[House Report 108-213]
[From the U.S. Government Publishing Office]
108th Congress Report
1st Session HOUSE OF REPRESENTATIVES 108-213
======================================================================
HEALTH CARE FOR VETERANS OF PROJECT 112/PROJECT SHAD ACT OF 2003
_______
July 16, 2003.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Smith of New Jersey, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 2433]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 2433) to amend title 38, United States Code, to
authorize the Secretary of Veterans Affairs to provide veterans
who participated in certain Department of Defense chemical and
biological warfare testing to be provided health care for
illness without requirement for proof of service-connection,
having considered the same, reports favorably thereon with
amendments and recommends that the bill as amended do pass.
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Care for Veterans of Project
112/Project SHAD Act of 2003''.
SEC. 2. PROVISION OF HEALTH CARE TO VETERANS WHO PARTICIPATED IN
CERTAIN DEPARTMENT OF DEFENSE CHEMICAL AND
BIOLOGICAL WARFARE TESTING.
Section 1710(e) of title 38, United States Code, is amended--
(1) in paragraph (1), by adding at the end the following new
subparagraph:
``(E) Subject to paragraphs (2) and (3), a veteran who participated
in a test conducted by the Department of Defense Deseret Test Center as
part of a program for chemical and biological warfare testing from 1962
through 1973 (including the program designated as `Project Shipboard
Hazard and Defense (SHAD)' and related land-based tests) is eligible
for hospital care, medical services, and nursing home care under
subsection (a)(2)(F) for any illness, notwithstanding that there is
insufficient medical evidence to conclude that such illness is
attributable to such testing.''.
(2) in paragraph (2)(B), by striking out ``paragraph (1)(C)
or (1)(D)'' and inserting ``subparagraph (C), (D), or (E) of
paragraph (1)''; and
(3) in paragraph (3)--
(A) by striking ``and'' at the end of subparagraph
(B);
(B) by striking the period at the end of subparagraph
(C) and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(D) in the case of care for a veteran described in
paragraph (1)(E), after December 31, 2005.''.
SEC. 3. IMPROVEMENTS TO THE RETENTION AND RECRUITMENT OF HEALTH CARE
PROFESSIONALS.
(a) Promotion Standards for Health Care Personnel.--Subsection (c) of
7403 of title 38, United States Code, is amended by striking
``Promotions'' and inserting ``Consistent with subsection (a) of
section 7422 of this title, and notwithstanding subsection (b) of that
section, promotions''.
(b) Promotions for Nurses Who Do Not have Baccalaureate Degrees.--
Such section is further amended by adding at the end the following new
subsection:
``(h) In a case in which a registered nurse has accomplished the
performance elements required for promotion to the next grade, the lack
of a baccalaureate degree in nursing shall not be a bar to promotion to
that grade, and in such a case the registered nurse shall not be denied
a promotion on that basis.''.
SEC. 4. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY FOR ADDITIONAL HEALTH
CARE WORKERS IN THE VETERANS HEALTH ADMINISTRATION.
(a) In General.--Section 7454(b) of title 38, United States Code, is
amended by adding at the end the following new paragraph:
``(3) Employees appointed under section 7408 of this title shall be
entitled to additional pay on the same basis as provided for nurses in
section 7453(c) of this title.''.
(b) Applicability.--The amendment made by subsection (a) shall apply
with respect to pay periods beginning on or after the date of the
enactment of this Act.
SEC. 5. COVERAGE OF EMPLOYEES OF VETERANS' CANTEEN SERVICE UNDER
ADDITIONAL EMPLOYMENT LAWS.
(a) Coverage.--Paragraph (5) of section 7802 of title 38, United
States Code, is amended by inserting before the semicolon a period and
the following: ``An employee appointed under this section may be
considered for appointment to a Department position in the competitive
service in the same manner that a Department employee in the
competitive service is considered for transfer to such position. An
employee of the Service who is appointed to a Department position in
the competitive service under the authority of the preceding sentence
may count toward the time-in-service requirement for a career
appointment in such position any previous period of employment in the
Service''.
(b) Technical Amendments.--Such section is further amended--
(1) by striking the semicolon at the end of each of
paragraphs (1) through (10) and inserting a period;
(2) by striking ``The Secretary '' and all that follows
through ``(1) establish,'' and inserting ``(a) Locations for
Canteens.--The Secretary shall establish,'';
(3) by redesignating paragraphs (2) through (11) as
subsections (b) through (k), respectively, and by realigning
those subsections (as so redesignated) so as to be flush to the
left margin;
(4) in subsection (b) (as so redesignated), by inserting
``Warehouses and Storage Depots.--The Secretary shall'' before
``establish'';
(5) in subsection (c) (as so redesignated), by inserting
``Space, Buildings, and Structures.--The Secretary shall''
before ``furnish'';
(6) in subsection (d) (as so redesignated), by inserting
``Equipment, Services, and Utilities.--The Secretary shall''
before ``transfer'';
(7) in subsection (e) (as so redesignated and as amended by
subsection (a)), by inserting ``Personnel.--The Secretary
shall'' before ``employ'';
(8) in subsection (f) (as so redesignated), by inserting
``Contracts and Agreements.--The Secretary shall'' before
``make all'';
(9) in subsection (g) (as so redesignated), by inserting
``Prices.--The Secretary shall'' before ``fix the'';
(10) in subsection (h) (as so redesignated), by inserting
``Gifts and Donations.--The Secretary may'' before ``accept'';
(11) in subsection (i) (as so redesignated), by inserting
``Rules and Regulations.--The Secretary shall'' before ``make
such'';
(12) in subsection (j) (as so redesignated), by inserting
``Delegation.--The Secretary may'' before ``delegate such'';
and
(13) in subsection (k) (as so redesignated), by inserting
``Authority To Cash Checks, Etc.--The Secretary may'' before
``authorize''.
Amend the title so as to read:
A bill to amend title 38, United States Code, to
authorize the Secretary of Veterans Affairs to provide veterans
who participated in certain Department of Defense chemical and
biological warfare testing with health care for their illness
without requirement for proof of service-connection, and for
other purposes.
Introduction
The reported bill reflects the Committee's consideration of
two bills in the 108th Congress, to include H.R. 2433 and
certain provisions of H.R. 1951. On June 11, 2003, Honorable
Ciro D. Rodriguez and Honorable Rob Simmons introduced H.R.
2433, the Health Care for Veterans of Project 112/Project SHAD
Act of 2003. On May 5, 2003, Honorable Stephen F. Lynch and
Honorable Jack Quinn introduced H.R. 1951, the VA Medical
Workforce Enhancement Act of 2003.
On October 9, 2002, the Subcommittee on Health held a
hearing on Project 112 and Operation Shipboard Hazard and
Defense (SHAD). Witnesses who appeared before the subcommittee
included Honorable William Winkenwerder, Jr., M.D., M.B.A.,
Assistant Secretary of Defense for Health Affairs, who was
accompanied by Dr. Michael E. Kilpatrick, Director of
Deployment Health Support, Dr. Anna Johnson-Winegar, Deputy
Assistant to the Secretary of Defense, Chemical and Biological
Defense; and Dr. Jonathan B. Perlin, Deputy Under Secretary for
Health, Department of Veterans Affairs, who was accompanied by
Mr. Robert J. Epley, Associate Deputy Under Secretary for
Policy and Program Management, Veterans Benefits
Administration.
On June 24, 2003, the Subcommittee on Health met and
unanimously ordered H.R. 2433, as amended, reported favorably
to the full Committee.
On June 26, 2003, the full Committee met and ordered H.R.
2433, as amended, reported favorably to the House by unanimous
voice vote.
Summary of the Reported Bill
H.R. 2433, as amended, would:
1. LAuthorize the Secretary of Veterans Affairs to provide
veterans who participated in a test conducted by the Department
of Defense Deseret Test Center from 1962 through 1973 higher
priority for hospital care, medical services, and nursing home
care without any requirement for proof of service-connection.
2. LExtend the authority to provide care to Project 112/
Project SHAD veterans through December 31, 2005.
3. LProvide that when a Veterans Health Administration
registered nurse has accomplished the performance elements for
promotion to the next higher grade, the lack of a specific type
of educational degree shall not be an impediment to such
promotion.
4. LAuthorize premium pay for Saturday duty to additional
Veterans Health Administration health care workers with direct
patient-care responsibilities.
5. LAllow employees of the Veterans' Canteen Service to be
considered for appointment in VA positions in the competitive
service in the same manner that VA employees in the competitive
service are considered for transfer to a Canteen Service
position.
Background and Discussion
Health Care for Veterans of Project 112/Project SHAD.--On
October 9, 2002, the Subcommittee on Health held a hearing on
``Project 112'', a series of Cold War chemical, nuclear, and
biological tests conducted both at sea and over land. During
this hearing the Department of Defense (DOD) announced the
results of a declassification review to examine the health
effects of 31 tests from Project 112. In addition, the
Subcommittee reviewed VA's role in contacting veterans who may
have participated in these tests, and its progress in
determining the health status of these veterans.
The Deseret Test Center was established in 1962 by DOD at
Fort Douglas, Utah, to manage this testing program. Project 112
was one of 150 Cold War-era military initiatives directed by
then-Secretary of Defense, Honorable Robert McNamara, to
identify U.S. military personnel and warship vulnerabilities to
chemical, nuclear, and biological attacks. The tests were
conducted between 1962 and 1973, and according to DOD were
intended to hypothesize and evaluate survivability of troops
and equipment (including robustness of ships at sea that were
sprayed by enemy aircraft) exposed in the battlefield to
hazardous agents. Some tests were planned in the Project 112/
Operation SHAD series involving the actual use of sarin, VX,
tularemia, anthrax, and other possibly dangerous agents.
The results of the testing program were used to develop
defense mechanisms against enemies' potential use of
biological, chemical, or nuclear weapons. Operation ``Shipboard
Hazard and Defense'' (SHAD) was the operational name given to
the shipboard portion of these tests. Much of the data
associated with the conduct of these tests has remained
classified since the tests were conducted.
DOD has acknowledged that it lacks documentation to prove
that test participants were informed of the risks involved with
these tests, or that they received appropriate protective gear
during testing. Since these activities were not medical in
nature, and did not involve medical research, no patient care
records were established to archive health effects.
Dr. Michael Kilpatrick of DOD stated that DOD's search for
materials associated with Project 112/Operation SHAD is onerous
and necessitates manual searches of paper archives to locate
ship crew manifests in attempts to tie the dates of specific
tests to on-board personnel. DOD advised the Committee that in
such searches it must ask basic questions of ``who, what,
where, and when,'' in order to associate the nature of these
activities with the scope of the original military effort. The
stated goal of DOD is to uncover the long-term health
consequences of these exposures.
Dr. William Winkenwerder testified at the October 9, 2002,
hearing that DOD is committed to an uncompromising and thorough
investigation of all chemical and biological warfare tests
planned and performed by the Deseret Test Center. Testifying on
behalf of VA, Dr. Jonathan Perlin discussed the outreach
efforts to contact the 5,000 veterans whom DOD has identified
as Project 112 participants, and efforts to establish
educational programs for its health care providers. The
Committee has encouraged VA to aggressively follow-up with
these veterans to ensure that they are afforded an opportunity
to review their medical histories with VA health care
providers.
In August 2000, based on a VA request, DOD began to review
and declassify information concerning the exact agents used and
other details of the Project 112 tests. An office in DOD now
known as the Health Affair's Deployment Health Support
Directorate was assigned the responsibility of identifying U.S.
ships, crew manifests, military units, and service members that
may have been involved in these tests, and thus potentially
affected by exposure to chemical and biological agents. In
addition, DOD began working with VA to identify individual
veterans who participated in these tests to determine whether
they suffered negative health consequences as a result of their
participation.
On June 30, 2003, DOD announced the completion of the
nearly three year long examination. Investigators confirmed
that 50 of the 134 planned operational tests at the Deseret
Test Center were conducted and 84 were canceled. All Deseret
Test Center tests were designated by test numbers. Initially,
cover names were also assigned to the tests. However, the
practice of using cover names was stopped in the later years of
the program. Tests were conducted on the open sea in the North
Atlantic, open water locations of the Pacific Ocean and near
the Marshall Islands, Hawaii, Baker Island, Puerto Rico and the
California coast. Land-based tests were conducted in the states
of Alaska, Hawaii, Maryland, Florida, Utah, and Georgia.
All Project 112 test fact sheets are available to the
public on the Deployment Health Support Directorate Web site,
(http://deploymentlink.osd.mil/current--issues/shad/shad--
intro.shtml). The site also includes a chart listing all
planned tests and what is known about their status.
The names of 5,842 servicemembers identified as having been
present in one or more of the tests were provided to VA, the
majority within the past year. Veterans who believe they were
involved in Deseret Test Center tests and have medical concerns
have been encouraged to contact VA for medical evaluations.
Project 112 veterans have complained of an array of ailments
from cancer to hypertension. Given the amount of time that has
passed and the relatively small number of veterans involved in
each test, VA may not be able to obtain the necessary
information to fully understand the effects of the testing.
The Committee bill would provide priority access to VA
hospital care, medical services, and nursing home care for
veterans who participated in the tests conducted by the Deseret
Test Center from 1962 through 1973, and not require medical
evidence that any illnesses are attributable to such testing.
Retention and Recruitment of Registered Nurses.--VA's Nurse
Qualification Standards (the standards) define the performance
and education requirements for a Registered Nurse (RN) to be
appointed to and promoted to one of the five nurse grade levels
in VA. Under these standards, all new hires must have a
baccalaureate degree in nursing (BSN) to be appointed at the
Nurse II grade level. RNs may be promoted to a Nurse II grade
level without a BSN only with a waiver of the education
requirements.
RNs must have educational preparation in nursing and meet
state licensing requirements. However, fewer nurses nationwide
are receiving a BSN as their educational preparation for
nursing practice. Sixty-two percent of employed staff nurses
received their nursing educational preparation through an
associate degree in nursing (ADN) or diploma nursing program.
According to the latest survey by the Department of Health and
Human Services, Health Resources and Service Administration, 45
percent of RNs in nurse clinician positions and 42 percent of
RNs in clinical nurse specialist positions have an ADN or
diploma degree as their highest educational preparation for
nursing. Further, nearly 40 percent of Certified Nurse
Anesthetists do not have a BSN.
As discussed, all RNs, regardless of their educational
preparation, must take rigorous licensing examinations
administered by state governments. RNs prepared with an ADN
have equivalent success rates in their licensing examinations
as RNs who obtain a BSN. Whether RNs have a two-year or four-
year nursing degree, they are licensed to perform the identical
scope of nursing practice.
Notwithstanding their years of experience or expertise in
nursing, VA will not hire RNs above the entry Nurse Level I
unless they have a BSN; VA will not hire RNs above the Nurse
Level II unless they have a master's degree, despite their
years of bedside experience or clinical proficiency in nursing.
Currently, VA nurses are also evaluated for promotion based
on the BSN and nine areas of competencies. The Nurse
Professional Standards Board evaluates nurses and may
recommend, subject to the concurrence of the Chief RN and
approval of the medical center director, a waiver of the BSN
requirement. If the medical center director denies a waiver,
the RN has no recourse.
VA's focus on the level at which a RN received his or her
educational preparation has created unintended consequences.
Currently, the U.S. has an estimated nationwide shortage of RNs
of around 6.5 percent. This shortage is projected to grow, and
could reach 28.8 percent in 2020 if the current trend continues
and no mitigating actions are taken. Given the national
shortage and the reduced number of RNs who want to work in
hospitals, the Committee believes that VA should focus on a
RN's expertise and experience, not where he or she went to
nursing school. The Committee bill would clarify that direct
patient care performance is the primary criteria in hiring and
promoting nurses.
Additional Pay for VA Nursing Personnel Completing Saturday
Shifts.--VA's hospitals must maintain safe staffing levels
during the weekends in order to meet veterans' medical needs.
Most private hospitals offer premium pay for weekend tours-of-
duty as an incentive and compensation for individuals to work
these shifts. Pursuant to sections 7453 and 7454 of title 38,
United States Code, registered nurses, licensed practical
nurses, pharmacists, physical therapists, occupational
therapists, and respiratory therapists who work regular
Saturday or Sunday shifts are paid a premium rate of pay (25
percent) for those shifts. The premium is not for overtime, but
rather for working a regular shift on the weekend. Federal law
for civil service employees employed under title 5, United
States Code, who represent a large group of VA medical support
personnel including nursing assistants, pharmacy technicians,
and medical technologists, provides premium pay of 25 percent
for employees who work regular shifts on Sundays at VA medical
facilities, but not on Saturdays. By authorizing Saturday
premium pay for all VA clinical staff members who work a
regular shift on Saturdays, the Committee bill would allow VA
to compete in the hiring of necessary staff to maintain
adequate levels of support on weekends.
Transfer Rights for VA Canteen Workers.--Veterans' Canteen
Service (VCS) employees are Federal employees hired under the
authority of section 7802 of title 38, United States Code. This
authority provides many of the same benefits that title 5,
United States Code, federal employees enjoy, such as workers
compensation, health benefits, retirement, and veterans'
preference. However, there are other benefits to which they are
not entitled. In particular, because VCS employees are
appointed without regard to title 5, United States Code,
competitive civil service rules, these workers are not
considered to be in the federal civil competitive service. As a
result, a VCS employee cannot transfer to another job in VA
without first going through a civil service competition, as if
he or she had never been a federal employee.
In 1979, the Office of Personnel Management (OPM) approved
a personnel interchange agreement with VA that permitted two-
way movement between the two hiring authorities for VCS
managers. The agreement allows VCS managers appointed under the
same statutory authority (38 U.S.C. 7802) as VCS employees who
are non-supervisors to transfer into other federal jobs as if
they were originally appointed in the competitive service under
title 5, United States Code.
Approximately 3,000 VCS hourly workers do not have the same
transfer rights to other VA positions that VCS managers enjoy.
They are prohibited from applying for jobs at VA as an internal
competitive service candidate. VA attempted to establish an
interchange agreement for these employees in 1984, 1987, and
1998, but OPM did not approve these proposals. This limits the
VA's ability to hire VA workers into needed positions to
provide ancillary and support services for medical care. The
Committee bill would provide transfer rights for hourly rate
VCS employees to title 5, United States Code, VA positions
through internal competitive procedures.
Section-By-Section Analysis
Section 1 of the bill would name this Act the ``Health Care
for Veterans of Project 112/Project SHAD Act of 2003''.
Section 2 of the bill would amend section 1710(e) of title
38, United States Code, to allow any veteran who participated
in chemical and biological warfare tests conducted by the
Department of Defense Deseret Test Center from 1962 through
1973 (including the program designated as ``Project Shipboard
Hazard and Defense'' and related land-based tests) to be
eligible for hospital care, medical services, and nursing home
care, notwithstanding insufficient medical evidence that links
any illness to such testing. Authority to provide access to
care on this basis expires on December 31, 2005.
Section 3(a) of the bill would amend subsection (c) of 7403
of title 38, United States Code, to allow labor organizations
representing physicians, dentists, podiatrists, optometrists,
registered nurses, physician assistants and expanded-duty
dental auxiliaries to engage in collective bargaining with
respect to the promotion policies for those employees.
Section 3(b) of the bill would amend subsection (c) of 7403
of title 38, United States Code, so that when a VA registered
nurse meets the requirements to be promoted to the next higher
grade, the lack of a specific type of educational degree will
not impede that promotion.
Section 4(a) of the bill would amend section 7454(b) of
title 38, United States Code, to allow VA nursing assistants,
pharmacy technicians, medical technologists, and other title 5,
United States Code, employees who complete a Saturday shift to
receive premium pay for that shift at a rate equal to 25
percent of their hourly rate of basic pay.
Section 4(b) of the bill would provide that the amendment
made by subsection (a) shall apply with respect to pay periods
beginning on or after the date of the enactment of this Act.
Section 5(a) of the bill would amend paragraph (5) of
section 7802 of title 38, United States Code, to allow
Veterans' Canteen Service employees to be considered for
appointment in VA positions in the competitive service, just as
VA employees in the competitive service are considered for
transfer to a Canteen Service position.
Performance Goals and Objectives
The Department of Veterans Affairs' performance goals and
objectives are established in annual performance plans and are
subject to the Committee's regular oversight and evaluation by
the U.S. General Accounting Office. VA also publishes a
performance and accountability report for each fiscal year.
Statement of the Views of the Administration
Testimony of Honorable William Winkenwerder, Jr., Assistant Secretary
for Health, Department of Defense, Health Subcommittee Hearing on
Project 112 & Operation Shipboard Hazard and Defense
October 9, 2002
As Assistant Secretary of Defense for Health Affairs, I want to
stress that the Department of Defense (DoD) is absolutely committed to
an aggressive and thorough investigation of all chemical and biological
warfare tests planned and performed by the Deseret Test Center between
1962 and 1973. The purpose of the investigation is to provide relevant
medical information to the Department of Veterans' Affairs (VA). The
Deseret Test Center was established as a result of Project 112. Project
112 was one of one hundred and fifty management initiatives begun by
Defense Secretary McNamara, after his review of the Department of
Defense in 1961. Under Project 112, the Deseret Test Center planned and
conducted a joint chemical and biological testing program that included
shipboard and land-based testing. Project Shipboard and Hazard Defense
(SHAD) was the shipboard portion. SHAD was designed to test ships'
vulnerability to biological or chemical attack.
When I testified before the Senate Veterans' Affairs Committee in
July of this year, I expressed that we are dedicated to finding and
declassifying all relevant medical information from those tests.
Additionally, we are committed to sharing this information with the VA
by June 2003. Today, I would like to discuss what we have done, what we
have learned and what are currently doing.
Since August 2000, when the Department of Veterans' Affairs
requested that the Department of Defense provide information concerning
classified Project SHAD tests, we have developed a close working
relationship with the VA. From the beginning of this process, VA staff
members have met regularly with our investigators to review their
activities and to verify that the information being sought was what VA
needed to assist them in addressing health care matters and settle
benefit questions. A team from our Deployment Health Support
Directorate meets regularly with VA personnel, to ensure we provide the
VA with the relevant medical information they need to address veterans'
concerns.
To date, our investigation has revealed a great deal about tests
planned and conducted by the Deseret Test Center. The Center planned
134 tests between 1962 and 1973. So far we have verified that 46 tests
were conducted and 62 were cancelled. We are working to determine the
status of the remaining 26 tests. The majority (24) were planned for
1970-1974, a period in which plans were being made to close the Deseret
Test Center.
We are working closely with the Department of the Army to
facilitate declassification of the necessary data, focusing on relevant
medical information. Because many of the same agents remain a threat to
our Forces today, the records cannot be casually declassified. Our
investigators identify the relevant medical information and request
declassification of this specific information in a process that has
been significantly expedited.
As information becomes available, it is provided to the VA in the
form of fact sheets. To date we have published 45 fact sheets on 41
tests which involved more than 5,000 service members. The fact sheets
detail which ships and units were involved in tests, when the tests
took place and what substances the crew may have been exposed to. In
order to expedite the VA's notification to affected veterans, we now
provide names and service numbers of service members involved in each
test to the VA as soon as we identify the ship or unit involved; we do
not wait for the declassification process to be completed. To date, we
have provided the VA with the names of 4,990 veterans from 16 of 18
known shipboard tests and are searching for classified reports which
identify the ships used in the remaining two tests.
Our investigation has confirmed that Deseret Test Center tests were
primarily conducted using simulants believed to be safe in place of
chemical or biological warfare agents. In those instances when
potentially harmful substances were used, there is no evidence that any
of the service members involved were exposed to them without proper
protection. Service members were vaccinated before testing that
involved live biological agents. If actual chemical agents were used
they were confined to airtight sections of their ship. When
appropriate, protective clothing was also worn. While some service
members may not have known all the details of these tests, it is likely
they knew that they were participating in testing due to use of
precautionary measures. We have learned that the scientists involved
informed senior leaders about tests using simulants. Like other
operational activities, service members were not informed of these
tests.
Information is presented to the VA as quickly as possible and is
posted on our web site, DeploymentLINK.mil. A chart located on that web
site shows the status of our investigation for each of the tests and is
updated regularly. In addition to responding to letters, e-mails and
telephone calls placed to our toll-free number, we have also attended
the reunion of the crew of the USS Power and have asked other crews to
allow us to attend their reunions to help us better understand the
concerns of these veterans. We have also sought out scientists and
senior officials involved with the tests to increase our understanding
of what happened during the tests.
With the termination of the U.S. offensive chemical and biological
weapons programs and with changes to operations and health research
standards, the use of live agents on humans is severely restricted.
With modern technology we can determine the effectiveness of defensive
measures by using mannequins. The military services do still use
simulants during operational testing and training. We are reviewing all
policies governing the use of simulants during testing and training.
Additionally, small amounts of live agent are used in training at the
chemical school. Our objective is to ensure that concerns like those
surrounding the Deseret Test Center tests do not arise in the future.
------
Testimony of Jonathan B. Perlin, M.D., Deputy Under Secretary for
Health, Department of Veterans Affairs, Health Subcommittee Hearing on
Project 112 & Operation Shipboard Hazard and Defense
October 9, 2002
I am here today to talk about the 5,000 veterans who have been
identified as Project 112 participants. I also want to tell you about
the wide range of outreach activities to veterans, educational programs
for VA health care providers, and health care services that VA has
implemented for those veterans who participated in tests conducted by
the U.S. Army's Deseret Test Center, including Project SHAD.
Deseret Test Center Project 112 and Project SHAD
According to the Department of Defense, Project SHAD, which stands
for Shipboard Hazard and Defense, was a portion Project 112, which was
a chemical and biological warfare test program of the Deseret Test
Center. DoD conducted these tests between 1962 and 1973. Project SHAD
itself was a series of tests apparently designed to determine potential
vulnerabilities of U.S. warships to attacks with chemical or biological
warfare agents. Other Project 112 tests involved similar tests
conducted on land rather than aboard ships.
VA first learned of Project SHAD when a veteran filed a claim for
service connection for disabilities that he felt were related to his
participation in those tests. In two meetings held with DoD in late
1997, VA was advised that all the relevant records about these tests
were classified and that general access to that material was not
possible. However, DoD offered to provide such information on a case-
by-case basis.
In May 2000, VA's Under Secretary for Benefits received a
congressional inquiry requesting assistance for veterans involved in
Project SHAD tests. A VA/DoD workgroup was subsequently established,
which met for the first time in October 2000. Since then, DOD and VA
have held a series of meetings to ensure that VA would have full access
to the information needed to provide appropriate health care and
benefits for veterans involved in these tests. In July 2002, DOD
committed to provide VA with all medically relevant data, as well as a
complete roster of participants involved in tests under the aegis of
Project 112 in the 1960's and 1970's.
As a result of their ongoing investigations, DOD has begun
providing to VA the names and service numbers of veterans of Project
112, including Project SHAD participants. As a consequence, VA has
initiated a significant outreach program to SHAD veterans and to the VA
health-care providers they may see. This program has expanded as we
have received more information from DOD about veterans involved in
tests conducted by the Deseret Test Center and about possible chemical
and biological exposures.
VA Outreach Efforts to SHAD Veterans
As of today, VA has been notified of approximately 5,000 veteran
participants in 12 declassified and two classified Project 112 tests.
VA has implemented a process for identifying and locating these
veterans. Identification is accomplished using a variety of sources,
including VA's Beneficiary Identification and Records Locator Subsystem
(BIRLS), its Compensation & Pension (C&P) Master Record file, the
National Cemetery Administration's database, and the National Personnel
Records Center in St. Louis. VA has been able to obtain addresses of
some of these veterans by matching records with the Internal Revenue
Service.
In May 2002, VA mailed outreach letters to 622 SHAD veterans, and
on August 15, mailed outreach letters to an additional 777 veterans.
The outreach letters provided them information about their
participation in Project 112 and the possible health effects related to
the chemical and biological warfare agents used in those tests.
Most recently, in September, DOD provided VA with the names and
service numbers of about 2,100 more veterans who were participants in
tests just declassified last week. VA is currently matching these data
against its BIRLS and C&P Master Record files to identify these
individuals.
Efforts to find current addresses for SHAD veterans is ongoing, but
for those whom VA has not yet been able to locate, we have established
a SHAD Help line (at 1-800-749-8387), an Internet web-site (at
www.VA.GOV/SHAD), and an e-mail address ([email protected]).
Through the week ending September 27, 2002, VA has received 417 calls
on its toll-free SHAD Help line.
Outreach to VA Health Care Providers
A has provided relevant information about Project SHAD to VA health
care providers through Information Letters from the Under Secretary for
Health. The Information Letters provide VA health care personnel with
background information on Project SHAD, as well as information about
the potential short- and long-term health effects of the specific
chemical and biological agents that DOD tells us were used in these
tests. They also include recommendations for reviewing the medical and
military exposure history of Project 112 veterans. The first
Information Letter was released on December 1, 2000. The most recent
Information Letter--the third in this series--is dated August 26, 2002.
It is entitled ``Possible Occupational Health Exposures of Veterans
Involved in Project SHAD Tests,'' and is based on additional
information obtained from DOD. This information has also been made
available on VA's SHAD web site at www.va.gov/SHAD.
In addition to Information Letters, the Veterans Health
Administration (VHA) has engaged in an extensive outreach effort to
ensure that every VA medical center knows about SHAD veterans and their
potential hazardous exposures during Project 112. VA medical center
directors and health care personnel have been regularly apprised of
Project SHAD through a series of national telephone hotline conference
calls beginning October 20, 2000. VA environmental health physicians
also have been kept informed of Project SHAD developments through
regular conference calls. Furthermore, a Directive issued last month
requires that enrolled SHAD veterans be clinically evaluated by
knowledgeable health care providers when those veterans present for
care. VA will continue to provide up-to-date information on Project 112
to its health care providers to ensure that these veterans receive
optimal health care. Lastly, as suggested by the Vietnam Veterans of
America, the VA and DOD web sites, which provide information on Project
112, have been linked to provide ready access to health data among VA
and DOD health care personnel and veterans.
Health Care and Benefits Status of Identified SHAD Veterans
VA prepared a preliminary report on the health and disability
status of the initial Project SHAD veterans identified for us by DOD in
follow-up to the July 10, 2002 hearing. A report dated August 5, 2002,
entitled ``VA Health Care and Compensation for Project SHAD Veterans''
was provided to the House and Senate Committees on Veterans' Affairs on
August 9, 2002. It also included information on compensation claims
previously filed by Project SHAD participants. The report stated that,
as of August 1, 2002, there were compensation claims pending decisions
for 28 veterans alleging disabilities due to exposure to agents and
substances while participating in Project SHAD. The full report is
available on our website at www.va.gov/SHAD. As of September 30, 2002,
VA had compensation claims pending decision for 53 veterans alleging
disabilities due to exposure to agents and substances while
participating in Project 112.
Of the 1,399 veterans who received notification letters in May and
August, 31 have newly enrolled for VA health care. Available data
indicate that Project SHAD veterans sought health care from VA during
FY 2002 at a rate comparable to the overall population of military
veterans. About 30 percent of Project SHAD veterans known to us as of
August have used VA services since 1970.
It has not been necessary to establish a special clinical program
for Project 112 veterans. In this regard, VA's progressive development
of its medical record system increasingly permits patient health
information to be studied. VHA can now track health care utilization by
special groups of veterans, such as the veterans who participated in
Project SHAD. The use of these standard health care databases provides
several important advantages in evaluating the health of Project SHAD
veterans over specialized clinical programs, such as those used to
evaluate particular cohorts of veterans, such as Vietnam and Gulf War
veterans. The use of VA's health databases allows VA to evaluate the
health care utilization of veterans every time they obtain care from
VA, not just on the one occasion that they elect to have a registry
examination. This practice will provide a much broader and longer-term
assessment of the health status of these veterans because many veterans
return frequently for VA health care, and because veterans are often
seen in different clinics or even different parts of the country for
specialized health care.
Evaluating Health Status of All SHAD Veterans
On September 30, 2002, VA entered into a three million dollar
contract with the Institute of Medicine, Medical Follow-up Agency of
the National Academy of Sciences to fully evaluate the long-term health
status of Project SHAD participants. They will conduct, over the next
three years, a formal epidemiological study of Project SHAD
participants in comparison with veterans who did not participate in
Project SHAD. This independent, epidemiological study will give us the
clearest possible picture of the health status of SHAD veterans and
tell us whether their health was harmed by participation in SHAD tests.
The study will compare the current health of veterans who participated
in the SHAD tests more than 30 years ago with the health of veterans
from the same era who served on ships not involved with the testing.
The study will also compare the mortality rates of the two groups. This
project may be expanded, if needed, as we learn the identity and
military exposures of additional Project 112 participants. Although it
will take time to conduct a valid epidemiological study, high quality
medical care is being provided right now for each Project 112 veteran
who chooses to come to the VA health care system.
VA welcomes DOD's accelerated schedule for providing relevant
information about Project 112 and the veterans who were involved in
these tests. We understand that it is problematic to locate and
declassify records that are 30 to 40 years old, and we appreciate DOD's
efforts in this regard. We also look forward to receiving this
information as quickly as possible so that we can address the health
concerns of these veterans and properly adjudicate their benefit
claims.
Congressional Budget Office Cost Estimate
The following letter was received from the Congressional
Budget Office concerning the cost of the reported bill:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 15, 2003
Hon. Christopher H. Smith
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2433, the Health
Care for Veterans of Project 112/Project SHAD Act of 2003.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss, who can be reached at 226-2840.
Sincerely,
Douglas Holtz-Eakin,
Director
Enclosure.
Congressional Budget Office Cost Estimate
H.R. 2433, Health Care for Veterans of Project 112/Project SHAD Act of
2003
As ordered reported by the House Committee on Veterans' Affairs on June
26, 2003
Summary
H.R. 2433 would increase benefits for certain veterans and
health care workers employed by the Department of Veterans
Affairs (VA). The bill would allow veterans who participated in
certain chemical and biological warfare tests while on active
duty to have greater eligibility for health care offered by VA.
In addition, the bill would change VA's current regulation
regarding the promotion of nurses and allow nurses who do not
have a baccalaureate degree to be promoted to higher pay
grades. Finally, H.R. 2433 would require VA to pay certain
health care workers a premium for working on Saturday.
CBO estimates that implementing the bill would cost $1
million in 2004 and $8 million over the 2004-2008 period,
assuming appropriation of the estimated amounts. The bill would
not affect direct spending or receipts. The estimate does not
include the costs of the provision that would require VA to pay
certain health care workers a premium for working on Saturday
because CBO cannot estimate the costs at this time.
H.R. 2433 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the federal government
The estimated budgetary impact of H.R. 2433 is shown in the
following table. This estimate assumes the legislation will be
enacted by the end of fiscal year 2003, that the necessary
funds for implementing the bill will be provided for each year,
and that outlays will follow historical spending patterns for
existing or similar programs. The costs of this legislation
fall within budget function 700 (veterans benefits and
services).
By Fiscal Year, in Millions of Dollars
-----------------------------------------------------
2003 2004 2005 2006 2007 2008
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Baseline Spending Under Current Law for Veterans' Medical
Care
Estimated Authorization Level a......................... 25,279 26,153 26,987 27,890 28,824 29,452
Estimated Outlays....................................... 25,677 26,179 26,783 27,655 28,583 29,271
Proposed Changes b
Estimated Authorization Level........................... 0 1 1 2 2 2
Estimated Outlays....................................... 0 1 1 2 2 2
Spending Under H.R. 2433 for Veterans' Medical Care
Estimated Authorization Level........................... 25,279 26,154 27,988 27,892 28,826 29,454
Estimated Outlays....................................... 25,677 26,180 26,784 27,657 28,585 29,273
----------------------------------------------------------------------------------------------------------------
a The 2003 level is the estimated net amount appropriated for that year. No full-year appropriation has yet been
provided for fiscal year 2004. The current-law amounts for the 2004-2008 period assume that appropriations
remain at the 2003 level with adjustments for anticipated inflation.
b These amounts do not include the costs of section 4 because CBO cannot estimate the costs at this time.
Basis of estimate
Project 112/Project SHAD
From 1962 to 1973, the Department of Defense (DoD)
conducted certain tests to determine the vulnerability of
personnel, buildings, and ships to various biological and
chemical threats. Some veterans claim that exposure to the
agents used in those tests has affected their current health
status and would like to receive medical treatment for their
health problems at VA facilities. Under H.R. 2433, those
veterans who are not currently eligible for medical care from
VA and those veterans who currently receive care but pay small
copayments based on their priority level would be eligible to
receive free health care from VA. This increased eligibility
would end on December 31, 2005. After December 31, 2005, CBO
expects that VA would allow those veterans who enroll to
receive health care from VA under the bill to remain enrolled
with VA, though with a lower priority level that would require
them to make copayments.
According to data from DoD, about 5,800 members of the
military participated in those tests. After adjusting for
mortality, CBO estimates that about 5,400 are alive today.
Based on information from VA, CBO estimates that 60 percent of
those veterans are already eligible to receive health care from
VA, though some of those veterans are required to make small
copayments for the services they receive. Under section 2, the
remaining 40 percent of these veterans, as well as the veterans
mentioned above who currently make copayments, would be
eligible for free health care. Based on enrollment data
provided by VA, CBO estimates that less than 300 veterans would
enroll for VA medical care under this bill at an estimated
average cost of $5,100 in 2004. Thus, CBO estimates that
implementing this section would cost $1 million in 2004 and $8
million over the 2004-2008 period, assuming appropriation of
the estimated amounts.
Under the bill, eligible veterans who are currently
enrolled in the VA health care system and pay small copayments
based on their priority level would no longer make these
payments through December 31, 2005. CBO estimates that the lost
receipts would be less than $500,000 each year over the 2004-
2006 period. After December 31, 2005, those veterans who would
have newly enrolled in the VA health care system under the bill
would have a lower priority and would start to make copayments.
CBO estimates that these increased receipts also would be less
than $500,000 a year over the 2006-2008 period. (Such payments
are recorded as offsetting collections, credited against
appropriations.)
Saturday Pay
Currently, many health care workers employed by VA do not
receive a pay premium when they work on weekends, although
nurses and some other specialized workers do receive that
premium. Section 4 would require that all employees providing
direct patient-care services or services incident to direct
patient-care services receive premium pay equal to 25 percent
of their hourly wage, for all hours worked from midnight on
Friday through midnight on Sunday. According to VA, these
workers are already receiving premium pay for working on
Sunday, so the only effect of implementing this section would
be to increase the pay they would receive on Saturday. CBO
cannot estimate the budgetary impact of implementing this
provision, however, since VA has not yet been able to provide
information about the amount of premium pay VA currently pays
for Saturday and Sunday work.
Nurse Promotion
Under current regulations, VA has five pay grades for its
nurses. A nurse cannot advance to a higher grade without both
demonstrating the necessary qualifications and having the
required college degree. In order to advance from grade 1 to
grade 2, nurses need a baccalaureate degree. Similarly, to
advance from grade 2 to grade 3 nurses must have a master's
degree. VA currently has a waiver program that allows nurses to
be promoted without the requisite degrees. Section 3 would bar
VA from requiring a baccalaureate degree as a requirement for
promotion, essentially affecting nurse promotions from grade 1
to grade 2.
According to VA, in 2002, only one nurse who sought a
promotion from grade 1 to grade 2 was denied a waiver; 468
nurses received waivers and were promoted. (VA also denied
promotions to 16 nurses who sought a promotion from grade 2 to
grade 3, but this bill would not affect nurses in those
grades.) Because VA already has a waiver program, CBO does not
expect that the implementation of this bill would affect a
significant number of nurses, especially since possession of a
baccalaureate degree is not the sole requirement for promotion.
Thus CBO estimates that implementing this provision would cost
less than $500,000 a year over the 2004-2008 period, assuming
the availability of appropriated funds.
Intergovernmental and private-sector impact
H.R. 2433 contains no intergovernmental or private-sector
mandates as defined in UMRA and would not affect the budgets of
state, local, or tribal governments.
Estimate prepared by:
Federal Costs: Sam Papenfuss (226-2840)
Impact on State, Local, and Tribal Governments: Melissa
Merrell (225-3220)
Impact on the Private Sector: Allison Percy (226-2900)
Estimate approved by:
Peter H. Fontaine
Deputy Assistant Director for Budget Analysis
Statement of Federal Mandates
The preceding Congressional Budget Office cost estimate
states that the bill contains no intergovernmental or private
sector mandates as defined in the Unfunded Mandates Reform Act.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME OR DOMICILIARY CARE AND MEDICAL
TREATMENT
Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care
(a) * * *
* * * * * * *
(e)(1)(A) * * *
* * * * * * *
(E) Subject to paragraphs (2) and (3), a veteran who
participated in a test conducted by the Department of Defense
Deseret Test Center as part of a program for chemical and
biological warfare testing from 1962 through 1973 (including
the program designated as ``Project Shipboard Hazard and
Defense (SHAD)'' and related land-based tests) is eligible for
hospital care, medical services, and nursing home care under
subsection (a)(2)(F) for any illness, notwithstanding that
there is insufficient medical evidence to conclude that such
illness is attributable to such testing.
(2)(A) * * *
(B) In the case of a veteran described in [paragraph (1)(C)
or (1)(D)] subparagraph (C), (D), or (E) of paragraph (1),
hospital care, medical services, and nursing home care may not
be provided under subsection (a)(2)(F) with respect to a
disability that is found, in accordance with guidelines issued
by the Under Secretary for Health, to have resulted from a
cause other than the service described in that paragraph.
(3) Hospital care, medical services, and nursing home care
may not be provided under or by virtue of subsection
(a)(2)(F)--
(A) * * *
(B) in the case of care for a veteran described in
paragraph (1)(C), after December 31, 2002; [and]
(C) in the case of care for a veteran described in
paragraph (1)(D), after a period of 2 years beginning
on the date of the veteran's discharge or release from
active military, naval, or air service[.]; and
(D) in the case of care for a veteran described in
paragraph (1)(E), after December 31, 2005.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION--
PERSONNEL
* * * * * * *
SUBCHAPTER I--APPOINTMENTS
* * * * * * *
Sec. 7403. Period of appointments; promotions
(a) * * *
* * * * * * *
(c) [Promotions] Consistent with subsection (a) of section
7422 of this title, and notwithstanding subsection (b) of that
section, promotions of persons to whom this section applies
shall be made only after examination given in accordance with
regulations prescribed by the Secretary. Advancement within
grade may be made in increments of the minimum rate of basic
pay of the grade in accordance with regulations prescribed by
the Secretary.
* * * * * * *
(h) In a case in which a registered nurse has accomplished
the performance elements required for promotion to the next
grade, the lack of a baccalaureate degree in nursing shall not
be a bar to promotion to that grade, and in such a case the
registered nurse shall not be denied a promotion on that basis.
* * * * * * *
SUBCHAPTER IV--PAY FOR NURSES AND OTHER HEALTH-CARE PERSONNEL
* * * * * * *
Sec. 7454. Physician assistants and other health care professionals:
additional pay
(a) * * *
(b)(1) * * *
* * * * * * *
(3) Employees appointed under section 7408 of this title
shall be entitled to additional pay on the same basis as
provided for nurses in section 7453(c) of this title.
* * * * * * *
CHAPTER 78--VETERANS' CANTEEN SERVICE
* * * * * * *
Sec. 7802. Duties of Secretary with respect to Service
[The Secretary shall--
[(1) establish,]
(a) Locations for Canteens.--The Secretary shall establish,
maintain, and operate canteens where deemed necessary and
practicable at hospitals and homes of the Department and at
other Department establishments where similar essential
facilities are not reasonably available from outside commercial
sources[;].
[(2)] (b) Warehouses and Storage Depots.--The Secretary shall
establish, maintain, and operate such warehouses and storage
depots as may be necessary in operating the canteens[;].
[(3)] (c) Space, Buildings, and Structures.--The Secretary
shall furnish the Service for its use in connection with the
establishment, maintenance, and operation thereof, such space,
buildings, and structures under control of the Department as
the Secretary may consider necessary, including normal
maintenance and repair service thereon. Reasonable charges, to
be determined by the Secretary, shall be paid annually by the
Service for the space, buildings, and structures so furnished,
except that the Secretary may reduce or waive such charges
whenever payment of such charges would impair the working
capital required by the Service[;].
[(4)] (d) Equipment, Services, and Utilities.--The Secretary
shall transfer to the Service without charge, rental, or
reimbursement such necessary equipment as may not be needed for
other purposes, and furnish the Service such services and
utilities, including light, water, and heat, as may be
available and necessary for its use. Reasonable charges, to be
determined by the Secretary, shall be paid annually by the
Service for the utilities so furnished[;].
[(5)] (e) Personnel.--The Secretary shall employ such persons
as are necessary for the establishment, maintenance, and
operation of the Service, and pay the salaries, wages, and
expenses of all such employees from the funds of the Service.
Personnel necessary for the transaction of the business of the
Service at canteens, warehouses, and storage depots shall be
appointed, compensated from funds of the Service, and removed
by the Secretary without regard to the provisions of title 5
governing appointments in the competitive service and chapter
51 and subchapter III of chapter 53 of title 5. Those employees
are subject to the provisions of title 5 relating to a
preference eligible described in section 2108(3) of title 5,
subchapter I of chapter 81 of title 5, and subchapter III of
chapter 83 of title 5. An employee appointed under this section
may be considered for appointment to a Department position in
the competitive service in the same manner that a Department
employee in the competitive service is considered for transfer
to such position. An employee of the Service who is appointed
to a Department position in the competitive service under the
authority of the preceding sentence may count toward the time-
in-service requirement for a career appointment in such
position any previous period of employment in the Service[;].
[(6)] (f) Contracts and Agreements.--The Secretary shall make
all necessary contracts or agreements to purchase or sell
merchandise, fixtures, equipment, supplies, and services,
without regard to section 3709 of the Revised Statutes (41
U.S.C. 5) and to do all things necessary to carry out such
contracts or agreements, including the making of necessary
adjustments and compromising of claims in connection
therewith[;].
[(7)] (g) Prices.--The Secretary shall fix the prices of
merchandise and services in canteens so as to carry out the
purposes of this chapter[;].
[(8)] (h) Gifts and Donations.--The Secretary may accept
gifts and donations of merchandise, fixtures, equipment, and
supplies for the use and benefit of the Service[;].
[(9)] (i) Rules and Regulations.--The Secretary shall make
such rules and regulations, not inconsistent with the
provisions of this chapter, as the Secretary considers
necessary or appropriate to effectuate its purposes[;].
[(10)] (j) Delegation.--The Secretary may delegate such
duties and powers to employees as the Secretary considers
necessary or appropriate, whose official acts performed within
the scope of the delegated authority shall have the same force
and effect as though performed by the Secretary[;].
[(11)] (k) Authority To Cash Checks, Etc.--The Secretary may
authorize the use of funds of the Service when available,
subject to such regulations as the Secretary may deem
appropriate, for the purpose of cashing checks, money orders,
and similar instruments in nominal amounts for the payment of
money presented by veterans hospitalized or domiciled at
hospitals and homes of the Department, and by other persons
authorized by section 7803 of this title to make purchases at
canteens. Such checks, money orders, and other similar
instruments may be cashed outright or may be accepted, subject
to strict administrative controls, in payment for merchandise
or services, and the difference between the amount of the
purchase and the amount of the tendered instrument refunded in
cash.
* * * * * * *