[House Report 106-1041]
[From the U.S. Government Publishing Office]



                                                 Union Calendar No. 603
106th Congress, 2d Session -  -  -  -  -  -  -  - House Report 106-1041



                           ACTIVITIES REPORT



                                of the



                    COMMITTEE ON VETERANS' AFFAIRS


                       HOUSE OF REPRESENTATIVES

                       ONE HUNDRED SIXTH CONGRESS

                               __________

                             first session

                        Convened January 6, 1999

                      Adjourned November 22, 1999

                             second session

                       Convened January 24, 2000

                      Adjourned December 15, 2000

                                     



 January 2, 2001--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed
                               __________

                    U.S. GOVERNMENT PRINTING OFFICE
89-006                     WASHINGTON : 2001



                     COMMITTEE ON VETERANS' AFFAIRS

                      BOB STUMP, Arizona, Chairman

CHRISTOPHER H. SMITH, New Jersey     LANE EVANS, Illinois
MICHAEL BILIRAKIS, Florida           BOB FILNER, California
FLOYD SPENCE, South Carolina         LUIS V. GUTIERREZ, Illinois
TERRY EVERETT, Alabama               CORRINE BROWN, Florida
STEVE BUYER, Indiana                 MICHAEL F. DOYLE, Pennsylvania
JACK QUINN, New York                 COLLIN C. PETERSON, Minnesota
CLIFF STEARNS, Florida               JULIA CARSON, Indiana
JERRY MORAN, Kansas                  SILVESTRE REYES, Texas
J.D. HAYWORTH, Arizona               VIC SNYDER, Arkansas
HELEN CHENOWETH-HAGE, Idaho          CIRO D. RODRIGUEZ, Texas
RAY La HOOD, Illinois                RONNIE SHOWS, Mississippi
JAMES V. HANSEN, Utah                SHELLEY BERKLEY, Nevada
HOWARD P. (BUCK) McKEON, California  BARON P. HILL, Indiana
JIM GIBBONS, Nevada                  TOM UDALL, New Mexico
MICHAEL K. SIMPSON, Idaho
RICHARD H. BAKER, Louisiana

          Carl D. Commenator, Chief Counsel and Staff Director

                               __________

                         SUBCOMMITTEE ON HEALTH

                    CLIFF STEARNS, Florida, Chairman

CHRISTOPHER H. SMITH, New Jersey     LUIS V. GUTIERREZ, Illinois
MICHAEL BILIRAKIS, Florida           MICHAEL F. DOYLE, Pennsylvania
JERRY MORAN, Kansas                  COLLIN C. PETERSON, Minnesota
HELEN CHENOWETH-HAGE, Idaho          JULIA CARSON, Indiana
HOWARD P. (BUCK) McKEON, California  VIC SNYDER, Arkansas
MICHAEL K. SIMPSON, Idaho            CIRO D. RODRIGUEZ, Texas
RICHARD H. BAKER, Louisiana          RONNIE SHOWS, Mississippi
                               __________

                        SUBCOMMITTEE ON BENEFITS

                     JACK QUINN, New York, Chairman

J.D. HAYWORTH, Arizona               BOB FILNER, California
RAY La HOOD, Illinois                SILVESTRE REYES, Texas
JAMES V. HANSEN, Utah                SHELLEY BERKLEY, Nevada
JIM GIBBONS, Nevada                  LANE EVANS, Illinois
                               __________

              SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

                    TERRY EVERETT, Alabama, Chairman

BOB STUMP, Arizona                   CORRINE BROWN, Florida
FLOYD SPENCE, South Carolina         BARON P. HILL, Indiana
STEVE BUYER, Indiana                 TOM UDALL, New Mexico

                                  (ii)

  
?

                                     

                            Committee Staff

          Carl D. Commenator, Chief Counsel and Staff Director

                 Patrick E. Ryan, Deputy Chief Counsel

Kingston E. Smith, General Counsel and Staff Director, Subcommittee on 
                      Oversight and Investigations

                    Daniel G. Amon, Press Secretary

        John M. Bradley, Staff Director, Subcommittee on Health

                   Bernadine Dotson, Staff Assistant

             Charles M. Durishin, Democratic Staff Director

  Susan C. Edgerton, Democratic Staff Director, Subcommittee on Health

     Ann Hendricks, Staff Assistant, Subcommittee on Oversight and 
                             Investigations

       William T. Houchins, Democratic Professional Staff Member

       Darryl W. Kehrer, Staff Director, Subcommittee on Benefits

 Elizabeth A. Kilker, Democratic Executive Assistant, Subcommittee on 
                                Benefits

                 Steve Kirkland, Systems Administrator

 Alicemary O. Leach, Investigative Counsel, Subcommittee on Oversight 
                           and Investigations

       Mary Ellen Mc Carthy, Democratic Professional Staff Member

 Sandra K. McClellan, Democratic Executive Assistant, Subcommittee on 
                                 Health

     Mary Stevens McDermott, Administrative and Financial Assistant

 Paige E. McManus, Professional Staff Member, Subcommittee on Benefits

               Jeanne M. McNally, Legislative Coordinator

       Thomas A. O'Donnell, Democratic Professional Staff Member

                   Juliana B. Perry, Staff Assistant

  Sarah A. Shigley, Professional Staff Member, Subcommittee on Health

    Deborah A. Smith, Democratic Administrative Assistant/Executive 
          Assistant, Subcommittee Oversight and Investigations

                    Jeremiah B. Tan, Printing Clerk

Arthur K. Wu, Professional Staff Member, Subcommittee on Oversight and 
                             Investigations

                                 (iii)

  
                          LETTER OF SUBMITTAL

                              ----------                              

                          House of Representatives,
                            Committee on Veterans' Affairs,
                                    Washington, DC, January 2, 2001

Hon. Jeff Trandahl,
Clerk, House of Representatives,
Washington, D.C.

    Dear Mr. Trandahl:
    In accordance with Clause 1(d) of Rule XI of the Rules of 
the House of Representatives, I submit herewith the report of 
the Committee on Veterans' Affairs setting forth its activities 
in reviewing and studying the application, administration, and 
execution of those laws, the subject matter of which is within 
the jurisdiction of our committee.

                                                 Bob Stump,
                                                           Chairman
                                FOREWORD

                              ----------                              

    The 106th Congress made far-reaching improvements to the 
benefit programs serving our Nation's 24 million veterans. An 
increased focus on meeting veterans' requests for authorized 
benefits and services resulted in record numbers of veterans 
drawing disability compensation or using the VA health care 
system. Looking toward the future, Congress initiated laws 
authorizing an expansion of VA's long-term health care system 
and making the Montgomery GI Bill (MGIB) educational assistance 
program more meaningful to entitled veterans seeking broader 
knowledge or advanced skills. Although much remains to be done, 
the American people can take pride that important issues have 
been identified and addressed by the 106th Congress, and that 
the groundwork has been laid for even greater progress in 
future Congresses.
    Almost as important as the design and authorization of 
programs is the need to examine them and provide the necessary 
resources to ensure that veterans are served as the Congress 
intended. While continuing the vigorous oversight that it began 
by establishing the Subcommittee on Oversight and 
Investigations in the 105th Congress, the VA Committee in the 
106th Congress took unprecedented action to advocate increased 
funding for veterans programs.
    At the beginning of the 106th Congress, the Administration 
submitted a VA budget that proposed to fund veterans medical 
care at the previous year's level. After examining the funding 
needs and shortfalls in the Administration's budget, the VA 
Committee recommended a $1.7 billion (9.6 percent) increase in 
veterans medical care funding for fiscal year 2000 that the 
Congress ultimately provided. In the second session, Congress 
approved a further increase of $1.4 billion, so that budget 
authority for veterans medical care increased by a total of 
$3.1 billion from $17.8 to $20.9 billion. Outlays for spending 
for disability compensation, educational assistance and other 
benefit programs rose by more than $2.3 billion (10 percent) 
during this Congress. Outlays for veterans medical care 
spending are projected to rise by another $1.5 billion in 
fiscal year 2001, for a three-year increase of $3.9 billion (22 
percent). The increased spending will help to meet the 
increased demand for VA health care by veterans with service-
connected disabilities and those who cannot afford to obtain 
health care through other means. These amounts would also 
provide funds requested to implement the health care expansions 
authorized in the Veterans Millenium Health Care and Benefits 
Act, Public Law 106-117.
    The 106th Congress was also confronted with a VA health 
care system that was attempting to shed its historic role as a 
provider of long-term care at a time when World War II 
veterans' demand for such care is expected to peak. Despite 
significant improvements in delivering care on an ambulatory 
basis, and despite its own pioneering work in caring for 
chronically ill, elderly and disabled veterans, a long-awaited 
federal advisory committee report on the future of VA long-term 
care failed to address several of the major issues on access 
and equity which the advisory committee had been charged to 
study. As a result of the advisory committee's failure to 
recommend how to establish priorities and reasonable cost-
sharing mechanisms, it fell to Congress to set out fundamental 
principles for VA long-term care policy. It did so with the 
enactment of the Veterans Millennium Health Care and Benefits 
Act.

    This Act:

           Requires the Secretary of Veterans Affairs 
        to operate and maintain extended care programs, to 
        include geriatric evaluations, VA and community-based 
        nursing home care, domiciliary care, adult day health 
        care, respite care, and such alternatives to 
        institutional care as the Secretary considers 
        reasonable and appropriate.
           Requires the Secretary of Veterans Affairs 
        to maintain nationally the level of ``in-house'' 
        extended care services provided as of September 30, 
        1998.
           Requires the Secretary of Veterans Affairs, 
        through 2003, to provide: (a) needed nursing home care 
        for veterans who are 70 percent service-connected or in 
        need of such care for a service-connected condition; 
        and (b) veterans who are enrolled for VA care with 
        alternatives to institutionalized care.
           Requires the Secretary of Veterans Affairs 
        to establish a co-payment policy applicable to extended 
        care of more than 21 days in a year in the case of care 
        furnished to a veteran who has no compensable service-
        connected disability, and whose income is above the 
        pension level.

    Additionally, this Act contained a number of other health 
care policy enhancements, benefit improvements, authorizations 
and requirements. These provisions:
           Authorize the Secretary of Veterans Affairs 
        to make payments for emergency care on behalf of 
        uninsured enrolled veterans and to require that a 
        veteran has received VA care within a two-year period 
        of a medical emergency to be eligible.
           Establish a specific eligibility for VA 
        health care for a veteran who was awarded the Purple 
        Heart.
           Establish a specific eligibility, subject to 
        the terms of a memorandum of understanding between the 
        Department of Defense and Department of Veterans 
        Affairs, for a veteran who has retired from military 
        service, is eligible for care under the TRICARE 
        program, and is not otherwise eligible for priority VA 
        care.
           Require the Secretary of Veterans Affairs to 
        establish a mechanism for augmenting the provision of 
        specialized mental health services, with particular 
        emphasis on programs for the treatment of post-
        traumatic stress disorder and substance-use disorder.
           Authorize the Secretary of Veterans Affairs 
        to: (1) increase the $2 drug co-payment amount; (2) 
        establish a maximum annual and monthly payment 
        applicable to veterans with multiple outpatient 
        prescriptions; and (3) revise co-payments on outpatient 
        care for ``higher-income'' veterans.
           Authorize the establishment of non-profit 
        corporations at any VA medical center to facilitate 
        education and training as well as research.
           Revise the priority system for the award of 
        grants under the State home construction program to: 
        (1) provide a higher priority for renovation projects 
        than accorded under current law (with highest priority 
        for projects to remedy life-safety problems); and (2) 
        in the case of applications for bed-producing projects, 
        provide priority based on the relative need for adding 
        new beds (with higher priority to States with great 
        need vs. those with moderate or limited need, and 
        taking into account existing VA and community nursing 
        home beds).
           Expand VA's authority to enter into 
        enhanced-use leases by: (1) authorizing VA to enter 
        into a long-term lease of property when that would 
        enable it to apply the proceeds of the lease to 
        demonstrably improve services in that geographic area; 
        (2) extending the duration of such a lease term for up 
        to 75 years; and (3) providing that funds from 
        enhanced-use leases shall be deposited in a new Health 
        Services Improvement Fund.
           Authorize reprogramming to provide a 
        domiciliary in Orlando, Florida, using previously 
        appropriated funds and construction of a surgical 
        addition at the Kansas City, Missouri, VA Medical 
        Center; a long-term care facility at the Lebanon, 
        Pennsylvania, VA Medical Center; renovations at VA 
        medical centers in both Fargo, North Dakota, and 
        Atlanta, Georgia; and demolition of buildings at the 
        Leavenworth, Kansas, VA Medical Center.
           Authorize leases of an outpatient clinic in 
        Lubbock, Texas, and of a research building in San 
        Diego, California.
           Authorize the payment of dependency and 
        indemnity compensation to the surviving spouses of 
        certain former prisoners of war who were rated totally 
        disabled due to any service-connected cause for a 
        period of one or more years immediately prior to death.
           Restore, following termination of a 
        remarriage, eligibility for CHAMPVA medical care, 
        education, and housing loans to surviving spouses who 
        lost eligibility for these benefits as the result of a 
        remarriage. These same spouses regained dependency and 
        indemnity compensation eligibility, but not these 
        related benefits, as the result of legislation enacted 
        in 1998.
           Expand the fundraising authorities of the 
        American Battle Monuments Commission (ABMC) to expedite 
        the establishment of the World War II Memorial in the 
        District of Columbia and ensure that adequate funds are 
        available for the repair and long-term maintenance of 
        the Memorial. To assure that groundbreaking, 
        construction, and dedication of the Memorial are 
        completed on a timely basis, the ABMC would be 
        authorized to borrow up to $65 million from the U.S. 
        Treasury.
           Direct the Secretary of Veterans Affairs to 
        obligate Advance Planning Funds during fiscal year 2000 
        to establish six additional national cemeteries for 
        veterans.
           Extend authorization for VA and Department 
        of Labor programs which assist homeless veterans.

    In the 2nd Session of the 106th Congress, the VA Committee 
devised a plan in compliance with Congressional Budget Act 
requirements to make a number of improvements in the 
educational assistance programs (Montgomery GI Bill and the 
Survivors' and Dependents' Educational Assistance program). 
Major provisions of the Veterans Benefits and Health Care 
Improvement Act of 2000 (Public Law 106-419) would:

           Increase, effective November 1, 2000, the 
        All-Volunteer Force Educational Assistance Program 
        basic benefit (commonly referred to as the Montgomery 
        GI Bill or MGIB) to $650 per month for a three-year 
        period of service and $528 per month for a two-year 
        period of service.
           Permit certain Post-Vietnam Era Veterans' 
        Educational Assistance program (VEAP) participants to 
        enroll in the Montgomery GI Bill program.
           Permit servicemembers to ``buy up'' their 
        MGIB basic benefit by making an after-tax contribution 
        of up to $600 which would provide up to $5,400 in 
        additional benefits over 36 months of entitlement, or 
        an additional $150 per month.
           Increase, effective November 1, 2000, the 
        basic educational allowance for survivors and 
        dependents to $588 per month, with annual cost-of-
        living adjustments.
           Allow monthly educational assistance 
        benefits to be paid between term, quarter, or semester 
        intervals of up to eight weeks.
           Allow veterans', survivors' and dependents' 
        educational assistance to be used to pay for up to 
        $2,000 in fees for civilian occupational licensing or 
        certification examinations.

    The Veterans Benefits and Health Care Improvement Act of 
2000 would also:

           Authorize annual ``national'' comparability 
        pay raises for VA nurses on par with that of other 
        federal employees.
           Revise the annual nurses locality pay survey 
        process.
           Provide for nurse participation in policy 
        and decision-making at network and medical center 
        levels.
           Revise and increase rates of special pay 
        provided to dentists employed by the Veterans Health 
        Administration.
           Authorize increased salaries for VA 
        pharmacists and increase the role of physician 
        assistants on all matters relating to employment and 
        utilization of physician assistants within VA.
           Require that VA enter into a contract with 
        an appropriate entity to carry out a new study on post-
        traumatic stress disorder independent of VA, to follow 
        up the study conducted under section 102 of Public Law 
        98-160.
           Authorize VA to furnish veterans and others 
        accompanying veterans with temporary lodging (such as 
        ``Fisher Houses'') in connection with treatment or 
        other services.
           Provide for transfer of land at four current 
        or former VA medical centers (Allen Park, Michigan; 
        Fort Lyon, Colorado; Dublin, Georgia; and Miles City, 
        Montana) to local authorities or land owners for 
        redevelopment.
           Provide that a stroke or heart attack that 
        is incurred or aggravated during inactive duty training 
        by a member of a reserve component in the performance 
        of duty while performing inactive duty training shall 
        be considered to be service-connected for purposes of 
        benefits under laws administered by the Secretary of 
        Veterans Affairs.
           Make women veterans eligible for special 
        monthly compensation due to the service-connected loss 
        of one or both breasts, including loss by mastectomy.
           Increase the amount of resources an 
        incompetent veteran with no dependents being provided 
        institutional care without charge by VA or a state may 
        retain and still qualify for payment of benefits, from 
        $1,500 to five times the benefit amount payable to a 
        service-disabled veteran.
           Increase the maximum amount of coverage 
        available through the Servicemembers' Group Life 
        Insurance program and the Veterans' Group Life 
        Insurance program from $200,000 to $250,000.
           Add recently separated veterans (veterans 
        who have been discharged or released from active duty 
        within a one-year period) to the definition of veterans 
        to whom federal contractors and subcontractors must 
        extend affirmative action to employ and advance.
           Extend eligibility for benefits normally 
        provided only to veterans of the United States armed 
        forces to Philippine Commonwealth Army veterans who 
        reside in the United States who have either become 
        citizens of the United States or have been lawfully 
        admitted for permanent residence in the United States.
           Provide health care, vocational training, 
        and monetary allowances to the children of women 
        Vietnam veterans who suffer from certain birth defects.

    The VA Committee has a long tradition of actively 
overseeing the programs which it authorizes and obtaining the 
views of affected veterans and their representatives on needed 
legislative changes. During the 106th Congress, it became 
apparent that a line of decisions by the United States Court of 
Appeals for Veterans Claims was resulting in fundamental 
changes to the informal nature of the system for adjudicating 
claims for veterans benefits. Although the Department of 
Veterans Affairs proposed to address the issues raised by this 
line of decisions through a regulatory proposal, the VA 
Committee decided that a legislative pronouncement would 
provide a more acceptable solution.
    Following public hearings and meetings with veterans 
service organization representatives and VA officials, the 
leadership of the VA Committee introduced H.R. 4864, a bill 
entitled the ``Veterans Claims Assistance Act of 2000''. A 
compromise version of this measure was considered and adopted 
by both the House and Senate at the close of the 106th Congress 
(Public Law 106-475). In brief, the Act would require the 
Secretary of Veterans Affairs to make reasonable efforts to 
assist veterans in obtaining evidence and information needed to 
substantiate their claims for benefits. A veteran would still 
have the responsibility to present and support a claim for 
benefits with information or evidence in the veteran's 
possession or which the Secretary determines the veteran should 
obtain. However, the Secretary would be required to obtain 
relevant information in the government's possession and to 
provide a medical opinion or examination in certain 
circumstances.
    The VA Committee's Ranking Minority Member during the 106th 
Congress was the Honorable Lane Evans. I wish to thank him for 
his leadership and bipartisan cooperation in accomplishing our 
objectives in both sessions. I also wish to thank the 
subcommittee chairmen and ranking minority members for their 
essential legislative and oversight activities. Our 
subcommittee leaders were: for the Subcommittee on Health, the 
Honorable Cliff Stearns, Chairman, and the Honorable Luis 
Gutierrez, Ranking Minority Member; for the Subcommittee on 
Benefits, the Honorable Jack Quinn, Chairman, and the Honorable 
Bob Filner, Ranking Minority Member; and for the Subcommittee 
on Oversight and Investigations, the Honorable Terry Everett, 
Chairman, and the Honorable Corrine Brown, Ranking Minority 
Member.
    During the 106th Congress, the House and Senate Committees 
on Veterans' Affairs continued their long tradition of working 
together on behalf of veterans. We added the important 
provisions described above to the body of veterans law. 
Therefore, I thank our Senate Committee on Veterans' Affairs 
counterparts, the Honorable Alan Specter, Chairman, and the 
Honorable John D. Rockefeller, Ranking Minority Member, for 
their hard work on so much legislation.
    I also appreciate the yeoman's work the Committee staff has 
done in ensuring smooth day-to-day operations and effective 
support for Members.
    Having the opportunity to help fulfill America's obligation 
to the courageous men and women who served in the Armed Forces 
was truly a special privilege for me. As Chairman of the House 
Committee on Veterans' Affairs, I endeavored to uphold the VA 
Committee's tradition of bipartisan accomplishment on behalf of 
veterans. While new rules adopted in 1994 limited my tenure as 
chairman to six years, I believe we made significant progress 
on many fronts. Everyone involved with the legislative process 
can be proud of the success we had, including but not limited 
to, the veterans service organizations, Members of Congress who 
introduced legislation affecting veterans benefits, Department 
of Veterans Affairs officials, various VA employee groups and 
representatives, and individual veterans who took the time to 
contact the Committee and Members' offices about their 
concerns.

                                                 Bob Stump,
                                                           Chairman
                            C O N T E N T S

                              ----------                              
                                                                   Page
Jurisdiction of the House Committee on Veterans' Affairs.........     1

Veterans programs:

    Department of Veterans Affairs...............................     2

        Veterans Health Administration...........................     3

            Medical care.........................................     3

            Medical and prosthetic research......................     4

        Veterans Benefits Administration.........................     5

            Compensation and pension.............................     5

            Insurance............................................     5

            Education............................................     6

            Home loan assistance.................................     6

            State cemetery grants program........................     6

        National Cemetery Administration.........................     6

    Department of Labor..........................................     7

    American Battle Monuments Commission.........................     8

Messages from the President and other Executive Branch 
  communications.................................................    10

Summary of action by the Committee on Veterans' Affairs..........    21

Hearings and Executive Sessions..................................    23

Legislation enacted into law:

    Public Law 106-83............................................    29

    Public Law 106-117...........................................    29

    Public Law 106-118...........................................    35

    Public Law 106-142...........................................    40

    Public Law 106-413...........................................    40

    Public Law 106-419...........................................    41

    Public Law 106-475...........................................    47

Activities of the subcommittees:

    Subcommittee on Health.......................................    49

    Subcommittee on Benefits.....................................    58

    Subcommittee on Oversight and Investigations.................    66

Committee web site...............................................    81

Oversight Plan for 106th Congress................................    83

    Subcommittee on Health.......................................    83

    Subcommittee on Benefits.....................................    86

    Subcommittee on Oversight and Investigations.................    88

Report on the budget for fiscal year 2000........................    92

Report on the budget for fiscal year 2001........................   129

Statistical data--war veterans and dependents....................   137
                                     

                                                       Calendar No. 603
106th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                    106-1041

======================================================================



 
ACTIVITIES OF THE COMMITTEE ON VETERANS' AFFAIRS FOR THE 106TH CONGRESS

                                _______
                                

 January 2, 2001--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Stump, from the Committee on Veterans' Affairs, pursuant to Clause 
                1(d) of Rule XI, submitted the following

                              R E P O R T

                              Jurisdiction

    Rule X of the Rules of the House of Representatives 
establishes the standing committees of the House and their 
jurisdiction. Under that rule, all bills, resolutions, and 
other matters relating to the subjects within the jurisdiction 
of any standing committee shall be referred to such committee. 
Clause 1(r) of Rule X establishes the jurisdiction of the 
Committee on Veterans' Affairs as follows:

          (1) Veterans' measures generally.
          (2) Cemeteries of the United States in which veterans 
        of any war or conflict are or may be buried, whether in 
        the United States or abroad (except cemeteries 
        administered by the Secretary of the Interior).
          (3) Compensation, vocational rehabilitation, and 
        education of veterans.
          (4) Life insurance issued by the Government on 
        account of service in the Armed Forces.
          (5) Pensions of all the wars of the United States, 
        general and special.
          (6) Readjustment of servicemen to civil life.
          (7) Soldiers' and sailors' civil relief.
          (8)Veterans' hospitals, medical care, and treatment 
        of veterans.

    This Committee was established January 2, 1947, as a part 
of the Legislative Reorganization Act of 1946 (60 Stat. 812), 
and was vested with jurisdiction formerly exercised by the 
Committee on World War Veterans' Legislation, Invalid Pensions, 
and Pensions. Jurisdiction over veterans' cemeteries 
administered by the Department of Defense was transferred from 
the Committee on Interior and Insular Affairs on October 20, 
1967, by H. Res. 241, 90th Congress.

                           Veterans Programs

                     DEPARTMENT OF VETERANS AFFAIRS

    President Herbert Hoover issued an executive order on July 
21, 1930 creating the Veterans Administration. At that time, VA 
had 54 hospitals and 31,600 employees. There were 4.7 million 
veterans. President Ronald Reagan signed legislation on October 
25, 1988 creating the Department of Veterans Affairs (VA), 
which assumed responsibility from the Veterans Administration 
for the mission of providing federal benefits to veterans and 
their dependents.
    VA carries out its missions nationwide in three 
administrations. The Veterans Health Administration (VHA) is 
responsible for veterans' health care programs. The Veterans 
Benefits Administration (VBA) is responsible for the 
compensation, pension, vocational rehabilitation, education 
assistance, home loan guaranty and insurance programs. The 
National Cemetery Administration (NCA) is responsible for all 
national cemeteries, except Arlington National Cemetery. A 
Board of Veterans' Appeals (BVA) provides final decisions for 
the Secretary on appeals of veterans benefits claims.
    As of September 30, 2000, VA had 219,547 employees. Among 
all the departments and agencies of the federal government, 
only the Department of Defense has a larger work force. Of the 
total number of VA employees, the Veterans Health 
Administration has 198,941, the Veterans Benefits 
Administration has 11,932, the National Cemetery System has 
1,458, and the Veterans Canteen Service has 3,285. The 
remaining 3,931 employees are in various staff offices. About 
27 percent of VA's employees are veterans, which makes VA a 
leading employer of veterans. Since the formation of the 
Department, the Secretaries of Veterans Affairs have been: Hon. 
Edward J. Derwinski, 1989-1992; Hon. Jesse Brown, 1993-1997; 
and Hon. Togo D. West, Jr. 1998-2000.
    In its current five-year strategic plan issued September 
29, 2000, VA's vision for the future is stated as follows:

          As the Department of Veterans Affairs heads into the 
        21st century, we will strive to meet the needs of the 
        Nation's veterans and their families today and 
        tomorrow. We will become an even more veteran-focused 
        organization, functioning as a single, comprehensive 
        provider of seamless service to the men and women who 
        have served our Nation. We will continuously benchmark 
        the quality and delivery of our service with the best 
        in business and use innovative means and high 
        technology to deliver world-class service. We will 
        foster partnerships with veterans organizations and 
        other stakeholders making them part of the 
        decisionmaking process. We will cultivate a dedicated 
        VA workforce of highly skilled employees who 
        understand, believe in, and take pride in our vitally 
        important mission.

    The veteran population was approximately 24.4 million on 
July 1, 2000. About 76 of every 100 veterans served during 
defined periods of armed hostilities. Altogether, approximately 
70 million veterans, dependents and survivors of deceased 
veterans--more than one-fourth of the nation's population--are 
potentially eligible for VA benefits and services.

                     Veterans Health Administration

    VA's largest and most visible component is its direct 
health care system. The system today has 174 medical centers, 
with at least one in each of the 48 contiguous states, Puerto 
Rico, and the District of Columbia, and with small VA inpatient 
bed complements in Alaska and Hawaii at military treatment 
facilities. In recent years, a concerted effort has been made 
to move veterans health care away from the traditional ``bricks 
and mortar'' approach to health care. Accordingly, only one new 
VA hospital--in West Palm Beach, Florida--has been constructed 
since the mid-1990s.
    In addition to its medical centers, VA now operates 599 
community-based outpatient clinics, with more than 100 new ones 
in various stages of planning. Efforts to streamline and 
simplify care and to revise facility missions accordingly have 
led to integration of a number of medical centers in common 
proximity. Twenty-six ``systems of care'' (several medical 
centers and clinics under one management group) have been 
organized from 54 of these VA medical centers and their 
clinics. With the advent of VA's ``Capital Assets Realignment 
for Enhanced Services'' (CARES) initiative, the Committee 
expects restructuring and reorienting of VA health systems to 
continue unabated, improving veterans' access by making VA more 
convenient to veterans and by promoting more efficient health 
care services.
Medical Care
    In 1999, with less than 25,000 average operating acute 
hospital beds VA treated 662,574 inpatients, 89,217 veterans in 
nursing home care units or in community nursing facilities, and 
21,371 veterans in home and other community care programs. VA's 
outpatient clinics registered nearly 37 million visits by 
veterans in 1999. Altogether, 3.61 million veterans received 
care under VA auspices in 1999.
    Across the nation, VA is currently affiliated with 107 
medical schools, 55 dental schools, and over 1,000 other 
schools offering students allied and associated education 
degrees or certificates in 40 health professions disciplines. 
More than one-half of all practicing physicians in the United 
States receive at least part of their clinical educational 
experiences in the VA health care system. In 1999, 
approximately 90,000 health care professionals received 
training in VA medical centers.
    Since 1979, through its Readjustment Counseling Service, VA 
has operated Vietnam Veteran Outreach Centers (Vet Centers) 
that provide readjustment counseling services to Vietnam-era 
veterans. After the experience of the Persian Gulf War, and 
reflecting on the aftermath of Vietnam, Congress extended 
eligibility for Vet Center counseling to Gulf War veterans and 
to veterans who served during other periods of U.S. armed 
forces action following the Vietnam era, principally in 
Lebanon, Grenada and Panama. Additionally, Public Law 104-262 
expands eligibility for Vet Center counseling to combat 
veterans of conflicts prior to the Vietnam era. However, Public 
Law 106-117 establishes a deadline of January 1, 2004 for non-
theater, Vietnam-era veterans seeking VA readjustment 
counseling.
    Currently, there are 206 Vet Centers nationwide. 
Approximately 1.5 million veterans have visited Vet Centers 
since the program began. Counseling is provided for a variety 
of reasons, including adjustment and employment problems, 
domestic difficulties, and post-traumatic stress disorder 
(PTSD). VA also conducts a variety of specialized programs 
including compensated work therapy to provide veterans with job 
skills and training and rehabilitative residencies to assist 
homeless veterans. Both substance-use disorder rehabilitation 
and PTSD outreach programs continue to be expanded.
    In operating its health care facilities, VA benefits from 
the contributions of time and energy of volunteers from all 
walks of life. More than 104,000 volunteers through VA's 
Voluntary Service donate more than 13 million hours of service 
each year to bring companionship, comfort and concern to 
hospitalized veterans and the millions of veterans who utilize 
VA outpatient clinics.
Medical and Prosthetic Research
    In concert with operating a nationwide health care system, 
VA carries out an extensive array of research targeted to the 
special needs of veterans but relevant as well to defining the 
medical standard of care in general. Among VA's major emphases 
are research into aging, chronic diseases, mental illnesses, 
substance-use disorders, sensory losses, and trauma-related 
illnesses. Its research programs are nationally recognized and 
have made important contributions in virtually every area of 
medicine and health.
    Historically, VA researchers played key roles in innovating 
and improving artificial limbs, eradicating tuberculosis, and 
in developing the cardiac pacemaker, the Computerized 
Tomographic (CT) scanner and magnetic resonance imager (MRI). 
The first kidney transplant in the United States was performed 
at a VA medical facility, and VA researchers pioneered the 
first successful drug treatments for high blood pressure and 
schizophrenia. The ``Seattle Foot'' was created by a VA 
researcher to give below-the-knee amputees the adaptive ability 
to walk, run and even jump. VA contributions to medical 
knowledge have won VA scientists many prestigious awards, 
including six Lasker Awards and three Nobel Prizes.
    Advances by VA researchers in the past two years include 
findings from several major clinical trials. One VA study found 
that colon cancer screening with colonoscopy is more effective 
than the more widely used sigmoidoscopy. Another found that 
raising levels of high-density lipoproteins--so-called ``good 
cholesterol''--lowers the risk of heart disease. Results of 
another VA study may significantly reduce costs of treating 
anemia in patients with kidney failure. A new VA study to be 
conducted with the Department of Defense is testing a cognitive 
behavioral treatment for post-traumatic stress disorder in 
women veterans.
    Also, VA researchers are assessing the prevalence of 
amyotrophic lateral sclerosis (``Lou Gehrig's Disease'') among 
Persian Gulf War veterans. Two other studies underway are 
testing the effectiveness of treatments for fatigue, muscle and 
joint pain, and memory and thinking problems reported by some 
veterans of the Gulf War. VA scientists are also assessing a 
vaccine for shingles, a painful skin infection that occurs in 
over 500,000 Americans each year.
    VA research has led to new strategies for treating chronic 
pain and diabetes. VA scientists discovered new information 
about the area of the brain that controls muscle movement, 
offering hope for spinal cord injury and stroke care. VA 
research has revealed the cause of narcolepsy. Other recent 
advances by VA scientists include the identification of a 
cellular pathway that may serve to help people with liver 
diseases; the discovery of a gene that works as an ``on-off'' 
switch for insulin production; the development of more 
effective AIDS drugs, including an international trial with 
Canadian and British researchers, and the successful use of a 
synthetic hormone to reverse the growth of kidney tumors.

                    Veterans Benefits Administration

    The Veterans Benefits Administration (VBA) is responsible 
for administering and delivering benefits and services to 
eligible veterans and certain survivors and dependents. VBA 
operates 57 regional offices throughout the United States, 
Puerto Rico and the Republic of the Philippines. The regional 
offices have been realigned into nine Service Delivery 
Networks, which manage goals, performance measures, and share 
responsibility for mission accomplishment within their 
geographic area. VBA programs include disability compensation 
and pension, education, life insurance, home loan guaranty, and 
vocational rehabilitation and counseling.
Compensation and Pension
    More than 2.6 million veterans receive disability 
compensation or pension payments from VBA. Some 598,534 
surviving spouses, children and parents of deceased veterans 
are being paid survivor compensation or death pension benefits. 
Their disability and death compensation and pension payments 
were more than $20 billion for fiscal year 2000.
Insurance
    VA operates one of the largest life insurance programs in 
the world and the seventh largest in the United States. VA 
administers seven life insurance programs under which 2.2 
million policies with a value of $23.4 billion remained in 
force at the end of fiscal year 1998. In addition, VA 
supervises the Servicemembers' Group Life Insurance and 
Veterans' Group Life Insurance programs, which provide some 
$465 billion in insurance coverage to approximately 2.7 million 
veterans and members of the uniformed services. The 2000 GI 
life insurance dividend will return almost $712 million to more 
than 1.8 million policyholders.
Education
    Since 1944, when the first GI Bill became law, more than 20 
million beneficiaries have participated in GI Bill education 
and training programs. This includes 7.8 million World War II 
veterans, 2.3 million Korean War veterans, and 8.2 million 
post-Korean and Vietnam era veterans, and active duty 
personnel. Proportionally, Vietnam era veterans were the 
greatest participants in GI Bill training. Approximately 76 
percent of those eligible took training, compared with 50.5 
percent for World War II veterans and 48.4 percent for Korean 
era veterans. The All-Volunteer Force Educational Assistance 
Program provides benefits for veterans, service personnel, and 
members of the Selected Reserve who train under the Montgomery 
GI Bill. In fiscal year 2000, 265,940 veterans, 72,375 service 
personnel and 71,300 reservists received those benefits. Since 
the enactment of the Servicemen's Readjustment Act of 1944, the 
cost of educational benefits has totaled more than $73 billion.
Home Loan Assistance
    VA's loan guaranty program has benefited more than 16 
million veterans and their dependents. From this program's 
establishment as part of the original GI Bill in 1944 through 
the end of fiscal year 1999, VA home loan guaranties totaled 
more than $653 billion. In 2000, VA guaranteed 199,160 loans 
valued at $23.3 billion and assisted 469 disabled veterans with 
grants totaling more than $18.1 million for specially adapted 
housing.
State Cemetery Grants Program
    The Department of Veterans Affairs State Cemetery Grants 
Program (SCGP) was established in 1978 to complement VA's 
National Cemetery Administration. The program assists states in 
providing gravesites for veterans in those areas where VA's 
national cemeteries cannot fully satisfy their burial needs. 
Grants may be used only for the purpose of establishing, 
expanding, or improving veterans cemeteries that are owned and 
operated by a state or U.S. territory. Aid can be granted only 
to states or U.S. territories. VA cannot provide grants to 
private organizations, counties, cities or other government 
agencies.
    During fiscal year 2000, the SCGP awarded seven new grants 
and seven grant increases for a total amount of $20,251,638, a 
record amount for one year. Currently, 27 states and 
territories have been awarded grants through the SCGP. 
Currently, states operate 42 cemeteries that the program has 
assisted.

                    National Cemetery Administration

    Since 1973, when VA assumed responsibility for the National 
Cemetery Administration (NCA), 17 new cemeteries have been 
established. Today the system comprises 119 cemeteries in 39 
states and Puerto Rico. Of these, 61 have available, unassigned 
gravesites for the burial of both casketed and cremated 
remains; 31 will only accept cremated remains and the remains 
of family members for interment in the same gravesite as a 
previously deceased family member; and 27 will only perform 
interments of family members in the same gravesite as a 
previously deceased family member. Additionally, NCA oversees 
33 soldiers' lots, monument sites and confederate cemeteries.
    During the period 1997 to 2000, VA opened five new national 
cemeteries: Tacoma National Cemetery in the Seattle/Tacoma, 
Washington area; Saratoga National Cemetery, near Albany, New 
York; Abraham Lincoln National Cemetery near Chicago, Illinois; 
Dallas-Ft. Worth National Cemetery to serve veterans in north 
and central Texas; and Ohio Western Reserve National Cemetery, 
near Cleveland, Ohio. The opening of five new national 
cemeteries within four years is unprecedented since the Civil 
War.
    In response to section 611(c) of the Veterans Millennium 
Health Care and Benefits Act of 1999, Public Law 106-117, VA is 
continuing to actively pursue the development of new cemeteries 
in those metropolitan areas that are presently not served by a 
national cemetery. VA has identified six areas for the 
establishment of a new national cemetery. These areas are: 
Atlanta, Georgia; Detroit, Michigan; Fort Sill, Oklahoma; 
Miami, Florida; Pittsburgh, Pennsylvania; and Sacramento, 
California.
    As required by the Millennium Act of 1999, an independent 
study will be conducted to identify the other geographic areas 
with the greatest concentration of veterans whose burial needs 
are not served by a national or state veterans cemetery, as 
well as the number of additional cemeteries required through 
2020. Interments in national cemeteries are expected to 
increase from 82,700 in fiscal year 2000 to more than 117,000 
in 2008.
    Since July 30, 1973, total acreage in the National Cemetery 
Administration has increased from 4,139 acres to over 13,000 
acres. The number of occupied graves maintained is projected to 
increase from 2,380,500 in fiscal year 2000 to over 2,998,100 
in 2008. In fiscal year 2000, VA provided over 336,000 
headstones and markers to mark the graves of veterans buried in 
private, state veterans, military/post, and national 
cemeteries.

                          DEPARTMENT OF LABOR

               Veterans' Employment and Training Service

    The Department of Labor (DOL) engages in a variety of 
activities to assist veterans obtain a job or the training and 
other employment development services they need to become 
employable. In accordance with Chapter 41 of title 38, United 
States Code, the highest priority is given to disabled veterans 
and veterans of the Vietnam era.
    The Assistant Secretary for Veterans' Employment and 
Training (ASVET) is the principal advisor to the Secretary of 
Labor regarding DOL policies and programs to meet the 
employment and training needs of veterans, to protect the 
reemployment rights of protected individuals in the uniformed 
services, and to facilitate the transition of military 
servicemembers to the civilian work force. The Office of the 
ASVET, through the Veterans' Employment and Training Service 
(VETS), administers grants to states and local government 
entities primarily to support veterans' employment specialist 
staffing, provides reemployment rights complaint investigation 
and mediation services, formulates and implements interagency 
agreements to ensure the seamless provision of services to 
veterans, provides technical assistance and training to 
veterans services providers' staff, monitors the performance of 
state job service agencies for veterans, conducts pilot 
projects to develop and test new approaches to serving 
veterans, and conducts pilot projects for veterans' hiring by 
public and private sector employers.
    The field staff of the VETS is stationed in a nationwide 
network of regional, state and area offices. There is at least 
one VETS representative in every state and DOL Regional Office 
(Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, 
Kansas City, Denver, San Francisco, and Seattle). Other than 
the regional office staff, most VETS staff are located in state 
job service agency offices.
    The major activities and programs for veterans, Reservists, 
National Guard members, and transitioners conducted by the 
Office of the ASVET are: the Job Service and One Stop Service 
Centers, the Disabled Veterans Outreach Program, the Transition 
Assistance Program, Unemployment Compensation for Ex-
servicemembers, Veterans Affirmative Action, training under the 
Job Training Partnership Act, Reemployment Rights, Veterans' 
Preference and Federal Contractor Non-Compliance Complaints, 
and the National Veterans' Training Institute.

                  AMERICAN BATTLE MONUMENTS COMMISSION

    The American Battle Monuments Commission (ABMC), created by 
an Act of Congress in 1923 (title 36, section 2102, U.S. Code) 
is a federal agency responsible for the construction and 
permanent maintenance of military cemeteries and memorials on 
foreign soil, as well as for certain memorials in the United 
States. Its principal functions are to commemorate, through the 
erection and maintenance of suitable memorial shrines, the 
sacrifices and achievements of the American armed forces where 
they have served since April 6, 1917; to design, construct, 
operate, and maintain permanent American military burial 
grounds and memorials in foreign countries; to control the 
design and construction on foreign soil of U.S. military 
monuments and markers by other U.S. citizens and organizations, 
both public and private; and to encourage U.S. governmental 
agencies and private individuals and organizations to maintain 
adequately the monuments and markers erected by them on foreign 
soils.
    In performance of these functions, ABMC administers, 
operates and maintains 24 permanent American military cemetery 
memorials and 52 monuments, memorials, markers and separate 
chapels in fourteen foreign countries, the Commonwealth of the 
Northern Mariana Islands, Gibraltar, and four memorials in the 
United States. When directed by Congress, the Commission 
develops and erects national military monuments in the United 
States, such as the Korean War Veterans Memorial and the World 
War II Memorial. ABMC also provides information and assistance, 
on request, to relatives and friends of the war dead interred 
or commemorated at its facilities.
    Interred in the cemeteries are 124,914 U.S. war dead--750 
from the Mexican War, 30,921 from World War I, and 93,243 from 
World War II. Additionally, 6,573 American veterans and others 
are interred in the Mexico City and Corozal cemeteries. The 
Mexico City cemetery and those of the World Wars are closed to 
future burials except for the remains of U.S. war dead yet to 
be found in the battle areas of World Wars I and II. In 
addition to burials at the cemeteries overseas, 94,132 U.S. 
servicemembers of the World Wars, Korea, and Vietnam are 
commemorated individually by name on the Tablets of the Missing 
at cemetery memorials and at three memorials on U.S. soil.
        MESSAGES FROM THE PRESIDENT AND EXECUTIVE COMMUNICATIONS

Feb. 2, 1999:

    A letter from the Director, National Legislative 
Commission, the American Legion, transmitting the proceedings 
of the 79th National Convention of the American Legion, held in 
Orlando, Florida from September 2, 3 and 4, 1997 as well as a 
financial statement and independent audit, pursuant to 36 
U.S.C. 49.

Feb. 2, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Additional Disability or Death Due to 
Hospital Care, Medical or Surgical Treatment, Examination, or 
Training and Rehabilitation Services (RIN: 2900-AJ04) Received 
January 11, 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

Feb. 9, 1999:

    A communication from the President of the United States, 
transmitting a report entitled the ``1999 National Drug Control 
Strategy''

Feb. 23, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Board of Veterans' Appeals: Rules of 
Practice Revision of Decisions on Grounds of C1ear and 
Unmistakable Error (RIN: 2900-AJ15) Received January 20, 1999, 
pursuant to 5 U.S.C. 801(a)(1)(A).

Mar. 3, 1999:

    A letter from the Director, Office of Regulations 
Management, Office of General Counsel, Department of Veterans 
Affairs, transmitting the Department's final rule--Board of 
Veterans' Appeals: Rules of Practice--Notification of 
Representatives in Connection with Motions for Revision of 
Decisions on Grounds of Clear and Unmistakable Error (RIN: 
2900-AJ75) Received February 22, 1999, pursuant to 5 U.S.C. 
801(a)(1)(A).

Apr. 19, 1999:

    A letter from the Assistant Secretary of Defense, for 
Health Affairs, Department of Defense, transmitting an annual 
report to Congress on outreach to Gulf War veterans, revision 
of Physical Evaluation Board criteria, and review of records 
and reevaluation of the ratings of previously discharged Gulf 
War veterans.

Apr. 20, 1999:

    A letter from the General Counsel of the Department of 
Defense, transmitting a draft of proposed legislation to 
authorize appropriations for fiscal years 2000 and 2001 for 
military activities of the Department of Defense, to prescribe 
military personnel strengths for fiscal years 2000 and 2001, 
and for other purposes.

May 3, 1999:

    A letter from the Principal Deputy Assistant Secretary for 
Congressional Affairs, Department of Veterans Affairs, 
transmitting a draft of proposed legislation to amend title 38, 
United States Code, to authorize VA to furnish the Department 
of Defense with drug and alcohol treatment resources.

May 10, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Loan Guaranty: Requirements for 
Interest Rate Reduction Refinancing Loans (RIN: 2900-A192) 
Received April 21, 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

May 10, 1999:

    A letter from the Secretary of Labor, transmitting the 
Uniformed Services Employment and Reemployment Rights Act of 
1994 (USERRA) Annual Report to Congress for Fiscal Year 1998.

May 12, 1999:

    A letter from the Principal Deputy Assistant Secretary for 
Congressional Affairs, Department of Veterans Affairs, 
transmitting a draR of proposed legislation to provide a 
temporary authority for the use of voluntary separation 
incentives by the Department of Veterans Affairs to reduce 
employment levels, restructure staff, and for other purposes.

May 13, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Claims and Effective Dates for the 
Award of Educational Assistance (RIN: 2900-AH76) Received May 
4, 1999, pursuant to 5 U.S.C. 801 (a)(1)(A).

May 13, 1999:

    A letter from the Director, Office of Regulations 
Management (02D), Department of Veterans Affairs, transmitting 
the Department's final rule--Estimated Economic Impact Due to 
Implementation of Reasonable Charges--Received April 22, 1999, 
pursuant to 5 U.S.C. 801(a)(1)(A).

June 7, 1999:

    A letter from the Veterans Benefits Administration, 
Veterans Affairs, transmitting the Department's final rule--
Reservists Education: Increase in Educational Assistance Rates 
(RIN: 2900-AJ38) Received May 13, 1999, pursuant to 5 U.S.C. 
801(a)(1)(A).

June 7, 1999:

    A letter from the Secretary of Defense, transmitting a 
report on the results of research conducted and the plan 
addressing the health consequences of military service in the 
Gulf War.

June 8, 1999:

    A letter from the Principal Deputy Assistant Secretary for 
Congressional Affairs, Department of Veterans Affairs, 
transmitting a draft of proposed legislation to amend title 38, 
United States Code, to authorize a cost-of-living adjustment in 
the rates of disability compensation for veterans with service-
connected disabilities and dependency and indemnity 
compensation for survivors of such veterans, to authorize 
payment of these benefits at full rates for certain Filipinos 
who reside in the United States, to make improvements in 
veterans home loan guaranty programs, to make permanent certain 
temporary authorities.

June 14, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Service Connection of Dental Conditions for Treatment Purposes 
(RIN: 2900-AH41) Received June 3, 1999, pursuant to 5 U.S.C 801 
(a)(1)(A).

June 14, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting Department's final rule--
Surviving spouse's benefit for month of veteran's death (RIN: 
2900-AJ64) Received June 3, 1999, pursuant to 5 U.S.C. 
801(a)(1)(A).

June 23, 1999:

    A letter from the Director, Office of Regulations 
Management, National Cemetery Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
National Cemetery Administration; Title Changes (RIN: 2900-
AJ79) Received June 7. 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

June 24, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Schedule for Rating Disabilities; Diseases of the Ear and Other 
Sense Organs (RIN: 2900-AF22) Received May 11, 1999, pursuant 
to 5 U.S.C. 801 (a)(1)(A).

July 12, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--VA Acquisition Regulation: Improper 
Business Practices and Personal Conflicts of Interest and 
Solicitation Provisions and Contract Clauses (RIN: 2900-AJ06) 
Received June 1, 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

July 12, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits, Department of Veterans Affairs, 
transmitting the Department's final rule--Reinstatement of 
Benefits Eligibility Based Upon Terminated Marital 
Relationships (RIN: 2900-AJ53) Received June 7, 1999, pursuant 
to 5 U.S.C. 801 (a)(1)(A).

July 12, 1999:

    A letter from the Secretary of Health and Human Services, 
transmitting a Memorandum which serves as the ``Implementation 
Plan for Veterans Subvention''.

July 19, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Veterans Education: Increase in 
Educational Assistance Rates (RIN: 2900-AJ37) Received June 14, 
1999, pursuant to 5 U.S.C. 801(a)(1)(A).

July 29, 1999:

    A letter from the Secretary of Education, Secretary of 
Veterans Affairs, transmitting a report on the progress of 
developing and implementing procedures for cancellations and 
deferments of federal student loans for eligible disabled 
veterans.

Aug. 3, 1999:

    A letter from the Secretary of Veterans Affairs, 
transmitting a response to the Report of the Congressional 
Commission on Servicemembers and Veterans Transition 
Assistance.

Aug. 4, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Veterans Education: Effective Date for Reducing Educational 
Assistance (RIN: 2900-AJ39) Received July 20, 1999, pursuant to 
5 U.S.C. 801 (a)(1)(A).

Aug. 4, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--VA Acquisition Regulation: Taxes (RIN: 
2900-AJ32) Received July 13, 1999, pursuant to 5 U.S.C. 
801(a)(1)(A).

Aug. 5, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Pension Benefits (RIN: 2900-AJ50) Received June 21, 1999, 
pursuant to 5 U.S.C. 801 (a)(1)(A).

Aug. 5, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Direct Service Connection (Post-traumatic Stress Disorder) 
(RIN: 2900-A197) Received June 21, 1999, pursuant to S U.S.C. 
801(a)(1)(A).

Aug. 5, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--VA Acquisition Regulation: Bonds and 
Insurance (RIN: 2900-AJ47) Received July 27, 1999, pursuant to 
5 U.S.C. 801 (a)(1)(A).

Aug. 5, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Schedule for Rating Disabilities; Fibromyalgia (RIN: 2900-AH05) 
Received June 17, 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 8, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Health Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Reconsideration of Denied Claims (RIN: 2900-AJ03) Received 
August 16, 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 8, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Veterans Education: Increased Allowances for the Educational 
Assistance Test Program (RIN: 2900-AJ40) Received August 16, 
1999, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 13, 1999:

    A letter from the Director, Office of Regulations 
Management, Office of General Counsel, Department of Veterans 
Affairs, transmitting the Department's final rule--Delegations 
of Authority; Tort Claims (RIN: 2900-AJ31) Received September 
3, 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 29, 1999:

    A letter from the Secretary of Labor, transmitting the 
Secretary's annual report on employment and training programs, 
pursuant to 29 U.S.C. 1579(d).

Sept. 29, 1999:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Veterans Education: Montgomery GI 
Bill--Active Duty; Administrative Error (RIN: 2900-AJ70) 
Received September 24, 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

Oct. 1, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Advance Payments and Lump-Sum Payments of Educational 
Assistance; Miscellaneous Nonsubstantive Changes (RIN: 2900-
A131) Received September 28, 1999, pursuant to 5 U.S.C. 
801(a)(1)(A).

Oct. 6, 1999:

    A letter from the Principal Deputy Assistant Secretary for 
Congressional Affairs, Department of Veterans Affairs, 
transmitting a draft bill to authorize major facility projects 
and lease programs for Fiscal Year 2000.

Oct. 12, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Health Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Enrollment-Provision of Hospital and Outpatient Care to 
Veterans (RIN: 2900-AJ18) Received October 6, 1999, pursuant to 
5 U.S.C. 801(a)(1)(A).

Oct. 12, 1999:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Returned and Canceled Checks (RIN: 2900-AJ61) Received October 
6, 1999, pursuant to 5 U.S.C. 801(a)(1)(A).

Oct. 18, 1999:

    A letter from the Health Affairs, Assistant Secretary of 
Defense, transmitting a report regarding the appropriate health 
care for Gulf War veterans who suffer from a Gulf War illness.

Oct. 20, 1999:

    A letter from the Principal Deputy Assistant Secretary for 
Congressional Affairs, Department of Veterans Affairs, 
transmitting a draft of proposed legislation entitled, 
``Veterans Programs Improvement Act of 1999''.

Jan. 27, 2000:

    A letter from the the Executive Secretary, the Disabled 
American Veterans, transmitting the 1999 National Convention 
proceedings of the Disabled American Veterans, pursuant to 36 
U.S.C. 90i and 44 U.S.C. 1332.

Jan. 27, 2000:

    A letter from the Director, Office of Regulations 
Management, Veterans Health Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--Per 
Diem for Nursing Home Care of Veterans in State Homes (RIN: 
2900-AE87) Received January 3, 2000, pursuant to 5 U.S.C. 
801(a)(1)(A).

Jan. 27, 2000:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--VA Acquisition Regulation: Simplified 
Acquisition Procedures (RIN: 2900-AJ16) Received December 13, 
1999, pursuant to 5 U.S.C. 801 (a)(1)(A).

Jan. 27, 2000:

    A letter from the Director, Office of Regulations 
Management, Board of Veterans' Appeals, Department of Veterans 
Affairs, transmitting the Department's final rule--Rules of 
Practice: Title Change (RIN: 2900-AJ57) Received January 7, 
2000, pursuant to 5 U.S.C. 801(a)(1)(A).

Feb. 1, 2000:

    A letter from the The American Legion, transmitting the 
proceedings of the 81st National Convention of the American 
Legion, held in Anaheim, California from September 7, 8 and 9, 
1999 as well as a report on the Organization's activities for 
the year preceding the Convention, pursuant to 36 U.S.C. 49.

Feb. 14, 2000:

    A letter from the Director, Office of Regulations 
Management, Board of Veterans' Appeals, Department of Veterans 
Affairs, transmitting the Department's final rule--Board of 
Veterans' Appeals: Rules of Practice--Revision of Decisions on 
Grounds of Clear and Unmistakeable Error; Clarification (RIN: 
2900-AJ98) Received January 5, 2000, pursuant to 5 U.S.C. 801 
(a)(1)(A).

Feb. 29, 2000:

    A letter from the Secretaries of Defense and Veterans 
Affairs, Departments of Defense and Veterans Affairs, 
transmitting a report on the implementation of the health 
resources sharing portion of the ``Department of Veterans 
Affairs and Department of Defense Health Resources Sharing and 
Emergency Operations Act''. pursuant to 38 U.S.C. 8111(f).

Feb. 29, 2000:

    A letter from the Secretary of Veterans Affairs and 
Secretary of Defense, transmitting the report for Fiscal Year 
1998 regarding the implementation of the health resources 
sharing portion of the ``Department of Veterans Affairs and 
Department of Defense Health Resources Sharing and Emergency 
Operations Act''.

Mar. 13, 2000:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
National Service Life Insurance (RIN: 2900-AJ78) Received 
February 14, 2000, pursuant to 5 U.S.C. 801 (a)(1)(A).

Mar. 14, 2000:

    A letter from the Secretary of Veterans Affairs, 
transmitting the FY 1998 annual report, pursuant to 31 U.S.C. 
3512(c)(3).

Mar. 15, 2000:

    A letter from the Director, Office of Personnel Management, 
transmitting the annual report on employment and training 
programs for veterans during program year 1998 (October 1, 1997 
through September 1, 1998), pursuant to 38 U.S.C. 2009(b).

Mar. 20, 2000:

    A letter from the Acting General Counsel, Department of 
Defense, transmitting a proposal of draft legislation, ``To 
authorize appropriations for fiscal year 2001 for military 
activities of the Department of Defense, to prescribe military 
personnel strengths for fiscal year 2001, and for other 
purposes.''.

Mar. 21, 2000:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--DIC Benefits for Survivors of Certain 
Veterans Rated Totally Disabled at Death (RIN: 2900-AJ65) 
Received January 2O, 200O, pursuant to 5 U.S.C. 801(a)(1)(A).

Mar. 28, 2000:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Child; Educational Institution (RIN: 
2900-AJ54) Received March 6, 2000, pursuant to 5 U.S.C. 801 
(a)(1)(A).

Apr. 4, 2000:

    A letter from the Under Secretary, Personnel and Readiness, 
Department of Defense, transmitting the response to the Report 
of the Congressional Commission on Servicemembers and Veterans 
Transitions Assistance.

Apr. 4, 2000:

    A letter from the Secretary of Defense, transmitting the 
report entitled, ``Outreach to Gulf War Veterans''.

Apr. 6, 2000:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Eligibility Criteria for the Montgomery GI Bill--Active Duty 
and Other Miscellaneous Issues (RIN: 2900-A163) Received 
February 8, 2000, pursuant to 5 U.S.C. 801(a)(1)(A).

Apr. 12, 2000:

    A letter from the Assistant Secretary for Planning and 
Analysis, Department of Veterans Affairs, transmitting a draft 
bill entitled, ``Veterans' Compensation Cost-of-Living 
Adjustment Act of 2000''.

May 2, 2000:

    A letter from the Director, Office of Management and 
Budget, Department of Veterans Affairs, transmitting the 
Department's final rule--Appeals Regulations and Rules of 
Practice--Case Docketing (RIN: 2900-AJ72) Received March 16, 
2000, pursuant to 5 U.S.C. 801(a)(1)(A).

May 2, 2000:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Veterans Education: Increased Allowances for the Educational 
Assistance Test Program (RIN: 2900-AJ87) Received March 16, 
2000, pursuant to 5 U.S.C. 801(a)(1)(A).

May 2, 2000:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Eligibility Reporting Requirements (RIN: 2900-AJ09) Received 
March 24, 2000, pursuant to 5 U.S.C. 801(a)(1)(A).

May 4, 2000:

    A letter from the Director, Veterans Benefits 
Administration, Department of Veterans Affairs, transmitting 
the Department's final rule--Criteria for Approving Flight 
Courses for Educational Assistance Programs (RIN: 2900-A176) 
Received March 7, 200O, pursuant to 5 U.S.C. 801 (a)(1)(A).

May 17, 2000:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Modified Eligibility Criteria for the Montgomery G.I. Bill--
Active Duty (RIN: 2900-AJ69) Received April 17, 200O, pursuant 
to 5 U.S.C. 801 (a)(1)(A).

May 18, 2000:

    A letter from the the Legislative Special Assistant, the 
Veterans of Foreign Wars of the U.S., transmitting proceedings 
of the 100th National Convention of the Veterans of Foreign 
Wars of the United States, held in Kansas City, Missouri, 
August 15-2O, 1999, pursuant to 36 U.S.C. 118 and 44 U.S.C. 
1332.

May 23, 2000:

    A letter from the the Legislative Special Assistant, the 
Veterans of Foreign Wars of the U.S., transmitting proceedings 
of the 99th National Convention of the Veterans of Foreign Wars 
of the United States, held in San Antonio, Texas, August 29-
September 4, 199B, pursuant to 36 U.S.C. 118 and 44 U.S.C. 
1332.

May 25, 2000:

    A letter from the Assistant Secretary for Planning and 
Analysis, Department of Veterans Affairs, transmitting a draft 
bill to amend title 38, United States Code, to designate 
members of the Board of Veterans' Appeals (Board) as veterans 
law judges and to clarify the beginning of the period in which 
Board decisions can be appealed to the United States Court of 
Appeals for Veterans Claims (Court).

June 6, 2000:

    A letter from the Secretary of Labor, transmitting a report 
entitled, ``Uniformed Services Employment and Reemployment 
Rights Act of 1994 (USERA) Annual Report to Congress For Fiscal 
Year 1999''.

June 28, 2000:

    A letter from the Assistant Secretary for Planning and 
Analysis, Department of Veterans Affairs, transmitting the 
Fiscal Year 2000 Veterans Equitable Resource Allocation (VERA).

July 11, 2000:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Children suffering from Spina Bifida 
who are Children of Vietnam Veterans (RIN: 2900-AJ25) Received 
June 2, 2000, pursuant to 5 U.S.C. 801 (a)(1)(A).

July 11, 2000:

    A letter from the Assistant Secretary for Planning and 
Analysis, Department of Veterans Affairs, transmitting a draft 
bill, ``To amend chapter 37 of title 38, United States Code, to 
extend the program for making direct housing loans to Native 
American Veterans, to repeal little-used loan authorities, to 
make technical amendments to the guaranteed housing loan 
program for veterans. and for other purposes''.

July 11, 2000:

    A letter from the Assistant Secretary for Planning and 
Analysis, Department of Veterans Affairs, transmitting a draft 
bill, ``To authorize major medical facility projects for the 
Department of Veterans Affairs for Fiscal Year 2001 and for 
other purposes''.

July 11, 2000:

    A letter from the Assistant Secretary for Planning and 
Analysis, Department of Veterans Affairs, transmitting a draft 
bill entitled, ``Enhanced Veterans' Education Benefits Act of 
2000''.

July 19, 2000:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--The Veterans Millennium Health Care 
and Benefits Act (RIN: 2900-AK04) Received July 7, 2000, 
pursuant to 5 U.S.C. 801(a)(1)(A).

July 24, 2000:

    A letter from the Secretary of Veterans Affairs, 
transmitting a report covering the disposition of cases granted 
relief from administrative error, overpayment and forfeiture by 
the Administrator in 1999, pursuant to 38 U.S.C. 210(c)(3)(B).

July 25, 2000:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Increase in Rates Payable Under the 
Montgomery GI Bill--Active Duty (RIN: 2900-AJ89) Received July 
19, 2000, pursuant to 5 U.S.C. 801(a)(1)(A).

July 25, 2000:

    A letter from the Commissioner of Social Security, 
transmitting a draft bill to make amendments to the 
Supplemental Security Income (SSI) program in support of the 
President's fiscal year 2001 budget with respect to the Social 
Security Administration.

Sept. 6, 2000:

    A letter from the Secretary of Labor, transmitting the 
annual report on employment and training programs for veterans 
during program year 1998 (July 1, 1998 through June 30, 1998) 
and fiscal year 1999 (October 1, 1998 through September 30, 
1999), pursuant to 38 U.S.C. 2009(b).

Sept. 6, 2000:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Veterans Training: Vocational Rehabilitation Subsistence 
Allowance Rates (RIN: 2900-A174) Received August 23, 2000, 
pursuant to 5 U.S.C. 801 (a)(1)(A).

Sept. 14, 2000:

    A letter from the Director, Office of Regulations 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Increase in Rates Payable Under the Montgomery GI Bill--Active 
Duty (RIN: 2900-Al89) Received September 8, 2000, pursuant to 5 
U.S.C. 801(a)(1)(A).

Sept. 18, 2000:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Appeals Regulations: Title for Members 
of the Board of Veterans' Appeals (RIN: 2900-AK14) Received 
September 11, 2000, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 19, 2000:

    A letter from the Director, Office of Regulations 
Management, Department of Veterans Affairs, transmitting the 
Department's final rule--Cash Values for National Service Life 
Insurance (NSLI) and Veterans Special Life Insurance Term-
Capped Policies (RIN: 2900-AJ35) Received September 11, 2000, 
pursuant to 5 U.S.C. 801(a)(1)(A).

                                                                          SUMMARY OF VETERANS' AFFAIRS COMMITTEE ACTION
                                                           BILLS AND RESOLUTIONS REFERRED AND HEARINGS / EXECUTIVE SESSIONS CONDUCTED
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                 Congress
                                         -------------------------------------------------------------------------------------------------------------------------------------------------------
                                           88th    89th    90th    91st     92d     93d    94th    95th    96th    97th    98th    99th    100th   101st   102d    103d    104th   105th   106th
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bills and resolutions referred..........     508     791     685     740     693     839     719     709     339     273     229     198     147     194     215     174     128     134     147
Hearing sessions........................      50      71      46      43      37      44      58      72      84      89      71      76      44      72      67      71      39      56      65
Meetings and mark-up sessions...........      21      32      13      27      21      16      30      26      19      18      16      20      16      26      20      23      19      18      13
Bills reported..........................      41      47  \8\ 19      34      26  \9\ 14      23      32      11      16      15      17      14      33      21      25      15      15      10
Bills in House..........................   \5\ 5   \6\ 4       4       1       4       1  ......       1       1       1       3       3       1       4       3      11  ......  ......       1
Pending in Senate committees............       7  \7\ 12       3       9       7       2  \10\ 9      17       3       6       6       8       9      23       7      11      10       1       1
Bills on Senate Calendar or in Senate...  ......       1  ......  ......  ......  ......  ......       1       1       1  ......       1       3       1       3       3  ......  ......  ......
Recommitted.............................  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......
Bills vetoed............................  ......  ......  ......  ......       2       1  ......  ......       1  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......
Bills passed over veto..................  ......  ......  ......  ......  ......       1  ......  ......       1  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......
Laws enacted............................      29      30      15      24      15      15      15      13       6       8       8       6       4       8      24      15       6       6      10
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Including 4 bills enacted as amendment in other legislation; 1 left in House when similar Senate bill returned to Senate; and 1 similar to another bill enacted (Public Law 87-645).
\2\ Includes 2 bills enacted as amendments to other bills.
\3\ Includes 1 bill enacted as amendment to another bill.
\4\ Some laws include the substance of more than 1 bill reported separately. 39 separately reported bills were enacted, 7 as amendments to other legislation.
\5\ Provisions of 3 of these bills were passed by the House as separate bills, and the provisions of 1 bill were included as an amendment to another bill which became public law.
\6\ \7\ One bill in a Senate committee had purpose accomplished administratively; 5 other were enacted as sections of another bill; and portions of 1 bill left in the House were enacted as
  part of another bill.
\8\ Includes S.J. Res. 197 making technical correction to law, which was brought to House floor for immediate consideration and passage by unanimous consent.
\9\ The difference in number of bills reported (14) and laws enacted (15) is due to the fact that S. 3705 did not go to the House Committee. However, the subject matter was included in H.R.
  12628.
\10\ Includes H.R. 9576 subject matter of which was contained in S. 969, passed in lieu.

                    HEARINGS AND EXECUTIVE SESSIONS

    (All hearings and executive sessions of the Committee are 
held in the Committee hearing room, Room 334, Cannon House 
Office Building unless otherwise designated.)

    February 3, 1999. OPEN. 4:00 p.m. Full Committee. Meeting. 
Organizational and Oversight Plan.

    February 11, 1999. OPEN. 9:30 a.m. Full Committee. Hearing. 
Department of Veterans Affairs Budget Request for Fiscal Year 
2000. (Serial No. 106-1)

    February 23, 1999. OPEN. 11:00 a.m. Full Committee. 
Hearing. To Receive the Report of the Congressional Commission 
on Servicemembers and Veterans Transition Assistance. (Serial 
No. 106-2)

    February 24, 1999. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. VA Medical Care Budget for FY 2000. (Serial No. 106-3)

    February 24, 1999. OPEN. 10:00 a.m. Subcommittee on 
Benefits. Hearing. Fiscal Year 2000 Budget for the Department 
of Labor Veterans' Employment and Training Service (VETS). 
(Serial No. 106-4)

    February 25, 1999. OPEN. 9:30 a.m. House and Senate 
Veterans' Affairs Committees. Joint Hearing. Room 345 Cannon 
HOB. The 1999 legislative priorities of the Military Order of 
the Purple Heart, Fleet Reserve Association, The Retired 
Enlisted Association, Gold Star Wives of America and Air Force 
Sergeants Association.

    March 2, 1999. OPEN. 9:30 a.m. House and Senate Veterans' 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
1999 legislative priorities of the Veterans of Foreign Wars.

    March 4, 1999. OPEN. 9:30 a.m. House and Senate Veterans' 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
1999 legislative priorities of the Veterans of World War 1, 
Jewish War Veterans, Paralyzed Veterans of America, Blinded 
Veterans Association and Non Commissioned Officers Association.

    March 10, 1999. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. VHA Capital Asset Management. (Serial No. 106-5)

    March 11, 1999. OPEN. 1:30 p.m. Full Committee. Meeting. 
Approve the Committee's View and Estimates of the 
Administration's Fiscal Year 2000 Budget.

    March 11, 1999. OPEN. 9:30 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Whistleblowing and Retaliation in 
the Department of Veterans Affairs. (Serial No. 106-6)

    March 17, 1999. OPEN. 10:00 a.m. House and Senate Veterans' 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
1999 legislative priorities of the Disabled American Veterans.

    March 18, 1999. OPEN. 2:30 p.m. Full Committee. Markup. 
H.R. 70.

    March 24, 1999. OPEN. 10:00 a.m. House and Senate Veterans' 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
1999 legislative priorities of the AMVETS, American ExPrisoners 
of War, Vietnam Veterans of America and The Retired Officers 
Association.

    March 25, 1999. OPEN. 9:30 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Management of the Federal 
Employees' Compensation Act Program at the Department of 
Veterans Affairs. (Serial No. 106-7)

    March 25, 1999. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Hearing. Room 340 Cannon HOB. Oversight on the Veterans 
Benefits Administration. (Serial No. 106-8)

    April 15, 1999. OPEN. 9:30 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Department of Veterans Affairs 
Year 2000 (Y2K) Readiness. (Serial No. 106-9)

    April 21, 1999. OPEN. 10:00 a.m. Subcommittee on Oversight 
and investigations and Subcommittee on Health. Joint Hearing. 
Suspension of Medical Research at West Los Angeles and 
Sepulveda VA Medical Facilities and Informed Consent and 
Patient Safety in VA Medical Research. (Serial No. 106-10)

    April 21 and May 20, 1999. OPEN. 10:00 a.m. Subcommittee on 
Benefits. Hearing. Room 340 Cannon HOB. H.R. 1071, the 
Montgomery GI Bill Improvements Act of 1999, and H.R. 1182, the 
Servicemembers Educational Opportunity Act of 1999. (Serial No. 
106-11)

    April 22, 1999. OPEN. 9:30 a.m. Subcommittee on Health. 
Hearing. VA Long-Term Care. (Serial No. 106-12)

    May 19, 1999. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. Veterans' Millennium Health Care Act. (Serial No. 106-
13)

    May 20, 1999. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Room 340 Cannon HOB. National and 
State Veterans' Cemeteries. (Serial No. 106-14)

    June 9, 1999. OPEN. 10:00 a.m. Subcommittee on Health. 
Markup. Draft Veterans' Millennium Health Care Act.

    June 10, 1999. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Hearing. H.R. 605, Court of Appeals for Veterans Claims Act of 
1999; H.R. 690, Relating to Bronchiolo-alveolar Carcinoma; H.R. 
708, Surviving Spouses Benefit Restoration Act; H.R. 784, 
Regarding Dependency and Indemnity Compensation for Surviving 
Spouses of Certain Former Prisoners of War; H.R. 1214, 
Veterans' Claims Adjudication Improvement Act of 1999; and H.R. 
1765, Veterans' Compensation Cost-of-Living Adjustment Act of 
1999. (Serial No. 106-15)

    June 16, 1999. OPEN. 10:30 a.m. Subcommittee on Benefits. 
Hearing. H.R. 1247, the World War 11 Memorial; H.R.1476, the 
National Cemetery Act of 1999; H.R. 1484, Authorization of 
Appropriations for Homeless Veterans Projects; H.R. 1603, the 
Selected Reserve Housing Loan Fairness Act of 1999; H.R. 1663, 
the Medal of Honor Memorial Act; and H.R. 2040, the Veterans' 
Cemetery Assessment Act of 1999. (Serial No. 106-16)

    June 17, 1999. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Markup. Draft Veterans Benefits improvement Act of 1999.

    June 23, 1999. OPEN. 10:00 a.m. Full Committee. Markup. 
H.R. 2116, H.R. 2280 and H.J. Res. 34.

    June 24, 1999. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Effectiveness of Federal Homeless 
Veterans Programs. (Serial No. 106-17)

    June 30, 1999. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. Cost Estimates for H.R. 2116, the Veterans' Millennium 
Health Care Act. (Serial No. 106-18)

    July 15, 1999. OPEN. 9:30 a.m. Subcommittee on Health. 
Hearing. VA's Experience in Implementing Patient Enrollment 
Under Public Law 104-262. (Serial No. 106-19)

    July 15, 1999. OPEN. 1:00 p.m. Full Committee. Markup. H.R. 
2116.

    July 22, 1999. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. VA's Capital Assets Realignment 
Plan for Enhancing Services to Veterans. (Serial No. 106-20)

    July 29, 1999. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Effectiveness and Strategic 
Planning of Veterans' Employment and Training Service Program. 
(Serial No. 106-21)

    September 9, 1999. OPEN. 10:00 a.m. Subcommittee on 
Benefits. Hearing. Veterans' Employment regarding Civilian 
Gedentialing Requirements for Military Job Skills. (Serial No. 
106-22)

    September 22, 1999. OPEN. 10:00 a.m. Full Committee. 
Markup. H.J. Res. 65 and H.R. 1663.

    September 23, 1999. OPEN. 10:00 a.m. Subcommittee on 
Oversight and Investigations. Hearing. VA Financial Management: 
Reducing Fraud and Increasing Collections. (Serial No. 106-23)

    September 28, 1999. OPEN. 9:30 a.m. House and Senate 
Veterans Affairs Committees. Joint Hearing. Room 345 Cannon 
HOB. The 1999 legislative priorities of The American Legion.

    September 30, 1999. OPEN. 10:00 a.m. Subcommittee on Over 
sight and Investigations. Hearing. Department of Veterans 
Affairs Office of Resolution Management and the Office of 
Employment Discrimination Complaint Adjudication. (Serial No. 
106-24)

    October 26, 1999. OPEN. 10:00 a.m. Subcommittee on Benefits 
Hearing. Persian Gulf War Veterans Issues. (Serial No 106-25)

    October 28, 1999. OPEN. 9:00 a.m. Subcommittee on Benefits. 
Hearing. Draft Legislative Concepts for 21st Century Veterans' 
Employment and Training Legislation, H.R. 364, Draft 
Legislative Concepts for Miscellaneous VA Education Programs, 
and H.R. 625. (Serial No. 106-26)

    October 28, 1999. OPEN. 10:00 a.m. Subcommittee on 
Oversight and Investigations. Hearing. Hearing V on Year 2000 
Readiness in the Department of Veterans Affairs. (Serial No. 
106-27)

    November 16, 1999. OPEN. 2:00 p.m. Subcommittee on Health 
and Subcommittee on Oversight and Investigations. Joint 
Hearing. Possible Health Effects of Pyridostigmine Bromide on 
Persian Gulf War Veterans. (Serial No. 106-28)

    February 9, 2000. OPEN. 10:20 a.m. Subcommittee on Health 
and Subcommittee on Health and the Environment and Subcommittee 
on Oversight and Investigations, Committee on Commerce. Joint 
Hearing. Room 2123 Rayburn HOB. Medical Errors: Improving 
Quality of Care and Consumer Information. (Serial No. 106-29)

    February 17, 2000. OPEN. 9:30 a.m. Full Committee. Hearing. 
The Department of Veterans Affairs Budget Request for Fiscal 
Year 2001. (Serial No. 106-30)

    March 1, 2000. OPEN. 10:00 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
2000 legislative priorities of the Disabled American Veterans.

    March 2, 2000. OPEN. 10:00 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
2000 legislative priorities of the Non Commissioned Officers 
Association, Jewish War Veterans, Paralyzed Veterans of 
America, and Blinded Veterans Association.

    March 7, 2000. OPEN. 9:30 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
2000 legislative priorities of The Retired Enlisted 
Association, Gold Star Wives of America, Military Order of the 
Purple Heart, Air Force Sergeants Association and Fleet Reserve 
Association.

    March 9, 2000. OPEN. 10:00 a.m. Subcommittee on Benefits 
and Subcommittee on Health. Joint Hearing. Room 345 Cannon HOB. 
Homeless Veterans' Issues. (Serial No. 106-31)

    March 14, 2000. OPEN. 10:00 a.m. Subcommittee on Benefits 
and Subcommittee on Government Programs and Oversight, 
Committee on Small Business. Hearing. B363 Rayburn HOB. 
Implementation of Public Law 106-50, the Veterans 
Entrepreneurship and Small Business Development Act of 1999.

    March 15, 2000. OPEN. 10:00 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
2000 legislative priorities of the Veterans of Foreign Wars.

    March 16, 2000. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Department of Veterans Affairs 
Loan Guaranty Service. (Serial No. 106-33)

    March 22, 2000. OPEN. 10:00 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
2000 legislative priorities of the National Association of 
State Directors of Veterans Affairs, the Vietnam Veterans of 
America, The Retired Officers Association, American ExPrisoners 
of War and AMVETS.

    March 23, 2000. OPEN. 9:30 a.m. Subcommittee on Benefits. 
Hearing. Well-Grounded Claims and H.R. 3193, the Duty to Assist 
Veterans Act of 1999. (Serial No. 106-34)

    April 5, 2000. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. VA Capital Asset Planning. (Serial No. 106-35)

    April 12, 2000. OPEN. 10:00 a.m. Subcommittee on health. 
Hearing. The Status of Recruitment, Retention and Compensation 
of the VA Health Care Workforce. (Serial No. 106-36)

    April 13, 2000. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Hearing. VA Adjudication of Hepatitis C Claims, and H.R. 1020, 
H.R. 3816, H.R. 3998 and H.R. 4131. (Serial No. 106-37)

    May 11, 2000. OPEN. 10:00 a.m. Full Committee. Markup. H.R. 
4268, Veterans and Dependents Millennium Education Act.

    May 11, 2000. OPEN. 11:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Department of Veterans Affairs 
Information Technology Program. (Serial No. 106-38)

    May 17, 2000. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. Department of Veterans Affairs/Department of Defense 
Health Care Sharing. (Serial No. 106-39)

    May 18, 2000. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Department of Veterans Affairs 
Disability Claims Processing. (Serial No. 106-40)

    May 25, 2000. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Joint Procurement of 
Pharmaceuticals by the Department of Veterans Affairs and the 
Department of Defense.

    June 1, 2000. OPEN. 10:00 a.m. Marion, Indiana. 
Subcommittee on Oversight and Investigations. Field Hearing. 
Hearing on Quality of Care, Patient and Employee Safety, and 
Management Effectiveness at the Marion VA Medical Center.

    June 8, 2000. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Women Veterans Issues.

    July 12, 2000. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Hearing. H.R. 4765, the 21st Century Veterans Employment and 
Training Act and H.R. 3256, Veterans' Right to Know Act.

    July 13, 2000. OPEN. 9:00 a.m. Subcommittee on Benefits. 
Hearing. H.R. 4765, 21st Century Veterans Employment and 
Training Act and H.R. 3256, Veterans' Right to Know Act.

    July 18, 2000. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Markup. H.R. 4850, Veterans Benefits Act of 2000; and H.R. 
4864, Veterans Claims Assistance Act of 2000.

    July 20, 2000. OPEN. 10:00 a.m. Full Committee. Markup. 
H.R. 4850, Veterans Benefits Act of 2000; and H.R. 4864, 
Veterans Claims Assistance Act of 2000.

    July 25, 2000. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. VA Pharmaceutical Procurement Policy.

    July 27, 2000. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Patient Safety and Quality 
Management in the Department of Veterans Affairs.

    September 7, 2000. OPEN. 10:00 a.m. Subcommittee on Health. 
Markup. H.R. 5109, Department of Veterans Affairs Health Care 
Personnel Act of 2000.

    September 13, 2000. OPEN. 10:30 a.m. Full Committee Markup. 
H.R. 5109, Department of Veterans Affairs Health Care Personnel 
Act of 2000.

    September 21, 2000. OPEN. 10:00 a.m. Subcommittee on 
Oversight and Investigations. Hearing. Follow-up Hearing on 
VA's Information Technology Program.

    September 26, 2000. OPEN. 9:30 a.m. House and Senate 
Veterans Affairs Committees. Joint Hearing. Room 345 Cannon 
HOB. The 2000 legislative priorities of The American Legion.

    September 27, 2000. OPEN. 10:00 a.m. Subcommittee on 
Oversight and Investigations. Hearing. 340 Cannon. Hearing on 
Veterans Employment and Training Service (VETS) Program 
Effectiveness and Strategic Planning.

    September 27, 2000. OPEN. 10:00 a.m. Subcommittee on 
Benefits. Hearing. Hearing on Licensing and Credentialing of 
Military Job Skills for Civilian Employment.

    September 28, 2000. OPEN. 10:00 a.m. Subcommittee on 
Oversight and Investigations. Hearing on Human Subjects 
Protections in VA Medical Research.

    October 3, 2000. OPEN. 9:30 a.m. Subcommittee on Health. 
Hearing on Chiropractic Services in the VA.
                      LEGISLATION ENACTED INTO LAW


                           Public Law 106-83


                        (H.R. 1663, AS AMENDED)

    Title: A Act to recognize National Medal of Honor sites in 
California, Indiana, and South Carolina.
    Summary: H.R. 1663, as amended, would:
    1. Recognize the following sites to honor recipients of 
the Medal of Honor as National Medal of Honor sites: (1) 
Riverside California--The memorial under construction at the 
Riverside National Cemetery in Riverside, California, to be 
dedicated on November 5, 1999; (2) Indianapolis, Indiana.--The 
memorial at the White River State Park in Indianapolis, 
Indiana, dedicated on May 28, 1999; (3) Mount Pleasant, South 
Carolina.--The Congressional Medal of Honor Museum at Patriots 
Point in Mount Pleasant, South Carolina, currently situated on 
the ex-U.S.S. Yorktown (CV-6).
    Effective date: Date of enactment.
    Cost: The Congressional Budget Office estimates that the 
cost of H.R. 1663 would have no effect on the federal budget 
and would not affect direct spending or receipts. H.R. 1663 
contains no intergovernmental or private-sector mandates as 
defined in the Unfunded Mandates Reform Act of 1995 and would 
not affect the budget of state, local, or tribal government. 
Any costs to state or local governments as a result of 
enactment of this bill would be incurred voluntarily.
    Legislative history
    Sep. 22, 1999: H.R.1663 ordered reported amended favorably 
by the Committee on Veterans' Affairs.
    Sep. 30, 1999: H.R.1663 reported amended by Committee on 
Veterans' Affairs. H.Rept. 106-351.
    Oct. 5,  1999: Passed the House amended under suspension by 
vote of 424-0 (Roll No. 474).
    Oct. 6,  1999: Referred to the Senate Committee on Armed 
Services.
    Oct. 20, 1999: Passed the Senate by unanimous consent.
    Oct. 28, 1999: Signed by the President, Public Law 106-83.
                                ------                                


                           Public Law 106-117


            VETERANS MILLENNIUM HEALTH CARE AND BENEFITS ACT

                        (H.R. 2116, AS AMENDED)

    Title: An Act to amend title 38, United States Code, to 
establish a program of extended care services for veterans, to 
make other improvements in health care programs of the 
Department of Veterans Affairs, to enhance compensation, 
memorial affairs, and housing programs of the Department of 
Veterans Affairs, to improve retirement authorities applicable 
to judges of the United States Court of Appeals for Veterans 
Claims, and for other purposes.
    Summary: H.R. 2116, as amended, would provide for the 
following:

                        Title I - Access to Care


                      Subtitle A -- Long-term Care

    1. Require the Secretary of Veterans Affairs to operate 
and maintain extended care programs, to include geriatric 
evaluations, VA and community-based nursing home care, 
domiciliary care, adult day health care, respite care, and such 
alternatives to institutional care as the Secretary considers 
reasonable and appropriate.
    2. Require the Secretary of Veterans Affairs to maintain 
nationally the level of ``in-house'' extended care services 
provided as of September 30, 1998.
    3. Require the Secretary of Veterans Affairs, through 
2003, to provide: (a) needed nursing home care for veterans who 
are 70 percent service-connected or in need of such care for a 
service-connected condition; and (b) veterans who are enrolled 
for VA care with alternatives to institutionalized care.
    4. Require the Secretary of Veterans Affairs to establish 
a copayment policy applicable to extended care of more than 21 
days in a year in the case of care furnished to a veteran who 
has no compensable service-connected disability, and whose 
income is above the pension level.
    5. Require establishment of a revolving fund in the 
Treasury in which to deposit copayments to be used to expand 
extended care services.
    6. Lift the six-month limit on VA providing adult day 
health care, and authorize VA to furnish respite care services 
under contract in veterans' homes or in any other setting.
    7. Authorize VA to expand the scope of the State home 
program to encompass all extended care services.
    8. Require the Secretary of Veterans Affairs to conduct 
pilot programs to determine the effectiveness of different 
models of providing all-inclusive care to reduce the need for 
institutionalizing patients.
    9. Establish a pilot program, that would authorize the 
Secretary of Veterans Affairs to provide assisted living 
services through contract arrangements.

               Subtitle B -- Other Access-to-care Matters

    1. Authorize the Secretary of Veterans Affairs to make 
payments for emergency care on behalf of uninsured enrolled 
veterans and require that a veteran has received VA care within 
a two-year period of a medical emergency to be eligible.
    2. Establish a specific eligibility for VA health care 
for a veteran who was awarded the Purple Heart.
    3. Establish a specific eligibility, subject to the terms 
of a memorandum of understanding between the Department of 
Defense and Department of Veterans Affairs, for a veteran who 
has retired from military service, is eligible for care under 
the TRICARE program, and is not otherwise eligible for priority 
VA care.
    4. Lift the restriction in law on VA's treating (under 
appropriate reimbursement arrangements) military members for 
substance-use disorders other than during the last 30 days of 
the member's period of service.
    5. Require the Secretary of Veterans Affairs to operate a 
sexual trauma program through December 31, 2004.
    6. Require the Secretary of Veterans Affairs to establish 
a mechanism for augmenting the provision of specialized mental 
health services, with particular emphasis on programs for the 
treatment of post-traumatic stress disorder and substance use 
disorder.

               Title II - Medical Program Administration

    1. Authorize the Secretary of Veterans Affairs to: (1) 
increase the $2 drug copayment amount; (2) establish a maximum 
annual and monthly payment applicable to veterans with multiple 
outpatient prescriptions; and (3) revise copayments on 
outpatient care for ``higher-income'' veterans.
    2. Establish a new fund in the Treasury in which VA is to 
deposit receipts and collections under the new authorities in 
the bill.
    3. Provide that, of the monies collected and recovered by 
VA, each facility is to receive that amount collected or 
recovered on behalf of that facility.
    4. Authorize the establishment of non-profit corporations 
at any VA medical center to facilitate education and training 
as well as research.
    5. Extend the date by which Vietnam-era veterans must 
apply to be eligible for readjustment counseling services 
through December 31, 2003.
    6. Extend for four years the requirement that VA operate 
a program to evaluate the health status of Gulf War veterans' 
dependents and continue to provide outreach to these veterans 
through a newsletter.
    7. Reestablish a VA Committee on post-traumatic stress 
disorder.
    8. Revise the priority system for the award of grants 
under the State home construction program: (a) to provide a 
higher priority for renovation projects than accorded under 
current law (with highest priority for projects to remedy life-
safety problems); and (b) in the case of applications for bed-
producing projects, priority based on the relative need for 
adding new beds (with higher priority to States with great need 
vs. those with moderate or limited need, and taking into 
account existing VA and community nursing home beds).
    9. Expand VA's authority to enter into enhanced-use 
leases by: (a) authorizing VA to enter into a long-term lease 
of property when that would enable it to apply the proceeds of 
the lease to demonstrably improve services in that geographic 
area; (b) extending the duration of such a lease term for up to 
75 years; and (c) providing that funds from enhanced-use leases 
shall be deposited in a new Health Services Improvement Fund.
    10. LProvide that VA may not employ a health care 
professional if a State has terminated for cause that 
individual's license, registration, or certification.
    11. LRequire the Secretaries of the Departments of Veterans 
Affairs and Defense to submit to Congress a report on 
cooperation between the Departments on procurement of 
pharmaceuticals and medical supplies.
    12. LRequire that for one year VA, in making payments under 
section 1728 of title 38, United States Code, use the payment 
schedule in effect for such purposes as of July 31, 1999, 
rather than the Participating Physician Fee Schedule under the 
Medicare program.

              Title III - Miscellaneous Medical Provisions

    1. Require the Secretary of Veterans Affairs to report 
and provide justification to Congress on, and defer for a 
period, plans to close within any fiscal year more than one-
half the beds within certain bed sections of VA medical 
centers.
    2. Lift the restrictions on VA's canteen service relating 
to sales for off-premises consumption and use.
    3. Require the VA Under Secretary for Health, in 
consultation with chiropractors, to establish a policy 
regarding chiropractic treatment.
    4. Designate the hospital replacement building under 
construction at the Reno, Nevada Veterans Affairs Medical 
Center as the ``Jack Streeter Building''.

             Title IV - Construction and Facilities Matters

    1. Authorize renovation to provide a domiciliary in 
Orlando, Florida, using previously appropriated funds and 
construction of a surgical addition at the Kansas City, 
Missouri, VA Medical Center; a long-term care facility at the 
Lebanon, Pennsylvania, VA Medical Center; renovations at VA 
medical centers in both Fargo, North Dakota, and Atlanta, 
Georgia; and demolition of buildings at the Leavenworth, 
Kansas, Veterans Affairs Medical Center.
    2. Authorize leases of an outpatient clinic in Lubbock, 
Texas, and of a research building in San Diego, California.
    3. Authorize appropriations for fiscal years 2000 and 
2001 of $57.5 million for construction, and $2,178,500 for the 
leases.

               Title V - Benefits and Employment Matters


                   Subtitle A -- Compensation and DIC

    1. Authorize the payment of dependency and indemnity 
compensation to the surviving spouses of certain former 
prisoners of war who were rated totally disabled due to any 
service-connected cause for a period of one or more years 
immediately prior to death.
    2. Restore, following termination of a remarriage, 
eligibility for CHAMPVA medical care, education, and housing 
loans to surviving spouses who lost eligibility for these 
benefits as the result of remarriage. These same spouses 
regained dependency and indemnity compensation eligibility, but 
not these related benefits, as the result of legislation 
enacted in 1998.
    3. Add bronchiolo-alveolar carcinoma, a rare form of lung 
cancer not associated with tobacco use, to the list of diseases 
presumed to be service-connected and thus compensable for 
certain radiation-exposed veterans.

                        Subtitle B -- Employment

    1. Clarify certain changes to the ``Veterans Employment 
Opportunities Act of 1998'' (Public Law 105-338), to confer 
competitive status on veterans hired under the Act, thereby 
allowing them the opportunity to compete for internal 
vacancies.

                      Title VI - Memorial Matters


           Subtitle A -- American Battle Monuments Commission

    1. Expand the fundraising authorities of the American 
Battle Monuments Commission (ABMC) to expedite the 
establishment of the World War II Memorial in the District of 
Columbia and ensure that adequate funds are available for the 
repair and long-term maintenance of the Memorial. To assure 
that groundbreaking, construction, and dedication of the 
Memorial are completed on a timely basis, the ABMC would be 
authorized to borrow up to $65 million from the U.S. Treasury.

                   Subtitle B -- National Cemeteries

    1. Direct the Secretary of Veterans Affairs to obligate 
Advance Planning Funds during fiscal year 2000 to establish six 
additional national cemeteries for veterans.
    2. Authorize the Secretary of Veterans Affairs to use 
flat grave markers at the Santa Fe National Cemetery in New 
Mexico.
    3. Require the Secretary of Veterans Affairs to conduct 
an independent study on improvements to veterans' cemeteries.

                     Subtitle C -- Burial Benefits

    1. Require the Secretary of Veterans Affairs to conduct 
an independent study on burial benefits.

               Title VII - Education and Housing Matters


                    Subtitle A -- Education Matters

    1. Extend Montgomery GI Bill education benefits 
eligibility for preparatory courses for college and graduate 
school entrance examinations.
    2. Extend Montgomery GI Bill eligibility to individuals 
whose obligated period of service is interrupted in order to 
accept a commission following successful completion of Officer 
Training School.
    3. Require the Secretary of Veterans Affairs, in 
consultation with the Departments of Defense, Education, and 
Labor, to provide a report to Congress on veterans' education 
and vocational training benefits provided by the States.

                     Subtitle B -- Housing Matters

    1. Extend VA's authority to provide eligibility for 
members of the Selected Reserve for veterans housing loan 
guaranties through 2007.

              Title VIII - Department of Veterans Affairs


                         Administrative Matters

    1. Require the Veterans Benefits Administration to 
implement a quality assurance program that meets governmental 
standards for internal control, separation of duties and 
organizational independence.
    2. Extend the authority of the Secretary of Veterans 
Affairs to operate a Veterans Benefits Administration regional 
office in the Republi of the Philippines through December 31, 
2003.
    3. Extend the Advisory Committee on Minority Veterans 
through December 31, 2003.

                 Title IX - Homeless Veterans Programs

    1. Authorize appropriations to the Department of Labor of 
$10 million for fiscal year 2000, $15 million for fiscal year 
2001, $20 million for fiscal year 2002, and $20 million for 
fiscal year 2003, for the Homeless Veterans Reintegration 
Program.
    2. Extend VA's authority to furnish assistance to 
homeless veterans through December 31, 2003.
    3. Extend through September 30, 2003, VA's authority to 
make grants (under the Homeless Veterans Comprehensive Service 
Program Act of 1992, as amended) for new programs to combat 
veteran homelessness, authorize grants to assist in expanding 
existing programs, eliminate the limitation on grant support 
for programs involving van procurement, and authorize annual 
appropriations of $50 million to carry out the Act.
    4. Direct the Secretary of Veterans Affairs, in 
consultation with the Secretaries of Labor and Housing and 
Urban Development, to submit a plan to evaluate the 
effectiveness of programs to assist homeless veterans.

      Title X - United States Court of Appeals for Veterans Claims

    1. Make various modifications to the retirement and 
survivor annuity programs applicable to judges of the United 
States Court of Appeals for Veterans Claims, so as to encourage 
staggered retirement and to be more consistent with those of 
other federal judges.

           Title XI - Voluntary Separation Incentive Program

    1. Authorize the Secretary of Veterans Affairs to offer 
employees voluntary separation incentives (``buyouts'') of up 
to $25,000 in order to restructure or reduce positions and 
functions identified in a plan designed to improve operating 
efficiency.
    Effective date: Date of Enactment.
    Legislative history
    July 15, 1999: H.R. 2116 ordered reported amended favorably 
by the Committee on Veterans' Affairs.
    July 16, 1999: H.R. 2116 reported amended by the Committee 
on Veterans' Affairs H. Rept. 106-237.
    Sep. 21, 1999: Passed the House amended under suspension by 
vote of 369-46 (Roll No. 427).
    Sep. 22, 1999: Referred to the Senate Committee on 
Veterans' Affairs.
    Nov. 5, 1999: Senate Committee on Veterans' Affairs 
discharged by unanimous consent.
    Nov. 5, 1999: Passed the Senate amended by unanimous 
consent.
    Nov. 5, 1999: Senate requested a Conference. Conferees 
appointed: Specter, Thurmond and Rockefeller.
    Nov. 8, 1999: Informal Conference meeting held.
    Nov. 8, 1999: House disagreed to the Senate Amendments by 
unanimous consent.
    Nov. 8, 1999: House agreed to a Conference. Conferees 
appointed: Stump, Smith (NJ), Quinn, Stearns, Evans, Brown (FL) 
and Doyle.
    Nov. 10, 1999: Conference meeting held. Conferees agreed to 
file conference report.
    Nov. 16, 1999: Conference report filed. H. Rept. 106-470.
    Nov. 16, 1999: House agreed to the Conference report under 
suspension by voice vote.
    Nov. 19, 1999: Senate agreed to Conference report by 
unanimous consent.
    Nov. 30, 1999: Signed by the President, Public Law 106-117.
                                ------                                


                           Public Law 106-118


      VETERANS' COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 1999

                        (H.R. 2280, AS AMENDED)

    Title: An Act to amend title 38, United States Code, to 
provide a cost-of-living adjustment in the rates of disability 
compensation for veterans with service-connected disabilities 
and the rates of dependency and indemnity compensation for 
survivors of such veterans.
    Summary: H.R. 2280, as amended, would:
  Authorize a cost-of-living adjustment in the rates of 
service-connected disability compensation and dependency and 
indemnity compensation of 2.4 percent effective December 1, 
1999 for:
  (1) LVeterans receiving compensation benefits for service-
connected disabilities;
  (2) LSurviving spouses and children of veterans who died of 
service-connected causes in receipt of dependency and indemnity 
compensation (DIC);
  (3) LEligible veterans and surviving spouses who require the 
regular aid and attendance of another person in their day-to-
day activities;
  (4) LEligible veterans in receipt of the housebound 
allowance;
  (5) LCertain veterans paid additional amounts for dependents;
  (6) LVeterans whose service-connected disabilities require 
the wearing or use of a prosthetic or orthopedic appliance 
which tends to wear or tear the clothing (from $534 to $546); 
and,
  (7) LSpouses' housebound rate (from $105 to $107) monthly.
        

          COMPENSATION AND DIC RATES EFFECTIVE DECEMBER 1, 1999
------------------------------------------------------------------------
                                                 Increase (monthly rate)
                                               -------------------------
                                                    From          To
------------------------------------------------------------------------
Percentage of disability or subsection under which payment
 is authorized:
    (a)               10 percent..............          $96          $98
    (b)               20 percent..............          184          188
    (c)               30 percent..............          282          288
    (d)               40 percent..............          404          413
    (e)               50 percent..............          576          589
    (f)               60 percent..............          726          743
    (g)               70 percent..............          916          937
    (h)               80 percent..............        1,062        1,087
    (i)               90 percent..............        1,196        1,224
    (j)               100 percent.............        1,989        2,036
Higher statutory awards for certain multiple disabilities:
    (k)               (1) Additional monthly             75           76
                       payment for anatomical
                       loss, or loss of use
                       of, any of the
                       following: one foot,
                       one hand, blindness in
                       one eye (having light
                       perception only), one
                       or more creative
                       organs, both buttocks,
                       organic aphonia (with
                       constant inability to
                       communicate by speech),
                       deafness of both ears
                       (having absence of air
                       and bone conduction)--
                       for each loss..
                      (2) Limit for veterans          2,474        2,533
                       receiving payments
                       under (a) to (j) above.
                      (3) Limit for veterans          2,474        2,533
                       receiving benefits
                       under (l) below.
                      (4) Limit for veterans          2,729        2,794
                       receiving benefits
                       under (m).
                      (5) Limit for veterans          3,105        3,179
                       receiving benefits
                       under (n).
    (l)               Anatomical loss or loss         2,474        2,533
                       of use of both feet,
                       one foot and one hand,
                       blindness in both eyes
                       (5/200) visual acuity
                       or less), permanently
                       bedridden or so
                       helpless as to require
                       aid and attendance..
    (m)               Anatomical loss or loss         2,729        2,794
                       of use of both hands,
                       or of both legs, at a
                       level preventing
                       natural knee action
                       with prosthesis in
                       place or of 1 arm and 1
                       leg at a level
                       preventing natural knee
                       or elbow action with
                       prosthesis in place or
                       blind in both eyes,
                       either with light
                       perception only or
                       rendering veteran so
                       helpless as to require
                       aid and attendance..
Percentage of disability or subsection under which payment
 is authorized:
    (n)               Anatomical loss of both         3,105        3,179
                       eyes or blindness with
                       no light perception or
                       loss of use of both
                       arms at a level
                       preventing natural
                       elbow action with
                       prosthesis in place or
                       anatomical loss of both
                       legs so near hip as to
                       prevent use of
                       prosthesis, or
                       anatomical loss of 1
                       arm and 1 leg so near
                       shoulder and hip to
                       prevent use of
                       prosthesis..
    (o)               Disability under                3,470        3,553
                       conditions entitling
                       veterans to two or more
                       of the rates provided
                       in (1) through (n), no
                       condition being
                       considered twice in the
                       determination, or
                       deafness rated at 60
                       percent or more
                       (impairment of either
                       or both ears service-
                       connected) in
                       combination with total
                       blindness (5/200 visual
                       acuity or less) or
                       deafness rated at 40
                       percent or total
                       deafness in one ear
                       (impairment of either
                       or both ears service-
                       connected) in
                       combination with
                       blindness having light
                       perception only or
                       anatomical loss of both
                       arms so near the
                       shoulder as to prevent
                       use of prosthesis..
    (p)               (1) If disabilities             3,470        3,553
                       exceed requirements of
                       any rates prescribed,
                       Secretary of Veterans
                       Affairs may allow next
                       higher rate or an
                       intermediate rate, but
                       in no case may
                       compensation exceed.
                      (2) Blindness in both           3,470        3,553
                       eyes (with 5/200 visual
                       acuity or less)
                       together with (a)
                       bilateral deafness
                       rated at 30 percent or
                       more disabling
                       (impairment of either
                       or both ears service-
                       connected) next higher
                       rate is payable, or (b)
                       service-connected total
                       deafness of one ear or
                       service-connected loss
                       or loss of use of an
                       extremity the next
                       intermediate rate is
                       payable, but in no
                       event may compensation
                       exceed.
    (3)               Blindness with only             3,470        3,553
                       light perception or
                       less with bilateral
                       deafness (hearing
                       impairment in either
                       one or both ears is
                       service-connected)
                       rated at 10 or 20
                       percent disabling, the
                       next intermediate rate
                       is payable, but in no
                       event may compensation
                       exceed.
    (4)               Anatomical loss or loss         3,470        3,553
                       of use of three
                       extremities, the next
                       higher rate in
                       paragraphs (l) to (n)
                       but in no event in
                       excess of.
    (q)               [This subsection
                       repealed by Public Law
                       90-493.].
    (r)               (1) If veteran entitled         1,490        1,525
                       to compensation under
                       (o) or to the maximum
                       rate under (p); or at
                       the rate between
                       subsections (n) and (o)
                       and under subsection
                       (k), and is in need of
                       regular aid and
                       attendance, he shall
                       receive a special
                       allowance of the amount
                       indicated at right for
                       aid and attendance in
                       addition to such rates..
                      (2) If the veteran, in          2,218        2,271
                       addition to need for
                       regular aid and
                       attendance is in need
                       of a higher level of
                       care, a special
                       allowance of the amount
                       indicated at right is
                       payable in addition to
                       (o) or (p) rate.
    (s)               Disability rated as             2,227        2,280
                       total, plus additional
                       disability
                       independently ratable
                       at 60 percent or over,
                       or permanently
                       housebound.
    (t)               [This subsection
                       repealed by Public Law
                       99-576.].
------------------------------------------------------------------------

  
  In addition to basic compensation rates and/or statutory 
awards to which the veteran may be entitled, dependency 
allowances are payable to veterans who are rated at not less 
than 30 percent disabled. The rates which follow are those 
payable to veterans while rated totally disabled. If the 
veteran is rated 30, 40, 50, 60, 70, 80 or 90 percent disabled, 
dependency allowances are payable in an amount bearing the same 
ratio to the amount specified below as the degree of disability 
bears to total disability. For example, a veteran who is 50 
percent disabled receives 50 percent of the amounts which 
appear below.

    COMPENSATION AND DIC RATES EFFECTIVE DECEMBER 1, 1999--Continued
------------------------------------------------------------------------
                                                 Increase (monthly rate)
                                               -------------------------
                                                    From          To
------------------------------------------------------------------------
If and while veteran is rated totally disabled
 and--
    Has a spouse..............................         $115         $117
    Has a spouse and child....................          197          201
    Has no spouse, 1 child....................           79           80
    For each additional child.................           60           61
    For each dependent parent.................           93           95
    For each child age 18-22 attending school.          182          186
    Has a spouse in nursing home or severely            217          222
     disabled.................................
    Has disabled, dependent adult child.......          217          222
------------------------------------------------------------------------

  

                 DEPENDENCY AND INDEMNITY COMPENSATION

  The rates of dependency and indemnity compensation payable 
with respect to service-related deaths occurring on and after 
January 1, 1998, (and payable with respect to any service-
connected death if payments based on a veteran's rank would 
result in a lesser payment) would be increased by 2.4 percent, 
from $861 to $881 for the base rate, and from $187 to $191 for 
the additional amount or ``kicker'' payable if the veteran 
suffered from a service-connected disability rated as totally 
disabling for a period of at least eight years immediately 
preceding death.
  The following table reflects increases provided for surviving 
spouses of deceased veterans whose service-connected deaths 
occurred prior to January 1, 1998, and who are not receiving 
dependency and (DIC) payments under the new rate structure at a 
higher rate:

------------------------------------------------------------------------
                                                 Increase (monthly rate)
                    Pay grade                  -------------------------
                                                    From          To
------------------------------------------------------------------------
    E-1-E6....................................          861          881
    E-7.......................................          890          911
    E-8.......................................          940          962
    E-9.......................................       \1\980     \1\1,003
    W-1.......................................          909          930
    W-2.......................................          946          968
    W-3.......................................          974          997
    W-4.......................................        1,030        1,054
    O-1.......................................          909          930
    O-2.......................................          940          962
    O-3.......................................        1,004        1,028
    O-4.......................................        1,062        1,087
    O-5.......................................        1,170        1,198
    O-6.......................................        1,318        1,349
    O-7.......................................        1,424        1,458
    O-8.......................................        1,561        1,598
    O-9.......................................        1,672        1,712
    O-10......................................     \2\1,834     \2\1,878
------------------------------------------------------------------------
\1\ If the veteran served as Sergeant Major of the Army, Senior Enlisted
  Advisor of the Navy, Chief Master Sergeant of the Air Force, Sergeant
  Major of the Marine Corps, or Master Chief Petty Officer of the Coast
  Guard, at the applicable time designated by section 1302 of this
  title, the surviving spouse's rate shall be $1,082.
\2\ If the veteran served as Chairman or Vice-Chairman of the Joint
  Chiefs of Staff, Chief of Staff of the Army, Chief of Naval
  Operations, Chief of Staff of the Air Force, Commandant of the Marine
  Corps or Commandant of the Coast Guard, at the applicable time
  designated by section 1302 of this title, the surviving spouse's rate
  shall be $2,013.

  When there is no surviving spouse receiving dependency and 
indemnity compensation, payment is made in equal shares to the 
children of the deceased veteran. These rates are increased as 
follows.
  

------------------------------------------------------------------------
                                                 Increase (monthly rate)
                                               -------------------------
                                                    From          To
------------------------------------------------------------------------
    One child.................................         $365         $373
    Two children..............................          526          538
    Three children............................          683          699
    Each additional child.....................          133          136
------------------------------------------------------------------------

  
    Effective date: December 1, 1999.
    Cost: The Congressional Budget Office estimates that H.R. 
2280,as amended, will add about $314 million to outlays in 2000 
and about $377 million a year to outlays thereafter. However, a 
cost of living adjustment equal to that payable to Social 
Security recipients is assumed in the budget resolution 
baseline, pursuant to section 257 of the Balanced Budget and 
Emergency Act of 1997 (Public Law 105-33). As a result, the act 
will have no budgetary effect relative to the baseline and 
would have no pay-as-you-go impact.
    Legislative history: Congressional Record, Vol. 145 (1999).
    June 23, 1999: H.R. 2280 ordered reported amended favorably 
by the Committee on Veterans' Affairs.
    June 25, 1999: H.R. 2280 reported amended by the Committee 
on Veterans' Affairs. H. Rept. 106-202.
    June 29, 1999: Passed the House amended under suspension by 
vote of 424-0 (Roll No. 257).
    June 30, 1999: Referred to the Senate Committee on 
Veterans' Affairs.
    July 26, 1999: Senate Committee on Veterans' Affairs 
discharged by unanimous consent
    July 26, 1999: Passed Senate in lieu of S. 1393 with an 
amendment by unanimous consent.
    Nov. 9,  1999: House agreed to Senate amendment with 
amendments pursuant to H. Res. 368.
    Nov. 19, 1999: Senate agreed to the House amendments to the 
Senate amendment by unanimous consent.
    Nov. 30, 1999: Signed by the President, Public Law 106-118.
                                ------                                


                           Public Law 106-142


 COMMENDING THE WORLD WAR II VETERANS WHO FOUGHT IN THE BATTLE OF THE 
                                 BULGE

                       (H.J. RES. 65, AS AMENDED)

    Title: A Act to Commend the World War II Veterans who 
fought in the Battle of the Bulge, and for other purposes.
    Summary: H.J. Res. 65, as amended, would:
    1. Commend the veterans of service in the United States 
Army who fought during World War II in the German Ardennes 
offensive known as the Battle of the Bulge.
    2. Honor those who gave their lives during that battle.
    3. Authorize the President to issue a proclamation 
calling upon the people of the United States to honor the 
veterans of the Battle of the Bulge with appropriate programs, 
ceremonies, and activities.
    4. Call upon the President to reaffirm the bond of 
friendship between the United States and both Belgium and 
Luxembourg.
    Effective date: Date of enactment.
    Cost: The Congressional Budget Office estimates that the 
cost of H.J. Res. 65 would have no effect on the federal budget 
and would not affect direct spending or receipts. H.J. Res. 65 
contains no intergovernmental or private sector mandates as 
defined in the Unfunded Mandates Reform Act of 1995 and would 
not affect the budget of state, local, or tribal governments.
    Legislative history
    Sep. 22, 1999: H.J. Res. 65 ordered reported amended 
favorably by the Committee on Veterans' Affairs.
    Sep. 30, 1999: H.J. Res. 65 reported amended by the 
Committee on Veterans' Affairs. H. Rept. 106-352, Part I.
    Oct. 5,  1999: Passed the House amended under suspension by 
vote of 422-0. (Roll No. 475).
    Oct. 6,  1999: Referred to the Senate Committee on the 
Judiciary.
    Nov. 2,  1999: Reported to the Senate by Senate Committee 
on the Judiciary.
    Nov. 19, 1999: Passed the Senate without amendments and 
with a preamble by unanimous consent.
    Dec. 7,  1999: Signed by the President, Public Law 106-142.
                                ------                                


                           Public Law 106-413


      VETERANS COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2000

                        (H.R. 4850, AS AMENDED)

    Title: To provide a cost-of-living adjustment in rates of 
compensation paid to veterans with service-connected 
disabilites.
    Summary: H.R. 4850, as amended, would:
    1.  Increase the rates, effective December 1, 2000, of 
disability compensation for veterans with service-connected 
disabilities and the rates of dependency and indemnity 
compensation for survivors of certain disabled veterans.
    2.  Round down, to the next lower dollar amount, all 
compensation and DIC benefits when the amount is not a whole 
dollar amount.
    Effective date: December 1, 2000.
    Cost: The bill would have no budgetary effect relative to 
the baseline as modified by the Balanced Budget Act of 1997.
    Legislative history
    July 20, 2000: H.R. 4850 ordered reported favorably by the 
Committee on Veterans' Affairs.
    July 24, 2000: H.R. 4850 reported by the Committee on 
Veterans' Affairs. H. Rept. 106-783.
    July 25, 2000: Passed the House under suspension by voice 
vote.
    July 25, 2000: Referred to the Senate Committee on 
Veterans' Affairs.
    Oct. 12, 2000: Senate Committee on Veterans' Affairs 
discharged by unanimous consent.
    Oct. 12, 2000: Passed the Senate with amendments and an 
amendment to the Title by unanimous consent.
    Oct. 12, 2000: Certain provisions incorporated. See. S. 
1402, Title III, Subtitle A, Sections 301 and 302; and Subtitle 
B, Section 313.
    Oct. 17, 2000: House agreed to the Senate amendments under 
suspension by voice vote.
    Nov. 1,  2000: Signed by the President, Public Law 106-413.
                                ------                                


                           Public Law 106-419


       VETERANS BENEFITS AND HEALTH CARE IMPROVEMENT ACT OF 2000

                         (S. 1402, AS AMENDED)

    Title: To amend title 38, United States Code, to increase 
the rates of educational assistance under the Montgomery GI 
Bill, to improve procedures for the adjustment of rates of pay 
for nurses employed by the Department of Veterans Affairs, and 
to make other improvements in veterans educational assistance, 
health care, and benefits programs, and for other purposes.
    Summary: S. 1402, as amended would:

               Title I-Educational Assistance Provisions


          Subtitle A-Montgomery GI Bill Educational Assistance

    1. Increase, effective November 1, the All-Volunteer 
Force Educational Assistance Program basic benefit (commonly 
referred to as the Montgomery GI Bill or MGIB) to $650 per 
month for a three-year period of service and $528 per month for 
a two-year period of service.
    2. Repeal the requirement that a servicemember obtain a 
high school diploma or equivalency certificate prior to the 
completion of the initial period of active duty as a condition 
of eligibility for MGIB benefits.
    3. Repeal the requirement that Montgomery GI Bill 
entitlement is predicated on completing an initial obligated 
period of service so that eligibility can be based on any 
subsequent period of service.
    4. Permit certain Post-Vietnam Era Veterans' Educational 
Assistance program (VEAP) participants to enroll in the 
Montgomery GI Bill program.
    5. Permit servicemembers to ``buy up'' their MGIB basic 
benefit by making an after-tax contribution of up to $600 which 
would provide up to $5,400 in additional benefits over 36 
months of entitlement, or an additional $150 per month.

      Subtitle B-Survivors' and Dependents' Educational Assistance

    1. Increase, effective November 1, the basic educational 
allowance for survivors and dependents to $588 per month, with 
annual cost-of-living adjustments.
    2. Allow children eligible for survivors' and dependents' 
educational assistance to choose the beginning date of their 
eligibility period between the date on which a rating decision 
is signed or the date of death and the date on which the 
Secretary first finds the death service connected.
    3. Permit the award of survivors' and dependents' 
educational assistance payments to be retroactive to the date 
of the entitling event, that is, the service-connected death or 
award of a total and permanent disability rating.
    4. Allow use of the survivors' and dependents' 
educational assistance for preparatory courses for college and 
graduate school entrance examination requirements.

               Subtitle C-General Educational Assistance

    1. Allow monthly educational assistance benefits to be 
paid between term, quarter, or semester intervals of up to 8 
weeks.
    2. Allow veterans', survivors' and dependents' 
educational assistance to be used to pay for up to $2,000 in 
fees for civilian occupational licensing or certification 
examinations; establish requirements regarding the use of such 
entitlement and requirements for organizations or entities 
offering licensing or certification tests; and establish a 
seven-member VA Professional Certification and Licensing 
Advisory Committee.
    3. Increase the amount available for State Approving 
Agencies for fiscal years 2001 and 2002 from $13 million to $14 
million.

                       Title II-Health Provisions


                      Subtitle A-Personnel Matters

    1. Authorize annual ``national'' comparability pay raises 
for VA nurses on par with that of other federal employees.
    2. Make optional annual locality survey processes for VA 
nurse pay. Define ``triggers'' that indicate the need for 
Directors to perform locality pay surveys for nurses such as 
turnover, lag time, looming nurse shortage, to be defined in 
criteria of Secretary; require communication to peer and senior 
management of intent to survey; and report to Congress.
    3. Eliminate sole discretion vested in facility directors 
to make pay decisions; clarify that absence of nurse 
recruitment or retention problem not be a basis for failure to 
provide pay increases; prohibit ``negative pay adjustments''; 
authorize use of independent survey results; and provide, to 
extent practicable, for pay surveys to collect actual salary 
and benefits data.
    4. Provide for nurse participation in policy and 
decision-making at network and medical center levels.
    5. Revise and increase rates of special pay provided to 
dentists employed by the Veterans Health Administration.
    6. Add pharmacists to occupations that are exempt from 
statutory caps on special salary rates.
    7. Require the Under Secretary for Health to designate 
physician assistants (PAs) to serve as consultants to the Under 
Secretary and seek advice of PA consultants on all matters 
relating to employment and utilization of PAs within VA.
    8. Authorize temporary appointments of up to two years 
for PAs who have successfully completed full course of training 
and are pending certification.
    9. Authorize temporary extensions of term appointments 
for medical support personnel in VA-funded research.
    10. LAuthorize the Secretary to waive state licensure 
requirements for VA social workers while completing training.
    11. LExtend and modify employee ``buyout'' legislation 
through December 31, 2002.

                   Subtitle B-Military Service Issues

    1. Provide a Sense of Congress Resolution urging VA to 
document pertinent military experiences and exposures that may 
contribute to a veterans' health status.
    2. Require that VA enter into a contract with an 
appropriate entity to carry out a new study on post-traumatic 
stress disorder independent of VA, to follow up the study 
conducted under section 102 of Public Law 98-160.

                   Subtitle C-Medical Administration

    1. Authorize VA to furnish veterans and others 
accompanying veterans with temporary lodging (such as ``Fisher 
Houses'') in connection with treatment or other services.
    2. Clarify VA establishment of VA outpatient clinics in 
State veterans' homes.
    3. Provide a Sense of Congress Resolution encouraging 
expanded joint procurement of medical items to include 
prescription drugs.
    4. Facilitate enactment of the Veterans Millennium Health 
Care and Benefits Act with technical and conforming changes.

                 Subtitle D-Construction Authorization

    1. Authorize the Secretary to construct and authorize 
appropriations of $120.9 million in fiscal year 2001 or 2002 
for major construction (gero-psychiatric care building at the 
Palo Alto, CA VA Medical Center [$26.6 million]; nursing home 
at the Beckley, WV VA Medical Center [$9.5 million]; utility 
plant at the Miami, FL VA Medical Center [$23.6 million--for 
2001 only]; and seismic improvements project at the Long Beach, 
CA VA Medical Center [$51.7 million]).
    2. Authorize a previously appropriated [$14 million], but 
not authorized, long-term psychiatric care facility at 
Murfreesboro, TN VA Medical Center; and extend through 2002 a 
previously authorized long-term care project at Lebanon, PA VA 
Medical Center [$14.5million].

                    Subtitle E-Real Property Matters

    1. Change the enhanced-use lease Congressional 
notification period from 60 ``legislative'' days, to 90 
``calendar'' days. It would also shorten the length of time VA 
waits before entering into enhanced-use lease.
    2. Release reversionary interest to State of Tennessee in 
Johnson City (Mountain Home VA Medical Center) property 
previously conveyed to Tennessee. (State has committed to 
transfer the land for public park and recreation but cannot do 
so without recision of government's reversionary interest.)
    3. Transfer land at the former Allen Park, MI VA Medical 
Center to Ford Motor Land Development Corporation. It would 
also allow for environmental cleanup by VA (remediation of 
hazardous material, etc.), and restoration of property to 
precede transfer.
    4. Transfer land at the Carl Vinson VA Medical Center, 
Dublin, GA, to the State of Georgia.
    5. Permit the land conveyance of Miles City, MT VA 
Medical Center to Custer County, Montana. (Transfer will save 
VA $500,000 for maintenance of facility, and provide funds to 
expand veterans' access to care.)
    6. Permit transfer of Fort Lyon, CO, VA Medical Center to 
State of Colorado for use as state prison. (Conveyance to take 
place only when arrangements made to protect interests of 
patients and employees. Patients to be provided private or 
other public care on same basis that care was provided by Ft. 
Lyon. VA to maintain capacity for long term care as required by 
law.)

 Title III-Compensation, Insurance, Housing, Employment, and Memorial 
                           Affairs Provisions


                Subtitle A-Compensation Program Changes

    1. Provide that a stroke or heart attack that is incurred 
or aggravated by a member of a reserve component in the 
performance of duty while performing inactive duty training 
shall be considered to be service connected for purposes of 
benefits under laws administered by the Secretary of Veterans 
Affairs.
    2. Make women veterans eligible for special monthly 
compensation under section 1114(k) of title 38, United States 
Code, due to the service-connected loss of one or both breasts, 
including loss by mastectomy.
    3. Provide compensation and health care benefits to 
veterans injured as a result of participation in a VA 
compensated work therapy program.
    4. Increase the amount of resources an incompetent 
veteran with no dependents may retain and still qualify for 
payment of benefits from $1,500, to five times the benefit 
amount payable to a service-disabled veteran rated as totally 
disabled while being provided institutional care without charge 
at VA's expense.
    5. Require the Department of Defense to contract with the 
National Academy of Sciences (NAS) to carry out periodic 
reviews of the dose reconstruction program of the Defense 
Threat Reduction Agency. The review would last 24 months and 
culminate in a report detailing NAS' findings and 
recommendations, if any, for a permanent review program.

                   Subtitle B-Life Insurance Matters

    1. Cap Service Disabled Veterans' Life Insurance (SDVI) 
premiums at the age 70 renewal rate; require VA to report to 
Congress, not later than September 30, 2001, on plans to 
liquidate unfunded liability in the SDVI program over the next 
ten years.
    2. Increase the maximum amount of coverage available 
through the Servicemembers' Group Life Insurance program and 
the Veterans' Group Life Insurance program from $200,000 to 
$250,000.
    3. Allow members of the Individual Ready Reserve who are 
subject to involuntary call-up authority to enroll in the 
Servicemembers' Group Life Insurance program.

               Subtitle C-Housing and Employment Programs

    1. Allow VA to make the maximum grant for specially 
adapted housing in cases where title to the housing unit is not 
vested solely in the veteran, if the veteran resides in the 
housing unit.
    2. Add recently separated veterans (veterans who have 
been discharged or released from active duty within a one-year 
period) to the definition of veterans to whom Federal 
contractors and subcontractors must extend affirmative action 
to employ and advance.
    3. Require employers to grant an authorized leave of 
absence for employees who are members of a reserve component to 
participate in honor guards for funerals of veterans.

               Subtitle D-Cemeteries and Memorial Affairs

    1. Extend eligibility for burial in national cemeteries 
to those Philippine Commonwealth Army veterans who die after 
enactment of section 331 of this legislation who 1) have either 
become citizens of the United States or have been lawfully 
admitted for permanent residence, and 2) who reside in the 
United States.
    2. Provide a full-rate burial benefit and plot allowance 
to Philippine Commonwealth Army veterans who, at the time of 
death, 1) are citizens of the United States or have been 
lawfully admitted for permanent residence and are residing in 
the U.S. and 2) are receiving compensation for a service 
connected disability or would have been eligible for VA pension 
benefits had their service been deemed to have been active 
military, naval, or air service.
    3.  Authorize VA to pay a plot allowance for burial of 
veterans in State veterans' cemeteries even though the cemetery 
allows burials of reservists who are not eligible for burial in 
national cemeteries.

                         Title IV-Other Matters

    1. Provide health care, vocational training, and monetary 
allowances to the children of women Vietnam veterans who suffer 
from certain birth defects.
    2. Extend temporary authorities through fiscal year 2008 
that would otherwise expire on September 30, 2002, including: 
VA-enhanced loan asset authority guaranteeing the payment of 
principal and interest on VA-issued certificates or other 
securities; VA home loan fees of \3/4\ of one percent of the 
total loan amount; procedures applicable to liquidation sales 
on defaulted home loans guaranteed by VA; VA/Department of 
Health and Human Services income verification authority through 
which VA verifies the eligibility for, VA needs-based benefits 
and VA means-tested medical care by gaining access to income 
records of the Department of Health and Human Services/Social 
Security Administration and the Internal Revenue Service; 
limitation on payment of VA pension to veterans without 
dependents who are receiving Medicaid-covered nursing home 
care; VA's special committee relating to the care of the 
seriously chronically mentally ill; and extend through 2005 
VA's authority to establish nonprofit foundations to foster 
research, education, or both, in VA medical centers.
    3. Reinstate the requirements that the Secretary provide 
periodic reports concerning equitable relief granted by the 
Secretary to an individual beneficiary (expires December 31, 
2004); work and activities of the Department; programs and 
activities examined by the Advisory Committees on (1) former 
prisoners of war and (2) women veterans (expires after biennial 
reports submitted in 2003); operation of the Montgomery GI Bill 
educational assistance program (expires December 31, 2004); and 
activities of the Secretary's special medical advisory group 
(expires December 31, 2004). The Secretary shall include with 
any report that is required by law or by a joint explanatory 
statement of a Congressional conference committee an estimate 
of the cost of preparing the report.
    Effective date: Date of enactment except the following 
sections:
    Sec. 101(a): November 1, 2000 and shall apply with respect 
to educational assistance allowances paid under chapter 30 for 
months after October 2000.
    Section 102(a) through (d): November 1, 2000 and shall 
apply with respect to educational assistance allowances paid 
under chapter 35 for months after October 2000.
    Section 102(f): Sections 3654 and 3687(d) as added by 
amendments made by this section shall take effect with respect 
to Fiscal Year 2002.
    Section 105: May 1, 2001, with retroactive eligibility to 
``buy up'' until July 31, 2001, for servicemembers separated 
after enactment but prior to May 1, 2001.
    Section 106: March 1, 2001
    Section 107: January 1, 2000.
    Section 301: December 1, 2000.
    Section 322: First day of the first month that begins more 
than 120 days after the date of enactment.
    Section 401: First day of the first month beginning more 
than one year after date of enactment, except as provided in 
paragraph (2).
    Section 405: Shall take effect with respect to funds 
appropriated for Fiscal Year 2002.
    Legislative history
    July 20, 1999: Reported to the Senate. S. Rept. 106-114
    July 26, 1999: Passed the Senate by unanimous consent.
    July 27, 1999: Referred to the House Committee on Veterans' 
Affairs, and in addition to the House Committee on Armed 
Services.
    May 23, 2000: Passed the House amended under suspension by 
vote of 417-0 (Roll No. 220). [The House amendment consisted of 
the text of H.R. 4268 as reported.]
    May 24, 2000: Message on House action received in the 
Senate and at the desk: House amendments to Senate bill.
    Oct. 12, 2000: Senate concurred in the House amendments 
with an amendment (SA 4314) and an amendment to the Title by 
unanimous consent. (Note: Consists of certain provisions from 
H.R. 284, H.R. 4268, H.R. 4850, H.R. 5109, S. 1076, S. 1810 and 
S. 3011.)
    Oct. 17, 2000: House agreed to the Senate amendments to the 
House amendments under suspension by voice vote.
    Nov. 1, 2000: Signed by the President, Public Law 106-419.
                                ------                                


                           Public Law 106-475


                 VETERANS CLAIMS ASSISTANCE ACT OF 2000

                        (H.R. 4864, AS AMENDED)

    Title: To amend title 38, United States Code, to reaffirm 
and clarify the duty of the Secretary of Veterans Affairs to 
assist claimants for benefits under laws administered by the 
Secretary, and for other purposes.
    Summary: H.R. 4864, as amended, would:
    1. Define a ``claimant'' who would be eligible to receive 
assistance from the Secretary as any person seeking veterans' 
benefits.
    2. Require the Secretary to furnish all instructions and 
forms necessary when a request is made, or intent expressed, by 
any person applying for veterans benefits.
    3. Require the Secretary to notify the veteran of any 
information or evidence needed in order to substantiate the 
claim.
    4. Eliminate the requirement that a claimant submit a 
``well-grounded'' claim before the Secretary can assist in 
obtaining evidence. (In the context of claims for service-
connected disability benefits, a ``well-grounded'' claim is one 
that has evidence of in-service injury or disease, a diagnosis 
of a current disability or disease, and a medical opinion that 
the current disability or disease is related to the in-service 
injury or disease).
    5. Require the Secretary to make reasonable efforts to 
assist a claimant and obtain evidence and relevant records that 
the claimant identifies and authorizes the Secretary to obtain, 
unless there is no reasonable possibility that assistance would 
aid in substantiating the claim.
    6. For service-connected disability compensation claims, 
require the Secretary to 1) obtain existing service medical 
records and other relevant records pertaining to the claimant's 
active military, naval, or air service that are maintained by a 
governmental entity if the claimant provides sufficient 
information to locate them, and 2) provide a medical 
examination or obtain a medical opinion when such an 
examination (or opinion) is necessary to make a decision on the 
claim.
    7. Require other Federal agencies to furnish relevant 
records to the Department at no cost to the claimant.
    8. Require the Secretary to consider all information and 
lay and medical evidence of record. The Secretary would be 
required to give the benefit of the doubt to the claimant when 
there is an approximate balance of positive and negative 
evidence regarding an issue material to the determination of a 
matter.
    Effective date:
    The changes made by the bill would apply to any claim filed 
1) on or after date of enactment or 2) filed before date of 
enactment and not final as of date of enactment. Also, any 
claim decided on or after July 14, 1999, can be readjudicated 
at the request of the claimant or on the Secretary's own motion 
made within two years of enactment.
    Cost: The Congressional Budget Office estimates that 
implementing the bill would cost $4 million in 2001 and $7 
million to $8 million annually thereafter. Because the bill 
would not affect direct spending or receipts, pay-as-you-go 
procedures would not apply.
    Legislative history
    July 20, 2000: H.R. 4864 ordered reported favorably, as 
amended, by the Committee on Veterans' Affairs.
    July 24, 2000: H.R. 4864 reported, as amended, by the 
Committee on Veterans' Affairs. H. Rept. 106-781.
    July 25, 2000: Passed the House, as amended, under 
suspension by vote of 414-0 (Roll No. 432).
    July 25, 2000: Referred to the Senate Committee on 
Veterans' Affairs.
    Sep. 25, 2000: Senate Committee on Veterans' Affairs 
discharged by unanimous consent.
    Sep. 25, 2000: Passed the Senate with an amendment by 
unanimous consent.
    Oct. 17, 2000: House agreed to the Senate amendment under 
suspension by voice vote.
    Nov. 9,  2000: Signed by the President, Public Law 106-475.

                    ACTIVITIES OF THE SUBCOMMITTEES


                         Subcommittee on Health

    The Subcommittee on Health has legislative and oversight 
jurisdiction over the Department of Veterans Affairs' health 
care programs and the VA's health care delivery system (see 
Oversight Plan for 106th Congress, p. 83).

                         Legislative Activities

First Session

    On June 9, 1999, H.R. 2116, the Veterans Millennium Health 
Care Act, was introduced in the House and marked up in the 
Subcommittee on Health. Four years ago, this Committee 
developed and held hearings on legislation to reform VA rules 
governing eligibility for care. That eligibility reform 
legislation, Public Law 104-262, paved the way for a major 
shift from primary use of hospital-focused services to less 
costly outpatient care. It also resulted in vastly improved 
access to care for many veterans, particularly with respect to 
VA's establishment of hundreds of community-based clinics.
    Eligibility legislation was intended as an initial step on 
a path to reform of the VA health care system. With H.R. 2116, 
the VA Committee took another significant step in addressing 
some major challenges for VA. This legislation tackled many of 
the key issues discussed in hearings in the 105th Congress, and 
offered a blueprint to better position VA to meet the pressing 
needs of aging veterans in the new millennium. The bill had 
four central themes: (1) to provide new direction to address 
veterans' long-term care needs; (2) to expand veterans' access 
to care; (3) to close gaps in current eligibility law; and (4) 
to establish needed reforms to improve the VA health care 
system. The legislation also included long-term care reforms 
that would mandate VA to operate and maintain a national 
program of extended care services including needed services for 
50 percent service-connected veterans or extended care for 
veterans in need of care for a service-connected condition. 
Other provisions included improving access through facility 
realignments, providing specific authority for VA care and 
treatment of veterans who sustained injuries in combat 
recognized by the award of the Purple Heart, and directing the 
Secretary to establish more rational co-payments for Category 
C, ``higher income'' veterans. The measure also would authorize 
VA to reimburse uninsured veterans their emergency care costs 
in private facilities, provided they were VA-enrolled, Category 
A (Priority 1 through 6) veterans who had received VA care 
within the previous 12 months.
    A major provision of the ``Millennium Bill'' would require 
VA to establish enhanced services programs to improve access 
and quality of service provided at medical centers that no 
longer can provide high quality, efficient care due to current 
or projected need for service, an aging physical plant, or the 
availability of convenient contract services in the community. 
This provision would set the stage for major restructuring of 
some unneeded facilities to enable VA to accelerate 
restructuring for better quality, more convenient and more 
accessible care for veterans.
    This legislation also provided that if the United States 
were successful in recouping costs incurred by the Government 
attributable to tobacco-related illnesses, the VA would retain 
the proportional amount of the funds attributable to VA for 
providing care to veterans for tobacco-related illnesses. These 
funds would be deposited in a trust fund in the U.S. Treasury 
to be used after fiscal year 2004 for providing medical care 
and conducting VA medical and prosthetic research.
    On June 23, 1999, the full Committee approved the bill and 
ordered it to be reported to the full House.
    The Subcommittee on Health heard testimony at a hearing on 
June 30, 1999, concerning cost estimates for H.R. 2116. The 
principal witnesses were Mr. Paul N. Van de Water, Assistant 
Director for Budget Analysis, Congressional Budget Office; and 
Dr. Thomas L. Garthwaite, VA Deputy Under Secretary for Health. 
Testimony indicated a discrepancy between the budget estimates 
for long-term care from the Congressional Budget Office (CBO), 
and from VA. VA's estimate, based on experience and trends in 
long-term care, was between $115-$184 million during the first 
year with offsets from co-payment collections, while CBO's 
estimate of VA's resource requirements, more theoretical in 
nature, was $1 billion per year.
    Based on cost concerns, the extended care provision was 
later changed from a required 50 percent service-connection to 
a 70 percent service-connection. The emergency care provision 
was changed in the compromise language to a two-year (rather 
than 12 month) requirement for VA care prior to emergency 
services being reimbursed by VA, but eligibility was extended 
to veterans of any priority group who were enrolled in the VA 
health care system. Conference language for H.R. 2116 did not 
include the tobacco illness provision. The enhanced services 
program was dropped in conference, but the idea was taken up by 
VA in its ``Capital Assets Realignment for Enhanced Services'' 
(CARES) program.
    As agreed by conferees, a new provision was added to the 
Millennium Bill to authorize a voluntary separation incentive 
program in which VA could offer up to 4,770 ``buyouts'' to 
selected VA employees and various staff offices. The program 
was intended to address VA's management needs but not to serve 
as a means for VA to ``downsize'' its workforce. The Committee 
closely observed VA's actions under this authority throughout 
the second session of the 106th Congress to ensure that buyouts 
were offered when these employment shifts were in VA's best 
interest; to restructure health care programs to enhance the 
quality of care for veterans; and to improve access to care for 
aging veterans.
    H.R. 2116, the Veterans Millennium Health Care and Benefits 
Act, was signed into law on November 30, 1999 (See summary of 
Public Law 106-117, p. 29).

Second Session

    During the second session of the 106th Congress, VA 
personnel issues and coordination of hospital benefits for 
veterans became issues forming the backbone for legislative 
development proposed by Members. Their ideas were incorporated 
in H.R. 4759, the ``VA Health Care Personnel Act of 2000.'' VA 
personnel issues were the focus of a hearing on recruitment, 
retention, and compensation of the VA health care workforce on 
April 12, 2000.
    Testimony at the hearing documented that nurses were not 
receiving locality pay increases that Congress had intended 
with legislation enacted in 1990. For example, if a medical 
center director decided that nurse locality pay increases were 
cost-prohibitive, pay remained at pre-survey levels, and in a 
few cases, pay rates were actually reduced. Also, the locality 
system itself was flawed in that sometimes needed pay raises 
were prevented from being approved.
    With a large percentage of the VA dental workforce becoming 
eligible for retirement or expected to retire in the next 
several years, witnesses testified that renewed pay incentives 
for VA's dental workforce would be necessary to keep many 
dental services viable at medical centers. Legislation in 1991 
had authorized VA to pay physicians and dentists supplementary 
amounts of pay (above base pay rates) in exchange for their 
agreements to work for additional specified terms. This special 
pay authority was intended to give the agency flexibility to 
respond to local labor market conditions. At the time in 1991, 
recruitment and retention of dentists did not pose as 
significant a problem for VA as it did for physicians and, 
accordingly, the Act provided lesser amounts of special pay in 
most categories for VA dentists than for VA physicians. Prior 
to the hearing, Representative Bob Filner of California had 
introduced legislation, H.R. 2660, which spurred the 
Committee's interest and action in addressing inequities in 
dental pay.
    During the VA capital asset planning hearing on April 5, 
2000, Representative Dave Weldon of Florida spoke of the 
success of a pilot project in his Congressional district in 
which veterans who were treated at the Viera Beach VA 
Outpatient Clinic were hospitalized in local hospitals for 
routine inpatient care, with VA coordinating their hospital 
benefits. Veterans who were approved for this program did not 
travel great distances to a VA medical center for these 
hospital episodes. Mr. Weldon had proposed legislation, H.R. 
4575, that would allow for several pilot programs throughout 
the country to provide veterans enrolled in VA outpatient care, 
but living distant from a VA medical center, to receive care at 
local hospitals for general medical-surgical hospitalizations. 
This provision was included in H.R. 4759 and then, later in the 
session, with significant changes to clarify intent and limit 
expenditures, in H.R. 5109. During negotiations with the 
Senate, the pilot proposal was dropped from the language in S. 
1402.
    Many of the provisions of H.R. 4759 were subsequently 
incorporated into a bipartisan bill, H.R. 5109, the Department 
of Veterans Affairs Health Care Personnel Act of 2000, a bill 
that was marked up by the Subcommittee on Health on September 
7, 2000 and unanimously approved by the full Committee on 
September 13, 2000.
    Section 101 of H.R. 5109 would reform the local labor 
market survey process and replace it with a discretionary 
survey technique. The bill would provide more flexibility to VA 
medical center directors to obtain the data needed to complete 
necessary surveys and also restrict their authority to withhold 
indicated rate increases. Directors would be prohibited from 
reducing nurse pay. In addition, the House bill would also 
guarantee VA nurses a national comparability increase 
equivalent to the amount provided to other federal employees. 
The bill also would require Veterans Health Administration 
network directors to consult with nurses on questions of policy 
affecting the work of VA nurses, and would provide for 
registered nurses' required participation on medical center 
committees considering clinical care, budget matters, or 
resource allocation involving the care and treatment of veteran 
patients. The Senate had no comparable provision in its 
legislation, so these provisions became part of S.1402.
    With respect to VA dentist pay levels, the compromise 
agreement between the Houses included the House language in 
which the Committees urge medical center directors to utilize 
the full range of pay increases authorized, including increases 
in the higher range, to optimize dentist recruitment and 
retention efforts.
    Under this legislation, the Under Secretary would be 
required to designate physician assistants (PAs) to serve as 
consultants to the Under Secretary to provide advice on all 
matters related to employment and utilization of PAs in the 
Department of Veterans Affairs.
    Other major health provisions in S. 1402 included 
construction authorization in Palo Alto, Beckley, Miami, and 
Long Beach, authorizing a long-term care psychiatric facility 
at the Murfreesboro VA Medical Center, and extending 
authorization for a long-term care project at the Lebanon VA 
Medical Center.
    Real property matters in S. 1402 included changing the 
enhanced-use lease Congressional notification period from 60 
``legislative'' days to 90 ``calendar'' days. The bill 
transfers parcels of land from Carl Vinson VA Medical Center to 
the State of Georgia; from Allen Park VA Medical Center to Ford 
Motor Land Development Corporation; from Miles City VA Medical 
Center to Custer County, Montana; and from Fort Lyon VA Medical 
Center to the State of Colorado; with conditions. The Miles 
City and Fort Lyon matters were proposed in a Senate bill. This 
language was adopted in the compromise agreement.
    S. 1402, the Veterans Benefits and Health Care Improvement 
Act of 2000, passed the Senate on October 12, 2000, passed the 
House on October 17, 2000, and became Public Law 106-419.

                          Oversight Activities

First Session

    The Subcommittee on Health held a hearing on February 24, 
1999 to give the Department of Veterans Affairs an opportunity 
to justify its budget request for VA medical care for FY 2000. 
The principal VA witness appearing at this hearing was Dr. 
Thomas L. Garthwaite, Deputy Under Secretary for Health. A 
panel of national veterans organizations also presented their 
views, including Mr. Dennis Cullinan, Executive Director, 
Veterans of Foreign Wars; Ms. Jacqueline Garrick, Deputy 
Director, National Veterans Affairs and Rehabilitation, The 
American Legion; Mr. Richard Wannemacher, Jr., Associate 
National Legislative Director, Disabled American Veterans; Mr. 
Harley Thomas, Associate Legislative Director, Paralyzed 
Veterans of America; Ms. Veronica A'zera, Legislative Director, 
AMVETS; Mr. George C. Duggins, National President, Vietnam 
Veterans of America; and Mr. Nick Bacon, Director, Arkansas 
Department of Veterans Affairs.
    Testimony was submitted for the record by Mr. Bobby L. 
Harnage, Sr., National President, American Federation of 
Government Employees. These individuals and organizations 
offered testimony on the President's budget request for 
veterans health care programs. A number of subcommittee Members 
expressed concerns about the adequacy of the budget request to 
maintain quality of care for an aging veteran population, given 
the Administration's apparent objective of holding VA's medical 
care spending to a fixed level in the face of obvious and 
persistent financial difficulties, especially in the northern, 
central and eastern parts of the national system. These 
concerns were not assuaged as a result of this hearing, and the 
Committee subsequently made strong recommendations to the 
Budget and Appropriations Committees to significantly increase 
the Veterans Benefits and Services allotment and Medical Care 
appropriation, respectively, for the fiscal year 2000 period.
    On March 10, 1999, the Subcommittee on Health held a 
hearing on VHA capital asset management. This hearing was 
motivated by the subcommittee's concerns about the state of 
VA's infrastructure, 4,700 aging and increasingly unused 
buildings. Appearing as GAO's lead witness was Mr. Stephen 
Backhus, Director of Veterans' Affairs and Military Health Care 
Issues. Also testifying at this hearing was Dr. Daniel H. 
Winship, Dean of the Loyola University Chicago Stritch School 
of Medicine and former VHA Associate Deputy Chief Medical 
Director. Dr. Thomas Garthwaite, Deputy Under Secretary for 
Health, appeared as the VA's lead witness.
    GAO testified that VA could enhance veterans' health care 
benefits if it reduced the level of resources spent on 
underused, inefficient, and obsolete buildings and instead 
reinvested these savings in providing health care more 
efficiently in modern facilities at existing locations or in 
new locations closer to where veterans live. GAO expressed 
concern at VA's slow progress in addressing the need to deal 
with its unneeded capital infrastructure. VA's witnesses 
expressed agreement in principle with GAO's critique, but 
asserted that VA's new approach was designed to address many of 
these concerns and would render overall improvements in VA's 
capital assets management practices (see Subcommittee on 
Oversight and Investigations follow-up hearing, July 22, 1999, 
p. 71).
    As a result of the March 10, 1999 and July 22, 1999 
hearings, the Committee included in Title II of its initial 
1999 health care bill, H.R. 2116, a statutory system to 
authorize VA to probe alternative uses and enhanced services to 
veterans from proceeds realized by disposals through out-
leasing, sale or donation of unneeded VA capital facilities. 
This statutory language was eventually dropped in conference 
with the Senate, but some of its objectives were subsequently 
realized in the previously discussed CARES initiative, 
currently underway.
    On April 21, 1999, the Subcommittee on Oversight and 
Investigations and the Subcommittee on Health held a joint 
hearing on suspension of medical research at the West Los 
Angeles and Sepulveda VA medical facilities, and on the status 
of informed consent and patient safety in VA medical research. 
The principal witnesses were Dr. J. Thomas Puglisi, Director, 
Division of Human Subject Protections, Office for Protection 
from Research Risks, National Institutes of Health, Department 
of Health and Human Services; Dr. Dean C. Norman, Acting Chief 
of Staff, West Los Angeles VAMC; Dr. Stephen Pandol, Former 
Director, Research and Development, West Los Angeles VAMC; Mr. 
Kenneth Clark, Chief Network Officer and Former Director, West 
Los Angeles VAMC; and Mr. Ronald Norby, Clinical Manager and 
Deputy Network Director, VISN 22. Also testifying were the 
Honorable Kenneth Kizer, VA Under Secretary for Health; Dr. 
Eric M. Meslin, Executive Director, National Bioethics Advisory 
Commission; Dr. Paul Appelbaum, Chair, Department of 
Psychiatry, University of Massachusetts Medical School, and 
Chair, American Psychiatric Association Ethics Appeals Board; 
and Dr. Adil E. Shamoo, Professor, Department of Biochemical 
and Molecular Biology, University of Maryland, Baltimore.
    While VA in its testimony attempted to reassure the 
subcommittees regarding its research program at West Los 
Angeles, other witnesses did not provide a basis for the 
subcommittees to be confident that human subject protections 
throughout the VA were thorough and rigorous. Therefore, the 
subcommittees subsequently requested GAO to conduct a 
comprehensive review of VA's human subject research programs 
(see Subcommittee on Oversight and Investigations follow-up 
hearing, September 28, 2000, p. 79).
    The Subcommittee on Health held a hearing on VA long-term 
care on April 22, 1999 to examine VA actions in the wake of the 
Report of the Federal Advisory Committee on VA long-term care. 
The VA's lead witness was the Honorable Kenneth W. Kizer, Under 
Secretary for Health. Other witnesses were Dr. John W. Rowe, 
Chairman, Federal Advisory Committee on the Future of VA Long-
Term Care; Mr. Robert Shaw, President, National Association of 
State Veterans Homes; Ms. Pamela Zingeser, Principal, Birch and 
Davis Associates, Inc.; Ms. Kathleen Greve, Chief, VA State 
Home Construction; Mr. Steve Watson, Administrator, Ocala 
Harborside Healthcare Nursing Home, Ocala, Florida; and Mr. 
Richard Jelinek, Senior Vice President, Managed Care Solutions.
    The advisory committee concluded that VA needed to launch 
more alternatives to the traditional approach of building and 
staffing VA nursing home beds to meet the needs of an aging 
veteran population. Among its recommendations were those to 
encourage VA to expand and enhance adult day care, assisted 
living, respite care and hospice care, and to rely more on 
community-based programs rather than VA institutional programs 
in attempting to meet these needs. VA testified that it was 
making progress on some of these initiatives but needed 
statutory clarification in order to proceed with some of the 
recommendations of the advisory committee. The Committee 
subsequently enacted expansions of a variety of VA long-term 
care programs in Public Law 106-117, the Veterans Millennium 
Health Care and Benefits Act of 1999.
    On July 15, 1999, the Subcommittee on Health conducted a 
hearing on VA's experience in implementing patient enrollment 
under Publilc Law 104-262. The principal witnesses were Mr. 
Stephen P. Backhus, Director, Veterans' Affairs and Military 
Health Care Issues, GAO; and Dr. Thomas L. Garthwaite, VA 
Acting Under Secretary for Health.
    This hearing concentrated on the issue of ``Priority 7'' 
veterans--those whose incomes are higher than the means test 
threshold and who must therefore agree to make co-payments to 
VA as a condition of eligibility. The Committee was concerned 
about the manner in which the VA Secretary had been managing 
the policy of annual enrollments as it affected these Priority 
7 veterans. The purpose of the hearing was to review whether VA 
was implementing correctly the statutory policy. In addition, 
the Committee focused on the level of funding available for VA 
health care--principally whether the management of eligibility 
policy and allocation of available resources were consistent 
and rational.
    On November 16, 1999, the Subcommittee on Health and 
Subcommittee on Oversight and Investigations conducted a joint 
hearing on the issue of the Department of Defense's use of the 
substance pyridostigmine bromide (PB) as a pre-treatment to 
protect against possible chemical nerve agent attacks in 
250,000 U.S. military service members in the Persian Gulf War. 
The witnesses included Dr. Beatrice Alexandra Golomb, 
Consultant, RAND Center for Military Health Policy Research, 
accompanied by Dr. C. Ross Anthony, Director; and Dr. Joseph S. 
Cassells, Project Director, Institute of Medicine, National 
Academy of Sciences. Other participants included the Honorable 
Sue B. Bailey, Assistant Secretary of Defense for Health 
Affairs; and Dr. Bernard D. Rostker, Special Assistant to the 
Deputy Secretary of Defense for Gulf War Illnesses. The VA's 
lead witness was Dr. Frances Murphy, Acting Deputy Under 
Secretary for Health. Service organizations were represented by 
Mr. Matthew L. Puglisi, Director of Veterans Affairs and 
Rehabilitation, The American Legion; Mr. Paul Sullivan, 
Executive Director, National Gulf War Resource Center; and 
Persian Gulf veteran nurse, Denise Nichols, Vice-Chairman, 
National Vietnam and Gulf War Veterans Coalition. The 
testimonies of witnesses explored the use of PB in the war, the 
possibility of toxic effects in human beings, and any potential 
relationship of PB exposure to the maladies often referred to 
as ``Gulf War illnesses.''

Second Session

    The House Committee on Commerce Subcommittee on Health and 
Environment and the Veterans' Affairs Subcommittee on Health 
conducted a joint hearing on medical errors and improving the 
quality of care on February 9, 2000. Witnesses included Dr. 
Donald M. Berwick, President and CEO, Institute of Healthcare 
Improvement, testifying for the Institute of Medicine; Mr. 
Randall Bovbjerg, Principal Research Associate, The Urban 
Institute; and Dr. Kenneth Kizer, President and Chief Executive 
Officer, The National Quality Forum and former VA Under 
Secretary for Health; Dr. Thomas Garthwaite, Deputy Under 
Secretary for Health, VHA; Ms. Janet Heinrich, Associate 
Director, Health Financing and Public Health Issues, GAO; Dr. 
Audrey Nelson, Director of Patient Safety Center of Inquiry, 
James A. Haley VAMC; Ms. Diane Cousins, Vice President, 
Practitioner and Product Experience Division, United States 
Pharmacopeia. Other witnesses included Mr. Daniel Perry, 
Executive Director, Alliance for Aging Research, testifying on 
behalf of the Foundation for Accountability; Dr. William 
Golden, President, American Health Quality Association; Ms. 
Mary Foley, President, American Nurses Association; Dr. Dennis 
S. O'Leary, President, Joint Commission on Accreditation of 
Healthcare Organizations; and Dr. Michael L. Lanberg, Senior 
Vice President, Medical Affairs, Chief Medical Officer, Cedars-
Sinai Health System, testifying on behalf of the American 
Hospital Association.
    This hearing was the result of concerns expressed in a 
landmark report by the Institute of Medicine of the National 
Academy of Sciences. The report concluded that preventable 
patient injuries from a wide range of medical mistakes were 
jeopardizing patient safety across all facets of American 
health care. IOM's report, however, noted VA's policies and 
practices are designed to protect VA patient safety by using a 
systems approach to reducing medical errors. The hearing 
explored these issues in depth.
    The Subcommittee on Benefits and Subcommittee on Health 
conducted a joint hearing March 9, 2000 on homeless veterans 
issues with Miss Heather French of Kentucky, Miss America 2000, 
as keynote witness. Miss French was joined in testimony by a 
number of VA officials, including clinicians working in various 
aspects of veterans programs for the homeless, as well as 
representatives from the veterans service organizations. Their 
testimony indicated that VA's programs are effective in meeting 
the needs of the homeless veterans VA actually serves, that a 
significant number of veterans in the United States still 
remain or will become homeless, and that VA is not reaching 
these veterans with the level of resources available to these 
programs.
    On April 5, 2000, the subcommittee held a hearing on 
capital asset planning in the VA health care system. 
Representative Dave Weldon of Florida presented his proposal 
for a pilot program for veterans health benefits coordination 
of VA-enrolled veterans through other insurers, including 
Medicare and indemnity insurers, in four VA community-based 
clinic sites. Mr. Weldon subsequently introduced his 
legislation on May 25, 2000, as H.R. 4575. The proposal 
authorized program participants to use local community 
hospitals for basic acute inpatient care. The subcommittee also 
heard testimony from VA, GAO and veterans service 
organizations. Two VA network directors testified on their 
local plans for restructuring VA facilities within their 
jurisdictions. Following the hearing, the Committee developed 
legislation that would authorize the pilot program of 
coordinating benefits envisioned by Dr. Weldon. This 
legislation was incorporated in H.R. 5109 (see Legislative 
Activities, pp. 51-52).
    Recruitment, retention, and compensation of the VA health 
care workforce were examined in a hearing on April 12, 2000 by 
the Subcommittee on Health. Witnesses for this hearing were Mr. 
Kenneth J. Clark, VA Chief Network Officer; Dr. John F. Burton, 
Jr., National Association of VA Physicians and Dentists; Dr. 
Robert M. Anderton, American Dental Association; Ms. Margaret 
Kruckemeyer, President, Nurses Organization of Veterans 
Affairs; and Mr. Bobby Harnage, Sr., President, American 
Federation of Government Employees.
    The subcommittee focused on the pay rates and systems for 
VA nurses and dentists, especially their impact on recruitment, 
retention and professional employee morale issues. 
Subsequently, the full Committee incorporated measures to 
reform VA nurse pay and to update VA dentist pay in its major 
health care legislation for 2000, H.R. 5109 (see also p. 52).
    The subcommittee's hearing on May 17, 2000 examined health 
resource sharing between the Departments of Veterans Affairs 
and Defense. Witnesses included Mr. Anthony J. Principi, 
Chairman, Congressional Commission on Servicemembers and 
Veterans Transition Assistance and former VA Deputy Secretary; 
Mr. Stephen P. Backhus, Director, Veterans' Affairs and 
Military Health Care Issues, GAO; Dr. Thomas L. Garthwaite, VA 
Deputy Under Secretary for Health, Ms. Gwendolyn A. Brown, 
Deputy Assistant Secretary of Defense, Health Budgets and 
Financial Policy, and Lt. Gen. Paul K. Carlton, Jr., Surgeon 
General, USAF.
    From testimony given at this hearing, the subcommittee 
concluded that while sharing has been a worthwhile effort on 
the part of both Departments, a number of barriers have 
prevented additional sharing and should be addressed (see also 
Subcommittee on Oversight and Investigations hearing, May 25, 
2000, on VA-DOD joint pharmaceutical procurement, p. 76).
    Pharmaceutical procurement policy was also examined in a 
subcommittee hearing on July 25, 2000 with Mr. William Flynn, 
Director, Retirement and Insurance Programs, Office of 
Personnel Management; the Honorable Edward A. Powell, VA 
Assistant Secretary for Management; Mr. Richard A. Wannemacher, 
Jr., Assistant National Legislative Director, Disabled American 
Veterans; and Dr. Robert B. Betz, Executive Director, Health 
Industry Group Purchasing Association; as the principal 
witnesses.
    The Office of Personnel Management and the VA were at the 
time of the hearing in negotiation to jointly sponsor an 
experiment in pharmaceutical procurements involving the use of 
the Federal Supply Schedule (FSS) by a participating 
organization of the Federal Employee Health Benefits Program. 
The experiment was intended to test whether this method of 
procurement through the FSS might offer a significant price 
advantage to this initial group of federal employees, and 
whether a price advantage could be gained by future expansion 
to other health plans used by federal workforce and federal 
retiree groups.
    The subcommittee was concerned about the implications of 
this initiative on the prices VA's pharmaceutical procurement 
programs are able to obtain under current law. Several weeks 
after the hearing, OPM announced that the pilot project had 
been cancelled due to lack of cooperation by pharmaceutical 
manufacturers.
    The subcommittee's final hearing of the 106th Congress was 
conducted on October 3, 2000 on the issue of chiropractic 
services in the Department of Veterans Affairs. Testifying as 
VA's principal witness was Dr. Frances M. Murphy, Acting Deputy 
Under Secretary for Health. Other witnesses were Dr. Rick A. 
McMichael, American Chiropractic Association; Dr. Michael S. 
McLean, International Chiropractors Association, accompanied by 
Mr. Ronald M. Hendrickson, Executive Director, International 
Chiropractors Association; Dr. George Goodman, President, Logan 
College of Chiropractic, and Immediate Past President, 
Association of Chiropractic Colleges, accompanied by Dr. Reed 
Phillips, President, Los Angeles College of Chiropractic and 
Past President, Association of Chiropractic Colleges. The 
principal witness for the Department of Defense was RADM 
Michael L. Cowan, USN, Deputy Executive Director and Chief 
Operating Officer, TRICARE Management Activity, Office of the 
Assistant Secretary of Defense for Health Affairs.
    Chiropractors had expressed concerns about their 
perceptions of barriers to their profession's effective 
utilization within the VA. Specifically, the professional 
organizations advocated for an increased role in direct health 
care delivery to veterans under the Department's care. VA 
opposed involving chiropractors as primary care providers 
within the VHA and instead relied upon policy VA published on 
May 5, 2000.
    Under this policy, Veterans Integrated Service Networks 
(VISNs) or medical centers were required to establish local 
policies consistent with the broader guidance of the national 
directive which significantly limited chiropractors' scope of 
practice. The chiropractic organizations testified in 
opposition to VA's approach and requested Congress consider 
legislation to create a more workable policy on the use of 
chiropractors in VA health care. The subcommittee has informed 
VA of its concerns about current policy and asked VA to re-
engage with chiropractic organizations in an effort to be more 
accommodating to the interests of veterans in gaining access to 
chiropractic care as a part of the VA health benefits package.

                        Subcommittee on Benefits

    The Subcommittee on Benefits has jurisdiction over 
veterans' matters affecting compensation, pension, insurance, 
memorial affairs, education, training, vocational 
rehabilitation, small business, employment and housing. In 
addition to overseeing programs administered by the Veterans 
Benefits Administration and the National Cemetery 
Administration, the subcommittee has oversight of Arlington 
National Cemetery under the jurisdiction of the U.S. Army, and 
overseas cemeteries under the jurisdiction of the American 
Battle Monuments Commission (see Oversight Plan for the 106th 
Congress, p. 83).

                         Legislative Activities

First Session

    On March 18, 1999, the full Committee marked up H.R. 70, 
the Arlington National Cemetery Burial Eligibility Act. The 
bill was favorably reported to the House (see House Report 106-
70), and passed by a vote of 428-2 on March 23, 1999.
    On April 21, 1999, the subcommittee held a legislative 
hearing on H.R. 1071, the Montgomery GI Bill Improvements Act 
of 1999, and H.R. 1182, the Servicemembers Educational 
Opportunity Act of 1999. Witnesses were the Honorable G.V. 
(Sonny) Montgomery; the Honorable G. Kim Wincup, Vice Chairman, 
Commission on Servicemembers and Veterans Transition 
Assistance; SFC Thomas R. Krech, Recruiter, USA; PO Laura D. 
Johnson, Recruiter, USN; SSgt. Robert A. Austin, Field 
Recruiter, USAF; Gunnery Sgt. Paul Jornet, Recruiter, USMC; 
Electricians Mate Second Class Keisha R. Gill, Recruiter, USCG, 
VADM Patricia A. Tracey, Deputy Assistant Secretary of Defense, 
Military Personnel Policy; Maj. Gen. Evan Gaddis, Commanding 
General, USA Recruiting Command; RADM Barbara E. McGann, 
Commander, USN Recruiting Command; Brig. Gen. Peter U. Sutton, 
Commander, USAF Recruiting Service; Maj. Gen. Gary L. Parks, 
Commanding General, USMC Recruiting; and RADM Thomas J. 
Barrett, Director of Reserve and Training, USCG. Mr. Joshua R. 
Krebs, Manager, Legislative Affairs, Air Force Sergeants 
Association; and Mr. Michael P. Cline, Executive Director, 
Enlisted Association of the National Guard, submitted testimony 
for the record.
    Mr. Montgomery, Mr. Wincup, the military associations, and 
service branch witnesses testified in support of H.R. 1071 and 
H.R. 1186. The Deputy Assistant Secretary of Defense for 
Military Policy testified that the Montgomery GI Bill has met 
or exceeded the expectations of its sponsors and has been a 
major contributor to the All-Volunteer Force.
    On May 20, 1999, the subcommittee held a second legislative 
hearing on H.R. 1071 and H.R. 1182. Witnesses included Ms. Nora 
Egan, VA Deputy Under Secretary for Management, VBA; Dr. Steven 
F. Kime, Chairman, Secretary of Veterans Affairs Advisory 
Committee on Education; Ms. Judith Lee Ladd, President, 
American School Counselor Association; Mr. David A. Guzman, 
President, National Association of Veterans Program 
Administrators; Mr. C. Donald Sweeney, Legislative Director, 
National Association of State Approving Agencies; Mr. Sid 
Daniels, Deputy Director, National Legislative Services, 
Veterans of Foreign Wars; Mr. William F. Frasure, Deputy 
Director, Government Relations, Vietnam Veterans of America; 
Mr. Peter Gaytan, Legislative Director, AMVETS; Mr. Matthew L. 
Puglisi, Assistant Director, National Veterans Affairs and 
Rehabilitation Commission, The American Legion; Mr. Harley 
Thomas, Associate Legislative Director, Paralyzed Veterans of 
America; Mr. Larry D. Rhea, Deputy Director, Legislative 
Affairs, Non Commissioned Officers Association; Mr. Charles L. 
Calkins, National Executive Secretary, Fleet Reserve 
Association; Mr. John J. Daly, Legislative Assistant, The 
Retired Enlisted Association; Mr. Benjamin H. Butler, Associate 
Legislative Counsel, National Association for Uniformed 
Services; Mr. Joshua W. Krebs, Manager, Legislative Affairs, 
Air Force Sergeants Association; Mr. Theodore Stroup, Vice 
President, Association of the U.S. Army; and Mr. Robert F. 
Norton, Deputy Director, Government Relations, The Retired 
Officers Association. The higher education, military, and 
veterans service organizations all supported H.R. 1071 and H.R. 
1186. VA acknowledged the MGIB's role in military recruiting 
and access to higher education, but said more study was needed 
before it could formulate a position.
    On June 10, 1999, the subcommittee held a legislative 
hearing to receive testimony on the following bills: H.R. 605, 
the Court of Appeals for Veterans Claims Act of 1999; H.R. 690, 
a bill to add bronchiolo-alveolar carcinoma to the list of 
diseases presumed to be service-connected for certain 
radiation-exposed veterans; H.R. 708, a bill to provide for the 
reinstatement of certain benefits administered by the Secretary 
of Veterans Affairs for remarried surviving spouses upon 
termination of their remarriage; H.R. 784, a bill to authorize 
the payment of Dependency and Indemnity Compensation to the 
surviving spouses of certain former prisoners of war; H.R. 
1214, the Veterans' Claims Adjudication Improvement Act of 
1999; and H.R. 1765, the Veterans' Compensation Cost-of-Living 
Adjustment Act of 1999.
    Representative Chris Smith of New Jersey testified in 
support of his bill, H.R. 690, and Representative Michael 
Bilirakis of Florida testified in support of H.R. 784, which he 
sponsored. The Honorable Joseph Thompson represented VA and 
opposed H.R. 690 and a portion of H.R. 605. The veterans 
service organization witnesses testified in support of the 
bills.
    On June 16, 1999, the subcommittee held a legislative 
hearing on H.R. 1247, the World War II Memorial Completion Act; 
H.R. 1476, the National Cemetery Act of 1999; H.R. 1484, to 
authorize appropriations for homeless veterans reintegration 
projects under the Stewart B. McKinney Homeless Assistance Act; 
H.R. 1603, the Selected Reserve Housing Loan Fairness Act of 
1999; H.R. 1663, the National Medal of Honor Act; and H.R. 
2040, the Veterans' Cemeteries Assessment Act of 1999. The 
veterans service and military organizations essentially 
supported these measures. VA testimony varied depending on the 
bill or specific aspects of each bill.
    On June 17, 1999, the subcommittee marked up a draft bill 
of the Veterans' Benefits Improvement Act of 1999, which 
included H.R. 605, H.R. 690, H.R. 708, H.R. 784, H.R. 1214, 
H.R. 1247, H.R. 1476, provisions of H.R. 1484, H.R. 1765, and 
H.R. 2040. The bill was reported favorably to the full 
Committee by voice vote. On June 23, 1999, the bill, H.R. 2280, 
was favorably reported to the House by the full Committee (see 
House Report 106-202).
    On October 28, 1999, the subcommittee held a hearing on 
draft legislative concepts for a 21st Century Veterans' 
Employment and Training bill, draft legislative concepts for 
miscellaneous VA education programs, H.R. 364, the Veterans' 
Employment and Training Bill of Rights Act of 1999, and H.R. 
625, the Veterans' Education Benefits Equity Act of 1999. 
Witnesses included Mr. Joseph Andry, Director, Veterans Service 
Division, Ohio Bureau of Employment Services; Ms. Effie 
Baldwin, Local Veterans Employment Representative, Arizona 
Department of Economic Security; Mr. Dennis A. Beagle, 
Executive Board Member, New York State Public Employees 
Federation; Mr. Michael Blecker, Executive Director, Swords to 
Plowshares, San Francisco, California; the Honorable Espiridion 
Borrego, Assistant Secretary for Veterans' Employment and 
Training, Department of Labor; Mr. Christopher J. Brennan, Dean 
of Business and Workforce Development and Mr. George J. 
Moriarity, Executive Director, The Career Place, Middlesex 
Community College; Ms. Celia P. Dollarhide, Director, VA 
Education Service; Mr. Ronald W. Drach, President, R. W. Drach 
Consulting; Mr. Robert C. Gross, President, Interstate 
Conference of Employment Security Agencies; Mr. John Hall, 
Disabled Veterans Outreach Program Specialist, New York 
Department of Labor; Mr. James H. Hartman, New York State 
Director of Veterans' Employment and Training, DOL; Mr. James 
B. Hubbard, Director, National Economic Commission, The 
American Legion; Mr. James N. Magill, Director, National 
Employment Policy, Veterans of Foreign Wars; Mr. Woodrow C. 
McCutcheon, President, Association of Small Business 
Development Centers; Representative Robert W. Ney of Ohio, Mr. 
Larry D. Rhea, Director of Legislative Affairs, Non 
Commissioned Officers Association; Mr. Philip Wilkerson, Deputy 
Director, Veterans Affairs and Rehabilitation, The American 
Legion; MG Thomas F. Sikora, USA, Ret., Vice President and 
Division General Manager, Resource Consultants, Inc.; and Mr. 
Anthony L. Baskerville, Deputy National Service Director for 
Employment, Disabled American Veterans.
    The purpose of this hearing was to obtain advice from 
witnesses regarding the feasibility of various concepts to 
revise policies governing the delivery of veterans employment 
and training in each of the states. The Department of Labor 
opposed most of the concepts while other witnesses supported 
some concepts but not others.

Second Session

    On March 23, 2000, the subcommittee held a hearing on H.R. 
3193, the Duty to Assist Veterans Act of 1999. Representatives 
from the Non Commissioned Officers Association, Vietnam 
Veterans of America, Disabled American Veterans, The American 
Legion, Paralyzed Veterans of America, and Veterans of Foreign 
Wars all testified in support of the bill. All the veterans 
service organization witnesses were opposed to the VA's 
proposed rules in response to the decision in Morton v. West, 
12 Vet. App. 477, remanded on other grounds   F.3d  , 2000 U.S. 
App. LEXIS 22464 (Fed. Cir., August 17, 2000), which was the 
impetus for the introduction of H.R. 3193. The Honorable Joseph 
Thompson, Under Secretary for Benefits, testified on behalf of 
the VA. The Department recommended the subcommittee defer 
action on the bill until VA completed its ongoing rulemaking. 
As the result of this hearing and subsequent meetings with 
representatives from the veterans service organizations and VA 
officials, H.R. 4864 was introduced and passed the House on 
July 25, 2000.
    On April 13, 2000, the subcommittee received testimony on 
H.R. 1020, the Veterans' Hepatitis C Benefits Act of 1999; H.R. 
3816, to provide that a stroke or heart attack suffered by a 
member of a reserve component while performing inactive duty 
for training shall be considered service-connected; H.R. 3998, 
the Veterans' Special Monthly Compensation Gender Equity Act; 
and H.R. 4131, the Veterans' Compensation Cost-of-Living Act of 
2000. In addition, the subcommittee received testimony on the 
VA's adjudication of hepatitis C claims.
    Representative Vic Snyder of Arkansas testified in support 
of his bill, H.R. 1020, and Representative Bart Stupak of 
Missouri testified in support of H.R. 3816, which he sponsored. 
Additional witnesses included Dr. Gary Roselle, Program 
Director for Infectious Diseases at the VA Medical Center in 
Cincinnati, Ohio; Mr. Keith Snyder, Mr. Michael Shallow, a 
hepatitis C-positive disabled veteran; Ms. Linda Spoonster 
Schwartz, Chair, VA Advisory Committee on Women Veterans; Ms. 
Joy Ilem, Disabled American Veterans; Mr. Harley Thomas, 
Paralyzed Veterans of America; Mr. Peter Gayton, AMVETS; Mr. 
Richard Schneider, Non Commissioned Officers Association; Mr. 
Sidney Daniels, Veterans of Foreign Wars; and Mr. Philip 
Wilkerson, The American Legion. Ms. Nora Egan testified on 
behalf of VHA.
    Mr. Shallow and Mr. Snyder testified in support of making 
hepatitis C a presumptive disease for purposes of VA disability 
compensation and cited the problems VA is having in 
adjudicating all claims. The veterans service organization 
witnesses testified in support of all the bills on the hearing 
agenda. VA supported H.R. 3816, H.R. 3998 and H.R. 4131, but 
opposed H.R. 1020. VA testified that they were in the process 
of proposing revisions to the rating schedule that would 
provide a separate code for hepatitis C, and new, more 
appropriate criteria for evaluating the condition.
    On May 11, 2000, the full Committee marked up H.R. 4268, 
the Veterans and Dependents Millennium Education Act. The bill 
was favorably reported to the House (see House Report 106-628). 
On May 23, 2000, the House passed S. 1402, as amended by H.R. 
4268, by a vote of 417-0.
    On July 12 and July 13, 2000, the subcommittee held 
hearings on H.R. 4765, the 21st Century Veterans Employment and 
Training Act. Witnesses included Miss Heather French, Miss 
America 2000; the Honorable Anthony J. Principi, Chairman, 
Congressional Commission on Servicemembers and Veterans 
Transition Assistance; the Honorable Espiridion Borrego, 
Assistant Secretary of Labor for Veterans' Employment and 
Training; Mr. Alan Gibson, Disabled Veterans Outreach Program 
Specialist (on extended disability leave from) Missouri 
Division of Workforce Development, Department of Labor and 
Industrial Relations, and President, Missouri State Council, 
Vietnam Veterans of America; Mr. James Hartman, Director of 
Veterans' Employment and Training, State of New York; Dr. Carol 
A. Cowan, President, Middlesex Community College; Mr. Stephen 
A. Horton, Manager, Employment Security Program Services, 
Alabama Department of Industrial Relations; Mr. Mike Sheridan, 
Former Executive Director, Texas Workforce Commission; Mr. 
Donald E. Shasteen, Former Assistant Secretary of Labor for 
Veterans' Employment and Training; Ms. Heather W. Whitley, 
Director, Division of Employment and Training, Kansas 
Department of Human Relations; Mr. William C. Plowden, Jr., 
Director for Veterans' Employment and Training, South Carolina; 
Mr. Peter Gaytan, Legislative Director, AMVETS; Mr. Dennis A. 
Beagle, Executive Board Member, New York State Employees 
Federation; Mr. Robert F. Gross, President of ICESA; Maj. Gen. 
Matthew P. Caulfield, USMC (Ret), CEO, MilitaryHub.com and 
Chairman of the Board, Hire Quality, Inc. and Third Rail, Inc.; 
Mr. Rick Weidman, Director, Government Relations, Vietnam 
Veterans of America; Mr. Raymond G. Boland, Secretary, 
Wisconsin Department of Veterans Affairs; Mr. James B. Hubbard, 
Director, National Economic Commission, The American Legion; 
Mr. Ronald W. Drach, President, R. W. Drach Consulting; Mr. 
James N. Magill, Director, National Employment Policy, Veterans 
of Foreign Wars; Mr. Geoff Hopkins, Associate Legislative 
Director, Paralyzed Veterans of America; and Mr. John Lopez, 
Chairman, Association of Service Disabled Veterans, accompanied 
by Mr. Joseph Forney, Assistant Coordinator, Disabled Veterans 
Enterprise Institute. Miss French and the Transition Commission 
witness strongly endorsed this bill. The Department of Labor 
largely opposed this legislation, arguing that it was 
unnecessary. Other witnesses largely supported the legislation 
with selected revisions for additional improvements.
    On July 18, the subcommittee marked up H.R. 4850, the 
Veterans Benefits Act of 2000 and H.R. 4864, the Veterans 
Claims Assistance Act of 2000. Both bills were reported 
favorably to the full Committee. On July 20, the full Committee 
met and marked up H.R. 4850 and H.R. 4864. Each bill was 
favorably reported to the House (see House Report 106-783 and 
106-781, respectively). On July 25, H.R. 4850 unanimously 
passed the House by voice vote; and H.R. 4864 passed the House 
by a vote of 414-0.

                          Oversight Activities

First Session

    On February 23, 1999, the full Committee held a hearing to 
receive the Report of the Commission on Servicemembers and 
Veterans Transition Assistance. The Honorable Anthony Principi, 
Chairman of the Commission, testified on the Commission's 
findings and its over 100 recommendations addressing 31 
separate issues. The Honorable Bob Dole, who introduced the 
Senate legislation that created the Commission on 
Servicemembers and Veterans Transition Assistance, testified in 
support of the Commission's efforts and urged the Congress to 
move forward on making the kinds of improvements necessary for 
servicemembers transitioning back into civilian life.
    On February 24, 1999, the subcommittee held an oversight 
hearing on the fiscal year 2000 budget for the Department of 
Labor Veterans' Employment and Training Service (VETS). The 
Honorable Espiridion Borrego, Assistant Secretary of Labor for 
Veterans' Employment and Training, testified on behalf of the 
Department of Labor. The veterans service organizations were 
represented by Vietnam Veterans of America, The American 
Legion, Veterans of Foreign Wars, AMVETS, and Non Commissioned 
Officers Association. Mr. Borrego, in addition to presenting 
VETS' budget, noted fiscal year 1998 accomplishments and 
addressed some of the Department of Labor's current efforts, 
pilots and initiatives. While the veterans service 
organizations were supportive of the overall monetary funding 
in the budget, they pointed out various areas where they saw a 
funding shortfall, most notably in the Disabled Veteran 
Outreach Program, the Local Veteran Employment Representative 
program, and the Homeless Veteran Reintegration Program.
    On March 25, 1999, the subcommittee held an oversight 
hearing on the state of the Veterans Benefits Administration. 
Witnesses included the Honorable Joseph Thompson, VA Under 
Secretary for Benefits, Ms. Cynthia Bascetta, Associate 
Director for Veterans Affairs and Military Health Care Issues, 
GAO, and representatives of veterans service organizations. Mr. 
Thompson testified that the Department has been working 
aggressively to address the areas of major concern detailed in 
prior hearings and meetings with all stakeholders. The six 
areas VBA is developing are; (1) focusing on veterans, (2) 
delivering exceptional service, (3) basing all areas on strong 
core values, (4) forming productive partnerships with 
stakeholders, (5) initiating change rather than responding to 
it, and (6) developing ways to equip future staff to serve 21st 
century veterans. Ms. Bascetta of GAO testified to the long-
standing challenges facing the VA in administering benefits, 
but noted recent progress the Department has made in major 
areas, including measurement of decision accuracy, 
accountability for performance, and training for 
decisionmakers. The veterans service organizations testified to 
the challenges VBA faces, including a system of adjudication 
that is process-oriented rather than results-oriented.
    On September 9, 1999, the subcommittee conducted a hearing 
on veterans' employment regarding civilian credentialing 
requirements for military job skills. Witnesses included the 
Honorable Espiridion Borrego, Assistant Secretary of Labor for 
Veterans Employment and Training, Mr. Victor Vasquez, Jr., 
Deputy Assistant Secretary of Defense, Personnel Support, 
Families and Education; Mr. Julius Williams, Jr., Director, 
Vocational Rehabilitation and Counseling Service, VBA; Mr. 
James Hubbard, The American Legion; the Honorable Ruby DeMesme, 
Assistant Secretary of the Air Force, Manpower, Reserve 
Affairs, Installations and Environment; RADM Fred Ames, 
Assistant Commandant for Human Resources, USCG; BG Kathryn 
Frost, The Adjutant General, USA; RADM David Brewer, III, Vice 
Chief of Naval Education and Training, USN; Lt. Gen. Jack 
Klimp, Deputy Chief of Staff for Manpower and Reserve Affairs, 
USMC; Mr. Steve Halsey, The Coalition for Professional 
Certification; Mr. Raymond Pryor, The Ohio Military Veteran 
Licensing and Certification Project; Maj. Gen. (Ret.) Matthew 
Caulfield, Hire Quality, Inc.; and Maj. Gen. (Ret.) Thomas 
Sikora, Resource Consultants.
    All the witnesses agreed that skilled servicemembers 
leaving the military may miss out on the chance to quickly move 
into good, high-paying, career-building jobs because they must 
undergo lengthy and expensive retraining in order to meet 
civilian licensure and certification requirements, often for 
the same types of jobs they held in the military. Each of the 
witnesses detailed what the service branches and private 
sectors are doing to ensure that separating servicemembers have 
the credentials necessary to transition into civilian 
employment.
    On October 26, 1999, the subcommittee held a hearing on 
claims adjudication issues facing certain Persian Gulf War 
veterans, specifically a past lack of consistency in claims 
decisions, inadequate employee training, relatively poor 
outreach and less than uniform development of evidence. The 
veterans service organizations, including The American Legion, 
Disabled American Veterans, National Gulf War Resource Center, 
Veterans of Foreign Wars, and the Vietnam Veterans of America, 
testified that VA has interpreted Public Law 103-446 in an 
overly narrow manner, thus veterans suffering from undiagnosed 
illnesses are significantly disadvantaged in terms of health 
care and claims adjudication. Dr. Claudia Miller, Environmental 
and Occupational Medicine, Department of Family Practice, 
University of Texas Health Science Center, testified on what 
has been done to understand why certain veterans are sick and 
suggested an ``unmasking'' study in order to isolate what 
exposures are producing symptoms. Dr. Victor Gordon, staff 
physician at the VAMC in Manchester, New Hampshire, described 
his experiences in treating Persian Gulf War veterans and 
provided an explanation on how physicians attribute similar 
signs and symptoms to a diagnosed condition. The Honorable 
Joseph Thompson, VA Under Secretary for Benefits, represented 
VBA. Mr. Thompson testified on the progress the VA has made in 
processing Gulf War claims, identified the Department's 
initiatives to aid in the processing of all claims, and 
detailed the interaction and coordination efforts between the 
VHA and the VBA in adjudicating Persian Gulf claims.

Second Session

    On March 9, 2000, the subcommittee conducted a hearing on 
the status of public and private sector initiatives to address 
homeless veterans issues. Witnesses included Miss Heather 
French, Miss America 2000; Dr. Fran Murphy, VHA; Ms. Estella 
Morris, Program Manager, VA Comprehensive Homeless Center, 
Little Rock, Arkansas; Ms. Henrietta Fishman, VISN 3; Mr. Fred 
Karnas, Deputy Assistant Secretary for Special Needs Programs, 
Department of Housing and Urban Development; the Honorable 
Espiridion Borrego, Assistant Secretary of Labor for Veterans' 
Employment and Training; Mr. Douglas Haywood, Western New York 
Veterans Housing Coalition; Mr. Raymond Boland, Wisconsin 
Department of Veterans Affairs; Mr Thomas Cantwell, U.S. Vets; 
Ms. Chris Noel, Vetsville Cease Fire House, Inc.; Ms. Lynne 
Heidel, Centre City Development Corporation; Mr. Harold 
Schultz, Disabled American Veterans; Mr. Joseph Caouette, 
Veterans of Foreign Wars; Mr. Richard Schneider, Non 
Commissioned Officers Association; and Mr. Calvin Gross, 
Vietnam Veterans of America.
    The Administration witnesses testified about their wide 
range of programs and services to address homeless veterans' 
needs. The private sector witnesses detailed the programs and 
services they offer, and the need for additional funds. Many 
witnesses would like to see the Department of Housing and Urban 
Development take more of an interest in, and provide additional 
funding for, veteran-specific programs.
    On March 14, 2000, the subcommittee held a joint oversight 
hearing with the Committee on Small Business' Subcommittee on 
Government Programs and Oversight on the implementation of 
Public Law 106-50, the Veterans Entrepreneurship and Small 
Business Development Act of 1999. Witnesses included Mr. Emil 
Naschinski, The American Legion; Mr. Rick Weidman, Vietnam 
Veterans of America; Mr. Geoffrey Hopkins, Paralyzed Veterans 
of America; Mr. John Lopez, Association of Service Disabled 
Veterans; Mr. Anthony Baskerville, Disabled American Veterans; 
Mr. Joseph Forney, Disabled Veteran Business Enterprise 
Network; Mr. Woodrow McCutchen, Association of Small Business 
Development Centers; Mr. W. Kenneth Yancey, National SCORE 
Office; and Mr. Darryl Dennis, U.S. Small Business 
Administration. Mr. Dennis outlined SBA's progress in 
implementing Public Law 106-50. Veterans organizations 
expressed their displeasure with what they perceived as SBA's 
recalcitrant implementation of the new law. The SBA disagreed, 
arguing that ``by definition'', start up of new services takes 
time, but it was completely committed to implementing the 
program.
    On September 27, 2000, the subcommittee held its second 
hearing on licensing and credentialing of military job skills 
for civilian employment. Witnesses included Mr. James Hubbard, 
The American Legion; Mr. Peter Gaytan, AMVETS; Mr. Michael 
Martin, National Organization for Competency Assurance; Maj. 
Gen. Matthew Caufield, Hire Quality, Inc.; Mr. Steven Halsey, 
The Coalition for Professional Certification; RADM Fred Ames, 
USCG; Lt. Gen. Jack Klimp, USMC; RADM David Brewer III, USN; 
Ms. Mary Lou Keener, Deputy Assistant Secretary for Manpower, 
Reserve Affairs, Installations and Environment; USAF; BG 
Kathryn Frost, USA; and the Honorable Espiridion Borrego, 
Assistant Secretary of Labor for Veterans' Employment and 
Training. The representatives of the service branches testified 
to the efforts being made to train and certify active duty 
servicemembers, along with joint service efforts. The hearing 
built upon the testimony the subcommittee received on September 
9, 1999.

              Subcommittee on Oversight and Investigations

    The Subcommittee on Oversight and Investigations reviews 
the benefits and the health care services that the federal 
government provides to eligible veterans and family members. It 
also oversees the programs and operations of the Department of 
Veterans Affairs, as well as those of other federal agencies 
that pertain to veterans. In carrying out its responsibilities, 
the subcommittee conducts hearings, site visits and 
investigations nationwide. It also requests reports from the 
General Accounting Office, the Congressional Research Service 
and the VA's Office of the Inspector General. The subcommittee 
does not have legislative jurisdiction so that its resources 
can be solely dedicated to oversight activities (see Oversight 
Plan for 106th Congress, p. 83).

                           Oversight Hearings

First Session

    The subcommittee held a hearing on March 11, 1999, on 
whistleblowing and retaliation in the VA. The principal 
witnesses included the Honorable Elaine Kaplan, Special 
Counsel, Office of Special Counsel; the Honorable Richard J. 
Griffin, VA Inspector General; the Honorable Eugene A. 
Brickhouse, VA Assistant Secretary for Human Resources and 
Administration; and the Honorable Leigh Bradley, VA General 
Counsel. Also testifying were Dr. Gordon D. Christensen, Dr. 
Edward H. Adelstein, Dr. Earl Dick, Mr. Donald Bumgardner, Mr. 
Kenneth Wilson, all VA employees, and Ms. Joan Pastor, a former 
VA employee.
    The subcommittee examined the VA's policies and protections 
for its employees who have claimed or been granted 
whistleblower status, as well as for employees who had filed 
various types of complaints or claims against the Department. A 
GAO survey of whistleblower protection in the VA found that VA 
health care employees were not confident that the Department 
would provide effective protection to those who report 
wrongdoing or expose waste, fraud and mismanagement. VA 
officials could not identify an instance when the Department 
protected a whistleblower. Moreover, VA officials could not 
identify VA managers or supervisors held accountable for 
retaliation without external pressure. In response, VA has 
undertaken education and training of managers, supervisors and 
employees, and has reaffirmed its policy of protecting 
whistleblowers. The subcommittee requested the OIG identify all 
senior managers that have had allegations of waste, fraud and 
mismanagement sustained against them. The OIG has not yet 
completed work on its response.
    On March 25, 1999, the subcommittee held an oversight 
hearing on the Department of Veterans Affairs management of the 
Federal Employees Compensation Act. Principal witnesses 
included Mr. Shelby Hallmark, Deputy Director, Office of 
Workers' Compensation Programs, Department of Labor; and the 
Honorable Richard J. Griffin, VA Inspector General. 
Representing the VA were Mr. Ronald E. Cowles, Deputy Assistant 
Secretary for Human Resources Management; Dr. Frances M. 
Murphy, Chief Consultant, Occupational and Environmental 
Health, Strategic Health Group; Mr. John Hancock, Director, 
Occupational Health and Safety Staff, Office of Administration; 
Mr. Frederick Malphurs, Director, VISN 2; and Mr. Smith 
Jenkins, Jr., Director, VISN 22.
    A December 21, 1999 audit report from the Office of 
Inspector General found that VA is still at significant risk 
for fraud, abuse and unnecessary costs related to its Workers' 
Compensation Program (WCP). The OIG concluded that VA could 
reduce program fraud and abuse with more effective review and 
oversight of WCP claims. OIG estimated VA annually pays $17.8 
million in unverified compensation claims payments. Based on 
these findings, the OIG projected total savings of 
approximately $250 million. The OIG concluded that management 
of the WCP needs to be improved.
    VA officials stated that 1994, the Department has 
implemented programs and practices to reduce workers' 
compensation costs. Among these initiatives is ``Workers' 
Compensation Management Information Systems'' developed in 
cooperation with the Department of Labor. This system provides 
current information to case managers from VA facilities as well 
as from DOL. In addition, VA is working to prevent injuries and 
illnesses by enhancing hazard identification and mishap 
prevention; promoting research into injury and illness 
causation; and seeking more effective methods to provide 
employee safety and health education opportunities.
    However, DOL asserted that VA's continued lack of 
timeliness in submitting claims exposes VA to potential 
overpayments and undetected fraudulent claims. DOL also 
emphasized the need for increased case management of workers' 
compensation claims.
    The subcommittee held a hearing on VA's Year 2000 (Y2K) 
readiness on April 15, 1999. Principal witnesses included Mr. 
Joel C. Willemssen, Director, Civil Agencies Information 
Systems, Accounting and Information Management Division, GAO; 
Mr. Michael Slachta, Jr., VA Deputy Assistant Inspector General 
For Auditing; the Honorable Hershel Gober, VA Deputy Secretary; 
Mr. Harold F. Gracey, Jr., VA Acting Assistant Secretary for 
Information and Technology; Mr. William K. Hubbard, Acting 
Deputy Commissioner for Policy, Food and Drug Administration 
(FDA); and Ms. Judy Bello, Executive Vice President for Policy 
and Strategic Affairs, Pharmaceutical Research and 
Manufacturers of America, accompanied by Mr. Del Persinger, 
Vice President, Finance and Operations.
    GAO testified that VA continued to make progress in its Y2K 
readiness initiatives, but that key actions remained to be 
performed. VBA and VHA had not completed testing all mission 
critical systems. VHA had not completed assessments of its 
facility systems to ensure uninterrupted health care. Neither 
VA nor FDA had implemented GAO's prior recommendation to review 
the test results for biomedical equipment used in critical care 
or life support environments.
    In response to VA and FDA's inability to identify to the 
subcommittee non-compliant biomedical equipment, both agencies 
partnered in developing a single data clearinghouse for 
biomedical equipment and its Y2K compliance status. FDA was 
prompted to launch much more aggressive initiatives to 
encourage and monitor biomedical equipment manufacturers' Y2K 
compliance. Pharmaceutical Research and Manufacturer of America 
urged its members to comply and respond to GAO's survey 
regarding Y2K plans and contingency plans.
    The subcommittee held a joint hearing with the Subcommittee 
on Health on the suspension of medical research at West Los 
Angeles and Sepulveda VA medical facilities and on informed 
consent and patient safety in VA medical research on April 21, 
1999. Principal witnesses included Dr. Thomas Puglisi, 
Director, Division of Human Subject Protections, Office for 
Protection from Research Risks, National Institutes of Health, 
Department of Health and Human Services; Mr. Dean C. Norman, 
Acting Chief of Staff, West Los Angeles VAMC; Dr. Stephen 
Pandol, Former Director, Research and Development, West Los 
Angeles VAMC, Mr. Kenneth Clark, VHA Chief Network Officer and 
Former Director, West Los Angeles VAMC; the Honorable Kenneth 
W. Kizer, VA Under Secretary for Health, Dr. John R. Feussner, 
VHA Chief Research and Development Officer; Dr. Eric M. Meslin, 
Executive Director, National Bioethics Advisory Commission; Dr. 
Paul Appelbaum, Chair, Department of Psychiatry at University 
of Massachusetts Medical School, and Chair, American 
Psychiatric Association Ethics Appeals Board; and Dr. Adil E. 
Shamoo, Professor, Department of Biochemical and Molecular 
Biology, University of Maryland, Baltimore.
    The subcommittee heard testimony on the unprecedented 
suspension of all human and animal subject medical research at 
the West Los Angeles and Sepulveda VA medical facilities. It 
also examined informed consent issues. VA officials 
acknowledged many sustained allegations of research 
irregularities and failure to correct deficiencies of informed 
consent procedures. These deficiencies did not meet regulatory 
standards identified by the Department of Health and Human 
Services and were not corrected over a six-year period. There 
also were numerous deficiencies in the Institutional Review 
Board's operating procedures and record-keeping practices. The 
subcommittee concluded that the VA had failed in its obligation 
to provide adequate levels of protections to veterans 
volunteering for VA medical research. In response to this 
hearing, VA announced the creation of an Office for Research 
Compliance and Assurance to provide external accreditation of 
VA research programs. The subcommittee requested GAO to conduct 
an independent audit to determine if the serious deficiencies 
demonstrated by the West Los Angeles VAMC were systemic in VA's 
research programs.
    On May 20, 1999, the subcommittee held an oversight hearing 
on maintenance and space planning at Arlington National 
Cemetery and the National Cemetery Administration. Witnesses 
included Representative Helen Chenoweth of Idaho; Mr. Philip 
Wilkerson, Deputy Director, Veterans Affairs and 
Rehabilitation, The American Legion; Ms. Joy J. Ilem, Associate 
National Legislative Director, Disabled American Veterans; Mr. 
Rick Weidman, Director, Government Relations, Vietnam Veterans 
of America; Col. Robert F. Norton, USA (Ret.), Deputy Director, 
Government Relations, The Retired Officers Association; Mr. 
Larry D. Rhea, Deputy Director, Legislative Affairs, Non 
Commissioned Officers Association; Mr. Ray Boland, Secretary, 
Wisconsin Department of Veterans Affairs; Mr. Charles F. Smith, 
Assistant Secretary, North Carolina Division of Veterans 
Affairs, Mr. Eli Panee, Program Manager; Lt. Col. Robin L. 
Higgins, USMC (Ret.), Executive Director, Florida Department of 
Veterans Affairs; Mr. Brian E. Burke, Principal Deputy 
Assistant Secretary of the Army (Civil Works), Department of 
the Army, Mr. John C. Metzler, Superintendent, Arlington 
National Cemetery (ANC); Mr. Roger R. Rapp, Acting Under 
Secretary, VA National Cemetery Administration (NCA); and Mr. 
Vincent L. Barile, NCA Director, Office of Operations Support.
    The purpose of the hearing was to examine the maintenance 
of national cemeteries, including Arlington National Cemetery, 
and VA's strategic planning for future cemetery needs, 
including construction of new cemeteries. The average age of 
the veteran population is rising and World War II veterans are 
dying at a rate of over 1,000 per day. Yet, despite the 
demographic trend for the next decade, the VA seemed to have no 
plans for new cemetery construction. The VA testified that it 
would ``continue to evaluate the potential establishment of new 
national cemeteries.''
    The hearing established that both national cemeteries and 
Arlington National Cemetery have a large backlog of deferred 
maintenance projects, even though all cemeteries are being 
maintained as much as current resources permit. Currently, many 
cemeteries have maintenance needs such as dirty and tilting 
headstones, crumbling walkways and deteriorating cemetery 
buildings.
    The hearing also identified burial and space needs and 
secured additional funding for cemetery maintenance and 
construction. The hearing resulted in approximately $3 million 
in additional funding for maintenance projects in the Arlington 
National Cemetery budget. In addition, the 1999 Veterans 
Millenium Health Care and Benefits Act, Public Law 106-117, 
directed the VA Secretary to use the advance planning fund for 
costs required to begin pre-construction planning for six new 
cemetery sites in the geographic areas most in need of a 
national cemetery. The Act further required the Secretary to 
contract for a study assessing one-time repairs required at 
each national cemetery.
    The subcommittee held a hearing on the effectiveness of 
federal homeless veterans programs on June 24, 1999. Witnesses 
included Ms. Cynthia A. Bascetta, Associate Director for 
Veterans Affairs and Military Health Care Issues, GAO; Ms. 
Linda Boone, Executive Director, National Coalition For 
Homeless Veterans; Mr. Thomas R. Cantwell, Jr., President, 
Westside Residence Hall; Col. Charles Williams, USA (Ret.), 
Executive Director, Maryland Center For Veterans Education & 
Training, Inc.; Ms. Toni Reinis, Executive Director, New 
Directions, Inc., accompanied by John Keaveney, Chief Operating 
Officer, New Directions, Inc., Dr. Lorin Linder, Program 
Director, New Directions, Inc.; Mr. Roosevelt Thompson, Jr., 
Account Associate, Xerox Business Services, Xerox Corporation, 
accompanied by Ms. Michele Cahn, Manager of External Affairs, 
Mr. Charles A. James, Jr., Manager, Business Development 
Private Sector, Xerox Business Services; the Honorable 
Espiridion A. Borrego, Assistant Secretary of Labor for 
Veterans' Employment and Training; Mr. Fred Karnas, Deputy 
Assistant Secretary For Special Needs Assistance Programs, 
Department of Housing and Urban and Development; Mr. Peter H. 
Dougherty, Director, VA Homeless Programs Office, accompanied 
by Dr. Robert Rosenheck, Director, VA Northeast Program 
Evaluation Center; Mr. Emil W. Naschinski, Assistant Director, 
National Economic Commission, The American Legion; Ms. Valerie 
Callaway, Employment Specialist, Veterans of Foreign Wars; and 
Mr. Rick Weidman, Director of Government Relations, Vietnam 
Veterans of America.
    The subcommittee heard testimony from GAO, several 
community-based homeless programs, and a former homeless 
veteran who had successfully reentered mainstream society. The 
subcommittee also heard from the Department of Housing and 
Urban Development, VA and several veterans service 
organizations. Homelessness among veterans continues to be a 
serious and complex problem with no easy solutions. The 
estimated number of homeless veterans has been estimated to be 
close to a quarter-million. The 1994 count was validated last 
year by findings of the Urban Institute (Contractor for the 
Inter-Agency Council) which found 824,000 people homeless in 
any week (annual total is higher). Of this figure, 24 percent 
or 202,000 are veterans. In fiscal year 1997, VA obligated 
approximately $84 million to homeless veterans programs. The 
entire federal government spent approximately $1.2 billion on 
homeless programs. GAO testified that while the VA has 
developed partnerships with other federal departments, state 
and local agencies, and community-based organizations, it has 
little information about the long-term effectiveness of its 
homeless programs. GAO recommended VA conduct a series of 
program evaluations to clarify the effectiveness of VA's 
homeless programs and identify best practices and ways to 
improve those programs. GAO concluded that VA's methodological 
shortcomings in obtaining information on outcomes prevents it 
from making clear conclusions about program effectiveness. GAO 
recommended that VA conduct further research on program 
effectiveness in order to direct VA's limited resources and 
improve its homeless programs. Witnesses from veterans service 
organizations and hands-on providers testified favorably 
regarding the effectiveness of VA and DOL grant programs for 
homeless veterans through community-based organizations.
    The subcommittee held a hearing on July 22, 1999 on VA's 
Capital Assets Realignment Plan for enhancing services to 
veterans. Principal witnesses included Mr. Stephen P. Backhus, 
Director, Veterans' Affairs and Military Health Care Issues, 
GAO; Mr. D. Mark Catlett, VA Deputy Assistant Secretary for 
Budget; and Mr. Kenneth Clark, VHA Chief Network Officer.
    VA's capital assets plan addresses how and when the 
Department is going to restructure its vast health care system. 
GAO testified that VA's hospital utilization has dropped from 
49,000 to 21,000 patients in the last ten years. It also stated 
that the veteran population will decline by 36 percent, or nine 
million people, over the next 20 years. VA's progress in light 
of these dramatic changes in demographics and medical practices 
has been limited. Its planning lacks uniformed guidelines and 
criteria needed to conduct fair and equitable decisions. VA has 
not prioritized its assessments in order to maximize the return 
on investment. GAO concluded that VA could be spending $1 
million or more a day to operate and maintain unneeded 
buildings. The subcommittee will continue to conduct oversight 
on this subject.
    On July 29, 1999, the subcommittee held an oversight 
hearing on the effectiveness and strategic planning of 
Veterans' Employment and Training Service Program (VETS) at the 
Department of Labor. The purpose of this hearing was to give 
VETS an opportunity to respond to the recent Congressional 
Transition Commission's report and to articulate its vision for 
the new century. Witnesses included Ms. Carlotta C. Joyner, 
Director of Operations, Health, Education, and Human Services 
Division, GAO; the Honorable Espiridion A. Borrego, Assistant 
Secretary of Labor for Veterans' Employment and Training; Mr. 
Ronald W. Drach, Former Commissioner, Commission On Service 
Members And Veterans Transition Assistance; Mr. James B. 
Hubbard, Director, National Economics Commission, The American 
Legion; Mr. Anthony L. Baskerville, Deputy National Service 
Director For Employment, Disabled American Veterans; Mr. James 
N. Magill, Director, National Employment Policy, Veterans of 
Foreign Wars; Mr. Calvin Gross, Chair of Employment Training 
And Business Opportunities Committee, Director of Government 
Relations, Vietnam Veterans of America;
    The General Accounting Office testified that VETS' May 1999 
revised strategic plan and its fiscal year 2000 performance 
plan ``lack vision and clarity and do not clearly identify what 
the program is to achieve and the direction the agency intends 
to take.''
    The Transition Commission concluded that based upon data 
provided by VETS, only two percent of veterans go to state 
employment services when looking for a job. The Commission also 
concluded that only 12 percent of those veterans who registered 
with state employment services obtained permanent employment. 
Furthermore, nine states were able to meet VETS performance 
standards while placing fewer than ten percent of registered 
veterans. The Commission found this overall performance to be 
an inadequate return on annual program costs of $183 million, 
and bluntly called this employment and training program ``a 
failed and expensive system with exorbitant overhead.''
    Subcommittee Chairman Terry Everett recommended to Chairman 
Jack Quinn of the Subcommittee on Benefits, which has 
legislative jurisdiction over these matters, that he consider 
giving VETS a time certain to greatly improve its performance 
and planning along the lines of the Transition Commissions 
suggestions. If it does not show improvement and produce a 
satisfactory roadmap to the future after this period, Chairman 
Everett stated that the program should be drastically 
overhauled.
    The subcommittee held a hearing on September 23, 1999 on 
VA's financial management in the areas of reducing fraud and on 
increasing third-party collections. Principal witnesses 
included the Honorable Richard J. Griffin, VA Inspector 
General; Mr. Stephen P. Backhus, Director, Veterans' Affairs 
and Military Health Care Issues, GAO; and the Honorable Edward 
A. Powell, Jr., VA Assistant Secretary for Financial 
Management; and Mr. D. Mark Catlett, VA Deputy Assistant 
Secretary for Budget.
    The subcommittee examined two recent cases involving VA 
employees from two separate VBA regional offices who stole over 
$1.2 million of veterans' compensation funds. The IG conducted 
a vulnerability assessment of VBA's regional office operations 
and management and identified 18 areas of vulnerability in six 
general internal control categories. These vulnerabilities 
diminished quality control and facilitated the ability to 
commit system-wide fraud in VBA. Recent Office of the Inspector 
General (OIG) audits in areas of improper payments identified 
opportunities for the Department to save millions of dollars. 
Senior VA officials acknowledged that fraud was successful 
because VA's own internal controls were either lacking, 
circumvented, or not followed.
    GAO testified that VA's third-party medical care 
collections are woefully inefficient, that they have declined 
over three consecutive years, and that they likely will 
continue declining. GAO verified the audits conducted by OIG, 
Price Waterhouse Coopers and the American Association of 
Retired Persons that concluded VA's billing process was 
``unacceptably inaccurate.'' Bill coding had been shown to be 
up to 90 percent inaccurate, compounding the poor third-party 
collection process.
    VA has acknowledged and is addressing the deficiencies and 
lack of management identified by OIG and GAO. The subcommittee 
should continue to conduct oversight on these issues.
    On September 30, 1999, the subcommittee held an oversight 
hearing on EEO Complaint Resolution in the Department of 
Veterans Affairs. The purpose of the hearing was to examine how 
the VA has implemented Public Law 105-114, the ``Veterans 
Benefits Act of 1997,'' with respect to the EEO Complaint 
Resolution System. Witnesses included Ms. Kathleen Dyer, 
Principal, Ms. Elaine Brenner, Associate, and Ms. Jan Bayer, 
Associate, Booz Allen & Hamilton Inc.; Mr. Carlton Hadden, 
Acting Director, EEOC Office of Federal Operations, U.S. Equal 
Employment Opportunity Commission; the Honorable Eugene A. 
Brickhouse, VA Assistant Secretary for Human Resources and 
Administration; Ms. Ventris C. Gibson, VA Deputy Assistant 
Secretary for Resolution Management; Mr. Charles R. DeLobe, 
Director, VA Office of Employment Discrimination Complaint 
Adjudication.
    The bill and the Public Law established within the VA the 
Office of Resolution Management (ORM) and the Office of 
Employment Discrimination Complaint Adjudication (OEDCA) which 
operate independently from field facilities and headquarters' 
offices. Each of the new organizations is headed by a director 
who is solely responsible for all complaints of unlawful 
employment discrimination and any associated complaints of 
reprisal.
    ORM and OEDCA have been in operation for more than a year. 
The hearing examined VA's efforts to restore confidence in the 
system that is supposed to resolve employment discrimination 
complaints and hold transgressors accountable.
    This subcommittee previously had heard concerns relating to 
problems with the system for resolving employment 
discrimination complaints. It was the perception of too many 
men and women of the VA that senior managers within the 
Department were not held accountable for their actions and too 
often did not take the EEO process seriously.
    Under the Act, VA was required to hire an independent 
contractor to conduct an assessment of its programs for 
improving the EEO environment and its approach to processing 
EEO-related complaints. VA hired Booz Allen & Hamilton, Inc. to 
conduct this assessment. Their testimony concluded that, based 
on their overall assessment, the complaint resolution system at 
VA had made ``notable strides in certain areas, such as working 
towards achieving its mission, providing initial training for 
ORM staff, and establishing administrative procedures to guide 
the program.''
    One year is not long enough to conclude that VA has 
corrected all the problems of the past. Employees still appear 
to quite concerned about reprisal from supervisors and managers 
if they file complaints. The subcommittee will continue to 
monitor the progress of these two new offices with respect to 
timeliness of complaint resolution and confidence and trust 
among VA employees.
    The subcommittee held its fifth hearing on VA's Y2K 
readiness on October 28, 1999. Principal witnesses included Mr. 
Joel C. Willemssen, Director, Civil Agencies Information 
Systems, GAO; Mr. William K. Hubbard, Senior Associate 
Commissioner for Policy, Planning and Legislation, Food and 
Drug Administration; the Honorable Hershel W. Gober, Deputy 
Secretary of Veterans Affairs; and Mr. Harold F. Gracey, Jr., 
VA Principal Deputy Assistant Secretary for Information 
Technology.
    The subcommittee examined VA's readiness to provide 
uninterrupted benefits delivery in compensation and pension 
checks, safe medical care and adequate pharmaceutical supplies. 
It also examined the testing, verification and confirmation of 
VA's contingency plans. GAO testified that VA continued to make 
progress in addressing the Y2K problem. It also noted that VBA 
had only tested its contingency and business continuity plan at 
ten percent of its 58 regional offices. GAO determined that FDA 
had made progress in making compliance information on 
biomedical equipment available to users through its Federal Y2K 
Biomedical Equipment web site. Prompted by this subcommittee, 
FDA decided to conduct surveys to determine the Y2K readiness 
of pharmaceutical, biological, and consumable medical product 
manufacturers. The subcommittee acknowledged the tremendous 
effort put forth by the VA and FDA and encouraged them to 
continue their testing and verification efforts up to the eve 
of the new millennium.
    On March 16, 2000, the subcommittee held an oversight 
hearing on the VA's Home Loan Guaranty Program. The purpose of 
this hearing was to review the management and efficiency of the 
home loan program. Principal witnesses included Representative 
Gary Ackerman of New York; Mr. Michael Slachta Jr., VA 
Assistant Inspector General for Auditing; Mr. Keith Pedigo, 
Director, Loan Guaranty Service, VBA; Mr. James B. Hubbard, 
Director, National Economic Commission, The American Legion; 
Mr. Peter S. Gayton, National Legislative Director, AMVETS; Mr. 
Benjamin H. Butler, Associate Legislative Counsel, National 
Association for Uniformed Services.
    The program generally appears to be operating to the 
benefit of the veteran and the taxpayer. The VA home loan 
guaranty program clearly remains popular with veterans and 
active duty members of our military services. It provides a 
valuable benefit for them and their families.
    However, some questions were raised by the testimony of the 
VA Inspector General's Office regarding the effective and 
aggressive oversight of lending institutions and contractors by 
the VA. The OIG witness stated there are material internal 
control weaknesses that impede timely completion of financial 
statements and reduce effectiveness of safeguards over program 
resources. The OIG witness further stated that VBA has 
represented that organization and system changes were underway 
to address the internal control weaknesses and all corrective 
actions should be completed by the end of fiscal year 2000.
    The loan guaranty service is increasingly utilizing 
commercial mortgage lending practices and delegating functions 
to lenders, so its own oversight and accountability practices 
must continue to be strengthened. The subcommittee requested 
that the VA report back to it when, as outlined by OIG, all 
corrective actions have been taken. The report should include 
an explanation and detailed description of all actions taken to 
remedy the material internal control weaknesses found by OIG. 
Also, VA is to report to the subcommittee regarding the results 
of the A-76 study on contracting out property management. 
Finally, the subcommittee is expecting a report from VA on the 
situation involving the contract for servicing on direct loans.
    The subcommittee held a hearing on VA's information 
technology (IT) programs on May 11, 2000. Principal witnesses 
included Mr. Joel C. Willemssen, Director, Civil Agencies 
Information Systems, GAO; the Honorable Richard J. Griffin, VA 
Inspector General; Mr. Harold F. Gracey, Jr., VA Principal 
Deputy Assistant Secretary for Information Technology; Mr. Dan 
L. Marsh, Associate Chief Information Officer for 
Implementation and Training, VHA; Ms. K. Adair Martinez, Chief 
Information Officer, VBA; Mr. Charles R. DeCoste, Director, 
Data Management Office, VBA; and Mr. Vincent L. Barile, 
Director of Operations Support, National Cemetery 
Administration.
    The focus of the subcommittee's first hearing on VA's $1.2 
billion IT program for fiscal year 2000 was on three specific 
projects: the Master Veteran Record (MVR), VBA's computer 
modernization programs (VETSNET), and VHA's Decision Support 
System (DSS). The delay in integrating the MVR with VBA's 
compensation and pension service line has resulted in a loss of 
significant savings in reduced overpayments. Two of VBA's ten-
year major modernization projects missed many significant 
milestones and currently had no expected completion dates. A $3 
million education redesign project was finally terminated 
without any deliverable product. VHA has spent more than $267 
million on its DSS system. Utilization of DSS in budget 
formulation, resource allocation, and collecting health 
outcomes has been very limited. The VA IG testified that its 
audits this year continue to demonstrate widespread system 
security control weaknesses. The IG reiterated that these 
weaknesses were reported in 1997, 1998 and 1999 financial 
statements and made recommendations for the Department to 
implement a comprehensive security program.
    The subcommittee requested the Department submit a plan 
within 60 days for an integrated systems architecture that 
includes specific completion milestones. The subcommittee held 
an IT hearing in the Fall to assess the Department's progress 
and determine which material weaknesses had been corrected.
    On May 18, 2000, the subcommittee held an oversight hearing 
on disability claims processing at the Department of Veterans 
Affairs. The hearing was intended to set a base line for the VA 
disability claims system as it has performed over the past 
decade. Principal witnesses included Representative Bill 
McCollum of Florida; Mr. Eugene R. Birge; Mr. Johnny Nixon; Mr. 
Michael G. Sullivan, VA Deputy Inspector General; Ms. Cynthia 
Bascetta, Associate Director, Veterans' Affairs and Military 
Health Care Issues, GAO; the Honorable Joseph Thompson, VA 
Under Secretary for Benefits; Mr. Robert Epley, Director, 
Compensation and Pension Service, VBA; Mr. Rick Surratt, Deputy 
National Legislative Director, Disabled American Veterans; Mr. 
Geoff Hopkins, Associate Legislative Director, Paralyzed 
Veterans of America; Mr. Jeff Dolezal, Director, Field 
Services, Paralyzed Veterans of America; Mr. Paul Ivas, 
Associate Director of Field Services, Paralyzed Veterans of 
America; and Mr. Ron Abrams, Deputy Director, National Veterans 
Legal Services Program.
    There are serious problems with the VA disability claims 
process. For the past decade, data has shown that the 
disability compensation adjudication process has experienced 
large claims backlogs, high error rates, and poor timeliness. 
In addition, some of VA's reported performance data is false or 
misleading, particularly for fiscal year 1997.
    Disability claims adjudication is an overly complex process 
that gives many veterans terrible service. In 1999, at least 
770 veterans died before their claims were decided.
    The VA outlined what it is doing to improve. But, if past 
performance is any indication, the VA will continue to fail 
unless it makes more fundamental improvements, both in process 
and management. Otherwise, any gains will be marginal and 
temporary.
    The subcommittee held a hearing on joint procurement of 
pharmaceuticals by VA and DOD on May 25, 2000. Principal 
witnesses included the Honorable G. Kim Wincup, Vice Chairman, 
Congressional Commission on Servicemembers and Veterans 
Transition Assistance; Mr. Steve P. Backhus, Director, 
Veterans' Affairs and Military Health Care Issues, GAO; Mr. 
Robert J. Lieberman, Assistant Inspector General for Auditing, 
DOD; Mr. Gary J. Krump, VA Deputy Assistant Secretary for 
Acquisitions and Materiel Management; Mr. John Ogden, Chief 
Consultant, Pharmacy Benefits Management Group, VHA; BG Daniel 
Mongeon, USA, Commander, Defense Supply Center, DOD, and Capt. 
Charles Hostettler, USN, Director, DOD Pharmacy Programs, 
TRICARE Management Activity.
    The GAO, DOD IG, and the Transition Commission testimony 
all agreed that increased VA/DOD joint medical purchasing could 
yield considerable savings. GAO estimated that the savings 
could amount to $1.5 billion over five years. It further 
recommended that DOD consider utilizing VA's mail-order 
pharmacy for its 25 million prescription refills that would 
result in annual savings of about $45 million. The subcommittee 
requested both Departments report within 90 days on the 
feasibility of a pilot demonstration project. The subcommittee 
also introduced H. Con. Res. 413. This Sense of the Congress 
encouraged VA and DOD to increase their joint procurement of 
medical items, including prescription drugs.
    The subcommittee held a field hearing on quality of care, 
patient and employee safety, and management effectiveness at 
the Marion VA Medical Center on June 1, 2000, at Marion, 
Indiana. Full Committee Chairman Bob Stump chaired the hearing, 
which was requested by Representative Steve Buyer of Indiana. 
Principal witnesses included Mr. Alanson Schweitzer, VA 
Assistant Inspector General for Healthcare Inspections; Dr. 
Michel Calache, Marion VAMC Staff Physician; Mr. Bill Overbey, 
President, Local 1020, American Federation of Government 
Employees; Mr. Steven Stewart, Marion VAMC employee; Mr. John 
Hickey, Director of Rehabilitation, Indiana Department, The 
American Legion; Mr. William Caywood, Commander, Indiana 
Department, Disabled American Veterans; Mr. William Hahn, Past 
5th District Commander, Veterans of Foreign Wars; Ms. Linda 
Belton, Director, VISN 11, VHA, accompanied by Dr. Michael 
Murphy, Director, Northern Indiana Health Care System, VHA; and 
Dr. Allen Mellow, Director, VA Network Mental Health Service 
Line.
    VA employees, union officials, and VA and OIG officials 
testified about understaffing, patient and employee safety, 
lack of communication between employees and management, and 
lack of proactive management from senior leadership. The OIG 
Combined Assessment Program Review (CAPR) identified sixteen 
areas of vulnerability that included the management of long-
term care, pharmaceutical control violations, patient and 
employee safety issues, and lack of assignment of 
accountability and responsibilities for these deficiencies. VA 
officials testified that the majority of the issues had been 
corrected or would be corrected when the new long-term care 
facility opened in the fall of 2000.
    After a series of post-hearing meetings with Mr. Buyer, 
subcommittee staff and VA officials highlighting the funding 
shortfalls, low employee morale, and patient and employee 
safety issues, VA approved $6.5 million in supplemental funding 
to address those issues.
    On June 8, 2000, the subcommittee held an oversight hearing 
on women veterans issues. The purpose of this hearing was to 
review the changing needs of women veterans. The number of 
women serving in our military has been steadily increasing and 
women now comprise 15 percent of active duty military service 
members. Witnesses included Dr. Linda Schwartz, Chair, VA 
Advisory Board on Women Veterans; Ms. Jacqueline Garrick, 
Deputy Director, Healthcare, National Veterans Affairs and 
Rehabilitation Commission, The American Legion; Ms. Joy J. 
Ilem, Associate National Legislative Director, Disabled 
American Veterans; Ms. Marsha Tansey Four, Chair, Women 
Veterans Committee, Vietnam Veterans of America; Ms. Joan 
Furey, Director, VA Center for Women Veterans, Ms. Carole 
Turner, Director, Women Veterans Health Program, VHA; and Mr. 
Robert Epley, Director, Compensation and Pension Service, VBA.
    The hearing documented VA's attention to the needs of women 
veterans in both benefits and health care services. However, 
the pace of improvement could reasonably be expected to be 
faster. Some medical centers have lagged behind the majority of 
providers within the VA medical system in providing more 
adequate services to women veterans. Congress expects VA to 
provide directly or by contract the same level of services for 
women veterans that it does for male veterans.
    On July 27, 2000, the subcommittee held a hearing on 
patient safety and quality management in VA. Principal 
witnesses included the Honorable Richard J. Griffin, VA 
Inspector General; Ms. Cynthia Bascetta, Associate Director, 
Veterans Affairs and Military Health Care, GAO; Ms. Linda 
Connell, Director, Aviation Safety Reporting System, NASA Ames 
Research Center; Dr. James Bagian, Director, National Center 
for Patient Safety, VHA, Dr. Jonathan Perlin, Chief Quality and 
Performance Officer, VHA; and Ms. Helen Cornish, Director, 
Lexington, KY, VAMC. Because votes on the House floor precluded 
the subcommittee from hearing the oral testimony of the 
witnesses, Chairman Terry Everett ordered that all written 
statements of the witnesses be submitted for the record.
    The subcommittee called this hearing after receiving 
disturbing reports of many avoidable patient deaths and other 
adverse medical events. Also, the subcommittee was aware of a 
1999 report by the Institute of Medicine (IOM) which estimated 
that 44,000 to 98,000 American deaths occurred as a result of 
medical errors. The subcommittee requested the GAO to determine 
the status of VA's initiatives to detect and prevent adverse 
events and to identify the obstacles and challenges VA would 
face in order to establish a major change in the organizational 
culture for safety. GAO testified that VA has developed a 
number of initiatives that will aid the Department in 
developing a culture for safety. GAO stated that VA leadership 
must make patient safety a priority that clearly establishes 
responsibilities and communicates the importance of patient 
safety to every VA employee. GAO also stated that VA had yet to 
establish outcome measures that would determine the 
effectiveness of its patient safety initiatives.
    VA has not defined or identified an implementation plan 
detailing timelines and milestones of accomplishments or 
measurable improvement outcomes. Subcommittee continuing 
oversight on VA research programs has been a factor in a number 
of initiatives in VA's patient safety program. VA established 
the National Center for Patient Safety to lead and integrate 
the Department's patient safety efforts. VA also established an 
independent Office of Research Compliance and Assurance (ORCA).
    The subcommittee held the second hearing on VA's 
information technology programs on September 21, 2000. 
Witnesses included Mr. Joel C. Willemssen, Director, Civil 
Agencies Information Systems, GAO; Mr. Michael Slachta, Jr., VA 
Assistant Inspector General for Auditing; Dr. Howard H. Green, 
retired VA employee; and Mr. Robert P. Bubniak, VA Acting 
Principal Deputy Assistant Secretary for Information 
Technology.
    This hearing focused on continuing weaknesses previously 
identified in previous hearings of this subcommittee. GAO 
testified on the status of VA's efforts to: improve its process 
for selecting, controlling and evaluating IT investments; fill 
the Chief Information Officer position; develop an overall 
strategy for reengineering its business processes; complete a 
department-wide integrated systems architecture; track its IT 
expenditures; implement the Veterans Health Administration's 
Decision Support System and the Veterans Benefits 
Administrations compensation and pension replacement project; 
and improve the Department's computer security.
    GAO and OIG testified on the extremely serious department-
wide information security weaknesses. GAO stated that it had 
reported on VA's computer security weaknesses as early as 
September 1998. This report identified weaknesses that could 
place critical VA operations such as financial management, 
health care delivery, and benefits payments at risk for 
inadvertent or deliberate misuse, fraud, improper disclosure, 
or destruction, which could possibly occur without detection. 
OIG's testimony reiterated that a number of significant control 
weaknesses existed that made VBA systems vulnerable to 
unauthorized access and misuse. OIG identified the high 
vulnerability in the computer systems as early as 1997.
    GAO was critical of the Department's plan not to develop a 
department-wide business process reengineering strategy. VA had 
yet to develop an integrated IT architecture as required by the 
Clinger-Cohen Act. VA lacked a uniform mechanism for tracking 
IT expenditures as required by its own VA Directive 6000. VHA 
has spent a quarter-billion dollars on its Decision Support 
System (DSS), yet utilization remains low. Of 140 VA medical 
centers, 59 were not using DSS in any capacity.
    The subcommittee concluded that while VA has made some 
improvements, VA's IT programs have been chaotic due to weak 
leadership and management. VA's improvement of its serious 
computer security weaknesses will take sustained leadership and 
commitment to develop and implement a comprehensive security 
management program.
    On September 27, 2000, the subcommittee held a second 
oversight hearing on the effectiveness and strategic planning 
of Veterans' Employment and Training Service (VETS) at the 
Department of Labor. The purpose of this hearing was to follow-
up this subcommittee's hearing in July 1999. Witnesses included 
Dr. Sigurd R. Nilsen, Associate Director, Education, Workforce, 
and Income Security Issues, GAO; Mr. Kenneth McGill, Associate 
Commissioner, Employment Support Program, Social Security 
Administration; Mr. Rick Weidman, Director, Government 
Relations, Vietnam Veterans of America; Mr. Anthony Eiland, 
Special Assistant for Veterans Employment, Veterans of Foreign 
Wars; Mr. Theodore Daywalt, President and CEO, VetJobs.com; Dr. 
George Boggs, President, American Association of Community 
Colleges; Mr. Raymond Boland, Secretary, Wisconsin Department 
of Veterans Affairs; and the Honorable Espiridion A. Borrego, 
Assistant Secretary of Labor for Veterans' Employment and 
Training.
    GAO testified that VETS has made ``some'' progress and 
improvements with regard to its strategic and performance 
plans. The subcommittee expected greater progress since VETS 
hired an outside contractor to write these plans. However, the 
subcommittee is skeptical about a plan that, in GAO's opinion, 
lacks a vision for the future. Further, the VETS plan has not 
articulated how it will integrate with the Workforce Investment 
Act that Congress passed two years ago.
    The other witnesses provided the subcommittee with 
suggestions for improvements in VETS and testified about new 
approaches being used in employment services as the result of 
dramatic changes over the past decade.
    On September 28, 2000, the subcommittee held a follow-up 
hearing on how the VA had improved its protection of human 
subjects in VA medical research since the suspension of all 
medical research at West Los Angeles VA medical facilities in 
May 1999. Principal witnesses included Dr. Greg E. Koski, 
Director, Office of Human Research Protections, Office of the 
Secretary, Department of Health and Human Services; Mr. Victor 
S. Rezendes, Assistant Comptroller General, GAO; the Honorable 
Thomas L. Garthwaite, VA Under Secretary for Health; Dr. John 
R. Feussner, Chief Research and Development Officer, VHA; Dr. 
John H. Mather, Chief Officer, Office of Research Compliance 
and Assurance, VHA; and Dr. James P. Bagian, Director, National 
Center for Patient Safety, VHA.
    This hearing was a result of the subcommittee's inquiry 
whether the widespread abuse and disregard of required patient 
protections that led to the suspension of all medical research 
at West Los Angeles VAMC was an anomaly in VA's vast research 
programs. The subcommittee requested the GAO review VA's 
research programs system-wide to determine if the violation of 
patients' protections was a systemic issue. GAO testified that 
the VA exhibited a disturbing pattern of non-compliance across 
the medical centers that were reviewed. GAO further stated, 
``The cumulative weight of the evidence indicated failures to 
consistently safeguard the rights and welfare of research 
subjects.''
    GAO identified three specific weaknesses that compromised 
VA's ability to protect human subjects: (1) lack of adequate 
guidance to medical centers about human subject protections. 
(2) insufficient monitoring of local protections; (3) 
inadequate attention to ensure those funds needed for human 
subject protection activities are allocated and available for 
those purposes. GAO concluded that while VA has begun to 
address these issues, progress has been slow. The subcommittee 
recommends another follow-up hearing in the 107th Congress.

                       Other Oversight Activities

    The Government Performance and Results Act of 1993 (Results 
Act) requires federal agencies to implement strategic planning, 
prepare annual performance plans that set performance measures 
and targets, and report annually on actual performance. VA 
began preparing an annual performance plan two years before it 
was first required by the Results Act. The first VA Strategic 
Plan under the Results Act was published in September 1997. 
During the 106th Congress, VA continued Results Act 
implementation. VA has improved development of performance 
measurements and targets, integration of strategic planning, 
budget formulation and program outcomes. VA is attempting to 
address the Department's strategic direction from a unified 
departmental perspective.
    A revised VA Strategic Plan was published in September 
2000. Since publication of the first VA Strategic Plan in 1997, 
VA has developed new strategic goals and objectives that are 
more outcome-oriented and veteran-focused. The fiscal year 1999 
Performance Report, the first required under the Results Act, 
was published at the end of March 2000. The Performance Report 
was rated the third best among the 24 agencies with chief 
financial officers.
    VA has made progress in aligning the Strategic Plan, Annual 
Performance Plan, budget, and Annual Performance Report. VA has 
also continued joint consultation with its major stakeholder 
groups. In order to achieve the consultation requirement of the 
Results Act more efficiently in a single forum, VA implemented 
a series of one-day ``Four Corners'' planning and consultation 
meetings with its stakeholders. VA leadership, House and Senate 
Veterans' Affairs Committee staff, and representatives of the 
Office of Management and Budget and veterans service 
organizations engaged in dialogue on issues impacting the 
Department's strategic direction. Five such meetings were held 
to discuss the strategic plan, scenario-based planning for the 
future, and a number of important policy issues, including 
discussion of VA's health care enrollment policy. The final 
draft of the FY 2001-2006 VA Strategic Plan was reviewed at a 
Four Corners meeting in August 2000. Several comments received 
from stakeholders resulted in improvements to the quality of 
the document that was submitted to the Administration and 
Congress on September 29, 2000.
    Over the past two years, VA completed its first formal 
program evaluation, which addressed the Montgomery GI Bill 
(MGIB) for active duty personnel and veterans; MGIB for 
selected reserves; and Survivors' and Dependents' education. In 
addition, VA initiated comprehensive evaluations of VA's 
Cardiac Care Program and Survivors Benefits Programs that 
include the Dependency Indemnity Compensation (DIC) and 
Insurance Programs. Planning has begun on evaluations of the 
Pension and Parent's DIC Programs and the Prosthetics and 
Sensory Aids Program. A key element of planning for each 
evaluation has been consultation with Congressional staff, 
veterans service organizations and other stakeholders in 
developing a consensus on the priorities and focus for each 
program evaluation. The consultations have included review of 
the contract Statement of Work and research questions prior to 
contract award. A multi-year schedule for program evaluations 
has been developed that includes evaluations of programs in 
most business lines during the period covered by the strategic 
plan. Better organizational and individual accountability for 
program results would provide improved services to veterans and 
greater return on investment for taxpayers. The subcommittee 
recommends continued oversight of VA's Results Act compliance 
and implementation.
    Finally, the chairman of the subcommittee requested GAO 
studies on VA travel expenditures, VA health care food service 
operations, and VA laundry services. In brief, GAO found in VA 
TRAVEL: Better Budgeting and Stronger Controls Needed, GAO/GGD-
99-137 (August 1999), that VA did not report to Congress that 
since 1993 it had spent $61 million in travel funds on items 
other than travel. GAO also found that some senior officials 
had approved their own travel. VA agreed to more carefully 
monitor travel authorizations and delegated travel authority, 
but asserted that travel funding reprogramming was not a major 
program activity and that reporting was not required. The 
subcommittee believes the practice of reprogramming substantial 
amounts of funding without reporting to Congress is undesirable 
and that continued monitoring of these expenditures is 
warranted.
    GAO found in VA LAUNDRY SERVICE: Consolidations and 
Competitive Sourcing Could Save Millions, GAO/01-61 (November 
2000), that VA has the opportunity to reduce costs by closing 
13 of its 67 laundries serving VA health care facilities and 
moving their workloads to other, underused laundries. According 
to GAO, these consolidations would reduce operating costs by $2 
million or more annually, and would also allow about $9 million 
in one-time savings. GAO also recommended VA explore greater 
use of competitive sourcing. VA concurred with GAO's 
recommendations. However, the American Federation of Government 
Employees opposed the recommendations because of concerns that 
wages of some VA workers could be reduced, or that jobs could 
be eliminated. During its review, GAO also conducted a special 
investigation of contractor practices at the Albany, NY, VA 
Medical Center. At Albany, GAO found inadequate management and 
oversight of the laundry contractor may have resulted in 
inflated contract costs for VA. The improper practices have 
been corrected.
    In a second report related to VA hospital support services, 
VA HEALTH CARE: Expanding Food Service Initiatives Could Save 
Millions, GAO/01-64 (November 2000), GAO found that VA could 
save an estimated $79 million annually--about one-quarter of 
its inpatient food service expenditures--by consolidating food 
production, shifting to Veterans Canteen Service workers, or 
contracting with private sector food service organizations. VA 
concurred in principle or concurred fully with GAO's 
recommendations. However, the American Federation of Government 
employees disagreed with the recommendations and expressed a 
number of concerns regarding them. The subcommittee believes 
that review of VA hospital support services should continue.

                           COMMITTEE WEB SITE

    The VA Committee's web site, http://veterans.house.gov, is 
a source of information on Committee activity and a gateway to 
veterans' resources. Activity on the site grew from 
approximately 18,000 visits during the early months of the 
105th Congress to a high of 113,939 visits in September 2000 
during the 106th Congress. The site contains over 5,000 files, 
with new files being added weekly. The site was also named 
``One of the Best Web Sites in Congress'' by the Congressional 
Management Foundation (CMF) on May 3, 1999.
    The site's Home Page has a table of contents, highlights of 
current issues, and a Committee News Section, which has digital 
photographs of recent hearings. The site includes a search 
engine and a Tour of the Site with a web index and links to 
other House sites. The site also consists of nine other 
categories of information: The Chairman's Welcome, About the 
Committee, Communications, Hearings, Issues, Legislation, 
Veterans' Information, Veterans in Congress and the Democrat's 
Home Page.
    For the 106th Congress, the site includes the text and 
summaries of all veterans legislation that was enacted and the 
witness statements or text of all VA Committee and subcommittee 
hearings. Whenever possible, witness statements for each 
hearing are posted on the site within two hours after the 
hearing is concluded. On its own pages and with its links to 
other web sites, including the Department of Veterans Affairs, 
the VA Committee's web site features information for veterans 
that is both easy to access and the most comprehensive ever 
available.
                   OVERSIGHT PLAN FOR 106th CONGRESS

    In accordance with clause 2(d)(1) of Rule X of the House of 
Representatives, the Committee on Veterans' Affairs has adopted 
by resolution of February 3, 1999, its oversight plan for the 
106th Congress.
    This oversight plan is directed at those matters most in 
need of oversight within the next two years. The Committee is 
cognizant of the requirement that it conduct oversight on all 
significant laws, programs, or agencies within its jurisdiction 
at least every ten years. To ensure coordination and 
cooperation with the other House committees having jurisdiction 
over the same or related laws affecting veterans, the Committee 
will consult as necessary with the Committee on Armed Services, 
the Committee on Education and the Workforce, and the Committee 
on Government Reform.
    Oversight will be accomplished through Committee and 
subcommittee hearings, field and site visits by members and 
staff, and meetings and correspondence with interested parties. 
Methods of oversight will include existing and requested 
reports, studies, estimates, investigations and audits by the 
Congressional Research Service, the Congressional Budget 
Office, the General Accounting Office, and the Offices of the 
Inspectors General of the Departments of Veterans Affairs and 
Labor.
    The Committee will seek the views of veterans' service 
organizations, military associations, other interest groups and 
private citizens. The Committee also welcomes communications 
from any individuals and organizations desiring to bring 
matters to its attention. A series of joint hearings is 
scheduled with the Senate Committee on Veterans' Affairs at 
which veterans' service organizations and military associations 
will present to the committees their national resolutions and 
agendas for veterans.
    While this oversight plan describes the foreseeable areas 
in which the Committee expects to conduct oversight during the 
106th Congress, the Committee and its subcommittees will 
undertake additional oversight activities as the need arises. 
Because the Committee generally conducts oversight through its 
subcommittees, the plan is organized by subcommittee.

Subcommittee on Health

    Veterans Health Administration (VHA) Budget. The operation 
of the VA health care system, the largest integrated health 
care provider in the country, represents the most visible 
expression of the nation's commitment to America's veterans. 
With a medical care budget exceeding $17 billion, VA provides 
care to some three million veterans annually. Through focused 
analyses and hearings, VHA spending choices will undergo 
careful scrutiny. Winter 1999 and Winter 2000.

    Capital Asset Planning. The VA health care system 
encompasses an extensive facility infrastructure including 
thousands of buildings, some over 100 years old. Its extensive 
and complex infrastructure requires substantial maintenance and 
repair. Its need for major and minor construction and 
renovation has outstripped available funding. The subcommittee 
will examine the adequacy of VA's capital asset planning and 
the manner in which the Department establishes its construction 
priorities and associated funding plans. Winter 1999.

    Hospital Consolidation and Missions Changes. Sweeping 
changes in health care delivery practice and hospital 
utilization have led hospitals in the private and public 
sectors to close beds and in some instances to cease operating. 
The VA health care system has closed thousands of operating 
beds and reduced its hospital workforce while increasing its 
ambulatory care capacity. As a decentralized system, the VA has 
employed different strategies across the country to improve 
operating efficiency. While hospital ``merger'' has been a 
widely used strategy, there exists no apparent national 
strategy to align infrastructure with patient need. In this 
seeming vacuum, a few networks have initiated more far-reaching 
steps, to include major medical center mission changes which 
range from ceasing to provide inpatient surgery programs to 
ceasing to provide acute hospital care directly. The 
subcommittee will review management ``solutions'' and the need 
for a national policy and appropriate realignment mechanisms. 
Spring 1999 and Spring 2000.

    Eligibility Reform Implementation. Congress enacted an 
``eligibility reform'' law (Public Law 104-262) to eliminate 
statutory barriers in VA to providing veterans needed 
ambulatory care. In expanding access to medical care, the law 
called for the establishment of an enrollment system to ensure 
that veterans with a high priority to care would be afforded 
treatment. The law left VA with discretion as to the categories 
of veterans to be served and the specific benefits to be 
furnished. The subcommittee will review the VA's decisions in 
implementing that law. Spring and Summer 1999.

    Resource Allocation. VA has implemented, and subsequently 
refined, a methodology for distributing funds so as to provide 
veterans similar access to care regardless of the region in 
which they live. The subcommittee will continue to review the 
extent to which the methodology meets its stated objectives. 
Summer 1999 and Spring 2000.

    Quality Management. ``Quality of Care'' has long been 
invoked as central to VA's obligation and commitment to 
veterans' care. Medicine, however, has yet to develop and 
refine reliable, comprehensive indicators for assessing the 
quality of care-delivery. While VA has long had organizational 
structures, process requirements, and policies in place 
designed to assure good quality care, quality management 
remains an ongoing challenge for any institution. The 
subcommittee will continue to review the record of compliance 
with such policies, and the risk that budget-driven decision-
making could compromise quality management efforts. Summer 1999 
and Summer 2000.

    VA Role in Long-term Care. The VA, in response to 
longstanding concerns about the manner in which it would meet 
the needs of aging veterans, established an advisory committee 
on long-term care. That committee's report calls on VA to 
maintain, invigorate and reengineer VA-provided long-term care 
while expanding noninstitutional community-based care services. 
Through focused analysis and a hearing, the subcommittee will 
review the status of VA's nursing home and long-term care 
programs, and will study the advisory committee's findings and 
recommendations, as well as the many important questions its 
report raises. The subcommittee will also review the state home 
program, the role that program can play in meeting veterans' 
long-term care needs, and the need for any legislative changes 
to the program. Spring 1999 and Summer 2000.

    VA Specialized Medical Programs. Public Law 104-262 
requires VA to maintain its capacity to provide for the 
specialized needs of disabled veterans through such clinical 
programs as post-traumatic stress disorder care, prosthetics, 
and spinal cord injury care and rehabilitation. As a follow-up 
to the subcommittee's oversight into VA's adherence to this 
provision, Congress in Public Law 105-368 required VA to 
institute performance requirements for network directors to 
ensure compliance with the specialized program capacity law. 
The subcommittee will carry out further oversight regarding 
these programs, VA's establishment of such performance 
requirements, and their impact. Fall 1999 and Fall 2000.

    VA Pharmaceutical Procurement and Management. With growing 
drug utilization in the VA, increasing numbers of VA patients, 
and high-cost breakthrough drugs coming to market, the 
Department's pharmaceutical spending is estimated to increase 
to $2 billion this fiscal year. As such, pharmaceuticals 
represent VA's largest single cost item other than personnel. 
Accordingly, the subcommittee will review issues associated 
with pharmaceutical procurement and benefits management. This 
will include the role of VA's pharmacy benefit in VA health 
care utilization, VA's drug formulary, opportunities for joint 
procurement with the Department of Defense, and VA's 
vulnerability to further price increases through efforts to 
expand access to the Federal Supply Schedule. Summer 1999 and 
Summer 2000.

    Infectious Disease Programs. By virtue of its size and the 
number of at-risk patients who rely on VA medical care 
services, the VA has become an important source of care for 
some of the major infectious disease problems affecting the 
nation, including AIDS and tuberculosis. Based on prevalence 
studies at selected VA medical centers, Department officials 
have cited Hepatitis C as also having particular importance for 
the VA health care system. The subcommittee will assess what is 
known about the incidence and prevalence of this disease among 
VA patients, likely medical consequences, the Department's 
response, research efforts underway on this disease, and 
emerging treatments. Fall 1999.

    Effectiveness of VA Health Care Delivery for Persian Gulf 
Veterans. In response to statute, VA is conducting two 
important clinical trials to determine effective health care 
treatments for the symptoms many Persian Gulf veterans have 
manifested that appear to be similar to chronic fatigue 
syndrome or fibromyalgia which occur in the general population. 
The first is assessing the benefits of antibiotic therapy; the 
second will determine the beneficial effects of exercise and 
cognitive behavioral therapy for this population. The 
subcommittee will review the results of these trials and ensure 
VA continues to identify effective strategies for improving 
health care delivery to Persian Gulf veterans. Summer 2000.

    Contracting for Medical Services. With VA's downsizing of 
its hospital bed capacity and ongoing efforts to establish new 
points of health care access, the system has increased its 
reliance on contracting as a means of service-delivery. The 
subcommittee will review the extent of such contracting, the 
extent to which such arrangements employ good business 
practices and sound quality controls, and the impact of 
contracting-out care. Summer 2000.

    Status of VA/DoD Sharing of Health Resources. Although 
provisions of law specifically encourage coordination and 
sharing of health care resources between VA and DoD health care 
facilities, there appear to be opportunities for greater 
collaboration, including those identified by the Report of the 
Congressional Commission on Servicemembers and Veterans 
Transition Assistance. The subcommittee will review the extent 
of VA/DoD sharing, opportunities for further expansion, and 
factors that have encouraged or impeded such initiatives. 
Summer 1999.

    VA Research Program. The VA research program complements 
the Department's medical care mission. As a national research 
program aimed at improving the medical care and health of 
veterans, the program supports medical research, outcomes and 
health systems research, and prosthetics research and 
development. The subcommittee will review the program's 
contributions and goals, examine the appropriateness and 
balance among its component elements, assess the effectiveness 
of its peer review and patient safety mechanisms, and review 
the role of VA research corporations to enhance the program. 
Summer 2000.

Subcommittee on Benefits

    Veterans Benefits Administration Services to Veterans. The 
Veterans Benefits Administration (VBA) administers programs for 
compensation and pension, vocational rehabilitation, education 
and training, home loan, survivors, and life insurance. About 3 
million veterans and dependents actively use these programs 
annually. Funding for such programs and administration 
comprises over one-half of VA's total budget. Myriad challenges 
exist with respect to poor quality of claims decisions, a 
declining workforce, a declining workforce skill level, and an 
outdated benefits delivery process. A hearing will examine 
progress in addressing such challenges. Winter 1999 and Winter 
2000.

    Veterans Employment: Military Occupational Specialties 
Requiring Civilian Licensing, Certification or Apprenticeship. 
The civilian employment sector increasingly relies on various 
forms of credentialing to regulate entry into an occupation and 
to promote accountability for performance and public safety. 
More than one-third of enlisted military separatees work in 
military occupations that have civilian equivalents with 
credentialing requirements. A hearing will examine the role of 
the Departments of Veterans Affairs, Labor, and Defense in 
helping separating servicemembers and veterans meet 
credentialing requirements. Spring 1999.

    Veterans' Claims Adjudication Commission and National 
Academy of Public Administration Reports. The Commission's 
December 1996 and the Academy's April 1997 reports to Congress 
made recommendations for improving veterans' benefits claims 
processing. A hearing will review VA's implementation of 
Commission and Academy recommendations through testimony from 
VA, veterans' service organizations, and other interested 
parties. Summer 1999.

    Veterans' Appeals of Benefit Claims. The Board of Veterans' 
Appeals is the first forum for a veteran to appeal a VA 
decision on a claim for benefits. Although the Board is making 
demonstrable progress in its productivity, major issues still 
exist with respect to applying U.S. Court of Appeals for 
Veterans Claims precedents, current law, and VA regulations in 
appellate decisions. In addition, on average VA regional 
offices require 558 days to act on BVA-remanded cases. The 
subcommittee will review Board and regional office appellate 
operations, as informed by Government Performance and Results 
Act principles and customer service standards. Fall 1999.

    Memorial Affairs. VA's department-wide strategic plan 
covers only a 5-year period--through the year 2003. The 
National Cemetery Administration (NCA) projects annual 
interments will increase over 40 percent between 1995 and 2010, 
and VA has not clearly articulated how it will meet the demand 
for burials through 2010. The subcommittee will review NCA 
plans to ensure that the Department is well prepared to meet 
the increasing workload which will result from the declining 
veteran population. Summer 1999.

    Veterans Entrepreneurship Opportunities. Veterans should be 
accorded a full opportunity to participate in the economic 
system that their service sustains. The November 1998 report of 
the SBA Veterans' Affairs Task Force for Entrepreneurship and 
the Congressional Commission on Servicemembers and Veterans 
Transition Assistance each made numerous recommendations for 
improvements in both SBA and VA services to current and 
prospective veteran small business owners. The subcommittee 
will review SBA and VA implementations of Task Force and 
Commission recommendations. Spring 2000.

    Long-Term Residuals of Mustard Gas and Lewisite Exposure. 
During World War II, the U.S. government used 60,000 U.S. 
servicemen as human subjects in secret tests to develop better 
methods of protecting U.S. forces against the use of mustard 
gas by our adversaries. Some testing was conducted in full-body 
gas chambers and focused on the development of protective 
clothing, which could prevent or lessen the severe blistering 
effects of mustard agents and Lewisite (an arsenic-containing 
agent). The subcommittee will examine implementation of 
Department of Defense and VA policy to identify such 
individuals. It will further examine implementation of VA 
policy to assess their health status and award them disability 
compensation for long-term residuals on VA's presumptive list. 
Summer 2000.

    Ionizing Radiation. VA provides medical treatment and 
compensation benefits to veterans suffering from exposure to 
ionizing radiation. The subcommittee plans to review the 
problems facing this category of veterans. Summer 2000.

    Persian Gulf War Veterans Benefits. In the 105th Congress, 
two public laws identified plans to determine conditions and 
diseases that should be presumed service-connected for purposes 
of compensation. Some provisions of the two laws are 
contradictory and the bills have been referred to the 
Department of Justice for resolution. The subcommittee will 
monitor the Department of Justice guidance to the VA, the VA's 
external study into conditions for which service-connected 
compensation for veterans may be warranted, and how VA 
addresses other matters described in these laws. Winter 2000.

    Commission on Servicemembers and Veterans Transition 
Assistance. In January 1999, the Commission released its 
findings and recommendations on the adequacy and effectiveness 
of benefits and programs for servicemembers and veterans in 
their transition and adjustment to civilian life. The 
Commission's review of benefits and services is the most 
comprehensive since the Omar Bradley Commission in 1955. A 
hearing will review implementation of Commission 
recommendations by the Departments of Veterans Affairs, Labor, 
and Defense, Small Business Administration, Office of Personnel 
Management, and state approving agencies. Summer 2000.

    Air Force Health Study (Ranch Hand). The study is a 20-year 
prospective epidemiological study of veterans of Operation 
Ranch Hand, the unit responsible for the aerial spraying of 
Agent Orange and other herbicides in Vietnam from 1961 to 1971. 
Study investigators report their progress and results annually 
to Congress and results are further reviewed and summarized bi-
annually by the National Academy of Sciences. Congress has used 
previous study findings as a basis to provide compensation for 
spina bifida in children of Vietnam veterans. A hearing will 
review the study's annual submission and results to date, as 
presented by AFHS epidemiologists. Fall 1999.

    ``Roadmap to Excellence''. This May 1998 document is the 
Veterans Benefits Administration's plan for reforming itself, 
so as to regain its focus and accomplish its mission. The plan 
expresses VBA's commitment to important changes in its 
organizational structure, workflow, job design, and 
relationship with veterans and their representatives. The 
subcommittee will determine VBA's progress, as measured against 
VBA's published activities and milestones. Summer 2000.

Subcommittee on Oversight and Investigations

    Facilities Management. The VA health care system, with its 
172 hospitals, 439 outpatient clinics, 131 nursing homes and 40 
domiciliaries, operates a multitude of support services for its 
facilities and the veterans they serve. The subcommittee will 
examine how efficiently and effectively the VA provides 
services, including the following areas: food service, 
institutional laundries, staff housing, biomedical equipment 
repair, engineering, energy savings performance contracting, 
janitorial services, waste management, fire protection, 
security and training. Summer 2000.

    Medical Resources Contracts. The Veterans Health 
Administration (VHA) is authorized under Public Law 104-262 to 
non-competitively contract with affiliated medical schools for 
medical services such as radiological imaging, laboratory 
services, nursing support services, scarce medical specialty 
care, medical examinations and consultations. The subcommittee 
will review the Department's efforts to ensure that such 
contracts follow recently adopted pricing guidelines. Summer 
1999.

    Realignment of the VA Health Care System. The subcommittee 
in conjunction with the Subcommittee on Health will review VA's 
long-term strategy to reorganize and restructure its health 
care delivery system. The subcommittee will also examine 
opportunities for the Departments of Defense and VA to partner 
in delivering health care to the men and women who serve or 
have served in uniform. Spring 2000.

    Patient Safety. The VA health care system continues to 
operate without a centralized or regional reporting system to 
track ``sentinel'' events in patient care. Reports of patient 
deaths and serious lapses in quality health care delivery raise 
concerns about the adequacy of quality assurance and quality 
management programs to correct, reduce or prevent potentially 
serious incidents. The subcommittee will continue its review of 
the investigation and forensic laboratory work of the Federal 
Bureau of Investigation concerning the 1992 veteran deaths that 
occurred at the Harry S Truman VA Medical Center, Columbia, MO. 
The subcommittee will also review VHA's practices regarding 
autopsies. Winter 1999.

    Information Technology. VA's information technology 
programs will spend over $1 billion on software, hardware and 
contractor support in 1999. The subcommittee will review VA's 
information technology programs and VA's progress in its 
computer-based Decision Support System and Master Veteran 
Record, VETSNET, Year 2000 preparations and other computer 
modernization. Summer 1999.

    Whistleblowing in the VA. The subcommittee will examine the 
VA's policies and protections for employees who have claimed or 
been granted whistleblower status as well as for employees who 
have filed various types of complaints or claims against the 
Department. The subcommittee will investigate allegations of 
retaliation and violations of confidentiality by the 
Department. Winter 1999.

    Central Alabama Veterans Health Care System and 
Accountability within VHA. The subcommittee will continue to 
follow-up the Department's actions to implement corrections and 
hold responsible officials accountable regarding the VA Office 
of Inspector General's findings of serious health care 
deficiencies, mismanagement, misconduct and prohibited 
personnel practices in the Central Alabama Veterans Health Care 
System. The subcommittee will also review accountability of 
management within VHA generally. The subcommittee will continue 
to monitor the integration of the Montgomery and Tuskegee VA 
Medical Centers, and VA medical facility mergers nationwide. 
Spring 1999 and Fall 1999.

    Office of Resolution Management. The subcommittee will 
examine the effectiveness of the VA's EEO complaint resolution 
system administered by the newly established Office of 
Resolution Management. The subcommittee will review the new 
system for timeliness, fairness, integrity, trust and 
independence from VA management in handling claims and appeals. 
Spring 1999 and Spring 2000.

    Civilian Health and Medical Programs of the Department of 
Veterans Affairs. There are approximately 80,000 beneficiaries 
of the CHAMPVA program who generate over 800,000 medical 
claims. Current annual program expenditures are in excess of 
$93 million and claims total $85.1 million. The subcommittee 
will review the effectiveness of program management controls 
for duplicate claims payments, eligibility verification, and 
recovery of fraudulent claims payments. Spring 1999.

    Office of Inspector General. The subcommittee will review 
the five-year strategic plan of the Office of the Inspector 
General (OIG). The review will include organizational 
structure, staffing, investigative protocols, responsiveness to 
congressional inquiries and management of hotline inquiries. 
Summer 1999.

    Procurement Management. The subcommittee will review VA's 
overall procurement process. The review will include: 
efficiencies of the National Acquisition Center; initiatives in 
electronic commerce; centralized acquisitions; pharmaceutical, 
medical and surgical supply procurement; performance based 
contracting; and other acquisition streamlining. Further, the 
subcommittee will review instances of vendor overcharges and 
contractor fraud, and departmental measures instituted to deter 
future incidents. The subcommittee will also review the backlog 
of capital medical equipment and VA's acquisition strategy for 
reducing the backlog. Winter 2000.

    Medical Care Collections Fund. VA collects over $500 
million per year from third party insurers for medical care 
provided to veterans with health care insurance. The 
subcommittee will review the efficiency and effectiveness of 
the VA's collection process. The review will focus on 
collection procedures, cost of collections and the adequacy of 
billing rates based on the quantity and cost of care provided 
to veterans. Spring 1999.

    Workers Compensation Claims by VA Employees. In 1995, a 
pilot program was initiated by OIG and VHA to identify VA 
employees who were fraudulently receiving workers compensation 
benefits. Because of the success of the pilot program, OIG and 
VHA expanded their investigative and audit efforts. The 
subcommittee will review the incidence of such fraudulent 
claims at VA as well as the efforts to detect and deter their 
occurrence. Spring 1999.

    Inappropriate Benefits Payments. Based on results of OIG 
audits, the Veterans Benefits Administration should develop and 
implement effective methods to identify inappropriate 
compensation and pension benefit payments. For example, VBA 
should improve procedures for offsetting disability 
compensation payments to active military reservists. The 
subcommittee will review VBA's efforts to implement procedures 
to timely identify deceased beneficiaries and terminate their 
compensation and pension benefits in order to reduce 
overpayments. Spring 1999.

    Government Performance and Results Act. The Government 
Performance and Results Act (Results Act) requires federal 
agencies to report performance outcomes annually to Congress. 
VA has numerous automated data collection systems in order to 
report the Results Act's objectives. Prior OIG audits have 
found unreliable data in VA's financial and management systems. 
The subcommittee will continue its oversight of the VA's 
compliance with the Results Act, including program evaluations, 
performance plans and strategic planning department-wide. Fall 
1999 and Fall 2000.

    Veterans' Vocational Rehabilitation Benefits and 
Employment. Subcommittee oversight activity will include review 
of the following programs: Transition Assistance Programs, 
Disabled Transition Assistance Programs, vocational 
rehabilitation programs at VA and veterans' employment and 
training programs at the Department of Labor. The extent of 
coordination among these programs will be part of the oversight 
review. Pertinent recommendations of the Commission on 
Servicemembers and Veterans Transition Assistance will be 
considered. Spring 2000.

    VBA Business Process Reengineering. Subcommittee oversight 
will include review of VBA's business process reengineering 
efforts for improving claims and appeals processing, and 
quality management. Government Performance and Results Act 
requirements, and recommendations of both the National Academy 
on Public Administration Analysis of Claims Processing and the 
Veterans' Claims Adjudication Commission will be considered. 
Winter 2000.

    Arlington National Cemetery Burial Waivers. The 
subcommittee will complete the investigation of burial waivers 
for Ambassador M. Larry Lawrence and Dr. C. Everett Koop which 
were begun in the previous Congress, and will examine 
administrative and eligibility issues regarding the cemetery. 
Spring 1999.

    Case Narratives on Persian Gulf War Veterans. The 
Department of Defense Office of the Special Assistant on Gulf 
War Illnesses (OSAGWI) has developed a series of case 
narratives to ascertain the likelihood of certain biochemical 
and environmental exposures in the Persian Gulf. In only one of 
the many cases reviewed has the office deemed an exposure 
``likely.'' The subcommittee will continue to review the 
standards and protocols OSAGWI has implemented for these case 
narratives to ensure that the process is thorough and fair to 
veterans who may have been exposed to hazardous materials 
during their service in Southwest Asia. Summer 1999.

    Departmental Travel and Videoconferencing. The subcommittee 
will review the VA's travel requests and expenditures for 
recent budget cycles, including whether the VA has adequate 
internal controls for approval of official travel. The 
subcommittee will also examine the VA's use of 
videoconferencing for hearings, conferencing and training. 
Winter 1999 and Fall 1999.
 REPORT TO THE COMMITTEE ON THE BUDGET FROM THE COMMITTEE ON VETERANS' 
 AFFAIRS ON THE BUDGET PROPOSED FOR FISCAL YEAR 2000, WITH ADDITIONAL 
           AND DISSENTING VIEWS, SUBMITTED ON MARCH 15, 1999


                BACKGROUND AND COMMITTEE RECOMMENDATIONS


                     Department of Veterans Affairs


                     VETERANS HEALTH ADMINISTRATION

                              Medical Care

    In the last four years, the VA health care system has 
undergone an extraordinary transformation, to include

    1. Lreductions in the number of hospital beds (down 52 
percent, or some 27,200 beds since September 1994) and a 31.7 
percent decline in hospital admissions;
    2. Lan accompanying increase of 9 million ambulatory care 
visits in the last four years; and
    3. La reduction in the medical care workforce since 1994 of 
some 19,000.

    As though unaware of the extraordinary savings VA has 
already wrung from its health care system, the architects of 
the President's budget propose that VA somehow continue to care 
for an increasing number of patients, take on costly new 
initiatives, and meet an acknowledged funding shortfall of more 
than $1 billion through more savings. VA concedes that there is 
no plan to achieve management efficiencies and savings, and 
defers to its network directors to identify and execute them. 
Those directors, in both testimony before our Subcommittee on 
Health at a February 24, 1999 hearing and telephone surveys, 
have candidly stated that this budget plan would require them 
to close needed programs and even hospitals, forego opening new 
clinics, and make additional cuts which would deny veterans 
access to care and delay care for others. While some modest 
additional savings may yet be realized, no responsible VA 
official has identified a means to achieve savings of the 
magnitude proposed without having a marked adverse impact on 
patient care.
    In capsule, this budget, which proposes to meet veterans' 
medical care needs at the FY 1999 level of $17.3 billion:

     seeks no funds for the projected $870 million in 
uncontrollable cost increases (including pay raises, inflation 
and State home payments) identified in the President's budget;

     proposes no new funds for a new medical 
obligation of major proportion--a nationwide hepatitis C 
problem, which is acknowledged to be more prevalent among VA 
patients than among the population at large--recognized in the 
President's budget;

     proposes, without seeking any new funds, 
expansion of several health-care priorities; and

     ``plugs'' the huge resultant shortfall with a 
staffing reduction of at least 6,949 full time positions.

    Looking below the surface, this budget would have a more 
severe impact than the Administration's submission suggests, 
because its projections mask the depth of the shortfall VA 
would face. For example, the Administration budget fails to 
take account of:

     VA pharmaceutical costs--already nearly $2 
billion--escalating at a considerably higher rate (more than 10 
percent annually) than the 4 percent inflation factor built 
into the budget. (At the Committee's budget hearing, for 
example, VA's Under Secretary for Health acknowledged that 
``the pharmaceutical budget increases are disproportionate to 
other elements of our budget''. Network directors cited cost 
increases ranging from 10-15 percent despite tight 
pharmaceutical benefits management and implementation of a 
national drug formulary.) Drug costs may thus be $110 to $200 
million higher than provided for under the budget.

     VA's prosthetics costs, now about $500 million/
year, have been increasing at a rate of approximately 18 
percent/year; yet the budget provides only about 4 percent for 
inflation. Prosthetics costs, projected to continue at double-
digit growth, are likely to be understated by some $50 million.

     VA's failure, despite the incentive of retaining 
these monies, to meet its recent medical collections' goals. 
With FY 1998 collections more than $139 million short, current 
year collections running behind target, and an FY 2000 goal 
$124 million higher than this year's, VA could realistically 
fall as much as $124 million short of projected revenues.

     The projection that VA would have to reduce 
``only'' 6949 FTE to realize $1.1 billion in savings fails to 
acknowledge that VA's ``30-20-10 plan'' (achieving a 30 percent 
reduction in unit costs and 20 percent increase in patients 
served and increasing non-appropriated revenues to 10 percent), 
which is the basis for this budget reduction, has broken down. 
As a recently retired network director testified, it would take 
a reduction of 20,000 employees to yield $1 billion savings.

    As VA medical administrators contemplate this very 
troubling budget, they must confront a unique patient 
population. It ranges from a growing population of aging 
veterans with complex medical needs to a large number of 
homeless patients. But VA also faces what the House Committee 
on Government Reform and Oversight recently characterized as a 
``silent epidemic''. Chairman Burton, in an October report, 
described hepatitis C (HCV), as posing a ``daunting challenge 
to public health'':

        Chronic infection can linger without symptoms for more 
        than 20 years, then produce profound health 
        consequences, including liver failure and cancer. There 
        is no preventive vaccine or universally effective 
        treatment. Up to 10,000 will die this year from the 
        disease. That number could triple in the next two 
        decades, according to the Centers for Disease Control 
        and Prevention. HCV has now spread to an estimated 4 
        million Americans. (H. Rept. 105-820)

    The budget does recognize a need for, and proposes, a 
national program to screen and treat VA patients at risk for 
hepatitis C. It projects spending on this program of an 
additional $136 million in FY 2000. These are new cost, yet the 
budget fails to request any funds to support such an effort. An 
additional concern is that the cost could be greater than 
projected. A combination of drugs has recently been shown to 
have some efficacy in treating the disease. While the cost of 
such drug therapy is known--in excess of $1000/patient/month--
there is limited data from which to estimate the prevalence of 
infection among veterans. Veterans who rely on VA for health 
care are expected to be at greater risk of hepatitis C than the 
rest of the U.S. population because of exposure to major risk 
factors for this infection, including blood transfusion prior 
to 1992 and a history of intravenous and other drug abuse. (The 
best evidence is from San Francisco where the rate of hepatitis 
C among VA patients is more than 10 times that of the U.S. 
adult population. The rate in San Francisco is likely to be 
higher than in VA settings overall because of the high 
prevalence of risk factors in the San Francisco area.) It is 
reasonable and conservative to assume that rates in San 
Francisco are twice as high as rates in other metropolitan 
settings. On this basis, it can be estimated that approximately 
8.9 percent of VA users nationwide are infected with hepatitis 
C. The President's budget estimates a prevalence of hepatitis C 
in the VA user population at 5.5 percent, an estimate which 
seems low, given the high levels of risk factors for the 
disease among VA patients. On the basis of assumptions made in 
the budget, the Committee estimates costs for hepatitis C 
screening and treatment in FY 2000 of $236 million, $122 
million above the projected spending level for FY 1999. Based 
on these estimates, the budget projection, which calls for an 
additional $136 million for FY 2000, would appear to be a 
reasonable estimate of VA's needs for this program. The 
Committee is concerned, however, that VA may be overestimating 
the scope of the screening effort for this fiscal year. If 
medical centers are slow in starting up this effort, the 
numbers screened in FY 2000 may be larger than anticipated and 
the costs closer to the full $236 million, resulting in a still 
larger shortfall.
    In essence, without even reaching the merits of the new 
initiatives proposed in the budget, it is apparent that VA 
would require an additional $1.1 billion just to maintain the 
services it is now providing. It is also clear to this 
Committee, in the face of what VA is now not providing, that 
shrinking VA's budget still further would have severe, 
irreversible repercussions. By way of illustration, this 
Committee has long questioned VA's planning for the needs of 
aging veterans. According to the June 1998 independent advisory 
committee report, ``VA Long Term Care at the Crossroads'', the 
number of veterans needing long-term care services is predicted 
to grow by 13 percent over the next five years. The report 
confirms this Committee's finding that in many areas to meet 
budget needs VA long-term care services have been downsized and 
the mission has been changed from long-term care to 
rehabilitation. The Committee's budget hearings made it clear 
that the FY 2000 budget would force still more network 
directors to make cuts of that kind. For VA to be shrinking 
nursing home care programs and reducing funding for other long 
term care programs at the very time that its population is 
aging is extraordinarily troubling. Such a shift in VA's long 
term care mission certainly also has implications beyond the VA 
medical care budget, and would be felt by Medicaid, Medicare, 
and State home programs, for example.

    Administration-proposed legislation--.The Administration's 
budget again recommends that Congress enact legislation to 
authorize ``a new smoking-cessation program for any honorably 
discharged veteran who began smoking in the military.'' The 
budget submission advises that, once this program is 
authorized, the Administration would submit a budget amendment 
requesting $56 million for this activity.
    This proposal is as ill-conceived as its predecessor last 
year. Notwithstanding this budget's huge funding shortfall, 
this recommendation calls for substantial new spending on a 
benefit, which as proposed, must be provided through contracts. 
It ignores authority under current law under which VA is 
already providing such services as part of the care furnished 
VA patients.
    The Administration also requests legislation to expand VA's 
very limited authority to cover emergency services furnished in 
community hospitals when VA emergency facilities are 
unavailable. As discussed above, however, it is troubling in 
the face of a budget shortfall in excess of $1 billion that the 
Administration would recommend an expansion in this or any 
other area, without providing needed funding to support it.
    The Administration's emergency care proposal also suffers 
from the lack of a coherent rationale. In advocating for a 
Patient Bill of Rights, the Administration has argued for 
legislation which would require any health plan to guarantee 
its participants emergency care coverage. In proposing that 
Congress provide emergency care coverage for veterans, however, 
the Administration would not cover many of those veterans most 
in need of such a guarantee. Certainly, legislation proposing 
to cover all veterans' emergency care needs would relieve third 
parties of contractual or other obligations. Many veterans, for 
example, do not use VA care exclusively and, through insurance 
or Medicare coverage, for example, have and use other 
alternatives. The Committee believes, however, that uninsured 
veterans who have a high priority to VA care (``category A'' 
veterans) who have relied on VA as their primary health-care 
provider should not incur extraordinary costs in medical 
emergencies where a VA facility is not reasonably accessible.
    As the Congress moves forward on legislation to provide 
certain minimum safeguards for those in health plans (to 
include a right to emergency care), it must certainly ensure no 
less for veterans. Accordingly the Committee would propose to 
take up legislation under which VA would cover reasonable costs 
of catastrophic care furnished in a medical emergency. Such 
legislation would provide VA with appropriate control 
mechanisms to contain costs including authority to ensure 
adequate utilization review. The Committee estimates that 
enactment of such legislation would entail costs of $500 
million in fiscal year 2000.

Additional Legislation: The ``Veterans' Millenium Plan''

    While recognizing the huge deficiencies of the FY 2000 
medical care budget, the Committee believes there is a need for 
legislation to help set the future of VA health care on a 
sounder footing and to better position VA for future year 
budgets. Such legislation should include a framework for better 
matching VA's infrastructure with veterans' needs, improving 
access to and the quality of VA care, and calling on veterans 
to bear a reasonable part of the cost of nonservice-connected 
long term care, for example.
    While this plan has several elements, the Committee 
strongly believes that its component parts--including a 
substantial increase in medical care appropriations for fiscal 
year 2000--are interdependent, both to achieve the goal of 
improved care and to win the support needed for enactment.
    The major themes of such legislation would include the 
following:

     providing greater access to needed care through 
facility realignment;

     preservation of long-term care programs, and
     providing for enhanced revenues.

    1. Improved access through facility realignment

    Historically, VA hospitals were not consistently sited near 
veteran population centers. Today, occupancy rates at numbers 
of VA hospitals are substantially below levels needed for 
efficient operation and optimal quality of care. Maintaining 
highly inefficient hospitals, which were designed and 
constructed decades ago to standards no longer deemed 
acceptable or, in some cases, functional, substantially 
diminishes the availability of funds needed to strengthen care-
delivery in facilities which should be retained.
    While the private sector has seen widespread closure of 
community hospitals, VA's first hospital closure in many years 
came about not through the persuasiveness of health planners, 
but as a result of an earthquake threat. The lessons of that 
experience are telling, however. The closure of the Martinez, 
California VA Medical Center and decision not to build a 
replacement hospital--but instead to establish a full-service 
ambulatory clinic--are widely recognized as having resulted in 
improved access to care for many veterans. Subsequent 
decisions, rejecting proposed construction of hospitals in 
California and Florida, and relying instead on multi-site 
contracts for hospital care and new outpatient care sites, 
provide important case studies. These experiences and 
subsequent mission changes at other VA hospitals suggest a 
framework for better matching underutilized, inefficient 
infrastructure with veterans' needs.
    Building on these experiences and VA system needs, the 
Committee, as one facet of its ``Millenium'' legislative plan, 
intends to develop legislation which would:

     require VA, pursuant to network-based strategic 
plans, to establish ``enhanced service programs'' at 
appropriate locations;

     provide that an ``enhanced service program'' 
would include
                  (1) establishing in the affected service area 
                a state-of-the-art outpatient clinic (and/or 
                expanded long-term care capacity),
                  (2) contracting in accordance with specific 
                legislation for needed hospital care (with 
                ongoing VA case-management), and
                  (3) preferential re-employment assistance for 
                dislocated VA employees in any area where VA 
                ceases to provide direct hospital care under 
                the terms of the bill;

     provide criteria for hospitals that might be 
considered for selection as ``enhanced service program'' sites;

     require that VA develop a plan (that takes 
account of veterans' and other interested parties' views) for 
each site which must improve accessibility and service-quality 
and which ensures that all savings remain in the network; and

     require that such plans could not be put into 
effect until Congress has had a period of time to review them.

    While acknowledging the need to better align VA's capital 
assets to needed missions, the Committee notes that the 
downsizing which has taken place in the past four years under a 
decentralized decisionmaking process may in some instances have 
gone too far. For example, as the aging veteran population has 
grown, budget-cutting goals have led to closure of long-term 
care programs in certain areas. While savings from the closure 
of psychiatric beds in some networks have funded new primary 
care clinics, intensive outpatient programs have not 
universally replaced the diminished hospital care capacity. 
With the recognition that pressures to ``increase workload'' 
may overtake statutory obligations to meet often costly patient 
needs, the Committee will also develop legislation to provide 
better oversight of significant program closures or downsizing 
before they are implemented. Such legislation would require VA 
to develop and submit to Congress detailed business plans 
associated with any proposed closure of a major health care 
services (such as the proposed closure of a hospital's surgical 
service), and to defer implementation for a prescribed review 
period.
    As envisioned, facility realignment should substantially 
improve veterans' access to care. At the same time, the 
Committee recognizes that provisions of law governing 
eligibility still limit some veterans' access. Congress in 1996 
enacted legislation, the ``Veterans Health Care Eligibility 
Reform Act of 1996'', which revised the patchwork of laws 
governing eligibility for VA medical care. Given its experience 
under that law, the Committee proposes to make further remedial 
changes to that ``eligibility reform''. Specifically, the 
Committee will develop legislation to provide express medical 
care eligibility for veterans who have been injured in combat 
(Purple Heart recipients). While their combat-incurred injuries 
are by definition service-incurred, some of these veterans have 
never sought compensation and could face lengthy delays in 
receiving needed care because their residual disability has 
never been formally adjudicated.
    The Committee will also seek to elevate the priority of 
veterans who have retired from military service. A retiree who 
is not service-connected disabled, has no other ``special'' 
eligibility status for VA care, and who has income in excess of 
VA's statutory ``means'' test, has generally had limited access 
to VA medical services. With the closure or downsizing of many 
military medical facilities, many retirees have also been 
deprived of access to promised care in military treatment 
facilities. While Government-sponsored care is available to 
them through the TRICARE program, many retirees reasonably 
question why they cannot receive care through the VA health 
care system. The Committee intends to pursue legislation to 
provide retirees such an option. Since provision of care to 
retirees is primarily a Department of Defense responsibility, 
the Committee believes such legislation should provide for that 
Department to reimburse VA. This legislation would also include 
appropriate safeguards to ensure that this proposed new 
treatment mission would not diminish or compromise VA's 
obligation to veterans already entitled to priority under law.

    2. Preservation of VA long-term care programs

    The Department of Veterans Affairs has long recognized the 
aging of America's World War II and Korean War veterans as a 
major challenge. Aging veterans' access to acute-care services 
has expanded significantly since the publication in 1984 of a 
VA needs-assessment entitled ``Caring for the Older Veteran''. 
In contrast, many veterans who have enjoyed markedly improved 
access to ambulatory or hospital care have been at relative 
risk with respect to needed nursing home care or alternatives 
to institutional care.
    VA's capacity to furnish needed long-term care has actually 
shrunk in some areas as officials, identifying such programs as 
``discretionary'', have closed beds or changed the mission of 
some nursing homes from long-term care to rehabilitation. The 
Committee is deeply concerned that VA network or facility 
directors have dismantled critically needed programs on the 
basis that nursing home care is costly or that Congress has 
somehow invited VA officials to exercise ``discretion'' to 
provide or not provide such care.
    The Committee proposes to address long-term care issues by:

     making it clear that nursing home care is not a 
``discretionary'' program, and is clearly part of the VA's 
health care mission;

     requiring that VA provide ongoing nursing home 
care in the case of a veteran (1) in need of such care for a 
service-connected disability or (2) who is 100-percent service-
connected;

     providing, for purposes of access to VA nursing 
homes for care of nonservice-connected conditions, priority for 
specialized patient populations (such as patients with 
geropsychiatric disorders and Alzheimers' disease), patients 
for whom there are no other suitable placement options, and 
patients in need of rehabilitation; and

    . requiring VA to augment provision of community-
based long-term care services such as adult day health and 
home-based care (subject to maintaining current level of 
program effort) through the establishment of a revolving fund 
in the Treasury for deposit of certain new revenues

    3. Enhanced revenues

    Through its long years of service to America's veterans, 
the VA health care system has found support primarily as a 
system dedicated to the care and rehabilitation of veterans 
with service-incurred disabilities and as a ``safety net'' for 
other veterans who lack medical insurance or other health care 
options. Consistent with this mission, Congress has provided 
for VA to furnish cost-free care to both veterans needing 
treatment for service-connected disabilities and to low-income 
veterans. While current law sets broadly applicable copayment 
requirements on outpatient prescriptions and requires higher-
income veterans to bear part of the cost of their care, there 
is an inherent inconsistency in these policies. This 
Committee's recommendation for increased medical care 
appropriations and its companion effort to establish a 
legislative foundation for better meeting veterans' health care 
needs makes it appropriate that it re-evaluate current policy 
on cost-sharing. Considerations of equity support such a re-
evaluation.
    For example, under current law, largely arbitrary 
circumstances often dictate whether similarly situated veterans 
will receive entirely cost-free VA nursing home care or bear 
very substantial costs of care--either in a State veterans 
nursing home or indirectly through a required spend-down of 
assets to qualify for Medicaid. All but three States operate 
State veterans' nursing homes, and in all but one State 
veterans are required to make payments toward the cost of their 
care, up to a prescribed maximum and subject to ability to pay.
    The severe reductions anticipated under the fiscal year 
2000 budget raise the prospect that many nonservice-connected 
veterans who now enjoy free or nearly cost-free VA care could 
lose access to VA services entirely. In that regard, recent 
news accounts highlight that those with other health-care 
options will, for example, face managed care-plan prescription 
copayments of $5 for generic drugs, $15 to $20 for a brand-name 
drug on a plan's formulary, and up to $40 for a brand-name non-
formulary drug (Wall Street Journal, January 12, 1999). Current 
law limits VA to charging a $2 copayment for each 30-day supply 
of medications furnished on an outpatient basis for treatment 
of a nonservice-connected disability. (Veterans who are 50 
percent or greater service-connected disabled and veterans with 
very limited income are exempt from this requirement.) Also in 
marked contrast to other health plans, VA is providing large 
numbers of veterans hearing aids, eyeglasses, and other devices 
under a liberal VA interpretation of eligibility law. 
Individuals seeking such services under other health plans 
would often incur out-of-pocket payments under copayment or 
deductible provisions, or be denied the service altogether. Yet 
most nonservice-connected veterans, receiving a benefit never 
before available in the VA, bear no part of its cost.
    In the context of the multi-faceted legislative plan 
discussed above, the Committee will develop legislation on 
cost-sharing which would:

     remove the inherent inequity in current law by 
requiring VA to establish a copayment policy applicable to any 
episode of nursing home care for a nonservice-connected 
condition. Such policy would be based on a copayment 
methodology derived from requirements used by States for 
veterans' nursing home care (to include ability to pay and 
protection of the spouse of a veteran from financial hardship). 
A similar requirement would be established for extended periods 
of home health care;

     provide that copayments applicable to long-term 
care would be for deposit into a revolving fund to be used 
exclusively to expand long-term care programming; and

     authorize the Secretary to establish reasonable 
copayment increases on prescription drugs and reasonable 
copayments on hearing aids and similar items (subject to the 
exemption policy reflected in section 1722A of title 38, United 
States Code). For veterans with higher incomes, the Secretary 
could seek to recover substantially higher copayments for such 
items.

                            Medical Research

    The proposed $316 million budget for medical and prosthetic 
research reflects a well-balanced strategy to continue broad-
based programs to expand understanding of disease and 
disability. The budget targets research areas of particular 
importance to veterans. While recognizing that this budget 
falls short of maintaining the level of research staffing for 
the current fiscal year, the Committee does not propose to 
increase this appropriation, given the extraordinary shortfall 
in medical care funding.

                       Major Medical Construction

    As the Veterans Health Administration continues to evolve 
from a hospital-based network to an integrated health care 
system which provides services through a broad spectrum of 
delivery mechanisms, VA is necessarily reviewing the missions 
of many of its facilities. In some instances hospitals have 
taken on more focused missions, and even ceased to provide 
hospital care. At the same time, many of VA's major tertiary 
care facilities have only grown in the complexity of the 
services they provide.
    VA's infrastructure is vast and has an estimated 
replacement cost of over $34 billion. It is an aging 
infrastructure, with more than 40 percent of its building over 
50 years old, an age industry would consider obsolete. Although 
many of its patient care facilities have undergone some 
renovation work over the years, few were designed and 
constructed to accommodate current medical practice patterns.

    While VA has made significant strides in establishing 
community-based outpatient clinics and shifting care from 
inpatient beds to outpatient services, VA will undoubtedly 
continue to need to operate hospitals, and, in many cases, VA 
must bring those facilities into compliance with patient care 
and safety needs. There continues to be an important role, 
accordingly, for major medical construction.
    VA has not had great success, however, in articulating 
where such construction should take place and how to establish 
priorities among competing construction needs. The Committee is 
disappointed with the fruits of its efforts to require the 
Department to employ systemwide strategic planning in answering 
those questions. To illustrate, the Committee has learned that 
seven of the 18 major construction projects identified by the 
Department (in its Strategic Planning Report in response to 
section 204 of Public Law 104-262) as its FY 1999 highest 
priority major medical construction projects were dropped from 
that list based on network re-evaluations. One must question 
the nature of this planning process when more than one-third of 
VA's top priorities last year are deemed ``rejects'' today. In 
that regard, it is perplexing--given the problem of medical 
centers which were not designed with significant ambulatory 
practice in mind--that a proposed construction project for the 
Washington, D.C. VA Medical Center, which was identified as a 
priority in the FY 1999 Strategic Plan, and which was 
authorized by Congress last year, was not proposed for funding 
this year (and, in fact, is among the projects which was 
dropped from the priority list).
    There is no question but that there is an extensive need 
for major medical construction in VA. Given uncertainty, 
however, regarding VA's own assessment of where construction 
should take place, and lack of a basis to understand its 
priority-setting, the Committee approaches the identification 
of needed major medical construction projects with great 
caution. Testimony by VA's Under Secretary for Health citing a 
need for additional hospital mission changes highlights the 
importance of such a cautious approach.
    Most of the unfunded construction projects recommended by 
this Committee last year and authorized by the Congress appear 
still to be needed. Accordingly, with an eye to meeting those 
construction needs as an initial priority, the Committee 
recommends a funding level of $140 million, a $66 million 
increase above the Administration's proposal.

                           Minor Construction

    The minor construction account funds a broad range of 
construction work on projects costing less than $4 million, 
ranging from inpatient and outpatient renovations and 
improvements to upgrading electrical, ventilation, and heating 
and cooling systems. Operating in facilities which are often 
many decades old, VA requires the flexibility provided by this 
account to correct safety and code deficiencies, replace 
utility systems, improve ambulatory care space, and address 
other such physical plant needs.
    The Committee is concerned, however, that minor 
construction funds are being committed to projects without any 
apparent connection to strategic plans. Accordingly, the 
Committee envisions further oversight on this area to ensure 
prudent allocation of the $175 million requested for this 
important account.

                        State Home Construction

    This program provides funding for up to 65 percent of the 
cost of construction or needed renovation to help assure that 
States can assist in meeting veterans' needs for nursing home 
and other long term care. The states have been reliable 
partners in this effort, and many have appropriated monies in 
advance to establish priority for grant funding. (States which 
have already made their share of funds available for a needed 
project have the highest priority for grant assistance.)
    With VA medical centers having reduced long-term care 
nursing home beds, the State Veterans Home Program has become 
even more critical to meeting the needs of aging veterans. 
Increasingly, VA nursing home beds are available only to 
veterans in need of short-term rehabilitation. It is most 
troubling, accordingly, that this budget would more than cut in 
half, to $40 million, appropriations for a program 
substantially dedicated to long-term nursing home care. Such a 
cut would leave without funding support in FY 2000 more than 
$75 million in pending ``priority #1'' projects, those for 
which the States have already put up the required funding.
    The Committee awaits with interest the results of a 
consultant management study on this program, and believes its 
findings and recommendations will be helpful in its review of 
proposals for revising the rules governing prioritization for 
funding of grant applications. The Committee's interest in 
considering such legislation should in no way, however, suggest 
a diminution in commitment to this program. Accordingly, the 
Committee proposes an appropriation of $90 million for fiscal 
year 2000.

  Medical Administration and Miscellaneous Operating Expenses (MAMOE)

    The MAMOE budget funds the headquarters' operations of the 
largest health care system in the country. Over the years, an 
ever-shrinking MAMOE budget has reduced the size of VA's 
headquarters' staff. Congress, however, has not reduced its 
expectations of VA. It looks to VA's headquarters not simply to 
set policy, but to manage and oversee the VA health care 
system. Last year, based on concerns regarding headquarters' 
lack of sufficient oversight of the quality of VA care, 
Congress increased the MAMOE budget. The proposed MAMOE budget 
of $61.2 million for FY 2000 will permit VA to meet the 
expectations set by Congress last year.

                    VETERANS BENEFITS ADMINISTRATION

General Operating Expenses

    The General Operating Expenses account funds full time 
employee equivalents (FTEE) and operating expenses for both the 
Veterans Benefits Administration (VBA) and VA's Central Office 
(headquarters). VBA administers a broad range of non-medical 
benefits to veterans, their dependents, and survivors through 
60 regional offices or medical and regional office centers. 
These programs include compensation and pension, education, 
vocational rehabilitation, insurance, and loan guaranty (home 
loans). VBA is also responsible for processing applications for 
these programs. Headquarters includes the Secretary's staff and 
other VA support staff, and is located in Washington, DC.
    The Department proposes to increase overall VBA staffing by 
creating 164 new FTEE in fiscal year 2000. Such positions would 
be used for adjudicating disability compensation and pension 
claims.
    The Committee supports this proposed increase in FTEE 
because VBA's backlog of claims waiting to be processed is 
again increasing, approaching 454,000 claims. The situation is 
simply this: the funnel into which all the work is being poured 
is too small. The adverse effects of the overflow are a decline 
in the quality of work and employee moral. The Administration 
and Congress must recognize that benefit programs cannot be 
delivered effectively without sufficiently well-trained staff.
    To illustrate the Committee's concern about the quality of 
work being affected by the FTEE levels, in January, 1998, VA 
completed the first Systematic Technical Accuracy Review 
(STAR). This review of a national sample of original 
compensation claims found that 36 percent of the claims 
contained at least one serious error. In that group of claims, 
errors averaged over four per claim. Clearly, this error rate 
is substantially higher than VA had ever admitted or recognized 
and the VA Committee highly commends VBA for its candor and 
willingness to finally document what most stakeholders have 
been saying for years.

Benefit Program Operations

    Compensation and Pension Service (C&P).--The ability of VA 
to provide timely and quality benefits delivery is heavily 
dependent on a combination of proper staffing levels, effective 
implementation of computer modernization initiatives, training 
and retention incentives, and inter-departmental cooperation 
between the various VA agencies and military service 
departments. Over the past decade the number of trained 
personnel in the adjudication division has declined by 
approximately 40 percent. The Committee commends the Department 
for continuing to reverse this trend--with the 140 FTEE 
increase it proposed for adjudication services in fiscal year 
1999--and a net additional 440 FTEE for such purposes for FY 
2000. The 440 FTEE increase is derived from two sources: (1) 
164 new FTEE mentioned above, and (2) 276 derived largely from 
a redistribution of resources from general support staff, and 
the education, housing, and insurance programs. These 
additional employees are critical as VBA faces the loss of 
numerous highly experienced claims decisionmakers due to 
retirement. Further, with VA's Inspector General reporting 
average processing times of 150.6 days for an original 
compensation claim and 145.6 days for a reopened compensation 
claim, the Committee supports the 440 FTEE increase in the C&P 
Service proposed in fiscal year 2000. The Committee recommends 
an additional $5 million to be used for quality assurance and 
staff training and development purposes.

    Vocational Rehabilitation and Counseling Program 
(VR&C)--.The goal of the Vocational Rehabilitation and 
Counseling Program is employment of disabled veterans and 
certain dependents. To accomplish that goal, VR&C is authorized 
to furnish all services and assistance necessary to enable 
service-connected disabled veterans to become employable, 
obtain and maintain suitable employment, or to achieve maximum 
independence in daily living. Additionally, VR&C is authorized 
to provide educational and vocational counseling services to 
eligible active-duty members, veterans, and dependents. Last 
year, about 9,000 veterans were rehabilitated, and VA projects 
a slight decline in program participants from 53,004 in FY 1998 
to 50,726 in FY 2000. Vocational rehabilitation specialists 
currently carry an average caseload of 300 participants, and 
the small decline in overall participation will not appreciably 
affect the average.
    The General Accounting Office issued reports in 1984, 1992, 
and 1996 citing significant program management problems, such 
as a failure to focus on employment, an inability to identify 
program costs, high drop-out rates, poor case management and an 
almost blanket use of college degree programs for 
rehabilitation. VA's Inspector General in 1988, VA's VR&C 
Design Team in 1996, and the Congressional Commission on 
Servicemembers and Veterans Transition Assistance in 1999 
confirmed such findings, especially with respect to a proper 
focus on long-term suitable employment for program 
participants. The Committee applauds VBA initiatives to (1) 
reduce the average number of days for veterans to enter 
suitable employment from 103 days in FY 1996 to 75 days in FY 
2000, (2) improve the percentage of participants who exit the 
program and are successfully rehabilitated from 42 percent in 
FY 1999 to at least 55 percent for the years beyond FY 2000, 
and (3) develop and implement a joint training program with the 
Department of Labor's Veterans' Employment and Training 
Service. The Committee is supportive of the budget request of 
969 FTEE for the Vocational Rehabilitation and Counseling 
Service. The Committee notes this request includes the 
establishment of the newly-created position of Employment 
Services Specialist in each of VBA's nine Service Delivery 
Networks. These are new positions that will be used to help 
place service-disabled veterans in long-term, suitable 
employment and will be funded through existing resources.

    Education Service.--VA's Education Service is responsible 
for several programs, most notably the Montgomery GI Bill 
(MGIB), which provides earned education assistance benefits to 
411,000 veterans, active duty, and National Guard and Reserve 
personnel, as well as programs for survivors of veterans who 
are 100 percent disabled, died of a service-connected 
disability or were killed on active duty.
    The Committee notes that today's veteran is different from 
veteran-populations under previous GI Bills. For example, it 
has been estimated that 10-20 percent of the uniformed military 
population during the Vietnam era was married. Today, 68 
percent of all separating soldiers and almost 40 percent of 
those eligible for Montgomery GI Bill benefits upon separation 
are married. Usage is lower for married veterans than for 
single veterans.
    The Committee commends VA for an initial savings of 19 FTEE 
generated in large part by electronic data interchange 
technology initiatives such as electronic claims folders, 
electronic certification and verification of monthly 
enrollment, and school-generated electronic awards. The 
Committee encourages continued development of such initiatives 
for program management purposes.

                    NATIONAL CEMETERY ADMINISTRATION

    The National Cemetery Administration (NCA) (known as the 
National Cemetery System from 1973 to 1998) provides national 
shrines honoring those who served in uniform and should be 
maintained as places of high honor, dignity and respect. 
Currently, 149 cemeteries and soldiers' lots located in 41 
states, the District of Columbia and Puerto Rico comprise the 
NCA. Since establishment of the NCA in 1862, approximately 2.6 
million veterans have been interred in national cemeteries and 
approximately 6.7 million headstones and markers have been 
furnished.
    For fiscal year 2000, the Administration is proposing an 
increase of $4.89 million to fund NCA. This includes funds for 
23 additional FTEE to accommodate increased workloads 
throughout the system as well as to support operations and 
activation requirements at the Abraham Lincoln, Dallas/Fort 
Worth and Saratoga National Cemeteries, and the new national 
cemetery in the Cleveland, Ohio, area. The Committee is in full 
support of the Administration's request for an additional $4.89 
million, including 21 FTEE, for the National Cemetery 
Administration.
    Between fiscal years 1995 and 2010, the veteran population 
will decrease by six million (23 percent). Consequently, NCA 
faces an increasing workload because many of the remaining 6.3 
million veterans of the World War II generation will seek 
burial in a national cemetery. The NCA's workload per FTEE will 
continue to grow in all areas of operations. For example, the 
total number of gravesites and acreage maintained will increase 
every year. The number of headstone and memorial certificates 
delivered will also increase. In fiscal year 1998, VA interred 
76,718 veterans and family members. In fiscal year 2000, VA 
expects to inter 80,300 individuals and by the year 2004, the 
number of interments is projected to increase to 98,700. VA 
also expects to process 342,000 grave marker applications in 
fiscal year 2000. Similarly, the number of gravesites 
maintained is estimated to exceed 2.3 million in fiscal year 
2000. NCA must have both human and material resources to 
accommodate these increases.

National Cemetery System Operating Account

    The Committee is pleased that VA is proposing to increase 
funding by $1.2 million for maintenance and repair, grounds 
maintenance and related supplies. These funds are vital to 
preserving the appearance of the cemeteries.
    The National Cemetery Administration maintains 
approximately 400 buildings and 100 miles of roads. To help 
with that maintenance, VA has an inventory of more than 8,000 
pieces of equipment with an estimated value of $23 million, 
approximately $7.2 million of which is past due for 
replacement. The Committee supports the Administration's 
proposal of $2.2 million to replace equipment and reduce the 
backlog of obsolete units by $400,000.

Cemetery Construction

    VA's construction needs for new and existing cemeteries are 
addressed through Major and Minor Construction appropriations. 
NCA has focused construction planning on creating new 
cemeteries in areas of the country with the greatest unserved 
veteran population, extending the life of existing cemeteries 
through gravesite development and repairing and maintaining the 
infrastructure of the system. The Committee notes (1) there are 
no funds requested for additional new cemeteries beyond the 
four scheduled to open through 2000, and (2) VA requests only 
$500,000 in Advance Planning Funds for cemetery construction.
    The Committee recommends adding $3.6 million in major 
construction planning funds, i.e. planning and site 
acquisition, to create national cemeteries in Atlanta, Georgia 
and Detroit, Michigan. Atlanta and Detroit appear on VA's list 
of the ten areas of the country having the greatest need for a 
national cemetery in light of veterans' burial needs, which 
will peak in fiscal year 2008. Prudent planning is essential 
as: (1) at the end of fiscal year 1998, of the 115 existing 
national cemeteries, only 57 contained available, unassigned 
gravesites for the burial of both casketed and cremated 
remains, and (2) by the year 2004, only 55 VA national 
cemeteries will be open for both casketed and cremated remains.
    The Administration's fiscal year 2000 proposal contains a 
$11.9 million major construction project for gravesite and 
columbarium development at the Leavenworth National Cemetery. 
The Committee fully supports this proposal.
    Minor construction projects, which are those costing less 
than $3 million, total $18.9 million for fiscal year 2000, and 
the Committee supports that request.

                     State Cemetery Grants Program

    The State Cemetery Grants Program provides grants to assist 
the states in establishing, expanding, and improving state-
owned veterans cemeteries. Increasing the availability of state 
veterans' cemeteries is one way to serve veterans who do not 
reside near a national cemetery. State cemeteries augment--but 
do not supplant in any way--VA's national cemetery program. The 
Veterans Benefits Improvements Act of 1998 made the State 
Cemetery Grants Program more attractive to the States by 
increasing the maximum Federal share of the costs of equipment 
from 50 percent to 100 percent, and by making initial equipment 
costs eligible for grant funding. The States remain responsible 
for providing the land and for paying all costs related to the 
operation and maintenance of the state cemeteries, including 
the costs for subsequent equipment purchases.
    The State Cemetery Grants Program is funded at $11 million 
for fiscal year 2000. Since its establishment in 1980, VA has 
made grants of $56.4 million through fiscal year 1998. Nearly 
100 grants have been awarded to 25 states, Saipan and Guam 
since the program's inception. For fiscal year 2000, NCA has 
budgeted $11 million for the State Cemetery Grants Program. In 
light of veterans' burial needs projected to peak in FY 2008, 
the Committee recommends an additional $4 million for the State 
Cemetery Grants program to help address such needs.

                      Arlington National Cemetery

    Arlington National Cemetery is the nation's premier 
resting-place for veterans. The cemetery is currently the final 
resting-place for over 250,000 remains. In fiscal year 2000, 
Arlington Cemetery officials estimate they will add about 5,900 
remains to that total, and conduct 2,800 non-funeral 
ceremonies.
    The Administration's request is $33,000 above the fiscal 
year 1999 appropriation. The Committee does not support that 
request and recommends an additional $500,000 to support 
operations and maintenance at Arlington National Cemetery. The 
Committee also recommends an additional $1.75 million to(a) 
design and construct a vehicle storage garage building at 
Arlington's facilities maintenance complex, (b) initiate a 
study relating to repairs needed at (1) the interior of the 
reception building at the Memorial Amphitheater, and (2) the 
Robert F. Kennedy gravesite.

                    Board of Veterans' Appeals (BVA)

    More than 80 percent of the Board's decisions concern 
contested disability compensation claims. Prior to fiscal year 
1992, BVA response time--the number of days it would take BVA 
to render decisions on all pending certified appeals at the 
processing rate of the immediately preceding on-year time 
frame--rarely exceeded 150 days. However, as the impact of the 
Court of Appeals for Veterans Claims decisions began to take 
effect, BVA's response time climbed steadily from 139 days in 
FY 1991 to a peak of 781 days at the end of fiscal year 1994. 
By the end of fiscal year 1998, the Board reduced its response 
time to less than 200 days (197 days) for the first time in 
seven years.
    A review of BVA data over the past three fiscal years 
provides a snapshot of the demonstrable progress BVA has made 
toward meeting the production levels needed to reduce the 
backlog of appeals pending. For example, the Board reduced the 
fiscal year 1996 backlog of over 60,000 appeals to under 35,000 
as a result of additional resources provided over fiscal years 
1997 and 1998, as well as several management initiatives. In 
fiscal year 1997, the BVA made over 43,000 decisions, an 
increase of 10,000 over the previous year. Regrettably, 
however, 42 percent of those decisions were remands to the 
regional offices, another example of the quality problems that 
continue to plague the regional offices. In FY 1998, BVA issued 
38,886 decisions. This total represents a 10.3 percent decrease 
from FY 1997, when the Board issued 43,347 decisions. The 
decrease is primarily a result of (1) a higher percentage of 
final, non-remand decisions (56.7 percent) than was issued the 
previous year (53.3 percent), and (2) a heightened emphasis on 
decisional quality.
    The Committee commends the Board on its recent integration 
into a single appeals tracking system of the formerly separate 
systems used by VBA and the Board. This joint system, Veterans' 
Appeals Control and Locator System, allows the Department to 
(1) monitor and process appeals in a more efficient manner, and 
(2) analyze appellate workload trends and appeals processing 
performance. The Committee also commends BVA's ongoing 
initiative to increase electronic exchange of information with 
VBA and thus improve date currency and decrease administrative 
handling.
    The Committee supports the Administration's request of 
$41.5 million for the Board.

                           Inspector General

    The VA's fiscal year 2000 request for a $7.2 million 
increase in budget authority for the Office of the Inspector 
General (OIG) is fully justified by the office's workload and 
scope of activities. The requested increase includes $4.7 
million to contract out the audit of VA's consolidated 
financial statement, and $2.5 million for current services. 
While the contract would free audit staff to address other 
audit issues, the budget request would not provide any funding 
for additional staff needed for essential investigation and 
inspection work. Despite the budget request's apparent 
misstatement that the funding would support an increase of 12 
in ``average employment,'' OIG employment for fiscal year 2000 
would actually remain at about the fiscal year 1999 level of 
360 authorized full time employees, well below the statutory 
floor of 417 set by 38 U.S.C. section 312.
    Therefore, the Committee recommends providing the OIG with 
increases for fiscal year 2000 of $4.7 million for contracting 
out audit of the consolidated financial statement, $2.5 million 
for maintaining current services, and $3.5 million for 35 
additional employees. The Committee believes 10 of the 
additional employees should be assigned to the IG Hotline, 
which is seriously understaffed and is referring many cases 
back to VA rather than to the OIG. This damages VA employee 
confidence in the Hotline by making assurances of 
confidentiality problematical. The remaining additional 
employees should be assigned to criminal investigations and 
health care inspections.

               U.S. Court of Appeals for Veterans Claims

    The Veterans' Judicial Review Act, Public Law 100-687, 
established the U.S. Court of Veterans Appeals as an executive 
branch court (later renamed as the U.S. Court of Appeals for 
Veterans Claims.) The Court is empowered to review decisions of 
the Board of Veterans' Appeals and may affirm, vacate, reverse 
or remand such decisions as appropriate. The Court has the 
authority to decide all relevant questions of law, to interpret 
constitutional, statutory, and regulatory provisions, and to 
determine the meaning or applicability of the terms of an 
action by the Secretary of Veterans Affairs. The Court also has 
the authority to compel actions of the Secretary that are found 
to have been unlawfully withheld or unreasonably delayed. The 
Committee supports the Court's budget request of $11.4 million.

                          Department of Labor


               VETERANS' EMPLOYMENT AND TRAINING SERVICE

    Congress has determined that our nation has a 
responsibility to meet the employment and training needs of 
veterans. To accomplish those goals, the Assistant Secretary of 
Labor for Veterans' Employment and Training (ASVET) is 
authorized to implement training and employment programs for 
veterans. The ASVET also acts as the principal advisor to the 
Secretary of Labor with respect to the formulation and 
implementation of all departmental policies and procedures that 
affect veterans.
    The Committee is aware of the significant changes in the 
national labor exchange system. States are changing the way 
they deliver employment services and adopting new service 
delivery models ranging from devolving state programs to the 
county level to privatizing some or all employment functions 
and instituting one-stop employment centers under the Workforce 
Investment Act of 1998.
    Since the Veterans' Employment and Training Service and its 
state-based Disabled Veterans Outreach Program Specialist and 
Local Veterans Employment Representative system depends upon 
the state employment services, VETS must adopt new strategies 
to deliver employment services to veterans. Aggressive 
recommendations for doing so are made in the January 14, 1999, 
report of the Congressional Commission on Servicemembers and 
Veterans Transition Assistance. By statute, the Secretary of 
Labor has until about April 19, 1999, to comment to the House 
and Senate Committees on Veterans' Affairs on the Commission's 
findings and recommendations.
    Such Commission findings include: (1) fewer than two 
percent of veterans go to the Employment Service (ES) when 
looking for a job and ES data show that only 12 percent of the 
veterans who do go to the ES get permanent jobs following their 
visit, and (2) according to DOL's 1997 Annual Report, nine 
states met DOL performance standards while placing fewer than 
10 percent of veteran registrants in jobs. Conversely, the 
Department of Labor states that during program year 1997 that 
it helped into jobs 26.5 percent of veterans registering for 
services.
    Commission recommendations include: (1) Congress should 
reengineer veterans' employment services to meet the new 
reality of a highly automated, integrated, and customer-focused 
environment; (2) Congress should replace the DVOP and LVER 
programs with (a) a new Veterans Case Manager program to 
provide job-seeking skills, job development, and referral 
services to disabled veterans, veterans facing employment 
barriers, and recently separated veterans, and (b) a new 
Veterans Employment Facilitator program to facilitate 
Transition Assistance Program (TAP) workshops and market 
veterans' employment to local employers; and (3) DOL should 
award grants for veterans employment and training services 
competitively on a state-by-state basis so that the most cost-
effective organizations can provide the services.
    The Committee wishes to note it has consistently supported 
the LVER program since Congress established it in 1944 as part 
of the original G.I. Bill of Rights. The Committee has also 
supported the DVOP program, including codifying it in 1980. In 
addition, with the 1988 enactment of Public Law 100-323, the 
Committee supported a statutory funding formula for both LVERs 
and DVOPs. Moreover, in its annual budget views and estimates, 
the Committee has consistently recommended full funding for 
DVOPs and LVERs, although such full funding has not occurred 
since 1989. However, in light of recent findings and 
recommendations of the Congressional Commission on 
Servicemembers and Veterans Transition Assistance, the 
Committee believes it should focus its efforts on reengineering 
the delivery of Veterans' Employment and Training Services 
rather than recommending additional resources for the current 
program.

                  Disabled Veterans' Outreach Program

    Under section 4103A, title 38, United States Code, the 
Secretary of Labor is required annually to make available 
sufficient funds for use in each state to support the 
appointment of one DVOP specialist per 6,900 veterans of the 
Vietnam era, veterans who entered active duty as a member of 
the armed forces after May 7, 1975, or service-disabled 
veterans. For fiscal year 1999, this formula results in 2,119 
DVOPs. The Administration's budget provides funds to support 
1,431 DVOP positions, 688 below the Congressionally-mandated 
level. The Committee supports this request.
    Congress established the Disabled Veterans Outreach Program 
(DVOP) to provide intensive employment and training services to 
service-connected disabled veterans and other veterans in need 
of job search and placement assistance. DVOPs serve as workshop 
facilitators for the Transition Assistance Program (TAP), a 3-
day program that provides transition counseling, job-search 
training and information, placement assistance and other 
information and services to servicemembers who are within 180 
days of separation from active duty. DVOPs also develop job and 
job-training opportunities for veterans through contacts with 
employers. Additionally, DVOPs provide assistance to community-
based organizations and grantees who provide services to 
veterans under other federal and federally-funded employment 
and training programs, such as the Job Training Partnership Act 
and the Stewart McKinney Act.

               Local Veterans' Employment Representatives

    Section 4104(a)(1), title 38, United States Code, mandates 
that the Secretary of Labor make available funding to support 
the appointment of at least 1,600 full-time LVERs and the 
states' administrative expenses associated with the appointment 
of that number of LVERs. The Administration's budget provides 
funds to support 1,306 LVER positions. The Committee supports 
this request.
    Congress established the LVER program to functionally 
supervise the provision of job counseling, testing, job 
development, referral and placement to veterans in local 
employment services offices. LVERs participate in TAP workshops 
and maintain regular contact with community leaders, employers, 
labor unions, training programs and veterans service 
organizations in order to keep them advised of eligible 
veterans available for employment and training. LVERs also 
provide labor exchange information to veterans, and promote and 
monitor participation of veterans in federally funded 
employment and training programs. Finally, LVERs monitor the 
listing of jobs by federal contractors and subsequent referrals 
of qualified veterans to these employment openings, refer 
eligible veterans to training, supportive services, and 
educational opportunities, and assist, through automated data 
processing, in securing and maintaining current information 
regarding available employment and training opportunities.
    DOL also manages the Homeless Veterans Reintegration 
Program (HVRP). The program is designed to provide support 
services to local agencies targeting homeless veterans with 
employment assistance. For the past three years, the President 
and the Appropriations Committee have failed to support funding 
for the program, while the law creating this program authorizes 
$10 million per year. This year the President has proposed $5 
million for HVRP. The Committee notes that the funding for HVRP 
veterans' employment and training initiatives has failed to 
keep pace with the funding for other agencies that provide 
transitional housing and supportive services. For example, 
Congress has increased funding for HUD (homeless) programs from 
$72 million in FY 1988 to $823 million in FY 1998, and also 
increased health care and substance abuse programs administered 
by the Department of Veterans Affairs from $13 million to $76 
million during the same time period. The Committee recommends 
funding for HVRP at the authorized level of $10 million to 
increase employment services to homeless veterans.
    The Committee notes that 458 DVOPs and 431 LVERs do not 
have personal computers or access to the Internet or America's 
Job Bank/Talent Bank. The employment search needs of many job-
ready veterans can be met primarily through their personal 
access to the Internet. Nevertheless, many veterans do not have 
personal access to such electronic job listings and must visit 
a local Employment Service office for help. The Committee 
recommends the addition of $1.75 million to outfit DVOPs 
($911,000) and LVERs ($840,000) with Internet/AJP access at 
their workstation or their outstation location.

     National Veterans' Employment and Training Services Institute

    The National Veterans' Employment and Training Services 
Institute (NVETSI) is operated under contract by the University 
of Colorado at Denver and provides basic and advanced 
instruction in veterans employment programs and services. 
Because this is the only source of formal training for federal 
and state employees for veterans employment programs, NVETSI is 
vital to the success of those programs. The President has 
recommended $2 million for fiscal year 2000 to train 1,500 
veteran service providers. Of the current 2,700 DVOP and LVER 
staff, 2,400 have not attended the new Labor Employment 
Specialist training to provide core competencies to veteran 
service provider staff. An additional $1 million would train 
2,800 veteran service providers. The Committee recommends 
funding NVETSI at $3 million for FY 2000.

                          Proposed Legislation

    Cost of Living Adjustment (COLA).--The Committee supports a 
cost-of-living adjustment (COLA) for compensation and 
dependency and indemnity compensation equal to the COLA 
calculation for Social Security recipients.
    The Committee will not take action on the Department's 
proposed legislation to pay Filipino veterans and survivors 
full disability compensation. Prior to the Committee's July 22, 
1998, oversight hearing on existing veterans' benefits for 
Filipinos, the Committee sent a series of questions to the 
Department. Because the Department will be affected by any 
change to existing law, the Committee requested that, among 
other things, VA address how it would prevent Filipino veterans 
not actually residing in the U.S. from using post office boxes 
or fictitious residences in order to qualify for compensation. 
History has shown a very real potential for fraud. To date, the 
Department has not provided the Committee with a plan for 
implementing the Administration's proposed legislation.

  Additional Legislative Items Which the VA Committee May Report with 
                      Direct Spending Implications

    Montgomery GI Bill.--The Committee recommends a $200 
million addition to the President's request for improvements to 
veterans' education benefits. This will provide improvements in 
the basic education benefit.
    The cost of education has increased over 7 percent per year 
since the inception of the Montgomery GI Bill in 1985. Today, a 
veteran with two years of honorable military service receives a 
maximum of $4,752 for a nine-month school year from the 
Montgomery GI Bill (MGIB). But the average annual cost in 1996 
for tuition, room and board, fees, books and transportation at 
a public institution was $10,759, a total increase of 109 
percent since 1987. For private schools, the annual cost is now 
$20,003, an increase of 84 percent since 1987. As a result, the 
Montgomery GI Bill falls short by $6,007 annually for a public 
school and $15,251 for a private school. The Committee notes 
that participation in the MGIB lags behind the Vietnam-era GI 
Bill. Through FY 1997, some 13 years after the 1984 enactment 
of the MGIB, 48.7 percent of eligible beneficiaries used the 
MGIB. Vietnam-era GI Bill usage for the first ten years (June 
1966 to June 1976) was 63.6 percent.
    The Committee notes the recent Congressional Commission on 
Servicemembers and Veterans Transition Assistance found that 
most college-bound youth and their families see a tour of 
military service as a detour from their college plans, not as a 
way to achieve that goal. Not surprisingly, each of the 
military services except the Marine Corps is experiencing 
recruiting problems in various ways. Each of the Joint Chiefs 
of Staff believes a rejuvenated Montgomery GI Bill would help 
recruitment, as evidenced by their testimony before the Senate 
Armed Services Committee on September 29, 1998.

    Minor Revisions Requiring Direct Spending Authority.--The 
Committee recommends $10 million for minor changes to the 
dependency and indemnity program and other limited revisions in 
the compensation program.

                      National Shrine Initiatives

    The Committee recommends $1 million for a one-time 
assessment, by an independent contractor, of the basic 
maintenance repairs needed at individual VA national cemeteries 
to ensure a proper and respectful setting. Such a step would 
serve as the first component of an on-going assessment of (1) 
how to make a reasonable number of VA national cemeteries more 
of the design/quality/stature of the American Battle Monuments 
Commission, and (2) the number of VA national cemeteries needed 
beyond 2010.

                Homeless Veterans Reintegration Program

    The Committee recommends a five year authorization for this 
program at $10 million per year, beginning in fiscal year 2000. 
Such reauthorization would make the program more permanent.

                                                          HOUSE COMMITTEE ON VETERANS' AFFAIRS
                                                                     March 11, 1999
                                                               [In Thousand U.S. Dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                      FY 1999 Enacted FTE     President's 2000 Budget
                                                  --------------------------          Request           99/'00 Budget      Committee     Administration/
                                                                            --------------------------    Comparison     Recommendation   Congressional
                                                       Amount         FTE        Amount         FTE                                         Comparison
--------------------------------------------------------------------------------------------------------------------------------------------------------
Benefits Programs

  Compensation and Pensions......................     $21,857,058  ........     $21,568,364  ........     $(-\288,694)      $21,568,364                0
  Proposed COLA (2.4%) eff. 12/1/99..............  ..............  ........         293,300  ........       (+293,300)          303,300       $(+10,000)
  Readjustment Benefits..........................       1,175,000  ........       1,469,000  ........       (+294,000)        1,469,000                0
  Proposed Legislation...........................  ..............  ........  ..............  ........  ...............          200,000       (+200,000)
  Veterans Insurance and Indemnities.............          46,450  ........          28,670  ........       (-\17,780)           28,670                0
  Veterans Housing Benefit Program Fund..........         746,503  ........         282,342  ........      (-\464,161)          282,342                0
  Veterans Housing Benefit Program Fund, Current.         159,121  ........         156,958  ........        (-\2,163)          156,958                0
  Native American Veterans Housing Program.......             515  ........             520  ........             (+5)              520                0
  Guaranteed Trans. Housing Loans; Homeless        ..............  ........           9,600  ........         (+9,600)            9,600                0
   Veterans......................................
  Education Loan Program.........................             207  ........             215  ........             (+8)              215                0
  Vocational Rehabilitation Program..............             455  ........             472  ........            (+17)              472                0

                                                  ------------------------------------------------------------------------------------------------------
Total Benefits Program...........................      23,985,309  ........      23,809,441  ........      (-\175,868)       24,019,441       (+210,000)
                                                  ======================================================================================================
Medical Programs

  Medical Care...................................      17,278,580   184,800      17,306,000   174,420        (+27,420)       18,499,000     (+1,193,000)
  Proposed Legislation...........................  ..............  ........  ..............  ........  ...............          500,000       (+500,000)
  Transfer from Med. Care Collections Fund.......         625,000  ........         749,141  ........       (+124,141)          625,000      (-\124,141)
                                                  ------------------------------------------------------------------------------------------------------
Subtotal Medical Care............................      17,903,580  ........      18,055,141  ........       (+151,561)       19,624,000     (+1,569,859)

  Medical and Prosthetic Research................         316,000     3,036         316,000     2,838                0          316,000                0
  MAMOE..........................................          63,000       540          61,200       573        (-\1,800)           61,200                0
                                                  ------------------------------------------------------------------------------------------------------
Total Medical Programs...........................      18,282,580   188,376      18,432,341   177,831       (+149,761)       20,001,200     (+1,569,859)
                                                  ======================================================================================================
Construction Programs

  Construction, Major............................         142,300        50          60,140        50       (-\82,160)          126,140        (+66,000)
  Construction, Minor............................         175,000  ........         175,000        80                0          175,000                0
  Parking Revolving Fund.........................  ..............  ........  ..............  ........  ...............  ...............  ...............
  Grants State Extended Care Facilities..........          90,000  ........          40,000  ........       (-\50,000)           90,000        (+50,000)
  Grants State Veterans Cemeteries...............          10,000  ........          11,000  ........         (+1,000)           15,000         (+4,000)
                                                  ------------------------------------------------------------------------------------------------------
Total Construction Programs......................         417,300       130         286,140       130      (-\131,160)          406,140       (+120,000)
                                                  ======================================================================================================
General Operation Expenses and Misc.

  GOE-VBA........................................         654,809    11,273         706,353    11,437        (+51,544)          711,353         (+5,000)
  GOE-General Administration.....................         228,392     2,490         206,000     2,601       (-\22,392)          206,000                0
  General Operating Expenses.....................         883,201    13,763         912,353    14,039        (+29,152)          917,353                0
  National Cemeteries System.....................          91,916     1,369          97,000     1,406         (+5,048)           98,000         (+1,000)
  Inspector General..............................          35,970       374          43,200       374         (+7,230)           47,900         (+4,700)
                                                  ------------------------------------------------------------------------------------------------------
Total GOE and MISC...............................       1,011,087    15,506       1,052,553    15,819        (+41,570)        1,063,253        (+10,700)
                                                  ======================================================================================================

Total Appropriation..............................     $43,696,276   204,012     $43,580,475   193,780     $(-\115,801)      $45,490,034    $(+1,909,559)
                                                  ======================================================================================================
--------------------------------------------------------------------------------------------------------------------------------------------------------

             ADDITIONAL AND DISSENTING VIEWS AND ESTIMATES


    On March 11, 1999, the House Committee on Veterans' Affairs 
met to recommend views and estimates on the Department of 
Veterans Affairs fiscal year 2000 budget. On a party-line vote 
to move the previous question, the Ranking Democrat, the 
Honorable Lane Evans, was denied the opportunity to offer a 
Democratic alternative to the Chairman's proposal.
    In the simplest terms, the Administration and the Committee 
majority have failed to recommend sufficient resources for 
fiscal year 2000 for the Department of Veterans Affairs (VA) 
and the Veterans Employment and Training Service (VETS) of the 
Department of Labor (DOL). Neither of these proposed budgets 
would provide the funding required to meet our national 
obligation to America's veterans. It is our view that, if we as 
a nation are to fulfill our commitment to this group of special 
and unique citizens, the Administration's FY 2000 budget 
request for VA and VETS must be increased by $3.196 billion. In 
contrast, the Committee majority recommends an increase of only 
$1.9 billion.
    Although the Administration would require the VA to provide 
an increased level of benefits and services, its budget 
proposal does not include the resources needed for VA to 
fulfill the goals set for it. Similarly, although the Committee 
has recommended a funding level significantly above that 
provided by the Administration, the Majority proposal also 
assumes the VA can successfully fulfill its added 
responsibilities without providing the necessary resources.
    We are concerned that, although the Committee majority has 
acknowledged that the resources proposed by the Administration 
for VA for next fiscal year are inadequate, they have 
underestimated the magnitude of the budget shortfall. We are 
also concerned that the majority appears to have embraced the 
Administration's overconfident assertion that increased VA 
management efficiencies will somehow provide the additional 
monies required to reduce and eliminate the funding shortfall.
    As the Committee has pointed out in past years, the 
decision to deny needed resources and claim that unreliable 
management efficiencies will generate the required funding is 
disingenuous, at best. Some, in fact, have described this 
approach to budgeting as cynical. The truth is that although 
carefully selected and implemented efficiencies can generate 
needed funding, these efficiencies simply cannot provide 
savings of the magnitude necessary to fund the initiatives 
proposed by the Administration and acknowledged by the 
Majority. Additionally, to the degree that management 
efficiencies do produce savings, there are not enough of those 
dollars to address existing problems, such as unacceptably long 
waits for health care, much less restore reductions in programs 
which have already occurred, provide the needed expansion of 
current programs and fund new initiatives.
    It should also be pointed out that management efficiencies 
are too often achieved by slashing staff and closing beds. The 
obvious result is that veterans must either wait longer and 
longer for medical care or choose another health care provider. 
An example of this inevitable result was illustrated in a 
recent edition of the Miles City (MT) Star. The article 
described a local veteran who, as a result of untimely VA care, 
was forced to obtain private care and a stiff bill even though 
his 50 percent service-connected disability should have ensured 
him access to VA care. The Salisbury (NC) Post recently 
described the plight of a veteran who for months unsuccessfully 
sought an appointment with a VA doctor because of pain in his 
foot. Finally giving up in frustration, the veteran was found 
to have an inoperable tumor by non-VA doctors. This is not the 
quality of care our grateful nation has promised to provide our 
veterans.
    We are also concerned that the majority budget, unlike the 
Democratic budget proposal, does not specifically include 
needed increases in funding for VA long-term care initiatives 
or mental health programs. Funding these two proposals is 
imperative if we are sincerely committed to meeting veterans' 
needs. Long-term care is virtually disappearing from the VA 
health care system as many facilities begin to ration this care 
because of budget constraints. Most facilities are now limiting 
what they continue to refer to as ``nursing home'' care to 
restorative care, rehabilitative care, and care for terminal 
illness. Lifetime placement is almost a thing of the past. Many 
of VA's medical centers are even discharging veterans with 
Alzheimer's disease.
    It is apparent to us that the need for long-term care for 
an aging veterans' population is limitless. While we cannot 
afford to provide ``everything to everybody'', neither can we 
ignore the problem while growing numbers of veterans are 
compelled to turn to Medicare or Medicaid to meet these needs. 
Unfortunately, this rationing is happening at a time when World 
War II veterans are reaching the age when their reliance on 
long-term care is at a peak.
    VA's Federal Advisory Committee on Long-term Care has 
recommended that VA double or triple its investment in home and 
community based extended care. The President's Budget 
recommended that VA commit $106 million to begin to achieve 
this goal, but did not provide the funding to do so. 
Additionally, the Majority budget does not expressly address 
the growing need for long-term care for veterans. In contrast, 
our proposal would support a $165 million initiative to allow 
VA to restore some nursing home care in its own programs, state 
homes, and the community.
    The Democratic budget includes $100 million in additional 
funding to bolster the faltering continuum of care available 
for chronically mentally ill veterans. The evidence that these 
programs are being seriously compromised, at least partially 
because of budget constraints, is substantial. The Northeast 
Program Evaluation Center (or NEPEC) says that the resources 
devoted to mental health programs are decreasing as a share of 
the budget. This is a clear indication that VA has trimmed all 
the ``fat'' and is beginning to cut into the bone. As a result, 
VA's mental health programs are being more adversely affected 
than other treatment programs. As in the private sector, which 
once had managed care but now has managed spending, VA is 
choosing to treat the ``visible wounds'' of our veterans over 
the psychic ones.
    The decreasing share of the budget provided for mental 
health is reflected in cutbacks in mental health workloads. If 
plans for 2000 are implemented, VA will have eliminated \2/3\ 
of its psychiatric census and almost \1/2\ of its psychiatric 
inpatients treated since fiscal year 1995. In addition, 
psychiatric beds have dropped from 16,392 in 1996 to 10,285 in 
1998, a 37 percent decrease.
    Ambulatory mental health care is also feeling the pinch. 
Outpatient visits for post-traumatic stress disorder (PTSD) 
dropped between 1995 and 1997. VA also closed specialized 
outpatient PTSD and specialized inpatient and residential PTSD 
programs. Between FY 96 and FY 97, VA also decreased both the 
number of veterans treated in the Health Care for Homeless 
Veterans program and the number of visits per veteran treated. 
Between FY 93 and FY 97, the homeless veterans VA treated were 
less likely to have either serious psychiatric disorders or a 
substance abuse disorder, indicating VA may be selecting easier 
cases over the most chronically ill. VA is closing these 
programs despite evidence of their effectiveness. The NEPEC has 
documented improvements in alcohol and drug problems, mental 
illness and social or vocational problems. Despite 
Congressional protection and demonstrated effectiveness, VA 
appears to be withdrawing its support of these programs, 
leading us to conclude the cause is inadequate funding. To 
ensure that VA can maintain effective programs for the 
chronically mentally ill, the Democratic budget recommends 
adding $100 million to restore these types of needed and 
effective programs. Neither the Administration budget nor the 
Majority proposal recommends the funding needed to strengthen 
these programs.
    The Democratic budget proposal will support a higher level 
of care for aging veterans and veterans with chronic mental 
illness. Evidence of program erosion in both of these areas is 
rampant and we must give VA the resources to halt and reverse 
it.
    As shown in the documents that follow, the Democratic 
budget also included increased funding levels for the 
Montgomery GI Bill, employment programs, burial benefits, VA 
staffing, and other important veterans' benefits and services. 
The Democratic members of the House Committee on Veterans 
Affairs carefully considered the needs of the veteran community 
and our national commitment to these special men and women. The 
budget we recommended was realistic, reasonable, responsible 
and appropriate. We are disappointed that the Republican 
majority refused us the opportunity to even discuss this 
proposal on behalf of the veterans of America.
    We listened closely to the testimony of the veterans' 
service organizations over the past few weeks and we heard a 
strong sense of urgency and frustration that we have never 
heard before. America's veterans are telling us they have done 
more than their fair share--and now they expect us to be their 
advocates. They are telling us to speak up--to speak up and 
remind our colleagues that America is safe and free only 
because of the generations of men and women who willingly 
endured the hardships and sacrifices required to preserve our 
liberty. They are telling us to speak up and remind our 
colleagues that no act of citizenship is worthier of our 
respect than the willingness to serve in America's Armed Forces 
and to protect and defend our ideals.
    In summary, the Democratic budget proposal is similar in 
magnitude to that recommended in the Independent Budget and 
would add $3.196 billion to the Administration proposal. The 
Democratic budget would increase health care spending by $2.17 
billion over the Administration request and $474 million over 
the Chairman's recommendation. Our proposal would increase GI 
Bill funding by $881 million over the Administration and $681 
million over the Chairman's proposal. The Democratic 
alternative would provide an additional $61.45 million in 
benefits over the Administration and $50.45 million over the 
Chairman. Finally, the Democratic proposal would provide $79.9 
million more than the Administration for veterans' employment 
services and VA general operating expenses. This is an increase 
of $66.9 million over the Chairman's proposal. We deeply regret 
the Majority's refusal to allow full consideration of the 
Democratic budget proposal for fiscal year 2000. Unfortunately, 
it is America's veterans who have served and sacrificed to 
defend democracy who, ironically, will suffer as a result of 
this subversion of the democratic process.
              
                                                        
                                                Representative 
                                                Lane Evans
                                                        
                                                Representative 
                                                Bob Filner
                                                        
                                                Representative 
                                                Luis Gutierrez
                                                        
                                                Representative 
                                                Corrine Brown

      
      
    [Attachments follow:]
    
    
 LETTER TO THE COMMITTEE ON THE BUDGET FROM THE COMMITTEE ON VETERANS' 
     AFFAIRS ON THE VETERANS' BUDGET PROPOSED FOR FISCAL YEAR 2001

                              ----------                              

                          House of Representatives,
                            Committee on Veterans' Affairs,
                                 Washington, DC, February 25, 2000.
Hon. John R. Kasich,
Chairman, Committee on the Budget,
U.S. House of Representatives, Washington, DC.

    Dear Mr. Chairman: We are writing in response to the Budget 
Committee's request that we provide our views by February 25, 
2000, on the budget for fiscal year 2001 for programs in the 
jurisdiction of the VA Committee. Although the veteran 
population is declining, an unexpected record number of 
veterans are drawing disability compensation and using the VA's 
health care system. The National Cemetery System is predictably 
experiencing an increase in requests for burial services, a 
trend that will probably continue through the end of this 
decade.
    In light of this increasing utilization of our Nation's 
services for veterans, there are two principles which guide our 
recommendations to your Committee. The first is that the 
general increase in productivity associated with the improved 
performance of businesses in the United States must be 
continuously examined for lessons that can be applied to the 
provision of veterans benefits and services. As stewards of 
this Nation's significant commitment to serve veterans, we can 
do no less. The second is that we must recognize when programs 
are not performing as intended, and make the necessary changes 
to assure that results meet Congress's and the American 
people's expectations. In the area of veterans health care and 
education, this means investing resources to provide better 
access to safer health care, and making sure that the Nation's 
most successful veterans readjustment program, the GI Bill, 
serves its intended purpose.

    Medical Care.--The Administration's budget identifies a 
need for some $1.4 billion in additional medical care funds for 
fiscal year 2001. Absent a good understanding of the VA health 
care system, one could question the rationale for this major 
increase in VA medical care funding on top of a record $1.7 
billion increase for this fiscal year. This is particularly so 
if one were only to examine current General Accounting Office 
(GAO) recommendations for closing VA hospitals.
    However, this is a responsible budget which sets VA on a 
sound course. It sustains a trend of increased reliance on non-
hospital services and projects an ability to serve 3.9 million 
veterans, almost one million more veterans than were served in 
1996. It specifically recognizes and plans for new costs to 
expand long-term care services to veterans residing outside of 
nursing homes and provide payments for emergency care for 
eligible veterans who have no other health coverage. At the 
same time, the budget also includes $10 million in funding for 
independent market-based studies recommended by GAO to enable 
VA to develop plans for potential hospital mission changes 
(savings from which would not be realized in FY 2001). This 
budget also recognizes the ongoing needs which led Congress to 
increase VA medical care funding last year: increasing numbers 
of patients and associated delays in providing timely care, 
greater-than-inflationary increases in the costs of 
pharmaceuticals veterans need, required pay increases for VA 
employees, and anticipated costs of treating Hepatitis C. While 
providing needed funding for new requirements and unavoidable 
costs of operations, VA projects that it will continue to 
realize efficiencies in many areas of operation as well as in 
national procurement policies.
    This is a complex budget, elements of which may exceed or 
fall short of projections. A significant new cost facing the 
Department results from enactment of legislation recommended by 
the Department to assist uninsured veterans who are in need of 
emergency care. Another new cost results from the overdue 
expansion of alternatives to nursing home care for older 
veterans. While estimating these new costs is necessarily 
imprecise, this budget's projections are in line with the VA 
Committee's estimates. It is important to recognize that many 
of the initiatives that the Department plans to undertake 
require substantial further policy development. The 
Department's emergency care authority, for example, requires 
the establishment of both a major regulatory framework and new 
administrative apparatus. With little progress to date in 
implementing these authorities, VA may not actually incur in 
full the costs projected for this type of care in FY 2001. On 
the other hand, continued growth in patient workload could 
contribute to both a greater increase in pharmaceutical costs 
than the 15 percent increase budgeted and to continued delays 
in providing timely care. Although workload is a key factor, it 
bears noting that policy changes in other governmental programs 
could substantially alter this budget's projections. 
Legislation expanding access to pharmaceuticals under the 
Medicare program or improving DoD's TRICARE program for 
military retirees, for example, would likely result in many 
veterans substantially diminishing their use of VA services, or 
foregoing VA services entirely.
    The Administration has unwisely included as part of the 
medical care budget a proposal that Congress amend the Veterans 
Millennium Health Care and Benefits Act, Public Law 106-117 
(the Act), to redirect new receipts to the Treasury. The VA 
Committee rejects this proposal. While the Administration is 
requesting a record level of funding for VA medical care, it 
also recommends requiring the deposit in the Treasury of the 
first $350 million in collections authorized under the 
Millennium Act. The Administration's receipts target for FY 
2001 must also be questioned. The Committee had anticipated 
that the Act's costs would ultimately be partially offset by 
new receipts. But more than half of the $350 million receipts 
target identified in the budget depend on Department of Defense 
reimbursements for care furnished to higher-income, TRICARE-
eligible military retirees under section 113 of the Act. The 
Act, however, provides for a phased implementation of section 
113, tied to the renegotiation of existing TRICARE contracts. 
With the first such contract renegotiation and award not 
occurring before the summer of 2001, there is no plausible 
scenario under which VA could receive any significant 
reimbursements for care in the coming fiscal year, let alone 
the projected $180 million.
    In sum, while untested assumptions and projections in this 
budget could heighten the challenge of meeting VA's goal of 
providing timely care to all veterans who seek it, a $1.4 
billion increase in medical care appropriations should meet 
VA's core requirements.

    Medical Research.--While recognizing the need to increase 
medical care funding in FY 2001, the Administration budget 
proposes to freeze VA medical research funding. Given inflation 
and required salary increases, flat funding is like a 10 
percent cut. The decision not to provide an increase in this 
account is in striking contrast to this Administration's call 
for ``a bold course of strategic growth'' for science and 
technology, and its proposed 6 percent increase for National 
Institutes of Health funding and 17 percent increase in 
National Science Foundation funding.
    The Department acknowledges the importance of a strong 
research program to maintaining its medical care program. In 
the interests of maintaining a strong medical and research 
program, the VA Committee recommends the appropriation of an 
additional $25 million (an 8 percent increase) for VA medical 
research. Of that amount, $11 million is needed to prevent 
erosion of VA's current level of research activity. Another $3 
million is requested to support new centers of excellence to 
investigate new treatments for Parkinson's Disease, and the 
remainder to further VA's important work on patient safety and 
other high priority areas.

    Construction.--There are differing views regarding VA's 
need for additional construction funds, but the most clear-cut 
instance of underfunding is in the State Veterans home 
construction grant program for which the Administration 
proposes only $60 million--an unwise $30 million reduction from 
the enacted level for fiscal year 2000. In proposing this 
reduction, the Administration's budget does not reflect the 
enactment of legislation last year (in the Millennium Act) 
which requires VA to fund a list of long-pending projects and 
to revise the priorities for the award of new grants. The 
proposed reduction in funding would defer for still another 
year up to $17 million in Congressionally approved projects, 
and another $70 million in applications submitted by states 
which have already appropriated the state's 35 percent share of 
funding. In light of the large backlog of pending projects, the 
VA Committee recommends that this account be increased by $80 
million to $140 million.
    The VA Committee is aware that the Department, through its 
own planning and review processes, has identified a number of 
major construction projects which were not included in the 
Administration's budget. The VA Committee notes the 
Department's plan to conduct market-based assessments of its 
capital asset needs, and ventures no view at this time as to 
the merits or relative merits of VA's pending projects. The VA 
Committee does intend to hold hearings early this year to 
review the Department's construction priorities and capital 
asset plans.

    Montgomery GI Bill (MGIB) and Other Educational Assistance 
Programs.--The recruiting success of the All-Volunteer Force 
and the MGIB educational assistance program are inextricably 
linked. Even though total Department of Defense recruiting 
requirements declined by 33 percent between 1989 and 1998, the 
Army, Navy, Air Force and Coast Guard are experiencing serious 
recruiting challenges. ``Money for college'' ranks as the major 
reason young men and women give for enlisting. However, many 
youth do not enlist because financial aid abounds for those who 
do not serve in the military. In addition, the purchasing power 
of the MGIB basic benefit has eroded dramatically for veterans 
who wish to use it as a transition tool. Figures furnished by 
the College Board show that in academic year 1998-1999 the MGIB 
covered only 54 percent of tuition and expenses for a commuter 
student at a four-year public college. Further, the VA 
Committee notes that Survivors' and Dependents' Educational 
Assistance benefits provided to the surviving spouse and 
dependent children of an individual who dies either on active 
duty or due to a service-connected cause similarly have not 
kept pace with college costs. Current benefits cover only 49 
percent of the cost of a four-year public college education. 
The VA Committee will also consider a number of recommendations 
to make VA education programs more accessible to veterans. In 
light of the pressing need to improve the MGIB, the Committee 
recommends that the Budget Committee provide $125 million in 
each of fiscal years 2001 and 2002 to fund a basic benefit 
increase and other improvements.

    Veterans Benefits Administration.--The Department is 
proposing a 13 percent increase in funding for the Veterans 
Benefits Administration (VBA). Factors compelling this 
recommended increase include a high incidence of errors in 
decisions on disability claims (32 percent national error rate 
in ``core rating work'' in 1999) and increases in the average 
time it takes to process an original compensation claim (from 
161 days in 1995 to 205 days in 1999). A number of training and 
office automation initiatives would be funded with this 
proposed higher level of funding, some of which are long 
overdue. Additional personnel will be added to the VA's 
``Compensation and Pension'' activity to permit more intensive 
training of personnel and to address claims backlogs. However, 
even this increased level of resources will probably not have a 
significant effect on results because of: 1) the increasing 
complexity in the body of law governing disability claims; 2) 
the projected loss of highly experienced decisionmakers; and, 
3) an increased propensity of separating servicemembers to file 
disability claims, many of which involve multiple claimed 
disabilities.
    The VA Committee has supported the Department's proactive 
initiatives to redirect FTEE from non-compensation and pension 
(C&P) programs into C&P claims adjudication in light of claims 
``backlogs.'' In FY 2000 and 2001, VA will have redirected 45 
FTEE from administration of the MGIB and various other 
education programs to C&P claims adjudication. The VA Committee 
recommends caution in further transfers of FTEE from the 
education program at a time when average days to complete 
original education claims continues to increase. Further, 
without benefit of additional FTEE, VA's four regional 
processing offices have assumed responsibility from the 57 
regional offices for administering a nationwide, toll-free 
education programs telephone service.

    Veterans Employment.--With respect to the Veterans' 
Employment and Training Service of the U.S. Department of 
Labor, the VA Committee's hearings have found that the current 
Local Veterans Employment Representative/Disabled Veterans 
Outreach Program contains no incentives to reward success or 
penalize failure. Individual states that place small 
percentages of veterans in jobs year after year receive grant 
funds in the same manner as states that consistently place 
larger percentages. The VA Committee expects to examine a 
number of possible initiatives including: (a) an allocation 
system that would require states to compete among themselves 
for available dollars based on performance; (b) an incentive 
system that would authorize up to $10 million annually for 
exemplary performance; and, (c) consistent with the Vice 
President's initiative to reduce Federal monopolies, provide 
the Secretary of Labor explicit authority to compete veterans' 
employment and training services in states that do not 
demonstrably improve services within two years.
    A summary table of the VA Committee's recommendations 
follows.

                                 Sincerely,

Bob Stump,                        Lane Evans,
Chairman                         Ranking Democratic Member

                                     

    Enclosure.

 Comparison of President's Proposed Budget, Independent Budget and VA 
   Committee Recommendations for the Department of Veterans Affairs 
                     (Budget Authority in millions)



 Additional Views On The Department of Veterans Affairs Budget For FY 
                      2001 of Honorable Bob Filner

    On February 17, 2000, the House Committee on Veterans' 
Affairs met to conduct a hearing on the Department of Veterans 
Affairs fiscal year 2001 budget. I am pleased that the 
Administration's budget for the year 2001 recognizes that the 
men and women who have served in uniform deserve an adequate 
budget for the Department of Veterans Affairs (VA).
    The $1.4 billion increase in the health care budget will 
assure our aging and disabled veterans who need medical care, 
especially long term care, emergency care and specialized 
services that their needs are a high priority. I join my 
colleagues and the authors of the Independent Budget in 
objecting to the proposal that $350 million of new resources 
for medical care authorized by the Veterans Millenium Health 
Care and Benefits Act be deposited to the Treasury. Funds 
collected from veterans for the provision of veterans' health 
care should be used to enhance the health care provided to 
veterans and not as a substitute for appropriated dollars.
    I wish to emphasize my continuing concern that VA is not 
adequately meeting the benefit and health care needs of those 
veterans who served in the Gulf War and who now suffer from 
various diagnosed and undiagnosed disabilities. It has been 
almost ten years since the men and women of our Armed Services 
were sent to the Gulf. The veterans of the Gulf War are sick 
with illnesses whose causes and cures remain a mystery. We must 
not relax our efforts to fund necessary and appropriate 
research. I join the authors of the Independent Budget in 
supporting an increase in funding for VA medical research and 
specifically request that the medical research budget be 
increased by $65 million as recommended in the Independent 
Budget and that at least $30 million of that increase be 
directed to research involving the health of Gulf War veterans.
    As our veteran population ages, the need for long-term care 
increases. One means of providing access to such care is 
through the funding of State Veterans Homes, such as we have in 
California. I am opposed to the proposed decrease in funding 
for State Homes and urge the Budget Committee to increase 
funding for this important program as recommended by the Full 
House Committee on Veterans Affairs.
    I am also pleased that this Administration has recognized 
what Members of Congress have known for years. Additional 
personnel are needed if VA is to promptly and accurately 
adjudicate claims for compensation and pension benefits. This 
budget will help to provide a well-trained corps of 
adjudicators to replace those who are nearing retirement age. 
Necessary improvements to the claims adjudication system will 
not achieve instant results. I want to emphasize that the 
continued loss of experienced adjudicators over the past seven 
years, together with an increased workload in the number of 
issues which must be decided in each claim, have led to serious 
problems of quality and timeliness. The increased staffing in 
this budget is essential to stem the tide of deterioration in 
claims processing.
    As a former college professor, I recognize the value of a 
quality education for our Nation's veterans. I am disappointed 
that no increase for the G.I. Bill is provided in the 
Administration's budget. Currently, the G.I. Bill provides far 
less than is needed to obtain an education at a public 
institution. I support raising the basic education benefit.
    As we honor our veterans during their lives, so must we 
honor their remembrance in death. The Administration's increase 
in funding for the National Cemetery System will improve the 
appearance of our cemeteries by a long-overdue and much needed 
renovation of grounds, gravesites and grave-markers. I urge the 
Budget Committee to fund the National Cemetery Administration 
and the State Cemetery Grants at the levels recommended by the 
Committee.

                                  Representative Bob Filner
             STATISTICAL DATA--WAR VETERANS AND DEPENDENTS


                          (As of October 2000)


                     American Revolution (1775-1783)

Total Servicemembers.............................................217,000
Battle Deaths......................................................4,435
Non-mortal Woundings...............................................6,188
Last Veteran, Daniel F. Bakeman, died April 5, 1869,................ 109
Last Widow, Catherine S. Damon, died November, 11, 1906,..........age 92
Last Dependent, Phoebe M. Palmeter, died April 25, 1911,..........age 90

                         War of 1812 (1812-1815)

Total Servicemembers.............................................286,730
Battle Deaths......................................................2,260
Non-mortal Woundings...............................................4,505
Last Veteran, Hiram Cronk, died May 13, 1905,....................age 105
Last Widow, Carolina King, died June 28, 1936,...............age unknown
Last Dependent, Esther A.H. Morgan, died March 12, 1946,..........age 89

                     Indian Wars (approx. 1817-1898)

Total Servicemembers........................................1 
                                                                 106,000
Battle Deaths.................................................1 
                                                                   1,000
Last Veteran, Fredrak Fraske, died June 18,1973,.................age 101

                         Mexican War (1846-1848)

Total Servicemembers..............................................78,718
Battle Deaths......................................................1,733
Other Deaths in Service...........................................11,550
Non-mortal Woundings...............................................4,152
Last Veteran, Owen Thomas Edgar, died September 3, 1929,..........age 98
Last Widow, Lena James Theobald, died June 20 1963,...............age 89
Last Dependent, Jesse G. Bivens, died November 1, 1962,...........age 94

                          Civil War (1861-1865)

Total Servicemembers (Union)...................................2,213,363
Battle Deaths (Union)............................................140,414
Other Deaths in Service (Union)..................................224,097
Non-mortal Woundings (Union).....................................281,881
Total Servicemembers (Confederate).............................1,050,000
Battle Deaths (Confederate).......................................74,524
Other Deaths in Service (Confederate)........................2 
                                                                  59,297
Non-mortal Woundings (Confederate)...............................Unknown
Last Union Veteran, Albert Woolson, died August 2, 1956,.........age 109
Last Confederate Veteran, John Salling, died March 16,1958,......age 112

                    Spanish-American War (1898-1902)

Total Servicemembers (Worldwide).................................306,760
Battle Deaths........................................................385
Other Deaths in Service............................................2,061
Non-mortal Woundings...............................................1,662
Last Veteran, Nathan E. Cook, died September 10, 1992,...........age 106

                         World War I (1917-1918)

Total Servicemembers (Worldwide)...............................4,734,991
Battle Deaths.....................................................53,402
Other Deaths in Service...........................................63,114
Non-mortal Woundings.............................................204,002
Living Veterans....................................................2,416

                        World War II (1940-1945)

Total Servicemembers (Worldwide)..............................16,112,566
Battle Deaths....................................................291,557
Other Deaths in Service..........................................113,842
Non-mortal Woundings.............................................671,846
Living Veterans................................................5,559,489

                       Korean Conflict (1950-1953)

Total Servicemembers (worldwide)...............................5,720,000
Battle Deaths.....................................................33,686
Other Deaths (In theater)..........................................2,830
Other Deaths in Service...........................................17,730
Non-mortal Woundings.............................................103,284
Living veterans................................................3,945,801

                         Vietnam Era (1964-1975)

Total Servicemembers (Worldwide)...............................9,200,000
Battle Deaths.....................................................47,410
Other Deaths (In Theater).........................................10,788
Other Deaths in Service......................................est. 32,000
Non-mortal Woundings.............................................153,303
Living Veterans................................................8,055,023

                          Gulf War (1990-1991)

Total Servicemembers (Worldwide)...............................2,322,332
Battle Deaths........................................................148
Other Deaths (In Theater)............................................235
Other Deaths in Service..............................................914
Non-mortal Woundings.................................................467
 Living Veterans...........................................1 
                                                               1,753,530

                          America's Wars Total

Military Service During War...................................42,303,460
Battle Deaths....................................................650,954
Other Deaths in Service (In Theater)..............................13,853
Other Deaths in Service (Non-Theater)............................524,605
Non-mortal Woundings...........................................1,431,290
  Living War Veterans......................................1 
                                                              19,316,259
  Living Ex-Servicemembers.................................1 
                                                              24,411,562
        

                          Veterans and Dependents on the Compensation and Pension Rolls
                                              (As of October 2000)
----------------------------------------------------------------------------------------------------------------
                                                                                                      SURVIVING
                                                                VETERANS     CHILDREN     PARENTS      SPOUSES
----------------------------------------------------------------------------------------------------------------
Civil War...................................................  ...........           13  ...........            1

Indian Wars.................................................  ...........            1  ...........            1

Spanish-American War........................................  ...........          264  ...........          438

Mexican Border..............................................           12           25  ...........          206

World War I.................................................          219        6,068            1       29,195

World War II................................................      679,426       18,981        1,639      278,851

Korean Conflict.............................................      255,430        4,127        1,675       64,512

Vietnam Era.................................................      847,326       13,713        6,448      112,746

Gulf War....................................................      322,621        8,078          347        5,875

TOTAL WARTIME...............................................    2,105,034       51,270       10,110      491,825

----------------------------------------------------------------------------------------------------------------
NOTE: Figures on the number of living veterans are projected from the final 1990 Census data and include only
  veterans living in the U.S. and Puerto Rico. Periods of service used in Census data may differ slightly from
  those of DOD. Although Gulf War figures are shown for the peak 1990-1991 period, the Gulf War period has not
  yet been officially terminated.

Source: Department of Defense, unless otherwise indicated.

``Other Deaths in Service'' is the number of servicemembers who died while on active duty, other than those
  attributable to combat, regardless of the location or cause of death.

\1\ VA estimate

\2\ An estimated additional 26,000 to 31,000 died in Union prisons.


                                  
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