[Congressional Record (Bound Edition), Volume 163 (2017), Part 2]
[House]
[Pages 2564-2568]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   ISSUES AND OPPORTUNITIES AT THE VA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2017, the Chair recognizes the gentleman from Texas (Mr. 
O'Rourke) for 30 minutes.
  Mr. O'ROURKE. Mr. Speaker, I came to the floor this evening primarily 
to talk about issues and opportunities at the VA and the successful 
confirmation of our new Secretary of Veterans Affairs, Dr. David 
Shulkin, but I would be remiss in not thanking my colleague from Texas 
(Mr. Green) for his powerful words about the NAACP and the profoundly 
positive impact that they have had on this country and on our ability 
to make the most of the potential that we have in every single 
community in the United States.
  Mr. Green is well aware of the inordinate pride that I have in the 
community I represent of El Paso, Texas, and how the first chapter of 
the NAACP was started in El Paso, Texas, through the good work of Dr. 
Lawrence Nixon, who also has the distinction of having been the man who 
effectively desegregated voting in the State of Texas, ending the all-
White primary which had prevailed following Reconstruction in our 
State, much to our lasting shame. But to our immense pride, he was the 
man and our community was the place where that successful fight began.
  As Mr. Green also knows, because I had the pleasure and honor of 
joining him in a Special Order not too long ago, El Paso also was the 
home of Thelma White, who, along with some other young, courageous El 
Pasoans, had gone to the all-African-American high school, Douglass 
High School, in El Paso. They attempted to enroll in Texas Western 
College, now known as the University of Texas at El Paso, but were 
denied entry simply based on the color of their skin.
  Thanks to the NAACP and one of their most promising attorneys, 
Thurgood Marshall, they were able to take this case to a Federal bench, 
in fact, the bench of R.E. Thompson, who also happens to be an El 
Pasoan, whose ruling not only ruled in their favor, but effectively 
desegregated higher education in the State of Texas at that time and 
forever more.
  So I just want to add my thanks and my support for an outstanding 
organization and the very positive impact that they have had on the 
State that I call home and the community that I am so lucky to serve 
and to represent. I thank the gentleman from Texas for staying just a 
little bit longer.
  Mr. Speaker, I am also here today to thank my colleagues in the 
Senate, who, 100-0, yesterday confirmed the President's nomination of 
Dr. David Shulkin to be the next Secretary of the VA at what I think is 
the most critical moment in the history of that critically important 
organization.
  We all know of the severe challenges that the VA and the veterans 
whom it purports to serve face today. We know of the challenges in 
service-connected disability claim wait times--in the appeals that are 
made to those claims when the judgment or the ruling is not in favor of 
the veteran in question or there is an error in that judgment or some 
additional information needs to

[[Page 2565]]

be added--and wait times in appeals that last not days or weeks or 
months, but measured in years.
  We know about challenges in wait times for those veterans who are 
seeking to get an appointment with a primary care physician, a 
specialty care physician, or, I think most critically, at a time when 
20 veterans a day in this country--and that is a conservative estimate, 
20 veterans a day--are taking their own lives, severe wait times to see 
a mental health care provider. Those are among the most important 
challenges that we as a Congress and those of us who serve on the 
Veterans' Affairs Committee face today.
  So, again, I am grateful for the Senate's work on this issue in 
confirming Dr. Shulkin. I have got to say, despite some deep 
disagreements, differences, and disappointments with the current 
administration, I am grateful to this President for the public good he 
has done in nominating Dr. Shulkin, a man who has served in previous 
roles as CEO of Beth Israel Medical Center in New York City, chair of 
medicine at Drexel University College of Medicine, and beginning in the 
summer of 2015, the Under Secretary for the Veterans Health 
Administration, where he hit the ground running and began working on 
the challenges before us, providing solutions to them nationally and in 
our individual congressional districts on the ground working with the 
teams there both at the VA, in the public and private sector, and with 
the various Representatives who brought these issues to his attention. 
So I could not be more grateful for his service, and I want to speak 
about that a little bit more.
  I also want to acknowledge that we have some excellent leadership on 
both the Senate Veterans' Affairs Committee and here in the House, 
where Dr. Phil Roe of Tennessee is taking the helm as the chairman of 
the House Veterans' Affairs Committee--he, himself, a medical doctor; 
he, himself, a veteran; and he, himself, someone who chose to serve on 
the committee as just one member of that committee in the years leading 
up to his selection by his colleagues as a chairman. I know from 
talking with him that he has big plans, significant and defined goals, 
and he is willing to work on a bipartisan basis to make sure that we 
achieve them. I am really looking forward to the ability to work with 
him. He is joined by returning Members who have sought position on the 
Veterans' Affairs Committee.
  Now, for those who don't know, for too long, the Veterans' Affairs 
Committee was seen as a backwater or a basement. It wasn't a place 
where an aspiring Member of Congress with ambitions went to do her or 
his work. This was a place they were relegated to when they couldn't 
make it on to a bigger or better committee. That was the old 
conventional wisdom.
  These days, I am proud to report, the Veterans' Affairs Committee is 
a place of distinction, where Members serve with pride, where we ask to 
join that committee, as I did after I was elected in 2012, so we can 
tackle some of the most difficult challenges before this Congress and, 
certainly, this country: how we ensure that we deliver the best care to 
the 20 million-plus veterans who have put their lives on the line and 
served this country in a way that no other American has, in a way that 
ensures that we have the America that so many of us take for granted, 
veterans whose service dates back to World War II and leads up to those 
who are just returning from Afghanistan, Iraq, and many places all over 
the world where we have U.S. servicemembers stationed in more than 140 
countries today.
  Ensuring that we fulfill our obligations to them, whether it is post-
9/11 GI Bill educational and workforce benefits, whether it is access 
to quality and consistent health care or ensuring that we quickly, 
effectively, and successfully respond to claims made after there is a 
service-connected disability incurred in service, we need to get these 
things right. The future of our country depends on it, our honor 
depends on it, and the commitments that we have made and the 
obligations that we have incurred as a country to these veterans, all 
that depends on our successful completion of that work.
  So I am grateful for the Members who have chosen to serve on that 
committee; I am grateful for our chairman; and I am grateful for our 
ranking member, Mr. Tim Walz of Minnesota, who also happens to be the 
highest ranking enlisted servicemember to ever serve in the Congress as 
a command sergeant major, someone who has asked to be on that 
committee, who has written significant legislation, has ensured that 
the Clay Hunt SAV Act, for example, became law, which gives us a better 
opportunity to reduce veteran suicide, which I think is the most 
critical issue that we can address, that we reduce the number of 
veterans who are taking their own lives and provide more resources and 
more help.
  I will say this about Mr. Walz: He is someone who puts his country 
above party, the work that he has to do above his own self-advancement, 
and I think it is with that attitude, with that character, and with the 
bipartisan group of House Veterans' Affairs Committee members that we 
are going to see great work come out of this committee, great 
leadership come from Mr. Walz and his chairman.
  I am so glad that Mr. Walz has decided to spend part of his 
Valentine's Day evening with me on the floor of the House talking about 
the great work that lies ahead for us when we try to serve the veterans 
of this country.
  Mr. Speaker, I yield to the gentleman from Minnesota (Mr. Walz).
  Mr. WALZ. Mr. Speaker, I thank the gentleman from El Paso.
  I very much appreciate, always, the story and the passion that you 
have for that great community and look at the leadership that comes out 
of there. I certainly know in your work for veterans your name will be 
added to that list. The passion, the willingness to solve problems, the 
willingness to find and make the tough choices to fulfill this Nation's 
commitment to our veterans is something I am just proud to serve 
alongside you.
  I would echo the gentleman's comments, having the opportunity today 
to witness the swearing in of Dr. David Shulkin as our next VA 
Secretary, being there with Vice President Pence along with Senators 
Isakson and Tester on the Senate side and Dr. Roe, of whom you spoke 
very accurately, Mr. O'Rourke--a true gentleman, an impassioned 
advocate for veterans, and a no-nonsense legislator, exactly what we 
need.

                              {time}  1930

  You just have to watch the sense of can-do spirit up there and see 
Dr. Shulkin and his family--with young children--and the sacrifice that 
goes into public service. This is a gentleman who could make far more 
money and probably have a lot less headaches if he would continue to 
serve in the private sector. He chose not to do that for all the right 
reasons.
  I think it probably brings us to the message that Mr. O'Rourke is 
delivering. This is something that unites this country more than 
anything else: the care and service to our veterans.
  It doesn't matter your political persuasion, it doesn't matter where 
you fall on the spectrum, it doesn't matter what you necessarily think 
of the wars or the conflicts that we are engaged in, but the care for 
those veterans is something that my folks in Mankato, Minnesota, your 
folks in El Paso, folks in Philadelphia, Los Angeles, Seattle, and 
every small town in between want us to get right. They want us to use 
the data to deliver the benefits that were earned. They want us to get 
it right to show that this Nation's commitment is not something that is 
fleeting or comes and goes. I think most people understand this is a 
complex issue.
  Again, I was reading recently--to put this into perspective--when 
they make this promise, when they raise their hand to serve this 
Nation, they are in it for the long haul. The Veterans Benefits 
Administration is still paying out $73 a month to the daughter of a 
Civil War veteran. 152 two years after the end of that conflict, this 
Nation still needs to keep its commitment.
  So, when you go to war, it comes with a long tail attached to it. 
That long tail attached is doing what President Lincoln asked us to do: 
care for those who bore the battle, their widow, and their orphan.

[[Page 2566]]

  I think it is within that spirit that I would encourage our 
constituents, Mr. Speaker, to take an eye and look at what is happening 
with veterans' issues. When they don't believe anything can work, and 
they believe everything up here is a fight and that we couldn't agree 
it is Tuesday today, that is simply not the case. We have good, smart 
people working for solutions to difficult problems who are in the best 
interest of this Nation, the best interest of our veterans, and the 
best interest of taxpayers.
  I would encourage people not to make rash generalizations. When 
people say, Oh, nothing works in the VA, that is not true. Many things 
work in the VA, and many things work very well. But when they don't, 
that is an abject failure. When one veteran is left behind or a 
situation like Phoenix arises, no, that is not good enough, and we can 
do better.
  But we have an attitude that we don't need to keep this commitment to 
the VA, that we don't need to do that, or somehow that we are not 
already using our resources in the private sector. The gentleman, I am 
sure, will talk about it, but last year, 31 percent of all healthcare 
needs were delivered in the private sector in fee-for-service.
  When that makes sense, when it is most efficient, when it is most 
convenient for the veteran, we should deliver that, but with an 
understanding the VA has a core mission to do research into extremity 
injuries or things that would not happen, outside of industrial 
accidents or war. The VA needs to be there. The VA needs to be there to 
train physicians. The VA needs to be there to make sure we keep that 
accountability, instead of telling a veteran: You are just on your on. 
Good luck getting your care.
  It is in that spirit that I, too, am hopeful. I think it needs to be 
said to our constituents, Mr. Speaker, and it goes through 
administration after administration, whether you like the 
administration or not, the commitment to veterans has to be there.
  They have got some of it right; they have got some of it wrong. I 
think there is a responsibility that, in the first choice of this 
administration in dealing with veterans, I believe they might have 
picked the one person in this country best suited to do the job for 
veterans. That says a lot.
  I think it is important to stress that point, understanding that that 
Secretary can't do it alone. Congress writes the laws. This House 
authorizes the money to make that happen. We have oversight 
responsibility, and we have partners in our veterans service 
organizations who are there to help, whether it be the American Legion, 
whether it be the VFW, the DAV, the Iraq and Afghanistan veterans. 
These are all folks out there who want to keep that commitment to want 
to help.
  The gentleman spoke true, and he spoke true from the heart that, at 
that one time, people may not have seen service on the VA Committee as 
something as a prize position. The folks who have found themselves 
there are committed to this, above everything. They are committed to it 
above party. They are committed above their own personal advancement. 
On both sides of the aisle, there is a camaraderie that is rarely seen 
in the press, that is rarely seen by the general public about getting 
this right.
  I think there is much that can be restored. If anything, I oftentimes 
say how we conduct ourselves in this people's House of Representatives 
must be a direct reflection on the sacrifice that gives us the right to 
self govern.
  Those who paid the ultimate sacrifice were doing it so that citizens 
could elect their Representatives to debate the issues of the day in a 
free and open democracy. So just the exercise tonight of having the 
opportunity and the privilege to share a little of the floor was given 
to us at great sacrifice. We need to conduct ourselves in a bipartisan, 
results-oriented manner that honors that commitment.
  I thank the gentleman from El Paso and look forward to his leadership 
as our ranking member on subcommittees that are coming up on issues 
that will affect employees at the VA and delivery of care. I know they 
are in good hands. As I say it again, I love the stories of El Paso 
from such an impassioned son of El Paso. I think your constituents 
should be proud you are there.
  Mr. O'ROURKE. I thank the gentleman from Minnesota and the ranking 
member of the full committee of the House Veterans' Affairs Committee 
for being here tonight and talking about not just our challenges, but 
some of the hope and opportunity that we have ahead with this new 
Secretary for the VA, this new leadership on the committee, and this 
renewed commitment from this Congress and this country to do the right 
thing by her veterans.
  I am so glad, Mr. Speaker, that he mentioned the necessity to ensure 
the long-time health and viability of the VA. There has been some talk 
about privatizing the VA and of just essentially asking our veterans to 
go find their own doctors and their own medical providers in the 
communities in which they live, no longer having the VA as the core of 
the delivery of care that they have depended on for so long.
  I think it is important that Secretary Shulkin, in his confirmation 
hearing, said that he would never be part of privatizing the VA, at 
least not on his watch, at least not during his tenure.
  While there are opportunities to capitalize on care in the community, 
as the ranking member said, only at the VA will we have doctors, 
nurses, providers, and frontline staff, many of whom are, by the way, 
themselves veterans who have uniquely cared for other veterans, know 
the signs to look for when we are trying to reduce veteran suicide, 
know specifically how to treat post-traumatic stress disorder, 
traumatic brain injury, military sexual trauma, traumatic amputations--
the kinds of conditions that don't typically occur in the civilian 
population and that we don't see at our general private-public 
hospitals, but are unique to the VA and unique to military medicine, 
where we uniquely will ensure that our veterans and military retirees 
get world-class care from those who are uniquely trained to deliver 
that to ensure the best outcomes.
  While we should never shy from the shortcomings or the challenges 
within the VA--and there are plenty of them--I think it is really 
important to reiterate how often we are successful in seeing veterans 
whose care depends upon a doctor or a provider at the VA who leaves 
that appointment grateful for the time that they were able to spend 
there, grateful for the care they received, and grateful for the fact 
that there is a VA.
  This last week, on Friday--it was a few days early--we took some 
Valentine's Day cards made by elementary school students at LBJ 
Elementary in El Paso to veterans at the VA. I was joined by Colonel 
Mike Amaral, the new permanent director of the El Paso VA, formerly 
chief of staff at William Beaumont Army Medical Center.
  We shook hands with veterans, shook hands with frontline staff, shook 
hands with nurses and providers at the VA, thanking them for their 
service, wishing them an early happy Valentine's Day. To each veteran 
either coming in or leaving the VA, I asked them what their experience 
was like in either making an appointment, if they were on their way in, 
or how their appointment went when they were on their way out.
  As the ranking member knows, the veterans who we represent are never 
shy about sharing the truth and the facts of their experience with the 
VA. We hear the good, we hear the bad, we hear the ugly.
  At the El Paso VA on Friday, for every veteran who had been seen by a 
doctor, the story was a positive one. For every veteran going in to see 
a doctor, the story was a positive one. It doesn't mean that every 
single veteran's story in El Paso is positive. Let's acknowledge that 
some appointments are dropped. Sometimes the phone isn't answered. 
Sometimes an appointment is made and the doctor is not there to see the 
veteran.
  All of those circumstances are unacceptable. I know Colonel Amaral 
feels the way I do. I know Secretary Shulkin feels the way I do. I know 
every single

[[Page 2567]]

Member of Congress feels the way I do. But let's remember that the vast 
majority of veterans are able to be seen, are getting great health care 
at the VA, and, for the most part, when they are referred to care in 
the community when a doctor is unavailable at the VA, when a 
psychiatrist is not able to see that veteran for a behavioral health 
appointment and referred to a provider in the community, most of those 
right now are working well. Not perfectly, not all the time.
  There is work before us that we must do, and it is critically 
important, but I am making the point that the VA needs to maintain the 
core of delivery of care to our veterans. We can add to that core the 
providers in our communities, public hospitals, private hospitals, 
clinics, doctors, those who want to step up at not great profit to 
themselves. The rates that they are reimbursed are just at or less than 
Medicare, but they do it because they want to do their part to continue 
to serve this country, to serve veterans who stood up, put their lives 
on the line, and ensured that we have the United States that we are so 
grateful for today.
  So I think that is a positive situation on which we can build with 
the right team here in Congress, at our local VAs, and with our new 
Secretary.
  I will tell you a story about Secretary Shulkin. Shortly after he was 
named Under Secretary of Veterans Health Administration, I brought to 
his attention the suicide crisis that we have in El Paso among El Paso 
veterans, in Texas, and in the United States, where we now know that 
today, by VA's latest estimate, 20 veterans are taking their own lives. 
The old estimate was 22. It was based on incomplete data. All 50 
States' basis for the new numbers shows us that we are at 20. That is 
too many. It is unacceptable. It has to become our number one priority. 
Unless it is, we won't reduce that number, we won't save more lives, we 
won't prevent more preventable deaths.
  I shared with Dr. Shulkin that, after hearing from veteran after 
veteran after veteran, while generally their care received in the VA 
was excellent--when they were there, they were treated like a king or a 
queen--too often, when they were seeking a behavioral health 
appointment, mental health care appointment, maybe related to post-
traumatic disorder, maybe a Vietnam-era veteran who had successfully 
bottled his trauma, experiences for 40, 45, 50 years who was now coming 
to terms when he reached certain crossroads in his life with that 
trauma and needed to speak to someone, too often they were not able to 
get in to see somebody at the VA.
  So we conducted a scientific, objective, third-party survey of 
veterans in El Paso, and we found--with a margin of error less than 4 
percent, so this is pretty conclusive--that more than a third of 
veterans in our community could not get in to see a mental health care 
provider when, at that time, the prescribed 2 weeks, not within 30 
days, not within a year. Just not ever.
  We know for a fact that care delayed becomes care denied. It leads to 
terrible outcomes. At a minimum, unnecessary suffering for that 
veteran; at worst, preventable deaths. Veterans taking their own lives.
  So I brought this issue to Dr. Shulkin's attention. I told him this 
community had rallied around our veterans in El Paso, Texas, and that 
the VA providers there, the public hospital, University Medical Center; 
Del Sol Hospital; Providence Hospital; Mentis Neurological 
Rehabilitation Center, another private facility; all of these folks 
wanted to come together to see if they could fill the gap in care and 
coverage that the VA was unable to meet.
  But we needed some leadership from the VA. We needed them to take a 
chance on a model that had never been tried before. We wanted Dr. 
Shulkin and the VHA to get behind a pilot program in El Paso that would 
allow us to take some of these matters into our own hands, where, 
despite the best intentions and significantly increased funding from 
the VA in El Paso, we still weren't able to see veterans who 
desperately need care.
  Dr. Shulkin reviewed the proposal with us, made some suggested 
changes, and within 4 months of having been sworn in as Under Secretary 
of VHA, he was able to help us get this pilot program approved, 
underway, with a collaboration with Texas Tech University Health 
Sciences Center in El Paso, after finding that the best performing VAs 
in the country are associated with academic teaching institutions.
  He made that partnership with Texas Tech possible. He made referring 
care out into the community where we didn't have the doctors in the VA 
possible. He ensured that at the VA we continue to concentrate on those 
areas of excellence--on service and combat-connected disabilities and 
conditions that we don't see in the general population that, more than 
anything else, makes the case for the VA: for strengthening the VA, for 
ensuring that it is not there just today, but forever.
  As long as we have a country, we should have a VA that performs at 
the high levels in those areas where veterans need it most--post-
traumatic stress disorder, traumatic brain injury, traumatic 
amputation, military sexual trauma--those conditions that are unique to 
service and to combat.

                              {time}  1945

  So I am really encouraged that we have him now as the Secretary of 
the full VA. I am really encouraged that we have the leadership like 
Mr. Walz and Dr. Roe in the Committee on Veterans' Affairs in the 
House. I am really encouraged by the leadership that we see on the 
Senate side, and I have got to tell you--and I am sure that Mr. Walz 
would agree with me--we have leadership out in every single community 
in this country, from the Veterans of Foreign Wars, from the Vietnam 
Veterans of America, from the Iraq and Afghanistan Veterans of America, 
from the Disabled American Veterans, from the Paralyzed Veterans of 
America, from every single veterans service organization, too many to 
mention in the time that I have allotted today, who put the pressure, 
provide the solutions, make trips up to Washington, D.C., as they will 
this next week, to ensure that they are holding us accountable for the 
terrific responsibility that we have before us, and that we perform 
against that responsibility and that we perform against the goals that 
we have set--very ambitious, but achievable goals--for this country and 
every single veteran who has served who lives in this country who we 
have a sacred obligation to today.
  I am encouraged that this committee, this Congress, this country 
works on a bipartisan--or let's just say a nonpartisan--basis to get 
that work done. We are introducing two bills tomorrow, for example, 
both with Republican cosponsors. The first bill is the Veteran 
Prescription Continuity Act with Representative Mike Coffman from 
Colorado and Representative Walter Jones from North Carolina. That 
bill, if made into law, will ensure that veterans who were dependent on 
the care provided in part through prescriptions prescribed while they 
were Active Duty servicemembers at a military treatment facility are 
still able to receive those prescriptions as veterans. A lot of folks 
don't know this, but we don't have a unified formulary between DOD and 
VA. Some veterans, some prescriptions get dropped along the way. Here 
is a no-brainer, quick bipartisan fix to that part of the problem.
  The other bill is the Mental Health Care Provider Retention Act, also 
introduced with Walter Jones from North Carolina. This ensures at a 
time of crisis when it comes to veteran suicide that if you are an 
Active Duty servicemember and you are receiving good treatment at a 
military treatment facility for post-traumatic stress disorder, for 
example, or other mental health issues, that if the VA cannot continue 
that care because we don't have enough psychiatrists or psychologists--
we are 45,000 clinical positions short in the VA today--if you are 
getting good care in the Department of Defense military treatment 
facility and there is not that care for you on the VA side as you 
transition out and separate in a given community like El Paso, that you 
will be able to continue

[[Page 2568]]

to receive quality mental health care treatment at that military 
treatment facility.
  Again, this isn't going to solve every access problem. It is not 
going to, in itself, reduce or solve the suicide crisis we have amongst 
veterans, but it is a commonsense, bipartisan approach that makes 
things a little bit better, that ensures that we have more access for 
more veterans and begin to take more steps toward reducing veteran 
suicide.
  Mr. Speaker, I am very encouraged today by the opportunities before 
us, by the leadership that is ready to take on that work, and with the 
opportunity I have to join these leaders to ensure that we fulfill 
every commitment that we have to every veteran in America.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________