize
our military capabilities while taking care of our Airmen, Guardians,
and families. It keeps us on the path toward a successful future
posture. The I2S continues to guide MILCON and FSRM budget decisions
and business practices as we endeavor to deliver ready, resilient
installations as cost effectively as possible. The MILCON portion of
the FY 22 request prioritizes nuclear enterprise modernization and
supports Combatant Commanders, with particular focus on the European
and Pacific theaters. The housing request provides the resources needed
to sustain and improve the DAF's inventory of government-owned homes
and provide oversight of privatized housing project owners. The
Department remains committed to overcoming challenges affecting this
portfolio and delivering effective, efficient installation engineering
services. The FY 22 President's Budget request ensures that our Airmen,
Guardians, and installations are ready to defend American interests now
and in the future.
Senator Heinrich. Thank you, General Berry. We will proceed
with questions and use the standard five-minute rounds.
Senators will be recognized in the order that they arrived, and
I will start by recognizing myself for five minutes.
To either General Evans or General Berry; I mentioned in my
opening statement that I am encouraged by the increased request
for ERCIP; however, it is my understanding that the demand for
funding still exceeds the request. So, for example, there are
microgrid projects ready to go at installations across the
country, including Kirtland Air Force Base in White Sands
Missile Range. Could you talk about the interest in ERCIP from
installations and the regions? And if there was additional
funding, what would the ability to execute be?
General Evans. Sir, thank you for the question. We are
budgeting $104 million this year for ERCIP, which is an
increase from last year, and we are also in the out years
increasing the use of ERCIP. I can get you those numbers. ERCIP
is an important program to us, as well as the other third-party
contracts that address climate control and environment. But I
can get you the numbers for the out years. We are increasing
our years, sir.
General Berry. Yes, sir. As far as the Air Force, so for
resilience, you know, we look at it through several different
lenses, through energy, through cyber, infrastructure, response
when something happens, of course, due to climate. From a
resilience perspective, I don't have the exact numbers for the
ERCIP, unfortunately for the Air Force. I can certainly take
that for the record to get back to you for particular projects
that we had in the budget for the 2022 request.
But as you know, and I think as both you and Senator
Boozman mentioned, the challenges that we have, right, are the
many demands on the portfolio. And so the many things that we
try to fit into the top line and the obligation authority that
we do have in the Department can't satisfy all the demands that
are there.
But it is important to us, we are committed to resilience.
We have, as I mentioned in my opening comments with Tyndall and
Offutt, many of the projects there in terms of building those
facilities and bases back to what we need, not just what was
there before, by incorporating resilience, and incorporating
all those resilience standards into our design standards,
moving forward, for future MILCON, restoration of modernization
is very, very important to us.
Senator Heinrich. Admiral Williamson or General Chiarotti;
the fiscal year 2022 ERCIP unfunded requirements list does not
include any Navy or Marine Corps projects. Do the four Navy and
single Marine Corps projects in the budget request reflect the
entirety of ERCIP demand in those services?
Admiral Williamson. Sir, fiscal year 2022 included $109
million for nine ERCIP projects. To give you an example of
those, one is Great Lakes Illinois, our single training
facility, and the other is at Atsugi.
Additionally, one of those projects we took advantage of,
not only the resilience that my counterparts talked about but
on San Clemente Island, which is very important to our
training. We are able to get wind turbines up there, which
allowed us to get away from using, diesel generators. It is a
very important part of our base master plans, and we validate
that through our mission assurance program, by going out
looking at the infrastructure of the base, ensuring that it can
respond to, you know, any loss of power, and also that we were
producing, the most efficient use of the power.
Senator Heinrich. General Chiarotti, do you want to add to
that?
General Chiarotti. Sure. Thank you. So from the Marine
Corps perspective we have--across our installations we have
undertaken an assessment analysis of where we stand with our
ability to maintain the resiliency that is needed to operate
our core functions. And as I mentioned in my opening statement,
some of our installations now are at net-zero, and we are able
to generate that utility that is required in order to sustain
the functions, and in some cases also sell back utilities. So
we find great value across the board. We continue to make those
investments, but we are moving at a very deliberate and
informed pace through our analysis that is being provided
there.
You will see in San Diego, MCRD San Diego where we are
pairing up with commercial utilities provider for a long-term
power sustainment, independence in that regard. So from the
Marine Corps perspective, yes, sir, we were taking max
advantage of that. Thank you.
Senator Heinrich. It is been interesting as we have worked
through some of these projects in New Mexico, where we have a
microgrid project at Kirtland Air Force Base. You know, we
started to realize that we have heavily relied on things like
diesel generators which, you know, one out of three times, you
try to get them started and they just don't start. And,
replacing those with on-grid storage has made quite a
difference. So look forward to hearing more.
And, with that, I will recognize our Ranking Member.
Senator Boozman. Thank you. Thank you, Mr. Chairman.
Mr. Cramer, the past couple of years, your office has been
working on military construction reform, looking for ways to
reduce cost and improve timeliness of delivery by looking at
specific key areas of the MILCON process. I did not see any
mention of that effort in your written statement. Again, we had
a really good visit in the office and talked about these
things. So can you just reaffirm what MILCON is thinking about
in regard to initiatives that are focusing on producing real
change and results for the MILCON program in that regard? Can
you share any specific examples of process improvements you
have identified and you are working towards from an enterprise-
wide approach?
Mr. Cramer. Thank you, Senator. Yes, so one of the measures
we talked about yesterday, as part of our MILCON reform, an
effort we started a couple of years ago, we kind of got
sidetracked with other more urgent needs, and while we've
talked about MILCON reform, and more staff to actually to
execute the MILCON reform so as part of the 2021 NDAA we split
back the what was combined into the Assistant Secretary of
Defense for Sustainment pulled apart what was usually called
ASD for Installation Energy and Environments, and also
Environment, Installation and Energy, so that stood up.
And with that, now I have a dedicated deputy assistant
secretary to do construction oversight. And so one of those,
Mike McAndrew, a long-serving SES and knows exactly what needs
to be done in MILCON reform. He was doing housing and MILCON
reform up until earlier this year. So now he is back and
dedicated, so he's now, in fact, today meeting with
representatives from our Design Construction Agents in the Air
Force's current facilities, the Civil Engineering Command. And
so that is the body of folks that actually then have oversight
of the Department's MILCON processes, and it is too long.
And if you look at the frontend in comparison, and if we do
it right before we seek budget, and the 35 percent design is
kind of the number we settled in on, and to say that is a
design sufficiency. But what we really want to go after is the
design risk. And then if we're--at the 35 percent there is some
risk involved in that design for the unknown, and the
installations will go through with the project.
So we want to add into the program amount, a sufficient
dollar to overcome those risks, so that we are not coming back
and doing reprogramming actions which will take a while to get
the process to get it up to you guys to approve.
So we want, in order to get the program amount on those
projects to about what we need to overcome the things that we
know to be risk at the time of the request. Things like the
pandemic and global construction, we can't foresee those, but
we can look into, you know, past practices to get better at
what is our design risk--so that we are not always seeking
reprogramming so that [inaudible].
Senator Boozman. Right.
Mr. Cramer. So I am trying to avoid that at the frontend of
the projects, and really get more design sufficiency and
project definition before we get to the [inaudible].
Senator Boozman. All right. Thank you. For one of our
Service witnesses, if you will just jump in, this applies to
all of you--very quickly. There has been a lot of attention in
recent years to the condition, not just housing, but also
barracks and dormitories. We have seen multiple stories of
barracks and dorms in poor condition, sometimes against the
backdrop of low morale, poor command climates, and troubling
stories. Most of you addressed this in your written and oral
statements, but I would like to address it here.
How are you prioritizing funding for barracks and dorms
within the MILCON budget, as well as against other quality of
life projects such as child development centers? Yes, sir?
General Evans. I will go first. Can you hear me, sir?
Senator Boozman. Yes, sir.
General Evans. All right. Sir, under the G-9 we lead a
Quality of Life Task Force for the Army. We have been leading
that since about November 2019, and there is six lines of
efforts, it is really six priorities that were really based on
the Chief of Staff of the Army's Transition Task Force, where
they canvassed the Army, talked to privates, all the way up to
generals, talk to civilians, talk to family members. And what
came out of that is the number one priority for people, which
is our number one priority, is housing. And included to that is
barracks.
And I think our budget request reflects that, you will see
five barracks projects they are wanting--and also includes a
reserve component. With your support the Chief of Staff's
fiscal year 2022 UFR list, there is about 13 barracks projects
in there. And then the third priority in that was child
development center. And you will see four child development
center projects in the UFR list, two CDC MILCON projects, and
two R&M projects, and you will see the same in our request.
And so that is how we look at it. Our priorities are
people, modernization, and readiness, and I think that our
budget request and our UFR request reflects that.
Senator Boozman. Good. Thank you, General. Thank you, Mr.
Chairman.
Senator Heinrich. Senator Collins.
Senator Collins. Thank you, Mr. Chairman.
Admiral Williamson, as you may know, the acting secretary
of the Navy recently visited the Portsmouth Naval Shipyard in
Kittery, Maine. He was clearly very impressed with what he saw
there, the outstanding, talented, highly-skilled employed, we
have an excellent captain commanding the shipyard, and the
entire Maine delegation, and New Hampshire delegation are
strongly supportive of the shipyard.
The Navy's budget requests 250 million for the second
increment of the Multi-Mission Dry Dock No. 1 extension project
at the Portsmouth Naval Shipyard. The Navy has included as its
number one MILCON unfunded priority an additional 225 million
that is needed to keep this essential project on schedule. It
is vitally important. Beginning of 2024 scheduled Virginia
Class maintenance availabilities at the shipyard will exceed
its capacity, and failure to complete this project on time will
result in 20 deferred availabilities through 2040.
In other words, we need this project completed in time, or
we risk our submarines and our sailors being unable to
accomplish their mission. Could you discuss the importance of
the additional funding to the success of the project? And with
this additional funding, number one on your unfunded priority
list? Would the Navy be able to eliminate the 20 deferred
availabilities so that we can return our submarines and our
sailors to the fleet on scheduled so they can perform their
important mission?
Admiral Williamson. Yes, ma'am. First, yesterday the CNO
testified, this is a once-in-a-century opportunity. The
shipyards play a very vital role. I am familiar with Portsmouth
Naval Shipyard, as you know, as a Commander of Navy Region Mid-
Atlantic. The shipyards, our dry docks are over 100 years old,
the infrastructure that supports is greater than 61 years old.
It is vital to support Columbia, and Virginia Class Submarines,
particularly for COCOM requirements.
We did have a project that came in over what we expected. I
think it was a tremendous opportunity for us to learn, because
we have not done a mega project this size in a very long time.
Our leadership has absolutely, with a sense of urgency said, we
need to learn quicker, and we will. The raw materials: for
example, the impact, the volatility due to COVID driving that
up, balancing the maintenance of building a new shipyard while
you are doing maintenance to a very complex platform, ensuring
that those maintenance availabilities are predictable and on
time allows you to maintain that superior workforce that is in
Portsmouth.
We are committed to learning from that. We have taken
several actions, you know, obviously taking on a task of this
size requires great expertise. So we are bringing on cost
engineers, and economists, experts to help us. We are also
bringing in third-party risk consultants to get better
accuracy, and reduce the risk as we move forward. In addition
to that, you know, it kind of ties into the resilience
conversation we had earlier. You know, the first element of
this is a digital twin. We are currently looking at all four of
our shipyards. Hawaii is completed. We hope to have the digital
twins completed by the end of this year for all of our
shipyards, and what that will allow us to do is do an area
development plan.
Senator Collins. But just to clarify. You stand by the
statement that is in the budget materials, that the additional
money would eliminate the 20 deferred maintenances?
Admiral Williamson. Yes, ma'am.
Senator Heinrich. Admiral, I was just going to say: Can
everyone, please, make sure your mics are on, and pull them in
nice and tight so that the folks who are watching on the
website can hear you.
Admiral Williamson. Apologize, sir.
Senator Heinrich. Yes.
Senator Collins. Thank you.
General Evans. I was pleased to see that the Army's budget
request includes 21 million for a new Joint Vehicle Maintenance
Shop for the Maine National Guard at its Saco location. The
existing undersized facility was constructed more than 80 years
ago, and it has a host of problems, including insufficient
lighting, poor ventilation, fire mitigation and electrical
wiring that is not up to code, asbestos in the structure, and
there are also force protection issues with the current
building. What would be the impact of a delay in replacing this
facility on readiness?
General Evans. Well, ma'am, all the reasons you stated. An
antiquated facility, it does not have the room----
Senator Heinrich. Can you make sure your mic is all the way
in because----
General Evans. Sorry, sir.
Senator Heinrich. There you go.
General Evans. All those reasons you stated, along with
that being the only vehicle maintenance facility in Bloomington
of its kind, it is also a shared facility with the Air National
Guard as well as the Army National Guard will have a tremendous
impact on the readiness of maintenance on combat and tactical
vehicles.
Senator Collins. Thank you. Thank you, Mr. Chairman.
Senator Heinrich. Thank you. I think we are going to start
a second round and I believe Senator Tester may be on his way
as well.
So I want to ask you Mr. Cramer. This is the first year
that DOD has requested funding for electric vehicle
infrastructure planning and design, it is critical that the
Department commit resources to understand its energy demand
needs, and electrical grid capacity, and to build out its
electric infrastructure where necessary. Could you discuss how
the Department is approaching electrification at installations,
in particular to support both the non-tactical and the tactical
vehicle fleet?
Mr. Cramer. Senator, I would start that with--it goes back
to--I didn't want to be accused of a spring [inaudible] to the
question you answered--or asked earlier about ERCIP, and really
the plan starts with our installation energy plans. And so if
we have a holistic plan of energy needs on an installation, a
subset of that would be the grid. Resilience of the grid,
electrification of the grid in order to provide electricity to
the point of need, regardless of what that point is; electric
vehicles, you know, command facilities.
And then also what we want to do, as part of our
installation energy plan, is build in efficiency into those
facilities so that we could reduce the demand which then
increases the O&M dollars to spread out. And so specifically
for electric vehicles and electrification to support, and
focused on the non-tactical. We are years away from
electrification of a tactical vehicle.
So non-tactical vehicles on an installation, we really have
to look at the point of need, and the sufficiency of the grid,
so we don't throw, you know, our whole electric system off
balance. So we really have to then hire some folks that are
experts in the field, which quite frankly, we don't have that
muscle memory within our organizations just yet. We may build
that, that capacity, but right now we are really gonna rely on
some consultants to come back and do an installation. And say:
All right, so here is what the grid looks like today. Here is
kind of the direction we are going to go. And we are going to
make sure that it fits into our overall installation energy
plan, and then we use the tools in the toolkit in order to
address a lot of that, ERCIP being one of those.
And I think what you will find is, is that while the FY DP
for an ERCIP does not look that deep today, as we fill out the
installation energy plans across the entire Department of
Defense, then that--you know, one to N list does get fairly
robust, because the need is there to support resilience on our
installations. That is what we are really looking for. How do
we continue to operate regardless of the events that take
place, and eliminate those single points of failure that exists
today in our grid?
Senator Heinrich. I forgot that. I am following my own
advice here. Is the Department integrating electrification
requirements into upfront facility design? For example, are you
updating the unified facilities' criteria to think about these
things so that we are not, down the road, retrofitting
expensive land? You know, a lot of what you talked about in
your testimony just now, it is not really rocket science. I
have been doing this for--I built my first electric vehicle in
the early '90s, and I have been driving electric for a few
years now. And oftentimes it is cheaper if you plan for it. It
is not cheaper if you retrofit.
So, for example, if you have a new office building, or if
you have a new housing, and you put in the smallest service
panel available when you build that, if you add additional
demand you are going to have to make an expensive upgrade.
Whereas, if you put a service panel in that has additional
slots in it, it is not a big deal. So are you making the shift
to thinking about this into the future, and planning so you are
avoiding, you know, expensive upgrades down the road?
Mr. Cramer. Yes, Senator. We have updated our Unified
Facilities Criteria, our version of design codes, and our
facilities guides that we give out to--or that our design
construction agents use to give out to their architects and
engineers. So those guide specs and facility criteria codes
have been updated, and then so we are not in the habit of doing
is retrofitting buildings for retrofit sake.
You know, we are going to go into a facility that has a
need for more than just one single item to correct. We will do
that restoration and modernization, and we will put in, you
know, all of the latest and greatest at that time of contract.
But we have got hundreds of thousands of facilities we have got
to get to. And so we are--we are really then, you know,
focusing on the retrofit as we go down. And I will let my
Service colleagues add on if they want.
Admiral Williamson. Sir, to address the question
specifically. As Mr. Cramer mentioned, as part of our
installation development plans, and part of our mission
assurance reviews of our bases, it is twofold. UFC standard as
we move to look at resiliency moving forward, and this being
part of our master plan, we specifically look at the bases with
grids, for example, to ensure that when we build back, we build
back better.
And that is built with two things in mind. One, of the
efficiency of the base, which is a multiplier for us, and two,
allows us resilience. I had the great fortune of being the CEO
of Naval Base San Diego, had a great partnership with San Diego
Gas & Electric, and obviously huge demand signals in that area.
But when you have the partnerships with the local energy
providers, it is a tremendous opportunity and leverage for us
to learn.
So certain times a year in San Diego, Naval Base San Diego
is home to 50 more ships, huge energy consumption, we come on
to ship's power to allow San Diego the same opportunity they
allow us to operate. And so through those partnerships, I think
it is tremendous learning, and it is also an operational
advantage for us.
Senator Heinrich. All right. Thank you.
Senator Hagerty.
Senator Hagerty. Thank you, Mr. Chairman. I appreciate the
opportunity to be here with such distinguished witnesses today,
and in particular, a very good friend, General ``Chuck''
Chiarotti. It is wonderful to see you again, Chuck.
And Chuck, I am going to I am going to direct some
questioning to you, if you don't mind. I want to go back and
talk about the 2018 National Defense Strategy, and quote from
that. ``China wants to shape a world consistent with its
authoritarian model, gaining veto authority over other nations'
economic, diplomatic, and security decisions.'' In pursuit of
that objective, each day China continues to strengthen its
posture in the Indo-Pacific region. It continues to maintain a
very real threat to the United States and to our allies. And
that is why the U.S. Military posture in the Indo-Pacific
region is more important than ever.
As Ambassador to Japan, it was my great honor to work
alongside you, General Chiarotti, and such a competent team of
United States Military professionals in that region. And we
continued to focus our posture to be as effective as we could
be every day. So I would like to get your perspective, if you
could describe the strategic environment and the Indo-Pacific
today, as it stands today, and whether China is continuing to
tilt the balance of power in its favor?
General Chiarotti. Senator Hagerty, it is good to see you,
sir. Sir, I will stay within my lane, and that is within the
area of logistics and facilities, and also of the United States
Marine Corps. Our commandant has put the Marine Corps on a
footing to address the threat that China is. In that regard he
has directed a force design, which really seeks to address the
growing risks that China has placed on the United States, and
as defined by the National Defense Strategy.
To that end, we are, as we always do when faced with a
threat, reevaluating our posture to ensure that we are able to
provide the Indo-Pacific Commander and the Nation, the
responsiveness that the United States Marine Corps is expected
to deliver, sir.
Senator Hagerty. Well, I want to thank you and the many
Marines that serve in that region. In my experience with China
the past couple of decades, they have increased their military
expenditure some eight-fold, and recently they just surpassed
the number of ships in their fleet, greater than the U.S.
Military's fleet.
Now, of course, our ships are far more capable, and a real
force in that region, but as you continue to think about our
posture there, do you think of us moving in a more dispersed
fashion? Do you think of us hardening our position? How do you
see, from a facility standpoint that evolved in, given the
breadth of the challenge in that region?
General Chiarotti. As you will know, sir, our installations
in the Indo-Pacific AOR are located within the first island
chain, the majority of those, and so we continually look at the
vulnerabilities that are--that we face both from environmental,
as well as kinetic threats from our potential adversaries. To
that end, the United States Marine Corps is an expeditionary
force, and so we see ourselves operating in a very dispersed
manner within that first island chain providing that
competition deterrent, and the ability to quickly transition
from competition to the blunt force, as directed within the
National Defense Strategy, sir.
Senator Hagerty. Well, I want to thank you for everything
that you have done in your career and service, Chuck, and I
want to let you know that, were it not for the strength that
you provide, our diplomacy would not be as effective as it is.
So thank you. And thanks to all of our witnesses today.
Mr. Chairman, I yield back. Thank you.
Senator Heinrich. Thank you.
Senator Tester.
Senator Tester. Thank you, Mr. Chairman, Ranking Member
Boozman, for having this hearing. I want to thank all the
witnesses for being here.
And Senator Hagerty, I look forward to working with you.
You laid out the challenges very, very well, both from a
military perspective, and an infrastructure perspective in this
country. So thank you for those statements.
Okay. Last year, the National Guard has been called to
respond to COVID-19, domestic unrest, and even to secure where
we are at right here today. One of the only major MILCON
accounts that saw a significant decrease in the budget request
was the Army National Guard MILCON account. We are relying on
our National Guard more than ever, and I am concerned that we
are going to reward them by asking them to do more with less.
So, General Evans, can you tell us about what kind of risks
that we are taking by funding the Army National Guard MILCON at
the level that is requested?
General Evans. Sir, thank you for the question. The MILCON
budget, to include the Army National Guard, is based on the
Army priorities, people, and readiness, and modernization. I
think what you see in Army National Guard MILCON account budget
request is addressing those items: barracks, vehicle
maintenance, as well as readiness center. You also see a number
of projects, with your support, in the Chief of Staff UFR lists
for the same barracks, readiness centers, and maintenance, to
address exactly what you are talking about, sir, the readiness
of the Army National Guard.
Senator Tester. So, just to follow up very quickly, General
Evans, you don't think we are taking any risk by having the
National Guard MILCON, funded at this level. Do you think it is
adequate?
General Evans. So I think the Army senior leaders, as they
prioritize the MILCON list, considered the risk across all
compo, sir. And I think what you have is it addresses the
people in readiness and modernization for all compos to include
Army National Guard, sir.
Senator Tester. So this is adequate?
General Evans. So I would say, with your support, with the
chief of staff, the Army's UFR list I think we will continue to
make ground on that. As you know, the Army does have an
infrastructure backlog, and I think the UFR list, along with
what we are doing now, addresses that, and we will continue to
address that based on the Army priority, sir.
Senator Tester. Okay.
General, General Berry, we have got Malmstrom Air Force
Base in my backyard, we have got a potential weapons storage
facility to be built there as long as well as one in Senator
Hoeven's state, in Wyoming. I believe they started on the one
in Wyoming. They are supposed to start on the one in Montana
soon, I think. It is well funded, but there has been somewhat
of a history of kicking the can down the road a bit, and I want
to make sure it does not get kicked down the road on the
weapons storage facility.
So, to cut to the chase, can you give me a timeframe about
when you think, because it is somewhat dependent on Wyoming,
when you think they will break ground on the Montana Weapons
Storage Facility?
General Berry. Senator, thanks for the question. So, as you
said, you know, as we do the construction, F.E. Warren, we are
learning lessons as we go along. There have been some design
changes from those lessons we learned at F.E. Warren that we
are now incorporating into the Weapons Generation Facility at
Malmstrom. We are proceeding with the 95 percent design on the
Malmstrom Weapons Generation Facility. Right now, talking to
our design and construction agent, we believe that we will be
ready for a contract award in the spring of 2022.
So once we do contract award, then you can start doing the
mobilization, and you can start doing the actual construction
at that site. So for now we have the $120 million first
increment for that structure, and that is a very, very
complicated facility. We think that is enough money for now to
carry us through fiscal year 2022 to get to the more robust
design and get us through contract award, sir.
Senator Tester. So a year from now--actually a little
before that--because we are in June now. So spring is, at least
in Montana, we are in summer, even though the calendar doesn't
state it.
General Berry. Yes, sir.
Senator Tester. The contract award will be given?
General Berry. That at is the current schedule that we are
marching to. Yes, sir.
Senator Tester. And what point in time after that contract
award does dirt start being moved?
General Berry. I can get back to you on the exact
timeframe.
Senator Tester. Typically, how long does it take?
General Berry. It is months later.
Senator Tester. Months?
General Berry. By the time you mobilize the contractor and
get them onsite, yes, sir.
Senator Tester. I appreciate that. And I will probably hold
it to it too. So thank you. On privatized--oh, I am out of
time. I will submit a question for the record, Mr. Chairman. I
just wanted to express my appreciation to all of you for the
work you do. Thank you.
Senator Heinrich. Thank you, Senator Tester.
Senator Hoeven.
Senator Hoeven. Thank you, Mr. Chairman. I am going to pick
up right where Senator Tester left off, no surprise to him. We
have common interest, both in the Weapons Generation Facility,
and also the MH-139 Facility. And we have worked very hard on
those--both of those, including the helicopter, getting the new
helicopter out to the ICBM bases. And so he mentioned
Malmstrom, and I am going to bring up the Minot Air Force Base.
General Berry, can you update me as to the status for well,
let's start with the MH-139 Facility. We appropriated, let's
see, $66 million in 2019, an additional $5.5 million in 2020 to
house that facility. I have been expecting that you all would
have had a groundbreaking by now. So can you update me on the
status of constructing that facility?
General Berry. Yes, sir. So it is a similar story to the
last question Senator Tester asked. As we put the bids out, the
bids came in higher than anticipated, and so our construction
agent right now is evaluating those bids to try to see if we
can get it more in line with what we expected that project to
cost. Since it is, right now, in solicitation, I am hesitant to
say anything publicly. I think we would be more than happy to
come talk to you privately about some of the challenges that we
are seeing on that MH-139 facility.
We do know that once the Corps of Engineers does award the
contract, it will be about a two-year period of performance to
actually get the facility completed. But until we can get
through the bids, I cannot give you a firm answer on when that
construction will actually start.
Senator Hoeven. Well, then I would ask that you come talk
to me privately, so to just know when that is going to be. All
right?
General Berry. Yes.
Senator Hoeven. Thank you. But then also I want to ask
about the Weapons Generation Facility, unlike F.E. Warren, or
Malmstrom, we have both the ICBM Ground-Based Nuclear
Deterrent, but also the B-52s with their nuclear weapons. So we
have been told that we have not been started on the new Weapons
Generation Facility because we have--you have to handle both
aircraft and missiles, and the others are just the missiles. I
understand that. I still want to know where we are at in
getting that done. I mean, this is the only dual nuclear base
in the country operating with an older facility. So it seems to
me it is of great importance. Can you tell me on the timeline
there?
General Berry. Yes. So, Senator, I unfortunately cannot
commit to a specific date of when we will get to that Weapons
Generation Facility. I think as you alluded to, right, it is
very, very complicated, that WGFs themselves are complicated
and complex facilities, when you design in all the safety and
security standards that come with that weapon system. We are
learning lessons at F.E. Warren, we will learn some lessons
when we get to Malmstrom. This fiscal year 2022 budget
increment one, for the Barksdale Weapons Generation Facilities
in there; that is the first bomber WGF that we will design and
build as well.
So all of those are giving us an opportunity to learn the
lessons that will then come to play at Minot, whereas, you
mentioned, we are putting both of these missions together into
one facility that makes it even more complex than the other
ones. So we think by doing that, we will get a better design,
we will get a better cost estimate, and we have a better chance
of meeting cost and schedule when we do it that way. But, but
right now we have not started the detailed design on that
structure.
Senator Hoeven. But you are also building Weapons
Generation Facilities for the new B-21 at Ellsworth and Dyess,
I think, and somewhere else. So I keep getting told this, we
are going to learn a lot of lessons, but I am quite anxious to
understand when we are going to get going on this facility. So
maybe that is something we could talk about as well.
General Berry. Absolutely, sir. We have a plan for the
Weapons Generation Facilities as they come online based on
mission need for the missions that are going to the various
bases. So we will be happy to come talk to you in more detail
about the Minot Project.
Senator Hoeven. This is the only base in the Nation with a
dual nuclear mission, performing at a high level strategically
important base for ICBMs, and a B-52 deployment that is very,
very high for both the Korean Peninsula and the Middle East.
High ops tempo, these soldiers are doing--these airmen and
women are doing a whale of a job out of that facility, and it
really does deserve the attention.
General Berry. Sir, we agree with you, with the importance
of the mission, and we are committed to replace the weapons
storage area with a WGF.
Senator Hoeven. Thank you. I guess on a positive front, I
would tell you from a funding standpoint, it looks to me like
we are keeping the new GBSD, Ground-Based Strategic Deterrent,
as well as the LRSO on schedule, which has been no small effort
on the part of this appropriating committee. So just any
thoughts you have there, are incredibly important as far as
part of the nuclear triad. We are committed to it. We are
working very hard to do that. And I know our chairman here is
very committed to the nuclear lab piece, since he has part of
that in his state; any thoughts as far as staying on schedule
with those?
General Berry. So the GBSD, I know that we have been very,
very grateful to the Congress for giving us some authorizations
there that will help us do the very, very complicated, when we
are talking about WGFs being complicated, GBSD, where you are
essentially going to replace a silo and wait for 8 years, is
going to be a very complicated endeavor as well.
So we are very grateful to the authorities we have gotten
from Congress. And I think those authorities that we have
received at least set us on the path to realizing the goal of
staying on cost and on budget for the GBSD transition.
Senator Hoeven. Thank you, General. Thank you, not only for
what you do, as in, to all of you here, gathered. Thank you. We
truly appreciate you very much. And thank you for all that you
do for us.
Senator Heinrich. Senator Murkowski?
Senator Murkowski. Thank you, Mr. Chairman. Gentlemen,
thank you for being here this morning, for your leadership. I
want to talk about housing today.
I had an opportunity just this morning to meet the new
incoming, Commander General Eifler. He is going to be taking
over for General Andrysiak, who has been doing a great job for
us in Alaska. And one of the issues that he and I have shared,
just a great deal, quite honestly, of anxiety and stress over
is--as what we have seen in the increasing rate of suicide in
Alaska, particularly within the Army.
Just really very, very disturbing, and as General Andrysiak
has used the term, it is heartbreaking. So we are trying to
address these issues, and you are trying to look to what are
the contributing factors, what is happening out there? Is it
deployments? What is it? And it seems that so much of it comes
back to some of the quality of life issues, and in how we are
able to support our soldiers, our airmen, our marines, how we
are there for them. And housing is kind of a basic thing.
So we want to make sure that we are doing right in all of
these spaces. We are really quite pleased that in Alaska we are
seeing a plus-up in terms of the military personnel that is
coming specifically to Eielson, but also at Fort Wainwright,
this is up in the interior of the state, owing to the F-35 bed-
down, Eielson is expected to receive 54 jets, an additional
1,300 military personnel, plus their families, by December of
2021. By 2023, Eielson will receive four more KC-135s, and more
than 200 active-duty Air Force personnel, plus their families
We are really excited about it. The Alaska delegation
certainly is, but also the communities up north. Those in the
Fairbanks North Star Borough where Eielson is located, have
been enthusiastic in every sense of the word, but they have
also been a little bit concerned about: How do we make sure
that we truly are that golden heart community where we not only
welcome all of our military and their families, but how do we
make sure that they are well cared for?
And so we have a housing issue in the region just more
largely, but on-base housing availability at both Eielson Fort
Wainwright are about 95 percent capacity that is right now. And
to my knowledge, there is no ongoing construction, planned
construction, or funding request for the creation of on-base
housing. And I think it is important to say, this is what
everyone had agreed to.
I am not laying the onus on anybody here, but it was going
to be necessary for the community to know that they were not
going to make that investment on the private side, build
things, and then have Air Force come in, and build housing that
would put the investments on the private side at risk. We have
been down that road before, and the community was not at all
interested in doing that.
So what we are trying to do is make this work for everyone.
Nearly all of these incoming personnel are going to live in the
community. And, and again, right now we have got housing issues
within the community at large, in addition to the number of
units, there has been a recent housing assessment that found
that 36 percent of households are cost-burdened, meaning more
that they--meaning that they spend more than 30 percent of
their income on housing. And this is due to a number of
factors.
It is called climate, it is aging homes, it is more
expensive. So that is a long question. I spent five minutes
outlining this which I shouldn't have, because I need your
input here.
And Mr. Cramer, this is probably for you. But General
Berry, General Evans I would certainly welcome your input on
this. What is happening within DOD, notably, the Air Force and
the Army to partner with the community, to identify, and
implement solutions, to make sure that we are getting airmen
and their families into these homes and at an affordable rate?
So that is a very broad question to you, but know that we are
very, very concerned that the timing on all this matches the
incoming number of personnel.
So Mr. Cramer, it looks like you are ready to go.
Mr. Cramer. Yes, Senator. I will start it off, yes. So
having served in the Army as a deputy assistant secretary for a
number of years, I am very familiar with the housing program in
the North Star Borough, both at Eielson and at Fort Wainwright.
Capacity issue is definitely a challenge, especially in the
larger homes where we see a lot of the military families have
more kids. And so in the two-bedroom, three-bedroom, there is a
good inventory; but four or five bedrooms, there is not.
Senator Murkowski. Right.
Mr. Cramer. And so with the Army, has kept online Birchwood
family housing, even though it was--it far exceeded both in-
leased and the out-leased for that project, so we have kept it
online just because it had the larger homes. And have partnered
with the community to try to, you know, entice development of
housing off-post, because in the Department of Defense, our
priority is still community first, housing, and not on-base
housing.
So to the extent we give assurances to the local
construction housing developers we are willing to do that, so
that they can spur some construction on. And, Senator I am
concerned about the 30 percent--36 percent house burden number
that you cited, because that, if it is military folks, you
know, we can do better in our base allowance for housing
surveys that we do annually to set the rates.
Because what we don't want to do is burden our soldiers and
airmen in having to spend more on a house, because then it
comes directly out of the rest of their household budget, you
know, and we are very concerned about. Because that leads to
what you started this conversation on.
And I will turn it over to General Berry and General Evans.
General Berry. Senator, I think Mr. Cramer hit, hit all the
points that I would have hit. I know that we are tracking the
concern. We are talking to the local leadership there so we can
really understand the details behind it. So then we know how we
can come in and help them, as required. But we are tracking it.
We continue to work with the local community to try and find
some creative solutions.
Senator Murkowski. Know that we appreciate that. We will
look forward to partnering very closely with you as the months,
proceed here. I will share just one, one factor that I picked
up at a roundtable that I did with military spouses a couple of
years ago, when we were talking about based-housing allowance,
and a recognition that Fairbanks, in the area you have many
homes that are not on city water.
So there is an additional fee to have your septic pump.
There is an additional fee for water delivery. And those are
not at least at the time--were not incorporated as part of that
allowance. So things like that, that we can look to,
creatively, I think help with these financial stressors.
Thank you, Mr. Chairman.
Senator Boozman. Thank you. Senator Heinrich is like the
rest of us, we have all got three, three of these going on that
are so important with such really important witnesses like
yourself, talking about some really important topics that are
going on. But I would like to just ask a real quick question,
because I think it is important. A follow-up on Senator
Hagerty, and maybe a couple of the other Service witnesses can
jump in.
The request that we have does not include investments in
Pacific deterrents and issues that we were expecting to see.
While the President's budget includes 5.1 billion in funding to
support the effort, none of it is for MILCON. What is your role
in the PDI funding process? Does the PDI tagged MILCON go
through traditional MILCON decisionmaking processes? Or are we
treating it differently somehow? We will end on an easy
question.
Mr. Cramer. I will, Senator.
Senator Boozman. But it is a very important question.
Mr. Cramer. It is a very important question, and so it goes
back to our earlier discussion about project development of
MILCON projects. And so we have sat through some classified
briefings to understand, you know, where we intend to go with
PDI? And I will just tell you that I think we are still early
to need on developing those projects within a budget year. And
what we don't want to do is get so far ahead of our headlights
that we identify projects in a specific country that we don't
have necessarily an agreement with to do any construction, and
then it languishes for a number of years. We have learned that
lesson in the not so recent past in, in Europe.
So we want to get all those stars aligned, get the project
defined, get the host nation agreements, and then go forward
with those projects, but it is in the works.
Senator Boozman. No, we appreciate that, and that is very
reassuring. Again, thank you all for being here today. We
appreciate you for taking the time to, again, talk about this
very important subject.
Also for the senators participating in today's hearing, I
look forward to working closely with you to address the
Military construction and family housing needs facing us. And I
say that on behalf of the entire committee.
Finally, we will keep the hearing open for a week.
Committee members who would like to submit written questions
for the record should do so by 5:00 p.m., Wednesday, June the
23rd. We appreciate the Department responding to them in a
reasonable period of time.
SUBCOMMITTEE RECESS
Senator Boozman. And with that, we stand adjourned.
[Whereupon, at 11:16 a.m., Wednesday, June 16, the
subcommittee was recessed, to reconvene at a time subject to
the call of the Chair.]
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS FOR FISCAL YEAR 2022
----------
WEDNESDAY, JUNE 23, 2021
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 10:00 a.m. in room SD-138, Dirksen
Senate Office Building, Hon. Martin Heinrich, chairman of the
subcommittee, presiding.
Present: Senators Heinrich, Schatz, Tester, Baldwin,
Boozman, and Hoeven.
DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF HON. DENIS R. MCDONOUGH, SECRETARY OF
VETERANS AFFAIRS
OPENING STATEMENT OF SENATOR MARTIN HEINRICH
Senator Heinrich. This hearing of the Military
Construction, Veterans Affairs, and Related Agencies
Appropriation Subcommittee is now called order.
Today, we are going to be discussing the Department of
Veterans Affairs' fiscal year 2022 Budget and fiscal year 2023
Advanced Appropriations Requests. Veterans deserve more than
just words of gratitude for their sacrifice when they return
home. They deserve the quality care and benefits that they have
earned. This budget strives to do that and requests a mandatory
appropriation of $153 billion, and a discretionary
appropriation of $113 billion. That is an 8.2 percent increase
over fiscal year 2021.
It also requests 156 billion mandatory advanced
appropriation, as well as 111 billion discretionary advanced
appropriation just to support its medical programs in fiscal
year 2023. The cost of medical care continues to grow, and
there are a lot of issues that we want to discuss this morning.
We understand that VA's budget request is a bit complicated
this year. The Department's request reflects the direct and
indirect costs of the pandemic, including addressing the
increases in the disability claims backlog, as well as the
provision of deferred care, and increased mental health
services. Funding provided in the Families First Act, the CARES
Act, and the American Rescue Plan demonstrate congressional
support for veterans during this challenging time, and much of
the funding remains available for use in fiscal year 2022.
In addition, this is the first year VA is allowed to use
flexibility provided by Congress in the Recurring Expenses
Transformational Fund, and VA plans to use $820 million of
expired funds to support information technology and minor
construction projects. While this is a robust request,
especially considering all of the additional funding recently
provided to the Department, VA must have what is necessary to
respond to veteran demand.
VA's requests for fiscal year 2023 shows a decrease in this
program without supplemental funding. I hope that the need has
subsided by then, but VA must plan effectively to avoid service
cliffs relative to demand in these programs.
This budget was developed prior to your undertaking a
strategic review of the Electronic Health Record Modernization
Program. We look forward to receiving more information on the
results of the review, how the findings will affect the
remainder of VA's ten-year plan, and how VHA's infrastructure
costs will be incorporated into the total cost of the effort.
The budget reflects VA's need to invest in physical
infrastructure. As veterans come back to receive care at the
VA, they deserve to be treated in facilities that are up to
date and modernized. This year VA is planning to invest in its
infrastructure through base funding, the Transformational Fund,
and the American Rescue Plan funding.
I look forward to working together to provide veterans with
the services and the benefits that they have earned and
deserve.
And with that, I would recognize the Ranking Member for his
opening statements.
STATEMENT OF SENATOR JOHN BOOZMAN
Senator Boozman. Thank you, Mr. Chairman. And thank you,
Mr. Secretary, for being here to discuss the Veteran's Affairs
fiscal year 2022 and 2023 budget request. The budget request of
$271 billion in fiscal year 2022 for the Department of Veterans
Affairs, including medical care, collections, and the new
Transformation Fund, represents a 10.4 percent increase over
fiscal year 2021 enacted levels.
This includes $118 billion in discretionary funds, a 10.4
billion or 9.7 percent increase over fiscal year 2021. The
budget also requests a total of $272 billion in advanced
appropriations for fiscal year 2023. The large fiscal year 2022
increase highlights the continued importance of programs for
veterans. It also reflects the continued growth and popularity
of the Veterans Community Care Program, which consolidated
multiple community care programs through the MISSION Act.
In fact, in this request the only dollars requested as part
of the second bite to supplement last year's advance
appropriations are for community care. Members of the
subcommittee remain committed to providing VA with the
resources needed to care for our veterans. However, continued
growth of 8, 9 and 10 percent gets really difficult, and
probably is unsustainable.
Mr. Secretary, we need to work together to make certain we
are prioritizing resources where they need to go, and to make
sure Congress does not mandate costly initiatives without
thoroughly considering the associated cost implications. Over
the last year VA received roughly $37 billion in emergency
funding to address COVID.
I have to say that, overall, VA performed admirably
throughout the crisis, and deserves praise and recognition for
that. There is no doubt that most of these funds were
absolutely necessary, and the obligation reports for the CARES
Act funding demonstrates this. I had the opportunity to be in a
number of facilities during that time, and again, the
Department, all of those on the frontlines, and just all of the
different areas really do deserve a big pat on the back.
I hope to hear more about the future needs of the VA,
especially after this large influx of emergency dollars; we
don't want to find ourselves in a situation where CARES and the
American Rescue Plan have reset the baseline for VA spending.
The budget requests $2.6 billion for electronic health
modernization, and many of us on this committee have long
advocated for single, joint medical record that will follow a
service member throughout their careers in the military and
into their time as a veteran. We understand that this strategic
review is nearing completion and we look forward to hearing the
new path forward for the program. In particular, we look
forward to receiving a revised deployment schedule as directed
in last year's Omnibus.
In addition to updates on those programs, we look forward
to hearing details about the Department's request for mental
health services, including efforts to combat opioid use
disorder, and prevent veteran suicide. These initiatives to
prevent veterans' homelessness also are very, very important,
and efforts to improve care for our rural veterans, including
through the greatly expanded telehealth program which, again,
we can be so proud that the VA has been a leader.
We look forward to discussing these and other issues this
morning. And with that, I yield back, Mr. Chairman.
Senator Heinrich. Well, I want to thank our witnesses for
participating today. We have Secretary of Veterans Affairs
Denis McDonough; and Assistant Secretary for Management and
Chief Financial Officer, Jon Rychalski.
Did I get that right, sir?
Mr. Rychalski. That is correct.
Senator Heinrich. Great, fantastic. We are going to start
with questions, and I will recognize myself for five minutes
first and then head to the--I apologize.
With that, we will go to each of you for your opening
statement.
SUMMARY STATEMENT OF HON. DENIS MCDONOUGH
Secretary McDonough. Thank you, Mr. Chairman, very much.
Let me start by just offering my deep condolences to the
family of Senator Warner, who will be laid to rest today, a
Navy and Marine Corps vet of World War II and Korea, Secretary
of the Navy for 30 years, and an outstanding senator. He was a
true patriot, an iconic statesman, who always did what he felt
was right for his constituents and for America. We will,
obviously, all miss him.
Chairman Heinrich, Ranking Member Boozman, Senators Schatz
and Tester, thank you for the opportunity to testify today in
support of the President's fiscal year 2022 and fiscal year
2023 Budget Request, and for your steadfast support for
veterans; I am accompanied today, as the chairman just said, by
our assistant Secretary for Management and Chief Financial
Officer, and proud Montanan, Jon Rychalski. Let me also
acknowledge the Veteran Service Organizations, and our union
partners, all of whom make us a stronger agency.
Some good news: First, we have taken steps to reduce the
backlog log of claims caused by the pandemic. We ramped up
scanning efforts to digitize Federal records for claims
processing, and temporarily assigned VA personnel to the
National Personnel Records Center to pull records for claims
processing. Now most of VA's requests for records are answered
in two to three days. The number of pending VA-related record
requests has dropped by 90 percent to pre-pandemic levels.
Second, VBA rated our one-millionth veteran disability
claim two weeks ago, hitting this important milestone faster
than in all but 1 year in VA history, notwithstanding the
challenge posed by COVID.
Third, VA has now vaccinated 3.4 million people with at
least one dose, including veterans, family members, caregivers,
employees, and members of other Federal agencies.
Last, and most importantly, on May 24th, just a month ago,
there were no, that is to say no COVID-related deaths in any VA
facility for the first time in 448 days, since March 18, 2020.
These positive outcomes are a direct result of two factors:
resources, which you have been critical in providing, and
caring, compassionate people. Let me tell you about one such
outcome. At the height of the pandemic Marine Veteran, Michael
Novielli, developed fatigue, aches, and a fever. He never,
``Felt this sick in his whole life,'' and his diagnosis was
exactly what he feared. Like millions of other Americans, he
had contracted COVID-19.
After four days at Northport VA Medical Center, Michael was
well enough to be discharged, but we placed him on our VA
telehealth program to monitor his symptoms. That decision
likely saved his life. He shared his temperature, oxygen
levels, and heart rate every day for two weeks via telehealth.
Then his VA nurse, Marjorie Rogers, noticed something unusual
in his heart rate. She called him and told him to go to the
emergency room immediately, where he was diagnosed with
pneumonia, admitted--and admitted for another two weeks.
''Marjorie saved my life.'' he said. ``If I wasn't on
telehealth, I would have stayed home with pneumonia.'' And
Michael would be the first to tell you that that would have
been, or could have been disastrous. Now that is the kind of
experience every single veteran deserves at VA. VA people are
the ones who cared for Michael, they are the ones who risked
their lives to serve veterans during the pandemic, and they are
the ones who made zero COVID deaths on May 24th possible.
But VA employees will also tell you that their life-saving
work is not possible without the resources they need; that is
why this budget request is critical. The fiscal year 2022
budget request will ensure VA can provide care and services to
veterans, their families, caregivers, and survivors, and to
other Americans such as the 488 non-veterans treated at VA
facilities as pandemic-related humanitarian missions, including
citizens from Arkansas, Arizona, and Texas, among others.
These resources will be put to good use, empowering our
Department to fulfill President Biden's charter for me to fight
like hell for our vets. The budget ensures we can continue the
growth and success of our Caregiver Support Program by fully
integrating families and caregivers into the care plans of the
veterans they love, continuing to implement MISSION Act
expansion of our Program of Comprehensive Assistance to all
generations of eligible veterans, and supporting the power--the
training of over 1,900 field-based staff.
The budget provides needed funding for women veterans. The
number of women using VA health care has more than tripled
since 2001. And this budget funds recruiting and hiring for
women's health care providers, improving access to reproductive
health services, and emergency services. The budget allows us
to continue our success in reducing veteran's homelessness,
building on the success of the last decade during which we
decreased veteran homelessness by 50 percent. And this budget
allows us to provide strong, sustainable, high quality direct
care to our veterans at a time when they need it most.
Community care, as Senator Boozman said, and direct care
are both important, and care in both contexts is rising
dramatically as the pandemic ebbs, and veterans returned to VA
for care. And while both are growing, care in the community is
rising at a faster rate than direct care. Veterans need deserve
a thriving direct care system for generations to come, because
it provides high quality, evidence-based, integrated care
tailored to their unique needs.
Beyond that, our Nation depends on the research,
innovation, and medical education components of VA direct care.
As well as an effective backstop to our country's health care
system, VA's Fourth Mission has been critically important
during this pandemic, as well as multiple other national
disasters.
That is not all these budget resources will do: they will
fund mental health and suicide prevention initiatives, address
major deficits in construction, physical information technology
infrastructure, continue our electronic health record
modernization, address issues of veterans environmental
exposures, and continue to ensure VA is always a place where
diversity is--diversity, equity, and inclusion are valued and
sought.
In short, this proposed budget allows us to deliver high-
quality whole health care and benefits to our veterans, and it
does so, in large part, by enabling the work of great people,
like those who cared for Michael Novielli. I commit to using
these appropriated resources responsibly and transparently in
close consultation with you, and getting greatest value out of
every dollar.
Mr. Chairman, Ranking Member Boozman, other members of the
committee, I thank you for the opportunity to appear before you
today. And I look forward to your questions.
[The statement follows:]
Prepared Statement of Hon. Denis McDonough
Chairman Heinrich, Senator Boozman, and distinguished Members of
the Subcommittee. Thank you for the opportunity to testify today in
support of the President's Fiscal Year 2022 Budget and Fiscal Year 2023
Advance Appropriations Request for the Department of Veterans Affairs
(VA), and for your longstanding support of Veterans and their families.
I am accompanied by Mr. Jon Rychalski, Assistant Secretary for
Management and Chief Financial Officer.
President Biden defined our country's most sacred obligation as
preparing and equipping the troops we send into harm's way and then
caring for them and their families when they return. It is the honor of
my lifetime to join the dedicated, highly skilled professionals who
constitute the VA workforce-many of them Veterans themselves. VA
employees are committed to serving Veterans, their families, caregivers
and survivors. The President's FY 2022 Budget Request reflects this
commitment. This budget request will ensure VA is moving swiftly and
smartly into the future, with much- needed monetary investments in our
most successful and vital programs. This Budget ensures all Veterans,
including women Veterans, Veterans of color, and LGBTQ+ Veterans,
receive the care and benefits they have earned and prioritizes Veteran
homelessness, suicide prevention outreach and caregiver support.
VA faces critical challenges, many of them made even more complex
by the COVID-19 pandemic. Getting our Veterans through this pandemic
continues to be one of our department's highest priorities. As our
country re-opens after 14 months of closures and necessary restrictions
on some activities, all of us at VA remain focused on the robust
clinical response to COVID-19. Our efforts include expanding COVID-19
vaccinations; ensuring Veterans stay connected to longitudinal care
through telehealth and in person care where necessary; keeping
employees safe; and, planning how to address the pandemic's future
impacts on Veterans and our workforce in the health care, benefits and
cemetery systems. VA has demonstrated resiliency through this crisis by
providing continuous services in line with national policy, and we
continue to update our safety guidelines in accordance with Centers for
Disease Control and Prevention (CDC) guidance. We encourage every
Veteran to be vaccinated as soon as possible. That is why we thank
Congress for providing additional authorities and we have expanded our
efforts to include vaccinations for all Veterans, regardless of whether
they are enrolled or eligible to enroll in VA health care, for
Veterans' spouses, and for Veterans' caregivers, and, most recently,
for some 12- to 17-year-olds, including those serving as Veteran
caregivers and those who qualify as beneficiaries under VA's Civilian
Health and Medical Program.
As of June 11, VA has fully vaccinated more than 3 million
Veterans, family members, caregivers, employees, and federal partners.
We are seeing the positive results of those efforts. I am honored and
delighted to report that VA recorded zero deaths from COVID-19 in our
facilities on May 24 for the first time in more than a year. That is a
critically important indicator of significant progress in fighting this
pandemic. As we prepared for Memorial Day, a time of special
significance for us and our Veteran communities, we followed CDC
guidance and relaxed restrictions at our National Cemeteries which
allowed us to remember our fallen heroes in person again this year.
We are seeking input from VA employees about how we can safely and
confidently bring our teams back to work in a manner consistent with
CDC guidance and data- driven facts. We look forward to our continued
return to normal operations, while recognizing that this pandemic has
had an impact on every aspect of daily life for Veterans, their
families, and all Americans.
fiscal year 2022 budget and 2023 advance appropriations
The President's FY 2022 Budget Request includes $269.9 billion
(with medical collections), a 10.0% increase above 2021. This includes
a discretionary budget request of $117.2 billion (with medical
collections). The request includes $101.5 billion (with collections)
for VA medical care, $8.7 billion or 9.4% above the 2021 enacted level.
The 2022 mandatory funding request totals $152.7 billion, an increase
of $14.9 billion or 10.8% above 2021. This funding is in addition to
the substantial resources provided in the American Rescue Plan Act of
2021.
The 2023 Medical Care Advance Appropriations Request includes a
discretionary funding request of $115.5 billion (with medical care
collections). The 2023 mandatory Advance Appropriations request is
$156.6 billion for Veterans benefits programs (Compensation and
Pensions, Readjustment Benefits, and Veterans Insurance and
Indemnities).
strategic focus
To fulfill our country's most sacred obligation, every decision I
make will be determined by whether it increases Veterans' access to
care and benefits and improves outcomes for them. I will work
tirelessly to rebuild trust and restore VA as the premier agency for
ensuring the well-being of America's Veterans through a persistent
focus on the three core responsibilities of the Department:
1. Providing our Veterans with timely world-class health care;
2. Ensuring our Veterans and their families have timely access to their
benefits; and
3. Honoring our Veterans with their final resting place and lasting
tributes to their service.
Under my leadership, the Department will make it a priority to
implement management reforms to improve accountability and ensure
Veterans receive the care and benefits they have earned. In addition to
the funding for medical care, this Budget includes $3.4 billion for the
General Operating Expenses--Veterans Benefits Administration (VBA)
account, including funds to hire 429 new disability compensation claims
processors, and $394 million for the National Cemetery Administration
(NCA). The Budget fully funds operation of the largest integrated
health care system in the United States, with over 9.2 million enrolled
Veterans, provides disability compensation benefits to nearly 6 million
Veterans and their survivors and administers pension benefits for over
350,000 Veterans and their survivors.
In addition to focusing on these three core responsibilities,
President Biden also tasked me with:
1. Getting our Veterans through this COVID-19 pandemic;
2. Helping our Veterans build civilian lives of opportunity with the
education and jobs worthy of their skills and talents;
3. Ensuring VA welcomes all our Veterans, including women Veterans,
Veterans of color, and LGBTQ+ Veterans; and Diversity, Equity and
Inclusion are woven into the fabric of the Department;
4. Working to eliminate Veteran homelessness and prevent suicide; and
5. Keeping faith with our families and caregivers.
Key Challenges:
As VA addresses the numerous challenges brought on or exacerbated
by the COVID-19 pandemic, we also will need to tackle other
longstanding issues that are essential to the Department's ability to
sustainably and effectively execute its mission, including (1)
establishing the right balance of direct care and purchased care, (2)
delivering timely access to high-quality mental health care, including
substance use disorder care, and preventing Veteran suicide, (3)
increasing support to families and caregivers, (4) increasing support
for the growing number of women Veterans who utilize VA services, (5)
providing a whole of government solution to drive progress to eliminate
Veteran homelessness, (6) improving support for transitioning
servicemembers through improvements to the Transition Assistance
Program (TAP), education and job training programs, and (7) addressing
an aging medical infrastructure.
establishing the right balance of va and community care
Providing Veterans with timely access to high quality health care
is essential. VA remains committed to a strong, thriving direct VA
health care system, augmented by a robust and high-quality community
care network. We will continue to expand access, innovate, and leverage
our research and education missions to push the boundaries of what is
possible in serving our Nation's Veterans. In short, we will lead--
empowering each Veteran with the confidence that their trusted system
will lead with sustained excellence on their behalf and on behalf of
future generations of Veterans. For the Veterans listening today: VA is
here as a welcoming, steady force ready to help you grow your health
and well-being with the excellence you expect from us.
access to mental health and suicide prevention
VA has made suicide prevention a top clinical priority and is
implementing a comprehensive public health approach to reach all
Veterans. The 2022 Budget Request includes $598 million, nearly $287
million above the 2021 enacted level, for existing programs dedicated
to suicide prevention outreach and related activities, including
funding to increase the capacity of the Veterans Crisis Line. Funding
for mental health in total grows to $13.5 billion in 2022, up from
$12.0 billion in 2021. Our commitment to a proactive, Veteran-centered
Whole Health approach is integral to our mental health care efforts and
includes online and telehealth access strategies. Whole Health can help
Veterans reconnect with their mission and purpose in life as part of
our comprehensive approach to reducing risk. Suicide is a complex issue
with no single cause. Maintaining the integrity of VA's mental health
care system is vitally important, but it is not enough. We know some
Veterans may not receive any health care services from VA, which
highlights VA alone cannot end Veteran suicide. This requires a
nationwide effort.
VA developed the National Strategy for Preventing Veteran Suicide
(2018),\1\ which laid the foundation for VA's approach to suicide. This
national vision for preventing Veteran suicide is grounded in three
major tenets in which we firmly believe: (1) suicide is preventable,
(2) suicide requires a public health approach, combining community-
based and clinical approaches and (3) everyone has a role to play in
suicide prevention. While the development of the National Strategy was
groundbreaking in defining the vision of reaching and serving Veterans
within and outside Veterans Health Administration (VHA) clinical care,
VA moved to translate the vision of the 10-year National Strategy into
operational plans of actions in: Suicide Prevention 2.0 (SP 2.0)
combined with the Suicide Prevention Now initiative.
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\1\ Department of Veterans Affairs (2018). National Strategy for
Preventing Veteran Suicide. Washington, DC. Available at https://
www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-
Health-and-Suicide-Prevention-National-Strategy-for-Preventing-
Veterans-Suicide.pdf.
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My promise to Veterans remains the same: (1) to promote, preserve
and restore Veterans' health and well-being, (2) to empower and equip
them to achieve their life goals using a whole health approach and (3)
to provide state-of-the-art clinical treatments. We will continue to
invest and share resources with community organizations in the fight
against Veteran suicide. We understand Veterans possess unique
characteristics and experiences related to their military service that
may increase their risk of suicide. Additionally, Veterans also tend to
possess skills and protective factors, like resilience and a strong
sense of belonging to a group.
supporting caregivers
The 2022 request includes $1.4 billion, an increase of $350 million
above 2021, in funding dedicated to the Caregiver Support Program
(CSP). The CSP empowers caregivers to provide care and support to
Veterans with a wide range of resources through the Program of General
Caregiver Support Services (PGCSS) and the Program of Comprehensive
Assistance for Family Caregivers (PCAFC). As a result of the John S.
McCain III, Daniel Akaka, and Samuel R. Johnson VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act of 2018, or
the VA MISSION Act of 2018, VA began a major expansion of PCAFC.
PCAFC expansion rolls out in two phases. The first phase, which
began on October 1, 2020, expands PCAFC eligibility to include eligible
Veterans who incurred or aggravated a serious injury in the line of
duty on or before May 7, 1975. Effective October 1, 2022, the second
phase will expand PCAFC eligibility to include eligible Veterans who
incurred or aggravated a serious injury in the line of duty between May
7, 1975, and September 11, 2001.
Expansion of this Program was contingent upon the implementation
and certification of the new IT system, Caregiver Record Management
Application (CARMA). CARMA automates manual processes and integrates
with other VA systems, increasing efficiencies and effectiveness, and
allowing for more effective monitoring and management of the program
for caregivers and VA staff.
CARMA supports consistency through systematic calculations of
monthly stipend payments and provides a mechanism for CARMA users to
identify upcoming reassessments of PCAFC participants, among other key
functions. A new digital version of VA FORM 10-10CG allows online PCAFC
applications.
VA also expedited the hiring of key staff with clinical
qualifications and organizational skills to support program needs,
provide a strong infrastructure and standardize application processing
and adjudication, ensuring consistent eligibility decision-making. The
expansion funded by this request will support providing training and
education to over 1,900 field-based staff dedicated to the caregiver
program. CSP has already expanded to approximately 1,800 staff. These
changes will help ensure Veterans and caregivers receive timely,
accurate assessments and eligibility determinations, as well as an
improved customer experience.
improving support for women veterans
As the number of women Veterans enrolling in VA health care
continues to increase, VA must be prepared to meet their needs. Women
make up 16.5% of today's Active Duty military forces and 19% of
National Guard and Reserves. Based on the trend, the expected number of
women Veterans using VA health care will rise rapidly. More women are
choosing VA for their health care than ever before, with women
accounting for over 30% of the increase in Veterans enrolled over the
past 5 years. The number of women Veterans using VA health care
services has more than tripled since 2001, growing from 159,810 to more
than 550,000 today. To support the growing number of women Veterans, VA
will increase total planned obligations from all funding sources for
gender-specific care from $630 million in 2021 to $706 million in 2022,
an increase of $76 million, or 12%.
To address the needs of the growing number of women Veterans who
are eligible for VA health care, VA is strategically enhancing services
and access for women Veterans by hiring women's health personnel
nationally to fill any gaps in capacity to provide gender specific
care--this includes hiring primary care providers, gynecologists,
mental health care providers and care coordinators across all VISNS so
that VA is able to fulfill the mission of caring for those we serve.
Funds also are available for programs such as pelvic floor physical
therapy or lactation support. These efforts will be sustained by the
2022 request, which includes $105 million for the Office of Women's
Health.
Each of the 171 VA medical centers across the United States now has
a full-time Women Veterans Program Manager tasked with advocating for
the health care needs of women Veterans. Mini residencies in women's
health with didactic and practicum components have been implemented to
enhance clinician proficiency. Since 2008, more than 7,600 health care
providers and nurses have been trained in the local and national mini-
residency programs and even more have participated in monthly webinars
and Talent Management System (TMS) trainings, not only developing
women's health experts, but also enhancing competency of all clinicians
across the system.
Under a new collaboration with the Office of Rural Health, we
established a pathway for accelerating access to women's health
training for rural primary care providers. VHA actively recruits
providers with experience in women's health care to join its care team.
VHA has launched numerous initiatives to improve access to state-of-
the- art reproductive health services, mental health services and
emergency services for women Veterans, as well as focusing on enhancing
care coordination through technological innovations such as registries
and mobile applications.
To provide the highest quality of care to women Veterans, VA offers
women Veterans trained and experienced designated Women's Health
Primary Care Providers (WH-PCP). National VA satisfaction and quality
data indicate women who are assigned to WH-PCPs have higher
satisfaction and higher quality of gender specific care than those
assigned to other providers. Importantly, we also find women assigned
to WH- PCPs are twice as likely to choose to stay in VA health care
over time. Designated WH- PCPs are available across all VA Health Care
Systems, and VA is actively recruiting additional new providers with
even more enhanced proficiency in women's health care. VA provides full
services to meet specific needs of women Veterans, such as gynecology,
maternity care, infertility services, reproductive mental health
services and military sexual trauma assistance.
eliminating veteran homelessness
VA remains committed to ending Veteran homelessness. The 2022
Budget Request includes $2.2 billion for Veteran homelessness programs,
an increase of 8.4% over the 2021 enacted level (base funding only). In
addition, VA will obligate $486 million in ARP funding in 2022, for a
total of $2.6 billion dedicated to reducing Veteran homelessness in
2022. The goal is to ensure every Veteran has permanent, sustainable
housing with access to high-quality health care and other supportive
services to prevent Veteran homelessness. VA has partnered closely with
other Federal agencies and with State and local programs across the
country to:
--Identify all Veterans experiencing homelessness;
--Provide shelter immediately to any Veteran experiencing unsheltered
homelessness;
--Provide service-intensive transitional housing to Veterans who
prefer and choose such a program;
--Move Veterans swiftly into permanent housing; and
--Have resources, plans, partnerships and system capacity in place
should any Veteran become homeless or be at risk of
homelessness.
VA has made significant progress to prevent and end Veteran
homelessness. The number of Veterans experiencing homelessness in the
United States has declined by nearly half since 2010. On any given
night in January 2020, an estimated 37,252 Veterans were experiencing
homelessness. Since 2010, over 850,000 Veterans and their family
members have been permanently housed or prevented from becoming
homeless. Efforts to end Veteran homelessness have resulted in an
expansion of services available to permanently house homeless Veterans
and the implementation of new programs aimed at prevention, including
low-threshold care/engagement strategies and monitoring homeless
outcomes. VA offers a wide array of interventions designed to find
Veterans experiencing homelessness, engage them in services, find
pathways to permanent housing and prevent homelessness from
reoccurring.
economic opportunity
As an overall group, Veterans fare better economically than the
average American. However, Veterans and their spouses still face
economic challenges. Helping Veterans build civilian lives of
opportunity with the education and jobs worthy of their skills and
talents is a critical priority. The budget request supports this
commitment by making key investments in VBA, including an increase of
$81.5 million to support the Digital GI Bill Modernization effort, as
well as an increase of $5 million for the Veterans' Clean Energy Job
Training program in conjunction with the Department of Labor, and $3.6
million for the VA Disability Employment Pilot Project to assist
Veterans with service-connected disabilities seeking employment
opportunities.
VA military-to-civilian transition programs are designed to give
transitioning Service members the best possible start to their post-
military lives. The VA Benefits and Services course, as part of the
interagency Transition Assistance Program (TAP), helps Service members
and their spouses understand how to access the VA benefits and services
they have earned. VA TAP provides resources and tools Service members
need to achieve emotional and physical health, attain economic
stability in civilian life and become career ready. Although TAP has
evolved significantly over the years, we continue to assess its
effectiveness and evolve where appropriate to promote meaningful and
economically enriching lives for Veterans and their families.
addressing an aging infrastructure
The 2022 request includes $2.2 billion, a 26.8% increase over 2021,
for Major and Minor Construction. The Major Construction request
includes funding for 12 medical facility and two cemetery expansion
projects. Additionally, the President requests $18 billion in mandatory
funding in the American Jobs Plan (AJP) to modernize VA health care
facilities with $3 billion to address immediate infrastructure needs
within VA health care facilities and the remaining $15 billion to fully
modernize or replace outdated medical centers with state-of-the-art
facilities. We look forward to working with Congress to achieve our
shared goal of addressing VA's aging infrastructure.
VA operates the largest integrated health care, member benefits and
cemetery system in the Nation, with more than 1,700 hospitals, clinics
and other health care facilities; a variety of benefits and service
locations; and national cemeteries. The VA infrastructure portfolio
consists of approximately 184 million owned and leased square feet-one
of the largest in the Federal Government. The median age of U.S.
private sector hospitals is 11 years; however, the median age of VA's
portfolio is 58 years, with 69% of VA hospitals over the age of 50.
With aging infrastructure comes operational disruption, risk and cost.
VA estimates that between $49 and $59 billion in short- and medium-term
investments will be needed to maintain our infrastructure using our
annual Strategic Capital Investment Planning process. However, any
effort to fully address the aging infrastructure portfolio needs would
likely far exceed those estimates and occur over a significant
timeline.
VA's market assessments have been on-going for nearly two years,
allowing VA to gain significant insights into trends and needs in the
VA health care delivery system--with enhancing Veteran access and
outcomes at the core. The VA MISSION Act requires VA to continue
construction, leasing, budgeting, and long-range capital planning
activities while the market assessment and Asset and Infrastructure
Review (AIR) Commission activities are occurring. The additional AJP
investment would enable planning to start sooner to address facilities
we know are not conducive to future health care delivery, while still
being informed by outcomes of the AIR process.
Health care innovation is occurring at an exponential pace and the
comparative age between VA facilities and private sector facilities is
informed by these trends. The architects who designed and constructed
many VA facilities in the decades following World War II could not have
anticipated the requirements of today's medical technology and the key
role infrastructure-and technological infrastructure-now plays in
delivering safe and high-quality health care. As a result, many of VA's
facilities were not designed with these technology and infrastructure
requirements, which limits our agility and ability to meet the evolving
health care needs of Veterans.
The experience of responding to the COVID-19 pandemic brought
critical lessons. Uncertainty regarding the timing and location of the
next surge or surges in cases across the country underscored the
importance of portable capabilities (e.g., 24- bed Intensive Care Unit
that can be transported) for VA health care's Fourth Mission role in
future public health emergencies.
Transforming VA health care to achieve a safer, sustainable,
greener, person- centered national health care model requires VA to
leverage innovations in medical technology and clinical procedures. As
technology-enabled trends in U.S. medicine bring health care closer to
individuals and communities, there is less demand for prodigious,
sprawling campuses and more demand for emphasis on ambulatory
facilities and virtual care. Many surgical, medical and diagnostic
procedures that once required a hospital stay now are performed safely
in the outpatient setting, and telehealth and tele-service delivery
bring expertise to a patient's own home.
This evolving landscape requires VA to rebalance and recapitalize
its infrastructure to optimize the mix of traditional inpatient
hospitals with outpatient hospitals, multi-specialty Community Based
Outpatient Clinics, single specialty Community Based Outpatient Clinics
and virtual care.
leveraging technology to support service and medical care delivery
VA is undergoing one of the most comprehensive information
technology (IT) infrastructure modernizations in the Federal
government, which will support seamless transition of health care
information throughout an individual's journey from military service to
Veteran status. The 2022 Budget Request includes $4.8 billion in
appropriations for the Office of Information and Technology to pilot
application transformation efforts, support cloud modernization,
deliver efficient IT services and enhance customer service experience.
Our three main transformative projects are the implementation of the
Electronic Health Record Modernization (EHRM); the replacement of VA's
multiple, aging systems to manage its inventory and assets with the
enterprise-wide inventory management system used by the Department of
Defense (DoD)-the Defense Medical Logistics Standard Support (DMLSS);
and the adoption of a new financial and acquisition management system-
our Financial Management Business Transformation (FMBT).
ehrm
In October 2020, VA deployed a new electronic health record (EHR)
system at the Mann-Grandstaff VA Medical Center in Spokane, Washington.
This effort is one of the most complex and transformational enterprise-
wide endeavors in the Department's history. The Budget includes $2.7
billion in FY 2022, which maintains a significant level of investment
in FY 2022 and in future years and ensures necessary infrastructure
upgrades are in place. This EHRM appropriation is in addition to the
request for the central IT appropriation. The vision for the new EHR
system is to empower Veterans, Service members and care teams with
longitudinal health care information to enable the achievement of
health and life goals from Service in the military to Veteran status.
The new EHR system also presents the opportunity to achieve
unprecedented interoperability with the DoD and functions as a catalyst
for advancing VA's leadership of health care in the United States.
In my first weeks in VA, I directed a 12-week strategic review of
the EHRM program, which consists of a full assessment of ongoing
activities in order to ensure the success of future EHR deployments.
Based on opportunities identified at the first ``go- live'' site in
Mann-Grandstaff, the strategic review is focused on ensuring patient
safety, identifying areas for additional productivity and clinical
workflow optimization, change management and team-based training; and
driving enhanced rigor into VA's management of cost, schedule, and
performance. Additionally, we are conducting a human-centered design
initiative to optimize the patient portal experience. We intend not
only to get this right but to drive the industry forward alongside DoD.
Furthermore, establishing strong, effective management of the EHRM
program sets the tone for our other key efforts: modernizing supply
chain management and enhancing financial and business transactions.
va logistics redesign (valor)
VA's response to COVID-19 highlighted the shortcomings of the
software and business practices supporting VA procurement, logistics
and infrastructure operations, including a 50-year-old inventory
system, separate procurement system and multiple stand-alone systems to
manage property accountability, distribution and transportation. VA
also uses multiple, stand-alone systems for health care technology and
facility management, which limit enterprise visibility of assets and
their respective readiness conditions. VA is requesting $299 million in
FY 2022, an increase of $103 million (53%) from FY 2021, to continue
its efforts in replacing these systems.
VHA is adopting DoD's proven software platform implementing the
Defense Medical Logistics Standard Support (DMLSS) information
technology system to modernize and standardize our supply chain,
property, health care technology and facility management business
lines. This improvement will allow us to manage the VHA supply chain
and support functions and operate like other integrated medical
systems. In doing so, we will ensure clinicians have the supplies and
equipment where and when needed to provide safe and high-quality care
to our Veterans. VA completed the first DMLSS deployment at the James
A. Lovell Federal Health Care Center in Chicago, Illinois, on September
21, 2020, and is continuing deployment on an accelerated schedule. We
are grateful for the ARP funds that will help facilitate the continued
modernization of VA's badly antiquated supply chain system.
By implementing DMLSS and standardizing our business practices,
leaders at every level will be able to leverage new capabilities and
capitalize on enterprise data to drive insights into operations and
enable evidence-based decision-making. This implementation, too, offers
significant opportunity for cost avoidance.
financial management business transformation
In support of VA fiscal stewardship, the Financial Management
Business Transformation (FMBT) program is increasing the transparency,
accuracy, timeliness and reliability of financial and acquisition
activities across the Department. The 2022 Budget includes $357 million
for FMBT, a program that is improving fiscal accountability to
taxpayers and enhancing mission outcomes for those who serve Veterans.
Our recent roll-out of the new Integrated Financial and Acquisition
Management System (iFAMS) at NCA and VBA has not been without
challenges and has exposed the incredible complexities inherent in a
financial and acquisition system implementation of this magnitude. We
are learning from these early deployments and adjusting our strategy
accordingly. Nonetheless, these implementations bring us one step
closer to providing a modern, standardized and secure integrated
solution that enables VA to meet its objectives and fully comply with
financial management and acquisition legislation and directives. The
next system rollout is Enterprise Acquisition for NCA, which is
scheduled for April 2022. System rollouts will then continue across the
remaining Administrations and Staff Offices until enterprise-wide
implementation is complete.
an evolving landscape will influence how va cares for veterans
As VA addresses challenges and longstanding issues, several long-
term demographic and fiscal trends will shape VA's ability to serve
Veterans in the future. Although the U.S. Veteran population is aging
and shrinking and simultaneously becoming more diverse, demand for VA
services continues to increase. As the Veteran population continues to
evolve, it also continues to use VA more-most likely the result of
nearly 20 years of sustained conflict, longer average terms of service
for military personnel and rising health care and educational costs
that will incentivize more Veterans to use the VA benefits they have
earned. U.S. health care is changing, too, from a hospital-centric
model of care to dispersed (and even virtual) care that can be
delivered through networks of direct and purchased-care providers.
congressional support
Over the past several years, Congress has generously supported VA's
budget requests, which have enabled the Department to address new and
growing challenges. More recently, Congress passed the ARP, which will,
among other things:
1. Help ensure health care access for the 9.2 million enrolled
Veterans who may have delayed care or have more complex health care
needs because of the COVID-19 pandemic;
2. Forgive Veteran health care copayments and other cost shares and
reimburse copays and other cost shares for care and prescriptions from
April 6, 2020 through September 30, 2021;
3. Fund construction grants and payments to State Veterans Homes to
greatly improve the living conditions of our most vulnerable Veterans;
4. Provide up to 12 months of training and employment assistance
for unemployed Veterans to enter high demand occupations; and
5. Help reduce the backlog of disability compensation and pension
claims, which has grown from 73,000 in March 2020 to 188,000 in May
2021.
The Department is grateful for the ARP, which not only will enhance
VA's ability to deliver world class services to Veterans and their
families, but also will ease thousands of Veterans' worries by
forgiving some debt, speed up VA disability compensation claims
adjudication and provide much needed funding to retrain Veterans in
high-demand occupations. We will work diligently to ensure these funds
are effectively and efficiently used.
new statutory authorities
Over the past 3 years, Congress has passed into law numerous, far-
reaching pieces of legislation, including the John S. McCain III,
Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems
and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION
Act of 2018), the Commander John Scott Hannon Veterans Mental Health
Care Improvement Act of 2019, the Veterans Comprehensive Prevention,
Access to Care, and Treatment Act of 2020 (Veterans COMPACT Act of
2020), the Johnny Isakson and David P. Roe, M.D. Veterans Health Care
and Benefits Improvement Act of 2020 and the National Defense
Authorization Act (NDAA) for Fiscal Year 2021.
The 2022 Budget Request includes over $500 million within VA's
Medical Care accounts to begin implementing new and recently expanded
health care programs for Veterans, including a new grant program for
suicide prevention outreach, increased eligibility for emergency
suicide prevention treatment, new investments in women's health
programs, expansion of homeless programs, and military sexual trauma
services. The funding also will further support the Department's
efforts to address substance use disorders.
environmental exposures
For some medical conditions that develop after military service,
the information needed to connect these conditions to military service
may be incomplete. Information may be needed about specific in-service
exposures or there may be incomplete scientific or medical evidence as
to whether an exposure causes a particular condition. These issues loom
large for all Veterans, represented currently by post-9/11 Veterans,
whose exposures to airborne and other environmental hazards may result
in unknown long-term health impacts. I am committed to a full review of
how VA provides health care and benefits to Veterans exposed to
environmental hazards to be responsive to the Veterans we serve. I
believe it is possible to strike a balance between the needs of
Veterans and the need for an evidentiary scientific basis for action.
In 2019, Congress passed legislation expanding benefits to tens of
thousands of Blue Water Navy (BWN) Vietnam Veterans. As of May 1, 2021,
VA has completed more than 54,000 BWN claims and paid out nearly 900
million in retroactive benefits. More recently, VA added three new
diseases to the Agent Orange presumptive conditions list in the FY 2021
NDAA. VA will begin implementing these provisions so that Vietnam
Veterans will no longer wait for these earned benefits. As the
Department harnesses its resources to execute these new requirements
and ensure Veterans receive the benefits they have earned, I have also
recommended initiation of rulemaking to establish a presumption of
service connection for respiratory conditions related to exposure to
particulate matter and other airborne hazards, which may conclude such
conditions as asthma, rhinitis, and sinusitis for Gulf War Veterans.
This decision was based on the first iteration of a newly formed
internal VA process to review scientific evidence relating to
exposures. VA will conduct broad outreach efforts to reach impacted
Veterans and encourages them to participate in the rulemaking process.
research
The Budget includes $882 million, the largest year-over-year
increase in recent history, for medical and prosthetic research. This
historic investment will advance the Department's understanding of the
impact of traumatic brain injury (TBI) and toxic exposure on long-term
health outcomes while continuing to prioritize research focused on the
needs of Veterans to include Mental Health and Suicide, Rare Cancers
and Prosthetics as well as other disease areas.
Increased TBI investment will enhance cutting-edge diagnostics and
treatments such as investigating the role genomics plays in resilience
and recovery from blast exposure, validating blast models, and studying
the link between TBI and suicide. Further investment in environmental
exposure includes the VA Military Exposures Research Program (MERP),
capacity building with Federal partners, and expanding the workforce in
military exposures research and training.
VA will also invest additional resources, including from the
American Rescue Plan, to advance the Department's understanding of
coronavirus related research and impacts. To remain on the cutting edge
of technology, VA will focus on software-as-a- service, cloud
computing, and data security, and will continue to partner with the
Department of Energy (DOE) to capitalize on DOE's computing power and
technical expertise to put Veteran data to work.
diversity, equity and inclusion
Diversity, equity, and inclusiveness are standards fundamental to
everything we do. We will welcome all Veterans, including women
Veterans, Veterans of color, and LGBTQ+ Veterans. Every person entering
a VA facility must feel safe, free of harassment and discrimination,
and we will never accept discrimination, harassment or assault at any
VA facility. We will provide a safe, inclusive environment for Veterans
and VA employees.
Diversity is a strength, never a weakness, among Veterans, VA
employees and all of America. Leveraging diversity, equity and
inclusiveness will produce the excellence in all our interactions with
Veterans. I recently instructed my team to establish a 120-day task
force on diversity, equity and inclusion. The task force's goal is to
offer concrete, actionable recommendations while building solidarity
across the VA system on diversity, equity and inclusion. To support the
Department's commitment to strengthening VA's diversity program and
preventing and resolving discrimination at the early stages, the Office
of Human Resources and Administration created the new Office of
Resolution Management, Diversity, and Inclusion (ORMDI) by
consolidating the Office of Diversity and Inclusion and with the Office
of Resolution Management. The budget for this combined office will
increase by $12.9 million and 74 FTE. These resources will also provide
a robust harassment prevention program and counseling services while
advancing equity for all who have been historically underserved.
The Budget Request also furthers the commitment of the VHA Office
of Health Equity to help eliminate health disparities based on race,
gender, age, religion, socio- economic status or disability by
improving health outcomes for underserved Veteran populations.
empowering leaders to implement positive change
I am mindful VA's capabilities have not always risen to the needs
of our Veterans. Consistent throughout many of these past shortcomings
has been a theme of leadership inconsistency and cultural challenges.
To rebuild trust and restore VA as the premier agency for ensuring the
well-being of America's Veterans, I am focusing on building a diverse
team of professional, experienced leaders who bring a great breadth and
depth of knowledge in government and Veterans issues. To that end, we
recently stood up a commission to identify candidates to lead and
manage VHA.
At the same time, I also am working to retain the talented and
hard-working leaders we currently have by empowering them to make
decisions in a structure that allows them to do what's right for
Veterans. As an initial step in support of that effort, I recently
signed a memo for VA employees emphasizing my intent to lead with VA's
ICARE Core Values-Integrity, Commitment, Advocacy, Respect and
Excellence--and have been seeking opportunities to engage with leaders
across the system to drive this point home. VA's success as a team-our
ability to deliver world-class care for our Veterans-also depends on
how employees treat one another and Veterans. Our respect for our
fellow VA employees and the Veterans we serve is critical to everything
we do.
Essential to ensuring a healthy and accountable culture at VA is
the Office of Inspector General's oversight. The 2022 Budget includes
the OIG's request of $239 million for 1,100 FTE to support its programs
and operations through independent audits, inspections, reviews, and
investigations. The OIG's efforts have a significant impact on the
services and benefits provided to Veterans. This funding level is
prudent to safeguard the significant investments in VA and to help
improve services and benefits for Veterans and their families.
I take full responsibility to ensure VA employees have everything
they need to carry out the important work before us and we operate in a
culture that celebrates and draws strength from our country's great
diversity. To ensure a welcoming environment for Veterans, we must
foster fair and inclusive VA workplaces where the experiences and
perspectives of our diverse employees are valued. The success of our
mission depends on everyone being able to contribute their expertise,
experience, talents, ideas and perspectives. I commit to advancing
equity in VA and providing all employees with opportunities to reach
their full potential. I commit to these principles and will make sure
my senior leadership team reflects and embeds them in everything we do.
At this moment when our country must come together, caring for our
country's Veterans and their families is a mission that can unite us
all, and I look forward to working with this Committee, Congress as a
whole and our many other partners to embrace our collective
responsibility to serve Veterans.
Mr. Chairman, Ranking Member Boozman, I look forward to working
with you and this Committee. Thank you for the opportunity to appear
before you today to discuss my priorities for the Department and how
the President's FY 2022 and FY 2023 Advance Appropriations Request will
serve our Nation's Veterans.
Senator Heinrich. Well, I want to thank you both. And, the
fiscal year 2022 request and the fiscal year 2023 advanced
appropriations request, Mr. Secretary, are record levels coming
on top of a record fiscal year 2021 appropriation, and
significant supplemental funding. The pandemic provided unique
challenges to projecting where veterans will demand those
services.
For instance, through transfers, and the second bite, VA is
significantly increasing resources to meet community care
demand in fiscal year 2022, yet, this budget assumes a decrease
in demand in fiscal year 2023. So, what is VA's vision for the
right balance between in-house and community care going into
the future; and is the medical community care request in 2023
the right number?
Secretary McDonough. Thank you very much. Thank you very
much, chairman. We have been talking with all of you and with
your teams, as well as within the agency about the right
balance. We are driven first and foremost by the requirement in
statute that we make decisions based on best outcome for
veterans. That is also the commitment I have made to the Senate
in the context of my confirmation, which is, every decision I
make will be based on increasing access and improving outcomes
for veterans.
So first and foremost, we will make a determination based
on what is medically best for our veterans. Second, I happen to
believe, and I think the data shows, that veterans in our care
do better than veterans not in our care. So, I think it is very
important that we maintain a sustainably funded, whole health
care system in VA, with the full range of specialties that our
vets have demanded over time, and with care provided by
providers who have particular understanding of the challenges
facing vets.
The fact is, however, that--and particularly in highly
rural areas--our vets will continue to be dependent on the
community as well. And this is something I have talked at
length with many members of this body about, and traveled to
see the impacts of our partnership with the community.
And so, we will be working over the course of this year and
next, as we manage this bow wave of care, our next year's
appropriation, advanced appropriation request, recognizes that
the expansion of provision of care is not as I think Senator
Boozman fears it may be, or asked for clarity, that it not be a
resetting of the baseline. But it is rather an ability to
manage this bow wave of care now, and then over time as we get
to post-pandemic, we will be in a position to right-size that
care in the system and find where we need to augment that care
in the community.
Senator Heinrich. Mr. Secretary, I know the AIR Commission
work is ongoing, but one of the concerns I have is that, to do
a market assessment during a pandemic raises a lot of questions
about the data that will go into those final decisions. We had
enormous market distortions. We saw that in impacts to your
budget, we saw it in the private sector. Will you provide that
data to the committee, but also, do you have concerns about the
quality of that data?
Secretary McDonough. So, our teams have been looking at
these market assessments now going back a couple of years. I
have not dug into that data aggressively myself. I do have a
belief. I do believe that it makes sense for us to relook that
data in light of the pandemic, also in light of the fact that
the U.S. Government has just gone through the decennial Census,
for example. So, there may be data there, too, for us to
prosecute as we do these market assessments.
So, we will be augmenting the review that we have had to
date. We are also committed, I have made this commitment in
other public hearings, and I reiterate it here, to provide you
that information for you to make your own decisions about this.
I think it is only right that we make decisions like this with
such import for the national interest in the light of public
day--in public light. And that is what we intend to do. So, I
would be more than happy to make sure that we get the committee
information.
Senator Heinrich. Great. I look forward to taking a look at
that, and I have concerns given what a unique year it is to
make very long-term impactful decisions based on data, in what
may be a year that is a complete anomaly. With that, we will go
to the Ranking Member for his questions.
Senator Boozman. Thank you, Mr. Chairman. The CARES Act and
the American Rescue Plan provided VA with $37 billion to
respond to the pandemic. One of the conditions in the CARES Act
was that any personnel hired using this money can only be
temporary employees, so as to avoid building a ``budget tail''
in years to come. And you discussed a little bit about this in
your previous question, but I want to follow up. The fiscal
year 2023 medical care advance appropriations requests $111.3
billion is an increase of $13.8 billion over fiscal year 2022
revised request.
So, I guess the question is, what is driving the 14 percent
increase? Is the budget proposing to make the temporary hires
permanent? Has the sudden influx of COVID-related funding reset
the VA baseline significantly higher than it was before the
pandemic?
Secretary McDonough. Yeah, we don't--I will ask Jon to pile
in with some additional specifics on this, Senator Boozman, but
we don't seek to reset the baseline. We are seeking to manage
both a strong pandemic response, which the CARES Act allows us
to do, and then ARP really allows us to sustain that response,
which is going to need to be sustained through this year,
because of this bow wave of care, and supports recovery.
But really what is happening, as we see care for our
veterans, is a series of fairly substantial, big-moving pieces
that include the fact that vets are living longer, that the
pandemic has increased the complexity of care that our vets are
facing. By the way, I think we have a better handle on that
than anybody. We are doing--if you look in--you can't open a
newspaper any morning now without seeing a story about VA-based
research on Long COVID, and to be honest with you, no other
system is doing that. We are doing that, thanks to your
support.
We have a particularly soft economy right now, and
historically what we know in soft economies is that vets who
were reliant on employer-provided care, until now, are relying
on their care for us. Lastly, all those things contribute to a
trend line towards complexity of care for our vets. That means
that any incident of care is more complex and therefore more
costly.
That is coming at a time when, for example, the MISSION Act
has increased what we call ``reliance on us.'' So, more vets
are getting more services from us, as a result of some of the
authorities in the MISSION Act, so what you see in that budget
is our best assessment based on our model, and a model that has
proven pretty decent over time, at what we anticipate in terms
of complexity of care, and reliance on us for our services from
our vets.
Anything you want to add, Jon? Did I miss anything?
Mr. Rychalski. Yeah, just one thing. I think when you look
at our budget, there is a request--an increase in the requests,
but when you compare how much we plan to spend in 2022, which
includes ARP funding, and then you compare what we plan to
spend in 2023, our budget actually goes down by about $4
billion. And I think from a strategic standpoint, what you see
is us hiring up, and then those FTEs staying on, but we are
putting most of our requests in 2023 in the direct care system,
and as the Secretary mentioned, we are betting that is going to
be where people are going to want to get their care.
And that this dramatic increase in community care is going
to level off a bit. And you also see, going back to what I
said, the $4 billion--sort of comes down about $4 billion in
2023, because we think that the community care will level off,
you know, that the demand for services in the direct care
system will rise. But net-net, we actually have a lower planned
expenditure in 2023 than 2022, because we don't have the same
supplemental funding.
Senator Boozman. So, what do you all feel, like is driving
the increased demand for community care now? Because when you
look at your modeling, and you look at the numbers that you are
requesting, certainly, you know, there is a bunch of community
care dollars now, but not in the future. And again, don't
misunderstand, myself, the entire committee is committed to in-
house specialists, you know, the quality of care, you know,
again, as good as anybody. And I think we can be very proud
that the VA has achieved that. On the other hand, I think what
we don't want are a bunch of surprises, going down the line,
which we have really seen in the last year or two.
Secretary McDonough. Look, I couldn't agree more Senator.
And I would start on your last point, which is, I don't
misunderstand you, and we couldn't misunderstand you because
you have been regularly supportive of all of our efforts. So we
are very grateful for that.
I think that what is driving community care at the moment
is that, by necessity, I think many providers in the community,
open to full services sooner than many of our providers did. So
that is one of the things that is driving this. The other is
that we are experiencing now what we have been talking about
for some months, which is that as the pandemic ebbs more of our
vets are coming back to address care that they forewent during
the pandemic. And that is also happening at a time when not all
of our facilities are fully open. And so, we do think that what
is driving the care in the community are the particulars of the
pandemic, and less a stated desire of our veterans to get into
the community.
That said, partly to inform our going-forward process. We
are in the field right now through our Veterans Experience
Office, talking to veterans about what their experience in care
during the pandemic was, and what that says about what they
expect going forward.
Senator Boozman. Good, very good. Thank you, Mr. Chairman.
Senator Heinrich. Senator Schatz.
Senator Schatz. Thank you, chairman; vice chairman.
Secretary, Assistant Secretary, thank you for being here.
Thank you for your service. I want to talk first about
telehealth.
Secretary McDonough. Yes.
Senator Schatz. Obviously VA has made tremendous strides in
telehealth as has the private sector, Medicare, Medicaid, DOD,
it is happening everywhere. The specific question I have to
start is: To what extent are any of the expansions of
telehealth services, dependent on or precipitated by the
pandemic, and likely to snap back to the Stone Ages when the
pandemic is over? Or are there plans in place to not only
institutionalize all these expansions of services, but to
expand them?
Secretary McDonough. Yes. So bottom line is that we have--
let me just give you some numbers around the expansion,
basically, we estimated at about an 1,800 percent increase in
video visits from VA to home, going from about 10,500 visits in
the first week of March 2020, to 220,000, or almost 230,000
visits at the end of February of this year. So, the numbers are
a dramatic expansion.
Another way to look at it is, halfway through this year,
nearly two million vets--this fiscal year--have had one or more
episodes of video care through our vets' Video Connect Program.
So that tells us that there is massive demand. We are
institutionalizing that as you say, we want to maintain it
because it is ease of access for vets who don't need to be seen
in person. We see a large degree of satisfaction from our vets.
In full candor, our clinicians sometimes are less excited about
it than our vets, but we are working that.
Senator Schatz. That is kind of what I am trying to get at,
is to what extent are any of these, at least currently
temporary changes in clinical standards, or standards of care
that need to be made permanent lest we go back to where
something is more comfortable for either VA docs, or
supervisors, or fiscal people.
Secretary McDonough. Yeah.
Senator Schatz. Do we need to institutionalize some of
these. Like, are there specific places we need to burrow into
the bureaucracy, or into the statutory law to make sure these
things stick?
Secretary McDonough. We are looking at exactly those
questions. I think overwhelmingly there is going to continue to
need to be things that are done in person, and we are looking--
we are developing those lists of what those are, working with
VHA. But I think as a system, we recognize the huge efficiency
gains and huge satisfaction gains, which come from the fact
that vets are spending less time traveling to our facilities,
while getting good care.
And so, we have a bias toward institutionalizing, but we
are going to let the data drive that too. So we will be more
than happy to stay in close touch with you on that.
Senator Schatz. Okay. I think I will send a QFR on this.
Secretary McDonough. Good.
Senator Schatz. So that we can get a little bit deeper
fidelity on----
Secretary McDonough. Fair enough.
Senator Schatz [continuing].--what changes you need to make
and how we can be supportive of it, because I have just seen in
Private Pay and Medicare, you know, there is going to be a
tendency to want to snap back to pre-pandemic time. And, I just
think there is going to be a patient revolt if--you know, 10
years ago if you told someone to interact with their clinician
via their iPhone, it would be an insult. And now if you can't
do that, it is an insult.
And so, I just think we are underestimating the extent to
which people are going to freak out in 18 months, if something
that was fantastic and available is suddenly not. And we want
to help you to make sure it is all permanent.
Secretary McDonough. I agree with that. And I don't want to
waste any more of your time, but I just make this point, which
is, we have such demand for mental health care, like everybody
else in our health care system, writ large, at such a position
of competing for providers, we get not insignificant marginal
gain of access through using video platforms, that it would be
foolhardy to walk away from that.
Senator Schatz. And there is at least anecdotal evidence
among veterans that accessing mental health services via
telemedicine can sort of overcome or circumvent the stigma.
Secretary McDonough. No doubt.
Senator Schatz. And so, it is all to the good, we just want
to help you to make it permanent. Final question, when we spoke
in January I mentioned the veterans on Hawaii Island are still
waiting for VA to break ground on the new outpatient clinic in
Hilo, Hawaii.
Secretary McDonough. Yes.
Senator Schatz. Can you please give me an update?
Secretary McDonough. Yes, so we have an interim lease, fix
in place, the permanent lease is taking far too long, both in
Hilo, but across the board. So, we are looking at that
systematically. The interim lease is in place, and I think we
are in a position now to execute against that interim lease as
we try to push on the permanent lease, which is now about 9
months delayed. So, we are staying on top of it.
Senator Schatz. Thank you.
Senator Heinrich. Senator Hoeven
Senator Hoeven. Thank you, Mr. Chairman.
Secretary McDonough, it is good to see you again.
Secretary McDonough. Nice to see you.
Senator Hoeven. For all that work you did as chief of
staff, and good to see you in your new role, congratulations on
that.
Secretary McDonough. Thank you.
Senator Hoeven. Appreciate the opportunity to work with you
again. Thanks for being here today, to both of you. One of the
things that I have been working on for a long time is--and we
have included language in a number of the bills, we passed the
VA MISSION Act, and a number of the other veterans' bills that
we passed.
If a nursing home takes Medicaid or Medicare reimbursement,
they have a set of standards and inspections that they have to
meet. But if they take VA reimbursement, then they have
additional standards they have to meet. So, they ended up with
multiple inspections and additional regulations. As a result,
only about 20 percent of the nursing homes in the country take
VA reimbursement for long-term care.
That makes a huge difference to our veterans because
qualifying veterans can actually draw on the VA benefit without
having to expand all our assets, unlike Medicaid, for example,
where they would have to first dissipate their assets down to,
you know, standard testing, varies a little bit by state. So,
for qualifying veterans, this is a big deal.
Now, about 20 percent of the nursing homes do take VA
care--or VA reimbursement, but a lot don't for that reason. And
so, we are trying to work with you, and with Labor, and with
HHS to get these veteran care agreements simplified so that,
you know, these nursing homes will take veterans with VA
reimbursement, because like I say, the asset test.
And so I would ask for your help. And we have just had a
number of different challenges. Sometimes the VA tells us,
``well, you know, those additional requirements, and those
additional inspections are--we are just trying to take care of
veterans,'' and ``we are just trying to protect the veterans.''
Well, I mean, that almost kind of makes the assumption that,
you know, HHS and states are not taking care of other seniors.
So, I mean, that does not really seem to fly. It really is
a red-tape problem. And so, if we could work with you to
streamline that, so that if a nursing home meets all the
requirements for Medicare or Medicaid, then they should not
have additional set of requirements for VA reimbursement. So
that is the issue, and I would ask for your help on it.
Secretary McDonough. Thank you, Senator. I confess that it
is, and I know you have been working with us, I am not deep on
this. I will just say the following, which is that our
experience during the pandemic is that our clinicians far
exceeded performance on reduction of COVID infection in our
facilities, as related to other facilities, both state-run
facilities, state-run veterans' facilities, and private
privately-run facilities. So, I think there is a lot of work
that we have done in this space, but I would be more than happy
to take this and commit to work with you on it.
Senator Hoeven. Yeah. And the key is access, you know,
because you may have loved ones that have to travel a distance
if they can't get their loved one in a nursing home close.
Secretary McDonough. Yeah.
Senator Hoeven. And this is not just a North Dakota
problem, this is a nationwide--that stat I have cited is a
nationwide stat.
Hyperbaric Oxygen Therapy, HBOT: the veterans really feel
that this is important to them, particularly for PTS. And we
have got a pilot program going, there is a number of locations,
including the VA center in Fargo, which is a high quality
outstanding center, serves a lot of North Dakota, but a lot of
Minnesota too. But are you committed to making sure that our
veterans can get access to HBOT?
Secretary McDonough. Yeah. Well, we are running that pilot
currently. I just asked for an update on it yesterday. It runs,
as you know, through this fiscal year, so we are absolutely
committed to making sure that we run this through, we get high
quality review of this, and then as we have assured you, we
will make the decisions based on that. So, I will be more than
happy to do that and stay in close touch with you.
Senator Hoeven. Yeah. We would like to work with you on
that too. We have talked to so many veterans that really,
really swear by it, and so I think this is going to be
something, and not just veterans, as you know, for concussions
and other things as well.
Secretary McDonough. Yeah.
Senator Hoeven. You know, All-Star football players like
John Boozman, and others, you know, sometimes--I think it has
been very beneficial to them. I am sure you have seen the Joe
Namath commercials, and he talks about it. The last thing I
will bring up.
Senator Boozman. The secretary played.
Senator Hoeven. Oh, is that right?
Senator Boozman. Yeah.
Secretary McDonough. Yes, I did.
Senator Hoeven. Where did you--where at, Minnesota
somewhere?
Secretary McDonough. I played at St. John's University.
Senator Hoeven. Oh, you are a Johnny. Was that back when
they had the fabulous teams? They had a long string of
championships.
Secretary McDonough. Yeah, they had a bad defensive back in
me, but very good teams.
Senator Hoeven. Good for you, fantastic.
A last question, I will be quick. I am sorry, Mr. Chairman.
It is just, ask for your help at the rural--we have the Rural
Initiative (cemeteries), great program.
Secretary McDonough. Yes.
Senator Hoeven. Huge kudos to you. We have one now in
eastern North Dakota. I just ask for your continued commitment
as we add, you know, really important things, like restrooms,
and storage, and wind walls, and things like that. Fabulous
initiative in rural America, and I would just ask your strong
support for it.
Secretary McDonough. Yes. You got it.
Senator Hoeven. Yes. Thank you. Thank you, Mr. Chairman.
Senator Heinrich. Senator Tester.
Senator Tester. Thank you, Mr. Chairman. A couple of
housekeeping things, first of all: I want to thank Secretary
McDonough for bringing up John Warner. John Warner gave me the
best advice I have had since I got here. And I have seen this
advice play out several times. His advice was, ``Don't stay
here too long, kid'' which was, which is good advice.
And then the other thing, Mr. Chairman, I just want to
point out that you have possibly the best staff director of any
of the appropriations committees, in Michelle Dominguez, she is
absolutely the most competent staff member on the
Appropriations Committee that I have ever been affiliated with.
And she used to work for me.
So, Mr. Secretary, you, or the VHA, brought on nearly 8,000
employees under the Temporary Emergency Funding of COVID-19.
What is your plan to keep those folks on board when the ARP
money runs out?
Secretary McDonough. Well, we are letting the demand for
services inform that. We have a particular set of demands, and
I know this is particularly important to you, around mental
health. So, our first and biggest effort is to retain the
excellent clinicians that we have, even as we approach a series
of expected retirements.
We are right in the middle of the annual Employee Survey at
the moment, we will get data from that, which will give us a
sense of what to expect coming in the new year. But the first
and biggest challenge for us is to retain the people that we
have. And then next is to make sure that we are not just out
competing with other health care systems, but that we are
adding to the available clinicians. And this is where our
education component and our residency programs become so
important to us. So, that is why we have the funding that we
have requested in the budget. And we will continue to work with
you guys on precisely that.
Senator Tester. Thank you. Community care was brought up
previously, but I just want to approach this from a little
different angle. There has been a lot of talk about the wait
time to see a doctor within the VA. And correct me if I am
wrong, but I understand you are meeting the guidelines for wait
time, is that correct?
Secretary McDonough. We are. Yes.
Senator Tester. Okay. Are you able to track the wait times
in the private sector?
Secretary McDonough. We are looking at that now to make
sure that we have a good handle on this. You know, come a year
from now, we have to make some decisions about our access
standards. That is what the law requires us to do. I have
implemented and started a process over the course of the last
six weeks, or so, where we get the data to help us inform the
decisionmaking that we have to make in consultation with you
for a year from now.
Among the data I am asking for is veteran satisfaction,
health outcomes, wait times, and commensurate wait times for
care in the community.
Senator Tester. I think it is really, really important,
because, the fact is wait times have been an issue which, by
the way, why we have community care to begin with. And if we
are not addressing that issue, the community care, then we need
to go back and address it.
Speaking of mental health, I was surprised in this year's
budget that the VA projects treating 6,000 fewer vets via
inpatient mental health care in 2022 than it did in 2021. Is
that because of telehealth, or is there another reason here?
Secretary McDonough. I think it is principally due to
telehealth. But, Jon, am I missing anything on this?
Mr. Rychalski. Don't have the answer to that.
Secretary McDonough. Okay. Well, let me take that
specifically, Chairman. But I think that is due to telehealth
because frankly we will see our demand is up across the board.
Senator Tester. Appreciate that. And I agree. Now I want to
talk about something that is near and dear to both our hearts;
and that is toxic exposure, and in a bill that Senator Boozman
is very familiar with, as well as myself, and other folks that
are on a VA committee. The budget supports about $7 million in
new spending on toxic exposure research, to focus on
collaboration between the VA, DOD, and the national academies,
and other stakeholders. My question is: Do you think the VA
should be the lead Federal agency on veteran toxic exposure
research?
Secretary McDonough. I do believe we should be. And I think
that we are.
Senator Tester. And do you feel that that increase of $7
million establishes the VA as a leader on this research?
Secretary McDonough. I think it does, but I also think,
Chairman, as you are aware, we have also set up a process
whereby we are getting the benefit of all the other science
agencies, DOD, Department of Labor, HHS, and their attendant
offices and capabilities on a very regular basis, in addition
to the National Academy of Science. And my commitment to you
all is to not only to continue to get that science, but to
report to you on a quarterly basis what that science is telling
us, including about whether we are in a position to connect
other conditions to service in Southwest Asia.
Senator Tester. I know that community care was talked about
earlier, and the amount of money that is being spent on
community care. And in some aspects, that is simply not
sustainable, especially as it applies to emergency room
treatment. I want to give you an example. And if I might, Mr.
Chairman, of a story that was relayed to me just last week by a
doctor that works for the VA, and is very proud to work for the
VA. And a patient came in, I believe he had kidney stones, and
he got to see him at about 4:30. And, of course the day ran out
at 5:00.
And the advice that was given to him by his superiors was:
just send him to the private sector. The guy wanted to be
treated by the VA and the easy way to do it--and maybe this is
the problem--the easy way to do it was just get him to the
private sector. I know you are concerned about this, and I
appreciate your concern. And I just think that we need to be
wise about how we utilize the private sector. It is the
veteran's choice, it is not the VA's choice. Thank you.
Secretary McDonough. Yeah. I would just say one thing about
that is--two things about that. One, what the clinicians tell
me is that to refer a vet to the community takes, in our
current electronic system, two clicks. To refer somebody back
into care in the system is something like 18 to 20 clicks. That
does not seem right to me.
That suggests, I think, as Senator Schatz was asking, a
kind of an institutional direction. So, have asked us to look
at that. The second is our facility in Ann Arbor is going
through and running a pilot about access to emergency care,
including access to mental health services. And this is
anecdotal, this is why we are out getting some kind of
statistically significant information from our vets.
But the anecdote there was, our hospital administrator told
me, is that when she invited vets back into care in the system,
they all asked--three of them said to her: I am grateful that
you ask, and I always wondered why he pushed me into the
community in the first instance.
And so, I don't know that that anecdote adds up to
something statistically significant, but I want to make sure
that we are giving the vet and the clinician the opportunity to
make the best--what the statute requires, the best possible
outcome for the vet deciding this. That requires us meeting our
wait times, but it also requires us making sure that we don't
tilt the--tilt the record.
Senator Tester. Thank you.
Senator Heinrich. Senator Baldwin.
Senator Baldwin. Thank you, Mr. Chairman.
And welcome, Secretary McDonough.
Secretary McDonough. It is good to see you, too.
Senator Baldwin. I know that when we spoke earlier this
year that we talked a bit about bipartisan legislation that I
had sponsored: the Jason Simcakoski Memorial and Promise Act.
Secretary McDonough. Yes. Jason's Law.
Senator Baldwin. Jason's Law. And, it was signed into law
in 2016, and the law has been effective in strengthening
oversight of the VA's opioid prescribing practices and
providing safer care for our veterans. So, I thank you for the
Department's support of Jason's Law in the fiscal year 2022
budget. The progress that Jason's law is making to improve the
care of veterans is, I think, really quite remarkable.
And I remain committed to working with you to ensure
delivery of the highest quality of care to our nation's
veterans. But I also want to thank you for your commitment to
meet with this Simcakoski family, to discuss implementation of
the law that is named after their son, Jason. Can you give me
any updates today on the VA's effort to reduce or right-size
the prescribing of opioids, in addition to the latest VA-wide
statistics on the rate of opioid and benzodiazepine
prescribing?
Secretary McDonough. I don't have those. I would be more
than happy to provide those data to you, you know, when we
leave here, I don't have those at my fingertips here. I believe
informed both by the tumultuous experience--traumatic
experience at Tomah, as well as, a national epidemic on
substance use disorder.
Our programming continues, as you suggest, to make good
progress. This includes very aggressive recordkeeping about
prescription practices, and that includes us working very hard
to harmonize our records, for prescribing in the community, as
well as for prescribing in the system. So, I think we are
making good progress there. But the fact is that substance use
disorder remains an epidemic in the country. And so, we will
stay on top of this.
Senator Baldwin. You know, on that note, the COVID-19
pandemic has, I think, increased the severity of our opioid
epidemic.
Secretary McDonough. Yeah.
Senator Baldwin. And I am wondering if there are any
particular Departmental programs to address this within the
veterans population, you know, pandemic-related, adverse mental
health and opioid abuse, or is this----
Secretary McDonough. There has been reporting on incidences
of increased prescription of opioids for pain treatment in Long
COVID. And overall, there has been reports, and across the
health system, not the VA system, but across U.S. health
system, of prescription of opioids for pain management in the
context of COVID.
In light--in reaction to those stories we went back in VHA
to look at prescribing practices. We don't see that currently
in our system. We have looked at that and we will stay on top
of that for the obvious reasons. But it also goes to the point
that I think the budget request also goes to, which is, the
research capacity that you enable through the budget at VA is
incredibly important.
Nobody is doing as much research right now on Long COVID as
we are. That is facilitated by how we aggregate data, and that
will be improved even greater when we get this electronic
health record on track. But it also speaks to the fact that
that is a fundamental capacity we need in house, and that we
need to make sure that we sustain over time. And we are using
that expressly on substance use disorder and watching it very
closely. And we will--obviously we know of your personal
interest in this, and we will stay in close touch with you on
it.
Senator Baldwin. Thank you very much, Mr. Secretary. I have
run out of time. I will submit two additional questions for the
record, one pertaining to K2 veterans and exposures. And the
other, dealing with, partnerships between the VA and, county or
tribal veterans, service officers, to make veterans in local
communities aware of the full array of services that they might
be eligible for.
Secretary McDonough. I would just--at the risk of going
over, we have the Annual Tribal Nations Summit at the White
House in this fall. This is one of the things that we will be--
we are trying to develop more robustly in anticipation of that.
We are seeing really useful, collaboration between our national
facilities, and local, and community facilities, and IHS
facilities that build on some authorities you have given us.
That might be something that we should follow up with.
Senator Baldwin. Great. Thank you.
Senator Heinrich. Mr. Secretary, I look forward to hearing
more on that front. Actually, I think Senator Baldwin and I
share an interest in, and that is a very complicated,
coordinated care model that oftentimes our tribal veterans have
to utilize.
I want to ask you a question about compensation and pension
exams. Under the previous administration, the Department
indicated that it planned to contract out nearly all of the
compensation and pension medical exams, and despite a number of
VSOs, many senators raising concerns, the VA continues to,
largely, privatize this component of its mission, and it is
requesting funding for more staff to oversee those contracts.
What is the financial basis, first off, for contracting out?
And how does the cost of providing this service internally
compare with providing it through these contracts?
Secretary McDonough. Yeah. So first and--first and
foremost, we have a significant backlog at the moment which--
so, I think part of the funding that you see reflected in the
budget is our commitment to get that backlog down. That backlog
springs from the pandemic. There is about a two-month period
during which we did no exams, out of deference to the safety
and health of our vets. That number is now at about 180,000
[sic]. That is down from about a hundred--sorry, about 220,000.
So, I don't have the dollar-for-dollar comparison, but I
will get that for you and submit that. But I think you are
right that we continue to rely a great deal on contracted C&MP
exams, but we have cranked up volume on two other ways to
administer the exams. One is in the system that is out of a
collaboration among Dr. Stone at VHA and Tom Murphy at VBA,
where VHA is now providing additional in-system C&MP exams.
That does come at the expense of other, or at the cost of other
services that VHA is providing. So, we are looking closely at
that and tracking that closely to make sure that that does not
tip in the wrong direction.
And then we are providing C&MP exams through video
telehealth, video and telehealth, and so that also increases
demand on our in-house practitioners. But I think it is really
important that we not--that we get that backlog down. So that
is what is reflected in the budget. As to the specific dollar-
for-dollar comparison, to let us make that, and we will get
that back to you unless you have that off the top of your head.
Mr. Rychalski. No.
Secretary McDonough. Okay.
Senator Heinrich. Great. No, I appreciate that. We have
talked a little bit about the unique challenges that rural
veterans face but, you know, access to care in-person or via
telehealth, it is just hard recruiting and retaining primary
care and specialty providers. This budget requests $307 million
to support rural health initiatives. It is a modest increase
over prior years, especially in comparison to the overall
budget growth, but can you talk to us just how is--how is VA
developing and implementing enterprise-wide initiatives to make
sure that we are serving veterans in those rural areas
adequately?
Secretary McDonough. Yeah, it is a great question. I mean,
we have our Office of Rural Health, which is kind of the
principal place where we are innovating on policy there. I will
give you a couple of examples that I think are useful.
And let me just correct the record on one thing. I looked
at my notes after my answer, and what it says here as, as of
June 21, the rating claims pending over 125 days is 190,000,
not 180,000. So, I misspoke there.
What we find is, a couple of different things about our
primary care physicians in rural areas. One is, obviously,
distances traveled. We have a relatively small number of
practitioners covering a lot of different CBOCs over, as you
know very well, over a wide expanse. We are trying to address
that by increasing the number of practitioners.
You have some isolation, professional isolation, where it
may be a very vibrant, and I know it does not happen with my
colleagues who work with me, but sometimes you work with a
colleague who happens to be, or colleagues who happen to be
very smart, very engaging, gives you opportunities to grow.
When you are on the road all the time, you get less of that.
So, we are trying to use, for example, telehealth
opportunities--sorry--and video connect opportunities to
increase that interaction.
We are also using available authorities through that same
Office of Rural Health to increase travel options for those
practitioners, so they are getting to additional career
development, specialty development options. Lastly, we are
increasing the use of econ--sorry--educational partnerships to,
again, enhance career building opportunities. So, none of these
alone adds up to everything we need, but each innovation in
that space I think is important. And we will continue, and this
budget does continue, to invest in our ability to do that.
Senator Heinrich. Yeah. I think all of us up here would
agree that that is incredibly important. And I am running short
on time, but I will just raise one more issue that is related
to that, which is the VA's Highly Rural Transportation Grant
Program. In fiscal year 2021, it was funded at less than $3
million. You know, our discretionary budget this year is $113
billion. I just think this is a place where we need to look to
make sure we are actually meeting demand, and that number in
fiscal year 2022 as it actually gets implemented, I think is a
place we need to look at beefing things up.
And with that, turn back to the ranking member.
Senator Boozman. Thank you, Mr. Chairman. I just want to
touch base on the Electronic Health Record Modernization
Program.
Secretary McDonough. Yes. Yes.
Senator Boozman. It is such a huge, huge issue, a big
expense, and just, you know, a gigantic project that is so, so
very important. I know the budget requests $2.7 billion for
fiscal year 2022, I understand there the review will reshape
the program significantly in every facet and, again, its
financial needs. The House is going to begin marking up their
version of this bill on Friday without the benefits of the
results of the strategic review.
So, I know you can't go into it, you know, in the sense
that it is not done, but can you just, kind of tell us how it
is going and when we can expect the information to come out?
Secretary McDonough. Yeah.
Senator Boozman. And the deployments.
Secretary McDonough. We don't anticipate changing the
budget request, the shape of it may change, but the numbers
themselves will not change as a result. You know, I am tempted
to try to say: it will be reduced over time, but I am not, I am
not going to say that.
Senator Boozman. Sure.
Secretary McDonough. But hopefully we can do that. We have
identified that--we believe that the technology, basically, is
sound. We think that we probably undervalued and underinvested
in training and support to our team in the field. And as they
are going through the change of this process, we also, I think,
have identified some structural inefficiencies in headquarters
in how we govern the project, so that--we will be changing
that, too.
We have not--the big question is, when we go to a next site
to deploy the system and the next site, under current--under
previous course and speed, we would be going next to Columbus,
Ohio, in fairly short order. That decision, I have not yet made
that, but that is a threshold decision. I anticipate making all
those decisions and talking to you about the full shape of this
by the middle of next week, by the 30th.
We owe you some answers, as you laid out in your opening
statement, pursuant to statute from last year. We are going to
live up to that and make sure that we get you the information
you need immediately on the 30th, but we will maintain a very
fluid conversation with you on this.
The last thing I would just say is, one of the reasons I
really want our deputy who is, you know, still pending here,
confirmed is, he is the person who will be overseeing this,
given both the traditional, the deputy in our Department, and
the statutory requirements that he personally oversee the
budget. I would love to get him down there soon, so he and I
can spend some time over the weekend, making sure that we are
on the same page before we submit all this paperwork to you on
Wednesday.
Senator Boozman. Good. We appreciate that. And again, you
know, the committee is very, very supportive of the project and
understands how important it is. I think I can speak for all of
us. And so, like I say, all of this is an effort to help you,
you know, push forward and, you know, we certainly will do that
any way we can.
So thank you, Mr. Chairman.
Senator Heinrich. No, thank you. And thanks to Secretary
McDonough, and Mr. Rychalski, and all of our senators for
participating in today's hearing. I think we all look forward
to working together to make sure we provide the resources for
the VA to be able to do its job, and do its job at the best
possible quality.
ADDITIONAL COMMITTEE QUESTIONS
Finally, I will keep the hearing record open for a week.
Any committee members who would like to submit written
questions for the record should do so by 5:00 p.m., Wednesday,
June the 30th. And we very much appreciate the Department
responding to them in a reasonable period of time.
Secretary McDonough. Thank you very much.
Questions Submitted by Senator Martin Heinrich
Question. The Department, and particularly the Veterans Health
Administration, has struggled to address workforce vacancies. VA used
administrative flexibilities and supplemental appropriations to hire
staff, which VHA plans to maintain through FY 2023 with base funding.
What is VA's personnel strategy to address clinical vacancies?
Answer.As the Nation's largest integrated health care delivery
system, the Veterans Health Administration's (VHA) workforce challenges
mirror those of the private health care industry. Demand for clinical
staff in all health care sectors exceeds the supply of appropriately-
trained health care professionals to meet projected Nation-wide health
care needs. VHA's strategy is to prioritize clinical vacancies as they
arise and use all the flexibilities authorized for recruitment and
retention to attract top talent, including direct and non-competitive
hiring authorities, competitive pay-setting, recruitment and retention
incentives, and education loan repayment and scholarships. VA also
utilizes a host of marketing efforts, including participation in
recruiting events, award-winning digital and social media marketing
campaigns and trainee recruitment events to transition VA Health
Professions Trainees to permanent employment.
At the end of fiscal year (FY) 2020, VA conducted a position
validation review resulting in a reduction of vacant positions by more
than 41%. As of March 31, 2021, there were 32,647 vacant total Full
Time Equivalents (FTE).\1\ Of those, 16,965 were clinical vacancies in
VHA. It is important to note that these vacancies do not represent
staffing gaps or shortages, nor do they represent the true unfunded
need of the organization or the number of positions that could possibly
be filled at any given time; instead, they reflect the constantly-
occurring turnover of employees in the organization and funded levels
of growth in FTE. For example, in response to the Coronavirus Disease
2019 (COVID-19) pandemic, clinical occupations in VHA grew by 4.2% in
FY 2020 and have continued to grow by another 1.2% in FY 2021 through
March 31, 2021, reflecting a total net increase of more than 12,600
additional clinical staff since the end of FY 2019.
---------------------------------------------------------------------------
\1\ This count does not include more than 20,000 FTEs that are
undergoing a position validation review.
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Question. How does VA plan to recruit, retain, and train staff in
regions where they are needed the most, including rural areas?
Answer. VA has taken great steps to increase access to care for
rural Veterans. The workforce shortage occupations for rural VA
facilities are comparable to those of non-rural VA facilities. The 2019
All Employee Survey found no difference in responses for job
satisfaction and burnout between employees at rural and non-rural
facilities. The Office of Rural Health (ORH) and its partners in
clinical program offices, Workforce Management and Consulting Office
and the Office of Academic Affiliations (OAA) have created a number of
initiatives designed to expand the rural workforce and to provide
training to keep providers in rural health care. These initiatives
include:
--Rural Health Training Initiative provides rural clinical training
sites for health professions students and clinical residents.
Trainees include social workers, nurse practitioners,
pharmacists, psychiatrists, optometry students and dental and
family medicine residents. The focus is on training
professionals at rural sites with the goal of recruiting
graduates to rural-serving VA facilities.
--Rural Interprofessional Faculty Development Initiative provides
training for residency proctors, enabling them to train, mentor
and monitor residents serving rural areas. Participants who
become professional faculty for academic partners have highly
regarded this professional development program. This evidence-
based program impacts job satisfaction for participants,
educates trainees in the nuances of rural health care and
expands the workforce in participating VA medical centers. In
all, this program has provided training for more than 256 new
faculty to date. ORH and OAA are working on expanding the
program, creating a new cohort in FY 2022.
--ORH Rural Scholars Fellowship Program provides professional
development opportunities for rural VA providers to develop the
skills and knowledge needed to lead innovation in rural health
care delivery, and ultimately improve recruitment and retention
of VA providers in rural facilities serving primary care. This
program allows providers to stay onsite in their rural
facilities and conduct research and process improvement
projects while receiving virtual mentoring from recognized
experts.
--Rural Health Career Development Award Program supports early
investigators in developing a research program focused on
issues of relevance to rural Veterans and their health care.
This award provides protected time, research funding and
methodologic guidance to help recipients develop an innovative
program of research in rural Veterans' health and help support
their overall career development as an independently-funded
investigator.
--Geriatric Scholars Program addresses the shortage of specialized
geriatric skills and knowledge in rural VA clinical settings by
training VA general clinicians in the treatment of older rural
Veterans.
--Simulation Learning, Education and Research Network Rural
Coordinators develop simulation-based training infrastructure
to improve rural clinicians' technical skills without leaving
their home clinic.
--Geriatric Research Education and Clinical Center Connect Program
trains VA providers to manage medically-complex cases through
case-based conferences, electronic consultations, virtual
meetings and clinical video telehealth.
--Extension for Community Health Outcomes (ECHO) programs provide
training to VA and some non-VA rural providers in a variety of
different areas. Rural participant satisfaction data indicate
that this professional exchange of knowledge results in greater
job satisfaction among participants. ORH currently partners on
three ECHO programs across VHA, including:
--VA-ECHO Expansion in Specialty Care uses telehealth to train
providers in a wide variety of specialties, including
treatment for chronic kidney disease, hepatitis C and pain
management.
--National Mental Health and Suicide Prevention ECHO connects rural
providers to national mental specialists for regular
discussion of clinical cases and targeted skill-building
training on suicide prevention and substance use disorder
treatment.
--COVID-19 VA ECHO focuses on COVID-19 care for patient care
providers from all disciplines in inpatient, outpatient and
residential care settings (also open to community
providers).
Question. After making tremendous progress in reducing the claims
backlog, it increased significantly over the past year due to the
pandemic, including challenges in completing medical exams and
accessing service records, and the inclusion of presumptive eligibility
for three conditions related to Agent Orange Exposures. The Budget
requests funding for an additional 429 FTE to address the increase in
claims.
What lessons from addressing the Blue Water Navy claims is VA
applying to the current workload?
Answer. VA recognizes the criticality of a robust and timely
evidence supply chain to support qualifying service review, which is
evident in the reviews of Blue Water Navy claims. VA has aggressive
plans to digitize personnel and medical records supporting benefits
determinations before a Veteran or survivor even files a claim.
Congress provided VA with $150 million in the American Rescue Plan
(ARP) Act of 2021 to proactively scan National Personnel Records Center
records. VA and the National Archives and Records Administration (NARA)
are collaborating to build an on-site scanning capability for this
effort. VA will provide digital copies of all scanned records to NARA
to help expedite future requests for records.
Question. How long will it take VA to work through the backlog and
return to a normal claims workload?
Answer. The disability compensation claims backlog is impacted by
two large claim groups. In April 2021, VA established more than 60,000
claims for review pursuant to the Nehmer court order and claims
remaining in the inventory from this group aged into backlog status,
resulting in more than 42,000 claims entering the backlog in August
2021. In June 2021, VA also established approximately 70,000 claims for
review for three new disabilities presumptively linked to Agent Orange
Exposure by the National Defense Authorization Act, and any unprocessed
claims from this group were added to the current backlog as of the end
of October 2021. As of November 4, 2021, there were 260,510 rating
claims in the backlog.
Increased receipts, fueled by the expansion of presumptive benefits
for Gulf War Veterans (which VA began processing in August 2021) and
typical annual receipt growth, will further impact backlog reduction.
To mitigate backlog growth, VA is leveraging ARP grants to fund
overtime to ensure timely claims processing, as well as aggressively
hiring nearly 2,000 claims processors during FY 2022. Assuming
continued improvement of the Veterans Benefits Administration's (VBA)
evidence supply chain (Compensation & Pension examinations and Federal
records), VA plans to reduce the current claims backlog to 100,000
claims by mid-FY 2024.
Any additional expansion in presumptive benefits, without
commensurate resource increases in FTE, technology and other process
improvement funding, as well as time to implement such changes, will
increase the current claims backlog further and reduce timely claims
decisions for all Veterans.
Question. How many claims raters will be needed if toxic exposure
legislation currently under consideration in the Senate is passed?
Answer. As part of VA's enhanced technical assistance for the
Comprehensive and Overdue Support for Troops (COST) of War Act of 2021,
VBA has identified a need for 9,871 FTE in the first year and an
average of approximately 8,000 FTE over 10 years, after passage. VA
provided this estimate to the United States Senate on July 30, 2021.
Question. VA provides for direct health care for tribal veterans
through partnerships with the Indian Health Service and Tribal Health
Programs, as well as through VA facilities. As veterans may need to go
to different facilities for different types of services, coordination
of care can be challenging. How does VA plan to improve access to care
for veterans who live in Indian Country, including coordination of care
with non-VA providers?
Answer. VA operates the Indian Health Service/Tribal Health
Programs (IHS/THP) Reimbursement Agreements Program (RAP) which
improves access to care by reimbursing IHS/THP facilities for direct
care provided to Veterans. To improve care coordination for Veterans
who need services beyond what IHS/THP facilities directly provide and
are referred back to VA, VA established the Healthcare Coordination
Advisory Board to assist in developing a standardized care coordination
process. Details of the approach can be found on the IHS/THP RAP
website under the Care Coordination section. VA has made progress in
implementing key elements of this effort. VA successfully partnered
with IHS and THP facilities to expand reimbursement coverage to include
telehealth through a modification signed by IHS and distributed to
tribes in late September/early October 2020. VA is currently developing
and implementing the Community Provider Orders/Standardized Request for
Service Process, a Nation-wide effort to improve care coordination
between community providers (including IHS/THP providers) and VA. This
process and accompanying tools allow for community providers to
electronically send referrals back to VA. Upon receipt of referrals, VA
staff will then be able to coordinate the care needed by the Veteran--
either in a VA facility or by a community provider through VA's
Community Care Network. VA is sharing information about this process
during training sessions with IHS/THP held as of July 2021 to
understand their interest in using this approach.
Question. About half of the States have veterans living in highly
rural areas, and main obstacles to veterans in these areas obtaining VA
health care is distance and transportation. VA's Highly Rural
Transportation Grant Program, which was funded at less than $3.0
million in FY 2021, is one tool to improve these Veterans access to
care. How does VA determine the demand for this program, and whether
the Department is meeting the demand?
Answer. VA establishes Highly-Rural Transportation Grant Program
demand through a grant request process by issuing an annual Notice of
Funding Availability (NOFA) letter. Eligible Veterans Service
Organizations and state Veterans agencies are responsible for
submitting grant requests. Demand for the program is gauged by the
number of requests received in response to the annual NOFA, and future
budget funding levels are informed by previous years' program demand
balanced against total funds available for competing priorities.
______
Questions Submitted by Senator Brian Schatz
va telehealth
Question. Does VA's ability to make permanent any of the telehealth
policies that it adopted during the COVID-19 pandemic rely on the
current federal public health declaration?
Answer. During the Coronavirus Disease 2019-declared public health
emergency, VA providers are authorized to prescribe controlled
substances following an audio-visual assessment of a Veteran using
telehealth technologies in the home. Once the public health declaration
is rescinded, VA will lose this authority. VA has advocated for this
authority to become permanent through a special registration for
telemedicine from the Drug Enforcement Administration. A special
registration for telemedicine is already authorized under Federal law
in the Controlled Substances Act but has not yet been established (21
U.S.C. Sec. 831(h)).
Question. What structural changes does VA need to make so that it
can institutionalize and expand on the telehealth policies and services
that it adopted during the COVID-19 pandemic, including with respect to
the following:
--Changes to the policies related to VA's electronic medical record
and appointment referral system;
--Changes to the way VA contracts for community care;
--Changes to the way VA contracts for internal medical care;
--Changes to the way that VA provides pay retention or other
incentives to internal health care physicians and staff;
--Changes to the way VA establishes standard of care models for its
patients;
--Changes to the equipment and training that VA providers need to
deliver care through telehealth; and
--Changes to the way VA ensures veterans have the ability to acquire
tablets or other devices to access telehealth care.
Answer. The Veterans Health Administration's (VHA) Connected Care
Strategic Vision builds on VA's strong foundation in virtual care
delivery and will contribute significantly to enhancing the exceptional
care that VHA already delivers. Solidifying connected care foundations
is one of three goals in the strategic vision.
Connected care foundations are the policies, legal authorities,
technical infrastructure, equipment and processes on top of which
connected care services operate. Key foundational goals have already
been achieved as part of VA's ongoing Anywhere to Anywhere telehealth
initiative, begun in 2017. These include license portability under
Federal law for VA health care professionals (VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act of 2018, P.L.
115-182) and for health professions trainees and other qualified health
care professionals (National Defense Authorization Act of 2021, P.L.
116-283). These also include modernization of bandwidth infrastructure
at community-based outpatient clinics, development of a standard
platform for telehealth delivery to Veteran homes (i.e., VA Video
Connect), a system to efficiently grant providers access to one or
multiple facility medical records, a systematic process to help
Veterans overcome the digital divide and publication of VA policy for
cross-facility clinical resource sharing and telework-telehealth.
As part of its next phase of solidifying connected care
foundations, VA is focused on:
--Integrating VA Video Connect scheduling into its front-line
Veterans Health Information Systems and Technology Architecture
scheduling application and increasing appointment flexibility;
--Establishing policy authorizing national health care professional
telehealth privileging;
--Enhancing cross-facility scheduling applications to facilitate
additional clinical resource sharing from telehealth hubs;
--Resolving legal barriers to controlled substance prescribing
including for substance abuse treatment;
--Developing a certification program for telehealth support staff
inside and outside VA;
--Enhancing accessibility options in telehealth applications;
--Integrating required components of VA connected care into Cerner;
--Developing systems to support provider collaboration across
facilities;
--Adding options to assist Veterans with overcoming the digital
divide; and
--Modernizing and simplifying telehealth equipment.
As part of its efforts to modernize care delivery, all options to
enhance VA's connected care foundations, and therefore VA services, are
being considered. While VA has not yet identified the need for specific
changes to community care policy, provider pay incentives, standards of
care or changes to the way Veterans obtain tablets from VA, these could
become future focus areas.
Question. Does VA require any new statutory authority to make any
of the structural changes identified above?
Answer. Legislative changes are needed to resolve barriers to
controlled substance prescribing, including for substance abuse
treatment. VA would appreciate engagement with Congress regarding
authorities for prescribing controlled substance(s) via telehealth.
______
Questions Submitted by Senator John Boozman
Question. Since Congress passed the 21st Century IDEA [Integrated
Digital Experience Act], the nature of how individuals engage with
government has fundamentally changed-in large part because of the
coronavirus pandemic. These changes underscore an even stronger need to
implement the 21st Century IDEA and allow federal agencies to deliver
an excellent customer experience from anywhere, to anyone, on any
device.
Has the Department of Veterans Affairs fully implemented the 21st
Century IDEA Act (Public Law No: 115-336)?
Answer. The breadth of services, transactions and content available
to Veterans on VA.gov is extremely large, and despite not fully
implementing the 21st Century Integrated Digital Experience Act (IDEA),
we have made great progress. VA has been working to modernize and
consolidate various tools into an enterprise-wide self-service platform
accessible from a single place: VA.gov. The new VA.gov launched in
November 2018, and it now serves as the primary front door to VA.
The site-wide navigation, on VA.gov web pages, allows users to sign
in or search VA.gov, and just below that on the homepage are the top
tasks Veterans told VA are the most important to them--representing
over 80% of the tasks users visited VA.gov to accomplish. The
modernized pages are all compliant with section 508 of the Americans
with Disabilities Act. Since relaunch, the Customer Satisfaction Score
for all VA.gov websites (including both modernized and legacy pages)
rose from 52.9% to 67.9 % (a 28% increase).
In order to continue to align VA's digital experience with our
users' expectations--and to meet the goals put forth by the 21st
Century IDEA--VA has placed a major focus on modernizing our digital
experience. Our Agency digital strategy has three primary goals: 1)
increase the use of self-service tools; 2) enable faster access to care
and more timely delivery of services; and 3) improve customer
experience and reliability on VA's online services. VA has continued to
make progress on these goals throughout 2021, even as we continue to
create new digital experience capabilities to support VA's Coronavirus
Disease 2019 pandemic response that began in March 2020.
Question. What barriers has the VA faced in implementing this law
and modernizing its digital services?
Answer. The process to modernize VA's inventory of forms and
digital services is driven by the demands and priorities of the Office
of Information and Technology's business partners. The Department
provides hundreds of benefits, with forms to enable Veterans to apply
for each and in many cases, online tools to help track and manage both
the application as well as the benefit itself.
Question. The final FY21 MilConVA Appropriations bill included
report language and funding direction for the VA to implement Section 4
of PL 115-336 ``21st Century IDEA,'' which required that no later than
two years after the date of enactment, each executive agency was
required to digitize and ensure any paper-based form was made available
to the public in a fully usable mobile friendly option.
Who is responsible inside VA for ensuring the agency fully
implements PL 115-336?
Answer. The Digital Experience product line, within the Office of
the Chief Technology Officer, is charged with executing VA's Digital
Modernization Strategy. This includes initial and ongoing efforts to
implement the 21st Century IDEA.
Question. Where does the VA stand in ensuring its forms can be
filled out and submitted electronically on all common, digital devices?
Answer. Currently, there are approximately 500 public-facing forms
available on VA's web properties. This number varies as forms are
added, removed or expire. Additionally, many VA medical centers create
and manage their own forms in a decentralized fashion, adding to and/or
subtracting from that overall total. All public-facing customer VA
forms are currently accessible online as fillable Portable Document
File forms. Those can be completed digitally, printed and then
submitted to VA by mail, fax or in-person. Approximately 20 of VA's
most used forms can be completed and submitted through an online
wizard. These comprise about 350,000 submissions per month. All of VA's
digital online experiences are compliant with section 508 and conform
to both the Privacy Act and the Paperwork Reduction Act. VA is working
to ensure that all digitized forms meet these standards.
VA is also working to identify and prioritize the digitization of
paper forms and non-digital services that are highly utilized by
Veterans. On VA.gov today, over 40% of traffic comes from mobile users,
so introducing new forms and services that are secure and mobile-
responsive will not only allow us to better connect with our users and
have a greater impact on their lives, but it will also help VA achieve
cost savings and workflow efficiencies.
Question. For more than ten years, VA has successfully provided
timely access to high quality dialysis services through community
providers under the Nationwide Dialysis Services contracts when VA
cannot directly provide such care. What factors have changed to trigger
consideration of changing contracts which has been successful in
providing care to these vulnerable veterans?
Answer. VA's Office of Community Care implemented the next
generation of Veteran Community Care in fiscal year 2020 with the
Community Care Network (CCN) roll out. As of today, CCN is operational
across the United States and will soon be operational in the Outer
Pacific Islands. With this implementation, previous Community Care
contracts began to sunset. The National Dialysis Services Contract
(NDSC), which had been VA's previous community Dialysis Program, also
began the sunset process for some contracts. However, nine NDSC
contracts will be renewed for another year. NDSC was a successful
program, but it did not encompass the full spectrum of dialysis care--
for example, nephrologist oversight and Acute Kidney Injury (AKI) were
not covered. Under the new CCN contracts, End Stage Renal Disease,
nephrologist oversight and AKI can be managed by the same Contractor's
in-network provider base.
______
Questions Submitted by Questions Senator Mitch McConnell
louisville va medical center (vamc)
Question. As you know, Kentucky veterans have been waiting for a
new VA medical facility in Louisville since 2006. Please provide an
update on the new Robley Rex Louisville VAMC, including the expected
timeline for construction and when the hospital will begin serving the
region's veterans.
Answer. On August 17, 2021, the United States Army Corps of
Engineers awarded the base construction contract to Walsh Turner Joint
Venture II (located in Chicago, Illinois) for construction of the new
Robley Rex Louisville VA Medical Center. At this time, construction
completion is scheduled for winter 2025, with the Beneficial Occupancy
Date of winter 2026.
Question. The VA's budget includes an additional $93 million for
this project to address increased costs stemming from project delays.
Please provide an explanation of these costs, as well as the potential
for additional funding needed to complete the project.
Answer. Of the budgeted $93 million requested for fiscal year (FY)
2022, $51 million is for cost escalation associated with a 2-year
solicitation delay (at approximately 3.8% per year) due to the lawsuit
by the Crossgate community over VA's compliance with the National
Environmental Policy Act. VA prevailed in spring 2021. The remaining
$42 million of the $93 million is for cost escalation and additional
contingency funds associated with executing contract options that will
not be awarded for 12-18 months after the base contract award.
Question. Can you please detail how the new Louisville VAMC will be
specifically equipped to provide state-of-the-art health services to
female veterans?
Answer. To specifically address the needs of our women Veterans,
the new hospital will include a Women's Health Clinic with four Patient
Aligned Care Teams (PACT). The clinic will include a dedicated
reception and waiting area, gynecology examination rooms with private
restrooms, general examination rooms, telehealth examination rooms,
PharmD consultation/examination, behavioral health consultation,
nutritional consultation, phlebotomy laboratory, procedure room with a
private restroom and an imaging suite. The imaging suite will include
equipment for comprehensive women's health care including Ultrasound,
Bone Densitometry and Mammography. In addition, the Women's Health
Clinic will have dedicated support space for all assigned staff. For
cases in which a woman Veteran would like to see a provider not
specifically assigned to the Women's Health Clinic, all other PACT
modules include gynecology examination rooms with private restrooms.
rural health
Question. Will you provide information on the VA's plans to improve
access to health care for Kentucky's rural veterans?
Answer. The Office of Rural Health, in collaboration with other VA
program offices, plans to maximize high-quality virtual care options
for Kentucky's rural Veterans by continuing its efforts to increase
access to health care by providing opportunities for the delivery of
health care services to rural Veterans through funding the following
initiatives: Telehealth Clinical Resource Hubs, Pharmacist Providers
for Rural Veterans with Opioid Use Disorder, VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act Emergency
Room Specialty Care Scribe Program, Women Veteran Care Coordination and
Management Program, Veteran Transportation Services and Telehealth
Equipment Modernization efforts, all delivered via telehealth, in-home
or in-clinic. VA will continue to expand our telehealth partnerships
with community partners and create strong partnerships to utilize
available facilities and resources to better serve rural Veterans,
their families and the communities where they live. Additionally, VA's
Community Care Network will provide a direct link with community
providers when needed that will ensure VA provides the right care, at
the right time, to Veterans.
Question. What are the VA's plans to expand telehealth options for
rural veterans who lack reliable access to the internet?
Answer. VA has established a 5-year strategic vision for connected
care which will enhance Veteran digital engagement, deliver health care
without walls, sustain and increase capacity in rural and highly rural
locations and solidify VA's connected care foundations. The strategy
includes initiatives that will enhance the accessibility of VA health
care in rural areas by delivering enhanced video telehealth care in the
home using VA Video Connect and VA-provided examination peripherals
(e.g., digital stethoscopes, blood pressure cuffs, pulse oximeters,
thermometers, etc.). The strategy also includes continued focus on
expanding the capacity of VA services in rural and underserved areas by
distributing clinical resources using telehealth through clinical
resource hubs and other virtual health care delivery initiatives.
Services that will be distributed include inpatient services such as
tele-critical care; high-volume outpatient services such primary care
and mental health; and low volume, highly-specialized services such as
stroke neurology. Additionally, the strategy supports expanding remote
patient monitoring capabilities, allowing rural and highly-rural
Veterans to attentively monitor and manage chronic health conditions,
in partnership with VA, from their homes.
As part of its vision to deliver trusted VA care, anytime and
anywhere, VA will continue efforts to bridge the digital divide for
Veterans who lack the technology or broadband internet connectivity
required to participate in VA telehealth services irrespective of their
location in the country. Central to this effort, VA has implemented a
national digital divide consult process in the electronic medical
record. Through this process, qualifying Veterans can obtain an
internet-connected device from VA or assistance in applying for Federal
Communications Commission (FCC)-administered internet subsidies. The
FCC subsidies are available through the Lifeline and Emergency
Broadband Benefit (EBB) programs. The Lifeline and EBB programs can
combine to provide many qualifying Veterans up to $59.25 per month for
their internet services. Veterans on tribal lands can receive up to
$109.25 through these programs. VA has completed over 49,500 digital
divide consultations since the beginning of FY 2021 and has distributed
more than 84,000 internet connected tablets since the start of the
pandemic. Additionally, VA has worked with major wireless carriers such
as Verizon, T-Mobile, SafeLink by Tracfone and AT&T to support
Veterans' access to VA telehealth services through Zero Rating the
telehealth platform VA uses to deliver telehealth to the home. Zero
Rating this platform allows Veterans, their families and caregivers to
use VA Video Connect with fewer worries about data fees.
VA will also continue enhancing existing telehealth infrastructure
at community-based clinics serving rural and highly-rural parts of the
country. Clinical video telehealth visits, with full remote examination
capabilities, allow Veterans to receive specialty care services at
their closest clinic, even if the specialist is elsewhere in the VA
system. This supports care in rural areas, even where affordable
broadband is not readily available in the community.
VA is also evaluating the opportunity to leverage community-based
telehealth access points through its Accessing Telehealth through Local
Area Stations (ATLAS) pilot program. ATLAS is a pilot designed to
bridge the digital divide and reach rural and underserved Veterans in
areas with limited access to broadband and health care. Through this
initiative, VA is teaming up with Philips, Walmart, Veterans of Foreign
Wars and The American Legion to provide convenient locations within
Veterans' communities equipped with the broadband and telehealth
technology necessary to access VA health care. Walmart has provided
space within their health services room as well as equipment, while
Philips designed unique and private spaces equipped with state-of-the-
art telehealth equipment within Veterans Service Organizations. VA
currently has 12 ATLAS locations nationally that are open and available
for scheduling. By the end of 2021, it is anticipated that a total of
13 ATLAS sites will offer clinical services by telehealth from VA
providers.
mental health
Question. Will you provide an update on the VA's efforts to improve
veterans' access to mental health care services, including through the
implementation of the President's Roadmap to Empower Veterans and End a
National Tragedy of Suicide (PREVENTS) and the Commander John Scott
Hannon Veterans Mental Health Care Improvement Act (P.L. 116-171)?
Answer. The Veteran Wellness, Empowerment and Suicide Prevention
Task Force under the President's Roadmap to Empower Veterans and End a
National Tragedy of Suicide (PREVENTS) Task Force was formed as a
result of Executive Order 13861, signed on March 5, 2019, with a call
to action to amplify and accelerate the progress in addressing Veteran
suicide in the United States. On June 17, 2020, the Task Force released
PREVENTS, which contains recommendations for a federally-coordinated
national public health strategy to address Veteran suicide.
In FY 2021, the PREVENTS national public health campaign called
Reach, Engage, Attend, Connect, Help (REACH), has garnered
approximately 5.7 billion impressions since it was launched in July
2020. The REACH website, https://www.reach.gov, has been visited more
than 12 million times and PREVENTS-produced public service
announcements have had nearly 1.3 million views. In March 2021,
PREVENTS launched the How We R.E.A.C.H. Coaching Tool to teach people
how to ``reach out'' to help someone in need. In 1 month, the Coaching
Tool was downloaded more than 1,600 times and its accompanying
application nearly 900 times. More than 16,000 individuals signed an
online pledge to help increase awareness of mental health challenges
and suicide prevention practices. These efforts demonstrate the
efficacy of PREVENTS contributions to VA's collective efforts to
improve Veterans' access to mental health care services.
Paid media is a critical component of any national public health
campaign. In FY 2021, paid media was implemented through a variety of
media platforms, including social media, television, radio, digital
content (such as news websites) and online media streaming services
(e.g., Pandora and Spotify). Paid media also included running public
service announcements in communities that have had high rates of
Veteran suicide, and during programming that is watched, listened to or
visited by targeted audiences as well as during events or activities
attended by Veterans (e.g., the Army/Navy football game). In FY 2022,
PREVENTS communications will continue to target Veterans at risk for
suicide and people in their communities to get them the resources they
need to prevent suicide with a goal of decreasing risk factors and
increasing prevention factors, particularly lethal means safety. VA
will also be evaluating the campaign to see what is effective in
driving exposure, awareness and engagement, and we will adjust efforts
as needed. All of this will be done in coordination with other VA
suicide prevention initiatives and programs to ensure public health
campaign communications are appropriately aligned and research is
informed. VA will also collaborate with others to carry the public
health campaign message forward when the PREVENTS Task Force terminates
on June 17, 2022.
Implementation of the Commander John Scott Hannon Veterans Mental
Health Care Improvement Act (P.L. 116-171) continues to move forward.
Prior to the President signing the legislation into law, VA established
a team within the Office of Mental Health and Suicide Prevention to
oversee implementation. Each section was assigned a primary Point of
Contact who is responsible for ensuring all actions in that section are
completed. All Congressionally-mandated reports due to date have been
submitted on time. A series of White Papers on each section, along with
responses to any questions or concerns needing clarification from
Congress, have been provided to the staff of the House Committee on
Veterans' Affairs (HVAC) and Senate Committee on Veterans' Affairs
(SVAC). VA continues to brief HVAC and SVAC on a regular basis (last
briefings were completed July 1 and July 6, respectively). Development
and implementation of the Staff Sergeant Parker Gordon Fox Suicide
Grant Program (section 201) and the Readjustment Counseling Service
Scholarship Program (section 502) continue to make exceptional
progress. Regarding section 502, the proposed regulation has been
reviewed and approved by VA's Office of General Counsel (OGC). The
Office Management and Budget (OMB) has determined that the Secretary
can sign the proposed rule for publication in the Federal Register
without full OMB review, which is anticipated to result in expediting
the scholarship award cycle.
toxic exposures
Question. I have heard from Kentucky veterans who were exposed to
contaminated water while stationed at Marine Corps Base Camp Lejeune
between 1953 and 1987. What steps has the VA taken to provide resources
and information on benefit eligibility to veterans and their family
members who may suffer from medical conditions caused by toxic exposure
at Camp Lejeune?
Answer. On March 14, 2017, VA effectuated 38 C.F.R.
Sec. 3.307(a)(7) to address the presumption of service connection for
certain conditions associated with exposure to contaminants in the
water supply at Camp Lejeune. The rule allows Service members with
records demonstrating no less than 30 days of service (either
consecutive or cumulative) at Camp Lejeune during the specified
timeframe, and who have been diagnosed with any of the eight
presumptive diseases, to be presumed to have a service-connected
disability for purposes of entitlement to VA benefits. The rule applies
to all military Active Duty, Reserve and National Guard personnel who
meet the requirements of the regulation. To address community concerns
and provide information, VA has held joint community meetings,
partnering with the Department of Defense (DoD), on Camp Lejeune.
Further, VA provides resources and information to the public regarding
benefit eligibility through its website at Camp Lejeune water
contamination health issues. Veterans and survivors may also call the
benefits toll-free hotline at 1-800-827-1000 to speak directly with a
VA employee, who may assist with benefit eligibility questions.
The Agency for Toxic Substances and Disease Registry held Community
Assistance Panel (CAP) meetings for 15 years. These quarterly meetings
included large public meetings and CAP board member meetings, and VA
attended these meetings. These meetings were online and in person, as
they were held before the onset of the Coronavirus Disease 2019 (COVID-
19) pandemic. VA discussed the programs available for both Veterans and
family members. VA answered an average of 200 individual questions for
these meetings. VA placed posters (electronic and/or paper when
available) in VA medical centers and clinics. VA prepared and conducted
training regarding Camp Lejeune exposures for its health care providers
and Compensation and Pension examiners. This was also available to
civilian providers via a platform called the TrainingFinder Real-time
Affiliate Integrated Network, or better known as TRAIN. VA newsletters
have featured articles about Camp Lejeune and benefits available to
Veterans and family members.
If one searches the term Camp Lejeune programs online, the first
items to appear are VA's Public Health website at https://
www.publichealth.va.gov/exposures/camp-lejeune/index.asp, which covers
Camp Lejeune questions and offers resources. VA's Community Care
website also offers information regarding Camp Lejeune at: https://
www.va.gov/COMMUNITYCARE/programs/dependents/CLFMP.asp. There are many
civilian, advocacy and law firm websites that reiterate VA benefits
when searched. VA coordinates with DoD mailings to those on the DoD
Camp Lejeune rosters about VA benefits. DoD has also placed full-page
advertisements in newspapers across the country to discuss the benefits
available.
Question. What statutory limitations, if any, prevent the VA from
efficiently accessing the Department of Defense records needed to
provide benefits or establish service connections for diseases related
to toxic exposures, both at Camp Lejeune and elsewhere?
Answer. 38 U.S.C. Sec. 320 codified the VA-DoD Joint Executive
Committee, which is, in part, tasked with providing recommendations to
both Secretaries about the strategic direction for the joint
coordination and sharing efforts between and within the two
Departments.
DoD and VA have worked together extensively since at least 2011 on
exposure-related issues. Regarding Camp Lejeune drinking water
contamination, the United States Marine Corps supported VA by providing
computerization of millions of personnel and housing records of
Veterans. Other efforts include the development of the Individual
Longitudinal Exposure Record (ILER), a web-based application that will
reference multiple data sources to create the exposure record for
Service members. ILER will provide medical providers with an available
exposure record, support VA clams processing for claims due to in-
service environmental exposures and have other functions and benefits.
Question. Veterans dealing with health conditions due to service-
related toxic exposures need timely access to life-saving VA benefits.
Once scientific research has identified a connection between a disease
and a toxic exposure, what steps does the VA take to ensure decisions
regarding service connections are made and implemented quickly?
Answer. Once rulemaking is complete, VA will develop procedures and
training curriculum to deploy to claims processors, as well as make any
required system updates to allow for processing of the condition(s).
This will include any needed updates to the Veterans Benefits
Management System. The scope of training will be dependent on the
number of impacted Veterans and scale of expected receipts; therefore,
training may be deployed to a subset of claims processors at a limited
number of sites or to all claims processors. Additionally, for efforts
with larger numbers of expected receipts, VA is likely to request
additional resources in future budgets or supplemental requests to
ensure timely claims processing.
veteran homelessness
Question. Will you provide an update on the permanent supportive
housing project in Lexington, Kentucky, which became operational in
fiscal year 2020? How many veterans are currently being served through
this enhanced-use lease project?
Answer. The Victory Point Apartments and Townhomes supportive
housing enhanced use lease project in Lexington, Kentucky, received its
first Certificate of Occupancy on May 6, 2020. The 50 units of
permanent supportive housing currently have 26 Veteran and 24 non-
Veteran residents.
Question. Will you provide an update on how the VA is meeting the
specific needs of female veterans who are homeless or at risk of
homelessness?
Answer. The national VA Homeless Program Office (HPO) provides a
full spectrum of services designed to meet the unique needs of all
Veterans, including women Veterans who are at-risk of or who are
experiencing homelessness. These services include clinical outreach,
treatment, transitional housing, supportive services and permanent
housing. VA's efforts are enhanced by harnessing the strength of
community providers in coordination with VA health care and benefits.
In FY 2020, including all homeless services provide under HPO, over
32,700 unique women Veterans were served. In 2021, HPO conducted an
analysis to identify potential gaps in services provided by VA homeless
programs for women Veterans experiencing or who are at-risk for
homelessness. Results from this analysis show that there are no
significant gaps in service delivery, outcomes and Veteran
satisfaction, and to the extent possible, VA is meeting the needs of
homeless and at-risk women Veterans.\2\ Additionally, the Johnny
Isakson and David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (P.L. 116-315) provides VA homeless programs
with flexibilities to address identified gaps, as detailed in the
summary below.
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\2\ A detailed review of data for corresponding findings will be
provided in a Congressionally Mandated Report (CMR) titled ``Gap
Analysis of Department of Veterans Affairs Programs that provide
assistance to women Veterans who are homeless.'' The CMR is currently
in concurrence for clearance and pending submission to Congress.
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Population Comparison: As of FY 2020, women Veterans represented
8.4% of the overall homeless Veteran population and 38.5% of women in
the general homeless population. Since 2017, the number of homeless
women Veterans decreased, while the number of homeless women in the
general homeless population increased. Women were equally represented
among the Veteran population (8.9%) and the homeless Veteran population
(8.7%); however, women Veterans comprised 11.5% of all Veterans served
by VA homeless programs. These data demonstrate that VA homeless
programs successfully reach women Veterans experiencing or who are at-
risk for homelessness and are providing services designed to resolve
their housing needs.
Homeless and At-Risk Veterans Served by VA Homeless Programs: A
demographic overview shows VA homeless programs provide a wide variety
of services to meet the diverse needs of the homeless population. This
analysis identified gender gaps in service engagement, which are
attributed to the often unique service needs and family composition of
women Veterans. Specifically, homeless and at-risk women Veterans are
more likely than men Veterans to have children in their custody and
require additional services and resources to accommodate dependents.
Additionally, many congregate living settings, like VA's residential
treatment programs, are mostly populated by men, with women as the
extreme minority. These congregate settings have limited designated
space available for women, such as separate living and bathroom
facilities. Traditionally, women Veterans are more likely to utilize
services that provide independent housing options such as housing
subsidies for an apartment/house or temporary shelter in a private
hotel. As a result, women Veterans have a higher rate of admission to
the Department of Housing and Urban Development-VA Supportive Housing
(HUD-VASH), Supportive Services for Veteran Families (SSVF) Prevention
and SSVF Rapid Re-housing (RRH) programs than to programs more
congregate in nature. VA's residential treatment Grant and Per Diem
(GPD) program serves approximately 50% less women Veterans than HUD-
VASH, SSVF or RRH. It should be noted that the Johnny Isakson and David
P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020
(P.L. 116-315 Sec. 4204) provides that in cases of a homeless Veteran
who has care of a minor dependent, GPD must pay, in addition to the
daily cost of care of the eligible Veteran, an amount that equals 50%
of the daily cost of care for each minor dependent.
We expect that this ability to pay for care for dependents will
make GPD a more viable option for women Veterans with minor dependents
and should increase the percentage of women served in GPD as time goes
on. Within HUD-VASH, there is a significant difference in service
utilization when comparing rates of program entry among women and men
Veterans with children, with close to 30% more women with children
entering HUD-VASH compared to men with children. In SSVF and RRH, there
are no significant differences in admission rates for this cohort.
Beyond the specified limitations of programs offering congregate living
settings, no significant gender gaps in homeless program service
provision or access were identified in this analysis.
VA Homeless Program Outreach: VA's Health Care for Homeless
Veterans (HCHV) program provides outreach and case management services
to at-risk and homeless Veterans. Women Veterans received more outreach
contacts proportionally than what they represent in the homeless women
Veteran population (10.9% of all outreach contacts were with women
Veterans, compared to the 8.4% of women represented in the homeless
Veteran population). This demonstrates that VA is actively reaching out
to women Veterans experiencing homelessness to ensure equitable access
to services. No significant gender gaps in outreach services were
identified in this analysis.
VA Homeless Program Referrals: VA homeless programs receive
referrals from community partners, self-referrals from Veterans and
other VA services. Self-referrals from Veterans can come through the
National Call Center for Homeless Veterans (NCCHV), which provides a
24-hour/7-day-a-week hotline for Veterans seeking housing services.
There were no significant gaps in referrals generated through NCCHV
when comparing men and women Veteran callers. While men represented
higher numbers of calls to NCCHV, a slightly higher proportion of Women
Veterans had a service provider visit within 90 days of reaching out to
NCCHV. Veterans receiving care across VA health care settings complete
an annual Homeless Screening Clinical Reminder (HSCR), which is a brief
screening to determine if a Veteran needs assistance with housing.
While men represented higher numbers of positive HSCRs, they also had a
slightly higher proportion of subsequent visits with a VA service
provider within 90 days of being screened. No significant gender gaps
in referrals and service provision from these two main referral sources
were identified in this analysis.
SSVF has innovative features that allow its grantees to address the
needs of women and in households where women were head of household.
These features, described below, have allowed SSVF to serve
significantly more women Veterans than would be expected as women
currently represent 8.4% of the homeless Veteran population but 13% of
Veterans served by SSVF in FY 2020.
--SSVF can offer families temporary child-care, thereby providing
opportunity for women Veterans with children to seek employment
and needed medical and mental health care.
--SSVF 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.
--SSVF is unique in that it can directly serve all household members,
including dependent children, of homeless and at-risk Veterans.
As women are often the primary caretakers for a family's
dependent children, this feature of SSVF is critical to meeting
the needs of these women Veterans.
--SSVF is currently working with communities across the country on a
national initiative that seeks to help at-risk Veteran families
avoid homelessness through family reunification. 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.
--If a Veteran is separated from their family for any reason
(including discord, hospitalization, incarceration or other
forms of institutionalization), services can be maintained and
provided to the Veteran's family members for up to 1 year.
VA Homeless Programs Outcomes: There were no significant gender
gaps in outcomes for women Veterans served in VA homeless programs, and
overall, women had better outcomes compared to men. Across all
programs, women had higher rates of permanent housing placements and
lower rates of negative program exits. Women were more likely than men
to exit HUD-VASH case management with a voucher at exit. Women Veterans
were also more likely than men to have full or part-time employment at
exit, except in the GPD program, where women and men were equally
likely to have full or part-time employment at exit. Finally, apart
from the Health Care for Homeless Veterans Contract Residential
Services/Low Demand Safe Haven (HCHV CRS/LDSH) programs, women Veterans
had higher rates of income and non-cash benefits at exit than men, with
slightly lower proportions of women exiting HCHV CRS/LDSH having income
and non-cash benefits at exit.
Veteran Satisfaction: VA's two primary satisfaction surveys reveal
that both women and men Veterans reported similarly high levels of
satisfaction with VA services. Over 90% of women and men agreed that
the services they received met their expectations and needs, and over
95% of women and men were satisfied with the overall services they
received. In 2019, three of the top five Veteran-met needs were the
same for homeless women and men Veteran respondents: Medical Services,
Medication Management and Tuberculosis Testing and Treatment. Of the
unmet Veteran needs in 2019, three of the top five were the same for
homeless women and men Veteran respondents: Legal Assistance to Expunge
a Criminal Record, Legal Assistance for Credit Issues/Debt Collection
and Tax Issues. It should be noted that under section 5105 of the
Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020, VA must enter into one or more agreements with
public or private entities to provide legal services to women Veterans.
As of this report, HPO has identified communities with the most
pronounced indications of unmet need for legal services among homeless
women Veterans and is conferring with OGC regarding the potential for
new or expanded partnerships with legal service providers in these
communities as a result of this legislation. No significant gender gaps
in reported satisfaction with VA homeless programs and services between
men and women served were identified in this analysis.
Question. Will you provide an update on how the VA is meeting the
specific needs of rural veterans who are homeless or at risk of
homelessness?
Answer. The Veterans Benefits Administration's (VBA) Veterans
Transportation Program (VTP) offers Veterans many travel solutions to
and from their VA health care facilities at little or no cost to
eligible Veterans. VTP provides safe and reliable transportation to
Veterans who require assistance traveling to and from VA health care
facilities and authorized non-VA health care appointments. In addition,
the VHA Office of Connected Care's ATLAS service is part of VA's
Anywhere to Anywhere telehealth initiative, which sets out to better
serve the nearly 9 million Veterans who receive care through VA no
matter where they are. ATLAS has teamed up with public and private
organizations to enhance underserved Veterans' access to VA health care
by offering them convenient locations to receive VA care closer to
home. This new option reduces obstacles such as long travel times to
appointments and poor internet connectivity at home.
HPO provides a full spectrum of services designed to meet the
unique needs of all Veterans, including the needs of rural Veterans who
are homeless or at risk of homelessness. VA's efforts are enhanced by
harnessing the strength of community providers in coordination with VA
health care and benefits.
--Grant and Per Diem: GPD's grant funding decisions consider a
variety of factors including geographic dispersion. When funds
are made available for a grant or per diem award under 38
C.F.R. part 61, VA will publish a Notice of Funding
Availability in the Federal Register. The notice will state any
priorities for or exclusions from funding to meet the statutory
mandate of 38 U.S.C. 2011, to ensure that awards do not result
in the duplication of ongoing services and to reflect to the
maximum extent practicable appropriate geographic dispersion
and an appropriate balance between urban and non-urban
locations. In this way, GPD promotes equity and is responsive
to the needs of communities. GPD continues to work to support
communities in need, such as rural communities, as they work to
end homelessness among Veterans by providing transitional
housing resources for use by Veterans experiencing or at risk
of homelessness.
--Supportive Services for Veteran Families: Through the SSVF program,
generally, grantees may use a maximum of 40% of the temporary
financial assistance to provide homeless prevention assistance
to those most at risk of becoming homeless. However, this
requirement has been waived for the duration of the COVID-19
health emergency. SSVF recognizes that rural areas often lack
the shelter capacity to meet local needs and therefore, rural
Veterans are more likely to be in temporary housing
arrangements that qualify only as prevention. To address this
unique feature of rural communities, SSVF allows rural grantees
to apply for a waiver to this 40% prevention spending limit.
Additionally, when selecting applicants to receive supportive
services grants, VA will, ``[t]o the extent practicable, ensure
that supportive services grants are equitably distributed
across geographic regions, including rural communities and
tribal lands.'' 38 C.F.R. Sec. 62.23(d).
--HUD-VA Supportive Housing: Approximately 9% of Veterans housed with
HUD-VASH vouchers live in rural or highly-rural areas. These
Veterans often require additional or modified case management
services to accommodate their remote locations. Even prior to
the challenges posed by the global COVID-19 pandemic, the
national HUD-VASH program office had encouraged facility-level
programs to adopt telehealth as a means to ensure Veterans were
able to access adequate case management supports.
--Tribal HUD-VASH: Serves American Indian/Alaska Native Veterans (AI/
AN) within the tribe's service area. HUD provides the grant
funding for rental assistance, administered by the tribe or
tribally-designated housing entity grantee, and VA provides the
case management and supportive services to enrolled AI/AN
Veterans. There are currently 26 tribes participating in the
program. Tribal HUD-VASH has case managers who travel to the
grantee's reservation or tribal areas to provide outreach to
homeless Veterans and Veterans at risk of homelessness. The
program has been developed to specifically address the unique
aspects of homelessness in tribal communities. Throughout the
pandemic, some of the tribal grantees have closed their borders
to non-tribal persons but made an exception for VA staff. These
tribes expressed their support for VA tribal HUD-VASH staff as
VA brings services to Veterans, instead of Veterans having to
travel to services. VA staff aided tribal members with
individual contacts, VA Video Connect (VVC) or other virtual
telehealth-type meetings, and through contactless delivery of
goods such as food, clothing and masks. VA was able to lend
smart phones with data plans to Veterans who did not have these
resources and assisted Veterans with use of the devices to
allow them to complete VVC meetings or to at least connect by
telephone if the Veteran was not comfortable using video
technology. Staff provided support and assistance to Veterans
who were experiencing significant losses of family, friends and
cultural connections due to the pandemic.
--Homeless Patient Aligned Care Teams (HPACT): The HPACT program is
committed to addressing the physical, mental health and social
needs of all Veterans experiencing homelessness or at risk of
homelessness including those residing in rural and highly-rural
areas. Work is focused on the expansion of HPACT sites and
services to provide optimal health to rural Veterans through
utilization of extensive outreach, engagement and telehealth to
increase access to care. Many HPACTs offer some form of
outreach and engagement including health assessment, health
education, medication prescriptions and referrals to homeless
programs or other needed VA services. Additionally, telehealth
services, such as VVC, enhance access and allow Veterans to
receive additional services when indicated.
______
Questions Submitted by Senator Lisa Murkowski
Question. I appreciate that the Department is increasing its
request for suicide prevention initiatives to $598 million dollars. A
92% increase is an impressive ask and I believe that it indicates that
you are making a serious commitment to provide support to our nations
veterans who are facing desperate situations, and you have my
wholehearted support in doing so. In 2019 and the wake of a tragic
cluster of suicides, the U.S. Army at Fort Wainwright in Fairbanks,
Alaska completed an in-depth Behavioral Health Epidemiological
Consultation that identified several actions they could take to try and
reduce suicide among active duty service members. Despite the Army's
serious commitment to implementing these changes, we have not seen a
significant decrease in suicides. I am worried that this may happen at
the VA, where we continually appropriate money at the problem but don't
see improvement in the situation.
What is different about this year's suicide prevention portion of
the budget request that will justify such a large ask?
Answer. There are four primary programmatic areas that account for
the suicide prevention budget increase: 1) Veterans Crisis Line's (VCL)
implementation of 988; 2) Suicide Prevention 2.0 (SP 2.0); 3)
President's Roadmap to Empower Veterans and End a National Tragedy of
Suicide (PREVENTS); and 4) the Staff Sergeant Parker Gordon Fox Suicide
Prevention Grant Program (SSG Fox SPGP).
First, VCL accounts for 50% of the total increase, which is to
support operational readiness in fulfillment of the National Suicide
Hotline Designation Act of 2020, which requires the Federal
Communications Commission (FCC) to designate 9-8-8 as the universal
telephone number for the National Suicide Prevention Lifeline and VCL.
A volume increase of 122% to 154% is anticipated for VCL, and the
transition to 988 must be complete by July 16, 2022. Once activated,
the 988 expansion will directly address the need for ease of access and
clarity in times of crisis, both for Veterans and non-Veterans alike.
By providing a universal, unique 3-digit dialing code, it will also
give VA an opportunity to work in greater collaboration with the
suicide prevention community across the United States and open the door
to engage new individuals in life-saving care.
Second, the increase for SP 2.0, which accounts for 12% of the
total increase, is to further the implementation of our public health
approach to suicide prevention. To accomplish its goal of reducing
suicide among all 20 million U.S. Veterans, and to reach Veterans both
inside and outside VA care, SP 2.0 is moving suicide prevention beyond
a one-size-fits-all model to a blended model combining community
prevention strategies and evidence-based clinical strategies that will
empower action at the national, regional and local levels. This
initiative is informed by the evidence supporting suicide prevention
interventions and public health approaches. The Centers for Disease
Control and Prevention, the Substance Abuse and Mental Health Services
Administration and the National Action Alliance for Suicide Prevention
have all moved toward a public health approach to suicide prevention.
The model works to incorporate reaching both Veterans in the community
as well as those we currently serve in VA with innovative community-
based prevention strategies combined with strategies with known
outcomes for reducing suicide and suicide attempts based upon the 2019
updated VA-DoD Clinical Practice Guideline (CPG) for the Assessment and
Management of Patients at Risk for Suicide.
Third, the increase for PREVENTS, which accounts for 18% of the
total increase, is to support Roadmap implementation and completion to
include an aggressive plan integrating Roadmap recommendation 1 with
Roadmap recommendation 8 across fiscal year (FY) 2022.
Fourth, SSG Fox SPGP accounts for 19% of the total increase. SSG
Fox SPGP supports section 201 of the Commander John Scott Hannon
Veterans Mental Health Care Improvement Act of 2019 (P.L. 116-171) and
will enable VA to provide resources toward community-based suicide
prevention efforts to meet the needs of Veterans and their families
through outreach, suicide prevention services and connection to VA and
community resources. In alignment with VA's National Strategy for
Preventing Veteran Suicide (2018), this grant program will assist in
further implementing a public health approach that blends community-
based prevention with evidence-based clinical strategies through
community efforts.
Question. Does this budget request have any points of focus on
Veteran suicide prevention programs that target rural or remote
communities like so many in Alaska?
Answer. The Office of Rural Health (ORH), in collaboration with
other VA program offices and research entities, have funded over 40
mental health and suicide prevention initiatives targeted at rural or
remote Veterans. The following programs have been established and are
delivered in rural and highly-rural communities to Veterans in
locations similar to those in Alaska: Telehealth Clinical Resource
Hubs, Rural Access Network for Growth Enhancement, Pharmacist Providers
for Rural Veterans with Opioid Use Disorder and Clinical Pharmacy
Specialist Providers programs. In addition, ORH funds several
initiatives in other rural communities such as the VA Farming and
Recovery Mental Health Services, National Mental Health and Suicide
Prevention Extension for Community Healthcare Outcomes, Community
Clergy Training to Support Rural Veterans Mental Health and the Rural
Suicide Prevention Program, just to name a few. These mental health and
suicide prevention programs contribute to VA's continuing efforts to
increase access to health care and to expand delivery of health care
services to rural Veterans where they live. Active partnership with the
Tribal Health Organizations in implementing these suicide prevention
programs will be essential in highly-rural Alaska. In addition,
providing postvention support when suicides happen and honoring those
individuals in their communities would help them heal and assist them
in being open to the resources.
The budget includes expansion of our Community-Based Interventions
for Suicide Prevention (CBI-SP) program to all Veterans Integrated
Service Networks (VISN), including VISN 20. This program brings
together the Governor's Challenge initiative (Alaska will be invited to
join in FY 2022), the Together With Veterans peer led rural program and
Veterans Health Administration (VHA) Community Engagement and
Partnership Coordinators to facilitate community-led suicide prevention
efforts. CBI-SP will facilitate the spread of the community suicide
prevention efforts to all communities by deploying trained and
dedicated VA staff who will help community coalitions organize, provide
technical assistance and provide training all within a unifying model.
Question. The VA is running a Native Veteran Suicide Prevention
Project with the goal of addressing risk factors or enhancing known
protective factors of suicide and developing Tribal partnerships. The
program is in the process of establishing, or has already established,
partnerships with 32 Tribes. Is the VA planning to expand this program
to any Alaskan Tribes?
Answer. The Tribal-VHA Partnerships for Suicide Prevention project
is a demonstration project with three VA medical centers: VA Puget
Sound Health Care System, Northern Arizona VA Health Care System and
the Oscar G. Johnson VA Medical Center in Iron Mountain, Michigan. The
tribal partnerships and outreach being conducted as part of this
project are specific to tribes in these health care systems within the
states of Washington, Arizona, Michigan and Wisconsin (which is served
by the facility in Iron Mountain). The goal of this project is to
develop and demonstrate a model for increasing partnership between VA
suicide prevention and rural tribes. This initial project deliverable
is due at the end of FY 2022, after which we expect to propose to roll
the model out further in order to support additional VA health care
systems that serve Native American Veterans.
______
Questions Submitted by Senator John Hoeven
Question. Section 102 of the VA MISSION Act called for the creation
of Veterans Care Agreements (VCAs), a new type of contract between the
VA and its community care providers. These types of contracts are
intended to be used in areas where VA community care is either not
provided or not sufficient to ensure that veterans can receive the care
they need. For example, Bismarck--the second largest city in North
Dakota--has zero nursing homes contracting with the VA, resulting in
veterans having to pay out-of-pocket to receive the long-term care they
need, or having to relocate away from family and friends.
What is the current status of Veterans Care Agreements?
Answer. Veterans Care Agreements (VCA) are currently being utilized
to supply providers to support VA's ability to deliver timely care to
Veterans to meet their medical needs. Pursuant to the legal standard
for use of VCAs that is set forth in the VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act, a provider
with a VCA is used to serve a Veteran when the hospital care, medical
services and/or extended care services needed for that Veteran is not
feasibly available from VA or through a conventional procurement
contract or a sharing agreement (e.g., health care resource sharing
agreement with the Department of Defense). There are 16,945 active VCAs
as of October 13, 2021, according to the VA Provider Portal Management
System.
Generally, the use of VCAs has been gradually decreasing as the
Community Care Network (CCN) has stabilized, and VA is less reliant on
them as the implementation of the CCN becomes more robust. Some of the
services VA is currently most reliant on utilization of VCAs to acquire
are homemaker/home health, mental health and dental services.
Question. Can you provide examples of where VA is currently using
Veterans Care Agreements?
Answer. A few examples of where VCAs are currently being used
include CCN Regions 4 and 5 (Alaska/California/Arizona), where VA
utilizes VCAs for mental health services, when necessary, to ensure
Veterans have timely access to mental health care. Additionally, VCAs
are currently VA's primary means of procuring family member Bowel and
Bladder coverage.
In many geographic areas, particularly rural areas, VCAs bridge the
gap for providing specialties related to homemaker home health care, as
well as for dental services in those areas where providers are still
being recruited into the CCN. As of October 13, 2021, there are
approximately 2,970 VCAs for Bowel and Bladder care, 3,300 VCAs for
home health care and 8,300 VCAs for dental services.
Question. Since 2019, the Fargo VA has carried out a hyperbaric
oxygen therapy (HBOT) clinical demonstration project. Under the
project, veterans who have yet to experience positive outcomes from two
traditional post-traumatic stress disorder (PTSD) therapies can be
referred for HBOT in the community.
Do you agree that in order to put an end to veteran suicide, we
need to address the problem with every possible option--including
expanding access to innovative, alternative treatment options like
HBOT?
Answer. VA agrees with the importance of providing effective mental
health care to address Veteran suicide and supports the use of
promising practices along with evidence-based treatments for mental
health. The effects of Hyperbaric Oxygen Therapy (HBOT) on suicidal
thoughts and behaviors have not been tested; however, HBOT does not
appear to be an effective treatment for mental health disorders. The
evidence on HBOT for traumatic brain injury (TBI), with or without
posttraumatic stress disorder (PTSD), that is based on the results of
four randomized controlled trials is largely negative, with only one
study showing some short-term benefit for PTSD. VA offers Veterans
access to a range of promising practices through its Whole Health
Program and will continue to monitor the evidence on HBOT and
potentially innovative strategies for addressing Veteran suicide.
Question. Given it is already July and the country is still
recovering from the COVID-19 pandemic, do you anticipate extending the
HBOT demonstration project beyond this fiscal year so that more
veterans can access this treatment option?
Answer. VA does not anticipate extending the HBOT clinical
demonstration project (program evaluation) beyond this fiscal year. VA
clinicians and Fargo VA Health Care System leadership will continue to
make case-by-case, evidence-based determinations on clinical care and
case management, including community care authorizations for HBOT for
any medical indication, consistent with VA policy and with
consideration for the unique needs, health factors and treatment
history of individual Veterans.
The clinical demonstration project was intended to identify
administrative implications of administering this therapy within VA and
has successfully accomplished that goal. It was never intended or
designed to address efficacy of HBOT for these conditions or influence
clinical care decisions, which are made by the provider in
collaboration with the Veteran patient.
On October 22, 2020, the Acting Under Secretary for Health agreed
to increase the total number of Veterans who could enroll in the
program evaluation across all five sites from 215 to 250, which
facilitated consistent opportunity for Veteran participation at each
location. At the end of fiscal year (FY) 2020, leadership at four of
the sites concluded their participation in the program evaluation
following the planned active period of approximately 24 months. Due to
the impact of Coronavirus Disease 2019 and the later start date, VA
leadership supported the continuation of the program evaluation at the
Fargo VA Health Care System for an additional 12 months (through the
end of FY 2021), which would be consistent with the 24-month active
period of the other four program evaluation sites. To maintain
consistency across sites, the program evaluation concluded at the end
of FY 2021.
Background:
--A total of 56 Veterans have been referred across all five sites.
--A total of 51% Veterans either dropped out or canceled before
beginning treatment across all sites.
--As of June 23, 2021, Fargo VA Health Care System remains the only
site that continued to enroll Veterans for FY 2021.
--A total of 23 Veterans have been referred to the Fargo site since
September 2019.
--A total of 45% of all Veterans have either dropped out or canceled
before beginning treatment at Fargo.
--Data indicate that the number of referrals for the first year (12
referrals) is similar to the second year (10 referrals over 10
months).
--HBOT is not recognized as an evidence-based treatment for PTSD or
TBI; is not approved by the Food and Drug Administration (under
guidance by the Undersea and Hyperbaric Medicine Society); and
is not reimbursable by Medicare, Medicaid and insurance.
Question. The National Cemetery Administration (NCA) has determined
that additional infrastructure--such as restrooms, storage sheds, and
wind walls--are necessary at Rural Initiative cemeteries in order to
better serve veterans and their families. Can you provide my office an
update on the pending design and construction of the infrastructure
projects at Fargo National Cemetery?
Answer. The infrastructure improvement project at Fargo National
Cemetery is currently under design. We anticipate the design phase will
be completed this fall. We also anticipate a construction contract will
be awarded over the winter, and the work will be completed in the fall
of next year.
______
Questions Submitted by Senator Susan M. Collins
Question. In December 2020 my legislation, the State Veterans Homes
Domiciliary Care Flexibility Act, was enacted into law. This
legislation requires the VA to implement regulations which allow the
waiver of certain eligibility requirements for domiciliary care per
diem payments when in the best interest of the veteran. This authority
would ensure that vulnerable veterans do not fall through the cracks
and receive the care they need, and I urge the VA to quickly complete
its rulemaking and delegate this waiver authority to local VA hospitals
and regional Veterans Integrated Service Networks (VISN). Can you
please provide the committee with a status update on these efforts?
Answer. The proposed changes to regulation 38 C.F.R. Sec. 51.51 are
currently going through the VA regulatory concurrence process which
follows the Administrative Procedures Act, which typically, though not
always, requires two rulemaking stages. This process takes generally 18
to 24 months and involves VA and the Office of Management and Budget.
Following internal development, review and approval of the regulation,
the Federal Register publishes VA's Notice of Proposed Rulemaking
(NPRM). VA's NPRM invites the public to comment on the proposed
amendments. VA considers and responds to all comments in the final
rulemaking. The proposed regulations will address the new waiver
authority in the Public Law.
Question. A 24-bed Substance Use Disorder Residential
Rehabilitation Treatment Program (SUD RRTP) facility was approved at
the Togus VA in August 2020 as an out-of-cycle Strategic Capital
Investment Plan project. Currently, veterans served by VA Maine are
unable to get these services within the State, and Maine veterans
waiting for admission to a SUD RRTP or unwilling to travel out-of-state
utilize over 500 acute inpatient bed days of care per year at VA Maine.
The establishment of a residential program at Togus would improve
veteran continuity of care and accessibility to vitally important
services for Maine veterans. My understanding is that a design was
internally approved by VA for FY21 funding in December 2020. However,
based on the Department's budget request submission, it does not appear
the VA has adequately prioritized this project. When does the VA plan
to construct this much needed facility?
Answer. The following is the anticipated timeline for the Substance
Use Disorder Residential Rehabilitation Treatment Program facility:
--Design Award--September 28, 2021
--Design Completion--February 2022 to June 2022
--Construction Award--December 2022 to January 2023
--Construction Completion--March 2024
--Activation--April 2024
--Occupancy--May 2024
Question. New International Guidelines for the Prevention and
Treatment of Pressure Injuries were made available in 2019. Hospital
acquired pressure ulcers impact over 2.5 million and cost the health
care system $26.8 billion annually. Following these guidelines could
make significant improvements in wound care for veterans being treated
at VA hospitals. When does VA anticipate adopting these guidelines as
the VA's standard of care and implementing the Standardized Pressure
Injury Prevention Protocol (SPIPP) Checklist to improve pressure injury
prevention?
Answer. VA is aware of the evolving evidence and research related
to Pressure Injury (PI) prevention and wound care. Moreover, VA has
adopted the 2019 International Prevention and Treatment of Pressure
Ulcer/Injury: Clinical Practice Guidelines, as well as areas contained
in the Standardized Pressure Injury Prevention Protocol Checklist,
within the recently-released Veterans Health Administration (VHA)
Directive 1352, Prevention and Management of Pressure Injuries. This
directive provides policy and implementation procedures for the
assessment, prevention and management of PIs across VHA clinical
practice settings. The directive contains practice recommendations and
is consistent with both national and international guidelines for PI
prevention and management. Additionally, the national VA Approved
Enterprise Standard Skin (VAAES) Inspection/Assessment electronic
health record template was developed to ensure staff documentation of
interventions were consistent with evidenced-based recommendations and
guidelines for PI prevention and management. VAAES also includes the
link to the 2019 International Prevention and Treatment of Pressure
Ulcer/Injury: Clinical Practice Guidelines.
______
Questions Submitted by Senator Shelley Moore Capito
Question. I appreciated you meeting with me and my colleagues last
month to update us on the actions that the Department is taking at the
Louis A. Johnson VAMC in Clarksburg, West Virginia, in the wake of the
horrific events that took place at the facility. As I know you observed
during your time at the facility, both staff and patient morale is low.
It is imperative that the VA continues to monitor the progress towards
restoring trust at the medical center.
During our visit, I brought up that there is still staff in
leadership roles at the facility, who were in those positions when the
murders took place. You told me that part of the issue is that the VA
could not begin its internal investigation, until after the OIG and DOJ
investigations concluded. While I understand that the internal
investigation is probably still ongoing, can you provide me with an
update on this and if the VA has found any new issues since our last
meeting, that need to be addressed?
Answer. The internal Administrative Investigation Board was
completed on December 18, 2020. No actions were taken until the Office
of Inspector General (OIG) report was published May 11, 2021. We were
awaiting completion of the OIG report to implement disciplinary actions
regarding this incident, all of which have since been effectuated.
Question. Are there still employees waiting to have disciplinary
action taken against them?
Answer. VA has taken the necessary administrative actions against
all identified employees. The administrative actions ranged from
written counseling to removal. There were several VA staff members
including the Medical Center Director, Chief of Staff and Associate
Chief Nurse who retired from their respective positions before
administrative action could be taken. Additionally, two staff members,
a Hospitalist and a Quality Manager, resigned before administrative
action could be taken.
SUBCOMMITTEE RECESS
Senator Heinrich. And with that, we stand adjourned.
[Whereupon, at 11:02 a.m., Wednesday, June 23, the hearing
was adjourned, and the subcommittee was recessed, to reconvene
at a time subject to the call of the Chair.]
LIST OF WITNESSES, COMMUNICATIONS, AND PREPARED STATEMENTS
----------
Page
Berry, Lieutenant General Warren, Deputy Chief of Staff for
Logistics, Engineering, and Force Protection:
Statement of................................................. 29
Prepared Statement of........................................ 30
Boozman, Senator John, U.S. Senator from Arkansas:
Questions Submitted by....................................... 85
Statement of ................................................ 3, 54
Capito, Senator Shelley Moore, U.S. Senator from West Virginia,
Questions Submitted by......................................... 98
Chiarotti, Lieutenant General Charles, Deputy Commandant,
Installations & Logistics:
Prepared Statement of........................................ 27
Statement of................................................. 26
Collins, Senator Susan M., U.S. Senator from Maine, Questions
Submitted by................................................... 97
Cramer, Paul, Performing the Duties of Assistant Secretary of
Defense for Sustainment:
Prepared Statement of........................................ 6
Summary Statement of......................................... 4
Evans, Lieutenant General Jason, Deputy Chief of Staff........... 17
Prepared Statement of........................................ 18
Heinrich, Senator Martin, U.S. Senator from New Mexico:
Opening Statement of ........................................ 1, 53
Questions Submitted by....................................... 80
Hoeven, Senator John, U.S. Senator from North Dakota, Questions
Submitted by................................................... 95
McConnell, Senator Mitch, U.S. Senator from Kentucky, Questions
Submitted by Questions......................................... 86
McDonough, Hon. Denis R., Secretary of Veterans Affairs:
Prepared Statement of........................................ 57
Summary Statement of......................................... 55
Murkowski, Senator Lisa, U.S. Senator from Alaska, Questions
Submitted by................................................... 94
Schatz, Senator Brian, U.S. Senator from Hawaii, Questions
Submitted by................................................... 84
Williamson, Vice Admiral Ricky, Deputy Chief of Naval Operations
for Fleet Readiness and Logistics:
Prepared Statement of........................................ 24
Statement of................................................. 24
SUBJECT INDEX
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Page
DEPARTMENT OF DEFENSE
Military Construction and Family Housing
Base Realignment and Closure (BRAC).............................. 37
Beyond the Budget................................................ 23
Budget Uncertainty and the Milcon Process........................ 28
Defense Environmental Restoration Programs....................... 9
Department of Defense Energy Programs............................ 12
Challenges....................................................... 30
Child Care....................................................... 20
Climate Change................................................... 6
Conclusion ......................................... 17, 23, 26, 29, 37
Energy Innovation................................................ 17
Enterprise-wide Energy Initiatives............................... 13
Environmental:
Conservation and Compatible Development...................... 11
Programs..................................................... 9
Technology................................................... 10
Facilities Sustainment and Recapitalization...................... 8
Facilities Sustainment, Restoration, and Modernization (FSRM).... 36
Family:
And Unaccompanied Housing.................................... 8
Housing and Barracks......................................... 19
Force Design and Installations................................... 28
FY 2022:.........................................................
Budget Request for Installation Infrastructure................... 22
Milcon Program............................................... 34
Health Care...................................................... 20
Historic Housing Program......................................... 20
Housing Construction and Operation and Maintenance............... 36
Infrastructure Sustainment and Restoration....................... 25
Installation Energy Resilience................................... 15
Installations Resiliency and Resiliency Initiatives.............. 27
Introduction .................................................... 6, 30
Key Areas of Concern............................................. 6
Milcon Execution................................................. 25
Military:........................................................
Construction ................................................ 7, 22
And Family Housing....................................... 7
Housing...................................................... 25
Privatization Initiative (MHPI).......................... 6
Modernize and Innovate........................................... 22
Operational Energy Resilience.................................... 14
Operation and Maintenance of Facilities.......................... 23
Overcoming Challenges............................................ 31
Per- and Polyfluoroalkyl Substances.............................. 9
Permanent Change of Station (PCS) Moves.......................... 21
Privatized Housing............................................... 36
PPV Housing...................................................... 28
Quality of Life Priorities....................................... 19
Special Interest Items........................................... 32
Spouse Employment................................................ 20
Strengthen Readiness and Resilience.............................. 21
Taking Care of People............................................ 18
The Army Installations Strategy.................................. 18
The Native American Lands Environmental Mitigation Program....... 10
Threats to Energy................................................ 13
__________
DEPARTMENT OF VETERANS AFFAIRS
Access to Mental Health and Suicide Prevention................... 59
Additional Committee Questions................................... 80
Addressing an Aging Infrastructure............................... 62
An Evolving Landscape Will Influence How VA Cares for Veterans... 64
Congressional Support............................................ 64
Diversity, Equity and Inclusion.................................. 66
Economic Opportunity............................................. 62
EHRM............................................................. 63
Eliminating Veteran Homelessness................................. 61
Empowering Leaders to Implement Positive Change.................. 66
Environmental Exposures.......................................... 65
Establishing the Right Balance of VA and Community Care.......... 59
Financial Management Business Transformation..................... 64
Fiscal Year 2022 Budget and 2023 Advance Appropriations.......... 58
Improving Support for Women Veterans............................. 60
Leveraging Technology to Support Service and Medical Care
Delivery....................................................... 63
Louisville VA Medical Center (VAMC).............................. 86
Mental Health.................................................... 88
New Statutory Authorities........................................ 65
Research......................................................... 65
Rural Health..................................................... 87
Strategic Focus.................................................. 58
Supporting Caregivers............................................ 60
Toxic Exposures.................................................. 89
VA Logistics Redesign (VALOR).................................... 63
VA Telehealth.................................................... 84
Veteran Homelessness............................................. 90
[all]